Recommended Exclusion of Selected Discretionary Drugs

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1 7100 N High Street Office Suite 305 Worthington, Ohio pharmaceuticalhorizons.com p f FROM: RE: Allan Zaenger R.Ph., MS Pharmaceutical Horizons, Inc. Recommended Exclusion of Selected Discretionary Drugs Due the high cost and discretionary nature of the medicines in the drugs classes that follows it is recommended that the brand drugs in these classes be excluded from coverage under prescription drug benefit programs. Accompanying this memorandum is a specific listing of the excluded brand drugs and available clinical alternatives at Special OTC, or Tier 1 or Tier2 copayments Many, if not all, of the brand name medicines in these classes have copayment discount cards that members can obtain to reduce the cost of the claim charge if necessary. It is recommended that the member discuss alternatives to the brand name medicine prescribed or seek financial assistance for copayments from the maker of the brand medicine. This can be done by doing an internet search on the drug name (example Nexium or Nexium.com) or be seeking assistance using the following link to a website called Needymeds.org : The drug classes that contain brand drugs to be excluded are: GPI Tetracycline Antibiotics (Adoxa, Solodyn, etc.) GPI Androgens (Androgel, Testim, etc.) GPI Estrogens (Premarin, Cenestin, Prempro, Vivelle Patches, Estring, Evamist, etc.) GPI Nicotinic Acid Derivatives (Niaspan) GPI Drugs for Erectile Dysfunction (Viagra, Cialis, Levitra, etc) GPI Non Sedating Antihistamines (Clarinex, Xyzal, etc.) GPI Nasal Medicines for Allergies (Nasonex, Veramyst, Omnaris, etc.) GPI Antihistamines & Decongestant Combinations (Clarinex-D, etc.) GPI Proton Pump Inhibitors (ex. Nexium, Dexilant, Aciphex, etc.) GPI Drugs for Benign Prostatic Hypertrophy (Avodart, Jalyn, etc.) GPI Drugs for Over Active Bladder (Detrol LA, Toviaz, Vesicare, etc.) GPI Ophthalmic AntiAllergy (Alamast, Alocril, Patanol, etc.) GPI Topical Antivirals (Denavir, Zovirax) To ensure patient access to clinical alternative at a covered copayment tier this program also includes adoption of coverage for selected OTC medicines in clinically comparable classes. The covered OTCs include:

2 1. Allegra Allergy and Allegra D Allergy and Congestion and any generic and trade alternatives to Allegra Allergy and Allegra D Allergy and Congestion. 2. Prilosec OTC, Prevacid-24, Zegerid OTC and any generic and trade alternatives to Prilosec OTC, Prevacid-24, and Zegerid OTC 3. Claritin, Claritin-D, and any generic and trade alternatives to Claritin and Claritin-D 4. Abreva and the generic and any generic and trade alternatives to Abreva 5. Zaditor and the generic and any generic and trade alternatives to Zaditor 6. Zyrtec, Zyrtec-D, and any generic and trade alternatives to Zyrtec and Zyrtec-D 7. Slo-Niacin Oral Tablet Extended Release, and any generic and trade alternatives to Slo- Niacin These medicines will be covered in the same fashion as a prescription medicine. A complete physician prescription is needed that includes: - date the prescription is written; - patient s full name - complete name of the medicine; - quantity dispensed; - directions for use; - any refills; - signature of the prescribing physician; The prescription for these OTC medicines will be treated by the pharmacy in the same way that a legend medicine, insulin, and/or syringes are processed. The claim will be submitted for processing by the pharmacy in the same fashion that a claim for a legend medicine is processed electronically with coverage information and copayment information returned for payment.

3 Drug Type Antibiotics Hormone Replacement Carve-Outs Not covered by the plan Tetracyclines: Adoxa Alodox Avidoxy Doryx Minocin Monodox Morgidox NicAzelDoxy NutriDox Ocudox Oracea Solodyn Vibramycin Androgens: Androl-50 Androderm Androgel Android Axiron Delatestryl Depo-Testosterone First Testosterone MC Fortesta Methitest Oxandrin Testim Striant Testopel Estrogens: Alora Cenestin Climara Delestrogen Depo-Estradiol Divigel Elestrin Enjuvia Estrace Estraderm Estrasorb Estrogel Estring Estrogel Estropipate Evamist Femring Menest Lower-Cost Alternatives Tier 1 Tier 2 Doxycycline Minocycline Tetracycline Testosterone Cypionate (injection) Estradiol Estropipate Estradiol patch

4 Heart Disease & Diabetes Incontinence Agents Allergies Antiulcer Menostar Minivelle Premarin Vivelle Estrace Vag Cream Premarin Vag Cream Vagifem Vag Tab Estrogen Combinations: Angeliq Activella Climara Pro Combipatch Femhrt Jinteli Prefest Premphase Prempro Antilipemics: Niacor Niaspan Incontinence: Detrol Detrol LA Enablex Gelnique Oxytrol Patch Sanctura XR Toviaz Vesicare Oral Antihistamines and Combinations: Clarinex Clarinex-D Decon-A Pediatex TD Promethazine VC Relhist Rescon-Jr Rescon-MX Semprex-D Xyzal Nasal Medications: Astelin, Astapro, Beconase AQ Nasacort AQ Nasonex Omnaris Patanase Rhinocort Aqua Veramyst Antiulcers: Aciphex Dexilant Esomeprazole Strontium Estradiol & norethindrone acetate Ethinyl estradiol & norethindrone acetate Esterified estrogens & ethyltestosterone Slo-Niacin Niacin ER Oxybutynin Oxybutynin XL Alavert Claritin Loratadine Cetirizine Cetirizine-D Claritin-D Fexofenadine Levocetirizine Montelukast Zyrtec Zyrtec-D Flunisolide nasal Fluticasone nasal Ipratropium bromide nasal Triamcinolone nasal Omeprazole Pantoprazole Prevacid-24 Prilosec OTC Zegerid OTC Tolterodine Trospium Trospium ER Desloratadine Fexofenadine w/pse Azelastine nasal spray Lansoprazole Rabeprazole

5 Benign Prostatic Hyperplasia (BPH) Urologicals Anti-Allergic & Related Agents Antivirals First-Lansoprazole First-Omeprazole Nexium Nexium PrevPac Omeprazole+Syrspend SF Alka Prevacid Prilosec Pylera Protonix Zegerid BPH: Avodart (QL) Jalyn Rapaflo Miscellaneous Urologicals: Caverject Cialis (ST) (QL) Edex Levitra (QL) (ST) Muse (QL) Viagra (QL) Staxyn Stendra Anti-Allergic & Related Agents: Alocril Alomide Bepreve Enadine Lacrisert Lastacaft Pataday Patanol Restasis Antivirals: Zovirax Cream Zovirax Ointment Denavir Lipsovir Xerese Alfuzosin Doxazosin Tamsulosin Terazosin Finasteride Sild enafil 20mg tablets Alaway Ketotifen Zaditor Azelastine Epinastine Abreva

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