2018 Formulary (List of Covered Drugs)

Transcription

1 08 Formulary (List of Covered Drugs) Dean Advantage Essential Dean Advantage Assurance Dean Advantage Balance Dean Advantage Confidence Dean Advantage Gold Complete (HMO) (HMO) (HMO) (HMO-POS) (HMO) Please read: This document contains information about the drugs we cover in this plan This formulary was updated on 0/0/08. For more recent information or other questions, please contact Dean Advantage at (TTY: 7), 8 am 8 pm, weekdays (year-round) and weekends (October February ), or visit deancare.com/medicare. Formulary ID: Version: 0 H Approved

2 Note to Existing Members This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. The Formulary may change at any time. You will receive notice when necessary. When this drug list (formulary) refers to we, us or our, it means Dean Health Plan. When it refers to plan or our plan, it means Dean Advantage Essential (HMO), Dean Advantage Assurance (HMO), Dean Advantage Balance (HMO), Dean Advantage Confidence (HMO-POS) or Dean Advantage Gold Complete (HMO). This document includes a list of the drugs (formulary) for our plan which is current as of 0/0/08. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January, 09 and from time to time during the year. The Dean Advantage Formulary What is the Dean Advantage Formulary? A formulary is a list of covered drugs selected by Dean Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Dean Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Dean Advantage network pharmacy and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. As opposed to the abridged drug formulary, this document is the entire list of Part D drugs covered by Dean Advantage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 08 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 08 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released.

3 Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same costsharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, or add prior authorization, quantity limits and/ or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 0/0/08. To get updated information about the drugs covered by Dean Advantage, please contact us. Our contact information appears on the front and back cover pages. In the event that Dean Advantage has CMS-approved non-maintenance changes to the formulary throughout the plan year (i.e. remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier), Dean Advantage will update our formulary and post it on our website. You will also be notified in writing if you are affected by the changes via errata sheets. We also maintain and update our online formulary on a monthly basis. How do I use the Formulary? There are two ways to find your drug within the formulary: Medical Condition The formulary begins on page 9. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular Agents-Misc. If you know what your drug is used for, look for the category name in the list that begins on page 9. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? Dean Advantage covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.

4 Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization (PA): Navitus MedicareRx (PDP) requires you [or your physician] to get prior authorization for certain drugs. This means that you will need to get approval from Dean Advantage before you fill your prescriptions. If you don t get approval, Dean Advantage may not cover the drug. Prior Authorization Restriction for Part B vs Part D Determination (): This drug may be eligible for payment under Medicare Part B or Part D. You (or your physician) are required to get prior authorization from Dean Advantage to determine that this drug is covered under Medicare Part D before you fill your prescription for this drug. Without prior approval, Dean Advantage may not cover this drug. Prior Authorization Restriction for New Starts Only (PA NSO): If this drug is new to the member, you (or your physician) are required to get prior authorization from Dean Advantage before you fill your prescription for this drug. Without prior approval, Dean Advantage may not cover this drug. Quantity Limits (QL): For certain drugs, Dean Advantage limits the amount of the drug that Dean Advantage will cover. This could include a: per fill, daily, monthly or yearly limitation. Step Therapy (ST): In some cases, Dean Advantage requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Dean Advantage may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Dean Advantage will then cover Drug B. Non-Mail-Order Drug (NM): You may be able to receive greater than a one-month supply of most of the drugs on your Formulary via mail order at a reduced cost share. Drugs not available via your mail-order benefit are noted with NM in the notes column of your Formulary. Limited Distribution (LD): The symbol (LD) next to a drug name indicates that the drug has been noted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs can only be obtained at specialty designated pharmacies able to appropriately handle the drugs. Non-Extended Day Supply (): Previously labeled as NM for Non-Mail-Order Drug. You may be able to receive greater than a -month supply of most of the drugs on your Formulary via mail order at a reduced cost share. Drugs noted with are limited to a -month supply for both Retail and Mail Order.

5 You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 9. You can also get more information about the restrictions applied to specific covered drugs by visiting our website. We have posted documents online that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask Dean Advantage to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to the Dean Advantage formulary? for information about how to request an exception. What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. If you learn that Dean Advantage does not cover your drug, you have two options: You can ask Member Services for a list of similar drugs that are covered by Dean Advantage. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Dean Advantage. You can ask Dean Advantage to make an exception and cover your drug. See the following section for information about how to request an exception. How do I request an exception to the Dean Advantage Formulary? You can ask Dean Advantage to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to cover a formulary drug at a lower cost-sharing level (if this drug is not on the specialty tier). If approved this would lower the amount you must pay for your drug. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Dean Advantage limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. Generally, Dean Advantage will only approve your request for an exception if the alternative drugs are included on the plan s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.

6 You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you request a formulary or utilization restriction exception, you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 7 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 7 hours for a decision. If your request to expedite is granted, we must give you a decision no later than hours after we get a supporting statement from your doctor or other prescriber. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary -day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first -day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with a 9-98-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a -day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. We will provide a one-time -day transition supply per drug, which will cover a temporary supply if you have a change in your medications due to a level-of-care change. A level-of-care change may include: Entering or leaving a long-term care (LTC) facility Discharged from a hospital to a home End a Medicare Part A skilled nursing facility stay Give up Hospice status and revert back to standard Medicare benefits End an LTC facility stay and return to their home 6

7 If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with 98-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a -day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. Level of Care Change: For members transitioning from SNF to LTC SNF to Home (Retail) LTC LTC (pharmacy must use SCC 8 on claim) Hospital to Home (Retail) Day Supply day supply 0 day supply day supply 0 day supply During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. For more information For more detailed information about your Dean Advantage prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Dean Advantage, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at -800-MEDICARE ( ) hours a day/7 days a week. TTY users should call Or, visit medicare.gov. Dean Advantage s Formulary The formulary below provides coverage information about the drugs covered by Dean Advantage. If you have trouble finding your drug in the list, turn to the Index that begins on page. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., LIDODERM) and generic drugs are listed in lower-case italics (e.g., lidocaine). The second column of the chart lists the Drug Tier. The information in the Requirements/Limits column tells you if Dean Advantage has any special requirements for coverage of your drug. 7

8 Keys and Abbreviations Drug Name column key: lowercase italics = Generic drugs ALL CAPS = Brand name drugs Tier column key: Tier Preferred generic drugs Tier Generic drugs Tier Preferred brand name drugs Tier Brand name drugs Tier Specialty drugs Key of abbreviations in the Requirements/Limits column: LD indicates that the drug has been noted as being restricted to certain pharmacies by the Food and Drug Administration. These drugs can only be obtained at specialty designated pharmacies able to appropriately handle the drugs. PA indicates that prior authorization may apply. indicates that prior authorization may apply for medications that could be eligible for payment under either Medicare Part B or Part D. PA NSO indicates that prior authorization may apply on certain medications for new members of the plan. QL indicates that quantities dispensed may be limited. ST indicates that step therapy may apply. NM indicates that the drug is not available via your mail-order benefit. Dean Advantage is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Dean Advantage depends on contract renewal. Limitations, copayments and restrictions may apply. Benefits, provider network, premium and/or copayments/coinsurance may change on January of each year. This information is not a complete description of benefits. Contact the plan for more information. You must continue to pay your Part B premium. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. 8

9 ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS AMPHETAMINES amphetamine 0mg er cap amphetamine 0mg amphetamine.mg amphetamine mg er cap amphetamine mg amphetamine 0mg er cap amphetamine 0mg amphetamine mg er cap amphetamine 0mg er cap amphetamine 0mg amphetamine mg er cap amphetamine mg amphetamine 7.mg dextroamphetamine sulfate 0mg er cap dextroamphetamine sulfate 0mg dextroamphetamine sulfate mg er cap dextroamphetamine sulfate mg er cap dextroamphetamine sulfate mg methamphetamine mg PA VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 0MG CAP VYVANSE 0MG CHEW VYVANSE 60MG CAP VYVANSE 60MG CHEW VYVANSE 70MG CAP ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine 00mg cap QL=60 EA/0 Days atomoxetine 0mg cap QL=60 EA/0 Days atomoxetine 8mg cap QL=60 EA/0 Days atomoxetine mg cap QL=60 EA/0 Days atomoxetine 0mg cap QL=60 EA/0 Days atomoxetine 60mg cap QL=60 EA/0 Days atomoxetine 80mg cap QL=60 EA/0 Days guanfacine mg er guanfacine mg er guanfacine mg er You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

10 guanfacine mg er STIMULANTS - MISC. armodafinil 0mg armodafinil 00mg armodafinil 0mg armodafinil 0mg dexmethylphenidate 0mg er cap dexmethylphenidate 0mg dexmethylphenidate mg er cap dexmethylphenidate.mg dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate 0mg er cap dexmethylphenidate mg er cap dexmethylphenidate mg metadate 0mg er methylphenidate 0mg cd cap methylphenidate 0mg chew methylphenidate 0mg er methylphenidate 0mg la cap methylphenidate 0mg METHYLPHENIDATE 8MG SR methylphenidate mg/ml oral soln methylphenidate.mg chew methylphenidate 0mg cd cap methylphenidate 0mg er methylphenidate 0mg la cap methylphenidate 0mg METHYLPHENIDATE 7MG SR methylphenidate mg/ml oral soln methylphenidate 0mg cd cap methylphenidate 0mg la cap METHYLPHENIDATE 6MG SR methylphenidate 0mg cd cap methylphenidate 0mg la cap methylphenidate 0mg cd cap METHYLPHENIDATE MG SR methylphenidate mg chew methylphenidate mg methylphenidate 60mg cd cap METHYLPHENIDATE 60MG LA CAP modafinil 00mg modafinil 00mg PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=60 EA/0 Days PA QL=60 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

11 RITALIN 0MG LA CAP AMINOGLYCOSIDES AMINOGLYCOSIDES amikacin 0mg/ml inj gentamicin.mg/ml inj gentamicin 0mg/ml inj gentamicin sulfate 0.8mg/ml inj gentamicin sulfate.6mg/ml inj gentamicin sulfate mg/ml inj neomycin sulfate 00mg paromomycin 0mg cap STREPTOMYCIN 00MG TOBI PODHALER KIT 8MG PACK TOBRAMYCIN 0MG/ML tobramycin 0mg/ml inj tobramycin 60mg/ml inh soln ANALGESICS - ANTI-INFLAMMATORY ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML HUMIRA 0MG/0.ML AUTO-ECTOR HUMIRA 0MG/0.ML HUMIRA 0MG/0.8ML AUTO-ECTOR HUMIRA 0MG/0.8ML HUMIRA PEDIATRIC CROHN'S STARTER PACK () 0MG/0.8ML HUMIRA PEDIATRIC CROHN'S STARTER PACK () 80MG/0.8ML HUMIRA PEDIATRIC CROHN'S STARTER PACK (6) 0MG/0.8ML HUMIRA PEDIATRIC CROHN'S STARTER PACK () 0MG/0.ML, 80MG/0.8ML HUMIRA PEN - CROHN'S STARTER PACK 0MG/0.8ML HUMIRA PEN - PSORIASIS STARTER PACK 0MG/0.8ML SIMPONI ARIA 0MG/ML GOLD COMPOU RIDAURA MG CAP INTERLEUKIN- BLOCKERS ARCALYST 0MG INTERLEUKIN-BETA BLOCKERS PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

12 ILARIS 0MG/ML NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib 00mg cap celecoxib 00mg cap celecoxib 00mg cap celecoxib 0mg cap diclofenac potassium 0mg diclofenac sodium 00mg er diclofenac sodium mg dr diclofenac sodium 0mg dr diclofenac sodium 0mg/misoprostol 0.mg diclofenac sodium 7mg dr diclofenac sodium 7mg/misoprostol 0.mg etodolac 00mg cap etodolac 00mg cap etodolac 00mg er etodolac 00mg etodolac 00mg er etodolac 00mg etodolac 600mg er FENOPROFEN 00MG CAP fenoprofen 600mg flurbiprofen 00mg flurbiprofen 0mg ibu 600mg ibu 800mg ibuprofen 0mg/ml oral susp ibuprofen 00mg ibuprofen 600mg ibuprofen 800mg INDOCIN MG/ML ORAL SUSP indomethacin mg cap indomethacin 0mg cap indomethacin 7mg er cap KETOPROFEN 00MG ER CAP ketoprofen 7mg cap ketorolac tromethamine 0mg ketorolac tromethamine mg/ml inj ketorolac tromethamine 0mg/ml cartridge ketorolac tromethamine 0mg/ml inj MECLOFENAMATE 00MG CAP MECLOFENAMATE 0MG CAP mefenamic acid 0mg cap meloxicam mg meloxicam 7.mg PA QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/ Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

13 nabumetone 00mg nabumetone 70mg naproxen 0mg naproxen mg/ml oral susp naproxen 7mg dr naproxen 7mg naproxen 00mg dr naproxen 00mg naproxen sodium 7mg oxaprozin 600mg profeno 600mg sulindac 0mg sulindac 00mg TOLMETIN 00MG CAP TOLMETIN 600MG PYRIMIDINE SYNTHESIS INHIBITORS leflunomide 0mg leflunomide 0mg SELECTIVE COSTIMULATION MODULATORS ORENCIA MG/ML AUTO-ECTOR ORENCIA MG/ML ORENCIA 0MG ORENCIA 0MG/0.ML ORENCIA 87.MG/0.7ML SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL MG ENBREL MG/0.ML ENBREL 0MG/ML SURECLICK ENBREL 0MG/ML ANALGESICS - NONNARCOTIC SALICYLATES diflunisal 00mg ANALGESICS - OPIOID OPIOID AGONISTS ABSTRAL 00MCG SL ABSTRAL 00MCG SL ABSTRAL 00MCG SL ABSTRAL 00MCG SL ABSTRAL 600MCG SL ABSTRAL 800MCG SL codeine sulfate mg codeine sulfate 0mg codeine sulfate 60mg duramorph 0.mg/ml inj PA PA PA PA PA PA PA PA PA PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=80 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

14 duramorph mg/ml inj EMBEDA 00-MG ER CAP EMBEDA 0-0.8MG ER CAP EMBEDA 0-.MG ER CAP EMBEDA 0-MG ER CAP EMBEDA 60-.MG ER CAP EMBEDA 80-.MG ER CAP fentanyl 0.0mg/hr patch fentanyl 0.0mg/hr patch fentanyl 0.0mg/hr patch fentanyl 0.07mg/hr patch fentanyl 0.mg/hr patch fentanyl 0.mg lozenge fentanyl 0.mg lozenge fentanyl 0.6mg lozenge fentanyl 0.8mg lozenge fentanyl.mg lozenge fentanyl.6mg lozenge FENTORA 00MCG BUCCAL FENTORA 00MCG BUCCAL FENTORA 00MCG BUCCAL FENTORA 600MCG BUCCAL FENTORA 800MCG BUCCAL hydromorphone 0mg/ml (ml) inj hydromorphone 0mg/ml (ml) inj hydromorphone mg er hydromorphone 6mg er hydromorphone mg/ml oral soln hydromorphone mg hydromorphone mg/ml syringe hydromorphone mg er hydromorphone mg hydromorphone 8mg er hydromorphone 8mg HYSINGLA 00MG ER HYSINGLA 0MG ER HYSINGLA 0MG ER HYSINGLA 0MG ER HYSINGLA 0MG ER HYSINGLA 60MG ER HYSINGLA 80MG ER KADIAN 00MG ER CAP KADIAN 0MG ER CAP LAZANDA 00MCG/ACT NASAL SPRAY LAZANDA 00MCG/ACT NASAL SPRAY QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=00 ML/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

15 LAZANDA 00MCG/ACT NASAL SPRAY LEVORPHANOL MG meperidine 00mg meperidine 00mg/ml inj MEPERIDINE 0MG/ML ORAL SOLN meperidine mg/ml inj meperidine 0mg meperidine 0mg/ml inj methadone 0mg METHADONE 0MG/ML methadone mg/ml oral soln methadone mg/ml oral soln methadone mg morphine sulfate 00mg er cap morphine sulfate 00mg er morphine sulfate 0mg er cap MORPHINE SULFATE 0MG ER (HR) CAP morphine sulfate mg er morphine sulfate mg morphine sulfate 00mg er morphine sulfate 0mg er cap morphine sulfate 0mg/ml oral soln morphine sulfate mg/ml oral soln MORPHINE SULFATE MG/ML MORPHINE SULFATE 0MG ER ( HR) CAP morphine sulfate 0mg er cap morphine sulfate 0mg er morphine sulfate 0mg MORPHINE SULFATE MG ER (HR) CAP morphine sulfate mg/ml oral soln morphine sulfate 0mg er cap MORPHINE SULFATE MG/ML MORPHINE SULFATE 60MG (HR) ER CAP morphine sulfate 60mg er cap morphine sulfate 60mg er MORPHINE SULFATE 7MG ER (HR) CAP morphine sulfate 80mg er cap MORPHINE SULFATE 90MG ER (HR) CAP NUCYNTA 00MG ER NUCYNTA 0MG ER NUCYNTA 00MG ER NUCYNTA 0MG ER NUCYNTA 0MG ER OXYCODONE 0MG ER (ABUSE-DETERRENT) PA QL=0 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days PA PA QL=70 EA/0 Days PA QL=60 EA/0 Days QL=600 ML/0 Days QL=800 ML/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=80 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=80 ML/0 Days QL=800 ML/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=80 EA/0 Days QL=60 EA/0 Days QL=900 ML/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days PA QL=0 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

16 oxycodone 0mg OXYCODONE MG ER (ABUSE-DETERRENT) oxycodone mg oxycodone mg/ml oral soln OXYCODONE 0MG ER (ABUSE-DETERRENT) oxycodone 0mg oxycodone 0mg/ml oral soln OXYCODONE 0MG ER (ABUSE-DETERRENT) oxycodone 0mg OXYCODONE 0MG ER (ABUSE-DETERRENT) oxycodone mg cap oxycodone mg OXYCODONE 60MG ER (ABUSE-DETERRENT) OXYCODONE 80MG ER (ABUSE-DETERRENT) oxymorphone 0mg oxymorphone mg tramadol 00mg er tramadol 00mg er (matrix delivery) tramadol 00mg er tramadol 00mg er (matrix delivery) tramadol 00mg er tramadol 00mg er (matrix delivery) tramadol 0mg XTAMPZA.MG ER CAP XTAMPZA 8MG ER CAP XTAMPZA 7MG ER CAP XTAMPZA 6MG ER CAP XTAMPZA 9MG ER CAP OPIOID COMBINATIONS acetaminophen.7mg/ml/hydrocodone bitartrate 0.mg/ml oral soln acetaminophen mg/ml/codeine phosphate.mg/ml oral soln acetaminophen 00mg/codeine phosphate mg acetaminophen 00mg/codeine phosphate 0mg acetaminophen 00mg/codeine phosphate 60mg QL=80 EA/0 Days PA QL=0 EA/0 Days QL=80 EA/0 Days QL=00 ML/0 Days PA QL=0 EA/0 Days QL=80 EA/0 Days QL=70 ML/0 Days PA QL=0 EA/0 Days QL=80 EA/0 Days PA QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days PA QL=0 EA/0 Days PA QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=00 ML/0 Days QL=980 ML/0 Days QL=90 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 6

17 acetaminophen 00mg/hydrocodone bitartrate 0mg acetaminophen 00mg/hydrocodone bitartrate mg acetaminophen 00mg/hydrocodone bitartrate 7.mg acetaminophen mg/hydrocodone bitartrate 0mg acetaminophen mg/hydrocodone bitartrate.mg acetaminophen mg/hydrocodone bitartrate mg acetaminophen mg/hydrocodone bitartrate 7.mg acetaminophen mg/oxycodone 0mg acetaminophen mg/oxycodone.mg acetaminophen mg/oxycodone mg acetaminophen mg/oxycodone 7.mg acetaminophen mg/tramadol 7.mg aspirin mg/oxycodone.8mg endocet 0-mg endocet -mg endocet 7.-mg hydrocodone 0mg/ibuprofen 00mg hydrocodone mg/ibuprofen 00mg hydrocodone bitartrate 7.mg/ibuprofen 00mg IBUPROFEN 00MG/OXYCODONE MG lorcet 0-mg lorcet -mg lorcet 7.-mg vicodin 0-00mg vicodin -00mg vicodin 7.-00mg OPIOID PARTIAL AGONISTS BUNAVAIL.-0.MG FILM BUNAVAIL.-0.7MG FILM BUNAVAIL 6.-MG FILM buprenorphine 0.mg/ml cartridge buprenorphine 0.mg/ml inj buprenorphine mg sl buprenorphine 8mg sl butorphanol tartrate 0mg/ml nasal spray BUTORPHANOL TARTRATE MG/ML butorphanol tartrate mg/ml inj QL=90 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=80 EA/0 Days QL=80 EA/0 Days QL=80 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days PA PA QL=0 ML/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 7

18 naloxone 0.mg/pentazocine 0mg SUBOXONE -MG STRIP SUBOXONE -0.MG STRIP SUBOXONE -MG STRIP SUBOXONE 8-MG STRIP ZUBSOLV.-.9MG SL ZUBSOLV.-0.6MG SL ZUBSOLV.9-0.7MG SL ZUBSOLV.7-.MG SL ZUBSOLV 8.6-.MG SL ANDROGENS-ANABOLIC ANABOLIC STEROIDS ANADROL-0 0MG oxandrolone 0mg oxandrolone.mg ANDROGENS ANDRODERM MG/HR PATCH ANDRODERM MG/HR PATCH ANDROGEL % (MG) GEL ANDROGEL % (0MG) GEL ANDROGEL.6% (.GM) GEL ANDROGEL.6% (.GM) GEL ANDROGEL.6% GEL danazol 00mg cap danazol 00mg cap danazol 0mg cap FORTESTA 0MG/ACT GEL METHITEST 0MG methyltestosterone 0mg cap TESTIM % GEL testosterone % (mg) gel testosterone % (0mg) gel testosterone % gel pump TESTOSTERONE 0MG/ACT GEL testosterone 0mg/act topical soln testosterone cypionate 00mg/ml inj testosterone cypionate 00mg/ml inj testosterone enanthate 00mg/ml inj VOGELXO % (0MG) GEL VOGELXO % GEL PUMP ANORECTAL AGENTS INTRARECTAL STEROIDS colocort 00mg/60ml enema hydrocortisone.67mg/ml enema QL=60 EA/0 Days QL=60 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days QL=90 EA/0 Days QL=60 EA/0 Days PA QL=60 EA/0 Days PA QL=0 EA/0 Days PA QL=00 GM/0 Days PA QL=00 GM/0 Days PA QL=7.0 GM/0 Days PA QL=0 GM/0 Days PA QL=0 GM/0 Days PA QL=0 GM/0 Days PA PA PA QL=00 GM/0 Days PA QL=00 GM/0 Days PA QL=00 GM/0 Days PA QL=00 GM/0 Days PA QL=0 GM/0 Days PA QL=80 ML/0 Days PA QL=00 GM/0 Days PA QL=00 GM/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 8

19 UCERIS MG/ACT FOAM RECTAL COMBINATIONS hydrocortisone/pramoxine -% rectal cream RECTAL STEROIDS procto-med.% cream procto-pak % rectal cream proctosol.% cream proctozone hc.% cream ANTHELMINTICS ANTHELMINTICS ALBENZA 00MG BILTRICIDE 600MG ivermectin mg ANTIANGINAL AGENTS ANTIANGINALS-OTHER RANEXA 000MG ER RANEXA 00MG ER NITRATES ISORDIL 0MG isosorbide dinitrate 0mg isosorbide dinitrate 0mg isosorbide dinitrate 0mg ISOSORBIDE DINITRATE 0MG ER isosorbide dinitrate mg isosorbide mononitrate 0mg isosorbide mononitrate 0mg er isosorbide mononitrate 0mg isosorbide mononitrate 0mg er isosorbide mononitrate 60mg er minitran 0.mg/hr patch minitran 0.mg/hr patch minitran 0.mg/hr patch minitran 0.6mg/hr patch NITRO-BID % OINTMENT NITRO-DUR 0.MG/HR PATCH NITRO-DUR 0.8MG/HR PATCH nitroglycerin 0.mg/hr patch nitroglycerin 0.mg/hr patch nitroglycerin 0.mg sl nitroglycerin 0.mg sl nitroglycerin 0.mg/act pump spray nitroglycerin 0.mg/hr patch nitroglycerin 0.6mg sl nitroglycerin 0.6mg/hr patch PA You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

20 ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC. buspirone 0mg buspirone mg buspirone 0mg buspirone mg buspirone 7.mg hydroxyzine 0mg hydroxyzine mg HYDROXYZINE MG/ML hydroxyzine mg/ml oral soln hydroxyzine 0mg hydroxyzine 0mg/ml inj HYDROXYZINE PAMOATE 00MG CAP hydroxyzine pamoate mg cap hydroxyzine pamoate 0mg cap meprobamate 00mg meprobamate 00mg BENZODIAZEPINES alprazolam 0.mg odt alprazolam 0.mg alprazolam 0.mg er alprazolam 0.mg odt alprazolam 0.mg alprazolam mg er alprazolam mg odt alprazolam mg ALPRAZOLAM MG/ML ORAL SOLN alprazolam mg er alprazolam mg odt alprazolam mg alprazolam mg er chlordiazepoxide 0mg cap chlordiazepoxide mg cap chlordiazepoxide mg cap clorazepate dipotassium mg clorazepate dipotassium.7mg clorazepate dipotassium 7.mg diazepam 0mg DIAZEPAM MG/ML ORAL SOLN diazepam mg diazepam mg diazepam mg/ml oral soln lorazepam 0.mg lorazepam mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

21 lorazepam mg lorazepam mg/ml oral conc oxazepam 0mg cap oxazepam mg cap oxazepam 0mg cap ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A disopyramide 00mg cap disopyramide 0mg cap NORPACE 00MG ER CAP NORPACE 0MG ER CAP PROCAINAMIDE 00MG/ML PROCAINAMIDE 00MG/ML quinidine gluconate mg er QUINIDINE GLUCONATE 80MG/ML QUINIDINE SULFATE 00MG QUINIDINE SULFATE 00MG ANTIARRHYTHMICS TYPE I-B mexiletine 0mg cap mexiletine 00mg cap mexiletine 0mg cap ANTIARRHYTHMICS TYPE I-C flecainide acetate 00mg flecainide acetate 0mg flecainide acetate 0mg propafenone 0mg propafenone mg er cap propafenone mg propafenone 00mg propafenone mg er cap propafenone mg er cap ANTIARRHYTHMICS TYPE III amiodarone 00mg amiodarone 00mg amiodarone 0mg/ml inj amiodarone hydrochloride 00mg dofetilide mcg cap dofetilide 0mcg cap dofetilide 00mcg cap MULTAQ 00MG NEXTERONE 0MG/00ML NEXTERONE 60MG/00ML pacerone 00mg pacerone 00mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

22 pacerone 00mg ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTIASTHMATIC - MONOCLONAL ANTIBODIES NUCALA 00MG PA XOLAIR 0MG PA ANTI-INFLAMMATORY AGENTS CROMOLYN SODIUM 0MG/ML INH SOLN BRONCHODILATORS - ANTICHOLINERGICS ATROVENT 7MCG INH INCRUSE 6.MCG INH ipratropium bromide 0.0% inh soln SPIRIVA.MCG RESPIMAT INH ST QL= GM/0 Days SPIRIVA 8MCG HANDIHALER SPIRIVA.MCG RESPIMAT INH SPIRIVA.MCG RESPIMAT INH (8 ACT) LEUKOTRIENE MODULATORS montelukast 0mg montelukast mg chew montelukast mg granules montelukast mg chew zafirlukast 0mg zafirlukast 0mg zileuton 600mg er ZYFLO 600MG SELECTIVE PHOSPHODIESTERASE (PDE) INHIBITORS DALIRESP 0MCG DALIRESP 00MCG STEROID INHALANTS ARNUITY 00MCG INH QL=0 EA/0 Days ARNUITY 00MCG INH QL=0 EA/0 Days ARNUITY 0MCG INH QL=0 EA/0 Days ASMANEX 00MCG (0ACT) HFA INH QL= GM/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 00MCG (0ACT) HFA INH QL= GM/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 0MCG (0ACT) INH QL= EA/0 Days ASMANEX 0MCG (60ACT) INH QL= EA/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days budesonide 0.mg/ml inh soln QL=0 ML/0 Days FLOVENT 00MCG DISKUS QL=60 EA/0 Days FLOVENT 0MCG HFA INH QL= GM/0 Days FLOVENT 0MCG HFA INH QL= GM/0 Days FLOVENT 0MCG DISKUS QL=60 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

23 FLOVENT MCG HFA INH FLOVENT 0MCG DISKUS SYMPATHOMIMETICS ADVAIR 00-0MCG DISKUS ADVAIR -MCG HFA INH ADVAIR 0-MCG HFA INH ADVAIR 0-0MCG DISKUS ADVAIR -MCG HFA INH ADVAIR 00-0MCG DISKUS albuterol 0.mg/ml (0.6mg/ml) inh soln albuterol 0.7mg/ml (.mg/ml) inh soln albuterol 0.mg/ml (mg/ml) oral soln albuterol 0.8mg/ml (0.08%) inh soln albuterol mg/ml (0.%) inh soln albuterol mg albuterol mg er albuterol mg albuterol 8mg er ANORO 6.-MCG ELLIPTA INH BREO 00-MCG ELLIPTA INH BREO 00-MCG ELLIPTA INH BROVANA MCG/ML INH SOLN COMBIVENT RESPIMAT 0-00MCG INH DULERA 00-MCG INH DULERA 00-MCG INH FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE -MCG/ACT POWDER INH ipratropium/albuterol 0.-.mg/ml inh soln levalbuterol 0.mg inh soln levalbuterol 0.6mg inh soln levalbuterol.mg inh soln levalbuterol.mg inh soln LEVALBUTEROL MCG INH METAPROTERENOL SULFATE 0MG METAPROTERENOL SULFATE 0MG METAPROTERENOL SULFATE MG/ML ORAL SOLN PERFOROMIST 0MCG/ML INH SOLN SEREVENT 0MCG/DOSE INH STIOLTO.-.MCG INH STIOLTO.-.MCG INH (8 ACT) QL=.0 GM/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL= GM/0 Days QL= GM/0 Days QL=60 EA/0 Days QL= GM/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL= GM/0 Days QL= GM/0 Days ST QL=0 GM/0 Days QL= GM/0 Days QL= GM/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

24 terbutaline sulfate mg/ml inj terbutaline sulfate.mg terbutaline sulfate mg TRELEGY 6.-MCG ELLIPTA INH VENTOLIN 08MCG INH XOPENEX MCG INH XANTHINES aminophylline mg/ml inj THEO- 00MG ER CAP THEO- 00MG ER CAP THEO- 00MG ER CAP THEO- ER CAP theophylline 00mg er theophylline 00mg er theophylline 00mg er theophylline 00mg er theophylline.mg/ml oral soln theophylline 600mg er ANTICOAGULANTS COUMARIN ANTICOAGULANTS COUMADIN 0MG COUMADIN MG COUMADIN.MG COUMADIN MG COUMADIN MG COUMADIN MG COUMADIN MG COUMADIN 6MG COUMADIN 7.MG jantoven 0mg jantoven mg jantoven.mg jantoven mg jantoven mg jantoven mg jantoven mg jantoven 6mg jantoven 7.mg warfarin sodium 0mg warfarin sodium mg warfarin sodium.mg warfarin sodium mg warfarin sodium mg warfarin sodium mg warfarin sodium mg QL=6 GM/0 Days ST QL=0 GM/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

25 warfarin sodium 6mg warfarin sodium 7.mg DIRECT FACTOR XA INHIBITORS ELIQUIS.MG ELIQUIS 0-DAY STARTER PACK ELIQUIS MG XARELTO 0MG XARELTO MG XARELTO 0MG XARELTO STARTER PACK HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin sodium 00mg/ml syringe enoxaparin sodium 0mg/0.8ml syringe enoxaparin sodium 0mg/ml syringe enoxaparin sodium 00mg/ml syringe enoxaparin sodium 0mg/0.ml syringe enoxaparin sodium 0mg/0.ml syringe enoxaparin sodium 60mg/0.6ml syringe enoxaparin sodium 80mg/0.8ml syringe fondaparinux sodium.mg/ml (0.ml) syringe fondaparinux sodium.mg/ml (0.6ml) syringe fondaparinux sodium.mg/ml (0.8ml) syringe fondaparinux sodium mg/ml syringe FRAGMIN 0000UNIT/ML FRAGMIN 00UNIT/0.ML FRAGMIN 000UNIT/0.6ML FRAGMIN 8000UNIT/0.7ML FRAGMIN 00UNIT/0.ML FRAGMIN 000UNIT/0.ML FRAGMIN 700UNIT/0.ML FRAGMIN 9000UNIT/.8ML heparin sodium, porcine 0000unit/ml inj heparin sodium, porcine 000unit/ml inj HEPARIN SODIUM, PORCINE 00UNIT/ML heparin sodium, porcine 0000unit/ml inj heparin sodium, porcine 0unit/ml inj heparin sodium, porcine 000unit/ml inj heparin sodium, porcine 0unit/ml inj THROMBIN INHIBITORS argatroban 00mg/ml inj ARGATROBAN MG/ML PRADAXA 0MG CAP PRADAXA 0MG CAP PRADAXA 7MG CAP ANTICONVULSANTS QL= ML/7 Days QL=7.0 ML/7 Days QL= ML/7 Days QL= ML/7 Days QL=0.0 ML/7 Days QL=.60 ML/7 Days QL=0.0 ML/7 Days QL=7.0 ML/7 Days PA PA PA PA You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

26 AMPA GLUTAMATE RECEPTOR ANTAGONISTS FYCOMPA 0.MG/ML ORAL SUSP FYCOMPA 0MG FYCOMPA MG FYCOMPA MG FYCOMPA MG FYCOMPA 6MG FYCOMPA 8MG ANTICONVULSANTS - BENZODIAZEPINES clonazepam 0.mg odt clonazepam 0.mg odt clonazepam 0.mg odt clonazepam 0.mg clonazepam mg odt clonazepam mg clonazepam mg odt clonazepam mg DIASTAT 0MG APPLICATOR DIASTAT.MG APPLICATOR DIASTAT 0MG PF APPLICATOR ONFI 0MG ONFI.MG/ML ORAL SUSP ONFI 0MG ANTICONVULSANTS - MISC. APTIOM 00MG APTIOM 00MG APTIOM 600MG APTIOM 800MG BANZEL 00MG BANZEL 00MG BANZEL 0MG/ML ORAL SUSP BRIVIACT 00MG BRIVIACT 0MG BRIVIACT 0MG/ML BRIVIACT 0MG/ML ORAL SOLN BRIVIACT MG BRIVIACT 0MG BRIVIACT 7MG carbamazepine 00mg chew carbamazepine 00mg er cap carbamazepine 00mg er carbamazepine 00mg er cap carbamazepine 00mg er carbamazepine 00mg carbamazepine 0mg/ml oral susp PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO QL=60 EA/0 Days PA NSO QL=60 EA/0 Days PA NSO PA NSO PA NSO QL=60 EA/0 Days PA NSO QL=60 EA/0 Days PA NSO QL=60 EA/0 Days You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 6

27 carbamazepine 00mg er cap carbamazepine 00mg er epitol 00mg gabapentin 00mg cap gabapentin 00mg cap gabapentin 00mg cap gabapentin 0mg/ml oral soln gabapentin 600mg gabapentin 800mg LAMICTAL BLUE KIT LAMICTAL GREEN KIT LAMICTAL ORANGE KIT LAMICTAL XR BLUE KIT LAMICTAL XR GREEN KIT LAMICTAL XR ORANGE KIT lamotrigine 00mg er lamotrigine 00mg odt lamotrigine 00mg lamotrigine 0mg lamotrigine 00mg er lamotrigine 00mg odt lamotrigine 00mg lamotrigine 0mg er lamotrigine mg chew lamotrigine mg er lamotrigine mg odt lamotrigine mg lamotrigine 00mg er lamotrigine 0mg er lamotrigine 0mg odt lamotrigine mg chew lamotrigine mg () starter pack lamotrigine mg ()/00mg (7) starter pack lamotrigine mg (8)/00mg () starter pack levetiracetam 000mg levetiracetam 00mg/ml inj levetiracetam 00mg/ml oral soln levetiracetam 0mg/ml inj levetiracetam mg/ml inj levetiracetam 0mg levetiracetam 00mg er levetiracetam 00mg levetiracetam mg/ml inj levetiracetam 70mg er levetiracetam 70mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 7

28 LYRICA 00MG CAP LYRICA 0MG CAP LYRICA 00MG CAP LYRICA 0MG/ML ORAL SOLN LYRICA MG CAP LYRICA MG CAP LYRICA 00MG CAP LYRICA 0MG CAP LYRICA 7MG CAP oxcarbazepine 0mg oxcarbazepine 00mg oxcarbazepine 600mg oxcarbazepine 60mg/ml oral susp OXTELLAR 0MG XR OXTELLAR 00MG XR OXTELLAR 600MG XR primidone 0mg primidone 0mg QUDEXY 00MG XR CAP QUDEXY 0MG XR CAP QUDEXY 00MG XR CAP QUDEXY MG XR CAP QUDEXY 0MG XR CAP roweepra 000mg roweepra 00mg er roweepra 00mg roweepra 70mg er roweepra 70mg SPRITAM 000MG ODT SPRITAM 0MG ODT SPRITAM 00MG ODT SPRITAM 70MG ODT TOPIRAMATE 00MG ER CAP topiramate 00mg TOPIRAMATE 0MG ER CAP topiramate mg cap TOPIRAMATE 00MG ER CAP topiramate 00mg topiramate mg cap TOPIRAMATE MG ER CAP topiramate mg TOPIRAMATE 0MG ER CAP topiramate 0mg TROKENDI 00MG XR CAP TROKENDI 00MG XR CAP PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO PA NSO You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 8

29 TROKENDI MG XR CAP TROKENDI 0MG XR CAP VIMPAT 00MG VIMPAT 0MG/ML ORAL SOLN VIMPAT 0MG VIMPAT 00MG VIMPAT 00MG/0ML VIMPAT 0MG zonisamide 00mg cap zonisamide mg cap zonisamide 0mg cap CARBAMATES felbamate 0mg/ml oral susp felbamate 00mg felbamate 600mg GABA MODULATORS GABITRIL MG GABITRIL 6MG SABRIL 00MG ORAL SOLN SABRIL 00MG tiagabine mg tiagabine 6mg tiagabine mg tiagabine mg vigabatrin 0mg/ml oral soln HYDANTOINS DILANTIN 0MG ER CAP fosphenytoin sodium 7mg/ml inj PEGANONE 0MG phenytoin mg/ml oral susp phenytoin 0mg chew phenytoin sodium 00mg er cap phenytoin sodium 00mg er cap phenytoin sodium 00mg er cap phenytoin sodium 0mg/ml inj SUCCINIMIDES CELONTIN 00MG CAP ethosuximide 0mg cap ethosuximide 0mg/ml oral soln VALPROIC ACID divalproex sodium mg dr cap divalproex sodium mg dr divalproex sodium 0mg dr divalproex sodium 0mg er PA NSO PA NSO QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days PA NSO PA NSO PA NSO You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 9

30 divalproex sodium 00mg dr divalproex sodium 00mg er valproic acid 00mg/ml inj valproic acid 0mg cap valproic acid 0mg/ml oral soln ANTIDEPRESSANTS ALPHA- RECEPTOR ANTAGONISTS (TETRACYCLICS) mirtazapine mg odt mirtazapine mg mirtazapine 0mg odt mirtazapine 0mg mirtazapine mg odt mirtazapine mg mirtazapine 7.mg ANTIDEPRESSANTS - MISC. APLENZIN 7MG ER APLENZIN 8MG ER APLENZIN MG ER bupropion 00mg sr bupropion 00mg bupropion 0mg sr ( hr) bupropion 0mg xl ( hr) bupropion 00mg sr bupropion 00mg xl bupropion 7mg MAPROTILINE MG MAPROTILINE 0MG MAPROTILINE 7MG MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM MG/HR PATCH EMSAM 6MG/HR PATCH EMSAM 9MG/HR PATCH MARPLAN 0MG phenelzine mg tranylcypromine 0mg SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram 0mg citalopram 0mg citalopram mg/ml oral soln citalopram 0mg escitalopram 0mg escitalopram mg/ml oral soln escitalopram 0mg escitalopram mg ST ST ST You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le. 0

31 fluoxetine 0mg cap fluoxetine 0mg cap fluoxetine 0mg cap fluoxetine mg/ml oral soln fluvoxamine maleate 00mg er cap ST fluvoxamine maleate 00mg fluvoxamine maleate 0mg er cap ST fluvoxamine maleate mg fluvoxamine maleate 0mg paroxetine 0mg paroxetine.mg er paroxetine 0mg paroxetine mg er paroxetine 0mg paroxetine 7.mg er paroxetine 0mg PAXIL 0MG/ML ORAL SUSP PEXEVA 0MG ST PEXEVA 0MG ST PEXEVA 0MG ST PEXEVA 0MG ST sertraline 00mg sertraline 0mg/ml oral soln sertraline mg sertraline 0mg SEROTONIN MODULATORS NEFAZODONE 00MG NEFAZODONE 0MG NEFAZODONE 00MG nefazodone 0mg nefazodone 0mg trazodone 00mg trazodone 0mg trazodone 00mg trazodone 0mg TRINTELLIX 0MG ST QL=0 EA/0 Days TRINTELLIX 0MG ST QL=0 EA/0 Days TRINTELLIX MG ST QL=0 EA/0 Days VIIBRYD 0/0MG STARTER PACK ST QL=0 EA/0 Days VIIBRYD 0MG ST QL=0 EA/0 Days VIIBRYD 0MG ST QL=0 EA/0 Days VIIBRYD 0MG ST QL=0 EA/0 Days SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DESVENLAFAXINE FUMARATE 00MG ER ST DESVENLAFAXINE FUMARATE 0MG ER ST You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

32 desvenlafaxine succinate 00mg er desvenlafaxine succinate mg er desvenlafaxine succinate 0mg er duloxetine 0mg dr cap duloxetine 0mg dr cap DULOXETINE 0MG DR CAP duloxetine 60mg dr cap FETZIMA 0MG ER CAP FETZIMA 0MG ER CAP FETZIMA 0MG ER CAP FETZIMA 80MG ER CAP FETZIMA PACK KHEDEZLA 00MG ER KHEDEZLA 0MG ER venlafaxine 00mg venlafaxine 0mg er cap venlafaxine 0mg er VENLAFAXINE MG ER venlafaxine mg venlafaxine 7.mg er cap venlafaxine 7.mg er venlafaxine 7.mg venlafaxine 0mg venlafaxine 7mg er cap venlafaxine 7mg er venlafaxine 7mg TRICYCLIC AGENTS amitriptyline 00mg amitriptyline 0mg amitriptyline 0mg amitriptyline mg amitriptyline 0mg amitriptyline 7mg AMOXAPINE 00MG AMOXAPINE 0MG AMOXAPINE MG AMOXAPINE 0MG clomipramine mg cap clomipramine 0mg cap clomipramine 7mg cap desipramine 00mg desipramine 0mg desipramine 0mg desipramine mg desipramine 0mg ST QL=0 EA/0 Days ST QL=0 EA/0 Days ST QL=0 EA/0 Days ST QL=0 EA/0 Days ST QL=0 EA/0 Days ST QL=0 EA/0 Days ST ST You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

33 desipramine 7mg doxepin 00mg cap doxepin 0mg cap doxepin 0mg/ml oral soln doxepin 0mg cap doxepin mg cap doxepin 0mg cap DOXEPIN 7MG CAP imipramine 0mg imipramine mg imipramine 0mg imipramine pamoate 00mg cap imipramine pamoate mg cap imipramine pamoate 0mg cap imipramine pamoate 7mg cap nortriptyline 0mg cap nortriptyline mg cap NORTRIPTYLINE MG/ML ORAL SOLN nortriptyline 0mg cap nortriptyline 7mg cap protriptyline 0mg protriptyline mg trimipramine 00mg cap trimipramine mg cap trimipramine 0mg cap ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS acarbose 00mg acarbose mg acarbose 0mg miglitol 00mg miglitol mg miglitol 0mg ANTIDIABETIC - AMYLIN ANALOGS SYMLIN 00MCG/.ML PEN SYMLIN 700MCG/.7ML PEN ANTIDIABETIC COMBINATIONS ACTOPLUS MET -000MG XR ACTOPLUS MET 0-000MG XR glimepiride mg/pioglitazone 0mg glimepiride mg/pioglitazone 0mg glipizide.mg/metformin 0mg glipizide.mg/metformin 00mg glipizide mg/metformin 00mg glyburide.mg/metformin 0mg You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.

34 glyburide.mg/metformin 00mg glyburide mg/metformin 00mg GLYXAMBI 0-MG GLYXAMBI -MG JANUMET MG XR JANUMET 0-000MG JANUMET 0-000MG XR JANUMET 0-00MG JANUMET 0-00MG XR JENTADUETO.-000MG JENTADUETO.-000MG XR JENTADUETO.-00MG JENTADUETO.-80MG JENTADUETO -000MG XR metformin 00mg/pioglitazone mg METFORMIN 00MG/REPAGLINIDE MG METFORMIN 00MG/REPAGLINIDE MG metformin 80mg/pioglitazone mg SYNJARDY.-000MG SYNJARDY.-00MG SYNJARDY -000MG SYNJARDY -00MG SYNJARDY XR 0-000MG SYNJARDY XR.-000MG SYNJARDY XR -000MG SYNJARDY XR -000MG XIGDUO 0-000MG XR XIGDUO 0-00MG XR XIGDUO.-000MG XR XIGDUO -000MG XR XIGDUO -00MG XR XULTOPHY 00UNIT-.6MG/ML PEN BIGUANIDES metformin 000mg metformin 00mg er metformin 00mg metformin 70mg er metformin 80mg RIOMET 00MG/ML ORAL SOLN DIABETIC OTHER GLUCAGEN MG HYPOKIT GLUCAGON MG KORLYM 00MG PROGLYCEM 0MG/ML ORAL SUSP DIPEPTIDYL PEPTIDASE- (DPP-) INHIBITORS QL=0 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days QL=0 EA/0 Days QL=60 EA/0 Days QL=60 EA/0 Days QL=0 EA/0 Days PA QL= ML/0 Days PA You can find information on what the symbols and abbreviations on this le mean by going to the beginning of this le.