Comparison of VA to Prescription Drug Plan (PDP) Formulary Coverage and Tier Placement for Top 200 Drugs. Coverage on Non- Preferred Brand Tier

Similar documents
Alaska Medicaid 90 Day** Generic Prescription Medication List

Riesbeck's Pharmacy Reward Club Generic Medication List October 2017

Riesbeck's Pharmacy Reward Club Generic Medication List September 2017

Riesbeck's Pharmacy Reward Club Generic Medication List February 2018 $4 30 Day Supply

Oakwood Healthcare Low Cost Drug List for OHSCare & BCN

Professionalism & Service with Great Prices

Ambetter 90-Day-Supply Maintenance Drug List

Cash Wise Pharmacy $4 GENERIC MEDICATION FORMULARY. Cash Wise Pharmacy s $4 generic medication formulary is sorted by medical condition.

Generic Drug List - Alphabetical

Pharmacy Savings Program

PRESCRIPTION SAVINGS CLUB FLAT- PRICED GENERIC DRUG LIST (EMDEON) Effective August 20, 2014

Formulary for the JHM Outpatient Medication Assistance Program (OMAP)

Fruth Pharmacy Prescription Savings Club Prescription Club October 2010 Generics item list 30 Day Qty

Club Members save even more with the $4 Plus Plan!

Everyday Low Cost Generics

RETAIL PRESCRIPTION PROGRAM DRUG LIST -- WALMART Revised 8/24/11

90-Day Generic Drug Discount List Treatment Medication Strength Dose Quantity Price Allergy/Cold&Flu Benzonatate 100mg Tablet 42 $15.

$4 Prescription Program October 23, 2007

AMANTADINE 50 MG/5 ML SYRUP ACYCLOVIR 200 MG CAPSULES ACYCLOVIR 400 MG TABLETS ACYCLOVIR 800 MG TABLETS 30 90

Allergy, Cough and Cold. Analgesic. Anti-Anxiety. Antibiotic

$4 Prescription Program May 5, 2008

Upper Peninsula Health Plan Advantage (HMO) (List of Covered Drugs)

Members enjoy more Pharmacy savings *

Amitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil

Amitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil

$0 Preferred Generics List

Special Generic Drug Pricing Program

Hospital Unit Dose Unit Dose Plus Liquid Unit Dose. BARCODE LISTING Spring See our new Barcode Scanning Guide on page 26

Home Delivery Prescription Program Drug List

PRIOR ADAP FORMULARY - RX OPTIONS

Members enjoy more Pharmacy savings *

Hundreds of Choices. More Savings Every Day. 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses

2013 Step Therapy (ST) Criteria

2010 Prescription Drug Guide

All Pharmacy and Prescribing Providers. Subject: State Maximum Allowable Cost (MAC) Updates

Members enjoy more Pharmacy savings *

CMI Marketplace 2015 (List of Covered Drugs)

Step Therapy Requirements

QTY LIMIT COPAY (30 DAY/90 DAY) BENIGN PROSTATIC HYPERPLASIA FINASTERIDE $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8

DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 759 M %

Hospital Unit Dose Unit Dose Plus BARCODE LISTING. Spring See our new Barcode Scanning Guide on page 30

ASEBP and ARTA TARP Drugs and Reference Price by Categories

Home Delivery Prescription Program Drug List

DT Description Price Category Price change

A BULLETIN FOR PHARMACY SERVICE PROVIDERS FROM ALBERTA BLUE CROSS. Pan-Canadian Select Molecule Price Initiative for Generic Drugs

2018 Step Therapy Criteria

Glossary of Medications

While there is around a 3% increase shown in costs for Category M lines, I think this is due to the inclusion of more lines in Category M.

GENERIC DISCOUNT FORMULARY March 2015

STEP THERAPY ALGORITHMS PUP Select Formulary

Table 1: Price increases for Brand Name Drugs with Generic Equivalents

FirstCarolinaCare Insurance Company Step Therapy Requirements

5/8/2017. Clinical Pharmacy Specialist Division of Kidney Disease and Hypertension

Chapter 2 ~ Cardiovascular system

Provider Toolkit PFFS/PPO

DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 702 M %

Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers

These medications will require preauthorization (PA) for HMSA Medicare Part D members.

FORMULARY Revised January 2019

ARBS MEDICATION(S) SUBJECT TO STEP THERAPY DIOVAN HCT MG TAB, DIOVAN HCT MG TABLET

Penicillin VK Vcillin K 250gm/5ml Penicillin VK Vcillin K 250mg Sulfameth/Trimeth Bactrim 400/80mg Sulfameth/Trimeth Bactrim/Septra DS 800/160mg

Table A1: Fifty Most Often Repeated Oral Drug Product Shortages (35 ingredients), Canada,

2014 Preferred Drug List An evidence-based pharmacy program that works for you

Matching, Fill in the Blank, Multiple Choice (1 point each)

Combined Troop Medical Clinic Outpatient Formulary. The availability of formulary items is subject to change.

Have You Ever Wondered

Pharma X Consultancy Inc. Inventory List

DT Description Price Category Price change Percentage

CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.

TN Cover Rx Tennessee CoverRx MAC Price Change List As of: 04/26/2018

Pharmacy Provider Training

ANTI COLD / ANTI ALLERGIC / ANTI-ASTHMATICS GIT PRODUCTS

FORMULARY NOTES ABOUT FORMULARY AND PHARMACY

ALLERGIC RHINITIS-NASAL

Drug Regimen Optimization

Step Therapy Requirements. Effective: 11/01/2018

TennCare Program TN MAC Price Change List As of: 03/30/2017

IEHP Medi-Cal Formulary Maintenance Drug List

SmithRx Standard Formulary Step Therapy List

ANTIDEPRESSANTS. Details. dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet. Criteria

Step Therapy Medications

Beta-blockers. Atenolol. Propranolol. Bisoprolol. Metoprolol. Labetalol. Carvedilol.

ADHD STIMULANTS-S(SHC)

Drug Regimen Optimization

Cigna Drug and Biologic Coverage Policy

FORMULARY Revised January 2018 NOTES ABOUT FORMULARY AND PHARMACY

Select Preventive Prescription Drugs Jan. 1, 2018

REWARDS. Picture the. of good health. Sign-up today to enjoy the benefits. Discounts on Generics: 30 and 90 day supply*

Step Therapy Requirements. Effective: 05/01/2018

IEHP Medi-Cal Formulary Maintenance Drug List

Step Therapy Requirements

Nebraska Medicaid Program NE Weekly MAC Price Change List For Period: 12/14/ /20/2017

Simply Step Therapy Document September 2018 Y0114_18_33074_I_009

Step Therapy Requirements. Effective: 12/01/2016

WELLCARE/ OHANA HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 08/2015)

AMANTADINE ER. Products Affected Step 2: OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, Details

VNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 01/01/2017

Transcription:

Comparis of to Plan (PDP) Formulary and Placement for Top 200 Drugs Drug Name N Brand Abilify Yes 100.0% 0.0% 0.0% 3.1% 96.9% 0.0% Acetaminophen-Codeine Yes 100.0% 0.0% 76.0% 24.0% 0.0% 0.0% Acyclovir (Oral) Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Acyclovir (Topical) Yes 90.02% 10.0% 13.40% 0.01% 76.62% 0.00% Advair Diskus No 76.5% 23.5% 0.0% 56.6% 20.0% 0.0% Alendrate Sodium Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Allopurinol Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Alprazolam Yes 96.8% 3.2% 65.7% 14.9% 16.2% 0.0% Amiodare HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Amitriptyline HCl Yes 100.0% 0.0% 49.0% 27.3% 23.8% 0.0% Amlodipine Besylate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Amlodipine Besylate-Benazepril No 69.0% 31.0% 40.9% 28.1% 0.0% 0.0% Amox TR-Potassium Clavulanate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Amoxicillin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Atenolol Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Atorvastatin Calcium Yes 100.0% 0.0% 98.1% 0.0% 1.9% 0.0% Avodart No 69.9% 30.1% 0.0% 52.0% 17.9% 0.0% Azithromycin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Baclofen Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Benazepril HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Benicar No 82.8% 17.2% 0.0% 82.8% 0.0% 0.0% Benztropine Mesylate Yes 100.0% 0.0% 57.5% 20.2% 22.3% 0.0% Bumetanide Yes 100.0% 0.0% 92.8% 7.2% 0.0% 0.0% Bupropi HCl SR Yes 100.0% 0.0% 51.4% 48.6% 0.0% 0.0% Bupropi Xl Yes 100.0% 0.0% 51.4% 48.6% 0.0% 0.0% Buspire HCl Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Bystolic No 63.3% 36.7% 0.0% 33.5% 29.8% 0.0% Carbamazepine Yes 100.0% 0.0% 74.4% 25.6% 0.0% 0.0% Carbidopa-Levodopa Yes 100.0% 0.0% 56.9% 43.1% 0.0% 0.0% Carisoprodol No 54.6% 45.4% 23.1% 31.5% 0.0% 0.0% Carvedilol Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Celebrex No 51.7% 48.3% 0.0% 3.3% 48.5% 0.0% Cephalexin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Chlorhexidine Glucate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Chlorthalide Yes 100.0% 0.0% 96.8% 0.0% 3.2% 0.0% Ciprofloxacin HCl (Oral) Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Ciprofloxacin HCl (Ophthalmic) Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Citalopram HBr Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Clindamycin HCl Yes 100.0% 0.0% 98.1% 0.0% 1.9% 0.0% Clobetasol Propiate Yes 100.0% 0.0% 55.3% 44.7% 0.0% 0.0% Clazepam Yes 100.0% 0.0% 68.9% 7.8% 23.4% 0.0% Clidine HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Clopidogrel Yes 100.0% 0.0% 98.5% 1.5% 0.0% 0.0% Clotrimazole-Betamethase No 79.0% 21.0% 22.0% 57.0% 0.0% 0.0% Colcrys Yes 100.0% 0.0% 0.0% 100.0% 0.0% 0.0% Crestor No 96.3% 3.7% 0.0% 88.5% 7.8% 0.0% Cyclobenzaprine HCl Yes 100.0% 0.0% 20.6% 7.2% 72.2% 0.0% Cymbalta Yes 100.0% 0.0% 18.0% 56.9% 25.1% 0.0% Detrol La No 54.3% 45.7% 8.0% 22.5% 23.8% 0.0% Dexilant No 84.2% 15.8% 0.0% 22.8% 61.4% 0.0% Diazepam Yes 100.0% 0.0% 66.9% 1.7% 31.4% 0.0% Diclofenac Sodium (Topical) Yes 43.0% 57.0% 3.7% 1.7% 8.2% 29.3% Diclofenac Sodium (Ophthalmic) Yes 93.0% 7.0% 91.0% 0.0% 1.9% 0.0% Dicyclomine HCl Yes 100.0% 0.0% 92.8% 0.0% 7.2% 0.0% Digox Yes 100.0% 0.0% 98.5% 1.5% 0.0% 0.0% Diltiazem 24Hr CD Yes 100.0% 0.0% 32.1% 66.0% 1.9% 0.0% Diltiazem 24Hr ER Yes 93.0% 7.0% 29.9% 61.2% 1.9% 0.0% Diltiazem ER Yes 100.0% 0.0% 32.1% 66.0% 1.9% 0.0% Diovan Yes 37.9% 62.1% 0.0% 9.9% 28.0% 0.0% Divalproex Sodium Yes 100.0% 0.0% 52.2% 38.7% 9.1% 0.0% Divalproex Sodium ER Yes 100.0% 0.0% 41.0% 8.6% 50.4% 0.0% Depezil HCl Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Dorzolamide-Timolol Yes 99.6% 0.4% 78.3% 21.3% 0.0% 0.0% Doxazosin Mesylate Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Doxycycline Hyclate Yes 100.0% 0.0% 36.1% 56.7% 7.2% 0.0% Enalapril Maleate Yes 100.0% 0.0% 81.4% 18.6% 0.0% 0.0% Escitalopram Oxalate Yes 100.0% 0.0% 66.1% 26.8% 7.2% 0.0% Page 1 of 3

Drug Name N Brand Estradiol Yes 100.0% 0.0% 74.5% 1.7% 23.8% 0.0% Evista No 100.0% 0.0% 23.2% 76.8% 0.0% 0.0% Exel No 100.0% 0.0% 13.9% 43.9% 42.3% 0.0% Famotidine Yes 100.0% 0.0% 81.4% 18.6% 0.0% 0.0% Fenofibrate No 100.0% 0.0% 67.2% 32.8% 0.0% 0.0% Fentanyl Yes 100.0% 0.0% 13.7% 34.1% 52.2% 0.0% Finasteride Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Flucazole Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Fluoxetine HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Fluticase Propiate (Topical) Yes 99.6% 0.4% 74.0% 25.6% 0.0% 0.0% Fluticase Propiate (Nasal Spray) Yes 100.0% 0.0% 96.6% 1.5% 1.9% 0.0% Furosemide Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Gabapentin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Gemfibrozil Yes 100.0% 0.0% 78.9% 19.1% 1.9% 0.0% Glimepiride No 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Glipizide Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Glipizide ER No 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Glyburide No 69.9% 30.1% 34.0% 25.6% 10.3% 0.0% Humalog No 64.1% 35.9% 0.0% 63.2% 1.0% 0.0% Hydralazine HCl Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Hydrochlorothiazide Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Hydrocode-Acetaminophen Yes 100.0% 0.0% 35.2% 57.7% 7.2% 0.0% Hydroxychloroquine Sulfate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Hydroxyzine HCl Yes 83.8% 16.2% 18.6% 18.6% 46.7% 0.0% Ibuprofen Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Irbesartan No 74.0% 26.0% 71.5% 2.5% 0.0% 0.0% Isosorbide Mitrate ER Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Januvia No 70.3% 29.7% 0.0% 60.5% 9.8% 0.0% Ketocazole (Oral) Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Ketocazole (Topical) Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Klor-C 10 Yes 90.6% 9.4% 65.0% 25.6% 0.0% 0.0% Klor-C M20 Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Labetalol Hcl Yes 100.0% 0.0% 78.9% 19.1% 1.9% 0.0% Lactulose Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lamotrigine Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lansoprazole No 68.3% 31.7% 16.6% 26.1% 25.6% 0.0% Lantus Yes 92.5% 7.5% 0.0% 91.9% 0.5% 0.0% Lantus Solostar No 92.5% 7.5% 0.0% 89.0% 3.5% 0.0% Latanoprost Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Levetiracetam Yes 100.0% 0.0% 73.9% 26.1% 0.0% 0.0% Levofloxacin (Oral/IV) Yes 100.0% 0.0% 67.8% 32.2% 0.0% 0.0% Levofloxacin (Ophthalmic) Yes 61.4% 38.6% 16.6% 44.8% 0.0% 0.0% Levothyroxine Sodium Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lidoderm Yes 100.0% 0.0% 22.0% 52.5% 25.5% 0.0% Lisinopril Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lisinopril-Hydrochlorothiazide Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lithium Carbate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lorazepam Yes 100.0% 0.0% 85.1% 14.9% 0.0% 0.0% Losartan Potassium Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Losartan-Hydrochlorothiazide No 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lovastatin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Lovaza No 100.0% 0.0% 23.2% 25.9% 50.9% 0.0% Lumigan Yes 91.4% 8.6% 0.0% 85.7% 5.7% 0.0% Lyrica No 100.0% 0.0% 0.0% 62.5% 37.5% 0.0% Meclizine HCl Yes 100.0% 0.0% 83.8% 16.2% 0.0% 0.0% Meloxicam Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Metformin HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Metformin HCl ER Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Methade HCl Yes 100.0% 0.0% 50.5% 33.3% 16.2% 0.0% Methotrexate Yes 100.0% 0.0% 80.0% 20.0% 0.0% 0.0% Methylprednisole Yes 100.0% 0.0% 77.2% 16.2% 6.6% 0.0% Metoclopramide HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Metoprolol Succinate Yes 100.0% 0.0% 60.4% 37.7% 1.9% 0.0% Metoprolol Tartrate Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Metridazole (Oral) Yes 100.0% 0.0% 74.4% 25.6% 0.0% 0.0% Metridazole (Topical) Yes 100.0% 0.0% 19.9% 30.7% 49.4% 0.0% Mirtazapine Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Mtelukast Sodium Yes 100.0% 0.0% 98.5% 1.5% 0.0% 0.0% Morphine Sulfate ER Yes 100.0% 0.0% 16.2% 74.7% 9.1% 0.0% Mupirocin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Namenda Yes 92.0% 8.0% 0.0% 89.5% 2.5% 0.0% Naproxen Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Page 2 of 3

Drug Name N Brand Nasex Yes 52.7% 47.3% 0.0% 25.8% 26.9% 0.0% Nexium No 65.0% 35.0% 0.0% 38.3% 26.7% 0.0% Niaspan Yes 89.1% 10.9% 23.2% 27.5% 38.5% 0.0% Nifedipine ER Yes 85.3% 14.7% 42.8% 40.6% 1.9% 0.0% Nitrofurantoin Mo-Macro Yes 100.0% 0.0% 11.4% 31.7% 56.8% 0.0% Nitrostat Yes 100.0% 0.0% 0.0% 92.3% 7.7% 0.0% Nortriptyline HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Novolog Yes 78.8% 21.2% 0.0% 78.2% 0.6% 0.0% Novolog Flexpen No 78.6% 21.4% 0.0% 78.2% 0.3% 0.0% Nystatin (Suspensi) Yes 100.0% 0.0% 64.7% 35.3% 0.0% 0.0% Nystatin (Topical) Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Olanzapine Yes 100.0% 0.0% 47.8% 24.0% 28.2% 0.0% Omeprazole Yes 100.0% 0.0% 79.5% 18.6% 1.9% 0.0% Ondansetr HCl Yes 100.0% 0.0% 71.8% 26.3% 1.9% 0.0% Oxybutynin Chloride Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Oxybutynin Chloride ER Yes 99.6% 0.4% 24.3% 75.3% 0.0% 0.0% Oxycode HCl Yes 100.0% 0.0% 17.8% 73.1% 9.1% 0.0% Oxycode-Acetaminophen Yes 100.0% 0.0% 16.3% 74.6% 9.1% 0.0% Oxyctin Yes 47.8% 52.2% 0.0% 39.1% 8.7% 0.0% Pantoprazole Sodium Yes 82.4% 17.6% 60.4% 20.1% 1.9% 0.0% Paroxetine HCl Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Phenytoin Sodium Extended Yes 100.0% 0.0% 98.3% 1.7% 0.0% 0.0% Pioglitaze HCl No 100.0% 0.0% 64.3% 33.7% 1.9% 0.0% Polyethylene Glycol 3350 Yes 100.0% 0.0% 82.3% 17.7% 0.0% 0.0% Potassium Chloride Yes 96.8% 3.2% 60.0% 0.0% 36.6% 0.0% Pradaxa Yes 100.0% 0.0% 0.0% 92.2% 7.8% 0.0% Pramipexole Dihydrochloride No 100.0% 0.0% 48.5% 51.5% 0.0% 0.0% Pravastatin Sodium Yes 100.0% 0.0% 98.1% 0.0% 1.9% 0.0% Prednisole Acetate No 92.2% 7.8% 48.5% 43.6% 0.0% 0.0% Prednise Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Premarin Yes 93.4% 6.6% 0.0% 72.8% 20.6% 0.0% Proair HFA No 100.0% 0.0% 0.0% 98.1% 1.9% 0.0% Promethazine HCL Yes 97.5% 2.5% 36.6% 6.1% 54.9% 0.0% Propranolol HCL Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Quetiapine Fumarate Yes 100.0% 0.0% 70.1% 1.7% 28.2% 0.0% Quinapril HCL No 93.0% 7.0% 74.4% 0.0% 18.6% 0.0% Ramipril Yes 93.0% 7.0% 74.4% 18.6% 0.0% 0.0% Ranitidine HCL Yes 100.0% 0.0% 81.4% 18.6% 0.0% 0.0% Restasis Yes 100.0% 0.0% 0.0% 77.8% 22.2% 0.0% Risperide Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Ropinirole HCL Yes 100.0% 0.0% 79.2% 20.8% 0.0% 0.0% Sertraline HCL Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Simvastatin Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Spiriva Yes 94.3% 5.7% 0.0% 74.2% 20.2% 0.0% Spirolacte Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Sulfamethoxazole-Trimethoprim Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Symbicort Yes 86.0% 14.0% 0.0% 83.8% 2.1% 0.0% Tamsulosin HCL Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Temazepam Yes 88.2% 11.8% 38.2% 0.0% 50.0% 0.0% Terazosin HCL Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Timolol Maleate No 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Tizanidine HCL Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Topiramate Yes 100.0% 0.0% 73.7% 19.1% 7.2% 0.0% Tramadol HCL Yes 100.0% 0.0% 97.2% 0.8% 1.9% 0.0% Travatan Z No 100.0% 0.0% 0.0% 87.2% 12.8% 0.0% Trazode HCL Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Triamcinole Acetide (Topical) Yes 100.0% 0.0% 74.4% 25.6% 0.0% 0.0% Triamcinole Acetide (Nasal Spray) Yes 47.9% 52.1% 11.8% 6.7% 29.4% 0.0% Triamterene-HCTZ Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Valacyclovir Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Valsartan-Hydrochlorothiazide No 91.7% 8.3% 65.5% 26.2% 0.0% 0.0% Venlafaxine HCl ER Yes 100.0% 0.0% 80.9% 19.1% 0.0% 0.0% Verapamil ER Yes 100.0% 0.0% 100.0% 0.0% 0.0% 0.0% Vesicare No 74.7% 25.3% 0.0% 47.5% 27.2% 0.0% Voltaren Yes 99.8% 0.2% 0.0% 75.1% 24.7% 0.0% Warfarin Sodium Yes 100.0% 0.0% 98.1% 0.0% 1.9% 0.0% Xarelto Yes 94.3% 5.7% 0.0% 94.3% 0.0% 0.0% Zetia No 100.0% 0.0% 0.0% 67.4% 32.6% 0.0% Zolpidem Tartrate Yes 99.8% 0.2% 48.6% 20.2% 30.9% 0.0% Zostavax Yes 100.0% 0.0% 0.0% 26.5% 73.3% 0.0% Page 3 of 3

Comparis of to Plan (PDP) Formulary and Placement for Top 200 Drugs, by Class Drug Class Number of Top 200 Drugs in Class N Brand Adrenals 3 100.0% 95.3% 4.7% 59.1% 33.3% 2.9% alpha-adrenergic Blocking Agents 2 100.0% 100.0% 0.0% 90.4% 9.6% 0.0% Ammia Detoxicants 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Angiotensin II Receptor Antagists 6 33.3% 81.1% 18.9% 56.2% 20.2% 4.7% Angiotensin-Cverting Enzyme Inhibitors 6 83.3% 97.7% 2.3% 88.4% 6.2% 3.1% Antiarrhythmic Agents 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Antibacterials 4 100.0% 90.3% 9.7% 59.1% 18.9% 12.4% Antibacterials, Miscellaneous 1 100.0% 100.0% 0.0% 98.1% 0.0% 1.9% Anticoagulants 3 100.0% 98.1% 1.9% 32.7% 62.2% 3.3% Anticvulsants, Miscellaneous 8 87.5% 100.0% 0.0% 64.4% 22.6% 13.0% Antidepressants 14 92.9% 100.0% 0.0% 79.8% 16.2% 4.0% Antifungals 3 66.7% 93.0% 7.0% 67.6% 25.4% 0.0% Antihistamines 1 100.0% 100.0% 0.0% 83.8% 16.2% 0.0% Anti-inflammatory Agents 3 100.0% 99.9% 0.1% 67.9% 31.9% 0.0% Antilipemic Agents, Miscellaneous 2 50.0% 94.6% 5.4% 23.2% 26.7% 44.7% Antimalarials 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Antimanic Agents 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Antimuscarinics/Antispasmodics 2 100.0% 97.2% 2.8% 46.4% 37.1% 13.7% Antineoplastic Agents 1 100.0% 100.0% 0.0% 80.0% 20.0% 0.0% Antiprotozoals, Miscellaneous 1 100.0% 100.0% 0.0% 74.4% 25.6% 0.0% Antipruritics and Local Anesthetics 1 100.0% 100.0% 0.0% 22.0% 52.5% 25.5% Antipsychotics 4 100.0% 100.0% 0.0% 49.7% 12.0% 38.3% Antivirals 1 100.0% 90.0% 10.0% 13.4% 0.0% 76.6% Anxiolytics, Sedatives, & Hypnotics Misc 3 100.0% 94.5% 5.5% 49.3% 19.3% 25.9% Azoles 2 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Benzodiazepines 5 100.0% 97.0% 3.0% 64.9% 7.9% 24.2% beta-adrenergic Agists 2 0.0% 88.3% 11.7% 0.0% 77.3% 10.9% beta-adrenergic Blocking Agents 8 75.0% 95.4% 4.6% 79.9% 11.3% 4.2% Biguanides 2 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Calcium-Channel Blocking Agents, Misc 4 100.0% 98.2% 1.8% 48.5% 48.3% 1.5% Carbic Anhydrase Inhibitors 1 100.0% 99.6% 0.4% 78.3% 21.3% 0.0% Cardiotic Agents 1 100.0% 100.0% 0.0% 98.5% 1.5% 0.0% Cathartics and Laxatives 1 100.0% 100.0% 0.0% 82.3% 17.7% 0.0% Central Alpha-Agists 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Central Nervous System Agents, Misc 1 100.0% 92.0% 8.0% 0.0% 89.5% 2.5% Centrally Acting Skeletal Muscle Relaxants 3 66.7% 84.9% 15.1% 41.5% 19.3% 24.1% Cephalosporins 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Cholesterol Absorpti Inhibitors 1 100.0% 100.0% 0.0% 0.0% 67.4% 32.6% Corticosteroids 4 75.0% 73.2% 26.8% 39.2% 19.4% 14.6% Dihydropyridines 3 66.7% 84.8% 15.2% 61.2% 22.9% 0.6% Dipeptidyl Peptidase IV (DPP-4) Inhibitors 1 0.0% 70.3% 29.7% 0.0% 60.5% 9.8% Direct Vasodilators 1 100.0% 100.0% 0.0% 80.9% 19.1% 0.0% EENT Anti-infectives, Miscellaneous 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% EENT Anti-inflammatory Agents, Misc 1 100.0% 100.0% 0.0% 0.0% 77.8% 22.2% Estrogen Agist-Antagists 1 0.0% 100.0% 0.0% 23.2% 76.8% 0.0% Estrogens 2 100.0% 96.7% 3.3% 37.3% 37.2% 22.2% Fibric Acid Derivatives 2 50.0% 100.0% 0.0% 73.1% 26.0% 1.0% GABA-derivative Skeletal Muscle Relaxants 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Histamine H2-Antagists 2 100.0% 100.0% 0.0% 81.4% 18.6% 0.0% HMG-CoA Reductase Inhibitors 5 80.0% 99.3% 0.7% 79.2% 17.7% 2.3% Hydantoins 1 100.0% 100.0% 0.0% 98.3% 1.7% 0.0% Insulins 5 40.0% 81.3% 18.7% 0.0% 80.1% 1.2% Leukotriene Modifiers 1 100.0% 100.0% 0.0% 98.5% 1.5% 0.0% Loop Diuretics 2 100.0% 100.0% 0.0% 96.4% 3.6% 0.0% Macrolides 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Mineralocorticoid (Aldost) Recept Antag 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Nitrates and Nitrites 2 100.0% 100.0% 0.0% 50.0% 46.1% 3.8% Nsteroidal Anti-inflammatory Agents 5 80.0% 88.9% 11.1% 78.2% 0.7% 10.1% Nucleosides and Nucleotides 2 100.0% 100.0% 0.0% 58.7% 39.4% 1.9% Opiate Agists 9 100.0% 94.2% 5.8% 35.9% 45.7% 12.6% Other 15 73.3% 93.2% 6.8% 56.4% 30.6% 6.2% Parasympathomimetic (Cholinergic) Agents 2 50.0% 100.0% 0.0% 47.4% 31.5% 21.1% Penicillins 2 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Phenothiazine Derivatives 1 100.0% 97.5% 2.5% 36.6% 6.1% 54.9% Platelet-Aggregati Inhibitors 1 100.0% 100.0% 0.0% 98.5% 1.5% 0.0% Polyenes 1 100.0% 100.0% 0.0% 64.7% 35.3% 0.0% Potassium-sparing Diuretics 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Prokinetic Agents 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Prostaglandin Analogs 3 66.7% 97.1% 2.9% 33.3% 57.6% 6.2% Prot-pump Inhibitors 5 40.0% 80.0% 20.0% 31.3% 25.2% 23.5% Quinoles 2 100.0% 100.0% 0.0% 83.9% 16.1% 0.0% Replacement Preparatis 3 100.0% 95.8% 4.2% 75.0% 8.5% 12.2% Page 1 of 2

Drug Class Number of Top 200 Drugs in Class N Brand Skin and Mucous Membrane Agents, Misc 2 100.0% 71.4% 28.6% 1.8% 38.4% 16.5% Sulfamides 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Sulfylureas 4 25.0% 92.5% 7.5% 83.5% 6.4% 2.6% Tetracyclines 1 100.0% 100.0% 0.0% 36.1% 56.7% 7.2% Thiazide Diuretics 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Thiazide-like Diuretics 1 100.0% 100.0% 0.0% 96.8% 0.0% 3.2% Thiazolidinedies 1 100.0% 100.0% 0.0% 64.3% 33.7% 1.9% Thyroid Agents 1 100.0% 100.0% 0.0% 100.0% 0.0% 0.0% Urinary Anti-infectives 1 100.0% 100.0% 0.0% 11.4% 31.7% 56.8% Vaccines 1 100.0% 100.0% 0.0% 0.0% 26.5% 73.3% Page 2 of 2