ANTICONVULSANT THERAPY

Network Health Insurance Corporation NetworkCares Step Therapy Last Updated: 7/2017 ANTICONVULSANT THERAPY Aptiom 200 mg tablet Aptiom 400 mg tablet Aptiom 600 mg tablet Aptiom 800 mg tablet Banzel 200 mg tablet Banzel 40 mg/ml oral suspension Banzel 400 mg tablet Briviact 10 mg tablet Briviact 10 mg/ml oral solution Briviact 100 mg tablet Briviact 25 mg tablet Briviact 50 mg tablet Briviact 50 mg/5 ml intravenous solution Briviact 75 mg tablet Celontin 300 mg capsule Dilantin 30 mg capsule Equetro 100 mg capsule, extended release Equetro 200 mg capsule, extended release Equetro 300 mg capsule, extended release Fycompa 0.5 mg/ml oral suspension Fycompa 10 mg tablet Fycompa 12 mg tablet Fycompa 2 mg tablet Fycompa 4 mg tablet Fycompa 6 mg tablet Fycompa 8 mg tablet Gabitril 12 mg tablet Gabitril 16 mg tablet Lamictal Starter (Blue) Kit 25 mg (35) tablets in a dose pack Lamictal Starter (Green) Kit 25 mg (84)- 100 mg (14) tablets, dose pack Lamictal Starter (Orange) Kit 25 mg (42)-100 mg (7) tablets, dose pack Lamictal XR Starter (Blue) 25 mg (21)- 50 mg (7) tablet,extend release Lamictal XR Starter (Green) 50 mg(14)- 100 mg(14)-200 mg(7) tab,ext.rel Lamictal XR Starter (Orange) 25 mg(14)-50 mg(14)-100 mg(7) tab,ext.rel Oxtellar XR 150 mg tablet,extended release Oxtellar XR 300 mg tablet,extended release Oxtellar XR 600 mg tablet,extended release Potiga 200 mg tablet Potiga 300 mg tablet Potiga 400 mg tablet Potiga 50 mg tablet Spritam 1,000 mg tablet for oral suspension Spritam 250 mg tablet for oral suspension Spritam 500 mg tablet for oral suspension Spritam 750 mg tablet for oral suspension Vimpat 10 mg/ml oral solution Vimpat 100 mg tablet Vimpat 150 mg tablet Vimpat 200 mg tablet Vimpat 200 mg/20 ml intravenous solution Vimpat 50 mg tablet period is 365 days. Step 1 drugs are Carbamazepine, Divalproex

Sodium, Epitol, Ethosuximide, Felbamate, Fosphenytoin, Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Phenytoin, Primidone, Roweepra, Tiagabine, Topiramate, Valproate Sodium, Valproic Acid, Zonisamide. 2

ARICEPT THERAPY donepezil 23 mg tablet period is 180 days. Step 1 drugs are Donepezil 10mg. 3

ATYPICAL ANTIPSYCHOTIC THERAPY Fanapt 1 mg tablet Fanapt 10 mg tablet Fanapt 12 mg tablet Fanapt 1mg(2)-2 mg(2)-4mg(2)-6 mg(2) tablets in a dose pack Fanapt 2 mg tablet Fanapt 4 mg tablet Fanapt 6 mg tablet Fanapt 8 mg tablet Latuda 120 mg tablet Latuda 20 mg tablet Latuda 40 mg tablet Latuda 60 mg tablet Latuda 80 mg tablet olanzapine 10 mg disintegrating tablet olanzapine 10 mg tablet olanzapine 15 mg disintegrating tablet olanzapine 15 mg tablet olanzapine 2.5 mg tablet olanzapine 20 mg disintegrating tablet olanzapine 20 mg tablet olanzapine 5 mg disintegrating tablet olanzapine 5 mg tablet olanzapine 7.5 mg tablet olanzapine-fluoxetine 12 mg-25 mg capsule olanzapine-fluoxetine 12 mg-50 mg capsule olanzapine-fluoxetine 3 mg-25 mg capsule olanzapine-fluoxetine 6 mg-25 mg capsule olanzapine-fluoxetine 6 mg-50 mg capsule paliperidone ER 1.5 mg tablet,extended release 24 hr paliperidone ER 3 mg tablet,extended release 24 hr paliperidone ER 6 mg tablet,extended release 24 hr paliperidone ER 9 mg tablet,extended release 24 hr quetiapine ER 150 mg tablet,extended release 24 hr quetiapine ER 200 mg tablet,extended release 24 hr quetiapine ER 300 mg tablet,extended release 24 hr quetiapine ER 400 mg tablet,extended release 24 hr quetiapine ER 50 mg tablet,extended release 24 hr Rexulti 0.25 mg tablet Rexulti 0.5 mg tablet Rexulti 1 mg tablet Rexulti 2 mg tablet Rexulti 3 mg tablet Rexulti 4 mg tablet Saphris (black cherry) 10 mg sublingual tablet Saphris (black cherry) 2.5 mg sublingual tablet Saphris (black cherry) 5 mg sublingual tablet Versacloz 50 mg/ml oral suspension Vraylar 1.5 mg (1)-3 mg (6) capsules in a dose pack Vraylar 1.5 mg capsule Vraylar 3 mg capsule Vraylar 4.5 mg capsule Vraylar 6 mg capsule Must first try two step one drugs to receive a step two drug. Look back 4

period is 365 days. Step 1 drugs are Aripiprazole (ODT, tablets), Clozapine, Fazaclo, Fluphenazine, Haloperidol, Loxapine, Molindone, Perphenazine, Pimozide, Quetiapine, Risperidone, Thioridazine, Thiothixene, Trifluoperazine, Ziprasidone. Members may request an exception and Rexulti, Quetiapine XR and fluoxetine-olanzapine will be allowed as first line treatment for Major Depressive Disorder. Latuda, fluoxetine/olanzapine or Quetiapine XR will be allowed as first line treatment for bipolar depression. 5

BALSALAZIDE THERAPY Giazo 1.1 gram tablet period is 180 days. Step 1 drugs are Balsalazide. 6

BASAL INSULIN Levemir 100 unit/ml subcutaneous solution Levemir FlexTouch 100 unit/ml (3 ml) subcutaneous insulin pen Tresiba FlexTouch U-100 100 unit/ml (3 ml) subcutaneous insulin pen Tresiba FlexTouch U-200 200 unit/ml (3 ml) subcutaneous insulin pen period is 180 days. Step 1 drugs are Lantus, Toujeo. 7

DPP-4 alogliptin 12.5 mg tablet alogliptin 12.5 mg-metformin 1,000 mg tablet alogliptin 12.5 mg-metformin 500 mg tablet alogliptin 12.5 mg-pioglitazone 15 mg tablet alogliptin 12.5 mg-pioglitazone 30 mg tablet alogliptin 12.5 mg-pioglitazone 45 mg tablet alogliptin 25 mg tablet alogliptin 25 mg-pioglitazone 15 mg tablet alogliptin 25 mg-pioglitazone 30 mg tablet alogliptin 25 mg-pioglitazone 45 mg tablet alogliptin 6.25 mg tablet Glyxambi 10 mg-5 mg tablet Glyxambi 25 mg-5 mg tablet Jentadueto 2.5 mg-1,000 mg tablet Jentadueto 2.5 mg-500 mg tablet Jentadueto 2.5 mg-850 mg tablet Jentadueto XR 2.5 mg-1,000 mg tablet, extended release Jentadueto XR 5 mg-1,000 mg tablet, extended release Kazano 12.5 mg-1,000 mg tablet Kazano 12.5 mg-500 mg tablet Nesina 12.5 mg tablet Nesina 25 mg tablet Nesina 6.25 mg tablet Oseni 12.5 mg-15 mg tablet Oseni 12.5 mg-30 mg tablet Oseni 12.5 mg-45 mg tablet Oseni 25 mg-15 mg tablet Oseni 25 mg-30 mg tablet Oseni 25 mg-45 mg tablet Tradjenta 5 mg tablet period is 180 days. Step 1 drugs are Janumet, Januvia, Kobmiglyze, Onglyza. 8

GLP-1 Adlyxin 10 mcg/0.2 ml-20 mcg/0.2 ml subcutaneous pen injector Adlyxin 20 mcg/0.2 ml subcutaneous pen injector Bydureon 2 mg subcutaneous extended release suspension Bydureon 2 mg/0.65 ml subcutaneous pen injector Byetta 10 mcg/dose(250 mcg/ml)2.4 ml subcutaneous pen injector Byetta 5 mcg/dose (250 mcg/ml)1.2 ml subcutaneous pen injector Tanzeum 30 mg/0.5 ml subcutaneous pen injector Tanzeum 50 mg/0.5 ml subcutaneous pen injector Trulicity 0.75 mg/0.5 ml subcutaneous pen injector Trulicity 1.5 mg/0.5 ml subcutaneous pen injector Victoza 3-Pak 0.6 mg/0.1 ml (18 mg/3 ml) subcutaneous pen injector period is 180 days. Step 1 drugs are Metformin OR Metformin/Glipizide. 9

HIGH RISK MEDICATIONS - SEDATIVE/HYPNOTICS Belsomra 10 mg tablet Belsomra 15 mg tablet Belsomra 20 mg tablet Belsomra 5 mg tablet Edluar 10 mg sublingual tablet Edluar 5 mg sublingual tablet eszopiclone 1 mg tablet eszopiclone 2 mg tablet eszopiclone 3 mg tablet zaleplon 10 mg capsule zaleplon 5 mg capsule zolpidem 10 mg tablet zolpidem 5 mg tablet zolpidem ER 12.5 mg tablet,extended release,multiphase zolpidem ER 6.25 mg tablet,extended release,multiphase This step therapy program applies to members aged 65 years or greater. period is 180 days. Step 1 drugs are Rozerem, Silenor, Trazodone. Authorization for Edluar may be given if the patient has difficulty swallowing or cannot swallow tablets. 10

INSPRA THERAPY Aldactazide 50 mg-50 mg tablet eplerenone 25 mg tablet eplerenone 50 mg tablet period is 180 days. Step 1 drugs are Spironolactone, Spironolactone/HCTZ. 11

NASAL CORTICOSTEROID THERAPY Beconase AQ 42 mcg (0.042 %) nasal spray budesonide 32 mcg/actuation nasal spray Dymista 137 mcg-50 mcg/spray nasal spray mometasone 50 mcg/actuation nasal spray Omnaris 50 mcg nasal spray QNASL 40 mcg/actuation nasal aerosol spray QNASL 80 mcg/actuation nasal aerosol spray triamcinolone acetonide 55 mcg nasal spray aerosol Zetonna 37 mcg/actuation nasal HFA inhaler period is 365 days. Step 1 drugs are Flunisolide, Fluticasone. Members may request an exception and mometasone will be allowed as first line treatment for Prophylaxis of Seasonal Allergic Rhinitis or nasal polyps. Members may request an exception and beclomethasone dipropionate (Beconase AQ) will be allowed as first line treatment for nasal polyps. 12

OPHTHALMIC BETA BLOCKER THERAPY Betimol 0.25 % eye drops Betimol 0.5 % eye drops Betoptic S 0.25 % eye drops,suspension Combigan 0.2 %-0.5 % eye drops Istalol 0.5 % eye drops Timoptic Ocudose (PF) 0.25 % eye drops in a dropperette Timoptic Ocudose (PF) 0.5 % eye drops in a dropperette period is 180 days. Step 1 drugs are Betaxalol, Carteolol, Dorzolamide/Timolol, Levobunolol, Metipranolol, Timolol. 13

OPHTHALMIC PROSTAGLANDIN THERAPY bimatoprost 0.03 % eye drops Lumigan 0.01 % eye drops Travatan Z 0.004 % eye drops Zioptan (PF) 0.0015 % eye drops in a dropperette period is 180 days. Step 1 drugs are Latanoprost. 14

OSTEOPOROSIS THERAPY Binosto 70 mg effervescent tablet Forteo 20 mcg/dose (600 mcg/2.4 ml) subcutaneous pen injector Fosamax Plus D 70 mg-2,800 unit tablet Fosamax Plus D 70 mg-5,600 unit tablet ibandronate 150 mg tablet ibandronate 3 mg/3 ml intravenous solution Prolia 60 mg/ml subcutaneous syringe risedronate 150 mg tablet risedronate 30 mg tablet risedronate 35 mg tablet risedronate 35 mg tablet (12 pack) risedronate 35 mg tablet (4 pack) risedronate 35 mg tablet,delayed release risedronate 5 mg tablet period is 180 days. Step 1 drugs are Alendronate. Members may request an exception and Prolia will be allowed as first line treatment for Breast cancer - Osteopenia, In members at high risk of fracture receiving aromatase inhibitor therapy, and for Osteopenia, In members at high risk of fracture receiving androgen deprivation therapy - Prostate cancer, Nonmetastatic. 15

PULMONARY ANTI-INFLAMMATORY Symbicort 160 mcg-4.5 mcg/actuation HFA aerosol inhaler Symbicort 80 mcg-4.5 mcg/actuation HFA aerosol inhaler period is 180 days. Step 1 drugs are Advair, Breo Ellipta, Dulera. 16

RESTLESS LEG THERAPY Horizant ER 300 mg tablet,extended release Horizant ER 600 mg tablet,extended release period is 180 days. Step 1 drugs are Gabapentin, Pramipexole, Ropinirole. 17

TRIPTAN THERAPY Onzetra Xsail 11 mg powder for nasal inhalation Relpax 20 mg tablet Relpax 40 mg tablet Treximet 10 mg-60 mg tablet Treximet 85 mg-500 mg tablet Zembrace Symtouch 3 mg/0.5 ml subcutaneous pen injector Zomig 2.5 mg nasal spray Zomig 5 mg nasal spray Must first try two step one drugs to receive a step two drug. Look back period is 365 days. Step 1 drugs are Almotriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan, Zolmitriptan. 18

ZINBRYTA Zinbryta 150 mg/ml subcutaneous syringe Must first try two step one drugs to receive a step two drug. Look back period is 365 days. Step 1 drugs are Avonex, Betaseron, Extavia, Gilenya, Plegridy, Rebif, Mitoxantrone, Copaxone, Glatopa, Aubagio, Tecfidera, Tysabri, and Ampyra. 19

Index A Adlyxin 10 mcg/0.2 ml-20 mcg/0.2 ml subcutaneous pen injector... 9 Adlyxin 20 mcg/0.2 ml subcutaneous pen injector... 9 Aldactazide 50 mg-50 mg tablet... 11 alogliptin 12.5 mg tablet... 8 alogliptin 12.5 mg-metformin 1,000 mg tablet... 8 alogliptin 12.5 mg-metformin 500 mg tablet... 8 alogliptin 12.5 mg-pioglitazone 15 mg tablet... 8 alogliptin 12.5 mg-pioglitazone 30 mg tablet... 8 alogliptin 12.5 mg-pioglitazone 45 mg tablet... 8 alogliptin 25 mg tablet... 8 alogliptin 25 mg-pioglitazone 15 mg tablet 8 alogliptin 25 mg-pioglitazone 30 mg tablet 8 alogliptin 25 mg-pioglitazone 45 mg tablet 8 alogliptin 6.25 mg tablet... 8 Aptiom 200 mg tablet... 1 Aptiom 400 mg tablet... 1 Aptiom 600 mg tablet... 1 Aptiom 800 mg tablet... 1 B Banzel 200 mg tablet... 1 Banzel 40 mg/ml oral suspension... 1 Banzel 400 mg tablet... 1 Beconase AQ 42 mcg (0.042 %) nasal spray... 12 Belsomra 10 mg tablet... 10 Belsomra 15 mg tablet... 10 Belsomra 20 mg tablet... 10 Belsomra 5 mg tablet... 10 Betimol 0.25 % eye drops... 13 Betimol 0.5 % eye drops... 13 Betoptic S 0.25 % eye drops,suspension.. 13 bimatoprost 0.03 % eye drops... 14 Binosto 70 mg effervescent tablet... 15 Briviact 10 mg tablet... 1 Briviact 10 mg/ml oral solution... 1 Briviact 100 mg tablet... 1 Briviact 25 mg tablet... 1 Briviact 50 mg tablet... 1 Briviact 50 mg/5 ml intravenous solution. 1 Briviact 75 mg tablet... 1 budesonide 32 mcg/actuation nasal spray. 12 Bydureon 2 mg subcutaneous extended release suspension... 9 Bydureon 2 mg/0.65 ml subcutaneous pen injector... 9 Byetta 10 mcg/dose(250 mcg/ml)2.4 ml subcutaneous pen injector... 9 Byetta 5 mcg/dose (250 mcg/ml)1.2 ml subcutaneous pen injector... 9 C Celontin 300 mg capsule... 1 Combigan 0.2 %-0.5 % eye drops... 13 D Dilantin 30 mg capsule... 1 donepezil 23 mg tablet... 3 Dymista 137 mcg-50 mcg/spray nasal spray... 12 E Edluar 10 mg sublingual tablet... 10 Edluar 5 mg sublingual tablet... 10 eplerenone 25 mg tablet... 11 eplerenone 50 mg tablet... 11 Equetro 100 mg capsule, extended release. 1 Equetro 200 mg capsule, extended release. 1 Equetro 300 mg capsule, extended release. 1 eszopiclone 1 mg tablet... 10 eszopiclone 2 mg tablet... 10 eszopiclone 3 mg tablet... 10 F Fanapt 1 mg tablet... 4 Fanapt 10 mg tablet... 4 Fanapt 12 mg tablet... 4 Fanapt 1mg(2)-2 mg(2)-4mg(2)-6 mg(2) tablets in a dose pack... 4 Fanapt 2 mg tablet... 4 Fanapt 4 mg tablet... 4 Fanapt 6 mg tablet... 4 Fanapt 8 mg tablet... 4 Forteo 20 mcg/dose (600 mcg/2.4 ml) subcutaneous pen injector... 15 20

Fosamax Plus D 70 mg-2,800 unit tablet.. 15 Fosamax Plus D 70 mg-5,600 unit tablet.. 15 Fycompa 0.5 mg/ml oral suspension... 1 Fycompa 10 mg tablet... 1 Fycompa 12 mg tablet... 1 Fycompa 2 mg tablet... 1 Fycompa 4 mg tablet... 1 Fycompa 6 mg tablet... 1 Fycompa 8 mg tablet... 1 G Gabitril 12 mg tablet... 1 Gabitril 16 mg tablet... 1 Giazo 1.1 gram tablet... 6 Glyxambi 10 mg-5 mg tablet... 8 Glyxambi 25 mg-5 mg tablet... 8 H Horizant ER 300 mg tablet,extended release... 17 Horizant ER 600 mg tablet,extended release... 17 I ibandronate 150 mg tablet... 15 ibandronate 3 mg/3 ml intravenous solution... 15 Istalol 0.5 % eye drops... 13 J Jentadueto 2.5 mg-1,000 mg tablet... 8 Jentadueto 2.5 mg-500 mg tablet... 8 Jentadueto 2.5 mg-850 mg tablet... 8 Jentadueto XR 2.5 mg-1,000 mg tablet, extended release... 8 Jentadueto XR 5 mg-1,000 mg tablet, extended release... 8 K Kazano 12.5 mg-1,000 mg tablet... 8 Kazano 12.5 mg-500 mg tablet... 8 L Lamictal Starter (Blue) Kit 25 mg (35) tablets in a dose pack... 1 Lamictal Starter (Green) Kit 25 mg (84)-100 mg (14) tablets, dose pack... 1 Lamictal Starter (Orange) Kit 25 mg (42)- 100 mg (7) tablets, dose pack... 1 Lamictal XR Starter (Blue) 25 mg (21)-50 mg (7) tablet,extend release... 1 Lamictal XR Starter (Green) 50 mg(14)-100 mg(14)-200 mg(7) tab,ext.rel... 1 Lamictal XR Starter (Orange) 25 mg(14)-50 mg(14)-100 mg(7) tab,ext.rel... 1 Latuda 120 mg tablet... 4 Latuda 20 mg tablet... 4 Latuda 40 mg tablet... 4 Latuda 60 mg tablet... 4 Latuda 80 mg tablet... 4 Levemir 100 unit/ml subcutaneous solution... 7 Levemir FlexTouch 100 unit/ml (3 ml) subcutaneous insulin pen... 7 Lumigan 0.01 % eye drops... 14 M mometasone 50 mcg/actuation nasal spray 12 N Nesina 12.5 mg tablet... 8 Nesina 25 mg tablet... 8 Nesina 6.25 mg tablet... 8 O olanzapine 10 mg disintegrating tablet... 4 olanzapine 10 mg tablet... 4 olanzapine 15 mg disintegrating tablet... 4 olanzapine 15 mg tablet... 4 olanzapine 2.5 mg tablet... 4 olanzapine 20 mg disintegrating tablet... 4 olanzapine 20 mg tablet... 4 olanzapine 5 mg disintegrating tablet... 4 olanzapine 5 mg tablet... 4 olanzapine 7.5 mg tablet... 4 olanzapine-fluoxetine 12 mg-25 mg capsule... 4 olanzapine-fluoxetine 12 mg-50 mg capsule... 4 olanzapine-fluoxetine 3 mg-25 mg capsule 4 olanzapine-fluoxetine 6 mg-25 mg capsule 4 olanzapine-fluoxetine 6 mg-50 mg capsule 4 Omnaris 50 mcg nasal spray... 12 Onzetra Xsail 11 mg powder for nasal inhalation... 18 Oseni 12.5 mg-15 mg tablet... 8 Oseni 12.5 mg-30 mg tablet... 8 Oseni 12.5 mg-45 mg tablet... 8 Oseni 25 mg-15 mg tablet... 8 Oseni 25 mg-30 mg tablet... 8 21

Oseni 25 mg-45 mg tablet... 8 Oxtellar XR 150 mg tablet,extended release... 1 Oxtellar XR 300 mg tablet,extended release... 1 Oxtellar XR 600 mg tablet,extended release... 1 P paliperidone ER 1.5 mg tablet,extended release 24 hr... 4 paliperidone ER 3 mg tablet,extended release 24 hr... 4 paliperidone ER 6 mg tablet,extended release 24 hr... 4 paliperidone ER 9 mg tablet,extended release 24 hr... 4 Potiga 200 mg tablet... 1 Potiga 300 mg tablet... 1 Potiga 400 mg tablet... 1 Potiga 50 mg tablet... 1 Prolia 60 mg/ml subcutaneous syringe... 15 Q QNASL 40 mcg/actuation nasal aerosol spray... 12 QNASL 80 mcg/actuation nasal aerosol spray... 12 quetiapine ER 150 mg tablet,extended release 24 hr... 4 quetiapine ER 200 mg tablet,extended release 24 hr... 4 quetiapine ER 300 mg tablet,extended release 24 hr... 4 quetiapine ER 400 mg tablet,extended release 24 hr... 4 quetiapine ER 50 mg tablet,extended release 24 hr... 4 R Relpax 20 mg tablet... 18 Relpax 40 mg tablet... 18 Rexulti 0.25 mg tablet... 4 Rexulti 0.5 mg tablet... 4 Rexulti 1 mg tablet... 4 Rexulti 2 mg tablet... 4 Rexulti 3 mg tablet... 4 Rexulti 4 mg tablet... 4 risedronate 150 mg tablet... 15 risedronate 30 mg tablet... 15 risedronate 35 mg tablet... 15 risedronate 35 mg tablet (12 pack)... 15 risedronate 35 mg tablet (4 pack)... 15 risedronate 35 mg tablet,delayed release.. 15 risedronate 5 mg tablet... 15 S Saphris (black cherry) 10 mg sublingual tablet... 4 Saphris (black cherry) 2.5 mg sublingual tablet... 4 Saphris (black cherry) 5 mg sublingual tablet... 4 Spritam 1,000 mg tablet for oral suspension... 1 Spritam 250 mg tablet for oral suspension. 1 Spritam 500 mg tablet for oral suspension. 1 Spritam 750 mg tablet for oral suspension. 1 Symbicort 160 mcg-4.5 mcg/actuation HFA aerosol inhaler... 16 Symbicort 80 mcg-4.5 mcg/actuation HFA aerosol inhaler... 16 T Tanzeum 30 mg/0.5 ml subcutaneous pen injector... 9 Tanzeum 50 mg/0.5 ml subcutaneous pen injector... 9 Timoptic Ocudose (PF) 0.25 % eye drops in a dropperette... 13 Timoptic Ocudose (PF) 0.5 % eye drops in a dropperette... 13 Tradjenta 5 mg tablet... 8 Travatan Z 0.004 % eye drops... 14 Tresiba FlexTouch U-100 100 unit/ml (3 ml) subcutaneous insulin pen... 7 Tresiba FlexTouch U-200 200 unit/ml (3 ml) subcutaneous insulin pen... 7 Treximet 10 mg-60 mg tablet... 18 Treximet 85 mg-500 mg tablet... 18 triamcinolone acetonide 55 mcg nasal spray aerosol... 12 Trulicity 0.75 mg/0.5 ml subcutaneous pen injector... 9 Trulicity 1.5 mg/0.5 ml subcutaneous pen injector... 9 22

V Versacloz 50 mg/ml oral suspension... 4 Victoza 3-Pak 0.6 mg/0.1 ml (18 mg/3 ml) subcutaneous pen injector... 9 Vimpat 10 mg/ml oral solution... 1 Vimpat 100 mg tablet... 1 Vimpat 150 mg tablet... 1 Vimpat 200 mg tablet... 1 Vimpat 200 mg/20 ml intravenous solution... 1 Vimpat 50 mg tablet... 1 Vraylar 1.5 mg (1)-3 mg (6) capsules in a dose pack... 4 Vraylar 1.5 mg capsule... 4 Vraylar 3 mg capsule... 4 Vraylar 4.5 mg capsule... 4 Vraylar 6 mg capsule... 4 Z zaleplon 10 mg capsule... 10 zaleplon 5 mg capsule... 10 Zembrace Symtouch 3 mg/0.5 ml subcutaneous pen injector... 18 Zetonna 37 mcg/actuation nasal HFA inhaler... 12 Zinbryta 150 mg/ml subcutaneous syringe... 19 Zioptan (PF) 0.0015 % eye drops in a dropperette... 14 zolpidem 10 mg tablet... 10 zolpidem 5 mg tablet... 10 zolpidem ER 12.5 mg tablet,extended release,multiphase... 10 zolpidem ER 6.25 mg tablet,extended release,multiphase... 10 Zomig 2.5 mg nasal spray... 18 Zomig 5 mg nasal spray... 18 23