1

2

Drug Name Reference Anticonvulsants - Drugs to Treat Seizures

Anticonvulsants, Other - Seizure Control Drugs

BRIVIACT ORAL KEPPRA ORAL KEPPRA XR levetiracetam er Roweepra XR levetiracetam oral Keppra phenobarbital oral tablet roweepra Roweepra roweepra xr Roweepra XR SPRITAM Calcium Channel Modifying Agents - Seizure Control Drugs

CELONTIN ethosuximide oral Zarontin ZARONTIN ZONEGRAN zonisamide oral Zonegran Gamma-Aminobutyric Acid (GABA) Augmenting Agents - Seizure Control Drugs

gabapentin oral capsule Neurontin gabapentin oral solution 250 mg/5ml Neurontin gabapentin oral tablet Neurontin GABITRIL MYSOLINE NEURONTIN phenobarbital oral elixir phenobarbital oral solution primidone oral Mysoline valproic acid oral capsule Glutamate Reducing Agents - Seizure Control Drugs

felbamate Felbatol FELBATOL LAMICTAL ODT ORAL TABLET DISPERSIBLE

3

Drug Name Reference LAMICTAL ORAL TABLET LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

lamotrigine er LaMICtal XR lamotrigine oral tablet Subvenite lamotrigine oral tablet chewable LaMICtal lamotrigine oral tablet dispersible LaMICtal ODT QUDEXY XR subvenite Subvenite TOPAMAX topiramate oral Topamax TROKENDI XR Sodium Channel Agents - Seizure Control Drugs

APTIOM BANZEL carbamazepine er Carbatrol carbamazepine oral CARBATROL DILANTIN DILANTIN INFATABS epitol Epitol oxcarbazepine Trileptal OXTELLAR XR PEGANONE PHENYTEK phenytoin infatabs Phenytoin Infatabs phenytoin oral suspension 125 mg/5ml Dilantin phenytoin oral tablet chewable Phenytoin Infatabs phenytoin sodium extended oral capsule 100 mg Dilantin

TEGRETOL TEGRETOL-XR TRILEPTAL VIMPAT ORAL Antidementia Agents - Drugs to Treat Alzheimer's Disease and Dementia

4

Drug Name Reference Cholinesterase Inhibitors - Alzheimer's Disease and Dementia Drugs

ARICEPT EXELON galantamine hydrobromide Razadyne galantamine hydrobromide er Razadyne ER RAZADYNE RAZADYNE ER rivastigmine Exelon rivastigmine tartrate N-methyl-D-aspartate (NMDA) Receptor Antagonist - Alzheimer's Disease and Dementia Drugs

NAMENDA NAMENDA XR Antidepressants - Drugs to Treat Depression

Antidepressants, Other - Antidepressants

APLENZIN FORFIVO XL mirtazapine oral Remeron REMERON SSRI/SNRI (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors)

BRISDELLE CELEXA citalopram hydrobromide oral tablet 20 mg, 40 mg CeleXA

EFFEXOR XR escitalopram oxalate Lexapro FETZIMA fluvoxamine maleate fluvoxamine maleate er LEXAPRO maprotiline hcl

5

Drug Name Reference paroxetine mesylate Brisdelle PAXIL PAXIL CR PEXEVA PRISTIQ PROZAC SARAFEM sertraline hcl oral tablet 50 mg Zoloft trazodone hcl oral tablet 100 mg, 150 mg, 50 mg

TRINTELLIX venlafaxine hcl venlafaxine hcl er Effexor XR VIIBRYD ZOLOFT Antigout Agents - Drugs to Treat Gout

Antigout Agents - Gout Drugs allopurinol oral Zyloprim COLCHICINE ORAL CAPSULE colchicine oral tablet Colcrys colchicine-probenecid COLCRYS febuxostat Uloric GLOPERBA MITIGARE probenecid ULORIC ZYLOPRIM Antimyasthenic Agents - Drugs to Treat Myasthenia Gravis

Parasympathomimetics - Myasthenia Gravis Drugs

MESTINON pyridostigmine bromide er Mestinon pyridostigmine bromide oral solution Mestinon pyridostigmine bromide oral tablet 30 mg

6

Drug Name Reference Antineoplastics - Drugs to Treat Cancer

Antiestrogens/Modifiers - Chemotherapy Agents

FARESTON SOLTAMOX tamoxifen citrate oral tablet 10 mg Aromatase Inhibitors, 3rd Generation - Chemotherapy Agents

anastrozole oral Arimidex ARIMIDEX AROMASIN exemestane Aromasin FEMARA letrozole oral Femara Antiparasitics - Drugs to Treat Parasitic Infections

Antiprotozoals - Protozoal Infection Drugs

hydroxychloroquine sulfate oral Plaquenil PLAQUENIL Antiparkinson Agents - Drugs to Treat Parkinson's Disease

Anticholinergics - Parkinson's Disease Drugs

benztropine mesylate oral trihexyphenidyl hcl oral tablet Antiparkinson Agents - Parkinson's Disease Drugs

NOURIANZ Antiparkinson Agents, Other - Parkinson's Disease Drugs

amantadine hcl oral capsule amantadine hcl oral syrup COMTAN entacapone Comtan GOCOVRI OSMOLEX ER TASMAR

7

Drug Name Reference tolcapone Tasmar Dopamine Agonists - Parkinson's Disease Drugs

bromocriptine mesylate oral Parlodel MIRAPEX MIRAPEX ER NEUPRO PARLODEL pramipexole dihydrochloride Mirapex pramipexole dihydrochloride er Mirapex ER REQUIP XL Dopamine Precursors/L-Amino Acid Decarboxylase Inhibitors - Parkinson's Disease Drugs

carbidopa oral Lodosyn carbidopa-levodopa oral tablet Sinemet LODOSYN RYTARY SINEMET STALEVO 100 STALEVO 125 STALEVO 150 STALEVO 200 STALEVO 50 STALEVO 75 Monoamine Oxidase B (MAO-B) Inhibitors - Parkinson's Disease Drugs

AZILECT selegiline hcl oral tablet XADAGO ZELAPAR Antipsychotics - Drugs to Treat Mood Disorders

2nd Generation/Atypical - Mood Disorder Drugs

CAPLYTA Anxiolytics - Drugs to Treat Anxiety Benzodiazepines - Anxiety Drugs

8

Drug Name Reference clonazepam oral tablet KlonoPIN KLONOPIN Bipolar Agents - Drugs to Treat Mood Disorders

Mood Stabilizers - Mood Disorder Drugs

DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLES divalproex sodium oral tablet delayed release Depakote

Blood Glucose Regulators - Drugs to Regulate Blood Sugar

Antidiabetic Agents - Diabetic Drugs

acarbose oral Precose ACTOPLUS MET ACTOS ADLYXIN ALOGLIPTIN BENZOATE AMARYL BYDUREON BYETTA 10 MCG PEN BYETTA 5 MCG PEN CYCLOSET DUETACT FORTAMET glimepiride Amaryl glipizide er Glucotrol XL glipizide ir Glucotrol glipizide xl Glucotrol XL GLUCOTROL GLUCOTROL XL GLUCOVANCE ORAL TABLET 5-500 MG

GLUMETZA glyburide oral GLYNASE GLYSET

9

Drug Name Reference GLYXAMBI INVOKAMET INVOKAMET XR INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO miglitol Glyset nateglinide Starlix NESINA ONGLYZA OSENI OZEMPIC pioglitazone hcl Actos PRECOSE QTERN repaglinide RIOMET RYBELSUS SEGLUROMET STARLIX STEGLATRO STEGLUJAN SYMLINPEN 60 SYNJARDY SYNJARDY XR tolbutamide TRADJENTA TRIJARDY XR TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML

VICTOZA XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG

Glycemic Agents - Diabetic Drugs

10

Drug Name Reference diazoxide oral Proglycem PROGLYCEM Insulins - Diabetic Drugs ADMELOG ADMELOG SOLOSTAR AFREZZA APIDRA VIAL HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

HUMALOG MIX 50/50 KWIKPEN HUMALOG MIX 50/50 VIAL HUMALOG MIX 75/25 KWIKPEN HUMALOG MIX 75/25 VIAL HUMALOG U-100 VIAL AND CARTRIDGE

HUMULIN N VIAL HUMULIN R VIAL INSULIN ASPART INSULIN ASPART FLEXPEN INSULIN ASPART PENFILL INSULIN ASPART PROT & ASPART INSULIN LISPRO INSULIN LISPRO (1 UNIT DIAL) INSULIN LISPRO JUNIOR KWIKPEN INSULIN LISPRO PROT & LISPRO LANTUS SOLOSTAR LANTUS U-100 VIAL LEVEMIR U-100 VIAL NOVOLIN 70/30 VIAL NOVOLIN N RELION NOVOLIN N VIAL NOVOLIN R RELION NOVOLIN R VIAL NOVOLOG MIX 70/30 FLEXPEN NOVOLOG MIX 70/30 VIAL NOVOLOG U-100 VIAL TRESIBA

11

Drug Name Reference TRESIBA FLEXTOUCH Blood Products/Modifiers/Volume Expanders - Drugs to Treat Blood Disorders

Anticoagulants - Blood Thinners ELIQUIS PRADAXA ORAL CAPSULE 150 MG, 75 MG

SAVAYSA XARELTO ZONTIVITY Platelet Modifying Agents - Platelet Modifying Drugs

AGGRENOX BRILINTA ORAL TABLET 90 MG cilostazol clopidogrel bisulfate oral tablet 75 mg Plavix dipyridamole oral EFFIENT PLAVIX PLETAL ORAL TABLET 100 MG, 50 MG prasugrel hcl Effient Cardiovascular Agents Cardiovascular Agents, Other NEXLIZET Cardiovascular Agents - Drugs to Treat Heart and Circulation Conditions

Alpha-adrenergic Agonists - Blood Pressure Drugs

CATAPRES CATAPRES-TTS-1 CATAPRES-TTS-2 clonidine hcl oral Catapres guanfacine hcl methyldopa Alpha-adrenergic Blocking Agents - Blood Pressure Drugs

CARDURA

12

Drug Name Reference DIBENZYLINE doxazosin mesylate oral tablet 2 mg, 4 mg, 8 mg Cardura

MINIPRESS phenoxybenzamine hcl oral Dibenzyline prazosin hcl oral Minipress Angiotensin II Receptor Antagonists - Blood Pressure Drugs

ATACAND AVAPRO BENICAR candesartan cilexetil Atacand COZAAR DIOVAN EDARBI irbesartan Avapro losartan potassium oral Cozaar MICARDIS telmisartan Micardis valsartan Diovan Angiotensin-Converting Enzyme (ACE) Inhibitors - Blood Pressure Drugs

ACCUPRIL ALTACE captopril oral enalapril maleate oral tablet 20 mg Vasotec EPANED lisinopril oral Prinivil LOTENSIN perindopril erbumine PRINIVIL QBRELIS ramipril Altace trandolapril VASOTEC ZESTRIL

13

Drug Name Reference Antiarrhythmics - Heart Regulation Drugs

amiodarone hcl oral tablet 200 mg Pacerone BETAPACE BETAPACE AF disopyramide phosphate Norpace dofetilide Tikosyn mexiletine hcl oral MULTAQ NORPACE PACERONE ORAL TABLET 100 MG, 400 MG

pacerone oral tablet 200 mg Pacerone propafenone hcl propafenone hcl er Rythmol SR quinidine gluconate er quinidine sulfate RYTHMOL SR sotalol hcl oral Betapace TIKOSYN Beta-adrenergic Blocking Agents - Blood Pressure Drugs

acebutolol hcl oral atenolol oral Tenormin BYSTOLIC carvedilol Coreg COREG COREG CR CORGARD FIRST - METOPROLOL HEMANGEOL INDERAL LA INDERAL XL INNOPRAN XL labetalol hcl oral tablet 300 mg LOPRESSOR nadolol oral Corgard pindolol

14

Drug Name Reference propranolol hcl er Inderal LA propranolol hcl oral TENORMIN timolol maleate oral TOPROL XL Calcium Channel Blocking Agents - Blood Pressure Drugs

ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

CALAN SR CARDIZEM CARDIZEM CD CARDIZEM LA cartia xt diltiazem hcl er oral capsule extended release 12 hour

diltiazem hcl oral Cardizem dilt-xr isradipine KATERZIA matzim la nicardipine hcl oral nifedipine er oral tablet extended release 24 hour 90 mg

nifedipine oral Procardia nimodipine oral nisoldipine er NORVASC PROCARDIA PROCARDIA XL SULAR taztia xt tiadylt er oral capsule extended release 24 hour 360 mg

TIAZAC verapamil hcl er oral tablet extended release 180 mg, 240 mg Calan SR

verapamil hcl oral VERELAN

15

Drug Name Reference VERELAN PM Cardiovascular Agents, Other - Miscellaneous Cardiac Drugs

ACCURETIC ALDACTAZIDE aliskiren fumarate Tekturna amiloride-hydrochlorothiazide ATACAND HCT atenolol-chlorthalidone Tenoretic 100 AVALIDE AZOR BENICAR HCT BIDIL CADUET CORLANOR DEMSER digitek Digitek digox Digitek digoxin oral Digitek DIOVAN HCT DUTOPROL DYAZIDE EDARBYCLOR ENTRESTO EXFORGE HYZAAR LANOXIN ORAL LOTENSIN HCT LOTREL MAXZIDE MAXZIDE-25 methyldopa-hydrochlorothiazide metyrosine Demser MICARDIS HCT pentoxifylline er PRESTALIA propranolol-hctz

16

Drug Name Reference RANEXA spironolactone-hctz Aldactazide TARKA TEKTURNA TEKTURNA HCT TENORETIC 100 TENORETIC 50 triamterene-hctz oral tablet Maxzide-25 TWYNSTA VASERETIC ZESTORETIC ZIAC Diuretics, Carbonic Anhydrase Inhibitors - Cardiac Drugs

methazolamide oral Diuretics, Loop - Cardiac Drugs bumetanide oral Bumex BUMEX EDECRIN furosemide oral LASIX torsemide Diuretics, Potassium-sparing - Cardiac Drugs

ALDACTONE amiloride hcl oral CAROSPIR DYRENIUM eplerenone Inspra INSPRA spironolactone oral tablet 25 mg Aldactone triamterene oral Dyrenium Diuretics, Thiazide - Cardiac Drugs chlorthalidone DIURIL hydrochlorothiazide oral indapamide

17

Drug Name Reference metolazone Dyslipidemics, Fibric Acid Derivatives - Cholesterol Control Drugs

fenofibrate micronized fenofibrate oral FENOGLIDE FIBRICOR gemfibrozil oral Lopid LIPOFEN LOPID TRICOR TRILIPIX Dyslipidemics, HMG CoA Reductase Inhibitors - Cholesterol Control Drugs

ALTOPREV atorvastatin calcium oral Lipitor CRESTOR FLOLIPID fluvastatin sodium fluvastatin sodium er Lescol XL LESCOL XL LIPITOR LIVALO lovastatin PRAVACHOL pravastatin sodium rosuvastatin calcium Crestor simvastatin oral Zocor ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 80 MG

ZYPITAMAG Dyslipidemics, Other - Miscellaneous Cholesterol Control Drugs

cholestyramine oral Questran colesevelam hcl Welchol COLESTID

18

Drug Name Reference COLESTID FLAVORED ezetimibe Zetia LOVAZA NEXLETOL niacin (antihyperlipidemic) Niacor niacin er (antihyperlipidemic) Niaspan niacor Niacor NIASPAN omega-3-acid ethyl esters Lovaza prevalite QUESTRAN VASCEPA VYTORIN WELCHOL ZETIA Vasodilators, Direct-acting Arterial - Chest Pain Drugs

hydralazine hcl oral minoxidil oral Vasodilators, Direct-acting Arterial/Venous - Chest Pain Drugs

DILATRATE-SR ISORDIL TITRADOSE isosorbide dinitrate isosorbide mononitrate oral tablet 20 mg minitran NITRO-BID NITRO-DUR nitroglycerin transdermal patch 24 hour 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr Minitran

nitro-time Central Nervous System Agents - Drugs to Treat Nerve Conditions

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines - ADHD Drugs

INTUNIV

19

Drug Name Reference Central Nervous System, Other - Miscellaneous Central Nervous System Drugs

GRALISE HORIZANT NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 21-10 MG, 7-10 MG

Fibromyalgia Agents - Drugs to Treat Muscle and Soft Tissue Pain

CYMBALTA LYRICA LYRICA CR pregabalin oral Lyrica SAVELLA Dental and Oral Agents - Drugs to Treat Mouth and Throat Conditions

EVOXAC pilocarpine hcl oral Salagen SALAGEN Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement - Vitamin, Mineral and Body Fluid Deficiency Drugs

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

effer-k oral tablet effervescent 25 meq Effer-K folic acid oral tablet 1 mg klor-con Klor-Con klor-con 10 Klor-Con 10 klor-con m10 KLOR-CON M15 klor-con m20 klor-con sprinkle Klor-Con Sprinkle klor-con/ef Effer-K K-PHOS k-prime Effer-K

20

Drug Name Reference K-TAB phospha 250 neutral Phospha 250 Neutral phosphorous Phospha 250 Neutral phospho-trin 250 neutral Phospha 250 Neutral potassium bicarbonate oral Effer-K potassium chloride er oral capsule extended release Klor-Con Sprinkle

potassium chloride er oral tablet extended release 10 meq Klor-Con 10

potassium chloride er oral tablet extended release 8 meq Klor-Con

potassium chloride oral packet Klor-Con Phosphate Binders - Phosphate-Removing Agents

AURYXIA FOSRENOL ORAL TABLET CHEWABLE PHOSLYRA RENAGEL RENVELA VELPHORO Vitamins DRISDOL ergocalciferol oral capsule Drisdol NASCOBAL vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut) Drisdol

Gastrointestinal Agents - Drugs to Treat Bowel, Intestine and Stomach Conditions

Antispasmodics, Gastrointestinal - Stomach and Intestine Drugs

hyoscyamine sulfate er Symax-SR LEVBID oscimin sr Symax-SR symax-sr Symax-SR Gastrointestinal Agents, Other - Miscellaneous Gastrointestinal Drugs

MOTEGRITY MOVANTIK

21

Drug Name Reference RELISTOR ORAL SYMPROIC TRULANCE Histamine2 (H2) receptor Antagonists - Ulcer and Stomach Acid Drugs

cimetidine hcl cimetidine oral Tagamet HB famotidine oral suspension reconstituted famotidine oral tablet 20 mg, 40 mg Pepcid nizatidine PEPCID Irritable Bowel Syndrome Agents - Bowel Treatment Drugs

AMITIZA LINZESS LOTRONEX VIBERZI Protectants - Ulcer and Stomach Acid Drugs

CARAFATE CYTOTEC misoprostol oral Cytotec sucralfate oral Carafate Proton Pump Inhibitors - Ulcer and Stomach Acid Drugs

ACIPHEX DEXILANT esomeprazole magnesium oral packet NexIUM ESOMEPRAZOLE STRONTIUM heartburn treatment 24 hour Prevacid lansoprazole oral Prevacid NEXIUM omeprazole oral capsule delayed release pantoprazole sodium oral Protonix PREVACID PREVACID 24HR PRILOSEC

22

Drug Name Reference PROTONIX ORAL TABLET DELAYED RELEASE

rabeprazole sodium oral tablet delayed release Aciphex

ZEGERID ORAL CAPSULE 40-1100 MG ZEGERID ORAL PACKET Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

CREON PANCREAZE PERTZYE VIOKACE ZENPEP Genitourinary Agents - Drugs to Treat Bladder, Genital and Kidney Conditions

Antispasmodics, Urinary - Bladder Control Drugs

darifenacin hydrobromide er Enablex DETROL DETROL LA DITROPAN XL ENABLEX ORAL TABLET EXTENDED RELEASE 24 HOUR 7.5 MG

GELNIQUE MYRBETRIQ OXYTROL solifenacin succinate VESIcare tolterodine tartrate Detrol tolterodine tartrate er Detrol LA TOVIAZ trospium chloride er VESICARE Benign Prostatic Hypertrophy Agents - Prostate Drugs

AVODART CARDURA XL dutasteride oral Avodart finasteride oral tablet 5 mg Proscar

23

Drug Name Reference FLOMAX JALYN PROSCAR RAPAFLO silodosin Rapaflo UROXATRAL Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) - Drugs to Regulate Hormones

Androgens - Hormone Replacement/Modifying Drugs

ANDRODERM ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%)

METHITEST methyltestosterone oral testosterone transdermal gel 1.62 %, 20.25 mg/act (1.62%) AndroGel Pump

testosterone transdermal gel 12.5 mg/act (1%) Vogelxo Pump

testosterone transdermal gel 20.25 mg/1.25gm (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%)

AndroGel

Estrogens - Hormone Replacement/Modifying Drugs

ACTIVELLA afirmelle ALORA altavera Altavera amabelz amethia amethia lo amethyst ANGELIQ apri aranelle ashlyna aubra

24

Drug Name Reference aubra eq aurovela 24 fe aurovela fe 1.5/30 aurovela fe 1/20 aviane ayuna Altavera azurette Azurette BALCOLTRA balziva Balziva bekyree Azurette BEYAZ BIJUVA briellyn Balziva camrese camrese lo caziant charlotte 24 fe chateal Altavera chateal eq Altavera CLIMARA CLIMARA PRO COMBIPATCH covaryx covaryx hs cryselle-28 cyred cyred eq daysee DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 0.75 MG/0.75GM, 1 MG/GM

dotti Dotti drospirenone-ethinyl estradiol oral tablet 3-0.02 mg Gianvi

DUAVEE eemt eemt hs elinest

25

Drug Name Reference eluryng emoquette enpresse-28 enskyce estarylla ESTRACE ORAL estradiol oral Estrace estradiol transdermal Dotti estradiol vaginal Estrace ESTRING ESTROGEL ESTROSTEP FE EVAMIST FALESSA falmina fayosim FEMRING femynor fyavolv GENERESS FE gianvi Gianvi introvale isibloom jaimiess jasmiel Gianvi jinteli jolessa juleber junel 1.5/30 junel 1/20 junel fe oral tablet 1-20 mg-mcg(24) kaitlib fe kalliga kariva Azurette kelnor 1/50 kurvelo Altavera larissia

26

Drug Name Reference layolis fe leena lessina levonest levora 0.15/30 (28) Altavera lillow Altavera LO LOESTRIN FE LOESTRIN 1.5/30 (21) LOESTRIN 1/20 (21) LOESTRIN FE 1.5/30 LOESTRIN FE 1/20 lojaimiess lopreeza loryna Gianvi LOSEASONIQUE low-ogestrel lo-zumandimine Gianvi lutera marlissa Altavera MENEST MENOSTAR microgestin 1.5/30 microgestin 1/20 microgestin fe 1.5/30 microgestin fe 1/20 mili mimvey MINASTRIN 24 FE MINIVELLE MIRCETTE mono-linyah NATAZIA nikki Gianvi NUVARING ocella orsythia philith Balziva

27

Drug Name Reference pimtrea Azurette portia-28 Altavera PREFEST PREMARIN ORAL PREMARIN VAGINAL PREMPHASE PREMPRO previfem QUARTETTE reclipsen rivelsa SAFYRAL SEASONIQUE setlakin simliya Azurette simpesse sprintec 28 sronyx syeda tarina 24 fe TAYTULLA tilia fe tri femynor tri-estarylla tri-linyah tri-lo-mili tri-mili tri-previfem tri-sprintec trivora (28) tri-vylibra tri-vylibra lo tydemy VAGIFEM velivet vienva viorele Azurette

28

Drug Name Reference VIVELLE-DOT volnea Azurette vyfemla Balziva vylibra wera wymzya fe xulane YASMIN 28 YAZ yuvafem Yuvafem zarah zovia 1/35e (28) zumandimine Progestins - Hormone Replacement/Modifying Drugs

AYGESTIN camila Camila deblitane Camila errin Camila heather Camila incassia Camila jencycla Camila lyza Camila medroxyprogesterone acetate oral Provera nora-be Camila norethindrone oral Camila norlyda Camila ORTHO MICRONOR progesterone micronized oral Prometrium PROMETRIUM PROVERA sharobel Camila tulana Camila Selective Estrogen Receptor Modifying Agents - Hormone Replacement/Modifying Drugs

EVISTA OSPHENA

29

Drug Name Reference Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Drugs to Replace Thyroid Hormones

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) - Thyroid Replacement Drugs

ARMOUR THYROID CYTOMEL euthyrox Euthyrox levo-t Euthyrox levothyroxine sodium oral Euthyrox levoxyl Euthyrox liothyronine sodium oral Cytomel NATURE-THROID ORAL TABLET 113.75 MG, 130 MG, 146.25 MG, 16.25 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 48.75 MG, 65 MG, 81.25 MG, 97.5 MG

np thyroid oral tablet 30 mg, 60 mg, 90 mg Armour Thyroid

SYNTHROID TIROSINT TIROSINT-SOL unithroid Euthyrox WESTHROID WP THYROID Hormonal Agents, Suppressant (Thyroid) - Drugs to Suppress Thyroid Hormones

Antithyroid Agents - Thyroid Suppressing Drugs

methimazole oral Tapazole propylthiouracil oral TAPAZOLE Immunological Agents - Drugs that Stimulate or Suppress the Immune System

Immunomodulators - Immune System Drugs

ARAVA

30

Drug Name Reference leflunomide oral Arava RIDAURA Inflammatory Bowel Disease Agents - Drugs to Treat Inflammatory Bowel Disease

Aminosalicylates - Inflammatory Bowel Disease Drugs

APRISO ASACOL HD balsalazide disodium Colazal CANASA COLAZAL DELZICOL DIPENTUM LIALDA mesalamine rectal mesalamine-cleanser Rowasa PENTASA ROWASA SFROWASA Glucocorticoids - Drugs to Treat Inflammation

ORTIKOS ORAL CAPSULE EXTENDED RELEASE 24 HOUR 6 MG

Sulfonamides - Antibiotics AZULFIDINE AZULFIDINE EN-TABS sulfasalazine oral Azulfidine Metabolic Bone Disease Agents - Drugs to Treat Bone Conditions

Metabolic Bone Disease Agents - Osteoporosis (Bone Loss) Drugs

ACTONEL alendronate sodium ATELVIA BINOSTO BONIVA ORAL FOSAMAX ibandronate sodium oral Boniva

31

Drug Name Reference risedronate sodium oral tablet Actonel Metabolic Bone Disease Agents - Other

calcitriol oral Rocaltrol ROCALTROL Miscellaneous Therapeutic Agents BLOOD GLUCOSE TEST STRIPS GLUCOSE CONTROL SOLUTIONS INBRIJA INSULIN PEN NEEDLES INSULIN SYRINGES LANCETS SSKI Ophthalmic Agents - Drugs to Treat Eye Conditions

Ophthalmic Agents, Other - Miscellaneous Eye Drugs

RHOPRESSA ROCKLATAN Ophthalmic Antiglaucoma Agents - Glaucoma Drugs

acetazolamide er acetazolamide oral ALPHAGAN P apraclonidine hcl AZOPT BETIMOL BETOPTIC-S brimonidine tartrate ophthalmic COMBIGAN COSOPT COSOPT PF DORZOLAMIDE HCL SOLUTION 2 % OPHTHALMIC

dorzolamide hcl solution 2 % ophthalmic Trusopt IOPIDINE ISOPTO CARPINE ISTALOL

32

Drug Name Reference levobunolol hcl pilocarpine hcl ophthalmic Isopto Carpine SIMBRINZA timolol maleate ophthalmic solution Timoptic TIMOPTIC TIMOPTIC OCUDOSE TIMOPTIC-XE TRUSOPT Ophthalmic Prostaglandin and Prostamide Analogs - Glaucoma Drugs

bimatoprost ophthalmic latanoprost ophthalmic Xalatan LUMIGAN TRAVATAN Z travoprost (bak free) Travatan Z VYZULTA XALATAN ZIOPTAN Respiratory Tract/Pulmonary Agents

Respiratory Tract Agents, Other BREZTRI AEROSPHERE Respiratory Tract/Pulmonary Agents - Drugs to Treat Allergies, Cough, Cold and Lung Conditions

Anti-Inflammatories, Inhaled Corticosteroids - Asthma/Lung Drugs

ALVESCO ASMANEX HFA INHALATION AEROSOL 100 MCG/ACT, 200 MCG/ACT

budesonide inhalation Pulmicort FLOVENT DISKUS FLOVENT HFA PULMICORT SUSPENSION QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED 40 MCG/ACT

33

Drug Name Reference Antileukotrienes - Asthma/Lung Drugs

ACCOLATE montelukast sodium oral Singulair SINGULAIR zafirlukast Accolate zileuton er ZYFLO Bronchodilators, Anticholinergic - Asthma/Lung Drugs

ATROVENT HFA ipratropium bromide inhalation LONHALA MAGNAIR REFILL KIT LONHALA MAGNAIR STARTER KIT SEEBRI NEOHALER TUDORZA PRESSAIR Bronchodilators, Sympathomimetic - Asthma/Lung Drugs

BROVANA PERFOROMIST SEREVENT DISKUS Phosphodiesterase Inhibitors, Airways Disease - Drugs for the Lungs

DALIRESP ELIXOPHYLLIN THEO-24 theophylline er Respiratory Tract Agents, Other - Asthma/Lung Drugs

ADVAIR DISKUS ADVAIR HFA AIRDUO RESPICLICK 113/14 AIRDUO RESPICLICK 232/14 AIRDUO RESPICLICK 55/14 ANORO ELLIPTA BREO ELLIPTA DULERA INHALATION AEROSOL 100-5 MCG/ACT, 200-5 MCG/ACT

34

Drug Name Reference FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

SYMBICORT wixela inhub