UPDATE Q Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective April 23, 2010 SUMMARY OF CHANGES

Transcription

1 UPDATE Q Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective April 23, 2010 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 4 Off Formulary Interchangeable Product(s) 11 Manufacturer Requested Discontinued Drug(s) 12 New Generic Name(s) 13 Drug Benefit Price(s) 14 New Manufacturer Name(s) 20 Not-A-Benefit Drug(s) 22 Discontinued Drug(s) (Removed From Payment & Listing) 23 Not-A-Benefit Drug(s) (Removed from Listing) 24 Status Change(s) from Not-A-Benefit to General Benefit 25 Trade Name Change(s) 26 New DiabeticTesting Agent(s) 28 New Nutrition Product(s) 29 Index 30 Page 1

2 New Single Source Drug(s) DIN PRODUCT GENERIC NAME MFR DBP Cosopt (Preservative free) 2% & 0.5% Oph Sol-0.2mL Pk DORZOLAMIDE HCL & TIMOLOL MALEATE MFC Reason for Use Code 310 Clinical Criteria As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents. LU Authorization Period: Indefinite. 393 For use as initial therapy in an urgent situation (e.g. patients with high baseline intraocular pressure) where monotherapy is unlikely to be effective. LU Authorization Period: Indefinite Coversyl Plus HD 8mg & 2.5mg Tab PERINDOPRIL ERBUMINE & INDAPAMIDE SEV Isentress 400mg Tab RALTEGRAVIR POTASSIUM MFC For use in combination with an optimized regimen, for the treatment of HIV-1 infection in treatment-experienced adult patients who cannot achieve complete viral suppression on multiple prior anti-retroviral regimens AND who have one of the following:. HIV-1 strains with documented resistance to at one drug in each of the major classes of anti-retrovirals: protease inhibitors (Pls), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs); OR. serious class-effect intolerance to Pls, NNRTIs and/or NRTIs precluding treatment with that antiretroviral class Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism Olmetec 20mg Tab OLMESARTAN MEDOXOMIL SCP Olmetec 40mg Tab OLMESARTAN MEDOXOMIL SCP Page 2

3 DIN PRODUCT GENERIC NAME MFR DBP Olmetec Plus 20mg & 12.5mg Tab OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE SCP Olmetec Plus 40mg & 12.5mg Tab OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE SCP Olmetec Plus 40mg & 25mg Tab OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE SCP Prezista 400mg Tab DARUNAVIR JNO Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. In combination with ritonavir, as part of a HIV treatment regimen for treatment-naïve adult patients. Page 3

4 New Multi-Source Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Apo-Ropinirole 0.25mg Tab APX Apo-Ropinirole 1mg Tab APX Apo-Ropinirole 2mg Tab APX Apo-Ropinirole 5mg Tab APX (Interchangeable with ReQuip) Apo-Venlafaxine XR 37.5mg ER Cap APX Apo-Venlafaxine XR 75mg ER Cap APX Apo-Venlafaxine XR 150mg ER Cap APX (Interchangeable with Effexor XR) Co Olanzapine 2.5mg Tab COB Co Olanzapine 5mg Tab COB Co Olanzapine 7.5mg Tab COB Co Olanzapine 10mg Tab COB Co Olanzapine 15mg Tab COB (Interchangeable with Zyprexa) Fosinopril Tablets 10mg Tab RAN Fosinopril Tablets 20mg Tab RAN (Interchangeable with Monopril) Gabapentin Capsules 100mg Cap RAN Gabapentin Capsules 300mg Cap RAN Gabapentin Capsules 400mg Cap RAN (Interchangeable with Neurontin) Reason for Use Code 136 Clinical Criteria As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. NOTE: Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months. LU Authorization Period: Indefinite. Page 4

5 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Jamp-Amlodipine 5mg Tab JPC Jamp-Amlodipine 10mg Tab JPC (Interchangeable with Norvasc) Jamp-Fosinopril 10mg Tab JPC Jamp-Fosinopril 20mg Tab JPC (Interchangeable with Monopril) Jamp-Quetiapine 25mg Tab JPC Jamp-Quetiapine 100mg Tab JPC Jamp-Quetiapine 200mg Tab JPC Jamp-Quetiapine 300mg Tab JPC (Interchangeable with Seroquel) Jamp-Ramipril 1.25mg Cap JPC Jamp-Ramipril 2.5mg Cap JPC Jamp-Ramipril 5mg Cap JPC Jamp-Ramipril 10mg Cap JPC (Interchangeable with Altace) Jamp-Simvastatin 5mg Tab JPC Jamp-Simvastatin 10mg Tab JPC Jamp-Simvastatin 20mg Tab JPC Jamp-Simvastatin 40mg Tab JPC Jamp-Simvastatin 80mg Tab JPC (Interchangeable with Zocor) Methylprednisolone Acetate Inj- 40mg/mL Inj Susp-1mL Pk SDZ Susp USP Methylprednisolone Acetate Inj- 80mg/mL Inj Susp-1mL Pk SDZ Susp USP (Interchangeable with Depo-Medrol) Page 5

6 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Novo-Methylphenidate ER-C 18mg SR Tab NOP Novo-Methylphenidate ER-C 27mg SR Tab NOP Novo-Methylphenidate ER-C 36mg SR Tab NOP Novo-Methylphenidate ER-C 54mg SR Tab NOP (Interchangeable with Concerta) Notes: Patients > 6 years of age diagnosed with ADHD according to DSM-IV criteria and where symptoms are not due to other medical conditions which affect concentration, and who require 12-hour continuous coverage due to academic and/or psychosocial needs, and who meet the following: 1) Patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND 2) Prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics or a general practitioner with expertise in ADHD; AND 3) Have been tried on methylphenidate immediate release (IR) or methylphenidate slow release (SR) or Dexedrine IR or Dexedrine SR (Spansules), and have experienced unsatisfactory results due to poor symptom control, side effects, administrative barriers, or societal barriers. Administrative barriers include:. inability of a school to dose the child at lunch;. the school lunch hour does not coincide with the dosing schedule;. poor compliance with noon or afternoon doses;. the patient is unable to swallow tablets. Societal barriers include:. the patient or patient's caregiver(s) has(have) a history of substance abuse or diversion of listed immediate-release alternatives;. the patient or patient's caregiver(s) is/are at risk of substance abuse or diversion of listed immediate-release alternatives Novo-Risedronate 5mg Tab NOP Novo-Risedronate 30mg Tab NOP Novo-Risedronate 35mg Tab NOP (Interchangeable with Actonel) PMS-Desmopressin 0.1mg Tab PMS PMS-Desmopressin 0.2mg Tab PMS (Interchangeable with DDAVP) PMS-Ramipril 1.25mg Cap PMS PMS-Ramipril 2.5mg Cap PMS PMS-Ramipril 5mg Cap PMS PMS-Ramipril 10mg Cap PMS (Interchangeable with Altace) Page 6

7 DIN BRAND STRENGTH DOSAGE FORM MFR DBP PMS-Testosterone 40mg Cap PMS (Interchangeable with Andriol) Reason for Use Code Clinical Criteria 397 For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria. LU Authorization Period: 1 Year Risperidone Tablets 0.25mg Tab RAN Risperidone Tablets 0.5mg Tab RAN Risperidone Tablets 1mg Tab RAN Risperidone Tablets 2mg Tab RAN Risperidone Tablets 3mg Tab RAN Risperidone Tablets 4mg Tab RAN (Interchangeable with Risperdal) Sandoz Azithromycin 100mg/5mL O/L-15mL Pk SDZ Sandoz Azithromycin 200mg/5mL O/L-15mL Pk SDZ Sandoz Azithromycin 200mg/5mL O/L-22.5mL Pk SDZ (Interchangeable with Zithromax) Page 7

8 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Sandoz Finasteride 5mg Tab SDZ (Interchangeable with Proscar) Reason for Use Code 384 Clinical Criteria For use in combination with an alpha blocker for the treatment of men with symptomatic* Benign Prostatic Hyperplasia. LU Authorization Period: Indefinite. 385 For monotherapy, as a second line agent in patients with symptomatic* Benign Prostatic Hyperplasia following treatment failure or intolerance to an alpha blocker. * Symptomatic is defined as having moderate (about half the time) to severe (almost always) symptoms related to the prostate in at least 4 of the following domains: 1. feeling of incomplete emptying of the bladder after voiding 2. needing to urinate again less than 2 hours after previous void 3. stopping and starting urine several times while voiding 4. difficulty postponing urination 5. weak urinary stream 6. pushing or straining to begin voiding 7. the need to get up to void at least 3 times in the night. LU Authorization Period: Indefinite Zym-Carvedilol 3.125mg Tab ZYN Zym-Carvedilol 6.25mg Tab ZYN Zym-Carvedilol 12.5mg Tab ZYN Zym-Carvedilol 25mg Tab ZYN (Interchangeable with Coreg) Reason for Use Code 183 Clinical Criteria a) NYHA Class II or III Congestive Heart Failure (CHF); and b) Currently being treated with an angiotension converting enzyme (ACE) inhibitor, diuretics with or without digoxin, or previously treated, and failed these agents; and c) An ejection fraction less than or equal to 35%; and d) At least one episode of symptomatic CHF within a 12 month period while receiving optimal management LU Authorization Period: Indefinite. Page 8

9 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Zym-Gabapentin 100mg Cap ZYN Zym-Gabapentin 300mg Cap ZYN Zym-Gabapentin 400mg Cap ZYN (Interchangeable with Neurontin) Reason for Use Code 136 Clinical Criteria As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. NOTE: Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months. LU Authorization Period: Indefinite Zym-Mirtazapine 30mg Tab ZYN (Interchangeable with Remeron) Zym-Risperidone 0.25mg Tab ZYN Zym-Risperidone 0.5mg Tab ZYN Zym-Risperidone 1mg Tab ZYN Zym-Risperidone 2mg Tab ZYN Zym-Risperidone 3mg Tab ZYN Zym-Risperidone 4mg Tab ZYN (Interchangeable with Risperdal) Page 9

10 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Zym-Topiramate 25mg Tab ZYN Zym-Topiramate 100mg Tab ZYN Zym-Topiramate 200mg Tab ZYN (Interchangeable with Topamax) Reason for Use Code 223 Clinical Criteria As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. NOTE: Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months. LU Authorization Period: Indefinite. Page 10

11 Off Formulary Interchangeable Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Apo-Hydro 12.5mg Tab APX (Interchangeable with PMS- Hydrochlorothiazide) Mylan-Omeprazole 10mg DR Cap MYL (Interchangeable with Losec DR Tab) Sandoz Naratriptan 2.5mg Tab SDZ (Interchangeable with Amerge) Supeudol 5mg Tab SDZ Supeudol 10mg Tab SDZ (Interchangeable with Oxy-IR) Zym-Pioglitazone 15mg Tab ZYN Zym-Pioglitazone 30mg Tab ZYN Zym-Pioglitazone 45mg Tab ZYN (Interchangeable with Actos) Page 11

12 Manufacturer Requested Discontinued Drug(s) Please note that these discontinued products will remain on the formulary until the current stock is depleted. DIN BRAND STRENGTH DOSAGE FORM MFR Captopril 12.5mg Tab ZYN Captopril 25mg Tab ZYN Captopril 50mg Tab ZYN Captopril 100mg Tab ZYN Co Glimepiride 1mg Tab COB Co Glimepiride 2mg Tab COB Co Glimepiride 4mg Tab COB Desyrel Dividose 150mg Tab BQU Elite Strip BAY Fenomax 160mg Tab ORY Monocor 5mg Tab BIO Nimotop 30mg SG Cap BAY Novo-Cimetine 200mg Tab NOP Novo-Cimetine 800mg Tab NOP Osmolite 1 Cal 1.06kcal/mL Liq-1000mL Pk ABB Osmolite 1.2 Cal 1.2kcal/mL Liq-1000mL Pk ABB Osmolite HN Liq-235mL Pk ABB Osmolite HN Plus Liq-235mL Pk ABB PMS-Methotrimeprazine 25mg Tab PMS Page 12

13 New Generic Name(s) DIN/PIN PRODUCT GENERIC NAME MFR Contour Strip GLUCOSE DEHYDROGENASE BAY Freestyle Lite Strip PQQ GLUCOSE DEHYDROGENASE ABB Page 13

14 Drug Benefit Price(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Accupril 5mg Tab PFI Accupril 10mg Tab PFI Accupril 20mg Tab PFI Accupril 40mg Tab PFI Accuretic 10mg & 12.5mg Tab PFI Accuretic 20mg & 12.5mg Tab PFI Accuretic 20mg & 25mg Tab PFI Adderall XR 5mg ER Cap SHI Adderall XR 10mg ER Cap SHI Adderall XR 15mg ER Cap SHI Adderall XR 20mg ER Cap SHI Adderall XR 25mg ER Cap SHI Adderall XR 30mg ER Cap SHI Aldactazide-25 25mg & 25mg Tab PFI Aldactazide-50 50mg & 50mg Tab PFI Aldactone 25mg Tab PFI Aldactone 100mg Tab PFI Alvesco 100mcg/Actuation Inh-120 Dose Pk NYC Alvesco 200mcg/Actuation Inh-120 Dose Pk NYC Amatine 2.5mg Tab SHI Amatine 5mg Tab SHI Androderm 12.2mg Transdermal Patch PAL Ansaid 50mg Tab PFI Ansaid 100mg Tab PFI Aricept 5mg Tab PFI Aricept 10mg Tab PFI Aromasin 25mg Tab PFI Arthrotec 50 50mg & 200mcg Tab PFI Arthrotec 75 75mg & 200mcg Tab PFI Betnesol 5mg/100mL Enema-100mL Pk PAL Bezalip 400mg SR Tab AGP Biaxin 125mg/5mL Ped Gran ABB Biaxin 250mg/5mL Susp ABB Biaxin 250mg Tab ABB Biphentin 10mg ER Cap PFP Biphentin 15mg ER Cap PFP Biphentin 20mg ER Cap PFP Biphentin 30mg ER Cap PFP Biphentin 40mg ER Cap PFP Biphentin 50mg ER Cap PFP Biphentin 80mg ER Cap PFP Brevicon 0.035mg & 0.5mg Tab-21 Pk PFI Brevicon 0.035mg & 0.5mg Tab-28 Pk PFI Brevicon 1/ mg & 1mg Tab-21 Pk PFI Brevicon 1/ mg & 1mg Tab-28 Pk PFI Page 14

15 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Cardizem 30mg Tab BIO Cardizem 60mg Tab BIO Cardizem CD 120mg LA Cap BIO Cardizem CD 180mg LA Cap BIO Cardizem CD 240mg LA Cap BIO Cardizem CD 300mg LA Cap BIO CeeNU 10mg Cap BQU CeeNU 40mg Cap BQU CeeNU 100mg Cap BQU Celebrex 100mg Cap PFI Celebrex 200mg Cap PFI Codeine Contin 50mg CR Tab PFP Codeine Contin 100mg CR Tab PFP Codeine Contin 150mg CR Tab PFP Codeine Contin 200mg CR Tab PFP Colestid Orange Gran-7.5g Pk PFI Colestid Regular Gran-5g Pk PFI Cortef 10mg Tab PFI Cortef 20mg Tab PFI Cortifoam 10% Rect Aero-15g Pk PAL Coumadin 1mg Tab BQU Coumadin 2mg Tab BQU Coumadin 2.5mg Tab BQU Coumadin 3mg Tab BQU Coumadin 4mg Tab BQU Coumadin 5mg Tab BQU Coumadin 10mg Tab BQU Cymbalta 30mg DR Cap LIL Cymbalta 60mg DR Cap LIL Cytosar 100mg Inj Pd-Vial Pk PFI Dalacin C 150mg Cap PFI Dalacin C 300mg Cap PFI Dalacin C 300mg/2mL Inj Sol-2mL Pk PFI Dalacin C Flavoured 15mg/mL Pd for Oral Susp PFI Granules Delatestryl 1000mg/5mL Oily Inj Sol-5mL Pk THE Demulen mg & 2mg Tab-21 Pk PFI Demulen mg & 2mg Tab-28 Pk PFI Depakene 250mg Cap ABB Depakene 50mg/mL O/L ABB Depo-Medrol 40mg/mL Inj Susp-1mL Pk PFI Depo-Medrol 80mg/mL Inj Susp-1mL Pk PFI Depo-Medrol 100mg/5mL Inj Susp-5mL Pk PFI Depo-Provera 50mg/mL Inj Sol-5mL Pk PFI Depo-Provera 150mg/mL Inj PFI Depo-Testosterone 100mg/mL Oily Inj Sol-10mL Pk PFI Detrol 1mg Tab PFI Detrol 2mg Tab PFI Detrol LA 2mg SR Cap PFI Page 15

16 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Detrol LA 4mg SR Cap PFI Dexedrine 5mg Tab PAL Diflucan P.O.S. 10mg/mL O/L PFI Diflucan mg Cap PFI Dilantin 30mg Cap PFI Dilantin 100mg Cap PFI Dilantin 6mg/mL O/L PFI Dilantin 25mg/mL O/L PFI Dilantin 50mg Tab PFI Dovonex 50mcg/g Cr LEO Dovonex 50mcg/g Oint LEO Duvoid 10mg Tab PAL Duvoid 25mg Tab PAL Duvoid 50mg Tab PAL Epival 125mg Ent Tab ABB Epival 250mg Ent Tab ABB Epival 500mg Ent Tab ABB ERYC 250mg Ent Pel Cap PFI Estring 2mg Vag Ring PFI Florinef 0.1mg Tab PAL FML 0.1% Oph Susp ALL Fragmin 2500IU/0.2mL Inj Pref Syr PFI Fragmin 5000IU/0.2mL Inj Pref Syr PFI Fragmin 10000IU/mL Inj Sol-1mL Pk PFI Fragmin 10000IU/0.4mL Inj Pref Syr PFI Fragmin 12500IU/0.5mL Inj Pref Syr PFI Fragmin 15000IU/0.6mL Inj Pref Syr PFI Fragmin 18000IU/0.72mL Inj Pref Syr PFI Fragmin 25000IU/mL Multidose 3.8mL Pk PFI Fucidin 2% Cr LEO Fucidin 2% Oint LEO Fungizone Inj Pd-50mg Pk BQU Humira 40mg/0.8mL Inj Sol-Pref Pen Pk ABB Humira 40mg/0.8mL Inj Sol-Pref Syr Pk ABB Humulin 30/70 100U/mL Inj Susp-5x3mL Pk LIL Humulin 30/ U/10mL Inj Susp-10mL Pk LIL Humulin N 100U/mL Inj Susp-5x3mL Pk LIL Humulin NPH 1000U/10mL Inj Susp-10mL Pk LIL Humulin R 100U/mL Inj Sol-5x3mL Pk LIL Humulin Regular 1000U/10mL Inj Sol-10mL Pk LIL Hycodan 1mg/mL O/L BQU Hydromorph Contin 3mg CR Cap PFP Hydromorph Contin 6mg CR Cap PFP Hydromorph Contin 12mg CR Cap PFP Hydromorph Contin 18mg CR Cap PFP Hydromorph Contin 24mg CR Cap PFP Hydromorph Contin 30mg CR Cap PFP Hytrin 1mg Tab ABB Hytrin 2mg Tab ABB Page 16

17 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Hytrin 5mg Tab ABB Hytrin 10mg Tab ABB Isoptin SR 180mg LA Tab ABB Isoptin SR 240mg LA Tab ABB Kaletra 80mg/mL & 20mg/mL O/L ABB Kaletra 200mg & 50mg Tab ABB Kenalog-10 50mg/5mL Inj Susp-5mL Pk BQU Kenalog-40 40mg/mL Inj Susp-1mL Pk BQU Kenalog mg/5mL Inj Susp-5mL Pk BQU Levemir Penfill 100U/mL Inj Sol-5x3mL Pk NOO Locacorten-Vioform 0.02% & 1% Ot Sol PAL Loestrin 1.5/ mg & 1.5mg Tab-21 Pk PAL Loestrin 1.5/ mg & 1.5mg Tab-28 Pk PAL Lomotil 2.5mg & 0.025mg Tab PFI Loniten 2.5mg Tab PFI Loniten 10mg Tab PFI Lopid 300mg Cap PFI Lupron Depot PDS 3.75mg Inj-Kit ABB Lupron Depot PDS 11.25mg Inj-Kit ABB Medrol 4mg Tab PFI Mezavant 1.2g Delayed & ER Tab SHI Minestrin 1/ mg & 1mg Tab-21 Pk PAL Minestrin 1/ mg & 1mg Tab-28 Pk PAL MS Contin 15mg SR/ER Tab PFP MS Contin 30mg SR/ER Tab PFP MS Contin 60mg SR/ER Tab PFP MS Contin 100mg SR/ER Tab PFP MS Contin 200mg SR/ER Tab PFP MS-IR 20mg Tab PFP MS-IR 30mg Tab PFP Mycobutin 150mg Cap PFI Neurontin 100mg Cap PFI Neurontin 300mg Cap PFI Neurontin 400mg Cap PFI Nitrol 2% Oint PAL Nitrostat 0.3mg SL Tab PFI Nitrostat 0.6mg SL Tab PFI Norvasc 5mg Tab PFI Norvasc 10mg Tab PFI Norvir 80mg/mL O/L ABB Norvir SEC 100mg Cap ABB Novo-Olanzapine OD 5mg Rapid Dissolve Tab NOP Novo-Olanzapine OD 10mg Rapid Dissolve Tab NOP Novo-Olanzapine OD 15mg Rapid Dissolve Tab NOP Novo-Olanzapine OD 20mg Rapid Dissolve Tab NOP NovoMix 30 Penfill 100U/mL Inj Susp-5x3mL Pk NOO NovoRapid 100U/mL Inj Sol-10mL Pk NOO NovoRapid Penfill 100U/mL Inj Sol-5x3mL Pk NOO Page 17

18 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Omnaris 50mcg/Actuation Metered Dose Nas Sp- NYC Dose Pk One-Alpha 0.25mcg Cap LEO One-Alpha 1mcg Cap LEO Oxycontin 10mg SR Tab PFP Oxycontin 20mg SR Tab PFP Oxycontin 40mg SR Tab PFP Oxycontin 80mg SR Tab PFP Pantoloc 40mg Ent Tab NYC PMS-Olanzapine 2.5mg Tab PMS PMS-Olanzapine 5mg Tab PMS PMS-Olanzapine 7.5mg Tab PMS PMS-Olanzapine 10mg Tab PMS PMS-Olanzapine 15mg Tab PMS Propyl-Thyracil 50mg Tab PAL Propyl-Thyracil 100mg Tab PAL Provera 2.5mg Tab PFI Provera 5mg Tab PFI Provera 10mg Tab PFI Provera 100mg Tab PFI QVAR 50mcg/Metered Dose Aero Inh-200 Dose Pk GRA QVAR 100mcg/Metered Dose Aero Inh-200 Dose Pk GRA Rythmol 150mg Tab ABB Rythmol 300mg Tab ABB Salazopyrin 500mg Ent Tab PFI Salazopyrin 500mg Tab PFI Sandomigran 0.5mg Tab PAL Sandomigran DS 1mg Tab PAL Soriatane 10mg Cap AGP Soriatane 25mg Cap AGP Synphasic 3 Phase Tab-21 Pk PFI Synphasic 3 Phase Tab-28 Pk PFI Synthroid 0.025mg Tab ABB Synthroid 0.05mg Tab ABB Synthroid 0.075mg Tab ABB Synthroid 0.088mg Tab ABB Synthroid 0.1mg Tab ABB Synthroid 0.112mg Tab ABB Synthroid 0.125mg Tab ABB Synthroid 0.15mg Tab ABB Synthroid 0.175mg Tab ABB Synthroid 0.2mg Tab ABB Tambocor 50mg Tab GRA Tambocor 100mg Tab GRA Trandate 100mg Tab PAL Trandate 200mg Tab PAL Trelstar (1 Month) 3.75mg/Vial Inj Pd-Vial Pk PAL Trelstar (1 Month) 3.75mg/Vial Inj Pd with Sterile Water-Vial Pk PAL Page 18

19 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Trelstar LA (3 Month) 11.25mg/Vial Inj Pd-Vial Pk PAL Trelstar LA (3 Month) 11.25mg/Vial Inj Pd with Sterile PAL Water-Vial Pk Vepesid 50mg Cap BQU Vfend 50mg Tab PFI Vfend 200mg Tab PFI Xanax 0.25mg Tab PFI Xanax 0.5mg Tab PFI Zithromax 100mg/5mL O/L-15mL Pk PFI Zithromax 200mg/5mL O/L-15mL Pk PFI Zithromax 200mg/5mL O/L-22.5mL Pk PFI Zithromax 250mg Tab PFI Zithromax 600mg Tab PFI Zoloft 25mg Cap PFI Zoloft 100mg Cap PFI Zyvoxam 600mg Tab PFI Page 19

20 New Manufacturer Name(s) DIN BRAND STRENGTH DOSAGE FORM MFR Gen-Amiodarone 200mg Tab MYL Gen-Amlodipine 5mg Tab MYL Gen-Amlodipine 10mg Tab MYL Gen-Cilazapril 1mg Tab MYL Gen-Cilazapril 2.5mg Tab MYL Gen-Cilazapril 5mg Tab MYL Gen-Clarithromycin 250mg Tab MYL Gen-Clarithromycin 500mg Tab MYL Gen-Clindamycin 150mg Cap MYL Gen-Clindamycin 300mg Cap MYL Gen-Clonazepam 0.5mg Tab MYL Gen-Clonazepam 2mg Tab MYL Gen-Doxazosin 1mg Tab MYL Gen-Doxazosin 2mg Tab MYL Gen-Doxazosin 4mg Tab MYL Gen-Eti-Cal Carepac 400mg/500mg Tab-90 Tablets Kit MYL Gen-Etidronate 200mg Tab MYL Gen-Famotidine 20mg Tab MYL Gen-Famotidine 40mg Tab MYL Gen-Fenofibrate Micro 200mg Cap MYL Gen-Gabapentin 100mg Cap MYL Gen-Gabapentin 300mg Cap MYL Gen-Gabapentin 400mg Cap MYL Gen-Gemfibrozil 300mg Cap MYL Gen-Gemfibrozil 600mg Tab MYL Gen-Gliclazide 80mg Tab MYL Gen-Indapamide 1.25mg Tab MYL Gen-Indapamide 2.5mg Tab MYL Gen-Lisinopril 5mg Tab MYL Gen-Lisinopril 10mg Tab MYL Gen-Lisinopril 20mg Tab MYL Gen-Metoprolol (Type L) 50mg Tab MYL Gen-Metoprolol (Type L) 100mg Tab MYL Gen-Minocycline 50mg Cap MYL Gen-Minocycline 100mg Cap MYL Gen-Nabumetone 500mg Tab MYL Gen-Nifedipine Extended Release 60mg ER Tab MYL Gen-Propafenone 150mg Tab MYL Gen-Propafenone 300mg Tab MYL Gen-Selegiline 5mg Tab MYL Gen-Sertraline 25mg Cap MYL Gen-Sertraline 50mg Cap MYL Gen-Sertraline 100mg Cap MYL Gen-Simvastatin 5mg Tab MYL Gen-Simvastatin 10mg Tab MYL Gen-Simvastatin 20mg Tab MYL Page 20

21 DIN BRAND STRENGTH DOSAGE FORM MFR Gen-Simvastatin 40mg Tab MYL Gen-Simvastatin 80mg Tab MYL Gen-Terbinafine 250mg Tab MYL Gen-Ticlopidine 250mg Tab MYL Page 21

22 Not-A-Benefit Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR Betaloc 50mg Tab AZC Betaloc 100mg Tab AZC Capoten 12.5mg Tab BQU Cytoxan 50mg Tab BQU Didronel 200mg Tab PGP Duragesic Mat 25mcg/hr Trans Patch JNO (Interchangeable with Duragesic 25 DIN # ) Duragesic Mat 50mcg/hr Trans Patch JNO (Interchangeable with Duragesic 50 DIN # ) Duragesic Mat 75mcg/hr Trans Patch JNO (Interchangeable with Duragesic 75 DIN # ) Duragesic Mat 100mcg/hr Trans Patch JNO (Interchangeable with Duragesic 100 DIN # ) Duricef 500mg Cap BQU Jamp-Pravastatin 10mg Tab JPC Jamp-Pravastatin 20mg Tab JPC Jamp-Pravastatin 40mg Tab JPC (Interchangeable with Pravachol) M.O.S. 5mg/mL O/L VAL Megace 160mg Tab BQU Mint-Pravastatin 10mg Tab MIN Mint-Pravastatin 20mg Tab MIN Mint-Pravastatin 40mg Tab MIN (Interchangeable with Pravachol) Surgam 300mg Tab SAV Symmetrel 10mg/mL O/L BQU Ventolin 0.4mg/mL O/L GSK Page 22

23 Discontinued Drug(s) (Removed From Payment & Listing) DIN BRAND STRENGTH DOSAGE FORM MFR Agenerase 50mg Cap GSK Agenerase 150mg Cap GSK Agenerase 15mg/mL O/L GSK Apo-Ipravent 0.03% Nasal Spray APX Apo-Labetalol 100mg Tab APX Apo-Labetalol 200mg Tab APX Apo-Loxapine 5mg Tab APX Apo-Loxapine 10mg Tab APX Apo-Loxapine 25mg Tab APX Apo-Loxapine 50mg Tab APX C.E.S. 1.25mg Tab VAL Combigan 0.2% & 0.5% Oph Sol-5mL Pk ALL Covera-HS 180mg SR Tab PFI Covera-HS 240mg SR Tab PFI Endantadine 100mg Cap BQU Eprex 20,000IU/mL Inj Sol - 1mL Vial Pk JNO Fluotic 20mg Tab SAV Lin-Fosinopril 10mg Tab LON Lin-Fosinopril 20mg Tab LON M.O.S. Conc 50 50mg/mL O/L VAL M.O.S mg Tab VAL Monistat 7 100mg Vag Sup-7 Pk MCL Monistat Derm 2% Cr MCL Novo-Bupropion SR 150mg Tab NOP Novo-Fluconazole mg Cap NOP Novo-Hylazin 25mg Tab NOP PMS-Diclofenac 25mg Ent Tab PMS PMS-Diclofenac 50mg Ent Tab PMS PMS-Terbinafine 250mg Tab PMS Pondocillin 500mg Tab LEO Promod Pd-275g Pk ABB Ratio-Beclomethasone AQ 50mcg Nas Sp-200 Dose Pk RPH Ratio-Clindamycin 150mg Cap RPH Ratio-Clindamycin 300mg Cap RPH Sab-Diclofenac 50mg Sup SDZ Sab-Diclofenac 100mg Sup SDZ Sandoz Paroxetine 20mg Tab SDZ Sandoz Paroxetine 30mg Tab SDZ Sandoz Ramipril Tab 1.25mg SDZ Sandoz Ramipril Tab 2.5mg SDZ Sandoz Ramipril Tab 5mg SDZ Sandoz Ramipril Tab 10mg SDZ Sansert 2mg Tab NOV Seconal 100mg Cap LIL Terazol 3 80mg Vag Ovule JNO Vitamin B6 25mg Tab PMS Vitamin B6-ICN 25mg Tab VAL Page 23

24 Not-A-Benefit Drug(s) (Removed From Listing) DIN BRAND STRENGTH DOSAGE FORM MFR Premarin 1.25mg Tab WAY Vitamin B6 25mg Tab RPR Page 24

25 Status Change(s) from Not-A-Benefit to General Benefit DIN BRAND STRENGTH DOSAGE FORM MFR DBP Sandoz Diclofenac SR 75mg LA Tab SDZ Sandoz Diclofenac SR 100mg LA Tab SDZ (Interchangeable with Voltaren SR) Page 25

26 Trade Name Change(s) DIN BRAND STRENGTH DOSAGE FORM MFR Mylan-Amiodarone 200mg Tab GEN Mylan-Amlodipine 5mg Tab GEN Mylan-Amlodipine 10mg Tab GEN Mylan-Cilazapril 1mg Tab GEN Mylan-Cilazapril 2.5mg Tab GEN Mylan-Cilazapril 5mg Tab GEN Mylan-Clarithromycin 250mg Tab GEN Mylan-Clarithromycin 500mg Tab GEN Mylan-Clindamycin 150mg Cap GEN Mylan-Clindamycin 300mg Cap GEN Mylan-Clonazepam 0.5mg Tab GEN Mylan-Clonazepam 2mg Tab GEN Mylan-Doxazosin 1mg Tab GEN Mylan-Doxazosin 2mg Tab GEN Mylan-Doxazosin 4mg Tab GEN Mylan-Eti-Cal Carepac 400mg/500mg Tab-90 Tablets Kit GEN Mylan-Etidronate 200mg Tab GEN Mylan-Famotidine 20mg Tab GEN Mylan-Famotidine 40mg Tab GEN Mylan-Fenofibrate Micro 200mg Cap GEN Mylan-Gabapentin 100mg Cap GEN Mylan-Gabapentin 300mg Cap GEN Mylan-Gabapentin 400mg Cap GEN Mylan-Gemfibrozil 300mg Cap GEN Mylan-Gemfibrozil 600mg Tab GEN Mylan-Gliclazide 80mg Tab GEN Mylan-Indapamide 1.25mg Tab GEN Mylan-Indapamide 2.5mg Tab GEN Mylan-Lisinopril 5mg Tab GEN Mylan-Lisinopril 10mg Tab GEN Mylan-Lisinopril 20mg Tab GEN Mylan-Metoprolol (Type L) 50mg Tab GEN Mylan-Metoprolol (Type L) 100mg Tab GEN Mylan-Minocycline 50mg Cap GEN Mylan-Minocycline 100mg Cap GEN Mylan-Nabumetone 500mg Tab GEN Mylan-Nifedipine Extended Release 60mg ER Tab GEN Mylan-Propafenone 150mg Tab GEN Mylan-Propafenone 300mg Tab GEN Mylan-Selegiline 5mg Tab GEN Mylan-Sertraline 25mg Cap GEN Mylan-Sertraline 50mg Cap GEN Mylan-Sertraline 100mg Cap GEN Mylan-Simvastatin 5mg Tab GEN Mylan-Simvastatin 10mg Tab GEN Mylan-Simvastatin 20mg Tab GEN Page 26

27 DIN BRAND STRENGTH DOSAGE FORM MFR Mylan-Simvastatin 40mg Tab GEN Mylan-Simvastatin 80mg Tab GEN Mylan-Terbinafine 250mg Tab GEN Mylan-Ticlopidine 250mg Tab GEN Page 27

28 New Diabetic Testing Agent(s) PIN PRODUCT MFR COST/ UNIT AMT MOH PAYS AMT PATIENT PAYS itest 2.71IU Blood Glucose Strip AUT Page 28

29 New Nutrition Product(s) PIN PRODUCT MFR COST/ PKG AMT MOH PAYS AMT PATIENT PAYS A. COMPLETE POLYMERIC, 3. FIBRE CONTAINING Jevity 1.5 Cal 1.5kcal/mL Liq-235mL Pk ABB Page 29

30 CONSOLIDATED INDEX mg Tab PEN P 10 3TC 10mg/mL O/L GSK H 7 3TC 150mg Tab GSK H 7 3TC 300mg Tab GSK H 7 5-AMINOSALICYLIC ACID E 3 H 3 5-Benzagel 5% Gel NOV F 6 Accel Pioglitazone 15mg Tab ACC L 16 Accel Pioglitazone 30mg Tab ACC L 16 Accel Pioglitazone 45mg Tab ACC L 16 Accupril 5mg Tab PFI Q 14 Accupril 10mg Tab PFI Q 14 Accupril 20mg Tab PFI Q 14 Accupril 40mg Tab PFI Q 14 Accuretic 10mg & 12.5mg Tab PFI Q 14 Accuretic 20mg & 12.5mg Tab PFI Q 14 Accuretic 20mg & 25mg Tab PFI H PFI Q 14 AcetOxyl 5% Gel STI M 7 AcetOxyl 10% Gel STI M 7 ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE E 8 ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE & CODEINE E 8 PHOSPHATE Aclasta 5mg/100mL Inj Sol-100mL Pk NOV C NOV H 7 Actonel 5mg Tab PGP A 11 Actonel 30mg Tab PGP A 11 Actonel 35mg Tab PGP A 11 Actonel 150mg Tab PGP J 2 Actos 15mg Tab TAK L 15 Actos 30mg Tab TAK L 15 Actos 45mg Tab TAK L 15 Adalat XL 20mg ER Tab BAY F BAY O 16 Adalat XL 30mg ER Tab BAY F BAY O 16 Adalat XL 60mg ER Tab BAY F 7 ADALIMUMAB I 2 Adderall XR 5mg ER Cap SHI H SHI Q 14 Adderall XR 10mg ER Cap SHI H SHI Q 14 Adderall XR 15mg ER Cap SHI H SHI Q 14 Page 30

31 Adderall XR 20mg ER Cap SHI H SHI Q 14 Adderall XR 25mg ER Cap SHI H SHI Q 14 Adderall XR 30mg ER Cap SHI H SHI Q 14 Adrenalin 30mg/30mL Inj Sol-30mL Pk ERF C ERF F ERF P 10 Advagraf 0.5mg ER Cap ASE H 2 Advagraf 1mg ER Cap ASE H 2 Advagraf 5mg ER Cap ASE H 2 Advair /125mcg/Metered Dose Inh-120 Dose Pk GSK H 7 Advair /250mcg/Metered Dose Inh-120 Dose Pk GSK H 7 Advair Diskus 50/100mcg Inh-60 Dose Pk GSK H 7 Advair Diskus 50/250mcg Inh-60 Dose Pk GSK H 7 Advair Diskus 50/500mcg Inh-60 Dose Pk GSK H 7 Agenerase 50mg Cap GSK H GSK Q 23 Agenerase 150mg Cap GSK H GSK Q 23 Agenerase 15mg/mL O/L GSK H GSK Q 23 Alcomicin 0.3% Oph Sol ALC M 7 Aldactazide-25 25mg & 25mg Tab PFI H PFI Q 14 Aldactazide-50 50mg & 50mg Tab PFI H PFI Q 14 Aldactone 25mg Tab PFI H PFI Q 14 Aldactone 100mg Tab PFI H PFI Q 14 ALENDRONATE N 2 ALENDRONATE & CHOLECALCIFEROL J 2 Alesse 20mcg & 100mcg Tab-21 Pk WAY H 7 Alesse 20mcg & 100mcg Tab-28 Pk WAY H 7 ALFUZOSIN HYDROCHLORIDE C 3 ALISKIREN D 3 Alkeran 2mg Tab GSK H 7 Allerdryl 25mg Cap VAL M 14 Allerdryl 50mg Cap VAL N 9 Altace Cap 1.25mg SAV H 7 Altace Cap 2.5mg SAV H 7 Altace Cap 5mg SAV H 7 Altace Cap 10mg SAV H 7 Altace HCT 5mg & 12.5mg Tab SAV H 7 Altace HCT 10mg & 12.5mg Tab SAV H 7 Altace HCT 5mg & 25mg Tab SAV H 7 Altace HCT 10mg & 25mg Tab SAV H 7 Page 31

32 Alvesco 100mcg/Actuation Inh-120 Dose Pk NYC H NYC Q 14 Alvesco 200mcg/Actuation Inh-120 Dose Pk NYC H NYC Q 14 Amatine 2.5mg Tab SHI Q 14 Amatine 5mg Tab SHI Q 14 AMLODIPINE L 3 O 2 Q 5 Amlodipine Tablets 5mg Tab RAN O 2 Amlodipine Tablets 10mg Tab RAN O 2 AMOXICILLIN C 9 Amytal Sodium 60mg Cap LIL M 7 Amytal Sodium 200mg Cap LIL M 7 Androderm 12.2mg Transdermal Patch PAL Q 14 Androgel 1% 2.5g Foil Packet SPH A 11 Ansaid 50mg Tab PFI Q 14 Ansaid 100mg Tab PFI Q 14 Anthraforte 1 1% Oint MEI F 6 Anthraforte 2 2% Oint MEI F 6 Anthranol 0.1% Cr MEI F 6 Anthranol 0.2% Cr MEI F 6 Anthranol 0.4% Cr MEI F 6 Anusol 0.5% Oint PFI M 7 Anzemet 50mg Tab SAV H 7 Anzemet 100mg Tab SAV H 7 Apidra 100U/mL Inj Sol-5x3mL Pk SAV K 2 Apidra 100U/mL Inj Sol-10mL Vial SAV K 2 Apo-Acetazolamide 250mg Tab APX H 7 Apo-Alfuzosin 10mg Prolong-Rel Tab APX C APX D 9 Apo-Amiloride 5mg Tab APX H 7 Apo-Amlodipine 5mg Tab APX L 3 Apo-Amlodipine 10mg Tab APX L 3 Apo-Atenidone 50 & 25mg Tab APX A 11 Apo-Atenidone 100 & 25mg Tab APX A 11 Apo-Brimonidine P 0.15% Oph Sol APX B APX C APX M 15 Apo-Carbamazepine CR 200mg LA Tab APX M APX P 16 Apo-Carbamazepine CR 400mg LA Tab APX M APX P 16 Apo-Cefaclor 25mg/mL Oral Susp APX P 8 Apo-Cefaclor 50mg/mL Oral Susp APX P 8 Apo-Cefaclor 375mg/5mL Oral Susp APX I 7 Apo-Cetirizine 10mg Tab APX O 16 Apo-Chlordiazepoxide 5mg Cap APX H 7 Apo-Chlordiazepoxide 10mg Cap APX H 7 Page 32

33 Apo-Chlordiazepoxide 25mg Cap APX H 7 Apo-Chlorthalidone 50mg Tab APX H 7 Apo-Cilazapril/HCTZ 5mg/12.5mg Tab APX H APX J 8 Apo-Cromolyn 1% Inh Sol-2mL Pk APX H 19 Apo-Cyclosporine Oral Solution 100mg/mL O/L APX F 3 Apo-Desmopressin 10mcg/Metered Dose Nas Sp-2.5mL Pk APX H 7 Apo-Diclo 25mg Ent Tab APX F 7 Apo-Diflunisal 500mg Tab APX H 7 Apo-Digoxin mg Tab APX K APX M 13 Apo-Digoxin 0.125mg Tab APX N 5 Apo-Digoxin 0.25mg Tab APX N 5 Apo-Diltiaz SR 60mg LA Cap APX H APX P 8 Apo-Diltiaz SR 90mg LA Cap APX H APX P 8 Apo-Diltiaz SR 120mg LA Cap APX H APX P 8 Apo-Diltiaz TZ 120mg SR Cap APX F 3 Apo-Diltiaz TZ 180mg SR Cap APX F 3 Apo-Diltiaz TZ 240mg SR Cap APX F 3 Apo-Diltiaz TZ 300mg SR Cap APX F 3 Apo-Diltiaz TZ 360mg SR Cap APX F 3 Apo-Dipyridamole 25mg Tab APX G 7 Apo-Dipyridamole 50mg Tab APX G 7 Apo-Dipyridamole 75mg Tab APX G 7 Apo-Doxepin 10mg Cap APX H 7 Apo-Doxy-Tabs 100mg Tab APX I 13 Apo-Enalapril 2.5mg Tab APX E1 3 Apo-Enalapril 5mg Tab APX E1 3 Apo-Enalapril 10mg Tab APX E1 3 Apo-Enalapril 20mg Tab APX E1 3 Apo-Erythro 250mg Tab APX H 7 Apo-Erythro-ES 600mg Tab APX H 8 Apo-Erythro-S 250mg Tab APX H 8 Apo-Erythro-S 500mg Tab APX H 8 Apo-Feno-Super 100mg Tab APX D 10 Apo-Feno-Super 160mg Tab APX F 7 Apo-Fenofibrate 100mg Cap APX J 8 Apo-Flecainide 50mg Tab APX H 8 Apo-Flecainide 100mg Tab APX H 8 Apo-Floctafenine 200mg Tab APX H 8 Apo-Floctafenine 400mg Tab APX H 8 Apo-Flunisolide 0.025% Nas Sp-25mL Pk APX J 8 Apo-Fluphenazine 1mg Tab APX H 8 Apo-Fluphenazine 2mg Tab APX H 8 Apo-Gabapentin 600mg Tab APX A 14 Apo-Gabapentin 800mg Tab APX A 14 Page 33

34 Apo-Gliclazide MR 30mg SR Tab APX A APX C 7 Apo-Granisetron 1mg Tab APX I 3 Apo-Hydro 12.5mg Tab APX Q 11 Apo-Imipramine 10mg Tab APX H 8 Apo-Imipramine 25mg Tab APX H 8 Apo-Imipramine 50mg Tab APX H 8 Apo-Ipravent 0.03% Nasal Spray APX H APX Q 23 Apo-Ipravent 0.06% Nasal Spray APX J 10 Apo-ISDN 5mg SL Tab APX H 8 Apo-ISDN 10mg Tab APX H 8 Apo-ISDN 30mg Tab APX H 8 Apo-Keto 50mg Cap APX H 8 Apo-Keto-E 50mg Ent Tab APX J 8 Apo-Keto-E 100mg Ent Tab APX H 8 Apo-Keto SR 200mg LA Tab APX H 8 Apo-Ketorolac 10mg Tab APX B 7 Apo-Labetalol 100mg Tab APX H APX L APX Q 23 Apo-Labetalol 200mg Tab APX H APX L APX Q 23 Apo-Lansoprazole 15mg DR Cap APX K APX N 7 Apo-Lansoprazole 30mg DR Cap APX K APX N 7 Apo-Levocarb CR 100mg & 25mg Tab APX K 5 Apo-Levocarb CR 200mg & 50mg Tab APX H 8 Apo-Levofloxacin 250mg Tab APX L 3 Apo-Levofloxacin 500mg Tab APX L 3 Apo-Levofloxacin 750mg Tab APX L 16 Apo-Lisinopril/HCTZ 20 & 25mg Tab APX A 14 Apo-Lithium Carbonate SR 300mg ER Tab APX N 6 Apo-Loxapine 5mg Tab APX H APX Q 23 Apo-Loxapine 10mg Tab APX H APX Q 23 Apo-Loxapine 25mg Tab APX H APX Q 23 Apo-Loxapine 50mg Tab APX H APX Q 23 Apo-Medroxy 100mg Tab APX H 8 Apo-Megestrol 40mg Tab APX H 8 Apo-Megestrol 160mg Tab APX J 8 Apo-Methazolamide 50mg Tab APX H 8 Apo-Methoprazine 2mg Tab APX H 8 Apo-Methyldopa 125mg Tab APX H 8 Page 34

35 Apo-Methyldopa 250mg Tab APX H 8 Apo-Methyldopa 500mg Tab APX H 8 Apo-Methylphenidate SR 20mg ER Tab APX J 8 Apo-Metoprolol SR 100mg LA Tab APX C 7 Apo-Metoprolol SR 200mg LA Tab APX C 7 Apo-Metronidazole 250mg Tab APX H 8 Apo-Midodrine 2.5mg Tab APX H 8 Apo-Midodrine 5mg Tab APX H 8 Apo-Misoprostol 100mcg Tab APX H 8 Apo-Misoprostol 200mcg Tab APX H 8 Apo-Naproxen 125mg Tab APX H 8 Apo-Naproxen SR 750mg SR Tab APX H 8 Apo-Nifed 5mg Cap APX H 8 Apo-Nifed 10mg Cap APX J 8 Apo-Nifed PA 10mg LA Tab APX H APX P 8 Apo-Nifed PA 20mg LA Tab APX H APX P 8 Apo-Nitrofurantoin 50mg Tab APX H 8 Apo-Nitrofurantoin 100mg Tab APX H 8 Apo-Olanzapine 2.5mg Tab APX O APX P 10 Apo-Olanzapine 5mg Tab APX O APX P 10 Apo-Olanzapine 7.5mg Tab APX O APX P 10 Apo-Olanzapine 10mg Tab APX O APX P 10 Apo-Olanzapine 15mg Tab APX O APX P 10 Apo-Olanzapine 20mg Tab APX O 19 Apo-Ondansetron 4mg/5mL O/L APX I 4 Apo-Oxycodone/Acet 5mg & 325mg Tab APX L 3 Apo-Perphenazine 2mg Tab APX H 8 Apo-Perphenazine 4mg Tab APX H 8 Apo-Perphenazine 8mg Tab APX H 8 Apo-Perphenazine 16mg Tab APX H 8 Apo-Prednisone 1mg Tab APX H 8 Apo-Primidone 125mg Tab APX H 8 Apo-Primidone 250mg Tab APX H 8 Apo-Propranolol 120mg Tab APX H 8 Apo-Quetiapine 25mg Tab APX D 4 Apo-Quetiapine 100mg Tab APX D 4 Apo-Quetiapine 200mg Tab APX D APX E 6 Apo-Quetiapine 300mg Tab APX D APX E 6 Apo-Raloxifene 60mg Tab APX I APX M 10 Page 35

36 Apo-Ramipril 15mg Cap APX J 10 Apo-Rivastigmine 1.5mg Cap APX P 3 Apo-Rivastigmine 3mg Cap APX P 3 Apo-Rivastigmine 4.5mg Cap APX P 3 Apo-Rivastigmine 6mg Cap APX P 3 Apo-Ropinirole 0.25mg Tab APX Q 4 Apo-Ropinirole 1mg Tab APX Q 4 Apo-Ropinirole 2mg Tab APX Q 4 Apo-Ropinirole 5mg Tab APX Q 4 Apo-Salvent 2mg Tab APX H 8 Apo-Salvent 4mg Tab APX H 9 Apo-Salvent CFC Free 100mcg/Metered Dose Inh-200 dose Pk APX N 7 Apo-Salvent Ipravent Sterules 500mcg/2.5mg/2.5mL Inh Sol-2.5mL Pk APX A APX K 11 Apo-Salvent Sterule 1mg/mL Inh Sol-2.5mL Pk APX H 19 Apo-Salvent Sterule 2mg/mL Inh Sol-2.5mL Pk APX H 19 Apo-Sibutramine 10mg Cap APX P 15 Apo-Sibutramine 15mg Cap APX P 15 Apo-Sulfinpyrazone 200mg Tab APX H 9 Apo-Tetra 250mg Cap APX H 9 Apo-Tramadol/Acet 37.5mg & 325mg Tab APX P 15 Apo-Trifluoperazine 1mg Tab APX H 9 Apo-Trifluoperazine 2mg Tab APX H 9 Apo-Trifluoperazine 5mg Tab APX H 9 Apo-Trifluoperazine 10mg Tab APX H 9 Apo-Trihex 2mg Tab APX H 9 Apo-Trihex 5mg Tab APX H 9 Apo-Trimethoprim 100mg Tab APX H 9 Apo-Trimethoprim 200mg Tab APX H 9 Apo-Trimip 75mg Cap APX H 9 Apo-Trimip 12.5mg Tab APX H 9 Apo-Trimip 25mg Tab APX J 8 Apo-Trimip 50mg Tab APX J 8 Apo-Trimip 100mg Tab APX J 8 Apo-Valacyclovir 500mg Tab APX A 5 Apo-Venlafaxine XR 37.5mg ER Cap APX Q 4 Apo-Venlafaxine XR 75mg ER Cap APX Q 4 Apo-Venlafaxine XR 150mg ER Cap APX Q 4 Apo-Zidovudine 100mg Cap APX J 10 Apri mg & 0.03mg Tab-21 Pk APX H 4 Apri mg & 0.03mg Tab-28 Pk APX H 4 Aredia 3mg/mL Inj Sol-10mL Vial NOV C 10 Aredia 6mg/mL Inj Sol-10mL Vial NOV H 21 Aredia 9mg/mL Inj Sol-10mL Vial NOV C 10 Aricept 5mg Tab PFI Q 14 Aricept 10mg Tab PFI Q 14 Arixtra 2.5mg Inj-0.5mL Pk GSK H 9 Aromasin 25mg Tab PFI Q 14 Artane 0.4mg/mL O/L LED A 16 Page 36

37 Arthrotec 50 50mg & 200mcg Tab PFI Q 14 Arthrotec 75 75mg & 200mcg Tab PFI Q 14 Asacol 400mg Tab PGP M 10 Asacol 800mg Tab PGP M 10 Ascensia Elite Strip BAL P 13 Atacand 32mg Tab AZC I 2 Atripla 600mg/300mg/200mg Tab BQU A BQU H 22 Atropine Sulfate 1% Oph Oint-3.5g Pk ALC M 7 Avalide 150 & 12.5mg Tab SAV H 9 Avalide 300 & 12.5mg Tab SAV H 9 Avalide 300 & 25mg Tab SAV H 9 Avapro 75mg Tab SAV H 9 Avapro 150mg Tab SAV H 9 Avapro 300mg Tab SAV H 9 Avelox 400mg Tab BAY F 7 Avodart 0.5mg Cap GSK H 9 AZITHROMYCIN J 3 P 3 Q 7 Bactroban 2% Cr GSK H 9 Bactroban 2% Oint GSK H 9 Benoxyl 5% Lot STI H 9 Benoxyl 10% Lot STI H 9 Benoxyl 20% Lot STI H 9 Betaloc 50mg Tab AZC L AZC Q 22 Betaloc 100mg Tab AZC L AZC Q 22 Betaseron 9,600,000IU Inj Pref Syr-0.3mg Pk BAH A 8 Betnesol 5mg/100mL Enema-100mL Pk SQI F PAL H PAL Q 14 Bezalip 400mg SR Tab AGP K AGP Q 14 Biaxin 125mg/5mL Ped Gran ABB G ABB Q 14 Biaxin 250mg/5mL Susp ABB G ABB Q 14 Biaxin 250mg Tab ABB G ABB Q 14 Biphentin 10mg ER Cap PFP K PFP Q 14 Biphentin 15mg ER Cap PFP K PFP Q 14 Biphentin 20mg ER Cap PFP K PFP Q 14 Biphentin 30mg ER Cap PFP K PFP Q 14 Page 37

38 Biphentin 40mg ER Cap PFP K PFP Q 14 Biphentin 50mg ER Cap PFP K PFP Q 14 Biphentin 60mg ER Cap PFP K 2 Biphentin 80mg ER Cap PFP K PFP Q 14 Bonefos 400mg Cap BAY F BAY P 10 Boost 1.0 Standard 1.06kcal/mL Liq-237mL Pk NES E 7 Boost 1.5 Plus Calories 1.5kcal/mL Liq-237mL Pk NES E 7 Boost Fruit Flavoured Beverage Liq-235mL Pk NES E 7 Botox 100U/Vial Pd Inj-100U Vial Pk ALL A ALL O 20 Breeze 2 Strip BAH E 10 Brevicon 0.035mg & 0.5mg Tab-21 Pk PFI Q 14 Brevicon 0.035mg & 0.5mg Tab-28 Pk PFI Q 14 Brevicon 1/ mg & 1mg Tab-21 Pk PFI Q 14 Brevicon 1/ mg & 1mg Tab-28 Pk PFI Q 14 BRIMONIDINE A 6 B 2 BRIMONIDINE TARTRATE & TIMOLOL MALEATE A 2 BUPROPION HCL E 3 C.E.S. 1.25mg Tab VAL B VAL Q 23 Caduet 5mg/10mg Tab PFI O 16 Caduet 5mg/20mg Tab PFI O 16 Caduet 5mg/40mg Tab PFI O 16 Caduet 5mg/80mg Tab PFI O 16 Caduet 10mg/20mg Tab PFI O 16 Cafergot 1mg & 100mg Tab NOV H 9 Calcimar 400IU/2mL Inj Sol-2mL Pk SAV H 9 CANDESARTAN CILEXETIL I 2 Capoten 12.5mg Tab BQU J BQU Q 22 Capoten 100mg Tab BQU H 17 Captopril 12.5mg Tab ZYN Q 12 Captopril 25mg Tab ZYN Q 12 Captopril 50mg Tab ZYN Q 12 Captopril 100mg Tab ZYN Q 12 Cardizem 30mg Tab BIO H BIO M BIO Q 15 Cardizem 60mg Tab BIO B BIO H BIO Q 15 Cardizem CD 120mg LA Cap BIO H BIO Q 15 Cardizem CD 180mg LA Cap BIO H 9 Page 38

39 BIO Q 15 Cardizem CD 240mg LA Cap BIO H BIO Q 15 Cardizem CD 300mg LA Cap BIO H BIO Q 15 CARVEDILOL P 4 Q 8 CeeNU 10mg Cap BQU H BQU Q 15 CeeNU 40mg Cap BQU H BQU Q 15 CeeNU 100mg Cap BQU H BQU Q 15 CEFEPIME I 13 Cefepime for Injection 1g Inj Pd-Vial Pk APX I 13 Cefepime for Injection 2g Inj Pd-Vial Pk APX I 13 CEFPROZIL D 4 O 2 P 3 Cefprozil Tablets 250mg Tab RAN P 3 Cefprozil Tablets 500mg Tab RAN O 2 Ceftin 125mg/5mL Susp GSK H 9 Ceftin 250mg Tab GSK H 9 Ceftin 500mg Tab GSK H 9 CEFTRIAXONE DISODIUM A 5 A 14 Ceftriaxone for Injection USP 0.25g/Vial Inj Pd-1 Vial Pk ORC A 5 Ceftriaxone for Injection USP 10g/Vial Inj Pd-1 Vial Pk APX A 14 Cefzil 125mg/5mL Oral Susp BQU H 9 Cefzil 250mg/5mL Oral Susp BQU H 9 Cefzil 250mg Tab BQU H 9 Cefzil 500mg Tab BQU H 9 Celebrex 100mg Cap PFI Q 15 Celebrex 200mg Cap PFI Q 15 Celexa 20mg Tab VLH I 9 Celexa 40mg Tab VLH I 9 Celontin 300mg Cap ERF P 10 Cerubidine Inj Pd-20mg Pk ERF C 7 Cetamide 10% Oph Oint-3.5g Pk ALC M 7 CETIRIZINE HYDROCHLORIDE E 8 M 12 Choledyl 10mg/mL O/L PDA H 20 Choledyl 20mg/mL O/L ERF C ERF F 7 CICLESONIDE L 2 CILAZAPRIL & HYDROCHLOROTHIAZIDE I 5 Cipralex 10mg Tab VLH C VLH I 9 Cipralex 20mg Tab VLH C 2 Page 39