電 話 一 通, 我 們 即 在! 1-877-817-5793 7 8 8 Connecticut: Florida: Georgia: WellCare Access (HMO SNP)...1-866-635-7047...1-866-579-8006 WellCare Access Libe

2014 綜 合 處 方 藥 目 錄 ( 承 保 藥 物 清 單 ) Medicare Advantage 計 劃 08/01/2014 WellCare/ Ohana www.wellcare.com/medicare www.ohanahealthplan.com/medicare WellCare/ Ohana 雙 重 資 格 會 員 特 殊 需 求 計 劃 (SNP) WellCare Access (HMO SNP) WellCare Liberty (HMO SNP) Ohana Liberty (HMO-POS SNP) WellCare Select (HMO SNP) 所 有 的 New York 和 Connecticut 計 劃 WellCare Choice (HMO/HMO-POS) WellCare Rx (HMO) WellCare Value (HMO/HMO-POS) HPMS ID 14171 21 Y0070_NA022832_WCM_FOR_CHI_FINAL_03 CMS Approved 08262013 WellCare 2014 NA_07_14 NA4V03FOR53290C_0814

電 話 一 通, 我 們 即 在! 1-877-817-5793 7 8 8 Connecticut: Florida: Georgia: WellCare Access (HMO SNP)...1-866-635-7047...1-866-579-8006 WellCare Access Liberty Select (HMO SNP)...1-866-637-8041 WellCare Access (HMO SNP)...1-866-482-3361 Hawaii: Ohana Liberty (HMO-POS SNP)...1-877-457-7621 Illinois: WellCare Access (HMO SNP)...1-866-439-1190 Kentucky: WellCare Access (HMO SNP)...1-877-560-3206 Louisiana: WellCare Access (HMO SNP)...1-866-530-9488 Missouri: New York: Ohio: WellCare Access (HMO SNP)...1-866-635-7049 WellCare Access (HMO SNP)...1-866-482-3363 WellCare Liberty (HMO SNP)...1-866-491-5746...1-800-278-5155 WellCare Access (HMO SNP)...1-866-530-9487 Texas: WellCare Access (HMO SNP)...1-866-530-9495 8 8 1 14 8 8 www.wellcare.com/medicare www.ohanahealthplan.com/medicare 護 士 諮 詢 專 線... 1-800-581-9952 7 24 上 述 所 有 的 TTY 號 碼... 1-877-247-6272

WellCare/ Ohana WellCare/ Ohana 08/01/2014 2014 1 甚 麼 是 WellCare Access (HMO SNP) WellCare Choice (HMO/HMO-POS) WellCare Liberty (HMO SNP) Ohana Liberty (HMO-POS SNP) WellCare Rx (HMO) WellCare Select (HMO SNP) 和 WellCare Value (HMO/HMO-POS) 綜 合 處 方 藥 目 錄? WellCare/ Ohana WellCare/ Ohana 1. 2. WellCare/ Ohana 3. 處 方 藥 目 錄 ( 藥 物 清 單 ) 會 更 改 嗎? 2014 2014 2014 年 綜 合 處 方 藥 目 錄 I

60 60 08/01/2014 WellCare/ Ohana www.wellcare.com/medicare www.ohanahealthplan.com/medicare www.wellcare.com/medicare www.ohanahealthplan.com/medicare 如 何 使 用 處 方 藥 目 錄? 醫 療 病 況 1 1 按 英 文 字 母 順 序 排 列 95 甚 麼 是 副 廠 藥? WellCare/ Ohana FDA 我 的 承 保 有 什 麼 限 制 嗎? WellCare/ Ohana 2014 年 綜 合 處 方 藥 目 錄 II

WellCare/ Ohana sumatriptan 25mg 31 9 WellCare/ Ohana A B B A A B 1 www.wellcare.com/medicare www.ohanahealthplan.com/medicare WellCare/ Ohana WellCare/ Ohana 如 果 我 的 藥 物 不 在 處 方 藥 目 錄 中 該 怎 麼 辦? WellCare/ Ohana WellCare/ Ohana WellCare/ Ohana WellCare/ Ohana 我 們 承 保 哪 些 疫 苗? Medicare Part D Part B 如 何 請 求 WellCare Access (HMO SNP) WellCare Choice (HMO/HMO-POS) WellCare Liberty (HMO SNP) Ohana Liberty (HMO-POS SNP) WellCare Rx (HMO) WellCare Select (HMO SNP) 和 WellCare Value (HMO/HMO-POS) 處 方 藥 目 錄 的 例 外 處 理? WellCare/ Ohana 2014 年 綜 合 處 方 藥 目 錄 III

最 初 承 保 決 定 例 外 處 理 使 用 限 制 例 外 處 理 層 級 界 定 例 外 處 理 WellCare/ Ohana 72 72 24 在 我 跟 我 的 醫 生 討 論 有 關 換 藥 或 要 求 例 外 處 理 之 前, 我 要 怎 麼 做? 93 31 31 93 2014 年 綜 合 處 方 藥 目 錄 IV

98 98 98 31 31 進 一 步 詳 情 WellCare/ Ohana WellCare/ Ohana www.wellcare.com/medicare www.ohanahealthplan.com/medicare Medicare 1-800-MEDICARE (1-800-633-4227) Medicare 7 24 TTY 1-877-486-2048 www.medicare.gov WellCare/ Ohana 處 方 藥 目 錄 1 WellCare/ Ohana 95 COUMADIN simvastatin WellCare/ Ohana MS 5 WellCare/ Ohana Exactus Pharmacy Solutions TM $0 1 32 1-866-892-9006 Exactus 7 24 TTY 1-866-507-6135 ** PA II 2014 年 綜 合 處 方 藥 目 錄 V

PA-BvsD Part B Part D Medicare Part B Part D WellCare/ Ohana Medicare Part D WellCare/ Ohana PA-NS QL III LA Exactus ST III ST-NS * = 31 ** WellCare Ohana Exactus Pharmacy Solutions 藥 物 層 級 共 付 款 共 同 保 險 費 金 額 WellCare/ Ohana 1 2 WellCare/ Ohana 3 WellCare/ Ohana 4 WellCare/ Ohana 5 * 31 3 4 5 2014 年 綜 合 處 方 藥 目 錄 VI

如 何 閱 讀 處 方 藥 目 錄 列 表 : phenobarbital 2 PA-NS MS phenobarbital 2 PA-NS MS POTIGA 50MG 200MG 300MG 5* PA-NS MS* POTIGA 400MG 4 PA-NS MS * = 31 = = 可 在 處 方 藥 目 錄 背 面 的 索 引 內 快 速 查 找 您 的 藥 物 LA = MS = PA = PA-BvsD = PART B PART D PA-NS = QL = ST = ST-NS = 2014 年 綜 合 處 方 藥 目 錄 VII

butalbital-acetaminophen 50-325 mg 2 PA; MS; QL 186 31 butalbital-apap-caff-cod 50-325-40-30 mg 2 PA; MS; QL 186 31 butalbital-apap-caffeine 50-325-40 mg 2 PA; MS; QL 186 31 butalbital-apap-caffeine 50-325-40 mg 2 PA; MS; QL 186 31 butalbital-apap-caffeine 50-500-40 mg 2 PA; MS butalbital-asa-caffeine 50-325-40 mg 3 PA; MS; QL 186 31 butalbital-aspirin-caffeine 50-325-40 mg 3 PA; MS; QL 186 31 zebutal 50-500-40 mg 2 PA; MS CELEBREX 100 MG 200 MG 400 MG 50 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 1 diclofenac potassium 50 mg diclofenac sodium 25 mg 50 mg 75 mg diclofenac sodium er 24 * 100 mg diflunisal 500 mg etodolac 200 mg 300 mg etodolac 400 mg 500 mg etodolac er 24 * 400 mg 500 mg 600 mg fenoprofen calcium 600 mg flurbiprofen 100 mg 50 mg ibuprofen 100 mg/5 ml ibuprofen 400 mg 600 mg 800 mg 1 MS indomethacin 25 mg 50 mg 2 PA; MS ketoprofen 50 mg 75 mg

ketoprofen er 24 200 mg 4 MS; QL 31 31 meloxicam 7.5 mg/5 ml meloxicam 15 mg 7.5 mg 1 MS nabumetone 500 mg 750 mg naproxen 125 mg/5 ml naproxen 250 mg 375 mg 500 mg naproxen dr 375 mg 500 mg naproxen sodium 275 mg 550 mg oxaprozin 600 mg piroxicam 10 mg 20 mg salsalate 500 mg 750 mg sulindac 150 mg 200 mg fentanyl 72 100 mcg 12mcg 25 mcg ; QL 20 30 50 mcg 75 mcg methadone hcl 10 mg/ml 4 MS methadone hcl 10 mg/ml methadone hcl 10 mg/5 ml 5 mg/5 ml methadone hcl 10 mg 5 mg 1 MS; QL 248 31 methadose 10 mg 1 MS; QL 248 31 morphine sulfate 15 mg 30 mg ; QL 248 31 morphine sulfate (pf) * 8 mg/ml morphine sulfate er * 100 mg 15 mg 200 mg 30 mg 60 mg OPANA ER 10 MG 15 MG 20 MG 30 MG 40 MG 5 MG 7.5 MG oxymorphone hcl er 12 * 10 mg 15 mg 20 mg 30 mg 40 mg 5 mg 7.5 mg ; QL 248 31 4 MS; QL 62 31 ; QL 62 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 2

acetaminophen-codeine 120-12 mg/5 ml ; QL 4650 ML 31 acetaminophen-codeine #2 300-15 mg ; QL 372 31 acetaminophen-codeine #3 300-30 mg ; QL 372 31 acetaminophen-codeine #4 300-60 mg ; QL 186 31 CO-GESIC 5-500 MG ; codeine sulfate 15 mg 30 mg ; QL 372 31 codeine sulfate 60 mg ; QL 186 31 duramorph 0.5 mg/ml 1 mg/ml endocet 10-325 mg 7.5-325 mg ; QL 372 31 endocet 10-650 mg 7.5-500 mg endocet 5-325 mg 1 MS; QL 372 31 fentanyl citrate 1200 mcg 1600 mcg 200 mcg 400 mcg 600 mcg 800 mcg hydrocodone-acetaminophen 7.5-325 mg/15 ml hydrocodone-acetaminophen 7.5-500 mg/15 ml hydrocodone-acetaminophen 10-325 mg 5-325 mg 7.5-325 mg hydrocodone-acetaminophen 10-500 mg 10-660 mg 10-750 mg hydrocodone-acetaminophen 10-650 mg 2.5-500 mg 7.5-500 mg 7.5-650 mg 75-750 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 3 5* PA; MS; QL 124 31 ; QL 3720 ML 31 ; QL 372 31 hydrocodone-acetaminophen 5-500 mg 1 MS hydrocodone-ibuprofen 7.5-200 mg ; QL 155 31 hydromorphone hcl 2 mg/ml 4 MS hydromorphone hcl 2 mg 4 mg 8 mg ; QL 248 31 hydromorphone hcl pf 1 mg/ml 4 mg/ml 500 mg/50 ml 4 MS

LAZANDA 100 MCG/ACT 400 MCG/ACT 5* PA; MS morphine sulfate 10 mg/ml 15 mg/ml 2 mg/ml 4 mg/ml 8 mg/ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 4 morphine sulfate 10 mg/5 ml 20 mg/5 ml morphine sulfate 20 mg/ml morphine sulfate (pf) 0.5 mg/ml 1 mg/ml morphine sulfate (pf) * 2 mg/ml 4 mg/ml oxycodone hcl 20 mg/ml 4 MS oxycodone hcl 10 mg 15 mg 20 mg 30 mg ; QL 248 31 oxycodone hcl 5 mg ; QL 248 31 oxycodone-acetaminophen 5-500 mg oxycodone-acetaminophen 10-325 mg 2.5-325 mg 7.5-325 mg oxycodone-acetaminophen 10-650 mg ; QL 372 31 oxycodone-acetaminophen 5-325 mg 1 MS; QL 372 31 REPREXAIN 10-200 MG ; QL 155 31 stagesic 5-500 mg tramadol hcl 50 mg 1 MS; QL 248 31 tramadol-acetaminophen 37.5-325 mg ; QL 310 31 lidocaine 5 % lidocaine hcl 2 % lidocaine hcl 4 % 1 MS lidocaine hcl 2 %

lidocaine hcl (pf) 0.5 % 1 % lidocaine viscous 2 % 1 MS lidocaine-prilocaine 2.5-2.5 % LIDODERM 5 % ; QL 93 31 acamprosate 333 mg 4 MS disulfiram 250 mg 500 mg naltrexone hcl 50 mg buprenorphine hcl 0.3 mg/ml 3 PA-BvsD; MS buprenorphine hcl 2 mg 8 mg 3 PA; MS naloxone hcl 1 mg/ml 1 MS SUBOXONE 12-3 MG 2-0.5 MG 4-1 MG 8-2 MG 4 PA; MS buproban 12 * 150 mg ; QL 62 31 CHANTIX 0.5 MG 1 MG 4 MS; QL 340 365 CHANTIX STARTING MONTH PAK 0.5 MG X 11 & 1 MG X 42 NICOTROL NS 10 MG/ML amikacin sulfate 50 mg/ml 500 mg/2ml gentak 0.3 % 4 MS; QL 106 365 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 5

gentamicin in saline * 0.8-0.9 mg/ml-% 1-0.9 mg/ml-% 1.6-0.9 mg/ml-% gentamicin sulfate 0.1 % 1 MS gentamicin sulfate 0.1 % 1 MS gentamicin sulfate 40 mg/ml gentamicin sulfate * 10 mg/ml gentamicin sulfate 0.3 % gentamicin sulfate 0.3 % neomycin sulfate 500 mg neomycin-polymyxin b gu 40-200000 paromomycin sulfate 250 mg streptomycin sulfate * 1 gm TOBI PODHALER 28 MG 5* PA; MS tobramycin 300 mg/5 ml 5* PA; MS tobramycin 0.3% 2 tobramycin sulfate 10 mg/ml 80 mg/2 ml tobramycin sulfate 1.2 gm ZYLET 0.5-0.3 % 4 MS baciim * 50000 bacitra-neomycin-polymyxin-hc 1 % bacitracin * 50000 bacitracin 500 gm bacitracin-polymyxin b 500-10000 gm LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 6

chloramphenicol sod succinate * 1 gm clindamycin hcl 150 mg 300 mg 75 mg 1 MS clindamycin phosphate * 600 mg/4 ml clindamycin phosphate 2 % clindamycin phosphate in d5w * 300 mg/50 ml 600 mg/50 ml 900 mg/50 ml colistimethate sodium 150 mg 4 MS CUBICIN * 500 MG 5* PA; MS methenamine hippurate 1 gm metronidazole 0.75 % metronidazole 0.75 % metronidazole 0.75 % metronidazole 250 mg 500 mg metronidazole 0.75 % metronidazole in nacl * 500-0.79 mg/100 ml-% mupirocin 2 % mupirocin calcium 2 % 4 MS neomycin-bacitracin zn-polymyx 5-400-10000 neomycin-polymyxin-gramicidin 1.75-10000-0.25 neomycin-polymyxin-hc 3.5-10000-1 nitrofurantoin macrocrystal 100 mg 50 mg 3 PA; MS; QL 90 365 nitrofurantoin monohyd macro 100 mg 3 PA; MS; QL 90 365 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 7

polycin b 500-10000 gm polymyxin b-trimethoprim 10000-0.1 ml-% LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 8 silver sulfadiazine 1 % ssd 1 % trimethoprim 100 mg TYGACIL * 50 MG 5* PA; MS vancomycin hcl * 10 gm 1000 mg 500 mg 5000 mg 750 mg vancomycin hcl 125 mg 250 mg 5* PA; MS vandazole 0.75 % XIFAXAN 200 MG 550 MG 5* ST; MS ZYVOX * 2 MG/ML 5* PA; MS ZYVOX 100 MG/5 ML 5* PA; MS ZYVOX 600 MG 5* PA; MS; QL 62 31 - 酰 cefaclor 250 mg 500 mg cefadroxil 500 mg cefadroxil 250 mg/5 ml 500 mg/5 ml cefadroxil 1 gm cefazolin sodium 1 gm 10 gm 500 mg cefazolin sodium * 1-5 gm-% cefdinir 300 mg cefdinir 125 mg/5 ml 250 mg/5ml cefepime hcl 1 gm 2 gm

cefotaxime sodium 1 gm 10 gm 2 gm 500 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 9 cefoxitin sodium 10 gm cefoxitin sodium * 1 gm 2 gm cefpodoxime proxetil 100 mg/5 ml 50 mg/5 ml cefpodoxime proxetil 100 mg 200 mg cefprozil 125 mg/5 ml 250 mg/5 ml cefprozil 250 mg 500 mg ceftazidime 1 gm 100 gm 2 gm 6 gm ceftazidime and dextrose * 1 gm/50 ml 2 gm/50 ml ceftriaxone sodium 250 mg 500 mg ceftriaxone sodium * 1 gm 10 gm 2 gm cefuroxime axetil 125 mg/5 ml cefuroxime axetil 250 mg 500 mg cefuroxime sodium 1.5 gm 7.5 gm 750 mg cephalexin 250 mg 500 mg 1 MS cephalexin 125 mg/5 ml 250 mg/5 ml cephalexin 250 mg 500 mg SUPRAX 400 MG 4 MS SUPRAX 100 MG/5 ML 200 MG/5 ML 500 MG/5 ML 4 MS

SUPRAX 400 MG 4 MS SUPRAX 100 MG 200 MG 4 MS - imipenem-cilastatin * 250 mg 500 mg INVANZ 1 GM 4 MS meropenem * 1 gm 500 mg 4 MS - amoxicillin 250 mg 500 mg 1 MS amoxicillin 125 mg/5 ml 200 mg/5 ml 250 mg/5 ml 400 mg/5 ml amoxicillin 500 mg 875 mg amoxicillin 125 mg 250 mg amoxicillin-pot clavulanate 200-28.5 mg/5 ml 250-62.5 mg/5 ml 400-57 mg/5 ml 600-42.9 mg/5 ml amoxicillin-pot clavulanate 250-125 mg 500-125 mg 875-125 mg amoxicillin-pot clavulanate 200-28.5 mg 400-57 mg ampicillin 250 mg 500 mg 1 MS ampicillin 125 mg/5 ml 250 mg/5 ml ampicillin sodium 1 gm 125 mg 2 gm 250 mg 500 mg 4 MS ampicillin-sulbactam sodium 3 (2-1) gm ampicillin-sulbactam sodium * 15 (10-5) gm LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 10

BACTOCILL IN DEXTROSE * 2 GM/50 ML 4 MS BICILLIN C-R * 1200000 2 ML BICILLIN C-R 900 300 * 900000-300000 2 ML BICILLIN L-A * 1200000 2 ML 2400000 4 ML 600000 ML dicloxacillin sodium 250 mg 500 mg oxacillin sodium 1 gm 10gm 2 gm 4 MS penicillin g potassium 20000000 5000000 penicillin g procaine * 600000 ml penicillin v potassium 125 mg/5 ml 250 mg/5 ml 4 MS 1 MS penicillin v potassium 250 mg 500 mg 1 MS PFIZERPEN-G 20000000 5000000 4 MS piperacillin sod-tazobactam so * 3-0.375 gm 4-0.5 gm LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 11 TIMENTIN * 3.1 GM AZASITE 1 % azithromycin * 500 mg azithromycin 1 gm azithromycin 100 mg/5 ml 200 mg/5 ml

azithromycin 250 mg 500 mg 600 mg clarithromycin 125 mg/5 ml 250 mg/5 ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 12 clarithromycin 250 mg 500 mg clarithromycin er 24 * 500 mg DIFICID 200 MG 5* PA; MS e.e.s. 400 400 mg E.E.S. GRANULES 200 MG 5 ML ERY-TAB 250 MG 333 MG 500 MG ERYPED 200 200 MG/5 ML ERYTHROCIN LACTOBIONATE * 500 MG 4 MS erythrocin stearate 250 mg erythromycin 2 % erythromycin 2 % erythromycin 5 mg/gm erythromycin base 250 mg 500 mg erythromycin ethylsuccinate 400 mg erythromycin-sulfisoxazole 200-600 gm/5 ml 喹 BESIVANCE 0.6 % 4 MS CIPRODEX 0.3-0.1 % 4 MS ciprofloxacin * 400 mg/40 ml ciprofloxacin hcl 0.3 %

ciprofloxacin hcl 100 mg 250 mg 500 mg 750 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 13 1 MS ciprofloxacin in d5w * 200 mg/100 ml gatifloxacin 0.5 % 4 MS levofloxacin * 25 mg/ml levofloxacin 25 mg/ml levofloxacin 250 mg 500 mg 750 mg levofloxacin in d5w * 250 mg/50 ml 500 mg/100 ml 750 mg/150 ml MOXEZA 0.5 % 4 MS ofloxacin 0.3 % ofloxacin 200 mg 300 mg 400 mg ofloxacin 0.3 % VIGAMOX 0.5 % 4 MS sulfacetamide sodium 10 % 1 MS sulfacetamide sodium 10 % sulfacetamide-prednisolone 10-0.23 % sulfadiazine 500 mg sulfamethoxazole-tmp ds 800-160 mg 1 MS sulfamethoxazole-trimethoprim * 400-80 mg/5 ml sulfamethoxazole-trimethoprim 200-40 mg/5 ml sulfamethoxazole-trimethoprim 400-80 mg demeclocycline hcl 150 mg 4 MS

demeclocycline hcl 300 mg 5* MS doxycycline hyclate * 100 mg doxycycline hyclate 100 mg 50 mg 1 MS doxycycline hyclate 100 mg 20 mg doxycycline hyclate 100 mg 150 mg 75 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 14 4 MS minocycline hcl 100 mg 50 mg 75 mg tetracycline hcl 250 mg 500 mg 1 MS APTIOM 200 MG 4 PA-NS; MS; OL 31 365 APTIOM 400 MG 800 MG 5* PA-NS; MS; OL 31 365 APTIOM 600 MG 5* PA-NS; MS; OL 62 365 FYCOMPA 10 MG 12 MG 2 MG 4 MG 8 MG 4 PA-NS; MS FYCOMPA 6 MG 5* PA-NS; MS levetiracetam * 500 mg/5 ml 4 MS levetiracetam 100 mg/ml levetiracetam 1000 mg 250 mg 500 mg 750 mg levetiracetam in nacl * 1000 mg/100 ml 1500 mg/100 ml 500 mg/100 ml 4 MS phenobarbital 20 mg/5 ml 2 PA-NS; MS phenobarbital 100 mg 15 mg 16.2 mg 30 mg 32.4 mg 60 mg 64.8 mg 97.2 mg 2 PA-NS; MS POTIGA 200 MG 300 MG 50 MG 5* PA-NS; MS POTIGA 400 MG 4 PA-NS; MS

CELONTIN 300 MG ethosuximide 250 mg ethosuximide 250 mg/5 ml LYRICA 100 MG 150 MG 200 MG 25 MG 50 MG 75 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 15 4 MS; QL 93 31 LYRICA 225 MG 300 MG 4 MS; QL 62 31 LYRICA 20 MG/ML 4 MS; QL 930 ml 31 zonisamide 100 mg 25 mg 50 mg - (GaBa) clonazepam 0.5 mg 1 MS; QL 93 31 clonazepam 1 mg 1 MS; QL 124 31 clonazepam 2 mg 1 MS; QL 310 31 clonazepam 0.125 mg 0.25 mg 4 MS; QL 62 31 clonazepam 0.5 mg 4 MS; QL 93 31 clonazepam 1 mg 4 MS; QL 124 31 clonazepam 2 mg 4 MS; QL 310 31 clorazepate dipotassium 15 mg 3.75 mg 7.5 mg diazepam 10 mg 2.5 mg 20 mg 4 MS divalproex sodium 125 mg divalproex sodium 125 mg 250 mg 500 mg divalproex sodium er 24 * 250 mg 500 mg gabapentin 100 mg 300 mg ; QL 372 31 gabapentin 400 mg ; QL 279 31 gabapentin 250 mg/5 ml gabapentin 600 mg ; QL 186 31

gabapentin 800 mg ; QL 140 31 GABITRIL 12 MG 16 MG 4 MS GRALISE 300 MG 600 MG 4 ST-NS; MS GRALISE STARTER 雑 300 & 600 MG 4 ST-NS; MS ONFI 2.5 MG/ML 4 MS ONFI 10 MG 20 MG 5 MG 4 MS primidone 250 mg 50 mg SABRIL 500 MG 5* PA-NS; LA; QL 186 31 SABRIL 500 MG 5* PA-NS; LA; QL 186 31 tiagabine hcl 2 mg 4 mg 4 MS valproate sodium * 100 mg/ml valproic acid 250 mg valproic acid 250 mg/5 ml felbamate 600 mg/5 ml 5* MS felbamate 400 mg 4 MS felbamate 600 mg 5* MS lamotrigine 100 mg 150 mg 200 mg 25 mg BANZEL 200 MG 400 MG 5* PA-NS; MS; QL 248 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 16 lamotrigine 25 mg 5 mg topiramate 15 mg 25 mg topiramate 100 mg 200 mg 25 mg 50 mg TROKENDI XR 24 100 MG 25 MG 50 MG 1 MS 4 PA-NS; MS; QL 62 31 TROKENDI XR 24 200 MG 5* PA-NS; MS; QL 62 31 BANZEL 40 MG/ML 5* PA-NS; MS

carbamazepine 100 mg/5 ml carbamazepine 200 mg carbamazepine er 12 100 mg 200 mg 300 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 17 DILANTIN 30 MG DILANTIN INFATABS 50 MG epitol 200 mg 1 MS fosphenytoin sodium 100 mg pe/2 ml oxcarbazepine 300 mg/5 ml 4 MS oxcarbazepine 150 mg 300 mg 600 mg PEGANONE 250 MG 4 MS phenytoin 125 mg/5 ml phenytoin 50 mg phenytoin sodium 50 mg/ml phenytoin sodium 100 mg 200 mg 300 mg VIMPAT * 200 MG/20 ML 4 MS VIMPAT 10 MG/ML 4 MS VIMPAT 100 MG 150 MG 200 MG 50 MG 4 MS ergoloid mesylates 1 mg donepezil hcl 10 mg 5 mg 1 MS donepezil hcl 10 mg 5 mg EXELON 2 MG/ML

EXELON 24 13.3 MG/ 24 4.6 MG/ 24 9.5 MG/ 24 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 18 ; QL 31 31 galantamine hydrobromide 4 mg/ml 4 MS; QL 186 ml 31 galantamine hydrobromide 12 mg 4 mg 8 mg galantamine hydrobromide er 24 16 mg 24 mg 8 mg rivastigmine tartrate 1.5 mg 3 mg 4.5 mg 6 mg N--D- (Nmda) 4 MS; QL 62 31 4 MS; QL 31 31 NAMENDA 10 MG/5 ML NAMENDA 10 MG 5 MG ; QL 62 31 NAMENDA 5 (28)-10 (21)MG NAMENDA XR 24 14 MG 21 MG 28 MG 7 MG NAMENDA XR 24 7 & 14 & 21 & 28 MG budeprion sr 12 * 100 mg 150 mg ; QL 31 31 bupropion hcl 100 mg 75 mg bupropion hcl er (sr) 12 * 100 mg 150 mg 200 mg bupropion hcl er (xl) 24 * 150 mg 300 mg ; QL 62 31 ; QL 62 31 ; QL 31 31 forfivo xl 24 * 450 mg ; QL 31 31 maprotiline hcl 25 mg 50 mg 75 mg mirtazapine 15 mg 30 mg 45 mg 7.5 mg

mirtazapine 15 mg 30 mg 45 mg nefazodone hcl 100 mg 150 mg 200 mg 250 mg 50 mg trazodone hcl 100 mg 150 mg 50 mg 1 MS trazodone hcl 300 mg EMSAM 24 12 MG/ 24 6 MG/ 24 9 MG/ 24 5* PA-NS; MS; QL 31 31 MARPLAN 10 MG 4 MS phenelzine sulfate 15 mg tranylcypromine sulfate 10 mg BRINTELLIX 10 MG 20 MG 5 MG 4 PA-NS; MS; QL 31 31 citalopram hydrobromide 10 mg/5 ml citalopram hydrobromide 10 mg 20 mg 1 MS; QL 62 31 citalopram hydrobromide 40 mg 1 MS; QL 31 31 duloxetine hcl 20 mg 30 mg 60 mg 4 MS; QL 62 31 escitalopram oxalate 5 mg/5 ml escitalopram oxalate 10 mg 20 mg 5 mg ; QL 31 31 FETZIMA 24 120 MG 20 MG 40 MG 80 MG 4 PA-NS; MS; QL 31 31 FETZIMA TITRATION C4PK 20 & 40 MG 4 PA-NS; MS; QL 31 31 fluoxetine hcl 10 mg 20 mg 40 mg 1 MS fluoxetine hcl 20 mg/5 ml fluoxetine hcl 10 mg 1 MS fluvoxamine maleate 100 mg 25 mg 50 mg paroxetine hcl 10 mg 20 mg 30 mg 40 mg ; QL 62 31 PAXIL 10 MG/5 ML 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 19

PRISTIQ 24 * 100 MG 50 MG 4 PA-NS; MS; QL 31 31 sertraline hcl 20 mg/ml sertraline hcl 100 mg 25 mg 50 mg 1 MS venlafaxine hcl 100 mg 25 mg 37.5 mg 50 mg 75 mg venlafaxine hcl er 24 150 mg 37.5 mg 75 mg ; QL 31 31 venlafaxine hcl er 24 * 150 mg 37.5 mg 75 mg 4 MS; QL 31 31 VIIBRYD 10 & 20 & 40 MG 4 ST-NS; MS; QL 31 31 VIIBRYD 10 MG 20 MG 40 MG 4 ST-NS; MS; QL 31 31 amitriptyline hcl 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg amoxapine 100 mg 150 mg 25 mg 50 mg chlordiazepoxide-amitriptyline 10-25 mg 5-12.5 mg 2 PA-NS; MS 2 PA-NS; MS clomipramine hcl 25 mg 50 mg 75 mg desipramine hcl 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg doxepin hcl 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg 2 PA-NS; MS doxepin hcl 10 mg/ml 2 PA-NS; MS imipramine hcl 10 mg 25 mg 50 mg 2 PA-NS; MS imipramine pamoate 100 mg 125 mg 150 mg 75 mg nortriptyline hcl 10 mg 25 mg 50 mg 75 mg 4 PA-NS; MS nortriptyline hcl 10 mg/5 ml 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 20

perphenazine-amitriptyline 2-10 mg 2-25 mg 4-10 mg 4-25 mg 4-50 mg 2 PA-NS; MS protriptyline hcl 10 mg 5 mg SURMONTIL 100 MG 25 MG 50 MG 4 MS trimipramine maleate 100 mg 25 mg 50 mg 3 PA-NS; MS hydroxyzine hcl 10 mg/5 ml 2 PA; MS hydroxyzine hcl 10 mg 25 mg 2 PA; MS meclizine hcl 12.5 mg 25 mg PHENADOZ 12.5 MG 25 MG 3 PA; MS promethazine hcl 12.5 mg 25 mg 3 PA; MS PROMETHEGAN 25 MG 50 MG 3 PA; MS dronabinol 10 mg 5 mg 5* PA; MS; QL 62 31 dronabinol 2.5 mg 3 PA; MS; QL 62 31 EMEND 125 MG 40 MG 80 & 125 MG 80 MG 4 PA-BvsD; MS granisetron hcl * 0.1 mg/ml 1 mg/ml 3 PA; MS; QL 10 ml 31 granisetron hcl 1 mg 3 PA; MS; QL 31 31 ondansetron 4 mg 8 mg 1 MS ondansetron hcl 4 mg/2 ml ondansetron hcl 4 mg/5 ml 3 PA; MS ondansetron hcl 24 mg 4 mg 8 mg 1 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 21

AMBISOME * 50 MG 5* PA; MS amphotericin b 50 mg CANCIDAS * 50 MG 70 MG 5* PA; MS ciclopirox 0.77 % ciclopirox 1 % ciclopirox 8 % ciclopirox olamine 0.77 % ciclopirox olamine 0.77 % clotrimazole 1 % clotrimazole 1 % clotrimazole 10 mg econazole nitrate 1 % fluconazole 10 mg/ml 40 mg/ml fluconazole 100 mg 150 mg 200 mg 50 mg fluconazole in dextrose * 200 mg/100 ml 400 mg/200 ml fluconazole in sodium chloride * 100-0.9 gm/50 ml-% LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 22 1 MS flucytosine 250 mg 500 mg 5* MS griseofulvin 125 mg/5 ml griseofulvin 500 mg 4 MS griseofulvin 125 mg 250 mg 4 MS itraconazole 100 mg 3 PA; MS ketoconazole 2 % ketoconazole 2 % 4 MS ketoconazole 2 %

ketoconazole 200 mg MYCAMINE * 100 MG 50 MG 5* PA; MS NAFTIN 1 % 2 % NAFTIN 1 % 2 % NATACYN 5 % NOXAFIL 40 MG/ML 4 PA; MS nyamyc 100000 gm nystatin 100000 gm nystatin 100000 gm nystatin 100000 gm nystatin 100000 ml nystatin 500000 nystatin-triamcinolone 100000-0.1 gm-% nystatin-triamcinolone 100000-0.1 gm-% nystop 100000 gm pedi-dri 100000 gm terbinafine hcl 250 mg terconazole 0.4 % 0.8 % terconazole 80 mg voriconazole * 200 mg 4 PA; MS voriconazole 200 mg 5* PA; MS; QL 62 31 voriconazole 50 mg 5* PA; MS; QL 186 31 zazole 0.4 % 0.8 % zazole 80 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 23

allopurinol 100 mg 300 mg 1 MS colchicine-probenecid 0.5-500 mg COLCRYS 0.6 MG probenecid 500 mg ULORIC 40 MG 80 MG 4 ST; MS dihydroergotamine mesylate 1 mg/ml MIGERGOT 2-100 MG 4 MS MIGRANAL 4 MG/ML 4 MS (5-Ht) 1B/1D naratriptan hcl 1 mg 2.5 mg ; QL 9 31 sumatriptan 20 mg/act 5 mg/act 4 MS; QL 12 31 sumatriptan succinate 100 mg 25 mg 50 mg sumatriptan succinate * 6 mg/0.5 ml sumatriptan succinate * 4 mg/0.5 ml sumatriptan succinate * 6 mg/0.5 ml sumatriptan succinate * 6 mg/0.5 ml guanidine hcl 125 mg MESTINON 60 MG/5 ML MESTINON * 180 MG pyridostigmine bromide 60 mg ; QL 9 31 ; QL 8 ml 31 4 MS; QL 8 ml 31 ; QL 8 ml 31 4 MS; QL 8 ml 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 24

dapsone 100 mg 25 mg MYCOBUTIN 150 MG 4 MS rifabutin 150 mg 4 MS CAPASTAT SULFATE 1 GM 4 MS ethambutol hcl 100 mg 400 mg isoniazid 50 mg/5 ml isoniazid 100 mg 300 mg 1 MS PASER 4 GM 4 MS PRIFTIN 150 MG 4 MS pyrazinamide 500 mg rifampin * 600 mg 4 MS rifampin 150 mg 300 mg TRECATOR 250 MG 4 MS cyclophosphamide 1 gm 2 gm 500 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 25 4 PA-BvsD; MS cyclophosphamide 25 mg 50 mg 3 PA-BvsD; MS HEXALEN 50 MG 5* PA-NS; MS ifosfamide * 1 gm LEUKERAN 2 MG lomustine 10 mg 100 mg 40 mg MATULANE 50 MG 5* MS TREANDA * 100 MG 25 MG 5* PA-BvsD; MS

CAPRELSA 100 MG 5* PA-NS; MS; QL 62 31 CAPRELSA 300 MG 5* PA-NS; MS; QL 31 31 REVLIMID 10 MG 15 MG 2.5 MG 20 MG 25 MG 5 MG THALOMID 100 MG 150 MG 200 MG 50 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 26 5* PA-NS; LA 5* PA-NS; MS EMCYT 140 MG 4 PA-NS; MS FARESTON 60 MG 5* MS; QL 31 31 FASLODEX * 250 MG/5 ML 5* SOLTAMOX 10 MG/5 ML 4 MS tamoxifen citrate 10 mg 20 mg ALIMTA * 100 MG 500 MG 5* PA-BvsD; MS DROXIA 200 MG 300 MG 400 MG ELITEK * 1.5 MG 7.5 MG 5* PA-BvsD; MS hydroxyurea 500 mg mercaptopurine 50 mg pentostatin * 10 mg 5* PA-NS; MS TABLOID 40 MG 4 PA-NS; MS TAFINLAR 50 MG 75 MG 5* PA-NS; LA amifostine * 500 mg 5* PA-BvsD; MS azacitidine 100 mg 5* PA-BvsD; MS PA-BvsD; MS; QL 10 ml 28

bleomycin sulfate 15 30 3 PA-BvsD; MS COMETRIQ 100 MG 劑 1 X 80 & 1 X 20 MG 5* PA-NS; MS COMETRIQ 140 MG 劑 1 X 80 & 3 X 20 MG 5* PA-NS; MS COMETRIQ 60 MG 20 MG 5* PA-NS; MS ERIVEDGE 150 MG 5* PA-NS; MS; QL 31 31 ICLUSIG 15 MG 45 MG 5* PA-NS; MS IXEMPRA KIT * 15 MG 45 MG 5* PA-BvsD; MS JAKAFI 10 MG 15 MG 20 MG 25 MG 5 MG leucovorin calcium 100 mg 200 mg 350 mg 50 mg 500 mg 5* PA-NS; MS leucovorin calcium * 10 mg/ml leucovorin calcium 10 mg 15 mg 25 mg 5 mg MEKINIST 0.5 MG 2 MG 5* PA-NS; LA MENEST 0.3 MG 0.625 MG 1.25 MG 2.5 MG 4 PA; MS mesna * 100 mg/ml MESNEX 400 MG 5* MS mitoxantrone hcl * 25 mg 12.5 ml 3 PA-BvsD; MS ONTAK * 150 MCG/ML 5* PA-BvsD; MS POMALYST 1 MG 2 MG 3 MG 4 MG 5* PA-NS; MS PROLEUKIN * 22000000 5* PA-BvsD; MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 27

SYLATRON * 296 MCG 4 X 296 MCG 4 X 444 MCG 4 X 888 MCG 444 MCG 888 MCG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 28 5* PA-NS; MS SYNRIBO * 3.5 MG 5* PA-NS; MS TRISENOX * 10 MG/10 ML 5* PA-BvsD; MS VELCADE * 3.5 MG 5* PA-BvsD; MS ZOLINZA 100 MG 5* PA-NS; MS; QL 124 31 ZYTIGA 250 MG 5* PA-NS; MS; QL 124 31 anastrozole 1 mg ; QL 31 31 exemestane 25 mg letrozole 2.5 mg GILOTRIF 20 MG 30 MG 40 MG 5* PA-NS; MS; QL 31 31 ZYKADIA 150 MG 5* PA-NS; MS; QL 155 31 AFINITOR 10 MG 2.5 MG 5 MG 7.5 MG AFINITOR DISPERZ 2 MG 3 MG 5 MG BOSULIF 100 MG 500 MG 5* PA-NS; MS 5* PA-NS; MS; QL 31 31 5* PA-NS; MS; QL 56 28 GLEEVEC 100 MG 5* PA-NS; MS; QL 186 31 GLEEVEC 400 MG 5* PA-NS; MS; QL 62 31 IMBRUVICA 140 MG 5* PA-NS; MS INLYTA 1 MG 5 MG 5* PA-NS; MS NEXAVAR 200 MG 5* PA-NS; LA; QL 124 31 SPRYCEL 100 MG 140 MG 20 MG 50 MG 70 MG 80 MG 5* PA-NS; MS; QL 31 31

STIVARGA 40 MG 5* PA-NS; MS SUTENT 12.5 MG 25 MG 50 MG 5* PA-NS; MS; QL 31 31 TARCEVA 100 MG 150 MG 25 MG 5* PA-NS; MS; QL 31 31 TASIGNA 150 MG 200 MG 5* PA-NS; MS; QL 124 31 TYKERB 250 MG 5* PA-NS; LA; QL 186 31 VOTRIENT 200 MG 5* PA-NS; MS; QL 124 31 XALKORI 200 MG 250 MG 5* PA-NS; MS; QL 62 31 ZELBORAF 240 MG 5* PA-NS; MS; QL 248 31 AVASTIN * 100 MG/4 ML 400 MG/16 ML LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 29 5* PA-BvsD; MS RITUXAN * 10 MG/ML 5* PA-NS; LA PANRETIN 0.1 % 5* MS TARGRETIN 1 % 5* PA-NS; MS TARGRETIN 75 MG 5* PA-NS; MS tretinoin 10 mg 5* MS ALBENZA 200 MG 4 MS STROMECTOL 3 MG ALINIA 100 MG/5 ML 4 PA; MS ALINIA 500 MG 4 PA; MS atovaquone 750 mg/5 ml 5* MS chloroquine phosphate 250 mg 500 mg DARAPRIM 25 MG

hydroxychloroquine sulfate 200 mg mefloquine hcl 250 mg MEPRON 750 MG/5 ML 5* MS NEBUPENT 300 MG 4 PA-BvsD; MS PENTAM 300 MG 4 PA; MS primaquine phosphate 26.3 mg acticin 5 % malathion 0.5 % permethrin 5 % benztropine mesylate 0.5 mg 1 mg 2 mg 2 PA; MS trihexyphenidyl hcl 0.4 mg/ml 2 PA; MS trihexyphenidyl hcl 2 mg 5 mg 2 PA; MS entacapone 200 mg TASMAR 100 MG 5* MS APOKYN * 10 MG/ML 5* PA; MS; QL 90 ml 30 bromocriptine mesylate 5 mg bromocriptine mesylate 2.5 mg pramipexole dihydrochloride 0.125 mg 0.25 mg 0.5 mg 0.75 mg 1 mg 1.5 mg ropinirole hcl 0.25 mg 0.5 mg 1 mg 2 mg 3 mg 4 mg 5 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 30

L- carbidopa 25 mg 4 MS carbidopa-levodopa 10-100 mg 25-100 mg 25-250 mg carbidopa-levodopa er * 25-100 mg 50-200 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 31 B (Mao-B) AZILECT 0.5 MG 1 MG 4 MS selegiline hcl 5 mg selegiline hcl 5 mg ZELAPAR 1.25 MG 4 MS chlorpromazine hcl 25 mg/ml chlorpromazine hcl 10 mg 100 mg 200 mg 25 mg 50 mg compro 25 mg fluphenazine decanoate 25 mg/ml fluphenazine hcl 2.5 mg/ml fluphenazine hcl 5 mg/ml fluphenazine hcl 2.5 mg/5 ml fluphenazine hcl 1 mg 10 mg 2.5 mg 5 mg HALDOL DECANOATE * 100 MG/ML 50 MG/ML haloperidol 0.5 mg 1 mg 10 mg 2 mg 20 mg 5 mg haloperidol decanoate * 100 mg/ml 50 mg/ml haloperidol lactate 5 mg/ml

haloperidol lactate 2 mg/ml loxapine succinate 10 mg 25 mg 5 mg 50 mg ORAP 1 MG 2 MG perphenazine 16 mg 2 mg 4 mg 8 mg prochlorperazine 25 mg prochlorperazine edisylate 5 mg/ml prochlorperazine maleate 10 mg 5 mg thioridazine hcl 10 mg 100 mg 25 mg 50 mg thiothixene 1 mg 10 mg 2 mg 5 mg trifluoperazine hcl 1 mg 10 mg 2 mg 5 mg ABILIFY * 9.75 MG/1.3 ML 4 PA-NS; MS ABILIFY 1 MG/ML 4 MS; QL 1050 ml 31 ABILIFY 10 MG 15 MG 2 MG 20 MG 30 MG 5 MG 4 MS; QL 31 31 ABILIFY DISCMELT 10 MG 4 PA-NS; MS; QL 93 31 ABILIFY DISCMELT 15 MG 4 PA-NS; MS; QL 62 31 ABILIFY MAINTENA * 300 MG 400 MG FANAPT 1 MG 10 MG 12 MG 2 MG 4 MG 6 MG 8 MG FANAPT 1 & 2 & 4 & 6 MG 4 PA-NS; MS 5* PA-NS; MS; QL 1 26 4 PA-NS; MS; QL 62 31 GEODON * 20 MG 4 MS; QL 12 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 32

INVEGA 24 * 1.5 MG 3 MG 9 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 33 4 PA-NS; MS; QL 31 31 INVEGA 24 * 6 MG 4 PA-NS; MS; QL 62 31 INVEGA SUSTENNA * 117 MG/0.75 ML 156 MG/ML 234 MG/1.5 ML INVEGA SUSTENNA * 39 MG/0.25 ML 78 MG/0.5 ML LATUDA 120 MG 20 MG 40 MG 60 MG 80 MG 5* MS 4 MS 4 ST-NS; MS olanzapine * 10 mg olanzapine 10 mg 15 mg 2.5 mg 20 mg 5 mg 7.5 mg olanzapine 10 mg 15 mg 20 mg 5 mg quetiapine fumarate 100 mg 200 mg 25 mg 300 mg 400 mg 50 mg RISPERDAL CONSTA * 12.5 MG 25 MG RISPERDAL CONSTA * 37.5 MG 50 MG ; QL 31 31 3 PA-NS; MS; QL 31 31 ; QL 93 31 4 MS; QL 4 28 5* MS; QL 4 28 risperidone 1 mg/ml ; QL 270 ml 31 risperidone 0.25 mg 0.5 mg 1 mg 2 mg 3 mg 4 mg risperidone 0.25 mg 0.5 mg 1 mg 2 mg 3 mg 4 mg RISPERIDONE M-TAB 0.5 MG 1 MG 2 MG 3 MG 4 MG ; QL 124 31 4 MS; QL 124 31 4 MS; QL 124 31 SAPHRIS 10 MG 5 MG 4 ST-NS; MS; QL 62 31

SEROQUEL XR 24 * 150 MG 200 MG SEROQUEL XR 24 * 300 MG 400 MG 50 MG ziprasidone hcl 20 mg 40 mg 60 mg 80 mg ZYPREXA RELPREVV * 210 MG 300 MG 405 MG clozapine 100 mg 200 mg 25 mg 50 mg clozapine 100 mg 12.5 mg 25 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 34 4 MS; QL 31 31 4 MS; QL 62 31 4 MS; QL 62 31 5* PA-NS; MS 3 PA-NS; MS FAZACLO 12.5 MG 4 PA-NS; MS VERSACLOZ 50 MG/ML 4 PA-NS; MS baclofen 10 mg 20 mg 1 MS tizanidine hcl 2 mg 4 mg 6 mg tizanidine hcl 2 mg 4 mg (Cmv) foscarnet sodium * 24 mg/ml 3 PA; MS ganciclovir sodium * 500 mg 4 PA; MS VALCYTE 50 MG/ML 5* MS; QL 1116 ml 31 VALCYTE 450 MG 5* MS; QL 124 31 ZIRGAN 0.15 % 4 MS adefovir dipivoxil 10 mg 5* MS; QL 31 31

BARACLUDE 0.05 MG/ML 4 MS BARACLUDE 0.5 MG 1 MG 5* MS; QL 31 31 INCIVEK 375 MG 5* PA; MS; QL 504 365 INTRON-A 10000000 ML 6000000 ML INTRON-A 10000000 18000000 50000000 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 35 5* PA-NS; MS 5* PA-NS; MS OLYSIO 150 MG 5* PA; MS; QL 28 28 PEG-INTRON * 120 MCG/0.5 ML 150 MCG/0.5 ML 50 MCG/0.5 ML 80 MCG/0.5 ML PEG-INTRON REDIPEN * 120 MCG/0.5 ML 150 MCG/0.5 ML 50 MCG/0.5 ML 80 MCG/0.5 ML PEG-INTRON REDIPEN PAK 4 * 120 MCG/0.5 ML 150 MCG/0.5 ML 50 MCG/0.5 ML 80 MCG/0.5 ML 5* PA; MS 5* PA; MS 5* PA; MS RIBASPHERE 200 MG RIBASPHERE RIBAPAK 200 & 400 MG 400 & 600 MG 400 MG 600 MG 5* MS ribavirin 200 mg SOVALDI 400 MG 5* PA; MS; QL 28 28 TYZEKA 600 MG 5* PA; MS VICTRELIS 200 MG 5* PA; MS; QL 336 28 acyclovir 5 % 4 MS acyclovir 200 mg acyclovir 200 mg/5 ml acyclovir 400 mg 800 mg acyclovir sodium * 50 mg/ml DENAVIR 1 %

famciclovir 125 mg 250 mg 500 mg trifluridine 1 % valacyclovir hcl 1 gm 500 mg ZOVIRAX 5 % 4 MS Hiv ATRIPLA 600-200-300 MG 5* MS; QL 31 31 COMPLERA 200-25-300 MG 5* MS EDURANT 25 MG 5* MS; QL 31 31 INTELENCE 100 MG 5* MS; QL 124 31 INTELENCE 200 MG 5* MS; QL 62 31 INTELENCE 25 MG 4 MS; QL 124 31 nevirapine 50 mg/5 ml nevirapine 200 mg nevirapine er 24 * 400 mg 4 MS RESCRIPTOR 100 MG 200 MG STRIBILD 150-150-200-300 MG 5* MS; QL 31 31 SUSTIVA 200 MG 5* MS SUSTIVA 50 MG 4 MS SUSTIVA 600 MG 5* MS VIRAMUNE 50 MG/5 ML 4 MS VIRAMUNE XR 24 * 100 MG 400 MG Hiv LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 36 4 MS abacavir sulfate 300 mg abacavir-lamivudine-zidovudine 300-150-300 mg 5* MS; QL 62 31

didanosine 125 mg 200 mg 250 mg 400 mg EMTRIVA 200 MG EMTRIVA 10 MG/ML EPIVIR 10 MG/ML 4 MS EPIVIR HBV 5 MG/ML 4 MS EPZICOM 600-300 MG 5* MS lamivudine 100 mg 4 MS lamivudine 150 mg 300 mg lamivudine-zidovudine 150-300 mg 5* MS RETROVIR * 10 MG/ML 4 MS stavudine 15 mg 20 mg 30 mg 40 mg stavudine 1 mg/ml 4 MS TRUVADA 200-300 MG 5* MS; QL 31 31 VIDEX 2 GM 4 MS VIREAD 40 MG/GM 5* MS VIREAD 150 MG 200 MG 250 MG 300 MG 5* MS ZERIT 1 MG/ML 4 MS ZIAGEN 20 MG/ML zidovudine 100 mg zidovudine 50 mg/5 ml zidovudine 300 mg Hiv FUZEON * 90 MG 5* MS; QL 62 31 FUZEON * 90 MG 5* MS; QL 62 31 ISENTRESS 400 MG 5* MS; QL 62 31 ISENTRESS 100 MG 25 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 37

SELZENTRY 150 MG 300 MG 5* MS; QL 124 31 TIVICAY 50 MG 5* MS; QL 62 31 Hiv APTIVUS 250 MG 5* MS; QL 124 31 APTIVUS 100 MG/ML 5* MS; QL 310 ML 31 CRIXIVAN 200 MG 400 MG INVIRASE 200 MG 5* MS INVIRASE 500 MG 5* MS KALETRA 400-100 MG/5 ML 5* MS KALETRA 100-25 MG 4 MS KALETRA 200-50 MG 5* MS LEXIVA 50 MG/ML 4 MS LEXIVA 700 MG 5* MS NORVIR 100 MG 4 MS NORVIR 80 MG/ML 4 MS NORVIR 100 MG 4 MS PREZISTA 100 MG/ML 5* MS; QL 372 ml 31 PREZISTA 150 MG 4 MS PREZISTA 400 MG 5* MS PREZISTA 600 MG 800 MG 5* MS; QL 62 31 PREZISTA 75 MG ; QL 62 31 REYATAZ 100 MG 150 MG 200 MG ; QL 62 31 REYATAZ 300 MG ; QL 31 31 VIRACEPT 250 MG 625 MG 5* MS amantadine hcl 100 mg amantadine hcl 50 mg/5 ml amantadine hcl 100 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 38

RELENZA DISKHALER 5 MG rimantadine hcl 100 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 39 ; QL 120 365 TAMIFLU 30 MG ; QL 112 365 TAMIFLU 45 MG 75 MG ; QL 56 365 TAMIFLU 6 MG/ML ; QL 720 ml 365 alprazolam 0.25 mg 0.5 mg 1 mg 2 mg 1 MS buspirone hcl 10 mg 15 mg 30 mg 5 mg 7.5 mg diazepam 1 mg/ml diazepam 10 mg 2 mg 5 mg 1 MS; QL 124 31 diazepam intensol 5 mg/ml estazolam 1 mg 2 mg lorazepam 0.5 mg 1 mg 2 mg 1 MS; QL 93 31 meprobamate 200 mg 400 mg 4 PA; MS oxazepam 10 mg 15 mg 30 mg ; QL 124 31 lithium carbonate 150 mg 300 mg 600 mg lithium carbonate 300 mg lithium carbonate er * 300 mg 450 mg lithium citrate 8 mg 5 ml

acarbose 100 mg 25 mg 50 mg BYDUREON * 2 MG 4 MS BYETTA 10 MCG PEN * 10 MCG/0.04 ML BYETTA 5 MCG PEN * 5 MCG/0.02 ML LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 40 4 MS 4 MS CYCLOSET 0.8 MG 4 PA; MS glimepiride 1 mg 2 mg 4 mg 1 MS; QL 62 31 glipizide 10 mg 5 mg 1 MS; QL 124 31 glipizide er 24 * 10 mg 2.5 mg 5 mg glipizide xl 24 * 10 mg 2.5 mg 5 mg glipizide-metformin hcl 2.5-250 mg 2.5-500 mg 5-500 mg ; QL 62 31 ; QL 62 31 ; QL 124 31 glyburide 1.25 mg 2.5 mg 5 mg 2 PA; MS; QL 124 31 glyburide micronized 1.5 mg 3 mg 6 mg glyburide-metformin 1.25-250 mg 2.5-500 mg 5-500 mg 2 PA; MS; QL 62 31 2 PA; MS; QL 124 31 JANUMET 50-1000 MG 50-500 MG 4 MS; QL 62 31 JANUMET XR 24 * 100-1000 MG 4 MS; QL 31 31 JANUMET XR 24 * 50-1000 MG 50-500 MG 4 MS; QL 62 31 JANUVIA 100 MG 4 MS; QL 31 31 JANUVIA 25 MG 50 MG 4 MS; QL 62 31 KOMBIGLYZE XR 24 * 2.5-1000 MG KOMBIGLYZE XR 24 * 5-1000 MG 5-500 MG 4 MS; QL 62 31 4 MS; QL 31 31

metformin hcl 1000 mg 1 MS; QL 78 31 metformin hcl 500 mg 1 MS; QL 155 31 metformin hcl 850 mg 1 MS; QL 93 31 metformin hcl er 24 * 500 mg metformin hcl er 24 * 750 mg ; QL 124 31 ; QL 77 31 metformin hcl er (osm) 24 * 1000 mg metformin hcl er (osm) 24 * 500 mg nateglinide 120 mg 60 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 41 ; QL 62 31 ; QL 124 31 ONGLYZA 2.5 MG 5 MG 4 MS; QL 31 31 pioglitazone hcl 15 mg 30 mg 45 mg ; QL 31 31 pioglitazone hcl-glimepiride 30-2 mg 30-4 mg pioglitazone hcl-metformin hcl 15-500 mg 15-850 mg PRANDIMET 1-500 MG 2-500 MG 4 MS repaglinide 0.5 mg 1 mg 2 mg 4 MS SYMLINPEN 120 * 2700 MCG/2.7 ML 4 PA; MS SYMLINPEN 60 * 1500 MCG/1.5 ML 4 PA; MS 4 MS; QL 31 31 4 MS; QL 93 31 tolazamide 250 mg 500 mg ; QL 62 31 tolbutamide 500 mg ; QL 186 31 GLUCAGEN HYPOKIT 1 MG ; QL 4 31 GLUCAGON 1 MG ; QL 4 31 PROGLYCEM 50 MG/ML 4 MS

HUMALOG * 100 ML ; QL 60 ml 30 HUMALOG KWIKPEN * 100 ML HUMALOG MIX 50/ 50 * (50-50) 100 ML HUMALOG MIX 50/ 50 KWIKPEN * (50-50) 100 ML HUMALOG 75/25 * (75-25) 100 ML HUMALOG 75/25 KWIKPEN * SUPN (75-25) 100 ML HUMULIN 75/30 * (70-30) 100 ML HUMULIN 75/30 PEN * (70-30) 100 ML LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 42 ; QL 60 ml 30 ; QL 60 ml 30 ; QL 60 ml 30 ; QL 60 ml 30 ; QL 60 ml 30 ; QL 60 ml 30 ; QL 60 ml 30 HUMULIN N * 100 ML ; QL 60 ml 30 HUMULIN N PEN * 100 ML ; QL 60 ml 30 HUMULIN R 100 ML ; QL 60 ml 30 HUMULIN R U-500* 500 ML 3 PA-BvsD; MS; QL 40 ml 30 LANTUS * 100 ML ; QL 60 ml 30 LANTUS SOLOSTAR * 100 ML ; QL 60 ml 30 LEVEMIR * 100 ML ; QL 60 ml 30 LEVEMIR FLEXPEN * 100 ML ; QL 60 ml 30 NOVOLIN 70/30 * (70-30) 100 ML 4 ST; MS; QL 60 ml 30 NOVOLIN N * 100 ML 4 ST; MS; QL 60 ml 30 NOVOLIN R 100 ML 4 ST; MS; QL 60 ml 30 NOVOLOG * 100 ML 4 ST; MS; QL 60 ml 30

NOVOLOG FLEXPEN * 100 ML NOVOLOG 70/30 * (70-30) 100 ML NOVOLOG 70/30 FLEXPEN * (70-30) 100 ML LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 43 4 ST; MS; QL 60 ml 30 4 ST; MS; QL 60 ml 30 4 ST; MS; QL 60 ml 30 NOVOLOG PENFILL * 100 ML 4 ST; MS; QL 60 ml 30 COUMADIN * 5 MG COUMADIN 1 MG 10 MG 2 MG 2.5 MG 3 MG 4 MG 5 MG 6 MG 7.5 MG ELIQUIS 2.5 MG 5 MG 4 MS enoxaparin sodium 300 mg/3 ml 4 MS; QL 24 ml 31 enoxaparin sodium * 100 mg/ml 150 mg/ml 5* MS; QL 28 ml 31 enoxaparin sodium 120 mg/0.8 ml 5* MS; QL 22.4 ml 31 enoxaparin sodium * 30 mg/0.3 ml 40 mg/0.4 ml 4 MS; QL 8.4 ml 31 enoxaparin sodium * 60 mg/0.6 ml 4 MS; QL 16.8 ml 31 enoxaparin sodium * 80 mg/0.8 ml 4 MS; QL 22.4 ml 31 fondaparinux sodium * 10 mg/0.8 ml fondaparinux sodium * 2.5 mg/0.5 ml fondaparinux sodium * 5 mg/0.4 ml fondaparinux sodium * 7.5 mg/0.6 ml 5* MS; QL 11.2 ml 31 4 MS; QL 16 ml 31 5* MS; QL 5.6 ml 31 5* MS; QL 8.4 ml 31

heparin (porcine) in d5w * 40-5 ml-% heparin (porcine) in nacl 100-0.45 ml-% 2-0.9 ml-% 50-0.45 ml-% heparin sodium (porcine) 1000 ml 10000 ml 20000 ml 2500 5000 ml heparin sodium (porcine) * 2000 ml jantoven 1 mg 10 mg 2 mg 2.5 mg 3 mg 4 mg 5 mg 6 mg 7.5 mg 1 MS PRADAXA 150 MG 75 MG 4 MS; QL 62 31 warfarin sodium 1 mg 10 mg 2 mg 2.5 mg 3 mg 4 mg 5 mg 6 mg 7.5 mg 1 MS XARELTO 10 MG 4 MS; QL 35 365 anagrelide hcl 0.5 mg 1 mg LEUKINE 500 MCG/ML 5* PA; MS LEUKINE * 250 MCG 5* PA; MS NEUMEGA * 5 MG 5* PA; MS NEUPOGEN 300 MCG/0.5 ML 300 MCG/ ML 480 MCG/0.8 ML 480 MCG/1.6 ML PROCRIT 10000 ML 2000 ML 3000 ML 4000 ML PROCRIT 20000 ML 40000 ML PROMACTA 12.5 MG 25 MG 50 MG 75 MG 5* PA; MS 3 PA; MS 5* PA; MS 5* PA; LA; QL 31 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 44

tranexamic acid * 100 mg/ml tranexamic acid 650 mg 4 MS AGGRENOX 12 25-200 MG 4 MS BRILINTA 90 MG cilostazol 100 mg 50 mg clopidogrel bisulfate 300 mg ; QL 1 31 clopidogrel bisulfate 75 mg 1 MS; QL 31 31 dipyridamole 25 mg 50 mg 75 mg 2 PA; MS EFFIENT 10 MG 5 MG ticlopidine hcl 250 mg - clonidine hcl 0.1 mg 0.2 mg 0.3 mg 1 MS CLORPRES 0.1-15 MG 0.2-15 MG 0.3-15 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 45 guanfacine hcl 1 mg 2 mg 2 PA; MS methyldopa 250 mg 500 mg methyldopa-hydrochlorothiazide 250-15 mg 250-25 mg midodrine hcl 10 mg 2.5 mg 5 mg - prazosin hcl 1 mg 2 mg 5 mg reserpine 0.1 mg 0.25 mg Ii DIOVAN 160 MG 40 MG 80 MG 4 MS; QL 62 31 DIOVAN 320 MG 4 MS; QL 31 31 EDARBI 40 MG 80 MG 4 MS; QL 31 31

EDARBYCLOR 40-12.5 MG 40-25 MG 4 MS; QL 31 31 losartan potassium 100 mg 1 MS; QL 31 31 losartan potassium 25 mg 50 mg 1 MS; QL 62 31 losartan potassium-hctz 100-12.5 mg 100-25 mg 1 MS; QL 31 31 losartan potassium-hctz 50-12.5 mg 1 MS; QL 62 31 telmisartan 20 mg 40 mg 80 mg 4 MS; QL 31 31 telmisartan-hctz 40-12.5 mg 80-12.5 mg 4 MS; QL 31 31 valsartan-hydrochlorothiazide 160-12.5 mg 80-12.5 mg valsartan-hydrochlorothiazide 160-25 mg 320-12.5 mg 320-25 mg ; QL 62 31 ; QL 31 31 (Ace) benazepril hcl 10 mg 20 mg 40 mg 5 mg benazepril-hydrochlorothiazide 10-12.5 mg 20-12.5 mg 20-25 mg 5-6.25 mg captopril 100 mg 12.5 mg 25 mg 50 mg captopril-hydrochlorothiazide 25-15 mg 25-25 mg 50-15 mg 50-25 mg enalapril maleate 10 mg 2.5 mg 20 mg 5 mg enalapril-hydrochlorothiazide 10-25 mg 5-12.5 mg 1 MS 1 MS 1 MS 1 MS fosinopril sodium 10 mg 20 mg 40 mg fosinopril sodium-hctz 10-12.5 mg 20-12.5 mg lisinopril 10 mg 2.5 mg 20 mg 30 mg 40 mg 5 mg 1 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 46

lisinopril-hydrochlorothiazide 10-12.5 mg 20-12.5 mg 20-25 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 47 1 MS moexipril hcl 15 mg 7.5 mg moexipril-hydrochlorothiazide 15-12.5 mg 15-25 mg 7.5-12.5 mg quinapril hcl 10 mg 20 mg 40 mg 5 mg quinapril-hydrochlorothiazide 10-12.5 mg 20-12.5 mg 20-25 mg ramipril 1.25 mg 10 mg 2.5 mg 5 mg trandolapril 1 mg 2 mg 4 mg amiodarone hcl 200 mg amiodarone hcl 400 mg disopyramide phosphate 100 mg 150 mg flecainide acetate 100 mg 150 mg 50 mg mexiletine hcl 150 mg 200 mg 250 mg MULTAQ 400 MG 4 MS NORPACE CR 12 100 MG 150 MG 4 MS PACERONE 100 MG 400 MG pacerone 200 mg procainamide hcl 100 mg/ml 500 mg/ml 1 MS propafenone hcl 150 mg 225 mg 300 mg quinidine gluconate er * 324 mg quinidine sulfate 200 mg 300 mg quinidine sulfate er * 300 mg sorine 120 mg 160 mg 240 mg 80 mg

sotalol hcl 120 mg 160 mg 240 mg 80 mg sotalol hcl (af) 120 mg 160 mg 80 mg TIKOSYN 125 MCG 250 MCG 500 MCG 4 MS - acebutolol hcl 200 mg 400 mg atenolol 100 mg 25 mg 50 mg 1 MS atenolol-chlorthalidone 100-25 mg 50-25 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 48 1 MS betaxolol hcl 10 mg 20 mg bisoprolol fumarate 10 mg 5 mg bisoprolol-hydrochlorothiazide 10-6.25 mg 2.5-6.25 mg 5-6.25 mg BYSTOLIC 10 MG 2.5 MG 20 MG 5 MG carvedilol 12.5 mg 25 mg 3.125 mg 6.25 mg COREG CR 24 10 MG 20 MG 40 MG 80 MG 1 MS 4 MS 1 MS labetalol hcl * 5 mg/ml labetalol hcl 100 mg 200 mg 300 mg metoprolol succinate er 24 * 100 mg 200 mg 25 mg 50 mg ; QL 31 31 metoprolol tartrate * 1 mg/ml metoprolol tartrate 100 mg 25 mg 50 mg metoprolol-hydrochlorothiazide 100-25 mg 100-50 mg 50-25 mg 1 MS nadolol 20 mg 40 mg 80 mg pindolol 10 mg 5 mg propranolol hcl * 1 mg/ml

propranolol hcl 20 mg/5 ml 40 mg/5 ml propranolol hcl 10 mg 20 mg 40 mg 60 mg 80 mg 1 MS propranolol hcl er 24 120 mg 160 mg 60 mg 80 mg propranolol-hctz 40-25 mg 80-25 mg timolol maleate 10 mg 20 mg 5 mg afeditab cr 24 * 30 mg 60 mg amlodipine besy-benazepril hcl 10-20 mg 10-40 mg 2.5-10 mg 5-10 mg 5-20 mg 5-40 mg amlodipine besylate 10 mg 2.5 mg 5 mg CARTIA XT 24 120 MG 180 MG 240 MG 300 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 49 ; QL 62 31 ; QL 31 31 1 MS dilt-cd 24 120 mg 300 mg dilt-xr 24 120 mg 180 mg 240 mg diltiazem hcl * 50 mg/10 ml diltiazem hcl * 100 mg diltiazem hcl 120 mg 30 mg 60 mg 90 mg diltiazem hcl er 12 120 mg 60 mg 90 mg diltiazem hcl er beads 24 180 mg 360 mg 420 mg diltiazem hcl er coated beads 24 120 mg 240 mg 300 mg 360 mg diltzac 24 120 mg 180 mg 240 mg 300 mg 360 mg

EXFORGE 10-160 MG 10-320 MG 5-160 MG 5-320 MG EXFORGE HCT 10-160-12.5 MG 10-160-25 MG 10-320-25 MG 5-160-12.5 MG 5-160-25 MG felodipine er 24 * 10 mg 2.5 mg 5 mg MATZIM LA 24 * 180 MG 240 MG 300 MG 360 MG 420 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 50 4 MS 4 MS ; QL 31 31 nicardipine hcl 20 mg 30 mg nifediac cc 24 * 90 mg ; QL 62 31 nifedical xl 24 * 30 mg 60 mg nifedipine 10 mg 20 mg 3 PA; MS nifedipine er osmotic 24 * 30 mg 60 mg 90 mg nimodipine 30 mg TAZTIA XT 24 120 MG 180 MG 240 MG 300 MG 360 MG telmisartan-amlodipine 40-10 mg 40-5 mg 80-10 mg 80-5 mg ; QL 62 31 ; QL 62 31 verapamil hcl 120 mg 40 mg 80 mg 1 MS verapamil hcl er 24 100 mg 120 mg 180 mg 200 mg 240 mg 300 mg 360 mg verapamil hcl er * 120 mg 180 mg 240 mg 4 MS; QL 31 31 digoxin 0.25 mg/ml digoxin 0.05 mg/ml digoxin 0.125 mg 1 MS

digoxin 0.25 mg 1 PA; MS LANOXIN 0.25 MG/ML LANOXIN 0.0625 MG 0.125 MG 0.25 MG 187.5 MCG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 51 LANOXIN 0.1 MG/ML pentoxifylline er * 400 mg RANEXA 12 * 1000 MG 500 MG 4 MS; QL 62 31 TEKTURNA 150 MG 300 MG 4 MS; QL 31 31 TEKTURNA HCT 150-12.5 MG 150-25 MG 300-12.5 MG 300-25 MG acetazolamide 125 mg 250 mg acetazolamide sodium 500 mg bumetanide 0.25 mg/ml bumetanide 0.5 mg 1 mg 2 mg furosemide 10 mg/ml furosemide 10 mg/ml 8 mg/ml furosemide 20 mg 40 mg 80 mg 1 MS torsemide 10 mg 100 mg 20 mg 5 mg amiloride hcl 5 mg amiloride-hydrochlorothiazide 5-50 mg spironolactone 100 mg 25 mg 50 mg spironolactone-hctz 25-25 mg triamterene-hctz 37.5-25 mg 4 MS; QL 31 31

triamterene-hctz 37.5-25 mg 75-50 mg chlorothiazide 250 mg 500 mg 1 MS chlorothiazide sodium * 500 mg chlorthalidone 25 mg 50 mg hydrochlorothiazide 12.5 mg 1 MS hydrochlorothiazide 12.5 mg 25 mg 50 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 52 1 MS indapamide 1.25 mg 2.5 mg 1 MS methyclothiazide 5 mg metolazone 10 mg 2.5 mg 5 mg fenofibrate 145 mg 48 mg fenofibrate 160 mg 54 mg fenofibrate 134 mg 200 mg 67 mg gemfibrozil 600 mg HMGCoa atorvastatin 10 mg 20 mg 40 mg 1 MS; QL 47 31 atorvastatin 80 mg 1 MS; QL 31 31 CRESTOR 10 MG 20 MG 40 MG 5 MG 4 MS; QL 31 31 LIVALO 1 MG 2 MG 4 MG 4 MS lovastatin 10 mg 20 mg 40 mg pravastatin sodium 10 mg 20 mg 40 mg 1 MS; QL 47 31 pravastatin sodium 80 mg 1 MS; QL 31 31 simvastatin 10 mg 20 mg 40 mg 5 mg 1 MS; QL 47 31 simvastatin 80 mg 1 MS; QL 31 31

cholestyramine 4 gm cholestyramine 4 gm cholestyramine 4 gm cholestyramine 4 gm colestipol hcl 5 gm colestipol hcl 1 gm JUXTAPID 10 MG 20 MG 5 MG 5* PA; MS LOVAZA 1 GM 4 MS colestipol hcl 1 gm niacin er * 1000 mg 500 mg 750 mg 4 MS NIACOR 500 MG omega-3-acid ethyl esters 1 gm 4 MS PREVALITE 4 GM PREVALITE 4 GM VYTORIN 10-10 MG 10-20 MG 10-40 MG 10-80 MG WELCHOL 3.75 GM 4 PA; MS WELCHOL 625 MG 4 PA; MS 4 MS; QL 31 31 ZETIA 10 MG 4 MS; QL 31 31 hydralazine hcl 20 mg/ml hydralazine hcl 10 mg 100 mg 25 mg 50 mg minoxidil 10 mg 2.5 mg isosorbide dinitrate 10 mg 20 mg 5 mg 1 MS isosorbide dinitrate 30 mg isosorbide dinitrate 2.5 mg 1 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 53

isosorbide dinitrate er * 40 mg isosorbide mononitrate 10 mg 20 mg isosorbide mononitrate er 24 * 120 mg 30 mg 60 mg minitran 24 0.1 mg 0.2 mg0.4 mg0.6 mg NITRO-BID 2 % nitroglycerin * 5 mg/ml 1 MS nitroglycerin 24 0.1 mg 0.2 mg0.4 mg0.6 mg NITROSTAT 0.3 MG 0.4 MG 0.6 MG amphetamine-dextroamphetamine 10 mg 12.5 mg 15 mg 20 mg 30 mg 5 mg 7.5 mg dextroamphetamine sulfate 10 mg 5 mg 3 PA; MS dextroamphetamine sulfate er 24 10 mg 15 mg 5 mg 3 PA; MS; QL 62 31 4 PA; MS clonidine hcl er 12 * 0.1 mg 4 PA; MS dexmethylphenidate hcl 10 mg 2.5 mg 5 mg KAPVAY 0.1 & 0.2 MG 4 PA; MS ; QL 124 31 METADATE ER * 20 MG ; QL 93 31 methylphenidate hcl 10 mg/5 ml 5 mg/5 ml ; QL 1116 ml 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 54

methylphenidate hcl 10 mg 20 mg 5 mg ; QL 93 31 methylphenidate hcl er * 20 mg ; QL 93 31 STRATTERA 10 MG 18 MG 25 MG 40 MG 4 PA; MS; QL 62 31 STRATTERA 100 MG 60 MG 80 MG 4 PA; MS; QL 31 31 NUEDEXTA 20-10 MG 4 PA; MS riluzole 50 mg XENAZINE 12.5 MG 5* PA; LA; QL 217 31 XENAZINE 25 MG 5* PA; LA; QL 124 31 SAVELLA 100 MG 12.5 MG 25 MG 50 MG SAVELLA 12.5 & 25 & 50 MG AUBAGIO 14 MG 7 MG 5* PA; MS; QL 31 31 BETASERON * 0.3 MG 5* PA; MS COPAXONE * 40 MG/ML 5* PA; MS; QL 12 28 COPAXONE * 20 MG/ML 5* PA; MS; QL 30 ml 30 GILENYA 0.5 MG 5* PA; MS; QL 31 31 REBIF * 22 MCG/0.5 ML 44MCG/0.5 ML REBIF REBIDOSE * 22 MCG/0.5 ML 44 MCG/0.5 ML REBIF REBIDOSE * 6 X 8.8 & 6 X 22 MCG 5* PA; MS; QL 6 ml 28 5* PA; MS; QL 6 ml 28 5* PA; MS; QL 4.2 ml 28 REBIF * 6 X 8.8 & 6 X 22 MCG 5* PA; MS; QL 4.2 ml 28 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 55

TYSABRI * 300 MG/15 ML 5* PA; MS chlorhexidine gluconate 0.12 % 1 MS dentagel 1.1 % 1 MS karigel 1.1 % 1 MS periogard 0.12 % 1 MS pilocarpine hcl 5 mg 7.5 mg triamcinolone acetonide 0.1 % 8-MOP 10 MG 5* MS acitretin 10 mg 17.5 mg 25 mg 5* MS; QL 62 31 ammonium 12 % ammonium 12 % AZELEX 20 % benzoyl peroxide-erythromycin 5-3 % calcipotriene 0.005 % 4 MS calcipotriene 0.005 % calcipotriene 0.005 % 4 MS CARAC 0.5 % 4 MS CLINDACIN PAC 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % clindamycin phosphate 1 % CONDYLOX 0.5 % 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 56

ELIDEL 1 % 4 PA; MS FINACEA 15 % FLUOROPLEX 1 % 4 MS fluorouracil 5 % fluorouracil 2 % 5 % 4 MS imiquimod 5 % 4 PA-NS; MS LACLOTION 12 % OXSORALEN ULTRA 10 MG 5* PA; MS podofilox 0.5 % REGRANEX 0.01 % 4 PA; MS SANTYL 250 GM 4 MS selenium sulfide 2.5 % sulfacetamide sodium 10 % TAZORAC 0.05 % 0.1 % 4 MS TAZORAC 0.05 % 0.1 % 4 MS tretinoin 0.01 % 0.025 % tretinoin 0.025 % 0.05 % 0.1 % urea 40 % 4 MS VOLTAREN 1 % X-VIATE 40 % 4 MS ADAGEN * 250 ML 5* PA-BvsD; MS ALDURAZYME * 2.9 MG/5 ML 5* PA-BvsD; LA BUPHENYL 500 MG 5* PA; MS CEREZYME * 200 400 5* PA; LA LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 57

CREON 12000 24000 3000-9500 36000 6000 4 MS CYSTADANE 5* MS CYSTAGON 150 MG 50 MG 3 PA; MS ELAPRASE * 6 MG/3 ML 5* PA-BvsD; MS FABRAZYME * 35 MG 5 MG 5* PA-BvsD; LA KUVAN 100 MG 5* PA; MS KUVAN 100 MG 5* PA; MS LUMIZYME * 50 MG 5* PA-BvsD; LA MYOZYME * 50 MG 5* PA-BvsD; LA NAGLAZYME * 1 MG/ML 5* PA-BvsD; LA ORFADIN 10 MG 2 MG 5 MG 5* PA; MS PERTZYE 16000 8000 4 MS SUCRAID 8500 ML 5* MS VPRIV * 400 5* PA; MS ZAVESCA 100 MG 5* PA; LA; QL 93 31 ZENPEP 10000 15000 20000 25000 3000-10000 5000 4 MS atropine sulfate 0.05 mg/ml 0.1 mg/ml 0.4 mg/ml dicyclomine hcl 10 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 58

dicyclomine hcl 10 mg/5 ml dicyclomine hcl 20 mg glycopyrrolate 0.2 mg/ml 0.4 mg/2 ml 4 mg/20 ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 59 glycopyrrolate 1 mg 2 mg methscopolamine bromide 2.5 mg 5 mg propantheline bromide 15 mg cromolyn sodium 100 mg/5 ml diphenoxylate-atropine 2.5-0.025 mg/5 ml diphenoxylate-atropine 2.5-0.025 mg LONOX 2.5-0.025 MG loperamide hcl 2 mg 1 MS metoclopramide hcl 5 mg/ml metoclopramide hcl 5 mg/5 ml metoclopramide hcl 10 mg 5 mg 1 MS RELISTOR * 12 MG/0.6 ML 4 PA; MS ursodiol 300 mg Histamine2 (H2) cimetidine 200 mg 300 mg 400 mg 800 mg cimetidine hcl 300 mg/5 ml famotidine * 20 mg/2 ml 1 MS famotidine 40 mg/5 ml famotidine 20 mg 40 mg 1 MS famotidine * 20-0.9 mg/50 ml-% 1 MS ranitidine hcl 150 mg/6 ml 50 mg/2 ml ranitidine hcl 15 mg/ml

ranitidine hcl 150 mg 300 mg 1 MS 腸 易 激 綜 合 徵 藥 物 AMITIZA 24MCG 8MCG 3 ST; MS LOTRONEX 0.5 MG 1 MG 5* MS; QL 62 31 constulose 10 gm/15 ml enulose 10 gm/15 ml gavilyte-c 240 gm 1 MS gavilyte-g 236 gm 1 MS gavilyte-n 420 gm 1 MS generlac 10 gm/15 ml lactulose 10 gm/15 ml MOVIPREP 100 GM 4 MS peg 3350/electrolytes 240 gm 1 MS polyethylene glycol 3350 PREPOPIK 10-3.5-12 MG-GM-GM 4 MS RELISTOR * 8 MG/0.4 ML 4 PA; MS SUPREP trilyte 420 gm 1 MS CARAFATE 1 GM/10 ML 4 MS misoprostol 100 mcg 200 mcg sucralfate 1 gm DEXILANT 30 MG 60 MG 4 MS; QL 31 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 60

esomeprazole sodium * 20 mg 40 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 61 4 MS NEXIUM 20 MG 40 MG 4 MS NEXIUM 10 MG 2.5 MG 20 MG 40 MG 5 MG omeprazole 10 mg 20 mg 40 mg 4 MS 1 MS pantoprazole sodium * 40 mg 4 MS pantoprazole sodium 20 mg 40 mg oxybutynin chloride 5 mg/5 ml oxybutynin chloride 5 mg oxybutynin chloride er 24 * 10 mg 15 mg 5 mg trospium chloride 20 mg VESICARE 10 MG 5 MG AVODART 0.5 MG ; QL 31 31 doxazosin mesylate 1 mg 2 mg 4 mg 8 mg 1 MS finasteride 5 mg JALYN 0.5-0.4 MG ; QL 31 31 RAPAFLO 4 MG 8 MG 4 MS; QL 31 31 tamsulosin hcl 0.4 mg terazosin hcl 1 mg 10 mg 2 mg 5 mg 1 MS

bethanechol chloride 10 mg 25 mg 5 mg 50 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 62 CIALIS 2.5 MG 5 MG 4 PA; MS; QL 31 31 FOSRENOL 1000 MG 500 MG 750 MG 4 MS RENVELA 0.8 GM 2.4 GM 4 MS RENVELA 800 MG 4 MS A-METHAPRED 125 MG 40 MG ala cort 1 % 1 MS alclometasone dipropionate 0.05 % alclometasone dipropionate 0.05 % amcinonide 0.1 % amcinonide 0.1 % amcinonide 0.1 % betamethasone dipropionate 0.05 % betamethasone dipropionate 0.05 % betamethasone dipropionate 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone dipropionate aug 0.05 % betamethasone valerate 0.1 % betamethasone valerate 0.12 %

betamethasone valerate 0.1 % betamethasone valerate 0.1 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate 0.05 % clobetasol propionate e 0.05 % clobetasol propionate 0.05 % clocortolone pivalate pump 0.1 % 4 MS CLODERM PUMP 0.1 % 4 MS clotrimazole-betamethasone 1-0.05 % clotrimazole-betamethasone 1-0.05 % COLOCORT 100 MG/60 ML CORDRAN 0.05 % 4 MS CORTIFOAM 90 MG 4 MS cortisone acetate 25 mg desonide 0.05 % desonide 0.05 % desonide 0.05 % desoximetasone 0.05 % desoximetasone 0.05 % 0.25 % desoximetasone 0.05 % 0.25 % 4 MS dexamethasone 0.5 mg 5 ml dexamethasone 0.5 mg 5 ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 63

dexamethasone 0.5 mg 0.75 mg 1 mg 1.5 mg 2 mg 4 mg 6 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 64 1 MS dexamethasone intensol 1 mg/ml dexamethasone sod phosphate pf 10 mg/ml dexamethasone sodium phosphate 10 mg/ml 120 mg/30 ml fludrocortisone acetate 0.1 mg fluocinolone acetonide 0.01 % 0.025 % fluocinolone acetonide 0.025 % fluocinolone acetonide 0.01 % fluocinolone acetonide 0.01 % fluocinolone acetonide 0.01 % fluocinolone acetonide 0.01 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide 0.05 % fluocinonide-e 0.05 % fluticasone propionate 0.05 % fluticasone propionate 0.005 % halobetasol propionate 0.05 % halobetasol propionate 0.05% hydrocortisone 1 % 2.5 % 1 MS hydrocortisone 2.5 % hydrocortisone 1 % 2.5 % 1 MS hydrocortisone 10 mg 20 mg 5 mg hydrocortisone butyrate 0.1 % hydrocortisone butyrate 0.1 %

hydrocortisone butyrate 0.1 % hydrocortisone valerate 0.2 % hydrocortisone valerate 0.2 % lokara 0.05 % MEDROL 2 MG 4 MS methylprednisolone 16 mg 32 mg 4 mg 8 mg methylprednisolone (pak) 4 mg methylprednisolone acetate 40 mg/ml 80 mg/ml methylprednisolone sodium succ 1 gm 1000 mg 125 mg 40 mg 500 mg MILLIPRED 5 MG mometasone furoate 0.1 % mometasone furoate 0.1 % mometasone furoate 0.1 % prednicarbate 0.1 % prednicarbate 0.1 % prednisolone 15 mg/5 ml prednisolone sodium phosphate 15 mg/5 ml 25 mg/5 ml 6.7 5 mg/5 ml prednisone 5 mg/5 ml prednisone 1 mg 10 mg 2.5 mg 20 mg 5 mg 50 mg 1 MS prednisone (pak) 10 mg, 5 mg 1 MS proctocream hc 2.5 % 1 MS proctosol hc 2.5 % 1 MS proctozone-hc 2.5 % 1 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 65

triamcinolone acetonide 0.025 % 0.1 % 0.5 % triamcinolone acetonide 0.025 % 0.1 % triamcinolone acetonide 0.025 % 0.1 % 0.5 % triderm 0.1 % chorionic gonadotropin * 10000 3 PA-BvsD; MS desmopressin ace 0.01 % ; QL 15 ml 31 desmopressin ace 0.01 % ; QL 15 ml 31 desmopressin acetate 4 mcg/ml desmopressin acetate 0.1 mg 0.2 mg desmopressin acetate spray 0.01 % ; QL 15 ml 31 EGRIFTA * 1 MG 5* PA; MS; QL 62 31 EGRIFTA * 2 MG 5* PA; MS; QL 30 30 HUMATROPE 12 MG 24 MG 5 MG 6 MG 5* PA; MS INCRELEX * 40 MG/4 ML 5* PA; LA TEV-TROPIN * 5 MG 4 PA; MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 66

KORLYM 300 MG 5* PA; MS; QL 124 31 ANADROL-50 50 MG 5* PA; MS oxandrolone 10 mg 5* PA; MS; QL 62 31 oxandrolone 2.5 mg 3 PA; MS; QL 124 31 ANDROXY 10 MG danazol 100 mg 200 mg 50 mg TESTIM 50 MG/5 GM 3 PA; MS testosterone cypionate * 100 mg/ml 200 mg/ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 67 testosterone enanthate * 200 mg/ml amethia 0.15-0.03 & 0.01 mg amethyst 90-20 mcg apri 0.15-30 mg-mcg aranelle 0.5/l/0.5-35 mg-mcg aviane 0.1-20 mg-mcg balziva 0.4-35 mg-mcg BREVICON (28) 0.5-35 MG-MCG briellyn 0.4-35 mg-mcg CAZIANT 0.1/0.125/0.15-0.025 MG CESIA 0.1/0.125/0.15-0.025 MG COMBIPATCH 0.05-0.14 MG 0.05-0.25 MG 4 MS cryselle-28 0.3-30 mg-mcg cyclafem 1/35 1-35 mg-mcg

cyclafem 7/7/7 0.5/0.75/1-35 mg-mcg drospirenone-ethinyl estradiol 3-0.03 mg 4 MS emoquette 0.15-30 mg-mcg enpresse-28 ESTRACE 0.1 MG/GM 4 MS estradiol 0.5 mg 1 mg 2 mg 2 PA; MS estradiol 0.025 mg/24 0.0375 mg/24 0.05 mg/24 0.06 mg/24 0.075 mg/24 0.1 mg/24 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 68 3 PA; MS estradiol-norethindrone acet 0.5-0.1 mg 4 MS estradiol-norethindrone acet 1-0.5 mg estropipate 0.75 mg 1.5 mg 3 mg 2 PA; MS gianvi 3-0.02 mg GILDAGIA 0.4-35 MG-MCG 4 MS introvale 0.15-0.03 mg jinteli 1-5 mg-mcg junel 1.5/30 1.5-30 mg-mcg junel 1/20 1-20 mg-mcg junel fe 1.5/30 1.5-30 mg-mcg junel fe 1/20 1-20 mg-mcg kariva 0.15-0.02/0.01 mg (21/5) kelnor 1/35 1-35 mg-mcg larin 1/20 1-20 mg-mcg larin fe 1.5/30 1.5-30 mg-mcg larin fe 1/20 1-20 mg-mcg leena 0.5/1/0.5-35 mg-mcg lessina 0.1-20 mg-mcg LEVONEST 4 MS

levonorgest-eth estrad 91 0.15-0.03 mg 4 MS levora 0.15/30 (28) 0.15-30 mg-mcg LORYNA 3-0.02 MG low-ogestrel 0.3-30 mg-mcg lutera 0.1-20 mg-mcg marlissa 0.15-30 mg-mcg microgestin 1.5/30 1.5-30 mg-mcg microgestin 1/20 1-20 mg-mcg microgestin fe 1.5/30 1.5-30 mg-mcg microgestin fe 1/20 1-20 mg-mcg MODICON (28) 0.5-35 MG-MCG mononessa 0.25-35 mg-mcg MYZILRA necon 0.5/35 (28) 0.5-35 mg-mcg necon 1/35 (28) 1-35 mg-mcg NECON 1/50 (28) 1-50 MG-MCG necon 10/11 (28) 35 mcg necon 7/7/7 0.5/0.75/1-35 mg-mcg norinyl 1+35 (28) 1-35 mg-mcg nortrel 0.5/35 (28) 0.5-35 mg-mcg nortrel 1/35 (21) 1-35 mg-mcg nortrel 1/35 (28) 1-35 mg-mcg nortrel 7/7/7 0.5/0.75/1-35 mg-mcg ocella 3-0.03 mg ogestrel 0.5-50 mg-mcg orsythia 0.1-20 mg-mcg ovcon-35 (28) 0.4-35 mg-mcg PHILITH 0.4-35 MG-MCG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 69

pimtrea 0.15-0.02/0.01 mg (21/5) pirmella 1/35 1-35 mg-mcg portia-28 0.15-30 mg-mcg prefest 1/1-0.09 mg (15/15) PREMARIN 25 MG PREMARIN 0.3 MG 0.45 MG 0.625 MG 0.9 MG 1.25 MG PREMARIN 0.625 MG/GM PREMPHASE 0.625-5 MG PREMPRO 0.3-1.5 MG 0.45-1.5 MG 0.625-2.5 MG 0.625-5 MG LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 70 ; QL 31 31 PREVIFEM 0.25-35 MG-MCG 4 MS quasense 0.15-0.03 mg reclipsen 0.15-30 mg-mcg SOLIA 0.15-30 MG-MCG sprintec 28 0.25-35 mg-mcg sronyx 0.1-20 mg-mcg tri-legest fe 1-20/1-30/1-35 mg-mcg tri-previfem 0.18/0.215/0.25 mg-35 mcg tri-sprintec 0.18/0.215/0.25 mg-35 mcg trinessa (28) 0.18/0.215/0.25 mg-35 mcg trivora (28) velivet 0.1/0.125/0.15-0.025 mg VESTURA 3-0.02 MG VIVELLE-DOT 0.025 MG/24 0.0375 MG/24 0.05 MG/24 0.075 MG/24 0.1 MG/24 vyfemla 0.4-35 mg-mcg

WYMZYA FE 0.4-35 MG-MCG ZENCHENT 0.4-35 MG-MCG 4 MS ZENCHENT FE 0.4-35 MG-MCG 4 MS zovia 1/35e (28) 1-35 mg-mcg zovia 1/50e (28) 1-50 mg-mcg camila 0.35 mg errin 0.35 mg jolivette 0.35 mg levonorgestrel 0.75 mg lyza 0.35 mg medroxyprogesterone acetate * 150 mg/ml medroxyprogesterone acetate 10 mg 2.5 mg 5 mg 1 MS megestrol acetate 40 mg/ml megestrol acetate 20 mg 40 mg nora-be 0.35 mg norethindrone 0.35 mg norethindrone acetate 5 mg EVISTA 60 MG ; QL 31 31 raloxifene hcl 60 mg ; QL 31 31 ARMOUR THYROID 120 MG 15 MG 180 MG 240 MG 30 MG 300 MG 60 MG 90 MG 3 PA; MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 71

levothroid 100 mcg 112mcg 125 mcg 137mcg 150 mcg 175 mcg 200 mcg 25 mcg 300 mcg 50 mcg 75 mcg 88mcg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 72 1 MS levothyroxine sodium * 100 mcg 4 MS levothyroxine sodium * 200 mcg 500 mcg levothyroxine sodium 100 mcg 112mcg 125 mcg 137mcg 150 mcg 175 mcg 200 mcg 25 mcg 300 mcg 50 mcg 75 mcg 88mcg levoxyl 100 mcg 112mcg 125 mcg 137mcg 150 mcg 175 mcg 200 mcg 25 mcg 50 mcg 75 mcg 88mcg liothyronine sodium 25 mcg 5 mcg 50 mcg 5* MS 1 MS np thyroid 30 mg 60 mg 90 mg 2 PA; MS SYNTHROID 100 MCG 112MCG 125 MCG 137MCG 150 MCG 175 MCG 200 MCG 25 MCG 300 MCG 50 MCG 75 MCG 88MCG THYROLAR-1 60 (12.5-50) MG (MCG) THYROLAR-1/2 30 (6.25-25) MG (MCG) THYROLAR-1/4 15 (3.1-12.5) MG (MCG) THYROLAR-2 120 (25-100) MG (MCG) THYROLAR-3 180 (37.5-150) MG (MCG) unithroid 100 mcg 112mcg 125 mcg 137mcg 150 mcg 175 mcg 200 mcg 25 mcg 300 mcg 50 mcg 75 mcg 88mcg LYSODREN 500 MG

SENSIPAR 30 MG ; QL 62 31 SENSIPAR 60 MG 5* MS; QL 62 31 SENSIPAR 90 MG 5* MS; QL 124 31 ELIGARD * 22.5 MG 30 MG 7.5 MG 4 PA-NS; MS ELIGARD * 45 MG 5* PA-NS; MS leuprolide acetate 1 mg/0.2 ml 3 PA-NS; MS octreotide acetate 100 mcg/ml 200 mcg/ml 50 mcg/ml octreotide acetate 1000 mcg/ml 500 mcg/ml SANDOSTATIN LAR DEPOT * 10 MG 20 MG 30 MG SOMATULINE DEPOT * 120 MG/0.5 ML 60 MG/0.2 ML 90 MG/0.3 ML SOMAVERT * 10 MG 15 MG 20 MG 4 PA; MS 5* PA; MS 5* PA; MS 5* PA; MS 5* PA; MS SYNAREL 2 MG/ML 5* MS TRELSTAR DEPOT * 3.75 MG 5* PA-BvsD; MS; QL 1 28 TRELSTAR DEPOT MIXJECT * 3.75 MG 5* PA-BvsD; MS; QL 1 28 TRELSTAR LA * 11.25 MG 5* PA-BvsD; MS; QL 1 84 TRELSTAR LA MIXJECT * 11.25 MG 5* PA-BvsD; MS; QL 1 84 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 73

TRELSTAR MIXJECT * 22.5 MG 5* PA-BvsD; MS; QL 1 168 bicalutamide 50 mg flutamide 125 mg NILANDRON 150 MG 4 MS XTANDI 40 MG 5* PA-NS; MS; QL 124 31 methimazole 10 mg 5 mg propylthiouracil 50 mg ASTAGRAF XL 24 0.5 MG 1 MG 5 MG 4 PA-NS; MS azathioprine 50 mg 2 PA-BvsD; MS azathioprine sodium 100 mg 3 PA-BvsD; MS CELLCEPT 200 MG/ML 5* PA-BvsD; MS cyclosporine * 50 mg/ml 3 PA-BvsD; MS cyclosporine 100 mg 25 mg 3 PA-BvsD; MS cyclosporine 100 mg 25 mg 50 mg 3 PA-BvsD; MS cyclosporine 100 mg/ml 3 PA-BvsD; MS ENBREL * 25 MG 5* PA; MS; QL 8 28 ENBREL * 25 MG/0.5 ML 50 MG/ML 5* PA; MS; QL 8 ML 28 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 74

ENBREL SURECLICK * 50 MG/ML 5* PA; MS; QL 8 ml 28 GENGRAF 100 MG 25 MG 3 PA-BvsD; MS GENGRAF 100 MG/ML 3 PA-BvsD; MS HECORIA 0.5 MG 1 MG 4 PA-BvsD; MS HECORIA 5 MG 5* PA-BvsD; MS HUMIRA * 20 MG/0.4 ML 40 MG/0.8 ML SANDIMMUNE 100 MG/ML 4 PA-BvsD; MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 75 5* PA; MS HUMIRA PEN * 40 MG/0.8 ML 5* PA; MS HUMIRA PEN-CROHNS STARTER * 40 MG/0.8 ML HUMIRA PEN-PSORIASIS STARTER * 40 MG/0.8 ML 5* PA; MS 5* PA; MS methotrexate 2.5 mg methotrexate sodium 1 gm 2 PA-BvsD; MS methotrexate sodium (pf) 50 mg 2 ml 2 PA-BvsD; MS mycophenolate mofetil 250 mg 3 PA-BvsD; MS mycophenolate mofetil 500 mg 3 PA-BvsD; MS mycophenolic acid 180 mg 360 mg 4 PA-BvsD; MS NULOJIX * 250 MG 5* PA-BvsD; MS PROGRAF * 5 MG/ML 3 PA-BvsD; MS RAPAMUNE 1 MG/ML 5* PA-BvsD; MS RAPAMUNE 1 MG 2 MG 5* PA-BvsD; MS REMICADE * 100 MG 5* PA; MS SANDIMMUNE * 50 MG/ML 4 PA-BvsD; MS

sirolimus 0.5 mg 3 PA-BvsD; MS tacrolimus 0.5 mg 1 mg 3 PA-BvsD; MS tacrolimus 5 mg 5* PA-BvsD; MS TREXALL 10 MG 15 MG 5 MG 7.5 MG 4 MS ZORTRESS 0.25 MG 5* PA-BvsD; MS; QL 62 31 ZORTRESS 0.5 MG 0.75 MG 5* PA-BvsD; MS CARIMUNE NF * 12 GM 3 GM 6 GM LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 76 5* PA; MS GAMMAGARD 2.5 GM/25 ML 5* PA; MS GAMUNEX-C 1 GM/10 ML 4 PA; MS THYMOGLOBULIN * 25 MG 3 PA-NS; MS VARIZIG 125 4 ACTIMMUNE * 2000000 0.5 ML 5* PA-NS; LA ARCALYST * 220 MG 5* PA; MS leflunomide 10 mg 20 mg RIDAURA 3 MG 5* MS TECFIDERA 120 MG 240 MG 5* PA; MS TECFIDERA 120 & 240 MG 5* PA; MS ACTHIB * 3 ADACEL * 5-2-15.5 3

BIOTHRAX * 4 BOOSTRIX * 5-2.5-18.5 3 CERVARIX * 3 COMVAX * 7.5-5 MCG/0.5 ML 3 DAPTACEL * 10-15-5 3 DECAVAC * 5-2 LFU 3 diphtheria-tetanus toxoids dt * 25-5 lfu/0.5 ml ENGERIX-B 10 MCG/0.5 ML 20 MCG/ML GARDASIL * 3 HAVRIX * 1440 EL U/ML 720 EL U/0.5 ML IMOVAX RABIES * 2.5 ML 3 INFANRIX * 25-58-10 3 IPOL 3 IXIARO * 3 JE-VAX * 3 KINRIX * 4 M-M-R II * 4 MENACTRA * 4 MENOMUNE * 3 MENVEO * 4 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 77 3 3 PA-BvsD PEDIARIX * 3 PA-BvsD PEDVAX HIB * 3 3

PENTACEL * 4 PROQUAD * 3 RABAVERT * 4 RECOMBIVAX HB 10 MCG/ML 40 MCG/ML ROTARIX 4 ROTATEQ 3 TENIVAC * 5-2 LFU 3 tetanus toxoid adsorbed * 5 lfu 3 tetanus-diphtheria toxoids td * 2-2 lf/0.5 ml 3 PA-BvsD TWINRIX * 720-20 3 PA-BvsD TYPHIM VI * 25 MCG/0.5 ML 3 VAQTA * 25 0.5 ML 3 VARIVAX * 1350 PFU/0.5 ML 3 YF-VAX * 3 ZOSTAVAX * 19400 0.65 ML APRISO 24 0.375 GM 4 MS balsalazide disodium 750 mg CANASA RE 1000 MG 4 MS DIPENTUM 250 MG 4 MS 3 4 QL 1 365 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 78

LIALDA 1.2 GM mesalamine-cleanser 4 gm budesonide er 24 3 mg 5* MS hydrocortisone 100 mg/60 ml sulfasalazine 500 mg sulfazine ec 500 mg alendronate sodium 70 mg/75 ml alendronate sodium 10 mg 5 mg 1 MS alendronate sodium 35 mg 70 mg 1 MS; QL 4 28 alendronate sodium 40 mg calcitonin 200 act calcitriol * 1mcg/ml calcitriol 0.25 mcg 0.5 mcg calcitriol 1mcg/ml etidronate disodium 200 mg 400 mg FORTEO * 600 MCG/2.4 ML 5* PA; MS; QL 2.4 ML 28 FORTICAL 200 ACT ibandronate sodium * 3 mg/3 ml 4 PA; MS; QL 3 ML 84 ibandronate sodium 150 mg 4 MS; QL 1 28 MIACALCIN 200 ML 4 PA; MS pamidronate disodium * 30 mg/10 ml 90 mg/10 ml LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 79 PROLIA * 60 MG/ML 4 ST; MS; QL 1 ML 180

XGEVA * 120 MG/1.7 ML 5* PA-NS; MS zemplar * 2mcg/ml 5 mcg/ml zemplar 1mcg 2mcg 4mcg zoledronic acid * 4 mg/5 ml 4 PA; MS zoledronic acid * 4 mg/100 ml 4 PA; MS zoledronic acid * 5 mg/100 ml 4 PA-BvsD; MS ZOMETA * 4 MG/100 ML 5* PA; MS alcohol preps 1 MS BD INSULIN SYRINGE ULTRAFINE 31 G X 5/16'' 1 ML EXEL PEN 1/3'' 31 GM X 8 MM fomepizole * 1 gm/ml 5* MS huber 22 gm x 3/4'' HUMAPEN LUXURA HUMAPEN MEMOIR hy-vee insulin syringe 30 gm x 1/2'' 0.3 ml insulin syringe 29 gm x 1'' 0.3 ml KLING V-GO 20 4 MS V-GO 30 4 MS V-GO 40 4 MS piperacillin sod-tazobactam so * 2-0.25 gm, 36-4.5 gm LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 80 VALCHLOR 0.016 % 5* PA-NA; MS

COMBIGAN 0.2-0.5 % 4 MS latanoprost 0.005 % LUMIGAN 0.01 % 4 MS; QL 5 ML 31 TRAVATAN Z 0.004 % 4 MS atropine sulfate 1 % atropine sulfate 1 % LACRISERT 5 MG 4 MS naphazoline hcl 0.1 % 1 MS phenylephrine hcl 10 % 2.5 % RESTASIS 0.05 % 4 MS tropicamide 0.5 % 1 % ALOCRIL 2 % cromolyn sodium 4 % PATADAY 0.2 % 4 MS PATANOL 0.1 % 4 MS acetazolamide er 12 500 mg ALPHAGAN P 0.1 % 0.15 % 4 MS AZOPT 1 % betaxolol hcl 0.5 % brimonidine tartrate 0.15 % 0.2 % carteolol hcl 1 % dorzolamide hcl 2 % LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 81

dorzolamide hcl-timolol mal 22.3-6.8 mg/ml levobunolol hcl 0.25 % 0.5 % methazolamide 25 mg 50 mg metipranolol 0.3 % pilocarpine hcl 1 % 2 % 4 % PILOPINE HS 4 % SIMBRINZA 1-0.2 % 4 MS timolol maleate 0.25 % 0.5 % timolol maleate 0.25 % 0.5 % ALREX 0.2 % 4 MS bromfenac sodium 0.09 % bromfenac sodium 0.09% dexamethasone sodium phosphate 0.1% diclofenac sodium 0.1 % DUREZOL 0.05 % 4 MS fluorometholone 0.1 % flurbiprofen sodium 0.03 % ILEVRO 0.3 % 4 MS ketorolac tromethamine 0.4 % 0.5 % LOTEMAX 0.5 % 4 MS LOTEMAX 0.5 % 4 MS LOTEMAX 0.5 % 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 82

neomycin-polymyxin-dexameth 3.5-10000-0.1 neomycin-polymyxin-dexameth 3.5-10000-0.1 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 83 NEVANAC 0.1 % 4 MS prednisolone acetate 1 % prednisolone sodium phosphate 1 % PROLENSA 0.07 % 4 MS tobramycin-dexamethasone 0.3-0.1% ACETASOL HC 2-1 % acetic acid 2 % acetic acid-aluminum acetate 2 % hydrocortisone-acetic acid 1-2 % neomycin-polymyxin-hc 3.5-10000-1 neomycin-polymyxin-hc 3.5-10000-1 azelastine hcl 137mcg carbinoxamine maleate 4 mg/5 ml carbinoxamine maleate 4 mg clemastine fumarate 2.68 mg cyproheptadine hcl 2 mg/5 ml 3 PA; MS cyproheptadine hcl 4 mg 2 PA; MS diphenhydramine hcl 50 mg/ml diphenhydramine hcl 50 mg

hydroxyzine hcl * 25 mg/ml 50 mg/ml 2 PA; MS hydroxyzine hcl 50 mg 2 PA; MS hydroxyzine pamoate 100 mg 25 mg 50 mg 2 PA; MS levocetirizine dihydrochloride 2.5 mg/5 ml 4 MS levocetirizine dihydrochloride 5 mg 4 MS; QL 31 31 promethazine hcl 25 mg/ml 50 mg/ml 3 PA; MS promethazine hcl 6.25 mg/5 ml 2 PA; MS promethazine hcl 12.5 mg 25 mg 50 mg ADVAIR DISKUS 100-50 MCG250-50 MCG 500-50 MCG ADVAIR HFA 115-21MCG/ACT 230-21MCG/ACT 45-21MCG/ACT ASMANEX 120 220 MCG/INH 2 PA; MS ; QL 60 30 ; QL 12 GM 30 ; QL 1 30 ASMANEX 14 220 MCG/INH ASMANEX 30 110 MCG/INH 220 MCG/INH ASMANEX 60 220 MCG/INH ASMANEX 7 110 MCG/INH ; QL 1 30 ; QL 1 30 ; QL 1 30 ; QL 1 30 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 84

BREO ELLIPTA 100-25 MCG/INH DULERA 100-5 MCG/ACT 200-5 MCG/ACT FLOVENT DISKUS 100 MCG/BLIST 250 MCG/BLIST 50 MCG/BLIST ; QL 60 30 ; QL 13 GM 30 ; QL 60 30 FLOVENT HFA 110 MCG/ACT ; QL 12 GM 30 FLOVENT HFA 220 MCG/ACT ; QL 24 GM 30 FLOVENT HFA 44MCG/ACT ; QL 10.6 GM 30 flunisolide 25 mcg/act (0.025%) 29 mcg/act (0.025%) fluticasone propionate 50 mcg/act NASONEX 50 MCG/ACT 4 MS PULMICORT FLEXHALER 180 MCG/ACT 90 MCG/ACT QVAR 40 MCG/ACT 80 MCG/ACT 4 MS; QL 1 30 ; QL 17.4 GM 30 montelukast sodium 4 mg 1 MS; QL 31 31 montelukast sodium 10 mg 1 MS; QL 31 31 montelukast sodium 4 mg 5 mg 1 MS; QL 31 31 zafirlukast 10 mg 20 mg ; QL 62 31 ANORO ELLIPTA 62.5-25 MCG/INH ATROVENT HFA 17MCG/ACT ; QL 25.8 GM 31 LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 85

COMBIVENT 18-103 MCG/ACT COMBIVENT RESPIMAT 20-100 MCG/ACT ; QL 8 GM 20 ipratropium bromide 0.02 % 2 PA-BvsD; MS ipratropium bromide 0.03 % 0.06 % ipratropium-albuterol 0.5-2.5 (3)mg/3 ml 2 PA-BvsD; MS SPIRIVA 18 MCG 4 MS; QL 30 30 TUDORZA PRESSAIR 400 MCG/ACT aminophylline * 25 mg/ml THEO-24 24 100 MG 200 MG 300 MG 400 MG theochron 12 * 100 mg 200 mg 300 mg theophylline er 12 * 100 mg 200 mg 300 mg 450 mg theophylline er 24 * 400 mg 600 mg albuterol sulfate 2.5 mg/3 ml 0.083%5 mg/ml 0.5% 0.63 mg/3 ml 1.25 mg/3 ml ; QL 1 30 2 PA-BvsD; MS albuterol sulfate 2 mg/5 ml 1 MS albuterol sulfate 2 mg 4 mg albuterol sulfate er 12 * 4 mg 8 mg ARCAPTA NEOHALER 75 MCG 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 86

AUVI-Q 0.15 MG/0.15 ML 0.3 MG/0.3 ML 4 MS; QL 2 31 metaproterenol sulfate 10 mg/5 ml metaproterenol sulfate 10 mg 20 mg SEREVENT DISKUS 50 MCG terbutaline sulfate 1 mg/ml 4 MS terbutaline sulfate 2.5 mg 5 mg VENTOLIN HFA 108 (90 BASE) MCG ACT ; QL 60 30 ; QL 36 GM 31 cromolyn sodium 20 mg/2 ml 3 PA-BvsD; MS ADCIRCA 20 MG 5* PA; MS; QL 62 31 LETAIRIS 10 MG 5 MG 5* PA; LA; QL 30 30 REMODULIN 1 MG/ML 10 MG/ML 2.5 MG/ML 5 MG/ML 5* PA; MS sildenafil citrate 20 mg 5* PA; MS; QL 93 31 TRACLEER 125 MG 62.5 MG 5* PA; MS acetylcysteine 10 % 20 % 2 PA-BvsD; MS DALIRESP 500 MCG 4 MS; QL 31 31 KALYDECO 150 MG 5* PA; MS; QL 62 31 PROLASTIN-C * 1000 MG 5* PA-BvsD; LA promethazine vc plain 6.25-5 mg/5 ml PULMOZYME 1 MG/ML 5* PA-BvsD; MS TYZINE 0.1 % LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 87

XOLAIR * 150 MG 5* PA; LA carisoprodol 350 mg 3 PA; MS; QL 124 31 cyclobenzaprine hcl 10 mg 5 mg 2 PA; MS; QL 93 31 methocarbamol 500 mg 750 mg 3 PA; MS Gaba flurazepam hcl 15 mg ; QL 62 31 flurazepam hcl 30 mg ; QL 31 31 temazepam 15 mg 22.5 mg 30 mg 7.5 mg LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 88 ; QL 31 31 triazolam 0.125 mg ; QL 31 31 triazolam 0.25 mg ; QL 62 31 zaleplon 10 mg 5 mg 2 PA; MS; QL 90 365 zolpidem tartrate 10 mg 5 mg 2 PA; MS; QL 90 365 modafinil 100 mg 4 PA; MS; QL 62 31 modafinil 200 mg 5* PA; MS; QL 62 31 XYREM 500 MG/ML 5* PA; LA; QL 558 ml 31 VELPHORO 500 MG 4 MS CUPRIMINE 250 MG 4 MS EXJADE 125 MG 250 MG 500 MG 5* PA; LA

KIONEX KIONEX 15 GM/60ML SAMSCA 15 MG 30 MG 5* PA; MS; QL 62 31 sodium lactate * 167 meq/l 5 meq/ml 4 MS sodium polystyrene sulfonate 15 gm/60 ml SPS 15 GM/60 ML SYPRINE 250 MG 5* MS AMINOSYN * 10 % 8.5% AMINOSYN II * 10 % 15 % 7 % 8.5 % AMINOSYN II IN DEXTROSE 25% * 4.25 % 5 % AMINOSYN II/ELECTROLYTES * 8.5 % AMINOSYN M * 3.5 % AMINOSYN-HBC * 7 % AMINOSYN-HF * 8 % AMINOSYN-PF * 10 % 7 % AMINOSYN-RF * 5.2 % AMINOSYN/ELECTROLYTES * 8.5 % calcium acetate 667 mg citric acid-sodium citrate 334-500 mg/5 ml CLINIMIX E/DEXTROSE (2.75/10) * 2.75 % 4 MS CLINIMIX E/DEXTROSE (2.75/5) * 2.75 % 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 89

CLINIMIX E/DEXTROSE (4.25/25) * 4.25 % 4 MS CLINIMIX E/DEXTROSE (4.25/5) * 4.25 % 4 MS CLINIMIX E/DEXTROSE (5/15) * 5 % 4 MS CLINIMIX E/DEXTROSE (5/20) * 5 % 4 MS CLINIMIX E/DEXTROSE (5/25) * 5 % 4 MS CLINIMIX/DEXTROSE (2.75/5) * 2.75 % 4 MS CLINIMIX/DEXTROSE (4.25/10) * 4.25 % 4 MS CLINIMIX/DEXTROSE (4.25/20) * 4.25 % 4 MS CLINIMIX/DEXTROSE (4.25/25) * 4.25 % 4 MS CLINIMIX/DEXTROSE (4.25/5) * 4.25 % 4 MS CLINIMIX/DEXTROSE (5/15) * 5 % 4 MS CLINIMIX DEXTROSE (5/20) * 5 % 4 MS CLINIMIX DEXTROSE (5/25) * 5 % 4 MS CLINISOL SF * 15 % cytra-2 500-334 mg/5 ml cytra-3 550-500-334 mg/5 ml dextrose * 10 % 5 % dextrose 5%/electrolyte #48 * LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 90

dextrose in lactated ringers * 5 % dextrose-nacl * 10-0.2 % 10-0.45 % 2.5-0.45 % 5-0.2 % 5-0.225 % 5-0.33 % 5-0.45 % 5-0.9% LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 91 ELIPHOS 667 MG FREAMINE III * 3 % 8.5 % 4 MS HEPATAMINE * 8 % 4 MS HEPATASOL * 8 % 4 MS INTRALIPID * 20 % 30% 4 MS IONOSOL-B IN D5W * 4 MS IONOSOL-MB IN D5W * 4 MS ISOLYTE-M IN D5W * 4 MS ISOLYTE-P IN D5W * 4 MS ISOLYTE-S * 4 MS kcl in dextrose-nacl * 10-5-0.45 meq/l-%-% 20-5-0.2 meq/l-%-% 20-5-0.225 meq/l-%-% 20-5-0.33 meq/l-%-% 20-5-0.45 meq/l-%-% 20-5-0.9 meq/l-%-% 30-5-0.45 meq/l-%-% 40-5-0.45 meq/l-%-% 40-5-0.9 meq/l-%-% 4 MS kcl-lactated ringers-d5w * 20 meq/l 4 MS klor-con 20 meq 25 meq klor-con * 8 meq klor-con 10 * 10 meq klor-con m10 * 10 meq klor-con m15 * 15 meq klor-con m20 * 20 meq lactated ringers * lactated ringers LIPOSYN II * 20 %

LIPOSYN III * 10 % 20% 30 % magnesium sulfate 50 % NEPHRAMINE * 5.4 % 4 MS NORMOSOL-M IN D5W * NORMOSOL-R IN D5W * NORMOSOL-R PH 7.4 * PHOSLYRA 667 MG/5 ML 4 MS PHYSIOLYTE 4 MS PHYSIOSOL IRRIGATION 4 MS PLASMA-LYTE 148 * 4 MS PLASMA-LYTE A * 4 MS PLASMA-LYTE-56 IN D5W * 4 MS potassium chloride * 0.4 meq/ml 10 meq/50 ml 2 meq/ml potassium chloride * 10 meq/100 ml 20 meq/100 ml 30 meq/100 ml 40 meq/100 ml 4 MS potassium chloride 20 meq/15 ml (10%) potassium chloride crys er * 10 meq 20 meq potassium chloride er * 10 meq 8 meq potassium chloride er * 8 meq potassium chloride in dextrose * 20-5 meq/l-% potassium chloride in dextrose * 40-5 meq/l-% 4 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 92

potassium chloride in nacl * 20-0.45 meq/l-% 20-0.9 meq/l-% 40-0.9 meq/l-% potassium citrate er * 10 meq 1080 mg5 meq 540 mg 4 MS 4 MS PREMASOL * 10 % 6% 4 MS PROCALAMINE * 3 % 4 MS PROSOL * 20 % 4 MS ringers * 4 MS ringers irrigation 4 MS sodium chloride 2.5 meq/ml sodium chloride * 0.45 % sodium chloride * 0.9 % 3 % 5 % sodium chloride 0.9 % sodium fluoride 2.2 (1 f) mg 1 MS TPN ELECTROLYTES * TRAVASOL * 10 % 4 MS TROPHAMINE * 10 % 6% prenatal plus 27-1 mg 1 MS prenatal plus iron 29-1 mg 1 MS prenatal/iron 1 MS LA = MS = PA = PA-NS = PA-BvsD = B D QL = ST = ST-NS = 5* - 31 - - 93

8-MOP... 56 abacavir sulfate... 36 abacavir-lamivudinezidovudine... 36 ABILIFY... 32 ABILIFY DISCMELT... 32 ABILIFY MAINTENA... 32 acamprosate calcium...5 acarbose... 40 acebutolol hcl... 48 acetaminophen-codeine... 3 acetaminophen-codeine #2... 3 acetaminophen-codeine #3... 3 acetaminophen-codeine #4... 3 ACETASOL HC... 83 acetazolamide... 51 acetazolamide er... 81 acetazolamide sodium... 51 acetic acid... 83 acetic acid-aluminum acetate... 83 acetylcysteine... 87 acitretin... 56 ACTHIB... 76 acticin... 30 ACTIMMUNE... 76 acyclovir... 35 acyclovir sodium... 35 ADACEL... 76 ADAGEN... 57 ADCIRCA... 87 adefovir dipivoxil... 34 ADVAIR DISKUS... 84 ADVAIR HFA... 84 afeditab cr... 49 AFINITOR... 28 AFINITOR DISPERZ... 28 AGGRENOX... 45 ala cort... 62 ALBENZA... 29 albuterol sulfate... 86 albuterol sulfate er... 86 alclometasone dipropionate... 62 alcohol preps... 80 ALDURAZYME... 57 alendronate sodium... 79 ALIMTA... 26 ALINIA... 29 allopurinol... 24 ALOCRIL... 81 ALPHAGAN P... 81 alprazolam... 39 ALREX... 82 amantadine hcl... 38 AMBISOME... 22 amcinonide... 62 A-METHAPRED... 62 amethia... 67 amethyst... 67 amifostine... 26 amikacin sulfate... 5 97 amiloride hcl... 51 amiloride-hydrochlorothiazide... 51 aminophylline... 86 AMINOSYN... 89 AMINOSYN II... 89 AMINOSYN II DEXTROSE 25%... 89 AMINOSYN II/ELECTROLYTES...89 AMINOSYN M... 89 AMINOSYN/ELECTROLYTES... 89 AMINOSYN-HBC... 89 AMINOSYN-HF... 89 AMINOSYN-PF... 89 AMINOSYN-RF... 89 amiodarone hcl... 47 AMITIZA... 60 amitriptyline hcl... 20 amlodipine besy-benazepril hcl... 49 amlodipine besylate... 49 ammonium lactate... 56 amoxapine... 20 amoxicillin... 10 amoxicillin-pot clavulanate... 10 amphetamine-dextroamphetami ne... 54 amphotericin b... 22 ampicillin... 10

ampicillin sodium... 10 ampicillin-sulbactam sodium... 10 ANADROL-50... 67 anagrelide hcl... 44 anastrozole... 28 ANDROXY... 67 ANORO ELLIPTA... 85 APOKYN... 30 apri... 67 APRISO... 78 APTIOM... 14 APTIVUS... 38 aranelle... 67 ARCALYST... 76 ARCAPTA NEOHALER... 86 ARMOUR THYROID... 71 ASMANEX 120... 84 ASMANEX 14... 84 ASMANEX 30... 84 ASMANEX 60... 84 ASMANEX 7... 84 ASTAGRAF XL... 74 atenolol... 48 atenolol-chlorthalidone... 48 atorvastatin calcium... 52 atovaquone... 29 ATRIPLA... 36 atropine sulfate... 58, 81 ATROVENT HFA... 85 AUBAGIO... 55 AUVI-Q... 87 AVASTIN... 29 aviane... 67 AVODART... 61 azacitidine... 26 AZASITE... 11 azathioprine... 74 azathioprine sodium... 74 azelastine hcl... 83 AZELEX... 56 AZILECT... 31 azithromycin... 11, 12 AZOPT... 81 baciim... 6 bacitracin... 6 bacitracin-polymyxin b... 6 bacitra-neomycin-polymyxin-hc...6 baclofen... 34 BACTOCILL DEXTROSE... 11 balsalazide disodium... 78 balziva... 67 BANZEL... 16 BARACLUDE... 35 BD ULTRAFINE... 80 benazepril hcl... 46 benazepril-hydrochlorothiazide... 46 benzoyl peroxide-erythromycin... 56 benztropine mesylate... 30 BESIVANCE... 12 betamethasone dipropionate... 62 betamethasone dipropionate aug... 62 98 betamethasone valerate... 62, 63 BETASERON... 55 betaxolol hcl... 48, 81 bethanechol chloride... 62 bicalutamide... 74 BICILLIN C-R... 11 BICILLIN C-R 900/300... 11 BICILLIN L-A... 11 BIOTHRAX... 77 bisoprolol fumarate... 48 bisoprolol-hydrochlorothiazide... 48 bleomycin sulfate... 27 BONIVA... 77 BOSULIF... 28 BREO ELLIPTA... 85 BREVICON (28)... 67 briellyn... 67 BRILINTA... 45 brimonidine tartrate... 81 BRINTELLIX... 19 bromfenac sodium... 82 bromfenac sodium... 82 bromocriptine mesylate... 30 budeprion sr... 18 budesonide er... 79 bumetanide... 51 BUPHENYL... 57 buprenorphine hcl

... 5 buproban... 5 bupropion hcl... 18 bupropion hcl er (sr)... 18 bupropion hcl er (xl)... 18 buspirone hcl... 39 butalbital-acetaminophen... 1 butalbital-apap-caff-cod... 1 butalbital-apap-caffeine... 1 butalbital-asa-caffeine... 1 butalbital-aspirin-caffeine... 1 BYDUREON... 40 BYETTA 10 MG... 40 BYETTA 5 MG... 40 BYSTOLIC... 48 calcipotriene... 56 calcitonin... 79 calcitriol... 79 calcium acetate... 89 camila... 71 CANASA... 78 CANCIDAS... 22 CAPASTAT SULFATE... 25 CAPRELSA... 26 captopril... 46 captopril-hydrochlorothiazide... 46 CARAC... 56 CARAFATE... 60 carbamazepine... 17 carbamazepine er... 17 carbidopa... 31 carbidopa-levodopa... 31 carbidopa-levodopa er... 31 carbinoxamine maleate... 83 CARIMUNE NF... 76 carisoprodol... 88 carteolol hcl... 81 CARTIA XT... 49 carvedilol... 48 CAZIANT... 67 cefaclor... 8 cefadroxil... 8 cefazolin sodium... 8 cefdinir... 8 cefepime hcl... 8 cefotaxime sodium... 9 cefoxitin sodium... 9 cefpodoxime proxetil... 9 cefprozil... 9 ceftazidime... 9 ceftazidime and dextrose... 9 ceftriaxone sodium... 9 cefuroxime axetil... 9 cefuroxime sodium... 9 CELEBREX... 1 CELLCEPT... 74 CELONTIN... 15 cephalexin... 9 CEREZYME... 57 CERVARIX... 77 CESIA... 67 CHANTIX... 5 CHANTIX...... 5 99 chloramphenicol sod succinate... 7 chlordiazepoxide-amitriptyline... 20 chlorhexidine gluconate... 56 chloroquine phosphate... 29 chlorothiazide... 52 chlorothiazide sodium... 52 chlorpromazine hcl... 31 chlorthalidone... 52 cholestyramine... 53 cholestyramine light... 53 chorionic gonadotropin... 66 CIALIS... 62 ciclopirox... 22 ciclopirox olamine... 22 cilostazol... 45 cimetidine... 59 cimetidine hcl... 59 CIPRODEX... 12 ciprofloxacin... 12 ciprofloxacin hcl... 12, 13 ciprofloxacin d5w... 13 citalopram hydrobromide... 19 citric acid-sodium citrate... 89 clarithromycin... 12 clarithromycin er... 12 clemastine fumarate... 83

CLINDACIN PAC... 56 clindamycin hcl... 7 clindamycin phosphate...... 7, 56 clindamycin phosphate d5w... 7 CLINIMIX E/DEXTROSE (2.75/10)... 89 CLINIMIX E/DEXTROSE (2.75/5)... 89 CLINIMIX E/DEXTROSE (4.25/25)... 90 CLINIMIX E/DEXTROSE (4.25/5)... 90 CLINIMIX E/DEXTROSE (5/15)... 90 CLINIMIX E/DEXTROSE (5/20)... 90 CLINIMIX E/DEXTROSE (5/25)... 90 CLINIMIX/DEXTROSE (2.75/5)... 90 CLINIMIX/DEXTROSE (4.25/10)... 90 CLINIMIX/DEXTROSE (4.25/20)... 90 CLINIMIX/DEXTROSE (4.25/25)... 90 CLINIMIX/DEXTROSE (4.25/5)... 90 CLINIMIX/DEXTROSE (5/15)... 90 CLINIMIX/DEXTROSE (5/20)... 90 CLINIMIX/DEXTROSE (5/25)... 90 CLINISOL SF... 90 clobetasol propionate... 63 clobetasol propionate e... 63 clobetasol propionate emulsion...63 clocortolone pivalate pump... 63 CLODERM PUMP... 63 clomipramine hcl... 20 clonazepam... 15 clonidine hcl... 45 clonidine hcl er... 54 clopidogrel bisulfate... 45 clorazepate dipotassium... 15 CLORPRES... 45 clotrimazole... 22 clotrimazole-betamethasone... 63 clozapine... 34 codeine sulfate... 3 CO-GESIC... 3 colchicine-probenecid... 24 COLCRYS... 24 colestipol hcl... 53 colistimethate sodium... 7 COLOCORT... 63 COMBIGAN... 81 COMBIPATCH... 67 COMBIVENT... 86 COMBIVENT RESPIMAT... 86 COMETRIQ 100 MG... 27 COMETRIQ 140 MG... 27 COMETRIQ 60 MG... 27 COMPLERA... 36 compro... 31 COMVAX... 77 CONDYLOX... 56 constulose... 60 COPAXONE... 55 CORDRAN... 63 COREG CR... 48 CORTIFOAM... 63 cortisone acetate... 63 COUMADIN... 43 CREON... 58 CRESTOR... 52 CRIXIVAN... 38 cromolyn sodium... 59, 81, 87 cryselle-28... 67 CUBICIN... 7 CUPRIMINE... 88 cyclafem 1/35... 67 cyclafem 7/7/7... 68 cyclobenzaprine hcl... 88 cyclophosphamide... 25 CYCLOSET... 40 cyclosporine... 74 cyclosporine modified... 74 cyproheptadine hcl... 83 CYSTADANE... 58 CYSTAGON... 58 cytra-2... 90 cytra-3... 90 DALIRESP... 87 danazol... 67 dapsone... 25 DAPTACEL... 77 DARAPRIM... 29 DECAVAC... 77 demeclocycline hcl... 13, 14 DENAVIR... 35 100

dentagel... 56 desipramine hcl... 20 desmopressin ace... 66 desmopressin ace... 66 desmopressin acetate... 66 desmopressin acetate... 66 desonide... 63 desoximetasone... 63 dexamethasone... 63, 64 dexamethasone intensol... 64 dexamethasone sod phosphate pf.... 64 dexamethasone sodium phosphate... 64, 82 DEXILANT... 60 dexmethylphenidate hcl... 54 dextroamphetamine sulfate... 54 dextroamphetamine sulfate er... 54 dextrose... 90 dextrose 5%/electrolyte #48... 90 dextrose... 91 dextrose-nacl... 91 diazepam... 15, 39 diazepam intensol... 39 diclofenac potassium... 1 diclofenac sodium... 1, 82 diclofenac sodium er... 1 dicloxacillin sodium... 11 dicyclomine hcl... 58, 59 didanosine... 37 DIFICID... 12 diflunisal... 1 digoxin... 50, 50 dihydroergotamine mesylate... 24 DILANTIN... 17 DILANTIN INFATABS... 17 dilt-cd... 49 diltiazem hcl... 49 diltiazem hcl er... 49 diltiazem hcl er... 49 diltiazem hcl er... 49 dilt-xr... 49 diltzac... 49 DIOVAN... 45 DIPENTUM... 78 diphenhydramine hcl... 83 diphenoxylate-atropine... 59 diphtheria-tetanus toxoids dt... 77 dipyridamole... 45 disopyramide phosphate... 47 disulfiram... 5 divalproex sodium... 15 divalproex sodium er... 15 donepezil hcl... 17 dorzolamide hcl... 81 dorzolamide hcl-timolol mal... 82 doxazosin mesylate... 61 doxepin hcl... 20 101 doxycycline hyclate... 14 dronabinol... 21 drospirenone-ethinyl estradiol... 68 DROXIA... 26 DULERA... 85 duloxetine hcl... 19 duramorph... 3 DUREZOL... 82 e.e.s. 400... 12 E.E.S. GRANULES... 12 econazole nitrate... 22 EDARBI... 45 EDARBYCLOR... 46 EDURANT... 36 EFFIENT... 45 EGRIFTA... 66 ELAPRASE... 58 ELIDEL... 57 ELIGARD... 73 ELIPHOS... 91 ELIQUIS... 43 ELITEK... 26 EMCYT... 26 EMEND... 21 emoquette... 68 EMSAM... 19 EMTRIVA... 37 enalapril maleate... 46 enalapril-hydrochlorothiazide... 46 ENBREL... 74 ENBREL SURECLICK...75 endocet... 3 ENGERIX-B... 77 enoxaparin sodium... 43 enpresse-28... 68 entacapone...

...30 enulose... 60 epitol... 17 EPIVIR... 37 EPIVIR HBV... 37 EPZICOM... 37 ergoloid mesylates... 17 ERIVEDGE... 27 errin... 71 ERYPED 200... 12 ERY-TAB... 12 ERYTHROCIN LACTOBIONATE...12 erythrocin stearate... 12 erythromycin... 12 erythromycin base... 12 erythromycin ethylsuccinate... 12 erythromycin-sulfisoxazole... 12 escitalopram oxalate... 19 esomeprazole sodium... 61 estazolam... 39 ESTRACE... 68 estradiol... 68 estradiol-norethindrone acet... 68 estropipate... 68 ethambutol hcl... 25 ethosuximide... 15 etidronate disodium... 79 etodolac... 1 etodolac er... 1 EXEL 1/3''... 80 EXELON... 17, 18 exemestane... 28 EXFORGE... 50 EXFORGE HCT... 50 EXJADE... 88 FABRAZYME... 58 famciclovir... 36 famotidine... 59 famotidine... 59 FANAPT... 32 FANAPT... 32 FARESTON... 26 FASLODEX... 26 FAZACLO... 34 felbamate... 16 felodipine er... 50 fenofibrate... 52 fenofibrate micronized... 52 fenoprofen calcium... 1 fentanyl... 2 fentanyl citrate... 3 FETZIMA... 19 FETZIMA... 19 FINACEA... 57 finasteride... 61 flecainide acetate... 47 FLOVENT DISKUS... 85 FLOVENT HFA... 85 fluconazole... 22 fluconazole dextrose... 22 fluconazole sodium chloride... 22 flucytosine... 22 fludrocortisone acetate... 64 flunisolide... 85 fluocinolone acetonide... 64 102 fluocinolone acetonide... 64 fluocinolone acetonide... 64 fluocinonide... 64 fluocinonide-e... 64 fluorometholone... 82 FLUOROPLEX... 57 fluorouracil... 57 fluoxetine hcl... 19 fluphenazine decanoate... 31 fluphenazine hcl... 31 flurazepam hcl... 88 flurbiprofen... 1 flurbiprofen sodium... 82 flutamide... 74 fluticasone propionate... 64, 85 fluvoxamine maleate... 19 fomepizole... 80 fondaparinux sodium... 43 forfivo xl... 18 FORTEO... 79 FORTICAL... 79 foscarnet sodium... 34 fosinopril sodium... 46 fosinopril sodium-hctz... 46 fosphenytoin sodium... 17 FOSRENOL... 62 FREAMINE III... 91 furosemide... 51 FUZEON... 37

FYCOMPA... 14 gabapentin... 15, 16 GABITRIL... 16 galantamine hydrobromide... 18 galantamine hydrobromide er... 18 GAMMAGARD... 76 GAMUNEX-C... 76 ganciclovir sodium... 34 GARDASIL... 77 gatifloxacin... 13 gavilyte-c... 60 gavilyte-g... 60 gavilyte-n... 60 gemfibrozil... 52 generlac... 60 GENGRAF... 75 gentak... 5 gentamicin saline... 6 gentamicin sulfate... 6 GEODON... 32 gianvi... 68 GILDAGIA... 68 GILENYA... 55 GILOTRIF... 28 GLEEVEC... 28 glimepiride... 40 glipizide... 40 glipizide er... 40 glipizide xl... 40 glipizide-metformin hcl... 40 GLUCAGEN HYPOKIT... 41 GLUCAGON... 41 glyburide... 40 glyburide... 40 glyburide-metformin... 40 glycopyrrolate... 59 GRALISE... 16 GRALISE... 16 granisetron hcl... 21 griseofulvin microsize... 22 griseofulvin ultramicrosize... 22 guanfacine hcl... 45 guanidine hcl... 24 HALDOL DECANOATE... 31 halobetasol propionate... 64 haloperidol... 31 haloperidol decanoate... 31 haloperidol lactate... 31, 32 HAVRIX... 77 HECORIA... 75 heparin (porcine) d5w... 44 heparin (porcine) nacl... 44 heparin sodium (porcine)... 44 HEPATAMINE... 91 HEPATASOL... 91 HEXALEN... 25 huber... 80 HUMALOG... 42 HUMALOG KWIKPEN... 42 HUMALOG 50/50... 42 HUMALOG 50/50 KWIKPEN... 42 HUMALOG 75/25... 42 103 HUMALOG MIX 75/25 KWIKPEN... 42 HUMAPEN LUXURA HD... 80 HUMAPEN MEMOIR... 80 HUMATROPE... 66 HUMIRA... 75 HUMIRA... 75 HUMIRA -CROHNS... 75 HUMIRA -PSORIASIS... 75 HUMULIN 70/30... 42 HUMULIN 70/30... 42 HUMULIN N... 42 HUMULIN N... 42 HUMULIN R... 42 HUMULIN R U-500... 42 hydralazine hcl... 53 hydrochlorothiazide... 52 hydrocodone-acetaminophen... 3 hydrocodone-ibuprofen... 3 hydrocortisone... 64, 79 hydrocortisone butyrate... 64, 65 hydrocortisone valerate... 65 hydrocortisone-acetic acid... 83 hydromorphone hcl... 3 hydromorphone hcl pf... 3

hydroxychloroquine sulfate... 30 hydroxyurea... 26 hydroxyzine hcl... 21, 84 hydroxyzine pamoate... 84 hy-vee... 80 ibandronate sodium... 79 ibuprofen... 1 ICLUSIG... 27 ifosfamide... 25 ILEVRO... 82 IMBRUVICA... 28 imipenem-cilastatin... 10 imipramine hcl... 20 imipramine pamoate... 20 imiquimod... 57 IMOVAX RABIES... 77 INCIVEK... 35 INCRELEX... 66 indapamide... 52 indomethacin... 1 INFANRIX... 77 INLYTA... 28 insulin syringe... 80 INTELENCE... 36 INTRALIPID... 91 INTRON-A... 35 introvale... 68 INVANZ... 10 INVEGA... 33 INVEGA SUSTENNA... 33 INVIRASE... 38 IONOSOL-B d5w... 91 IONOSOL-MB d5w... 91 IPOL... 77 ipratropium bromide... 86 ipratropium-albuterol... 86 ISENTRESS... 37 ISOLYTE-M d5w... 91 ISOLYTE-P d5w... 91 ISOLYTE-S... 91 isoniazid... 25 isosorbide dinitrate... 53 isosorbide dinitrate er... 54 isosorbide mononitrate... 54 isosorbide mononitrate er... 54 itraconazole... 22 IXEMPRA... 27 IXIARO... 77 JAKAFI... 27 JALYN... 61 jantoven... 44 JANUMET... 40 JANUMET XR... 40 JANUVIA... 40 JE-VAX... 77 jinteli... 68 jolivette... 71 junel 1.5/30... 68 junel 1/20... 68 junel fe 1.5/30... 68 junel fe 1/20... 68 JUXTAPID... 53 KALETRA... 38 KALYDECO... 87 104 KAPVAY... 54 karigel... 56 kariva... 68 kcl DEXTROSE -nacl... 91 kcl-lactated ringers-d5w... 91 kelnor 1/35... 68 ketoconazole... 22, 23 ketoprofen... 1 ketoprofen er... 2 ketorolac tromethamine... 82 KINRIX... 77 KIONEX... 89 KLING... 80 klor-con... 91 klor-con 10... 91 klor-con m10... 91 klor-con m15... 91 klor-con m20... 91 KOMBIGLYZE XR... 40 KORLYM... 67 KUVAN... 58 labetalol hcl... 48 LACLOTION... 57 LACRISERT... 81 lactated ringers... 91 lactulose... 60 lamivudine... 37 lamivudine-zidovudine... 37 lamotrigine... 16 LANOXIN... 51 LANOXIN... 51 LANTUS... 42 LANTUS SOLOSTAR

... 42 larin 1/20... 68 larin fe 1.5/30... 68 larin fe 1/20... 68 latanoprost... 81 LATUDA... 33 LAZANDA... 4 leena... 68 leflunomide... 76 lessina... 68 LETAIRIS... 87 letrozole... 28 leucovorin calcium... 27 LEUKERAN... 25 LEUKINE... 44 leuprolide acetate... 73 LEVEMIR... 42 LEVEMIR FLEXPEN... 42 levetiracetam... 14 levetiracetam nacl... 14 levobunolol hcl... 82 levocetirizine dihydrochloride... 84 levofloxacin... 13 levofloxacin d5w... 13 LEVONEST... 68 levonorgest-eth estrad 91... 69 levonorgestrel... 71 levora 0.15/30 (28)... 69 levothroid... 72 levothyroxine sodium... 72 levoxyl... 72 LEXIVA... 38 LIALDA... 79 lidocaine... 4 lidocaine hcl... 4 lidocaine hcl (pf)... 5 lidocaine viscous... 5 lidocaine-prilocaine... 5 LIDODERM... 5 liothyronine sodium... 72 LIPOSYN II... 91 LIPOSYN III... 92 lisinopril... 46 lisinopril-hydrochlorothiazide... 47 lithium carbonate... 39 lithium carbonate er... 39 lithium citrate... 39 LIVALO... 52 lokara... 65 lomustine... 25 LONOX... 59 loperamide hcl... 59 lorazepam... 39 LORYNA... 69 losartan potassium... 46 losartan potassium-hctz... 46 LOTEMAX... 82 LOTRONEX... 60 lovastatin... 52 LOVAZA... 53 low-ogestrel... 69 loxapine succinate... 32 LUMIGAN... 81 LUMIZYME... 58 lutera... 69 LYRICA... 15 LYSODREN... 72 105 lyza... 71 magnesium sulfate... 92 malathion... 30 maprotiline hcl... 18 marlissa... 69 MARPLAN... 19 MATULANE... 25 MATZIM LA... 50 meclizine hcl... 21 MEDROL... 65 medroxyprogesterone acetate... 71 mefloquine hcl... 30 megestrol acetate... 71 MEKINIST... 27 meloxicam... 2 MENACTRA... 77 MENEST... 27 MENOMUNE... 77 MENVEO... 77 meprobamate... 39 MEPRON... 30 mercaptopurine... 26 meropenem... 10 mesalamine-cleanser... 79 mesna... 27 MESNEX... 27 MESTINON... 24 METADATE ER... 54 metaproterenol sulfate... 87 metformin hcl... 41

metformin hcl er... 41 metformin hcl er (osm)... 41 methadone hcl... 2 methadose... 2 methazolamide... 82 methenamine hippurate... 7 methimazole... 74 methocarbamol... 88 methotrexate... 75 methotrexate sodium... 75 methotrexate sodium (pf)... 75 methscopolamine bromide... 59 methyclothiazide... 52 methyldopa... 45 methyldopa-hydrochlorothiazide... 45 methylphenidate hcl... 54, 55 methylphenidate hcl er... 55 methylprednisolone... 65 methylprednisolone (pak)... 65 methylprednisolone acetate... 65 methylprednisolone sodium succ... 65 metipranolol... 82 metoclopramide hcl... 59 metolazone... 52 metoprolol succinate er... 48 metoprolol tartrate... 48 metoprolol-hydrochlorothiazide... 48 metronidazole... 7 metronidazole nacl... 7 mexiletine hcl... 47 MIACALCIN... 79 microgestin 1.5/30... 69 microgestin 1/20... 69 microgestin fe 1.5/30... 69 microgestin fe 1/20... 69 micronized colestipol hcl... 53 midodrine hcl... 45 MIGERGOT... 24 MIGRANAL... 24 MILLIPRED... 65 minitran... 54 minocycline hcl... 14 minoxidil... 53 mirtazapine... 18, 19 misoprostol... 60 mitoxantrone hcl... 27 M-M-R II... 77 modafinil... 88 MODICON (28)... 69 moexipril hcl... 47 moexipril-hydrochlorothiazide... 47 mometasone furoate... 65 mononessa... 69 montelukast sodium... 85 morphine sulfate... 2, 4 morphine sulfate... 4 morphine sulfate (pf)... 2, 4 morphine sulfate er... 2 MOVIPREP... 60 MOXEZA... 13 MULTAQ... 47 mupirocin... 7 mupirocin calcium... 7 MYCAMINE... 23 MYCOBUTIN... 25 mycophenolate mofetil... 75 mycophenolic acid... 75 MYOZYME... 58 MYZILRA... 69 nabumetone... 2 nadolol... 48 NAFTIN... 23 NAGLAZYME... 58 naloxone hcl... 5 naltrexone hcl... 5 NAMENDA... 18 NAMENDA... 18 NAMENDA XR... 18 NAMENDA XR... 18 naphazoline hcl... 81 naproxen... 2 naproxen dr... 2 naproxen sodium... 2 106

naratriptan hcl... 24 NASONEX... 85 NATACYN... 23 nateglinide... 41 NEBUPENT... 30 necon 0.5/35 (28)... 69 necon 1/35 (28)... 69 NECON 1/50 (28)... 69 necon 10/11 (28)... 69 necon 7/7/7... 69 nefazodone hcl... 19 neomycin sulfate... 6 neomycin-bacitracin znpolymyx... 7 neomycin-polymyxin b gu... 6 neomycin-polymyxindexameth... 83 neomycin-polymyxingramicidin... 7 neomycin-polymyxin-hc... 7, 83 NEPHRAMINE... 92 NEUMEGA... 44 NEUPOGEN... 44 NEVANAC... 83 nevirapine... 36 nevirapine er... 36 NEXAVAR... 28 NEXIUM... 61 niacin er... 53 NIACOR... 53 nicardipine hcl... 50 NICOTROL NS... 5 nifediac cc... 50 nifedical xl... 50 nifedipine... 50 nifedipine er osmotic... 50 NILANDRON... 74 nimodipine... 50 NITRO-BID... 54 nitrofurantoin macrocrystal... 7 nitrofurantoin monohyd macro... 7 nitroglycerin... 54 NITROSTAT... 54 nora-be... 71 norethindrone... 71 norethindrone acetate... 71 norinyl 1+35 (28)... 69 NORMOSOL-M d5w... 92 NORMOSOL-R d5w... 92 NORMOSOL-R PH 7.4... 92 NORPACE CR... 47 nortrel 0.5/35 (28)... 69 nortrel 1/35 (21)... 69 nortrel 1/35 (28)... 69 nortrel 7/7/7... 69 nortriptyline hcl... 20 NORVIR... 38 NOVOLIN 70/30... 42 NOVOLIN N... 42 NOVOLIN R... 42 NOVOLOG... 42 107 NOVOLOG FLEXPEN... 43 NOVOLOG MIX 70/30... 43 NOVOLOG MIX 70/30 FLEXPEN... 43 NOVOLOG... 43 NOXAFIL... 23 np thyroid... 72 NUEDEXTA... 55 NULOJIX... 75 nyamyc... 23 nystatin... 23 nystatin-triamcinolone... 23 nystop... 23 ocella... 69 octreotide acetate... 73 ofloxacin... 13 ogestrel... 69 olanzapine... 33 OLYSIO... 35 omega-3-acid ethyl esters... 53 omeprazole... 61 ondansetron... 21 ondansetron hcl... 21 ONFI... 16 ONGLYZA... 41 ONTAK... 27 OPANA ER... 2 ORAP... 32 ORFADIN... 58 orsythia... 69 ovcon-35 (28)... 69 oxacillin sodium... 11 oxandrolone... 67 oxaprozin... 2 oxazepam... 39 oxcarbazepine... 17

OXSORALEN ULTRA... 57 oxybutynin chloride... 61 oxybutynin chloride er... 61 oxycodone hcl... 4 oxycodone-acetaminophen... 4 oxymorphone hcl er... 2 PACERONE... 47 pacerone... 47 pamidronate disodium... 79 PANRETIN... 29 pantoprazole sodium... 61 paromomycin sulfate... 6 paroxetine hcl... 19 PASER... 25 PATADAY... 81 PATANOL... 81 PAXIL... 19 PEDIARIX... 77 pedi-dri... 23 PEDVAX HIB... 77 peg 3350/electrolytes... 60 PEGANONE... 17 PEG-INTRON... 35 PEG-INTRON REDIPEN... 35 PEG-INTRON REDIPEN PAK 4... 35 penicillin g potassium... 11 penicillin g procaine... 11 penicillin v potassium... 11 PENTACEL... 78 PENTAM... 30 pentostatin... 26 pentoxifylline er... 51 periogard... 56 permethrin... 30 perphenazine... 32 perphenazine-amitriptyline... 21 PERTZYE... 58 PFIZERPEN-G... 11 PHENADOZ... 21 phenelzine sulfate... 19 phenobarbital... 14 phenylephrine hcl... 81 phenytoin... 17 phenytoin sodium... 17 phenytoin sodium... 17 PHILITH... 69 PHOSLYRA... 92 PHYSIOLYTE... 92 PHYSIOSOL... 92 pilocarpine hcl... 56, 82 PILOPINE HS... 82 pimtrea... 70 pindolol... 48 pioglitazone hcl... 41 pioglitazone hcl-glimepiride... 41 pioglitazone hcl-metformin hcl... 41 piperacillin sod-tazobactam so... 11, 80 pirmella 1/35... 70 piroxicam... 2 PLASMA-LYTE 148 108... 92 PLASMA-LYTE A... 92 PLASMA-LYTE-56 d5w... 92 podofilox... 57 polycin b... 8 polyethylene glycol 3350... 60 polymyxin b-trimethoprim... 8 POMALYST... 27 portia-28... 70 potassium chloride... 92 potassium chloride crys er... 92 potassium chloride er... 92 potassium chloride dextrose....92 potassium chloride nacl... 93 potassium citrate er... 93 POTIGA... 14 PRADAXA... 44 pramipexole dihydrochloride... 30 PRANDIMET... 41 pravastatin sodium... 52 prazosin hcl... 45 prednicarbate... 65 prednisolone... 65 prednisolone acetate... 83 prednisolone sodium phosphate... 65, 83 prednisone... 65 prednisone (pak)... 65 prefest... 70 PREMARIN... 70 PREMASOL

... 93 PREMPHASE... 70 PREMPRO... 70 prenatal plus... 93 prenatal plus iron... 93 prenatal/iron... 93 PREPOPIK... 60 PREVALITE... 53 PREVIFEM... 70 PREZISTA... 38 PRIFTIN... 25 primaquine phosphate... 30 primidone... 16 PRISTIQ... 20 probenecid... 24 procainamide hcl... 47 PROCALAMINE... 93 prochlorperazine... 32 prochlorperazine edisylate... 32 prochlorperazine maleate... 32 PROCRIT... 44 proctocream hc... 65 proctosol hc... 65 proctozone-hc... 65 PROGLYCEM... 41 PROGRAF... 75 PROLASTIN-C... 87 PROLENSA... 83 PROLEUKIN... 27 PROLIA... 79 PROMACTA... 44 promethazine hcl... 21, 84 promethazine vc plain... 87 PROMETHEGAN... 21 propafenone hcl... 47 propantheline bromide... 59 propranolol hcl... 48, 49 propranolol hcl er... 49 propranolol-hctz... 49 propylthiouracil... 74 PROQUAD... 78 PROSOL... 93 protriptyline hcl... 21 PULMICORT FLEXHALER... 85 PULMOZYME... 87 pyrazinamide... 25 pyridostigmine bromide... 24 quasense... 70 quetiapine fumarate... 33 quinapril hcl... 47 quinapril-hydrochlorothiazide... 47 quinidine gluconate er... 47 quinidine sulfate... 47 quinidine sulfate er... 47 QVAR... 85 RABAVERT... 78 raloxifene hcl... 71 ramipril... 47 109 RANEXA... 51 ranitidine hcl... 59, 60 RAPAFLO... 61 RAPAMUNE... 75 REBIF... 55 REBIF REBIDOSE... 55 REBIF REBIDOSE... 55 REBIF... 55 reclipsen... 70 RECOMBIVAX HB... 78 REGRANEX... 57 RELENZA... 39 RELISTOR... 59, 60 REMICADE... 75 REMODULIN... 87 RENVELA... 62 repaglinide... 41 REPREXAIN... 4 RESCRIPTOR... 36 reserpine... 45 RESTASIS... 81 RETROVIR... 37 REVLIMID... 26 REYATAZ... 38 RIBASPHERE... 35 RIBASPHERE RIBAPAK...35 ribavirin... 35 RIDAURA... 76 rifabutin... 25 rifampin... 25 riluzole... 55 rimantadine hcl... 39 ringers... 93 ringers irrigation... 93

RISPERDAL CONSTA... 33 risperidone... 33 RISPERIDONE M-TAB... 33 RITUXAN... 29 rivastigmine tartrate... 18 ropinirole hcl... 30 ROTARIX... 78 ROTATEQ... 78 SABRIL... 16 salsalate... 2 SAMSCA... 89 SANDIMMUNE... 75 SANDOSTATIN LAR DEPOT... 73 SANTYL... 57 SAPHRIS... 33 SAVELLA... 55 SAVELLA... 55 selegiline hcl... 31 selenium sulfide... 57 SELZENTRY... 38 SENSIPAR... 73 SEREVENT DISKUS... 87 SEROQUEL XR... 34 sertraline hcl... 20 sildenafil citrate... 87 silver sulfadiazine... 8 SIMBRINZA... 82 simvastatin... 52 sirolimus... 76 sodium chloride... 93 sodium fluoride... 93 sodium lactate... 89 sodium polystyrene sulfonate... 89 SOLIA... 70 SOLTAMOX... 26 SOMATULINE DEPOT... 73 SOMAVERT... 73 sorine... 47 sotalol hcl... 48 sotalol hcl (af)... 48 SOVALDI... 35 SPIRIVA HANDIHALER... 86 spironolactone... 51 spironolactone-hctz... 51 sprintec 28... 70 SPRYCEL... 28 SPS... 89 sronyx... 70 ssd... 8 stagesic... 4 stavudine... 37 STIVARGA... 29 STRATTERA... 55 streptomycin sulfate... 6 STRIBILD... 36 STROMECTOL... 29 SUBOXONE... 5 SUCRAID... 58 sucralfate... 60 sulfacetamide sodium... 13, 57 sulfacetamide-prednisolone... 13 sulfadiazine 110... 13 sulfamethoxazole-tmp ds... 13 sulfamethoxazole-trimethoprim... 13 sulfasalazine... 79 sulfazine ec... 79 sulindac... 2 sumatriptan... 24 sumatriptan succinate... 24 sumatriptan succinate refill... 24 SUPRAX... 9, 10 SUPREP... 60 SURMONTIL... 21 SUSTIVA... 36 SUTENT... 29 SYLATRON... 28 SYMLINPEN 120... 41 SYMLINPEN 60... 41 SYNAREL... 73 SYNRIBO... 28 SYNTHROID... 72 SYPRINE... 89 TABLOID... 26 tacrolimus... 76 TAFINLAR... 26 TAMIFLU... 39 tamoxifen citrate... 26 tamsulosin hcl... 61 TARCEVA... 29 TARGRETIN... 29 TASIGNA... 29 TASMAR... 30 TAZORAC... 57 TAZTIA XT... 50

TECFIDERA... 76 TEKTURNA... 51 TEKTURNA HCT... 51 telmisartan... 46 telmisartan-amlodipine... 50 telmisartan-hctz... 46 temazepam... 88 TENIVAC... 78 terazosin hcl... 61 terbinafine hcl... 23 terbutaline sulfate... 87 terconazole... 23 TESTIM... 67 testosterone cypionate... 67 testosterone enanthate... 67 tetanus toxoid adsorbed... 78 tetanus-diphtheria toxoids td... 78 tetracycline hcl... 14 TEV-TROPIN... 66 THALOMID... 26 THEO-24... 86 theochron... 86 theophylline er... 86 thioridazine hcl... 32 thiothixene... 32 THYMOGLOBULIN... 76 THYROLAR-1... 72 THYROLAR-1/2... 72 THYROLAR-1/4... 72 THYROLAR-2... 72 THYROLAR-3... 72 tiagabine hcl... 16 ticlopidine hcl... 45 TIKOSYN... 48 TIMENTIN... 11 timolol maleate... 49, 82 TIVICAY... 38 tizanidine hcl... 34 TOBI.... 6 TOBI PODHALER... 6 tobramycin... 6 tobramycin sulfate... 6 tobramycin-dexamethasone... 83 tolazamide... 41 tolbutamide... 41 topiramate... 16 torsemide... 51 TPN ELECTROLYTES... 93 TRACLEER... 87 tramadol hcl... 4 tramadol-acetaminophen... 4 trandolapril... 47 tranexamic acid... 45 tranylcypromine sulfate... 19 TRAVASOL... 93 TRAVATAN Z... 81 trazodone hcl... 19 TREANDA... 25 TRECATOR... 25 TRELSTAR DEPOT... 73 TRELSTAR DEPOT MIXJECT 111... 73 TRELSTAR LA... 73 TRELSTAR LA MIXJECT... 73 TRELSTAR MIXJECT... 74 tretinoin... 29, 57 TREXALL... 76 triamcinolone acetonide... 56, 66 triamterene-hctz... 52, 52 triazolam... 88 triderm... 66 trifluoperazine hcl... 32 trifluridine... 36 trihexyphenidyl hcl... 30 tri-legest fe... 70 trilyte... 60 trimethoprim... 8 trimipramine maleate... 21 trinessa (28)... 70 tri-previfem... 70 TRISENOX... 28 tri-sprintec... 70 trivora (28)... 70 TROKENDI XR... 16 TROPHAMINE... 93 tropicamide... 81 trospium chloride... 61 TRUVADA... 37 TUDORZA PRESSAIR... 86 TWINRIX... 78 TYGACIL... 8 TYKERB... 29 TYPHIM VI... 78 TYSABRI... 56 TYZEKA... 35

TYZINE... 87 ULORIC... 24 unithroid... 72 urea... 57 ursodiol... 59 valacyclovir hcl... 36 VALCHLOR... 80 VALCYTE... 34 valproate sodium... 16 valproic acid... 16 valsartan-hydrochlorothiazide... 46 vancomycin hcl... 8 vandazole... 8 VAQTA... 78 VARIVAX... 78 VARIZIG... 76 VELCADE... 28 velivet... 70 VELPHORO... 88 venlafaxine hcl... 20 venlafaxine hcl er... 20 VENTOLIN HFA... 87 verapamil hcl... 50 verapamil hcl er... 50 VERSACLOZ... 34 VESICARE... 61 VESTURA... 70 V-GO 20... 80 V-GO 30... 80 V-GO 40... 80 VICTRELIS... 35 VIDEX... 37 VIGAMOX... 13 VIIBRYD... 20 VIMPAT... 17 VIRACEPT... 38 VIRAMUNE... 36 VIRAMUNE XR... 36 VIREAD... 37 VIVELLE-DOT... 70 VOLTAREN... 57 voriconazole... 23 VOTRIENT... 29 VPRIV... 58 vyfemla... 70 VYTORIN... 53 warfarin sodium... 44 WELCHOL... 53 WYMZYA FE... 71 XALKORI... 29 XARELTO... 44 XENAZINE... 55 XGEVA... 80 XIFAXAN... 8 XOLAIR... 88 XTANDI... 74 X-VIATE... 57 XYREM... 88 YF-VAX... 78 zafirlukast... 85 zaleplon... 88 ZAVESCA... 58 zazole... 23 zebutal... 1 ZELAPAR... 31 ZELBORAF... 29 zemplar... 80 ZENCHENT... 71 ZENCHENT FE... 71 ZENPEP... 58 ZERIT... 37 ZETIA... 53 ZIAGEN... 37 zidovudine... 37 ziprasidone hcl... 34 ZIRGAN... 34 zoledronic acid... 80 112 ZOLINZA... 28 zolpidem tartrate... 88 ZOMETA... 80 zonisamide... 15 ZORTRESS... 76 ZOSTAVAX... 78 zovia 1/35e (28)... 71 zovia 1/50e (28)... 71 ZOVIRAX... 36 ZYKADIA...28 ZYLET... 6 ZYPREXA RELPREVV... 34 ZYTIGA... 28 ZYVOX... 8

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This information is available for free in other languages. Please call our Customer Service number at 1-877-374-4056, Monday-Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are available Monday-Sunday, 8 a.m. to 8 p.m. TTY users should call 1-877-247-6272. Esta información está disponible gratis en otros idiomas. Por favor llame a nuestro número de Servicio al Cliente al 1-877-374-4056, de lunes a viernes, de 8 a.m. a 8 p.m. Entre el 1 de octubre y el 14 de febrero, los representantes están disponibles de lunes a domingo de 8 a.m. a 8 p.m. Los usuarios de TTY deben llamar al 1-877-247-6272. Ohana Health Plan WellCare Health Insurance of Arizona, Inc. WellCare (HMO) Medicare Medicare Advantage WellCare/ Ohana (HMO) WellCare (HMO SNP) Medicare Medicaid Medicare Advantage WellCare/ Ohana (HMO SNP) WellCare/ Ohana Medicare 2014 1 08/01/2014 WellCare/ Ohana www.wellcare.com/medicare www.ohanahealthplan.com/medicare P.O. Box 31389 Tampa, FL 33631-3389 62164