[PDF] 2016 Formulary. Reference Guide FORMERLY

1 2016 Formulary Reference Guide FORMERLY2 2016 Essential Health Benefits With Oral Chemotherapy Designation Formulary R...

2016 Formulary

Reference Guide

FORMERLY

2016 Essential Health Benefits Formulary Reference Guide

With Oral Chemotherapy Designation

Your formulary utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories.

FORMULARY DESIGN Optum has chosen a closed formulary structure for our Essential Health Benefits Formulary. The formulary structure features generics, preferred and non-preferred brand-name drugs, specialty drugs, oral chemotherapy drugs, and ACA (Affordable Care Act) preventive drugs. A closed formulary limits coverage to only those products listed in these levels. Products not listed on the formulary are generally not covered. •

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Generic drugs: Most generic drugs are listed under “GENERIC”. Drugs listed under “GENERIC” have the same active ingredient as the brand-name versions but at a lower cost. Preferred drugs: Drugs listed under “PREFERRED” include preferred brand name drugs that will generally have lower co-payments than non-preferred brand name drugs. Non-preferred drugs: Drugs listed under “NON PREFERRED” generally have higher co-payments than preferred brand name drugs. Specialty drugs: Drugs listed under “SPECIALTY” generally have the highest co-payment and cost. Specialty drugs are prescription medications that are sometimes used to treat complex and chronic conditions. They may require special monitoring or handling. ACA preventive drugs: Drugs listed under “PREVENTIVE” may have coverage and no co-payment when health care reform requirements are met for age, gender, and/or risk factors. Oral chemotherapy: Drugs listed under “ORAL CHEMO” may have a designated copayment or co-insurance specific to these products based on state laws surrounding oral chemotherapeutic agents.

EssentialHealthBenefits(withoralchemotherapydesignation)FormularyReferenceGuide

REASONABLE MEDICAL MANAGEMENT Optum’s formulary also uses medical and utilization management functions to determine whether a prescription is medically necessary. These industry recognized and accepted management functions include but are not limited to quantity limits, step therapy, and prior authorization and help Optum and its clients determine whether the prescribed medication was prescribed in accordance with generally accepted medical practice standards, is clinically appropriate, and confirm that the prescribed medication is not more costly than an alternative product that is as likely to produce therapeutically equivalent results. As recommended by the United States Department of Labor, Optum’s reasonable medical and utilization management functions apply to ACA preventive drugs.

USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS Many health plans use the Optum formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer. However, choosing a generic or preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable.

SAVING ON OUT-OF-POCKET COSTS Your health plan sets the co-payments for each formulary drug status which include oral chemo, generic, preferred brand-name, non-preferred brand-name, and specialty medications. Co-payments and deductibles for preventive products follow health care reform rules. Health plans often design prescription drug plans to encourage the use of generic and preferred brand-name drugs. Choosing non-preferred drugs (or specialty drugs) may mean paying higher out-of-pocket expenses (such as coinsurance, copayments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs. PLEASE NOTE: Brand-name drugs may become non-formulary if a generic version becomes available.

CONSULTING THE PRESCRIBER’S OFFICE WHEN APPROPRIATE When employers and other health plans design their prescription drug plans, they may choose to provide coverage only for certain medications, time periods, doses, quantities, or for a specific indications (e.g. they may exclude coverage for medications

EssentialHealthBenefits(withoralchemotherapydesignation)FormularyReferenceGuide

for unapproved, unproven, or cosmetic indications). When coverage for medications is provided based on use or quantity, your pharmacy benefit may contact your prescriber’s office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Member Services representative to determine specific coverage requirements.

KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED The following formulary reference guide is designed in the following order: oral chemo, generics, generic preventive, preferred brand name, non-preferred brand name, brand name preventive, specialty drugs. In addition, immediately preceding the index is a section listing ACA preventive drugs by category.

OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. We are an OptumTM company — a leading provider of integrated health services. Learn more at optum.com. All Optum

trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or

*FormularyDisclaimer:Coverageforsomedrugsmaybelimitedtospecificdosageformsand/orstrengths.Thebenefitdesigndetermineswhatis coveredandtheapplicableco‐payment.Themedicationslistedonthisformularyaresubjecttochangepursuanttotheformularymanagement activitiesofOptum.Thepresenceofamedicationonthisformularylistdoesnotguaranteecoverage.Todeterminethemostup‐to‐dateformulary statusofyourmedication,pleasevisityourmemberwebsiteorcallmemberservicesatthenumberlistedonyourIDcard.

Table of Contents ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FIFTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

vagin*L PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACA PREVENTIVE DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ASPIRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FLUORIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FOLIC ACID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IMMUNIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SMOKING CESSATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VITAMIN D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BOWEL PREPARATION AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BREAST CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NON PREFERRED Cedax Claforan Suprax

July 2016

FOURTH GENERATION GENERIC cefepime NON PREFERRED Maxipime

ANTI-INFECTIVES PENICILLINS GENERIC amoxicillin amoxicillin/clavulanate potassium amoxicillin/clavulanate potassium ER ampicillin ampicillin sodium ampicillin-sulbactam dicloxacillin sodium nafcillin sodium oxacillin sodium penicillin v potassium penicillin G potassium piperacillin sodium/ tazobactam sodium piperacillin sodium/tazobactam sodium piperacillin/tazobactam Amoxicillin/Clavulanate Potassium Ampicillin-sulbactam PREFERRED Augmentin NON PREFERRED Bactocill IN Dextrose Bicillin C-R Bicillin L-a Moxatag Timentin

FIFTH GENERATION NON PREFERRED Teflaro

MACROLIDES GENERIC azithromycin clarithromycin clarithromycin ER erythromycin Erythromycin Base NON PREFERRED Azithromycin DificidQL Ery-TAB Erythrocin Lactobionate PCE Zithromax

TETRACYCLINES GENERIC avidoxy demeclocycline HCL doxy 100 doxycycline doxycycline hyclate doxycycline hyclate DR doxycycline monohydrate minocycline HCL minocycline HCL ER mondoxyne nl morgidox 1X100MG morgidox 2X100MG tetracycline HCL Tetracycline HCL

CEPHALOSPORIN FIRST GENERATION GENERIC cefadroxil cefazolin sodium cephalexin

SECOND GENERATION GENERIC cefaclor cefotetan cefoxitin sodium cefprozil cefuroxime axetil cefuroxime sodium Cefaclor Cefotetan Cefotetan/Dextrose Cefuroxime Sodium NON PREFERRED Ceftin Mefoxin Zinacef

THIRD GENERATION GENERIC cefdinir cefixime cefotaxime sodium cefpodoxime proxetil ceftazidime ceftriaxone sodium tazicef tazidime Cefditoren Pivoxil Ceftriaxone IN Iso-osmotic Dextrose

QUINOLONES GENERIC ciprofloxacin ciprofloxacin ER ciprofloxacin HCL ciprofloxacin I.V.-IN D5W levofloxacin levofloxacin IN D5W moxifloxacin HCL ofloxacin Ciprofloxacin HCL Ofloxacin PREFERRED Avelox NON PREFERRED Factive Noroxin

AMINOGLYCOSIDES GENERIC amikacin sulfate gentamicin sulfate gentamicin sulfate pediatric gentamicin sulfate/0.9% sodium chloride

Effective July 1, 2016 v.1 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. © 2016 Optum, Inc. All rights reserved. TM

isotonic gentamicin neomycin sulfate paromomycin sulfate tobramycin sulfate Streptomycin Sulfate SPECIALTY tobramycinPA tobramycin inhalation solution PAKPA Tobi PodhalerQL,PA

SULFONAMIDES GENERIC Sulfadiazine

ANTIMYCOBACTERIAL AGENTS GENERIC ethambutol HCL isoniazid pyrazinamide rifabutin rifampin PREFERRED Isoniazid Priftin Sirturo NON PREFERRED Capastat Sulfate Paser Rifamate Rifater Trecator

ANTIFUNGALS GENERIC bio-statin fluconazole fluconazole IN dextrose fluconazole IN NACL flucytosine griseofulvin microsize griseofulvin ultramicrosize itraconazolePA ketoconazole nystatin terbinafine HCLQL voriconazole Amphotericin B PREFERRED Cancidas Lamisil Mycamine Noxafil SporanoxPA NON PREFERRED Abelcet Ambisome Amphotec Cresemba Eraxis

ANTIVIRALS GENERIC abacavir abacavir sulfate/lamivudine/zidovudineQL acyclovir acyclovir sodium cidofovir didanosine famciclovirQL

ganciclovir lamivudine lamivudine/zidovudine nevirapine nevirapine ER rimantadine HCL stavudine valacyclovir HCLQL zidovudine PREFERRED Aptivus AtriplaQL CompleraQL Crixivan Edurant Emtriva Epivir HBV Epzicom Evotaz FuzeonQL Intelence Invirase Isentress Kaletra Lexiva Nevirapine Norvir Prezcobix Prezista Relenza DiskhalerQL Rescriptor Retrovir IV Infusion Reyataz SelzentryPA StribildQL Sustiva TamifluQL Tivicay TriumeqQL Truvada Tybost Videx Pediatric Viracept Viramune Viread Vitekta Ziagen SPECIALTY adefovir dipivoxilQL,PA entecavirQL,PA moderiba ribasphere ribavirin valganciclovir BaracludeQL,PA DaklinzaQL,PA HarvoniPA Moderiba Moderiba 1200 Dose Pack Moderiba 800 Dose Pack Peg-intronPA Peg-intron RedipenPA Peg-intron Redipen PAK 4PA PegasysPA Pegasys ProclickPA PegintronPA Rebetol Ribasphere Ribasphere Ribapak Ribatab

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

SovaldiPA TyzekaQL,PA Valcyte Victrelis Virazole ZepatierQL,PA

Ketek Primsol Vibativ Zyvox SPECIALTY CaystonPA

ANTIMALARIALS GENERIC atovaquone/proguanil HCL chloroquine phosphate hydroxychloroquine sulfate mefloquine HCL quinine sulfatePA Primaquine Phosphate PREFERRED Coartem Daraprim

ANTINEOPLASTICS, ETC ALKYLATING AGENTS ORAL CHEMO temozolomidePA Alkeran Cyclophosphamide Gleostine Hexalen Leukeran Lomustine Myleran SPECIALTY carboplatin cisplatin cyclophosphamide ifosfamide melphalan hydrochloride oxaliplatin Bendeka Bicnu Busulfex Cisplatin Gliadel Wafer Ifex Ifosfamide Mustargen Temodar Treanda ValchlorPA Yondelis Zanosar

ANTHELMINTICS GENERIC ivermectin PREFERRED Albenza NON PREFERRED Biltricide

MISC. ANTI-INFECTIVES GENERIC atovaquone aztreonam baciim bacitracin clindamycin clindamycin palmitate HCL clindamycin phosphate clindamycin phosphate add-vantage clindamycin phosphate pharmacy bulk package clindamycin phosphate IN D5W clindamycin HCL colistimethate sodium e.s.p. imipenem/cilastatin lincomycin HCL linezolidQL meropenem metronidazole metronidazole IN NACL 0.79% polymyxin b sulfate sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS sulfatrim pediatric tinidazole trimethoprim vancomycin HCL Dapsone Linezolid PREFERRED Alinia Nebupent SivextroQL Tygacil XifaxanPA NON PREFERRED Azactam IN Iso-osmotic Dextrose Cubicin Doribax Flagyl ER Invanz

ANTIBIOTICS GENERIC bleomycin sulfate SPECIALTY adriamycin daunorubicin HCL doxorubicin HCL doxorubicin HCL liposome epirubicin HCL idarubicin HCL lipodox lipodox 50 mitomycin mitoxantrone HCLQL,PA Adriamycin Daunoxome Doxorubicin HCL Epirubicin HCL Mitomycin Valstar

ANTINEOPLASTIC ENZYMES SPECIALTY Erwinaze Oncaspar

ANTIMETABOLITES ORAL CHEMO capecitabinePA mercaptopurine

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

methotrexate Tabloid Trexall GENERIC methotrexate sodium Methotrexate Sodium SPECIALTY adrucil azacitidinePA cladribine cytarabine cytarabine aqueous decitabinePA floxuridine fludarabine phosphate fluorouracil gemcitabine gemcitabine HCL Alimta Arranon Clolar Cytarabine Depocyt Floxuridine Folotyn

ANGIOGENESIS INHIBITORS SPECIALTY Avastin ZaltrapQL,PA

ANTIBODIES SPECIALTY AdcetrisPA ArzerraPA BlincytoPA DarzalexPA EmplicitiPA Erbitux GazyvaPA HerceptinPA KadcylaPA OpdivoPA PerjetaPA PortrazzaPA Rituxan Unituxin Vectibix YervoyPA Zevalin Y-90

HORMONAL AGENTS ORAL CHEMO anastrozole bicalutamide exemestane flutamide letrozole megestrol acetate tamoxifen citrate Emcyt Fareston Lysodren Nilandron Soltamox XtandiPA ZytigaPA PREFERRED Depo-provera

SPECIALTY leuprolide acetatePA EligardQL,PA Faslodex FirmagonQL,PA Lupron DepotQL,PA TrelstarQL,PA Trelstar MixjectQL,PA VantasQL,PA ZoladexQL

IMMUNOMODULATORS ORAL CHEMO PomalystPA RevlimidPA ThalomidPA GENERIC azathioprine cyclosporine cyclosporine modified gengraf hecoria mycophenolate mofetil mycophenolic acid DR sirolimus tacrolimus Azathioprine PREFERRED Azasan Rapamune Sandimmune NON PREFERRED Atgam Cellcept Intravenous NulojixPA Prograf Simulect Thymoglobulin ZortressPA

MITOTIC INHIBITORS ORAL CHEMO Etoposide PREFERRED Teniposide SPECIALTY docetaxel etoposide pacl*taxel toposar vincasar PFS vincristine sulfate vinorelbine tartrate Abraxane Docefrez Docetaxel Docetaxel (non- Alcohol Formula) Docetaxel (non-alcohol Formula) Etopophos HalavenPA Ixempra Kit JevtanaPA Marqibo Pacl*taxel Vinblastine Sulfate

ENZYME INHIBITORS ORAL CHEMO imatinib mesylatePA

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

AfinitorQL,PA Afinitor DisperzPA BosulifPA CaprelsaQL,PA CometriqPA CotellicQL,PA FarydakQL,PA GilotrifQL,PA GleevecPA IbrancePA IclusigPA ImbruvicaPA InlytaPA JakafiPA Lenvima 10MG Daily DosePA Lenvima 14MG Daily DosePA Lenvima 20MG Daily DosePA Lenvima 24MG Daily DosePA LynparzaPA MekinistPA NexavarPA NinlaroQL,PA SprycelPA StivargaPA SutentPA TafinlarPA TagrissoQL,PA TarcevaQL,PA TasignaPA TykerbPA VotrientPA XalkoriPA ZelborafQL,PA ZolinzaPA ZydeligPA ZykadiaPA SPECIALTY IstodaxPA KyprolisPA Torisel VelcadePA

TOPOISOMERASE I INHIBITOR ORAL CHEMO Hycamtin SPECIALTY irinotecan topotecan HCL Camptosar Irinotecan Onivyde Topotecan HCL

ANTINEOPLASTICS MISC. ORAL CHEMO bexarotenePA hydroxyurea tretinoin ErivedgePA Matulane PREFERRED Photofrin Uvadex SPECIALTY dacarbazine Actimmune Alferon N Dacarbazine Intron APA

Intron A W/DiluentPA Nipent Proleukin SylatronPA SynriboPA Theracys Tice Bcg Trisenox

CHEMOTHERAPY RESCUE ORAL CHEMO leucovorin calcium Leucovorin Calcium Mesnex SPECIALTY amifostine dexrazoxane levoleucovorin levoleucovorin calcium mesna Fusilev Levoleucovorin Totect Voraxaze

CHEMOTHERAPY ADJUNCTS SPECIALTY Elitek Kepivance

ANTINEOPLASTIC COMBO ORAL CHEMO LonsurfQL,PA

CARDIOVASCULAR DRUGS PHOSPHODIESTERASE INHBTR GENERIC milrinone lactate milrinone IN dextrose

CARDIAC GLYCOSIDES GENERIC digitek digox digoxin

ANTIANGINAL AGENTS GENERIC isosorbide dinitrate isosorbide mononitrate isosorbide mononitrate ER minitran nitro-time nitroglycerin lingual nitroglycerin transdermal nitroglycerin ER nitroglycerin IN dextrose 5% nitroglycerin IN 5% dextrose Isosorbide Dinitrate Nitroglycerin Lingual PREFERRED Dilatrate SR Nitro-bid Nitrostat Ranexa NON PREFERRED Nitromist

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

BETA BLOCKERS GENERIC acebutolol HCL atenolol betaxolol HCL bisoprolol fumarate carvedilol esmolol HCL labetalol HCL metoprolol succinate ER metoprolol tartrate nadolol pindolol propranolol HCL propranolol HCL ER sorine sotalol HCL sotalol HCL (AF) Metoprolol Tartrate Timolol Maleate PREFERRED Bystolic Coreg CR NON PREFERRED Inderal XL Innopran XL Levatol

CALCIUM CHANNEL BLOCKERS GENERIC afeditab CR amlodipine besylate cartia XT dilt-XR diltiazem CD diltiazem HCL diltiazem HCL CD diltiazem HCL ER felodipine ER isradipine matzim LA nicardipine HCL nifedical XL nifedipine nifedipine ER nimodipine nisoldipine taztia XT verapamil HCL verapamil HCL ER verapamil HCL SR NON PREFERRED Cardene IV Cardizem LA

ANTIARRHYTHMICS GENERIC adenosine amiodarone HCL disopyramide phosphate flecainide acetate ibutilide fumarate lidocaine HCL lidocaine HCL IN D5W lidocaine HCL/dextrose mexiletine HCL pacerone propafenone HCL propafenone HCL ER

quinidine gluconate CR quinidine gluconate ER quinidine sulfate Quinidine Sulfate PREFERRED Tikosyn NON PREFERRED Multaq Nexterone Norpace CR

ACE INHIBITORS GENERIC benazepril HCL captopril enalapril maleate enalaprilat fosinopril sodium lisinopril moexipril HCL perindopril erbumine quinapril HCL ramipril trandolapril

ANGIOTENSIN RCPTR BLOCKER GENERIC candesartan cilexetilST irbesartan losartan potassium telmisartan valsartan Eprosartan Mesylate PREFERRED Benicar NON PREFERRED EdarbiST

DIRECT RENIN INHIBITORS PREFERRED Tekturna

ANTIHYPERTENSIVES MISC. GENERIC clonidine HCL doxazosin doxazosin mesylate eplerenone fenoldopam mesylate guanfacine HCL hydralazine HCL methyldopa minoxidil phenoxybenzamine hydrochloride prazosin HCL terazosin HCL Methyldopate HCL PREFERRED Demser

ANTIHYPERTENSIVE COMBO GENERIC amlodipine besylate/benazepril hydrochloride amlodipine besylate/benazepril HCL amlodipine besylate/valsartan amlodipine/valsartan/hctz atenolol/chlorthalidone benazepril HCL/hydrochlorothiazide bisoprolol fumarate/hydrochlorothiazide

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

candesartan cilexetil/hydrochlorothiazide enalapril maleate/hydrochlorothiazide fosinopril sodium/hydrochlorothiazide irbesartan/hydrochlorothiazide lisinopril/hydrochlorothiazide losartan potassium/hydrochlorothiazide metoprolol/hydrochlorothiazide moexipril/hydrochlorothiazide nadolol/bendroflumethiazide quinapril/hydrochlorothiazide telmisartan/amlodipine telmisartan/hydrochlorothiazide trandolapril/verapamil HCL trandolapril/verapamil HCL ER valsartan/hydrochlorothiazide PREFERRED Amturnide Azor Benicar HCT Tekamlo Tekturna HCT Tribenzor

DIURETICS GENERIC acetazolamide acetazolamide sodium acetazolamide ER amiloride HCL amiloride/hydrochlorothiazide bumetanide chlorothiazide chlorothiazide sodium ethacrynate sodium furosemide hydrochlorothiazide indapamide mannitol methazolamide metolazone osmitrol viaflex spironolactone spironolactone/hydrochlorothiazide torsemide triamterene/hydrochlorothiazide Acetazolamide Chlorothiazide Chlorthalidone Methyclothiazide Triamterene/Hydrochlorothiazide NON PREFERRED Dyrenium Edecrin SPECIALTY KeveyisQL,PA

VASOPRESSORS GENERIC dobutamine HCL dobutamine HCL/D5W dobutamine/dextrose 5% dopamine HCL dopamine HCL-dextrose 5% dopamine HCL/dextrose 5% dopamine/D5W ephedrine sulfate midodrine HCL norepinephrine bitartrate phenylephrine HCL

Dopamine HCL Epinephrine PREFERRED Auvi-q Epipen 2-PAK Epipen-JR 2-PAK

ANTIHYPERLIPIDEMICS GENERIC atorvastatin calcium cholestyramine cholestyramine light colestipol HCL fenofibrate fenofibrate micronized fenofibric acid DR fluvastatin fluvastatin sodium ER gemfibrozil lovastatin micronized colestipol HCL niacin ER omega-3-acid ethyl esters pravastatin sodium prevalite rosuvastatin calcium simvastatin Fenofibric Acid PREFERRED Vascepa Vytorin Welchol Zetia NON PREFERRED Fenofibrate Fenoglide Fibricor Livalo Triglide SPECIALTY JuxtapidQL,PA PraluentQL,PA RepathaQL,PA Repatha SureclickQL,PA

CARDIOVASCULAR - MISC. GENERIC amlodipine besylate/atorvastatin calcium cardioplegic papaverine HCL PREFERRED CialisQL ViagraQL NON PREFERRED Bidil SPECIALTY epoprostenol sodiumPA sildenafilQL,PA sildenafil citrateQL,PA AdcircaQL,PA AdempasQL,PA LetairisQL,PA OpsumitQL,PA OrenitramPA RemodulinPA TracleerQL,PA TyvasoQL,PA Tyvaso RefillQL,PA Tyvaso StarterQL,PA

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

UptraviQL,PA VeletriPA VentavisQL,PA

DERMATOLOGICALS ACNE PRODUCTS GENERIC amnesteem avar cleanser avar-e emollient avar-e green benzepro benzepro creamy wash benzepro foaming cloths benzepro SHORT contact benziq wash benzoyl peroxide benzoyl peroxide SHORT contact bp foam bp foaming wash bp wash bp 10-1 bpo 6% foaming cloths cerisa wash claravis claris clarifying wash clearplex x clindacin etz pledgets clindacin-p clindamax clindamycin phosphate clindamycin/benzoyl peroxide ery erythromycin erythromycin/benzoyl peroxide myorisan neuac oscion cleanser pr benzoyl peroxide wash prascion prascion fc rosanil cleanser rosula se bpo wash se 10-5 ss sodium sulfacetamide sodium sulfacetamide/sulfur sodium sulfacetamide/sulfur cleanser sodium sulfacetamide/sulfur cleansing cloths sodium sulfacetamide/sulfur green sodium sulfacetamide/sulfur w/sunscreen sodium sulfacetamide/sulfur wash ss 10-2 sss 10-5 sss 10%-5% sulfacetamide sodium sulfacetamide sodium/sulfur sulfacetamide sodium/sulfur cleanser sulfacleanse 8/4 virti-sulf zenatane zencia NON PREFERRED Azelex

ROSACEA AGENTS GENERIC metronidazole rosadan

Doxycycline PREFERRED Finacea Oracea

ANTIBIOTICS - TOPICAL GENERIC mupirocin mupirocin calcium NON PREFERRED Altabax Cortisporin Neo-synalar

ANTIFUNGALS - TOPICAL GENERIC ciclodan ciclopirox ciclopirox nail lacquer ciclopirox olamine ciclopirox treatmentPA clotrimazole clotrimazole/betamethasone dipropionate econazole nitrate ketoconazole ketodan naftifine hydrochlorideST nyamyc nystatin nystatin/triamcinolone nystop oxiconazole nitrate pedi-dri NON PREFERRED Cnl8 Nail KitPA ErtaczoST ExeldermST MentaxST Oxistat Pedipirox-4 NailPA XolegelST

ANTIVIRALS - TOPICAL GENERIC acyclovir PREFERRED Denavir Zovirax

ANTI-INFLAMMATORY AGENTS GENERIC diclofenac sodiumQL,PA diclotral PAK klofensaid IIQL,PA sure result dss premium pack

ANTIPRURITICS GENERIC Doxepin Hydrochloride

ANTIPSORIATICS GENERIC acitretin calcipotriene calcitrene methoxsalen Calcitriol PREFERRED TazoracQL,PA

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

8-mop NON PREFERRED Vectical

ANTISEBORRHEIC AGENTS GENERIC seb-prev wash selenium sulfide sodium sulfacetamide sodium sulfacetamide wash

CORTICOSTEROIDS - TOPICAL GENERIC ala cort alclometasone dipropionate alphatrex augmented betamethasone dipropionate betamethasone dipropionate betamethasone valerate calcipotriene/betamethasone dipropionateQL,PA clobetasol propionate clobetasol propionate e clobetasol propionate emollient clodan cormax scalp application desonide desoximetasone fluocinolone acetonide fluocinolone acetonide body fluocinolone acetonide scalp fluocinonide fluocinonide-e flurandrenolide fluticasone propionate halobetasol propionate halonate PAC hydrocortisone hydrocortisone acetate/aloe hydrocortisone butyrate hydrocortisone butyrate (lipid) hydrocortisone butyrate (lipophilic) hydrocortisone valerate hydrocortisone IN absorbase lokara mometasone furoate prednicarbate scalacort triamcinolone acetonide triderm Amcinonide Apexicon E Desoximetasone Diflorasone Diacetate PREFERRED TaclonexQL,PA NON PREFERRED Capex Cordran Cordran Tape Halog Locoid Texacort

IMMUNOMODULATING AGENTS GENERIC imiquimod tacrolimus PREFERRED Elidel

DERMATOLOGICALS - MISC. GENERIC ammonium lactate anodynz avalin-RX ceramax cerovel cidaleaze diclofenac sodium elenzapatch episone CRE fluorouracil glydo grafco silver nitrate applicator grafco silver nitrate applicator 12" hypercare k2k pain relieving patch lactic acid lactic acid e lactic acid w/vitamin e latrix lidenza patch lidocaine lidocaine HCL lidocaine HCL jelly lidocaine-prilocaine-cream base lidocaine/prilocaine lidodextrapine lidopin lindane livixil PAK lorenza mafenide acetate malathion migryl permethrin podofilox pramox gel premium lidocaine provenza rea LO 39 rea LO 40 reciphexamine relador PAK relador PAK plus releevia ML remeven salacyn salicylic acid salicylic acid cream salicylic acid lotion salicylic acid wart remover silver sulfadiazine sodium hyaluronate ssd synvexia tetrix thermazene tropazone u-kera e umecta mousse ure-k urea urea hydrating urea nail urea topical urea IN zinc undecylenate/lactic acid vehicle urea 40% nail film urea-c40

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

x-viate xyphex zeruvia Cem-urea CARB-o-philic 40 CARB-o-philic/40 LP lite PAK Salicylic Acid PREFERRED Condylox Oxsoralen RegranexPA Sulfamylon NON PREFERRED Eurax Fluoroplex Panretin Picato Sklice Ulesfia Veregen SPECIALTY TargretinPA ValchlorPA

ENDOCRINE AND METABOLIC CORTICOSTEROIDS GENERIC baycadron betamethasone sodium phosphate/betamethasone acetate budesonide deltasone dexamethasone dexamethasone sodium phosphate fludrocortisone acetate hydrocortisone methylprednisolone methylprednisolone acetate methylprednisolone dose pack methylprednisolone sodiumsuccinate prednisolone prednisolone sodium phosphate prednisolone sodium phosphate odt prednisone A-hydrocort Dexamethasone Dexamethasone Sodium Phosphate Prednisone NON PREFERRED Depo-medrol Dexamethasone Intensol Dexpak 10 Day Dexpak 13 Day Dexpak 6 Day Prednisone Intensol Solu-cortef

ANDROGENS-ANABOLIC GENERIC danazol methyltestosterone oxandroloneQL,PA testosterone testosterone cypionatePA testosterone enanthatePA testosterone P.M. Testosterone Testosterone P.M.

PREFERRED Androgel Androgel P.M. Androxy Axiron Methitest NON PREFERRED Anadrol-50PA StriantST

ESTROGENS GENERIC estradiol estradiol valerate estradiol/norethindrone acetate estropipate fyavolv jevantique LO jinteli lopreeza mimvey mimvey LO norethindrone acetate/ethinyl estradiol ortho-est PREFERRED Cenestin Combipatch Enjuvia Evamist Premarin Premphase Prempro NON PREFERRED Menest

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

delyla desogestrel/ethinyl estradiol drospirenone/ethinyl estradiol econtra EZ elinest emoquette enpresse-28 enskyce errin estarylla fallback solo falmina gianvi gildagia gildess FE 1.5/30 gildess FE 1/20 gildess 1.5/30 gildess 1/20 gildess 24 FE heather introvaleQL jencycla jolessaQL jolivette juleber junel FE 1.5/30 junel FE 1/20 junel FE 24 junel 1.5/30 junel 1/20 kaitlib FE kariva kelnor 1/35 kimidess kurvelo larin FE 1.5/30 larin FE 1/20 larin 1.5/30 larin 1/20 larin 24 FE layolis FE leena lessina levonest levonorgestrel levonorgestrel and ethinyl estradiolQL levonorgestrel/ethinyl estradiol levora 0.15/30-28 lomedia 24 FE loryna low-ogestrel lutera lyza marlissa medroxyprogesterone acetateQL microgestin FE microgestin FE 1.5/30 microgestin 1.5/30 microgestin 1/20 microgestin 24 FE mono-linyah mononessa my way myzilra necon 0.5/35-28 necon 1/35 necon 7/7/7 next choice one dose nikki nora-be

norethindrone norethindrone & ethinyl estradiol ferrous fumarate norethindrone acetate/ethinyl estradiol norethindrone acetate/ethinyl estradiol/ferrous fumarate norgestimate/ethinyl estradiol norlyroc nortrel 0.5/35 (28) nortrel 1/35 nortrel 7/7/7 ocella opcicon one-step orsythia philith pimtrea pirmella 1/35 pirmella 7/7/7 portia-28 previfem quasenseQL reclipsen setlakinQL sharobel sprintec 28 sronyx syeda take action tarina FE 1/20 tilia FE tri-estarylla tri-legest FE tri-linyah tri-previfem tri-sprintec tri-LO-estarylla tri-LO-marzia tri-LO-sprintec trinessa trinessa LO trivora-28 velivet vestura vienva viorele vyfemla wera wymzya FE zarah zenchent zenchent FE zovia 1/35e Levonorgestrel Ogestrel Xulane PREFERRED LO Loestrin FE Minastrin 24 FE PREVENTIVE Natazia NuvaringQL NON PREFERRED Depo-subq Provera 104QL PREVENTIVE Ella PREVENTIVE Implanon Liletta Mirena Nexplanon Paragard Intrauterine Copper Contraceptive T380a Skyla

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

BIGUANIDES

PROGESTINS GENERIC medroxyprogesterone acetate megestrol acetate norethindrone acetate progesterone SPECIALTY MakenaPA

ANTIDIABETIC AGENTS INSULIN PREFERRED Lantus Lantus Solostar Novolin N Novolin N Relion Novolin R Novolin R Relion Novolin 70/30 Novolin 70/30 Relion Novolog Novolog Flexpen Novolog Mix 70/30 Novolog Mix 70/30 Prefilled Flexpen Novolog Penfill Toujeo Solostar NON PREFERRED ApidraST Apidra SolostarST HumalogST Humalog KwikpenST Humalog Mix 50/50ST Humalog Mix 50/50 KwikpenST Humalog Mix 75/25ST Humalog Mix 75/25 KwikpenST Humulin NST Humulin N KwikpenST Humulin RST Humulin R U-500 (concentrated)ST Humulin 70/30ST Humulin 70/30 KwikpenST LevemirST Levemir FlexpenST Levemir FlextouchST

AMYLIN ANALOGS PREFERRED Symlinpen 120PA Symlinpen 60PA

INCRETIN MIMETIC AGENTS PREFERRED Bydureon Byetta TrulicityQL,ST Victoza

SULFONYLUREAS GENERIC glimepiride glipizide glipizide ER glipizide XL glyburide glyburide micronized tolazamide Chlorpropamide Glyburide Tolazamide Tolbutamide NON PREFERRED Diabeta

GENERIC metformin HCL metformin HCL ER PREFERRED Riomet

MEGLITINIDE ANALOGUES GENERIC nateglinide repaglinide

DIABETIC OTHER PREFERRED Glucagen Hypokit Glucagon Emergency Kit InvokanaPA Proglycem NON PREFERRED Cycloset JardianceST

ALPHA-GLUCOSIDASE INHIBIT GENERIC acarbose NON PREFERRED Glyset

DPP-4 INHIBITORS GENERIC Alogliptin PREFERRED Januvia Onglyza NON PREFERRED Tradjenta

INSULIN SENSITIZING AGENT GENERIC pioglitazone HCL NON PREFERRED Avandia

ANTIDIABETIC COMBINATIONS GENERIC glipizide/metformin HCL glyburide/metformin HCL pioglitazone HCL-glimepiride pioglitazone HCL/metformin HCL Alogliptin/Metformin HCL Alogliptin/Pioglitazone Repaglinide/Metformin Hydrochloride PREFERRED Actoplus Met XR Janumet Janumet XR Kombiglyze XR

BISPHOSPHONATES GENERIC alendronate sodium ibandronate sodiumQL risedronate sodiumQL,ST risedronate sodium DRQL,ST Etidronate Disodium PREFERRED Alendronate Sodium Fosamax Plus DQL SPECIALTY pamidronate disodium zoledronic acidPA Pamidronate Disodium Zoledronic AcidPA ZometaPA

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

CALCITONINS GENERIC calcitonin salmonQL calcitonin-salmonQL NON PREFERRED Miacalcin

vasopressin SPECIALTY Stimate

CORTICOTROPIN SPECIALTY H.p. ActharPA

PARATHYROID HORMONE SPECIALTY ForteoQL

PROLACTIN INHIBITORS GENERIC cabergoline

RANK LIGAND INHIBITORS SPECIALTY ProliaQL,PA XgevaPA

HORMONE RECEPTOR MDLTR GENERIC raloxifene hydrochloride

FERTILITY REGULATORS SPECIALTY chorionic gonadotropinQL clomiphene citrate novarelQL pregnyl w/diluent benzyl alcohol/NACLQL serophene

LHRH/GNRH AGONIST SPECIALTY Lupron Depot-PEDQL,PA Supprelin LAQL,PA Synarel

GROWTH HORMONES SPECIALTY Norditropin CartridgeQL,PA Norditropin FlexproQL,PA Norditropin Nordiflex PenQL,PA Nutropin AQ Nuspin 10QL,PA Nutropin AQ Nuspin 20QL,PA Nutropin AQ Nuspin 5QL,PA Nutropin AQ PenQL,PA SerostimQL,PA ZorbtiveQL,PA

VASOPRESSIN ANTAGONISTS SPECIALTY SamscaQL

METABOLIC MODIFIERS GENERIC calcitriol doxercalciferol levocarnitine paricalcitol PREFERRED SensiparPA NON PREFERRED Hectorol SPECIALTY sodium phenylbutyrate AldurazymePA Buphenyl Carbaglu Cystadane ElaprasePA FabrazymePA KanumaPA KuvanPA LumizymePA MyaleptPA MyozymePA NaglazymePA Orfadin RavictiPA StrensiqPA VimizimPA

THYROID AGENTS GHRH SPECIALTY EgriftaQL,PA

SOMATOMEDINS SPECIALTY IncrelexPA

SOMATOSTATIC AGENTS SPECIALTY octreotide acetatePA Sandostatin Lar DepotPA SigniforQL,PA Somatuline DepotQL,PA

GH RECEPTOR ANTAGONISTS SPECIALTY SomavertPA

POSTERIOR PITUITARY GENERIC desmopressin acetate

GENERIC levo-t levothyroxine sodium levoxyl liothyronine sodium methimazole propylthiouracil unithroid unithroid direct NP thyroid NP thyroid 60 NP thyroid 90 PREFERRED Armour Thyroid NON PREFERRED Thyrolar-1 Thyrolar-1/2 Thyrolar-1/4 Thyrolar-2 Thyrolar-3

GASTROINTESTINAL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Gastrinex NF Nizatidine PREFERRED Carafate NON PREFERRED Aciphex SprinkleQL Atropen Cantil Cuvposa DexilantQL Esomeprazole StrontiumQL NexiumQL Omeclamox-PAK Pylera

LAXATIVES GENERIC constulose gavilyte-h lactulose peg-prep pegylax polyethylene glycol 3350 PREVENTIVE gavilyte-c gavilyte-n/flavor pack gavilyte-G peg 3350/electrolytes peg-3350/electrolytes peg-3350/NACL/NA bicarbonate/KCL trilyte PREFERRED Moviprep Suprep Bowel Prep NON PREFERRED Osmoprep Prepopik

ANTIDIARRHEALS GENERIC diphenoxylate/atropine lofene loperamide HCL opium opium tincture

ULCER DRUGS GENERIC atropine sulfate chlordiazepoxide HCL/clidinium bromide cimetidine cimetidine HCL dicyclomine hci dicyclomine HCL ed-spaz esomeprazole magnesiumQL esomeprazole sodium famotidine glycopyrrolate hyomax-SL hyoscyamine sulfate hyoscyamine sulfate odt hyoscyamine sulfate ER hyoscyamine sulfate SR hyosyne lansoprazoleQL lansoprazole/amoxicillin/clarithromycin methscopolamine bromide misoprostol nizatidine nulev omeprazoleQL omeprazole/sodium bicarbonateQL oscimin oscimin SR pantoprazole sodiumQL rabeprazole sodiumQL ranitidine HCL sucralfate symax fastabs symax-SL symax-SR Esomeprazole Sodium Famotidine

ANTIEMETICS GENERIC dronabinolQL,PA granisetron HCLQL meclizine HCL ondansetron odtQL ondansetron HCLQL trimethobenzamide HCL PREFERRED Aloxi EmendQL SancusoQL Transderm-scop NON PREFERRED AkynzeoQL AnzemetQL CesametQL,PA GranisolQL

DIGESTIVE AIDS PREFERRED Creon Pancrelipase NON PREFERRED ZenpepST SPECIALTY Sucraid

GASTROINTESTINAL - MISC. GENERIC alosetron hydrochloride ana-lex balsalazide disodium calcium acetate colocort cromolyn sodium enulose generlac hydrocort ene 100MG hydrocortisone hydrocortisone acetate/lidocaine HCL hydrocortisone acetate/pramoxine lactulose lidazone HC lidocaine HCL/hydrocortisone acetate mesalamine metoclopramide odt metoclopramide HCL pramcort procto-MED HC procto-PAK proctosol HC proctozone-HC sulfasalazine

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

ursodiol PREFERRED AmitizaQL Asacol HD Canasa Chenodal Cortifoam Delzicol Fosrenol Lialda LinzessQL Pentasa Rectiv RelistorQL,PA Renvela Sevelamer Carbonate NON PREFERRED Dipentum Phoslyra Renagel SPECIALTY CimziaQL,PA Cimzia Starter KitQL,PA GattexPA RemicadeQL,PA

GENITOURINARY URINARY ANTI-INFECTIVES GENERIC azuphen mb hyolev mb hyophen indiomin mb me/naphos/mb/hyo 1 methenamine hippurate methenamine mandelate nitrofurantoin nitrofurantoin macrocrystals nitrofurantoin monohydrate nitrofurantoin monohydrate/macrocrystals phosphasal ur n-c uramit mb urelle uretron d/s uribel urin d/s uro-blue uro-l uro-mp uroav-b uroav-81 urolet mb urophen mb uryl ustell uta uticap utira-c utrona-c NON PREFERRED Monurol

URINARY ANTISPASMODICS GENERIC bethanechol chloride darifenacin hydrobromide ER darifenacin ER flavoxate HCL

oxybutynin chloride oxybutynin chloride ER tolterodine tartrate tolterodine tartrate ER trospium chloride trospium chloride ER PREFERRED Gelnique Myrbetriq OxytrolQL Toviaz Vesicare

vagin*L PRODUCTS GENERIC clindamycin phosphate metronidazole vagin*l terconazole vandazole zazole PREVENTIVE vcf vagin*l contraceptivegel PREFERRED Estrace Vagifem NON PREFERRED Avc Gynazole-1 PREVENTIVE Encare Options Gynol II vagin*l Contraceptive Shur-seal Today Sponge Vcf vagin*l Contraceptive Film Vcf vagin*l Contraceptive Foam SPECIALTY Crinone

GENITOURINARY - MISC. GENERIC acetic acid 0.25% alfuzosin HCL ER aminoacetic acid argyle sterile saline 100ML citric acid/sodium citrate curity sterile saline cytra k crystals cytra-k cytra-2 dutasteride dutasteride/tamsulosin hydrochloride dutasteride/tamsulosin HCL finasteride glycine neomycin/polymyxin b sulfates phenazo phenazopyridine HCL potassium citrate ER potassium citrate-citric acid crystals potassium citrate/citric acid potassium citrate/sodium citrate/citric acid sodium chloride sodium chloride 0.9% sodium citrate/citric acid tamsulosin HCL taron-crystals tricitrates virtrate-k virtrate-2

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

virtrate-3 PREFERRED Elmiron Rapaflo NON PREFERRED Cardura XL SPECIALTY Cystagon ProcysbiPA

HEMATOLOGICAL HEMATOPOIETIC AGENTS GENERIC airavite corvita 150 cyanocobalamin dexferrum fabb ferocon ferotrinsic ferrocite plus ferrogels forte folbee folic acid/vitamin b-6/vitamin b-12 folplex 2.2 foltrin hematinic plus vitamins/minerals hematinic/folic acid hematogen hematogen forte hemocyte-f hemocyte-plus iferex 150 forte k-tan plus myferon 150 forte nufol poly-iron 150 forte polysaccharide iron forte purevit dualfe plus se-tan plus tricon trigels-f forte virt-gard virt-vite AV-vite fb Bp Vit 3 FE c plus Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc TL gard RX TL icon TL-hem 150 PREVENTIVE bprotected pedia iron eq slow-release iron eql folic acid eql iron supplement therapy eql slow release iron ezfe 200 fa-8 feosol fer-iron ferate fergon ferosul ferrex 150 ferric x-150 ferro-bob ferrocite

ferrotabs ferrous drops ferrous fumarate 324 ferrous gluconate ferrous sulfate ferrousul folic acid gnp folic acid gnp iron gnp slow release iron high potency iron iferex 150 iron iron slow release iron supplement iron supplement childrens kp ferrous gluconate kp ferrous sulfate kp folic acid meijer ferrous sulfate myferon 150 nu-iron 150 poly-iron 150 px folic acid px iron qc ferrous sulfate ra folic acid ra high potency iron ra iron ra slow release iron slow iron slow release iron slow FE slow-release iron sm folic acid sm iron sm iron slow release sm slow release iron th folic acid th iron th slow release iron wee care yl folic acid CVS folic acid CVS iron Ferretts FE gluconate FE TABS HM folic acid HM iron HM iron slow release HM slow release iron PREFERRED Droxia Nascobal PREVENTIVE CVS Slow Release Iron Elite Iron Fa-8 Femiron Feosol Ferretts Chewable Iron Ferretts IPS Ferrimin 150 Ferro-sequels Ferrous Fumarate Ferrous Gluconate Ferrous Sulfate FE Aspartate High Potency Iron

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Iron Iron Chews Pediatric Iron Up Mykidz Iron 10 Novaferrum Pediatric Drops Perfect Iron Profe Proferrin ES Slow Release Iron Sm Slow Release Iron SPECIALTY sodium ferric gluconate complex/sucrose Aranesp Albumin Free CerezymePA ElelysoPA EpogenPA LeukinePA MozobilQL,PA NeulastaPA Neulasta Onpro KitPA NeumegaPA NeupogenPA NplatePA ProcritPA PromactaPA VprivPA ZavescaPA

ANTICOAGULANTS GENERIC argatroban bivalirudin enoxaparin sodiumQL fondaparinux sodiumQL hep flush-10 heparin lock heparin lock flush heparin lock flush for flushing vascular access devices heparin lock flush/NACL for flushing vascular access devices heparin sodium heparin sodium dcu heparin sodium lock flush heparin sodium/sodium chloride 0.9% premix heparin sodium/D5W heparin sodium/NACL 0.9% jantoven monoject pharma grade flush syringe/heparin lock monoject prefill advanced heparin lock flush sash kit for flushing vascular access devices warfarin sodium PREFERRED EliquisQL PradaxaQL XareltoQL Xarelto Starter PackQL NON PREFERRED Argatroban FragminQL SavaysaQL

HEMOSTATICS GENERIC aminocaproic acid tranexamic acid

HEMATOLOGICAL - MISC. GENERIC albuked 25

albuked 5 albumin human albumin-zlb albuminar-25 albuminar-5 alburx albutein anagrelide hydrochloride buminate cilostazol clopidogrel dipyridamole eptifibatide flexbumin hetastarch 6%/NACL human albumin grifols kedbumin pentoxifylline ER plasbumin-25 plasbumin-5 ticlopidine HCL Aspirin/Dipyridamole PREFERRED Aggrenox Brilinta Effient Zontivity NON PREFERRED Aggrastat SPECIALTY Advate Alphanate/Von Willebrand Factor Complex/Human Alphanine SD Bebulin Benefix Berinert Ceprotin Cinryze Coagadex Corifact Eloctate Feiba Feiba NF Firazyr Helixate FS Hemofil M Humate-p Idelvion Kalbitor Koate-dvi Kogenate FS Kogenate FS Bio-set Monoclate-p Mononine Novoseven Novoseven Rt Obizur Profilnine Profilnine SD Recombinate Riastap Rixubis SolirisPA Thrombate Iii W/10 ML Sterile Water Thrombate Iii W/20 ML Sterile Water Tretten Wilate Xyntha Xyntha Solofuse

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

MOUTH/THROAT/DENTAL AGENT GENERIC cavarest cavirinse cevimeline HCL chlorhexidine gluconate chlorhexidine gluconate oral rinse clinpro 5000 clotrimazole controlrx denta 5000 plus dentagel easygel fluoridex daily defense fluoridex daily defense enhanced whitening fluoridex daily defense sensitivity relief karigel karigel-n lidocaine viscous lidocaine HCL viscous neutragard advanced neutral sodium fluoride nystatin oralone paroex periogard phos-flur pilocarpine hydrochloride pilocarpine HCL stannous fluoride oral rinse topex topical anesthetic triamcinolone acetonide triamcinolone IN orabase SF SF 5000 plus NON PREFERRED Oravig

NEUROLOGY, CNS, PSYCH ANTIANXIETY AGENTS GENERIC alprazolam alprazolam odt alprazolam ER alprazolam XR buspirone HCL chlordiazepoxide HCL clorazepate dipotassium diazepam diazepam intensol droperidol gene-xene TAB 15MG gene-xene TAB 3.75MG gene-xene TAB 7.5MG hydroxyzine pamoate hydroxyzine HCL lorazepam lorazepam intensol meprobamate oxazepam Diazepam Hydroxyzine Pamoate

ANTIDEPRESSANTS GENERIC amitriptyline HCL bupropion HCL bupropion HCL ERQL

bupropion HCL SRQL bupropion HCL XLQL citalopram hydrobromide clomipramine HCL desipramine HCL doxepin HCL duloxetine HCLQL escitalopram oxalate fluoxetine DRQL fluoxetine HCL fluvoxamine maleate fluvoxamine maleate ERQL imipramine pamoate imipramine HCL mirtazapine mirtazapine odt nefazodone HCL nortriptyline HCL paroxetine HCL paroxetine HCL ER phenelzine sulfate protriptyline HCL sertraline HCL tranylcypromine sulfate trazodone HCL trimipramine maleate venlafaxine HCL venlafaxine HCL ER Amoxapine Doxepin HCL Maprotiline HCL Nefazodone HCL Nortriptyline HCL Venlafaxine HCL ER PREFERRED PristiqQL NON PREFERRED AplenzinQL Duloxetine HCLQL EmsamQL Marplan Paxil ViibrydQL Viibryd Starter PackQL

ANTIPSYCHOTICS GENERIC aripiprazoleQL chlorpromazine HCL clozapineQL clozapine odtQL compazine compro fluphenazine decanoate fluphenazine HCL haloperidol haloperidol decanoate haloperidol lactate lithium carbonate lithium carbonate ER loxapine loxapine succinate olanzapineQL olanzapine odtQL paliperidone ERQL,ST perphenazine prochlorperazine prochlorperazine edisylate prochlorperazine maleate

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

quetiapine fumarateQL risperidoneQL risperidone odtQL risperidone M-TABQL thioridazine HCL thiothixene trifluoperazine HCL ziprasidone HCLQL Aripiprazole OdtQL Clozapine OdtQL PREFERRED AbilifyQL Abilify DiscmeltQL Abilify Maintena LatudaQL Molindone Hydrochloride Risperdal Consta Seroquel XRQL NON PREFERRED FanaptQL,ST Fanapt Titration PackQL,ST FazacloQL Geodon Invega Sustenna Invega Trinza Lithium RexultiQL,ST SaphrisQL,ST Zyprexa Relprevv

HYPNOTICS GENERIC dexmedetomidine HCL estazolam eszopicloneQL flurazepam HCL phenobarbital temazepam triazolam zaleplonQL zolpidem tartrateQL zolpidem tartrate ERQL Flurazepam HCL Phenobarbital Phenobarbital Sodium Quazepam Triazolam PREFERRED RozeremQL SPECIALTY HetliozQL,PA

ADHD, NARCOLEPSY, ETC. GENERIC amphetamine/dextroamphetamineQL caffeine citrate clonidine HCL ER dexedrineQL dexmethylphenidate HCLQL dexmethylphenidate HCL ERQL dextroamphetamine sulfateQL dextroamphetamine sulfate ERQL doxapram HCL guanfacine ER metadate ERQL methamphetamine HCLQL methylphenidate hydrochloride methylphenidate HCLQL methylphenidate HCL CDQL

methylphenidate HCL ERQL methylphenidate HCL SRQL modafinilQL,PA zenzediQL Methylphenidate HCL ER ProcentraQL PREFERRED DaytranaQL NuvigilQL,PA Quillivant XRQL StratteraQL VyvanseQL NON PREFERRED ConcertaQL Focalin XRQL

ANTICONVULSANTS GENERIC carbamazepine carbamazepine ER clonazepam clonazepam odt divalproex sodium divalproex sodium DR divalproex sodium ER epitol ethosuximide felbamate fosphenytoin sodium gabapentin lamotrigine lamotrigine odt lamotrigine titration lamotrigine ER levetiracetam levetiracetam ER oxcarbazepine phenytoin phenytoin infatabs phenytoin sodium phenytoin sodium extended primidone roweepra tiagabine hydrochloride topiragen topiramate valproate sodium valproic acid zonisamide PREFERRED Banzel Celontin Dilantin Fycompa Gabitril LyricaQL Onfi Peganone Potiga Vimpat NON PREFERRED Lamictal Stavzor SPECIALTY SabrilPA

ANTIPARKINSON AGENTS GENERIC amantadine HCL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

benztropine mesylate bromocriptine mesylate carbidopa carbidopa/levodopa carbidopa/levodopa odt carbidopa/levodopa ER entacapone pramipexole dihydrochloride pramipexole dihydrochloride ER ropinirole ER ropinirole HCL selegiline HCL tolcapone trihexyphenidyl HCL Carbidopa/Levodopa/Entacapone PREFERRED Azilect Mirapex ER NON PREFERRED NeuproST SPECIALTY ApokynQL,PA

NEUROLOGY, PSYCH - MISC. GENERIC acamprosate calcium DR disulfiram donepezil HCL ergoloid mesylates galantamine hydrobromide memantine hydrochloride memantine HCL memantine HCL titration PAK olanzapine/fluoxetineQL pimozide rivastigmine tartrate rivastigmine transdermal system Ergoloid Mesylates Galantamine Hydrobromide Perphenazine/Amitriptyline PREVENTIVE buprobanQL bupropion HCL SRQL eq nicotineQL eq nicotine gum refillQL eq nicotine gum starterQL eq nicotine polacrilexQL eq nicotine step 3QL eql nicotineQL eql nicotine polacrilexQL eql nicotine polacrilex refillQL eql nicotine polacrilex starterQL gnp nicotine mini lozengeQL gnp nicotine polacrilexQL gnp nicotine polacrilex miniQL goodsense nicotine gumQL kls quit2QL kls quit4QL nicoreliefQL nicotineQL nicotine mini lozengeQL nicotine polacrilexQL nicotine polacrilex refillQL nicotine polacrilex starter kitQL nicotine step 1QL nicotine step 2QL nicotine step 3QL nicotine transdermal systemQL nicotine transdermal system step 1QL

nicotine transdermal system step 2QL nicotine transdermal system step 3QL px stop smoking aidQL qc nicotine polacrilexQL ra mini nicotineQL ra nicotineQL ra nicotine polacrilexQL ra nicotine transdermal system step 3QL sm nicotineQL sm nicotine polacrilexQL sm nicotine transdermal systemQL sw nicotine polacrilexQL tgt nicotine gumQL tgt nicotine polacrilexQL tgt nicotine step oneQL tgt nicotine step threeQL tgt nicotine step twoQL thriveQL CVS nicotineQL CVS nicotine lozengeQL CVS nicotine polacrilexQL CVS nicotine polacrilex starterQL CVS nicotine transdermal systemQL CVS nts step 1QL HM nicotine polacrilexQL HM nicotine transdermal systemQL HM nicotine transdermal system step 3QL SR nicotine gumQL PREFERRED GraliseQL Gralise StarterQL Namenda XRQL Namenda XR Titration PackQL Nuedexta SavellaQL PREVENTIVE ChantixQL Chantix Continuing Month PAKQL Chantix Starting Month PAKQL Nicotine Transdermal SystemQL NON PREFERRED HorizantQL,PA PREVENTIVE Nicotrol InhalerQL Nicotrol NsQL SPECIALTY glatopaQL,PA tetrabenazinePA AmpyraQL,PA AubagioQL,PA AvonexQL,PA Avonex Pen BetaseronQL,PA CopaxoneQL,PA GilenyaQL,PA LemtradaPA Rebif Rebif Rebidose Rebif Rebidose Titration Pack Rebif Titration Pack TecfideraQL,PA Tecfidera Starter PackQL,PA TysabriQL,PA XyremQL,PA

NEUROMUSCULAR AGENTS GENERIC atracurium besylate cisatracurium besylate

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

pancuronium bromide riluzoleQL,PA rocuronium bromide vecuronium bromide SPECIALTY BotoxQL,PA DysportQL,PA MyoblocQL,PA XeominQL,PA

MUSCULOSKELETAL AGENTS GENERIC baclofen carisoprodol carisoprodol/aspirin carisoprodol/aspirin/codeine chlorzoxazone cyclobenzaprine HCL dantrolene sodium metaxall metaxalone methocarbamol orphenadrine citrate orphenadrine citrate ER revonto tizanidine HCL Metaxalone Orphenadrine/Asa/Caffeine NON PREFERRED Lorzone SPECIALTY MonoviscPA OrthoviscPA SynviscPA Synvisc OnePA

ANTIMYASTHENIC AGENTS GENERIC neostigmine methylsulfate pyridostigmine bromide Guanidine HCL PREFERRED Mestinon

OPHTHALMOLOGY AND OTIC ANTI-INFECTIVES GENERIC ak-poly-bac bacitracin/polymyxin b ciprofloxacin HCL erythromycin garamycin gatifloxacin gentak gentamicin sulfate ilotycin levofloxacin neo-polycin neomycin/bacitracin/polymyxin neomycin/polymyxin/bacitracin zinc neomycin/polymyxin/gramicidin ofloxacin polycin polycin b polymyxin b sulfate/trimethoprim sulfate romycin sodium sulfacetamide sulfacetamide sodium tobramycin sulfate

trifluridine trimethoprim sulfate/polymyxin b sulfate Bacitracin PREFERRED Besivance Moxeza Natacyn Vigamox NON PREFERRED Ciloxan Tobrex Zirgan

ARTIFICIAL TEAR/LUBRICANT NON PREFERRED Lacrisert

BETA-BLOCKERS GENERIC betaxolol HCL carteolol HCL dorzolamide HCL/timolol maleate levobunolol HCL timolol maleate timolol maleate ophthalmic gel forming Metipranolol PREFERRED Combigan NON PREFERRED Betimol

OPHTHALMIC STEROIDS GENERIC dexamethasone sodium phosphate fluorometholone neo-polycin HC neomycin/polymyxin/bacitracin/hydrocortisone neomycin/polymyxin/dexamethasone poly-dex prednisolone acetate sulfacetamide sodium/prednisolone sodium phosphate tobramycin/dexamethasone PREFERRED Alrex FML Lotemax Pred Mild Tobradex Tobradex ST NON PREFERRED Durezol Flarex Ozurdex Vexol

PROSTAGLANDINS GENERIC latanoprostQL BimatoprostQL PREFERRED LumiganQL Travatan ZQL

CYCLOPLEGIC MYDRIATICS GENERIC atropine sulfate atropine-care cyclopentolate hydrochloride cyclopentolate HCL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

IlevroQL NevanacQL Pataday NON PREFERRED Acuvail Alocril Alomide Azopt Emadine Lastacaft SPECIALTY CystaranQL,PA Eylea Jetrea Lucentis Macugen Visudyne

homatropaire homatropine HBR mydral tropicamide

DECONGESTANTS GENERIC altafrin neofrin phenylephrine HCL

MIOTICS GENERIC pilocarpine HCL PREFERRED Phospholine Iodide NON PREFERRED Isopto Carbachol

OTIC AGENTS ADRENERGIC AGENTS GENERIC apraclonidine brimonidine tartrate PREFERRED Alphagan P NON PREFERRED Iopidine

IMMUNOMODULATORS PREFERRED RestasisQL,PA

LOCAL ANESTHETICS GENERIC altacaine parcaine proparacaine HCL tetcaine tetracaine HCL tetravisc tetravisc forte

OPHTHALMICS - MISC. GENERIC ak-fluor altafluor azelastine HCL balanced salt balanced salt solution bio GLO bromfenac bss cromolyn sodium diclofenac sodium dorzolamide HCL epinastine HCL flucaine fluor-i-strips a.t. fluorescein-benoxinate fluorescein/proparacaine flurbiprofen sodium flurox ful-GLO green GLO lissamine greenophthalmic strips ketorolac tromethamine lissamine green olopatadine HCL PREFERRED Bepreve

GENERIC acetasol HC acetic acid antipyrine/benzocaine aurodex fluocinolone acetonide fluocinolone acetonide ear drops hydrocortisone/acetic acid neomycin/polymyxin/hydrocortisone neomycin/polymyxin/HC ofloxacin otic care oticin PREFERRED Ciprodex NON PREFERRED Coly-mycin S Cortisporin-tc

OXYTOCICS GENERIC methergine methylergonovine maleate oxytocin

PAIN MANAGEMENT ANALGESICS - NONNARCOTIC GENERIC alagesic LQ butalbital/acetaminophen butalbital/acetaminophen/caffeine butalbital/aspirin/caffeine capacet choline magnesium trisalicylate clonidine HCL diflunisal duraxin ed-flex esgic margesic marten-TAB salsalate tencon zebutal PREVENTIVE adult aspirin EC low strength aspir-low aspir-81 aspirin

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

aspirin adult low dose aspirin adult low strength aspirin childrens aspirin enteric coated adult low strength aspirin low dose aspirin low strength aspirin EC aspirin EC low dose aspirin 81 aspirin 81 low dose aspirtab bayer advanced aspirin regular strength bayer aspirin bayer aspirin regimen bayer aspirin EC low dose bayer chewable low dose bayer low dose childrens aspirin childrens aspirin low strength coated aspirin ecotrin ecotrin low strength ecpirin enteric coated aspirin eq adult aspirin low strength eq aspirin eq aspirin adult low dose eq aspirin low dose eq aspirin EC eq childrens aspirin eql adult aspirin low strength eql aspirin eql aspirin low dose eql aspirin EC eql childrens aspirin gnp adult aspirin low strength gnp aspirin gnp aspirin low dose goodsense aspirin low dose kls aspirin low dose kls aspirin EC kp aspirin meijer aspirin EC miniprin low dose norwich aspirin px aspirin px enteric aspirin qc aspirin qc aspirin low dose qc childrens aspirin ra aspirin ra aspirin adult low dose ra aspirin adult low strength ra aspirin childrens ra aspirin EC ra aspirin EC adult low strength ra childrens aspirin sm aspirin sm aspirin adult low strength sm aspirin enteric coated sm aspirin EC low strength sm childrens aspirin st joseph aspirin st joseph low dose aspirin tgt aspirin tgt aspirin low dose tgt childrens aspirin tgt enteric-coated aspirin th aspirin th aspirin low dose

th enteric aspirin CVS aspirin CVS aspirin adult low dose CVS aspirin adult low strength CVS aspirin child CVS aspirin low dose CVS aspirin low strength CVS aspirin EC CVS childrens aspirin CVS enteric aspirin EC-81 aspirin HM aspirin HM aspirin EC HM aspirin EC low dose MM aspirin SB aspirin SB aspirin EC SB childrens aspirin SB low dose asa EC PREVENTIVE Aspirin Low Dose SPECIALTY Prialt

ANALGESICS - OPIOID GENERIC acetaminophen/caffeine/dihydrocodeine acetaminophen/codeine acetaminophen/codeine #2 acetaminophen/codeine #3 acetaminophen/codeine #4 acetaminophen/codeine phosphate alfentanil ascomp/codeine buprenorphine HCLQL,PA buprenorphine HCL/naloxone HCLQL,PA butalbital/acetaminophen/caffeine/codeine butalbital/aspirin/caffeine/codeine butorphanol tartrate codeine sulfate duramorph endocet endodan fentanylQL fentanyl citrate oral transmucosalQL,PA hydrocodone bitartrate/acetaminophen hydrocodone/acetaminophen hydrocodone/ibuprofen hydromorphone HCL hydromorphone HCL dosette hydromorphone HCL ERQL ibudone lorcet lorcet plus lorcet HD lortab meperidine HCL methadone HCL methadone HCL intensol methadose morphine sulfate morphine sulfate ERQL nalbuphine HCL oxycodone HCL oxycodone/acetaminophen oxycodone/aspirin oxycodone/ibuprofen oxymorphone hydrochloride oxymorphone hydrochloride ERQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

pentazocine/naloxone HCL reprexain roxicet tramadol hydrochloride/acetaminophen tramadol HCL tramadol HCL ERQL verdrocet vicodin vicodin ES vicodin HP xylon zamicet Aspirin-caffeine-dihydrocodeine FentanylQL Hydrocodone/Acetaminophen Hydromorphone HCL ERQL Hydromorphone HCL/Sodium Chloride Levorphanol Tartrate Morphine Sulfate Morphine Sulfate ERQL Oxycodone HCL ERQL PREFERRED ButransQL,PA LazandaQL,PA Nucynta Nucynta ERQL Opana ER (crush Resistant)QL OxycontinQL SuboxoneQL,PA NON PREFERRED EmbedaQL ExalgoQL Oxaydo Talwin

ANTI-INFLAMMATORY GENERIC celecoxibQL diclofenac potassium diclofenac sodium DR diclofenac sodium ER diclofenac sodium/misoprostol etodolac etodolac ER flurbiprofen ibuprofen ibuprofen lysine indomethacin indomethacin ER inflammacin ketoprofen ketorolac tromethamineQL leflunomide mefenamic acid meloxicam nabumetone naproxen naproxen kit naproxen sodium naproxen sodium CR naproxen sodium ER naproxen DR oxaprozin piroxicam sulindac tolmetin sodium Fenoprofen Calcium Meclofenamate Sodium Naproxen

Tolmetin Sodium PREFERRED Ridaura NON PREFERRED Nalfon Naprelan Rheumatrex SprixQL SPECIALTY ArcalystPA EnbrelQL,PA Enbrel SureclickQL,PA HumiraPA Humira Pediatric Crohns Disease Starter PackPA Humira PenPA Humira Pen-crohns DiseasestarterPA Humira Pen-psoriasis StarterPA IlarisQL,PA KineretPA OrenciaQL,PA SimponiPA Simponi AriaQL,PA

MIGRAINE PRODUCTS GENERIC almotriptan malateQL,ST dihydroergotamine mesylate frovatriptan succinateQL,ST naratriptan HCLQL rizatriptan benzoateQL rizatriptan benzoate odtQL sumatriptan succinateQL sumatriptan succinate refillQL zolmitriptanQL zolmitriptan odtQL Dihydroergotamine MesylateQL Sumatriptan SuccinateQL PREFERRED RelpaxQL NON PREFERRED Cafergot Ergomar ZomigQL,ST Zomig Nasal SprayQL,ST

GOUT AGENTS GENERIC allopurinol probenecid probenecid/colchicine PREFERRED Colchicine Colcrys Uloric SPECIALTY KrystexxaPA

LOCAL ANESTHETICS-INJ GENERIC bupivacaine spinal bupivacaine HCL bupivacaine/epinephrine chloroprocaine HCL lidocaine HCL lidocaine/epinephrine polocaine polocaine-mpf ropivacaine ropivacaine HCL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

sensorcaine sensorcaine-mpf sensorcaine-mpf spinal sensorcaine-mpf/epinephrine sensorcaine/epinephrine xylocaine dental Tetracaine HCL

promethazine/dextromethorphan promethazine/phenylephrine promethazine/phenylephrine/codeine pulmosal sodium chloride tussigon

ANTIASTHMATIC/COPD AGENTS

RESPIRATORY, ALLERGY, ETC ANTIHISTAMINES GENERIC arbinoxa bpm carbinoxamine maleate cetirizine HCL clemastine fumarate cyproheptadine HCL desloratadine diphenhydramine HCL levocetirizine dihydrochloride pharbedryl phenadoz phenergan promethazine HCL promethazine HCL plain promethegan Clemastine Fumarate Dexchlorpheniramine Maleate NON PREFERRED Clarinex Desloratadine Odt

NASAL AGENTS GENERIC azelastine HCLQL budesonideQL flunisolideQL fluticasone propionateQL ipratropium bromideQL mometasone furoateQL olopatadine HCLQL triamcinolone acetonideQL PREFERRED DymistaQL NON PREFERRED Bactroban Nasal

COUGH/COLD/ALLERGY GENERIC acetylcysteine benzonatate biotuss biotuss pediatric bpm pseudo bromfed DM bromphen/pseudoephedrine HCL/dextromethorphan HBR giltuss pediatric hydrocodone bitartrate/chlorpheniramine maleate/PSE hydrocodone bitartrate/homatropine methylbromide hydrocodone polistirex/chlorpheniramine polistirex hydrocodone/homatropine hydromet nebusal nortuss-DE phenylephrine/guaifenesin promethazine VC plain promethazine VC/codeine promethazine-DM promethazine/codeine

GENERIC albuterol albuterol sulfate albuterol sulfate ER albuterol TAB 4MG aminophylline budesonide difil-G forte epinephrine HCL ipratropium bromideQL ipratropium bromide/albuterol sulfateQL levalbuterolQL levalbuterol HCLQL montelukast sodium terbutaline sulfate theochron theophylline theophylline CR theophylline ER zafirlukast Cromolyn Sodium Metaproterenol Sulfate PREFERRED Arcapta NeohalerQL Asmanex HFAQL Asmanex Twisthaler 120 Metered DosesQL Asmanex Twisthaler 14 Metered DosesQL Asmanex Twisthaler 30 Metered DosesQL Asmanex Twisthaler 60 Metered DosesQL Asmanex Twisthaler 7 Metered DosesQL Atrovent HFAQL Combivent RespimatQL Daliresp DuleraQL Foradil AerolizerQL PerforomistQL Proair HFAQL Proair RespiclickQL Pulmicort FlexhalerQL QvarQL Serevent DiskusQL Spiriva HandihalerQL Spiriva RespimatQL Stiolto RespimatQL SymbicortQL Tudorza PressairQL NON PREFERRED BrovanaQL Elixophyllin Incruse ElliptaQL Lufyllin Theo-24 Zyflo CR SPECIALTY NucalaQL,PA XolairPA

RESPIRATORY AGENTS - MISC SPECIALTY Aralast NPPA EsbrietPA

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

GlassiaPA KalydecoPA OfevPA Prolastin-cPA PulmozymePA ZemairaPA

Fluvirin 2013-2014 Fluvirin 2014-2015 Fluvirin 2015-2016 Fluzone High-dose PF 2013-2014 Fluzone High-dose PF 2014-2015 Fluzone High-dose PF 2015-2016 Fluzone Intradermal Fluzone Intradermal Quadrivalent 2015-2016 Fluzone Pediatric PF 2013-2014 Fluzone PF 2013-2014 Fluzone PF 2014-2015 Fluzone Quadrivalent 2013-2014 Fluzone Quadrivalent 2014-2015 Fluzone Quadrivalent 2015-2016 Fluzone Split 2013-2014 Fluzone Split 2014-2015 Fluzone Split 2015-2016 Gardasil Gardasil 9 Havrix Hiberix Ipol Inactivated IPV M-m-r II Medical Provider EZ Flu Shot PF 2013-2014 Medical Provider EZ Flu Shot PF 2014-2015 Medical Provider EZ Flu Shot 2013-2014 Medical Provider EZ Flu Shot 2014-2015 Medical Provider EZ Flu Shot 2015-2016 Medical Provider Single Use EZ Flu Shot Menactra Menhibrix Menomune-a/C/Y/W-135 Menveo Pedvax HIB Pneumovax 23 Pneumovax 23/1 Dose Pneumovax 23/5 Dose Prevnar 13 Proquad Recombivax HB Rotarix Rotateq Trumenba Twinrix Vaqta Varivax Zostavax

TOXOIDS PREFERRED Tetanus Toxoid Adsorbed PREVENTIVE Adacel Boostrix Daptacel Diphtheria/Tetanus Toxoids Adsorbed Pediatric Infanrix Kinrix Pediarix Pentacel Quadracel Tenivac Tetanus/Diphtheria Toxoids-adsorbed Tetanus/Diphtheria Toxoids-adsorbed Adult

VACCINES PREFERRED Bcg Vaccine Biothrax Imovax Rabies (h.d.c.v.) Ixiaro Rabavert Typhim VI Vivotif Yf-vax PREVENTIVE Acthib Afluria PF 2012-2013 Afluria PF 2013-2014 Afluria PF 2014-2015 Afluria PF 2015-2016 Afluria 2012-2013 Afluria 2013-2014 Afluria 2014-2015 Afluria 2015-2016 Bexsero Cervarix Comvax Engerix-b Fluarix Quadrivalent 2013-2014 Fluarix Quadrivalent 2014-2015 Fluarix Quadrivalent 2015-2016 Fluarix 2013-2014 Fluarix 2014-2015 Flublok 2013-2014 Flublok 2014-2015 Flublok 2015-2016 Flucelvax 2013-2014 Flucelvax 2014-2015 Flucelvax 2015-2016 Flulaval Quadrivalent 2013-2014 Flulaval Quadrivalent 2014-2015 Flulaval Quadrivalent 2015-2016 Flulaval 2013-2014 Flulaval 2014-2015 Flumist Quadrivalent Fluvirin PF 2013-2014 Fluvirin PF 2014-2015

VITAMINS VITAMINS GENERIC ascorbic acid ergocalciferol mega-c/a plus ortho-CS 250 phytonadione thiamine HCL vitamin c 222MG vitamin d vitamin k1 PREVENTIVE aqueous vitamin d infants bio-d-mulsion bio-d-mulsion forte bprotected pedia d-vite calcidol calciferol d 1000 d 10000

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

d 2000 d 400 d 5000 d-vita d-1000 d-1000 extra strength d-2000 maximum strength d-3-5 d-400 d-5000 d-5000 maximum strength decara delta d3 dialyvite vitamin d 5000 dialyvite vitamin d3 max d2000 ultra strength d3 d3 adult d3 adult gummy d3 high potency d3 kids d3 maximum strength d3 super strength d3 ultra strength d3 2000 d3-1000 d3-50 eql childrens vitamin d gummies eql vitamin d-3 eql vitamin d3 gnp vitamin d gnp vitamin d maximum strength gnp vitamin d super strength gnp vitamin d3 extra strength healthy kids vitamin d3 just d kp vitamin d maximum d3 nat-rul vitamin d natural vitamin d-3 optimal-d optimal-d pack opurity vitamin d pronutrients vitamin d3 ra vitamin d-3 sm vitamin d sm vitamin d3 th vitamin d3 thera-d rapid repletion thera-d sport thera-d 2000 vitajoy daily d gummies vitamin d high potency vitamin d 400 vitamin d-1000 vitamin d-1000 maximum strength vitamin d-3 vitamin d-400 vitamin d3 vitamin d3 adult gummies vitamin d3 high potency vitamin d3 maximum strength vitamin d3 super strength vitamin d3 400 CVS d3 CVS vitamin d CVS vitamin d 5000 high-potency CVS vitamin d3 HM vitamin d HM vitamin d3

PA vitamin d-3 PA vitamin d-3 gummy PREFERRED Mephyton PREVENTIVE Baby Super Daily D3 Ddrops Decara D3 Dots HM Vitamin D3 Optimal D3 M Replesta Replesta Childrens Replesta Nx Sm Vitamin D3 Maximum Strength Super Daily D3 Thera-d 4000 Vitamelts Vitamin D Vitamin D2 Vitamin D3 Wellesse Vitamin D3

MULTIVITAMINS GENERIC b-complex 100 b-plex b-plex plus biocel corvita corvite free dialyvite floriva plus folbee plus folbee plus cz infuvite infuvite adult infuvite pediatric lysiplex plus mult-vitamin/fluoride multi vitamin/fluoride multi-vit/fluoride multi-vit/iron/fluoride multi-vitamin/fluoride multi-vitamin/fluoride/iron multivitamin with fluoride multivitamin/fluoride multivitamins/fluoride mynephrocaps nephronex niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper nutrifac ZX rena-vite RX renal renalpren reno CAPS tri-vit/fluoride tri-vitamin/fluoride triphrocaps triple-vitamin/fluoride urosex v-c forte vic-forte virt-vite plus virt-CAPS vita s forte vita-min vitacel vitamax pediatric vitamin b-complex 100

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

vitamins a/c/d/fluoride vol-care RX vp-vite RX Bp Folinatal Plus B Bp Multinatal Plus Cavan-EC Sod DHA Complete Natal DHA Completenate CO-natal Fa Elite-OB Escavite LQ Inatal Advance Inatal GT Inatal Ultra M-vit Macnatal CN DHA Mynatal Advance Mynatal Plus Mynatal Ultracaplet Mynatal-z Mynate 90 Plus MVC-fluoride Obstetrix EC Pr Natal 400 Pr Natal 400 EC Pr Natal 430 Pr Natal 430 EC Prenaissance Plus Prenaplus Prenatabs Fa Prenatabs RX Prenatal Ad Prenatal Plus Prenatal 19 Prenatal-u PNV-select PNV-DHA Quflora Pediatric Se-natal 19 Se-tan DHA Taron-prex Triadvance Tricare Trinatal RX 1 Trinate Ultimatecare One Ultimatecare One NF Ultra TABS Vinate C Vinate Care Vinate IC Vinate II Vinate M Vinate One Vitafol-OB Vp-zel PREVENTIVE sm prenatal vitamins Classic Prenatal Eql Prenatal Formula Gnp Prenatal Vitamins Mission Prenatal HP Multi Prenatal Perry Prenatal Pre-natal Formula Prenatal Prenatal And Iron Prenatal Formula Prenatal Forte Prenatal Low Iron

Prenatal Vitamins Px Prenatal Multivitamins Ra Prenatal Sm Prenatal Vitamins PREVENTIVE Atabex Prenatal Brainstrong Prenatal Cadeau DHA Centrum Specialist Prenatal CVS Prenatal CVS Prenatal Gummy/DHA/Folic Acid CVS Prenatal Multi+dha Enfamil Expecta Gnp Daily Prenatal Gnp Prenatal Goodsense Prenatal Vitamins Healthy Mama Be Well Rounded HM One Daily Prenatal Combo HM Prenatal Kp Prenatal Multivitamins Mission Prenatal Nat-rul Prenatal Vitamins One A Day Womens Prenatal/DHA One A Day Womens Prenatal1 One-a-day Womens Prenatal Prenatal Complete Prenatal Multi + DHA Prenatal Multi +dha Prenatal Multivitamin + DHA Prenatal Multivitamin Plus DHA Prenatal One Daily Prenatal Plus DHA Prenatal Vitamin Prenatal/Omega-3/Folic Acid/Iron PA Prenatal Formula Qc Prenatal Ra One Daily Ra Prenatal Formula/Folicacid Right Step Prenatal Similac Prenatal Early Shield Sm One Daily Prenatal Stuart One Stuart Prenatal Th Prenatal Vitamins Your Life Multi Prenatal

MEDICAL DEVICES DIABETIC SUPPLIES PREFERRED Accu-chek Fastclix LancetsQL Accu-chek Multiclix LancetsQL Accu-chek Safe-t-pro LancetsQL Accu-chek Safe-t-pro PluslancetsQL Accu-chek Soft Touch LancetsQL Accu-chek Softclix LancetsQL Acti-lance Lancets 28GQL Acti-lance Lite Safety Lancets 28GQL Acti-lance Special Safety Lancets 17GQL Acti-lance Special Safetylancets 17GQL Acti-lance Universal Safety Lancets 23GQL Active 1ST Blood Lancets 30G/Easy Twist CAPQL Advocate LancetsQL Advocate Lancets 30GQL Advocate Safety LancetsQL Advocate Safety Lancets 26GQL Agamatrix Ultra-thin Lancets 33GQL Assure Comfort Lancets Ultra Thin 28GQL Assure Comfort Lancets Ultra Thin 30GQL Assure Haemolance Plus High Flow 18GQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Assure Haemolance Plus Low Flow 25GQL Assure Haemolance Plus Micro Flow 28GQL Assure Haemolance Plus Normal Flow 21GQL Assure Haemolance Plus Pediatric BladeQL Assure Lance LancetsQL Assure Lance Lancets 21GQL Assure Lance Plus Safety Lancets 25GQL Assure Lance Plus Safety Lancets 30GQL Assure LancetsQL Aurora Lancet Super Thin 30GQL Aurora Lancet Thin 23GQL AF Lancets Super ThinQL AT Last LancetsQL B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16"QL B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16"QL B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16"QL B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL B-d Insulin Syringe Ultrafine/1ML/30G X 1/2"QL Bayer Microlet LancetsQL Bullseye Mini Safety LancetsQL Bullseye Safety LancetsQL BD Autoshield Duo 30G X 3/16"QL BD Autoshield 29G X 3/16"QL BD Autoshield 29G X 5/16"QL BD Insulin Syringe LUER-LOK/U-100/1MLQL BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"QL BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"QL BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"QL BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"QL BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"QL BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"QL BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"QL BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"QL BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16"QL BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"QL BD Insulin Syringe Safetyglide/1ML/29G X 1/2"QL BD Insulin Syringe Slip Tip/U-100/1MLQL BD Insulin Syringe U-40/1ML/25G X 5/8"QL BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"QL BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16"QL BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64"QL BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64"QL BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64"QL BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"QL BD Insulin Syringe Ultrafine/1ML/30G X 1/2"QL BD Insulin Syringe Ultrafine/1ML/31G X 5/16"QL BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1"QL BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8"QL BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2"QL BD Insulin Syringe/U-100/0.5ML/30G X 1/2"QL BD Insulin Syringe/U-100/1ML/27G X 1/2"QL BD Insulin Syringe/U-100/1ML/28G X 1/2"QL

BD Insulin Syringe/U-100/2ML/27.5G X 5/8"QL BD Insulin Syringe/U-100/2ML/29G X 1/2"QL BD Integra Insulin Syringe/U-100/1ML/29G X 1/2"QL BD Integra Syringe/Retracting Needle/1ML/25G X 1"QL BD Lancet Ultrafine 30GQL BD Lancet Ultrafine 33GQL BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2"QL BD Microtainer LancetsQL BD Pen Needle/Mini/Ultrafine/31G X 3/16"QL BD Pen Needle/Nano/Ultra Fine/32G X 4MMQL BD Pen Needle/SHORT/Ultrafine/31G X 5/16"QL BD Pen Needle/Ultrafine/29G X 12.7MMQL BD Pen Needle/Ultrafine/29GX1/2" 12.7MMQL BD Pen Needles SHORT/Ultrafine/31G X 5/16"QL BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2"QL BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2"QL BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16"QL BD-insul SYR Mis LO DoseQL Careone Lancet ThinQL Careone Lancet Ultra ThinQL Cleanlet Lancets 28GQL Clever Chek Lancets UltrathinQL Clever Chek Lancets Ultrathin 30GQL Coaguchek LancetsQL Comfort Assured Lancets Micro Thin 33GQL Comfort Assured Lancets Super Thin 28GQL Comfort LancetsQL CVS Lancets Micro Thin 33GQL CVS Lancets OriginalQL CVS Lancets Thin 26GQL CVS Lancets Ultra Thin 30GQL CVS Lancets 21GQL CVS Ultra Thin LancetsQL Diastar Easy Test II Lancets 30GQL Diastar Easy Test Lancets30GQL Droplet Lancets Ultra Thin 30GQL Drug Mart Lancets ThinQL Drug Mart Lancets Ultra ThinQL Drug Mart On-the-go Lancets Gentle 30GQL Drug Mart Unilet Lancets Super Thin 30GQL Drug Mart Unilet Lancets Ultra Thin 28GQL Duane Reade Lancet Alternate Site 26GQL Duane Reade Lancet Super Thin 30GQL Duane Reade Lancet Ultra Thin 28GQL E-z Ject LancetsQL E-z Ject Lancets ColorQL E-z Ject Lancets Super ThinQL E-z Ject Lancets Super Thin 30GQL E-z Ject Lancets Thin 26GQL E-z Ject Lancets 21GQL E-ZJECT Lancets Micro-thin 33GQL Easy Comfort LancetsQL Easy Comfort Lancets 30G/Pull TopQL Easy Comfort Lancets 30G/Thin TopQL Easy Touch Lancets 21G/Pressure ActivatedQL Easy Touch Lancets 23G/Pressure ActivatedQL Easy Touch Lancets 26G/Pressure ActivatedQL Easy Touch Lancets 26G/Pull-topQL Easy Touch Lancets 26G/TwistQL Easy Touch Lancets 28G/Pressure ActivatedQL Easy Touch Lancets 28G/Pull-topQL Easy Touch Lancets 28G/TwistQL Easy Touch Lancets 30G/Button-activatedQL Easy Touch Lancets 30G/Pressure ActivatedQL Easy Touch Lancets 30G/Pull-topQL Easy Touch Lancets 30G/TwistQL Easy Touch Lancets 32G/Pressure ActivatedQL Easy Touch Lancets 32G/Pull-topQL Easy Touch Lancets 32G/TwistQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Easy Touch Lancets 33G/TwistQL Easy Touch Safety Lancets21G/Pressure ActivatedQL Easy Touch Safety Lancets23G/Pressure ActivatedQL Easy Touch Safety Lancets26G/Button ActivatedQL Easy Touch Safety Lancets26G/Pressure ActivatedQL Easy Touch Safety Lancets28G/Button ActivatedQL Easy Touch Safety Lancets28G/Pressure ActivatedQL Easy Twist & CAP LancetsQL Easytest II LancetsQL Easytest LancetsQL Embrace Lancets Ultra Thin 30GQL Eql Color Lancets Micro Thin 33GQL Eql Color Lancets 21GQL Eql Super Thin Lancets 30GQL Eql Thin Lancets 26GQL EZ Smart Blood Glucose LancetsQL EZ-lets Lancets 21GQL EZ-lets Lancets 23GQL EZ-lets Lancets 26G Super-softQL EZ-lets Lancets 28G Ultra-softQL EZ-lets Lancets 30GQL Fifty50 Safety Seal Lancets 30GQL Fifty50 Safety Seal Lancets 32GQL Fifty50 Unilet Lancets 33GQL Fine 30QL Fingerstix LancetsQL Fora LancetsQL Freds Pharmacy Unilet Lancets Super Thin 30GQL Freds Pharmacy Unilet Lancets Ultra Thin 28GQL Freestyle LancetsQL Freestyle Unistick II LancetsQL Gentle-let GP LancetsQL Gentle-let Lancets General Purpose Style/Fine PointQL Gentle-let Lancets General Purpose Style/Medium PointQL Gentle-let Lancets Safety Style/Fine PointQL Gentle-let Lancets Safety Style/Medium PointQL Global Inject Ease Lancets 28GQL Global Inject Ease Lancets 30GQL Glucocom Lancets 28GQL Glucocom Lancets 30GQL Glucocom Lancets 33GQL Glucose Control Normal Glucose Control Solution Glucosource LancetsQL Gmate Lancets 30GQL Gnp LancetsQL Gnp Lancets Micro Thin 33GQL Gnp Lancets Super Thin 30GQL Gnp Lancets ThinQL Gnp Lancets Thin 26GQL Gnp Lancets 21GQL Gnp Micro Thin Lancets 33GQL Gnp Super Thin Lancets/30GQL H&h Thinlet Lancets 26GQL H&h Thinlet Super Thin Lancets 30GQL H-e-b Incontrol Lancets Micro Thin 33GQL H-e-b Incontrol Lancets Super Thin 30GQL H-e-b Incontrol Lancets Ultra Thin 28GQL HaemolanceQL Haemolance Low Flow LancetsQL Haemolance PlusQL Haemolance Plus High FlowQL Haemolance Plus Low FlowQL Haemolance Plus Max FlowQL Haemolance Plus Pediatric FlowQL Healthwise Lancets 30GQL Healthy Accents Unilet Lancets Super Thin 30GQL Hy-vee LancetsQL Hy-vee Thin LancetsQL HM Lancets Micro Thin 33GQL

HM Lancets Ultra Thin 30GQL IN Touch Diabetes Management Software IN Touch Sterile Lancets 30GQL Kinney LancetsQL Kinney Thin LancetsQL Kroger LancetsQL Kroger Lancets Micro Thin33GQL Kroger Lancets Super ThinQL Kroger Lancets ThinQL Kroger Lancets Thin 26GQL Kroger Lancets Ultrathin 30GQL Kroger Lancets 21GQL LancetsQL Lancets Bullseye SafetyQL Lancets Micro Thin 33GQL Lancets Safety Seal 21GQL Lancets Safety Seal 26GQL Lancets Safety Seal 28GQL Lancets Safety Seal 30GQL Lancets Super Thin 28GQL Lancets ThinQL Lancets Twist TopQL Lancets Ultra FineQL Lancets Ultra ThinQL Lancets Ultra Thin 30GQL Lancets 26G Twist TopQL Lancets 28GQL Lancets 30GQL Lancets 30G Twist TopQL Lancets 30G/Twist TopQL Lancets 31G Twist TopQL Lancets 33G Universal DesignQL Leader Lancets ColoredQL Leader Super Thin LancetQL Leader Thin LancetsQL Liberty Blood Glucose MeterQL Liberty Glucose Control Mid Liberty Glucose Control Normal Liberty Medical Lancets 30GQL Liberty Mini Lancing Device Liberty Test StripsQL Lifescan Unistik II LancetsQL Lifescan Unistik 2 Deep PenetrationQL Lite Touch LancetsQL Litetouch Lancets Micro Thin 33GQL Live Better Lancet Super Thin 30GQL Live Better Lancet Ultra Thin 28GQL Longs Lancets StandardQL Longs Lancets ThinQL Longs Lancets Ultra ThinQL Medichoice Pre-set Safety Lancet Dual UseQL Medichoice Pre-set Safety Lancet Low FlowQL Medichoice Pre-set Safety Lancet Medium FlowQL Medichoice Pre-set Safety Lancet Moderate FlowQL Medichoice Safety Lancet ExtraQL Medichoice Safety Lancet NormalQL Medicine Shoppe LancetsQL Medicine Shoppe Lancets ThinQL Medisense Thin LancetsQL Medlance Plus Extra Lancets 21GQL Medlance Plus LancetsQL Medlance Plus Lancets Lite 25GQL Medlance Plus Lite Lancets 25GQL Medlance Plus Special Lancets 0.8MMQL Medlance Plus Superlite 30GQL Medlance Plus Superlite 30G/Comfort MaxQL Medlance Plus Universal Lancets 21GQL Medlance Plus/Lite 25GQL Medlance/ExtraQL Medlance/LiteQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Medlance/UniversalQL Meijer Color Lancets Universal 33GQL Meijer LancetsQL Meijer Lancets ThinQL Meijer Lancets Universal 33GQL Meijer Super Thin LancetsQL Microlet LancetsQL Microtainer Safety Flow Lancet/Sterile/Single-useQL Monolet LancetsQL Monolet Opd LancetsQL Monolettor Safety LancetsQL Myglucohealth Mgh Softlance Lancets 30GQL Netgroup LancetsQL Nova Safety Lancets 23GQL Nova Safety Lancets 28GQL Nova Sureflex LancetsQL On Call LancetsQL On Call Plus LancetsQL Onetouch Club Lancets Fine PointQL Onetouch Combo PackQL Onetouch Delica Lancets Extra Fine 33GQL Onetouch Delica Lancets Fine 30GQL Onetouch Delica Lancing Device Onetouch Finepoint LancetsQL Onetouch LancetsQL Onetouch Ping Meter Remote Onetouch Suresoft Lancing Device/18G Onetouch Suresoft Lancing Device/21G Onetouch Suresoft Lancing Device/28G Onetouch Ultra BlueQL Onetouch Ultra Control Onetouch Ultra MiniQL Onetouch Ultra 2QL Onetouch Ultralink System (hex)QL Onetouch Ultralink System (DEC)QL Onetouch Ultrasoft LancetsQL Onetouch VerioQL Onetouch Verio Control Solution High Onetouch Verio Flex Bloodglucose Monitoring SystemQL Onetouch Verio IQ Blood Glucose Monitoring SystemQL Onetouch Verio Mid Control Solution Onetouch Verio Sync Bloodglucose Monitoring SystemQL Onetouch Verio Test StripsQL Penlet II Automatic Bloodsampler Penlet II Replacement CAPS Penlet II Replacement CAPS-deep Penlet II Replacement CAPS-regular Perfect Lancets 30GQL Perfect Pressure Activated Safety Lancets 28GQL Pharmacist Choice Ultra Thin LancetsQL Pharmacist Choice Ultra Thin Lancets 28GQL Pharmacist Choice Ultra Thin Lancets 30GQL Pharmacist Choice Ultra Thin Lancets 31GQL Pharmacist Choice Ultra Thin Lancets 33GQL Pharmacy Counter LancetsQL Precision Thin LancetsQL Precision Thins GP LancetQL Precision Ultra LancetQL Preferred Plus Lancets Colored 21GQL Preferred Plus Lancets Super Thin 30GQL Preferred Plus Lancets Thin 26GQL Pressure Activated Safetylancet 21GQL Prodigy Pressure Activated Safety LancetsQL Prodigy Safety LancetsQL Prodigy Twist Top LancetsQL Pss Select GP LancetsQL Pss Select Safety LancetsQL Push Button Safety Lancets 21GQL Push Button Safety Lancets 28GQL Px Lancets Ultra ThinQL

Qc LancetsQL Qc Lancets Super ThinQL Qc Lancets ThinQL Qc Lancets Ultra ThinQL Qc Unilet Lancets 28G/Ultra ThinQL Qc Unilet Lancets 33G/Micro ThinQL Ra E-ZJECT Color Lancets Micro-thin 33GQL Ra E-ZJECT Lancets Thin 26GQL Ra E-ZJECT Lancets Thin 28GQL Ra E-ZJECT Lancets Ultra Thin 30GQL Ra E-ZJECT Lancets 28GQL Reality LancetsQL Reality Trigger LancetsQL Relion Lancets Micro-thin33GQL Relion Lancets Standard 21GQL Relion Lancets Thin 26GQL Relion Lancets Ultra-thin30GQL Relion Thin LancetsQL Relion Ultra Thin LancetsQL Relion Ultra Thin Lancets30GQL Relion Ultra Thin Plus Lancets 32GQL Relion Ultra Thin Plus Lancets 33GQL Renew Advanced Lancing Cartridge RefillsQL Rexall Lancets Ultra ThinQL Rightest Gl300 LancetsQL Safe-t-lance Low Flow 25GQL Safe-t-lance Normal Flow 21GQL Safe-t-lance Plus Safety Lancet High FlowQL Safe-t-lance Plus Safety Lancet Low FlowQL Safe-t-lance Plus Safety Lancet Normal FlowQL Safety Lancet 21G/Pressure ActivatedQL Safety Lancet 28G/Pressure ActivatedQL Safety LancetsQL Safety Lancets 21GQL Safety Lancets 28GQL Safety Let LancetsQL Safety Seal Lancets 28GQL Safety Seal Lancets 30GQL Safety-glide Insulin Syringe/0.3ML/29G X 1/2"QL Sapscare Twist Top Lancets 30GQL Shopko On-the-go Comfort Lancets 30GQL Shopko Unilet Lancets Super Thin 30GQL Shopko Unilet Lancets Ultra Thin 28GQL Side Button Safety Lancet21GQL Single-letQL Sm Lancets 21GQL Sm Micro Thin Lancets 33GQL Sm Super Thin LancetsQL Sm Super Thin Lancets 30GQL Sm Thin Lancets 26GQL Smart Diabetes Vantage Universal Lancets 30GQL Smart Sense Color Lancets Universal 33GQL Smart Sense Standard Lancets Universal 21GQL Smart Sense Super Thin Lancets Universal 30GQL Smart Sense Thin Lancets Universal 26GQL Smartest Lancets 28GQL Solus V2 Pressure Activated Safety Lancets 28GQL Solus V2 Twist Lancets 30GQL Sterilance TLQL Super Thin LancetsQL Sure Comfort Lancets 28GQL Sure Comfort Lancets 30GQL Sure-lance Flat LancetsQL Sure-lance Lancets 26GQL Sure-lance Thin Lancets 28GQL Sure-lance Ultra Thin LancetsQL Sure-touch Lancets UniversalQL Surelite LancetsQL Surestep Glucose Control Surestep Glucose Control Solution

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Surestep Pro High Glucosecontrol Surestep Pro Linearity Kit Surestep Pro Low Glucose Control Surestep Pro Normal Glucose Control SB Lancets ThinQL SB Lancets Ultra ThinQL Techlite AST LancetsQL Techlite LancetsQL Techlite Lancets 30GQL Tgt Lancet Alternate SiteQL Tgt Lancet Micro Thin 33GQL Tgt Lancet Super Thin 30GQL Tgt Lancet Thin 23GQL Tgt Lancet Thin 26GQL Tgt Lancet Ultra Thin 28GQL Tgt Lancet Ultra Thin 30GQL Thinlets GP LancetsQL Thinlets LancetQL Todays Health Super Thin Lancets 30GQL Todays Health Ultra Thin Lancets 28GQL Travel Lancets 30GQL Trueplus Lancets 26GQL Trueplus Lancets 28GQL Trueplus Lancets 28G Super ThinQL Trueplus Lancets 30GQL Trueplus Lancets 30G Ultra ThinQL Trueplus Lancets 33GQL Trueplus Lancets 33G Micro ThinQL Trueplus Safety Lancets 28GQL Ulticare Thin Lancets 30GQL Ultilet Classic LancetsQL Ultilet LancetsQL Ultilet Lancets 33GQL Ultilet Safety Lancets 23GQL Ultra Thin Lancets 28GQL Ultra Thin Lancets 30GQL Ultra-thin II Auto LancetQL Ultra-thin II Lancets 28GQL Ultra-thin II Lancets 30GQL Ultra-thin II Safety Autolancets 26GQL Unilet Comfortouch LancetQL Unilet ExceliteQL Unilet Excelite IIQL Unilet G.p. LancetQL Unilet G.p. Superlite LancetQL Unilet GP 28 Ultra ThinQL Unilet LancetQL Unilet Lancets Micro-thin33GQL Unilet Lancets Super-thin30GQL Unilet Lancets Ultra-thin 28GQL Unilet Superlite LancetQL Unistik Safety Lancets 28GQL Unistik Safety Lancets 30GQL Unistik Touch Safety Lancets 21GQL Unistik Touch Safety Lancets 23GQL Unistik Touch Safety Lancets 28GQL Unistik Touch Safety Lancets 30GQL Unistik 3 GentleQL Universal 1 Lancets Thin 26GQL Universal 1 Lancets Ultra Thin 30GQL V-go 20 V-go 30 V-go 40 Value Plus Lancets Standard 21GQL Value Plus Lancets Super Thin 30GQL Value Plus Lancets Thin 26GQL Valumark Lancet Super Thin 30GQL Valumark Lancet Ultra Thin 28GQL Vida Mia Unilet Lancets Super Thin 30GQL Vida Mia Unilet Lancets Ultra Thin 28GQL

Vitalet Pro LancetsQL Vitalet Pro Plus LancetsQL W&f Lancets Colored 21GQL W&f Lancets 26GQL Walgreens Advanced Travellancets 28GQL Walgreens Comfort Assuredlancets Micro Thin/33GQL Walgreens Comfort Assuredlancets Super Thin/28GQL Walgreens LancetsQL Walgreens Thin LancetsQL Walgreens Ultra Thin LancetsQL 1ST Choice Lancets Super ThinQL 1ST Choice Lancets ThinQL 1ST Choice Lancets Ultra ThinQL 1ST Tier Unilet Comfortouch Lancets 28GQL 1ST Tier Unilet Comfortouch Lancets 30GQL NON PREFERRED Accu-chek Active Glucose Control Solution Accu-chek Active StripsQL Accu-chek AvivaQL Accu-chek Aviva PlusQL Accu-chek Comfort Curve Control Solution (2 Levels) Accu-chek Comfort Curve Linearity Solution Accu-chek Comfort Curve Test StripsQL Accu-chek Compact Blue Control Solution (2 Levels) Accu-chek Compact PlusQL Accu-chek Compact Plus Care KitQL Accu-chek Compact Plus Clear Control Solution (2 Levels) Accu-chek Compact Test DrumQL Accu-chek Fastclix Lancetdevice Kit Accu-chek Instant Glucosecontrol Solution (2 Levels) Accu-chek Multiclix Lanc Et Device Kit Accu-chek Nano SmartviewQL Accu-chek Smartview Control Accu-chek Smartview StripsQL Accu-chek Softclix Lancetdevice Accu-chek Softclix Lancetdevice Kit Accu-chek VoicemateQL Adjustable Lancing Device Advocate Insulin Pen Needles 29GX12.7MMQL Advocate Insulin Pen Needles 31GX5MMQL Advocate Insulin Pen Needles 31GX8MMQL Advocate Insulin Syringe/U-100/0.3ML/29GX1/2"QL Advocate Insulin Syringe/U-100/0.3ML/30GX5/16"QL Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"QL Advocate Insulin Syringe/U-100/0.5ML/29GX1/2"QL Advocate Insulin Syringe/U-100/0.5ML/30GX5/16"QL Advocate Insulin Syringe/U-100/0.5ML/31GX5/16"QL Advocate Insulin Syringe/U-100/1ML/29GX1/2"QL Advocate Insulin Syringe/U-100/1ML/30GX5/16"QL Advocate Insulin Syringe/U-100/1ML/31GX5/16"QL Advocate Lancing Device Advocate Rapid-safe Lancing Device Alternate Site Lancing Device Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2"QL Aqua Lance Adjustable Lancing Device Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"QL Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL Aurora Pen Needles 29GX12MMQL Aurora Pen Needles 31G X 6MMQL Aurora Pen Needles 31G X 8MMQL Aurora Unifine Pentips/Mini/31GX3/16"QL Aurora Unifine Pentips/32GX5/32"QL Auto-lancet Auto-lancet Mini Autolet Impression Autolet Impression Lancing Device Autolet II Clinisafe Autolet Lite Clinisafe

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Autolet Lite Starter Pack Autolet Mini Autolet Platforms Bayer Microlet 2 Lancing Device BD Lancet Device Cardiocom Lancing Device Carefine Pen Needle 32GX4MMQL Carefine Pen Needles 29GX1/2"QL Carefine Pen Needles 30GX5/16"QL Carefine Pen Needles 31GX6MMQL Carefine Pen Needles 31GX8MMQL Carefine Pen Needles 32GX5MMQL Carefine Pen Needles 32GX6MMQL Careone Advanced Lancing Device Careone Insulin Syringes/0.3ML/30G X 1/2"QL Careone Insulin Syringes/0.3ML/31G X 5/16"QL Careone Insulin Syringes/0.5ML/30G X 1/2"QL Careone Insulin Syringes/0.5ML/31G X 5/16"QL Careone Insulin Syringes/1ML/30G X 1/2"QL Careone Insulin Syringes/1ML/31GX5/16"QL Careone Unifine Pentips Pen Needles 32GX4MMQL Careone Unifine Pentips Plus Pen Needles 29GX12MMQL Careone Unifine Pentips Plus Pen Needles 31GX5MMQL Careone Unifine Pentips Plus Pen Needles 31GX6MMQL Careone Unifine Pentips Plus Pen Needles 31GX8MMQL Careone Unifine Pentips Plus Pen Needles 32GX4MMQL Careone Unifine Pentips 29GX12MMQL Careone Unifine Pentips 31GX5MMQL Careone Unifine Pentips 31GX6MMQL Careone Unifine Pentips 31GX8MMQL Chemstrip Bg Log Book Clever Choice Comfort EZ Insulin Pen Needles 31GX8MMQL Clever Choice Comfort EZ Insulin Syringe/U100/1ML/31GX5/16"QL Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16"QL Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16"QL Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16"QL Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16"QL Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/1ML/28G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2"QL Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16"QL Clever Choice Comfort EZ Pen Needles 29GX12MMQL Clever Choice Comfort EZ Pen Needles 31GX5MMQL Clever Choice Comfort EZ Pen Needles 31GX6MMQL Clever Choice Comfort EZ Pen Needles 31GX8MMQL Clever Choice Comfort EZ Pen Needles 32GX4MMQL Clever Choice Comfort EZ Pen Needles 32GX5MMQL Clever Choice Comfort EZ Pen Needles 32GX6MMQL Clever Choice Comfort EZ Pen Needles 32GX8MMQL Clever Choice Comfort EZ Pen Needles 33GX4MMQL Clever Choice Comfort EZ Pen Needles 33GX5MMQL Clever Choice Comfort EZ Pen Needles 33GX6MMQL Clever Choice Comfort EZ Pen Needles 33GX8MMQL

Clickfine Pen Needle Universal/31GX1/4"QL Clickfine Pen Needle Universal/31GX5/16"QL Clickfine Pen Needle 32GX5/32"QL Clickfine Pen Needles/31GX1/4"QL Clickfine Pen Needles/31GX5/16"QL Clickfine Universal Pen Needles 31GX5/16"QL Closercare Comfort Assist Insulin Syringe 0.3ML/29G X 1/2"QL Comfort Assist Insulin Syringe/0.3ML/30G X 5/16"QL Comfort Assist Insulin Syringe/0.3ML/31G X 5/16"QL Comfort Assist Insulin Syringe/0.5ML/29G X 1/2"QL Comfort Assist Insulin Syringe/0.5ML/30G X 5/16"QL Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"QL Comfort Assist Insulin Syringe/1ML/29G X 1/2"QL Comfort Assist Insulin Syringe/1ML/30G X 5/16"QL Comfort Assist Insulin Syringe/1ML/31G X 5/16"QL CVS Insulin Syringe/0.3ML/29G X 1/2"QL CVS Insulin Syringe/0.3ML/30G X 1/2"QL CVS Insulin Syringe/0.5ML/29G X 1/2"QL CVS Insulin Syringe/0.5ML/30G X 1/2"QL CVS Insulin Syringe/1ML/29G X 1/2"QL CVS Lancing Device Diascreen Liquid Urine Controls Diascreen 1b Diascreen 1k Diascreen 1G Diascreen 10 Diascreen 2GK Diascreen 2GP Diascreen 3 Diascreen 4nl Diascreen 4obl Diascreen 4PH Diascreen 5 Diascreen 6 Diascreen 7 Diascreen 8 Diascreen 9 Droplet Lancing Device Droplet Pen Needles 29GX10MMQL Droplet Pen Needles 29GX12MMQL Droplet Pen Needles 31GX5MMQL Droplet Pen Needles 31GX6MMQL Droplet Pen Needles 31GX8MMQL Droplet Pen Needles 32GX4MMQL Droplet Pen Needles 32GX5MMQL Droplet Pen Needles 32GX6MMQL Droplet Pen Needles 32GX8MMQL Drug Mart Adjustable Lancing Device Drug Mart Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"QL Drug Mart Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"QL Drug Mart Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"QL Drug Mart Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"QL Drug Mart Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"QL Drug Mart Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL Drug Mart Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL Drug Mart Unifine Pentips 31GX5MMQL Drug Mart Unifine Pentipsplus 32GX4MMQL Drug Mart Unifine Pentips29G X 12MMQL Drug Mart Unifine Pentips31GX6MMQL Drug Mart Unifine Pentips31GX8MMQL Drug Mart Unifine Pentips32GX4MMQL Duane Reade Unifine Pentips 29G X 12MMQL Duane Reade Unifine Pentips 31G X 6MM Ultra SHORTQL Duane Reade Unifine Pentips 31G X 8MM SHORTQL Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL Easy Comfort Insulin Syringe/0.3ML/30G X 5/16"QL Easy Comfort Insulin Syringe/0.5ML/30G X 5/16"QL Easy Comfort Insulin Syringe/0.5ML/31G X 5/16"QL Easy Comfort Insulin Syringe/1ML/30G X 5/16"QL Easy Comfort Insulin Syringe/1ML/31G X 5/16"QL Easy Comfort Pen Needles 31GX1/4"QL Easy Comfort Pen Needles 31GX3/16"QL Easy Comfort Pen Needles 31GX5/16"QL Easy Comfort Pen Needles 32GX5/32"QL Easy Mini Eject Lancing Device Easy Mini Lancing Device Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2"QL Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2"QL Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16"QL Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16"QL Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X 1/2"QL Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X 5/16"QL Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2"QL Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2"QL Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"QL Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2"QL Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2"QL Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2"QL Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2"QL Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16"QL Easy Touch Insulin Syringe/0.3ML/30G X 5/16"QL Easy Touch Insulin Syringe/0.3ML/31G X 5/16"QL Easy Touch Insulin Syringe/0.5ML/29G X 1/2"QL Easy Touch Insulin Syringe/0.5ML/30G X 5/16"QL Easy Touch Insulin Syringe/1ML/30G X 5/16"QL Easy Touch Lancing Device/Ejector Easy Touch Pen Needles 29GX1/2"QL Easy Touch Pen Needles 31GX1/4"QL Easy Touch Pen Needles 31GX5/16"QL Easy Touch Pen Needles 32GX1/4"QL Easy Touch Pen Needles 32GX3/16"QL Easy Touch Pen Needles 32GX5/32"QL Easy Touch Pen Needles/31G X 3/16"QL Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2"QL Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16"QL Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16"QL Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2"QL Easy Touch 32GX5MMQL Easy Touch 32GX6MMQL Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16"QL Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16"QL Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2"QL Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16"QL Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2"QL Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16"QL Elite-thin Insulin Syringe/0.3ML/31G X 5/16"QL Elite-thin Insulin Syringe/0.5ML/29G X 1/2"QL Elite-thin Insulin Syringe/0.5ML/30G X 5/16"QL Elite-thin Insulin Syringe/1ML/29G X 5/16"QL Elite-thin Insulin Syringe/1ML/30G X 5/16"QL

Eql Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Eql Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Eql Insulin Syringe/U-100/1ML/29G X 1/2"QL Eql Insulin Syringe/0.3ML/29G X 1/2"QL Eql Insulin Syringe/0.3ML/30G X 5/16"QL Eql Insulin Syringe/0.3ML/31G X 5/16"QL Eql Insulin Syringe/0.5ML/29G X 1/2"QL Eql Insulin Syringe/0.5ML/30G X 5/16"QL Eql Insulin Syringe/0.5ML/31G X 5/16"QL Eql Insulin Syringe/1ML/29G X 1/2"QL Eql Insulin Syringe/1ML/30G X 5/16"QL Eql Insulin Syringe/1ML/31G X 5/16"QL Eql SHORT Pen Needles 31G X 8MMQL Eql Ultra Comfort Insulinsyringe/0.3ML/31G X 5/16"QL Eql Ultra Comfort Insulinsyringe/1ML/30G X 5/16"QL Eql Ultra SHORT Pen Needles 31G X 6MMQL Excel Comfort Point Insulin Pen Needles 31G X 4MMQL Exel Comfort Point Insulin Pen Needles 29G X 12MMQL Exel Comfort Point Insulin Pen Needles 31G X 6MMQL Exel Comfort Point Insulin Pen Needles 31G X 8MMQL Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2"QL Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"QL Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2"QL Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2"QL Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16"QL Exel Comfort Point Insulin Syringe/1ML/28G X 1/2"QL Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"QL Exel Comfort Point Insulin Syringe/1ML/30G X 5/16"QL Fifty50 Lancing Device Fifty50 Pen Needles 31G X3/16" (5MM)QL Fifty50 Pen Needles 31G X5/16" (8MM)QL Fifty50 Pen Needles 31GX5MMQL Fifty50 Pen Needles/31GX8MMQL Fifty50 Pen Needles/32GX4MMQL Fifty50 Pen Needles/32GX6MMQL Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16"QL Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16"QL Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16"QL Fora Lancing Device Fora Lancing Device/Clearcap Freds Pharmacy Autolet Lancing Device Freds Pharmacy Unifine Pentips Pen Needles 32GX4MMQL Freds Pharmacy Unifine Pentips Plus 31GX5MMQL Freds Pharmacy Unifine Pentips Plus 31GX8MMQL Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16"QL Freestyle Precision Insulin Syringes/U-100/1ML/30G X 5/16"QL Gentle-let Platforms 2.4MM Gentle-let Platforms 3.0MM Global Ease Inject Pen Needles 29GX12MMQL Global Ease Inject Pen Needles 31GX8MMQL Global Ease Inject Pen Needles 32GX4MMQL Global Ease Inject Pen Neeedles 31GX5MMQL Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X 1/2"QL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Global Inject Ease Insulin Syringe/U-100/1ML/28G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2"QL Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16"QL Global Inject Ease Insulin Syringe/U-100/1ML/31G X 5/16"QL Global Lancing Device Glucocom Autolink Telemonitoring System Glucolet 2 Automatic Lancing Device Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Glucopro Insulin Syringe/U-100/1ML/30G X 1/2"QL Glucopro Insulin Syringe/U-100/1ML/30G X 5/16"QL Glucopro Insulin Syringe/U-100/1ML/31G X 5/16"QL Glucosource Lancet Device Gmate Lancing Device Gnp Clickfine Pen Needle Universal/31GX5/16"QL Gnp Clickfine Universal Pen Needles 31GX1/4"QL Gnp Clickfine Universal Pen Needles 31GX5/16"QL Gnp Insulin Syringe/0.3ML/29G X 1/2"QL Gnp Insulin Syringe/0.3ML/30G X 5/16"QL Gnp Insulin Syringe/0.3ML/31G X 5/16"QL Gnp Insulin Syringe/0.5ML/28G X 1/2"QL Gnp Insulin Syringe/0.5ML/29G X 1/2"QL Gnp Insulin Syringe/0.5ML/30G X 5/16"QL Gnp Insulin Syringe/0.5ML/31G X 5/16"QL Gnp Insulin Syringe/1ML/28G X 1/2"QL Gnp Insulin Syringe/1ML/29G X 1/2"QL Gnp Insulin Syringe/1ML/30G X 5/16"QL Gnp Insulin Syringe/1ML/31G X 5/16"QL Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"QL Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORTQL Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORTQL Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"QL Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"QL Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORTQL Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORTQL Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORTQL Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORTQL H-e-b Incontrol Advanced Lancing Device H-e-b Incontrol Pen Needles 29GX12MMQL H-e-b IN Control Pen Needles 31GX5MMQL H-e-b IN Control Pen Needles 31GX6MMQL H-e-b IN Control Pen Needles 31GX8MMQL H-e-b IN Control Pen Needles/Nano/32GX4MMQL H-e-b IN Control Unifine Pentips Plus 31GX5MMQL H-e-b IN Control Unifine Pentips Plus 32GX4MMQL Health Care Lancing Device Healthwise Lancing Pen

Healthwise Mini Pen Needles 31GX6MMQL Healthwise Pen Needles 29GX12MMQL Healthwise SHORT Pen Needles 31GX8MMQL Healthwise Unifine Pentips Pen Needles 32GX4MMQL Healthy Accents Autolet Impression Lancing Device Healthy Accents Unifine Pentips Pen Needles 29GX12MMQL Healthy Accents Unifine Pentips Pen Needles 31GX5MMQL Healthy Accents Unifine Pentips Pen Needles 31GX6MMQL Healthy Accents Unifine Pentips Pen Needles 31GX8MMQL Healthy Accents Unifine Pentips Pen Needles 32GX4MMQL Hypolance AST Lancing Kit Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Insulin Syringe/U-100/1ML/28G X 1/2"QL Insulin Syringe/U-100/1ML/29G X 1/2"QL Insulin Syringe/U-100/1ML/30G X 5/16"QL Insulin Syringe/U-100/1ML/31G X 5/16"QL Insulin Syringe/0.3ML/29G X 1/2"QL Insulin Syringe/0.3ML/29G X 1"QL Insulin Syringe/0.3ML/30G X 5/16"QL Insulin Syringe/0.3ML/31G X 5/16"QL Insulin Syringe/0.5ML/27G X 1/2"QL Insulin Syringe/0.5ML/28G X 1/2"QL Insulin Syringe/0.5ML/29G X 1/2"QL Insulin Syringe/0.5ML/30G X 1/2"QL Insulin Syringe/0.5ML/30G X 5/16"QL Insulin Syringe/0.5ML/31G X 5/16"QL Insulin Syringe/1ML/28G X 1/2"QL Insulin Syringe/1ML/29G X 1/2"QL Insulin Syringe/1ML/30G X 5/16"QL Insulin Syringe/1ML/31G X 5/16"QL Insupen Pen Needles 32G X4MMQL Insupen Sensitive 32GX6MMQL Insupen Sensitive 32GX8MMQL Insupen Ultrafin 29GX12MMQL Insupen Ultrafin 30GX8MMQL Insupen Ultrafin 31GX6MMQL Insupen Ultrafin 31GX8MMQL Insupen 33GX4MMQL IN Touch Lancing Device Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16"QL Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16"QL Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16"QL Kinray Insulin Syringe/0.5ML/29G X 1/2"QL Kmart Valu Plus Insulin Syringe/0.3ML/30GQL Kmart Valu Plus Insulin Syringe/0.5ML/29GQL Kmart Valu Plus Insulin Syringe/0.5ML/30GQL Kmart Valu Plus Insulin Syringe/1ML/29GQL Kmart Valu Plus Insulin Syringe/1ML/30GQL Kroger Insulin Syringe/0.3ML/29G X 1/2"QL Kroger Insulin Syringe/0.3ML/30G X 5/16"QL Kroger Insulin Syringe/0.3ML/31G X 5/16"QL Kroger Insulin Syringe/0.5ML/29G X 1/2"QL Kroger Insulin Syringe/0.5ML/30G X 5/16"QL Kroger Insulin Syringe/0.5ML/31G X 5/16"QL Kroger Insulin Syringe/1ML/29G X 1/2"QL Kroger Insulin Syringe/1ML/30G X 5/16"QL Kroger Insulin Syringe/1ML/31G X 5/16"QL Kroger Lancing Device Kroger Pen Needles 29G X 12MMQL Kroger Pen Needles 31G X 8MMQL Kroger Pen Needles 31GX1/4"QL Lancet Device Adjustable Lancet Device With Ejector Lancet Transporter Case

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Lancing Device Lancing Device Adjustable Lanzo Leader Advanced Lancing Device Leader Insulin Syringe/0.3ML/29G X 1/2"QL Leader Insulin Syringe/0.3ML/30G X 5/16"QL Leader Insulin Syringe/0.3ML/31G X 5/16"QL Leader Insulin Syringe/0.5ML/28G X 1/2"QL Leader Insulin Syringe/0.5ML/29G X 1/2"QL Leader Insulin Syringe/0.5ML/30G X 5/16"QL Leader Insulin Syringe/0.5ML/31G X 5/16"QL Leader Insulin Syringe/1ML/28G X 1/2"QL Leader Insulin Syringe/1ML/29G X 1/2"QL Leader Insulin Syringe/1ML/30G X 5/16"QL Leader Insulin Syringe/1ML/31G X 5/16"QL Leader Unifine Pentips Plus/Mini/31GX3/16"QL Leader Unifine Pentips Plus/SHORT/31GX5/16"QL Leader Unifine Pentips/Mini/31GX3/16"QL Leader Unifine Pentips/Nano/32GX5/32"QL Leader Unifine Pentips/Plus/32GX5/32"QL Lite Touch Lancing Device Lite Touch Lancing Pen Lite Touch Pen Needles/31G X 3/16"QL Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Litetouch Insulin Syringe/U-100/1ML/28G X 1/2"QL Litetouch Insulin Syringe/U-100/1ML/29G X 1/2"QL Litetouch Insulin Syringe/U-100/1ML/31G X 5/16"QL Litetouch Insulin Syringe/0.3ML/29G X 1/2"QL Litetouch Insulin Syringe/0.3ML/30G X 5/16"QL Litetouch Insulin Syringe/0.3ML/31G X 5/16"QL Litetouch Insulin Syringe/0.5ML/30G X 5/16"QL Litetouch Insulin Syringe/0.5ML/31G X 5/16"QL Litetouch Insulin Syringe/1ML/30G X 5/16"QL Litetouch Pen Needles 29GX12.7MMQL Litetouch Pen Needles 31G X 6MMQL Litetouch Pen Needles 31GX8MM SHORTQL Live Better Advanced Lancing Device Live Better Pen Needles 29G X 12MMQL Live Better Pen Needles 31G X 12MMQL Live Better Pen Needles 31G X 6MMQL Longs Insulin Syringe/0.5ML/31G X 5/16"QL Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2"QL Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16"QL Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"QL Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16"QL Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"QL Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"QL Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2"QL Medic Insulin Syringe/0.3ML/30G X 5/16"QL Medic Insulin Syringe/0.5ML/30G X 5/16"QL Medicine Shoppe Pen Needles 29G X 12MMQL Medicine Shoppe Pen Needles 31G X 6MMQL Medicine Shoppe Pen Needles 31G X 8MMQL Meijer Pen Needles 29G X 12MMQL Meijer Pen Needles 31G X 6MMQL Meijer Pen Needles 31G X 8MMQL Mini Lancing Device Monoject Insulin Syringe Regular LUER Tip/Softpack/1MLQL Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"QL Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"QL Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2"QL Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2"QL Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2"QL

Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2"QL Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2"QL Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2"QL Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2"QL Monoject Insulin Syringe/Softpack/1ML/27G X 1/2"QL Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL Monoject Insulin Syringe/U-100/1ML/30G X 5/16"QL Monoject Insulin Syringe/1MLQL Monoject Insulin Syringe/1ML/31G X 5/16"QL Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"QL Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"QL Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"QL Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"QL Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"QL Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"QL Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"QL Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL Monojector End CAPS Monojector Opd End CAPS Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Moore MED Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL Moore MED Monoject Insulin Syringe/U-100/1ML/29G X 1/2"QL Multi-lancet Device Multi-lancet Device 2 MS Insulin Syringe/0.3ML/29G X 1/2"QL MS Insulin Syringe/0.3ML/30G X 5/16"QL MS Insulin Syringe/0.3ML/31G X 5/16"QL MS Insulin Syringe/0.5ML/29G X 1/2"QL MS Insulin Syringe/0.5ML/30G X 5/16"QL MS Insulin Syringe/0.5ML/31G X 5/16"QL MS Insulin Syringe/1ML/29G X 1/2"QL MS Insulin Syringe/1ML/30G X 5/16"QL MS Insulin Syringe/1ML/31G X 5/16"QL Nova Sureflex Lancing Device Novofine Autocover 30GX8MMQL Novofine Plus 32GX4MMQL Novofine 30GX8MMQL Novofine 32GX6MMQL Novotwist 30GX8MMQL Novotwist 32GX5MMQL On Call Lancing Device On Call Plus Lancing Device Pen Needles 29G X 12MMQL Pen Needles 29GX1/2"QL Pen Needles 30GX5/16"QL Pen Needles 31G X 1/4" SHORTQL Pen Needles 31G X 3/16"QL Pen Needles 31G X 5MMQL Pen Needles 31G X 6MMQL Pen Needles 31GX5/16"QL Pen Needles 31GX8MMQL Pen Needles 32GX4MMQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Pentips 31GX5MMQL Pentips 31GX8MMQL Pentips 32GX4MMQL Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16"QL Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2"QL Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2"QL Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8"QL Precision Sure-dose Insulin Syringe/1ML/28G X 1/2"QL Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2"QL Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2"QL Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2"QL Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2"QL Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16"QL Preferred Plus Unifine Pentips 29G X 12MMQL Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORTQL Preferred Plus Unifine Pentips 31G X 8MM SHORTQL Preferred Plus Unifine Pentips 32GX4MMQL Preferred Plus Unifine Pentips/Mini/31GX5MMQL Prodigy Insulin Mini Pen Needles/31G X 3/16"QL Prodigy Insulin Pen Needles/29G X 1/2"QL Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16"QL Prodigy Insulin Syringe/1/2ML/31G X 5/16"QL Prodigy Insulin Syringe/1ML/28G X 1/2"QL Prodigy Insulin SHORT Penneedles/31G X 5/16"QL Prodigy Lancing Device Pss Select Platforms Px Advanced Lancing Device Px Extra SHORT Pen Needles 31GX6MMQL Px Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Px Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Px Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Px Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Px Insulin Syringe/U-100/1ML/30G X 1/2"QL Px Insulin Syringe/U-100/1ML/31G X 5/16"QL Px Lancet Auto Injector Px Mini Pen Needles 31GX5MMQL Px Pen Needle 29GX12MMQL Px Pen Needle 31GX8MMQL Px Shortlength Pen Needles/31GX8MMQL PC Unifine Pentips 29G X 1/2"QL PC Unifine Pentips 31G X 5MM MiniQL PC Unifine Pentips 31G X 6MM Ultra SHORTQL PC Unifine Pentips 31G X 8MM SHORTQL Qc Advanced Lancing Device Qc Insulin Syringe 0.5ML/29GQL Qc Insulin Syringe 0.5ML/30GQL Qc Insulin Syringe 1ML/29GQL Qc Insulin Syringe/0.3ML/29GQL Qc Insulin Syringe/0.3ML/29G X 1/2"QL Qc Insulin Syringe/0.5ML/29G X 1/2"QL Qc Insulin Syringe/0.5ML/31G X 5/16"QL Qc Insulin Syringe/1ML/29G X 1/2"QL Qc Insulin Syringe/1ML/30GQL Qc Insulin Syringe/1ML/31G X 5/16"QL Qc Pen Needles 29G X 12MMQL Qc Pen Needles 31G X 6MMQL Qc Pen Needles 31G X 8MMQL Qc Unifine Pentips 32GX4MMQL Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Ra Insulin Syringe/U-100/1 ML/30G X 5/16"QL Ra Insulin Syringe/0.5ML/29G X 1/2"QL Ra Insulin Syringe/1ML/29G X 1/2"QL Ra Lancing Device

Ra Pen Needles 31G X 5MM 3/16"QL Ra Pen Needles 31G X 8MM 5/16"QL Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Reality Insulin Syringe/U-100/1ML/28G X 1/2"QL Reality Insulin Syringe/U-100/1ML/29G X 1/2"QL Relion Insulin Syringe/U -100/0.5ML/29GQL Relion Insulin Syringe/U-00/1ML/29G X 1/2"QL Relion Insulin Syringe/U-100/0.3ML/29GQL Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Relion Insulin Syringe/U-100/0.3ML/30GQL Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Relion Insulin Syringe/U-100/0.5ML/30GQL Relion Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Relion Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Relion Insulin Syringe/U-100/1ML/30GQL Relion Insulin Syringe/U-100/1ML/30G X 5/16"QL Relion Insulin Syringe/U-100/1ML/31G X 5/16"QL Relion Lancing Device Relion Mini Pen Needles 31GX6MMQL Relion Pen Needles 29GX12MMQL Relion Pen Needles 31GX8MMQL Relion Pen Needles 32GX4MMQL Relion SHORT Pen Needles 31GX8MMQL Relion 2-IN-1 Lancing Device 25G Relion 2-IN-1 Lancing Device 30G Renew Advanced Lancing Device Rightest GD-L500 Alternate Site Adapter Rightest GD500 Lancing Device Safesnap Insulin Syringe/0.3ML/30G X 5/16"QL Safesnap Insulin Syringe/0.5ML/29G X 1/2"QL Safesnap Insulin Syringe/0.5ML/30G X 5/16"QL Safesnap Insulin Syringe/1ML/28G X 1/2"QL Safesnap Insulin Syringe/1ML/29G X 1/2"QL Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2"QL Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X 5/16"QL Select-lite Device/Lancets Select-lite Lancing Device Shopko Autolet Lancing Device Shopko Unifine Pentips Pen Needles/Micro/32GX4MMQL Shopko Unifine Pentips Pen Needles/Mini/31GX5MMQL Shopko Unifine Pentips Pen Needles/Original/29GX12MMQL Shopko Unifine Pentips Pen Needles/SHORT/31GX8MMQL Simple Diagnostics Lancing Device Sm Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Sm Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Sm Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Sm Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Sm Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Sm Insulin Syringe/U-100/1ML/28G X 1/2"QL Sm Insulin Syringe/U-100/1ML/29G X 1/2"QL Sm Insulin Syringe/U-100/1ML/30G X 5/16"QL Sm Insulin Syringe/0.3ML/31G X 5/16"QL Sm Insulin Syringe/0.5ML/31G X 5/16"QL Sm Insulin Syringe/1ML/31G X 5/16"QL Smart Diabetes Vantage Lancing Device Solus V2 Lancing Device Sterilance PA Supreme II Confidence Paddles Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16QL Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16QL Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL Sure Comfort Lancing Pen Sure Comfort Pen Needles 29GX1/2" 12.7MMQL Sure Comfort Pen Needles 30GX5/16" SHORTQL Sure Comfort Pen Needles 31GX3/16" (5MM)QL Sure Comfort Pen Needles 31GX5/16" (8MM)QL Sure Comfort Pen Needles 32GX5/32"QL Sure Comfort Pen Needles 32GX6MMQL Sure-fine Pen Needles 29GX1/2" 12.7MMQL Sure-fine Pen Needles 31GX3/16" 5MMQL Sure-fine Pen Needles 31GX5/16" 8MMQL Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2"QL Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2"QL Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16"QL Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16"QL Sure-pen SB Insulin Syringe/U-100/0.5ML/29G X 1/2"QL SB Insulin Syringe/U-100/0.5ML/30G X 5/16"QL SB Insulin Syringe/U-100/1ML/29G X 1/2"QL SB Insulin Syringe/U-100/1ML/30G X 5/16"QL SB Insulin Syringe/U-100/1ML/31G X 5/16"QL Techlite Pen Needles/31G X 5MMQL Techlite Pen Needles/31G X 6 MMQL Techlite Pen Needles/31G X 8MMQL Techlite Pen Needles/32G X 4MMQL Techlite Pen Needles/32G X 6MMQL Techlite Pen Needles/32G X 8MMQL Terumo Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Terumo Insulin Syringe/U-100/0.5ML/27G X 1/2"QL Terumo Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Terumo Insulin Syringe/U-100/1ML/28G X 1/2"QL Terumo Insulin Syringe/0.3ML/30G X 3/8"QL Terumo Insulin Syringe/0.5ML/29G X 1/2"QL Terumo Insulin Syringe/0.5ML/30G X 3/8"QL Terumo Insulin Syringe/1ML/27G X 1/2"QL Terumo Insulin Syringe/1ML/29G X 1/2"QL Terumo Insulin Syringe/1ML/30G X 3/8"QL Terumo Surguard Insulin Syringe/0.3ML/29G X 1/2"QL Terumo Surguard Insulin Syringe/0.5ML/28G X 1/2"QL Terumo Surguard Insulin Syringe/0.5ML/29G X 1/2"QL Terumo Surguard Insulin Syringe/1ML/28G X 1/2"QL Terumo Surguard Insulin Syringe/1ML/29G X 1/2"QL Tgt Advanced Lancing Device Tgt Lancing Device Thinpro Insulin Syringe/0.3ML/29G X 1/2"QL Thinpro Insulin Syringe/0.3ML/30G X 3/8"QL Thinpro Insulin Syringe/0.3ML/31G X 3/8"QL Thinpro Insulin Syringe/0.5ML/28G X 1/2"QL Thinpro Insulin Syringe/0.5ML/29G X 1/2"QL Thinpro Insulin Syringe/0.5ML/30G X 3/8"QL Thinpro Insulin Syringe/0.5ML/31G X 3/8"QL Thinpro Insulin Syringe/1ML/28G X 1/2"QL Thinpro Insulin Syringe/1ML/29G X 1/2"QL Thinpro Insulin Syringe/1ML/30G X 3/8"QL Thinpro Insulin Syringe/1ML/31G X 3/8"QL

Todays Health Advanced Lancing Device Todays Health Mini Pen Needles 31G X 1/4"QL Todays Health Original Pen Needles 29G X 1/2"QL Todays Health SHORT Pen Needles 31G X 5/16"QL Topcare Clickfine Universal Pen Eedles 31GX1/4"QL Topcare Clickfine Universal Pen Eedles 31GX5/16"QL Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"QL Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"QL Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"QL Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"QL Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16"QL Topco Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Topco Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Topco Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Topco Insulin Syringe/U-100/1ML/28G X 1/2"QL Topco Insulin Syringe/U-100/1ML/29G X 1/2"QL Tracer II 3 Volt Battery Truedraw Lancing Device Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Trueplus Insulin Syringe/U-100/1ML/28G X 1/2"QL Trueplus Insulin Syringe/U-100/1ML/29G X 1/2"QL Trueplus Insulin Syringe/U-100/1ML/30G X 5/16"QL Trueplus Insulin Syringe/U-100/1ML/31G X 5/16"QL Ulti-lance Automatic/ Clear Tip Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2"QL Ulticare Insulin Safety Syringe/1ML/29G X 1/2"QL Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16"QL Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16"QL Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16"QL Ulticare Insulin Syringe 1CC/28G U-100 1/2"QL Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16"QL Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16"QL Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2"QL Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2"QL Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Ulticare Insulin Syringe/U-100/1ML/29G X 1/2"QL Ulticare Insulin Syringe/U-100/1ML/30G X 1/2"QL Ulticare Insulin Syringe/U-100/1ML/30G X 5/16"QL Ulticare Insulin Syringe/U-100/1ML/31G X 5/16"QL Ulticare Insulin Syringe/0.3ML/29G X 1/2"QL Ulticare Insulin Syringe/0.3ML/30G X 1/2"QL Ulticare Insulin Syringe/0.3ML/30G X 5/16"QL Ulticare Insulin Syringe/0.5ML/28G X 1/2"QL Ulticare Insulin Syringe/0.5ML/29G X 1/2"QL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Ulticare Insulin Syringe/0.5ML/30G X 1/2"QL Ulticare Insulin Syringe/0.5ML/30G X 5/16"QL Ulticare Insulin Syringe/1ML/28G X 1/2"QL Ulticare Insulin Syringe/1ML/29G X 1/2"QL Ulticare Insulin Syringe/1ML/30G X 1/2"QL Ulticare Insulin Syringe/1ML/30G X 5/16"QL Ulticare Micro Pen Needles 31G X 8MMQL Ulticare Micro Pen Needles 32G X 4MMQL Ulticare Micro Pen Needles/31G X 8MMQL Ulticare Micro Pen Needles/32G X 4MMQL Ulticare Mini Pen Needles Ulti-fine IVQL Ulticare Mini Pen Needles 31GX6MMQL Ulticare Mini Pen Needles/31G X 6MMQL Ulticare Mini Pen Needles31GX6MMQL Ulticare Original Pen Needles Ulti-fineQL Ulticare Pen Needles/29G X 12.7MMQL Ulticare SHORT Pen Needles Ulti-fine IVQL Ulticare SHORT Pen Needles 31GX8MMQL Ulticare SHORT Pen Needles/31G X 8MMQL Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4"QL Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4"QL Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4"QL Ulticare U-100 Insulin Syringes/1ML/31G X 1/4"QL Ultiguard Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Ultiguard Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Ultiguard Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Ultiguard Insulin Syringe/U-100/1ML/29G X 1/2"QL Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16"QL Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16"QL Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16"QL Ultilet Pen Needle 32GX4MM/SHORTQL Ultilet SHORT Pen Needles 31GX5/16"QL Ultilet SHORT Pen Needles31GX3/16"QL Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Ultra Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16"QL Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/30GX5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/31GX5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/30GX5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/31GX5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/1ML/30GX5/16"QL Ultra-thin II Insulin Syringe SHORT/U100/1ML/31GX5/16"QL Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2"QL Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2"QL Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2"QL Ultra-thin II Mini Pen Neeedles/31GX3/16"QL Ultra-thin II Pen Needles 29GX1/2"QL Ultra-thin II Pen Needles/SHORT/31GX5/16"QL Ultralance Unifine Pentips Plus 29GX12MMQL Unifine Pentips Plus 31GX5MMQL

Unifine Pentips Plus 31GX6MMQL Unifine Pentips Plus 31GX8MMQL Unifine Pentips Plus 32GX4MMQL Unifine Pentips 29GX12MMQL Unifine Pentips 31G X 3/16"QL Unifine Pentips 31G X 6MMQL Unifine Pentips 31G X 8MMQL Unifine Pentips 31GX5MMQL Unifine Pentips 31GX6MMQL Unifine Pentips 31GX8MMQL Unifine Pentips 32GX4MMQL Unistik CZT Comfort Unistik CZT Normal Unistik 1 Unistik 2 Unistik 2 Comfort Unistik 2 Extra Unistik 2 Neonatal Unistik 2 Normal Unistik 2 Super Unistik 3 Unistik 3 Comfort Unistik 3 Extra Unistik 3 Neonatal Unistik 3 Normal Urin-tek V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL V-r Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2"QL Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"QL Value Health Insulin Syringe/U-100/1ML/29G X 1/2"QL Value Plus Lancing Device Valumark Pen Needles 29GX12MMQL Valumark Pen Needles 31G X 6MMQL Valumark Pen Needles 31G X 8MMQL Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"QL Vanishpoint Insulin Syringe/1ML/29G X 1/2"QL Vida Mia Autolet Lancing Device Vida Mia Unifine Pentips Mini 31GX6MMQL Vida Mia Unifine Pentips Original 29GX12MMQL Vida Mia Unifine Pentips 32GX4MMQL Vida Mia Unipfine Pentipsshort 31GX8MMQL Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"QL Wd Medic Insulin Syringe/0.3ML/29G X 1/2"QL Wd Medic Insulin Syringe/0.3ML/30G X 5/16"QL Wd Medic Insulin Syringe/0.5ML/29G X 1/2"QL Wd Medic Insulin Syringe/0.5ML/30G X 5/16"QL Wd Medic Insulin Syringe/1ML/29G X 1/2"QL Wd Medic Insulin Syringe/1ML/30G X 5/16"QL Wegmans Unifine Pentips Plus 32GX4MMQL Wegmans Unifine Pentips Plus/Mini/31GX5MMQL Wegmans Unifine Pentips Plus/SHORT/31GX8MMQL Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MMQL 1ST Tier Unifine Pentips /Mini/31GX5MMQL 1ST Tier Unifine Pentips Plus 31GX8MMQL 1ST Tier Unifine Pentips Plus 32GX4MMQL 1ST Tier Unifine Pentips Plus/Mini/31GX5MMQL 1ST Tier Unifine Pentips Plus/Original/29GX12MMQL 1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MMQL 1ST Tier Unifine Pentips 29GX12MMQL 1ST Tier Unifine Pentips 31GX6MMQL 1ST Tier Unifine Pentips 31GX8MMQL 1ST Tier Unifine Pentips 32GX4MMQL

MEDICAL DEVICES - MISC PREFERRED Aerochamber Mini Aerosol ChamberQL

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Aerochamber MVQL Aerochamber Plus Flow VUQL Aerochamber Plus Flow-VUQL Aerochamber Plus Flow-VU/Large MaskQL Aerochamber Plus Flow-VU/MaskQL Aerochamber Plus Flow-VU/Medium MaskQL Aerochamber Plus Flow-VU/Small MaskQL Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VUQL Aerochamber Z-stat Plus/FlowsignalQL Aerochamber Z-stat Plus/Large MaskQL Aerochamber Z-stat Plus/Medium MaskQL Aerochamber Z-stat Plus/Small MaskQL Aerochamber/FlowsignalQL Aerovent Plus Holding Chamber/CollapsibleQL Alcoh-glove Contoured Wipe Alcoh-wipe 12" X 12" Alcohol Pads Alcohol Prep Pads Alcohol Preps Alcohol Swabs Alcohol Swabstick Alcohol Wipes Arial ChamberQL BreatheriteQL Breatherite Collapsible Adult Spacer W/MaskQL Breatherite Collapsible Child Spacer W/MaskQL Breatherite Collapsible Infant Spacer W/MaskQL Breatherite Collapsible Small Child Spacer W/MaskQL Breatherite Collapsible Spacer W/ Neonate MaskQL Breatherite Rigid Spacer W/MaskQL Breatherite W/Large MaskQL Breatherite W/Medium MaskQL Breatherite W/Small MaskQL BD Swabs Single Use BD Swabs Single Use Butterfly Curity Alcohol Preps/Medium 2 Ply Curity Alcohol Swabs CVS Alcohol Prep Swabs CVS Alcohol Swabs CVS Prep Pads E-z SpacerQL E-z Spacer The Body Guards PackQL EasiventQL Easivent/Mask-largeQL Easivent/Mask-mediumQL Easivent/Mask-smallQL Easy Touch Alcohol Prep Pads/Medium Fifty50 Alcohol Prep Pads FlexichamberQL Flexichamber Adult Mask/Small Flexichamber Child Mask/Large Flexichamber Child Mask/Small Global Alcohol Prep Ease Pads Gnp Alcohol Swabs Healthwise Alcohol Prep Pads Inspirachamber/Anti-static Valved/MouthpieceQL Inspirachamber/LargeQL Inspirachamber/Soothermask/Inspiramask/MediumQL Inspirachamber/Soothermask/Inspiramask/SmallQL Inspirease Bags Inspirease Drug Delivery SystemQL Inspirease Mouthpiece Inspirease Reservoir Bags LiteaireQL Mask Vortex/Baby Whirl Duckling Mask Vortex/Child/Frog Mask Vortex/Spinner The Duck Mask Vortex/Toddler/Lady Bug Meijer Alcohol Swabs Extra-thick MicrochamberQL

MicrospacerQL Nessi Spacer/Large MaskQL Nessi Spacer/MouthpieceQL Nessi Spacer/Small/MED MaskQL Optichamber AdvantageQL Optichamber DiamondQL Optichamber Diamond/Largeface MaskQL Optichamber Diamond/Medium Face MaskQL Optichamber Diamond/Smallface MaskQL OptihalerQL Optihaler MDI Drug Delivery SystemQL Panda Mask Large Panda Mask Medium Panda Mask Small Pediatric Panda Mask Pharmacist Choice Alcoholprep Pads Pocket ChamberQL Pocket SpacerQL Qc Alcohol Swabs Ra Alcohol Swabs Reality Swabs Relion Alcohol Swabs RitefloQL Saps Care Alcohol Prep Pads Shopko Alcohol Swabs Sm Alcohol Prep Pads Sure Comfort Alcohol Prep Pads Sure-prep Alcohol Prep Pads SB Alcohol Prep Pads Tgt Alcohol Swabs Valved Holding ChamberQL Vortex Valved Holding ChamberQL WatchhalerQL Webcol Alcohol Prep Large 1 Ply Webcol Alcohol Prep Large 2 Ply Webcol Alcohol Prep Medium 2 Ply

MISCELLANEOUS GENERIC acetylcysteine adenosine alprostadil aminorelief rms aminosyn II 8.5%/electrolytes aminosyn 8.5%/electrolytes argyle sterile water 100ML calcium chloride calcium gluconate chloromag clinisol SF 15% cosyntropin cysteine HCL deferoxamine mesylate dehydrated alcohol delflex-lm/1.5% dextrose dextrose 10% dextrose 10% flex container dextrose 2.5%/sodium chloride 0.45% dextrose 2.5%/NACL 0.45% dextrose 30% partial fill dextrose 5% dextrose 5% viaflex dextrose 5%/lactated ringers dextrose 5%/potassium chloride 0.15% dextrose 5%/ringers dextrose 5%/sodium chloride 0.2% dextrose 5%/sodium chloride 0.33% dextrose 5%/sodium chloride 0.45%

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

dextrose 5%/sodium chloride 0.9% dextrose 5%/NACL 0.2% dextrose 5%/NACL 0.33% dextrose 5%/NACL 0.45% dextrose 5%/NACL 0.9% dextrose 50% dextrose 70% dipyridamole effer-k effervescent pot chloride effervescent potassium effervescent potassium/chloride flumazenil fomepizole formadon formaldehyde indigo carmine indocyanine green intralipid isolyte-m/dextrose 5% isosulfan blue k-effervescent k-prime k-sol k-vescent kendall sodium chloride flush kionex klor-CON klor-CON m10 klor-CON m20 klor-CON sprinkle klor-CON 10 klor-CON 8 klor-CON/EF l-cysteine HCL lactated ringers lactated ringers dextrose 5% viaflex lactated ringers irrigation lactated ringers viaflex lanolin liposyn iii magnesium chloride magnesium sulfate methylene blue monoject pharma grade flush syringe monoject sodium chloride flush morrhuate sodium multitrace-4 concentrate multitrace-5 concentrate n-acetyl-l-cysteine naloxone HCL naltrexone HCL normal saline flush normal saline flush for flushing vascular access devices normal saline i.v. flush nutrilipid nutrilyte nutrilyte II phospha 250 neutral physiolyte physiosol irrigation plenamine potassium acetate potassium chloride potassium chloride CR potassium chloride ER potassium chloride SR potassium chloride 0.15% /NACL 0.45% viaflex potassium chloride 0.15% w/NACL 0.9% viaflex potassium chloride 0.15% D5W/NACL 0.33%

potassium chloride 0.15% D5W/NACL 0.45% potassium chloride 0.15% D5W/NACL 0.45% viaflex potassium chloride 0.15% NACL 0.9% potassium chloride 0.15%/D5W potassium chloride 0.15%/NACL 0.9% potassium chloride 0.22% D5W/NACL 0.45% potassium chloride 0.224%/D5W/NACL 0.45% potassium chloride 0.224%D5W/NACL 0.45% viaflex potassium chloride 0.3%/ NACL 0.9% potassium chloride 0.3%/D5W potassium chloride 0.3%/NACL 0.9%/viaflex potassium phosphate potassium phosphates premasol ringers injection ringers irrigation saline flush saline flush zr/sterile field sodium acetate sodium bicarbonate sodium bicarbonate partial fill sodium chloride sodium chloride bacteriostatic sodium chloride flush sodium chloride pab sodium chloride 0.45% sodium chloride 0.45% viaflex sodium phosphate sodium polystyrene sulfonate sodium thiosulfate sps sterile diluent for epoprostenol sodium sterile water for injection sterile water irrigation sterile water irrigation plastic bottle sterile water irrigation w/hanger swabflush saline flush tis-u-sol tpn electrolytes virt-phos 250 neutral AV-phos 250 neutral BD posiflush Delflex-lm/2.5% Dextrose Delflex-lm/4.25% Dextrose Delflex-sm/1.5% Dextrose Delflex-sm/2.5% Dextrose KCL 0.075%/D5W/NACL 0.45% KCL 0.15%/D5W/ NACL 0.3% KCL 0.15%/D5W/NACL 0.2% KCL 0.15%/D5W/NACL 0.45% KCL 0.15%/D5W/NACL 0.9% KCL 0.3%/D5W/NACL 0.45% MD-gastroview Naloxone HCL Potassium Chloride ER PREVENTIVE fluor-a-day fluoride fluoritab flura-drops karidium ludent nafrinse nafrinse drops sodium fluoride PREFERRED Chemet Chemstrip-k Cuprimine Fluor-a-day

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

Hyperrab S/D K-phos NON PREFERRED Acetest Chek-stix Combo PAK Urinalysis Control Chek-stix Control Depen Titratabs Effer-k Isolyte-s Ketocare Ketone Test Strips Ketostix Klor-CON M15 Narcan Plasma-lyte A Plasma-lyte-148 Plasma-lyte-56/D5W Relion Ketone Relion Ketone Test Strips Veltassa SPECIALTY Adagen BenlystaPA BivigamPA Carimune NanofilteredPA CytogamPA ExjadePA FerriproxPA Flebogamma DifPA Gamastan S/DPA Gammagard LiquidPA Gammagard S/DPA Gammagard S/D Iga Less Than 1mcg/MLPA GammakedPA GammaplexPA Gamunex-cPA Hepagam B HizentraPA Hyperhep B S/D Hyperrho S/D Hyperrho S/D Mini-dose JadenuPA Micrhogam Ultra-filtered Plus Nabi-HB OctagamPA PrivigenPA Rhogam Ultra-filtered Plus Rhophylac SynagisPA Syprine ThyrogenQL,PA Vivitrol Winrho SDF XiaflexPA

ACA PREVENTIVE DRUGS ASPIRIN PREVENTIVE adult aspirin EC low strength aspir-low aspir-81 aspirin aspirin adult low dose aspirin adult low strength aspirin childrens aspirin enteric coated adult low strength aspirin low dose aspirin low strength aspirin EC

aspirin EC low dose aspirin 81 aspirin 81 low dose aspirtab bayer advanced aspirin regular strength bayer aspirin bayer aspirin regimen bayer aspirin EC low dose bayer chewable low dose bayer low dose childrens aspirin childrens aspirin low strength coated aspirin ecotrin ecotrin low strength ecpirin enteric coated aspirin eq adult aspirin low strength eq aspirin eq aspirin adult low dose eq aspirin low dose eq aspirin EC eq childrens aspirin eql adult aspirin low strength eql aspirin eql aspirin low dose eql aspirin EC eql childrens aspirin gnp adult aspirin low strength gnp aspirin gnp aspirin low dose goodsense aspirin low dose kls aspirin low dose kls aspirin EC kp aspirin meijer aspirin EC miniprin low dose norwich aspirin px aspirin px enteric aspirin qc aspirin qc aspirin low dose qc childrens aspirin ra aspirin ra aspirin adult low dose ra aspirin adult low strength ra aspirin childrens ra aspirin EC ra aspirin EC adult low strength ra childrens aspirin sm aspirin sm aspirin adult low strength sm aspirin enteric coated sm aspirin EC low strength sm childrens aspirin st joseph aspirin st joseph low dose aspirin tgt aspirin tgt aspirin low dose tgt childrens aspirin tgt enteric-coated aspirin th aspirin th aspirin low dose th enteric aspirin CVS aspirin CVS aspirin adult low dose CVS aspirin adult low strength CVS aspirin child CVS aspirin low dose CVS aspirin low strength

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

CVS aspirin EC CVS childrens aspirin CVS enteric aspirin EC-81 aspirin HM aspirin HM aspirin EC HM aspirin EC low dose MM aspirin SB aspirin SB aspirin EC SB childrens aspirin SB low dose asa EC PREVENTIVE Aspirin Low Dose

CONTRACEPTIVES PREVENTIVE aftera altavera alyacen 1/35 alyacen 7/7/7 amethiaQL amethia LOQL amethyst apri aranelle ashlynaQL aubra aviane azurette balziva bekyree blisovi FE 1.5/30 blisovi FE 1/20 blisovi 24 FE briellyn camila camreseQL camrese LOQL caziant chateal cryselle-28 cyclafem 1/35 cyclafem 7/7/7 cyred dasetta 1/35 dasetta 7/7/7 dayseeQL deblitane delyla desogestrel/ethinyl estradiol drospirenone/ethinyl estradiol econtra EZ elinest emoquette enpresse-28 enskyce errin estarylla fallback solo falmina gianvi gildagia gildess FE 1.5/30 gildess FE 1/20 gildess 1.5/30 gildess 1/20 gildess 24 FE heather

introvaleQL jencycla jolessaQL jolivette juleber junel FE 1.5/30 junel FE 1/20 junel FE 24 junel 1.5/30 junel 1/20 kaitlib FE kariva kelnor 1/35 kimidess kurvelo larin FE 1.5/30 larin FE 1/20 larin 1.5/30 larin 1/20 larin 24 FE layolis FE leena lessina levonest levonorgestrel levonorgestrel and ethinyl estradiolQL levonorgestrel/ethinyl estradiol levora 0.15/30-28 lomedia 24 FE loryna low-ogestrel lutera lyza marlissa medroxyprogesterone acetateQL microgestin FE microgestin FE 1.5/30 microgestin 1.5/30 microgestin 1/20 microgestin 24 FE mono-linyah mononessa my way myzilra necon 0.5/35-28 necon 1/35 necon 7/7/7 next choice one dose nikki nora-be norethindrone norethindrone & ethinyl estradiol ferrous fumarate norethindrone acetate/ethinyl estradiol norethindrone acetate/ethinyl estradiol/ferrous fumarate norgestimate/ethinyl estradiol norlyroc nortrel 0.5/35 (28) nortrel 1/35 nortrel 7/7/7 ocella opcicon one-step orsythia philith pimtrea pirmella 1/35 pirmella 7/7/7 portia-28 previfem quasenseQL reclipsen

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

setlakinQL sharobel sprintec 28 sronyx syeda take action tarina FE 1/20 tilia FE tri-estarylla tri-legest FE tri-linyah tri-previfem tri-sprintec tri-LO-estarylla tri-LO-marzia tri-LO-sprintec trinessa trinessa LO trivora-28 vcf vagin*l contraceptivegel velivet vestura vienva viorele vyfemla wera wymzya FE zarah zenchent zenchent FE zovia 1/35e Levonorgestrel Ogestrel Xulane PREFERRED LO Loestrin FE Minastrin 24 FE PREVENTIVE Natazia NuvaringQL NON PREFERRED Depo-subq Provera 104QL PREVENTIVE Caya Encare Fc Female Condom Fc2 Female Condom Femcap Omniflex Diaphragm Options Gynol II vagin*l Contraceptive Ortho Diaphragm Coil Spring Kit 100 Ortho Diaphragm Coil Spring Kit 105 Ortho Diaphragm Coil Spring Kit 50 Ortho Diaphragm Flat Spring Kit 55 Ortho Diaphragm Flat Spring Kit 60 Ortho Diaphragm Flat Spring Kit 65 Ortho Diaphragm Flat Spring Kit 70 Ortho Diaphragm Flat Spring Kit 75 Ortho Diaphragm Flat Spring Kit 80 Ortho Diaphragm Flat Spring Kit 85 Ortho Diaphragm Flat Spring Kit 90 Ortho Diaphragm Flat Spring Kit 95 Prentif Cavity-rim Cervical CAP Prentif Fitting Set Shur-seal Vcf vagin*l Contraceptive Film Vcf vagin*l Contraceptive Foam Wide-seal Silicone Diaphragm Kit 60 Wide-seal Silicone Diaphragm Kit 65 Wide-seal Silicone Diaphragm Kit 70

Wide-seal Silicone Diaphragm Kit 75 Wide-seal Silicone Diaphragm Kit 80 Wide-seal Silicone Diaphragm Kit 85 Wide-seal Silicone Diaphragm Kit 90 Wide-seal Silicone Diaphragm Kit 95 PREVENTIVE Implanon Liletta Mirena Nexplanon Skyla

FLUORIDE PREVENTIVE fluor-a-day fluoride fluoritab flura-drops karidium ludent nafrinse nafrinse drops sodium fluoride PREFERRED Fluor-a-day

FOLIC ACID GENERIC M-vit Prenaplus Prenatal Plus Tricare PREVENTIVE eql folic acid fa-8 folic acid gnp folic acid kp folic acid px folic acid ra folic acid sm folic acid sm prenatal vitamins th folic acid yl folic acid Classic Prenatal CVS folic acid Eql Prenatal Formula Gnp Prenatal Vitamins HM folic acid Mission Prenatal HP Multi Prenatal Perry Prenatal Pre-natal Formula Prenatal Prenatal And Iron Prenatal Formula Prenatal Forte Prenatal Low Iron Prenatal Vitamins Px Prenatal Multivitamins Ra Prenatal Sm Prenatal Vitamins PREVENTIVE Atabex Prenatal CVS Prenatal Fa-8 Gnp Daily Prenatal Gnp Prenatal Goodsense Prenatal Vitamins

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

HM One Daily Prenatal Combo HM Prenatal Kp Prenatal Multivitamins Mission Prenatal Nat-rul Prenatal Vitamins One-a-day Womens Prenatal Prenatal Complete Prenatal Multi +dha Prenatal One Daily Prenatal Vitamin PA Prenatal Formula Qc Prenatal Ra One Daily Ra Prenatal Formula/Folicacid Right Step Prenatal Sm One Daily Prenatal Stuart Prenatal Th Prenatal Vitamins

Fluzone Quadrivalent 2014-2015 Fluzone Quadrivalent 2015-2016 Fluzone Split 2013-2014 Fluzone Split 2014-2015 Fluzone Split 2015-2016 Gardasil Gardasil 9 Havrix Hiberix Infanrix Ipol Inactivated IPV Kinrix M-m-r II Medical Provider EZ Flu Shot PF 2013-2014 Medical Provider EZ Flu Shot PF 2014-2015 Medical Provider EZ Flu Shot 2013-2014 Medical Provider EZ Flu Shot 2014-2015 Medical Provider EZ Flu Shot 2015-2016 Medical Provider Single Use EZ Flu Shot Menactra Menomune-a/C/Y/W-135 Menveo Pediarix Pedvax HIB Pentacel Pneumovax 23 Pneumovax 23/1 Dose Pneumovax 23/5 Dose Prevnar 13 Proquad Quadracel Recombivax HB Rotarix Rotateq Tenivac Tetanus/Diphtheria Toxoids-adsorbed Tetanus/Diphtheria Toxoids-adsorbed Adult Trumenba Twinrix Vaqta Varivax Zostavax

IMMUNIZATIONS PREVENTIVE Acthib Adacel Afluria PF 2012-2013 Afluria PF 2013-2014 Afluria PF 2014-2015 Afluria PF 2015-2016 Afluria 2012-2013 Afluria 2013-2014 Afluria 2014-2015 Afluria 2015-2016 Bexsero Boostrix Cervarix Comvax Daptacel Diphtheria/Tetanus Toxoids Adsorbed Pediatric Engerix-b Fluarix Quadrivalent 2013-2014 Fluarix Quadrivalent 2014-2015 Fluarix Quadrivalent 2015-2016 Fluarix 2013-2014 Fluarix 2014-2015 Flublok 2013-2014 Flublok 2014-2015 Flublok 2015-2016 Flucelvax 2013-2014 Flucelvax 2014-2015 Flucelvax 2015-2016 Flulaval Quadrivalent 2013-2014 Flulaval Quadrivalent 2014-2015 Flulaval Quadrivalent 2015-2016 Flulaval 2013-2014 Flulaval 2014-2015 Flumist Quadrivalent Fluvirin PF 2013-2014 Fluvirin PF 2014-2015 Fluvirin 2013-2014 Fluvirin 2014-2015 Fluvirin 2015-2016 Fluzone High-dose PF 2013-2014 Fluzone High-dose PF 2014-2015 Fluzone High-dose PF 2015-2016 Fluzone Intradermal Fluzone Intradermal Quadrivalent 2015-2016 Fluzone Pediatric PF 2013-2014 Fluzone PF 2013-2014 Fluzone PF 2014-2015 Fluzone Quadrivalent 2013-2014

IRON PREVENTIVE bprotected pedia iron eq slow-release iron eql iron supplement therapy eql slow release iron ezfe 200 feosol fer-iron ferate fergon ferosul ferrex 150 ferric x-150 ferro-bob ferrotabs ferrous drops ferrous gluconate ferrous sulfate ferrousul gnp iron gnp slow release iron high potency iron iferex 150 iron iron slow release

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

iron supplement iron supplement childrens kp ferrous gluconate kp ferrous sulfate meijer ferrous sulfate myferon 150 nu-iron 150 poly-iron 150 px iron qc ferrous sulfate ra high potency iron ra iron ra slow release iron slow iron slow release iron slow FE slow-release iron sm iron sm iron slow release sm slow release iron th iron th slow release iron wee care CVS iron Ferretts FE gluconate FE TABS HM iron HM iron slow release HM slow release iron PREVENTIVE CVS Slow Release Iron Elite Iron Femiron Feosol Ferretts IPS Ferrimin 150 Ferro-sequels Ferrous Fumarate Ferrous Gluconate Ferrous Sulfate FE Aspartate High Potency Iron Iron Iron Chews Pediatric Iron Up Mykidz Iron 10 Novaferrum Pediatric Drops Perfect Iron Profe Proferrin ES Slow Release Iron Sm Slow Release Iron

SMOKING CESSATION PREVENTIVE buprobanQL bupropion HCL SRQL eq nicotineQL eq nicotine gum refillQL eq nicotine gum starterQL eq nicotine polacrilexQL eq nicotine step 3QL eql nicotineQL eql nicotine polacrilexQL eql nicotine polacrilex refillQL eql nicotine polacrilex starterQL gnp nicotine mini lozengeQL gnp nicotine polacrilexQL

gnp nicotine polacrilex miniQL goodsense nicotine gumQL kls quit2QL kls quit4QL nicoreliefQL nicotineQL nicotine mini lozengeQL nicotine polacrilexQL nicotine polacrilex refillQL nicotine polacrilex starter kitQL nicotine step 1QL nicotine step 2QL nicotine step 3QL nicotine transdermal systemQL nicotine transdermal system step 1QL nicotine transdermal system step 2QL nicotine transdermal system step 3QL px stop smoking aidQL qc nicotine polacrilexQL ra mini nicotineQL ra nicotineQL ra nicotine polacrilexQL ra nicotine transdermal system step 3QL sm nicotineQL sm nicotine polacrilexQL sm nicotine transdermal systemQL sw nicotine polacrilexQL tgt nicotine gumQL tgt nicotine polacrilexQL tgt nicotine step oneQL tgt nicotine step threeQL tgt nicotine step twoQL thriveQL CVS nicotineQL CVS nicotine lozengeQL CVS nicotine polacrilexQL CVS nicotine polacrilex starterQL CVS nicotine transdermal systemQL CVS nts step 1QL HM nicotine polacrilexQL HM nicotine transdermal systemQL HM nicotine transdermal system step 3QL SR nicotine gumQL PREVENTIVE ChantixQL Chantix Continuing Month PAKQL Chantix Starting Month PAKQL Nicotine Transdermal SystemQL PREVENTIVE Nicotrol InhalerQL Nicotrol NsQL

VITAMIN D PREVENTIVE aqueous vitamin d infants bio-d-mulsion bio-d-mulsion forte bprotected pedia d-vite d 1000 d 10000 d 2000 d 400 d 5000 d-vita d-1000 d-1000 extra strength d-2000 maximum strength d-3-5 d-400

Effective July 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits;

d-5000 d-5000 maximum strength decara delta d3 dialyvite vitamin d 5000 dialyvite vitamin d3 max d2000 ultra strength d3 d3 adult d3 adult gummy d3 high potency d3 kids d3 maximum strength d3 super strength d3 ultra strength d3 2000 d3-1000 d3-50 eql childrens vitamin d gummies eql vitamin d-3 eql vitamin d3 gnp vitamin d gnp vitamin d maximum strength gnp vitamin d super strength gnp vitamin d3 extra strength healthy kids vitamin d3 just d kp vitamin d maximum d3 nat-rul vitamin d natural vitamin d-3 optimal-d optimal-d pack opurity vitamin d pronutrients vitamin d3 ra vitamin d-3 sm vitamin d sm vitamin d3 th vitamin d3 thera-d rapid repletion thera-d sport thera-d 2000 vitajoy daily d gummies vitamin d vitamin d high potency vitamin d 400 vitamin d-1000 vitamin d-1000 maximum strength vitamin d-3 vitamin d-400 vitamin d3 vitamin d3 adult gummies vitamin d3 high potency vitamin d3 maximum strength vitamin d3 super strength vitamin d3 400 CVS d3 CVS vitamin d CVS vitamin d 5000 high-potency CVS vitamin d3 HM vitamin d HM vitamin d3 PA vitamin d-3 PA vitamin d-3 gummy PREVENTIVE Baby Super Daily D3 Ddrops Decara D3 Dots HM Vitamin D3

Optimal D3 M Replesta Replesta Childrens Replesta Nx Sm Vitamin D3 Maximum Strength Super Daily D3 Thera-d 4000 Vitamelts Vitamin D Vitamin D3 Wellesse Vitamin D3

BOWEL PREPARATION AGENTS PREVENTIVE gavilyte-c gavilyte-n/flavor pack gavilyte-G peg 3350/electrolytes peg-3350/electrolytes peg-3350/NACL/NA bicarbonate/KCL trilyte

BREAST CANCER ORAL CHEMO tamoxifen citrate

Index Acti-lance Lancets 28G, 28 Acti-lance Lite Safety Lancets 28G, 28 A-hydrocort, 10 Acti-lance Special Safety Lancets 17G, abacavir, 2 28 abacavir sulfate/lamivudine/zidovudine, 2 Acti-lance Special Safetylancets 17G, 28 Abelcet, 2 Acti-lance Universal Safety Lancets 23G, Abilify, 19 28 Abilify Discmelt, 19 Actimmune, 5 Abilify Maintena, 19 Active 1ST Blood Lancets 30G/Easy Abraxane, 4 Twist CAP, 28 acamprosate calcium DR, 20 Actoplus Met XR, 12 acarbose, 12 Acuvail, 22 Accu-chek Active Glucose Control acyclovir, 2, 8 Solution, 32 acyclovir sodium, 2 Accu-chek Active Strips, 32 Adacel, 26, 45 Accu-chek Aviva, 32 Adagen, 42 Accu-chek Aviva Plus, 32 Adcetris, 4 Accu-chek Comfort Curve Control Adcirca, 7 Solution (2 Levels), 32 adefovir dipivoxil, 2 Accu-chek Comfort Curve Linearity Adempas, 7 Solution, 32 adenosine, 6, 40 Accu-chek Comfort Curve Test Strips, 32 Adjustable Lancing Device, 32 Accu-chek Compact Blue Control adriamycin, 3 Solution (2 Levels), 32 Adriamycin, 3 Accu-chek Compact Plus, 32 adrucil, 4 Accu-chek Compact Plus Care Kit, 32 adult aspirin EC low strength, 22, 42 Accu-chek Compact Plus Clear Control Advate, 17 Solution (2 Levels), 32 Advocate Insulin Pen Needles Accu-chek Compact Test Drum, 32 29GX12.7MM, 32 Accu-chek Fastclix Lancetdevice Kit, 32 Advocate Insulin Pen Needles Accu-chek Fastclix Lancets, 28 31GX5MM, 32 Accu-chek Instant Glucosecontrol Advocate Insulin Pen Needles Solution (2 Levels), 32 31GX8MM, 32 Accu-chek Multiclix Lanc Et Device Kit, Advocate Insulin Syringe/U32 100/0.3ML/29GX1/2", 32 Accu-chek Multiclix Lancets, 28 Advocate Insulin Syringe/UAccu-chek Nano Smartview, 32 100/0.3ML/30GX5/16", 32 Accu-chek Safe-t-pro Lancets, 28 Advocate Insulin Syringe/UAccu-chek Safe-t-pro Pluslancets, 28 100/0.3ML/31GX5/16", 32 Accu-chek Smartview Control, 32 Advocate Insulin Syringe/UAccu-chek Smartview Strips, 32 100/0.5ML/29GX1/2", 32 Accu-chek Soft Touch Lancets, 28 Advocate Insulin Syringe/UAccu-chek Softclix Lancetdevice, 32 100/0.5ML/30GX5/16", 32 Accu-chek Softclix Lancetdevice Kit, 32 Advocate Insulin Syringe/UAccu-chek Softclix Lancets, 28 100/0.5ML/31GX5/16", 32 Accu-chek Voicemate, 32 Advocate Insulin Syringe/Uacebutolol HCL, 6 100/1ML/29GX1/2", 32 acetaminophen/caffeine/dihydrocodeine, Advocate Insulin Syringe/U23 100/1ML/30GX5/16", 32 acetaminophen/codeine, 23 Advocate Insulin Syringe/Uacetaminophen/codeine #2, 23 100/1ML/31GX5/16", 32 acetaminophen/codeine #3, 23 Advocate Lancets, 28 acetaminophen/codeine #4, 23 Advocate Lancets 30G, 28 acetaminophen/codeine phosphate, 23 Advocate Lancing Device, 32 acetasol HC, 22 Advocate Rapid-safe Lancing Device, 32 acetazolamide, 7 Advocate Safety Lancets, 28 Acetazolamide, 7 Advocate Safety Lancets 26G, 28 acetazolamide ER, 7 Aerochamber Mini Aerosol Chamber, 39 acetazolamide sodium, 7 Aerochamber MV, 40 Acetest, 42 Aerochamber Plus Flow VU, 40 acetic acid, 22 Aerochamber Plus Flow-VU, 40 acetic acid 0.25%, 15 Aerochamber Plus Flow-VU/Large Mask, acetylcysteine, 25, 40 40 Aciphex Sprinkle, 14 Aerochamber Plus Flow-VU/Mask, 40 acitretin, 8 Aerochamber Plus Flow-VU/Medium Acthib, 26, 45

Mask, 40 Aerochamber Plus Flow-VU/Small Mask, 40 Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU, 40 Aerochamber Z-stat Plus/Flowsignal, 40 Aerochamber Z-stat Plus/Large Mask, 40 Aerochamber Z-stat Plus/Medium Mask, 40 Aerochamber Z-stat Plus/Small Mask, 40 Aerochamber/Flowsignal, 40 Aerovent Plus Holding Chamber/Collapsible, 40 AF Lancets Super Thin, 29 afeditab CR, 6 Afinitor, 5 Afinitor Disperz, 5 Afluria 2012-2013, 26, 45 Afluria 2013-2014, 26, 45 Afluria 2014-2015, 26, 45 Afluria 2015-2016, 26, 45 Afluria PF 2012-2013, 26, 45 Afluria PF 2013-2014, 26, 45 Afluria PF 2014-2015, 26, 45 Afluria PF 2015-2016, 26, 45 aftera, 10, 43 Agamatrix Ultra-thin Lancets 33G, 28 Aggrastat, 17 Aggrenox, 17 airavite, 16 ak-fluor, 22 ak-poly-bac, 21 Akynzeo, 14 ala cort, 9 alagesic LQ, 22 Albenza, 3 albuked 25, 17 albuked 5, 17 albumin human, 17 albumin-zlb, 17 albuminar-25, 17 albuminar-5, 17 alburx, 17 albutein, 17 albuterol, 25 albuterol sulfate, 25 albuterol sulfate ER, 25 albuterol TAB 4MG, 25 alclometasone dipropionate, 9 Alcoh-glove Contoured Wipe, 40 Alcoh-wipe 12" X 12", 40 Alcohol Pads, 40 Alcohol Prep Pads, 40 Alcohol Preps, 40 Alcohol Swabs, 40 Alcohol Swabstick, 40 Alcohol Wipes, 40 Aldurazyme, 13 alendronate sodium, 12 Alendronate Sodium, 12 alfentanil, 23 Alferon N, 5 alfuzosin HCL ER, 15 Alimta, 4 Alinia, 3

Alkeran, 3 allopurinol, 24 almotriptan malate, 24 Alocril, 22 Alogliptin, 12 Alogliptin/Metformin HCL, 12 Alogliptin/Pioglitazone, 12 Alomide, 22 alosetron hydrochloride, 14 Aloxi, 14 Alphagan P, 22 Alphanate/Von Willebrand Factor Complex/Human, 17 Alphanine SD, 17 alphatrex, 9 alprazolam, 18 alprazolam ER, 18 alprazolam odt, 18 alprazolam XR, 18 alprostadil, 40 Alrex, 21 Altabax, 8 altacaine, 22 altafluor, 22 altafrin, 22 altavera, 10, 43 Alternate Site Lancing Device, 32 alyacen 1/35, 10, 43 alyacen 7/7/7, 10, 43 amantadine HCL, 19 Ambisome, 2 Amcinonide, 9 amethia, 10, 43 amethia LO, 10, 43 amethyst, 10, 43 amifostine, 5 amikacin sulfate, 1 amiloride HCL, 7 amiloride/hydrochlorothiazide, 7 aminoacetic acid, 15 aminocaproic acid, 17 aminophylline, 25 aminorelief rms, 40 aminosyn 8.5%/electrolytes, 40 aminosyn II 8.5%/electrolytes, 40 amiodarone HCL, 6 Amitiza, 15 amitriptyline HCL, 18 amlodipine besylate, 6 amlodipine besylate/atorvastatin calcium, 7 amlodipine besylate/benazepril HCL, 6 amlodipine besylate/benazepril hydrochloride, 6 amlodipine besylate/valsartan, 6 amlodipine/valsartan/hctz, 6 ammonium lactate, 9 amnesteem, 8 Amoxapine, 18 amoxicillin, 1 amoxicillin/clavulanate potassium, 1 Amoxicillin/Clavulanate Potassium, 1 amoxicillin/clavulanate potassium ER, 1 amphetamine/dextroamphetamine, 19 Amphotec, 2 Amphotericin B, 2 ampicillin, 1 ampicillin sodium, 1

ampicillin-sulbactam, 1 Ampicillin-sulbactam, 1 Ampyra, 20 Amturnide, 7 ana-lex, 14 Anadrol-50, 10 anagrelide hydrochloride, 17 anastrozole, 4 Androgel, 10 Androgel P.M., 10 Androxy, 10 anodynz, 9 Anti-stick Insulin Syringe/U100/0.5ML/28G X 1/2", 32 Anti-stick Insulin Syringe/U100/0.5ML/29G X 1/2", 32 Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2", 32 antipyrine/benzocaine, 22 Anzemet, 14 Apexicon E, 9 Apidra, 12 Apidra Solostar, 12 Aplenzin, 18 Apokyn, 20 apraclonidine, 22 apri, 10, 43 Aptivus, 2 Aqua Lance Adjustable Lancing Device, 32 aqueous vitamin d infants, 26, 46 Aralast NP, 25 aranelle, 10, 43 Aranesp Albumin Free, 17 arbinoxa, 25 Arcalyst, 24 Arcapta Neohaler, 25 argatroban, 17 Argatroban, 17 argyle sterile saline 100ML, 15 argyle sterile water 100ML, 40 Arial Chamber, 40 aripiprazole, 18 Aripiprazole Odt, 19 Armour Thyroid, 13 Arranon, 4 Arzerra, 4 Asacol HD, 15 ascomp/codeine, 23 ascorbic acid, 26 ashlyna, 10, 43 Asmanex HFA, 25 Asmanex Twisthaler 120 Metered Doses, 25 Asmanex Twisthaler 14 Metered Doses, 25 Asmanex Twisthaler 30 Metered Doses, 25 Asmanex Twisthaler 60 Metered Doses, 25 Asmanex Twisthaler 7 Metered Doses, 25 aspir-81, 22, 42 aspir-low, 22, 42 aspirin, 22, 42 aspirin 81, 23, 42 aspirin 81 low dose, 23, 42 aspirin adult low dose, 23, 42

aspirin adult low strength, 23, 42 aspirin childrens, 23, 42 aspirin EC, 23, 42 aspirin EC low dose, 23, 42 aspirin enteric coated adult low strength, 23, 42 aspirin low dose, 23, 42 Aspirin Low Dose, 23, 43 aspirin low strength, 23, 42 Aspirin-caffeine-dihydrocodeine, 24 Aspirin/Dipyridamole, 17 aspirtab, 23, 42 Assure Comfort Lancets Ultra Thin 28G, 28 Assure Comfort Lancets Ultra Thin 30G, 28 Assure Haemolance Plus High Flow 18G, 28 Assure Haemolance Plus Low Flow 25G, 29 Assure Haemolance Plus Micro Flow 28G, 29 Assure Haemolance Plus Normal Flow 21G, 29 Assure Haemolance Plus Pediatric Blade, 29 Assure ID Insulin Safety Syringe/U100/0.5ML/29G X 1/2", 32 Assure ID Insulin Safety Syringe/U100/1ML/29G X 1/2", 32 Assure Lance Lancets, 29 Assure Lance Lancets 21G, 29 Assure Lance Plus Safety Lancets 25G, 29 Assure Lance Plus Safety Lancets 30G, 29 Assure Lancets, 29 AT Last Lancets, 29 Atabex Prenatal, 28, 44 atenolol, 6 atenolol/chlorthalidone, 6 Atgam, 4 atorvastatin calcium, 7 atovaquone, 3 atovaquone/proguanil HCL, 3 atracurium besylate, 20 Atripla, 2 Atropen, 14 atropine sulfate, 14, 21 atropine-care, 21 Atrovent HFA, 25 Aubagio, 20 aubra, 10, 43 augmented betamethasone dipropionate, 9 Augmentin, 1 aurodex, 22 Aurora Lancet Super Thin 30G, 29 Aurora Lancet Thin 23G, 29 Aurora Pen Needles 29GX12MM, 32 Aurora Pen Needles 31G X 6MM, 32 Aurora Pen Needles 31G X 8MM, 32 Aurora Unifine Pentips/32GX5/32", 32 Aurora Unifine Pentips/Mini/31GX3/16", 32 Auto-lancet, 32 Auto-lancet Mini, 32 Autolet II Clinisafe, 32

Autolet Impression, 32 Autolet Impression Lancing Device, 32 Autolet Lite Clinisafe, 32 Autolet Lite Starter Pack, 33 Autolet Mini, 33 Autolet Platforms, 33 Auvi-q, 7 AV-phos 250 neutral, 41 AV-vite fb, 16 avalin-RX, 9 Avandia, 12 avar cleanser, 8 avar-e emollient, 8 avar-e green, 8 Avastin, 4 Avc, 15 Avelox, 1 aviane, 10, 43 avidoxy, 1 Avonex, 20 Avonex Pen, 20 Axiron, 10 azacitidine, 4 Azactam IN Iso-osmotic Dextrose, 3 Azasan, 4 azathioprine, 4 Azathioprine, 4 azelastine HCL, 22, 25 Azelex, 8 Azilect, 20 azithromycin, 1 Azithromycin, 1 Azopt, 22 Azor, 7 aztreonam, 3 azuphen mb, 15 azurette, 10, 43

bayer advanced aspirin regular strength, 23, 42 bayer aspirin, 23, 42 bayer aspirin EC low dose, 23, 42 bayer aspirin regimen, 23, 42 bayer chewable low dose, 23, 42 bayer low dose, 23, 42 Bayer Microlet 2 Lancing Device, 33 Bayer Microlet Lancets, 29 Bcg Vaccine, 26 BD Autoshield 29G X 3/16", 29 BD Autoshield 29G X 5/16", 29 BD Autoshield Duo 30G X 3/16", 29 BD Insulin Syringe LUER-LOK/U100/1ML, 29 BD Insulin Syringe Microfine IV/U100/0.3ML/28G X 1/2", 29 BD Insulin Syringe Microfine IV/U100/0.5ML/28G X 1/2", 29 BD Insulin Syringe Microfine IV/U100/1ML/27G X 5/8", 29 BD Insulin Syringe Microfine IV/U100/1ML/28G X 1/2", 29 BD Insulin Syringe Microfine/U100/0.3ML/28G X 1/2", 29 BD Insulin Syringe Microfine/U100/0.5ML/28G X 1/2", 29 BD Insulin Syringe Microfine/U100/1ML/27G X 5/8", 29 BD Insulin Syringe Microfine/U100/1ML/28G X 1/2", 29 BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2", 29 BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 29 BD Insulin Syringe Safetyglide/U100/0.3ML/31G X 5/16", 29 BD Insulin Syringe Slip Tip/U-100/1ML, B 29 b-complex 100, 27 BD Insulin Syringe U-40/1ML/25G X 5/8", B-d Insulin Syringe Ultrafine II/0.3ML/31G 29 X 5/16", 29 BD Insulin Syringe Ultrafine HalfB-d Insulin Syringe Ultrafine II/0.5ML/31G unit/0.3ML/31G X 5/16", 29 X 5/16", 29 BD Insulin Syringe Ultrafine B-d Insulin Syringe Ultrafine II/1ML/31G X II/SHORT/0.5ML/31G X 5/16", 29 5/16", 29 BD Insulin Syringe Ultrafine B-d Insulin Syringe Ultrafine/0.3ML/30G X II/SHORT/1ML/31G X 5/16", 29 1/2", 29 BD Insulin Syringe Ultrafine/0.3ML/30G X B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 29 1/2", 29 BD Insulin Syringe Ultrafine/0.3ML/31G X B-d Insulin Syringe Ultrafine/1ML/30G X 5/16", 29 1/2", 29 BD Insulin Syringe Ultrafine/0.5ML/30G X b-plex, 27 1/2", 29 b-plex plus, 27 BD Insulin Syringe Ultrafine/0.5ML/31G X Baby Super Daily D3, 27, 47 5/16", 29 baciim, 3 BD Insulin Syringe Ultrafine/1ML/30G X bacitracin, 3 1/2", 29 Bacitracin, 21 BD Insulin Syringe Ultrafine/1ML/31G X bacitracin/polymyxin b, 21 5/16", 29 baclofen, 21 BD Insulin Syringe Ultrafine/UBactocill IN Dextrose, 1 100/0.3ML/29G X 1/2", 29 Bactroban Nasal, 25 BD Insulin Syringe Ultrafine/Ubalanced salt, 22 100/0.3ML/30G X 1/2", 29 balanced salt solution, 22 BD Insulin Syringe Ultrafine/Ubalsalazide disodium, 14 100/0.3ML/31G X 15/64", 29 balziva, 10, 43 BD Insulin Syringe Ultrafine/UBanzel, 19 100/0.3ML/31G X 5/16", 29 Baraclude, 2 BD Insulin Syringe Ultrafine/U-100/0. baycadron, 10

5ML/29G X 1/2", 29 BD Insulin Syringe Ultrafine/U100/0.5ML/30G X 1/2", 29 BD Insulin Syringe Ultrafine/U100/0.5ML/31G X 15/64", 29 BD Insulin Syringe Ultrafine/U100/0.5ML/31G X 5/16", 29 BD Insulin Syringe Ultrafine/U100/1ML/29G X 1/2", 29 BD Insulin Syringe Ultrafine/U100/1ML/30G X 1/2", 29 BD Insulin Syringe Ultrafine/U100/1ML/31G X 15/64", 29 BD Insulin Syringe Ultrafine/U100/1ML/31G X 5/16", 29 BD Insulin Syringe/Detachable Needle/U100/1ML/25G X 1", 29 BD Insulin Syringe/Detachable Needle/U100/1ML/25G X 5/8", 29 BD Insulin Syringe/Detachable Needle/U100/1ML/26G X 1/2", 29 BD Insulin Syringe/U-100/0.5ML/30G X 1/2", 29 BD Insulin Syringe/U-100/1ML/27G X 1/2", 29 BD Insulin Syringe/U-100/1ML/28G X 1/2", 29 BD Insulin Syringe/U-100/2ML/27.5G X 5/8", 29 BD Insulin Syringe/U-100/2ML/29G X 1/2", 29 BD Integra Insulin Syringe/U100/1ML/29G X 1/2", 29 BD Integra Syringe/Retracting Needle/1ML/25G X 1", 29 BD Lancet Device, 33 BD Lancet Ultrafine 30G, 29 BD Lancet Ultrafine 33G, 29 BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 29 BD Microtainer Lancets, 29 BD Pen Needle/Mini/Ultrafine/31G X 3/16", 29 BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 29 BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 29 BD Pen Needle/Ultrafine/29G X 12.7MM, 29 BD Pen Needle/Ultrafine/29GX1/2" 12.7MM, 29 BD Pen Needles SHORT/Ultrafine/31G X 5/16", 29 BD posiflush, 41 BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2", 29 BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2", 29 BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16", 29 BD Swabs Single Use, 40 BD Swabs Single Use Butterfly, 40 BD-insul SYR Mis LO Dose, 29 Bebulin, 17 bekyree, 10, 43 benazepril HCL, 6 benazepril HCL/hydrochlorothiazide, 6 Bendeka, 3

Benefix, 17 Benicar, 6 Benicar HCT, 7 Benlysta, 42 benzepro, 8 benzepro creamy wash, 8 benzepro foaming cloths, 8 benzepro SHORT contact, 8 benziq wash, 8 benzonatate, 25 benzoyl peroxide, 8 benzoyl peroxide SHORT contact, 8 benztropine mesylate, 20 Bepreve, 22 Berinert, 17 Besivance, 21 betamethasone dipropionate, 9 betamethasone sodium phosphate/betamethasone acetate, 10 betamethasone valerate, 9 Betaseron, 20 betaxolol HCL, 6, 21 bethanechol chloride, 15 Betimol, 21 bexarotene, 5 Bexsero, 26, 45 bicalutamide, 4 Bicillin C-R, 1 Bicillin L-a, 1 Bicnu, 3 Bidil, 7 Biltricide, 3 Bimatoprost, 21 bio GLO, 22 bio-d-mulsion, 26, 46 bio-d-mulsion forte, 26, 46 bio-statin, 2 biocel, 27 Biothrax, 26 biotuss, 25 biotuss pediatric, 25 bisoprolol fumarate, 6 bisoprolol fumarate/hydrochlorothiazide, 6 bivalirudin, 17 Bivigam, 42 bleomycin sulfate, 3 Blincyto, 4 blisovi 24 FE, 10, 43 blisovi FE 1.5/30, 10, 43 blisovi FE 1/20, 10, 43 Boostrix, 26, 45 Bosulif, 5 Botox, 21 bp 10-1, 8 bp foam, 8 bp foaming wash, 8 Bp Folinatal Plus B, 28 Bp Multinatal Plus, 28 Bp Vit 3, 16 bp wash, 8 bpm, 25 bpm pseudo, 25 bpo 6% foaming cloths, 8 bprotected pedia d-vite, 26, 46 bprotected pedia iron, 16, 45 Brainstrong Prenatal, 28 Breatherite, 40

Breatherite Collapsible Adult Spacer W/Mask, 40 Breatherite Collapsible Child Spacer W/Mask, 40 Breatherite Collapsible Infant Spacer W/Mask, 40 Breatherite Collapsible Small Child Spacer W/Mask, 40 Breatherite Collapsible Spacer W/ Neonate Mask, 40 Breatherite Rigid Spacer W/Mask, 40 Breatherite W/Large Mask, 40 Breatherite W/Medium Mask, 40 Breatherite W/Small Mask, 40 briellyn, 10, 43 Brilinta, 17 brimonidine tartrate, 22 bromfed DM, 25 bromfenac, 22 bromocriptine mesylate, 20 bromphen/pseudoephedrine HCL/dextromethorphan HBR, 25 Brovana, 25 bss, 22 budesonide, 10, 25(2) Bullseye Mini Safety Lancets, 29 Bullseye Safety Lancets, 29 bumetanide, 7 buminate, 17 Buphenyl, 13 bupivacaine HCL, 24 bupivacaine spinal, 24 bupivacaine/epinephrine, 24 buprenorphine HCL, 23 buprenorphine HCL/naloxone HCL, 23 buproban, 20, 46 bupropion HCL, 18 bupropion HCL ER, 18 bupropion HCL SR, 18, 20, 46 bupropion HCL XL, 18 buspirone HCL, 18 Busulfex, 3 butalbital/acetaminophen, 22 butalbital/acetaminophen/caffeine, 22 butalbital/acetaminophen/caffeine/codein e, 23 butalbital/aspirin/caffeine, 22 butalbital/aspirin/caffeine/codeine, 23 butorphanol tartrate, 23 Butrans, 24 Bydureon, 12 Byetta, 12 Bystolic, 6

C cabergoline, 13 Cadeau DHA, 28 Cafergot, 24 caffeine citrate, 19 calcidol, 26 calciferol, 26 calcipotriene, 8 calcipotriene/betamethasone dipropionate, 9 calcitonin salmon, 13 calcitonin-salmon, 13 calcitrene, 8 Calcitriol, 8 calcitriol, 13

calcium acetate, 14 calcium chloride, 40 calcium gluconate, 40 camila, 10, 43 Camptosar, 5 camrese, 10, 43 camrese LO, 10, 43 Canasa, 15 Cancidas, 2 candesartan cilexetil, 6 candesartan cilexetil/hydrochlorothiazide, 7 Cantil, 14 capacet, 22 Capastat Sulfate, 2 capecitabine, 3 Capex, 9 Caprelsa, 5 captopril, 6 Carafate, 14 CARB-o-philic 40, 10 CARB-o-philic/40, 10 Carbaglu, 13 carbamazepine, 19 carbamazepine ER, 19 carbidopa, 20 carbidopa/levodopa, 20 carbidopa/levodopa ER, 20 carbidopa/levodopa odt, 20 Carbidopa/Levodopa/Entacapone, 20 carbinoxamine maleate, 25 carboplatin, 3 Cardene IV, 6 Cardiocom Lancing Device, 33 cardioplegic, 7 Cardizem LA, 6 Cardura XL, 16 Carefine Pen Needle 32GX4MM, 33 Carefine Pen Needles 29GX1/2", 33 Carefine Pen Needles 30GX5/16", 33 Carefine Pen Needles 31GX6MM, 33 Carefine Pen Needles 31GX8MM, 33 Carefine Pen Needles 32GX5MM, 33 Carefine Pen Needles 32GX6MM, 33 Careone Advanced Lancing Device, 33 Careone Insulin Syringes/0.3ML/30G X 1/2", 33 Careone Insulin Syringes/0.3ML/31G X 5/16", 33 Careone Insulin Syringes/0.5ML/30G X 1/2", 33 Careone Insulin Syringes/0.5ML/31G X 5/16", 33 Careone Insulin Syringes/1ML/30G X 1/2", 33 Careone Insulin Syringes/1ML/31GX5/16", 33 Careone Lancet Thin, 29 Careone Lancet Ultra Thin, 29 Careone Unifine Pentips 29GX12MM, 33 Careone Unifine Pentips 31GX5MM, 33 Careone Unifine Pentips 31GX6MM, 33 Careone Unifine Pentips 31GX8MM, 33 Careone Unifine Pentips Pen Needles 32GX4MM, 33 Careone Unifine Pentips Plus Pen Needles 29GX12MM, 33 Careone Unifine Pentips Plus Pen

Needles 31GX5MM, 33 Careone Unifine Pentips Plus Pen Needles 31GX6MM, 33 Careone Unifine Pentips Plus Pen Needles 31GX8MM, 33 Careone Unifine Pentips Plus Pen Needles 32GX4MM, 33 Carimune Nanofiltered, 42 carisoprodol, 21 carisoprodol/aspirin, 21 carisoprodol/aspirin/codeine, 21 carteolol HCL, 21 cartia XT, 6 carvedilol, 6 Cavan-EC Sod DHA, 28 cavarest, 18 cavirinse, 18 Caya, 44 Cayston, 3 caziant, 10, 43 Cedax, 1 cefaclor, 1 Cefaclor, 1 cefadroxil, 1 cefazolin sodium, 1 cefdinir, 1 Cefditoren Pivoxil, 1 cefepime, 1 cefixime, 1 cefotaxime sodium, 1 cefotetan, 1 Cefotetan, 1 Cefotetan/Dextrose, 1 cefoxitin sodium, 1 cefpodoxime proxetil, 1 cefprozil, 1 ceftazidime, 1 Ceftin, 1 Ceftriaxone IN Iso-osmotic Dextrose, 1 ceftriaxone sodium, 1 cefuroxime axetil, 1 cefuroxime sodium, 1 Cefuroxime Sodium, 1 celecoxib, 24 Cellcept Intravenous, 4 Celontin, 19 Cem-urea, 10 Cenestin, 10 Centrum Specialist Prenatal, 28 cephalexin, 1 Ceprotin, 17 ceramax, 9 Cerezyme, 17 cerisa wash, 8 cerovel, 9 Cervarix, 26, 45 Cesamet, 14 cetirizine HCL, 25 cevimeline HCL, 18 Chantix, 20, 46 Chantix Continuing Month PAK, 20, 46 Chantix Starting Month PAK, 20, 46 chateal, 10, 43 Chek-stix Combo PAK Urinalysis Control, 42 Chek-stix Control, 42 Chemet, 41 Chemstrip Bg Log Book, 33

Chemstrip-k, 41 Chenodal, 15 childrens aspirin, 23, 42 childrens aspirin low strength, 23, 42 chlordiazepoxide HCL, 18 chlordiazepoxide HCL/clidinium bromide, 14 chlorhexidine gluconate, 18 chlorhexidine gluconate oral rinse, 18 chloromag, 40 chloroprocaine HCL, 24 chloroquine phosphate, 3 chlorothiazide, 7 Chlorothiazide, 7 chlorothiazide sodium, 7 chlorpromazine HCL, 18 Chlorpropamide, 12 Chlorthalidone, 7 chlorzoxazone, 21 cholestyramine, 7 cholestyramine light, 7 choline magnesium trisalicylate, 22 chorionic gonadotropin, 13 Cialis, 7 ciclodan, 8 ciclopirox, 8 ciclopirox nail lacquer, 8 ciclopirox olamine, 8 ciclopirox treatment, 8 cidaleaze, 9 cidofovir, 2 cilostazol, 17 Ciloxan, 21 cimetidine, 14 cimetidine HCL, 14 Cimzia, 15 Cimzia Starter Kit, 15 Cinryze, 17 Ciprodex, 22 ciprofloxacin, 1 ciprofloxacin ER, 1 ciprofloxacin HCL, 1, 21 Ciprofloxacin HCL, 1 ciprofloxacin I.V.-IN D5W, 1 cisatracurium besylate, 20 cisplatin, 3 Cisplatin, 3 citalopram hydrobromide, 18 citric acid/sodium citrate, 15 cladribine, 4 Claforan, 1 claravis, 8 Clarinex, 25 claris clarifying wash, 8 clarithromycin, 1 clarithromycin ER, 1 Classic Prenatal, 28, 44 Cleanlet Lancets 28G, 29 clearplex x, 8 clemastine fumarate, 25 Clemastine Fumarate, 25 Clever Chek Lancets Ultrathin, 29 Clever Chek Lancets Ultrathin 30G, 29 Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM, 33 Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2", 33 Clever Choice Comfort EZ Insulin

Syringe/0.3ML/30G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16", 33 Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16", 33 Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16", 33 Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16", 33 Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/1ML/28G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2", 33 Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16", 33 Clever Choice Comfort EZ Insulin Syringe/U-100/1ML/31GX5/16", 33 Clever Choice Comfort EZ Pen Needles 29GX12MM, 33 Clever Choice Comfort EZ Pen Needles 31GX5MM, 33 Clever Choice Comfort EZ Pen Needles 31GX6MM, 33 Clever Choice Comfort EZ Pen Needles 31GX8MM, 33 Clever Choice Comfort EZ Pen Needles 32GX4MM, 33 Clever Choice Comfort EZ Pen Needles 32GX5MM, 33 Clever Choice Comfort EZ Pen Needles 32GX6MM, 33 Clever Choice Comfort EZ Pen Needles 32GX8MM, 33 Clever Choice Comfort EZ Pen Needles 33GX4MM, 33 Clever Choice Comfort EZ Pen Needles 33GX5MM, 33 Clever Choice Comfort EZ Pen Needles 33GX6MM, 33 Clever Choice Comfort EZ Pen Needles 33GX8MM, 33 Clickfine Pen Needle 32GX5/32", 33 Clickfine Pen Needle Universal/31GX1/4", 33 Clickfine Pen Needle Universal/31GX5/16", 33 Clickfine Pen Needles/31GX1/4", 33 Clickfine Pen Needles/31GX5/16", 33 Clickfine Universal Pen Needles 31GX5/16", 33 clindacin etz pledgets, 8 clindacin-p, 8 clindamax, 8 clindamycin, 3 clindamycin HCL, 3 clindamycin palmitate HCL, 3 clindamycin phosphate, 3, 8, 15 clindamycin phosphate add-vantage, 3 clindamycin phosphate IN D5W, 3 clindamycin phosphate pharmacy bulk

package, 3 clindamycin/benzoyl peroxide, 8 clinisol SF 15%, 40 clinpro 5000, 18 clobetasol propionate, 9 clobetasol propionate e, 9 clobetasol propionate emollient, 9 clodan, 9 Clolar, 4 clomiphene citrate, 13 clomipramine HCL, 18 clonazepam, 19 clonazepam odt, 19 clonidine HCL, 6, 22 clonidine HCL ER, 19 clopidogrel, 17 clorazepate dipotassium, 18 Closercare, 33 clotrimazole, 8, 18 clotrimazole/betamethasone dipropionate, 8 clozapine, 18 clozapine odt, 18 Clozapine Odt, 19 Cnl8 Nail Kit, 8 CO-natal Fa, 28 Coagadex, 17 Coaguchek Lancets, 29 Coartem, 3 coated aspirin, 23, 42 codeine sulfate, 23 Colchicine, 24 Colcrys, 24 colestipol HCL, 7 colistimethate sodium, 3 colocort, 14 Coly-mycin S, 22 Combigan, 21 Combipatch, 10 Combivent Respimat, 25 Cometriq, 5 Comfort Assist Insulin Syringe 0.3ML/29G X 1/2", 33 Comfort Assist Insulin Syringe/0.3ML/30G X 5/16", 33 Comfort Assist Insulin Syringe/0.3ML/31G X 5/16", 33 Comfort Assist Insulin Syringe/0.5ML/29G X 1/2", 33 Comfort Assist Insulin Syringe/0.5ML/30G X 5/16", 33 Comfort Assist Insulin Syringe/0.5ML/31G X 5/16", 33 Comfort Assist Insulin Syringe/1ML/29G X 1/2", 33 Comfort Assist Insulin Syringe/1ML/30G X 5/16", 33 Comfort Assist Insulin Syringe/1ML/31G X 5/16", 33 Comfort Assured Lancets Micro Thin 33G, 29 Comfort Assured Lancets Super Thin 28G, 29 Comfort Lancets, 29 compazine, 18 Complera, 2 Complete Natal DHA, 28 Completenate, 28

compro, 18 Comvax, 26, 45 Concerta, 19 Condylox, 10 constulose, 14 controlrx, 18 Copaxone, 20 Cordran, 9 Cordran Tape, 9 Coreg CR, 6 Corifact, 17 cormax scalp application, 9 Cortifoam, 15 Cortisporin, 8 Cortisporin-tc, 22 corvita, 27 corvita 150, 16 corvite free, 27 cosyntropin, 40 Cotellic, 5 Creon, 14 Cresemba, 2 Crinone, 15 Crixivan, 2 cromolyn sodium, 14, 22 Cromolyn Sodium, 25 cryselle-28, 10, 43 Cubicin, 3 Cuprimine, 41 Curity Alcohol Preps/Medium 2 Ply, 40 Curity Alcohol Swabs, 40 curity sterile saline, 15 Cuvposa, 14 CVS Alcohol Prep Swabs, 40 CVS Alcohol Swabs, 40 CVS aspirin, 23, 42 CVS aspirin adult low dose, 23, 42 CVS aspirin adult low strength, 23, 42 CVS aspirin child, 23, 42 CVS aspirin EC, 23, 43 CVS aspirin low dose, 23, 42 CVS aspirin low strength, 23, 42 CVS childrens aspirin, 23, 43 CVS d3, 27, 47 CVS enteric aspirin, 23, 43 CVS folic acid, 16, 44 CVS Insulin Syringe/0.3ML/29G X 1/2", 33 CVS Insulin Syringe/0.3ML/30G X 1/2", 33 CVS Insulin Syringe/0.5ML/29G X 1/2", 33 CVS Insulin Syringe/0.5ML/30G X 1/2", 33 CVS Insulin Syringe/1ML/29G X 1/2", 33 CVS iron, 16, 46 CVS Lancets 21G, 29 CVS Lancets Micro Thin 33G, 29 CVS Lancets Original, 29 CVS Lancets Thin 26G, 29 CVS Lancets Ultra Thin 30G, 29 CVS Lancing Device, 33 CVS nicotine, 20, 46 CVS nicotine lozenge, 20, 46 CVS nicotine polacrilex, 20, 46 CVS nicotine polacrilex starter, 20, 46 CVS nicotine transdermal system, 20, 46 CVS nts step 1, 20, 46

CVS Prenatal, 28, 44 CVS Prenatal Gummy/DHA/Folic Acid, 28 CVS Prenatal Multi+dha, 28 CVS Prep Pads, 40 CVS Slow Release Iron, 16, 46 CVS Ultra Thin Lancets, 29 CVS vitamin d, 27, 47 CVS vitamin d 5000 high-potency, 27, 47 CVS vitamin d3, 27, 47 cyanocobalamin, 16 cyclafem 1/35, 10, 43 cyclafem 7/7/7, 10, 43 cyclobenzaprine HCL, 21 cyclopentolate HCL, 21 cyclopentolate hydrochloride, 21 Cyclophosphamide, 3 cyclophosphamide, 3 Cycloset, 12 cyclosporine, 4 cyclosporine modified, 4 cyproheptadine HCL, 25 cyred, 10, 43 Cystadane, 13 Cystagon, 16 Cystaran, 22 cysteine HCL, 40 cytarabine, 4 Cytarabine, 4 cytarabine aqueous, 4 Cytogam, 42 cytra k crystals, 15 cytra-2, 15 cytra-k, 15

D d 1000, 26, 46 d 10000, 26, 46 d 2000, 27, 46 d 400, 27, 46 d 5000, 27, 46 d-1000, 27, 46 d-1000 extra strength, 27, 46 d-2000 maximum strength, 27, 46 d-3-5, 27, 46 d-400, 27, 46 d-5000, 27, 47 d-5000 maximum strength, 27, 47 d-vita, 27, 46 d2000 ultra strength, 27, 47 d3, 27, 47 d3 2000, 27, 47 d3 adult, 27, 47 d3 adult gummy, 27, 47 D3 Dots, 27, 47 d3 high potency, 27, 47 d3 kids, 27, 47 d3 maximum strength, 27, 47 d3 super strength, 27, 47 d3 ultra strength, 27, 47 d3-1000, 27, 47 d3-50, 27, 47 dacarbazine, 5 Dacarbazine, 5 Daklinza, 2 Daliresp, 25 danazol, 10 dantrolene sodium, 21 Dapsone, 3

Daptacel, 26, 45 Daraprim, 3 darifenacin ER, 15 darifenacin hydrobromide ER, 15 Darzalex, 4 dasetta 1/35, 10, 43 dasetta 7/7/7, 10, 43 daunorubicin HCL, 3 Daunoxome, 3 daysee, 10, 43 Daytrana, 19 Ddrops, 27, 47 deblitane, 10, 43 decara, 27, 47 Decara, 27, 47 decitabine, 4 deferoxamine mesylate, 40 dehydrated alcohol, 40 delflex-lm/1.5% dextrose, 40 Delflex-lm/2.5% Dextrose, 41 Delflex-lm/4.25% Dextrose, 41 Delflex-sm/1.5% Dextrose, 41 Delflex-sm/2.5% Dextrose, 41 delta d3, 27, 47 deltasone, 10 delyla, 11, 43 Delzicol, 15 demeclocycline HCL, 1 Demser, 6 Denavir, 8 denta 5000 plus, 18 dentagel, 18 Depen Titratabs, 42 Depo-medrol, 10 Depo-provera, 4 Depo-subq Provera 104, 11, 44 Depocyt, 4 desipramine HCL, 18 desloratadine, 25 Desloratadine Odt, 25 desmopressin acetate, 13 desogestrel/ethinyl estradiol, 11, 43 desonide, 9 desoximetasone, 9 Desoximetasone, 9 dexamethasone, 10 Dexamethasone, 10 Dexamethasone Intensol, 10 dexamethasone sodium phosphate, 10, 21 Dexamethasone Sodium Phosphate, 10 Dexchlorpheniramine Maleate, 25 dexedrine, 19 dexferrum, 16 Dexilant, 14 dexmedetomidine HCL, 19 dexmethylphenidate HCL, 19 dexmethylphenidate HCL ER, 19 Dexpak 10 Day, 10 Dexpak 13 Day, 10 Dexpak 6 Day, 10 dexrazoxane, 5 dextroamphetamine sulfate, 19 dextroamphetamine sulfate ER, 19 dextrose 10%, 40 dextrose 10% flex container, 40 dextrose 2.5%/NACL 0.45%, 40 dextrose 2.5%/sodium chloride 0.45%,

40 dextrose 30% partial fill, 40 dextrose 5%, 40 dextrose 5% viaflex, 40 dextrose 5%/lactated ringers, 40 dextrose 5%/NACL 0.2%, 41 dextrose 5%/NACL 0.33%, 41 dextrose 5%/NACL 0.45%, 41 dextrose 5%/NACL 0.9%, 41 dextrose 5%/potassium chloride 0.15%, 40 dextrose 5%/ringers, 40 dextrose 5%/sodium chloride 0.2%, 40 dextrose 5%/sodium chloride 0.33%, 40 dextrose 5%/sodium chloride 0.45%, 40 dextrose 5%/sodium chloride 0.9%, 41 dextrose 50%, 41 dextrose 70%, 41 Diabeta, 12 dialyvite, 27 dialyvite vitamin d 5000, 27, 47 dialyvite vitamin d3 max, 27, 47 Diascreen 10, 33 Diascreen 1b, 33 Diascreen 1G, 33 Diascreen 1k, 33 Diascreen 2GK, 33 Diascreen 2GP, 33 Diascreen 3, 33 Diascreen 4nl, 33 Diascreen 4obl, 33 Diascreen 4PH, 33 Diascreen 5, 33 Diascreen 6, 33 Diascreen 7, 33 Diascreen 8, 33 Diascreen 9, 33 Diascreen Liquid Urine Controls, 33 Diastar Easy Test II Lancets 30G, 29 Diastar Easy Test Lancets30G, 29 diazepam, 18 Diazepam, 18 diazepam intensol, 18 diclofenac potassium, 24 diclofenac sodium, 8, 9, 22 diclofenac sodium DR, 24 diclofenac sodium ER, 24 diclofenac sodium/misoprostol, 24 diclotral PAK, 8 dicloxacillin sodium, 1 dicyclomine hci, 14 dicyclomine HCL, 14 didanosine, 2 Dificid, 1 difil-G forte, 25 Diflorasone Diacetate, 9 diflunisal, 22 digitek, 5 digox, 5 digoxin, 5 dihydroergotamine mesylate, 24 Dihydroergotamine Mesylate, 24 Dilantin, 19 Dilatrate SR, 5 dilt-XR, 6 diltiazem CD, 6 diltiazem HCL, 6 diltiazem HCL CD, 6

diltiazem HCL ER, 6 Dipentum, 15 diphenhydramine HCL, 25 diphenoxylate/atropine, 14 Diphtheria/Tetanus Toxoids Adsorbed Pediatric, 26, 45 dipyridamole, 17, 41 disopyramide phosphate, 6 disulfiram, 20 divalproex sodium, 19 divalproex sodium DR, 19 divalproex sodium ER, 19 dobutamine HCL, 7 dobutamine HCL/D5W, 7 dobutamine/dextrose 5%, 7 Docefrez, 4 docetaxel, 4 Docetaxel, 4 Docetaxel (non- Alcohol Formula), 4 Docetaxel (non-alcohol Formula), 4 donepezil HCL, 20 dopamine HCL, 7 Dopamine HCL, 7 dopamine HCL-dextrose 5%, 7 dopamine HCL/dextrose 5%, 7 dopamine/D5W, 7 Doribax, 3 dorzolamide HCL, 22 dorzolamide HCL/timolol maleate, 21 doxapram HCL, 19 doxazosin, 6 doxazosin mesylate, 6 doxepin HCL, 18 Doxepin HCL, 18 Doxepin Hydrochloride, 8 doxercalciferol, 13 doxorubicin HCL, 3 Doxorubicin HCL, 3 doxorubicin HCL liposome, 3 doxy 100, 1 doxycycline, 1 Doxycycline, 8 doxycycline hyclate, 1 doxycycline hyclate DR, 1 doxycycline monohydrate, 1 dronabinol, 14 droperidol, 18 Droplet Lancets Ultra Thin 30G, 29 Droplet Lancing Device, 33 Droplet Pen Needles 29GX10MM, 33 Droplet Pen Needles 29GX12MM, 33 Droplet Pen Needles 31GX5MM, 33 Droplet Pen Needles 31GX6MM, 33 Droplet Pen Needles 31GX8MM, 33 Droplet Pen Needles 32GX4MM, 33 Droplet Pen Needles 32GX5MM, 33 Droplet Pen Needles 32GX6MM, 33 Droplet Pen Needles 32GX8MM, 33 drospirenone/ethinyl estradiol, 11, 43 Droxia, 16 Drug Mart Adjustable Lancing Device, 33 Drug Mart Lancets Thin, 29 Drug Mart Lancets Ultra Thin, 29 Drug Mart On-the-go Lancets Gentle 30G, 29 Drug Mart Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 33 Drug Mart Ultra Comfort Insulin

Syringe/0.3ML/30G X 5/16", 33 Drug Mart Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 33 Drug Mart Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 33 Drug Mart Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 33 Drug Mart Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 33 Drug Mart Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 33 Drug Mart Unifine Pentips 31GX5MM, 33 Drug Mart Unifine Pentips29G X 12MM, 33 Drug Mart Unifine Pentips31GX6MM, 33 Drug Mart Unifine Pentips31GX8MM, 33 Drug Mart Unifine Pentips32GX4MM, 33 Drug Mart Unifine Pentipsplus 32GX4MM, 33 Drug Mart Unilet Lancets Super Thin 30G, 29 Drug Mart Unilet Lancets Ultra Thin 28G, 29 Duane Reade Lancet Alternate Site 26G, 29 Duane Reade Lancet Super Thin 30G, 29 Duane Reade Lancet Ultra Thin 28G, 29 Duane Reade Unifine Pentips 29G X 12MM, 33 Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT, 33 Duane Reade Unifine Pentips 31G X 8MM SHORT, 33 Dulera, 25 duloxetine HCL, 18 Duloxetine HCL, 18 duramorph, 23 duraxin, 22 Durezol, 21 dutasteride, 15 dutasteride/tamsulosin HCL, 15 dutasteride/tamsulosin hydrochloride, 15 Dymista, 25 Dyrenium, 7 Dysport, 21

E E-z Ject Lancets, 29 E-z Ject Lancets 21G, 29 E-z Ject Lancets Color, 29 E-z Ject Lancets Super Thin, 29 E-z Ject Lancets Super Thin 30G, 29 E-z Ject Lancets Thin 26G, 29 E-z Spacer, 40 E-z Spacer The Body Guards Pack, 40 E-ZJECT Lancets Micro-thin 33G, 29 e.s.p., 3 Easivent, 40 Easivent/Mask-large, 40 Easivent/Mask-medium, 40 Easivent/Mask-small, 40 Easy Comfort Insulin Syringe/0.3ML/30G X 5/16", 34 Easy Comfort Insulin Syringe/0.5ML/30G X 5/16", 34 Easy Comfort Insulin Syringe/0.5ML/31G X 5/16", 34 Easy Comfort Insulin Syringe/1ML/30G X

5/16", 34 Easy Comfort Insulin Syringe/1ML/31G X 5/16", 34 Easy Comfort Insulin Syringe/U100/0.5ML/30G X 1/2", 33 Easy Comfort Insulin Syringe/U100/1ML/30G X 1/2", 34 Easy Comfort Lancets, 29 Easy Comfort Lancets 30G/Pull Top, 29 Easy Comfort Lancets 30G/Thin Top, 29 Easy Comfort Pen Needles 31GX1/4", 34 Easy Comfort Pen Needles 31GX3/16", 34 Easy Comfort Pen Needles 31GX5/16", 34 Easy Comfort Pen Needles 32GX5/32", 34 Easy Mini Eject Lancing Device, 34 Easy Mini Lancing Device, 34 Easy Touch 32GX5MM, 34 Easy Touch 32GX6MM, 34 Easy Touch Alcohol Prep Pads/Medium, 40 Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2", 34 Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2", 34 Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16", 34 Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16", 34 Easy Touch Insulin Syringe/0.3ML/30G X 5/16", 34 Easy Touch Insulin Syringe/0.3ML/31G X 5/16", 34 Easy Touch Insulin Syringe/0.5ML/29G X 1/2", 34 Easy Touch Insulin Syringe/0.5ML/30G X 5/16", 34 Easy Touch Insulin Syringe/1ML/30G X 5/16", 34 Easy Touch Insulin Syringe/Safety/U100/0.5ML/29G X 1/2", 34 Easy Touch Insulin Syringe/Safety/U100/0.5ML/30G X 5/16", 34 Easy Touch Insulin Syringe/Safety/U100/1ML/29G X 1/2", 34 Easy Touch Insulin Syringe/Safety/U100/1ML/30G X 1/2", 34 Easy Touch Insulin Syringe/U100/0.3ML/30G X 1/2", 34 Easy Touch Insulin Syringe/U100/0.5ML/27G X 1/2", 34 Easy Touch Insulin Syringe/U100/0.5ML/28G X 1/2", 34 Easy Touch Insulin Syringe/U100/0.5ML/30G X 1/2", 34 Easy Touch Insulin Syringe/U100/0.5ML/31G X 5/16", 34 Easy Touch Insulin Syringe/U100/1ML/27G X 1/2", 34 Easy Touch Insulin Syringe/U100/1ML/28G X 1/2", 34 Easy Touch Insulin Syringe/U100/1ML/29G X 1/2", 34 Easy Touch Insulin Syringe/U100/1ML/30G X 1/2", 34 Easy Touch Insulin Syringe/U-

100/1ML/31G X 5/16", 34 Easy Touch Lancets 21G/Pressure Activated, 29 Easy Touch Lancets 23G/Pressure Activated, 29 Easy Touch Lancets 26G/Pressure Activated, 29 Easy Touch Lancets 26G/Pull-top, 29 Easy Touch Lancets 26G/Twist, 29 Easy Touch Lancets 28G/Pressure Activated, 29 Easy Touch Lancets 28G/Pull-top, 29 Easy Touch Lancets 28G/Twist, 29 Easy Touch Lancets 30G/Buttonactivated, 29 Easy Touch Lancets 30G/Pressure Activated, 29 Easy Touch Lancets 30G/Pull-top, 29 Easy Touch Lancets 30G/Twist, 29 Easy Touch Lancets 32G/Pressure Activated, 29 Easy Touch Lancets 32G/Pull-top, 29 Easy Touch Lancets 32G/Twist, 29 Easy Touch Lancets 33G/Twist, 30 Easy Touch Lancing Device/Ejector, 34 Easy Touch Pen Needles 29GX1/2", 34 Easy Touch Pen Needles 31GX1/4", 34 Easy Touch Pen Needles 31GX5/16", 34 Easy Touch Pen Needles 32GX1/4", 34 Easy Touch Pen Needles 32GX3/16", 34 Easy Touch Pen Needles 32GX5/32", 34 Easy Touch Pen Needles/31G X 3/16", 34 Easy Touch Safety Lancets21G/Pressure Activated, 30 Easy Touch Safety Lancets23G/Pressure Activated, 30 Easy Touch Safety Lancets26G/Button Activated, 30 Easy Touch Safety Lancets26G/Pressure Activated, 30 Easy Touch Safety Lancets28G/Button Activated, 30 Easy Touch Safety Lancets28G/Pressure Activated, 30 Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2", 34 Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16", 34 Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16", 34 Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2", 34 Easy Twist & CAP Lancets, 30 easygel, 18 Easytest II Lancets, 30 Easytest Lancets, 30 EC-81 aspirin, 23, 43 econazole nitrate, 8 econtra EZ, 11, 43 ecotrin, 23, 42 ecotrin low strength, 23, 42 ecpirin, 23, 42 ed-flex, 22 ed-spaz, 14 Edarbi, 6 Edecrin, 7 Edurant, 2

effer-k, 41 Effer-k, 42 effervescent pot chloride, 41 effervescent potassium, 41 effervescent potassium/chloride, 41 Effient, 17 Egrifta, 13 Elaprase, 13 Elelyso, 17 elenzapatch, 9 Elidel, 9 Eligard, 4 elinest, 11, 43 Eliquis, 17 Elite Iron, 16, 46 Elite-OB, 28 Elite-thin Insulin Syringe/0.3ML/31G X 5/16", 34 Elite-thin Insulin Syringe/0.5ML/29G X 1/2", 34 Elite-thin Insulin Syringe/0.5ML/30G X 5/16", 34 Elite-thin Insulin Syringe/1ML/29G X 5/16", 34 Elite-thin Insulin Syringe/1ML/30G X 5/16", 34 Elite-thin Insulin Syringe/U100/0.5ML/28G X 1/2", 34 Elite-thin Insulin Syringe/U100/0.5ML/28G X 5/16", 34 Elite-thin Insulin Syringe/U100/0.5ML/29G X 5/16", 34 Elite-thin Insulin Syringe/U100/0.5ML/31G X 5/16", 34 Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2", 34 Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16", 34 Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2", 34 Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16", 34 Elitek, 5 Elixophyllin, 25 Ella, 11 Elmiron, 16 Eloctate, 17 Emadine, 22 Embeda, 24 Embrace Lancets Ultra Thin 30G, 30 Emcyt, 4 Emend, 14 emoquette, 11, 43 Empliciti, 4 Emsam, 18 Emtriva, 2 enalapril maleate, 6 enalapril maleate/hydrochlorothiazide, 7 enalaprilat, 6 Enbrel, 24 Enbrel Sureclick, 24 Encare, 15, 44 endocet, 23 endodan, 23 Enfamil Expecta, 28 Engerix-b, 26, 45 Enjuvia, 10 enoxaparin sodium, 17

enpresse-28, 11, 43 enskyce, 11, 43 entacapone, 20 entecavir, 2 enteric coated aspirin, 23, 42 enulose, 14 ephedrine sulfate, 7 epinastine HCL, 22 Epinephrine, 7 epinephrine HCL, 25 Epipen 2-PAK, 7 Epipen-JR 2-PAK, 7 epirubicin HCL, 3 Epirubicin HCL, 3 episone CRE, 9 epitol, 19 Epivir HBV, 2 eplerenone, 6 Epogen, 17 epoprostenol sodium, 7 Eprosartan Mesylate, 6 eptifibatide, 17 Epzicom, 2 eq adult aspirin low strength, 23, 42 eq aspirin, 23, 42 eq aspirin adult low dose, 23, 42 eq aspirin EC, 23, 42 eq aspirin low dose, 23, 42 eq childrens aspirin, 23, 42 eq nicotine, 20, 46 eq nicotine gum refill, 20, 46 eq nicotine gum starter, 20, 46 eq nicotine polacrilex, 20, 46 eq nicotine step 3, 20, 46 eq slow-release iron, 16, 45 eql adult aspirin low strength, 23, 42 eql aspirin, 23, 42 eql aspirin EC, 23, 42 eql aspirin low dose, 23, 42 eql childrens aspirin, 23, 42 eql childrens vitamin d gummies, 27, 47 Eql Color Lancets 21G, 30 Eql Color Lancets Micro Thin 33G, 30 eql folic acid, 16, 44 Eql Insulin Syringe/0.3ML/29G X 1/2", 34 Eql Insulin Syringe/0.3ML/30G X 5/16", 34 Eql Insulin Syringe/0.3ML/31G X 5/16", 34 Eql Insulin Syringe/0.5ML/29G X 1/2", 34 Eql Insulin Syringe/0.5ML/30G X 5/16", 34 Eql Insulin Syringe/0.5ML/31G X 5/16", 34 Eql Insulin Syringe/1ML/29G X 1/2", 34 Eql Insulin Syringe/1ML/30G X 5/16", 34 Eql Insulin Syringe/1ML/31G X 5/16", 34 Eql Insulin Syringe/U-100/0.3ML/29G X 1/2", 34 Eql Insulin Syringe/U-100/0.5ML/29G X 1/2", 34 Eql Insulin Syringe/U-100/1ML/29G X 1/2", 34 eql iron supplement therapy, 16, 45 eql nicotine, 20, 46 eql nicotine polacrilex, 20, 46 eql nicotine polacrilex refill, 20, 46 eql nicotine polacrilex starter, 20, 46

Eql Prenatal Formula, 28, 44 Eql SHORT Pen Needles 31G X 8MM, 34 eql slow release iron, 16, 45 Eql Super Thin Lancets 30G, 30 Eql Thin Lancets 26G, 30 Eql Ultra Comfort Insulinsyringe/0.3ML/31G X 5/16", 34 Eql Ultra Comfort Insulinsyringe/1ML/30G X 5/16", 34 Eql Ultra SHORT Pen Needles 31G X 6MM, 34 eql vitamin d-3, 27, 47 eql vitamin d3, 27, 47 Eraxis, 2 Erbitux, 4 ergocalciferol, 26 ergoloid mesylates, 20 Ergoloid Mesylates, 20 Ergomar, 24 Erivedge, 5 errin, 11, 43 Ertaczo, 8 Erwinaze, 3 ery, 8 Ery-TAB, 1 Erythrocin Lactobionate, 1 erythromycin, 1, 8, 21 Erythromycin Base, 1 erythromycin/benzoyl peroxide, 8 Esbriet, 25 Escavite LQ, 28 escitalopram oxalate, 18 esgic, 22 esmolol HCL, 6 esomeprazole magnesium, 14 esomeprazole sodium, 14 Esomeprazole Sodium, 14 Esomeprazole Strontium, 14 estarylla, 11, 43 estazolam, 19 Estrace, 15 estradiol, 10 estradiol valerate, 10 estradiol/norethindrone acetate, 10 estropipate, 10 eszopiclone, 19 ethacrynate sodium, 7 ethambutol HCL, 2 ethosuximide, 19 Etidronate Disodium, 12 etodolac, 24 etodolac ER, 24 Etopophos, 4 Etoposide, 4 etoposide, 4 Eurax, 10 Evamist, 10 Evotaz, 2 Exalgo, 24 Excel Comfort Point Insulin Pen Needles 31G X 4MM, 34 Exel Comfort Point Insulin Pen Needles 29G X 12MM, 34 Exel Comfort Point Insulin Pen Needles 31G X 6MM, 34 Exel Comfort Point Insulin Pen Needles 31G X 8MM, 34

Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2", 34 Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16", 34 Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2", 34 Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2", 34 Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16", 34 Exel Comfort Point Insulin Syringe/1ML/28G X 1/2", 34 Exel Comfort Point Insulin Syringe/1ML/29G X 1/2", 34 Exel Comfort Point Insulin Syringe/1ML/30G X 5/16", 34 Exelderm, 8 exemestane, 4 Exjade, 42 Eylea, 22 EZ Smart Blood Glucose Lancets, 30 EZ-lets Lancets 21G, 30 EZ-lets Lancets 23G, 30 EZ-lets Lancets 26G Super-soft, 30 EZ-lets Lancets 28G Ultra-soft, 30 EZ-lets Lancets 30G, 30 ezfe 200, 16, 45

F fa-8, 16, 44 Fa-8, 16, 44 fabb, 16 Fabrazyme, 13 Factive, 1 fallback solo, 11, 43 falmina, 11, 43 famciclovir, 2 famotidine, 14 Famotidine, 14 Fanapt, 19 Fanapt Titration Pack, 19 Fareston, 4 Farydak, 5 Faslodex, 4 Fazaclo, 19 Fc Female Condom, 44 Fc2 Female Condom, 44 FE Aspartate, 16, 46 FE c plus, 16 FE gluconate, 16, 46 FE TABS, 16, 46 Feiba, 17 Feiba NF, 17 felbamate, 19 felodipine ER, 6 Femcap, 44 Femiron, 16, 46 fenofibrate, 7 Fenofibrate, 7 fenofibrate micronized, 7 Fenofibric Acid, 7 fenofibric acid DR, 7 Fenoglide, 7 fenoldopam mesylate, 6 Fenoprofen Calcium, 24 fentanyl, 23 Fentanyl, 24 fentanyl citrate oral transmucosal, 23 feosol, 16, 45

Feosol, 16, 46 fer-iron, 16, 45 ferate, 16, 45 fergon, 16, 45 ferocon, 16 ferosul, 16, 45 ferotrinsic, 16 Ferretts, 16, 46 Ferretts Chewable Iron, 16 Ferretts IPS, 16, 46 ferrex 150, 16, 45 ferric x-150, 16, 45 Ferrimin 150, 16, 46 Ferriprox, 42 ferro-bob, 16, 45 Ferro-sequels, 16, 46 ferrocite, 16 ferrocite plus, 16 ferrogels forte, 16 ferrotabs, 16, 45 ferrous drops, 16, 45 Ferrous Fumarate, 16, 46 ferrous fumarate 324, 16 ferrous gluconate, 16, 45 Ferrous Gluconate, 16, 46 ferrous sulfate, 16, 45 Ferrous Sulfate, 16, 46 ferrousul, 16, 45 Fibricor, 7 Fifty50 Alcohol Prep Pads, 40 Fifty50 Lancing Device, 34 Fifty50 Pen Needles 31G X3/16" (5MM), 34 Fifty50 Pen Needles 31G X5/16" (8MM), 34 Fifty50 Pen Needles 31GX5MM, 34 Fifty50 Pen Needles/31GX8MM, 34 Fifty50 Pen Needles/32GX4MM, 34 Fifty50 Pen Needles/32GX6MM, 34 Fifty50 Safety Seal Lancets 30G, 30 Fifty50 Safety Seal Lancets 32G, 30 Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16", 34 Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16", 34 Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16", 34 Fifty50 Unilet Lancets 33G, 30 Finacea, 8 finasteride, 15 Fine 30, 30 Fingerstix Lancets, 30 Firazyr, 17 Firmagon, 4 Flagyl ER, 3 Flarex, 21 flavoxate HCL, 15 Flebogamma Dif, 42 flecainide acetate, 6 flexbumin, 17 Flexichamber, 40 Flexichamber Adult Mask/Small, 40 Flexichamber Child Mask/Large, 40 Flexichamber Child Mask/Small, 40 floriva plus, 27 floxuridine, 4 Floxuridine, 4 Fluarix 2013-2014, 26, 45

Fluarix 2014-2015, 26, 45 Fluarix Quadrivalent 2013-2014, 26, 45 Fluarix Quadrivalent 2014-2015, 26, 45 Fluarix Quadrivalent 2015-2016, 26, 45 Flublok 2013-2014, 26, 45 Flublok 2014-2015, 26, 45 Flublok 2015-2016, 26, 45 flucaine, 22 Flucelvax 2013-2014, 26, 45 Flucelvax 2014-2015, 26, 45 Flucelvax 2015-2016, 26, 45 fluconazole, 2 fluconazole IN dextrose, 2 fluconazole IN NACL, 2 flucytosine, 2 fludarabine phosphate, 4 fludrocortisone acetate, 10 Flulaval 2013-2014, 26, 45 Flulaval 2014-2015, 26, 45 Flulaval Quadrivalent 2013-2014, 26, 45 Flulaval Quadrivalent 2014-2015, 26, 45 Flulaval Quadrivalent 2015-2016, 26, 45 flumazenil, 41 Flumist Quadrivalent, 26, 45 flunisolide, 25 fluocinolone acetonide, 9, 22 fluocinolone acetonide body, 9 fluocinolone acetonide ear drops, 22 fluocinolone acetonide scalp, 9 fluocinonide, 9 fluocinonide-e, 9 fluor-a-day, 41, 44 Fluor-a-day, 41, 44 fluor-i-strips a.t., 22 fluorescein-benoxinate, 22 fluorescein/proparacaine, 22 fluoride, 41, 44 fluoridex daily defense, 18 fluoridex daily defense enhanced whitening, 18 fluoridex daily defense sensitivity relief, 18 fluoritab, 41, 44 fluorometholone, 21 Fluoroplex, 10 fluorouracil, 4, 9 fluoxetine DR, 18 fluoxetine HCL, 18 fluphenazine decanoate, 18 fluphenazine HCL, 18 flura-drops, 41, 44 flurandrenolide, 9 flurazepam HCL, 19 Flurazepam HCL, 19 flurbiprofen, 24 flurbiprofen sodium, 22 flurox, 22 flutamide, 4 fluticasone propionate, 9, 25 fluvastatin, 7 fluvastatin sodium ER, 7 Fluvirin 2013-2014, 26, 45 Fluvirin 2014-2015, 26, 45 Fluvirin 2015-2016, 26, 45 Fluvirin PF 2013-2014, 26, 45 Fluvirin PF 2014-2015, 26, 45 fluvoxamine maleate, 18 fluvoxamine maleate ER, 18

Fluzone High-dose PF 2013-2014, 26, 45 Fluzone High-dose PF 2014-2015, 26, 45 Fluzone High-dose PF 2015-2016, 26, 45 Fluzone Intradermal, 26, 45 Fluzone Intradermal Quadrivalent 20152016, 26, 45 Fluzone Pediatric PF 2013-2014, 26, 45 Fluzone PF 2013-2014, 26, 45 Fluzone PF 2014-2015, 26, 45 Fluzone Quadrivalent 2013-2014, 26, 45 Fluzone Quadrivalent 2014-2015, 26, 45 Fluzone Quadrivalent 2015-2016, 26, 45 Fluzone Split 2013-2014, 26, 45 Fluzone Split 2014-2015, 26, 45 Fluzone Split 2015-2016, 26, 45 FML, 21 Focalin XR, 19 folbee, 16 folbee plus, 27 folbee plus cz, 27 folic acid, 16, 44 folic acid/vitamin b-6/vitamin b-12, 16 Folotyn, 4 folplex 2.2, 16 foltrin, 16 fomepizole, 41 fondaparinux sodium, 17 Fora Lancets, 30 Fora Lancing Device, 34 Fora Lancing Device/Clearcap, 34 Foradil Aerolizer, 25 formadon, 41 formaldehyde, 41 Forteo, 13 Fosamax Plus D, 12 fosinopril sodium, 6 fosinopril sodium/hydrochlorothiazide, 7 fosphenytoin sodium, 19 Fosrenol, 15 Fragmin, 17 Freds Pharmacy Autolet Lancing Device, 34 Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM, 34 Freds Pharmacy Unifine Pentips Plus 31GX5MM, 34 Freds Pharmacy Unifine Pentips Plus 31GX8MM, 34 Freds Pharmacy Unilet Lancets Super Thin 30G, 30 Freds Pharmacy Unilet Lancets Ultra Thin 28G, 30 Freestyle Lancets, 30 Freestyle Precision Insulin Syringe/U100/0.5ML/30G X 5/16", 34 Freestyle Precision Insulin Syringe/U100/0.5ML/31G X 5/16", 34 Freestyle Precision Insulin Syringe/U100/1ML/31G X 5/16", 34 Freestyle Precision Insulin Syringes/U100/1ML/30G X 5/16", 34 Freestyle Unistick II Lancets, 30 frovatriptan succinate, 24 ful-GLO, 22 furosemide, 7

Fusilev, 5 Fuzeon, 2 fyavolv, 10 Fycompa, 19

G gabapentin, 19 Gabitril, 19 galantamine hydrobromide, 20 Galantamine Hydrobromide, 20 Gamastan S/D, 42 Gammagard Liquid, 42 Gammagard S/D, 42 Gammagard S/D Iga Less Than 1mcg/ML, 42 Gammaked, 42 Gammaplex, 42 Gamunex-c, 42 ganciclovir, 2 garamycin, 21 Gardasil, 26, 45 Gardasil 9, 26, 45 Gastrinex NF, 14 gatifloxacin, 21 Gattex, 15 gavilyte-c, 14, 47 gavilyte-G, 14, 47 gavilyte-h, 14 gavilyte-n/flavor pack, 14, 47 Gazyva, 4 Gelnique, 15 gemcitabine, 4 gemcitabine HCL, 4 gemfibrozil, 7 gene-xene TAB 15MG, 18 gene-xene TAB 3.75MG, 18 gene-xene TAB 7.5MG, 18 generlac, 14 gengraf, 4 gentak, 21 gentamicin sulfate, 1, 21 gentamicin sulfate pediatric, 1 gentamicin sulfate/0.9% sodium chloride, 1 Gentle-let GP Lancets, 30 Gentle-let Lancets General Purpose Style/Fine Point, 30 Gentle-let Lancets General Purpose Style/Medium Point, 30 Gentle-let Lancets Safety Style/Fine Point, 30 Gentle-let Lancets Safety Style/Medium Point, 30 Gentle-let Platforms 2.4MM, 34 Gentle-let Platforms 3.0MM, 34 Geodon, 19 gianvi, 11, 43 gildagia, 11, 43 gildess 1.5/30, 11, 43 gildess 1/20, 11, 43 gildess 24 FE, 11, 43 gildess FE 1.5/30, 11, 43 gildess FE 1/20, 11, 43 Gilenya, 20 Gilotrif, 5 giltuss pediatric, 25 Glassia, 26 glatopa, 20 Gleevec, 5

Gleostine, 3 Gliadel Wafer, 3 glimepiride, 12 glipizide, 12 glipizide ER, 12 glipizide XL, 12 glipizide/metformin HCL, 12 Global Alcohol Prep Ease Pads, 40 Global Ease Inject Pen Needles 29GX12MM, 34 Global Ease Inject Pen Needles 31GX8MM, 34 Global Ease Inject Pen Needles 32GX4MM, 34 Global Ease Inject Pen Neeedles 31GX5MM, 34 Global Inject Ease Insulin Syringe/U100/0.3ML/29G X 1/2", 34 Global Inject Ease Insulin Syringe/U100/0.3ML/30G X 1/2", 34 Global Inject Ease Insulin Syringe/U100/0.3ML/30G X 5/16", 34 Global Inject Ease Insulin Syringe/U100/0.3ML/31G X 5/16", 34 Global Inject Ease Insulin Syringe/U100/0.5ML/28G X 1/2", 34 Global Inject Ease Insulin Syringe/U100/0.5ML/29G X 1/2", 34 Global Inject Ease Insulin Syringe/U100/0.5ML/30G X 1/2", 35 Global Inject Ease Insulin Syringe/U100/0.5ML/30G X 5/16", 35 Global Inject Ease Insulin Syringe/U100/0.5ML/31G X 5/16", 35 Global Inject Ease Insulin Syringe/U100/1ML/28G X 1/2", 35 Global Inject Ease Insulin Syringe/U100/1ML/29G X 1/2", 35 Global Inject Ease Insulin Syringe/U100/1ML/30G X 1/2", 35 Global Inject Ease Insulin Syringe/U100/1ML/30G X 5/16", 35 Global Inject Ease Insulin Syringe/U100/1ML/31G X 5/16", 35 Global Inject Ease Lancets 28G, 30 Global Inject Ease Lancets 30G, 30 Global Lancing Device, 35 Glucagen Hypokit, 12 Glucagon Emergency Kit, 12 Glucocom Autolink Telemonitoring System, 35 Glucocom Lancets 28G, 30 Glucocom Lancets 30G, 30 Glucocom Lancets 33G, 30 Glucolet 2 Automatic Lancing Device, 35 Glucopro Insulin Syringe/U100/0.3ML/30G X 1/2", 35 Glucopro Insulin Syringe/U100/0.3ML/30G X 5/16", 35 Glucopro Insulin Syringe/U100/0.3ML/31G X 5/16", 35 Glucopro Insulin Syringe/U100/0.5ML/30G X 1/2", 35 Glucopro Insulin Syringe/U100/0.5ML/30G X 5/16", 35 Glucopro Insulin Syringe/U100/0.5ML/31G X 5/16", 35 Glucopro Insulin Syringe/U-100/1ML/30G

X 1/2", 35 Glucopro Insulin Syringe/U-100/1ML/30G X 5/16", 35 Glucopro Insulin Syringe/U-100/1ML/31G X 5/16", 35 Glucose Control Normal, 30 Glucose Control Solution, 30 Glucosource Lancet Device, 35 Glucosource Lancets, 30 glyburide, 12 Glyburide, 12 glyburide micronized, 12 glyburide/metformin HCL, 12 glycine, 15 glycopyrrolate, 14 glydo, 9 Glyset, 12 Gmate Lancets 30G, 30 Gmate Lancing Device, 35 gnp adult aspirin low strength, 23, 42 Gnp Alcohol Swabs, 40 gnp aspirin, 23, 42 gnp aspirin low dose, 23, 42 Gnp Clickfine Pen Needle Universal/31GX5/16", 35 Gnp Clickfine Universal Pen Needles 31GX1/4", 35 Gnp Clickfine Universal Pen Needles 31GX5/16", 35 Gnp Daily Prenatal, 28, 44 gnp folic acid, 16, 44 Gnp Insulin Syringe/0.3ML/29G X 1/2", 35 Gnp Insulin Syringe/0.3ML/30G X 5/16", 35 Gnp Insulin Syringe/0.3ML/31G X 5/16", 35 Gnp Insulin Syringe/0.5ML/28G X 1/2", 35 Gnp Insulin Syringe/0.5ML/29G X 1/2", 35 Gnp Insulin Syringe/0.5ML/30G X 5/16", 35 Gnp Insulin Syringe/0.5ML/31G X 5/16", 35 Gnp Insulin Syringe/1ML/28G X 1/2", 35 Gnp Insulin Syringe/1ML/29G X 1/2", 35 Gnp Insulin Syringe/1ML/30G X 5/16", 35 Gnp Insulin Syringe/1ML/31G X 5/16", 35 gnp iron, 16, 45 Gnp Lancets, 30 Gnp Lancets 21G, 30 Gnp Lancets Micro Thin 33G, 30 Gnp Lancets Super Thin 30G, 30 Gnp Lancets Thin, 30 Gnp Lancets Thin 26G, 30 Gnp Micro Thin Lancets 33G, 30 gnp nicotine mini lozenge, 20, 46 gnp nicotine polacrilex, 20, 46 gnp nicotine polacrilex mini, 20, 46 Gnp Prenatal, 28, 44 Gnp Prenatal Vitamins, 28, 44 gnp slow release iron, 16, 45 Gnp Super Thin Lancets/30G, 30 Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 35 Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORT, 35

Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 35 Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 35 Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2", 35 Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 35 Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORT, 35 gnp vitamin d, 27, 47 gnp vitamin d maximum strength, 27, 47 gnp vitamin d super strength, 27, 47 gnp vitamin d3 extra strength, 27, 47 goodsense aspirin low dose, 23, 42 goodsense nicotine gum, 20, 46 Goodsense Prenatal Vitamins, 28, 44 grafco silver nitrate applicator, 9 grafco silver nitrate applicator 12", 9 Gralise, 20 Gralise Starter, 20 granisetron HCL, 14 Granisol, 14 green GLO lissamine greenophthalmic strips, 22 griseofulvin microsize, 2 griseofulvin ultramicrosize, 2 guanfacine ER, 19 guanfacine HCL, 6 Guanidine HCL, 21 Gynazole-1, 15

Haemolance Plus High Flow, 30 Haemolance Plus Low Flow, 30 Haemolance Plus Max Flow, 30 Haemolance Plus Pediatric Flow, 30 Halaven, 4 halobetasol propionate, 9 Halog, 9 halonate PAC, 9 haloperidol, 18 haloperidol decanoate, 18 haloperidol lactate, 18 Harvoni, 2 Havrix, 26, 45 Health Care Lancing Device, 35 Healthwise Alcohol Prep Pads, 40 Healthwise Lancets 30G, 30 Healthwise Lancing Pen, 35 Healthwise Mini Pen Needles 31GX6MM, 35 Healthwise Pen Needles 29GX12MM, 35 Healthwise SHORT Pen Needles 31GX8MM, 35 Healthwise Unifine Pentips Pen Needles 32GX4MM, 35 Healthy Accents Autolet Impression Lancing Device, 35 Healthy Accents Unifine Pentips Pen Needles 29GX12MM, 35 Healthy Accents Unifine Pentips Pen Needles 31GX5MM, 35 Healthy Accents Unifine Pentips Pen Needles 31GX6MM, 35 Healthy Accents Unifine Pentips Pen Needles 31GX8MM, 35 Healthy Accents Unifine Pentips Pen Needles 32GX4MM, 35 Healthy Accents Unilet Lancets Super Thin 30G, 30 healthy kids vitamin d3, 27, 47 Healthy Mama Be Well Rounded, 28 H heather, 11, 43 H&h Thinlet Lancets 26G, 30 hecoria, 4 H&h Thinlet Super Thin Lancets 30G, 30 Hectorol, 13 H-e-b IN Control Pen Needles Helixate FS, 17 31GX5MM, 35 hematinic plus vitamins/minerals, 16 H-e-b IN Control Pen Needles hematinic/folic acid, 16 31GX6MM, 35 hematogen, 16 H-e-b IN Control Pen Needles hematogen forte, 16 31GX8MM, 35 hemocyte-f, 16 H-e-b IN Control Pen hemocyte-plus, 16 Needles/Nano/32GX4MM, 35 Hemofil M, 17 H-e-b IN Control Unifine Pentips Plus hep flush-10, 17 31GX5MM, 35 Hepagam B, 42 H-e-b IN Control Unifine Pentips Plus heparin lock, 17 32GX4MM, 35 heparin lock flush, 17 H-e-b Incontrol Advanced Lancing heparin lock flush for flushing vascular Device, 35 access devices, 17 H-e-b Incontrol Lancets Micro Thin 33G, heparin lock flush/NACL for flushing 30 vascular access devices, 17 H-e-b Incontrol Lancets Super Thin 30G, heparin sodium, 17 30 heparin sodium dcu, 17 H-e-b Incontrol Lancets Ultra Thin 28G, heparin sodium lock flush, 17 30 heparin sodium/D5W, 17 H-e-b Incontrol Pen Needles 29GX12MM, heparin sodium/NACL 0.9%, 17 35 heparin sodium/sodium chloride 0.9% H.p. Acthar, 13 premix, 17 Haemolance, 30 Herceptin, 4 Haemolance Low Flow Lancets, 30 hetastarch 6%/NACL, 17 Haemolance Plus, 30

Hetlioz, 19 Hexalen, 3 Hiberix, 26, 45 high potency iron, 16, 45 High Potency Iron, 16, 46 Hizentra, 42 HM aspirin, 23, 43 HM aspirin EC, 23, 43 HM aspirin EC low dose, 23, 43 HM folic acid, 16, 44 HM iron, 16, 46 HM iron slow release, 16, 46 HM Lancets Micro Thin 33G, 30 HM Lancets Ultra Thin 30G, 30 HM nicotine polacrilex, 20, 46 HM nicotine transdermal system, 20, 46 HM nicotine transdermal system step 3, 20, 46 HM One Daily Prenatal Combo, 28, 45 HM Prenatal, 28, 45 HM slow release iron, 16, 46 HM vitamin d, 27, 47 HM vitamin d3, 27, 47 HM Vitamin D3, 27, 47 homatropaire, 22 homatropine HBR, 22 Horizant, 20 Humalog, 12 Humalog Kwikpen, 12 Humalog Mix 50/50, 12 Humalog Mix 50/50 Kwikpen, 12 Humalog Mix 75/25, 12 Humalog Mix 75/25 Kwikpen, 12 human albumin grifols, 17 Humate-p, 17 Humira, 24 Humira Pediatric Crohns Disease Starter Pack, 24 Humira Pen, 24 Humira Pen-crohns Diseasestarter, 24 Humira Pen-psoriasis Starter, 24 Humulin 70/30, 12 Humulin 70/30 Kwikpen, 12 Humulin N, 12 Humulin N Kwikpen, 12 Humulin R, 12 Humulin R U-500 (concentrated), 12 Hy-vee Lancets, 30 Hy-vee Thin Lancets, 30 Hycamtin, 5 hydralazine HCL, 6 hydrochlorothiazide, 7 hydrocodone bitartrate/acetaminophen, 23 hydrocodone bitartrate/chlorpheniramine maleate/PSE, 25 hydrocodone bitartrate/homatropine methylbromide, 25 hydrocodone polistirex/chlorpheniramine polistirex, 25 hydrocodone/acetaminophen, 23 Hydrocodone/Acetaminophen, 24 hydrocodone/homatropine, 25 hydrocodone/ibuprofen, 23 hydrocort ene 100MG, 14 hydrocortisone, 9, 10, 14 hydrocortisone acetate/aloe, 9 hydrocortisone acetate/lidocaine HCL, 14

hydrocortisone acetate/pramoxine, 14 hydrocortisone butyrate, 9 hydrocortisone butyrate (lipid), 9 hydrocortisone butyrate (lipophilic), 9 hydrocortisone IN absorbase, 9 hydrocortisone valerate, 9 hydrocortisone/acetic acid, 22 hydromet, 25 hydromorphone HCL, 23 hydromorphone HCL dosette, 23 hydromorphone HCL ER, 23 Hydromorphone HCL ER, 24 Hydromorphone HCL/Sodium Chloride, 24 hydroxychloroquine sulfate, 3 hydroxyurea, 5 hydroxyzine HCL, 18 hydroxyzine pamoate, 18 Hydroxyzine Pamoate, 18 hyolev mb, 15 hyomax-SL, 14 hyophen, 15 hyoscyamine sulfate, 14 hyoscyamine sulfate ER, 14 hyoscyamine sulfate odt, 14 hyoscyamine sulfate SR, 14 hyosyne, 14 hypercare, 9 Hyperhep B S/D, 42 Hyperrab S/D, 42 Hyperrho S/D, 42 Hyperrho S/D Mini-dose, 42 Hypolance AST Lancing Kit, 35

I ibandronate sodium, 12 Ibrance, 5 ibudone, 23 ibuprofen, 24 ibuprofen lysine, 24 ibutilide fumarate, 6 Iclusig, 5 idarubicin HCL, 3 Idelvion, 17 iferex 150, 16, 45 iferex 150 forte, 16 Ifex, 3 ifosfamide, 3 Ifosfamide, 3 Ilaris, 24 Ilevro, 22 ilotycin, 21 imatinib mesylate, 4 Imbruvica, 5 imipenem/cilastatin, 3 imipramine HCL, 18 imipramine pamoate, 18 imiquimod, 9 Imovax Rabies (h.d.c.v.), 26 Implanon, 11, 44 IN Touch Diabetes Management Software, 30 IN Touch Lancing Device, 35 IN Touch Sterile Lancets 30G, 30 Inatal Advance, 28 Inatal GT, 28 Inatal Ultra, 28 Increlex, 13 Incruse Ellipta, 25

indapamide, 7 Inderal XL, 6 indigo carmine, 41 indiomin mb, 15 indocyanine green, 41 indomethacin, 24 indomethacin ER, 24 Infanrix, 26, 45 inflammacin, 24 infuvite, 27 infuvite adult, 27 infuvite pediatric, 27 Inlyta, 5 Innopran XL, 6 Inspirachamber/Anti-static Valved/Mouthpiece, 40 Inspirachamber/Large, 40 Inspirachamber/Soothermask/Inspiramas k/Medium, 40 Inspirachamber/Soothermask/Inspiramas k/Small, 40 Inspirease Bags, 40 Inspirease Drug Delivery System, 40 Inspirease Mouthpiece, 40 Inspirease Reservoir Bags, 40 Insulin Syringe/0.3ML/29G X 1", 35 Insulin Syringe/0.3ML/29G X 1/2", 35 Insulin Syringe/0.3ML/30G X 5/16", 35 Insulin Syringe/0.3ML/31G X 5/16", 35 Insulin Syringe/0.5ML/27G X 1/2", 35 Insulin Syringe/0.5ML/28G X 1/2", 35 Insulin Syringe/0.5ML/29G X 1/2", 35 Insulin Syringe/0.5ML/30G X 1/2", 35 Insulin Syringe/0.5ML/30G X 5/16", 35 Insulin Syringe/0.5ML/31G X 5/16", 35 Insulin Syringe/1ML/28G X 1/2", 35 Insulin Syringe/1ML/29G X 1/2", 35 Insulin Syringe/1ML/30G X 5/16", 35 Insulin Syringe/1ML/31G X 5/16", 35 Insulin Syringe/U-100/0.3ML/29G X 1/2", 35 Insulin Syringe/U-100/0.5ML/28G X 1/2", 35 Insulin Syringe/U-100/0.5ML/29G X 1/2", 35 Insulin Syringe/U-100/1ML/28G X 1/2", 35 Insulin Syringe/U-100/1ML/29G X 1/2", 35 Insulin Syringe/U-100/1ML/30G X 5/16", 35 Insulin Syringe/U-100/1ML/31G X 5/16", 35 Insupen 33GX4MM, 35 Insupen Pen Needles 32G X4MM, 35 Insupen Sensitive 32GX6MM, 35 Insupen Sensitive 32GX8MM, 35 Insupen Ultrafin 29GX12MM, 35 Insupen Ultrafin 30GX8MM, 35 Insupen Ultrafin 31GX6MM, 35 Insupen Ultrafin 31GX8MM, 35 Intelence, 2 intralipid, 41 Intron A, 5 Intron A W/Diluent, 5 introvale, 11, 43 Invanz, 3 Invega Sustenna, 19

Invega Trinza, 19 Invirase, 2 Invokana, 12 Iopidine, 22 Ipol Inactivated IPV, 26, 45 ipratropium bromide, 25(2) ipratropium bromide/albuterol sulfate, 25 irbesartan, 6 irbesartan/hydrochlorothiazide, 7 irinotecan, 5 Irinotecan, 5 iron, 16, 45 Iron, 17, 46 Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc, 16 Iron Chews Pediatric, 17, 46 iron slow release, 16, 45 iron supplement, 16, 46 iron supplement childrens, 16, 46 Iron Up, 17, 46 Isentress, 2 isolyte-m/dextrose 5%, 41 Isolyte-s, 42 isoniazid, 2 Isoniazid, 2 Isopto Carbachol, 22 isosorbide dinitrate, 5 Isosorbide Dinitrate, 5 isosorbide mononitrate, 5 isosorbide mononitrate ER, 5 isosulfan blue, 41 isotonic gentamicin, 2 isradipine, 6 Istodax, 5 itraconazole, 2 ivermectin, 3 Ixempra Kit, 4 Ixiaro, 26

J Jadenu, 42 Jakafi, 5 jantoven, 17 Janumet, 12 Janumet XR, 12 Januvia, 12 Jardiance, 12 jencycla, 11, 43 Jetrea, 22 jevantique LO, 10 Jevtana, 4 jinteli, 10 jolessa, 11, 43 jolivette, 11, 43 juleber, 11, 43 junel 1.5/30, 11, 43 junel 1/20, 11, 43 junel FE 1.5/30, 11, 43 junel FE 1/20, 11, 43 junel FE 24, 11, 43 just d, 27, 47 Juxtapid, 7

K k-effervescent, 41 K-phos, 42 k-prime, 41 k-sol, 41 k-tan plus, 16

k-vescent, 41 k2k pain relieving patch, 9 Kadcyla, 4 kaitlib FE, 11, 43 Kalbitor, 17 Kaletra, 2 Kalydeco, 26 Kanuma, 13 karidium, 41, 44 karigel, 18 karigel-n, 18 kariva, 11, 43 KCL 0.075%/D5W/NACL 0.45%, 41 KCL 0.15%/D5W/ NACL 0.3%, 41 KCL 0.15%/D5W/NACL 0.2%, 41 KCL 0.15%/D5W/NACL 0.45%, 41 KCL 0.15%/D5W/NACL 0.9%, 41 KCL 0.3%/D5W/NACL 0.45%, 41 kedbumin, 17 kelnor 1/35, 11, 43 kendall sodium chloride flush, 41 Kepivance, 5 Ketek, 3 Ketocare, 42 ketoconazole, 2, 8 ketodan, 8 Ketone Test Strips, 42 ketoprofen, 24 ketorolac tromethamine, 22, 24 Ketostix, 42 Keveyis, 7 kimidess, 11, 43 Kineret, 24 Kinney Lancets, 30 Kinney Thin Lancets, 30 Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16", 35 Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16", 35 Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16", 35 Kinray Insulin Syringe/0.5ML/29G X 1/2", 35 Kinrix, 26, 45 kionex, 41 klofensaid II, 8 klor-CON, 41 klor-CON 10, 41 klor-CON 8, 41 klor-CON m10, 41 Klor-CON M15, 42 klor-CON m20, 41 klor-CON sprinkle, 41 klor-CON/EF, 41 kls aspirin EC, 23, 42 kls aspirin low dose, 23, 42 kls quit2, 20, 46 kls quit4, 20, 46 Kmart Valu Plus Insulin Syringe/0.3ML/30G, 35 Kmart Valu Plus Insulin Syringe/0.5ML/29G, 35 Kmart Valu Plus Insulin Syringe/0.5ML/30G, 35 Kmart Valu Plus Insulin Syringe/1ML/29G, 35 Kmart Valu Plus Insulin Syringe/1ML/30G, 35

Koate-dvi, 17 Kogenate FS, 17 Kogenate FS Bio-set, 17 Kombiglyze XR, 12 kp aspirin, 23, 42 kp ferrous gluconate, 16, 46 kp ferrous sulfate, 16, 46 kp folic acid, 16, 44 Kp Prenatal Multivitamins, 28, 45 kp vitamin d, 27, 47 Kroger Insulin Syringe/0.3ML/29G X 1/2", 35 Kroger Insulin Syringe/0.3ML/30G X 5/16", 35 Kroger Insulin Syringe/0.3ML/31G X 5/16", 35 Kroger Insulin Syringe/0.5ML/29G X 1/2", 35 Kroger Insulin Syringe/0.5ML/30G X 5/16", 35 Kroger Insulin Syringe/0.5ML/31G X 5/16", 35 Kroger Insulin Syringe/1ML/29G X 1/2", 35 Kroger Insulin Syringe/1ML/30G X 5/16", 35 Kroger Insulin Syringe/1ML/31G X 5/16", 35 Kroger Lancets, 30 Kroger Lancets 21G, 30 Kroger Lancets Micro Thin33G, 30 Kroger Lancets Super Thin, 30 Kroger Lancets Thin, 30 Kroger Lancets Thin 26G, 30 Kroger Lancets Ultrathin 30G, 30 Kroger Lancing Device, 35 Kroger Pen Needles 29G X 12MM, 35 Kroger Pen Needles 31G X 8MM, 35 Kroger Pen Needles 31GX1/4", 35 Krystexxa, 24 kurvelo, 11, 43 Kuvan, 13 Kyprolis, 5

L l-cysteine HCL, 41 labetalol HCL, 6 Lacrisert, 21 lactated ringers, 41 lactated ringers dextrose 5% viaflex, 41 lactated ringers irrigation, 41 lactated ringers viaflex, 41 lactic acid, 9 lactic acid e, 9 lactic acid w/vitamin e, 9 lactulose, 14(2) Lamictal, 19 Lamisil, 2 lamivudine, 2 lamivudine/zidovudine, 2 lamotrigine, 19 lamotrigine ER, 19 lamotrigine odt, 19 lamotrigine titration, 19 Lancet Device Adjustable, 35 Lancet Device With Ejector, 35 Lancet Transporter Case, 35 Lancets, 30 Lancets 26G Twist Top, 30

Lancets 28G, 30 Lancets 30G, 30 Lancets 30G Twist Top, 30 Lancets 30G/Twist Top, 30 Lancets 31G Twist Top, 30 Lancets 33G Universal Design, 30 Lancets Bullseye Safety, 30 Lancets Micro Thin 33G, 30 Lancets Safety Seal 21G, 30 Lancets Safety Seal 26G, 30 Lancets Safety Seal 28G, 30 Lancets Safety Seal 30G, 30 Lancets Super Thin 28G, 30 Lancets Thin, 30 Lancets Twist Top, 30 Lancets Ultra Fine, 30 Lancets Ultra Thin, 30 Lancets Ultra Thin 30G, 30 Lancing Device, 36 Lancing Device Adjustable, 36 lanolin, 41 lansoprazole, 14 lansoprazole/amoxicillin/clarithromycin, 14 Lantus, 12 Lantus Solostar, 12 Lanzo, 36 larin 1.5/30, 11, 43 larin 1/20, 11, 43 larin 24 FE, 11, 43 larin FE 1.5/30, 11, 43 larin FE 1/20, 11, 43 Lastacaft, 22 latanoprost, 21 latrix, 9 Latuda, 19 layolis FE, 11, 43 Lazanda, 24 Leader Advanced Lancing Device, 36 Leader Insulin Syringe/0.3ML/29G X 1/2", 36 Leader Insulin Syringe/0.3ML/30G X 5/16", 36 Leader Insulin Syringe/0.3ML/31G X 5/16", 36 Leader Insulin Syringe/0.5ML/28G X 1/2", 36 Leader Insulin Syringe/0.5ML/29G X 1/2", 36 Leader Insulin Syringe/0.5ML/30G X 5/16", 36 Leader Insulin Syringe/0.5ML/31G X 5/16", 36 Leader Insulin Syringe/1ML/28G X 1/2", 36 Leader Insulin Syringe/1ML/29G X 1/2", 36 Leader Insulin Syringe/1ML/30G X 5/16", 36 Leader Insulin Syringe/1ML/31G X 5/16", 36 Leader Lancets Colored, 30 Leader Super Thin Lancet, 30 Leader Thin Lancets, 30 Leader Unifine Pentips Plus/Mini/31GX3/16", 36 Leader Unifine Pentips Plus/SHORT/31GX5/16", 36

Leader Unifine Pentips/Mini/31GX3/16", 36 Leader Unifine Pentips/Nano/32GX5/32", 36 Leader Unifine Pentips/Plus/32GX5/32", 36 leena, 11, 43 leflunomide, 24 Lemtrada, 20 Lenvima 10MG Daily Dose, 5 Lenvima 14MG Daily Dose, 5 Lenvima 20MG Daily Dose, 5 Lenvima 24MG Daily Dose, 5 lessina, 11, 43 Letairis, 7 letrozole, 4 leucovorin calcium, 5 Leucovorin Calcium, 5 Leukeran, 3 Leukine, 17 leuprolide acetate, 4 levalbuterol, 25 levalbuterol HCL, 25 Levatol, 6 Levemir, 12 Levemir Flexpen, 12 Levemir Flextouch, 12 levetiracetam, 19 levetiracetam ER, 19 levo-t, 13 levobunolol HCL, 21 levocarnitine, 13 levocetirizine dihydrochloride, 25 levofloxacin, 1, 21 levofloxacin IN D5W, 1 levoleucovorin, 5 Levoleucovorin, 5 levoleucovorin calcium, 5 levonest, 11, 43 levonorgestrel, 11, 43 Levonorgestrel, 11, 44 levonorgestrel and ethinyl estradiol, 11, 43 levonorgestrel/ethinyl estradiol, 11, 43 levora 0.15/30-28, 11, 43 Levorphanol Tartrate, 24 levothyroxine sodium, 13 levoxyl, 13 Lexiva, 2 Lialda, 15 Liberty Blood Glucose Meter, 30 Liberty Glucose Control Mid, 30 Liberty Glucose Control Normal, 30 Liberty Medical Lancets 30G, 30 Liberty Mini Lancing Device, 30 Liberty Test Strips, 30 lidazone HC, 14 lidenza patch, 9 lidocaine, 9 lidocaine HCL, 6, 9, 24 lidocaine HCL IN D5W, 6 lidocaine HCL jelly, 9 lidocaine HCL viscous, 18 lidocaine HCL/dextrose, 6 lidocaine HCL/hydrocortisone acetate, 14 lidocaine viscous, 18 lidocaine-prilocaine-cream base, 9 lidocaine/epinephrine, 24

lidocaine/prilocaine, 9 lidodextrapine, 9 lidopin, 9 Lifescan Unistik 2 Deep Penetration, 30 Lifescan Unistik II Lancets, 30 Liletta, 11, 44 lincomycin HCL, 3 lindane, 9 linezolid, 3 Linezolid, 3 Linzess, 15 liothyronine sodium, 13 lipodox, 3 lipodox 50, 3 liposyn iii, 41 lisinopril, 6 lisinopril/hydrochlorothiazide, 7 lissamine green, 22 Lite Touch Lancets, 30 Lite Touch Lancing Device, 36 Lite Touch Lancing Pen, 36 Lite Touch Pen Needles/31G X 3/16", 36 Liteaire, 40 Litetouch Insulin Syringe/0.3ML/29G X 1/2", 36 Litetouch Insulin Syringe/0.3ML/30G X 5/16", 36 Litetouch Insulin Syringe/0.3ML/31G X 5/16", 36 Litetouch Insulin Syringe/0.5ML/30G X 5/16", 36 Litetouch Insulin Syringe/0.5ML/31G X 5/16", 36 Litetouch Insulin Syringe/1ML/30G X 5/16", 36 Litetouch Insulin Syringe/U100/0.5ML/28G X 1/2", 36 Litetouch Insulin Syringe/U100/0.5ML/29G X 1/2", 36 Litetouch Insulin Syringe/U-100/1ML/28G X 1/2", 36 Litetouch Insulin Syringe/U-100/1ML/29G X 1/2", 36 Litetouch Insulin Syringe/U-100/1ML/31G X 5/16", 36 Litetouch Lancets Micro Thin 33G, 30 Litetouch Pen Needles 29GX12.7MM, 36 Litetouch Pen Needles 31G X 6MM, 36 Litetouch Pen Needles 31GX8MM SHORT, 36 Lithium, 19 lithium carbonate, 18 lithium carbonate ER, 18 Livalo, 7 Live Better Advanced Lancing Device, 36 Live Better Lancet Super Thin 30G, 30 Live Better Lancet Ultra Thin 28G, 30 Live Better Pen Needles 29G X 12MM, 36 Live Better Pen Needles 31G X 12MM, 36 Live Better Pen Needles 31G X 6MM, 36 livixil PAK, 9 LO Loestrin FE, 11, 44 Locoid, 9 lofene, 14 lokara, 9 lomedia 24 FE, 11, 43

Lomustine, 3 Longs Insulin Syringe/0.5ML/31G X 5/16", 36 Longs Lancets Standard, 30 Longs Lancets Thin, 30 Longs Lancets Ultra Thin, 30 Lonsurf, 5 loperamide HCL, 14 lopreeza, 10 lorazepam, 18 lorazepam intensol, 18 lorcet, 23 lorcet HD, 23 lorcet plus, 23 lorenza, 9 lortab, 23 loryna, 11, 43 Lorzone, 21 losartan potassium, 6 losartan potassium/hydrochlorothiazide, 7 Lotemax, 21 lovastatin, 7 low-ogestrel, 11, 43 loxapine, 18 loxapine succinate, 18 LP lite PAK, 10 Lucentis, 22 ludent, 41, 44 Lufyllin, 25 Lumigan, 21 Lumizyme, 13 Lupron Depot, 4 Lupron Depot-PED, 13 lutera, 11, 43 Lynparza, 5 Lyrica, 19 lysiplex plus, 27 Lysodren, 4 lyza, 11, 43

M M-m-r II, 26, 45 M-vit, 28, 44 Macnatal CN DHA, 28 Macugen, 22 mafenide acetate, 9 Magellan Insulin Safety Syringe/U100/0.3ML/29G X 1/2", 36 Magellan Insulin Safety Syringe/U100/0.3ML/30G X 5/16", 36 Magellan Insulin Safety Syringe/U100/0.5ML/29G X 1/2", 36 Magellan Insulin Safety Syringe/U100/0.5ML/30G X 5/16", 36 Magellan Insulin Safety Syringe/U100/1ML/29G X 1/2", 36 Magellan Insulin Safety Syringe/U100/1ML/30G X 5/16", 36 magnesium chloride, 41 magnesium sulfate, 41 Makena, 12 malathion, 9 mannitol, 7 Maprotiline HCL, 18 margesic, 22 marlissa, 11, 43 Marplan, 18 Marqibo, 4

marten-TAB, 22 Mask Vortex/Baby Whirl Duckling, 40 Mask Vortex/Child/Frog, 40 Mask Vortex/Spinner The Duck, 40 Mask Vortex/Toddler/Lady Bug, 40 Matulane, 5 matzim LA, 6 Maxi-comfort Insulin Syringe/U100/0.5ML/28GX1/2", 36 Maxi-comfort Insulin Syringe/U100/1ML/28GX1/2", 36 maximum d3, 27, 47 Maxipime, 1 MD-gastroview, 41 me/naphos/mb/hyo 1, 15 meclizine HCL, 14 Meclofenamate Sodium, 24 Medic Insulin Syringe/0.3ML/30G X 5/16", 36 Medic Insulin Syringe/0.5ML/30G X 5/16", 36 Medical Provider EZ Flu Shot 2013-2014, 26, 45 Medical Provider EZ Flu Shot 2014-2015, 26, 45 Medical Provider EZ Flu Shot 2015-2016, 26, 45 Medical Provider EZ Flu Shot PF 20132014, 26, 45 Medical Provider EZ Flu Shot PF 20142015, 26, 45 Medical Provider Single Use EZ Flu Shot, 26, 45 Medichoice Pre-set Safety Lancet Dual Use, 30 Medichoice Pre-set Safety Lancet Low Flow, 30 Medichoice Pre-set Safety Lancet Medium Flow, 30 Medichoice Pre-set Safety Lancet Moderate Flow, 30 Medichoice Safety Lancet Extra, 30 Medichoice Safety Lancet Normal, 30 Medicine Shoppe Lancets, 30 Medicine Shoppe Lancets Thin, 30 Medicine Shoppe Pen Needles 29G X 12MM, 36 Medicine Shoppe Pen Needles 31G X 6MM, 36 Medicine Shoppe Pen Needles 31G X 8MM, 36 Medisense Thin Lancets, 30 Medlance Plus Extra Lancets 21G, 30 Medlance Plus Lancets, 30 Medlance Plus Lancets Lite 25G, 30 Medlance Plus Lite Lancets 25G, 30 Medlance Plus Special Lancets 0.8MM, 30 Medlance Plus Superlite 30G, 30 Medlance Plus Superlite 30G/Comfort Max, 30 Medlance Plus Universal Lancets 21G, 30 Medlance Plus/Lite 25G, 30 Medlance/Extra, 30 Medlance/Lite, 30 Medlance/Universal, 31 medroxyprogesterone acetate, 11, 12, 43

mefenamic acid, 24 mefloquine HCL, 3 Mefoxin, 1 mega-c/a plus, 26 megestrol acetate, 4, 12 Meijer Alcohol Swabs Extra-thick, 40 meijer aspirin EC, 23, 42 Meijer Color Lancets Universal 33G, 31 meijer ferrous sulfate, 16, 46 Meijer Lancets, 31 Meijer Lancets Thin, 31 Meijer Lancets Universal 33G, 31 Meijer Pen Needles 29G X 12MM, 36 Meijer Pen Needles 31G X 6MM, 36 Meijer Pen Needles 31G X 8MM, 36 Meijer Super Thin Lancets, 31 Mekinist, 5 meloxicam, 24 melphalan hydrochloride, 3 memantine HCL, 20 memantine HCL titration PAK, 20 memantine hydrochloride, 20 Menactra, 26, 45 Menest, 10 Menhibrix, 26 Menomune-a/C/Y/W-135, 26, 45 Mentax, 8 Menveo, 26, 45 meperidine HCL, 23 Mephyton, 27 meprobamate, 18 mercaptopurine, 3 meropenem, 3 mesalamine, 14 mesna, 5 Mesnex, 5 Mestinon, 21 metadate ER, 19 Metaproterenol Sulfate, 25 metaxall, 21 metaxalone, 21 Metaxalone, 21 metformin HCL, 12 metformin HCL ER, 12 methadone HCL, 23 methadone HCL intensol, 23 methadose, 23 methamphetamine HCL, 19 methazolamide, 7 methenamine hippurate, 15 methenamine mandelate, 15 methergine, 22 methimazole, 13 Methitest, 10 methocarbamol, 21 methotrexate, 4 methotrexate sodium, 4 Methotrexate Sodium, 4 methoxsalen, 8 methscopolamine bromide, 14 Methyclothiazide, 7 methyldopa, 6 Methyldopate HCL, 6 methylene blue, 41 methylergonovine maleate, 22 methylphenidate HCL, 19 methylphenidate HCL CD, 19 methylphenidate HCL ER, 19

Methylphenidate HCL ER, 19 methylphenidate HCL SR, 19 methylphenidate hydrochloride, 19 methylprednisolone, 10 methylprednisolone acetate, 10 methylprednisolone dose pack, 10 methylprednisolone sodiumsuccinate, 10 methyltestosterone, 10 Metipranolol, 21 metoclopramide HCL, 14 metoclopramide odt, 14 metolazone, 7 metoprolol succinate ER, 6 metoprolol tartrate, 6 Metoprolol Tartrate, 6 metoprolol/hydrochlorothiazide, 7 metronidazole, 3, 8 metronidazole IN NACL 0.79%, 3 metronidazole vagin*l, 15 mexiletine HCL, 6 Miacalcin, 13 Micrhogam Ultra-filtered Plus, 42 Microchamber, 40 microgestin 1.5/30, 11, 43 microgestin 1/20, 11, 43 microgestin 24 FE, 11, 43 microgestin FE, 11, 43 microgestin FE 1.5/30, 11, 43 Microlet Lancets, 31 micronized colestipol HCL, 7 Microspacer, 40 Microtainer Safety Flow Lancet/Sterile/Single-use, 31 midodrine HCL, 7 migryl, 9 milrinone IN dextrose, 5 milrinone lactate, 5 mimvey, 10 mimvey LO, 10 Minastrin 24 FE, 11, 44 Mini Lancing Device, 36 miniprin low dose, 23, 42 minitran, 5 minocycline HCL, 1 minocycline HCL ER, 1 minoxidil, 6 Mirapex ER, 20 Mirena, 11, 44 mirtazapine, 18 mirtazapine odt, 18 misoprostol, 14 Mission Prenatal, 28, 45 Mission Prenatal HP, 28, 44 mitomycin, 3 Mitomycin, 3 mitoxantrone HCL, 3 MM aspirin, 23, 43 modafinil, 19 moderiba, 2 Moderiba, 2 Moderiba 1200 Dose Pack, 2 Moderiba 800 Dose Pack, 2 moexipril HCL, 6 moexipril/hydrochlorothiazide, 7 Molindone Hydrochloride, 19 mometasone furoate, 9, 25 mondoxyne nl, 1 mono-linyah, 11, 43

Monoclate-p, 17 Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML, 36 Monoject Insulin Syringe/1ML, 36 Monoject Insulin Syringe/1ML/31G X 5/16", 36 Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8", 36 Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2", 36 Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2", 36 Monoject Insulin Syringe/Perm Needle/U100/0.5ML/28G X 1/2", 36 Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2", 36 Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2", 36 Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2", 36 Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2", 36 Monoject Insulin Syringe/Softpack/1ML/27G X 1/2", 36 Monoject Insulin Syringe/Softpack/U100/0.5ML/28G X 1/2", 36 Monoject Insulin Syringe/U100/0.3ML/30G X 5/16", 36 Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 36 Monoject Insulin Syringe/U100/0.5ML/30G X 5/16", 36 Monoject Insulin Syringe/U-100/1ML/28G X 1/2", 36 Monoject Insulin Syringe/U-100/1ML/30G X 5/16", 36 monoject pharma grade flush syringe, 41 monoject pharma grade flush syringe/heparin lock, 17 monoject prefill advanced heparin lock flush, 17 monoject sodium chloride flush, 41 Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 36 Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 36 Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 36 Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 36 Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 36 Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 36 Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 36 Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2", 36 Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 36 Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 36 Monojector End CAPS, 36 Monojector Opd End CAPS, 36 Monolet Lancets, 31 Monolet Opd Lancets, 31 Monolettor Safety Lancets, 31 mononessa, 11, 43

Mononine, 17 Monovisc, 21 montelukast sodium, 25 Monurol, 15 Moore MED Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 36 Moore MED Monoject Insulin Syringe/U100/0.5ML/29G X 1/2", 36 Moore MED Monoject Insulin Syringe/U100/1ML/28G X 1/2", 36 Moore MED Monoject Insulin Syringe/U100/1ML/29G X 1/2", 36 morgidox 1X100MG, 1 morgidox 2X100MG, 1 morphine sulfate, 23 Morphine Sulfate, 24 morphine sulfate ER, 23 Morphine Sulfate ER, 24 morrhuate sodium, 41 Moviprep, 14 Moxatag, 1 Moxeza, 21 moxifloxacin HCL, 1 Mozobil, 17 MS Insulin Syringe/0.3ML/29G X 1/2", 36 MS Insulin Syringe/0.3ML/30G X 5/16", 36 MS Insulin Syringe/0.3ML/31G X 5/16", 36 MS Insulin Syringe/0.5ML/29G X 1/2", 36 MS Insulin Syringe/0.5ML/30G X 5/16", 36 MS Insulin Syringe/0.5ML/31G X 5/16", 36 MS Insulin Syringe/1ML/29G X 1/2", 36 MS Insulin Syringe/1ML/30G X 5/16", 36 MS Insulin Syringe/1ML/31G X 5/16", 36 mult-vitamin/fluoride, 27 Multaq, 6 Multi Prenatal, 28, 44 multi vitamin/fluoride, 27 Multi-lancet Device, 36 Multi-lancet Device 2, 36 multi-vit/fluoride, 27 multi-vit/iron/fluoride, 27 multi-vitamin/fluoride, 27 multi-vitamin/fluoride/iron, 27 multitrace-4 concentrate, 41 multitrace-5 concentrate, 41 multivitamin with fluoride, 27 multivitamin/fluoride, 27 multivitamins/fluoride, 27 mupirocin, 8 mupirocin calcium, 8 Mustargen, 3 MVC-fluoride, 28 my way, 11, 43 Myalept, 13 Mycamine, 2 mycophenolate mofetil, 4 mycophenolic acid DR, 4 mydral, 22 myferon 150, 16, 46 myferon 150 forte, 16 Myglucohealth Mgh Softlance Lancets 30G, 31 Mykidz Iron 10, 17, 46 Myleran, 3

Mynatal Advance, 28 Mynatal Plus, 28 Mynatal Ultracaplet, 28 Mynatal-z, 28 Mynate 90 Plus, 28 mynephrocaps, 27 Myobloc, 21 myorisan, 8 Myozyme, 13 Myrbetriq, 15 myzilra, 11, 43

N n-acetyl-l-cysteine, 41 Nabi-HB, 42 nabumetone, 24 nadolol, 6 nadolol/bendroflumethiazide, 7 nafcillin sodium, 1 nafrinse, 41, 44 nafrinse drops, 41, 44 naftifine hydrochloride, 8 Naglazyme, 13 nalbuphine HCL, 23 Nalfon, 24 naloxone HCL, 41 Naloxone HCL, 41 naltrexone HCL, 41 Namenda XR, 20 Namenda XR Titration Pack, 20 Naprelan, 24 naproxen, 24 Naproxen, 24 naproxen DR, 24 naproxen kit, 24 naproxen sodium, 24 naproxen sodium CR, 24 naproxen sodium ER, 24 naratriptan HCL, 24 Narcan, 42 Nascobal, 16 Nat-rul Prenatal Vitamins, 28, 45 nat-rul vitamin d, 27, 47 Natacyn, 21 Natazia, 11, 44 nateglinide, 12 natural vitamin d-3, 27, 47 Nebupent, 3 nebusal, 25 necon 0.5/35-28, 11, 43 necon 1/35, 11, 43 necon 7/7/7, 11, 43 nefazodone HCL, 18 Nefazodone HCL, 18 neo-polycin, 21 neo-polycin HC, 21 Neo-synalar, 8 neofrin, 22 neomycin sulfate, 2 neomycin/bacitracin/polymyxin, 21 neomycin/polymyxin b sulfates, 15 neomycin/polymyxin/bacitracin zinc, 21 neomycin/polymyxin/bacitracin/hydrocorti sone, 21 neomycin/polymyxin/dexamethasone, 21 neomycin/polymyxin/gramicidin, 21 neomycin/polymyxin/HC, 22 neomycin/polymyxin/hydrocortisone, 22 neostigmine methylsulfate, 21

nephronex, 27 Nessi Spacer/Large Mask, 40 Nessi Spacer/Mouthpiece, 40 Nessi Spacer/Small/MED Mask, 40 Netgroup Lancets, 31 neuac, 8 Neulasta, 17 Neulasta Onpro Kit, 17 Neumega, 17 Neupogen, 17 Neupro, 20 neutragard advanced, 18 neutral sodium fluoride, 18 Nevanac, 22 nevirapine, 2 Nevirapine, 2 nevirapine ER, 2 Nexavar, 5 Nexium, 14 Nexplanon, 11, 44 next choice one dose, 11, 43 Nexterone, 6 niacin ER, 7 niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper, 27 nicardipine HCL, 6 nicorelief, 20, 46 nicotine, 20, 46 nicotine mini lozenge, 20, 46 nicotine polacrilex, 20, 46 nicotine polacrilex refill, 20, 46 nicotine polacrilex starter kit, 20, 46 nicotine step 1, 20, 46 nicotine step 2, 20, 46 nicotine step 3, 20, 46 nicotine transdermal system, 20, 46 Nicotine Transdermal System, 20, 46 nicotine transdermal system step 1, 20, 46 nicotine transdermal system step 2, 20, 46 nicotine transdermal system step 3, 20, 46 Nicotrol Inhaler, 20, 46 Nicotrol Ns, 20, 46 nifedical XL, 6 nifedipine, 6 nifedipine ER, 6 nikki, 11, 43 Nilandron, 4 nimodipine, 6 Ninlaro, 5 Nipent, 5 nisoldipine, 6 Nitro-bid, 5 nitro-time, 5 nitrofurantoin, 15 nitrofurantoin macrocrystals, 15 nitrofurantoin monohydrate, 15 nitrofurantoin monohydrate/macrocrystals, 15 nitroglycerin ER, 5 nitroglycerin IN 5% dextrose, 5 nitroglycerin IN dextrose 5%, 5 nitroglycerin lingual, 5 Nitroglycerin Lingual, 5 nitroglycerin transdermal, 5 Nitromist, 5

Nitrostat, 5 nizatidine, 14 Nizatidine, 14 nora-be, 11, 43 Norditropin Cartridge, 13 Norditropin Flexpro, 13 Norditropin Nordiflex Pen, 13 norepinephrine bitartrate, 7 norethindrone, 11, 43 norethindrone & ethinyl estradiol ferrous fumarate, 11, 43 norethindrone acetate, 12 norethindrone acetate/ethinyl estradiol, 10, 11, 43 norethindrone acetate/ethinyl estradiol/ferrous fumarate, 11, 43 norgestimate/ethinyl estradiol, 11, 43 norlyroc, 11, 43 normal saline flush, 41 normal saline flush for flushing vascular access devices, 41 normal saline i.v. flush, 41 Noroxin, 1 Norpace CR, 6 nortrel 0.5/35 (28), 11, 43 nortrel 1/35, 11, 43 nortrel 7/7/7, 11, 43 nortriptyline HCL, 18 Nortriptyline HCL, 18 nortuss-DE, 25 Norvir, 2 norwich aspirin, 23, 42 Nova Safety Lancets 23G, 31 Nova Safety Lancets 28G, 31 Nova Sureflex Lancets, 31 Nova Sureflex Lancing Device, 36 Novaferrum Pediatric Drops, 17, 46 novarel, 13 Novofine 30GX8MM, 36 Novofine 32GX6MM, 36 Novofine Autocover 30GX8MM, 36 Novofine Plus 32GX4MM, 36 Novolin 70/30, 12 Novolin 70/30 Relion, 12 Novolin N, 12 Novolin N Relion, 12 Novolin R, 12 Novolin R Relion, 12 Novolog, 12 Novolog Flexpen, 12 Novolog Mix 70/30, 12 Novolog Mix 70/30 Prefilled Flexpen, 12 Novolog Penfill, 12 Novoseven, 17 Novoseven Rt, 17 Novotwist 30GX8MM, 36 Novotwist 32GX5MM, 36 Noxafil, 2 NP thyroid, 13 NP thyroid 60, 13 NP thyroid 90, 13 Nplate, 17 nu-iron 150, 16, 46 Nucala, 25 Nucynta, 24 Nucynta ER, 24 Nuedexta, 20 nufol, 16

nulev, 14 Nulojix, 4 nutrifac ZX, 27 nutrilipid, 41 nutrilyte, 41 nutrilyte II, 41 Nutropin AQ Nuspin 10, 13 Nutropin AQ Nuspin 20, 13 Nutropin AQ Nuspin 5, 13 Nutropin AQ Pen, 13 Nuvaring, 11, 44 Nuvigil, 19 nyamyc, 8 nystatin, 2, 8, 18 nystatin/triamcinolone, 8 nystop, 8

O Obizur, 17 Obstetrix EC, 28 ocella, 11, 43 Octagam, 42 octreotide acetate, 13 Ofev, 26 ofloxacin, 1, 21, 22 Ofloxacin, 1 Ogestrel, 11, 44 olanzapine, 18 olanzapine odt, 18 olanzapine/fluoxetine, 20 olopatadine HCL, 22, 25 Omeclamox-PAK, 14 omega-3-acid ethyl esters, 7 omeprazole, 14 omeprazole/sodium bicarbonate, 14 Omniflex Diaphragm, 44 On Call Lancets, 31 On Call Lancing Device, 36 On Call Plus Lancets, 31 On Call Plus Lancing Device, 36 Oncaspar, 3 ondansetron HCL, 14 ondansetron odt, 14 One A Day Womens Prenatal/DHA, 28 One A Day Womens Prenatal1, 28 One-a-day Womens Prenatal, 28, 45 Onetouch Club Lancets Fine Point, 31 Onetouch Combo Pack, 31 Onetouch Delica Lancets Extra Fine 33G, 31 Onetouch Delica Lancets Fine 30G, 31 Onetouch Delica Lancing Device, 31 Onetouch Finepoint Lancets, 31 Onetouch Lancets, 31 Onetouch Ping Meter Remote, 31 Onetouch Suresoft Lancing Device/18G, 31 Onetouch Suresoft Lancing Device/21G, 31 Onetouch Suresoft Lancing Device/28G, 31 Onetouch Ultra 2, 31 Onetouch Ultra Blue, 31 Onetouch Ultra Control, 31 Onetouch Ultra Mini, 31 Onetouch Ultralink System (DEC), 31 Onetouch Ultralink System (hex), 31 Onetouch Ultrasoft Lancets, 31 Onetouch Verio, 31

Onetouch Verio Control Solution High, 31 Onetouch Verio Flex Bloodglucose Monitoring System, 31 Onetouch Verio IQ Blood Glucose Monitoring System, 31 Onetouch Verio Mid Control Solution, 31 Onetouch Verio Sync Bloodglucose Monitoring System, 31 Onetouch Verio Test Strips, 31 Onfi, 19 Onglyza, 12 Onivyde, 5 Opana ER (crush Resistant), 24 opcicon one-step, 11, 43 Opdivo, 4 opium, 14 opium tincture, 14 Opsumit, 7 Optichamber Advantage, 40 Optichamber Diamond, 40 Optichamber Diamond/Largeface Mask, 40 Optichamber Diamond/Medium Face Mask, 40 Optichamber Diamond/Smallface Mask, 40 Optihaler, 40 Optihaler MDI Drug Delivery System, 40 Optimal D3 M, 27, 47 optimal-d, 27, 47 optimal-d pack, 27, 47 Options Gynol II vagin*l Contraceptive, 15, 44 opurity vitamin d, 27, 47 Oracea, 8 oralone, 18 Oravig, 18 Orencia, 24 Orenitram, 7 Orfadin, 13 orphenadrine citrate, 21 orphenadrine citrate ER, 21 Orphenadrine/Asa/Caffeine, 21 orsythia, 11, 43 Ortho Diaphragm Coil Spring Kit 100, 44 Ortho Diaphragm Coil Spring Kit 105, 44 Ortho Diaphragm Coil Spring Kit 50, 44 Ortho Diaphragm Flat Spring Kit 55, 44 Ortho Diaphragm Flat Spring Kit 60, 44 Ortho Diaphragm Flat Spring Kit 65, 44 Ortho Diaphragm Flat Spring Kit 70, 44 Ortho Diaphragm Flat Spring Kit 75, 44 Ortho Diaphragm Flat Spring Kit 80, 44 Ortho Diaphragm Flat Spring Kit 85, 44 Ortho Diaphragm Flat Spring Kit 90, 44 Ortho Diaphragm Flat Spring Kit 95, 44 ortho-CS 250, 26 ortho-est, 10 Orthovisc, 21 oscimin, 14 oscimin SR, 14 oscion cleanser, 8 osmitrol viaflex, 7 Osmoprep, 14 otic care, 22 oticin, 22 oxacillin sodium, 1

oxaliplatin, 3 oxandrolone, 10 oxaprozin, 24 Oxaydo, 24 oxazepam, 18 oxcarbazepine, 19 oxiconazole nitrate, 8 Oxistat, 8 Oxsoralen, 10 oxybutynin chloride, 15 oxybutynin chloride ER, 15 oxycodone HCL, 23 Oxycodone HCL ER, 24 oxycodone/acetaminophen, 23 oxycodone/aspirin, 23 oxycodone/ibuprofen, 23 Oxycontin, 24 oxymorphone hydrochloride, 23 oxymorphone hydrochloride ER, 23 oxytocin, 22 Oxytrol, 15 Ozurdex, 21

P PA Prenatal Formula, 28, 45 PA vitamin d-3, 27, 47 PA vitamin d-3 gummy, 27, 47 pacerone, 6 pacl*taxel, 4 Pacl*taxel, 4 paliperidone ER, 18 pamidronate disodium, 12 Pamidronate Disodium, 12 Pancrelipase, 14 pancuronium bromide, 21 Panda Mask Large, 40 Panda Mask Medium, 40 Panda Mask Small, 40 Panretin, 10 pantoprazole sodium, 14 papaverine HCL, 7 Paragard Intrauterine Copper Contraceptive T380a, 11 parcaine, 22 paricalcitol, 13 paroex, 18 paromomycin sulfate, 2 paroxetine HCL, 18 paroxetine HCL ER, 18 Paser, 2 Pataday, 22 Paxil, 18 PC Unifine Pentips 29G X 1/2", 37 PC Unifine Pentips 31G X 5MM Mini, 37 PC Unifine Pentips 31G X 6MM Ultra SHORT, 37 PC Unifine Pentips 31G X 8MM SHORT, 37 PCE, 1 pedi-dri, 8 Pediarix, 26, 45 Pediatric Panda Mask, 40 Pedipirox-4 Nail, 8 Pedvax HIB, 26, 45 peg 3350/electrolytes, 14, 47 peg-3350/electrolytes, 14, 47 peg-3350/NACL/NA bicarbonate/KCL, 14, 47 Peg-intron, 2

Peg-intron Redipen, 2 Peg-intron Redipen PAK 4, 2 peg-prep, 14 Peganone, 19 Pegasys, 2 Pegasys Proclick, 2 Pegintron, 2 pegylax, 14 Pen Needles 29G X 12MM, 36 Pen Needles 29GX1/2", 36 Pen Needles 30GX5/16", 36 Pen Needles 31G X 1/4" SHORT, 36 Pen Needles 31G X 3/16", 36 Pen Needles 31G X 5MM, 36 Pen Needles 31G X 6MM, 36 Pen Needles 31GX5/16", 36 Pen Needles 31GX8MM, 36 Pen Needles 32GX4MM, 36 penicillin G potassium, 1 penicillin v potassium, 1 Penlet II Automatic Bloodsampler, 31 Penlet II Replacement CAPS, 31 Penlet II Replacement CAPS-deep, 31 Penlet II Replacement CAPS-regular, 31 Pentacel, 26, 45 Pentasa, 15 pentazocine/naloxone HCL, 24 Pentips 31GX5MM, 37 Pentips 31GX8MM, 37 Pentips 32GX4MM, 37 pentoxifylline ER, 17 Perfect Iron, 17, 46 Perfect Lancets 30G, 31 Perfect Pressure Activated Safety Lancets 28G, 31 Perforomist, 25 perindopril erbumine, 6 periogard, 18 Perjeta, 4 permethrin, 9 perphenazine, 18 Perphenazine/Amitriptyline, 20 Perry Prenatal, 28, 44 pharbedryl, 25 Pharmacist Choice Alcoholprep Pads, 40 Pharmacist Choice Ultra Thin Lancets, 31 Pharmacist Choice Ultra Thin Lancets 28G, 31 Pharmacist Choice Ultra Thin Lancets 30G, 31 Pharmacist Choice Ultra Thin Lancets 31G, 31 Pharmacist Choice Ultra Thin Lancets 33G, 31 Pharmacy Counter Lancets, 31 phenadoz, 25 phenazo, 15 phenazopyridine HCL, 15 phenelzine sulfate, 18 phenergan, 25 phenobarbital, 19 Phenobarbital, 19 Phenobarbital Sodium, 19 phenoxybenzamine hydrochloride, 6 phenylephrine HCL, 7, 22 phenylephrine/guaifenesin, 25 phenytoin, 19

phenytoin infatabs, 19 phenytoin sodium, 19 phenytoin sodium extended, 19 philith, 11, 43 phos-flur, 18 Phoslyra, 15 phospha 250 neutral, 41 phosphasal, 15 Phospholine Iodide, 22 Photofrin, 5 physiolyte, 41 physiosol irrigation, 41 phytonadione, 26 Picato, 10 pilocarpine HCL, 18, 22 pilocarpine hydrochloride, 18 pimozide, 20 pimtrea, 11, 43 pindolol, 6 pioglitazone HCL, 12 pioglitazone HCL-glimepiride, 12 pioglitazone HCL/metformin HCL, 12 piperacillin sodium/ tazobactam sodium, 1 piperacillin sodium/tazobactam sodium, 1 piperacillin/tazobactam, 1 pirmella 1/35, 11, 43 pirmella 7/7/7, 11, 43 piroxicam, 24 plasbumin-25, 17 plasbumin-5, 17 Plasma-lyte A, 42 Plasma-lyte-148, 42 Plasma-lyte-56/D5W, 42 plenamine, 41 Pneumovax 23, 26, 45 Pneumovax 23/1 Dose, 26, 45 Pneumovax 23/5 Dose, 26, 45 PNV-DHA, 28 PNV-select, 28 Pocket Chamber, 40 Pocket Spacer, 40 podofilox, 9 polocaine, 24 polocaine-mpf, 24 poly-dex, 21 poly-iron 150, 16, 46 poly-iron 150 forte, 16 polycin, 21 polycin b, 21 polyethylene glycol 3350, 14 polymyxin b sulfate, 3 polymyxin b sulfate/trimethoprim sulfate, 21 polysaccharide iron forte, 16 Pomalyst, 4 portia-28, 11, 43 Portrazza, 4 potassium acetate, 41 potassium chloride, 41 potassium chloride 0.15% /NACL 0.45% viaflex, 41 potassium chloride 0.15% D5W/NACL 0.33%, 41 potassium chloride 0.15% D5W/NACL 0.45%, 41 potassium chloride 0.15% D5W/NACL 0.45% viaflex, 41

potassium chloride 0.15% NACL 0.9%, 41 potassium chloride 0.15% w/NACL 0.9% viaflex, 41 potassium chloride 0.15%/D5W, 41 potassium chloride 0.15%/NACL 0.9%, 41 potassium chloride 0.22% D5W/NACL 0.45%, 41 potassium chloride 0.224%/D5W/NACL 0.45%, 41 potassium chloride 0.224%D5W/NACL 0.45% viaflex, 41 potassium chloride 0.3%/ NACL 0.9%, 41 potassium chloride 0.3%/D5W, 41 potassium chloride 0.3%/NACL 0.9%/viaflex, 41 potassium chloride CR, 41 potassium chloride ER, 41 Potassium Chloride ER, 41 potassium chloride SR, 41 potassium citrate ER, 15 potassium citrate-citric acid crystals, 15 potassium citrate/citric acid, 15 potassium citrate/sodium citrate/citric acid, 15 potassium phosphate, 41 potassium phosphates, 41 Potiga, 19 pr benzoyl peroxide wash, 8 Pr Natal 400, 28 Pr Natal 400 EC, 28 Pr Natal 430, 28 Pr Natal 430 EC, 28 Pradaxa, 17 Praluent, 7 pramcort, 14 pramipexole dihydrochloride, 20 pramipexole dihydrochloride ER, 20 pramox gel, 9 prascion, 8 prascion fc, 8 pravastatin sodium, 7 prazosin HCL, 6 Pre-natal Formula, 28, 44 Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16", 37 Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2", 37 Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2", 37 Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8", 37 Precision Sure-dose Insulin Syringe/1ML/28G X 1/2", 37 Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2", 37 Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2", 37 Precision Thin Lancets, 31 Precision Thins GP Lancet, 31 Precision Ultra Lancet, 31 Pred Mild, 21 prednicarbate, 9 prednisolone, 10 prednisolone acetate, 21 prednisolone sodium phosphate, 10

prednisolone sodium phosphate odt, 10 prednisone, 10 Prednisone, 10 Prednisone Intensol, 10 Preferred Plus Insulin Syringe/U100/0.3ML/29G X 1/2", 37 Preferred Plus Insulin Syringe/U100/0.3ML/30G X 5/16", 37 Preferred Plus Insulin Syringe/U100/0.5ML/28G X 1/2", 37 Preferred Plus Insulin Syringe/U100/0.5ML/29G X 1/2", 37 Preferred Plus Insulin Syringe/U100/0.5ML/30G X 5/16", 37 Preferred Plus Insulin Syringe/U100/1ML/28G X 1/2", 37 Preferred Plus Insulin Syringe/U100/1ML/29G X 1/2", 37 Preferred Plus Insulin Syringe/U100/1ML/30G X 5/16", 37 Preferred Plus Lancets Colored 21G, 31 Preferred Plus Lancets Super Thin 30G, 31 Preferred Plus Lancets Thin 26G, 31 Preferred Plus Unifine Pentips 29G X 12MM, 37 Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT, 37 Preferred Plus Unifine Pentips 31G X 8MM SHORT, 37 Preferred Plus Unifine Pentips 32GX4MM, 37 Preferred Plus Unifine Pentips/Mini/31GX5MM, 37 pregnyl w/diluent benzyl alcohol/NACL, 13 Premarin, 10 premasol, 41 premium lidocaine, 9 Premphase, 10 Prempro, 10 Prenaissance Plus, 28 Prenaplus, 28, 44 Prenatabs Fa, 28 Prenatabs RX, 28 Prenatal, 28, 44 Prenatal 19, 28 Prenatal Ad, 28 Prenatal And Iron, 28, 44 Prenatal Complete, 28, 45 Prenatal Formula, 28, 44 Prenatal Forte, 28, 44 Prenatal Low Iron, 28, 44 Prenatal Multi + DHA, 28 Prenatal Multi +dha, 28, 45 Prenatal Multivitamin + DHA, 28 Prenatal Multivitamin Plus DHA, 28 Prenatal One Daily, 28, 45 Prenatal Plus, 28, 44 Prenatal Plus DHA, 28 Prenatal Vitamin, 28, 45 Prenatal Vitamins, 28, 44 Prenatal-u, 28 Prenatal/Omega-3/Folic Acid/Iron, 28 Prentif Cavity-rim Cervical CAP, 44 Prentif Fitting Set, 44 Prepopik, 14 Pressure Activated Safetylancet 21G, 31

prevalite, 7 previfem, 11, 43 Prevnar 13, 26, 45 Prezcobix, 2 Prezista, 2 Prialt, 23 Priftin, 2 Primaquine Phosphate, 3 primidone, 19 Primsol, 3 Pristiq, 18 Privigen, 42 Proair HFA, 25 Proair Respiclick, 25 probenecid, 24 probenecid/colchicine, 24 Procentra, 19 prochlorperazine, 18 prochlorperazine edisylate, 18 prochlorperazine maleate, 18 Procrit, 17 procto-MED HC, 14 procto-PAK, 14 proctosol HC, 14 proctozone-HC, 14 Procysbi, 16 Prodigy Insulin Mini Pen Needles/31G X 3/16", 37 Prodigy Insulin Pen Needles/29G X 1/2", 37 Prodigy Insulin SHORT Penneedles/31G X 5/16", 37 Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16", 37 Prodigy Insulin Syringe/1/2ML/31G X 5/16", 37 Prodigy Insulin Syringe/1ML/28G X 1/2", 37 Prodigy Lancing Device, 37 Prodigy Pressure Activated Safety Lancets, 31 Prodigy Safety Lancets, 31 Prodigy Twist Top Lancets, 31 Profe, 17, 46 Proferrin ES, 17, 46 Profilnine, 17 Profilnine SD, 17 progesterone, 12 Proglycem, 12 Prograf, 4 Prolastin-c, 26 Proleukin, 5 Prolia, 13 Promacta, 17 promethazine HCL, 25 promethazine HCL plain, 25 promethazine VC plain, 25 promethazine VC/codeine, 25 promethazine-DM, 25 promethazine/codeine, 25 promethazine/dextromethorphan, 25 promethazine/phenylephrine, 25 promethazine/phenylephrine/codeine, 25 promethegan, 25 pronutrients vitamin d3, 27, 47 propafenone HCL, 6 propafenone HCL ER, 6 proparacaine HCL, 22

propranolol HCL, 6 propranolol HCL ER, 6 propylthiouracil, 13 Proquad, 26, 45 protriptyline HCL, 18 provenza, 9 Pss Select GP Lancets, 31 Pss Select Platforms, 37 Pss Select Safety Lancets, 31 Pulmicort Flexhaler, 25 pulmosal, 25 Pulmozyme, 26 purevit dualfe plus, 16 Push Button Safety Lancets 21G, 31 Push Button Safety Lancets 28G, 31 Px Advanced Lancing Device, 37 px aspirin, 23, 42 px enteric aspirin, 23, 42 Px Extra SHORT Pen Needles 31GX6MM, 37 px folic acid, 16, 44 Px Insulin Syringe/U-100/0.3ML/30G X 1/2", 37 Px Insulin Syringe/U-100/0.3ML/31G X 5/16", 37 Px Insulin Syringe/U-100/0.5ML/30G X 1/2", 37 Px Insulin Syringe/U-100/0.5ML/31G X 5/16", 37 Px Insulin Syringe/U-100/1ML/30G X 1/2", 37 Px Insulin Syringe/U-100/1ML/31G X 5/16", 37 px iron, 16, 46 Px Lancet Auto Injector, 37 Px Lancets Ultra Thin, 31 Px Mini Pen Needles 31GX5MM, 37 Px Pen Needle 29GX12MM, 37 Px Pen Needle 31GX8MM, 37 Px Prenatal Multivitamins, 28, 44 Px Shortlength Pen Needles/31GX8MM, 37 px stop smoking aid, 20, 46 Pylera, 14 pyrazinamide, 2 pyridostigmine bromide, 21

Q Qc Advanced Lancing Device, 37 Qc Alcohol Swabs, 40 qc aspirin, 23, 42 qc aspirin low dose, 23, 42 qc childrens aspirin, 23, 42 qc ferrous sulfate, 16, 46 Qc Insulin Syringe 0.5ML/29G, 37 Qc Insulin Syringe 0.5ML/30G, 37 Qc Insulin Syringe 1ML/29G, 37 Qc Insulin Syringe/0.3ML/29G, 37 Qc Insulin Syringe/0.3ML/29G X 1/2", 37 Qc Insulin Syringe/0.5ML/29G X 1/2", 37 Qc Insulin Syringe/0.5ML/31G X 5/16", 37 Qc Insulin Syringe/1ML/29G X 1/2", 37 Qc Insulin Syringe/1ML/30G, 37 Qc Insulin Syringe/1ML/31G X 5/16", 37 Qc Lancets, 31 Qc Lancets Super Thin, 31 Qc Lancets Thin, 31 Qc Lancets Ultra Thin, 31

qc nicotine polacrilex, 20, 46 Qc Pen Needles 29G X 12MM, 37 Qc Pen Needles 31G X 6MM, 37 Qc Pen Needles 31G X 8MM, 37 Qc Prenatal, 28, 45 Qc Unifine Pentips 32GX4MM, 37 Qc Unilet Lancets 28G/Ultra Thin, 31 Qc Unilet Lancets 33G/Micro Thin, 31 Quadracel, 26, 45 quasense, 11, 43 Quazepam, 19 quetiapine fumarate, 19 Quflora Pediatric, 28 Quillivant XR, 19 quinapril HCL, 6 quinapril/hydrochlorothiazide, 7 quinidine gluconate CR, 6 quinidine gluconate ER, 6 quinidine sulfate, 6 Quinidine Sulfate, 6 quinine sulfate, 3 Qvar, 25

R Ra Alcohol Swabs, 40 ra aspirin, 23, 42 ra aspirin adult low dose, 23, 42 ra aspirin adult low strength, 23, 42 ra aspirin childrens, 23, 42 ra aspirin EC, 23, 42 ra aspirin EC adult low strength, 23, 42 ra childrens aspirin, 23, 42 Ra E-ZJECT Color Lancets Micro-thin 33G, 31 Ra E-ZJECT Lancets 28G, 31 Ra E-ZJECT Lancets Thin 26G, 31 Ra E-ZJECT Lancets Thin 28G, 31 Ra E-ZJECT Lancets Ultra Thin 30G, 31 ra folic acid, 16, 44 ra high potency iron, 16, 46 Ra Insulin Syringe/0.5ML/29G X 1/2", 37 Ra Insulin Syringe/1ML/29G X 1/2", 37 Ra Insulin Syringe/U-100/0.5ML/30G X 5/16", 37 Ra Insulin Syringe/U-100/1 ML/30G X 5/16", 37 ra iron, 16, 46 Ra Lancing Device, 37 ra mini nicotine, 20, 46 ra nicotine, 20, 46 ra nicotine polacrilex, 20, 46 ra nicotine transdermal system step 3, 20, 46 Ra One Daily, 28, 45 Ra Pen Needles 31G X 5MM 3/16", 37 Ra Pen Needles 31G X 8MM 5/16", 37 Ra Prenatal, 28, 44 Ra Prenatal Formula/Folicacid, 28, 45 ra slow release iron, 16, 46 ra vitamin d-3, 27, 47 Rabavert, 26 rabeprazole sodium, 14 raloxifene hydrochloride, 13 ramipril, 6 Ranexa, 5 ranitidine HCL, 14 Rapaflo, 16 Rapamune, 4 Ravicti, 13

rea LO 39, 9 rea LO 40, 9 Reality Insulin Syringe/U-100/0.5ML/28G X 1/2", 37 Reality Insulin Syringe/U-100/0.5ML/29G X 1/2", 37 Reality Insulin Syringe/U-100/1ML/28G X 1/2", 37 Reality Insulin Syringe/U-100/1ML/29G X 1/2", 37 Reality Lancets, 31 Reality Swabs, 40 Reality Trigger Lancets, 31 Rebetol, 2 Rebif, 20 Rebif Rebidose, 20 Rebif Rebidose Titration Pack, 20 Rebif Titration Pack, 20 reciphexamine, 9 reclipsen, 11, 43 Recombinate, 17 Recombivax HB, 26, 45 Rectiv, 15 Regranex, 10 relador PAK, 9 relador PAK plus, 9 releevia ML, 9 Relenza Diskhaler, 2 Relion 2-IN-1 Lancing Device 25G, 37 Relion 2-IN-1 Lancing Device 30G, 37 Relion Alcohol Swabs, 40 Relion Insulin Syringe/U -100/0.5ML/29G, 37 Relion Insulin Syringe/U-00/1ML/29G X 1/2", 37 Relion Insulin Syringe/U-100/0.3ML/29G, 37 Relion Insulin Syringe/U-100/0.3ML/29G X 1/2", 37 Relion Insulin Syringe/U-100/0.3ML/30G, 37 Relion Insulin Syringe/U-100/0.3ML/30G X 5/16", 37 Relion Insulin Syringe/U-100/0.3ML/31G X 5/16", 37 Relion Insulin Syringe/U-100/0.5ML/29G X 1/2", 37 Relion Insulin Syringe/U-100/0.5ML/30G, 37 Relion Insulin Syringe/U-100/0.5ML/30G X 5/16", 37 Relion Insulin Syringe/U-100/0.5ML/31G X 5/16", 37 Relion Insulin Syringe/U-100/1ML/30G, 37 Relion Insulin Syringe/U-100/1ML/30G X 5/16", 37 Relion Insulin Syringe/U-100/1ML/31G X 5/16", 37 Relion Ketone, 42 Relion Ketone Test Strips, 42 Relion Lancets Micro-thin33G, 31 Relion Lancets Standard 21G, 31 Relion Lancets Thin 26G, 31 Relion Lancets Ultra-thin30G, 31 Relion Lancing Device, 37 Relion Mini Pen Needles 31GX6MM, 37 Relion Pen Needles 29GX12MM, 37

Relion Pen Needles 31GX8MM, 37 Relion Pen Needles 32GX4MM, 37 Relion SHORT Pen Needles 31GX8MM, 37 Relion Thin Lancets, 31 Relion Ultra Thin Lancets, 31 Relion Ultra Thin Lancets30G, 31 Relion Ultra Thin Plus Lancets 32G, 31 Relion Ultra Thin Plus Lancets 33G, 31 Relistor, 15 Relpax, 24 remeven, 9 Remicade, 15 Remodulin, 7 rena-vite RX, 27 Renagel, 15 renal, 27 renalpren, 27 Renew Advanced Lancing Cartridge Refills, 31 Renew Advanced Lancing Device, 37 reno CAPS, 27 Renvela, 15 repaglinide, 12 Repaglinide/Metformin Hydrochloride, 12 Repatha, 7 Repatha Sureclick, 7 Replesta, 27, 47 Replesta Childrens, 27, 47 Replesta Nx, 27, 47 reprexain, 24 Rescriptor, 2 Restasis, 22 Retrovir IV Infusion, 2 Revlimid, 4 revonto, 21 Rexall Lancets Ultra Thin, 31 Rexulti, 19 Reyataz, 2 Rheumatrex, 24 Rhogam Ultra-filtered Plus, 42 Rhophylac, 42 Riastap, 17 ribasphere, 2 Ribasphere, 2 Ribasphere Ribapak, 2 Ribatab, 2 ribavirin, 2 Ridaura, 24 rifabutin, 2 Rifamate, 2 rifampin, 2 Rifater, 2 Right Step Prenatal, 28, 45 Rightest GD-L500 Alternate Site Adapter, 37 Rightest GD500 Lancing Device, 37 Rightest Gl300 Lancets, 31 riluzole, 21 rimantadine HCL, 2 ringers injection, 41 ringers irrigation, 41 Riomet, 12 risedronate sodium, 12 risedronate sodium DR, 12 Risperdal Consta, 19 risperidone, 19 risperidone M-TAB, 19

risperidone odt, 19 Riteflo, 40 Rituxan, 4 rivastigmine tartrate, 20 rivastigmine transdermal system, 20 Rixubis, 17 rizatriptan benzoate, 24 rizatriptan benzoate odt, 24 rocuronium bromide, 21 romycin, 21 ropinirole ER, 20 ropinirole HCL, 20 ropivacaine, 24 ropivacaine HCL, 24 rosadan, 8 rosanil cleanser, 8 rosula, 8 rosuvastatin calcium, 7 Rotarix, 26, 45 Rotateq, 26, 45 roweepra, 19 roxicet, 24 Rozerem, 19

S Sabril, 19 Safe-t-lance Low Flow 25G, 31 Safe-t-lance Normal Flow 21G, 31 Safe-t-lance Plus Safety Lancet High Flow, 31 Safe-t-lance Plus Safety Lancet Low Flow, 31 Safe-t-lance Plus Safety Lancet Normal Flow, 31 Safesnap Insulin Syringe/0.3ML/30G X 5/16", 37 Safesnap Insulin Syringe/0.5ML/29G X 1/2", 37 Safesnap Insulin Syringe/0.5ML/30G X 5/16", 37 Safesnap Insulin Syringe/1ML/28G X 1/2", 37 Safesnap Insulin Syringe/1ML/29G X 1/2", 37 Safety Lancet 21G/Pressure Activated, 31 Safety Lancet 28G/Pressure Activated, 31 Safety Lancets, 31 Safety Lancets 21G, 31 Safety Lancets 28G, 31 Safety Let Lancets, 31 Safety Seal Lancets 28G, 31 Safety Seal Lancets 30G, 31 Safety-glide Insulin Syringe/0.3ML/29G X 1/2", 31 salacyn, 9 salicylic acid, 9 Salicylic Acid, 10 salicylic acid cream, 9 salicylic acid lotion, 9 salicylic acid wart remover, 9 saline flush, 41 saline flush zr/sterile field, 41 salsalate, 22 Samsca, 13 Sancuso, 14 Sandimmune, 4 Sandostatin Lar Depot, 13

Saphris, 19 Saps Care Alcohol Prep Pads, 40 Sapscare Twist Top Lancets 30G, 31 sash kit for flushing vascular access devices, 17 Savaysa, 17 Savella, 20 SB Alcohol Prep Pads, 40 SB aspirin, 23, 43 SB aspirin EC, 23, 43 SB childrens aspirin, 23, 43 SB Insulin Syringe/U-100/0.5ML/29G X 1/2", 38 SB Insulin Syringe/U-100/0.5ML/30G X 5/16", 38 SB Insulin Syringe/U-100/1ML/29G X 1/2", 38 SB Insulin Syringe/U-100/1ML/30G X 5/16", 38 SB Insulin Syringe/U-100/1ML/31G X 5/16", 38 SB Lancets Thin, 32 SB Lancets Ultra Thin, 32 SB low dose asa EC, 23, 43 scalacort, 9 Schnucks Insulin Syringe Ulti-fine/U100/0.5ML/29G X 1/2", 37 Schnucks Insulin Syringe Ulti-fine/U100/0.5ML/30G X 5/16", 37 se 10-5 ss, 8 se bpo wash, 8 Se-natal 19, 28 Se-tan DHA, 28 se-tan plus, 16 seb-prev wash, 9 Select-lite Device/Lancets, 37 Select-lite Lancing Device, 37 selegiline HCL, 20 selenium sulfide, 9 Selzentry, 2 Sensipar, 13 sensorcaine, 25 sensorcaine-mpf, 25 sensorcaine-mpf spinal, 25 sensorcaine-mpf/epinephrine, 25 sensorcaine/epinephrine, 25 Serevent Diskus, 25 serophene, 13 Seroquel XR, 19 Serostim, 13 sertraline HCL, 18 setlakin, 11, 44 Sevelamer Carbonate, 15 SF, 18 SF 5000 plus, 18 sharobel, 11, 44 Shopko Alcohol Swabs, 40 Shopko Autolet Lancing Device, 37 Shopko On-the-go Comfort Lancets 30G, 31 Shopko Unifine Pentips Pen Needles/Micro/32GX4MM, 37 Shopko Unifine Pentips Pen Needles/Mini/31GX5MM, 37 Shopko Unifine Pentips Pen Needles/Original/29GX12MM, 37 Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM, 37

Shopko Unilet Lancets Super Thin 30G, 31 Shopko Unilet Lancets Ultra Thin 28G, 31 Shur-seal, 15, 44 Side Button Safety Lancet21G, 31 Signifor, 13 sildenafil, 7 sildenafil citrate, 7 silver sulfadiazine, 9 Similac Prenatal Early Shield, 28 Simple Diagnostics Lancing Device, 37 Simponi, 24 Simponi Aria, 24 Simulect, 4 simvastatin, 7 Single-let, 31 sirolimus, 4 Sirturo, 2 Sivextro, 3 Sklice, 10 Skyla, 11, 44 slow FE, 16, 46 slow iron, 16, 46 slow release iron, 16, 46 Slow Release Iron, 17, 46 slow-release iron, 16, 46 Sm Alcohol Prep Pads, 40 sm aspirin, 23, 42 sm aspirin adult low strength, 23, 42 sm aspirin EC low strength, 23, 42 sm aspirin enteric coated, 23, 42 sm childrens aspirin, 23, 42 sm folic acid, 16, 44 Sm Insulin Syringe/0.3ML/31G X 5/16", 37 Sm Insulin Syringe/0.5ML/31G X 5/16", 37 Sm Insulin Syringe/1ML/31G X 5/16", 37 Sm Insulin Syringe/U-100/0.3ML/29G X 1/2", 37 Sm Insulin Syringe/U-100/0.3ML/30G X 5/16", 37 Sm Insulin Syringe/U-100/0.5ML/28G X 1/2", 37 Sm Insulin Syringe/U-100/0.5ML/29G X 1/2", 37 Sm Insulin Syringe/U-100/0.5ML/30G X 5/16", 37 Sm Insulin Syringe/U-100/1ML/28G X 1/2", 37 Sm Insulin Syringe/U-100/1ML/29G X 1/2", 37 Sm Insulin Syringe/U-100/1ML/30G X 5/16", 37 sm iron, 16, 46 sm iron slow release, 16, 46 Sm Lancets 21G, 31 Sm Micro Thin Lancets 33G, 31 sm nicotine, 20, 46 sm nicotine polacrilex, 20, 46 sm nicotine transdermal system, 20, 46 Sm One Daily Prenatal, 28, 45 sm prenatal vitamins, 28, 44 Sm Prenatal Vitamins, 28, 44 sm slow release iron, 16, 46 Sm Slow Release Iron, 17, 46 Sm Super Thin Lancets, 31

Sm Super Thin Lancets 30G, 31 Sm Thin Lancets 26G, 31 sm vitamin d, 27, 47 sm vitamin d3, 27, 47 Sm Vitamin D3 Maximum Strength, 27, 47 Smart Diabetes Vantage Lancing Device, 37 Smart Diabetes Vantage Universal Lancets 30G, 31 Smart Sense Color Lancets Universal 33G, 31 Smart Sense Standard Lancets Universal 21G, 31 Smart Sense Super Thin Lancets Universal 30G, 31 Smart Sense Thin Lancets Universal 26G, 31 Smartest Lancets 28G, 31 sodium acetate, 41 sodium bicarbonate, 41 sodium bicarbonate partial fill, 41 sodium chloride, 15, 25, 41 sodium chloride 0.45%, 41 sodium chloride 0.45% viaflex, 41 sodium chloride 0.9%, 15 sodium chloride bacteriostatic, 41 sodium chloride flush, 41 sodium chloride pab, 41 sodium citrate/citric acid, 15 sodium ferric gluconate complex/sucrose, 17 sodium fluoride, 41, 44 sodium hyaluronate, 9 sodium phenylbutyrate, 13 sodium phosphate, 41 sodium polystyrene sulfonate, 41 sodium sulfacetamide, 8, 9, 21 sodium sulfacetamide wash, 9 sodium sulfacetamide/sulfur, 8 sodium sulfacetamide/sulfur cleanser, 8 sodium sulfacetamide/sulfur cleansing cloths, 8 sodium sulfacetamide/sulfur green, 8 sodium sulfacetamide/sulfur w/sunscreen, 8 sodium sulfacetamide/sulfur wash, 8 sodium thiosulfate, 41 Soliris, 17 Soltamox, 4 Solu-cortef, 10 Solus V2 Lancing Device, 37 Solus V2 Pressure Activated Safety Lancets 28G, 31 Solus V2 Twist Lancets 30G, 31 Somatuline Depot, 13 Somavert, 13 sorine, 6 sotalol HCL, 6 sotalol HCL (AF), 6 Sovaldi, 3 Spiriva Handihaler, 25 Spiriva Respimat, 25 spironolactone, 7 spironolactone/hydrochlorothiazide, 7 Sporanox, 2 sprintec 28, 11, 44 Sprix, 24

Sprycel, 5 sps, 41 SR nicotine gum, 20, 46 sronyx, 11, 44 ss 10-2, 8 ssd, 9 sss 10%-5%, 8 sss 10-5, 8 st joseph aspirin, 23, 42 st joseph low dose aspirin, 23, 42 stannous fluoride oral rinse, 18 stavudine, 2 Stavzor, 19 Sterilance PA, 37 Sterilance TL, 31 sterile diluent for epoprostenol sodium, 41 sterile water for injection, 41 sterile water irrigation, 41 sterile water irrigation plastic bottle, 41 sterile water irrigation w/hanger, 41 Stimate, 13 Stiolto Respimat, 25 Stivarga, 5 Strattera, 19 Strensiq, 13 Streptomycin Sulfate, 2 Striant, 10 Stribild, 2 Stuart One, 28 Stuart Prenatal, 28, 45 Suboxone, 24 Sucraid, 14 sucralfate, 14 sulfacetamide sodium, 8, 21 sulfacetamide sodium/prednisolone sodium phosphate, 21 sulfacetamide sodium/sulfur, 8 sulfacetamide sodium/sulfur cleanser, 8 sulfacleanse 8/4, 8 Sulfadiazine, 2 sulfamethoxazole/trimethoprim, 3 sulfamethoxazole/trimethoprim DS, 3 Sulfamylon, 10 sulfasalazine, 14 sulfatrim pediatric, 3 sulindac, 24 sumatriptan succinate, 24 Sumatriptan Succinate, 24 sumatriptan succinate refill, 24 Super Daily D3, 27, 47 Super Thin Lancets, 31 Supprelin LA, 13 Suprax, 1 Supreme II Confidence Paddles, 37 Suprep Bowel Prep, 14 Sure Comfort Alcohol Prep Pads, 40 Sure Comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 37 Sure Comfort Insulin Syringe/U100/0.3ML/30G X 1/2", 37 Sure Comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 37 Sure Comfort Insulin Syringe/U100/0.3ML/31G X 5/16, 37 Sure Comfort Insulin Syringe/U100/0.3ML/31G X 5/16", 37 Sure Comfort Insulin Syringe/U-100/0.

5ML/28G X 1/2", 37 Sure Comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 38 Sure Comfort Insulin Syringe/U100/0.5ML/30G X 1/2", 38 Sure Comfort Insulin Syringe/U100/0.5ML/30G X 5/16", 38 Sure Comfort Insulin Syringe/U100/0.5ML/31G X 5/16, 38 Sure Comfort Insulin Syringe/U100/1ML/28G X 1/2", 38 Sure Comfort Insulin Syringe/U100/1ML/29G X 1/2", 38 Sure Comfort Insulin Syringe/U100/1ML/30G X 1/2", 38 Sure Comfort Insulin Syringe/U100/1ML/30G X 5/16", 38 Sure Comfort Insulin Syringe/U100/1ML/31G X 5/16", 38 Sure Comfort Lancets 28G, 31 Sure Comfort Lancets 30G, 31 Sure Comfort Lancing Pen, 38 Sure Comfort Pen Needles 29GX1/2" 12.7MM, 38 Sure Comfort Pen Needles 30GX5/16" SHORT, 38 Sure Comfort Pen Needles 31GX3/16" (5MM), 38 Sure Comfort Pen Needles 31GX5/16" (8MM), 38 Sure Comfort Pen Needles 32GX5/32", 38 Sure Comfort Pen Needles 32GX6MM, 38 sure result dss premium pack, 8 Sure-fine Pen Needles 29GX1/2" 12.7MM, 38 Sure-fine Pen Needles 31GX3/16" 5MM, 38 Sure-fine Pen Needles 31GX5/16" 8MM, 38 Sure-ject Insulin Syringe/U100/0.3ML/29G X 1/2", 38 Sure-ject Insulin Syringe/U100/0.3ML/30G X 5/16", 38 Sure-ject Insulin Syringe/U100/0.3ML/31G X 5/16", 38 Sure-ject Insulin Syringe/U100/0.5ML/28G X 1/2", 38 Sure-ject Insulin Syringe/U100/0.5ML/29G X 1/2", 38 Sure-ject Insulin Syringe/U100/0.5ML/30G X 5/16", 38 Sure-ject Insulin Syringe/U100/0.5ML/31G X 5/16", 38 Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2", 38 Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2", 38 Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16", 38 Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16", 38 Sure-lance Flat Lancets, 31 Sure-lance Lancets 26G, 31 Sure-lance Thin Lancets 28G, 31 Sure-lance Ultra Thin Lancets, 31 Sure-pen, 38

Sure-prep Alcohol Prep Pads, 40 Sure-touch Lancets Universal, 31 Surelite Lancets, 31 Surestep Glucose Control, 31 Surestep Glucose Control Solution, 31 Surestep Pro High Glucosecontrol, 32 Surestep Pro Linearity Kit, 32 Surestep Pro Low Glucose Control, 32 Surestep Pro Normal Glucose Control, 32 Sustiva, 2 Sutent, 5 sw nicotine polacrilex, 20, 46 swabflush saline flush, 41 syeda, 11, 44 Sylatron, 5 symax fastabs, 14 symax-SL, 14 symax-SR, 14 Symbicort, 25 Symlinpen 120, 12 Symlinpen 60, 12 Synagis, 42 Synarel, 13 Synribo, 5 synvexia, 9 Synvisc, 21 Synvisc One, 21 Syprine, 42

T Tabloid, 4 Taclonex, 9 tacrolimus, 4, 9 Tafinlar, 5 Tagrisso, 5 take action, 11, 44 Talwin, 24 Tamiflu, 2 tamoxifen citrate, 4, 47 tamsulosin HCL, 15 Tarceva, 5 Targretin, 10 tarina FE 1/20, 11, 44 taron-crystals, 15 Taron-prex, 28 Tasigna, 5 tazicef, 1 tazidime, 1 Tazorac, 8 taztia XT, 6 Tecfidera, 20 Tecfidera Starter Pack, 20 Techlite AST Lancets, 32 Techlite Lancets, 32 Techlite Lancets 30G, 32 Techlite Pen Needles/31G X 5MM, 38 Techlite Pen Needles/31G X 6 MM, 38 Techlite Pen Needles/31G X 8MM, 38 Techlite Pen Needles/32G X 4MM, 38 Techlite Pen Needles/32G X 6MM, 38 Techlite Pen Needles/32G X 8MM, 38 Teflaro, 1 Tekamlo, 7 Tekturna, 6 Tekturna HCT, 7 telmisartan, 6 telmisartan/amlodipine, 7 telmisartan/hydrochlorothiazide, 7

temazepam, 19 Temodar, 3 temozolomide, 3 tencon, 22 Teniposide, 4 Tenivac, 26, 45 terazosin HCL, 6 terbinafine HCL, 2 terbutaline sulfate, 25 terconazole, 15 Terumo Insulin Syringe/0.3ML/30G X 3/8", 38 Terumo Insulin Syringe/0.5ML/29G X 1/2", 38 Terumo Insulin Syringe/0.5ML/30G X 3/8", 38 Terumo Insulin Syringe/1ML/27G X 1/2", 38 Terumo Insulin Syringe/1ML/29G X 1/2", 38 Terumo Insulin Syringe/1ML/30G X 3/8", 38 Terumo Insulin Syringe/U-100/0.3ML/29G X 1/2", 38 Terumo Insulin Syringe/U-100/0.5ML/27G X 1/2", 38 Terumo Insulin Syringe/U-100/0.5ML/28G X 1/2", 38 Terumo Insulin Syringe/U-100/1ML/28G X 1/2", 38 Terumo Surguard Insulin Syringe/0.3ML/29G X 1/2", 38 Terumo Surguard Insulin Syringe/0.5ML/28G X 1/2", 38 Terumo Surguard Insulin Syringe/0.5ML/29G X 1/2", 38 Terumo Surguard Insulin Syringe/1ML/28G X 1/2", 38 Terumo Surguard Insulin Syringe/1ML/29G X 1/2", 38 testosterone, 10 Testosterone, 10 testosterone cypionate, 10 testosterone enanthate, 10 testosterone P.M., 10 Testosterone P.M., 10 Tetanus Toxoid Adsorbed, 26 Tetanus/Diphtheria Toxoids-adsorbed, 26, 45 Tetanus/Diphtheria Toxoids-adsorbed Adult, 26, 45 tetcaine, 22 tetrabenazine, 20 tetracaine HCL, 22 Tetracaine HCL, 25 tetracycline HCL, 1 Tetracycline HCL, 1 tetravisc, 22 tetravisc forte, 22 tetrix, 9 Texacort, 9 Tgt Advanced Lancing Device, 38 Tgt Alcohol Swabs, 40 tgt aspirin, 23, 42 tgt aspirin low dose, 23, 42 tgt childrens aspirin, 23, 42 tgt enteric-coated aspirin, 23, 42 Tgt Lancet Alternate Site, 32

Tgt Lancet Micro Thin 33G, 32 Tgt Lancet Super Thin 30G, 32 Tgt Lancet Thin 23G, 32 Tgt Lancet Thin 26G, 32 Tgt Lancet Ultra Thin 28G, 32 Tgt Lancet Ultra Thin 30G, 32 Tgt Lancing Device, 38 tgt nicotine gum, 20, 46 tgt nicotine polacrilex, 20, 46 tgt nicotine step one, 20, 46 tgt nicotine step three, 20, 46 tgt nicotine step two, 20, 46 th aspirin, 23, 42 th aspirin low dose, 23, 42 th enteric aspirin, 23, 42 th folic acid, 16, 44 th iron, 16, 46 Th Prenatal Vitamins, 28, 45 th slow release iron, 16, 46 th vitamin d3, 27, 47 Thalomid, 4 Theo-24, 25 theochron, 25 theophylline, 25 theophylline CR, 25 theophylline ER, 25 thera-d 2000, 27, 47 Thera-d 4000, 27, 47 thera-d rapid repletion, 27, 47 thera-d sport, 27, 47 Theracys, 5 thermazene, 9 thiamine HCL, 26 Thinlets GP Lancets, 32 Thinlets Lancet, 32 Thinpro Insulin Syringe/0.3ML/29G X 1/2", 38 Thinpro Insulin Syringe/0.3ML/30G X 3/8", 38 Thinpro Insulin Syringe/0.3ML/31G X 3/8", 38 Thinpro Insulin Syringe/0.5ML/28G X 1/2", 38 Thinpro Insulin Syringe/0.5ML/29G X 1/2", 38 Thinpro Insulin Syringe/0.5ML/30G X 3/8", 38 Thinpro Insulin Syringe/0.5ML/31G X 3/8", 38 Thinpro Insulin Syringe/1ML/28G X 1/2", 38 Thinpro Insulin Syringe/1ML/29G X 1/2", 38 Thinpro Insulin Syringe/1ML/30G X 3/8", 38 Thinpro Insulin Syringe/1ML/31G X 3/8", 38 thioridazine HCL, 19 thiothixene, 19 thrive, 20, 46 Thrombate Iii W/10 ML Sterile Water, 17 Thrombate Iii W/20 ML Sterile Water, 17 Thymoglobulin, 4 Thyrogen, 42 Thyrolar-1, 13 Thyrolar-1/2, 13 Thyrolar-1/4, 13 Thyrolar-2, 13

Thyrolar-3, 13 tiagabine hydrochloride, 19 Tice Bcg, 5 ticlopidine HCL, 17 Tikosyn, 6 tilia FE, 11, 44 Timentin, 1 Timolol Maleate, 6 timolol maleate, 21 timolol maleate ophthalmic gel forming, 21 tinidazole, 3 tis-u-sol, 41 Tivicay, 2 tizanidine HCL, 21 TL gard RX, 16 TL icon, 16 TL-hem 150, 16 Tobi Podhaler, 2 Tobradex, 21 Tobradex ST, 21 tobramycin, 2 tobramycin inhalation solution PAK, 2 tobramycin sulfate, 2, 21 tobramycin/dexamethasone, 21 Tobrex, 21 Today Sponge, 15 Todays Health Advanced Lancing Device, 38 Todays Health Mini Pen Needles 31G X 1/4", 38 Todays Health Original Pen Needles 29G X 1/2", 38 Todays Health SHORT Pen Needles 31G X 5/16", 38 Todays Health Super Thin Lancets 30G, 32 Todays Health Ultra Thin Lancets 28G, 32 tolazamide, 12 Tolazamide, 12 Tolbutamide, 12 tolcapone, 20 tolmetin sodium, 24 Tolmetin Sodium, 24 tolterodine tartrate, 15 tolterodine tartrate ER, 15 Topcare Clickfine Universal Pen Eedles 31GX1/4", 38 Topcare Clickfine Universal Pen Eedles 31GX5/16", 38 Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16", 38 Topcare Ultra Comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 38 Topcare Ultra Comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 38 Topcare Ultra Comfort Insulin Syringe/U-

100/1ML/29G X 1/2", 38 Topco Insulin Syringe/U-100/0.3ML/29G X 1/2", 38 Topco Insulin Syringe/U-100/0.5ML/28G X 1/2", 38 Topco Insulin Syringe/U-100/0.5ML/29G X 1/2", 38 Topco Insulin Syringe/U-100/1ML/28G X 1/2", 38 Topco Insulin Syringe/U-100/1ML/29G X 1/2", 38 topex topical anesthetic, 18 topiragen, 19 topiramate, 19 toposar, 4 topotecan HCL, 5 Topotecan HCL, 5 Torisel, 5 torsemide, 7 Totect, 5 Toujeo Solostar, 12 Toviaz, 15 tpn electrolytes, 41 Tracer II 3 Volt Battery, 38 Tracleer, 7 Tradjenta, 12 tramadol HCL, 24 tramadol HCL ER, 24 tramadol hydrochloride/acetaminophen, 24 trandolapril, 6 trandolapril/verapamil HCL, 7 trandolapril/verapamil HCL ER, 7 tranexamic acid, 17 Transderm-scop, 14 tranylcypromine sulfate, 18 Travatan Z, 21 Travel Lancets 30G, 32 trazodone HCL, 18 Treanda, 3 Trecator, 2 Trelstar, 4 Trelstar Mixject, 4 tretinoin, 5 Tretten, 17 Trexall, 4 tri-estarylla, 11, 44 tri-legest FE, 11, 44 tri-linyah, 11, 44 tri-LO-estarylla, 11, 44 tri-LO-marzia, 11, 44 tri-LO-sprintec, 11, 44 tri-previfem, 11, 44 tri-sprintec, 11, 44 tri-vit/fluoride, 27 tri-vitamin/fluoride, 27 Triadvance, 28 triamcinolone acetonide, 9, 18, 25 triamcinolone IN orabase, 18 triamterene/hydrochlorothiazide, 7 Triamterene/Hydrochlorothiazide, 7 triazolam, 19 Triazolam, 19 Tribenzor, 7 Tricare, 28, 44 tricitrates, 15 tricon, 16 triderm, 9

trifluoperazine HCL, 19 trifluridine, 21 trigels-f forte, 16 Triglide, 7 trihexyphenidyl HCL, 20 trilyte, 14, 47 trimethobenzamide HCL, 14 trimethoprim, 3 trimethoprim sulfate/polymyxin b sulfate, 21 trimipramine maleate, 18 Trinatal RX 1, 28 Trinate, 28 trinessa, 11, 44 trinessa LO, 11, 44 triphrocaps, 27 triple-vitamin/fluoride, 27 Trisenox, 5 Triumeq, 2 trivora-28, 11, 44 tropazone, 9 tropicamide, 22 trospium chloride, 15 trospium chloride ER, 15 Truedraw Lancing Device, 38 Trueplus Insulin Syringe/U100/0.3ML/29G X 1/2", 38 Trueplus Insulin Syringe/U100/0.3ML/30G X 5/16", 38 Trueplus Insulin Syringe/U100/0.3ML/31G X 5/16", 38 Trueplus Insulin Syringe/U100/0.5ML/28G X 1/2", 38 Trueplus Insulin Syringe/U100/0.5ML/29G X 1/2", 38 Trueplus Insulin Syringe/U100/0.5ML/30G X 5/16", 38 Trueplus Insulin Syringe/U100/0.5ML/31G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/28G X 1/2", 38 Trueplus Insulin Syringe/U-100/1ML/29G X 1/2", 38 Trueplus Insulin Syringe/U-100/1ML/30G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/31G X 5/16", 38 Trueplus Lancets 26G, 32 Trueplus Lancets 28G, 32 Trueplus Lancets 28G Super Thin, 32 Trueplus Lancets 30G, 32 Trueplus Lancets 30G Ultra Thin, 32 Trueplus Lancets 33G, 32 Trueplus Lancets 33G Micro Thin, 32 Trueplus Safety Lancets 28G, 32 Trulicity, 12 Trumenba, 26, 45 Truvada, 2 Tudorza Pressair, 25 tussigon, 25 Twinrix, 26, 45 Tybost, 2 Tygacil, 3 Tykerb, 5 Typhim VI, 26 Tysabri, 20 Tyvaso, 7 Tyvaso Refill, 7

Tyvaso Starter, 7 Tyzeka, 3

X 5/16", 38 Ulticare Insulin Syringe/U-100/1ML/29G X 1/2", 38 U Ulticare Insulin Syringe/U-100/1ML/30G X u-kera e, 9 1/2", 38 Ulesfia, 10 Ulticare Insulin Syringe/U-100/1ML/30G X Uloric, 24 5/16", 38 Ulti-lance Automatic/ Clear Tip, 38 Ulticare Insulin Syringe/U-100/1ML/31G X Ulticare Insulin Safety Syringe/0.5ML/29G 5/16", 38 X 1/2", 38 Ulticare Micro Pen Needles 31G X 8MM, Ulticare Insulin Safety Syringe/1ML/29G 39 X 1/2", 38 Ulticare Micro Pen Needles 32G X 4MM, Ulticare Insulin Syringe 1CC/28G U-100 39 1/2", 38 Ulticare Micro Pen Needles/31G X 8MM, Ulticare Insulin Syringe Ultrafine U39 100/0.3ML/31G X 5/16", 38 Ulticare Micro Pen Needles/32G X 4MM, Ulticare Insulin Syringe Ultrafine U39 100/0.5ML/31G X 5/16", 38 Ulticare Mini Pen Needles 31GX6MM, 39 Ulticare Insulin Syringe Ultrafine UUlticare Mini Pen Needles Ulti-fine IV, 39 100/1ML/31G X 5/16", 38 Ulticare Mini Pen Needles/31G X 6MM, Ulticare Insulin Syringe/0.3ML/29G X 39 1/2", 38 Ulticare Mini Pen Needles31GX6MM, 39 Ulticare Insulin Syringe/0.3ML/30G X Ulticare Original Pen Needles Ulti-fine, 1/2", 38 39 Ulticare Insulin Syringe/0.3ML/30G X Ulticare Pen Needles/29G X 12.7MM, 39 5/16", 38 Ulticare SHORT Pen Needles 31GX8MM, Ulticare Insulin Syringe/0.5ML/28G X 39 1/2", 38 Ulticare SHORT Pen Needles Ulti-fine IV, Ulticare Insulin Syringe/0.5ML/29G X 39 1/2", 38 Ulticare SHORT Pen Needles/31G X Ulticare Insulin Syringe/0.5ML/30G X 8MM, 39 1/2", 39 Ulticare Thin Lancets 30G, 32 Ulticare Insulin Syringe/0.5ML/30G X Ulticare U-100 Insulin 5/16", 39 Syringes/0.3ML/31G X 1/4", 39 Ulticare Insulin Syringe/1ML/28G X 1/2", Ulticare U-100 Insulin 39 Syringes/0.3ML/31G X1/4", 39 Ulticare Insulin Syringe/1ML/29G X 1/2", Ulticare U-100 Insulin 39 Syringes/0.5ML/31G X 1/4", 39 Ulticare Insulin Syringe/1ML/30G X 1/2", Ulticare U-100 Insulin Syringes/1ML/31G 39 X 1/4", 39 Ulticare Insulin Syringe/1ML/30G X 5/16", Ultiguard Insulin Syringe/U39 100/0.3ML/29G X 1/2", 39 Ulticare Insulin Ultiguard Insulin Syringe/USyringe/SHORT/0.3ML/30G X 5/16", 38 100/0.3ML/30G X 5/16", 39 Ulticare Insulin Ultiguard Insulin Syringe/USyringe/SHORT/0.3ML/31G X 5/16", 38 100/0.5ML/29G X 1/2", 39 Ulticare Insulin Ultiguard Insulin Syringe/USyringe/SHORT/0.5ML/30G X 5/16", 38 100/0.5ML/30G X 5/16", 39 Ulticare Insulin Ultiguard Insulin Syringe/U-100/1ML/29G Syringe/SHORT/0.5ML/31G X 5/16", 38 X 1/2", 39 Ulticare Insulin Syringe/SHORT/1ML/30G Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16", 38 X 5/16", 39 Ulticare Insulin Syringe/SHORT/1ML/31G Ultilet Classic Lancets, 32 X 5/16", 38 Ultilet Insulin Syringe/SHORT/0.3ML/30G Ulticare Insulin Syringe/U-100/0.3ML/29G X 5/16", 39 X 1/2", 38 Ultilet Insulin Syringe/SHORT/0.3ML/31G Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16", 39 X 1/2", 38 Ultilet Insulin Syringe/SHORT/0.5ML/30G Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16", 39 X 5/16", 38 Ultilet Insulin Syringe/SHORT/0.5ML/31G Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16", 39 X 5/16", 38 Ultilet Insulin Syringe/SHORT/1ML/30G X Ulticare Insulin Syringe/U-100/0.5ML/29G 5/16", 39 X 1/2", 38 Ultilet Insulin Syringe/SHORT/1ML/31G X Ulticare Insulin Syringe/U-100/0.5ML/30G 5/16", 39 X 1/2", 38 Ultilet Lancets, 32 Ulticare Insulin Syringe/U-100/0.5ML/30G Ultilet Lancets 33G, 32 X 5/16", 38 Ultilet Pen Needle 32GX4MM/SHORT, Ulticare Insulin Syringe/U-100/0.5ML/31G

39 Ultilet Safety Lancets 23G, 32 Ultilet SHORT Pen Needles 31GX5/16", 39 Ultilet SHORT Pen Needles31GX3/16", 39 Ultimatecare One, 28 Ultimatecare One NF, 28 Ultra Comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 39 Ultra Comfort Insulin Syringe/U100/0.5ML/28G X 1/2", 39 Ultra TABS, 28 Ultra Thin Lancets 28G, 32 Ultra Thin Lancets 30G, 32 Ultra-comfort Insulin Syringe/U100/0.3ML/29G X 1/2", 39 Ultra-comfort Insulin Syringe/U100/0.3ML/30G X 5/16", 39 Ultra-comfort Insulin Syringe/U100/0.3ML/31G X 5/16", 39 Ultra-comfort Insulin Syringe/U100/0.5ML/28G X 1/2", 39 Ultra-comfort Insulin Syringe/U100/0.5ML/29G X 1/2", 39 Ultra-comfort Insulin Syringe/U100/0.5ML/30G X 5/16", 39 Ultra-comfort Insulin Syringe/U100/0.5ML/31G X 5/16", 39 Ultra-comfort Insulin Syringe/U100/1ML/28G X 1/2", 39 Ultra-comfort Insulin Syringe/U100/1ML/29G X 1/2", 39 Ultra-comfort Insulin Syringe/U100/1ML/30G X 5/16", 39 Ultra-comfort Insulin Syringe/U100/1ML/31G X 5/16", 39 Ultra-thin II Auto Lancet, 32 Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/30GX5/16", 39 Ultra-thin II Insulin Syringe SHORT/U100/0.3ML/31GX5/16", 39 Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/30GX5/16", 39 Ultra-thin II Insulin Syringe SHORT/U100/0.5ML/31GX5/16", 39 Ultra-thin II Insulin Syringe SHORT/U100/1ML/30GX5/16", 39 Ultra-thin II Insulin Syringe SHORT/U100/1ML/31GX5/16", 39 Ultra-thin II Insulin Syringe/U100/0.3ML/29GX1/2", 39 Ultra-thin II Insulin Syringe/U100/0.5ML/29GX1/2", 39 Ultra-thin II Insulin Syringe/U100/1ML/29GX1/2", 39 Ultra-thin II Lancets 28G, 32 Ultra-thin II Lancets 30G, 32 Ultra-thin II Mini Pen Neeedles/31GX3/16", 39 Ultra-thin II Pen Needles 29GX1/2", 39 Ultra-thin II Pen Needles/SHORT/31GX5/16", 39 Ultra-thin II Safety Autolancets 26G, 32 Ultralance, 39 umecta mousse, 9 Unifine Pentips 29GX12MM, 39 Unifine Pentips 31G X 3/16", 39

Unifine Pentips 31G X 6MM, 39 Unifine Pentips 31G X 8MM, 39 Unifine Pentips 31GX5MM, 39 Unifine Pentips 31GX6MM, 39 Unifine Pentips 31GX8MM, 39 Unifine Pentips 32GX4MM, 39 Unifine Pentips Plus 29GX12MM, 39 Unifine Pentips Plus 31GX5MM, 39 Unifine Pentips Plus 31GX6MM, 39 Unifine Pentips Plus 31GX8MM, 39 Unifine Pentips Plus 32GX4MM, 39 Unilet Comfortouch Lancet, 32 Unilet Excelite, 32 Unilet Excelite II, 32 Unilet G.p. Lancet, 32 Unilet G.p. Superlite Lancet, 32 Unilet GP 28 Ultra Thin, 32 Unilet Lancet, 32 Unilet Lancets Micro-thin33G, 32 Unilet Lancets Super-thin30G, 32 Unilet Lancets Ultra-thin 28G, 32 Unilet Superlite Lancet, 32 Unistik 1, 39 Unistik 2, 39 Unistik 2 Comfort, 39 Unistik 2 Extra, 39 Unistik 2 Neonatal, 39 Unistik 2 Normal, 39 Unistik 2 Super, 39 Unistik 3, 39 Unistik 3 Comfort, 39 Unistik 3 Extra, 39 Unistik 3 Gentle, 32 Unistik 3 Neonatal, 39 Unistik 3 Normal, 39 Unistik CZT Comfort, 39 Unistik CZT Normal, 39 Unistik Safety Lancets 28G, 32 Unistik Safety Lancets 30G, 32 Unistik Touch Safety Lancets 21G, 32 Unistik Touch Safety Lancets 23G, 32 Unistik Touch Safety Lancets 28G, 32 Unistik Touch Safety Lancets 30G, 32 unithroid, 13 unithroid direct, 13 Unituxin, 4 Universal 1 Lancets Thin 26G, 32 Universal 1 Lancets Ultra Thin 30G, 32 Uptravi, 8 ur n-c, 15 uramit mb, 15 ure-k, 9 urea, 9 urea 40% nail film, 9 urea hydrating, 9 urea IN zinc undecylenate/lactic acid vehicle, 9 urea nail, 9 urea topical, 9 urea-c40, 9 urelle, 15 uretron d/s, 15 uribel, 15 urin d/s, 15 Urin-tek, 39 uro-blue, 15 uro-l, 15 uro-mp, 15

uroav-81, 15 uroav-b, 15 urolet mb, 15 urophen mb, 15 urosex, 27 ursodiol, 15 uryl, 15 ustell, 15 uta, 15 uticap, 15 utira-c, 15 utrona-c, 15 Uvadex, 5

V v-c forte, 27 V-go 20, 32 V-go 30, 32 V-go 40, 32 V-r Monoject Insulin Syringe/U100/0.3ML/29G X 1/2", 39 V-r Monoject Insulin Syringe/U100/0.5ML/28G X 1/2", 39 V-r Monoject Insulin Syringe/U100/0.5ML/29G X 1/2", 39 V-r Monoject Insulin Syringe/U100/1ML/28G X 1/2", 39 V-r Monoject Insulin Syringe/U100/1ML/29G X 1/2", 39 Vagifem, 15 valacyclovir HCL, 2 Valchlor, 3, 10 Valcyte, 3 valganciclovir, 2 valproate sodium, 19 valproic acid, 19 valsartan, 6 valsartan/hydrochlorothiazide, 7 Valstar, 3 Value Health Insulin Syringe/U100/0.5ML/29G X 1/2", 39 Value Health Insulin Syringe/U100/1ML/29G X 1/2", 39 Value Plus Lancets Standard 21G, 32 Value Plus Lancets Super Thin 30G, 32 Value Plus Lancets Thin 26G, 32 Value Plus Lancing Device, 39 Valumark Lancet Super Thin 30G, 32 Valumark Lancet Ultra Thin 28G, 32 Valumark Pen Needles 29GX12MM, 39 Valumark Pen Needles 31G X 6MM, 39 Valumark Pen Needles 31G X 8MM, 39 Valved Holding Chamber, 40 vancomycin HCL, 3 vandazole, 15 Vanishpoint Insulin Syringe/0.5ML/30G X 1/2", 39 Vanishpoint Insulin Syringe/1ML/29G X 1/2", 39 Vantas, 4 Vaqta, 26, 45 Varivax, 26, 45 Vascepa, 7 vasopressin, 13 Vcf vagin*l Contraceptive Film, 15, 44 Vcf vagin*l Contraceptive Foam, 15, 44 vcf vagin*l contraceptivegel, 15, 44 Vectibix, 4 Vectical, 9

vecuronium bromide, 21 Velcade, 5 Veletri, 8 velivet, 11, 44 Veltassa, 42 venlafaxine HCL, 18 venlafaxine HCL ER, 18 Venlafaxine HCL ER, 18 Ventavis, 8 verapamil HCL, 6 verapamil HCL ER, 6 verapamil HCL SR, 6 verdrocet, 24 Veregen, 10 Vesicare, 15 vestura, 11, 44 Vexol, 21 Viagra, 7 Vibativ, 3 vic-forte, 27 vicodin, 24 vicodin ES, 24 vicodin HP, 24 Victoza, 12 Victrelis, 3 Vida Mia Autolet Lancing Device, 39 Vida Mia Unifine Pentips 32GX4MM, 39 Vida Mia Unifine Pentips Mini 31GX6MM, 39 Vida Mia Unifine Pentips Original 29GX12MM, 39 Vida Mia Unilet Lancets Super Thin 30G, 32 Vida Mia Unilet Lancets Ultra Thin 28G, 32 Vida Mia Unipfine Pentipsshort 31GX8MM, 39 Videx Pediatric, 2 vienva, 11, 44 Vigamox, 21 Viibryd, 18 Viibryd Starter Pack, 18 Vimizim, 13 Vimpat, 19 Vinate C, 28 Vinate Care, 28 Vinate IC, 28 Vinate II, 28 Vinate M, 28 Vinate One, 28 Vinblastine Sulfate, 4 vincasar PFS, 4 vincristine sulfate, 4 vinorelbine tartrate, 4 viorele, 11, 44 Viracept, 2 Viramune, 2 Virazole, 3 Viread, 2 virt-CAPS, 27 virt-gard, 16 virt-phos 250 neutral, 41 virt-vite, 16 virt-vite plus, 27 virti-sulf, 8 virtrate-2, 15 virtrate-3, 16 virtrate-k, 15

Visudyne, 22 vita s forte, 27 vita-min, 27 vitacel, 27 Vitafol-OB, 28 vitajoy daily d gummies, 27, 47 Vitalet Pro Lancets, 32 Vitalet Pro Plus Lancets, 32 vitamax pediatric, 27 Vitamelts Vitamin D, 27, 47 vitamin b-complex 100, 27 vitamin c 222MG, 26 vitamin d, 26, 47 vitamin d 400, 27, 47 vitamin d high potency, 27, 47 vitamin d-1000, 27, 47 vitamin d-1000 maximum strength, 27, 47 vitamin d-3, 27, 47 vitamin d-400, 27, 47 Vitamin D2, 27 vitamin d3, 27, 47 Vitamin D3, 27, 47 vitamin d3 400, 27, 47 vitamin d3 adult gummies, 27, 47 vitamin d3 high potency, 27, 47 vitamin d3 maximum strength, 27, 47 vitamin d3 super strength, 27, 47 vitamin k1, 26 vitamins a/c/d/fluoride, 28 Vitekta, 2 Vivitrol, 42 Vivotif, 26 vol-care RX, 28 Voraxaze, 5 voriconazole, 2 Vortex Valved Holding Chamber, 40 Votrient, 5 Vp Insulin Syringe/U-100/0.3ML/29G X 1/2", 39 vp-vite RX, 28 Vp-zel, 28 Vpriv, 17 vyfemla, 11, 44 Vytorin, 7 Vyvanse, 19

W W&f Lancets 26G, 32 W&f Lancets Colored 21G, 32 Walgreens Advanced Travellancets 28G, 32 Walgreens Comfort Assuredlancets Micro Thin/33G, 32 Walgreens Comfort Assuredlancets Super Thin/28G, 32 Walgreens Lancets, 32 Walgreens Thin Lancets, 32 Walgreens Ultra Thin Lancets, 32 warfarin sodium, 17 Watchhaler, 40 Wd Medic Insulin Syringe/0.3ML/29G X 1/2", 39 Wd Medic Insulin Syringe/0.3ML/30G X 5/16", 39 Wd Medic Insulin Syringe/0.5ML/29G X 1/2", 39 Wd Medic Insulin Syringe/0.5ML/30G X 5/16", 39

Wd Medic Insulin Syringe/1ML/29G X 1/2", 39 Wd Medic Insulin Syringe/1ML/30G X 5/16", 39 Webcol Alcohol Prep Large 1 Ply, 40 Webcol Alcohol Prep Large 2 Ply, 40 Webcol Alcohol Prep Medium 2 Ply, 40 wee care, 16, 46 Wegmans Unifine Pentips Plus 32GX4MM, 39 Wegmans Unifine Pentips Plus/Mini/31GX5MM, 39 Wegmans Unifine Pentips Plus/SHORT/31GX8MM, 39 Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM, 39 Welchol, 7 Wellesse Vitamin D3, 27, 47 wera, 11, 44 Wide-seal Silicone Diaphragm Kit 60, 44 Wide-seal Silicone Diaphragm Kit 65, 44 Wide-seal Silicone Diaphragm Kit 70, 44 Wide-seal Silicone Diaphragm Kit 75, 44 Wide-seal Silicone Diaphragm Kit 80, 44 Wide-seal Silicone Diaphragm Kit 85, 44 Wide-seal Silicone Diaphragm Kit 90, 44 Wide-seal Silicone Diaphragm Kit 95, 44 Wilate, 17 Winrho SDF, 42 wymzya FE, 11, 44

X x-viate, 10 Xalkori, 5 Xarelto, 17 Xarelto Starter Pack, 17 Xeomin, 21 Xgeva, 13 Xiaflex, 42 Xifaxan, 3 Xolair, 25 Xolegel, 8 Xtandi, 4 Xulane, 11, 44 xylocaine dental, 25 xylon, 24 Xyntha, 17 Xyntha Solofuse, 17 xyphex, 10 Xyrem, 20

Y Yervoy, 4 Yf-vax, 26 yl folic acid, 16, 44 Yondelis, 3 Your Life Multi Prenatal, 28

Z zafirlukast, 25 zaleplon, 19 Zaltrap, 4 zamicet, 24 Zanosar, 3 zarah, 11, 44 Zavesca, 17 zazole, 15 zebutal, 22 Zelboraf, 5 Zemaira, 26

zenatane, 8 zenchent, 11, 44 zenchent FE, 11, 44 zencia, 8 Zenpep, 14 zenzedi, 19 Zepatier, 3 zeruvia, 10 Zetia, 7 Zevalin Y-90, 4 Ziagen, 2 zidovudine, 2 Zinacef, 1 ziprasidone HCL, 19 Zirgan, 21 Zithromax, 1 Zoladex, 4 zoledronic acid, 12 Zoledronic Acid, 12 Zolinza, 5 zolmitriptan, 24 zolmitriptan odt, 24 zolpidem tartrate, 19 zolpidem tartrate ER, 19 Zometa, 12 Zomig, 24 Zomig Nasal Spray, 24 zonisamide, 19 Zontivity, 17 Zorbtive, 13 Zortress, 4 Zostavax, 26, 45 zovia 1/35e, 11, 44 Zovirax, 8 Zydelig, 5 Zyflo CR, 25 Zykadia, 5 Zyprexa Relprevv, 19 Zytiga, 4 Zyvox, 3

1 1ST Choice Lancets Super Thin, 32 1ST Choice Lancets Thin, 32 1ST Choice Lancets Ultra Thin, 32 1ST Tier Unifine Pentips /Mini/31GX5MM, 39 1ST Tier Unifine Pentips 29GX12MM, 39 1ST Tier Unifine Pentips 31GX6MM, 39 1ST Tier Unifine Pentips 31GX8MM, 39 1ST Tier Unifine Pentips 32GX4MM, 39 1ST Tier Unifine Pentips Plus 31GX8MM, 39 1ST Tier Unifine Pentips Plus 32GX4MM, 39 1ST Tier Unifine Pentips Plus/Mini/31GX5MM, 39 1ST Tier Unifine Pentips Plus/Original/29GX12MM, 39 1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM, 39 1ST Tier Unilet Comfortouch Lancets 28G, 32 1ST Tier Unilet Comfortouch Lancets 30G, 32

8 8-mop, 9

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