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Preferred Prescriptions® Member Guide

Please bring this guide with you on your next doctor visit.

Medco and Preferred Prescriptions are registered trademarks of Medco Health Solutions, Inc. © 2007 Medco Health Solutions, Inc. All rights reserved. Medco is a registered trademark of Medco Health Solutions, Inc. If you have questions about your prescription drug benefit, visit www.medco.com or call Member Services using the toll-free number on the back of your prescription drug ID card.

MG920297 MEIPG (Ed. 10/07 - reflects 1/1/08 formulary changes)

Medco manages your prescription drug benefit for your health plan.

Preferred Prescriptions® is a formulary list of medications that may be covered under your prescription drug plan. This list was reviewed by an independent group of practicing doctors and pharmacists, and it contains medications made by most pharmaceutical manufacturers. It includes medications for many covered conditions.

SAVING

MONEY ON PRESCRIPTIONS

Your plan may prefer some medications over others. These are called preferred drugs.

You may pay: · Lowest co-payment for generic drugs · Higher co-payment for preferred brand-name drugs · Highest co-payment for nonpreferred brand-name drugs

Your doctor may be able to help you save money by prescribing generic and preferred brand-name drugs if appropriate. So be sure to bring this guide with you on every visit to your doctor. Some commonly prescribed nonpreferred drugs are also listed in this guide for your reference. Please note: This guide does not contain a complete list of preferred and nonpreferred drugs. It only lists the most commonly prescribed drugs. For an updated and complete listing of your prescription benefit, you can visit the "Benefit Highlights" section of our website--www.medco.com--and click on the View your preferred drug list link.

FINDING

MEDICATIONS WITH LOWER CO-PAYMENTS

This guide lists medications two ways to help you find some generic, preferred, and nonpreferred brand-name drugs.

SECTION I - ALPHABETICALLY

BY DRUG CATEGORY (SUCH AS RESPIRATORY)

Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferred brand-name drugs sorted separately:

G P NP

Means a preferred generic medication Means a preferred brand-name medication Means a nonpreferred brand-name medication

BY BRAND NAME

SECTION II - ALPHABETICALLY

After each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives.

SAFETY

CONSIDERATION SYMBOLS

Here is a quick guide for you and your doctor, which explains our safety symbols. These symbols appear next to certain medications. Means weigh risk of birth defects or other adverse outcomes. Means do not use in pregnancy.

The information in this guide was in effect at the time of printing and may be subject to change.

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SECTION I: THERAPEUTIC DRUG CATEGORIES

ANTI-INFECTIVES

Oral Penicillins

G G G G G P P P P NP NP NP NP NP NP G G G G G P P NP NP NP NP NP NP NP NP G G G G G G G G P P NP NP NP NP NP amoxicillin trihydrate amoxicillin trihydrate/ potassium clavulanate ampicillin trihydrate dicloxacillin sodium penicillin v potassium Augmentin Chewable Tablet 125 - 31.25mg, 250 - 62.5mg Augmentin Suspension 125 - 31.25mg/5, 250 - 62.5mg/5 Augmentin Tablet 250-125mg Augmentin XR Augmentin Chewable Tablet 200 - 28.5mg, 400 - 57mg Augmentin ES Augmentin Suspension 200 - 28.5mg/5, 400 - 57mg/5 Augmentin Tablet 500 - 125mg, 875 - 125mg Dispermox Geocillin doxycycline hyclate capsule doxycycline hyclate tablet doxycycline monohydrate minocycline HCl tetracycline HCl Adoxa Vibramycin Suspension Doryx Dynacin Minocin Monodox Oracea Periostat Solodyn Vibramycin Syrup cefaclor cefadroxil hydrate cefdinir cefpodoxime proxetil cefprozil cefuroxime axetil cephalexin monohydrate cephradine Ceftin Suspension Ceftin Tablet 125mg Ceclor CD Cedax Ceftin Tablet 250mg, 500mg Cefzil Duricef

(Antibiotics/Antifungals)

NP NP NP NP NP NP NP G G G G G G P NP NP NP NP NP G G P P P P P NP NP NP NP NP NP NP G G G G NP NP NP G G G G G G P NP

Keflex Keftab Omnicef Spectracef Suprax Vantin Velosef azithromycin clarithromycin erythromycin base tablet, enteric coated erythromycin ethylsuccinate erythromycin ethylsuccinate/ sulfisoxazole acetyl erythromycin stearate Biaxin XL Biaxin EryPed PCE Zithromax Zmax ciprofloxacin HCl tablet ofloxacin Avelox Cipro Suspension Cipro Tablet 100mg Levaquin Noroxin Cipro Tablet 250mg, 500mg, 750mg Cipro XR Factive Floxin Maxaquin Proquin XR Tequin erythromycin ethylsuccinate/ sulfisoxazole acetyl sulfadiazine sulfamethoxazole/ trimethoprim sulfisoxazole Bactrim DS Gantrisin Septra DS methenamine hippurate methenamine mandelate nitrofurantoin macrocrystal nitrofurantoin/nitrofurantoin macrocrystal phenazopyridine HCl trimethoprim Furadantin Hiprex

NP NP NP NP NP G G G G G G G P P P P NP NP NP NP NP NP NP NP NP NP NP G G P P P NP NP NP G G G G G P NP NP

Macrobid Macrodantin Monurol Neggram Primsol clotrimazole fluconazole griseofulvin ultramicrosize itraconazole ketoconazole nystatin terbinafine HCl Ancobon Noxafil Sporanox Oral Solution Vfend Tablet Diflucan Fulvicin U/F Fungizone Grifulvin V Gris-Peg Lamisil Tablet Mycostatin Mycelex Troche Nizoral Sporanox Capsule Vfend Suspension clindamycin HCl neomycin sulfate Dapsone Tobi Ampul for Nebulization Zyvox Cleocin HCl Ketek Xifaxan fluconazole miconazole nitrate vaginal suppository nystatin terconazole vaginal cream terconazole vaginal suppository Gynazole-1 Terazol Suppository,Vaginal Terazol Vaginal Cream with Applicator

Oral Antifungal Agents

Oral Erythromycins

Oral Quinolones

Oral Tetracyclines

Oral Miscellaneous Agents

Oral Sulfas

Vaginal Antifungals

Oral Cephalosporins

Oral Urinary Tract Agents

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

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PSYCHOTHERAPEUTICS

Hypnotic Agents

G G G G G G P P P NP NP NP NP NP NP NP NP G G G G G G G P P P NP NP NP NP NP NP NP NP G G G G G

(Anxiety/Depression)

chloral hydrate estazolam flurazepam HCl temazepam triazolam zolpidem tartrate Ambien CR Restoril 7.5mg, 22.5mg Sonata Ambien Dalmane Doral Halcion Lunesta ProSom Restoril 15mg, 30mg Rozerem amitriptyline HCl amoxapine clomipramine HCl desipramine HCl doxepin HCl imipramine HCl nortriptyline HCl Surmontil Tofranil-PM Vivactil Anafranil Asendin Aventyl HCl Elavil Norpramin Pamelor Sinequan Tofranil bupropion HCl tablet bupropion HCl tablet, sustained action maprotiline HCl mirtazapine tablet mirtazapine tablet, rapid dissolve

G G P P NP NP NP NP NP NP NP NP NP NP G G G G G G G G G P P P P P P P P P P P NP NP NP G G G G G

trazodone HCl venlafaxine HCl Cymbalta Wellbutrin XL 150mg Desyrel Effexor Effexor XR Ludiomil Remeron SolTab Remeron Tablet Serzone Wellbutrin Wellbutrin SR Wellbutrin XL 300mg chlorpromazine HCl clozapine fluphenazine HCl haloperidol haloperidol lactate concentrate, oral loxapine succinate perphenazine thiothixene trifluoperazine HCl Clozaril Geodon Moban Orap Risperdal Risperdal M-Tab Serentil Seroquel Seroquel XR Zyprexa Zyprexa Zydis Abilify Invega Symbyax alprazolam alprazolam XR buspirone HCl chlordiazepoxide HCl clorazepate dipotassium

G G G NP NP NP NP NP NP NP NP NP NP NP G P NP NP G G G G G P NP NP NP NP NP NP NP NP NP

diazepam lorazepam oxazepam Ativan Buspar Librium Niravam Paxipam Serax Tranxene SD Tranxene T-Tab Valium Xanax Xanax XR tranylcypromine sulfate Nardil Emsam Parnate citalopram HBr fluoxetine HCl fluvoxamine maleate paroxetine HCl sertraline HCl Paxil CR Celexa Lexapro Luvox Paxil Pexeva Prozac Prozac Weekly Sarafem Zoloft

Antipsychotics

MAOI Antidepressants

Tricyclic Antidepressants

SSRI Antidepressants

Miscellaneous Antidepressants

Anxiolytics

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

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CARDIOVASCULAR

Beta Blockers

G G G G G G G G G G G G G P NP NP NP NP NP NP NP NP NP NP NP NP NP NP

(Blood Pressure/Heart/Cholesterol)

P Atacand P Atacand HCT P Benicar Calcium Blockers P Benicar HCT G diltiazem HCl P Cozaar G diltiazem HCl capsule, P Diovan sustained action P Diovan HCT G diltiazem HCl capsule, P Hyzaar sustained release 12 hr P Micardis G diltiazem HCl capsule, P Micardis HCT sustained release 24 hr NP Avalide G nimodipine NP Avapro G verapamil HCl NP Tekturna G verapamil HCl tablet, sustained NP Teveten action NP Teveten HCT P Cardizem LA Antilipidemics P Covera-HS G cholestyramine/aspartame NP Calan SR G cholestyramine/sucrose Cardizem NP G colestipol HCl NP Cardizem CD fenofibrate, micronized G Cardizem SR NP G gemfibrozil NP Isoptin S.R. G lovastatin Nimotop NP G niacin Tiazac NP G pravastatin NP Verelan simvastatin G NP Verelan PM Advicor P Dihydropyridines P Altoprev G amlodipine besylate P Crestor isradipine G Lipitor P G felodipine ER P Lovaza G nifedipine P Niaspan G nifedipine tablet, sustained P Tricor action P Triglide G nifedipine tablet, sustained Vytorin P release osmotic push Welchol P P Sular P Zetia Adalat CC NP NP Antara Cardene SR NP NP Caduet NP DynaCirc NP Colestid

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

acebutolol HCl atenolol betaxolol HCl bisoprolol fumarate carvedilol labetalol HCl metoprolol succinate metoprolol tartrate nadolol pindolol propranolol HCl propranolol HCl capsule, sustained action 24 hr timolol maleate Coreg CR Coreg Corgard Inderal Inderal LA Innopran XL Kerlone Levatol Lopressor Normodyne Sectral Tenormin Toprol XL Trandate Zebeta

NP NP NP NP G P NP G G G G G G G P NP NP NP NP NP NP

DynaCirc CR Norvasc Plendil Procardia XL nitroglycerin patch Minitran Patch Nitro-Dur Patch clonidine HCl doxazosin mesylate guanfacine HCl methyldopa prazosin HCl reserpine terazosin HCl Catapres-TTS Patch Cardura Cardura XL Catapres Hytrin Minipress Tenex

Nitroglycerin Patches

Adrenergic Antagonists & Related ACE Inhibitors Drugs

G G G G G G G P P NP NP NP NP NP NP NP NP NP G G G G G G G G G G G G G G P NP NP NP NP NP NP NP NP NP NP NP NP NP NP NP NP

NP NP NP NP NP NP NP NP NP

Lescol Lescol XL Lofibra Lopid Mevacor Pravachol Questran Questran Light Zocor benazepril HCl captopril enalapril maleate fosinopril sodium lisinopril quinapril trandolapril Aceon Altace Accupril Capoten Lotensin Mavik Monopril Prinivil Univasc Vasotec Zestril

Angiotensin II Blockers & Renin Inhibitors

Combination Antihypertensives

amlodipine besylate/benazepril atenolol/chlorthalidone benazepril HCl/ hydrochlorothiazide bisoprolol fumarate/ hydrochlorothiazide captopril/hydrochlorothiazide enalapril maleate/ hydrochlorothiazide fosinopril/hydrochlorothiazide hydralazine HCl/ hydrochlorothiazide lisinopril/hydrochlorothiazide methyldopa/ hydrochlorothiazide metoprolol/hydrochlorothiazide moexipril/hydrochlorothiazide propranolol HCl/ hydrochlorothiazide quinapril/hydrochlorothiazide Lotrel Accuretic Capozide Clorpres Corzide Exforge Lexxel Lopressor HCT Lotensin HCT Monopril HCT Prinzide Tarka Tenoretic Uniretic Vaseretic Zestoretic Ziac

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

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ENDOCRINE

P P P P P P P P P P NP NP G G G G G G G G G G G G G P P P P P P P P P P P P P NP NP NP NP NP NP NP NP NP NP NP

(Diabetes/Hormones/Contraceptives)

Insulin Therapy

Apidra Humalog Humalog Mix 50/50 Humalog Mix 75/25 Humulin Lantus Lantus SoloStar Levemir NovoLog NovoLog Mix 70/30 Exubera Novolin acetohexamide chlorpropamide glimepiride glipizide glipizide/metformin HCl glipizide tablet, sustained release osmotic push glyburide glyburide/metformin HCl glyburide, micronized metformin HCl metformin HCl tablet, sustained release 24 hr tolazamide tolbutamide Actoplus Met Actos Avandamet Avandaryl Avandia Byetta Duetact Janumet Januvia Prandin Precose Starlix Symlin Amaryl DiaBeta Glucophage Glucophage XR Glucotrol Glucotrol XL Glucovance Glynase Glyset Metaglip Micronase

Blood Glucose Test Strips

G P P P P P P P P P P G G G G G G G G G G G P P P P P P P P NP NP NP NP NP NP NP NP NP NP NP alcohol antiseptic pads Accu-Chek Active Test Strips Accu-Chek Aviva Test Strips Accu-Chek Comfort Curve Test Strips Accu-Chek Compact Test Strips Fast Take Test Strips One Touch Test Strips One Touch Ultra Test Strips Surestep Pro Test Strips Surestep Test Strips Tracer BG Test Strips desogestrel-ethinyl estradiol desogestrel-ethinyl estradiol/ethinyl estradiol ethynodiol d-ethinyl estradiol levonorgestrel-ethinyl estradiol norethindrone norethindrone a-e estradiol norethindrone a-e estradiol/ferrous fumarate norethindrone-ethinyl estradiol norethindrone-mestranol norgestimate-ethinyl estradiol norgestrel-ethinyl estradiol Cyclessa NuvaRing Ortho Tri-Cyclen Lo Ovrette Plan B Seasonique Yasmin Yaz Alesse Brevicon Demulen Desogen Estrostep Fe Levlen Levlite Loestrin Loestrin Fe Loestrin 24 Fe Lo/Ovral

Non-Insulin Hypoglycemic Agents

Contraceptive Agents

NP NP NP NP NP NP NP NP NP NP NP NP NP NP NP

Lybrel Mircette Modicon Nordette Norinyl Ortho-Cept Ortho-Cyclen Ortho Evra Ortho Micronor Ortho-Novum Ortho Tri-Cyclen Seasonale Tri-Levlen Tri-Norinyl Triphasil

Estrogens/Estrogen Combinations

G G G G P P P P P P P P P P P P P P P NP NP NP NP NP NP NP NP NP NP NP NP NP estradiol patch, transdermal weekly estradiol tablet estropipate methyltestosterone/ estrogens, esterified Activella Cenestin Climara Patch Combipatch Enjuvia Estraderm Patch Estratest Estratest H.S. Estring Vaginal Ring Premarin Tablet Premarin Vaginal Cream Premphase Prempro Vagifem Vivelle Patch Alora Angeliq Climara Pro Patch Elestrin Esclim Patch Estrace Estrasorb Femhrt Femring Femtrace Menest Ogen Ortho-Prefest

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

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GI

G G G G G G G P

(Ulcer)

Ulcer Drugs

cimetidine HCl liquid cimetidine tablet famotidine misoprostol nizatidine omeprazole ranitidine HCl Axid Oral Solution

P P NP NP NP NP NP NP NP

Nexium Capsule Nexium Suspension Aciphex Axid Capsule Cytotec Pepcid Prevacid Prilosec Rx Protonix

NP NP NP NP G P NP

Tagamet Zantac Rx Syrup Zantac Rx Tablet Zegerid sucralfate tablet Carafate Suspension Carafate Tablet

Other G I Drugs

NSAIDS

NSAIDs

G G G G G G G G G

(Pain Relievers)

etodolac etodolac tablet, sustained release 24 hr flurbiprofen ibuprofen indomethacin indomethacin capsule, sustained action ketoprofen ketoprofen capsule, 24 hr sustained release pellets meclofenamate sodium

G G G G G G G G G NP NP NP NP

meloxicam nabumetone naproxen naproxen sodium naproxen sodium tablet, sustained action oxaprozin piroxicam sulindac tolmetin sodium Clinoril Daypro diclofenac potassium diclofenac sodium

NP NP NP NP NP NP NP NP NP P

Indocin Lodine Lodine XL Mobic Motrin Naprelan Oruvail Relafen Voltaren Celebrex

NSAID COX-2 Inhibitors

MIGRAINE/HEADACHE THERAPY

G G G G G G acetaminophen/butalbital acetaminophen/caffeine/ butalbital aspirin/caffeine/butalbital ergotamine/caffeine tablet ergotamine tartrate/caffeine suppository, rectal dihydroergotamine mesylate G P P P P P P P isometheptene mucate/ acetaminophen/ dichloralphenazone Amerge Ergomar Frova Imitrex Injection Imitrex Nasal Spray Imitrex Tablet Maxalt P P P P P P P NP NP NP NP Maxalt MLT Phrenilin Phrenilin Forte Relpax Zomig Nasal Spray Zomig Tablet Zomig ZMT Axert Cafergot tablet Midrin Migranal

DRUGS TO TREAT ALZHEIMER'S DISEASE

P P P Aricept Aricept ODT Exelon P P NP Razadyne Razadyne ER Cognex NP Namenda

DRUGS TO TREAT OVERACTIVE BLADDER

G G P flavoxate oxybutynin chloride Detrol P P P Detrol LA Enablex Oxytrol P NP NP Vesicare Ditropan XL Sanctura

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

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RESPIRATORY

G G G G NP NP NP NP G G G G P P P P P P P NP NP NP NP NP NP NP NP P P P P P P P P P NP NP NP G G P P P P NP NP NP

(Allergy/Asthma)

Beta Agonists Oral

albuterol sulfate albuterol sulfate SR metaproterenol sulfate terbutaline sulfate Alupent Brethine Ventolin Volmax albuterol aerosol albuterol sulfate solution isoetharine HCl solution metaproterenol sulfate solution Accuneb Foradil Maxair Autohaler Proventil HFA Serevent Diskus Xopenex Xopenex HFA Alupent Brovana Perforomist Proair HFA Proventil Inhalation Solution Proventil Inhaler Ventolin HFA Ventolin Inhaler Asmanex Flovent Diskus Flovent HFA Flovent Inhaler Flovent Rotadisk Pulmicort Flexhaler Pulmicort Inhaler Pulmicort Respules QVAR Aerobid Aerobid-M Azmacort flunisolide fluticasone propionate Nasacort AQ Nasonex Rhinocort Aqua Veramyst Beconase AQ Flonase Nasacort

NP NP NP NP G G G P P P P P P P P P P P P P P P P P NP NP NP

Nasalide Nasarel Rhinocort Vancenase acetylcysteine vial cromolyn sodium ampul for nebulization ipratropium bromide solution Accolate Advair Diskus Advair HFA Atrovent HFA Atrovent Inhaler Combivent Inhaler Duoneb Intal Inhaler Letairis Pulmozyme Revatio Singulair Spiriva Symbicort Tilade Inhaler Tracleer Ventavis Atrovent Inhalation Solution Xolair Zyflo

G

Miscellaneous Pulmonary Agents

G G

Beta Agonist Inhalers

G G P P P P P P P P NP NP NP NP NP NP G G G G G G G P P P P P P P NP NP NP NP NP

brompheniramine maleate pseudoephedrine HCl/ brompheniramine maleate capsule, sustained release 12 hr pseudoephedrine HCl/ chlorpheniramine maleate pseudoephedrine HCl/ chlorpheniramine maleate capsule, sustained release 12 hr pseudoephedrine tannate/ chlorpheniramine tannate pseudoephedrine tannate/ dexchlorpheniramine tannate Allegra-D Deconamine Chewable Tablet Deconamine SR Deconamine Syrup Histex Liquid Histex SR Respi-Tann Zyrtec-D Clarinex-D 12 hr Clarinex-D 24 hr Deconamine Tablet Rynatan Rynatuss Semprex-D clemastine fumarate cyproheptadine HCl dexchlorpheniramine maleate syrup diphenhydramine HCl fexofenadine HCl hydroxyzine HCl hydroxyzine pamoate Allegra Oral Suspension Astelin Nasal Spray Clarinex RediTabs Clarinex Tablet Zyrtec Chewable Tablet Zyrtec Syrup Zyrtec Tablet Allegra Tablet Atarax Clarinex Syrup Histex IE Vistaril

Inhaled Steroids

Antihistamine/Decongestant Combinations

G G carbetapentane tannate/ chlorpheniramine tannate carbetapentane tannate/ ephedrine tannate/ phenylephrine/ chlorpheniramine suspension carbetapentane tannate/ phenylephrine tannate/ chlorpheniramine suspension phenylephrine HCl/ phenyltoloxamine citrate/ chlorpheniramine phenylephrine HCl/ promethazine HCl phenylephrine tannate/ chlorpheniramine tannate phenylephrine tannate/ diphenhydramine tannate suspension phenylephrine tannate/ pyrilamine tannate/ chlorpheniramine tablet pseudoephedrine HCl/

Antihistamines

G G G G G G G

Nasal Corticosteroids

OSTEOPOROSIS/PAGET'S DISEASE

P P P P Boniva Evista Forteo Fosamax Plus D P P P NP Fosamax Solution Fosamax Tablet Miacalcin Nasal Spray Actonel 5mg NP NP NP Actonel 35mg Actonel 75mg Actonel with Calcium

Key: G = Means a preferred generic medication. P = Means a preferred brand-name medication. NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes. = Means do not use in pregnancy.

7

SECTION II: NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED ALTERNATIVES

Nonpreferred Product

Abilify

®

Possible Preferred Products

clozapine (generic), Geodon® (Pfizer), Risperdal® (Janssen Pharmaceutical), Seroquel® (AstraZeneca), Zyprexa® (Eli Lilly) quinapril (generic) quinaretic (generic) omeprazole (generic), Nexium® (AstraZeneca) Boniva® (Roche), Fosamax 5mg® (Merck), Fosamax 10mg® (Merck) Boniva® (Roche), Fosamax 35mg® (Merck), Fosamax 70mg® (Merck) Boniva® (Roche), Fosamax® (Merck) nifedipine ER tablet, sustained action (generic), amlodipine besylate (generic), Sular® (First-Horizon) Asmanex® (Schering), Flovent Inhaler® (GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca), QVAR® (Ivax) Asmanex® (Schering), Flovent Inhaler® (GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca), QVAR® (Ivax) fexofenadine HCl (generic), Clarinex® (Schering), Zyrtec® (Pfizer) Aviane® (Barr-branded generic*), Lessina® (Barr-branded generic*), Lutera® (Watson-branded generic*) estradiol patch (generic), Climara® (Berlex), Estraderm® (Novartis),Vivelle® (Novartis) albuterol (generic), Maxair Autohaler® (3M) glimepiride (generic) zolpidem tartrate (generic) amoxicillin trihydrate (generic) clomipramine HCl (generic) naproxen sodium (generic) Activella® (Novo Nordisk), Premphase® (Wyeth), Prempro® (Wyeth) flurbiprofen (generic) fenofibrate (generic), gemfibrozil (generic),Tricor® (Abbott),Triglide® (First Horizon) Celebrex® (Pfizer) amoxapine (generic) hydroxyzine HCl (generic) lorazepam (generic) ipratropium bromide (generic) amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) Atacand HCT® (AstraZeneca), Benicar HCT® (Sankyo), Diovan HCT® (Novartis), Hyzaar® (Merck), Micardis HCT® (BIPI) Atacand® (AstraZeneca), Benicar® (Sankyo), Cozaar® (Merck), Diovan® (Novartis), Micardis® (BIPI) nortriptyline HCl (generic) Amerge® (GlaxoSmithKline), Frova® (Endo), Imitrex® (GlaxoSmithKline), Maxalt® (Merck), Relpax® (Pfizer), Zomig® (AstraZeneca) nizatidine (generic) Asmanex® (Schering), Flovent Inhaler® (GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca), QVAR® (Ivax) sulfamethoxazole/trimethoprim (generic) flunisolide (generic), fluticasone propionate (generic), Nasacort AQ® (Aventis), Nasonex® (Schering), Rhinocort Aqua® (AstraZeneca) clarithromycin (generic) pseudoephedrine HCl/chlorpheniramine maleate (generic) terbutaline sulfate (generic) Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*) albuterol sulfate (generic), Foradil® (Schering), Serevent Diskus® (GlaxoSmithKline) buspirone HCl (generic) chloral hydrate (generic), temazepam (generic), triazolam (generic) amlodipine besylate (generic), Lipitor® (Pfizer) verapamil HCl tablet, sustained action (generic) captopril (generic) captopril/hydrochlorothiazide (generic) sucralfate (generic) amlodipine besylate (generic), nifedipine ER tablet, sustained release osmotic push (generic), Sular® (First-Horizon) diltiazem HCl (generic) diltiazem HCl capsule, sustained release 24 hr (generic) diltiazem HCl capsule, sustained release 12 hr (generic) doxazosin mesylate (generic) etodolac (generic), ibuprofen (generic), naproxen (generic)

Accupril® Accuretic® Aciphex® Actonel 5mg® Actonel 35mg® Actonel® with Calcium Adalat CC® Aerobid® Aerobid-M® Allegra® Tablet Alesse® Alora® Alupent® Amaryl® Ambien® Amoxil® Anafranil® Anaprox DS® Angeliq® Ansaid® Antara® Arthrotec® Asendin® 50mg, 100mg Atarax® Ativan® Atrovent® solution, non-oral Augmentin® chewable tablet 200-28.5mg, 400-57mg Augmentin® suspension 200-28.5mg/5, 400-57mg/5 Augmentin® tablet 500-125mg, 875-125mg Augmentin ES® Avalide® Avapro® Aventyl HCl® Axert® Axid® Capsule Azmacort® Bactrim DS® Beconase AQ® Biaxin® Biohist-LA® Brethine® Brevicon® Brovana® Buspar® Butisol Sodium® Caduet® Calan SR® Capoten® Capozide® Carafate Tablet® Cardene SR® Cardizem® Cardizem CD® Cardizem SR® Cardura® Cataflam®

*Branded generics have the same co-payment as regular generics.

8

Nonpreferred Product

Catapres® Ceclor CD® Cedax® Ceftin Tablet® 250mg, 500mg Cefzil® Celexa® Cipro Tablet® 250mg, 500mg, 750mg Clarinex-D 12 Hour® Clarinex-D 24 Hour® Clarinex Syrup® Cleocin HCl® Climara Pro® Clinoril® Clorpres® Cognex® Colestid® Coreg® Corgard® Corzide® Cytotec® Dallergy® syrup Dalmane® Daypro® Deconamine® tablet Demulen® Desogen® Desyrel® DiaBeta® Diclofenac Potassium Diclofenac Sodium Diflucan® Dilacor XR® Dispermox® Ditropan XL® Doral® Doryx® Duricef® Dynacin® DynaCirc® DynaCirc CR® EC-Naprosyn® Effexor® Effexor XR® Elavil® Elestrin® Emsam® Enduronyl® Enduronyl Forte® EryPed Chewable Tablet® 200mg EryPed Suspension® 400mg/5ml Esclim® Estrace Tablet® Estrace Vaginal Cream® Estrasorb® Estrogel® Estrostep Fe® Exubera® Factive®

Possible Preferred Products

clonidine HCl (generic) cefaclor (generic), cefuroxime axetil (generic), Omnicef® (Abbott) cefaclor (generic), cefuroxime axetil (generic), Omnicef® (Abbott) cefuroxime axetil (generic) cefaclor (generic), cefuroxime axetil (generic), Omnicef® (Abbott) citalopram (generic) ciprofloxacin HCl tablet (generic) Allegra-D® (Aventis), Zyrtec-D® (Pfizer) Allegra-D® (Aventis), Zyrtec-D® (Pfizer) Zyrtec Syrup® (Pfizer) clindamycin HCl (generic) Combipatch® (Novartis) sulindac (generic) clonidine HCl (generic), chlorthalidone (generic) Aricept® (Eisai), Exelon® (Novartis), Razadyne® (Janssen Pharmaceuticals) cholestyramine/sucrose (generic),Welchol® (Sankyo) carvedilol (generic) nadolol (generic) bisoprolol fumarate/hydrochlorothiazide (generic), metoprolol/hydrochlorothiazide (generic), propranolol HCl/hydrochlorothiazide (generic) misoprostol (generic) pseudoephedrine HCl/brompheniramine maleate (generic) flurazepam HCl (generic) oxaprozin (generic) pseudoephedrine w/chlorpheniramine (generic) Zovia® (Watson-branded generic*) Apri® (Barr-branded generic*), Solia® (Prasco Labs-branded generic*) trazodone HCl (generic) glyburide (generic) etodolac (generic), ibuprofen (generic), naproxen (generic) etodolac (generic), ibuprofen (generic), naproxen (generic) fluconazole (generic) diltiazem XR (generic) amoxicillin trihydrate suspension (generic), amoxicillin trihydrate chewable tablet (generic) oxybutynin chloride ER (generic) temazepam (generic), triazolam (generic), zolpidem tartrate (generic), Restoril® (Mallinckrodt), Sonata® (Wyeth) doxycycline hyclate (generic) cefadroxil hydrate (generic) minocycline HCl (generic), myrac (generic) isradipine (generic), amlodipine besylate (generic), nifedipine ER tablet, sustained release osmotic push (generic), Sular® (First-Horizon) amlodipine besylate (generic), nifedipine ER tablet, sustained release osmotic push (generic), Sular® (First-Horizon) naproxen (generic) venlafaxine HCl (generic) venlafaxine HCl (generic), citalopram (generic), fluoxetine HCl (generic), paroxetine HCl (generic), sertraline HCl (generic), Cymbalta® (Eli Lilly) amitriptyline HCl (generic) estradiol patch (generic), Climara® (Berlex), Estraderm® (Novartis),Vivelle® (Novogyne) tranylcypromine sulfate (generic), Nardil® (Parke-Davis) hydrochlorothiazide (generic), methyldopa/HCTZ (generic) hydrochlorothiazide (generic), methyldopa/HCTZ (generic) erythromycin ethylsuccinate (generic) erythromycin ethylsuccinate (generic) estradiol (generic) estradiol (generic) Premarin Vaginal Cream® (Wyeth) estradiol patch (generic) estradiol patch (generic), Climara Patch® (Berlex), Estraderm Patch® (Novartis),Vivelle Patch® (Novartis) Apri® (Barr-branded generic*), Kariva® (Barr-branded generic*), Microgestin Fe® (Watson-branded generic*), Cyclessa® (Organon) Humalog® (Eli Lilly), Novolog® (Novo Nordisk) ciprofloxacin (generic), Avelox® (Schering), Levaquin® (J&J)

*Branded generics have the same co-payment as regular generics.

9

Nonpreferred Product

Feldene® Femhrt® Femring® Femtrace® Flonase® Floxin® Fortamet® tablet, SR osmotic push 24 hr Fulvicin U/F® Gantrisin® Geocillin® Glucophage® Glucophage XR® Glucotrol® Glucotrol XL® Glucovance® Glynase® Glyset® Grifulvin V® Gris-Peg® Guanabenz Acetate® Halcion® Hiprex® Hytrin® Inderal® Inderal LA® Indocin® Innopran XL® Invega® Isoptin S.R.® Keflex® Keftab® Kerlone® Ketek® Lamisil® Lescol® Lescol XL® Levatol® Levlen® Levlite® Lexapro® Lexapro Solution® Lexxel® Librium® Lodine® Lodine XL® Loestrin® Loestrin Fe® Loestrin 24 Fe® Lofibra® Lo/Ovral® Lopid® Lopressor® Lopressor HCT® Lotensin® Lotensin HCT® Ludiomil® Lunesta® Luvox®

Possible Preferred Products

piroxicam (generic) Activella® (Novo Nordisk), Premphase® (Wyeth), Prempro® (Wyeth) Estring® (Pfizer), Premarin Vaginal Cream® (Wyeth) estradiol (generic) fluticasone propionate (generic) ofloxacin (generic) metformin HCl ER tablet, sustained release 24 hr (generic), metformin HCl tablet (generic) griseofulvin ultramicrosize (generic), itraconazole (generic), ketoconazole (generic), terbinafine HCl (generic) sulfisoxazole (generic) ciprofloxacin HCl (generic) metformin HCl (generic) metformin HCl ER tablet, sustained release 24 hr (generic), metformin HCl tablet (generic) glipizide (generic) glipizide ER (generic) glyburide/metformin HCl (generic) glyburide, micronized (generic) Precose® (Bayer) griseofulvin ultramicrosize (generic), itraconazole (generic), ketoconazole (generic), terbinafine HCl (generic) griseofulvin ultramicrosize (generic), itraconazole (generic), ketoconazole (generic), terbinafine HCl (generic) clonidine HCl (generic), methyldopa (generic) triazolam (generic) methenamine hippurate (generic) terazosin (generic) propranolol HCl (generic) propranolol capsule, sustained action (generic) indomethacin (generic) propranolol capsule, sustained action (generic) Geodon® (Pfizer), Risperdal® (Janssen Pharmaceutical), Seroquel® (AstraZeneca), Zyprexa® (Eli Lilly) verapamil HCl tablet, sustained action (generic) cephalexin monohydrate (generic) cephalexin monohydrate (generic) betaxolol HCl (generic) amoxicillin trihydrate/potassium clavulanate (generic), azithromycin (generic), Avelox® (Schering), Levaquin® (J&J) terbinafine HCl (generic) lovastatin (generic), simvastatin (generic), Altoprev® (Andrx), Crestor® (AstraZeneca), Lipitor® (Pfizer), VytorinTM (Merck/Schering) lovastatin (generic), simvastatin (generic), Altoprev® (Andrx), Crestor® (AstraZeneca), Lipitor® (Pfizer), VytorinTM (Merck/Schering) acebutolol HCl (generic), atenolol (generic), metoprolol tartrate (generic) Levora® (Watson-branded generic*), Portia® (Barr-branded generic*) Aviane® (Barr-branded generic*), Lessina® (Barr-branded generic*) citalopram (generic), fluoxetine HCl (generic), paroxetine HCl (generic), sertraline HCl (generic), Paxil CR® (GlaxoSmithKline) citalopram solution (generic), fluoxetine HCl solution (generic), paroxetine HCl suspension (generic) Lotrel® (Novartis) chlordiazepoxide HCl (generic) etodolac (generic) etodolac (generic) Junel® (Barr-branded generic*), Microgestin® (Watson-branded generic*) Junel Fe® (Barr-branded generic*), Microgestin Fe® (Watson-branded generic*) Junel Fe® (Barr-branded generic*), Microgestin Fe® (Watson-branded generic*) fenofibrate (generic),Tricor® (Abbott),Triglide® (First Horizon) Low-Ogestrel® (Watson-branded generic*) gemfibrozil (generic) metoprolol tartrate (generic) metoprolol/hydrochlorothiazide (generic) benazepril HCl (generic) benazepril HCl/hydrochlorothiazide (generic) maprotiline HCl (generic) temazepam (generic), zolpidem tartrate (generic), Ambien CR® (Sanofi-Aventis) fluvoxamine maleate (generic)

*Branded generics have the same co-payment as regular generics.

10

Nonpreferred Product

Macrobid® Macrodantin® Mandelamine® Mandelamine Hafgrams® Mavik® Maxaquin® Mellaril® Menest® Menostar Patch® Mescolor® Metaglip® Mevacor® Micronase® Midrin® Migranal® Minipress® Minocin® Mircette® Mobic® Modicon® Monistat 3 Vaginal Suppository® Monodox® Monopril® Monopril HCT® Monurol® Motrin® Nalex-A® Nalfon® Namenda Dose Pack® Namenda Oral Solution® Namenda Tablet® Naprelan® Naprosyn® Nasacort® Nasalide® Nasarel® Neggram® Nembutal Sodium® Nimotop® Niravam® Nitro-Dur® Nizoral® Nordette® Norinyl® Normodyne® Norpramin® Norvasc® Novolin® Ogen® Omnicef® Oracea® Orinase® Ortho-Cept® Ortho-Cyclen® Ortho Evra® Ortho Micronor®

Possible Preferred Products

nitrofurantoin monohyd macro (generic) nitrofurantoin macrocrystal (generic) methenamine mandelate (generic) methenamine mandelate (generic) trandolapril HCl (generic), benazepril HCl (generic), enalapril maleate (generic), lisinopril (generic), quinapril (generic), Aceon® (Solvay Pharmaceuticals), Altace® (Monarch) ciprofloxacin HCl (generic), Avelox® (Schering), Levaquin® (J&J) chlorpromazine HCl (generic), haloperidol (generic), Risperdal® (Janssen), Seroquel® (AstraZeneca) estradiol (generic), estropipate (generic), Cenestin® (Duramed/Barr), Enjuvia® (Duramed/Barr), Premarin® (Wyeth) Climara Patch® (Berlex),Vivelle Patch® (Novartis) Deconamine SR® (Bradley) glipizide/metformin (generic) lovastatin (generic) glyburide (generic) isometheptene/apap/dichloralphenazone (generic) Imitrex® Nasal Spray (GlaxoSmithKline), Zomig® Nasal Spray (AstraZeneca), Amerge® (GlaxoSmithKline), Frova® (Endo), Maxalt® (Merck), Relpax® (Pfizer) prazosin HCl (generic) minocycline HCl (generic) Kariva® (Barr-branded generic*) meloxicam (generic) Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*) miconazole 3 vaginal suppository (generic) doxycycline monohydrate (generic) fosinopril sodium (generic) fosinopril/hydrochlorothiazide (generic) ciprofloxacin HCl (generic), sulfamethoxazole/trimethoprim (generic), trimethoprim (generic), Noroxin® (Merck) ibuprofen (generic) rhinacon-A (generic) etodolac (generic), ibuprofen (generic), indomethacin (generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) Aricept® (Eisai), Exelon® (Novartis), Razadyne® (Janssen Pharmaceuticals) Exelon Oral Solution® (Novartis), Razadyne Oral Solution® (Janssen Pharmaceuticals) Aricept® (Eisai), Exelon® (Novartis), Razadyne® (Janssen Pharmaceuticals) naproxen sodium (generic) naproxen (generic) Nasacort AQ® (Aventis) flunisolide (generic) flunisolide (generic), fluticasone propionate (generic), Nasacort AQ® (Aventis), Nasonex® (Schering), Rhinocort Aqua® (AstraZeneca) ciprofloxacin HCl (generic), sulfamethoxazole/trimethoprim (generic), trimethoprim (generic), Noroxin® (Merck) chloral hydrate (generic), temazepam (generic), triazolam (generic) nimodipine (generic) alprazolam (generic) nitroglycerin patch (generic), Minitran® (3M) ketoconazole (generic) Levora® (Watson-branded generic*), Portia® (Barr-branded generic*) Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*) labetalol HCl (generic) desipramine HCl (generic) amlodipine besylate (generic) Humulin® (Eli Lilly) estropipate (generic) cefdinir (generic) doxycycline monohydrate (generic) tolbutamide (generic) Apri®(Barr-branded generic*), Solia® (Prasco Labs-branded generic*) MonoNessa® (Watson-branded generic*), Previfem® (Teva-branded generic*), Sprintec® (Barr-branded generic*) MonoNessa® (Watson-branded generic*),TriNessa® (Watson-branded generic*) norethindrone acetate (generic)

*Branded generics have the same co-payment as regular generics.

11

Nonpreferred Product

Ortho-Novum® 1/35, 7/7/7 Ortho-Novum® 1/50 Ortho-Prefest® Ortho Tri-Cyclen® Oruvail® Ovcon® Ovral® Pamelor® Paxil® Paxipam® PCE® Pepcid® Perforomist® Periostat® Pexeva® Phenergan® Plendil® Ponstel® Pravachol® Prevacid® Prevacid Suspension® Prilosec Rx® Primsol® Prinivil® Prinzide® Proair HFA® Procardia XL® Proquin XR® ProSom® Protonix® Proventil® Proventil Multiphasic Release Tablet® Prozac® Prozac Weekly® Questran® Questran Light® Raniclor® tablet, chewable Relafen® Remeron® Restoril® 15mg, 30mg Rhinocort® Riomet Solution® Rozerem® Rynatan® Rynatuss® tablet Sanctura® Sarafem® Seasonale® Seconal Sodium® Sectral® Semprex-D® Septra DS® Serax® Serzone® Sinequan® Solodyn® Spectracef® Sporanox® capsule Suprax®

Possible Preferred Products

Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*) Necon® (Watson-branded generic*) Activella® (Novo Nordisk), Premphase® (Wyeth), Prempro® (Wyeth) TriNessa® (Watson-branded generic*),Tri-Previfem® (Teva-branded generic*),Tri-Sprintec® (Barr-branded generic*) ketoprofen (generic) Necon® (Watson-branded generic*) Ogestrel® (Watson-branded generic*) nortriptyline HCl (generic) paroxetine HCl (generic) clorazepate dipotassium (generic), diazepam (generic), lorazepam (generic), oxazepam (generic) erythromycin base (generic) famotidine (generic) albuterol sulfate (generic), Foradil® (Schering), Serevent Diskus® (GlaxoSmithKline) doxycycline hyclate (generic) paroxetine HCl (generic) promethazine HCl (generic) felodipine ER (generic), amlodipine besylate (generic), nifedipine ER tablet, sustained release osmotic push (generic), Sular® (First-Horizon) etodolac (generic), ibuprofen (generic), indomethacin (generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) pravastatin (generic) omeprazole (generic), Nexium® (AstraZeneca) omeprazole (generic), Nexium® (AstraZeneca) omeprazole (generic), Nexium® (AstraZeneca) trimethoprim (generic) lisinopril (generic) lisinopril/hydrochlorothiazide (generic) albuterol inhaler (generic), Proventil HFA® (Schering), Xopenex HFA® (Sepracor) nifedipine ER tablet, sustained release osmotic push (generic) ciprofloxacin HCl (generic) estazolam (generic) omeprazole (generic), Nexium® (AstraZeneca) albuterol (generic) albuterol sulfate (generic) fluoxetine HCl (generic) fluoxetine HCl (generic) cholestyramine/sucrose (generic) cholestyramine/aspartame (generic) cefaclor suspension (generic), cefaclor capsule (generic) nabumetone (generic) mirtazapine soltabs (generic), mirtazapine tabs (generic) temazepam (generic) Rhinocort AQ® (AstraZeneca) metformin HCl (generic) estazolam (generic), temazepam (generic), triazolam (generic), zolpidem tartrate (generic) phenclor tannate pediatric (generic), brompheniramine/pseudoephedrine (generic), pseudoephedrine HCl/chlorpheniramine maleate (generic) Deconamine SR® (Bradley) oxybutynin chloride (generic), Detrol® (Pharmacia/Upjohn), Detrol LA® (Pharmacia/Upjohn), Enablex® (Novartis),Vesicare® (GlaxoSmithKline) fluoxetine HCl (generic) Jolessa® (Barr-branded generic*), Quasense® (Watson-branded generic*), Seasonique® (Duramed/Barr), chloral hydrate (generic), temazepam (generic), triazolam (generic) acebutolol HCl (generic) pseudoephedrine HCl/brompheniramine (generic), pseudoephedrine HCl/chlorpheniramine (generic) sulfamethoxazole/trimethoprim (generic) oxazepam (generic) fluoxetine HCl (generic), paroxetine HCl (generic) doxepin HCl (generic) minocycline HCl (generic), doxycycline monohydrate (generic) cefaclor (generic), cefuroxime axetil (generic), Omnicef® (Abbott) itraconazole (generic) cefuroxime axetil (generic), Omnicef ® (Abbott)

*Branded generics have the same co-payment as regular generics.

12

Nonpreferred Product

Symbyax® Tagamet® Tarka® Tenex® Tenoretic® Tenormin® Tequin® Terazol® Teveten® Teveten HCT® Thioridazine HCl® Tiazac® 120mg, 180mg, 240mg, 300mg, 360mg Tiazac® 420mg Tofranil® Toprol XL® Toradol® Trandate® Tranxene SD® Tranxene T-Tab® Tri-Levlen® Tri-Norinyl® Triphasil® Uniretic® Univasc® Valium® Vancenase® Vantin Suspension® Vantin Tablet® Vaseretic® Vasotec® Velosef® Ventolin® Ventolin HFA® Verelan® Verelan PM® Vfend Suspension® Vibramycin Syrup® Vistaril® Volmax® Voltaren® Voltaren-XR® Wellbutrin® Wellbutrin SR® Wellbutrin XL® 300mg Wytensin® Xanax® Xanax XR® Xifaxan® Xolair® Zantac Rx Syrup® Zantac Rx Tablet® Zebeta® Zegerid® Zestoretic® Zestril® Ziac® Zithromax® Zmax® Zocor® Zoloft® Zyflo®

Possible Preferred Products

fluoxetine HCl (generic), Risperdal Tablet® (Janssen), Seroquel® (AstraZeneca), Zyprexa® (Eli Lilly) cimetidine (generic) Lotrel® (Novartis) guanfacine HCl (generic) atenolol/chlorthalidone (generic) atenolol (generic) Avelox® (Schering), Levaquin® (J&J) terconazole (generic) Atacand® (AstraZeneca), Benicar® (Sankyo), Cozaar® (Merck), Diovan® (Novartis), Micardis® (BIPI) Atacand HCT® (AstraZeneca), Benicar HCT® (Sankyo), Diovan HCT® (Novartis), Hyzaar® (Merck), Micardis HCT® (BIPI) chlorpromazine HCl (generic), haloperidol (generic), Risperdal® (Janssen), Seroquel® (AstraZeneca) diltiazem HCl capsule, sustained release 24 hr (generic) Cardizem LA® (Biovail) imipramine HCl (generic) metoprolol succinate (generic) etodolac (generic), ibuprofen (generic), indomethacin (generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) labetalol HCl (generic) clorazepate dipotassium (generic) clorazepate dipotassium (generic) Enpresse® (Barr-branded generic*),Trivora® (Watson-branded generic*) Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*) Enpresse® (Barr-branded generic*),Trivora® (Watson-branded generic*) moexipril/hydrochlorothiazide (generic), benazepril HCl/hydrochlorothiazide (generic), enalapril maleate/hydrochlorothiazide (generic), lisinopril/hydrochlorothiazide (generic) benazepril (generic), enalapril maleate (generic), lisinopril (generic), Aceon® (Solvay Pharmaceuticals), Altace® (Monarch) diazepam (generic) Nasonex® (Schering), Rhinocort AQ® (AstraZeneca) cefaclor suspension (generic), Omnicef Suspension® (Abbott) cefpodoxime proxetil tablet (generic) enalapril maleate/hydrochlorothiazide (generic) enalapril maleate (generic) cephradine (generic) albuterol (generic) albuterol (generic), Proventil HFA® (Schering) verapamil ER (generic) verapamil ER PM (generic) Vfend Tablet® (Pfizer) Vibramycin Suspension® (Pfizer) hydroxyzine pamoate (generic) albuterol sulfate (generic) etodolac (generic), ibuprofen (generic), naproxen (generic) etodolac (generic), ibuprofen (generic), naproxen (generic) bupropion HCl (generic) bupropion HCl tablet, sustained release (generic) bupropion tablet, sustained release (generic) clonidine HCl (generic), methyldopa (generic) alprazolam (generic) alprazolam XR (generic) ciprofloxacin HCl (generic), azithromycin (generic) Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline), Pulmicort® (AstraZeneca), QVAR® (Ivax) ranitidine HCl tablet (generic), Axid Oral Solution® (Braintree) ranitidine HCl tablet (generic) bisoprolol fumarate (generic) omeprazole (generic), Nexium® (AstraZeneca) lisinopril/hydrochlorothiazide (generic) lisinopril (generic) bisoprolol fumarate/hydrochlorothiazide (generic) azithromycin (generic) azithromycin (generic) simvastatin (generic) sertraline HCl (generic) Accolate® (AstraZeneca), Singulair® (Merck)

*Branded generics have the same co-payment as regular generics.

13

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