2020 Essential Drug Listdhhs.nv.gov/uploadedFiles/dhhsnvgov/content/HCPWD/2020... · 2020. 2....

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Steve Sisolak Governor Richard Whitley, MS Director Lisa Sherych DPBH Administrator 2020 Essential Drug List Report Date: February 1, 2020 Revised March 24, 2020 Prepared by: Primary Care and Health Workforce Development Office, State of Nevada Division of Public and Behavioral Health (DPBH) 4150 Technology Way, Suite 300, Carson City, NV 89706 Office: (775) 684-4255 Email: [email protected] drugtransparency.nv.gov Helping People. Its who we are and what we do.

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Steve Sisolak

Governor

Richard Whitley, MS

Director

Lisa Sherych

DPBH Administrator

2020 Essential Drug List

Report Date:

February 1, 2020 Revised March 24, 2020

Prepared by: Primary Care and Health Workforce Development Office, State of Nevada

Division of Public and Behavioral Health (DPBH) 4150 Technology Way, Suite 300, Carson City, NV 89706

Office: (775) 684-4255 Email: [email protected]

Helping People. It’s who we are and what we do.

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)

Introduction

NRS 439B.630

During the 79th legislative session, Senate Bill (SB) 539, which supports prescription drug transparency, was approved. SB 539 was codified in Nevada Revised Statutes (NRS) 439B. The law requires in NRS 439B.630 that the Department of Health and Hu-man Services (DHHS) compile a list of prescription drugs essential for treating diabetes and asthma in Nevada:

Department to annually compile lists of certain prescription drugs essential for treating asthma and diabetes. On or before February 1 of each year, the Department shall compile:

1. A list of prescription drugs that the Department determines to be essential fortreating asthma and diabetes in this State and the wholesale acquisition cost ofeach such drug on the list. The list must include, without limitation, all forms ofinsulin and biguanides marketed for sale in this State.

2. A list of prescription drugs described in subsection 1 that have been subject to anincrease in the wholesale acquisition cost of a percentage equal to or greaterthan:

a) The percentage increase in the Consumer Price Index, Medical CareComponent during the immediately preceding calendar year; or

b) Twice the percentage increase in the Consumer Price Index, MedicalCare Component during the immediately preceding 2 calendar years.

(Added to NRS by 2017, 4297; A 2019, 1465

The first essential diabetes drug list was published on October 31, 2017. The 2020 Essential Drug List identifies Nevada’s essential diabetes and asthma drugs as of the publication date and also indicates if these drugs underwent a significant price increase as defined by NRS 439B.630 (2). Labelers that manufacture (including repackers or relabelers) , or distributes drugs found on this list are required to submit reports by April 1, 2019 that include information about these drugs as outlined in NRS 439B.635 and NRS 439B.640. Additionally, Pharmacy Benefit Manag-ers (PBMs) are required to provide information to DHHS by April 1, 2019 regarding these drugs as outlined in NRS 439B.645. Data from these reports will be aggregated and published in the DHHS report required by NRS 439B.650 by June 1, 2020.

Report Methodology

To compile the 2020 DHHS Essential Drug list, DHHS utilized a methodology that met the re-quirements of NRS 439B.630. Two versions of the list are published: (1) a summary of the nonproprietary and brand or proprietary drug names found on the essential list [Appendix 1], and (2) a detailed list of all the National Drug Codes (NDCs) indicated by DHHS as essential drugs for diabetes and asthma and if each drug NDC experienced a significant price increase [Appendix 2]. The summary list (Appendix 1) provides a concise outline of the essential drugs, while the NDC list (Appendix 2) identifies the specific drug NDCs that will be monitored by DHHS and included in the yearly report.

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To generate the final list, DHHS compiled an initial list of diabetes and asthma drug NDCs that included varying drug packing formulations based on prior and current stakeholder input of essential diabetes and asthma drugs. These NDC codes were fil-tered down to include the drugs for which Nevada Medicaid expended funds in 2018 and/or 2019.

This essential list does not include any drugs used to treat co-morbidities often present in indi-viduals with diabetes or asthma. The list does not contain every single drug that may be an ef-fective treatment for diabetes/asthma. This list attempts to refine the numerous treatments to those approved for treatment, identified by prescribers as essential, and most frequently pre-scribed in Nevada (as determined by publicly available data sources). For this reason, some brand names are excluded while generics or alternative brands are included.

DHHS welcomes feedback regarding this report. DHHS strives to ensure that consumers receive accurate information. Any identified errors, omissions, or feedback can be submitted to the de-partment via email at [email protected]

DHHS invites you to view the Drug Transparency website at drugtransparency.nv.gov. If you are interested in receiving email notifications for Nevada Drug Transparency information and up-dates, please subscribe online at http://drugtransparency.nv.gov to the DHHS Drug Transparen-cy LISTSERV.

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Appendix 1:

2020 DHHS Essential Diabetes and

Asthma Drug

Summary List

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Appendix 1: 2020 DHHS Essential Diabetes Drug Summary ListPage 1 of 2

Essential Non-Propietary Drug NameIncluded Essential Drug Brand Names

(Note: some brand names are excluded from this list)

Acarbose PrecoseAlbiglutide TanzeumAlogloptin Benzoate Alogliptin, NesinaAlogloptin Benzoate and Metformin HCL KazanoAlogloptin Benzoate and Pioglitazone HCL OseniCanagliflozin InvokanaCanaglifozin and Metformin HCL Invokamet, Invokamet XRDapagliflozin Propanediol FarxigaDapagliflozin Propanediol and Metformin HCL Xigduo XrDapagliflozin Propanediol and Saxagliptin HCL QternDulaglutide TrulicityEmpagliflozin JardianceEmpagliflozin and Linagliptin GlyxambiEmpagliflozin and Metformin HCL Synjardy, Synjardy XrErtugliflozin Pidolate SteglatroErtugliflozin Pidolate and Metformin HCL SeglurometErtugliflozin Pidolate and Sitagliptin Phosphate SteglujanExenatide ByettaExenatide Microspheres Bydureon, Bydureon Pen, Bydureon BciseGlimepiride AmarylGlipizide Glucotrol, Glucotrol XL, Glipzide ER, Glipzide XLGlipizide and Metformin HCLGlyburide DiabetaGlyburide,Micronized GlynaseGlyburide and Metformin HCL GlucovanceInsulin Aspart Novolog, Novolog FlexpenInsulin Aspart (Niacinamide) Fiasp, Fiasp Flextouch, Fiasp PenfillInsulin Aspart Protamine Human and Insulin Aspart

Novolog Mix 70-30, Novolog Mix 70-30 Flexpen

Insulin Degludec Tresiba, Tresiba FlextouchInsulin Degludec/Liraglutide XultophyInsulin Detemir Levemir, Levemir FlextouchInsulin Glargine,Human Recombinant Analog Basaglar Kwikpen, Toujeo Solostar, Toujeo Max Solostar,

Lantus, Lantus SolostarInsulin Glargine,Human Recombinant Analog and Lixisenatide

Soliqua

Insulin Glulisine Apidra, Apidra SolostarInsulin Lispro Humalog, Humalog Kwikpen, Humalog Junior Kwikpen,

Admelog, Admelog SolostarInsulin Lispro Protamine and Insulin Lispro Humalog Mix 75-25, Humalog Mix 50-50, Humalog Mix 75-

25 Kwikpen, Admelog Solostar, Insulin Lispro, Insulin Lispro Kwikpen

Insulin Nph Human Isophane Humulin N, Humulin N Kwikpen, Novolin NInsulin Nph Human Isophane and Insulin Regular Human

Humulin 70-30, Humulin 70/30 Kwikpen, Novolin 70-30, Novolin 70-30 Flexpen

Insulin Regular, Human Humulin R, Humulin R Kwikpen, Afrezza, Novolin RLinagliptin Tradjenta

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Appendix 1: 2020 DHHS Essential Diabetes Drug Summary ListPage 2 of 2

Essential Non-Propietary Drug NameIncluded Essential Drug Brand Names

(Note: some brand names are excluded from this list)

Linagliptin and Metformin HCL Jentadueto, Jentadueto XrLiraglutide VictozaLixisenatide AdlyxinMetformin Hcl, Metformin HCL ER, Metformin Er Osmotic, Metformin Er Gastric

Glucophage, Glucophage Xr, Riomet, Fortamet, GlumetzaMiglitol GlysetNateglinide StarlixPioglitazone HCL ActosPioglitazone HCL and Glimepiride DuetactPioglitazone Hcl/Metformin HCL Actoplus Met, Actoplus Met XrPramlintide Acetate SymlinpenRepaglinide PrandinRosiglitazone Maleate AvandiaSaxagliptin HCL OnglyzaSaxagliptin HCL and Metformin HCL Kombiglyze XrSemaglutide Ozempic, RybelsusSitagliptin Phosphate JanuviaSitagliptin Phosphate and Metformin HCL Janumet, Janumet XR

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Appendix 1: 2020 DHHS Essential Asthma Drug Summary ListPage 1 of 1

Essential Non-Propietary Drug NameIncluded Essential Drug Brand Names

(Note: some brand names are excluded from this list)Albuterol Sulfate Proair Respiclick, Proair Digihaler, Proair HFA, Proventil Hfa,

Ventolin HFABeclomethasone Dipropionate Qvar, Qvar RedihalerBenralizumab Fasenra, Fasenra PenBudesonide Pulmicort, FlexhalerBudesonide/Formoterol Fumarate SymbicortCiclesonide AlvescoCromolyn SodiumFluticasone Furoate Arnuity Ellipta

Fluticasone Furoate and Vilanterol Trifenatate Breo ElliptaFluticasone Propionate Armonair Respiclick, Flovent Diskus, Flovent HFAFluticasone Propionate and Salmeterol Xinafoate Advair Diskus, Advair HFA, Airduo Respiclick,

Wixela InhubLevalbuterol Hcl Xopenex, Xopenex ConcentrateLevalbuterol Tartrate Xopenex HFAMepolizumab NucalaMometasone Furoate Asmanex, Asmanex HFAMometasone Furoate/Formoterol Fumarate DuleraMontelukast Sodium SingulairOmalizumab XolairReslizumab CinqairSalmeterol Xinafoate Serevent DiskusTheophylline Anhydrous Elixophyllin, Theo-24, Theochron, TheophyllineTiotropium Bromide Spiriva, Spiriva RespimatZafirlukast AccolateZileuton Zileuton ER, Zyflo, Zyflo CR

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Helping People. It’s who we are and what we do.

Appendix 2:

2020 Essential Diabetes and Asthma

Drug

NDC List

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 1 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

47781-0340-01 ACARBOSE ALVOGEN INC47781-0341-01 ACARBOSE ALVOGEN INC47781-0342-01 ACARBOSE ALVOGEN INC00054-0140-25 ACARBOSE ROXANE/WEST-WAR00054-0141-25 ACARBOSE ROXANE/WEST-WAR00054-0142-25 ACARBOSE ROXANE/WEST-WAR64380-0758-06 ACARBOSE STRIDES PHARMA64380-0759-06 ACARBOSE STRIDES PHARMA64380-0760-06 ACARBOSE STRIDES PHARMA69543-0120-10 ACARBOSE VIRTUS PHARMACE69543-0120-11 ACARBOSE VIRTUS PHARMACE69543-0121-10 ACARBOSE VIRTUS PHARMACE69543-0121-11 ACARBOSE VIRTUS PHARMACE69543-0122-10 ACARBOSE VIRTUS PHARMACE64764-0151-04 ACTOS TAKEDA PHARMACE00024-5745-02 ADLYXIN SANOFI-AVENTIS Yes00024-5747-02 ADLYXIN SANOFI-AVENTIS Yes00024-5924-10 ADMELOG SANOFI-AVENTIS00024-5926-05 ADMELOG SANOFI-AVENTIS00024-5925-05 ADMELOG SOLOSTAR SANOFI-AVENTIS47918-0874-90 AFREZZA MANNKIND CORPOR Yes47918-0878-90 AFREZZA MANNKIND CORPOR Yes47918-0880-18 AFREZZA MANNKIND CORPOR Yes47918-0891-90 AFREZZA MANNKIND CORPOR Yes47918-0898-18 AFREZZA MANNKIND CORPOR Yes47918-0902-18 AFREZZA MANNKIND CORPOR Yes45802-0087-65 ALOGLIPTIN PERRIGO CO.45802-0103-65 ALOGLIPTIN PERRIGO CO.45802-0150-65 ALOGLIPTIN PERRIGO CO.45802-0169-72 ALOGLIPTIN-METFORMIN PERRIGO CO.45802-0211-72 ALOGLIPTIN-METFORMIN PERRIGO CO.45802-0238-65 ALOGLIPTIN-PIOGLITAZONE PERRIGO CO.45802-0260-65 ALOGLIPTIN-PIOGLITAZONE PERRIGO CO.45802-0351-65 ALOGLIPTIN-PIOGLITAZONE PERRIGO CO.45802-0402-65 ALOGLIPTIN-PIOGLITAZONE PERRIGO CO.45802-0499-65 ALOGLIPTIN-PIOGLITAZONE PERRIGO CO.00088-2500-33 APIDRA SANOFI-AVENTIS Yes00088-2502-05 APIDRA SOLOSTAR SANOFI-AVENTIS Yes00173-0861-18 AVANDIA GLAXOSMITHKLINE00173-0863-13 AVANDIA GLAXOSMITHKLINE00002-7715-59 BASAGLAR KWIKPEN U-100 ELI LILLY & CO.00310-6520-04 BYDUREON ASTRAZENECA00310-6540-04 BYDUREON BCISE ASTRAZENECA00310-6530-04 BYDUREON PEN ASTRAZENECA

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 2 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00310-6512-01 BYETTA ASTRAZENECA00310-6524-01 BYETTA ASTRAZENECA00310-6205-30 FARXIGA ASTRAZENECA00310-6210-30 FARXIGA ASTRAZENECA00169-3201-11 FIASP NOVO NORDISK00169-3204-15 FIASP FLEXTOUCH NOVO NORDISK16729-0001-01 GLIMEPIRIDE ACCORD HEALTHCA16729-0001-16 GLIMEPIRIDE ACCORD HEALTHCA16729-0002-01 GLIMEPIRIDE ACCORD HEALTHCA16729-0002-16 GLIMEPIRIDE ACCORD HEALTHCA16729-0003-01 GLIMEPIRIDE ACCORD HEALTHCA16729-0003-16 GLIMEPIRIDE ACCORD HEALTHCA69452-0129-20 GLIMEPIRIDE BIONPHARMA INC.68001-0177-00 GLIMEPIRIDE BLUEPOINT LABOR68001-0177-03 GLIMEPIRIDE BLUEPOINT LABOR68001-0178-00 GLIMEPIRIDE BLUEPOINT LABOR68001-0178-03 GLIMEPIRIDE BLUEPOINT LABOR68001-0179-00 GLIMEPIRIDE BLUEPOINT LABOR68001-0179-03 GLIMEPIRIDE BLUEPOINT LABOR61442-0115-01 GLIMEPIRIDE CARLSBAD TECH61442-0116-01 GLIMEPIRIDE CARLSBAD TECH61442-0116-05 GLIMEPIRIDE CARLSBAD TECH61442-0117-01 GLIMEPIRIDE CARLSBAD TECH55111-0320-01 GLIMEPIRIDE DR.REDDY'S LAB55111-0320-05 GLIMEPIRIDE DR.REDDY'S LAB55111-0321-01 GLIMEPIRIDE DR.REDDY'S LAB55111-0321-05 GLIMEPIRIDE DR.REDDY'S LAB55111-0322-01 GLIMEPIRIDE DR.REDDY'S LAB55111-0322-05 GLIMEPIRIDE DR.REDDY'S LAB54458-0966-16 GLIMEPIRIDE INTERNATIONAL L68645-0572-90 GLIMEPIRIDE LEGACY PHARMACE68645-0573-90 GLIMEPIRIDE LEGACY PHARMACE42571-0100-01 GLIMEPIRIDE MICRO LABS USA,42571-0101-01 GLIMEPIRIDE MICRO LABS USA,42571-0103-01 GLIMEPIRIDE MICRO LABS USA,00378-4013-01 GLIMEPIRIDE MYLAN43547-0394-10 GLIMEPIRIDE SOLCO HEALTHCAR43547-0395-10 GLIMEPIRIDE SOLCO HEALTHCAR43547-0396-10 GLIMEPIRIDE SOLCO HEALTHCAR00093-7254-01 GLIMEPIRIDE TEVA USA00093-7255-01 GLIMEPIRIDE TEVA USA00093-7256-01 GLIMEPIRIDE TEVA USA00093-7256-52 GLIMEPIRIDE TEVA USA69543-0123-10 GLIMEPIRIDE VIRTUS PHARMACE

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 3 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

69543-0123-50 GLIMEPIRIDE VIRTUS PHARMACE69543-0124-10 GLIMEPIRIDE VIRTUS PHARMACE69543-0124-50 GLIMEPIRIDE VIRTUS PHARMACE69543-0125-10 GLIMEPIRIDE VIRTUS PHARMACE69543-0125-50 GLIMEPIRIDE VIRTUS PHARMACE16729-0139-16 GLIPIZIDE ACCORD HEALTHCA16729-0140-00 GLIPIZIDE ACCORD HEALTHCA00591-0460-01 GLIPIZIDE ACTAVIS/TEVA00591-0460-05 GLIPIZIDE ACTAVIS/TEVA00591-0460-10 GLIPIZIDE ACTAVIS/TEVA00591-0461-01 GLIPIZIDE ACTAVIS/TEVA00591-0461-05 GLIPIZIDE ACTAVIS/TEVA00591-0461-10 GLIPIZIDE ACTAVIS/TEVA60505-0141-00 GLIPIZIDE APOTEX CORP60505-0141-01 GLIPIZIDE APOTEX CORP60505-0141-02 GLIPIZIDE APOTEX CORP60505-0142-00 GLIPIZIDE APOTEX CORP60505-0142-01 GLIPIZIDE APOTEX CORP60505-0142-02 GLIPIZIDE APOTEX CORP60505-0142-04 GLIPIZIDE APOTEX CORP57664-0398-13 GLIPIZIDE CARACO/SUN PHAR68645-0151-59 GLIPIZIDE LEGACY PHARMACE68645-0574-54 GLIPIZIDE LEGACY PHARMACE68645-0575-59 GLIPIZIDE LEGACY PHARMACE00378-1105-01 GLIPIZIDE MYLAN00378-1105-05 GLIPIZIDE MYLAN00378-1110-01 GLIPIZIDE MYLAN00378-1110-05 GLIPIZIDE MYLAN51079-0810-20 GLIPIZIDE MYLAN INSTITUTI00781-1452-01 GLIPIZIDE SANDOZ00781-1452-10 GLIPIZIDE SANDOZ00781-1453-01 GLIPIZIDE SANDOZ00781-1453-10 GLIPIZIDE SANDOZ00591-0844-01 GLIPIZIDE ER ACTAVIS/TEVA00591-0844-10 GLIPIZIDE ER ACTAVIS/TEVA00591-0845-01 GLIPIZIDE ER ACTAVIS/TEVA00591-0845-10 GLIPIZIDE ER ACTAVIS/TEVA00591-0900-30 GLIPIZIDE ER ACTAVIS/TEVA59651-0268-30 GLIPIZIDE ER AUROBINDO PHARM59651-0269-01 GLIPIZIDE ER AUROBINDO PHARM59651-0270-01 GLIPIZIDE ER AUROBINDO PHARM65862-0888-30 GLIPIZIDE ER AUROBINDO PHARM65862-0889-01 GLIPIZIDE ER AUROBINDO PHARM65862-0890-01 GLIPIZIDE ER AUROBINDO PHARM

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 4 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00378-0340-93 GLIPIZIDE ER MYLAN16714-0894-01 GLIPIZIDE ER NORTHSTAR RX LL16714-0895-01 GLIPIZIDE ER NORTHSTAR RX LL16714-0896-01 GLIPIZIDE ER NORTHSTAR RX LL16714-0896-02 GLIPIZIDE ER NORTHSTAR RX LL10370-0745-01 GLIPIZIDE ER PAR PHARM.10370-0745-05 GLIPIZIDE ER PAR PHARM.10370-0746-01 GLIPIZIDE ER PAR PHARM.10370-0746-05 GLIPIZIDE ER PAR PHARM.64980-0279-03 GLIPIZIDE ER RISING PHARM64980-0280-01 GLIPIZIDE ER RISING PHARM64980-0280-05 GLIPIZIDE ER RISING PHARM64980-0280-10 GLIPIZIDE ER RISING PHARM64980-0281-01 GLIPIZIDE ER RISING PHARM64980-0281-05 GLIPIZIDE ER RISING PHARM68382-0335-06 GLIPIZIDE ER ZYDUS PHARMACEU68382-0337-01 GLIPIZIDE ER ZYDUS PHARMACEU59762-0540-01 GLIPIZIDE XL GREENSTONE LLC.59762-0541-01 GLIPIZIDE XL GREENSTONE LLC.59762-0541-02 GLIPIZIDE XL GREENSTONE LLC.59762-0542-01 GLIPIZIDE XL GREENSTONE LLC.59762-0542-02 GLIPIZIDE XL GREENSTONE LLC.23155-0115-01 GLIPIZIDE-METFORMIN HERITAGE PHARMA23155-0116-01 GLIPIZIDE-METFORMIN HERITAGE PHARMA23155-0117-01 GLIPIZIDE-METFORMIN HERITAGE PHARMA00378-3132-01 GLIPIZIDE-METFORMIN MYLAN00093-7455-01 GLIPIZIDE-METFORMIN TEVA USA00093-7456-01 GLIPIZIDE-METFORMIN TEVA USA00093-7457-01 GLIPIZIDE-METFORMIN TEVA USA68382-0184-01 GLIPIZIDE-METFORMIN ZYDUS PHARMACEU68382-0185-01 GLIPIZIDE-METFORMIN ZYDUS PHARMACEU68382-0186-01 GLIPIZIDE-METFORMIN ZYDUS PHARMACEU00087-6070-05 GLUCOPHAGE BMS PRIMARYCARE00087-6071-11 GLUCOPHAGE BMS PRIMARYCARE68012-0003-16 GLUMETZA SANTARUS INC/SA68012-0004-50 GLUMETZA SANTARUS INC/SA65862-0028-01 GLYBURIDE AUROBINDO PHARM65862-0029-01 GLYBURIDE AUROBINDO PHARM65862-0030-01 GLYBURIDE AUROBINDO PHARM65862-0030-99 GLYBURIDE AUROBINDO PHARM23155-0056-01 GLYBURIDE HERITAGE PHARMA23155-0057-01 GLYBURIDE HERITAGE PHARMA23155-0058-01 GLYBURIDE HERITAGE PHARMA23155-0058-10 GLYBURIDE HERITAGE PHARMA

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 5 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

75834-0204-01 GLYBURIDE NIVAGEN PHARMAC00093-8342-01 GLYBURIDE TEVA USA00093-8343-01 GLYBURIDE TEVA USA00093-8343-05 GLYBURIDE TEVA USA00093-8343-10 GLYBURIDE TEVA USA00093-8344-01 GLYBURIDE TEVA USA00093-8344-05 GLYBURIDE TEVA USA00093-8344-10 GLYBURIDE TEVA USA00093-8344-98 GLYBURIDE TEVA USA00093-9364-01 GLYBURIDE TEVA USA00093-9364-05 GLYBURIDE TEVA USA00093-9364-10 GLYBURIDE TEVA USA00093-9433-01 GLYBURIDE TEVA USA00093-9433-05 GLYBURIDE TEVA USA00093-9477-53 GLYBURIDE TEVA USA52817-0122-10 GLYBURIDE TRUPHARMA, LLC.00093-8034-01 GLYBURIDE MICRONIZED TEVA USA00093-8036-01 GLYBURIDE MICRONIZED TEVA USA00143-9918-01 GLYBURIDE MICRONIZED WEST-WARD/HIKMA00143-9919-01 GLYBURIDE MICRONIZED WEST-WARD/HIKMA00143-9920-01 GLYBURIDE MICRONIZED WEST-WARD/HIKMA00228-2752-11 GLYBURIDE-METFORMIN HCL ACTAVIS/TEVA65862-0080-01 GLYBURIDE-METFORMIN HCL AUROBINDO PHARM65862-0081-01 GLYBURIDE-METFORMIN HCL AUROBINDO PHARM65862-0082-01 GLYBURIDE-METFORMIN HCL AUROBINDO PHARM65862-0082-05 GLYBURIDE-METFORMIN HCL AUROBINDO PHARM00115-1649-01 GLYBURIDE-METFORMIN HCL IMPAX GENERICS57237-0023-01 GLYBURIDE-METFORMIN HCL RISING PHARM57237-0024-01 GLYBURIDE-METFORMIN HCL RISING PHARM57237-0024-05 GLYBURIDE-METFORMIN HCL RISING PHARM57237-0025-01 GLYBURIDE-METFORMIN HCL RISING PHARM57237-0025-05 GLYBURIDE-METFORMIN HCL RISING PHARM00597-0164-30 GLYXAMBI BOEHRINGER ING.00597-0164-39 GLYXAMBI BOEHRINGER ING.00597-0164-90 GLYXAMBI BOEHRINGER ING.00597-0182-30 GLYXAMBI BOEHRINGER ING.00597-0182-39 GLYXAMBI BOEHRINGER ING.00597-0182-90 GLYXAMBI BOEHRINGER ING.00002-7510-01 HUMALOG ELI LILLY & CO.00002-7510-17 HUMALOG ELI LILLY & CO.00002-7516-59 HUMALOG ELI LILLY & CO.00002-7714-59 HUMALOG JUNIOR KWIKPEN ELI LILLY & CO.00002-8799-59 HUMALOG KWIKPEN U-100 ELI LILLY & CO.00002-7712-27 HUMALOG KWIKPEN U-200 ELI LILLY & CO.

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 6 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00002-7512-01 HUMALOG MIX 50-50 ELI LILLY & CO.00002-8798-59 HUMALOG MIX 50-50 KWIKPEELI LILLY & CO.00002-7511-01 HUMALOG MIX 75-25 ELI LILLY & CO.00002-8797-59 HUMALOG MIX 75-25 KWIKPEELI LILLY & CO.00002-8803-59 HUMULIN 70/30 KWIKPEN ELI LILLY & CO.00002-8715-01 HUMULIN 70-30 ELI LILLY & CO.00002-8715-17 HUMULIN 70-30 ELI LILLY & CO.00002-8315-01 HUMULIN N ELI LILLY & CO.00002-8315-17 HUMULIN N ELI LILLY & CO.00002-8805-59 HUMULIN N KWIKPEN ELI LILLY & CO.00002-8215-01 HUMULIN R ELI LILLY & CO.00002-8215-17 HUMULIN R ELI LILLY & CO.00002-8501-01 HUMULIN R U-500 ELI LILLY & CO.00002-8824-27 HUMULIN R U-500 KWIKPEN ELI LILLY & CO.66733-0773-01 INSULIN LISPRO ELI LILLY & CO.66733-0822-59 INSULIN LISPRO KWIKPEN U-1ELI LILLY & CO.50458-0540-60 INVOKAMET JANSSEN PHARM. Yes50458-0541-60 INVOKAMET JANSSEN PHARM. Yes50458-0542-60 INVOKAMET JANSSEN PHARM. Yes50458-0543-60 INVOKAMET JANSSEN PHARM. Yes50458-0940-01 INVOKAMET XR JANSSEN PHARM. Yes50458-0941-01 INVOKAMET XR JANSSEN PHARM. Yes50458-0943-01 INVOKAMET XR JANSSEN PHARM. Yes50458-0140-30 INVOKANA JANSSEN PHARM. Yes50458-0140-90 INVOKANA JANSSEN PHARM. Yes50458-0141-30 INVOKANA JANSSEN PHARM. Yes50458-0141-90 INVOKANA JANSSEN PHARM. Yes00006-0575-61 JANUMET MERCK SHARP & D Yes00006-0575-62 JANUMET MERCK SHARP & D Yes00006-0577-61 JANUMET MERCK SHARP & D Yes00006-0577-62 JANUMET MERCK SHARP & D Yes00006-0577-82 JANUMET MERCK SHARP & D Yes00006-0078-61 JANUMET XR MERCK SHARP & D Yes00006-0080-61 JANUMET XR MERCK SHARP & D Yes00006-0080-62 JANUMET XR MERCK SHARP & D Yes00006-0081-31 JANUMET XR MERCK SHARP & D Yes00006-0081-54 JANUMET XR MERCK SHARP & D Yes00006-0112-28 JANUVIA MERCK SHARP & D Yes00006-0112-31 JANUVIA MERCK SHARP & D Yes00006-0112-54 JANUVIA MERCK SHARP & D Yes00006-0221-28 JANUVIA MERCK SHARP & D Yes00006-0221-31 JANUVIA MERCK SHARP & D Yes00006-0221-54 JANUVIA MERCK SHARP & D Yes00006-0277-02 JANUVIA MERCK SHARP & D Yes

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 7 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00006-0277-28 JANUVIA MERCK SHARP & D Yes00006-0277-31 JANUVIA MERCK SHARP & D Yes00006-0277-33 JANUVIA MERCK SHARP & D Yes00006-0277-54 JANUVIA MERCK SHARP & D Yes00006-0277-82 JANUVIA MERCK SHARP & D Yes00597-0152-30 JARDIANCE BOEHRINGER ING. Yes00597-0152-37 JARDIANCE BOEHRINGER ING. Yes00597-0152-90 JARDIANCE BOEHRINGER ING. Yes00597-0153-30 JARDIANCE BOEHRINGER ING. Yes00597-0153-37 JARDIANCE BOEHRINGER ING. Yes00597-0153-90 JARDIANCE BOEHRINGER ING. Yes00597-0146-18 JENTADUETO BOEHRINGER ING. Yes00597-0146-60 JENTADUETO BOEHRINGER ING. Yes00597-0147-18 JENTADUETO BOEHRINGER ING. Yes00597-0147-60 JENTADUETO BOEHRINGER ING. Yes00597-0148-18 JENTADUETO BOEHRINGER ING. Yes00597-0148-60 JENTADUETO BOEHRINGER ING. Yes00597-0270-73 JENTADUETO XR BOEHRINGER ING. Yes00597-0270-94 JENTADUETO XR BOEHRINGER ING. Yes00597-0275-33 JENTADUETO XR BOEHRINGER ING. Yes00597-0275-81 JENTADUETO XR BOEHRINGER ING. Yes64764-0335-60 KAZANO TAKEDA PHARMACE Yes64764-0337-60 KAZANO TAKEDA PHARMACE Yes00310-6125-60 KOMBIGLYZE XR ASTRAZENECA00310-6135-30 KOMBIGLYZE XR ASTRAZENECA00310-6145-30 KOMBIGLYZE XR ASTRAZENECA00088-2220-33 LANTUS SANOFI-AVENTIS Yes00088-5021-01 LANTUS SANOFI-AVENTIS Yes00088-2219-05 LANTUS SOLOSTAR SANOFI-AVENTIS Yes00088-5020-05 LANTUS SOLOSTAR SANOFI-AVENTIS Yes00169-3687-12 LEVEMIR NOVO NORDISK Yes00169-6438-10 LEVEMIR FLEXTOUCH NOVO NORDISK Yes00591-2412-19 METFORMIN ER GASTRIC ACTAVIS/TEVA68180-0338-01 METFORMIN ER GASTRIC LUPIN PHARMACEU68180-0339-09 METFORMIN ER GASTRIC LUPIN PHARMACEU68682-0018-90 METFORMIN ER GASTRIC OCEANSIDE PHARM68682-0021-50 METFORMIN ER GASTRIC OCEANSIDE PHARM47335-0306-88 METFORMIN ER GASTRIC SUN PHARMA GLOB00591-2720-60 METFORMIN ER OSMOTIC ACTAVIS/TEVA42806-0406-60 METFORMIN ER OSMOTIC EPIC PHARMA LLC50742-0633-60 METFORMIN ER OSMOTIC INGENUS PHARMAC50742-0634-60 METFORMIN ER OSMOTIC INGENUS PHARMAC68180-0336-07 METFORMIN ER OSMOTIC LUPIN PHARMACEU68180-0337-07 METFORMIN ER OSMOTIC LUPIN PHARMACEU

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 8 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00378-6001-91 METFORMIN ER OSMOTIC MYLAN00378-6002-91 METFORMIN ER OSMOTIC MYLAN29033-0031-06 METFORMIN ER OSMOTIC NOSTRUM LABORAT29033-0032-06 METFORMIN ER OSMOTIC NOSTRUM LABORAT71093-0132-04 METFORMIN HCL ACI HEALTHCARE71093-0132-05 METFORMIN HCL ACI HEALTHCARE71093-0132-06 METFORMIN HCL ACI HEALTHCARE71093-0133-05 METFORMIN HCL ACI HEALTHCARE71093-0134-04 METFORMIN HCL ACI HEALTHCARE71093-0134-05 METFORMIN HCL ACI HEALTHCARE53746-0218-01 METFORMIN HCL AMNEAL PHARMACE53746-0218-05 METFORMIN HCL AMNEAL PHARMACE53746-0218-10 METFORMIN HCL AMNEAL PHARMACE53746-0219-05 METFORMIN HCL AMNEAL PHARMACE53746-0219-10 METFORMIN HCL AMNEAL PHARMACE53746-0220-01 METFORMIN HCL AMNEAL PHARMACE53746-0220-05 METFORMIN HCL AMNEAL PHARMACE65162-0218-50 METFORMIN HCL AMNEAL PHARMACE65162-0219-10 METFORMIN HCL AMNEAL PHARMACE65162-0220-10 METFORMIN HCL AMNEAL PHARMACE65162-0220-50 METFORMIN HCL AMNEAL PHARMACE67877-0561-01 METFORMIN HCL ASCEND LABORATO67877-0561-05 METFORMIN HCL ASCEND LABORATO67877-0561-10 METFORMIN HCL ASCEND LABORATO67877-0562-01 METFORMIN HCL ASCEND LABORATO67877-0562-05 METFORMIN HCL ASCEND LABORATO67877-0562-10 METFORMIN HCL ASCEND LABORATO67877-0563-01 METFORMIN HCL ASCEND LABORATO67877-0563-05 METFORMIN HCL ASCEND LABORATO67877-0563-10 METFORMIN HCL ASCEND LABORATO65862-0008-01 METFORMIN HCL AUROBINDO PHARM65862-0008-05 METFORMIN HCL AUROBINDO PHARM65862-0008-99 METFORMIN HCL AUROBINDO PHARM65862-0009-01 METFORMIN HCL AUROBINDO PHARM65862-0009-05 METFORMIN HCL AUROBINDO PHARM65862-0010-01 METFORMIN HCL AUROBINDO PHARM65862-0010-05 METFORMIN HCL AUROBINDO PHARM65862-0010-99 METFORMIN HCL AUROBINDO PHARM51991-0805-05 METFORMIN HCL BRECKENRIDGE51991-0805-10 METFORMIN HCL BRECKENRIDGE51991-0806-05 METFORMIN HCL BRECKENRIDGE51991-0807-05 METFORMIN HCL BRECKENRIDGE51991-0807-10 METFORMIN HCL BRECKENRIDGE57664-0397-51 METFORMIN HCL CARACO/SUN PHAR

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 9 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

57664-0397-53 METFORMIN HCL CARACO/SUN PHAR57664-0397-58 METFORMIN HCL CARACO/SUN PHAR57664-0435-53 METFORMIN HCL CARACO/SUN PHAR42806-0213-10 METFORMIN HCL EPIC PHARMA LLC42806-0215-01 METFORMIN HCL EPIC PHARMA LLC42806-0221-05 METFORMIN HCL EPIC PHARMA LLC42806-0313-05 METFORMIN HCL EPIC PHARMA LLC42806-0314-01 METFORMIN HCL EPIC PHARMA LLC42806-0315-05 METFORMIN HCL EPIC PHARMA LLC68462-0159-10 METFORMIN HCL GLENMARK PHARMA23155-0102-01 METFORMIN HCL HERITAGE PHARMA23155-0102-05 METFORMIN HCL HERITAGE PHARMA23155-0102-10 METFORMIN HCL HERITAGE PHARMA23155-0103-01 METFORMIN HCL HERITAGE PHARMA23155-0103-05 METFORMIN HCL HERITAGE PHARMA23155-0103-10 METFORMIN HCL HERITAGE PHARMA23155-0104-01 METFORMIN HCL HERITAGE PHARMA23155-0104-05 METFORMIN HCL HERITAGE PHARMA23155-0104-10 METFORMIN HCL HERITAGE PHARMA50742-0154-05 METFORMIN HCL INGENUS PHARMAC50742-0154-10 METFORMIN HCL INGENUS PHARMAC42385-0902-10 METFORMIN HCL LAURUS LABS LIM42385-0904-10 METFORMIN HCL LAURUS LABS LIM68645-0300-59 METFORMIN HCL LEGACY PHARMACE68645-0544-59 METFORMIN HCL LEGACY PHARMACE68645-0545-59 METFORMIN HCL LEGACY PHARMACE68645-0546-59 METFORMIN HCL LEGACY PHARMACE68645-0547-59 METFORMIN HCL LEGACY PHARMACE00904-6689-61 METFORMIN HCL MAJOR PHARMACEU71717-0104-11 METFORMIN HCL MEGALITH PHARMA71717-0105-50 METFORMIN HCL MEGALITH PHARMA71717-0106-11 METFORMIN HCL MEGALITH PHARMA58657-0640-50 METFORMIN HCL METHOD PHARMACE00378-7185-05 METFORMIN HCL MYLAN00378-7186-05 METFORMIN HCL MYLAN00378-7187-05 METFORMIN HCL MYLAN51079-0172-20 METFORMIN HCL MYLAN INSTITUTI50228-0105-01 METFORMIN HCL SCIEGEN PHARMAC50228-0105-05 METFORMIN HCL SCIEGEN PHARMAC50228-0105-10 METFORMIN HCL SCIEGEN PHARMAC50228-0106-01 METFORMIN HCL SCIEGEN PHARMAC50228-0106-05 METFORMIN HCL SCIEGEN PHARMAC50228-0107-01 METFORMIN HCL SCIEGEN PHARMAC50228-0107-05 METFORMIN HCL SCIEGEN PHARMAC

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 10 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

50228-0107-10 METFORMIN HCL SCIEGEN PHARMAC43547-0357-10 METFORMIN HCL SOLCO HEALTHCAR43547-0357-11 METFORMIN HCL SOLCO HEALTHCAR43547-0359-10 METFORMIN HCL SOLCO HEALTHCAR43547-0359-50 METFORMIN HCL SOLCO HEALTHCAR51224-0020-70 METFORMIN HCL TAGI PHARMA51224-0220-50 METFORMIN HCL TAGI PHARMA51224-0220-70 METFORMIN HCL TAGI PHARMA69367-0181-05 METFORMIN HCL WESTMINSTER PHA68382-0030-01 METFORMIN HCL ZYDUS PHARMACEU68382-0030-10 METFORMIN HCL ZYDUS PHARMACEU68382-0758-01 METFORMIN HCL ZYDUS PHARMACEU68382-0758-05 METFORMIN HCL ZYDUS PHARMACEU68382-0758-10 METFORMIN HCL ZYDUS PHARMACEU68382-0759-01 METFORMIN HCL ZYDUS PHARMACEU68382-0760-01 METFORMIN HCL ZYDUS PHARMACEU68382-0760-05 METFORMIN HCL ZYDUS PHARMACEU68382-0760-10 METFORMIN HCL ZYDUS PHARMACEU62037-0571-01 METFORMIN HCL ER ACTAVIS/TEVA62037-0571-10 METFORMIN HCL ER ACTAVIS/TEVA62037-0577-01 METFORMIN HCL ER ACTAVIS/TEVA62037-0577-10 METFORMIN HCL ER ACTAVIS/TEVA53746-0178-01 METFORMIN HCL ER AMNEAL PHARMACE53746-0178-05 METFORMIN HCL ER AMNEAL PHARMACE53746-0178-10 METFORMIN HCL ER AMNEAL PHARMACE53746-0178-90 METFORMIN HCL ER AMNEAL PHARMACE53746-0179-01 METFORMIN HCL ER AMNEAL PHARMACE65162-0178-09 METFORMIN HCL ER AMNEAL PHARMACE65162-0178-10 METFORMIN HCL ER AMNEAL PHARMACE65162-0178-11 METFORMIN HCL ER AMNEAL PHARMACE65162-0178-50 METFORMIN HCL ER AMNEAL PHARMACE65162-0179-10 METFORMIN HCL ER AMNEAL PHARMACE60505-0260-01 METFORMIN HCL ER APOTEX CORP60505-0260-02 METFORMIN HCL ER APOTEX CORP60505-1329-01 METFORMIN HCL ER APOTEX CORP67877-0159-01 METFORMIN HCL ER ASCEND LABORATO67877-0159-05 METFORMIN HCL ER ASCEND LABORATO76385-0128-10 METFORMIN HCL ER BAYSHORE PHARMA76385-0129-01 METFORMIN HCL ER BAYSHORE PHARMA70010-0491-01 METFORMIN HCL ER GRANULES PHARMA70010-0491-05 METFORMIN HCL ER GRANULES PHARMA70010-0491-10 METFORMIN HCL ER GRANULES PHARMA70010-0492-01 METFORMIN HCL ER GRANULES PHARMA00781-5503-01 METFORMIN HCL ER SANDOZ

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 11 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

62756-0142-01 METFORMIN HCL ER SUN PHARMACEUTI62756-0142-02 METFORMIN HCL ER SUN PHARMACEUTI62756-0143-01 METFORMIN HCL ER SUN PHARMACEUTI51224-0007-50 METFORMIN HCL ER TAGI PHARMA51224-0007-60 METFORMIN HCL ER TAGI PHARMA51224-0107-50 METFORMIN HCL ER TAGI PHARMA51224-0107-60 METFORMIN HCL ER TAGI PHARMA00093-7267-01 METFORMIN HCL ER TEVA USA00093-7267-10 METFORMIN HCL ER TEVA USA49483-0623-01 METFORMIN HCL ER TIME-CAP LABS Yes49483-0623-09 METFORMIN HCL ER TIME-CAP LABS49483-0623-10 METFORMIN HCL ER TIME-CAP LABS49483-0623-50 METFORMIN HCL ER TIME-CAP LABS Yes49483-0624-01 METFORMIN HCL ER TIME-CAP LABS57664-0684-88 MIGLITOL SUN PHARMACEUTI57664-0685-88 MIGLITOL SUN PHARMACEUTI55111-0328-90 NATEGLINIDE DR.REDDY'S LAB49884-0984-01 NATEGLINIDE PAR PHARM.49884-0985-01 NATEGLINIDE PAR PHARM.68382-0721-16 NATEGLINIDE ZYDUS PHARMACEU68382-0722-16 NATEGLINIDE ZYDUS PHARMACEU64764-0125-30 NESINA TAKEDA PHARMACE Yes64764-0250-30 NESINA TAKEDA PHARMACE Yes00169-1837-11 NOVOLIN 70-30 NOVO NORDISK00169-1837-02 NOVOLIN 70-30 NOVO NORDISK-WA00169-3007-15 NOVOLIN 70-30 FLEXPEN NOVO NORDISK00169-3007-25 NOVOLIN 70-30 FLEXPEN NOVO NORDISK-WA00169-1834-11 NOVOLIN N NOVO NORDISK00169-1834-02 NOVOLIN N NOVO NORDISK-WA00169-1833-11 NOVOLIN R NOVO NORDISK00169-1833-02 NOVOLIN R NOVO NORDISK-WA00169-3303-12 NOVOLOG NOVO NORDISK00169-7501-11 NOVOLOG NOVO NORDISK00169-6339-10 NOVOLOG FLEXPEN NOVO NORDISK00169-3685-12 NOVOLOG MIX 70-30 NOVO NORDISK00169-3696-19 NOVOLOG MIX 70-30 FLEXPE NOVO NORDISK00310-6100-30 ONGLYZA ASTRAZENECA00310-6100-90 ONGLYZA ASTRAZENECA00310-6105-30 ONGLYZA ASTRAZENECA00310-6105-90 ONGLYZA ASTRAZENECA64764-0251-03 OSENI TAKEDA PHARMACE Yes00169-4132-12 OZEMPIC NOVO NORDISK Yes00169-4136-02 OZEMPIC NOVO NORDISK Yes16729-0020-10 PIOGLITAZONE HCL ACCORD HEALTHCA

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 12 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

16729-0020-15 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0020-16 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0021-10 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0021-15 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0021-16 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0022-10 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0022-15 PIOGLITAZONE HCL ACCORD HEALTHCA16729-0022-16 PIOGLITAZONE HCL ACCORD HEALTHCA65862-0512-05 PIOGLITAZONE HCL AUROBINDO PHARM65862-0513-05 PIOGLITAZONE HCL AUROBINDO PHARM65862-0513-30 PIOGLITAZONE HCL AUROBINDO PHARM33342-0054-07 PIOGLITAZONE HCL MACLEODS PHARMA33342-0054-10 PIOGLITAZONE HCL MACLEODS PHARMA33342-0054-15 PIOGLITAZONE HCL MACLEODS PHARMA33342-0055-07 PIOGLITAZONE HCL MACLEODS PHARMA33342-0055-10 PIOGLITAZONE HCL MACLEODS PHARMA33342-0055-15 PIOGLITAZONE HCL MACLEODS PHARMA33342-0056-07 PIOGLITAZONE HCL MACLEODS PHARMA33342-0056-10 PIOGLITAZONE HCL MACLEODS PHARMA33342-0056-15 PIOGLITAZONE HCL MACLEODS PHARMA00378-0048-93 PIOGLITAZONE HCL MYLAN00378-0228-05 PIOGLITAZONE HCL MYLAN00378-0228-93 PIOGLITAZONE HCL MYLAN00378-0318-93 PIOGLITAZONE HCL MYLAN63304-0313-30 PIOGLITAZONE HCL RANBAXY/SUN PHA57237-0219-05 PIOGLITAZONE HCL RISING PHARM57237-0219-30 PIOGLITAZONE HCL RISING PHARM57237-0219-90 PIOGLITAZONE HCL RISING PHARM57237-0220-05 PIOGLITAZONE HCL RISING PHARM57237-0220-30 PIOGLITAZONE HCL RISING PHARM57237-0221-05 PIOGLITAZONE HCL RISING PHARM57237-0221-30 PIOGLITAZONE HCL RISING PHARM57237-0221-90 PIOGLITAZONE HCL RISING PHARM00781-5420-31 PIOGLITAZONE HCL SANDOZ00781-5420-92 PIOGLITAZONE HCL SANDOZ00781-5421-10 PIOGLITAZONE HCL SANDOZ00781-5421-31 PIOGLITAZONE HCL SANDOZ00781-5421-92 PIOGLITAZONE HCL SANDOZ00781-5422-10 PIOGLITAZONE HCL SANDOZ00781-5422-31 PIOGLITAZONE HCL SANDOZ00781-5422-92 PIOGLITAZONE HCL SANDOZ43547-0426-03 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0426-09 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0427-03 PIOGLITAZONE HCL SOLCO HEALTHCAR

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 13 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

43547-0427-09 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0427-50 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0428-03 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0428-09 PIOGLITAZONE HCL SOLCO HEALTHCAR43547-0428-50 PIOGLITAZONE HCL SOLCO HEALTHCAR00093-7271-05 PIOGLITAZONE HCL TEVA USA00093-7271-56 PIOGLITAZONE HCL TEVA USA00093-7271-98 PIOGLITAZONE HCL TEVA USA00093-7272-05 PIOGLITAZONE HCL TEVA USA00093-7272-56 PIOGLITAZONE HCL TEVA USA00093-7272-98 PIOGLITAZONE HCL TEVA USA00093-7273-05 PIOGLITAZONE HCL TEVA USA00093-7273-56 PIOGLITAZONE HCL TEVA USA00093-7273-98 PIOGLITAZONE HCL TEVA USA13668-0119-05 PIOGLITAZONE HCL TORRENT PHARMAC13668-0119-30 PIOGLITAZONE HCL TORRENT PHARMAC13668-0119-90 PIOGLITAZONE HCL TORRENT PHARMAC13668-0120-30 PIOGLITAZONE HCL TORRENT PHARMAC13668-0120-90 PIOGLITAZONE HCL TORRENT PHARMAC13668-0140-05 PIOGLITAZONE HCL TORRENT PHARMAC13668-0140-30 PIOGLITAZONE HCL TORRENT PHARMAC13668-0140-90 PIOGLITAZONE HCL TORRENT PHARMAC66993-0822-30 PIOGLITAZONE-GLIMEPIRIDE PRASCO LABS65862-0525-60 PIOGLITAZONE-METFORMIN AUROBINDO PHARM65862-0526-18 PIOGLITAZONE-METFORMIN AUROBINDO PHARM65862-0526-60 PIOGLITAZONE-METFORMIN AUROBINDO PHARM33342-0176-09 PIOGLITAZONE-METFORMIN MACLEODS PHARMA33342-0177-09 PIOGLITAZONE-METFORMIN MACLEODS PHARMA00378-1575-91 PIOGLITAZONE-METFORMIN MYLAN57237-0217-60 PIOGLITAZONE-METFORMIN RISING PHARM57237-0218-60 PIOGLITAZONE-METFORMIN RISING PHARM00781-5626-60 PIOGLITAZONE-METFORMIN SANDOZ00781-5627-60 PIOGLITAZONE-METFORMIN SANDOZ13668-0280-60 PIOGLITAZONE-METFORMIN TORRENT PHARMAC13668-0281-60 PIOGLITAZONE-METFORMIN TORRENT PHARMAC00310-6780-30 QTERN ASTRAZENECA65862-0670-01 REPAGLINIDE AUROBINDO PHARM65862-0671-01 REPAGLINIDE AUROBINDO PHARM65862-0672-01 REPAGLINIDE AUROBINDO PHARM51991-0854-01 REPAGLINIDE BRECKENRIDGE51991-0855-01 REPAGLINIDE BRECKENRIDGE57664-0745-88 REPAGLINIDE CARACO/SUN PHAR57664-0747-88 REPAGLINIDE CARACO/SUN PHAR00574-0240-01 REPAGLINIDE PERRIGO CO.

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 14 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00574-0241-01 REPAGLINIDE PERRIGO CO.00574-0242-01 REPAGLINIDE PERRIGO CO.57237-0157-01 REPAGLINIDE RISING PHARM57237-0158-01 REPAGLINIDE RISING PHARM57237-0159-01 REPAGLINIDE RISING PHARM10631-0206-01 RIOMET SUN PHARMACEUTI10631-0206-02 RIOMET SUN PHARMACEUTI10631-0238-01 RIOMET SUN PHARMACEUTI10631-0238-02 RIOMET SUN PHARMACEUTI00006-5369-03 SEGLUROMET MERCK SHARP & D Yes00006-5370-03 SEGLUROMET MERCK SHARP & D Yes00006-5373-03 SEGLUROMET MERCK SHARP & D Yes00006-5373-06 SEGLUROMET MERCK SHARP & D Yes00006-5373-07 SEGLUROMET MERCK SHARP & D00006-5374-03 SEGLUROMET MERCK SHARP & D Yes00006-5374-06 SEGLUROMET MERCK SHARP & D Yes00006-5374-07 SEGLUROMET MERCK SHARP & D00024-5761-05 SOLIQUA 100-33 SANOFI-AVENTIS Yes00006-5363-03 STEGLATRO MERCK SHARP & D Yes00006-5363-06 STEGLATRO MERCK SHARP & D Yes00006-5363-07 STEGLATRO MERCK SHARP & D Yes00006-5364-03 STEGLATRO MERCK SHARP & D Yes00006-5364-06 STEGLATRO MERCK SHARP & D Yes00006-5364-07 STEGLATRO MERCK SHARP & D Yes00006-5367-03 STEGLUJAN MERCK SHARP & D Yes00006-5368-03 STEGLUJAN MERCK SHARP & D Yes00597-0159-18 SYNJARDY BOEHRINGER ING. Yes00597-0159-60 SYNJARDY BOEHRINGER ING. Yes00597-0168-18 SYNJARDY BOEHRINGER ING. Yes00597-0168-60 SYNJARDY BOEHRINGER ING. Yes00597-0175-18 SYNJARDY BOEHRINGER ING. Yes00597-0175-60 SYNJARDY BOEHRINGER ING. Yes00597-0180-18 SYNJARDY BOEHRINGER ING. Yes00597-0180-60 SYNJARDY BOEHRINGER ING. Yes00597-0280-73 SYNJARDY XR BOEHRINGER ING. Yes00597-0280-90 SYNJARDY XR BOEHRINGER ING. Yes00597-0290-59 SYNJARDY XR BOEHRINGER ING. Yes00597-0290-74 SYNJARDY XR BOEHRINGER ING. Yes00597-0295-78 SYNJARDY XR BOEHRINGER ING. Yes00597-0295-88 SYNJARDY XR BOEHRINGER ING. Yes00597-0300-45 SYNJARDY XR BOEHRINGER ING. Yes00597-0300-93 SYNJARDY XR BOEHRINGER ING. Yes00173-0866-35 TANZEUM GLAXOSMITHKLINE00024-5871-02 TOUJEO MAX SOLOSTAR SANOFI-AVENTIS Yes

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Appendix 2: 2020 DHHS Essential Diabetes Drug NDC ListPage 15 of 15

NDCEssential Diabetes Drug

NameLabeler

Significant Price Increase

00024-5869-03 TOUJEO SOLOSTAR SANOFI-AVENTIS Yes00597-0140-30 TRADJENTA BOEHRINGER ING. Yes00597-0140-90 TRADJENTA BOEHRINGER ING. Yes00169-2662-11 TRESIBA NOVO NORDISK Yes00169-2660-15 TRESIBA FLEXTOUCH U-100 NOVO NORDISK Yes00169-2550-13 TRESIBA FLEXTOUCH U-200 NOVO NORDISK Yes00002-1433-80 TRULICITY ELI LILLY & CO. Yes00002-1434-80 TRULICITY ELI LILLY & CO. Yes00169-4060-12 VICTOZA 2-PAK NOVO NORDISK Yes00169-4060-13 VICTOZA 3-PAK NOVO NORDISK Yes00310-6225-60 XIGDUO XR ASTRAZENECA00310-6250-30 XIGDUO XR ASTRAZENECA00310-6260-60 XIGDUO XR ASTRAZENECA00310-6270-30 XIGDUO XR ASTRAZENECA00310-6280-30 XIGDUO XR ASTRAZENECA00169-2911-15 XULTOPHY 100-3.6 NOVO NORDISK Yes

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 1 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

00173-0695-00 ADVAIR DISKUS GLAXOSMITHKLINE00173-0695-04 ADVAIR DISKUS GLAXOSMITHKLINE00173-0696-00 ADVAIR DISKUS GLAXOSMITHKLINE00173-0696-04 ADVAIR DISKUS GLAXOSMITHKLINE00173-0697-00 ADVAIR DISKUS GLAXOSMITHKLINE00173-0697-04 ADVAIR DISKUS GLAXOSMITHKLINE00173-0715-20 ADVAIR HFA GLAXOSMITHKLINE00173-0715-22 ADVAIR HFA GLAXOSMITHKLINE00173-0716-20 ADVAIR HFA GLAXOSMITHKLINE00173-0716-22 ADVAIR HFA GLAXOSMITHKLINE00173-0717-20 ADVAIR HFA GLAXOSMITHKLINE00173-0717-22 ADVAIR HFA GLAXOSMITHKLINE59310-0805-06 AIRDUO RESPICLICK TEVA SPECIALTY59310-0812-06 AIRDUO RESPICLICK TEVA SPECIALTY59310-0822-06 AIRDUO RESPICLICK TEVA SPECIALTY00472-0825-16 ALBUTEROL SULFATE ACTAVIS/TEVA00591-3467-53 ALBUTEROL SULFATE ACTAVIS/TEVA00591-3468-53 ALBUTEROL SULFATE ACTAVIS/TEVA00591-3797-30 ALBUTEROL SULFATE ACTAVIS/TEVA00591-3797-60 ALBUTEROL SULFATE ACTAVIS/TEVA00591-3797-83 ALBUTEROL SULFATE ACTAVIS/TEVA50383-0740-16 ALBUTEROL SULFATE HI-TECH/AKORN C50383-0741-20 ALBUTEROL SULFATE HI-TECH/AKORN C Yes53489-0176-01 ALBUTEROL SULFATE MUTUAL PHARM CO53489-0177-01 ALBUTEROL SULFATE MUTUAL PHARM CO00378-0255-01 ALBUTEROL SULFATE MYLAN00378-0572-01 ALBUTEROL SULFATE MYLAN00378-4122-01 ALBUTEROL SULFATE MYLAN00378-6991-52 ALBUTEROL SULFATE MYLAN00378-6992-52 ALBUTEROL SULFATE MYLAN00378-8270-52 ALBUTEROL SULFATE MYLAN00378-8270-55 ALBUTEROL SULFATE MYLAN00378-8270-91 ALBUTEROL SULFATE MYLAN00378-8270-93 ALBUTEROL SULFATE MYLAN00487-0301-01 ALBUTEROL SULFATE NEPHRON CORP00487-9501-01 ALBUTEROL SULFATE NEPHRON CORP00487-9501-03 ALBUTEROL SULFATE NEPHRON CORP00487-9501-25 ALBUTEROL SULFATE NEPHRON CORP00487-9501-60 ALBUTEROL SULFATE NEPHRON CORP00487-9901-30 ALBUTEROL SULFATE NEPHRON CORP00487-9904-01 ALBUTEROL SULFATE NEPHRON CORP00487-9904-25 ALBUTEROL SULFATE NEPHRON CORP70752-0102-12 ALBUTEROL SULFATE QUAGEN PHARMACE64980-0442-01 ALBUTEROL SULFATE RISING PHARM

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 2 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

64980-0443-01 ALBUTEROL SULFATE RISING PHARM76204-0200-01 ALBUTEROL SULFATE RITEDOSE PHARMA76204-0200-25 ALBUTEROL SULFATE RITEDOSE PHARMA76204-0200-30 ALBUTEROL SULFATE RITEDOSE PHARMA76204-0200-60 ALBUTEROL SULFATE RITEDOSE PHARMA00781-7155-29 ALBUTEROL SULFATE SANDOZ69543-0290-10 ALBUTEROL SULFATE VIRTUS PHARMACE69543-0291-10 ALBUTEROL SULFATE VIRTUS PHARMACE00254-1007-52 ALBUTEROL SULFATE HFA PAR PHARM.66993-0019-68 ALBUTEROL SULFATE HFA PRASCO LABS00093-3174-31 ALBUTEROL SULFATE HFA TEVA USA70515-0711-01 ALVESCO COVIS PHARMA70515-0712-01 ALVESCO COVIS PHARMA59310-0705-06 ARMONAIR RESPICLICK TEVA SPECIALTY00173-0874-10 ARNUITY ELLIPTA GLAXOSMITHKLINE00173-0874-14 ARNUITY ELLIPTA GLAXOSMITHKLINE00173-0876-10 ARNUITY ELLIPTA GLAXOSMITHKLINE00173-0876-14 ARNUITY ELLIPTA GLAXOSMITHKLINE00173-0888-10 ARNUITY ELLIPTA GLAXOSMITHKLINE00085-1341-01 ASMANEX MERCK SHARP & D00085-1341-02 ASMANEX MERCK SHARP & D00085-1341-06 ASMANEX MERCK SHARP & D00085-1341-07 ASMANEX MERCK SHARP & D00085-1461-02 ASMANEX MERCK SHARP & D00085-4333-01 ASMANEX HFA MERCK SHARP & D00085-4334-01 ASMANEX HFA MERCK SHARP & D00173-0859-10 BREO ELLIPTA GLAXOSMITHKLINE00173-0859-14 BREO ELLIPTA GLAXOSMITHKLINE00173-0882-10 BREO ELLIPTA GLAXOSMITHKLINE00173-0882-14 BREO ELLIPTA GLAXOSMITHKLINE69097-0318-87 BUDESONIDE CIPLA USA, INC.69097-0319-87 BUDESONIDE CIPLA USA, INC.69097-0321-87 BUDESONIDE CIPLA USA, INC.00115-1687-74 BUDESONIDE IMPAX GENERICS00115-1689-74 BUDESONIDE IMPAX GENERICS68180-0984-30 BUDESONIDE LUPIN PHARMACEU00487-9601-01 BUDESONIDE NEPHRON CORP00487-9601-30 BUDESONIDE NEPHRON CORP00487-9701-01 BUDESONIDE NEPHRON CORP00487-9701-30 BUDESONIDE NEPHRON CORP00781-7515-87 BUDESONIDE SANDOZ00781-7516-87 BUDESONIDE SANDOZ00781-7517-87 BUDESONIDE SANDOZ00093-6815-73 BUDESONIDE TEVA USA

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 3 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

00093-6816-55 BUDESONIDE TEVA USA00093-6816-73 BUDESONIDE TEVA USA00093-6817-73 BUDESONIDE TEVA USA59310-0610-31 CINQAIR TEVA SPECIALTY Yes00172-6406-49 CROMOLYN SODIUM TEVA USA Yes69784-0205-60 CROMOLYN SODIUM WOODWARD PHARMA00085-4610-01 DULERA MERCK SHARP & D00085-4610-05 DULERA MERCK SHARP & D00085-7206-01 DULERA MERCK SHARP & D00085-7206-07 DULERA MERCK SHARP & D49708-0644-90 ELIXOPHYLLIN CARACO PHARMACE00310-1730-30 FASENRA ASTRAZENECA00173-0600-02 FLOVENT DISKUS GLAXOSMITHKLINE00173-0601-00 FLOVENT DISKUS GLAXOSMITHKLINE00173-0601-02 FLOVENT DISKUS GLAXOSMITHKLINE00173-0602-00 FLOVENT DISKUS GLAXOSMITHKLINE00173-0602-02 FLOVENT DISKUS GLAXOSMITHKLINE00173-0718-20 FLOVENT HFA GLAXOSMITHKLINE00173-0719-20 FLOVENT HFA GLAXOSMITHKLINE00173-0720-20 FLOVENT HFA GLAXOSMITHKLINE66993-0584-97 FLUTICASONE-SALMETEROL PRASCO LABS66993-0585-97 FLUTICASONE-SALMETEROL PRASCO LABS66993-0586-97 FLUTICASONE-SALMETEROL PRASCO LABS00093-3607-82 FLUTICASONE-SALMETEROL TEVA USA00093-3608-82 FLUTICASONE-SALMETEROL TEVA USA00093-3609-82 FLUTICASONE-SALMETEROL TEVA USA00378-6993-93 LEVALBUTEROL CONCENTRATMYLAN00591-2737-23 LEVALBUTEROL HCL ACTAVIS/IMPAX G00115-9931-78 LEVALBUTEROL HCL IMPAX GENERICS00378-9681-44 LEVALBUTEROL HCL MYLAN00378-9682-44 LEVALBUTEROL HCL MYLAN00378-9691-52 LEVALBUTEROL HCL MYLAN00378-9692-52 LEVALBUTEROL HCL MYLAN66993-0021-27 LEVALBUTEROL HCL PRASCO LABS66993-0022-27 LEVALBUTEROL HCL PRASCO LABS66993-0023-27 LEVALBUTEROL HCL PRASCO LABS76204-0700-25 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0800-01 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0800-24 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0800-25 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0900-01 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0900-24 LEVALBUTEROL HCL RITEDOSE PHARMA76204-0900-25 LEVALBUTEROL HCL RITEDOSE PHARMA00093-4145-56 LEVALBUTEROL HCL TEVA USA

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 4 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

00093-4145-64 LEVALBUTEROL HCL TEVA USA00093-4146-56 LEVALBUTEROL HCL TEVA USA00093-4146-64 LEVALBUTEROL HCL TEVA USA Yes00093-4148-56 LEVALBUTEROL HCL TEVA USA00591-2927-54 LEVALBUTEROL TARTRATE HF ACTAVIS/TEVA16729-0119-10 MONTELUKAST SODIUM ACCORD HEALTHCA16729-0119-15 MONTELUKAST SODIUM ACCORD HEALTHCA16729-0119-17 MONTELUKAST SODIUM ACCORD HEALTHCA27241-0015-31 MONTELUKAST SODIUM AJANTA PHARMA L27241-0016-03 MONTELUKAST SODIUM AJANTA PHARMA L27241-0016-09 MONTELUKAST SODIUM AJANTA PHARMA L27241-0017-03 MONTELUKAST SODIUM AJANTA PHARMA L27241-0017-09 MONTELUKAST SODIUM AJANTA PHARMA L27241-0018-03 MONTELUKAST SODIUM AJANTA PHARMA L27241-0018-09 MONTELUKAST SODIUM AJANTA PHARMA L27241-0018-90 MONTELUKAST SODIUM AJANTA PHARMA L65862-0567-90 MONTELUKAST SODIUM AUROBINDO PHARM65862-0568-90 MONTELUKAST SODIUM AUROBINDO PHARM65862-0574-30 MONTELUKAST SODIUM AUROBINDO PHARM65862-0574-90 MONTELUKAST SODIUM AUROBINDO PHARM69452-0105-13 MONTELUKAST SODIUM BIONPHARMA INC.69452-0105-19 MONTELUKAST SODIUM BIONPHARMA INC.69452-0105-32 MONTELUKAST SODIUM BIONPHARMA INC.69452-0106-13 MONTELUKAST SODIUM BIONPHARMA INC.69452-0106-19 MONTELUKAST SODIUM BIONPHARMA INC.69452-0107-13 MONTELUKAST SODIUM BIONPHARMA INC.69452-0107-19 MONTELUKAST SODIUM BIONPHARMA INC.68001-0248-03 MONTELUKAST SODIUM BLUEPOINT LABOR68001-0248-04 MONTELUKAST SODIUM BLUEPOINT LABOR68001-0248-05 MONTELUKAST SODIUM BLUEPOINT LABOR68001-0361-03 MONTELUKAST SODIUM BLUEPOINT LABOR68001-0361-04 MONTELUKAST SODIUM BLUEPOINT LABOR68001-0361-05 MONTELUKAST SODIUM BLUEPOINT LABOR31722-0726-10 MONTELUKAST SODIUM CAMBER PHARMACE31722-0726-30 MONTELUKAST SODIUM CAMBER PHARMACE31722-0726-90 MONTELUKAST SODIUM CAMBER PHARMACE31722-0727-30 MONTELUKAST SODIUM CAMBER PHARMACE31722-0727-90 MONTELUKAST SODIUM CAMBER PHARMACE31722-0728-30 MONTELUKAST SODIUM CAMBER PHARMACE31722-0728-90 MONTELUKAST SODIUM CAMBER PHARMACE55111-0725-30 MONTELUKAST SODIUM DR.REDDY'S LAB55111-0725-90 MONTELUKAST SODIUM DR.REDDY'S LAB55111-0763-03 MONTELUKAST SODIUM DR.REDDY'S LAB62175-0210-32 MONTELUKAST SODIUM KREMERS/LANNETT

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 5 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

62175-0210-46 MONTELUKAST SODIUM KREMERS/LANNETT68645-0560-54 MONTELUKAST SODIUM LEGACY PHARMACE33342-0102-07 MONTELUKAST SODIUM MACLEODS PHARMA33342-0102-10 MONTELUKAST SODIUM MACLEODS PHARMA33342-0102-15 MONTELUKAST SODIUM MACLEODS PHARMA33342-0110-07 MONTELUKAST SODIUM MACLEODS PHARMA33342-0110-10 MONTELUKAST SODIUM MACLEODS PHARMA33342-0111-07 MONTELUKAST SODIUM MACLEODS PHARMA33342-0111-10 MONTELUKAST SODIUM MACLEODS PHARMA00603-4653-16 MONTELUKAST SODIUM PAR PHARM.66993-0416-30 MONTELUKAST SODIUM PRASCO LABS00603-4655-28 MONTELUKAST SODIUM QUALITEST/PAR P57237-0212-30 MONTELUKAST SODIUM RISING PHARM57237-0212-90 MONTELUKAST SODIUM RISING PHARM57237-0213-30 MONTELUKAST SODIUM RISING PHARM57237-0213-90 MONTELUKAST SODIUM RISING PHARM57237-0255-30 MONTELUKAST SODIUM RISING PHARM00054-0259-13 MONTELUKAST SODIUM ROXANE/WEST-WAR00054-0259-22 MONTELUKAST SODIUM ROXANE/WEST-WAR00054-0289-13 MONTELUKAST SODIUM ROXANE/WEST-WAR00054-0289-22 MONTELUKAST SODIUM ROXANE/WEST-WAR00781-5554-31 MONTELUKAST SODIUM SANDOZ00781-5554-92 MONTELUKAST SODIUM SANDOZ00781-5555-31 MONTELUKAST SODIUM SANDOZ00781-5555-92 MONTELUKAST SODIUM SANDOZ00781-5560-31 MONTELUKAST SODIUM SANDOZ00781-5560-92 MONTELUKAST SODIUM SANDOZ00093-7424-56 MONTELUKAST SODIUM TEVA USA00093-7424-98 MONTELUKAST SODIUM TEVA USA00093-7425-56 MONTELUKAST SODIUM TEVA USA00093-7425-98 MONTELUKAST SODIUM TEVA USA00093-7426-10 MONTELUKAST SODIUM TEVA USA00093-7426-56 MONTELUKAST SODIUM TEVA USA00093-7426-98 MONTELUKAST SODIUM TEVA USA00093-7487-56 MONTELUKAST SODIUM TEVA USA13668-0079-30 MONTELUKAST SODIUM TORRENT PHARMAC13668-0079-90 MONTELUKAST SODIUM TORRENT PHARMAC13668-0080-05 MONTELUKAST SODIUM TORRENT PHARMAC13668-0080-30 MONTELUKAST SODIUM TORRENT PHARMAC13668-0080-90 MONTELUKAST SODIUM TORRENT PHARMAC13668-0081-05 MONTELUKAST SODIUM TORRENT PHARMAC13668-0081-30 MONTELUKAST SODIUM TORRENT PHARMAC13668-0081-90 MONTELUKAST SODIUM TORRENT PHARMAC13668-0531-94 MONTELUKAST SODIUM TORRENT PHARMAC

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 6 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

29300-0220-10 MONTELUKAST SODIUM UNICHEM PHARMAC29300-0220-13 MONTELUKAST SODIUM UNICHEM PHARMAC29300-0220-19 MONTELUKAST SODIUM UNICHEM PHARMAC00054-0288-13 MONTELUKAST SODIUM WEST-WARD/HIKMA00054-0288-22 MONTELUKAST SODIUM WEST-WARD/HIKMA00173-0881-01 NUCALA GLAXOSMITHKLINE00173-0892-01 NUCALA GLAXOSMITHKLINE59310-0579-22 PROAIR HFA TEVA SPECIALTY59310-0580-20 PROAIR RESPICLICK TEVA SPECIALTY00085-1132-01 PROVENTIL HFA MERCK SHARP & D00085-1132-04 PROVENTIL HFA MERCK SHARP & D00186-1988-04 PULMICORT ASTRAZENECA00186-1989-04 PULMICORT ASTRAZENECA00186-1990-04 PULMICORT ASTRAZENECA00186-0916-12 PULMICORT FLEXHALER ASTRAZENECA00186-0917-06 PULMICORT FLEXHALER ASTRAZENECA59310-0202-12 QVAR TEVA SPECIALTY59310-0204-12 QVAR TEVA SPECIALTY59310-0302-40 QVAR REDIHALER TEVA SPECIALTY59310-0304-80 QVAR REDIHALER TEVA SPECIALTY00173-0520-00 SEREVENT DISKUS GLAXOSMITHKLINE00173-0521-00 SEREVENT DISKUS GLAXOSMITHKLINE00006-9117-31 SINGULAIR MERCK SHARP & D00006-9117-54 SINGULAIR MERCK SHARP & D00597-0100-31 SPIRIVA RESPIMAT BOEHRINGER ING. Yes00597-0100-51 SPIRIVA RESPIMAT BOEHRINGER ING.00597-0100-61 SPIRIVA RESPIMAT BOEHRINGER ING. Yes00597-0160-61 SPIRIVA RESPIMAT BOEHRINGER ING. Yes00186-0370-20 SYMBICORT ASTRAZENECA00186-0370-28 SYMBICORT ASTRAZENECA00186-0372-20 SYMBICORT ASTRAZENECA00186-0372-28 SYMBICORT ASTRAZENECA52244-0100-10 THEO-24 AUXILIUM/ENDO P Yes52244-0200-10 THEO-24 AUXILIUM/ENDO P Yes52244-0300-10 THEO-24 AUXILIUM/ENDO P Yes52244-0400-10 THEO-24 AUXILIUM/ENDO P Yes00378-0486-01 THEOPHYLLINE MYLAN42858-0701-01 THEOPHYLLINE RHODES PHARMACE42858-0702-01 THEOPHYLLINE RHODES PHARMACE54838-0556-80 THEOPHYLLINE SILARX/LANNETT27808-0033-01 THEOPHYLLINE TRIS PHARMA INC62332-0025-31 THEOPHYLLINE ANHYDROUS ALEMBIC PHARMAC62332-0026-31 THEOPHYLLINE ANHYDROUS ALEMBIC PHARMAC50111-0482-02 THEOPHYLLINE ANHYDROUS TEVA USA

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Appendix 2: 2020 DHHS Essential Asthma Drug NDC ListPage 7 of 7

NDCEssential Asthma Drug

NameLabeler

Significant Price Increase

00173-0682-20 VENTOLIN HFA GLAXOSMITHKLINE00173-0682-24 VENTOLIN HFA GLAXOSMITHKLINE00378-9320-32 WIXELA INHUB MYLAN00378-9321-32 WIXELA INHUB MYLAN00378-9322-32 WIXELA INHUB MYLAN50242-0040-62 XOLAIR GENENTECH, INC.50242-0214-01 XOLAIR GENENTECH, INC.50242-0215-01 XOLAIR GENENTECH, INC.17478-0173-24 XOPENEX AKORN INC. Yes17478-0174-24 XOPENEX AKORN INC. Yes17478-0171-30 XOPENEX CONCENTRATE AKORN INC.63402-0510-01 XOPENEX HFA SUNOVION PHARMA55111-0625-60 ZAFIRLUKAST DR.REDDY'S LAB55111-0626-60 ZAFIRLUKAST DR.REDDY'S LAB49884-0549-02 ZAFIRLUKAST PAR PHARM.49884-0554-02 ZAFIRLUKAST PAR PHARM.66993-0485-32 ZILEUTON ER PRASCO LABS