products and pricing on the alberta blue cross drug price ...163.8080 00002395274 act temozolomide...

115
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective March 13, 2015 This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 115 DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price 00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3375 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.2548 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3970 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.2207 00002166607 5 BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML 0.1984 00000437999 5% DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML 0.0027 00080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.2000 00002414619 ABBOTT-TOPIRAMATE 100 MG TABLET ORL TAB ABB TAB 0.5928 00002414627 ABBOTT-TOPIRAMATE 200 MG TABLET ORL TAB ABB TAB 0.8853 00002414600 ABBOTT-TOPIRAMATE 25 MG TABLET ORL TAB ABB TAB 0.3128 00001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.5417 00001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.7092 00001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.8258 00002420864 ABILIFY MAINTENA 300 MG/VIAL INJECTION INJ DEFAUL OTS VIAL 490.3900 00002420872 ABILIFY MAINTENA 400 MG/VIAL INJECTION INJ DEFAUL OTS VIAL 490.3900 00002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.0000 00002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.0750 00002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.8410 00002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 13.4050 00002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 16.0750 00002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 18.2640 00002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 24.3640 00002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 30.4510 00001922246 AC & C 8 MG TABLET ORL TAB PPH TAB 0.0510 00000095494 AC WITH CODEINE 8 MG TABLET ORL TAB DTC TAB 0.0592 00002341107 ACCEL-AMLODIPINE 10 MG TABLET ORL TAB ACP TAB 0.3587 00002341093 ACCEL-AMLODIPINE 5 MG TABLET ORL TAB ACP TAB 0.2417 00002419874 ACCEL-DONEPEZIL 10 MG TABLET ORL TAB ACP TAB 1.0472 00002419866 ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB 1.0472 00002164396 ACEBUTOLOL-100 100 MG TABLET ORL TAB PDL TAB 0.0787 00002164418 ACEBUTOLOL-200 200 MG TABLET ORL TAB PDL TAB 0.1177 00002164426 ACEBUTOLOL-400 400 MG TABLET ORL TAB PDL TAB 0.2466 00002230435 ACET 160 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.8325 00001999648 ACET CODEINE 30 TABLET ORL TAB PMS TAB 0.1413 00000374148 ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB 0.0184 00000605751 ACETAMINOPHEN 325 MG TABLET ORL TAB WTR TAB 0.0326 00000789798 ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB 0.0444

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Page 1: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.337500002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.254800002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.397000002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.220700002166607 5 BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML 0.198400000437999 5% DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML 0.002700080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.200000002414619 ABBOTT-TOPIRAMATE 100 MG TABLET ORL TAB ABB TAB 0.592800002414627 ABBOTT-TOPIRAMATE 200 MG TABLET ORL TAB ABB TAB 0.885300002414600 ABBOTT-TOPIRAMATE 25 MG TABLET ORL TAB ABB TAB 0.312800001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.541700001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.709200001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.825800002420864 ABILIFY MAINTENA 300 MG/VIAL INJECTION INJ DEFAUL OTS VIAL 490.390000002420872 ABILIFY MAINTENA 400 MG/VIAL INJECTION INJ DEFAUL OTS VIAL 490.390000002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.000000002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.075000002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.841000002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 13.405000002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 16.075000002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 18.264000002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 24.364000002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 30.451000001922246 AC & C 8 MG TABLET ORL TAB PPH TAB 0.051000000095494 AC WITH CODEINE 8 MG TABLET ORL TAB DTC TAB 0.059200002341107 ACCEL-AMLODIPINE 10 MG TABLET ORL TAB ACP TAB 0.358700002341093 ACCEL-AMLODIPINE 5 MG TABLET ORL TAB ACP TAB 0.241700002419874 ACCEL-DONEPEZIL 10 MG TABLET ORL TAB ACP TAB 1.047200002419866 ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB 1.047200002164396 ACEBUTOLOL-100 100 MG TABLET ORL TAB PDL TAB 0.078700002164418 ACEBUTOLOL-200 200 MG TABLET ORL TAB PDL TAB 0.117700002164426 ACEBUTOLOL-400 400 MG TABLET ORL TAB PDL TAB 0.246600002230435 ACET 160 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.832500001999648 ACET CODEINE 30 TABLET ORL TAB PMS TAB 0.141300000374148 ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB 0.018400000605751 ACETAMINOPHEN 325 MG TABLET ORL TAB WTR TAB 0.032600000789798 ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB 0.0444

Page 2: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 2 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001905864 ACETAMINOPHEN 80 MG/ML ORAL DROPS ORL DPS TLI ML 0.130000002272482 ACETAMINOPHEN ARTHRITIS PAIN 650 MG EXT.REL TABLET ORL ERT PRI TAB 0.075500000706221 ACETAMINOPHEN CAFFEINE & CODEINE 8 MG TABLET ORL TAB WTR TAB 0.025800002028174 ACETAMINOPHEN COMPOUND WITH CODEINE CAPLET ORL TAB PPH TAB 0.042800001905856 ACETAMINOPHEN COMPRIME A CROQUER 80 MG ORL TAB TLI TAB 0.100000002255251 ACETAMINOPHEN EXT STR EASY TO SWALLOW 500 MG TAB ORL TAB PMT TAB 0.066000000605778 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB WTR TAB 0.039000002252813 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB 0.062100001904132 ACETAMINOPHEN EXTRA-STRENGTH 500 MG TABLET ORL TAB TAN TAB 0.017900001958836 ACETAMINOPHEN ORAL SOLUTION FOR CHILDREN USP ORL SOL TLI ML 0.029600002143933 ACETAMINOPHEN WITH CODEINE CAPLET ORL TAB ROG TAB 0.046000002025337 ACETAMINOPHEN WITH CODEINE TABLET ORL TAB PMS TAB 0.043200002251914 ACETAMINOPHEN, CAFFEINE & 8 MG CODEINE PHOS. TAB ORL TAB PMT TAB 0.039600002017458 ACETAMINOPHENE 80MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB 0.100000000834319 ACETAZONE FORTE C-8 TABLET ORL TAB RPH TAB 0.474000000834300 ACETAZONE FORTE TABLET ORL TAB RPH TAB 0.358600001999656 ACET-CODEINE 60 MG TABLET ORL TAB PMS TAB 0.150400002300435 ACETYLCYSTEINE 20% INHALATION SOLUTION INH SOL ALV ML 1.650000000718831 ACETYLSALICYLIC ACID 325 MG TABLET ORL TAB PHH TAB 0.062100002247551 ACID REDUCER 75 MG TABLET ORL TAB PMS TAB 0.106700080011789 ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP 0.111300002394898 ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB 2.622300002374765 ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB 0.513200002376520 ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB 0.350200002403196 ACT CLARITHROMYCIN XL 500 MG TAB EXTENDED-RELEASE ORL ERT APH TAB 1.257200002397625 ACT DONEPEZIL ODT 10 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB 3.726100002397617 ACT DONEPEZIL ODT 5 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB 3.726100002305682 ACT FAMCICLOVIR 125 MG TABLET ORL TAB APH TAB 2.085000002305690 ACT FAMCICLOVIR 250 MG TABLET ORL TAB APH TAB 2.801700002305704 ACT FAMCICLOVIR 500 MG TABLET ORL TAB APH TAB 4.354800002397285 ACT IMATINIB 100 MG TABLET ORL TAB COB TAB 21.069300002397293 ACT IMATINIB 400 MG TABLET ORL TAB COB TAB 84.277300002250020 ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB 0.584000002250012 ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB 0.506100002325713 ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB 10.618600002404095 ACT OLAPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APH ML 10.764000002403986 ACT OLOPATADINE 0.1% OPH SOLUTION OPH SOL APH ML 5.3820

Page 3: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 3 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002394189 ACT OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.452200002394197 ACT OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.678300002394200 ACT OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 1.175500002394170 ACT OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.324400002394219 ACT OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 2.171200002262746 ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB 1.074300002297310 ACT PRAMIPEXOLE 0.5 MG TABLET ORL TAB APH TAB 1.427600002402955 ACT PREGABALIN 150 MG CAPSULE ORL CAP APH CAP 1.778800002402971 ACT PREGABALIN 225 MG CAPSULE ORL CAP APH CAP 1.778800002402912 ACT PREGABALIN 25 MG CAPSULE ORL CAP APH CAP 0.635800002402998 ACT PREGABALIN 300 MG CAPSULE ORL CAP APH CAP 1.778800002402920 ACT PREGABALIN 50 MG CAPSULE ORL CAP APH CAP 0.997300002402939 ACT PREGABALIN 75 MG CAPSULE ORL CAP APH CAP 1.290400002372088 ACT SILDENAFIL 100 MG TABLET ORL TAB APH TAB 9.476000002372053 ACT SILDENAFIL 25 MG TABLET ORL TAB APH TAB 8.537500002372061 ACT SILDENAFIL 50 MG TABLET ORL TAB APH TAB 9.112500002257882 ACT SUMATRIPTAN 25 MG TABLET ORL TAB APH TAB 9.260000002395282 ACT TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APH CAP 117.004500002395290 ACT TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APH CAP 163.808000002395274 ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP 23.402000002395312 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP 292.504000002337487 ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB 0.599800002424770 ACTEMRA 162 MG /0.9 ML INJECTION SYRINGE INJ DEFAUL HLR SYR 355.000000002238302 ACTIFED 60 MG/2.5 MG TABLET ORL TAB PFI TAB 0.324600002249405 ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB 2.192100002309009 ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB 2.192100002316838 ACTONEL 150 MG TABLET ORL TAB ASC TAB 60.640000002370417 ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB 14.132500002248722 ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML 3.582000002236926 ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL PPC ML 12.584000002281074 ACZONE 5% TOPICAL GEL TOP GEL VCL G 1.135000002240255 ADACEL INJECTION INJ DEFAUL SFP ML 60.460000002352044 ADACEL-POLIO INJECTION INJ DEFAUL SFP ML 40.464000002313766 ADALAT XL PLUS 20 MG/81 MG TABLET ORL ERT BAI TAB 0.655500002313774 ADALAT XL PLUS 30 MG/81 MG TABLET ORL ERT BAI TAB 0.617000002313782 ADALAT XL PLUS 60 MG/81 MG TABLET ORL ERT BAI TAB 0.937300000266507 ADASEPT 0.5% TOPICAL LIQUID TOP LIQ ODN ML 0.0295

Page 4: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 4 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002290081 ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML 0.173800002401347 ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL 4840.000000002338327 ADCIRCA 20 MG TABLET ORL TAB LIL TAB 14.666400002248809 ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.653700002248810 ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.972300002248811 ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.291000002248812 ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.609600002248813 ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.928500002248808 ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.335100002412764 ADEMPAS 0.5 MG TABLET ORL TAB BAI TAB 42.750000002412772 ADEMPAS 1 MG TABLET ORL TAB BAI TAB 42.750000002412799 ADEMPAS 1.5 MG TABLET ORL TAB BAI TAB 42.750000002412802 ADEMPAS 2 MG TABLET ORL TAB BAI TAB 42.750000002412810 ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB 42.750000002071002 ADRIAMYCIN PFS 2MG/ML INJECTION INJ DEFAUL PFI ML 11.208000002296462 ADVAGRAF 0.5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 1.970000002296470 ADVAGRAF 1 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 2.709000002331667 ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 7.560000002296489 ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 13.566400080025646 ADVANCED B COMPLEX ORL CAP AOR CAP 0.294100002270447 ADVICOR 1000 MG/20 MG TABLET ORL TAB SUN TAB 1.390000002270439 ADVICOR 500 MG/20 MG TABLET ORL TAB SUN TAB 1.240000001933558 ADVIL 200 MG TABLET ORL TAB PDH TAB 0.193000002036312 ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB 0.384000002248645 ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB 0.422000002244577 ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB 0.275600002248231 ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP 0.385000001933531 ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB 0.147900002246403 ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB 0.320000002241769 ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP 0.277500002242522 ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML 0.326700002243919 AERIUS 5 MG TABLET ORL TAB SCH TAB 1.013000002339528 AFINITOR 10 MG TABLET ORL TAB NOV TAB 202.949300002369257 AFINITOR 2.5 MG TABLET ORL TAB NOV TAB 202.949300002339501 AFINITOR 5 MG TABLET ORL TAB NOV TAB 202.949300002243542 AGENERASE 150 MG CAPSULE ORL CAP GSK CAP 1.920000002346850 AGRIFLU INJECTION SYRINGE INJ DEFAUL NVD SYR 9.3000

Page 5: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 5 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002236859 AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP 6.210000002410265 AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB 0.364600002410273 AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB 0.556500000888230 A-HYDROCORT 100 MG/VIAL INJECTION INJ DEFAUL HSP VIAL 3.450000002408848 AJ-CISATRACURIUM 2MG/ML WITH PRESERVATIVE INJ INJ DEFAUL AJP ML 2.165200000001147 ALBALON 0.1% OPH SOLUTION OPH SOL ALL ML 0.610700000433519 ALBALON-A OPH SOLUTION OPH SOL ALL ML 0.576000002254506 ALDURAZYME 0.58 MG/ML INJECTION INJ DEFAUL GZM ML 209.000000002381478 ALENDRONATE SODIUM 5 MG TABLET ORL TAB AHI TAB 1.037100002301733 ALEVE 220 MG TABLET ORL TAB BAI TAB 0.224000002414759 ALFUZOSIN 10 MG PROLONGED-RELEASE TABLET ORL SRT PDL TAB 0.496600080014418 ALIGN PROBIOTIC CAPSULE ORL CAP PGI CAP 0.948900002253437 ALIMTA 500 MG/VIAL INJECTION INJ DEFAUL LIL VIAL 2750.000000000004715 ALKERAN 2 MG TABLET ORL TAB APR TAB 1.789400002231462 ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB 0.401700002242819 ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB 0.786700002239853 ALLEGRA-D SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.538000002146142 ALLER-AIDE 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML 0.034200002176483 ALLER-AIDE 25 MG CAPLET ORL TAB ROG TAB 0.219800000271411 ALLERDRYL 50 MG CAPSULE ORL CAP VCL CAP 0.130300001949454 ALLERGY 25 MG TABLET ORL TAB TAN TAB 0.093800000764647 ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML 0.188000000833266 ALLERGY ELIXIR 2.5 MG/ML ORAL ELIXIR ORL ELX TAN ML 0.019000002141728 ALLERGY FORMULA 25 MG CAPLET ORL TAB PRI TAB 0.120000002240266 ALLERGY RELIEF 10 MG TABLET ORL TAB APX TAB 0.408300002230398 ALLERGY TABLETS EXTRA STRENGTH 50 MG TABLET ORL TAB TAN TAB 0.162500000804193 ALLERNIX 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML 0.045700002097583 ALLERNIX 25 MG CAPLET ORL TAB ROG TAB 0.233300002097575 ALLERNIX EXTRA STRENGTH 50 MG CAPLET ORL TAB ROG TAB 0.466700002369656 ALLERNIX MULTI SYMPTOM 5 MG TABLET ORL TAB ROG TAB 0.512000002364689 ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB 0.408000002240265 ALLER-RELIEF 10 MG TABLET ORL TAB APX TAB 0.408300000555681 ALLOPURINOL 100 MG TABLET ORL TAB PDL TAB 0.078000002130157 ALLOPURINOL 200 MG TABLET ORL TAB PDL TAB 0.130000000555703 ALLOPURINOL 300 MG TABLET ORL TAB PDL TAB 0.212500000569801 ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML 0.017900002424029 ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB 7.0433

Page 6: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 6 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002241407 ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML 6.846000000893560 ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL ALC ML 1.214000002381710 ALOXI 0.05 MG/ML INJECTION INJ DEFAUL EIS ML 18.000000002381729 ALOXI 0.5 MG CAPSULE ORL CAP EIS CAP 71.720000080005881 ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP 0.108700002248151 ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML 3.764000001908189 ALPRAZOLAM-0.25 MG TABLET ORL TAB PDL TAB 0.060900001908170 ALPRAZOLAM-0.5 MG TABLET ORL TAB PDL TAB 0.072800002248706 ALPRAZOLAM-1 1 MG TABLET ORL TAB PDL TAB 0.209200002241680 ALPROSTADIL 0.5 MG/ML INJECTION INJ DEFAUL TEV ML 185.000000002320924 ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML 6.044000002281112 ALTACE 15 MG CAPSULE ORL CAP/TAB SAV CAP 1.272500002245272 AMARYL 1 MG TABLET ORL TAB SAV TAB 1.001700002245273 AMARYL 2 MG TABLET ORL TAB SAV TAB 1.090000002245274 AMARYL 4 MG TABLET ORL TAB SAV TAB 1.166700002241630 AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 121.000000002230575 AMETOP 4% TOPICAL GEL TOP GEL SNE G 3.146700000870943 AMI-HYDRO TABLET ORL TAB PDL TAB 0.083800002242971 AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML 29.180000000370991 AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB 0.043500000371009 AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB 0.082900000456349 AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB 0.154000002326795 AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB 0.138000000638064 AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML 0.334000002326515 AMOXI-CLAV 500 MG/125 MG TABLET ORL TAB PDL TAB 0.667300002326523 AMOXI-CLAV 875 MG/125 MG TABLET ORL TAB PDL TAB 1.000800002125862 AMPHOJEL 320 MG/5ML ORAL LIQUID ORL LIQ AXC ML 0.018900002124971 AMPHOJEL 600 MG TABLET ORL TAB AUP TAB 0.132400080006771 A-MULSION ORAL LIQUID ORL LIQ SRL ML 0.400000002221861 ANANDRON 50 MG TABLET ORL TAB SAV TAB 2.406200002245345 ANDROGEL (2.5 G/ PACKET) 1% TOPICAL GEL TOP GEL ABB G 0.969300002245346 ANDROGEL (5 G/ PACKET) 1% TOPICAL GEL TOP GEL ABB G 0.857000002249499 ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL ABB G 0.979300000874019 ANEXATE 0.1 MG/ ML INJECTION INJ DEFAUL HLR ML 5.695600002268825 ANGELIQ 1 MG / 1 MG TABLET ORL TAB BAI TAB 0.850000002418401 ANORO ELLIPTA 62.5 MCG/25MCG INHALATION POWDER INH MIP GSK DOSE 2.934000002280361 ANTHELIOS XL SPF 60 TOPICAL CREAM TOP CRM LRP G 0.1772

Page 7: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 7 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000566756 ANTHRAFORTE 1 1% TOPICAL OINTMENT TOP ONT MPQ G 0.369600000566748 ANTHRAFORTE 2 2% TOPICAL OINTMENT TOP ONT MPQ G 0.806600000695351 ANTHRASCALP 0.4% TOPICAL LOTION TOP LOT STI ML 0.700000002222132 ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G 0.060400001945939 ANUSOL 0.5% RECTAL OINTMENT RT ONT WLA G 0.162300001945920 ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP WLA SUP 0.443300001945912 ANUSOL PLUS RECTAL OINTMENT RT ONT WLA G 0.191700001945904 ANUSOL PLUS RECTAL SUPPOSITORY RT SUP WLA SUP 0.592500000621447 ANUZINC 0.5% W/W TOPICAL OINTMENT TOP ONT SDZ G 0.125000000621439 ANUZINC 10 MG RECTAL SUPPOSITORY RT SUP SDZ SUP 0.443300002248424 ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G 0.117300002231379 ANZEMET 100 MG TABLET ORL TAB SAV TAB 29.595300080017904 AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP 0.133300080005832 AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP 0.137500002229873 APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB 0.035400000544981 APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB 0.035400002420333 APO-ADEFOVIR 10 MG TABLET ORL TAB APX TAB 22.211000002248727 APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB 1.068100002243611 APO-ALPRAZ 1 MG TABLET ORL TAB APX TAB 0.336800002243612 APO-ALPRAZ TS 2 MG TABLET ORL TAB APX TAB 0.598500002411318 APO-AMLODIPINE-ATORVASTATIN 10 MG/10 MG TABLET ORL TAB APX TAB 0.947000002411326 APO-AMLODIPINE-ATORVASTATIN 10 MG/20 MG TABLET ORL TAB APX TAB 1.054100002411334 APO-AMLODIPINE-ATORVASTATIN 10 MG/40 MG TABLET ORL TAB APX TAB 1.094300002411342 APO-AMLODIPINE-ATORVASTATIN 10 MG/80 MG TABLET ORL TAB APX TAB 1.094300002411253 APO-AMLODIPINE-ATORVASTATIN 5 MG/10 MG TABLET ORL TAB APX TAB 0.777800002411261 APO-AMLODIPINE-ATORVASTATIN 5 MG/20 MG TABLET ORL TAB APX TAB 0.884900002411288 APO-AMLODIPINE-ATORVASTATIN 5 MG/40 MG TABLET ORL TAB APX TAB 0.925000002411296 APO-AMLODIPINE-ATORVASTATIN 5 MG/80 MG TABLET ORL TAB APX TAB 0.925000002288559 APO-AMOXI CLAV 80 MG/11.4 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.202700002374420 APO-ANASTROZOLE 1 MG TABLET ORL TAB APX TAB 2.766700000510696 APO-ASEN ECT 325 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.153700000472476 APO-ASEN ECT 650 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.250000002318024 APO-ATOMOXETINE 10 MG CAPSULE ORL CAP APX CAP 2.514700002318083 APO-ATOMOXETINE 100 MG CAPSULE ORL CAP APX CAP 4.729000002318032 APO-ATOMOXETINE 18 MG CAPSULE ORL CAP APX CAP 2.882000002318040 APO-ATOMOXETINE 25 MG CAPSULE ORL CAP APX CAP 3.181800002318059 APO-ATOMOXETINE 40 MG CAPSULE ORL CAP APX CAP 3.6270

Page 8: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 8 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002318067 APO-ATOMOXETINE 60 MG CAPSULE ORL CAP APX CAP 4.023200002318075 APO-ATOMOXETINE 80 MG CAPSULE ORL CAP APX CAP 4.342300002296063 APO-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB 4.179000002399210 APO-BOSENTAN 125 MG TABLET ORL TAB APX TAB 22.462500002399202 APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB 22.462500002301334 APO-BRIMONIDINE P 0.15% OPHTHALMIC SOLUTION OPH SOL APX ML 1.883000002242504 APO-BUTORPHANOL 10 MG/ML NASAL SPRAY NAS SPR APX ML 24.572000000682047 APO-CAL 250 625 MG TABLET ORL TAB APX TAB 0.028200000682039 APO-CAL 500 MG TABLET ORL TAB APX TAB 0.070000002365340 APO-CANDESARTAN 4 MG TABLET ORL TAB APX TAB 0.369300001999559 APO-CAPTO 6.25 MG TABLET ORL TAB APX TAB 0.134400002293951 APO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.236700002231603 APO-CETIRIZINE 10 MG TABLET ORL TAB APX TAB 0.443700000399302 APO-CHLORPROPAMIDE 100 MG TABLET ORL TAB APX TAB 0.081000000312711 APO-CHLORPROPAMIDE 250 MG TABLET ORL TAB APX TAB 0.082600002298953 APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G 8.415000000749494 APO-CIMETIDINE 800 MG TABLET ORL TAB APX TAB 0.250300002263130 APO-CIPROFLOX 0.3% OPHTHALMIC SOL. OPH SOL APX ML 1.812000002274744 APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB 0.447900002274752 APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB 1.770500002243433 APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB 0.427800002354403 APO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL APX ML 0.516500002291037 APO-DILTIAZ TZ 120 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP 0.213300002291045 APO-DILTIAZ TZ 180 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP 0.288900002291053 APO-DILTIAZ TZ 240 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP 0.383200002291061 APO-DILTIAZ TZ 300 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP 0.472000002291088 APO-DILTIAZ TZ 360 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP 0.577800002296055 APO-DORZOLAMIDE 2% OPHTHALMIC SOLUTION OPH SOL APX ML 1.688000002386054 APO-ELETRIPTAN 20 MG TABLET ORL TAB APX TAB 10.958300002386062 APO-ELETRIPTAN 40 MG TABLET ORL TAB APX TAB 10.958300002339099 APO-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APX TAB 2.031000002339102 APO-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT APX TAB 2.030900002419726 APO-EXEMESTANE 25 MG TABLET ORL TAB APX TAB 4.238700002292025 APO-FAMCICLOVIR 125 MG TABLET ORL TAB APX TAB 2.084700002292041 APO-FAMCICLOVIR 250 MG TABLET ORL TAB APX TAB 2.801700002292068 APO-FAMCICLOVIR 500 MG TABLET ORL TAB APX TAB 4.594300000545031 APO-FERROUS GLUCONATE 300 MG TABLET ORL TAB APX TAB 0.0428

Page 9: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 9 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001912518 APO-FERROUS SULFATE-FC 300 MG TABLET ORL TAB APX TAB 0.035300002294745 APO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM APX DOSE 0.198900002426471 APO-FROVATRIPTAN 2.5 MG TABLET ORL TAB APX TAB 13.586700002293358 APO-GABAPENTIN 600 MG TABLET ORL TAB APX TAB 1.417500002293366 APO-GABAPENTIN 800 MG TABLET ORL TAB APX TAB 1.890000000885754 APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML 0.525300002295377 APO-GLIMEPIRIDE 1 MG TABLET ORL TAB APX TAB 0.532500002295385 APO-GLIMEPIRIDE 2 MG TABLET ORL TAB APX TAB 0.532500002295393 APO-GLIMEPIRIDE 4 MG TABLET ORL TAB APX TAB 0.532500000396796 APO-HALOPERIDOL 0.5 MG TABLET ORL TAB APX TAB 0.126100000396818 APO-HALOPERIDOL 1 MG TABLET ORL TAB APX TAB 0.189400000463698 APO-HALOPERIDOL 10 MG TABLET ORL TAB APX TAB 0.656900000396826 APO-HALOPERIDOL 2 MG TABLET ORL TAB APX TAB 0.274800000396834 APO-HALOPERIDOL 5 MG TABLET ORL TAB APX TAB 0.438500002327856 APO-HYDRO 12.5 MG TABLET ORL TAB APX TAB 0.036700000441643 APO-IBUPROFEN 200 MG TABLET ORL TAB APX TAB 0.070000002355337 APO-IMATINIB 100 MG TABLET ORL TAB APX TAB 21.069300002355345 APO-IMATINIB 400 MG TABLET ORL TAB APX TAB 84.277300002369052 APO-LAMIVUDINE 150 MG TABLET ORL TAB APX TAB 3.735700002369060 APO-LAMIVUDINE 300 MG TABLET ORL TAB APX TAB 7.471400002375540 APO-LAMIVUDINE-ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB APX TAB 8.509400002358514 APO-LETROZOLE 2.5 MG TABLET ORL TAB APX TAB 2.838700002426552 APO-LINEZOLID 600 MG TABLET ORL TAB APX TAB 71.321300002261979 APO-LISINOPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB APX TAB 0.208300002261987 APO-LISINOPRIL/HCTZ 20 MG/12.5 MG TABLET ORL TAB APX TAB 0.250300002261995 APO-LISINOPRIL/HCTZ 20 MG/25 MG TABLET ORL TAB APX TAB 0.361100002243880 APO-LORATADINE 10 MG TABLET ORL TAB APX TAB 0.681000002248974 APO-MELOXICAM 15 MG TABLET ORL TAB APX TAB 0.616100002248973 APO-MELOXICAM 7.5 MG TABLET ORL TAB APX TAB 0.534000002366487 APO-MEMANTINE 10 MG TABLET ORL TAB APX TAB 1.777400002305062 APO-METFORMIN ER 500 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB 0.427300002258935 APO-METHIMAZOLE 5 MG TABLET ORL TAB APX TAB 0.173500002273950 APO-METHYLPHENIDATE 5 MG TABLET ORL TAB APX TAB 0.108100002286610 APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB 0.407300002286637 APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB 1.222300002352559 APO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP APX CAP 1.120300002352567 APO-MYCOPHENOLATE 500 MG TABLET ORL TAB APX TAB 2.2407

Page 10: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 10 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002372738 APO-MYCOPHENOLIC ACID 180 MG ENTERIC-COATED TAB ORL ECT APX TAB 1.845200002372746 APO-MYCOPHENOLIC ACID 360 MG ENTERIC-COATED TAB ORL ECT APX TAB 3.690200002365499 APO-NARATRIPTAN 1 MG TABLET ORL TAB APX TAB 8.433800002365502 APO-NARATRIPTAN 2.5 MG TABLET ORL TAB APX TAB 6.143700002245231 APO-NITRAZEPAM 10 MG TABLET ORL TAB APX TAB 0.053400002245230 APO-NITRAZEPAM 5 MG TABLET ORL TAB APX TAB 0.035700002220156 APO-NIZATIDINE 150 MG CAPSULE ORL CAP APX CAP 0.209800002220164 APO-NIZATIDINE 300 MG CAPSULE ORL CAP APX CAP 0.391600002223511 APO-NORTRIPTYLINE 10 MG CAPSULE ORL CAP APX CAP 0.050000002223538 APO-NORTRIPTYLINE 25 MG CAPSULE ORL CAP APX CAP 0.101100002333015 APO-OLANZAPINE 20 MG TABLET ORL TAB APX TAB 11.202600002360632 APO-OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APX TAB 5.516000002360640 APO-OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APX TAB 7.825700002305054 APO-OLOPATADINE 0.1% OPH SOLUTION OPH SOL APX ML 5.678000002402823 APO-OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APX ML 11.356000002243661 APO-OXAPROZIN 600 MG TABLET ORL TAB APX TAB 0.709900002284294 APO-OXCARBAZEPINE 150 MG TABLET ORL TAB APX TAB 0.674700002284308 APO-OXCARBAZEPINE 300 MG TABLET ORL TAB APX TAB 0.989100002284316 APO-OXCARBAZEPINE 600 MG TABLET ORL TAB APX TAB 1.978100002366754 APO-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.477000002394766 APO-OXYCODONE CR 15 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.575900002366762 APO-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.715600002394774 APO-OXYCODONE CR 30 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.896100002306530 APO-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.240200002366746 APO-OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.342300002394782 APO-OXYCODONE CR 60 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.622200002366789 APO-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 2.290700002248844 APO-PACLITAXEL 6 MG/ML INJECTION INJ DEFAUL APX ML 37.080800002292912 APO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB 1.385500002240907 APO-PAROXETINE 10 MG TABLET ORL TAB APX TAB 1.133400000755885 APO-PINDOL 10 MG TABLET ORL TAB APX TAB 0.252400000755893 APO-PINDOL 15 MG TABLET ORL TAB APX TAB 0.366200000755877 APO-PINDOL 5 MG TABLET ORL TAB APX TAB 0.147900002302942 APO-PIOGLITAZONE 15 MG TABLET ORL TAB APX TAB 0.515000002302950 APO-PIOGLITAZONE 30 MG TABLET ORL TAB APX TAB 0.721000002302977 APO-PIOGLITAZONE 45 MG TABLET ORL TAB APX TAB 1.081500002292386 APO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB APX TAB 1.4276

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 11 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000598194 APO-PREDNISONE 1 MG TABLET ORL TAB APX TAB 0.103500002394278 APO-PREGABALIN 150 MG CAPSULE ORL CAP APX CAP 1.778800002394286 APO-PREGABALIN 225 MG CAPSULE ORL CAP APX CAP 1.778800002394235 APO-PREGABALIN 25 MG CAPSULE ORL CAP APX CAP 0.635800002394294 APO-PREGABALIN 300 MG CAPSULE ORL CAP APX CAP 1.778800002394243 APO-PREGABALIN 50 MG CAPSULE ORL CAP APX CAP 0.997300002394251 APO-PREGABALIN 75 MG CAPSULE ORL CAP APX CAP 1.290500000402788 APO-PROPRANOLOL 10 MG TABLET ORL TAB APX TAB 0.019200000663719 APO-PROPRANOLOL 20 MG TABLET ORL TAB APX TAB 0.028500000402753 APO-PROPRANOLOL 40 MG TABLET ORL TAB APX TAB 0.034800000402761 APO-PROPRANOLOL 80 MG TABLET ORL TAB APX TAB 0.058500002325381 APO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP 0.929100002377721 APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB 44.500000002248203 APO-SILDENAFIL 100 MG TABLET ORL TAB APX TAB 9.997500002248201 APO-SILDENAFIL 25 MG TABLET ORL TAB APX TAB 9.007500002248202 APO-SILDENAFIL 50 MG TABLET ORL TAB APX TAB 9.615000002418118 APO-SILDENAFIL R 20 MG TABLET ORL TAB APX TAB 7.512800000778354 APO-SULIN 150 MG TABLET ORL TAB APX TAB 0.382400000778362 APO-SULIN 200 MG TABLET ORL TAB APX TAB 0.392000000812404 APO-TAMOX 10 MG TABLET ORL TAB APX TAB 0.180200000812390 APO-TAMOX 20 MG TABLET ORL TAB APX TAB 0.360500002413094 APO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APX CAP 113.596000002413116 APO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APX CAP 159.036000002413124 APO-TEMOZOLOMIDE 180 MG CAPSULE ORL CAP APX CAP 253.672600002413043 APO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APX CAP 22.720000002413132 APO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APX CAP 283.984000002413035 APO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APX CAP 5.850000002136112 APO-TIAPROFENIC 200 MG TABLET ORL TAB APX TAB 0.343700002136120 APO-TIAPROFENIC 300 MG TABLET ORL TAB APX TAB 0.325700000755850 APO-TIMOL 10 MG TABLET ORL TAB APX TAB 0.283500000755869 APO-TIMOL 20 MG TABLET ORL TAB APX TAB 0.543900000755842 APO-TIMOL 5 MG TABLET ORL TAB APX TAB 0.181700002290812 APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML 2.812000002426153 APO-TRAMADOL 50 MG TABLET ORL TAB APX TAB 0.693900002336790 APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB 0.680700002371510 APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB 0.599700001946323 APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP 1.4396

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 12 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002434946 APO-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB 1.188400002436159 APO-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB 1.182500002375885 APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP 2.833200000723754 APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL 12.659000002426862 APTIOM 200 MG TABLET ORL TAB SUN TAB 10.158700002426870 APTIOM 400 MG TABLET ORL TAB SUN TAB 10.158700002426889 APTIOM 600 MG TABLET ORL TAB SUN TAB 10.158700002426897 APTIOM 800 MG TABLET ORL TAB SUN TAB 10.158700002273322 APTIVUS 250 MG CAPSULE ORL CAP BOE CAP 8.250000002162075 AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML 0.933600002269465 ARICEPT RDT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.288900002269457 ARICEPT RDT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.288900002224135 ARIMIDEX 1 MG TABLET ORL TAB AZC TAB 5.563700080008677 ARNICA 7% GEL TOP GEL BCI G 0.131400080015109 ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G 0.097100002242705 AROMASIN 25 MG TABLET ORL TAB PFI TAB 5.736300002286653 ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB 0.122500002229632 ARTIFICIAL TEARS EXTRA OPH SOLUTION OPH SOL PMS ML 0.303300002229570 ARTIFICIAL TEARS OPH SOLUTION OPH SOL PPH ML 0.292700002381559 ARZERRA 100 MG/5 ML VIAL INJECTION INJ DEFAUL GSK VIAL 336.000000002381567 ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL GSK VIAL 3360.000000000180041 ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB 0.042600000036145 ASA 325 MG TABLET ORL TAB WAM TAB 0.013600000230324 ASA 325 MG TABLET ORL TAB TEV TAB 0.062100000530336 ASA 325 MG TABLET ORL TAB VTH TAB 0.027300002244993 ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.039400002426811 ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT SNS TAB 0.053000002046253 ASADOL 325 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.012500002009013 ASAPHEN 80 MG TABLET ORL TAB PMS TAB 0.059400002243974 ASAPHEN 81 MG CHEWABLE TABLET ORL CTB PMS TAB 0.075500002238545 ASAPHEN E.C. 80 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.056000002242281 ASAPHEN E.C. 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.088700002280167 ASATAB 80 MG CHEWABLE TABLET ORL CTB ODN TAB 0.061200002352427 ASATAB EC 325 MG ENTERIC-COATED TABLET ORL ECT ODN TAB 0.029500000266086 ASCORBIC ACID 500 MG TABLET ORL TAB PMT TAB 0.030000002074710 ASPERCREME CREME RUB 10% TOPICAL CREAM TOP CRM SLL G 0.058100002150328 ASPIRIN 325 MG TABLET ORL TAB BAI TAB 0.1138

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 13 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002316897 ASPIRIN STOMACH GUARD EXTRA STRENGTH 500 MG CAPLET ORL TAB BIC TAB 0.096000002229967 ASPIRIN WITH STOMACH GUARD EXTRA STRENGTH CAPLET ORL TAB BAI TAB 0.101800002239090 ATACAND 4 MG TABLET ORL TAB AZC TAB 0.786000000293482 ATASOL 325 MG TABLET ORL TAB CHD TAB 0.063000000013668 ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB 0.057600000293504 ATASOL-15 TABLET ORL TAB CHD TAB 0.115000000293512 ATASOL-30 TABLET ORL TAB CHD TAB 0.133800000293490 ATASOL-8 TABLET ORL TAB CHD TAB 0.075600002326701 ATENOLOL 25 MG TABLET ORL TAB PDL TAB 0.067600000828793 ATENOLOL-100 MG TABLET ORL TAB PDL TAB 0.236200000828807 ATENOLOL-50 MG TABLET ORL TAB PDL TAB 0.143700002396904 ATOMOXETINE 10 MG CAPSULE ORL CAP PDL CAP 1.404000002396912 ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP 1.609300002396920 ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP 1.776700002396939 ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP 2.025000002396947 ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP 2.246300002387891 ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.416000002346486 ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.313800002396424 ATORVASTATIN 10 MG TABLET ORL TAB APX TAB 0.313800002346494 ATORVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.392200002387905 ATORVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.520000002396432 ATORVASTATIN 20 MG TABLET ORL TAB APX TAB 0.392200002346508 ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.421600002396440 ATORVASTATIN 40 MG TABLET ORL TAB APX TAB 0.421600002387913 ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.559000002396459 ATORVASTATIN 80 MG TABLET ORL TAB APX TAB 0.421600002346516 ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB 0.421600002387921 ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB 0.559000002351765 ATORVASTATIN-20 20 MG TABLET ORL TAB PDL TAB 0.156900002421429 ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB 4.130800002299925 ATRIANCE 5 MG/ML INJECTION INJ DEFAUL GSK ML 9.689200002300699 ATRIPLA TABLET ORL TAB BMG TAB 45.444300002094703 ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML 2.717000002148358 ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002163713 ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML 2.158000002332477 AURALGAN OTIC SOLUTION OT SOL PAL ML 0.555000002407256 AURO-ATORVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.3138

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 14 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002407264 AURO-ATORVASTATIN 20 MG TABLET ORL TAB AUR TAB 0.392200002407272 AURO-ATORVASTATIN 40 MG TABLET ORL TAB AUR TAB 0.421600002407280 AURO-ATORVASTATIN 80 MG TABLET ORL TAB AUR TAB 0.421600002418517 AURO-CARVEDILOL 12.5 MG TABLET ORL TAB AUR TAB 0.337700002418525 AURO-CARVEDILOL 25 MG TABLET ORL TAB AUR TAB 0.337700002418495 AURO-CARVEDILOL 3.125 MG TABLET ORL TAB AUR TAB 0.337700002418509 AURO-CARVEDILOL 6.25 MG TABLET ORL TAB AUR TAB 0.337700002418428 AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB 8.498400002385627 AURO-FLUOXETINE 10 MG CAPSULE ORL CAP AUR CAP 0.459500002414414 AURO-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB AUR TAB 7.830800002423650 AURO-LOSARTAN HCT 100 MG/12.5 MG TABLET ORL TAB AUR TAB 0.308200002423669 AURO-LOSARTAN HCT 100 MG/25 MG TABLET ORL TAB AUR TAB 0.314600002423642 AURO-LOSARTAN HCT 50 MG/12.5 MG TABLET ORL TAB AUR TAB 0.314600002390892 AURO-MELOXICAM 15 MG TABLET ORL TAB AUR TAB 0.462300002390884 AURO-MELOXICAM 7.5 MG TABLET ORL TAB AUR TAB 0.400700002411695 AURO-MIRTAZAPINE 15 MG TABLET ORL TAB AUR TAB 0.375000002299801 AURO-MIRTAZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.296700002299828 AURO-MIRTAZAPINE OD 30 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.593300002299836 AURO-MIRTAZAPINE OD 45 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.890000002430487 AURO-MODAFINIL 100 MG TABLET ORL TAB AUR TAB 0.929300002318601 AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB 2.469000002384906 AURO-PIOGLITAZONE 15 MG TABLET ORL TAB AUR TAB 0.580900002384914 AURO-PIOGLITAZONE 30 MG TABLET ORL TAB AUR TAB 0.813900002384922 AURO-PIOGLITAZONE 45 MG TABLET ORL TAB AUR TAB 1.223700002405156 AURO-SIMVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.505700002405164 AURO-SIMVASTATIN 20 MG TABLET ORL TAB AUR TAB 0.625000002405172 AURO-SIMVASTATIN 40 MG TABLET ORL TAB AUR TAB 0.625000002405148 AURO-SIMVASTATIN 5 MG TABLET ORL TAB AUR TAB 0.255600002405180 AURO-SIMVASTATIN 80 MG TABLET ORL TAB AUR TAB 0.450100002414201 AURO-VALSARTAN 40 MG TABLET ORL TAB AUR TAB 0.524000002363798 AVA-ACEBUTOLOL 100 MG TABLET ORL TAB AVA TAB 0.163000002363801 AVA-ACEBUTOLOL 200 MG TABLET ORL TAB AVA TAB 0.244000002363828 AVA-ACEBUTOLOL 400 MG TABLET ORL TAB AVA TAB 0.484800002360969 AVA-ATENOLOL 25 MG TABLET ORL TAB AVA TAB 0.173000002363372 AVA-AZITHROMYCIN 20 MG/ML ORAL SUSPENSION ORL SUS AVA ML 0.640700002363364 AVA-AZITHROMYCIN 250 MG TABLET ORL TAB AVA TAB 2.965000002363380 AVA-AZITHROMYCIN 40 MG/ML ORAL SUSPENSION ORL SUS AVA ML 0.9080

Page 15: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 15 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002371413 AVA-BACLOFEN 10 MG TABLET ORL TAB AVA TAB 0.291100002371421 AVA-BACLOFEN 20 MG TABLET ORL TAB AVA TAB 0.566700002360993 AVA-BICALUTAMIDE 50 MG TABLET ORL TAB AVA TAB 4.057300002363895 AVA-BISOPROLOL 10 MG TABLET ORL TAB AVA TAB 0.365400002363887 AVA-BISOPROLOL 5 MG TABLET ORL TAB AVA TAB 0.220500002363399 AVA-BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB 0.336500002363402 AVA-BUPROPION SR 150 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB 0.504000002370751 AVA-CARVEDILOL 12.5 MG TABLET ORL TAB AVA TAB 0.756400002370786 AVA-CARVEDILOL 25 MG TABLET ORL TAB AVA TAB 0.756400002370735 AVA-CARVEDILOL 3.125 MG TABLET ORL TAB AVA TAB 0.756400002370743 AVA-CARVEDILOL 6.25 MG TABLET ORL TAB AVA TAB 0.756400002362864 AVA-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS AVA ML 0.094800002362848 AVA-CEFPROZIL 250 MG TABLET ORL TAB AVA TAB 0.970300002362872 AVA-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS AVA ML 0.189600002362856 AVA-CEFPROZIL 500 MG TABLET ORL TAB AVA TAB 1.902500002364255 AVA-CITALOPRAM 10 MG TABLET ORL TAB AVA TAB 0.446400002366371 AVA-CLARITHROMYCIN 250 MG TABLET ORL TAB AVA TAB 1.100100002366398 AVA-CLARITHROMYCIN 500 MG TABLET ORL TAB AVA TAB 1.824900002364719 AVA-CLINDAMYCIN 150 MG CAPSULE ORL CAP AVA CAP 0.489000002364727 AVA-CLINDAMYCIN 300 MG CAPSULE ORL CAP AVA CAP 0.978000002360861 AVA-CLONIDINE 0.025 MG TABLET ORL TAB AVA TAB 0.152300002360888 AVA-CLONIDINE 0.1 MG TABLET ORL TAB AVA TAB 0.176500002366665 AVA-DICLOFENAC 25 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 0.190200002366673 AVA-DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 0.380400002366703 AVA-DICLOFENAC SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB 0.760800002366681 AVA-DICLOFENAC SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB 0.570600002364271 AVA-DOMPERIDONE 10 MG TABLET ORL TAB AVA TAB 0.141800002363488 AVA-ENALAPRIL 10 MG TABLET ORL TAB AVA TAB 0.593200002363453 AVA-ENALAPRIL 2.5 MG TABLET ORL TAB AVA TAB 0.417200002363496 AVA-ENALAPRIL 20 MG TABLET ORL TAB AVA TAB 0.715600002363461 AVA-ENALAPRIL 5 MG TABLET ORL TAB AVA TAB 0.493500002373920 AVA-FAMOTIDINE 20 MG TABLET ORL TAB AVA TAB 0.589600002373939 AVA-FAMOTIDINE 40 MG TABLET ORL TAB AVA TAB 1.061200002364409 AVA-FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP AVA CAP 1.089000002364530 AVA-FLUOXETINE 20 MG CAPSULE ORL CAP AVA CAP 1.011200002363771 AVA-FLUVOXAMINE 100 MG TABLET ORL TAB AVA TAB 0.890200002363763 AVA-FLUVOXAMINE 50 MG TABLET ORL TAB AVA TAB 0.4952

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 16 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002364573 AVA-FUROSEMIDE 20 MG TABLET ORL TAB AVA TAB 0.044500002364581 AVA-FUROSEMIDE 40 MG TABLET ORL TAB AVA TAB 0.067000002364603 AVA-FUROSEMIDE 80 MG TABLET ORL TAB AVA TAB 0.122000002363518 AVA-GLICLAZIDE 80 MG TABLET ORL TAB AVA TAB 0.224200002363704 AVA-GLYBURIDE 2.5 MG TABLET ORL TAB AVA TAB 0.039300002363712 AVA-GLYBURIDE 5 MG TABLET ORL TAB AVA TAB 0.068300002363968 AVA-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB AVA TAB 0.039500002363976 AVA-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB AVA TAB 0.055100002373327 AVA-IRBESARTAN 150 MG TABLET ORL TAB AVA TAB 0.544400002373335 AVA-IRBESARTAN 300 MG TABLET ORL TAB AVA TAB 0.544400002373319 AVA-IRBESARTAN 75 MG TABLET ORL TAB AVA TAB 0.544400002373343 AVA-IRBESARTAN/HCTZ 150/12.5 MG TABLET ORL TAB AVA TAB 0.544400002373351 AVA-IRBESARTAN/HCTZ 300/12.5 MG TABLET ORL TAB AVA TAB 0.544400002373378 AVA-IRBESARTAN/HCTZ 300/25 MG TABLET ORL TAB AVA TAB 0.540700002371677 AVA-LEVETIRACETAM 250 MG TABLET ORL TAB AVA TAB 0.963200002371685 AVA-LEVETIRACETAM 500 MG TABLET ORL TAB AVA TAB 1.173900002371693 AVA-LEVETIRACETAM 750 MG TABLET ORL TAB AVA TAB 1.625400002361027 AVA-LEVOFLOXACIN 250 MG TABLET ORL TAB AVA TAB 2.849400002361035 AVA-LEVOFLOXACIN 500 MG TABLET ORL TAB AVA TAB 3.215300002362880 AVA-LISINOPRIL HCT 10 MG/12.5 MG TABLET ORL TAB AVA TAB 0.501900002362899 AVA-LISINOPRIL HCT 20 MG/12.5 MG TABLET ORL TAB AVA TAB 0.603000002362902 AVA-LISINOPRIL HCT 20 MG/25 MG TABLET ORL TAB AVA TAB 0.603000002364239 AVA-LOVASTATIN 20 MG TABLET ORL TAB AVA TAB 1.090700002364247 AVA-LOVASTATIN 40 MG TABLET ORL TAB AVA TAB 2.011700002364506 AVA-METFORMIN 500 MG TABLET ORL TAB AVA TAB 0.121600002364514 AVA-METFORMIN 850 MG TABLET ORL TAB AVA TAB 0.204000002364859 AVA-METOPROLOL (TYPE L) 100 MG TABLET ORL TAB AVA TAB 0.222300002364840 AVA-METOPROLOL (TYPE L) 50 MG TABLET ORL TAB AVA TAB 0.122500002364832 AVA-METOPROLOL 100 MG TABLET ORL TAB AVA TAB 0.222300002364824 AVA-METOPROLOL 50 MG TABLET ORL TAB AVA TAB 0.122500002362937 AVA-MIRTAZAPINE 30 MG TABLET ORL TAB AVA TAB 0.694400002298589 AVAMYS 27.5 MCG/DOSE NASAL SPRAY NAS SPM GSK DOSE 0.227600002365820 AVA-NAPROXEN 375 MG TABLET ORL TAB AVA TAB 0.145800002365839 AVA-NAPROXEN 500 MG TABLET ORL TAB AVA TAB 0.211000002365847 AVA-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 0.246700002365855 AVA-NAPROXEN EC 375 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 0.323400002365863 AVA-NAPROXEN EC 500 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 0.5842

Page 17: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 17 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247085 AVANDAMET 1 MG/500 MG TABLET ORL TAB GSK TAB 0.690300002366304 AVA-NORFLOXACIN 400 MG TABLET ORL TAB AVA TAB 1.220400002364301 AVA-NORTRIPTYLINE 10 MG CAPSULE ORL CAP AVA CAP 0.126000002364328 AVA-NORTRIPTYLINE 25 MG CAPSULE ORL CAP AVA CAP 0.254600002373467 AVA-OLANZAPINE 10 MG TABLET ORL TAB AVA TAB 4.227000002373432 AVA-OLANZAPINE 2.5 MG TABLET ORL TAB AVA TAB 1.056800002373440 AVA-OLANZAPINE 5 MG TABLET ORL TAB AVA TAB 2.113500002373459 AVA-OLANZAPINE 7.5 MG TABLET ORL TAB AVA TAB 3.170300002363429 AVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT AVA TAB 1.213500002363305 AVA-PRAMIPEXOLE 0.25 MG TABLET ORL TAB AVA TAB 0.588700002363321 AVA-PRAMIPEXOLE 1 MG TABLET ORL TAB AVA TAB 1.177600002363348 AVA-PRAMIPEXOLE 1.5 MG TABLET ORL TAB AVA TAB 1.177600002363267 AVA-RAMIPRIL 1.25 MG TABLET ORL CAP/TAB AVA TAB 0.417400002363291 AVA-RAMIPRIL 10 MG TABLET ORL CAP/TAB AVA TAB 0.610000002363275 AVA-RAMIPRIL 2.5 MG TABLET ORL CAP/TAB AVA TAB 0.481500002363283 AVA-RAMIPRIL 5 MG TABLET ORL CAP/TAB AVA TAB 0.481500002364816 AVA-RISEDRONATE 35 MG TABLET ORL TAB AVA TAB 4.816900002367173 AVA-RISPERIDONE 0.25 MG TABLET ORL TAB AVA TAB 0.261500002367181 AVA-RISPERIDONE 0.5 MG TABLET ORL TAB AVA TAB 0.437900002367203 AVA-RISPERIDONE 1 MG TABLET ORL TAB AVA TAB 0.604800002364344 AVA-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL AVA ML 0.772700002367211 AVA-RISPERIDONE 2 MG TABLET ORL TAB AVA TAB 1.207500002367238 AVA-RISPERIDONE 3 MG TABLET ORL TAB AVA TAB 1.811300002367246 AVA-RISPERIDONE 4 MG TABLET ORL TAB AVA TAB 2.415000002363682 AVA-SOTALOL 160 MG TABLET ORL TAB AVA TAB 0.577100002363674 AVA-SOTALOL 80 MG TABLET ORL TAB AVA TAB 0.492200002270994 AVASTIN 25 MG/ML INJECTION INJ DEFAUL HLR ML 135.832500002366266 AVA-SUMATRIPTAN 100 MG TABLET ORL TAB AVA TAB 9.843300002366258 AVA-SUMATRIPTAN 50 MG TABLET ORL TAB AVA TAB 8.935000002366231 AVA-TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT AVA TAB 0.270000002370980 AVA-TOPIRAMATE 100 MG TABLET ORL TAB AVA TAB 1.253700002370999 AVA-TOPIRAMATE 200 MG TABLET ORL TAB AVA TAB 1.984500002370972 AVA-TOPIRAMATE 25 MG TABLET ORL TAB AVA TAB 0.661500002367130 AVA-VALSARTAN 160 MG TABLET ORL TAB AVA TAB 0.572400002367149 AVA-VALSARTAN 320 MG TABLET ORL TAB AVA TAB 0.550000002367114 AVA-VALSARTAN 40 MG TABLET ORL TAB AVA TAB 0.524000002367122 AVA-VALSARTAN 80 MG TABLET ORL TAB AVA TAB 0.5724

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 18 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002367084 AVA-VALSARTAN HCT 160 MG/ 25 MG TABLET ORL TAB AVA TAB 0.572400002367076 AVA-VALSARTAN HCT 160 MG/12.5 MG TABLET ORL TAB AVA TAB 0.572400002367092 AVA-VALSARTAN HCT 320 MG/12.5 MG TABLET ORL TAB AVA TAB 0.563300002367106 AVA-VALSARTAN HCT 320 MG/25 MG TABLET ORL TAB AVA TAB 0.563300002367068 AVA-VALSARTAN HCT 80 MG/12.5 MG TABLET ORL TAB AVA TAB 0.572400002237792 AVAXIM 160 U/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 46.130000002243741 AVAXIM-PEDIATRIC 80 UNIT/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 22.640000002363534 AVA-ZOPICLONE 5 MG TABLET ORL TAB AVA TAB 0.223100002363542 AVA-ZOPICLONE 7.5 MG TABLET ORL TAB AVA TAB 0.468500002317508 AVEENO CREAM TOP CRM JJI G 0.021900002241416 AVEENO MOISTURIZING BATH TOP PWR JJI G 0.049400002237770 AVONEX (30 MCG) 6 MILLION IU/VIAL INJECTION INJ DEFAUL BIO VIAL 364.762500002382369 AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML 1.488700002343002 AZATHIOPRINE 50 MG TABLET ORL TAB SNS TAB 0.240500002284642 AZILECT 0.5 MG TABLET ORL TAB TMP TAB 7.834700002284650 AZILECT 1.0 MG TABLET ORL TAB TMP TAB 7.834700000598577 B COMPLEX 50 TABLET ORL TAB JAM TAB 0.112700000598569 B COMPLEX 75 TABLET ORL TAB JAM TAB 0.168600000123803 B COMPLEX PLUS C TABLET ORL TAB JAM TAB 0.084500080007498 B&C VITAMINS TABLET ORL TAB WBP TAB 0.066900080002409 B12 1000 MCG TABLET ORL TAB WNP TAB 0.085000002245512 B50 COMPLEX CAPSULE ORL CAP WNP CAP 0.125200001927906 BACID 1 B CAPSULE ORL CAP ERF CAP 0.659800000876488 BACIMYXIN TOPICAL OINTMENT TOP ONT PMS G 0.243300000584908 BACITIN 500 UNIT/G TOPICAL OINTMENT TOP ONT PPH G 0.206700000030708 BACITRACIN 50,000 U/VIAL INJECTION INJ DEFAUL PFI VIAL 12.514000002152584 BACLOFEN 10 MG TABLET ORL TAB PDL TAB 0.159500002152592 BACLOFEN 20 MG TABLET ORL TAB PDL TAB 0.310400000037818 BACTERIOSTATIC SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.213000002243425 BALANCED B COMPLEX 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMT TAB 0.085000002244010 BALMINIL CODEINE NIGHT TIME + EXPECTORANT ORL SYR ROG ML 0.029500000436895 BALMINIL DM 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.045000001908855 BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML 0.049600002369613 BANZEL 100 MG TABLET ORL TAB EIS TAB 0.780700002369621 BANZEL 200 MG TABLET ORL TAB EIS TAB 1.560900002369648 BANZEL 400 MG TABLET ORL TAB EIS TAB 3.364600002060841 BARRIERE 20% TOPICAL CREAM TOP CRM WSP G 0.0710

Page 19: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 19 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002135620 BASALJEL 500 MG CAPSULE ORL CAP AUP CAP 0.163000002243966 BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML 0.048500000075124 BCG VACCINE (FREEZE-DRIED) 1 MG INJECTION INJ DEFAUL NNA VIAL 189.510000000498815 B-COMPLEX 100 SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.221000002237567 BEANO 150 UNIT TABLET ORL TAB GSK TAB 0.190700002019736 BENADRYL 12.5 MG/5 ML ORAL ELIXIR ORL ELX PDH ML 0.057200002019701 BENADRYL 2% TOPICAL CREAM TOP CRM WLA G 0.286700002017849 BENADRYL 25 MG CAPLET ORL TAB PDH TAB 0.411700002019671 BENADRYL 50 MG CAPSULE ORL CAP PDH CAP 0.251400002061287 BENADRYL ALLERGY JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB 0.448300002229367 BENADRYL ALLERGY SINUS HEADACHE CAPLET ORL TAB PDH TAB 0.317500002019698 BENADRYL CHILDREN'S 1.25 MG/ML ORAL LIQUID ORL LIQ PDH ML 0.057200002239138 BENADRYL EXTRA STRENGTH 50 MG CAPLET ORL TAB PDH TAB 0.558300002370050 BENLYSTA 120 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 285.300000002370069 BENLYSTA 400 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 950.990000002245709 BENYLIN 2 COLD AND FLU WITH CODEINE ORAL SYRUP ORL SYR PDH ML 0.057000001944738 BENYLIN DM 3 MG/ML ORAL SYRUP ORL SYR WLA ML 0.052400002215268 BENYLIN DM FOR CHILDREN 1.5 MG/ML ORAL SYRUP ORL SYR WLA ML 0.052400002245383 BENYLIN DM FREEZER POPS 7.5 MG/ PACKET ORAL LIQUID ORL LIQ PDH PCKT 0.592500001944746 BENYLIN DM-D FOR CHILDREN ORAL SYRUP ORL SYR WWA ML 0.052400001944711 BENYLIN DM-D ORAL SYRUP ORL SYR PDH ML 0.047400002003317 BENYLIN DM-D-E EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.038800001944673 BENYLIN DM-D-E ORAL SYRUP ORL SYR PDH ML 0.052400001944762 BENYLIN DM-E ORAL SYRUP ORL SYR WLA ML 0.052400002265427 BENYLIN E EXTRA STR W/ MENTHACTIN 40/3MG/ML SYR ORL SYR PDH ML 0.051800001912437 BENZAC AC 10% TOPICAL COPOLYMER GEL TOP COPGEL GAL G 0.333300001925199 BENZAC W10 10% TOPICAL WASH TOP WAS GAL G 0.311100002162121 BENZAGEL 5 5% WASH TOP WAS NVC ML 0.061900002225271 BENZAMYCIN TOPICAL GEL TOP GEL VCL G 1.192300002336847 BESIVANCE 0.6% OPHTHALMIC SOLUTION OPH SOL BSH ML 2.910000000716634 BETADERM 0.1% SCALP LOTION SCP LOT TAR ML 0.092500000158348 BETADINE 10% TOPICAL SOLUTION TOP SOL PUR ML 0.031100002237835 BETAJECT INJECTION INJ DEFAUL SDZ ML 10.797000002417030 BEXSERO SUSPENSION 0.5 ML SYRINGE INJECTION INJ NDL NOV SYR 109.750000002359685 BIACNA 1.2%/0.025% TOPICAL GEL TOP GEL VCL G 1.149800002325985 BICALUTAMIDE 50 MG TABLET ORL TAB AHI TAB 4.057200002382423 BICALUTAMIDE 50 MG TABLET ORL TAB SIV TAB 4.0573

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002291924 BICILLIN L-A 1,200,000 IU/2 ML INJ SYR INJ NDL PFI SYR 44.804000000297763 BICNU 100 MG/VIAL INJECTION INJ DEFAUL BMS VIAL 120.040000002230897 BILTRICIDE 600 MG TABLET ORL TAB BAI TAB 6.835000002392143 BIO-AMLODIPINE 10 MG TABLET ORL TAB BMD TAB 0.358700002392127 BIO-AMLODIPINE 2.5 MG TABLET ORL TAB BMD TAB 0.138000002392135 BIO-AMLODIPINE 5 MG TABLET ORL TAB BMD TAB 0.241700002392186 BIO-ATENOLOL 100 MG TABLET ORL TAB BMD TAB 0.236200002392194 BIO-ATENOLOL 25 MG TABLET ORL TAB BMD TAB 0.067600002392178 BIO-ATENOLOL 50 MG TABLET ORL TAB BMD TAB 0.143700000621366 BIODERM TOPICAL OINTMENT TOP ONT ODN G 0.360000002247371 BIO-FUROSEMIDE 20 MG TABLET ORL TAB BMD TAB 0.037300002247372 BIO-FUROSEMIDE 40 MG TABLET ORL TAB BMD TAB 0.055800080012473 BIOGAIA DROPS ORL DPS FEI ML 4.320000002247170 BIO-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.015700002247171 BIO-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.021700080006533 BIOMEDIC MULTIVITAMIN ORL CAP VTH CAP 0.130000002216051 BION TEARS OPH SOLUTION OPH SOL ALC ML 0.979200000116785 BIONET TABLET ORL TAB CHD TAB 0.205600080003128 BIONUTRITION FORMULA 3 CAPSULE ORL CAP BNI CAP 1.166600000999776 BIOTENE ORAL BALANCE GEL ORL GEL GSK G 0.171500000999782 BIOTENE ORAL RINSE ORL MWH GSK ML 0.015300000999777 BIOTENE SPRAY ORL SPR GSK ML 0.163700000437522 BIOTIN 250 MCG TABLET ORL TAB JAM TAB 0.059200002326302 BI-PEGLYTE KIT ORL ECT/PWR PPH KIT 21.190000002361450 BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP JPC SUP 0.468100002273411 BISACODYL-ODAN 5 MGENTERIC-COATED TABLET ORL ECT ODN TAB 0.055000002131692 BLEOMYCIN SULFATE 15 UNIT/VIAL INJECTION INJ DEFAUL MNP VIAL 457.890000000220442 BONAMINE 25 MG CHEWABLE TABLET ORL CTB JJM TAB 0.442000002247600 BOOSTRIX INJECTION SYRINGE INJ DEFAUL GSK SYR 29.470000002419149 BOSULIF 100 MG TABLET ORL TAB PFI TAB 36.590000002419157 BOSULIF 500 MG TABLET ORL TAB PFI TAB 146.340000002268140 BRAVELLE 75 UNIT/VIAL POWDER FOR INJECTION INJ DEFAUL FEI VIAL 74.978000002408872 BREO ELLIPTA 100 MCG/25 MCG POWDER FOR INHALATION INH MIP GSK DOSE 4.346700002220520 BROMAZEPAM 3 MG TABLET ORL TAB PDL TAB 0.037500002220539 BROMAZEPAM 6 MG TABLET ORL TAB PDL TAB 0.054800000522791 BRONCHOPHAN FORTE DM ORAL SYRUP ORL SYR ATL ML 0.026800000512990 BSS BALANCED SALT OPH SOLUTION OPH SOL ALC ML 0.4180

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 21 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000729655 BUCKLEY'S DM ORAL LIQUID ORL LIQ BUA ML 0.051800002247970 BUGS BUNNY AND FRIENDS COMPLETE MULTI VIT CHEW TAB ORL CTB BIC TAB 0.087300080022907 BUGS BUNNY AND FRIENDS COMPLETE MULTI VIT CHEW TAB ORL CTB BIC TAB 0.087300002331616 BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.266700000728284 BURINEX 1 MG TABLET ORL TAB LEO TAB 0.810300000728276 BURINEX 5 MG TABLET ORL TAB LEO TAB 3.126000000674222 BURO-SOL OTIC SOLUTION OT SOL TCD ML 0.276000000579947 BURO-SOL TOPICAL POWDER TOP PWR GSK G 0.751000002223163 BUSPIRONE 10 MG TABLET ORL TAB PDL TAB 0.352100002341212 BUTRANS 10 (10 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 24.450000002341220 BUTRANS 20 (20 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 44.445000002341174 BUTRANS 5 (5 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 13.312500002361817 BYETTA 10 MCG/DOSE (2.4 ML) INJECTION SYRINGE INJ NDL AZC SYR 149.630000002361809 BYETTA 5 MCG/DOSE (1.2 ML) INJECTION SYRINGE INJ NDL AZC SYR 149.630000002399016 BYSTOLIC 10 MG TABLET ORL TAB FLC TAB 1.290000002398990 BYSTOLIC 2.5 MG TABLET ORL TAB FLC TAB 1.304000002399024 BYSTOLIC 20 MG TABLET ORL TAB FLC TAB 1.290000002399008 BYSTOLIC 5 MG TABLET ORL TAB FLC TAB 1.304000002273284 CADUET 10 MG/10 MG TABLET ORL TAB PFI TAB 2.662300002273292 CADUET 10 MG/20 MG TABLET ORL TAB PFI TAB 3.319100002273306 CADUET 10 MG/40 MG TABLET ORL TAB PFI TAB 3.440000002273314 CADUET 10 MG/80 MG TABLET ORL TAB PFI TAB 3.440000002273233 CADUET 5 MG/10 MG TABLET ORL TAB PFI TAB 2.521700002273241 CADUET 5 MG/20 MG TABLET ORL TAB PFI TAB 2.973700002273268 CADUET 5 MG/40 MG TABLET ORL TAB PFI TAB 3.109400002273276 CADUET 5 MG/80 MG TABLET ORL TAB PFI TAB 3.109400002238389 CAELYX 2 MG/ML PEGYLATED LIPOSOME INJECTION INJ DEFAUL SCH ML 68.300000000176095 CAFERGOT TABLET ORL TAB NOV TAB 0.890700002241460 CAL MAG 2:1 WITH D TABLET ORL TAB WNP TAB 0.039100000730602 CALCIUM & MAGNESIUM WITH VITAMIN D CAPSULE ORL CAP SIS CAP 0.244200002240973 CALCIUM (CARBONATE) W/ VITAMIN D 500 MG/125 U TAB ORL TAB WNP TAB 0.075000080003658 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.025500000621722 CALCIUM 500 MG TABLET ORL TAB HAL TAB 0.027400002240240 CALCIUM 500 MG TABLET ORL TAB PMT TAB 0.085000002240977 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.044900080000248 CALCIUM 650 MG TABLET ORL TAB JAM TAB 0.074500080009369 CALCIUM 650 MG TABLET ORL TAB PMT TAB 0.0342

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 22 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080007105 CALCIUM 650 MG WITH VITAMIN D 400 IU CAPLET ORL TAB JAM TAB 0.074500002040875 CALCIUM AND MAGNESIUM CAPLET ORL TAB JAM TAB 0.070300002245170 CALCIUM AND MAGNESIUM CITRATE WITH VITAMIN D TAB ORL TAB WNP TAB 0.064100080006568 CALCIUM AND MAGNESIUM TABLET ORL TAB GFR TAB 0.114000002244861 CALCIUM AND MAGNESIUM WITH VITAMIN D TAB ORL TAB PMT TAB 0.034500002048965 CALCIUM AND MAGNESIUM WITH ZINC CAPLET ORL TAB JAM TAB 0.033500002243418 CALCIUM BONE SOLUTION ORL LIQ ULT ML 0.034300000730599 CALCIUM CARBONATE & VITAMIN D3 500 MG/125 U TABLET ORL TAB PMT TAB 0.034500000644684 CALCIUM CARBONATE 500 MG (BASE) TABLET ORL TAB WBP TAB 0.024500001922238 CALCIUM CARBONATE 500 MG CHEWABLE TABLET ORL CTB WAM TAB 0.098800080003855 CALCIUM CITRATE 300 MG TABLET ORL TAB WNP TAB 0.067200002243766 CALCIUM CITRATE 300 MG TABLET ORL TAB PMT TAB 0.079100002158728 CALCIUM CITRATE 350 MG TABLET ORL TAB SWS TAB 0.094500002237590 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB JAM TAB 0.069000002243669 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB WNP TAB 0.083300002141019 CALCIUM GLUCONATE 94 MG/ML INJECTION INJ DEFAUL PPC ML 0.979000080007103 CALCIUM MAGNESIUM WITH VITAMIN D CAPLET ORL TAB JAM TAB 0.070300002040905 CALCIUM MAGNESIUM WITH VITAMIN D TABLET ORL TAB JAM TAB 0.068500080007265 CALCIUM SOFT CHEWS WITH VITAMIN D ORL CAP JAM CAP 0.182000001906828 CAL-MAG WITH ZINC & VITAMIN D CAPLET ORL TAB SWS TAB 0.090200080027151 CALMOSEPTINE OINTMENT TOP ONT CAL G 0.065000002198630 CALMYLIN ACE 2 MG/ML SYRUP ORL SYR RPH ML 0.102100000535230 CALMYLIN WITH CODEINE COUGH ORAL LIQUID ORL LIQ RPH ML 0.055400002172917 CALMYLIN WITH CODEINE ORAL SYRUP ORL SYR ROG ML 0.059000002007134 CALTINE 100 UNIT/ML INJECTION INJ DEFAUL FEI ML 8.055000002242997 CALTRATE 600 MG WITH VITAMIN D SOFT CHEWS TABLET ORL CTB WCH TAB 0.192200002231948 CALTRATE 600 MG WITH VITAMIN D TABLET ORL TAB WCH TAB 0.183200080003751 CALTRATE 600 TABLET ORL TAB PDH TAB 0.183200002240959 CALTRATE PLUS CHEWABLE TABLET ORL CTB WCH TAB 0.230600080009423 CALTRATE PLUS CHEWABLES 400 IU ORL TAB PDH TAB 0.222100080009761 CALTRATE PLUS TABLET ORL TAB PDH TAB 0.192200080023065 CALTRATE SELECT 600 MG/400 IU TABLET ORL TAB PDH TAB 0.219800002247976 CALTRATE SELECT 600 MG/400 IU TABLET ORL TAB WCH TAB 0.219800080012593 CALTRATE WITH VITAMIN D SOFT CHEWS ORL CTB WAY TAB 0.192200002381680 CAMBIA 50 MG ORAL POWDER PACKET ORL PWDPKT TRI PCKT 10.757800002293269 CAMPRAL 333 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 0.869300002231622 CAMPTOSAR 20 MG/ML INJECTION INJ DEFAUL PFI ML 119.5380

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 23 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002377942 CANDESARTAN 16 MG TABLET ORL TAB PDL TAB 0.342000002422069 CANDESARTAN 32 MG TABLET ORL TAB PDL TAB 0.285000002435845 CANDESARTAN 32 MG TABLET ORL TAB SNS TAB 0.285000002388901 CANDESARTAN 4 MG TABLET ORL TAB SNS TAB 0.340000002388693 CANDESARTAN 4 MG TABLET ORL TAB SIV TAB 0.340000002377934 CANDESARTAN 8 MG TABLET ORL TAB PDL TAB 0.342000002379260 CANDESARTAN CILEXETIL 4 MG TABLET ORL TAB AHI TAB 0.340000002392275 CANDESARTAN-HCTZ 16 MG/12.5 MG TABLET ORL TAB PDL TAB 0.299300080038188 CANDIBACTIN BR TABLET ORL TAB MTG TAB 0.303300080050373 CANDIBACTIN-AR CAPSULE ORL CAP MTG CAP 0.455000002311690 CANESORAL 150 MG CAPSULE ORL CAP BIC CAP 18.690000002311739 CANESORAL COMBI-PAK KIT ORL/VAG CAP/CRM BIC KIT 17.630000002311720 CANESTEN 1% EXTERNAL CREAM TOP CRM BIC G 13.310000002150867 CANESTEN 1% TOPICAL CREAM TOP CRM BAI G 0.391300080028872 CANTHACUR 0.7% TOPICAL SOLUTION TOP SOL PMS ML 6.990700000589500 CANTHACUR-PS TOPICAL SOLUTION TOP SOL PMS ML 8.684000080023975 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL DLX ML 6.660000000619035 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL BAK ML 7.237300000772011 CANTHARONE PLUS TOPICAL SOLUTION TOP SOL DLX ML 8.685300000619027 CANTHARONE PLUS TOPICAL SOLUTION TOP SOL BAK ML 7.993000002242738 CAPEX 0.01% TOPICAL SHAMPOO TOP SHP GAL ML 0.720300002157101 CAPSAICIN 0.025% TOPICAL CREAM TOP CRM VLP G 0.203200002157128 CAPSAICIN 0.075% TOPICAL CREAM TOP CRM VLP G 0.246500002060043 CARBACHOL 2 MG TABLET ORL TAB BNQ TAB 0.590000002413590 CARBAMAZEPINE CR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.093000002413604 CARBAMAZEPINE CR 400 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.185900002241999 CARBOCAINE 10 MG/ML INJECTION INJ DEFAUL HSP ML 0.631300002242001 CARBOCAINE 20 MG/ ML INJECTION INJ DEFAUL HSP ML 1.262500002245511 CARBOCAL D 400 TABLET ORL TAB EUP TAB 0.126000002011239 CARBOLITH 600 MG CAPSULE ORL CAP VCL CAP 0.199100002126680 CARBOPLATIN 10 MG/ML INJECTION INJ DEFAUL HSP ML 19.250000002397447 CARIPUL 0.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 17.176000002397455 CARIPUL 1.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 34.447000002324520 CARVEDILOL 12.5 MG TABLET ORL TAB PDL TAB 0.635000002324539 CARVEDILOL 25 MG TABLET ORL TAB PDL TAB 0.635000002324504 CARVEDILOL 3.125 MG TABLET ORL TAB PDL TAB 0.635000002324512 CARVEDILOL 6.25 MG TABLET ORL TAB PDL TAB 0.6350

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 24 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002184478 CASODEX 50 MG TABLET ORL TAB AZC TAB 7.465300000291889 CATAPRES 0.2 MG TABLET ORL TAB BOE TAB 0.330600002245859 CATHFLO 1 MG/ML POWDER FOR SOLUTION INJ DEFAUL HLR ML 34.773000002215756 CAVERJECT 20 MCG INJECTION INJ DEFAUL PFI VIAL 25.736000000465208 CECLOR 25 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.128600000465186 CECLOR 250 MG CAPSULE ORL CAP PPH CAP 1.109200000832804 CECLOR 375 MG/5ML ORAL SUSPENSION ORL SUS PHH ML 0.287200000465216 CECLOR 50 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.235400000465194 CECLOR 500 MG CAPSULE ORL CAP PPH CAP 2.177700000360430 CEENU 10 MG CAPSULE ORL CAP BMS CAP 7.613500000360414 CEENU 100 MG CAPSULE ORL CAP BMS CAP 21.669500000360422 CEENU 40 MG CAPSULE ORL CAP BMS CAP 13.268000002237138 CEFAZOLIN 1 G/VIAL USP INJECTION INJ DEFAUL PPC VIAL 6.000000002319039 CEFEPIME 2G/VIAL INJECTION INJ DEFAUL APX VIAL 30.196000002036274 CEFOTAN 1 G/VIAL INJECTION INJ DEFAUL WAY VIAL 15.000000002240773 CEFOXITIN 10 G/VIAL USP INJECTION INJ DEFAUL TEV VIAL 105.950000002332027 CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.236600000886971 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL PPC VIAL 31.970000000886955 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL PPC VIAL 60.810000000886963 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL PPC VIAL 190.990000002212307 CEFTIN 125 MG/5ML ORAL SUSPENSION ORL SUS GSK ML 0.189900002409968 CEFTRIAXONE 100 G/SMARTPAK BULK PACKAGE INJECTION INJ DEFAUL PPC G 21.420000002292262 CEFTRIAXONE FOR INJECTION BP 0.25G/VIAL INJECTION INJ DEFAUL SDZ VIAL 7.525000002287668 CEFTRIAXONE SODIUM FOR INJECTION 10 G/VIAL INJ INJ DEFAUL TEV VIAL 214.200000002250292 CEFTRIAXONE SODIUM FOR INJECTION BP 1 G/VIAL INJ INJ DEFAUL HSP VIAL 35.250000002241639 CEFUROXIME 1.5 G/VIAL USP INJECTION INJ DEFAUL PPC VIAL 39.790000002241640 CEFUROXIME 7.5 G/VIAL USP INJECTION INJ DEFAUL PPC VIAL 149.200000002241638 CEFUROXIME 750 MG/VIAL USP INJECTION INJ DEFAUL PPC VIAL 19.890000002436299 CELECOXIB 100 MG CAPSULE ORL CAP SNS CAP 0.174800002424371 CELECOXIB 100 MG CAPSULE ORL CAP PDL CAP 0.177600002429675 CELECOXIB 100 MG CAPSULE ORL CAP SIV CAP 0.174800002436302 CELECOXIB 200 MG CAPSULE ORL CAP SNS CAP 0.349700002424398 CELECOXIB 200 MG CAPSULE ORL CAP PDL CAP 0.355300002429683 CELECOXIB 200 MG CAPSULE ORL CAP SIV CAP 0.349700002357844 CELESTODERM-V 0.1% TOPICAL CREAM TOP CRM VLP G 0.099000002357852 CELESTODERM-V 0.1% TOPICAL OINTMENT TOP ONT VLP G 0.099000002357860 CELESTODERM-V/2 0.05% TOPICAL CREAM TOP CRM VLP G 0.0664

Page 25: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 25 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002357879 CELESTODERM-V/2 0.05% TOPICAL OINTMENT TOP ONT VLP G 0.062900002242145 CELLCEPT 200 MG/ ML ORAL SUSPENSION ORL SUS HLR ML 1.792500002192748 CELLCEPT 250 MG ORAL CAPSULE ORL CAP HLR CAP 2.240700002237484 CELLCEPT 500 MG TABLET ORL TAB HLR TAB 4.481400002240347 CELLCEPT I.V. 500 MG/VIAL INJECTION POWDER FOR SOL INJ DEFAUL HLR VIAL 32.000000000870153 CELLUVISC 1% OPH SOLUTION OPH SOL ALL ML 0.845800000022802 CELONTIN 300 MG CAPSULE ORL CAP ERF CAP 0.637800002299844 CELSENTRI 150 MG TABLET ORL TAB PFI TAB 17.737500002299852 CELSENTRI 300 MG TABLET ORL TAB PFI TAB 16.500000080013657 CENTRUM ADVANTAGE TABLET ORL TAB PDH TAB 0.196300080022930 CENTRUM CARDIO TABLET ORL TAB PDH TAB 0.225800080024482 CENTRUM FOR WOMEN ORL TAB PDH TAB 0.151700080005174 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.170000080020794 CENTRUM JUNIOR COMPLETE CHEWABLE TABLET ORL CTB PDH TAB 0.130500002246440 CENTRUM SELECT CHEWABLE TABLET ORL CTB WCH TAB 0.222300080005153 CENTRUM SELECT TABLET ORL TAB PFI TAB 0.157700002246362 CENTRUM TABLET ORL TAB PDH TAB 0.096900080021452 CENTRUM TABLET ORL TAB PDH TAB 0.132800002099365 CEPACOL MINT WITH FLUORIDE MOUTHWASH ORL MWH SKB ML 0.004000000828866 CEPHALEXIN 500 MG TABLET ORL TAB PDL TAB 0.450000002410923 CERAVE TOPICAL LOTION TOP LOT VCL ML 0.101000002230988 CEREBYX 75 MG/ML INJECTION INJ DEFAUL PFI ML 9.450000002230694 CEREZYME 200 U/VIAL INJECTION INJ DEFAUL GZM VIAL 1230.000000002241751 CEREZYME 400 U/VIAL INJECTION INJ DEFAUL GZM VIAL 2460.000000001926683 CERUBIDINE 20 MG/VIAL INJECTION INJ DEFAUL ERF VIAL 92.000000000158356 CERUMENEX 10% OTIC DROPS OT DPS PUR ML 0.574000000221570 CERUMOL OTIC DROPS OT DPS PAL ML 0.519100002342227 CERVARIX 0.5 ML INJECTION INJ DEFAUL GSK ML 195.600000002312263 CESAMET 0.25 MG ORAL CAPSULE ORL CAP VCL CAP 1.835600002247766 CETROTIDE 0.25 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 96.750000002247767 CETROTIDE 3 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 340.000000000496685 CHELATED CHROMIUM 200 MCG TABLET ORL TAB JAM TAB 0.072800080009742 CHEWABLE PEPPERMINT VITAMIN D 1000 IU ORL TAB SWS TAB 0.047900002248435 CHILDREN'S ADVIL COLD ORAL SUSPENSION ORL SUS PDH ML 0.061000002238626 CHILDREN'S MOTRIN 40 MG/ML SUSPENSION DROPS ORL DPS MCL ML 0.273300000870455 CHILDRENS TYLENOL COLD DM CHEWABLE TABLET ORL CTB MCL TAB 0.176300002039990 CHILDREN'S TYLENOL COLD DM ORAL SUSPENSION ORL SUS MCL ML 0.0549

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 26 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002229538 CHILDRENS TYLENOL DECONGESTANT LIQUID ORL LIQ MCL ML 0.054900002046040 CHILDREN'S TYLENOL GRAPE 32 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.057200002247621 CHLORAL HYDRATE-ODAN 100 MG/ML ORAL SYRUP ORL SYR ODN ML 0.043300000738972 CHLOR-TRIPOLON 4 MG TABLET ORL TAB SCH TAB 0.224200001970399 CHLOR-TRIPOLON N.D. SUSTAINED-RELEASE TABLET ORL TAB SCH TAB 0.434200000738964 CHLOR-TRIPOLON REPETABS 12 MG SUST RELEASE TABLET ORL SRT SCH TAB 0.340400080015373 CHONDROCARE TABLET ORL TAB MTG TAB 0.450000002247459 CHORIONIC GONADOTROPIN 10,000 UNIT/VIAL INJECTION INJ DEFAUL PPC VIAL 130.390000002248088 CIALIS 10 MG TABLET ORL TAB LIL TAB 15.245000002296888 CIALIS 2.5 MG TABLET ORL TAB LIL TAB 4.662500002248089 CIALIS 20 MG TABLET ORL TAB LIL TAB 15.797500002296896 CIALIS 5 MG TABLET ORL TAB LIL TAB 4.662500002238274 CI-CAL + D TABLET ORL TAB EUP TAB 0.151300002238273 CI-CAL 250 MG TABLET ORL TAB EUP TAB 0.143700002410346 CICLOPIROX 8% TOPICAL SOLUTION TOP SOL STM G 7.743300002350971 CILAZAPRIL 2.5 MG TABLET ORL TAB SNS TAB 0.428400002200864 CILOXAN 0.3% OPH OINTMENT OPH ONT ALC G 3.282900002331675 CIMZIA 200 MG/ML INJECTION SYRINGE INJ NDL UCB SYR 722.090000002391449 CIPRALEX MELTZ 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.840000002391457 CIPRALEX MELTZ 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.959000002251787 CIPRO XL 1000 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.381600002247916 CIPRO XL 500 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.381600002304546 CIPROFLOXACIN INTRAVENOUS INFUSION BP 2 MG/ML INJ INJ DEFAUL APX ML 0.144500002304759 CIPROFLOXACIN INTRAVENOUS INFUSION BP 2 MG/ML INJ INJ DEFAUL SDZ ML 0.154000002403188 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL TEV ML 6.337000002126613 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL MNP ML 6.460000002301822 CITALOPRAM 10 MG TABLET ORL TAB MEL TAB 0.446400002387948 CITALOPRAM 10 MG TABLET ORL TAB SIV TAB 0.249300002430517 CITALOPRAM 10 MG TABLET ORL TAB JPC TAB 0.143200002301830 CITALOPRAM 20 MG TABLET ORL TAB MEL TAB 0.875000002301849 CITALOPRAM 40 MG TABLET ORL TAB MEL TAB 0.875000002325047 CITALOPRAM-10 10 MG TABLET ORL TAB PDL TAB 0.143200002257521 CITALOPROM-40 40 MG TABLET ORL TAB PDL TAB 0.332900000519235 CITANEST PLAIN 4% INJECTION INJ DEFAUL DSC ML 0.865800002150220 CITRACAL MG TABLET ORL TAB SFD TAB 0.153500002150158 CITRACAL PLUS D CAPLET ORL TAB SFD TAB 0.164000000262609 CITRO MAG 50 MG ORAL LIQUID ORL LIQ ROG ML 0.0155

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 27 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002324490 CLARITHROMYCIN 500 MG TABLET ORL TAB PDL TAB 1.629700002237734 CLARITIN 10 MG RAPID DISSOLVE TONGUE TABLET ORL DISPTAB SCH TAB 0.710000000782696 CLARITIN 10 MG TABLET ORL TAB SCH TAB 0.898300001945157 CLARITIN EXTRA SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.710000000442968 CLEARASIL BP PLUS 5% TOPICAL LOTION TOP LOT RBC ML 0.189300002324989 CLEARLAX ORAL POWDER ORL PWR PRI G 0.027500002250616 CLIMARA PRO 4.40 MG/1.39 MG TRANSDERMAL PATCH TRD PTH BAI PTH 6.930000002408511 CLINDAMYCIN IV INFUSION 12 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.372400002408538 CLINDAMYCIN IV INFUSION 18 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.544500002248525 CLINDAMYCINE-150 150 MG TABLET ORL TAB PDL TAB 0.221700002248526 CLINDAMYCINE-300 300 MG CAPSULE ORL CAP PDL CAP 0.443400002242970 CLINDASOL 1% TOPICAL CREAM TOP CRM GSK G 0.811200002243050 CLINDETS PLEDGET 1% TOPICAL PAD TOP PAD GSK PAD 0.727800080007070 CLINIDERM GENTLE SPF 45 LOTION TOP LOT SAH ML 0.241500002248454 CLOBAZAM-10 10 MG TABLET ORL TAB PDL TAB 0.109700002256398 CLOBEX 0.05% TOPICAL LOTION TOP LOT GAL ML 0.814100002256371 CLOBEX 0.05% TOPICAL SHAMPOO TOP SHP GAL ML 0.814100002299739 CLOBEX 0.05% TOPICAL SPRAY TOP SPR GAL ML 1.630000001910396 CLONIDINE 0.1 MG TABLET ORL TAB PDL TAB 0.135800002394820 CLOPIDOGREL 75 MG TABLET ORL TAB PDL TAB 0.657700000812382 CLOTRIMADERM 1% TOPICAL CREAM TOP CRM TAR G 0.323500002229380 CLOTRIMAZOLE 1% TOPICAL CREAM USP TOP CRM TAR G 0.210000002274337 CO BICALUTAMIDE 50 MG TABLET ORL TAB APH TAB 4.179000002285215 CO CILAZAPRIL 2.5 MG TABLET ORL TAB APH TAB 0.184900002285223 CO CILAZAPRIL 5 MG TABLET ORL TAB APH TAB 0.208500002270641 CO CLONAZEPAM 0.5 MG TABLET ORL TAB APH TAB 0.049500002270668 CO CLONAZEPAM 1.0 MG TABLET ORL TAB APH TAB 0.148700002270676 CO CLONAZEPAM 2.0 MG TABLET ORL TAB APH TAB 0.128600002390183 CO EXEMESTANE 25 MG TABLET ORL TAB APH TAB 4.017700002274248 CO GLIMEPIRIDE 1 MG TABLET ORL TAB APH TAB 0.490000002274256 CO GLIMEPIRIDE 2 MG TABLET ORL TAB APH TAB 0.490000002274272 CO GLIMEPIRIDE 4 MG TABLET ORL TAB APH TAB 0.490000002379996 CO MYCOPHENOLATE 500 MG TABLET ORL TAB APH TAB 2.123800002269627 CO NORFLOXACIN 400 MG TABLET ORL TAB APH TAB 0.544900002327589 CO OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB 5.516000002327597 CO OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB 7.825700002302861 CO PIOGLITAZONE 15 MG TABLET ORL TAB APH TAB 0.5983

Page 28: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 28 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002302888 CO PIOGLITAZONE 30 MG TABLET ORL TAB APH TAB 0.838300002302896 CO PIOGLITAZONE 45 MG TABLET ORL TAB APH TAB 1.260400080006266 CO Q10 100 MG CAPSULE ORL CAP SIS CAP 0.166600080007078 CO Q10 LIQUID ORL LIQ INN ML 0.794100002270633 CO SOTALOL 160 MG TABLET ORL TAB APH TAB 0.405800002270625 CO SOTALOL 80 MG TABLET ORL TAB APH TAB 0.370800002383209 CO TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APH TAB 0.645200000068756 COACTIFED EXPECTORANT ORAL LIQUID ORL LIQ GSK ML 0.190600000068594 COACTIFED ORAL SYRUP ORL SYR GSK ML 0.178500000068608 COACTIFED TABLET ORL TAB GSK TAB 1.088000002150417 COATED ASPIRIN 325 MG CAPLET ORL ECT BAI TAB 0.085000002237726 COATED ASPIRIN DAILY LOW DOSE 81 MG ECT ORL ECT BIC TAB 0.115300002150425 COATED ASPIRIN EXTRA STRENGTH 500 MG CAPLET ORL ECT BAI TAB 0.087500002243897 COATED DAILY LOW-DOSE ASA 81 MG TABLET ORL ECT PMS TAB 0.043300002009757 CODEINE 30 MG TABLET ORL TAB RIV TAB 0.077300002163748 CODEINE CONTIN 100 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.712800002163780 CODEINE CONTIN 150 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.069300002163799 CODEINE CONTIN 200 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.425700002230302 CODEINE CONTIN 50 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.356500000050024 CODEINE PHOSPHATE 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.055500002248644 COENZYME Q10 100 MG CAPSULE ORL CAP VTH CAP 0.326600002246219 COENZYME Q10 100 MG CAPSULE ORL CAP WNP CAP 0.140300080010367 COENZYME Q10 150 MG SOFTGEL ORL CAP WBP CAP 0.388700080006827 COENZYME Q10 30 MG CAPSULE ORL CAP WNP CAP 0.127200002245926 COENZYME Q10 60 MG CAPSULE ORL CAP HHC CAP 0.254000002231735 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.300000080006674 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.259300080006505 COENZYME Q10 SOFTGEL ORL TAB WNP TAB 0.291700000287873 COLCHICINE 0.6 MG TABLET ORL TAB EUP TAB 0.278700000621374 COLCHICINE 1 MG TABLET ORL TAB ODN TAB 0.528500000476420 COLY-MYCIN M 150 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 42.920000001944363 COMBANTRIN 125 MG TABLET ORL TAB PDH TAB 1.175000001944355 COMBANTRIN 50 MG/ML (BASE) ORAL SUSPENSION ORL SUS PDH ML 0.278900002419106 COMBIVENT RESPIMAT 20 MCG/100 MCG INH SOLUTION INH CTG BOE CTG 28.700000002239213 COMBIVIR TABLET ORL TAB GSK TAB 11.224300002374129 COMPLERA 200 MG/25 MG/300 MG TABLET ORL TAB GIL TAB 44.330000002229633 COMPLETE MULTI-ADULT TABLET ORL TAB WAM TAB 0.0607

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 29 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247732 CONCERTA 18 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.280300002250241 CONCERTA 27 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.631600002247733 CONCERTA 36 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.983000002247734 CONCERTA 54 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.685400001945149 CONDYLINE 0.5% TOPICAL SOLUTION TOP SOL SAV ML 12.408600002417162 CONSTELLA 145 MCG CAPSULE ORL CAP FLC CAP 3.586000002417170 CONSTELLA 290 MCG CAPSULE ORL CAP FLC CAP 5.300000002224577 COPHYLAC ORAL SOLUTION ORL SOL VLP ML 2.372700002176955 COQ10 30 MG CAPSULE ORL CAP JAM CAP 0.224800080012965 COQ10 MRB 60 MG SOFTGEL CAPSULE ORL CAP INN CAP 0.795000001980661 CORTAMED 25 MG/G OPH OINTMENT OPH ONT SDZ G 6.085700000513288 CORTATE 0.5% TOPICAL CREAM TOP CRM MFC G 0.146700001912828 CORTISPORIN OTIC SOLUTION OT SOL GSK ML 1.406000000666246 CORTISPORIN TOPICAL OINTMENT TOP ONT GSK G 0.847300000022381 CORTROSYN 0.25 MG/VIAL INJECTION INJ DEFAUL LYN VIAL 98.760000002181215 COTAZYM ECS 4 CAPSULE (ENTERIC-COATED PELLET) ORL CAP/ENCP ORG CAP 0.179500002099748 COUGH SYRUP WITH CODEINE ORL SYR ROG ML 0.016200002240206 COUMADIN 6 MG TABLET ORL TAB DPM TAB 0.512900002243063 COVAN ORAL SYRUP ORL SYR PMS ML 0.061300002246568 COVERSYL PLUS LD 2 MG/0.625 MG TABLET ORL TAB SEV TAB 0.921000080027158 CRANBERRY COMPLEX 500 MG CAPSULE ORL CAP JAM CAP 0.200200002239007 CREON 5 MINIMICROSPHERES CAPSULE ORL CAP/ENCP ABB CAP 0.170300002415194 CREON MINIMICROSPHERES 6 CAPSULE ORL CAP/ENCP ABB CAP 0.183100000299561 CREO-RECTAL ADULT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.772000000299588 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.602000000299596 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.750000002241013 CRINONE 8% VAGINAL GEL VAG GEL SRO G 8.993100002277778 CRITIC-AID CLEAR OINTMENT TOP ONT COC G 0.169000002229161 CRIXIVAN 200 MG CAPSULE ORL CAP MFC CAP 1.346700002229196 CRIXIVAN 400 MG CAPSULE ORL CAP MFC CAP 2.926700001950541 CROMOLYN 2% NASAL SOLUTION NAS SOL PPH ML 0.813800002299909 CUBICIN 500 MG/VIAL INJECTION INJ DEFAUL CUB VIAL 174.000000002089912 CUTIVATE 0.05% TOPICAL CREAM TOP CRM GKC G 0.725000002413795 CYANOCOBALAMIN 1000 MCG/ML INJECTION INJ DEFAUL MYP ML 0.450000002220644 CYCLOBENZAPRINE 10 MG TABLET ORL TAB PDL TAB 0.372700002424584 CYCLOBENZAPRINE 10 MG TABLET ORL TAB SIV TAB 0.372700002148331 CYCLOPENTOLATE HCL 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 30 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002148382 CYCLOPENTOLATE HCL 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002290308 CYESTRA-35 TABLET ORL TAB PMS TAB 1.207600002238526 CYSTADANE 1 G/SCOOP ORAL POWDER ORL PWR ORP G 4.552400080038525 CYSTA-Q CAPSULE ORL CAP TPI CAP 0.541500002126656 CYTARABINE 100MG/ ML INJECTION INJ DEFAUL MNP ML 16.702000000386715 CYTOSAR 100 MG/5ML INJECTION INJ DEFAUL PFI VIAL 10.724000002060604 DALACIN 2% VAGINAL CREAM VAG CRM PAL G 0.821000000582301 DALACIN T 1% (BASE) TOPICAL SOLUTION TOP SOL PFI ML 0.362000000507415 DAN-GARD 2% TOPICAL SHAMPOO TOP SHP VLP ML 0.056000001997653 DANTRIUM 100 MG CAPSULE ORL CAP JHP CAP 0.768400000004774 DARAPRIM 25 MG TABLET ORL TAB COR TAB 1.397800002359456 DAXAS 500 MCG TABLET ORL TAB TAK TAB 2.282000002027860 DAYPRO 600 MG TABLET ORL TAB PFI TAB 0.725500002285002 DDAVP MELT 120 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 2.154000002285010 DDAVP MELT 240 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 3.877700002284995 DDAVP MELT 60 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 1.077000080001791 DDROPS 1,000 IU/DROP ORAL LIQUID ORL LIQ DDR ML 1.490000002389282 DECAPEPTYL 0.1 MG/ML INJECTION SYRINGE INJ DEFAUL FEI SYR 13.040000000791172 DECONGEST 0.1 MG NASAL SOLUTION NAS SOL RPH ML 0.151000002018403 DELSYM 6 MG/ML CONTROLLED-RELEASE SUSPENSION ORL CRSUS NVC ML 0.063400002238848 DENAVIR 1% TOPICAL CREAM TOP CRM BRR G 14.320000000681989 DERMAFLEX HC 1% CREAM TOP CRM PAL G 0.189800000681997 DERMAFLEX HC 1% TOPICAL LOTION TOP LOT PAL ML 0.112700002247093 DERMAL THERAPY- HEEL CARE CREAM TOP CRM DTR ML 0.084000002239903 DERMALAC 12% CREAM TOP CRM TAR G 0.062800002060345 DERMAREST DRICORT 0.5% TOPICAL CREAM TOP CRM DEL G 0.165700000873292 DERMA-SMOOTHE/FS 0.01% TOPICAL OIL TOP OIL HDI ML 0.305300002230642 DERMATOP 0.1% EMOLLIENT CREAM TOP EMCRM VCL G 1.807000002227517 DERMATOP 0.1% TOPICAL OINTMENT TOP ONT VCL G 1.663000002238407 DERMAZINC 0.25% TOPICAL SPRAY TOP SPR DPI ML 0.233300002300559 DERMOTIC OIL EAR DROPS 0.01% OTIC SOLUTION OT SOL HDI ML 1.738500002216280 DESIPRAMINE 100 MG TABLET ORL TAB AAP TAB 0.968700001942417 DESITIN DIAPER RASH OINTMENT TOP ONT PDH G 0.058800002298155 DESLORATADINE ALLERGY CONTROL 5 MG TABLET ORL TAB PMS TAB 0.566200002239064 DETROL 1 MG TABLET ORL TAB PFI TAB 1.054700002239065 DETROL 2 MG TABLET ORL TAB PFI TAB 1.070300002204274 DEXAMETHASONE OMEGA 10 MG/ML INJECTION INJ DEFAUL OMG ML 1.3940

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 31 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002204266 DEXAMETHASONE OMEGA 4 MG/ML INJECTION INJ DEFAUL OMG ML 1.606000000832030 DEXIDIN 20 MG TOPICAL SOLUTION TOP LIQ ATL ML 0.037400002354950 DEXILANT 30 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.390700002354969 DEXILANT 60 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.390700000833231 DEXTROMETHORPHAN 15 MG/5 ML COUGH SYRUP ORL SYR TAN ML 0.019900002058235 DEY-PAK SODIUM CHLORIDE 0.9% INHALATION SOLUTION INH SOL MYP ML 0.061600002237450 D-FORTE 50000 IU CAPSULE ORL CAP EUP CAP 0.198600002398958 DIACOMIT 250 MG CAPSULE ORL CAP BCF CAP 6.366700002398974 DIACOMIT 250 MG ORAL POWDER PACKET ORL PWDPKT BCF PCKT 6.366700002398966 DIACOMIT 500 MG CAPSULE ORL CAP BCF CAP 12.733300002398982 DIACOMIT 500 MG ORAL POWDER PACKET ORL PWDPKT BCF PCKT 12.733300080028781 DIAMINE TABLET ORL TAB EUP TAB 0.063100002245391 DIAMINE TABLET ORL TAB EUP TAB 0.066300002233542 DIANE-35 2 MG/0.035 MG TABLET ORL TAB BHP TAB 1.745200002229552 DIARR-EZE 2 MG CAPLET ORL TAB PMS TAB 0.300000002248994 DIARRHEA RELIEF 2 MG TABLET ORL TAB PMS TAB 0.261700002238162 DIASTAT RECTAL DELIVERY SYS 5 MG/ML RECTAL GEL RT GEL VCL SYS 82.775000000434388 DIAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.086700000313580 DIAZEPAM 5 TABLET ORL TAB PDL TAB 0.065000000870978 DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.202400002351684 DICLOFENAC POTASSIUM 50 MG TABLET ORL TAB SNS TAB 0.393700002224127 DICLOFENAC-SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.404800002224119 DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.234300000392820 DICYCLOMINE HCL 10 MG CAPSULE ORL CAP SDZ CAP 0.075800000392812 DICYCLOMINE HYDROCHLORIDE 10 MG/ML INJECTION INJ DEFAUL SDZ ML 4.308000002176017 DIDROCAL 400 MG/500 MG TABLET ORL TAB ASC TAB 0.494200002231592 DIFFERIN 0.1% TOPICAL CREAM TOP CRM GAL G 1.691800002148749 DIFFERIN 0.1% TOPICAL GEL TOP GEL GAL G 1.709700002274000 DIFFERIN XP 0.3% TOPICAL GEL TOP GEL GAL G 1.691800002387174 DIFICID 200 MG FILM-COATED TABLET ORL TAB OPL TAB 110.000000002241163 DIHYDROERGOTAMINE MESYLATE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 3.906700000627100 DILAUDID 2 MG/ML INJECTION INJ DEFAUL PUR ML 1.083200002085895 DILAUDID STERILE POWDER 250 MG/VIAL INJECTION INJ DEFAUL PUR VIAL 66.635000000622133 DILAUDID-HP 10 MG/ML INJECTION INJ DEFAUL PUR ML 2.651000002325306 DILTIAZEM TZ 120 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.404300002325314 DILTIAZEM TZ 180 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.536600002325322 DILTIAZEM TZ 240 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.7118

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 32 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002325330 DILTIAZEM TZ 300 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.889700002325349 DILTIAZEM TZ 360 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.073200002231472 DILTIAZEM-CD 120 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.352900002231474 DILTIAZEM-CD 180 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.468400002231475 DILTIAZEM-CD 240 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.621300002231057 DILTIAZEM-CD 300 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.776600002300648 DIMENHYDRINATE 50 MG/ML INJECTION INJ DEFAUL ALV ML 2.717000002244079 DIMETANE EXPECTORANT C ORAL SYRUP ORL SYR PDH ML 0.091900002244080 DIMETANE EXPECTORANT DC ORAL SYRUP ORL SYR PDH ML 0.124200002243083 DIMETAPP DAYTIME COLD EXTRA STRENGTH CAPLET ORL TAB WCH TAB 0.291300002243969 DIMETAPP DM COUGH & COLD ORAL LIQUID ORL LIQ PDH ML 0.053000002243091 DIMETAPP NIGHTTIME COLD EXTRA STRENGTH CAPLET ORL TAB WCH TAB 0.312500002244078 DIMETAPP-C ORAL SYRUP ORL SYR PDH ML 0.117800002243231 DIMETHYL SULFOXIDE IRRIGAT. 500 MG/G BLADDER SOL. BLDIR SOL SDZ ML 1.219600002027100 DIONEPHRINE 2.5% OPH SOLUTION OPH SOL DIO ML 0.718000002023717 DIOPHENYL-T OPH SOLUTION OPH SOL DIO ML 1.946700002023768 DIOPRED 1% OPH SUSPENSION OPH SUS SDZ ML 1.940000002270528 DIOVAN 40 MG TABLET ORL TAB NOV TAB 1.268200002157624 DIOVOL PLUS AF CHEWABLE TABLET ORL CTB CHD TAB 0.126000002157616 DIOVOL PLUS AF-SUSPENSION ORL SUS CHD ML 0.018000000116815 DIOVOL PLUS ORAL SUSPENSION ORL SUS CHD ML 0.018000000116882 DIOVOL PLUS TABLET ORL TAB CHD TAB 0.126000002257548 DIPHENHYDRAMINE HYDROCHLORIDE 25 MG CAPLET ORL TAB JPC TAB 0.137900002257556 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG CAPLET ORL TAB JPC TAB 0.165900002369567 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG/ML INJECTION INJ DEFAUL PPC ML 4.390000002219336 DIPHENIST 50 MG/ML INJECTION INJ DEFAUL OMG ML 4.100000000417262 DIPROGEN TOPICAL CREAM TOP CRM SCH G 0.855600002243961 DITROPAN XL 10 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.475400002243960 DITROPAN XL 5 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.475400002240341 DIVALPROEX-125 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.072400002240342 DIVALPROEX-250 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.130100002240343 DIVALPROEX-500 MG ENTERIC-COATED TABLET ORL TAB PDL TAB 0.260400000579955 DOAK OIL 2% TOPICAL SOLUTION TOP SOL TCD ML 0.029600002228335 DOBUTAMINE HYDROCHLORIDE 12.5 MG/ML INJECTION INJ DEFAUL TEV VIAL 23.250000002412225 DOCETAXEL 28 MG/ML (20 MG/0.72 ML) INJECTION INJ DEFAUL TEV ML 317.319400002412233 DOCETAXEL 28 MG/ML (80 MG/2.88 ML) INJECTION INJ DEFAUL TEV ML 317.319400002246741 DOCUSATE CALCIUM 240 MG CAPSULE ORL CAP ROG CAP 0.1360

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000870218 DOCUSATE SODIUM 10 MG/ML ORAL DROPS ORL DPS ROG ML 0.197200002246036 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP ROG CAP 0.044600000830267 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TLI CAP 0.033800002245946 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP JPC CAP 0.039000000794406 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP VTH CAP 0.033400002246854 DOCUSATE SODIUM 4 MG/ML ORAL SYRUP ORL SYR ROG ML 0.026000000614491 DOLORAL 1 MG ORAL SYRUP ORL SYR ATL ML 0.032700000614505 DOLORAL 5 MG ORAL SYRUP ORL SYR ATL ML 0.055900002130963 DOM-AMANTADINE 100 MG CAPSULE ORL CAP DPC CAP 0.517900002246331 DOM-AMIODARONE 200 MG TABLET ORL TAB DPC TAB 0.617700002326841 DOM-AMLODIPINE 10 MG TABLET ORL TAB DPC TAB 0.358700002326825 DOM-AMLODIPINE 2.5 MG TABLET ORL TAB DPC TAB 0.138000002326833 DOM-AMLODIPINE 5 MG TABLET ORL TAB DPC TAB 0.241700002229468 DOM-ATENOLOL 100 MG TABLET ORL TAB DPC TAB 0.330600002229467 DOM-ATENOLOL 50 MG TABLET ORL TAB DPC TAB 0.201100002399482 DOM-ATORVASTATIN 10 MG TABLET ORL TAB DPC TAB 0.313700002399490 DOM-ATORVASTATIN 20 MG TABLET ORL TAB DPC TAB 0.392200002399504 DOM-ATORVASTATIN 40 MG TABLET ORL TAB DPC TAB 0.421600002278499 DOM-AZITHROMYCIN 250 MG TABLET ORL TAB DPC TAB 1.231700002138271 DOM-BACLOFEN 10 MG TABLET ORL TAB DPC TAB 0.159500002138298 DOM-BACLOFEN 20 MG TABLET ORL TAB DPC TAB 0.460700002232564 DOM-BUSPIRONE 10 MG TABLET ORL TAB DPC TAB 0.352100002238222 DOM-CARBAMAZEPINE CR 200 MG SUSTAINED-RELEASE TAB ORL SRT DPC TAB 0.130100002238223 DOM-CARBAMAZEPINE CR 400 MG SUSTAINED-RELEASE TAB ORL SRT DPC TAB 0.260200002251280 DOM-CIPROFLOXACIN 500 MG TABLET ORL TAB DPC TAB 0.697900002273055 DOM-CITALOPRAM 10 MG TABLET ORL TAB DPC TAB 0.143200002351005 DOM-CLARITHROMYCIN 500 MG TABLET ORL TAB DPC TAB 1.629300002247230 DOM-CLOBAZAM 10 MG TABLET ORL TAB DPC TAB 0.153800002130998 DOM-CLONAZEPAM 0.5 MG TABLET ORL TAB DPC TAB 0.069400002131013 DOM-CLONAZEPAM 2 MG TABLET ORL TAB DPC TAB 0.119600002224100 DOM-CLONAZEPAM-R 0.5 MG TABLET ORL TAB DPC TAB 0.069400002238633 DOM-CYCLOBENZAPRINE 10 MG TABLET ORL TAB DPC TAB 0.372700002130092 DOM-DESIPRAMINE 25 MG TABLET ORL TAB DPC TAB 0.272300002231662 DOM-DICLOFENAC 25 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.109400002231664 DOM-DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT DPC TAB 0.406000002238315 DOM-DOMPERIDONE 10 MG TABLET ORL TAB DPC TAB 0.083100002376709 DOM-FINASTERIDE 5 MG TABLET ORL TAB DPC TAB 0.4633

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002246109 DOM-FLUCONAZOLE 100 MG TABLET ORL TAB DPC TAB 3.204700002246108 DOM-FLUCONAZOLE 50 MG TABLET ORL TAB DPC TAB 1.806500002177617 DOM-FLUOXETINE 10 MG CAPSULE ORL CAP DPC CAP 0.865000002177625 DOM-FLUOXETINE 20 MG CAPSULE ORL CAP DPC CAP 0.643800002241348 DOM-FLUVOXAMINE 100 MG TABLET ORL TAB DPC TAB 0.529700002241347 DOM-FLUVOXAMINE 50 MG TABLET ORL TAB DPC TAB 0.294700002243743 DOM-GABAPENTIN 100 MG CAPSULE ORL CAP DPC CAP 0.145600002243744 DOM-GABAPENTIN 300 MG CAPSULE ORL CAP DPC CAP 0.354200002243745 DOM-GABAPENTIN 400 MG CAPSULE ORL CAP DPC CAP 0.422100002241608 DOM-GEMFIBROZIL 300 MG CAPSULE ORL CAP DPC CAP 0.180300002234514 DOM-GLYBURIDE 5 MG TABLET ORL TAB DPC TAB 0.068300002239913 DOM-INDAPAMIDE 1.25 MG TABLET ORL TAB DPC TAB 0.104300002239917 DOM-INDAPAMIDE 2.5 MG TABLET ORL TAB DPC TAB 0.170600002372193 DOM-IRBESARTAN 150 MG TABLET ORL TAB DPC TAB 0.302500002414775 DOM-LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC DPC CAP 0.500000002245784 DOM-LORAZEPAM 0.5 MG TABLET ORL TAB DPC TAB 0.035900002245785 DOM-LORAZEPAM 1 MG TABLET ORL TAB DPC TAB 0.038000002247232 DOM-LOVASTATIN 40 MG TABLET ORL TAB DPC TAB 1.257900002242726 DOM-METFORMIN 850 MG TABLET ORL TAB DPC TAB 0.118600002231122 DOM-METOPROLOL-L 100 MG TABLET ORL TAB DPC TAB 0.194100002231121 DOM-METOPROLOL-L 50 MG TABLET ORL TAB DPC TAB 0.087400002376695 DOM-MONTELUKAST FC 10 MG TABLET ORL TAB DPC TAB 0.819500002178729 DOM-NORTRIPTYLINE 10 MG CAPSULE ORL CAP DPC CAP 0.077200002178737 DOM-NORTRIPTYLINE 25 MG CAPSULE ORL CAP DPC CAP 0.156000002125145 DOM-NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION ORL SUS DPC ML 0.052100002333430 DOM-OMEPRAZOLE DR 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT DPC TAB 0.411700002241285 DOM-OXYBUTYNIN 5 MG TABLET ORL TAB DPC TAB 0.150800002248447 DOM-PAROXETINE 10 MG TABLET ORL TAB DPC TAB 0.821000002248448 DOM-PAROXETINE 20 MG TABLET ORL TAB DPC TAB 0.632000002248449 DOM-PAROXETINE 30 MG TABLET ORL TAB DPC TAB 0.671400002236857 DOMPERIDONE-10 10 MG TABLET ORL TAB PDL TAB 0.059400002238046 DOM-PINDOLOL 10 MG TABLET ORL TAB DPC TAB 0.325300002238047 DOM-PINDOLOL 15 MG TABLET ORL TAB DPC TAB 0.471800002231650 DOM-PINDOLOL 5 MG TABLET ORL TAB DPC TAB 0.190500002249723 DOM-PRAVASTATIN 10 MG TABLET ORL TAB DPC TAB 0.405000002249731 DOM-PRAVASTATIN 20 MG TABLET ORL TAB DPC TAB 0.477800002249758 DOM-PRAVASTATIN 40 MG TABLET ORL TAB DPC TAB 0.8057

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 35 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002320460 DOM-RABEPRAZOLE EC 20 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.240700002287986 DOM-RAMIPRIL 10 MG CAPSULE ORL CAP/TAB DPC CAP 0.186200002287951 DOM-RAMIPRIL 2.5 MG CAPSULE ORL CAP/TAB DPC CAP 0.147000002287978 DOM-RAMIPRIL 5 MG CAPSULE ORL CAP/TAB DPC CAP 0.147000002243038 DOM-RANITIDINE 150 MG TABLET ORL TAB DPC TAB 0.180000002309831 DOM-RISEDRONATE 35 MG TABLET ORL TAB DPC TAB 2.427500002396203 DOM-RIZATRIPTAN RDT 10 MG ORALLY DISINTEG TAB ORL DISNTAB DPC TAB 3.705000002216949 DOM-SALBUTAMOL 1 MG/ML INHALATION SOLUTION INH SOL DPC ML 0.361800002245750 DOM-SERTRALINE 100 MG CAPSULE ORL CAP DPC CAP 0.420000002245748 DOM-SERTRALINE 25 MG CAPSULE ORL CAP DPC CAP 0.200400002245749 DOM-SERTRALINE 50 MG CAPSULE ORL CAP DPC CAP 0.400000002238635 DOM-SOTALOL 160 MG TABLET ORL TAB DPC TAB 0.162300002238634 DOM-SOTALOL 80 MG TABLET ORL TAB DPC TAB 0.296600002270765 DOM-SUMATRIPTAN 100 MG TABLET ORL TAB DPC TAB 7.860000002243749 DOM-TERAZOSIN 10 MG TABLET ORL TAB DPC TAB 0.618300002128969 DOM-TRAZODONE 100 MG TABLET ORL TAB DPC TAB 0.098900002128950 DOM-TRAZODONE 50 MG TABLET ORL TAB DPC TAB 0.055400002414147 DOM-VALSARTAN 80 MG TABLET ORL TAB DPC TAB 0.295700002299313 DOM-VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC DPC CAP 0.346900002299291 DOM-VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAP ORL ERC DPC CAP 0.164300002299305 DOM-VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAP ORL ERC DPC CAP 0.328500002240321 DOM-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT DPC TAB 0.676700002389525 DOM-ZOLMITRIPTAN 2.5 MG TABLET ORL TAB DPC TAB 4.605000002246317 DOM-ZOPICLONE 5 MG TABLET ORL TAB DPC TAB 0.223100002240823 DOM-ZOPICLONE 7.5 MG TABLET ORL TAB DPC TAB 0.468500002416425 DONEPEZIL 10 MG TABLET ORL TAB PDL TAB 1.234000002416417 DONEPEZIL 5 MG TABLET ORL TAB PDL TAB 1.234000002230108 DOXORUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL TEV ML 11.400000002413973 DOXORUBICIN HYDROCHLORIDE 2MG/ML INJECTION USP INJ DEFAUL MYP ML 11.400000000817120 DOXYCIN 100 MG CAPSULE ORL CAP RIV CAP 0.586000000860751 DOXYCIN 100 MG TABLET ORL TAB RIV TAB 0.586000000887064 DOXYTAB 100 MG TABLET ORL TAB PDL TAB 0.586000001929313 DRISTAN DECONGESTANT NASAL MIST SOLUTION NAS SOL PDH ML 0.328000001929372 DRISTAN LONG LASTING 0.05% NASAL MIST SOLUTION NAS SOL PDH ML 0.328000001929380 DRISTAN LONG LASTING MENTHOLATED 0.05% NASAL SPRAY NAS SPR PDH ML 0.328000000740861 DRIXORAL DESCONGESTANT 0.05% NASAL SOLUTION NAS SOL SCH ML 0.159300000298433 DRIXORAL SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.4260

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 36 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000342742 DRYSOL 20% TOPICAL SOLUTION TOP SOL SFD ML 0.453900000821772 D-TAB 10,000 UNIT TABLET ORL TAB RIV TAB 0.221500002247208 DUKORAL ORAL SUSPENSION ORL SUS AVE DOSE 39.110000002292165 DUODOPA 20 MG/ML / 5MG/ML (100 ML) INTESTINAL GEL INTRA GEL ABV CAS 166.000000002239299 DUOFILM 40% TOPICAL PATCH TOP PTH MMH PTH 0.463300000370576 DUOFILM TOPICAL SOLUTION TOP SOL GSK ML 0.541300002125706 DUOLUBE OPH OINTMENT OPH ONT BSH G 1.565700000656747 DUONALC E (MILD) 20% TOPICAL SOLUTION TOP SOL VCL ML 0.219600000490156 DUONALC E 47.5% TOPICAL SOLUTION TOP SOL VCL ML 0.219600002148633 DUOVENT UDV INHALATION SOLUTION INH SOL BOE ML 0.898000002275848 DURAGESIC MAT 75 (75 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 38.664000002275856 DURAGESIC MAT 100 (100 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 48.124000002334186 DURAGESIC MAT 12 (12 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 5.214000002275813 DURAGESIC MAT 25 (25 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 14.606000002275821 DURAGESIC MAT 50 (50 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 27.492000002373017 DURELA 100 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 1.238700002373025 DURELA 200 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.260300002373033 DURELA 300 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 3.281700002415534 DUREZOL 0.05% OPHTHALMIC EMULSION OPH EML ALC ML 5.868000000999010 DUROLANE DEFAUL DEV QMD ML 116.666700002421712 DUTASTERIDE 0.5 MG CAPSULE ORL CAP PDL CAP 0.962400002429012 DUTASTERIDE 0.5 MG CAPSULE ORL CAP SIV CAP 0.420700001947958 DUVOID 10 MG TABLET ORL TAB PAL TAB 0.323200001947931 DUVOID 25 MG TABLET ORL TAB PAL TAB 0.523500001947923 DUVOID 50 MG TABLET ORL TAB PAL TAB 0.689600002260638 EBIXA 10 MG TABLET ORL TAB LBC TAB 2.615300002421739 ECL-CITALOPRAM 10 MG TABLET ORL TAB ECL TAB 0.143200002421747 ECL-CITALOPRAM 20 MG TABLET ORL TAB ECL TAB 0.239700002421755 ECL-CITALOPRAM 40 MG TABLET ORL TAB ECL TAB 0.239700002381389 EDARBI 40 MG TABLET ORL TAB TAK TAB 1.281700002381397 EDARBI 80 MG TABLET ORL TAB TAK TAB 1.295700002397749 EDARBYCLOR 40 MG/12.5 MG TABLET ORL TAB TAK TAB 1.295700002397765 EDARBYCLOR 40 MG/25 MG TABLET ORL TAB TAK TAB 1.295700002397757 EDARBYCLOR 80 MG/12.5 MG TABLET ORL TAB TAK TAB 1.295700002370603 EDURANT 25 MG TABLET ORL TAB JAI TAB 15.582000080009719 EFAMOL 1000 MG CAPSULE ORL CAP FMD CAP 0.166700002349124 EFFIENT 10 MG TABLET ORL TAB LIL TAB 2.9483

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 37 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002209764 EGOZINC-HC RECTAL OINTMENT RT ONT PMS G 0.448700002210517 EGOZINC-HC RECTAL SUPPOSITORY RT SUP PMS SUP 0.607500002425637 ELELYSO 200 UNIT/VIAL INJECTION INJ DEFAUL PFI VIAL 648.360000002247238 ELIDEL 1 % TOPICAL CREAM TOP CRM VCL G 2.474200002248239 ELIGARD 10.2 MG/SYR INJECTION INJ NDL SAV SYR 343.580000002248240 ELIGARD 28.2 MG/SYR INJECTION INJ NDL SAV SYR 957.820000002248999 ELIGARD 35.8 MG/SYR INJECTION INJ NDL SAV SYR 1381.590000002268892 ELIGARD 56.3 MG/SYR INJECTION INJ NDL SAV SYR 1575.640000000627410 ELIXIR DE THEOPHYLLINE ORL ELX ATL ML 0.005000002296284 ELOXATIN 5 MG/ML INJECTION INJ DEFAUL SAV ML 51.816000002103109 ELTOR-120 120 MG SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.290800002298805 EMEND 125 MG CAPSULE ORL CAP MFC CAP 33.223300002324679 EMEND IV 115MG/VIAL INJ DEFAUL MFC VIAL 30.180000000886858 EMLA TOPICAL CREAM TOP CRM AZC G 1.978000002057794 EMLA TOPICAL PATCH TOP PTH AZC PTH 2.905000080008611 EMPOWER 18 PLUS CAPSULE ORL CAP TRU CAP 0.302500002248209 ENCA 100 MG CAPSULE ORL CAP PRP CAP 1.033200002248208 ENCA 50 MG CAPSULE ORL CAP PRP CAP 0.535000002334992 ENDOMETRIN 100 MG VAGINAL EFFERVESCENT TABLET VAG EVT FEI TAB 4.346700002296454 ENGERIX-B 10 MCG/0.5 ML SUSPENSION INJ DEFAUL GSK ML 22.520000002010526 ENTERIC COATED ASA 325 MG TABLET ORL ECT WTR TAB 0.028000000794244 ENTERIC COATED ASA 650 MG TABLET ORL ECT VTH TAB 0.056600002246971 ENTEX LA SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.408100000010340 ENTROPHEN 10 650 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.084300001905392 ENTROPHEN 10 SUPER EXTRA STRENGTH 650 MG ECCPT ORL ECT PPH TAB 0.070500000852015 ENTROPHEN 500 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.068600002050161 ENTROPHEN REGULAR STRENGTH (CAPLET) 325 MG ECCPT ORL ECT PPH TAB 0.053300000010332 ENTROPHEN REGULAR STRENGTH 325 MG ECT ORL ECT PPH TAB 0.053300000880183 EPI-LYT TOP LOT VLP ML 0.116100000721891 EPINEPHRINE 1 MG/ML INJECTION USP INJ NDL HSP SYR 4.184000002264927 EPIRUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL HSP ML 13.319600002396971 EPURIS 10 MG CAPSULE ORL CAP CIP CAP 1.163700002396998 EPURIS 20 MG CAPSULE ORL CAP CIP CAP 1.567300002397005 EPURIS 30 MG CAPSULE ORL CAP CIP CAP 1.971300002397013 EPURIS 40 MG CAPSULE ORL CAP CIP CAP 2.374700002243801 EQUATE DAILY LOW-DOSE 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.109600002271249 ERBITUX 2 MG/ML INJECTION INJ DEFAUL BMS ML 6.7000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080003615 ERDOL 8288 IU/ML ORAL SOLUTION ORL SOL ODN ML 0.415200002409267 ERIVEDGE 150 MG CAPSULE ORL CAP HLR CAP 294.223800002034506 ERYSOL TOPICAL (ALCOHOL) GEL TOP ALCGEL GSK G 0.700400002393751 ESBRIET 267 MG CAPSULE ORL CAP HLR CAP 13.030200002424401 ESCITALOPRAM 10 MG TABLET ORL TAB PDL TAB 1.468000002429039 ESCITALOPRAM 10 MG TABLET ORL TAB SIV TAB 0.431800002429047 ESCITALOPRAM 20 MG TABLET ORL TAB SIV TAB 0.459700002424428 ESCITALOPRAM 20 MG TABLET ORL TAB PDL TAB 1.563000002394839 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.588700002394847 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.588700002431173 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT SNS TAB 1.869000002244990 ESSENTIAL VITAMINS AND MINERALS TABLET ORL TAB WNP TAB 0.021400002237515 ESTER C 1000 MG TABLET ORL TAB SIS TAB 0.172700002247480 ESTER-C 250 MG CHEWABLE TABLET ORL CTB WNP TAB 0.086300080003499 ESTER-C CAPSULE ORL CAP BMD CAP 0.149600000727369 ESTRAGYN 1MG/G VAGINAL CREAM VAG CRM PAL G 0.641600002403404 ESTROGEL PROPAK 0.06% TRANSDERM. GEL/100MG CAPSULE TRD/ORL GEL/CAP MFC KIT 51.000000000247960 ETIBI 100 MG TABLET ORL TAB VCL TAB 0.217300000247979 ETIBI 400 MG TABLET ORL TAB VCL TAB 0.652000002080036 ETOPOSIDE 20 MG/ML INJECTION INJ DEFAUL TEV ML 15.000000000637726 EUFLEX 250 MG TABLET ORL TAB MFC TAB 1.413100080013021 EUPHORBIUM COMPOSITUM SN ORAL DROPS ORL DPS HEE ML 0.765000000623377 EURAX 10% TOPICAL CREAM TOP CRM CLC G 0.389400002242291 EURO - K8 600 MG SUSTAINED-RELEASE CAPSULE ORL SRC EUP CAP 0.061400080003010 EURO D 800 IU CAPSULE ORL CAP EUP CAP 0.060000002303825 EURO DOCUSATE C 100 MG CAPSULE ORL CAP EUP CAP 0.034400002245668 EURO-CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP ORL SYR EUP ML 0.067800002242651 EURO-D VITAMIN D3 400 IU CAPSULE ORL CAP EUP CAP 0.031700002247385 EURO-DOCUSATE 100 MG CAPSULE ORL CAP EUP CAP 0.032800002246590 EURO-FER 20 MG/ML ORAL SUSPENSION ORL SUS EUP ML 0.085800002237556 EURO-FER 300 MG CAPSULE ORL CAP EUP CAP 0.153700002241802 EURO-FER CF CAPSULE ORL CAP EUP CAP 0.245700002412926 EURO-HYDROCORTISONE 1% CREAM TOP CRM EUP G 0.125100002247383 EURO-LAC 667 MG/ML SOLUTION ORL SOL PMS ML 0.015400002247389 EURO-SENNA 8.6 MG TABLET ORL TAB EUP TAB 0.046400002247390 EURO-SENNA S 8.6 MG/50 MG TABLET ORL TAB EUP TAB 0.119200002264374 EUTHYROX 100 MCG TABLET ORL TAB SRO TAB 0.0306

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002264390 EUTHYROX 112 MCG TABLET ORL TAB SRO TAB 0.064400002264404 EUTHYROX 125 MCG TABLET ORL TAB SRO TAB 0.065400002264412 EUTHYROX 137 MCG TABLET ORL TAB SRO TAB 0.114800002264420 EUTHYROX 150 MCG TABLET ORL TAB SRO TAB 0.033900002264439 EUTHYROX 175 MCG TABLET ORL TAB SRO TAB 0.069900002264447 EUTHYROX 200 MCG TABLET ORL TAB SRO TAB 0.035900002264323 EUTHYROX 25 MCG TABLET ORL TAB SRO TAB 0.056400002264455 EUTHYROX 300 MCG TABLET ORL TAB SRO TAB 0.078500002264331 EUTHYROX 50 MCG TABLET ORL TAB SRO TAB 0.024900002264358 EUTHYROX 75 MCG TABLET ORL TAB SRO TAB 0.061000002264366 EUTHYROX 88 MCG TABLET ORL TAB SRO TAB 0.061000080005494 EVENING PRIMROSE OIL SOFTGEL CAPSULE ORL CAP WNP CAP 0.082200002248297 EVRA 6 MG/0.6 MG TRANSDERMAL PATCH TRD PTH JAI PTH 5.976700002377179 EXACT ANTI-NAUSEANT 50 MG TABLET ORL TAB APX TAB 0.062700002243896 EXACT DAILY LOW-DOSE ASA 81 MG ENTERIC-COATED TAB ORL ECT PMS TAB 0.133000001990675 EXCEDRIN EXTRA-STRENGTH CAPLET ORL TAB NVC TAB 0.076700002302853 EXELON PATCH 10 (9.5 MG/24 H) TRD PTH NOV PTH 4.893300002302845 EXELON PATCH 5 (4.6 MG/24 H) TRD PTH NOV PTH 4.888000002226030 EX-LAX CHOCOLATED TABLET ORL TAB NVC TAB 0.212800002237524 EX-LAX EXTRA STRENGHT 25 MG TABLET ORL TAB NVC TAB 0.249600002184672 EXOREX 1% TOPICAL GEL TOP GEL YNG ML 0.225000002184680 EXOREX 2% TOPICAL GEL TOP GEL YNG ML 0.225000000813095 EXPECTORANT COUGH FORMULA 100 MG/5 ML ORAL SYRUP ORL SYR TAN ML 0.019900002315955 EXTRA STRENGTH ALLERGY RELIEF 10 MG TABLET ORL TAB PMS TAB 0.414500002242632 EXTRA STRENGTH MOTRIN IB 300 MG TABLET ORL TAB MCL TAB 0.138500002244142 EXTRA STRENGTH NIGHTTIME COLD RELIEF TABLET ORL TAB PPH TAB 0.128300000889806 EYELUBE .5% OPH DROPS OPH DPS SDZ ML 0.309300000874965 EYELUBE 1% OPH DROPS OPH DPS SDZ ML 0.384000000707937 EYE-STREAM EYE LIQUID OPH LIQ ALC ML 0.094700002415992 EYLEA 2 MG/VIAL INJECTION INJ DEFAUL BHP VIAL 1540.870000002422549 EZETIMIBE 10 MG TABLET ORL TAB PDL TAB 0.461200002248968 FACTIVE 320 MG TABLET ORL TAB ABB TAB 7.524000002324865 FAMCICLOVIR 125 MG TABLET ORL TAB PDL TAB 0.139400002247745 FAMOTIDINE OMEGA-(W PRES,BENZYL ALC) 10 MG/ML INJ INJ DEFAUL OMG ML 1.400000002247735 FAMOTIDINE OMEGA-(W/O PRESERVATIVE) 10 MG/ML INJ INJ DEFAUL OMG ML 2.350000002379910 FAMPYRA 10 MG SUSTAINED-RELEASE TABLET ORL SRT BIO TAB 9.967300002229110 FAMVIR 125 MG TABLET ORL TAB NOV TAB 3.1460

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002229129 FAMVIR 250 MG TABLET ORL TAB NOV TAB 4.220700002177102 FAMVIR 500 MG TABLET ORL TAB NOV TAB 7.615200002248624 FASLODEX 250 MG/5 ML INJECTION INJ NDL AZC SYR 606.350000002231384 FEMARA 2.5 MG TABLET ORL TAB NOV TAB 6.733000002242531 FEMHRT 1/5 TABLET ORL TAB PFI TAB 0.840000002240360 FENO-MICRO-200 MG CAPSULE ORL CAP PDL CAP 0.272300002395703 FENTANYL 100 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 12.052000002395657 FENTANYL 12 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 2.348000002395665 FENTANYL 25 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 3.660000002395673 FENTANYL 50 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 6.884000002395681 FENTANYL 75 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 9.682000002126648 FENTANYL CITRATE 50 MCG/ML INJECTION INJ DEFAUL MNP ML 1.500000000888346 FENTANYL CITRATE 50 MCG/ML INJECTION INJ DEFAUL HSP ML 1.755000002384124 FENTANYL CITRATE SDZ 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.024000002408007 FENTORA 100 MCG EFFERVESCENT TABLET BUC/SLG EVT TEV TAB 11.841100002408015 FENTORA 200 MCG EFFERVESCENT TABLET BUC/SLG EVT TEV TAB 11.841100002408023 FENTORA 400 MCG EFFERVESCENT TABLET BUC/SLG EVT TEV TAB 11.841100002408031 FENTORA 600 MCG EFFERVESCENT TABLET BUC/SLG EVT TEV TAB 11.841100002408058 FENTORA 800 MCG EFFERVESCENT TABLET BUC/SLG EVT TEV TAB 11.841100002377217 FERAHEME 30 MG/ML INJECTION INJ DEFAUL TAK ML 11.856600080033717 FERAMAX 15/1/4 TSP POWDER ORL PWR BIS G 0.234200080013210 FERAMAX 150 150 MG CAPSULE ORL CAP BIS CAP 0.486000000232599 FERMALAC VAGINAL CAPSULE VAG CAP ROG CAP 1.931000002248699 FERODAN 300 MG TABLET ORL TAB ODN TAB 0.019900002243333 FERRLECIT 12.5 MG/ ML INJECTION INJ DEFAUL SAV ML 5.535600002138751 FERROUS FUMARATE 200 MG TABLET ORL TAB VTH TAB 0.020900000031089 FERROUS FUMARATE 300 MG TABLET ORL TAB WAM TAB 0.128900080009681 FERROUS GLUCONATE 300 MG TABLET ORL TAB WAM TAB 0.066200000031097 FERROUS GLUCONATE 300 MG TABLET ORL TAB WAM TAB 0.022400002244532 FERROUS GLUCONATE 300 MG TABLET ORL TAB PMT TAB 0.040000000041157 FERROUS GLUCONATE 300 MG TABLET ORL TAB ADA TAB 0.037100000582727 FERROUS GLUCONATE 324 MG TABLET ORL TAB VTH TAB 0.027700002245389 FERROUS GLUCONATE 35 MG TABLET ORL TAB WNP TAB 0.078500000346918 FERROUS SULFATE 300 MG TABLET ORL TAB PMT TAB 0.038500000782114 FERROUS SULFATE 300 MG TABLET ORL TAB WTR TAB 0.034600080005803 FIBER PLUS CAPSULE ORL CAP PLT CAP 0.200000002207230 FIBRE LAXATIVE 3.4 G/12 G ORAL POWDER ORL PWR PRI G 0.0060

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080009650 FIBRE LAXATIVE SMOOTH TEXTURE ORANGE FLAVOUR ORL PWR ACV G 0.010300080009651 FIBRE LAXATIVE UNFLAVOURED ORAL POWDER ORL PWR APH G 0.010900002408163 FIBRISTAL 5 MG TABLET ORL TAB ASC TAB 12.453000002350270 FINASTERIDE 5 MG TABLET ORL TAB PDL TAB 0.463300002425696 FIRAZYR 10 MG/ML (3 ML) INJECTION SYRINGE INJ DEFAUL SOT SYR 2700.000000002337037 FIRMAGON 120 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 405.500000002337029 FIRMAGON 80 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 300.000000001926853 FLAGYL 500 MG CAPSULE ORL CAP SAV CAP 1.154800000323098 FLAMAZINE 1% TOPICAL CREAM TOP CRM SNE G 0.264000080000193 FLAX SEED OIL ORL LIQ HHC CAP 0.041000002149133 FLAX SEED OIL 500 MG CAPSULE ORL CAP JAM CAP 0.064900080000580 FLAXSEED OIL 1000 MG SOFTGEL ORL CAP PMT CAP 0.093700080000840 FLAXSEED OIL LIQUID ORL LIQ VML ML 0.042200002206218 FLEET PHOSPO-SODA ORAL LIQUID ORL LIQ JJM ML 0.083800080021934 FLINTSTONES MULTI VITAMINS COMPLETE CHEWABLE TAB ORL CTB BAI TAB 0.137700002230845 FLOLAN 0.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 18.640000002230848 FLOLAN 1.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 37.270000002213672 FLONASE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM GSK DOSE 0.281300080011335 FLORASMART TABLET ORL TAB RLC TAB 0.542100080013321 FLORASTOR 250 MG CAPSULE ORL CAP BCX CAP 1.101000002244405 FLORAZOLE ER 750 MG EXTENDED-RELEASE TABLET ORL ERT FEI TAB 2.070000002237245 FLOVENT DISKUS 100 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.433300002237244 FLOVENT DISKUS 50 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.274000002261472 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL BAX ML 0.163500002248443 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.483600002388448 FLUCONAZOLE INJECTION SDZ 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.469500002247749 FLUCONAZOLE OMEGA 2 MG/ML INJECTION INJ DEFAUL OMG ML 0.366000002246226 FLUDARA 10 MG TABLET ORL TAB SAV TAB 43.548500002249561 FLUMAZENIL 0.1 MG/ML INJECTION INJ DEFAUL SDZ ML 5.476800002352621 FLUMIST INFLUENZA VACCINE NASAL SPRAY NAS SPR AZC ML 78.240000001977857 FLUOR A DAY 1.1 MG CHEWABLE TABLET ORL CTB PMS TAB 0.092200002090139 FLUOR-A-DAY 0.56 MG CHEWABLE TABLET ORL CTB PMS TAB 0.089600000012882 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL VCL ML 1.463000002182742 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL MNP ML 2.037600002331721 FLUPENTIXOL DECANOATE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 27.550000000578479 FLURAZEPAM 15 MG CAPSULE ORL CAP PDL CAP 0.067500000578487 FLURAZEPAM 30 MG CAPSULE ORL CAP PDL CAP 0.0775

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 42 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002015986 FLUVIRAL S/F SPLIT-VIRION INFLUENZA VACCINE INJ INJ DEFAUL IAF ML 16.000000002236754 FLUVOXAMINE 100 MG TABLET ORL TAB PDL TAB 0.378300002236753 FLUVOXAMINE 50 MG TABLET ORL TAB PDL TAB 0.210500000247855 FML LIQUIFILM 0.1% OPH SUSPENSION OPH SUS ALL ML 3.490000080000549 FOLAPRO 0.8 MG TABLET ORL TAB MTG TAB 0.191600000318973 FOLIC ACID 1 MG TABLET ORL TAB JAM TAB 0.042200000647039 FOLIC ACID 1 MG TABLET ORL TAB VTH TAB 0.007900002048841 FOLIC ACID USP 1 MG TABLET ORL TAB PMT TAB 0.017100002254689 FORTEO 250 MCG/ML INJECTION INJ DEFAUL LIL ML 411.637500002435470 FORXIGA 10 MG TABLET ORL TAB AZC TAB 2.620000002435462 FORXIGA 5 MG TABLET ORL TAB AZC TAB 2.620000002241568 FORZA-10 TABLET ORL TAB EUP TAB 0.171000002201038 FOSAMAX 40 MG TABLET ORL TAB MFC TAB 4.074300002276429 FOSAVANCE 70 MG/2800 UNIT TABLET ORL TAB MFC TAB 5.022500002332566 FOSINOPRIL 10 MG TABLET ORL TAB RAN TAB 0.497700002332574 FOSINOPRIL 20 MG TABLET ORL TAB RAN TAB 0.598500002303000 FOSINOPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.217800002303019 FOSINOPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.261900002287188 FOSRENOL 1000 MG CHEWABLE TABLET ORL CTB SHB TAB 4.849000002287145 FOSRENOL 250 MG CHEWABLE TABLET ORL CTB SHB TAB 1.215000002287153 FOSRENOL 500 MG CHEWABLE TABLET ORL CTB SHB TAB 2.430200002287161 FOSRENOL 750 MG CHEWABLE TABLET ORL CTB SHB TAB 3.657100002377454 FRAGMIN 2,500 IU/ML INJECTION INJ DEFAUL PFI ML 4.078500002221799 FRISIUM 10 MG TABLET ORL TAB LUI TAB 0.477300002257084 FROVA 2.5 MG TABLET ORL TAB TMP TAB 15.265700002264625 FSME-IMMUN 2.4 MCG/0.5 ML INJECTION SYRINGE INJ NDL BAX SYR 51.000000002238578 FUCIDIN H TOPICAL CREAM TOP CRM LEO G 1.364300002243862 FUCITHALMIC 1% VISCOUS OPH DROPS (PRESERVED) OPH GEL LEO G 2.236000002243861 FUCITHALMIC 1% VISCOUS OPH DROPS (UNPRESERVED) OPH GEL LEO G 5.191700002360365 FUROSEMIDE 10MG/ML INJECTION INJ DEFAUL OMG ML 1.050000000496723 FUROSEMIDE 20 TABLET ORL TAB PDL TAB 0.037300000397792 FUROSEMIDE 40 MG TABLET ORL TAB PDL TAB 0.055800000667080 FUROSEMIDE-80 MG TABLET ORL TAB PDL TAB 0.122000002247725 FUZEON 108 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 42.742000002388200 GABAPENTIN 600 MG TABLET ORL TAB SIV TAB 1.304500002431289 GABAPENTIN 600 MG TABLET ORL TAB SNS TAB 1.304500002392526 GABAPENTIN 600 MG TABLET USP ORL TAB AHI TAB 1.3045

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 43 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002388219 GABAPENTIN 800 MG TABLET ORL TAB SIV TAB 1.277300002431297 GABAPENTIN 800 MG TABLET ORL TAB SNS TAB 1.739300002392534 GABAPENTIN 800 MG TABLET USP ORL TAB AHI TAB 1.739300002416581 GALANTAMINE ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.246700002416603 GALANTAMINE ER 24 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.246700002416573 GALANTAMINE ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.246700000512192 GARAMYCIN 3 MG/ML OPH SOLUTION OPH SOL MFC ML 0.406000000512184 GARAMYCIN 3 MG/ML OTIC SOLUTION OT SOL MFC ML 1.032000000682217 GARASONE 3 MG/ML / 1 MG/ML OTIC OPH SOLUTION OT/OPH SOL MFC ML 1.281300002283190 GARDASIL 0.5 ML INJECTION INJ DEFAUL MFC ML 308.060000000896675 GAS X EXTRA STRENGTH TABLET ORL TAB NVC TAB 0.250000002300761 GAS X ULTRA STRENGTH 180 MG CAPSULE ORL CAP NVC CAP 0.209300002159791 GAVISCON HEARTBURN RELIEF CHEWABLE TABLET ORL CTB SKB TAB 0.146800002231538 GAVISCON HEARTBURN RELIEF EXTRA STRENGTH TABLET ORL TAB SKB TAB 0.287500002159775 GAVISCON HEARTBURN RELIEF ORAL LIQUID - FRUIT ORL LIQ SKB ML 0.021600002434806 GAZYVA 1000 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 131.887500002280124 GD-AMLODIPINE 2.5 MG TABLET ORL TAB GMD TAB 0.138000002342235 GD-ELETRIPTAN 20 MG TABLET ORL TAB GMD TAB 10.958300002342243 GD-ELETRIPTAN 40 MG TABLET ORL TAB GMD TAB 10.958300002285843 GD-GABAPENTIN 600 MG TABLET ORL TAB GMD TAB 1.417500002285851 GD-GABAPENTIN 800 MG TABLET ORL TAB GMD TAB 1.795500002360179 GD-PREGABALIN 150 MG CAPSULE ORL CAP GMD CAP 1.727000002360195 GD-PREGABALIN 225 MG CAPSULE ORL CAP GMD CAP 1.727000002360136 GD-PREGABALIN 25 MG CAPSULE ORL CAP GMD CAP 0.617300002360209 GD-PREGABALIN 300 MG CAPSULE ORL CAP GMD CAP 1.727000002360144 GD-PREGABALIN 50 MG CAPSULE ORL CAP GMD CAP 0.968300002360152 GD-PREGABALIN 75 MG CAPSULE ORL CAP GMD CAP 1.252800002290995 GD-QUINAPRIL 10 MG TABLET ORL TAB GMD TAB 0.686700002291002 GD-QUINAPRIL 20 MG TABLET ORL TAB GMD TAB 0.686700002291010 GD-QUINAPRIL 40 MG TABLET ORL TAB GMD TAB 0.686700002290987 GD-QUINAPRIL 5 MG TABLET ORL TAB GMD TAB 0.686700002352818 GD-TERBINAFINE 250 MG TABLET ORL TAB GMD TAB 2.524300002352877 GD-TOPIRAMATE 100 MG TABLET ORL TAB GMD TAB 0.592800002352885 GD-TOPIRAMATE 200 MG TABLET ORL TAB GMD TAB 1.984500002352850 GD-TOPIRAMATE 25 MG TABLET ORL TAB GMD TAB 0.661500002028107 GEL-KAM 0.4% DENTAL GEL DEN GEL COL G 0.070500002366150 GELNIQUE 100 MG/G TOPICAL GEL TOP GEL ASC G 3.0427

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001945831 GELUSIL EXTRA STRENGTH CHEWABLE TABLET ORL CTB WLA TAB 0.148400001933906 GELUSIL TABLET ORL TAB WSP TAB 0.133000002324210 GEMCITABINE 1 G/VIAL INJECTION INJ DEFAUL AHI VIAL 265.000000002412292 GEMCITABINE 40 MG/ML INJECTION INJ DEFAUL SDZ ML 10.812000002136058 GEMFIBROZIL-600 MG TABLET ORL TAB PDL TAB 0.515700002230309 GEMZAR 1 G/ VIAL INJECTION INJ DEFAUL LIL VIAL 308.350000002230308 GEMZAR 200 MG/ VIAL INJECTION INJ DEFAUL LIL VIAL 65.670000080020663 GENESTRA BRAND HMF INTENSIVE PROBIOTIC ORL CAP SRL CAP 1.716600080034399 GENESTRA BRANDS DIGEST GLUTEN PLUS CAPSULE ORL CAP SRL CAP 0.314300080008885 GENESTRA BRANDS D-MULSION ORL LIQ SRL ML 0.566300080012475 GENESTRA BRANDS D-MULSION 400 ORL LIQ SRL ML 0.236700002246047 GEN-NIZATIDINE 300 MG CAPSULE ORL CAP MYP CAP 0.958000002082144 GENTAMICIN (E) 1.2 MG/ML INJECTION INJ DEFAUL BAX ML 0.079400002082152 GENTAMICIN (E) 1.6 MG/ML INJECTION INJ DEFAUL BAX ML 0.089000002268531 GENTAMICIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 5.278500002148404 GENTAMICIN SULFATE 0.3% (BASE) OPH SOL (MINIMS) OPH SOL NVO ML 6.348300002082136 GENTAMICINE (E) 1 MG/ML INJECTION INJ DEFAUL BAX ML 0.046700002231289 GENTEAL 0.3% OPHTHALMIC DROPS OPH DPS ALC ML 0.440700002242977 GENTEAL 0.3% OPHTHALMIC GEL OPH GEL ALC ML 0.827000002415666 GIOTRIF 20 MG TABLET ORL TAB BOE TAB 80.000000002415674 GIOTRIF 30 MG TABLET ORL TAB BOE TAB 80.000000002415682 GIOTRIF 40 MG TABLET ORL TAB BOE TAB 80.000000080003490 GLA 130 PRIMROSE OIL CAPSULE ORL CAP SRL CAP 0.443800002244725 GLEEVEC 100 MG CAPSULE ORL CAP NOV CAP 25.324000002253275 GLEEVEC 100 MG TABLET ORL TAB NOV TAB 29.759600002253283 GLEEVEC 400 MG TABLET ORL TAB NOV TAB 119.038300002248453 GLICLAZIDE-80 MG TABLET ORL TAB PDL TAB 0.093100080000015 GLUCOSAMINE SULFATE 500 MG CAPLET ORL TAB JAM TAB 0.054600080000082 GLUCOSAMINE SULFATE 500 MG CAPSULE ORL CAP WBP CAP 0.030200080000083 GLUCOSAMINE SULFATE 500 MG TABLET ORL TAB WBP TAB 0.038800002300451 GLUMETZA 1000 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.277000002268493 GLUMETZA 500 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 0.633500080009026 GLUTAMINE MAXX ORAL POWDER ORL PWR IHS G 0.060000001959352 GLYBURIDE-2.5 MG TABLET ORL TAB PDL TAB 0.032100001926039 GLYCERIN RECTAL SUPPOSITORY RT SUP WSP SUP 0.160000000873462 GLYCERINE 90% RECTAL SUPPOSITORY USP RT SUP MCO SUP 0.085000080006852 GLYCINE ORAL POWDER ORL PWR AOR G 0.0639

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002229516 GLYCON 500 MG TABLET ORL TAB VCL TAB 0.128900002239214 GLYCON 850 MG TABLET ORL TAB VCL TAB 0.089800002382857 GLYCOPYRROLATE 0.2 MG/ML INJECTION INJ DEFAUL OMG ML 3.975000002382849 GLYCOPYRROLATE 0.2 MG/ML MULTIDOSE INJECTION INJ DEFAUL OMG ML 3.000000002247884 GLYQUIN XM TOPICAL CREAM TOP CRM VCL G 1.250000000652512 GOLYTELY POWDER FOR ORAL LAVAGE SOLUTION ORL PWR BAX G 0.004400002248156 GONAL-F 33 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 457.140000002248154 GONAL-F 5.5 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 76.200000002248157 GONAL-F 77 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 992.250000002270404 GONAL-F PEN 300 IU/0.5 ML INJECTION SYRINGE INJ NDL SRO SYR 304.760000002270390 GONAL-F PEN 450 IU/0.75 ML INJECTION SYRINGE INJ NDL SRO SYR 457.140000002270382 GONAL-F PEN 900 IU/1.5 ML INJECTION SYRINGE INJ NDL SRO SYR 914.290000002232483 GRAMCAL 1000 MG EFFERVESCENT TABLET ORL EVT NVC TAB 0.791500080006061 GRAPE SEED CAPLET ORL TAB JAM TAB 0.332200002418304 GRASTEK 2800 UNIT SUBLINGUAL TABLET SLG DISNTAB MFC TAB 4.129300000116858 GRAVERGOL CAPSULE ORL CAP AXS CAP 1.010800002254409 GRAVOL 100 MG LONG ACTING SUSTAINED-RELEASE CAPLET ORL SRT CHD TAB 0.476200000511196 GRAVOL 15 MG CHEWABLE TABLET ORL CTB CHD TAB 0.258300000230197 GRAVOL 3 MG/ML ORAL LIQUID ORL SYR CHD ML 0.075100000013803 GRAVOL 50 MG TABLET ORL TAB CHD TAB 0.387500000013609 GRAVOL ADULT 100 MG RECTAL SUPPOSITORY RT SUP CHD SUP 0.570000000783595 GRAVOL CHILDREN 25 MG RECTAL SUPPOSITORIES RT SUP CHD SUP 0.526000002248180 GRAVOL GINGER LOZENGE ORL LOZ CHD LOZ 0.232500000013579 GRAVOL I.M. 50 MG/ML INJECTION INJ DEFAUL CHD ML 1.237000002245718 GRAVOL NATURAL SOURCE 500 MG TABLET ORL TAB CHD TAB 0.228500080014526 GREEN TEA PHYTOSOME COMPLEX CAPSULE ORL CAP JAM CAP 0.228000080012417 GREENS+ BONE BUILDER ORAL POWDER ORL PWR GNH G 0.094800002384272 GUM PAROEX 0.12% ORAL RINSE ORL MWH SUA ML 0.016600002248417 GYNAZOLE 1 2% VAGINAL CREAM VAG CRM FEI G 3.450000002377438 HALAVEN 0.5 MG/ML INJECTION INJ DEFAUL EIS ML 270.000000000271691 HALIBUT LIVER OIL SUPER CAPSULE ORL CAP SWS CAP 0.032900000202061 HALIBUT LIVER OIL WITH VITAMIN D CAPSULE ORL CAP WAM CAP 0.026800002366010 HALOPERIDOL (PRESERVATIVE FREE) 5 MG/ML INJECTION INJ DEFAUL OMG ML 5.325000000587796 HALOPERIDOL 0.5 MG TABLET ORL TAB PDL TAB 0.036000002130297 HALOPERIDOL LA 50 MG/ML INJECTION INJ DEFAUL SDZ ML 8.464000002239640 HALOPERIDOL-LA 100 MG/ML INJECTION INJ DEFAUL OMG ML 13.690000002432226 HARVONI 400 MG/90 MG TABLET ORL TAB GIL TAB 797.6190

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002187078 HAVRIX 1,440 U/ML INJECTION INJ DEFAUL GSK ML 47.800000002231056 HAVRIX JUNIOR 720 U/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 23.910000000740578 HEPALEAN-LOK 100 IU/ML LOCK FLUSH INJECTION USP INJ LOCFLUSH ORG ML 0.327500000453781 HEPARIN LEO 25,000 IU/ML INJECTION INJ DEFAUL LEO ML 8.339000000640468 HEPARIN LOCK FLUSH SOLUTION 10 UNIT/ML INJECTION INJ LOCFLUSH HSP ML 1.205600002303086 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL SDZ ML 0.565000002264315 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL PPC ML 2.600000002382296 HEPARIN SODIUM 1,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 0.501000002382326 HEPARIN SODIUM 10,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 5.010000002382334 HEPARIN SODIUM 5,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 1.247000002303094 HEPARIN SODIUM(PRESERVAT FREE)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 5.727000002303108 HEPARIN SODIUM(WITH PRESERVAT)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 3.716000002239194 HEPTOVIR 5 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.230000002240692 HERCEPTIN 440 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2902.500000000430617 HEXIT 1.0% TOPICAL SHAMPOO TOP SHP ODN ML 0.146200002244784 HILL-VITE TABLET ORL TAB HIL TAB 0.132000000575178 HISTANTIL 25 MG TABLET ORL TAB PMS TAB 0.115800000575186 HISTANTIL 50 MG TABLET ORL TAB PMS TAB 0.190800002436027 HOLKIRA PAK TABLET ORL TAB ABV TAB 166.250000001948903 HONEY BEE VENOM 1.1 MG INJ DEFAUL ALG VIAL 30.866700001948911 HONEY BEE VENOM 120 MCG INJ DEFAUL ALG VIAL 30.866700002241793 HONVOL 50 MG/ML INJECTION INJ DEFAUL ASM ML 2.998600002078759 HUMATIN 250 MG CAPSULE ORL CAP PFI CAP 2.895900000745626 HUMATROPE 1 MG/ML INJECTION INJ DEFAUL LIL VIAL 250.850000002243079 HUMATROPE 24 MG INJECTION INJ DEFAUL LIL VIAL 1217.130000000999015 HYALGAN DEFAUL DEV MDX ML 25.000000001916580 HYCODAN 1 MG/ML ORAL SYRUP ORL SYR BMS ML 0.134500001916599 HYCODAN 5 MG TABLET ORL TAB BMS TAB 1.138800001916564 HYCOMINE ORAL SYRUP ORL SYR DPM ML 0.216500001916521 HYCOMINE-S PEDIATRIC ORAL SYRUP ORL SYR DPM ML 0.189500000230316 HYCORT 1.67 MG/ML RECTAL ENEMA RT ENM VCL ENM 5.297100002231476 HYDRASENSE NASAL SOLUTION NAS SOL SCH ML 0.075100000465283 HYDREA 500 MG CAPSULE ORL CAP BMS CAP 1.108700000341975 HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PDL TAB 0.015700002242930 HYDROCORTISONE ACETATE 0.5% TOPICAL CREAM TOP CRM TAR G 0.084600002244797 HYDROMORPHONE HP FORTE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 58.800000000564281 HYDROSONE 0.5% CREAM TOP CRM RPH G 0.1347

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002343096 HYDROXYUREA 500 MG CAPSULE ORL CAP SNS CAP 1.020300002229868 HYOSCINE BUTYLBROMIDE 20 MG/ML INJECTION INJ DEFAUL SDZ ML 4.906000002230697 HYPERTET S/D 250 IU/SYR INJECTION INJ DEFAUL GRL SYR 78.000000002133253 HYPOTEARS 1% OPH SOLUTION OPH SOL ALC ML 0.414700002133288 HYPOTEARS 85%/15% EYE OINTMENT OPH ONT ALC G 1.588600002275864 HYPURIN NPH INSULIN ISOPHANE PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.900000002275872 HYPURIN REGULAR INSULIN PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.900000002425890 IBAVYR 400 MG TABLET ORL TAB PPH TAB 15.756400002425904 IBAVYR 600 MG TABLET ORL TAB PPH TAB 23.634600080022866 IBEROGAST ORAL SOLUTION ORL SOL STA ML 0.195100002257912 IBUPROFEN 200 MG TABLET ORL TAB PMT TAB 0.049800002317338 IBUPROFEN 400 MG CAPLET ORL TAB PMT TAB 0.039200000636533 IBUPROFEN 400 MG TABLET ORL TAB PDL TAB 0.037200002344939 ILARIS 150 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 16000.000000002411393 ILEVRO 0.3% OPHTHALMIC SUSPENSION OPH SUS ALC ML 7.943300002183862 IMODIUM 2 MG CAPLET ORL TAB MCL TAB 0.773300002376016 IMODIUM 2 MG CAPSULE ORL CAP MCL CAP 0.870000002245185 IMODIUM ADVANCED CAPLET ORL TAB MCL TAB 0.928000002237297 IMODIUM ADVANCED CHEWABLE TABLET ORL CTB MCL TAB 0.928000002230542 IMODIUM QUICK DISSOLVE 2 MG TABLET ORL TAB MCL TAB 0.869000001959042 IMOVAX POLIO INJECTION SYRINGE INJ NDL SFP SYR 46.200000001908286 IMOVAX RABIES VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL SFP VIAL 211.670000002240713 IMUNOVIR 500 MG TABLET ORL TAB RIP TAB 1.950900002244895 IMURAN 50 MG/VIAL INJECTION INJ DEFAUL APR VIAL 96.060000002042266 INDERAL-LA 120 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.058700002042274 INDERAL-LA 160 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.252100002042231 INDERAL-LA 60 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.609800002042258 INDERAL-LA 80 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.687600002046059 INFANTS' TYLENOL 80 MG/ML ORAL SUSPENSION DROPS ORL DPS MCL ML 0.306700002419475 INFLECTRA 100 MG/VIAL INJECTION INJ DEFAUL HSP VIAL 650.000000002269562 INFLUVAC VACCINE INJECTION SYRINGE INJ DEFAUL ABB SYR 9.300000002221780 INFUFER 50 MG/ML INJECTION INJ DEFAUL SDZ ML 14.750000002389630 INLYTA 1 MG TABLET ORL TAB PFI TAB 19.995000002389649 INLYTA 5 MG TABLET ORL TAB PFI TAB 99.975000002429470 INNOHEP 12000 IU/0.6 ML INJECTION SYRINGE INJ NDL LEO SYR 21.216000002429489 INNOHEP 16000 IU/0.8 ML INJECTION SYRINGE INJ NDL LEO SYR 28.288000002429462 INNOHEP 8000 IU/0.4 ML INJECTION SYRINGE INJ NDL LEO SYR 14.1440

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080013031 INNO-Q-NOL 100 MG SOFT GEL CAPSULE ORL CAP INN CAP 1.132500002323052 INSPRA 25 MG TABLET ORL TAB PFI TAB 2.866000002323060 INSPRA 50 MG TABLET ORL TAB PFI TAB 2.840000080026628 INSTAFLEX JOINT SUPPORT CAPSULE ORL CAP DDI CAP 0.333200000762040 INSTA-GLUCOSE (1 DOSE PER TUBE) ORAL LIQUID ORL LIQ VCL DOSE 3.943300002294990 INSTILLAGEL 2% /0.05% TOPICAL GEL TOP GEL PPH ML 0.966700002348756 INTANZA INJECTION SYRINGE INJ DEFAUL SFP SYR 12.900000002306778 INTELENCE 100 MG TABLET ORL TAB JAI TAB 6.308600002375931 INTELENCE 200 MG TABLET ORL TAB JAI TAB 12.226000002238675 INTRON A 10 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 131.420000002223406 INTRON A 10,000,000 UNIT/VIAL INJECTION INJ DEFAUL MFC ML 125.200000002238674 INTRON A 6 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 72.563300002240693 INTRON A MULTI-DOSE PEN 15 MIU/ML INJECTION SYR INJ NDL MFC SYR 234.020000002240694 INTRON A MULTI-DOSE PEN 25 MIU/ML INJECTION SYR INJ NDL MFC SYR 391.940000002240695 INTRON A MULTI-DOSE PEN 50 MIU/ML INJECTION SYR INJ NDL MFC SYR 780.030000002409100 INTUNIV XR 1 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.260000002409119 INTUNIV XR 2 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.966300002409127 INTUNIV XR 3 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.672600002409135 INTUNIV XR 4 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 5.378900002216965 INVIRASE 200 MG CAPSULE ORL CAP HLR CAP 2.026500002279320 INVIRASE 500 MG TABLET ORL TAB HLR TAB 4.676600002425483 INVOKANA 100 MG TABLET ORL TAB JAI TAB 2.844300002425491 INVOKANA 300 MG TABLET ORL TAB JAI TAB 2.844300000888354 IOPIDINE 1% OPH SOLUTION (UNIT DOSE) OPH SOL ALC ML 62.375000002246084 IPRAVENT 0.06% NASAL SPRAY NAS SPR AAP ML 1.619300002365200 IRBESARTAN 150 MG TABLET ORL TAB PDL TAB 0.342500002365219 IRBESARTAN 300 MG TABLET ORL TAB PDL TAB 0.342500002365197 IRBESARTAN 75 MG TABLET ORL TAB PDL TAB 0.342500002365162 IRBESARTAN-HCTZ 150 MG/12.5 MG TABLET ORL TAB PDL TAB 0.342500002365170 IRBESARTAN-HCTZ 300 MG/12.5 MG TABLET ORL TAB PDL TAB 0.342500002365189 IRBESARTAN-HCTZ 300 MG/25 MG TABLET ORL TAB PDL TAB 0.338400002248676 IRESSA 250 MG TABLET ORL TAB AZC TAB 73.300000002392437 ISENTRESS 100 MG CHEWABLE TABLET ORL CTB MFC TAB 3.833300002392429 ISENTRESS 25 MG CHEWABLE TABLET ORL CTB MFC TAB 0.958300002301881 ISENTRESS 400 MG TABLET ORL TAB MFC TAB 14.669800000897639 ISOPROTERENOL HYDROCHLORIDE 0.2 MG/ML INJECTION INJ DEFAUL SDZ ML 8.016000000000809 ISOPTO TEARS 0.5% OPH DROPS OPH DPS ALC ML 0.5247

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 49 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000000817 ISOPTO TEARS 1.0% OPH DROPS OPH DPS ALC ML 0.524700000272655 ISOTAMINE 300 MG TABLET ORL TAB VCL TAB 0.089900002414295 ISTODAX 10 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 2582.000000002333279 IXIARO 6 MCG/0.5ML INJECTION SYRINGE INJ NDL NOV SYR 210.000000002388014 JAKAVI 15 MG TABLET ORL TAB NOV TAB 88.356200002388022 JAKAVI 20 MG TABLET ORL TAB NOV TAB 88.356200002388006 JAKAVI 5 MG TABLET ORL TAB NOV TAB 88.356200002372010 JALYN 0.5 MG/0.4 MG MODIFIED RELEASE CAPSULE ORL MRC GSK CAP 1.800700002246040 JAMP CALCIUM 500 MG TABLET ORL TAB JPC TAB 0.021600002388308 JAMP-ACET-TRAMADOL 37.5 MG/325 MG TABLET ORL TAB JPC TAB 0.645200080037789 JAMP-AD 5000 IU/ 400 IU CHEWABLE TABLET ORL CTB JPC TAB 0.105300002421593 JAMP-ALLOPURINOL 100 MG TABLET ORL TAB JPC TAB 0.078000002421607 JAMP-ALLOPURINOL 200 MG TABLET ORL TAB JPC TAB 0.130000002421615 JAMP-ALLOPURINOL 300 MG TABLET ORL TAB JPC TAB 0.212500002339080 JAMP-ANASTROZOLE 1 MG TABLET ORL TAB JPC TAB 2.545800002283905 JAMP-ASA 80 MG TABLET ORL DRT JPC TAB 0.056000002357216 JAMP-BICALUTAMIDE 50 MG TABLET ORL TAB JPC TAB 4.057200002410893 JAMP-BISACODYL 5 MG SUPPOSITORY RT SUP JPC SUP 0.435400002246039 JAMP-BISACODYL 5 MG TABLET ORL TAB JPC TAB 0.045000080028892 JAMP-CALCIUM CITRATE 250 MG + VIT D 1000 IU TABLET ORL TAB JPC TAB 0.122400002373823 JAMP-COLCHICINE 0.6 MG TABLET ORL TAB JPC TAB 0.264200002420147 JAMP-CYANOCOBALAMIN 1000 MCG/ML INJECTION INJ DEFAUL JPC ML 0.450000002391619 JAMP-DICYCLOMINE HCL 10 MG TABLET ORL TAB JPC TAB 0.122600002366088 JAMP-DICYCLOMINE HCL 20 MG TABLET ORL TAB JPC TAB 0.220700002283220 JAMP-DOCUSATE SODIUM 50 MG/ML ORAL SYRUP ORL SYR JPC ML 0.920300080036242 JAMP-E 200 IU CHEWABLE TABLET ORL CTB JPC TAB 0.147400002423235 JAMP-EZETIMIBE 10 MG TABLET ORL TAB JPC TAB 0.461200080024232 JAMP-FER 300 MG CAPSULE ORL CAP JPC CAP 0.129900080025200 JAMP-FER FC 100 MG/ 0.5 MG/ 200 MG CAPSULE ORL CAP JPC CAP 0.228100080047569 JAMP-FERROUS POLYSACCHARIDE 150 MG CAPSULE ORL CAP JPC CAP 0.430600000031100 JAMP-FERROUS SULFATE 300 MG TABLET ORL TAB JPC TAB 0.066200080053274 JAMP-FOLIC ACID 1 MG TABLET ORL TAB JPC TAB 0.017100002366061 JAMP-FOLIC ACID 5 MG TABLET ORL TAB JPC TAB 0.043900002402289 JAMP-GABAPENTIN 600 MG TABLET ORL TAB JPC TAB 1.304500002402297 JAMP-GABAPENTIN 800 MG TABLET ORL TAB JPC TAB 1.739300002401290 JAMP-IBUPROFEN 400 MG TABLET ORL TAB JPC TAB 0.047400080047136 JAMP-IRON POLYPEPTIDE 11 MG TABLET ORL TAB JPC TAB 0.6062

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080023817 JAMP-K-CITRATE 10 MEQ TABLET ORL SRT JPC TAB 0.162600002280078 JAMP-LACTULOSE 667 MG/ML ORAL SYRUP ORL SYR JPC ML 0.014500002373009 JAMP-LETROZOLE 2.5 MG TABLET ORL TAB JPC TAB 2.756000080041590 JAMP-MAGNESIUM 100 MG TABLET ORL TAB JPC TAB 0.263200080009357 JAMP-MAGNESIUM 25 MG ORAL LIQUID ORL LIQ JPC ML 0.021000080043440 JAMP-MAGNESIUM 250 MG TABLET ORL TAB JPC TAB 0.102600002419173 JAMP-METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL JPC ML 5.625000002406640 JAMP-OLANZAPINE 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB JPC TAB 5.355300002406659 JAMP-OLANZAPINE 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB JPC TAB 7.597700002408414 JAMP-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT JPC TAB 1.275000002397307 JAMP-PIOGLITAZONE 15 MG TABLET ORL TAB JPC TAB 0.580900002365529 JAMP-PIOGLITAZONE 30 MG TABLET ORL TAB JPC TAB 0.813900002365537 JAMP-PIOGLITAZONE 45 MG TABLET ORL TAB JPC TAB 1.223700002380617 JAMP-PYRANTEL PAMOATE 125 MG TABLET ORL TAB JPC TAB 0.993000080040279 JAMP-QUININE 200 MG CAPSULE ORL CAP JPC CAP 0.239000080040277 JAMP-QUININE 300 MG CAPSULE ORL CAP JPC CAP 0.375000002405687 JAMP-SILDENAFIL 100 MG TABLET ORL TAB JPC TAB 9.997500002405660 JAMP-SILDENAFIL 25 MG TABLET ORL TAB JPC TAB 9.007500002405679 JAMP-SILDENAFIL 50 MG TABLET ORL TAB JPC TAB 9.615000002331039 JAMP-SIMVASTATIN 10 MG TABLET ORL TAB JPC TAB 0.728700002331047 JAMP-SIMVASTATIN 20 MG TABLET ORL TAB JPC TAB 0.900500002331055 JAMP-SIMVASTATIN 40 MG TABLET ORL TAB JPC TAB 0.900500002331020 JAMP-SIMVASTATIN 5 MG TABLET ORL TAB JPC TAB 0.370400002331063 JAMP-SIMVASTATIN 80 MG TABLET ORL TAB JPC TAB 0.900500080034416 JAMP-SODIUM PHOSPHATE 0.891 G -2.4 G/5 ML SOLUTION ORL SOL JPC ML 0.094700002420309 JAMP-VANCOMYCIN 1 G/VIAL INJECTION INJ DEFAUL JPC VIAL 58.990000002420325 JAMP-VANCOMYCIN 10 G/VIAL INJECTION INJ DEFAUL JPC VIAL 589.900000002420317 JAMP-VANCOMYCIN 5 G/VIAL INJECTION INJ DEFAUL JPC VIAL 509.790000002420295 JAMP-VANCOMYCIN 500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 31.050000080028902 JAMP-VITAMIN B12 1000 MCG RAPID DISSOLVE TABLET ORL TAB JPC TAB 0.088400002379007 JAMP-VITAMIN D 10000 UNIT TABLET ORL TAB JPC TAB 0.216300002416794 JANUMET XR 50 MG/1000 MG EXTENDED-RELEASE TABLET ORL ERT MFC TAB 1.725200002388839 JANUVIA 25 MG TABLET ORL TAB MFC TAB 3.183700002388847 JANUVIA 50 MG TABLET ORL TAB MFC TAB 3.183700002408295 JAYDESS 13.5 MG INTRAUTERINE INSERT IU INS BAI SYS 294.130000002410818 JETREA 0.5 MG/VIAL INJECTION INJ DEFAUL ALC VIAL 3950.000000002048744 JE-VAX INJECTION INJ DEFAUL CNG VIAL 131.6633

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002369524 JEVTANA 40 MG/ML INJECTION INJ DEFAUL SAV VIAL 5800.000000002413388 JUBLIA 10% TOPICAL SOLUTION TOP SOL VCL ML 11.591700002247344 JUNIOR STRENGTH MOTRIN 100 MG CHEWABLE TABLET ORL CTB MCL TAB 0.225000002337282 JURNISTA 16 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 5.004000002337290 JURNISTA 32 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 10.007000002337266 JURNISTA 4 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.250700002337274 JURNISTA 8 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.501300002420376 JUXTAPID 10 MG CAPSULE ORL CAP AEP CAP 1040.000000002420384 JUXTAPID 20 MG CAPSULE ORL CAP AEP CAP 1040.000000002420341 JUXTAPID 5 MG CAPSULE ORL CAP AEP CAP 1040.000000002412365 KADCYLA 20 MG/ML INJECTION POWDER FOR SOLUTION INJ DEFAUL HLR ML 430.000000002312301 KALETRA 100 MG/25 MG TABLET ORL TAB ABV TAB 2.999000002285533 KALETRA 200 MG/50 MG TABLET ORL TAB ABV TAB 5.997900002243644 KALETRA 80MG/20MG ORAL SOLUTION ORL SOL ABV ML 2.374000002417235 KAZANO 12.5 MG/1000 MG TABLET ORL TAB TAK TAB 1.370000002417219 KAZANO 12.5 MG/500 MG TABLET ORL TAB TAK TAB 1.370000002417227 KAZANO 12.5 MG/850 MG TABLET ORL TAB TAK TAB 1.370000080011529 K-CITRA 2 MEQ/ML SOLUTION ORL LIQ SFD ML 0.034900002243768 K-CITRA POTASSIUM CITRATE 10 MEQ SRT ORL SRT SFD TAB 0.290100000376167 KEMSOL 70% TOPICAL SOLUTION TOP SOL AXS ML 0.278600000224391 KETALAR 10 MG/ML INJECTION INJ DEFAUL ERF ML 1.738500000224405 KETALAR 50 MG/ML INJECTION INJ DEFAUL ERF ML 5.759000002246796 KETAMINE 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 5.435000002246795 KETAMINE HYDROCHLORIDE 10 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.787500002244947 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL PPC ML 5.433200002400871 KETOTIFEN 0.25 MG/ML OPH SOLUTION OPH SOL STM ML 4.600000001926438 KIDROLASE 10,000 UNIT/VIAL INJECTION INJ DEFAUL AVE VIAL 134.790000080020666 KID'S LIQUID VITAMIN D 400 IU ORL LIQ WBP ML 0.141000002269341 KIVEXA 600 MG/300 MG TABLET ORL TAB GSK TAB 25.286300001928783 KOFFEX SIROP 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.020200002389185 KOMBOGLYZE 2.5 MG/1000 MG TABLET ORL TAB AZC TAB 1.380000002389169 KOMBOGLYZE 2.5 MG/500 MG TABLET ORL TAB AZC TAB 1.380000002389177 KOMBOGLYZE 2.5 MG/850 MG TABLET ORL TAB AZC TAB 1.380000080022006 KRILL OIL SOFTGEL CAPSULE ORL CAP WBP CAP 0.229700002350580 KUVAN 100 MG TABLET ORL TAB BMI TAB 33.000000080004073 KYOLIC AGED GARLIC EXTRACT ORAL CAPLET ORL TAB WKG TAB 0.599100002185881 KYTRIL 1 MG TABLET ORL TAB HLR TAB 10.0730

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002387468 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL MYP ML 1.293000002231689 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL SDZ ML 1.510500000210889 LACRI-LUBE OPH OINTMENT OPH ONT ALL G 2.114300002250624 LACRISERT 5 MG OPHTHALMIC INSERT OPH INS ATP DEV 3.362300080012831 LACTOBACILLUS ACIDOPHILUS & BIFIDUS ORL CAP SWS CAP 0.112300000468401 LAIT DE MAGNESIE ORL SUSP (MILK OF MAGNESIA) ORL SUS ATL ML 0.006900002243803 LAMICTAL 2 MG CHEWABLE TABLET ORL CTB GSK TAB 0.184700002428210 LAMOTRIGINE 100 MG TABLET ORL TAB SIV TAB 0.373500002428229 LAMOTRIGINE 150 MG TABLET ORL TAB SIV TAB 0.550500002428202 LAMOTRIGINE 25 MG TABLET ORL TAB SIV TAB 0.093600002385767 LANSOPRAZOLE 15 MG DELAYED-RELEASE CAPSULE ORL DRC SIV CAP 0.500000002433001 LANSOPRAZOLE 15 MG DELAYED-RELEASE CAPSULE ORL DRC PMS CAP 0.500000002366282 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.600000002433028 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PMS CAP 0.500000002385775 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC SIV CAP 0.500000000608734 LANSOYL JELLY 78% ORL GEL JOU G 0.049500002186926 LANSOYL SUGAR FREE JELLY 78% ORL GEL JOU G 0.046700000282081 LANVIS 40 MG TABLET ORL TAB APR TAB 4.820400002224690 LASIX 20 MG TABLET ORL TAB SAV TAB 0.087300002375508 LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL RIV ML 3.632000002422050 LATUDA 20 MG TABLET ORL TAB SUN TAB 4.386000002413361 LATUDA 60 MG TABLET ORL TAB SUN TAB 4.433700002415828 LEFLUNOMIDE 10 MG TABLET ORL TAB PDL TAB 2.643300002415836 LEFLUNOMIDE 20 MG TABLET ORL TAB PDL TAB 2.643300002418320 LEMTRADA 12 MG/1.2 ML INJECTION INJ DEFAUL GZM VIAL 11964.000000002347997 LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.756000002338459 LETROZOLE 2.5 MG TABLET ORL TAB AHI TAB 3.061700002402025 LETROZOLE 2.5 MG TABLET ORL TAB PDL TAB 1.378000002183005 LEUCOVORIN CALCIUM 10 MG/ML INJECTION INJ DEFAUL MNP ML 12.704000000004626 LEUKERAN 2 MG TABLET ORL TAB APR TAB 1.559200002236840 LEVAQUIN 25 MG/ML INJECTION INJ DEFAUL JAI ML 2.289500002236841 LEVAQUIN 250 MG TABLET ORL TAB JAI TAB 5.032400002236839 LEVAQUIN 5 MG/ML INJECTION INJ DEFAUL JAI ML 0.457800002412829 LEVEMIR FLEXTOUCH 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 7.734000002250470 LEVITRA 10 MG TABLET ORL TAB BAI TAB 13.292500002250489 LEVITRA 20 MG TABLET ORL TAB BAI TAB 14.395000002250462 LEVITRA 5 MG TABLET ORL TAB BAI TAB 11.9150

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002415879 LEVOFLOXACIN 500 MG TABLET ORL TAB PDL TAB 1.371800002245948 LEVOTHYROXINE SODIUM 0.5 MG/VIAL INJECTION INJ DEFAUL PPC VIAL 220.840000002243933 LEVULAN KERASTICK 20% TOPICAL SOLUTION TOP SOL DSP ML 166.000000002296187 LIDOCAINE HCL 2% INJECTION (BLOCK OR INFILTRATION) INJ LIQ ALV ML 1.050000000436208 LIDOCAINE HYDROCHLORIDE 2% INJECTION INJ DEFAUL HSP ML 5.934000002231147 LIDODAN ENDOTRACHEAL 10 MG/DOSE NON-AEROSOL SPRAY TOP SPR ODN DOSE 0.216000000874949 LIDOMYXIN OTIC LIQUID OT LIQ SDZ ML 0.614000002243101 LIFE BRAND DAILY LOW DOSE ASA 81 MG ECT ORL ECT PMS TAB 0.159700080003212 LIFE BRAND ORAL LAXATIVE ORL LIQ HJS ML 0.092000000030732 LINCOCIN 300 MG/ML INJECTION INJ DEFAUL PFI ML 2.942000002402637 LINEZOLID 2 MG/ML INJECTION INJ DEFAUL TEV ML 0.295800002269082 LIPIDIL EZ 145 MG TABLET ORL TAB FOU TAB 1.192700002269074 LIPIDIL EZ 48 MG TABLET ORL TAB FOU TAB 0.465700080006893 LIQUID CALCIUM WITH VITAMIN D ORL LIQ WBP ML 0.017600080001853 LIQUID GLUCOSAMINE ORL LIQ JAM ML 0.032300080007222 LIQUID OMEGA-3 PLUS VITAMIN A & D ORL LIQ WNP ML 0.098400002266695 LITHMAX 300 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.271100002131625 LIVOSTIN 0.5 MG/ML (BASE) OPH SUSPENSION OPH SUS NOV ML 5.136000002020017 LIVOSTIN 50 MCG PER DOSE NASAL SPRAY NAS SPR JAI ML 1.942700000074462 LOCACORTEN VIOFORM TOPICAL CREAM TOP CRM PAL G 0.993300002417456 LOLO (28 DAY) TABLET ORL TB ASC TAB 0.645400000590819 LOPRESOR 1.0 MG/ML INJECTION INJ DEFAUL NOV ML 1.330000002221810 LOPROX 1% TOPICAL LOTION TOP LOT VCL ML 0.542300002244692 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.444200002243278 LORAZEPAM 4 MG INJECTION USP INJ DEFAUL SDZ ML 21.200000002394383 LOSARTAN 100 MG TABLET ORL TAB PDL TAB 0.314700002394367 LOSARTAN 25 MG TABLET ORL TAB PDL TAB 0.314700002394375 LOSARTAN 50 MG TABLET ORL TAB PDL TAB 0.314700002394405 LOSARTAN-HCTZ 100 MG/12.5 MG TABLET ORL TAB PDL TAB 0.308300002394413 LOSARTAN-HCTZ 100 MG/25 MG TABLET ORL TAB PDL TAB 0.314700002394391 LOSARTAN-HCTZ 50 MG/12.5 MG TABLET ORL TAB PDL TAB 0.314600002119579 LOSEC 10 MG SUSTAINED-RELEASE CAPSULE ORL SRC AZC CAP 1.007900002421941 LOTEMAX 0.5% OPHTHALMIC OINTMENT OPH ONT BSH G 6.285700002321114 LOTEMAX 0.5% OPHTHALMIC SUSPENSION OPH SUS BSH ML 4.782000002179709 LOZIDE 1.25 MG TABLET ORL TAB SEV TAB 0.323700002425629 LUCENTIS 10 MG/ML INJECTION SYRINGE INJ DEFAUL NOV SYR 1575.000000002239833 LUPRON DEPOT 30 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1535.1000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242933 LUSTRA 4% TOPICAL CREAM TOP CRM MEI G 1.162000002242934 LUSTRA-AF TOPICAL CREAM TOP CRM MEI G 1.293000002046210 LUTREPULSE 0.8 MG/VIAL INJECTION INJ DEFAUL FEI VIAL 115.000000002269066 LUVERIS 75 IU/VIAL INJECTION INJ DEFAUL SRO VIAL 28.480000002366924 LUXIQ 0.12% TOPICAL FOAM TOP FOA GSK G 0.818400002268450 LYRICA 150 MG CAPSULE ORL CAP PFI CAP 2.502200002268477 LYRICA 225 MG CAPSULE ORL CAP PFI CAP 2.502200002268418 LYRICA 25 MG CAPSULE ORL CAP PFI CAP 0.894300002268485 LYRICA 300 MG CAPSULE ORL CAP PFI CAP 2.502200002268426 LYRICA 50 MG CAPSULE ORL CAP PFI CAP 1.402800002268434 LYRICA 75 MG CAPSULE ORL CAP PFI CAP 1.815200000463221 LYSODREN 500 MG TABLET ORL TAB BMS TAB 4.890500002244690 MAALOX ANTACID WITH ANTI-GAS EXTRA STRENGTH SUSP ORL SUS NVC ML 0.022400002244689 MAALOX ANTACID WITH ANTI-GAS ORAL SUSPENSION ORL SUS NVC ML 0.019200002238291 MAALOX QUICK DISSOVE EXTRA STR. CHEWABLE TABLET ORL TAB NVC TAB 0.109400002267225 MACUGEN 0.3 MG/SYR INJECTION SYRINGE INJ NDL PFI SYR 995.000000002068400 MAGNESIUM 100 MG TABLET ORL TAB JAM TAB 0.072800080025339 MAGNESIUM 250 MG TABLET ORL TAB WNP TAB 0.049100002040921 MAGNESIUM 50 MG TABLET ORL TAB JAM TAB 0.057700080005581 MAGNESIUM CITRATE 150 MG CAPSULE ORL CAP WBP CAP 0.079000080005079 MAGNESIUM COMPLEX 250 MG CAPLET ORL TAB JAM TAB 0.094900002247017 MAGNESIUM COMPLEX 250 MG TABLET ORL TAB JAM TAB 0.045000080013414 MAGNESIUM EXTRA STRENGTH 500 MG TABLET ORL TAB WNP TAB 0.077500000299448 MAGNESIUM OXIDE 420 MG TABLET ORL TAB VCL TAB 0.034800080014800 MAGNESIUM PLUS CALCIUM POWDER FOR SUSPENSION ORL PWRSUS NCC G 0.097300000392618 MAGNESIUM SULFATE 20% INJECTION INJ DEFAUL SDZ ML 0.511700000602264 MAGNESIUM SULFATE 50% INJECTION USP INJ DEFAUL SDZ ML 1.645000002139499 MAGNESIUM SULFATE 500 MG/ML INJECTION USP INJ DEFAUL PPC ML 0.431000000202045 MAGNOLAX ORAL EMULSION ORL EML PPH ML 0.014200001927639 MAJEPTIL 10 MG (BASE) TABLET ORL TAB ERF TAB 0.544200002264935 MALARONE PEDIATRIC TABLET ORL TAB GSK TAB 1.686700002238151 MALARONE TABLET ORL TAB GSK TAB 5.062500002243459 MALTLEVOL-12 ORAL LIQUID ORL LIQ CHD ML 0.022200000499013 MANDELAMINE 500 MG TABLET ORL TAB ERF TAB 0.396600000899356 MANERIX 150 MG TABLET ORL TAB MED TAB 0.690800002166747 MANERIX 300 MG TABLET ORL TAB MED TAB 1.371200002429861 MAR-AMITRIPTYLINE 10 MG TABLET ORL TAB MAR TAB 0.0664

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002429888 MAR-AMITRIPTYLINE 25 MG TABLET ORL TAB MAR TAB 0.121100002429896 MAR-AMITRIPTYLINE 50 MG TABLET ORL TAB MAR TAB 0.234700002429918 MAR-AMITRIPTYLINE 75 MG TABLET ORL TAB MAR TAB 0.363400002371707 MAR-AMLODIPINE 2.5 MG TABLET ORL TAB MAR TAB 0.172600002379562 MAR-ANASTROZOLE 1 MG TABLET ORL TAB MAR TAB 3.328000002241918 MARCAINE 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 0.815600002241919 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.970400002305909 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.969600002241917 MARCAINE 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 1.971800002241915 MARCAINE E 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 0.845400002241914 MARCAINE SPINAL 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 12.722500002403870 MAR-DOMPERIDONE 10 MG TABLET ORL TAB MAR TAB 0.164600002422662 MAR-EZETIMIBE 10 MG TABLET ORL TAB MAR TAB 0.461200000611190 MARINOL 2.5 MG CAPSULE ORL CAP ABB CAP 2.229200000611204 MARINOL 5 MG CAPSULE ORL CAP ABB CAP 4.458200002373424 MAR-LETROZOLE 2.5 MG TABLET ORL TAB MAR TAB 3.061700002422484 MAR-LOSARTAN 100 MG TABLET ORL TAB MAR TAB 0.314700002422468 MAR-LOSARTAN 25 MG TABLET ORL TAB MAR TAB 0.314700002422476 MAR-LOSARTAN 50 MG TABLET ORL TAB MAR TAB 0.314700002432560 MAR-MODAFINIL 100 MG TABLET ORL TAB MAR TAB 0.929300002389118 MAR-OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB MAR TAB 6.962300002389126 MAR-OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB MAR TAB 7.590000002416557 MAR-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT MAR TAB 1.275000002411946 MAR-PAROXETINE 10 MG TABLET ORL TAB MAR TAB 1.043000002420503 MAR-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB MAR CAP 0.855000002432102 MAR-TOPIRAMATE 100 MG TABLET ORL TAB MAR TAB 0.592800002432110 MAR-TOPIRAMATE 200 MG TABLET ORL TAB MAR TAB 0.885300002432099 MAR-TOPIRAMATE 25 MG TABLET ORL TAB MAR TAB 0.312800002388324 MAR-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MAR TAB 0.626400000012750 MATULANE 50 MG CAPSULE ORL CAP SGM CAP 63.106400002244533 MAXILENE 4% TOPICAL CREAM TOP CRM RGR G 1.738000002245939 MAXILENE 5 % TOPICAL CREAM TOP CRM RGR G 1.590000002163632 MAXIPIME 1 G/VIAL INJECTION INJ DEFAUL TMD VIAL 17.765000002163640 MAXIPIME 2 G/VIAL INJECTION INJ DEFAUL TMD VIAL 35.525000002379104 MED-ANASTROZOLE 1 MG TABLET ORL TAB GMP TAB 1.782000002426935 MED-LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL GMP ML 3.632000002253550 MEDROXY-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.0416

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 56 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002253577 MEDROXY-5 5MG TABLET ORL TAB PDL TAB 0.082300002322250 MEDROXYPROGESTERONE ACETATE 150 MG/ML INJECTION INJ DEFAUL SDZ ML 22.660000002244366 MEFLOQUINE 250 MG TABLET ORL TAB AAP TAB 4.015000002040891 MEGA-CAL CALCIUM W/ VITAMIN D 650 MG/200 UNIT CPT ORL TAB JAM TAB 0.102800002242594 MEGA-VIM CAPLET ORL TAB JAM TAB 0.189300002409623 MEKINIST 0.5 MG TABLET ORL TAB GSK TAB 77.937300002409658 MEKINIST 2 MG TABLET ORL TAB GSK TAB 311.750000080006449 MELATONIN TIMED RELEASED ORL TAB PLH TAB 0.055600002353156 MELOXICAM 15 MG TABLET ORL TAB SNS TAB 0.567000002353148 MELOXICAM 7.5 MG TABLET ORL TAB SNS TAB 0.491300002279924 MENACTRA A/C/Y/W-135 (0.5ML SINGLE-DOSE) INJECTION INJ DEFAUL SFP ML 239.060000002248649 MENINGITEC (10 MCG/15 MCG) 0.5 ML INJECTION INJ DEFAUL NBV ML 139.800000002243820 MENJUGATE VACCINE (10 MCG/25 MCG) .5 ML INJECTION INJ DEFAUL NOV VIAL 96.710000000588490 MENOMUNE A/C/Y/W-135 (MULTI-DOSE) INJECTION INJ DEFAUL SFP VIAL 157.290000001959018 MENOMUNE A/C/Y/W-135 (SINGLE-DOSE) INJECTION INJ DEFAUL SFP VIAL 174.110000002283093 MENOPUR 75 IU/VIAL INJECTION INJ DEFAUL FEI VIAL 69.000000002347393 MENVEO 0.5 ML INJECTION INJ DEFAUL NOV ML 217.160000000725749 MEPERIDINE HYDROCHLORIDE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 1.338000000725757 MEPERIDINE HYDROCHLORIDE 75 MG/ML INJECTION INJ DEFAUL SDZ ML 1.263000002415275 MERCAPTOPURINE 50 MG TABLET ORL TAB STM TAB 3.109200002378795 MEROPENEM 1G/VIAL INJECTION INJ DEFAUL SDZ VIAL 47.990000002378787 MEROPENEM 500 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 23.995000002047667 MERSYNDOL WITH CODEINE TABLET ORL TAB SAV TAB 0.229600002241615 METAMUCIL FIBRE APPLE CRISP 3.4 G/2 WAFERS ORL WAF PGI WAF 0.224500002241614 METAMUCIL FIBRE CINNAMON SPICE 3.4 G/2 WAFERS ORL WAF PGI WAF 0.212000002174812 METAMUCIL FIBRE THERAPY 3.4 G/TSP ORAL POWDER ORL PWR PGI G 0.028500002247034 METAMUCIL FIBRE THERAPY CAPSULE ORL CAP PGI CAP 0.129300002174782 METAMUCIL FIBRE THERAPY-SMOOTH TEXTURE-ORANGE S.F. ORL PWR PGI G 0.072700002174790 METAMUCIL SMOOTH TEXTURE-ORANGE 3 G/TBSP ORAL PWDR ORL PWR PGI G 0.016700002174804 METAMUCIL SMOOTH UNFLAVORED SUGAR FREE POWDER ORL PWR PGI G 0.033900002398427 METHOTREXATE (PRESERVED) 25 MG/ML INJECTION USP INJ DEFALT SDZ ML 8.370000002182971 METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL MNP ML 7.875500002417626 METHOTREXATE 25 MG/ML INJECTION (UNPRESERVED) INJ DEFAUL MYP ML 6.250000002182947 METHOTREXATE SODIUM (UNPRESERVED) 10 MG/ML INJ INJ DEFAUL MNP ML 8.981000002230521 METHOXACET CAPLET ORL TAB RPH TAB 0.335000002236872 METHOXACET-C 1/8 CAPLET ORL TAB RPH TAB 0.626700000868868 METHOXISAL CAPLET ORL TAB RPH TAB 0.2772

Page 57: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 57 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001966375 METHOXISAL-C 1/2 TABLET ORL TAB RPH TAB 1.035000001966367 METHOXISAL-C 1/4 TABLET ORL TAB RPH TAB 0.882500001941895 METHOXISAL-C 1/8 CAPLET ORL TAB RPH TAB 0.566700002326248 METHYLPHENIDATE 10 MG TABLET ORL TAB PDL TAB 0.126200002326256 METHYLPHENIDATE 20 MG TABLET ORL TAB PDL TAB 0.243500002326221 METHYLPHENIDATE 5 MG TABLET ORL TAB PDL TAB 0.094700002243563 METOCLOPRAMIDE OMEGA 5MG/ML INJECTION INJ DEFAUL OMG ML 1.025000002320037 METOJECT 10 MG/1 ML INJECTION SYRINGE INJ NDL MDX SYR 53.100000002320045 METOJECT 15 MG/1.5 ML INJECTION SYRINGE INJ NDL MDX SYR 58.700000002304767 METOJECT 20 MG/2 ML INJECTION SYRINGE INJ NDL MDX SYR 64.280000002320053 METOJECT 25 MG/2.5 ML INJECTION SYRINGE INJ NDL MDX SYR 69.880000002320029 METOJECT 7.5 MG/0.75 ML INJECTION SYRINGE INJ NDL MDX SYR 50.310000002351404 METOPROLOL SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.141500002351412 METOPROLOL SR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.249900000648027 METOPROLOL-100 MG TABLET ORL TAB PDL TAB 0.125000000648019 METOPROLOL-50 MG TABLET ORL TAB PDL TAB 0.062400002092832 METROGEL 0.75% TOPICAL GEL TOP GEL GAL G 1.448800002248562 METRONIDAZOLE 500 MG CAPSULE ORL CAP AAP CAP 0.763700002323273 METVIX 16.8% TOPICAL CREAM TOP CRM GAL G 162.820000000795860 MEVACOR 20 MG TABLET ORL TAB MFC TAB 2.061000000795852 MEVACOR 40 MG TABLET ORL TAB MFC TAB 3.764700002085852 MICATIN 2% TOPICAL CREAM TOP CRM WSP G 0.384000002171775 MICONAZOLE 3 DAY OVULE TREATMENT VAG OVL VTH OVL 1.696600002091143 MICRO PLUS 4 CONCETRATE INJECTION INJ DEFAUL SDZ ML 2.527600002091135 MICRO PLUS 4 REGULAR STRENGTH INJECTION INJ DEFAUL SDZ ML 0.909000002063905 MICROLAX MICRO RECTAL ENEMA RT ENM JJM ENM 1.295000000787000 MICRO-ZN 5 MG/ML INJECTION INJ DEFAUL SDZ ML 2.404200000487805 MIDAMOR 5 MG TABLET ORL TAB OPI TAB 0.286000002240285 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.847600002242904 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL PPC ML 1.244000002242905 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL PPC ML 4.455500002382873 MIDAZOLAM INJECTION SDZ 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.847500002244622 MILRINONE LACTATE 1 MG/ML INJECTION INJ DEFAUL PPC ML 5.061000001935348 MINERAL OIL (HEAVY) ORL LIQ RBW ML 0.008800000485802 MINERAL OIL 100% ORAL LIQUID ORL LIQ RPH ML 0.012200002246500 MINIRIN 0.1 MG TABLET ORL TAB FEI TAB 1.436100002393573 MINT-ANASTROZOLE 1 MG TABLET ORL TAB MPI TAB 1.7821

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 58 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002423243 MINT-EZETIMIBE 10 MG TABLET ORL TAB MPI TAB 0.475000002425947 MINT-HYDROCHLOROTHIAZIDE 12.5 MG TABLET ORL TAB MPI TAB 0.034100002426196 MINT-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB MPI TAB 0.015700002426218 MINT-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB MPI TAB 0.021700002422999 MINT-IRBESARTAN 150 MG TABLET ORL TAB MPI TAB 0.302500002423006 MINT-IRBESARTAN 300 MG TABLET ORL TAB MPI TAB 0.302500002422980 MINT-IRBESARTAN 75 MG TABLET ORL TAB MPI TAB 0.302500002326477 MINT-PIOGLITAZONE 15 MG TABLET ORL TAB MPI TAB 0.580900002326485 MINT-PIOGLITAZONE 30 MG TABLET ORL TAB MPI TAB 0.813900002326493 MINT-PIOGLITAZONE 45 MG TABLET ORL TAB MPI TAB 1.223700002393085 MINT-SILDENAFIL 100 MG TABLET ORL TAB MPI TAB 9.200000002393069 MINT-SILDENAFIL 25 MG TABLET ORL TAB MPI TAB 8.290000002393077 MINT-SILDENAFIL 50 MG TABLET ORL TAB MPI TAB 8.847500002389800 MINT-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MPI TAB 0.626400000042544 MIOSTAT 0.01% OPH SOLUTION OPH SOL ALC ML 13.511700002241594 MIRAPEX 0.5 MG TABLET ORL TAB BOE TAB 2.355000002312786 MIRTAZAPINE-30 30 MG TABLET ORL TAB PDL TAB 0.195000002248846 MISOPROSTOL-200 200 MCG TABLET ORL TAB PDL TAB 0.285000002230451 MITOMYCIN 20 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 377.200000002230450 MITOMYCIN 5 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 94.300000001948873 MIXED VESPID VENOM PROTEIN 1.1 MG VIAL INJ INJ DEFAUL ALK ML 71.383300001948881 MIXED VESPID VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 71.383300000466085 M-M-R II VIRUS VACCINE LIVE ATTENUATED INJECTION INJ DEFAUL MSD VIAL 32.176000002242786 MOBICOX 15 MG TABLET ORL TAB BOE TAB 1.004400002242785 MOBICOX 7.5 MG TABLET ORL TAB BOE TAB 0.870500002238696 MOI-STIR SPRAY ORAL LIQUID ORL LIQ PMS ML 0.067500001909142 MOISTUREL TOPICAL CREAM TOP CRM WSD G 0.060100001909169 MOISTUREL TOPICAL LOTION TOP LOT WSD ML 0.022000002239601 MONISTAT 1 1200 MG VAGINAL OVULE VAG OVL MCL OVL 12.740000002244005 MONISTAT 3 4% VAGINAL CREAM VAG CRM MCL G 0.849300002126605 MONISTAT 3 400 MG VAGINAL OVULE VAG OVL MCL OVL 4.246700002126249 MONISTAT 3 DUAL-PAK KIT VAG/TOP OVL/CRM MCL KIT 14.590000002084309 MONISTAT 7 2% VAGINAL CREAM VAG CRM MCL G 0.364000002126257 MONISTAT 7 DUAL-PAK VAGINAL OVULE/TOPICAL CREAM VAG/TOP OVL/CRM MCL KIT 14.590000002126567 MONISTAT DERM 2% TOPICAL CREAM TOP CRM MCL G 0.416700002239600 MONISTAT-1 COMBINATION PACK VAG OVULE/TOP CREAM VAG/TOP OVL/CRM MCL KIT 14.590000001907107 MONOPRIL 10 MG TABLET ORL TAB BMS TAB 0.9262

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 59 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001907115 MONOPRIL 20 MG TABLET ORL TAB BMS TAB 1.113800000999332 MONOVISC DEFAUL DEV PMS ML 93.750000002379856 MONTELUKAST 10 MG TABLET ORL TAB PDL TAB 0.946000002379821 MONTELUKAST 4 MG TABLET ORL TAB PDL TAB 0.946000002379848 MONTELUKAST 5 MG TABLET ORL TAB PDL TAB 0.946000000676411 MORPHINE HP 25 25 MG/ML INJECTION INJ DEFAUL SDZ ML 3.721000002350920 MORPHINE SR 100 MG SUSTAINED RELEASE TABLET ORL SRT SNS TAB 1.040000002350947 MORPHINE SR 200 MG SUSTAINED RELEASE TABLET ORL SRT SNS TAB 1.933600001964437 MORPHINE SULFATE 2 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.260400001964429 MORPHINE SULFATE 5 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.415300001980696 MORPHINE SULFATE 1 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.372600002242484 MORPHINE SULFATE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 1.949000080028360 MOTION MEDICINE TOPICAL CREAM TOP CRM NDP G 0.121200002186934 MOTRIN IB 200 MG TABLET ORL TAB MCL TAB 0.130400080001844 MSM 1000 MG ORL TAB WNP TAB 0.068600002125013 MUCAINE ORAL SUSPENSION ORL SUS AXC ML 0.024300000599875 MUCILLIUM 500 MG/G ORAL POWDER ORL PWR PMS G 0.018500002330989 MULTAQ 400 MG TABLET ORL TAB SAV TAB 2.338000000782203 MULTI VITAMIN PLUS IRON TABLET ORL TAB VTH TAB 0.060000000782211 MULTI VITAMIN TABLET ORL TAB VTH TAB 0.027000000586315 MULTI-1000 INJECTION INJ DEFAUL SDZ ML 0.819700002100606 MULTI-12 INJECTION INJ DEFAUL SDZ ML 0.915000002244898 MULTIPLE VITAMIN TABLET ORL TAB PMT TAB 0.070000000374083 MULTIPLE VITAMIN WITH MINERAL TABLET ORL TAB ADA TAB 0.110000002248775 MULTISURE FOR WOMEN ORL CAP WNP CAP 0.170200002248778 MULTISURE FOR WOMEN OVER 50 GELATIN CAPSULE ORL CAP WBP CAP 0.127600002240942 MULTI-TAR PLUS REGULAR TOPICAL SHAMPOO TOP SHP VCL ML 0.038100000233498 MULTIVITAMIN TABLET ORL TAB WAM TAB 0.222600080005483 MULTI-VITAMIN TABLET ORL TAB WNP TAB 0.035700002242779 MULTIVITAMINS & MULTIMINERALS FORMULA FORTE SR.TAB ORL TAB PMT TAB 0.080000002242939 MULTIVITAMINS + MULTIMINERALS 50+ FORMULA TAB. ORL TAB PMT TAB 0.066500002242780 MULTIVITAMINS AND MULTIMINERALS FORMULA FORTE TAB ORL TAB PMT TAB 0.067800002244864 MULTIVITAMINS FOR ADULTS TABLET ORL TAB PMT TAB 0.030000000750816 MURO-128 5% OPH OINTMENT OPH ONT BSH G 3.125700000750824 MURO-128 5% OPH SOLUTION OPH SOL BSH ML 0.729300002238595 MUSE 1000 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 33.760000002238593 MUSE 250 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 33.7600

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 60 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002238594 MUSE 500 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 33.760000000016063 MUSTARGEN HCL TRITURATION 10 MG/VIAL INJECTION INJ DEFAUL LUI VIAL 8.550000002415380 MYA 28 TABLET ORL TB APX TAB 0.459600002311054 MYCAMINE 100 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 196.000000002294222 MYCAMINE 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 98.000000002264560 MYFORTIC 180 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 2.170800002264579 MYFORTIC 360 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 4.341500002270110 MYLAN-ALENDRONATE 5 MG TABLET ORL TAB MYP TAB 1.037000002229813 MYLAN-ALPRAZOLAM 1 MG TABLET ORL TAB MYP TAB 0.336800002229814 MYLAN-ALPRAZOLAM 2 MG TABLET ORL TAB MYP TAB 0.550800002139200 MYLAN-AMANTADINE 100 MG CAPSULE ORL CAP MYP CAP 0.517900002253054 MYLAN-ANAGRELIDE 0.5 MG CAPSULE ORL CAP MYP CAP 3.349100002361418 MYLAN-ANASTROZOLE 1 MG TABLET ORL TAB MYP TAB 2.749700002378981 MYLAN-ATOMOXETINE 100 MG CAPSULE ORL CAP MYP CAP 4.352000002378930 MYLAN-ATOMOXETINE 18 MG CAPSULE ORL CAP MYP CAP 2.650000002378949 MYLAN-ATOMOXETINE 25 MG CAPSULE ORL CAP MYP CAP 2.928100002378957 MYLAN-ATOMOXETINE 40 MG CAPSULE ORL CAP MYP CAP 3.337500002378965 MYLAN-ATOMOXETINE 60 MG CAPSULE ORL CAP MYP CAP 3.702400002378973 MYLAN-ATOMOXETINE 80 MG CAPSULE ORL CAP MYP CAP 3.996000002402165 MYLAN-ATOVAQUONE/PROGUANIL 250 MG/ 100 MG TABLET ORL TAB MYP TAB 4.488700002302403 MYLAN-BICALUTAMIDE 50 MG TABLET ORL TAB MYP TAB 4.057300002384426 MYLAN-BISOPROLOL 10 MG TABLET ORL TAB MYP TAB 0.145000002384418 MYLAN-BISOPROLOL 5 MG TABLET ORL TAB MYP TAB 0.108000002383500 MYLAN-BOSENTAN 125 MG TABLET ORL TAB MYP TAB 22.462500002383497 MYLAN-BOSENTAN 62.5 MG TABLET ORL TAB MYP TAB 22.462500002241003 MYLAN-BUDESONIDE AQ 64 MCG/DOSE MET DOSE NAS SPRAY NAS SPM MYP DOSE 0.091700002408090 MYLAN-BUPRENORPHINE NALOXONE 2 MG/0.5 MG SUBL TAB ORL SLT MYP TAB 2.269500002408104 MYLAN-BUPRENORPHINE NALOXONE 8 MG/2 MG SUBL TAB ORL SLT MYP TAB 4.020500002379120 MYLAN-CANDESARTAN 4 MG TABLET ORL TAB MYP TAB 0.340000002241883 MYLAN-CARBAMAZEPINE CR 400 MG SUSTAIN RELEASE TAB ORL SRT MYP TAB 0.185900002227479 MYLAN-CIMETIDINE 800 MG TABLET ORL TAB MYP TAB 0.243000002381524 MYLAN-EFAVIRENZ 600 MG TABLET ORL TAB MYP TAB 12.181700002383039 MYLAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 2.030900002383047 MYLAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 2.030900002247323 MYLAN-ETI-CAL CAREPAC 400 MG/500 MG TABLET ORL TAB MYP TAB 0.222100002392631 MYLAN-FINASTERIDE HG 1 MG TABLET ORL TAB MYP TAB 1.145300002397471 MYLAN-GABAPENTIN 600 MG TABLET ORL TAB MYP TAB 1.3045

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 61 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002397498 MYLAN-GABAPENTIN 800 MG TABLET ORL TAB MYP TAB 1.739300002185407 MYLAN-GEMFIBROZIL 300 MG CAPSULE ORL CAP MYP CAP 0.128800002230476 MYLAN-GEMFIBROZIL 600 MG TABLET ORL TAB MYP TAB 0.515700000808733 MYLAN-GLYBE 2.5 MG TABLET ORL TAB MYP TAB 0.032100002242920 MYLAN-HYDROXYUREA 500 MG CAPSULE ORL CAP MYP CAP 1.108700002319225 MYLAN-LEFLUNOMIDE 10 MG TABLET ORL TAB MYP TAB 6.041700002319233 MYLAN-LEFLUNOMIDE 20 MG TABLET ORL TAB MYP TAB 6.041700002255995 MYLAN-MELOXICAM 15 MG TABLET ORL TAB MYP TAB 0.616100002255987 MYLAN-MELOXICAM 7.5 MG TABLET ORL TAB MYP TAB 0.491400002371154 MYLAN-MYCOPHENOLATE 250 MG CAPSULE ORL CAP MYP CAP 1.031000002370549 MYLAN-MYCOPHENOLATE 500 MG TABLET ORL TAB MYP TAB 2.240600002244563 MYLAN-NABUMETONE 500 MG TABLET ORL TAB MYP TAB 0.362500002387727 MYLAN-NEVIRAPINE 200 MG TABLET ORL TAB MYP TAB 1.728500002382725 MYLAN-OLANZAPINE ODT 15 MG ORALLY DISINTEG. TABLET ORL DISNTAB MYP TAB 4.124000002382733 MYLAN-OLANZAPINE ODT 20 MG ORALLY DISINTEG.TABLET ORL DISNTAB MYP TAB 7.597700002230800 MYLAN-OXYBUTYNIN 5 MG TABLET ORL TAB MYP TAB 0.098600002248012 MYLAN-PAROXETINE 10 MG TABLET ORL TAB MYP TAB 1.043000002298279 MYLAN-PIOGLITAZONE 15 MG TABLET ORL TAB MYP TAB 0.631200002298287 MYLAN-PIOGLITAZONE 30 MG TABLET ORL TAB MYP TAB 0.884400002298295 MYLAN-PIOGLITAZONE 45 MG TABLET ORL TAB MYP TAB 1.329700002376369 MYLAN-PRAMIPEXOLE 0.5 MG TABLET ORL TAB MYP TAB 1.051400002245372 MYLAN-PROPAFENONE 150 MG TABLET ORL TAB MYP TAB 0.322200002245373 MYLAN-PROPAFENONE 300 MG TABLET ORL TAB MYP TAB 0.568000002397773 MYLAN-RISEDRONATE 150 MG TABLET ORL TAB MYP TAB 40.950000002332809 MYLAN-RIVASTIGMINE 1.5 MG CAPSULE ORL CAP MYP CAP 1.302900002332817 MYLAN-RIVASTIGMINE 3 MG CAPSULE ORL CAP MYP CAP 1.302900002332825 MYLAN-RIVASTIGMINE 4.5 MG CAPSULE ORL CAP MYP CAP 1.302900002332833 MYLAN-RIVASTIGMINE 6 MG CAPSULE ORL CAP MYP CAP 1.302900002229778 MYLAN-SOTALOL 80 MG TABLET ORL TAB MYP TAB 0.296600002268906 MYLAN-SUMATRIPTAN 25 MG TABLET ORL TAB MYP TAB 8.990000002019795 MYLANTA REGULAR STRENGTH CHEWABLE TABLET ORL CTB WLA TAB 0.106200002088428 MYLAN-TAMOXIFEN 10 MG TABLET ORL TAB MYP TAB 0.175000002089858 MYLAN-TAMOXIFEN 20 MG TABLET ORL TAB MYP TAB 0.350000002298570 MYLAN-TAMSULOSIN 0.4 MG EXTENDED-RELEASE CAPSULE ORL SRC MYP CAP 0.237500002272059 MYLAN-TIZANIDINE 4 MG TABLET ORL TAB MYP TAB 0.368600002425599 MYLAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MYP TAB 0.626400002231684 MYLAN-TRAZODONE 100 MG TABLET ORL TAB MYP TAB 0.0989

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 62 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002351560 MYLAN-VALACYCLOVIR 1000 MG CAPLET ORL TAB MYP TAB 3.392400002351579 MYLAN-VALACYCLOVIR 500 MG CAPLET ORL TAB MYP TAB 0.847500002184648 MYLAN-VALPROIC 250 MG CAPSULE ORL CAP MYP CAP 0.136600002383527 MYLAN-VALSARTAN 40 MG TABLET ORL TAB MYP TAB 0.523900002287501 MYLAN-WARFARIN 6 MG TABLET ORL TAB MYP TAB 0.280500002287528 MYLAN-WARFARIN 7.5 MG TABLET ORL TAB MYP TAB 0.301400000004618 MYLERAN 2 MG TABLET ORL TAB APR TAB 1.636400002372169 MYL-LETROZOLE 2.5 MG TABLET ORL TAB MYP TAB 2.756000002408694 MYL-PREGABALIN 150 MG CAPSULE ORL CAP MYP CAP 1.727000002408651 MYL-PREGABALIN 25 MG CAPSULE ORL CAP MYP CAP 0.617300002408708 MYL-PREGABALIN 300 MG CAPSULE ORL CAP MYP CAP 1.727000002408678 MYL-PREGABALIN 50 MG CAPSULE ORL CAP MYP CAP 0.968300002408686 MYL-PREGABALIN 75 MG CAPSULE ORL CAP MYP CAP 1.252900002392593 MYL-SILDENAFIL 100 MG TABLET ORL TAB MYP TAB 9.200700002392577 MYL-SILDENAFIL 25 MG TABLET ORL TAB MYP TAB 8.290000002392585 MYL-SILDENAFIL 50 MG TABLET ORL TAB MYP TAB 8.847700001927612 MYOCHRYSINE 25 MG/ML INJECTION INJ DEFAUL AVE ML 16.082000002226022 MYOFLEX EXTRA STRENGTH 15% CREAM TOP CRM BIC G 0.098800002402874 MYRBETRIQ 25 MG EXTENDED-RELEASE TABLET ORL ERT ASP TAB 1.890800002402882 MYRBETRIQ 50 MG EXTENDED-RELEASE TABLET ORL ERT ASP TAB 1.890800002343282 NABUMETONE 500 MG TABLET ORL TAB SNS TAB 0.376900000828815 NADOLOL-40 MG TABLET ORL TAB PDL TAB 0.246500000818704 NADOLOL-80 MG TABLET ORL TAB PDL TAB 0.351500002382601 NALOXONE HYDROCHLORIDE (PRES. FREE) 0.4 MG/ML INJ INJ DEFAUL SDZ ML 14.936000002148706 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJECTION INJ DEFAUL SDZ ML 14.936000002148714 NALOXONE HYDROCHLORIDE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 20.752000000390283 NAPHCON FORTE 0.1% OPH SOLUTION OPH SOL ALC ML 0.513300000481408 NAPHCON-A OPH SOLUTION OPH SOL ALC ML 0.484000002242505 NAPRELAN 375 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 1.043600002242506 NAPRELAN 500 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 1.372700002162792 NAPROSYN E 250 MG ENTERIC-COATED TABLET ORL ECT HLR TAB 0.417400000618721 NAPROXEN 500 MG TABLET ORL TAB PDL TAB 0.211000002362430 NAPROXEN 220 MG TABLET ORL TAB PMS TAB 0.249600000590762 NAPROXEN 250 MG TABLET ORL TAB PDL TAB 0.106800000655686 NAPROXEN-375 375 MG TABLET ORL TAB PDL TAB 0.145800002153386 NAPROXEN-NA DF 550 MG TABLET ORL TAB PDL TAB 0.666700002229415 NAROPIN 5 MG/ML INJECTION INJ DEFAUL AZC ML 0.3798

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 63 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002213834 NASACORT AQ 55 MCG NASAL METERED DOSE SPRAY NAS SPM SAV DOSE 0.217300002192799 NASAL + SINUS DECONGESTANT RELIEF 60 MG TABLET ORL TAB VTH TAB 0.131700000788503 NASAL DECONGESTANT SPRAY 0.1% NAS LIQ CNF ML 0.092000002409003 NAT-CITALOPRAM 10 MG TABLET ORL TAB NTP TAB 0.143200000024457 NAVANE 10 MG CAPSULE ORL CAP ERF CAP 0.441600080029758 NEBUSAL 7% INHALATION SOLUTION MIS DEFAUL STM ML 0.264200080027142 NEILMED NASAL SINUS RINSE NAS PWS NPI PCKT 0.238400002245057 NEISVAC-C 10 MCG/20 MCG INJECTION SYRINGE INJ NDL SHB SYR 80.185000000147680 NEO-BEX (LIDOCAINE HCL) INJECTION VIAL INJ DEFAUL BRO ML 6.144000000666157 NEOSPORIN IRRIGATING SOLUTION IR SOL GSK ML 1.812500000666122 NEOSPORIN TOPICAL OINTMENT TOP ONT GSK G 0.468000000874957 NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 0.884400000885282 NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.998100001915436 NEOSTIGMINE METHYLSULFATE 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 3.434200002230593 NEOSTIGMINE OMEGA 0.5 MG/ML INJECTION INJ DEFAUL OMG ML 0.940000002230592 NEOSTIGMINE OMEGA 1 MG/ML INJECTION INJ DEFAUL OMG ML 1.050000001958690 NEOSTRATA HQ 2% GEL TOP GEL CDX G 0.812700000999459 NEOVISC DEFAUL DEV STL ML 41.333300000999922 NEPRO ORAL LIQUID ORL LIQ ABN ML 0.009000002028719 NERISALIC OILY TOPICAL CREAM TOP CRM GSK G 0.530300000587826 NERISONE 0.1% TOPICAL CREAM TOP CRM GSK G 0.394300000587834 NERISONE 0.1% TOPICAL OINTMENT TOP ONT GSK G 0.386300080007796 NERVOHEEL N TABLET ORL TAB HEE TAB 0.285800002417197 NESINA 12.5 MG TABLET ORL TAB TAK TAB 2.617700002417200 NESINA 25 MG TABLET ORL TAB TAK TAB 2.617700002417189 NESINA 6.25 MG TABLET ORL TAB TAK TAB 2.617700002403897 NEUPRO 1 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.846700002403900 NEUPRO 2 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.846700002403919 NEUPRO 3 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.063300002403927 NEUPRO 4 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.063300002403935 NEUPRO 6 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.900000002403943 NEUPRO 8 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.811700002239717 NEURONTIN 600 MG TABLET ORL TAB PFI TAB 2.003400002239718 NEURONTIN 800 MG TABLET ORL TAB PFI TAB 2.673700080006269 NEUTROGENA BODY CLEAR BODY WASH PINK GRAPEFRUIT TOP GEL JJI ML 0.027000002308983 NEVANAC 0.1% OPHTHALMIC SUSPENSION OPH SUS ALC ML 4.334000080039670 NEW NORDIC HAIR VOLUME TABLET ORL TAB NNO TAB 0.9313

Page 64: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 64 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002284227 NEXAVAR 200 MG TABLET ORL TAB BAI TAB 49.919600002300524 NEXIUM 10 MG/DOSE DEL REL GRANULES FOR ORAL SUSP ORL DRGRNUL AZC PCKT 2.366700002244521 NEXIUM 20 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.366700002244522 NEXIUM 40 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.366700000232459 NIACIN 100 MG TABLET ORL TAB ADA TAB 0.083000000779806 NIACIN 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC VTH CAP 0.923700000309737 NIACIN 500 MG TABLET ORL TAB JAM TAB 0.059200002244702 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB JAM TAB 0.204700002242138 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB QVS TAB 0.142300002262339 NIASPAN 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.327000002262347 NIASPAN 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.374300002262355 NIASPAN 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.418000002309289 NIASPAN FCT 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.445200002309254 NIASPAN FCT 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.445200002309262 NIASPAN FCT 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.429800002247347 NICORETTE MINI LOZENGE 2 MG ORL LOZ MCL LOZ 0.471400002247348 NICORETTE MINI LOZENGE 4 MG ORL LOZ MCL LOZ 0.542300002065762 NICORETTE PATCH 15MG; NICORETTE COMBOQUIT TOP PTH MCL PTH 3.477100080007461 NICOTINE LOZENGES; THRIVE LOZENGES 1 MG ORL LOZ NOV LOZ 0.274400080007464 NICOTINE LOZENGES; THRIVE LOZENGES 2 MG ORL LOZ NOV LOZ 0.311900080000402 NICOTINELL/THRIVE 4 MG ORAL GUM ORL GUM NVC PIECE 0.311900080000396 NICOTINELL; THRIVE 2 MG ORAL GUM ORL GUM NOV PIECE 0.278100002125226 NIDAGEL 0.75% VAGINAL GEL VAG GEL VCL G 0.323300002325926 NIMOTOP 30 MG TABLET ORL TAB BAI TAB 10.833400002229655 NITRAZADON 10 MG TABLET ORL TAB AAP TAB 0.128200002229654 NITRAZADON 5 MG TABLET ORL TAB AAP TAB 0.070800002182920 NIZORAL 2% TOPICAL SHAMPOO TOP SHP MCL ML 0.102800002397927 NOCDURNA 25 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 1.434300002048485 NOLVADEX-D 20 MG (BASE) TABLET ORL TAB AZC TAB 0.400300080016396 NON-FLUSH/FLUSH FREE NIACIN CAPSULE ORL CAP PLH CAP 0.156000080008766 NORDIC NATURALS ARCTIC COD LIVER OIL ORL LIQ NRD ML 0.110500080007895 NORDIC NATURALS ARCTIC COD LIVER OIL LIQUID ORL LIQ NRD ML 0.082700080002913 NORDIC NATURALS OMEGA-3 LIQUID ORL LIQ NRD ML 0.082700001966154 NORFLEX 100 MG TABLET ORL TAB MMH TAB 0.841400001966162 NORFLEX 30 MG/ML INJECTION INJ DEFAUL GRC ML 5.664200002285576 NORLEVO 0.75 MG TABLET ORL TAB BAI TAB 9.345000000023760 NORLUTATE 5 MG TABLET ORL TAB PFI TAB 1.4693

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 65 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002357593 NORVIR 100 MG FILM-COATED TABLET ORL TAB ABV TAB 1.594000002229145 NORVIR 80 MG SOLUTION ORL SOL ABV ML 1.285400002241480 NORVIR SEC 100 MG CAPSULE ORL CAP ABB CAP 1.561200002049481 NOVAHISTEX DH ADULT ORAL LIQUID ORL LIQ SAV ML 0.186300002049473 NOVAHISTINE DH CHILDREN ORAL LIQUID ORL LIQ SAV ML 0.151700000216666 NOVASEN 325 MG ENTERIC-COATED TABLET ORL ECT TEV TAB 0.032200002314282 NOVO-ALFUZOSIN PR 10 MG PROLONGED-RELEASE TABLET ORL SRT TEV TAB 0.598000002315157 NOVO-AZITHROMYCIN 20 MG/ML PEDIATRIC SUSPENSION ORL SUS TEV ML 0.384000002315165 NOVO-AZITHROMYCIN 40 MG/ML PEDIATRIC SUSPENSION ORL SUS TEV ML 0.544000002310422 NOVO-BENZYDAMINE 0.15% ORAL RINSE ORL RNS TEV ML 0.029900002270226 NOVO-BICALUTAMIDE 50 MG TABLET ORL TAB TEV TAB 4.179000000603678 NOVO-CIMETINE 400 MG TABLET ORL TAB TEV TAB 0.135000002248138 NOVO-CLAVAMOXIN 875 MG/125 MG TABLET ORL TAB TEV TAB 0.571500002309556 NOVO-CYPROTERONE/ETHINYL ESTRADIOL 2MG/0.035MG TAB ORL TAB TEV TAB 1.207600002048698 NOVO-DIFENAC SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT TEV TAB 0.416900002048493 NOVO-DIFLUNISAL FC 250 MG TABLET ORL TAB TEV TAB 0.564700001913468 NOVO-DOXEPIN 100 MG CAPSULE ORL CAP TEV CAP 0.355400001913476 NOVO-DOXEPIN 150 MG CAPSULE ORL CAP TEV CAP 1.249100001913425 NOVO-DOXEPIN 25 MG CAPSULE ORL CAP TEV CAP 0.101500001913433 NOVO-DOXEPIN 50 MG CAPSULE ORL CAP TEV CAP 0.188200001913441 NOVO-DOXEPIN 75 MG CAPSULE ORL CAP TEV CAP 0.378300002300230 NOVO-ENALAPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB TEV TAB 0.564300002300222 NOVO-ENALAPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.507300002324199 NOVO-ETIDRONATECAL 400 MG/500 MG TABLET ORL TAB TEV TAB 0.289200002243551 NOVO-FENOFIBRATE MICRONIZED 67 MG CAPSULE ORL CAP TEV CAP 0.432500000021458 NOVOFERROGLUC 300 MG TABLET ORL TAB TEV TAB 0.025400000595829 NOVO-FIBER 469 MG TABLET ORL TAB TEV TAB 0.074800002239954 NOVO-FLUVOXAMINE 100 MG TABLET ORL TAB TEV TAB 0.567100000389218 NOVO-GESIC 325 MG TABLET ORL TAB TEV TAB 0.035400002273756 NOVO-GLIMEPIRIDE 1 MG TABLET ORL TAB TEV TAB 0.504700002273764 NOVO-GLIMEPIRIDE 2 MG TABLET ORL TAB TEV TAB 0.504700002273772 NOVO-GLIMEPIRIDE 4 MG TABLET ORL TAB TEV TAB 0.504700002210479 NOVO-IPRAMIDE 0.25% INHALATION SOLUTION INH SOL TEV ML 0.325000002230201 NOVO-KETOROLAC 10 MG TABLET ORL TAB TEV TAB 0.408500002176084 NOVO-KETOTIFEN 0.2 MG/ML (BASE) ORAL SYRUP ORL SYR TEV ML 0.468200002230730 NOVO-KETOTIFEN 1 MG TABLET ORL TAB TEV TAB 0.652500002158612 NOVO-MAPROTILINE 25 MG TABLET ORL TAB TEV TAB 0.5957

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 66 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002158620 NOVO-MAPROTILINE 50 MG TABLET ORL TAB TEV TAB 1.128100002158639 NOVO-MAPROTILINE 75 MG TABLET ORL TAB TEV TAB 1.540600002265435 NOVOMIX 30 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.968000002265443 NOVOMIX 30 FLEXPEN 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.183300002364883 NOVO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP TEV CAP 1.061900002348675 NOVO-MYCOPHENOLATE 500 MG TABLET ORL TAB TEV TAB 2.123800002240868 NOVO-NABUMETONE 750 MG TABLET ORL TAB TEV TAB 0.946800002126753 NOVO-NADOLOL 40 MG TABLET ORL TAB TEV TAB 0.253900002126761 NOVO-NADOLOL 80 MG TABLET ORL TAB TEV TAB 0.351500002240457 NOVO-NIZATIDINE 150 MG CAPSULE ORL CAP TEV CAP 0.216100002240458 NOVO-NIZATIDINE 300 MG CAPSULE ORL CAP TEV CAP 0.413100002231781 NOVO-NORTRIPTYLINE 10 MG CAPSULE ORL CAP TEV CAP 0.051500002231782 NOVO-NORTRIPTYLINE 25 MG CAPSULE ORL CAP TEV CAP 0.104100000021202 NOVO-PEN-VK 300 MG TABLET ORL TAB TEV TAB 0.073100000021288 NOVO-PHENIRAM 4 MG TABLET ORL TAB TEV TAB 0.069000000021695 NOVO-PREDNISONE 5 MG TABLET ORL TAB TEV TAB 0.043600000232378 NOVO-PREDNISONE 50 MG TABLET ORL TAB TEV TAB 0.188500002283891 NOVO-RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB TEV CAP 0.432700000605859 NOVO-RYTHRO EES 40 MG/ML (BASE) ORAL SUSPENSION ORL SUS TEV ML 0.099600000652318 NOVO-RYTHRO EES 80 MG/ML (BASE) ORAL SUSPENSION ORL SUS TEV ML 0.146400002326450 NOVO-SALBUTAMOL HFA 100 MCG/DOSE METERED DOSE AERO INH AEM TEV DOSE 0.033500002231181 NOVO-SOTALOL 80 MG TABLET ORL TAB TEV TAB 0.305500002100630 NOVO-VALPROIC 250 MG CAPSULE ORL CAP TEV CAP 0.258400002218321 NOVO-VALPROIC 500 MG ENTERIC COATED CAPSULE ORL ECC TEV CAP 0.535300002211920 NOVO-VERAMIL SR 240MG SUSTAINED-RELEASE TABLET ORL SRT TEV TAB 0.507500002322854 NPLATE 250 MCG/0.5 ML VIAL INJECTION INJ DEFAUL AMG VIAL 946.480000002322862 NPLATE 500 MCG/1 ML VIAL INJECTION INJ DEFAUL AMG VIAL 1892.970000001913980 NUBAIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 10.629000001913972 NUBAIN 20 MG/ML INJECTION INJ DEFAUL SDZ ML 6.085000002415585 NUCYNTA 100 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.600700002415593 NUCYNTA 150 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.142800002415607 NUCYNTA 200 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.778000002415615 NUCYNTA 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.846700002415577 NUCYNTA 50 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.068200002360381 NUCYNTA CR 100 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.473000002360403 NUCYNTA CR 150 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.119800002360411 NUCYNTA CR 200 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.7780

Page 67: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 67 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002360438 NUCYNTA CR 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.846700002360373 NUCYNTA CR 50 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.056700002378299 NUCYNTA IR 100 MG TABLET ORL TAB JAI TAB 1.600600002378272 NUCYNTA IR 50 MG TABLET ORL TAB JAI TAB 1.068200002378280 NUCYNTA IR 75 MG TABLET ORL TAB JAI TAB 1.319900000623385 NUPERCAINAL ANESTHETIC 1% RECTAL OINTMENT RT ONT NVC G 0.140700002216191 NUTROPIN 10 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 389.440000002229722 NUTROPIN AQ 5 MG/ML INJECTION INJ DEFAUL HLR ML 194.718300002249002 NUTROPIN AQ 5 MG/ML PEN CARTRIDGE INJ CTG HLR ML 214.870000002376393 NUTROPIN AQ NUSPIN 10 10 MG/2ML PEN CARTRIDGE INJ CTG HLR ML 197.735000002399083 NUTROPIN AQ NUSPIN 20 20 MG/2 ML SOLUTION INJ DEFAUL HLR ML 778.880000002399091 NUTROPIN AQ NUSPIN 5 5 MG/2 ML SOLUTION INJ DEFAUL HLR ML 194.720000002253186 NUVARING 11.4 MG/2.6 MG SLOW-RELEASE VAGINAL RING VAG SDE MFC RNG 16.233300000716901 NYADERM 25,000 U/G VAGINAL CREAM VAG CRM TAR G 0.135800002239742 OBUSFORME EXTRA STRENGTH (W ACETAMINOPHEN) CAPLET ORL TAB WAM TAB 0.361100002237577 OBUSFORME METHOCARBAMOL & ACETAMINOPHEN CAPLET ORL TAB WAM TAB 0.330600000687766 O-CALCIUM 250 MG AND VITAMIN D TABLET ORL TAB WTR TAB 0.062000000622443 O-CALCIUM 500 MG (BASE) TABLET ORL TAB VTH TAB 0.025700002024179 OCTOSTIM 15 MCG INJECTION INJ DEFAUL FEI ML 36.288000002299437 OCTREOTIDE 100 MCG/ML INJECTION INJ DEFAUL TEV ML 5.670000002299445 OCTREOTIDE 200 MCG/ML INJECTION INJ DEFAUL TEV ML 15.584000002299453 OCTREOTIDE 500 MCG/ML INJECTION INJ DEFAUL TEV ML 38.072000002248640 OCTREOTIDE ACETATE OMEGA 100 MCG/ML INJECTION INJ DEFAUL OMG ML 11.200000002248642 OCTREOTIDE ACETATE OMEGA 200 MCG/ML INJECTION INJ DEFAUL OMG ML 23.400000002248639 OCTREOTIDE ACETATE OMEGA 50 MCG/ML INJECTION INJ DEFAUL OMG ML 5.950000002248641 OCTREOTIDE ACETATE OMEGA 500 MCG/ML INJECTION INJ DEFAUL OMG ML 52.300000080038562 OCUVITE ADULT 50+ ORL CAP BSH CAP 0.264400000358495 ODANS LIQUOR CARBONIS DETERGENS TOP LIQ ODN ML 0.075000002311992 OLANZAPINE 10 MG TABLET ORL TAB PDL TAB 1.785700002312018 OLANZAPINE 15 MG TABLET ORL TAB PDL TAB 2.677500002311968 OLANZAPINE 2.5 MG TABLET ORL TAB PDL TAB 0.449300002421704 OLANZAPINE 20 MG TABLET ORL TAB PDL TAB 5.937700002311976 OLANZAPINE 5 MG TABLET ORL TAB PDL TAB 0.893600002311984 OLANZAPINE 7.5 MG TABLET ORL TAB PDL TAB 1.347900002416522 OLANZAPINE FOR INJECTION 10MG/VIAL INJ INJ DEFAUL SDZ VIAL 24.080000002338653 OLANZAPINE ODT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 1.785700002343681 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SIV TAB 2.6780

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 68 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002338661 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 2.677700002352990 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SNS TAB 5.355300002425114 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 5.937700002343703 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SIV TAB 7.422700002338645 OLANZAPINE ODT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 0.893700002344408 OLUX-E 0.05% TOPICAL FOAM TOP FOA GSK G 1.570100002239144 OMBRELLE ECRAN SPF 60 TOPICAL CREAM TOP CRM COS G 0.099100002241277 OMBRELLE EXTREME SPF 30 TOPICAL LOTION TOP LOT COS ML 0.087500002303639 OMBRELLE SPF 60 TOPICAL LOTION TOP LOT OMB ML 0.106800002239016 OMBRELLE VAPO SPORT SPF 15 TOPICAL LOTION TOP LOT COS ML 0.086800080003480 OMEGA 3 CAPSULE ORL CAP PMT CAP 0.099000080008273 OMEGA 3 CAPSULE ORL CAP WNP CAP 0.258700080044844 OMEGA 3 KRILL OIL 500 MG CAPSULE ORL CAP JMS CAP 0.425000080015284 OMEGA 3 LIQUID ORL LIQ WNP ML 0.027400080002435 OMEGA 3 PREMIUM FISH OIL 1000 MG CAPSULE ORL CAP WNP CAP 0.060000080002596 OMEGA 3 SELECT CAPSULE ORL CAP JAM CAP 0.113100080019234 OMEGA 3 TRIPLE STRENGTH 900 MG SOFTGEL ORL CAP WBP CAP 0.255200002240743 OMEGA 3-6-9 CAPSULE ORL CAP JAM CAP 0.164700080003356 OMEGA 3-6-9 ORAL CAPSULE ORL CAP JAM CAP 0.098300080003127 OMEGA-3 ELITE SOFTGEL ORL CAP WBP CAP 0.061300080003179 OMEGA-3 TABLET ORL TAB JAM TAB 0.164100002339927 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT PDL CAP 0.411700002385384 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT SIV CAP 0.550000002303671 OMNARIS 50 MCG/DOSE METERED DOSE NASAL SPRAY NAS SPM TAK DOSE 0.233400002153513 ONCOTICE 800 M UNIT/VIAL FOR BLADDER INSTILLATION BLDIR PWS MFC VIAL 273.140000002271761 ONDANSETRON OMEGA (PRESERVATIVE FREE) 2 MG/ML INJ INJ DEFAUL OMG ML 8.175000002271788 ONDANSETRON OMEGA (WITH PRESERVATIVE) 2 MG/ML INJ INJ DEFALT OMG ML 8.125000002306212 ONDANSETRON-ODAN 4 MG TABLET ORL TAB ODN TAB 3.350000080020211 ONE A DAY FRUITI-SSENTIAL GUMMIES ORL CTB BAI TAB 0.164000002248292 ONE A DAY MEN 50 PLUS TABLET ORL TAB BIC TAB 0.109900002248319 ONE A DAY WEIGHTSMART TABLET ORL TAB BAI TAB 0.128700080003089 ONGLES & CHEVEUX CAPSULE ORL CAP VTH CAP 0.106300002375842 ONGLYZA 2.5 MG TABLET ORL TAB AZC TAB 2.537000002421208 ONRELTEA 0.33 % TOPICAL GEL TOP GEL GAL G 3.823000002350661 ONSOLIS 200 MCG BUCCAL SOLUBLE FILM BUC FILM MED FILM 12.000000000750794 OPCON-A OPH SOLUTION OPH SOL BSH ML 0.296700002415690 OPSUMIT 10 MG FILM COATED TABLET ORL TAB ACT TAB 128.3333

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 69 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000990059 OPTICHAMBER DEVICE DEFAUL DEV ACM DEV 30.720000000990061 OPTICHAMBER LARGE FACE MASK DEVICE DEFAUL ADUDEV ACM DEV 35.340000000990062 OPTICHAMBER MEDIUM FACE MASK DEVICE DEFAUL PEDDEV ACM DEV 28.530000000990063 OPTICHAMBER SMALL FACE MASK DEVICE DEFAUL INFDEV ACM DEV 29.430000000999420 OPTIMENTAL ORAL LIQUID ORL LIQ ABN ML 0.027800000355666 OPTIMINE 1 MG TABLET ORL TAB SCH TAB 0.421600002160889 OPTIMYXIN OPHTHALMIC OINTMENT OPH ONT SDZ G 1.497100000701785 OPTIMYXIN OTIC OPH DROPS OT/OPH DPS SDZ ML 0.668000000807435 OPTIMYXIN PLUS OTIC OPH SOLUTION OT/OPH SOL SDZ ML 0.823000002371189 OPTION 2 0.75 MG TABLET ORL TAB PRI TAB 7.795000080027592 OPUS D-1000 SOFTGEL ORL CAP OPU CAP 0.070000002035286 ORABASE PASTE ORL PST CVO G 1.141300001985396 ORAJEL MAXIMUM STRENGTH GEL ORL GEL CHD G 0.438900002381885 ORALAIR 100 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 1.370000002381893 ORALAIR 300 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 4.129200000313815 ORAP 2 MG TABLET ORL TAB PPH TAB 0.328200002047535 ORFENACE 100 MG TABLET ORL TAB KPC TAB 0.470000002245641 ORGALUTRAN 250 MCG/ 0.5 ML INJECTION SYRINGE INJ NDL MFC SYR 94.710000002209055 ORO-CLENSE 0.12% ORAL RINSE ORL MWH GER ML 0.016800080023808 ORTHO BONE CAPSULE ORL CAP AOR CAP 0.156500000999460 ORTHOVISC DEFAUL DEV PMS ML 57.500000000999490 OSTENIL DEFAUL DEV TRB ML 50.260000002247548 OSTEOCIT D PLUS TABLET ORL TAB SFD TAB 0.182700002301911 OSTO-D2 50000 IU CAPSULE ORL CAP TPI CAP 0.220200002434318 OTEZLA 10 MG/20 MG/30 MG TABLET STARTER PACK ORL TAB CLG TAB 18.904100002434334 OTEZLA 30 MG TABLET ORL TAB CLG TAB 18.904100002238867 OTRIVIN 0.05% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.248000000653330 OTRIVIN 0.1% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.248000000741043 OTRIVIN 0.1% METERED DOSE SPRAY DEFAUL SPM CGS ML 0.248000002331403 OTRIVIN MOIST 0.1% NASAL SPRAY NAS SPR NVC ML 0.326000002262088 OVIDREL 250 MCG INJECTION SYRINGE INJ NDL SRO SYR 77.400000002371588 OVIDREL 250 MCG/0.5 ML PEN CARTRIDGE INJECTION INJ DEFAUL SRO ML 72.000000000013617 OVOL 40 MG/ML ORAL DROPS ORL DPS CHD ML 0.360000002239298 OVOL-180 ULTRA STRENGTH 180 MG CAPSULE ORL CAP CHD CAP 0.187500000292990 OVOL-80 80 MG TABLET ORL TAB CHD TAB 0.137800000497754 OXAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.035000000497762 OXAZEPAM 15 MG TABLET ORL TAB PDL TAB 0.0550

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000497770 OXAZEPAM 30 MG TABLET ORL TAB PDL TAB 0.075000001907476 OXSORALEN 1% TOPICAL LOTION TOP LOT VCL ML 1.508000001946374 OXSORALEN 10 MG CAPSULE ORL CAP VCL CAP 0.592600000252654 OXSORALEN ULTRA 10 MG CAPSULE ORL CAP VCL CAP 0.441400002220636 OXYBUTYNINE-5 5 MG TABLET ORL TAB PDL TAB 0.098600002231934 OXY-IR 5 MG TABLET ORL TAB PUR TAB 0.284700002139561 OXYTOCIN 10 UNIT/ML INJECTION INJ DEFAUL PPC ML 7.237200002254735 OXYTROL 36 MG TRANSDERMAL PATCH TRD PTH ASC PTH 7.330000080001408 OYSTER SHELL CALCIUM 500 MG CAPLET ORL TAB NCI TAB 0.029000002248374 OYSTER SHELL CALCIUM WITH VIT D 500 MG TABLET ORL TAB VTH TAB 0.028200002363445 OZURDEX 0.7 MG INTRAVITREAL IMPLANT OPH IMP ALL SYS 1352.500000002130947 PACIS 120 MG INJECTION INJ DEFAUL IAF VIAL 113.600000001923420 PALAFER 300 MG CAPSULE ORL CAP GKC CAP 0.248700001923455 PALAFER-CF CAPSULE ORL CAP GKC CAP 0.340000002264951 PAMIDRONATE DISODIUM 30 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 88.350000002246597 PAMIDRONATE DISODIUM 30MG/10ML VIAL INJECTION INJ DEFAUL PPC ML 15.750000002246598 PAMIDRONATE DISODIUM 60 MG/10ML INJECTION INJ DEFAUL PPC ML 29.900000002264978 PAMIDRONATE DISODIUM 60 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 12.698000002264986 PAMIDRONATE DISODIUM 90 MG/VIAL INJECTION INJ DEFAUL SDZ ML 25.395000002246599 PAMIDRONATE DISODIUM 90MG/10ML VIAL INJECTION INJ DEFAUL PPC ML 44.800000002249677 PAMIDRONATE DISODIUM OMEGA 60 MG/10 ML VIAL INJ INJ DEFAUL OMG ML 17.670000000718130 PAMPRIN EXTRA STRENGTH CAPLET ORL TAB CTE TAB 0.206300000263699 PANOXYL 10 TOPICAL (ALCOHOL) GEL TOP ALCGEL GSK G 0.146200002214830 PANOXYL 2.5% AQUAGEL TOP WTRGEL STI G 0.120800000373036 PANOXYL 20 TOPICAL (ALCOHOL) GEL TOP ALCGEL GSK G 0.190500002188708 PANOXYL 4% CREAMY WASH TOP WAS GSK G 0.067100000263702 PANOXYL 5 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL STI G 0.124300000483184 PANOXYL 5 5% TOPICAL BAR TOP BAR GSK G 0.085300002214857 PANOXYL 5 5% WASH TOP WAS STI ML 0.060900002214849 PANOXYL 5% AQUAGEL TOP WTRGEL STI G 0.124300002239616 PANTO IV 40 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 13.700000002241804 PANTOLOC 20 MG ENTERIC-COATED TABLET ORL ECT TAK TAB 1.965600002385740 PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.275000002431327 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.362800002318695 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.978500002306727 PANTOPRAZOLE SODIUM FOR INJECTION 40 MG/VIAL INJ INJ DEFAUL SDZ VIAL 11.910000002428172 PANTOPRAZOLE-20 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.2750

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002428180 PANTOPRAZOLE-40 40 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 0.362800002282844 PAROXETINE 10 MG TABLET ORL TAB SNS TAB 1.043000002388227 PAROXETINE 10 MG TABLET ORL TAB SIV TAB 1.043000002248913 PAROXETINE-10 MG TABLET ORL TAB PDL TAB 0.821000002248914 PAROXETINE-20 MG TABLET ORL TAB PDL TAB 0.451300002248915 PAROXETINE-30 MG TABLET ORL TAB PDL TAB 0.479600002362171 PATADAY 0.2% OPHTHALMIC SOLUTION OPH SOL ALC ML 12.940000002233143 PATANOL 0.1% OPH SOLUTION OPH SOL ALC ML 6.470000002381737 PAT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.120400002381745 PAT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.240800002389274 PAT-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB PAT TAB 0.626300002027887 PAXIL 10 MG TABLET ORL TAB GSK TAB 1.838700002248503 PAXIL CR 12.5 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.872300002248504 PAXIL CR 25 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 2.045700000577790 PDP-ISONIAZID 100 MG TABLET ORL TAB PPH TAB 0.794800000577804 PDP-ISONIAZID 300 MG TABLET ORL TAB PPH TAB 0.794800000577812 PDP-ISONIAZID 50 MG/5ML ORAL LIQUID ORL LIQ PPH ML 0.249600002242863 PEDIAFER 30 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.028600002232202 PEDIAFER 75 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.194600002245747 PEDIAFLOUR 5.56 MG/ML ORAL SOLUTION ORL DPS EUP ML 0.069700002162431 PEDIAPHARM NAPROXEN 25 MG/ML ORAL SUSPENSION ORL SUS PPI ML 0.063100080004595 PEDIAVIT D DROPS 400 IU ORL LIQ EUP ML 0.115600002358034 PEG 3350 ORAL POWDER ORL PWR MES G 0.054400002328232 PEGALAX ORAL POWDER ORL PWR MFI G 0.038700000468029 PENICILLINE V 300 TABLET ORL TAB PDL TAB 0.071000002250535 PENLAC NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL VCL G 13.691700002247265 PENNSAID 1.5% TOPICAL SOLUTION TOP SOL PAL ML 0.845800001980602 PENTA-3B PLUS VITAMIN C TABLET ORL TAB SDZ TAB 0.582000001980599 PENTA-3B TABLET ORL TAB SDZ TAB 0.478000002183080 PENTAMIDINE ISETHIONATE 300 MG/VIAL INJECTION BP INJ DEFAUL HSP VIAL 127.120000001980556 PENTAMYCETIN 0.25% OPH SOLUTION OPH SOL SDZ ML 0.618000002164051 PENTAMYCETIN 0.5% OPH SOLUTION OPH SOL SDZ ML 0.630000001980564 PENTAMYCETIN 1% OPH OINTMENT OPH ONT SDZ G 2.160000001980580 PENTAMYCETIN-HC OTIC OPH OINTMENT OT/OPH ONT SDZ G 2.971400001980572 PENTAMYCETIN-HC OTIC OPH SUSPENSION OT/OPH SUS SDZ ML 2.458000002185938 PEPCID AC 10 MG TABLET ORL TAB MFC TAB 0.341000000728128 PEPCID IV 10 MG/ML INJECTION INJ DEFAUL MFC ML 1.9955

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002097079 PEPTO-BISMOL 17.6 MG/ML ORAL LIQUID ORL LIQ PGI ML 0.024700002177994 PEPTO-BISMOL CAPLET ORL TAB PGI TAB 0.168300002237315 PEPTO-BISMOL CHEWABLES CHEWABLE TABLET ORL CTB PGI TAB 0.336700000999423 PERATIVE ORAL LIQUID ORL LIQ ABN ML 0.011300000254916 PERGONAL 75 UNIT/75 UNIT INJECTION INJ DEFAUL SRO VIAL 46.000000002240433 PERICHLOR 0.12% ORAL RINSE ORL MWH PMS ML 0.019700002237452 PERIDEX 0.12% ORAL RINSE ORL MWH ZIL ML 0.024400002207796 PERIOGARD 0.12% ORAL RINSE ORL MWH COL ML 0.017100002247104 PERIOSTAT 20 MG CAPSULE ORL CAP PPH CAP 1.358300002229501 PERI-WASH II ANTISEPTIC 0.1% CLEANSER TOP WAS COC ML 0.014700080017389 PGX 750 DAILY CAPSULE ORL CAP NFN CAP 0.195200080001122 PHARMA-CAL 500 MG ORL CAP PPH CAP 0.022200080004281 PHARMA-CAL D 500 MG/125 IU TABLET ORL TAB PMS TAB 0.070000002371499 PHARMA-D 10,000 UNIT CAPSULE ORL CAP PMS CAP 0.210000080001145 PHARMA-D 400 IU GELCAP ORL CAP PPH CAP 0.032200002371502 PHARMA-D 50,000 UNIT CAPSULE ORL CAP PMS CAP 0.950000080040416 PHARMA-K20 20 MEQ SUSTAINED-RELEASE TABLET ORL TAB/SRT PMS TAB 0.199500080038071 PHARMANAC TM ACETYLCYSTEINE 900 MG TABLET ORL TAB BAP TAB 0.705600002162180 PHENERGAN EXPECTORANT WITH CODEINE ORAL SYRUP ORL SYR CLC ML 0.079400002304090 PHENOBARBITAL SODIUM 120 MG/ML INJECTION USP INJ DEFAUL SDZ ML 12.411000002304082 PHENOBARBITAL SODIUM 30 MG/ML INJECTION USP INJ DEFAUL SDZ ML 11.145000002148455 PHENYLEPHRINE HCL 10% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002148447 PHENYLEPHRINE HYDROCHLORIDE OPH SOLUTION (MINIMS) OPH SOL OPT ML 6.666700002150638 PHILLIPS MAGNESIA 300 MG CHEWABLE TABLET ORL CTB BAI TAB 0.051600002150646 PHILLIPS MILK OF MAGNESIA 80 MG/ML ORAL LIQUID ORL LIQ BAI ML 0.014700002017733 PHISOHEX 3% TOPICAL CLEANSER TOP CLR SAV ML 0.077600002245781 PHL-AMIODARONE 200 MG TABLET ORL TAB PHH TAB 1.297100002273543 PHL-CITALOPRAM 10 MG TABLET ORL TAB PHH TAB 0.143200002249359 PHL-CYCLOBENZAPRINE 10 MG TABLET ORL TAB PHH TAB 0.376500002248608 PHL-MELOXICAM 15 MG TABLET ORL TAB PHH TAB 0.567000002248607 PHL-MELOXICAM 7.5 MG TABLET ORL TAB PHH TAB 0.491400002281732 PHL-MIRTAZAPINE 15 MG TABLET ORL TAB PHH TAB 0.375000002307669 PHL-PIOGLITAZONE 15 MG TABLET ORL TAB PHH TAB 1.571600002307677 PHL-PIOGLITAZONE 30 MG TABLET ORL TAB PHH TAB 0.201700002307723 PHL-PIOGLITAZONE 45 MG TABLET ORL TAB PHH TAB 3.310500002249766 PHL-PRAVASTATIN 10 MG TABLET ORL TAB PHH TAB 0.567000002249774 PHL-PRAVASTATIN 20 MG TABLET ORL TAB PHH TAB 0.6689

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002249782 PHL-PRAVASTATIN 40 MG TABLET ORL TAB PHH TAB 0.805700002299062 PHL-QUETIAPINE 100 MG TABLET ORL TAB PHH TAB 0.922600002299089 PHL-QUETIAPINE 200 MG TABLET ORL TAB PHH TAB 1.852700002299054 PHL-QUETIAPINE 25 MG TABLET ORL TAB PHH TAB 0.345800002299097 PHL-QUETIAPINE 300 MG TABLET ORL TAB PHH TAB 2.703800002271192 PHL-TOPIRAMATE 100 MG TABLET ORL TAB PHH TAB 0.592800002271206 PHL-TOPIRAMATE 200 MG TABLET ORL TAB PHH TAB 0.885300002271184 PHL-TOPIRAMATE 25 MG TABLET ORL TAB PHH TAB 0.312800002236942 PHL-TRAZODONE 100 MG TABLET ORL TAB PHH TAB 0.395600002236941 PHL-TRAZODONE 50 MG TABLET ORL TAB PHH TAB 0.221400002294052 PHL-ZOPICLONE 5 MG TABLET ORL TAB PHH TAB 0.223100002294060 PHL-ZOPICLONE 7.5 MG TABLET ORL TAB PHH TAB 0.468500002229437 PHOSLO 667 MG ORAL TABLET ORL TAB PRP TAB 0.450000002230399 PHOSPHATES SOLUTION ORAL LIQUID ORL LIQ PPH ML 0.092400002019876 PHOTOFRIN 75MG/ VIAL INJECTION INJ DEFAUL AXC VIAL 19255.100000002400987 PICATO 0.015% TOPICAL GEL TOP GEL LEO DOSE 138.730000002400995 PICATO 0.05% TOPICAL GEL TOP GEL LEO DOSE 208.095000002254794 PICO SALAX ORAL POWDER ORL PWR FEI PCKT 8.640000002300583 PICODAN ORL PWDPKT ODN PCKT 3.600000002148463 PILOCARPINE NITRATE 2% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002148471 PILOCARPINE NITRATE 4% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.348300000828424 PINDOLOL-10 MG TABLET ORL TAB PDL TAB 0.232300000828416 PINDOLOL-5 MG TABLET ORL TAB PDL TAB 0.136100002374013 PIOGLITAZONE HCL 15 MG TABLET ORL TAB SIV TAB 0.929500002374021 PIOGLITAZONE HCL 30 MG TABLET ORL TAB SIV TAB 1.302200002374048 PIOGLITAZONE HCL 45 MG TABLET ORL TAB SIV TAB 1.958000002391600 PIOGLITAZONE HYDROCHLORIDE 15 MG TABLET ORL TAB AHI TAB 0.871800002339587 PIOGLITAZONE HYDROCHLORIDE 30 MG TABLET ORL TAB AHI TAB 0.813900002339595 PIOGLITAZONE HYDROCHLORIDE 45 MG TABLET ORL TAB AHI TAB 1.223700002246640 PIPERACILLIN 2 G/VIAL INJECTION INJ DEFAUL MNP VIAL 9.500000002248939 PIPERACILLIN 2 G/VIAL INJECTION USP INJ DEFAUL PPC VIAL 15.280000002246641 PIPERACILLIN 3 G/VIAL INJECTION INJ DEFAUL MNP VIAL 22.820000002248940 PIPERACILLIN 3 G/VIAL INJECTION USP INJ DEFAUL PPC VIAL 22.930000002246642 PIPERACILLIN 4 G/VIAL INJECTION INJ DEFAUL MNP VIAL 19.000000002248941 PIPERACILLIN 4 G/VIAL INJECTION USP INJ DEFAUL PPC VIAL 30.550000002330547 PIPERACILLIN SOD/TAZOBACTAM SOD 12G/1500 MG VL INJ INJ DEFAUL SDZ VIAL 67.500000002370158 PIPERACILLIN/TAZOBACTAM 2G/250 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 9.6120

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000501190 PLACEBO 100 MG TABLET ORL TAB ODN TAB 0.075000002237405 PLANTE GUMMI BEAR MULTIPLE VITAMINS ORAL GUM ORL GUM PLI PIECE 0.166000001946897 PMS DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR ORL ELX PMS ML 0.405200000792691 PMS-ACETAMINOPHEN 32 MG/ML ORAL SOLUTION ORL SOL PPH ML 0.028100002243435 PMS-ADENOSINE 3 MG/ML INJECTION INJ DEFAUL PMS ML 21.190000000654523 PMS-AMITRIPTYLINE 10 MG TABLET ORL TAB PMS TAB 0.072200000654515 PMS-AMITRIPTYLINE 25 MG TABLET ORL TAB PMS TAB 0.131600000654507 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.255000002247304 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.234600002274949 PMS-ANAGRELIDE 0.5 MG CAPSULE ORL CAP PMS CAP 3.449600002320738 PMS-ANASTROZOLE 1 MG TABLET ORL TAB PMS TAB 2.622300002284529 PMS-ASA EC 325 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.030900002283700 PMS-ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.057600002381028 PMS-ATOMOXETINE 10 MG CAPSULE ORL CAP PMS CAP 2.383300002381036 PMS-ATOMOXETINE 18 MG CAPSULE ORL CAP PMS CAP 2.732000002381044 PMS-ATOMOXETINE 25 MG CAPSULE ORL CAP PMS CAP 3.016000002381052 PMS-ATOMOXETINE 40 MG CAPSULE ORL CAP PMS CAP 3.437700002381060 PMS-ATOMOXETINE 60 MG CAPSULE ORL CAP PMS CAP 3.813300002313448 PMS-ATORVASTATIN 10 MG TABLET ORL TAB PMS TAB 0.341000002313456 PMS-ATORVASTATIN 20 MG TABLET ORL TAB PMS TAB 0.404000002313464 PMS-ATORVASTATIN 40 MG TABLET ORL TAB PMS TAB 0.458100002313472 PMS-ATORVASTATIN 80 MG TABLET ORL TAB PMS TAB 0.434200000587265 PMS-BENZTROPINE 2 MG TABLET ORL TAB PMS TAB 0.045000002330237 PMS-BETAHISTINE 24 MG TABLET ORL TAB PMS TAB 0.541500002275589 PMS-BICALUTAMIDE 50 MG TABLET ORL TAB PMS TAB 4.179000002383020 PMS-BOSENTAN 125 MG TABLET ORL TAB PMS TAB 49.578000002383012 PMS-BOSENTAN 62.5 MG TABLET ORL TAB PMS TAB 52.304800002244508 PMS-BUTORPHANOL 10MG/ML NASAL SPRAY NAS SPR PMS ML 16.660000002391171 PMS-CANDESARTAN 4 MG TABLET ORL TAB PMS TAB 0.350300002185830 PMS-CEFACLOR 250 MG CAPSULE ORL CAP PMS CAP 0.643000002185857 PMS-CEFACLOR 25MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.076200002185865 PMS-CEFACLOR 50 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.139500002185849 PMS-CEFACLOR 500 MG CAPSULE ORL CAP PMS CAP 1.262500002185873 PMS-CEFACLOR 75 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.201000002315963 PMS-CETIRIZINE 20 MG TABLET ORL TAB PMS TAB 0.818800002413574 PMS-CICLOPIROX NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL PMS G 7.975800002253933 PMS-CIPROFLOXACIN 0.3% OPHTHALMIC SOL. OPH SOL PMS ML 0.7640

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 75 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002416433 PMS-CIPROFLOXACIN XL 500 MG EXTENDED-RELEASE TAB ORL ERT PMS TAB 2.511200002232195 PMS-CLOBETASOL 0.05% SCALP LOTION SCP LOT PMS ML 0.234200002232191 PMS-CLOBETASOL 0.05% TOPICAL CREAM TOP CRM PMS G 0.406800002232193 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.406800002309548 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.268400002243450 PMS-DEFEROXAMINE 2G/VIAL INJECTION INJ DEFAUL PMS VIAL 21.970000002242055 PMS-DEFEROXAMINE 500 MG/VIAL INJ INJ DEFAUL PMS VIAL 8.175000001946277 PMS-DESIPRAMINE 50 MG TABLET ORL TAB PMS TAB 0.411000000891797 PMS-DIAZEPAM 1 MG/ML ORAL SOLUTION ORL SOL PMS ML 0.112700002247492 PMS-DIAZEPAM 10 MG TABLET ORL TAB PMS TAB 0.094200002247490 PMS-DIAZEPAM 2 MG TABLET ORL TAB PMS TAB 0.055200002247491 PMS-DIAZEPAM 5 MG TABLET ORL TAB PMS TAB 0.067000000721344 PMS-DICITRATE ORAL SOLUTION ORL SOL PMS ML 0.051500002356783 PMS-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL PMS ML 0.627700002239753 PMS-DICLOFENAC-K 50 MG TABLET ORL TAB PMS TAB 0.427800000757683 PMS-DIPHENHYDRAMINE 25 MG CAPSULE ORL CAP PPH CAP 0.093100000757691 PMS-DIPHENHYDRAMINE 50 MG CAPSULE ORL CAP PPH CAP 0.116900002434342 PMS-ELETRIPTAN 20 MG TABLET ORL TAB PMS TAB 10.085000002434350 PMS-ELETRIPTAN 40 MG TABLET ORL TAB PMS TAB 10.085000002379171 PMS-ESOMEPRAZOLE 40 MG DELAYED-RELEASE CAPSULE ORL DRC PMS CAP 1.925100002416409 PMS-EZETIMIBE 10 MG TABLET ORL TAB PMS TAB 0.475000002278081 PMS-FAMCICLOVIR 125 MG TABLET ORL TAB PMS TAB 2.199000002278103 PMS-FAMCICLOVIR 250 MG TABLET ORL TAB PMS TAB 2.955700002278111 PMS-FAMCICLOVIR 500 MG TABLET ORL TAB PMS TAB 4.594400002273551 PMS-FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP PMS CAP 0.272300000586323 PMS-FERROUS SULFATE 300 MG TABLET ORL TAB PPH TAB 0.021000002222574 PMS-FERROUS SULFATE INFANT DROPS 75 MG/ML ORL DPS PMS ML 0.359300002320169 PMS-FINASTERIDE 1 MG TABLET ORL TAB PMS TAB 1.244800002238568 PMS-FLUOROMETHOLONE 0.1% OPH SUSPENSION OPH SUS PMS ML 1.788000000726354 PMS-FLUPHENAZINE 5 MG TABLET ORL TAB PMS TAB 0.186900002230104 PMS-FLUTAMIDE 250 MG TABLET ORL TAB PMS TAB 1.353000002240683 PMS-FLUVOXAMINE 100 MG TABLET ORL TAB PMS TAB 0.550600002240682 PMS-FLUVOXAMINE 50 MG TABLET ORL TAB PMS TAB 0.306300002247493 PMS-FUROSEMIDE 20 MG TABLET ORL TAB PMS TAB 0.038400002247494 PMS-FUROSEMIDE 40 MG TABLET ORL TAB PMS TAB 0.081100002255898 PMS-GABAPENTIN 600 MG TABLET ORL TAB PMS TAB 1.417500002255901 PMS-GABAPENTIN 800 MG TABLET ORL TAB PMS TAB 1.8900

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 76 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002239951 PMS-GEMFIBROZIL 300 MG CAPSULE ORL CAP PMS CAP 0.296400002230183 PMS-GEMFIBROZIL 600 MG TABLET ORL TAB PMS TAB 0.752000002247386 PMS-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.047400002247387 PMS-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.056800002324253 PMS-HYDROCODONE 1 MG/ML ORAL SYRUP ORL SYR PMS ML 0.124900000836133 PMS-IBUPROFEN 400 MG TABLET ORL TAB PMS TAB 0.101000002288265 PMS-LEFLUNOMIDE 10 MG TABLET ORL TAB PMS TAB 6.565300002288273 PMS-LEFLUNOMIDE 20 MG TABLET ORL TAB PMS TAB 6.565300002309114 PMS-LETROZOLE 2.5 MG TABLET ORL TAB PMS TAB 2.994700002237991 PMS-LEVOBUNOLOL 0.5% OPH SOLUTION OPH SOL PMS ML 1.238000000811874 PMS-LIDOCAINE VISCOUS 2% ORAL LIQUID ORL LIQ PMS ML 0.103200002074834 PMS-LITHIUM CITRATE 8 MMO/5ML ORAL SYRUP ORL SYR PMS ML 0.076900002248268 PMS-MELOXICAM 15 MG TABLET ORL TAB PMS TAB 0.616100002248267 PMS-MELOXICAM 7.5 MG TABLET ORL TAB PMS TAB 0.534000002321130 PMS-MEMANTINE 10 MG TABLET ORL TAB PMS TAB 1.777400002413728 PMS-METHYLPHENIDATE 18 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.470400002413736 PMS-METHYLPHENIDATE 27 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.696900002413744 PMS-METHYLPHENIDATE 36 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.923400002413752 PMS-METHYLPHENIDATE 54 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 2.376400000783137 PMS-METRONIDAZOLE 500 MG CAPSULE ORL CAP PMS CAP 0.763700002405776 PMS-NEVIRAPINE 200 MG TABLET ORL TAB PMS TAB 2.683200002177714 PMS-NIZATIDINE 150 MG CAPSULE ORL CAP PMS CAP 0.209800002177722 PMS-NIZATIDINE 300 MG CAPSULE ORL CAP PMS CAP 0.380200002246596 PMS-NORFLOXACIN 400 MG TABLET ORL TAB PMS TAB 0.544900002177692 PMS-NORTRIPTYLINE 10 MG CAPSULE ORL CAP PMS CAP 0.050000002177706 PMS-NORTRIPTYLINE 25 MG CAPSULE ORL CAP PMS CAP 0.109700002252570 PMS-OFLOXACIN 0.3% OPH SOLUTION OPH SOL PMS ML 0.920000002367483 PMS-OLANZAPINE 20 MG TABLET ORL TAB PMS TAB 10.618600002303213 PMS-OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB PMS TAB 5.516000002423944 PMS-OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB PMS TAB 7.825700000792942 PMS-OXTRIPHYLLINE ORAL ELIXIR ORL ELX PMS ML 0.033500002309882 PMS-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.477000002309890 PMS-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.715600002309904 PMS-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 1.240200002309912 PMS-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 2.290700002247750 PMS-PAROXETINE 10 MG TABLET ORL TAB PMS TAB 1.074300002231537 PMS-PINDOLOL 10 MG TABLET ORL TAB PMS TAB 0.2524

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 77 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002231539 PMS-PINDOLOL 15 MG TABLET ORL TAB PMS TAB 0.337000002231536 PMS-PINDOLOL 5 MG TABLET ORL TAB PMS TAB 0.136100002303124 PMS-PIOGLITAZONE 15 MG TABLET ORL TAB PMS TAB 0.598300002303132 PMS-PIOGLITAZONE 30 MG TABLET ORL TAB PMS TAB 0.838300002303140 PMS-PIOGLITAZONE 45 MG TABLET ORL TAB PMS TAB 1.260400002240363 PMS-POLYTRIMETHOPRIM OPHTHALMIC SOLUTION OPH SOL PMS ML 2.388000002290138 PMS-PRAMIPEXOLE 0.5 MG TABLET ORL TAB PMS TAB 1.506100002359634 PMS-PREGABALIN 150 MG CAPSULE ORL CAP PMS CAP 1.876600002398079 PMS-PREGABALIN 225 MG CAPSULE ORL CAP PMS CAP 1.876600002359596 PMS-PREGABALIN 25 MG CAPSULE ORL CAP PMS CAP 0.670800002359642 PMS-PREGABALIN 300 MG CAPSULE ORL CAP PMS CAP 1.876600002359618 PMS-PREGABALIN 50 MG CAPSULE ORL CAP PMS CAP 1.052200002359626 PMS-PREGABALIN 75 MG CAPSULE ORL CAP PMS CAP 1.361500000753688 PMS-PROCHLORPERAZINE 10 MG RECTAL SUPPOSITORY RT SUP PMS SUP 0.855000000753637 PMS-PROCHLORPERAZINE 10 MG TABLET ORL TAB PMS TAB 0.202500000753661 PMS-PROCHLORPERAZINE 5 MG TABLET ORL TAB PMS TAB 0.165900002294559 PMS-PROPAFENONE 150 MG TABLET ORL TAB PMS TAB 0.464500002294575 PMS-PROPAFENONE 300 MG TABLET ORL TAB PMS TAB 0.819000000815993 PMS-PSEUDOEPHEDRINE HCL 6 MG/ML ORAL SYRUP ORL SYR PMS ML 0.044300000618810 PMS-PYRAZINAMIDE 500 MG TABLET ORL TAB PMS TAB 1.295100002340569 PMS-QUINAPRIL 10 MG TABLET ORL TAB PMS TAB 0.746200002340577 PMS-QUINAPRIL 20 MG TABLET ORL TAB PMS TAB 0.746200002340585 PMS-QUINAPRIL 40 MG TABLET ORL TAB PMS TAB 0.746200002340550 PMS-QUINAPRIL 5 MG TABLET ORL TAB PMS TAB 0.746200002343932 PMS-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB PMS CAP 0.813300002424177 PMS-RISEDRONATE 150 MG TABLET ORL TAB PMS TAB 42.180000002306069 PMS-RIVASTIGMINE 6 MG CAPSULE ORL CAP PMS CAP 1.260500002371642 PMS-SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.475000002371626 PMS-SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 9.007500002371634 PMS-SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 8.848100002412179 PMS-SILDENAFIL R 20 MG TABLET ORL TAB PMS TAB 7.294000002252635 PMS-SIMVASTATIN 10 MG TABLET ORL TAB PMS TAB 0.505700002252651 PMS-SIMVASTATIN 40 MG TABLET ORL TAB PMS TAB 0.625000002256428 PMS-SUMATRIPTAN 25 MG TABLET ORL TAB PMS TAB 9.769000002237460 PMS-TAMOXIFEN 20 MG TABLET ORL TAB PMS TAB 0.350000002240807 PMS-TERBINAFINE 250 MG TABLET ORL TAB PMS TAB 2.524500002239577 PMS-TOBRAMYCIN 0.3% OPH SOLUTION OPH SOL PMS ML 0.6560

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 78 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002401657 PMS-TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PMS TAB 0.645200002381230 PMS-VALACYCLOVIR 1000 MG CAPLET ORL TAB PMS TAB 3.144700002312999 PMS-VALSARTAN 40 MG TABLET ORL TAB PMS TAB 0.569300001954504 PMS-YOHIMBINE 2 MG TABLET ORL TAB PMS TAB 0.206300001954342 PMS-YOHIMBINE 5.4 MG TABLET ORL TAB PMS TAB 0.439500001985604 PMS-YOHIMBINE 6 MG TABLET ORL TAB PMS TAB 0.685000002231259 PNEUMO 23 25 MCG/0.5ML INJECTION SYRINGE INJ DEFAUL CNG SYR 19.240000000431648 PNEUMOVAX 23 25 MCG/VIAL INJECTION INJ DEFAUL MSD VIAL 19.010000000990067 POCKET CHAMBER DEVICE DEFAUL DEV MMS DEV 15.990000000990069 POCKET CHAMBER PEDIATRIC MEDIUM MASK DEVICE DEFAUL PEDDEV MMS DEV 49.990000000598208 PODOFILM 250 MG/ML TOPICAL LIQUID TOP LIQ PMS ML 1.365200000464988 POLLINEX R INJECTION INJ DEFAUL BEE ML 189.875000000999389 POLYCAL ORAL POWDER ORL PWR XXX G 0.022400000999928 POLYCOSE ORAL POWDER ORL PWR ABN G 0.025300002230844 POLYSPORIN 10,000 U/0.25 MG ANTIBIOTIC TOPICAL CRM TOP CRM PFI G 0.385300002237227 POLYSPORIN ANTIBIOTIC TOPICAL OINTMENT TOP ONT WLA G 0.385300002239155 POLYSPORIN PLUS PAIN RELIEF EAR DROPS OT SOL JJI ML 0.910000002239201 POLYSPORIN PLUS PAIN RELIEF TOPICAL CREAM TOP CRM WLA G 0.417300002239157 POLYSPORIN STERILE OPHTHALMIC OINTMENT OPH ONT PFI G 1.688600002239156 POLYSPORIN STERILE OTIC OPH DROPS OT/OPH DPS WLA ML 0.965000002237226 POLYSPORIN TRIPLE ANTIBIOTIC TOPICAL OINTMENT TOP ONT PDH G 0.417300001981021 POLYTAR AF TOPICAL SHAMPOO TOP SHP GSK ML 0.062300000249866 POLYTAR REGULAR 1% TOPICAL SHAMPOO TOP SHP GSK ML 0.040300001942921 POLYTOPIC TOPICAL OINTMENT TOP ONT SDZ G 0.380100002011956 POLYTRIM OPH SOLUTION OPH SOL ALL ML 3.575000002419580 POMALYST 1 MG CAPSULE ORL CAP CLG CAP 500.000000002419599 POMALYST 2 MG CAPSULE ORL CAP CLG CAP 500.000000002419602 POMALYST 3 MG CAPSULE ORL CAP CLG CAP 500.000000002419610 POMALYST 4 MG CAPSULE ORL CAP CLG CAP 500.000000002424622 POSANOL 100 MG DELAYED-RELEASE TABLET ORL DRT MFC TAB 50.227200002293404 POSANOL 40 MG/ML ORAL SUSPENSION ORL SUS MFC ML 10.045400000316121 POTASSIUM 50 MG TABLET ORL TAB JAM TAB 0.056300000804789 POTASSIUM PHOSPHATE 224 MG/ML/ 236 MG/ML INJECTION INJ DEFAUL SDZ ML 0.437600002139545 POTASSIUM PHOSPHATES 224 MG/ML/236 MG/ML INJECTION INJ DEFAUL PPC ML 0.494000002312433 PRADAXA 75 MG CAPSULE ORL CAP BOE CAP 1.738700002367602 PRAMIPEXOLE 0.25 MG TABLET ORL TAB SNS TAB 0.262800002309130 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SIV TAB 1.3860

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 79 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002367610 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SNS TAB 1.386000002367629 PRAMIPEXOLE 1 MG TABLET ORL TAB SNS TAB 0.525700000770957 PRAMOX H.C. TOPICAL CREAM TOP CRM DPT G 0.482900001954210 PRAMOX H.C. TOPICAL LOTION TOP LOT DPT ML 0.199200000893749 PRAVACHOL 10 MG TABLET ORL TAB BMS TAB 1.558700002243824 PRAVASTATIN-10 10 MG TABLET ORL TAB PDL TAB 0.405000002243825 PRAVASTATIN-20 20 MG TABLET ORL TAB PDL TAB 0.477700002243826 PRAVASTATIN-40 40 MG TABLET ORL TAB PDL TAB 0.575500002148498 PREDNISOLONE SOD PHOS 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 7.245000000156876 PREDNISONE 5 MG TABLET ORL TAB PDL TAB 0.022000000607517 PREDNISONE-50 50 MG TABLET ORL TAB PDL TAB 0.091300002396521 PREGABALIN 150 MG CAPSULE ORL CAP PDL CAP 1.169800002403722 PREGABALIN 150 MG CAPSULE ORL CAP SIV CAP 1.727000002405563 PREGABALIN 150 MG CAPSULE ORL CAP SNS CAP 1.727000002403749 PREGABALIN 225 MG CAPSULE ORL CAP SIV CAP 1.169800002396483 PREGABALIN 25 MG CAPSULE ORL CAP PDL CAP 0.418100002403692 PREGABALIN 25 MG CAPSULE ORL CAP SIV CAP 0.617300002405539 PREGABALIN 25 MG CAPSULE ORL CAP SNS CAP 0.617300002405598 PREGABALIN 300 MG CAPSULE ORL CAP SNS CAP 1.727000002396548 PREGABALIN 300 MG CAPSULE ORL CAP PDL CAP 1.169800002403730 PREGABALIN 300 MG CAPSULE ORL CAP SIV CAP 1.727000002405547 PREGABALIN 50 MG CAPSULE ORL CAP SNS CAP 0.968300002396505 PREGABALIN 50 MG CAPSULE ORL CAP PDL CAP 0.655800002403706 PREGABALIN 50 MG CAPSULE ORL CAP SIV CAP 0.968300002405555 PREGABALIN 75 MG CAPSULE ORL CAP SNS CAP 1.252800002396513 PREGABALIN 75 MG CAPSULE ORL CAP PDL CAP 0.848600002403714 PREGABALIN 75 MG CAPSULE ORL CAP SIV CAP 1.252900002411768 PREGABALIN-150 150 MG CAPSULE ORL CAP SIV CAP 1.727000002411725 PREGABALIN-25 25 MG CAPSULE ORL CAP SIV CAP 0.617300002411733 PREGABALIN-50 50 MG CAPSULE ORL CAP SIV CAP 0.968300002411741 PREGABALIN-75 75 MG CAPSULE ORL CAP SIV CAP 1.252900002182904 PREGNYL 10,000 UNIT INJECTION INJ DEFAUL MFC VIAL 78.240000002276194 PREGVIT FOLIC 5 TABLET ORL TAB DUI TAB 0.577200002246067 PREGVIT TABLET ORL TAB DUI TAB 0.398500002414678 PREMARIN 0.3 MG SUSTAINED-RELEASE TABLET ORL SRT PFI TAB 0.302700002414686 PREMARIN 0.625 MG SUSTAINED-RELEASE TABLET ORL SRT PFI TAB 0.302900002414694 PREMARIN 1.25 MG SUSTAINED-RELEASE TABLET ORL SRT PFI TAB 0.3029

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 80 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002043386 PREMARIN 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 44.640000002244574 PRENATAL VITAMIN AND MINERAL SUPPLEMENT CAPLET ORL TAB WNP TAB 0.076600000886750 PREPARATION H TOPICAL CREAM TOP CRM PDH G 0.262800001926217 PREPARATION H TOPICAL OINTMENT TOP ONT PDH G 0.232400000693820 PRESSYN 20 U/ML INJECTION INJ DEFAUL FEI ML 7.900000002246133 PRESSYN AR 20U/ML INJECTION INJ DEFAUL FEI ML 10.000000002249464 PREVACID FASTAB 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB ABB TAB 2.173300002249472 PREVACID FASTAB 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB ABB TAB 2.173300000635189 PREVEX 67% TOPICAL CREAM TOP CRM GSK G 0.156500002210754 PREVIDENT 5000 PLUS DENTAL CREAM DEN CRM COL G 0.210800002335204 PREVNAR 13 SUSPENSION 0.5 ML SYRINGE INJECTION INJ NDL PFI SYR 96.550000002244081 PREVNAR VACCINE 0.5 ML INJECTION INJ DEFAUL PFI ML 191.030000002426501 PREZCOBIX 800 MG/150 MG TABLET ORL TAB JAI TAB 23.172000002369753 PREZISTA 150 MG TABLET ORL TAB JAI TAB 3.786000002324016 PREZISTA 400 MG TABLET ORL TAB JAI TAB 11.672300002324024 PREZISTA 600 MG TABLET ORL TAB JAI TAB 16.597000002338432 PREZISTA 75 MG TABLET ORL TAB JAI TAB 1.893000002393050 PREZISTA 800 MG TABLET ORL TAB JAI TAB 23.597700080033655 PRIMADOPHILUS OPTIMA MAX BIFIDO 90 BILLION CAPSULE ORL CAP ENT CAP 1.428300000717274 PRIMAXIN 250 MG/250 MG INJECTION INJ DEFAUL MFC VIAL 326.000000000884413 PRINZIDE 20 MG/12.5 MG TABLET ORL TB MFC TAB 0.903800002239208 PRIORIX VIAL INJECTION INJ DEFAUL GSK VIAL 27.776000002321106 PRISTIQ 100 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.960300002321092 PRISTIQ 50 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.960700000644315 PRO AMOX-500 MG CAPSULE ORL CAP PDL CAP 0.341700002311518 PRO-AAS (CROQUABLE) 80 MG CHEWABLE TABLET ORL CTB PDL TAB 0.056000002311496 PRO-AAS EC 80 MG TABLET ORL ECT PDL TAB 0.560000002309661 PRO-AMIODARONE-200 200 MG TABLET ORL TAB PDL TAB 0.514700000644331 PRO-AMOX 250 MG/5 ML POWDER FOR ORAL SUSPENSION ORL SUS PDL ML 0.054000080026419 PROARGI-9 PLUS ORAL POWDER ORL PWR NHP G 0.125200002310600 PRO-AZITHROMYCINE 250 MG TABLET ORL TAB PDL TAB 2.466700002209071 PROBETA 0.5% OPHTHALMIC SOLUTION OPH SOL ALL ML 2.950000002311038 PRO-BICALUTAMIDE-50 50 MG TABLET ORL TAB PDL TAB 1.610000080014464 PROBIOTIC 10 BILLION ORL CAP JAM CAP 0.239800002184486 PROCAINAMIDE HYDROCHLORIDE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 2.816000000638676 PROCAN 500 MG SUSTAINED-RELEASE TABLET ORL SRT ERF TAB 0.544500000638684 PROCAN 750 MG SUSTAINED-RELEASE TABLET ORL SRT ERF TAB 0.9425

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002311062 PRO-CEFADROXIL-500 500 MG CAPSULE ORL CAP PDL CAP 0.842100002311453 PRO-CEFUROXIME-500 500 MG TABLET ORL TAB PDL TAB 1.433700002232658 PROCET-30 TABLET ORL TAB PDL TAB 0.130000000789747 PROCHLORPERAZINE 5 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.502000002317796 PRO-CIPROFLOXACIN 250 MG TABLET ORL TAB PDL TAB 0.618600002317818 PRO-CIPROFLOXACIN 500 MG TABLET ORL TAB PDL TAB 0.697900002311607 PRO-CLONAZEPAM 1 MG TABLET ORL TAB PDL TAB 0.186000002311615 PRO-CLONAZEPAM 2 MG TABLET ORL TAB PDL TAB 0.159500002223260 PROCTOSEDYL RECTAL SUPPOSITORY RT SUP AXC SUP 1.264200002241799 PROCYTOX 1,000 MG/VIAL INJECTION INJ DEFAUL ASM VIAL 77.810000002241797 PROCYTOX 200 MG/VIAL INJECTION INJ DEFAUL ASM VIAL 51.870000002241795 PROCYTOX 25 MG TABLET ORL TAB ASM TAB 0.619400002241796 PROCYTOX 50 MG TABLET ORL TAB ASM TAB 0.836300002241800 PROCYTOX INJECTION INJ DEFAUL ASM VIAL 152.350000002311267 PRO-DEXAMETHASONE-4 4 MG TABLET ORL TAB PDL TAB 0.304600002246645 PRODIEM BULK FIBRE THERAPY 625 MG TABLET ORL TAB NVC TAB 0.174300002246576 PRODIEM OVERNIGHT RELIEF THERAPY 15 MG TABLET ORL TAB NVC TAB 0.215300002311429 PRO-ENALAPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.264700002311402 PRO-ENALAPRIL-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.186300002311437 PRO-ENALAPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.319500002311410 PRO-ENALAPRIL-5 5 MG TABLET ORL TAB PDL TAB 0.220300002310228 PRO-FENO-SUPER-100 100 MG TABLET ORL TAB PDL TAB 0.540600002310236 PRO-FENO-SUPER-160 160 MG TABLET ORL CAP/TAB PDL TAB 0.272300002247909 PROFERRIN 11 MG TABLET ORL TAB CBI TAB 0.525700002310686 PRO-FLUCONAZOLE 100 MG TABLET ORL TAB PDL TAB 2.289000002314991 PRO-FLUOXETINE 10 MG CAPSULE ORL CAP PDL CAP 0.459500002315009 PRO-FLUOXETINE 20 MG CAPSULE ORL CAP PDL CAP 0.459800002310449 PRO-GABAPENTIN 100 MG CAPSULE ORL CAP PDL CAP 0.104000002310457 PRO-GABAPENTIN 300 MG CAPSULE ORL CAP PDL CAP 0.253000002310465 PRO-GABAPENTIN 400 MG CAPSULE ORL CAP PDL CAP 0.301500002310473 PRO-GABAPENTIN 600 MG TABLET ORL TAB PDL TAB 0.958000002310481 PRO-GABAPENTIN 800 MG TABLET ORL TAB PDL TAB 1.277300000503347 PROGLYCEM 100 MG CAPSULE ORL CAP MFC CAP 1.657000002243144 PROGRAF 0.5 MG CAPSULE ORL CAP ASP CAP 2.140700002175991 PROGRAF 1 MG CAPSULE ORL CAP ASP CAP 2.738400002175983 PROGRAF 5 MG CAPSULE ORL CAP ASP CAP 13.713500002311011 PRO-HYDROXYQUINE-200 200 MG TABLET ORL TAB PDL TAB 0.2620

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 82 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000646261 PRO-INDO 25 MG CAPSULE ORL CAP PDL CAP 0.087100000646288 PRO-INDO 50 MG CAPSULE ORL CAP PDL CAP 0.151100002204606 PROLASTIN-C 1 G/VIAL INJECTION INJ DEFAUL GRL VIAL 429.060000002310988 PRO-LISINOPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.161900002310996 PRO-LISINOPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.194500002310961 PRO-LISINOPRIL-5 5 MG TABLET ORL TAB PDL TAB 0.134700000655643 PRO-LORAZEPAM 0.5 MG TABLET ORL TAB PDL TAB 0.035900000655651 PRO-LORAZEPAM 1.0 MG TABLET ORL TAB PDL TAB 0.044700000655678 PRO-LORAZEPAM 2 MG TABLET ORL TAB PDL TAB 0.069900002314908 PRO-METFORMIN 500 MG TABLET ORL TAB PDL TAB 0.058700002314894 PRO-METFORMIN 850 MG TABLET ORL TAB PDL TAB 0.084700002343053 PROPAFENONE 150 MG TABLET ORL TAB SNS TAB 0.430300002343061 PROPAFENONE 300 MG TABLET ORL TAB SNS TAB 0.753700002243783 PROPAFENONE-150 150 MG TABLET ORL TAB PDL TAB 0.339500002243784 PROPAFENONE-300 300 MG TABLET ORL TAB PDL TAB 0.522700002238213 PROPECIA 1 MG TABLET ORL TAB MFC TAB 1.927500002311224 PRO-QUININE-300 300 MG CAPSULE ORL CAP PDL CAP 0.375000002315181 PRO-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.120400002315203 PRO-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.240800002310023 PRO-RAMIPRIL-1.25 1.25 MG CAPSULE ORL CAP/TAB PDL CAP 0.205700002310104 PRO-RAMIPRIL-10 10 MG CAPSULE ORL CAP/TAB PDL CAP 0.300300002310066 PRO-RAMIPRIL-2.5 2.5 MG CAPSULE ORL CAP/TAB PDL CAP 0.237000002310074 PRO-RAMIPRIL-5 5 MG CAPSULE ORL CAP/TAB PDL CAP 0.237000002316536 PRO-SOTALOL 160 MG TABLET ORL TAB PDL TAB 0.649200002316528 PRO-SOTALOL 80 MG TABLET ORL TAB PDL TAB 0.593200000519367 PRO-TRIAZIDE TABLET ORL TAB PDL TAB 0.060800000512524 PROTRIN DF 800 MG/160 MG TABLET ORL TAB PDL TAB 0.122100000287709 PROTYLOL 10 MG CAPSULE ORL CAP PDL CAP 0.065500000513059 PROTYLOL 20 MG TABLET ORL TAB PDL TAB 0.181700002239656 PROVOCHOLINE 100 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 40.000000002243834 PROVOCHOLINE 1280 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 487.000000002246492 PROVOCHOLINE 160 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 64.000000002246493 PROVOCHOLINE 320 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 128.000000002313065 PRO-ZOPICLONE 5 MG TABLET ORL TAB PDL TAB 0.223100002313073 PRO-ZOPICLONE 7.5 MG TABLET ORL TAB PDL TAB 0.468500080002201 PSN 056 CAPSULE ORL CAP PSN CAP 0.075000000999412 PULMOCARE ORAL LIQUID ORL LIQ ABN ML 0.0137

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000466409 PULMOPHYLLINE 5.3 MG/ML ORAL ELIXIR ORL ELX RIV ML 0.008600002046733 PULMOZYME 1 ML AMPOULE INHALATION SOLUTION INH SOL HLR ML 16.635600002242439 PUREGON 100 IU/ML INJECTION INJ DEFAUL MFC ML 97.000000002242441 PUREGON 200 IU/ML INJECTION INJ DEFAUL MFC ML 208.560000002243948 PUREGON 833 IU/ML INJECTION CARTRIDGE INJ CTG MFC ML 808.333300002317966 PURG-ODAN ORL POWDER ORL PWDPKT ODN PCKT 5.640000000004723 PURINETHOL 50 MG TABLET ORL TAB TEV TAB 3.109200080009682 PYCNOGENOL 25 MG ORAL CASPULE ORL CAP NFN CAP 0.566500000497517 PYRIDOXINE HCL 100 MG/ML INJECTION INJ DEFAUL HSP ML 1.950000002245215 PYRIDOXINE HYDROCHLORIDE 100 MG/ML INJECTION INJ DEFAUL BNQ ML 1.267300080015945 QUEST TABLET ORL TAB PLH TAB 0.394300002417367 QUETIAPINE XR 150 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.778000002417790 QUETIAPINE XR 150 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.875300002417375 QUETIAPINE XR 200 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 1.052000002417804 QUETIAPINE XR 200 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 1.188200002417383 QUETIAPINE XR 300 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 1.544000002417812 QUETIAPINE XR 300 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 1.750500002417820 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 2.376300002417391 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 2.096000002417782 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.444500002417359 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.395000002415925 QUINAPRIL 10 MG TABLET ORL TAB PDL TAB 0.532900002415933 QUINAPRIL 20 MG TABLET ORL TAB PDL TAB 0.532900002415941 QUINAPRIL 40 MG TABLET ORL TAB PDL TAB 0.532900002415917 QUINAPRIL 5 MG TABLET ORL TAB PDL TAB 0.532900000695440 QUININE-ODAN 200 MG CAPSULE ORL CAP ODN CAP 0.259700000695459 QUININE-ODAN 300 MG CAPSULE ORL CAP ODN CAP 0.407500000695432 QUININE-ODAN 300 MG TABLET ORL TAB ODN TAB 0.407500080039114 Q-UROL TABLET ORL TAB TPI TAB 0.741500002267667 RABAVERT VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL MFC VIAL 186.770000002423723 RAGWITEK 12 UNIT SUBLINGUAL TABLET SLG TAB MFC TAB 4.085000002299194 RALIVIA 100 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.359800002299208 RALIVIA 200 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 2.484200002299216 RALIVIA 300 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 3.603300002415852 RALOXIFENE 60 MG TABLET ORL TAB PDL TAB 0.481400002308363 RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB SIV CAP 0.127400002287943 RAMIPRIL 10 MG CAPSULE ORL CAP/TAB SIV CAP 0.1862

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002287927 RAMIPRIL 2.5 MG CAPSULE ORL CAP/TAB SIV CAP 0.147000002287935 RAMIPRIL 5 MG CAPSULE ORL CAP/TAB SIV CAP 0.147000002415895 RAMIPRIL-HCTZ 10 MG/ 12.5 MG TABLET ORL TAB PDL TAB 0.263300002415909 RAMIPRIL-HCTZ 10 MG/25 MG TABLET ORL TAB PDL TAB 0.263300002415887 RAMIPRIL-HCTZ 5 MG/12.5 MG TABLET ORL TAB PDL TAB 0.206700002384698 RAN-ALENDRONATE 5 MG TABLET ORL TAB RAN TAB 1.068200002398877 RAN-AMLODIPINE 2.5 MG TABLET ORL TAB RAN TAB 0.142100002328690 RAN-ANASTROZOLE 1 MG TABLET ORL TAB RAN TAB 2.622100002371324 RAN-BICALUTAMIDE 50 MG TABLET ORL TAB RAN TAB 4.409000002380684 RAN-CANDESARTAN 4 MG TABLET ORL TAB RAN TAB 0.350200002361426 RAN-CLARITHROMYCIN 250 MG TABLET ORL TAB RAN TAB 0.447900002361434 RAN-CLARITHROMYCIN 500 MG TABLET ORL TAB RAN TAB 1.678200002423979 RAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT RAN TAB 1.869000002423987 RAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT RAN TAB 1.869000002294524 RAN-FOSINOPRIL 10 MG TABLET ORL TAB RAN TAB 0.217700002294532 RAN-FOSINOPRIL 20 MG TABLET ORL TAB RAN TAB 0.261900002351706 RAN-IMIPENEM-CILASTATIN 500 MG/500 MG/VIAL INJ INJ DEFAUL RAN VIAL 21.940000000740748 RANITIDINE 150 MG TABLET ORL TAB PDL TAB 0.180000000740756 RANITIDINE 300 MG TABLET ORL TAB PDL TAB 0.360000002372282 RAN-LETROZOLE 2.5 MG TABLET ORL TAB RAN TAB 2.838700002421364 RAN-MEMANTINE 10 MG TABLET ORL TAB RAN TAB 1.635700002358077 RAN-NABILONE 0.25 MG CAPSULE ORL CAP RAN CAP 1.517200002414112 RAN-OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB RAN TAB 5.516100002414120 RAN-OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB RAN TAB 7.825700002305038 RAN-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RAN TAB 1.313200002375850 RAN-PIOGLITAZONE 15 MG TABLET ORL TAB RAN TAB 0.631200002375869 RAN-PIOGLITAZONE 30 MG TABLET ORL TAB RAN TAB 0.884400002375877 RAN-PIOGLITAZONE 45 MG TABLET ORL TAB RAN TAB 1.329700002392844 RAN-PREGABALIN 150 MG CAPSULE ORL CAP RAN CAP 1.778800002392852 RAN-PREGABALIN 225 MG CAPSULE ORL CAP RAN CAP 1.778800002392801 RAN-PREGABALIN 25 MG CAPSULE ORL CAP RAN CAP 0.635800002392860 RAN-PREGABALIN 300 MG CAPSULE ORL CAP RAN CAP 1.778800002392828 RAN-PREGABALIN 50 MG CAPSULE ORL CAP RAN CAP 0.997300002392836 RAN-PREGABALIN 75 MG CAPSULE ORL CAP RAN CAP 1.290400002425548 RAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RAN CAP 0.855000002280906 RAN-RISPERIDONE 0.25 MG TABLET ORL TAB RAN TAB 0.261500002280914 RAN-RISPERIDONE 0.5 MG TABLET ORL TAB RAN TAB 0.4379

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002280922 RAN-RISPERIDONE 1 MG TABLET ORL TAB RAN TAB 0.604800002280930 RAN-RISPERIDONE 2 MG TABLET ORL TAB RAN TAB 1.207500002280949 RAN-RISPERIDONE 3 MG TABLET ORL TAB RAN TAB 1.811200002280957 RAN-RISPERIDONE 4 MG TABLET ORL TAB RAN TAB 2.487500002383136 RAN-SILDENAFIL 100 MG TABLET ORL TAB RAN TAB 9.475000002383101 RAN-SILDENAFIL 25 MG TABLET ORL TAB RAN TAB 8.537500002383128 RAN-SILDENAFIL 50 MG TABLET ORL TAB RAN TAB 9.112500002396084 RAN-TOPIRAMATE 100 MG TABLET ORL TAB RAN TAB 0.610600002396092 RAN-TOPIRAMATE 200 MG TABLET ORL TAB RAN TAB 0.962000002396076 RAN-TOPIRAMATE 25 MG TABLET ORL TAB RAN TAB 0.322200002388197 RAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB RAN TAB 0.645200002363062 RAN-VALSARTAN 40 MG TABLET ORL TAB RAN TAB 0.539600002361663 RAPAFLO 4 MG CAPSULE ORL CAP ASC CAP 2.020300002361671 RAPAFLO 8 MG CAPSULE ORL CAP ASC CAP 2.020700002247111 RAPAMUNE 1 MG TABLET ORL TAB PFI TAB 8.599700002243237 RAPAMUNE 1 MG/ML ORAL LIQUID ORL LIQ PFI ML 8.507500002302063 RASILEZ 150 MG TABLET ORL TAB NOV TAB 1.361400002302071 RASILEZ 300 MG TABLET ORL TAB NOV TAB 1.361400002332728 RASILEZ HCT 150 MG/12.5 MG TABLET ORL TAB NOV TAB 1.367100002332736 RASILEZ HCT 150 MG/25 MG TABLET ORL TAB NOV TAB 1.352500002332744 RASILEZ HCT 300 MG/12.5 MG TABLET ORL TAB NOV TAB 1.352500002332752 RASILEZ HCT 300 MG/25 MG TABLET ORL TAB NOV TAB 1.367100002275279 RATIO-ALENDRONATE 70 MG TABLET ORL TAB RPH TAB 2.543000002277700 RATIO-BICALUTAMIDE 50 MG TABLET ORL TAB RPH TAB 4.179000000550477 RATIO-CALMYDONE ORAL SYRUP ORL SYR RPH ML 0.059600002247818 RATIO-CLARITHROMYCIN 250 MG TABLET ORL TAB RPH TAB 0.424600002247819 RATIO-CLARITHROMYCIN 500 MG TABLET ORL TAB RPH TAB 1.678200002103656 RATIO-CLONAZEPAM 0.5 MG TABLET ORL TAB RPH TAB 0.116600002103737 RATIO-CLONAZEPAM 2 MG TABLET ORL TAB RPH TAB 0.201000000694827 RATIO-CORISTEX-DH ORAL LIQUID ORL LIQ RPH ML 0.082600002053403 RATIO-COTRIDIN EXPECTORANT ORAL SYRUP ORL SYR RPH ML 0.063100002169126 RATIO-COTRIDIN ORAL SYRUP ORL SYR RPH ML 0.056700002229781 RATIO-DILTIAZEM CD 120 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.363500002229782 RATIO-DILTIAZEM CD 180 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.684600002229783 RATIO-DILTIAZEM CD 240 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.639900002229784 RATIO-DILTIAZEM CD 300 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 1.135100002296071 RATIO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM RPH DOSE 0.1989

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002218461 RATIO-FLUVOXAMINE 100 MG TABLET ORL TAB RPH TAB 0.378300002275252 RATIO-FOSINOPRIL 10 MG TABLET ORL TAB RPH TAB 0.497700002275260 RATIO-FOSINOPRIL 20 MG TABLET ORL TAB RPH TAB 0.598500000805386 RATIO-GENTAMICIN SULFATE 0.1% TOPICAL CREAM TOP CRM RPH G 0.456000000805025 RATIO-GENTAMYCIN SULFATE 0.1% TOPICAL OINTMENT TOP ONT RPH G 0.427300002273101 RATIO-GLIMEPIRIDE 1 MG TABLET ORL TAB RPH TAB 0.504700002273128 RATIO-GLIMEPIRIDE 2 MG TABLET ORL TAB RPH TAB 0.504700002273136 RATIO-GLIMEPIRIDE 4 MG TABLET ORL TAB RPH TAB 0.532300002243789 RATIO-IPRA SAL UDV INHALATION SOLUTION INH SOL RPH ML 0.452400002097168 RATIO-IPRATROPIUM UDV 250 MCG/ML INHALATION SOL'N INH UDSOL RPH ML 0.717000002247461 RATIO-KETOROLAC 0.5% OPH SOLUTION OPH SOL RPH ML 1.600000002243353 RATIO-LAMOTRIGINE 100 MG TABLET ORL TAB RPH TAB 0.573900002243352 RATIO-LAMOTRIGINE 25 MG TABLET ORL TAB RPH TAB 0.096400000653233 RATIO-LENOLTEC NO.1 TABLET ORL TAB RPH TAB 0.054700002031159 RATIO-LEVOBUNOLOL 0.25% OPH SOLUTION OPH SOL RPH ML 3.900000002248031 RATIO-MELOXICAM 15 MG TABLET ORL TAB RPH TAB 0.584000002247889 RATIO-MELOXICAM 7.5 MG TABLET ORL TAB RPH TAB 0.491400002320908 RATIO-MEMANTINE 10 MG TABLET ORL TAB RPH TAB 1.777400002194163 RATIO-NYSTATIN 100,000 UNIT/G VAGINAL CREAM VAG CRM RPH G 0.346700002260867 RATIO-OMEPRAZOLE 20 MG SUSTAINED-RELEASE TABLET ORL CAP/SRT RPH TAB 0.411700002308681 RATIO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RPH TAB 1.275000002247810 RATIO-PAROXETINE 10 MG TABLET ORL TAB RPH TAB 1.043000002247812 RATIO-PAROXETINE 30 MG TABLET ORL TAB RPH TAB 0.721700002301423 RATIO-PIOGLITAZONE 15 MG TABLET ORL TAB RPH TAB 0.598300002301431 RATIO-PIOGLITAZONE 30 MG TABLET ORL TAB RPH TAB 0.838300002301458 RATIO-PIOGLITAZONE 45 MG TABLET ORL TAB RPH TAB 1.260400002311194 RATIO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RPH CAP 0.813300002319500 RATIO-SILDENAFIL R 20 MG TABLET ORL TAB RPH TAB 7.512800002247068 RATIO-SIMVASTATIN 10 MG TABLET ORL TAB RPH TAB 0.375300002247070 RATIO-SIMVASTATIN 40 MG TABLET ORL TAB RPH TAB 0.463600002247071 RATIO-SIMVASTATIN 80 MG TABLET ORL TAB RPH TAB 0.463300000317225 RATIO-THEO-BRONC ORAL SOLUTION ORL SOL RPH ML 0.035000000550507 RATIO-TRIACOMB REGULAR TOPICAL CREAM TOP CRM RPH G 0.394700002140063 RATIO-VALPROIC 50 MG/ML ORAL SYRUP ORL SYR RPH ML 0.039800002223554 REACTINE 10 MG TABLET ORL TAB PDH TAB 0.996700001900978 REACTINE 20 MG TABLET ORL TAB PDH TAB 0.924000002223546 REACTINE 5 MG TABLET ORL TAB PDH TAB 0.5725

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 87 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002246162 REACTINE ALLERGY & SINUS EXTENDED-RELEASE TABLET ORL ERT PDH TAB 0.746000002368064 REACTINE ALLERGY LIQUID GELS 10 MG CAPSULE ORL CAP MCL CAP 0.760400002358352 REACTINE FAST MELT 10 MG ODT ORL ODT MCL TAB 1.082500002243676 RECOMBIVAX HB (PRESERVATIVE FREE) 5MCG/0.5ML INJ INJ DEFAUL MFC ML 23.220000000749486 RECOMBIVAX-HB 10 MCG/ML(RECOMBINANT) INJECTION INJ DEFAUL MFC ML 21.350000000013447 REDOXON (BL CHERRY) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.270000000897221 REDOXON (LEMON) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.264000000897256 REDOXON (ORANGE) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.270000002138670 REFRESH 1.4% OPH SOLUTION OPH SOL ALL ML 0.879200002244650 REFRESH LIQUIGEL 1% OPH SOLUTION OPH SOL ALL ML 0.529300002399148 REFRESH OPTIVE ADVANCED NAS SOL ALL ML 0.949000002049260 REFRESH PLUS 0.5% OPH SOLUTION OPH SOL ALL ML 0.781700002231008 REFRESH TEARS 0.5% OPH SOLUTION OPH SOL ALL ML 0.441300002239405 REGRANEX TOPICAL GEL TOP GEL JAI G 35.333300002242592 REGULAR VITA-VIM CAPLET ORL TAB JAM TAB 0.101200002192640 REJUVA-A 0.025% TOPICAL CREAM TOP CRM GSK G 1.841000002346672 RELAXA PEG 3350 ORAL POWDER ORL PWR RED G 0.027700002240863 RELENZA 5 MG/DOSE INHALATION DISK INH DSK GSK DISC 7.942000002308215 RELISTOR 20 MG/ML INJECTION INJ DEFAUL SLX ML 63.333300002256290 RELPAX 20 MG TABLET ORL TAB PFI TAB 14.875000002256304 RELPAX 40 MG TABLET ORL TAB PFI TAB 14.875000002248542 REMERON RD 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.454700002248543 REMERON RD 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.909000002248544 REMERON RD 45 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 1.363700002246552 REMODULIN 1 MG/ML INJECTION INJ DEFAUL NTH ML 45.000000002246555 REMODULIN 10 MG/ML INJECTION INJ DEFAUL NTH ML 450.000000002246553 REMODULIN 2.5 MG/ML INJECTION INJ DEFAUL NTH ML 112.500000002246554 REMODULIN 5 MG/ML INJECTION INJ DEFAUL NTH ML 225.000000002244310 RENAGEL 800 MG TABLET ORL TAB SAV TAB 1.784900002222000 RENEDIL 10 MG EXTENDED-RELEASE TABLET ORL ERT SAV TAB 0.725700002221985 RENEDIL 2.5 MG EXTENDED-RELEASE TABLET ORL ERT SAV TAB 0.317000002221993 RENEDIL 5 MG EXTENDED-RELEASE TABLET ORL ERT SAV TAB 0.463300002052407 RENOVA 0.05% TOPICAL CREAM TOP CRM MCN G 1.350000002354586 RENVELA 800 MG TABLET ORL TAB SAV TAB 1.684600002415968 REPAGLINIDE 0.5 MG TABLET ORL TAB PDL TAB 0.099600002415976 REPAGLINIDE 1 MG TABLET ORL TAB PDL TAB 0.103600002415984 REPAGLINIDE 2 MG TABLET ORL TAB PDL TAB 0.1075

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002249057 REPLAGAL 1 MG/ML INJECTION INJ DEFAUL PAL ML 657.142900002247790 REPRONEX 75 UNIT/VIAL INJECTION INJ DEFAUL FEI VIAL 74.544000002377012 RESOTRAN 1 MG FILM-COATED TABLET ORL TAB JAI TAB 2.442100002377020 RESOTRAN 2 MG FILM-COATED TABLET ORL TAB JAI TAB 3.748900000999551 RESOURCE KID ESSENTIALS ORAL LIQUID ORL LIQ NHN ML 0.008700002355655 RESTASIS 0.05% OPH EMULSION OPH EML ALL ML 9.005800002318164 RESTORALAX ORAL POWDER ORL PWR SPL G 0.063900000443816 RETIN-A 0.025% TOPICAL GEL TOP GEL JJI G 0.425700000443794 RETIN-A 0.05% TOPICAL CREAM TOP CRM JJI G 0.430300002264633 RETIN-A MICRO 0.04% TOPICAL GEL TOP GEL JJI G 1.170000002243914 RETIN-A MICRO 0.1% GEL TOP GEL JJI G 1.170000002306980 RETISERT 0.59 MG INTRAVITREAL IMPLANT OPH IMP BSH SYS 16000.000000002008726 RETISOL-A 0.01% TOPICAL CREAM TOP CRM GSK G 0.790400002008696 RETISOL-A 0.025% TOPICAL CREAM TOP CRM GSK G 0.764900002008718 RETISOL-A 0.05% TOPICAL CREAM TOP CRM GSK G 0.764900002008688 RETISOL-A O.1% TOPICAL CREAM TOP CRM GSK G 0.764900001902660 RETROVIR 100 MG CAPSULE ORL CAP GSK CAP 2.003400001902652 RETROVIR 50 MG/5ML ORAL SYRUP ORL SYR GSK ML 0.212300002279401 REVATIO 20 MG TABLET ORL TAB PFI TAB 11.956000002213826 REVIA 50 MG TABLET ORL TAB BAR TAB 9.335600002035871 REVITONUS C-1000 ORAL LIQUID ORL LIQ SDZ AMP 0.811000002304902 REVLIMID 10 MG CAPSULE ORL CAP CLG CAP 361.000000002317699 REVLIMID 15 MG CAPSULE ORL CAP CLG CAP 382.000000002317710 REVLIMID 25 MG CAPSULE ORL CAP CLG CAP 424.000000002304899 REVLIMID 5 MG CAPSULE ORL CAP CLG CAP 340.000000002361825 REVOLADE 25 MG TABLET ORL TAB GSK TAB 62.500000002361833 REVOLADE 50 MG TABLET ORL TAB GSK TAB 125.000000002248610 REYATAZ 150 MG CAPSULE ORL CAP BMS CAP 12.016800002248611 REYATAZ 200 MG CAPSULE ORL CAP BMS CAP 11.058700002294176 REYATAZ 300 MG CAPSULE ORL CAP BMS CAP 24.033700002220806 RHINARIS LUBRICATING NASAL GEL NAS GEL PMS G 0.285100000732230 RHINARIS NASAL AEROSOL NAS AER PMS DOSE 0.193300002231923 RHINOCORT AQUA 64 MCG/DOSE METERED DOSE NAS. SPRAY NAS SPM AZC DOSE 0.098700080026370 RHODIOLA ROSEA CAPSULE ORL CAP AOR CAP 0.254600001910140 RHOTRAL 100 MG TABLET ORL TAB SDZ TAB 0.163000001910159 RHOTRAL 200 MG TABLET ORL TAB SDZ TAB 0.244000001910167 RHOTRAL 400 MG TABLET ORL TAB SDZ TAB 0.4848

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 89 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002260107 RHOXAL-ANAGRELIDE 0.5 MG CAPSULE ORL CAP SDZ CAP 3.449600002269589 RHOXAL-GLIMEPIRIDE 1 MG TABLET ORL TAB SDZ TAB 0.532300002269597 RHOXAL-GLIMEPIRIDE 2 MG TABLET ORL TAB SDZ TAB 0.532300002269619 RHOXAL-GLIMEPIRIDE 4 MG TABLET ORL TAB SDZ TAB 0.504700002243559 RHOXAL-ORPHENADRINE 100 MG EXTENDED-RELEASE TABLET ORL ERT SDZ TAB 0.857000000309702 RIBOFLAVINE 100 MG TABLET ORL TAB JAM TAB 0.067500002091887 RIFADIN 150 MG CAPSULE ORL CAP SAV CAP 0.912200002092808 RIFADIN 300 MG CAPSULE ORL CAP SAV CAP 1.435600002347474 RISEDRONATE 35 MG TABLET ORL TAB PDL TAB 2.427500002352141 RISEDRONATE 35 MG TABLET ORL TAB SIV TAB 2.489300002298465 RISPERDAL CONSTA 12.5 MG/VIAL INJECTION INJ DEFAUL JAI VIAL 85.400000002247217 RIVA-AMIODARONE 200 MG TABLET ORL TAB RIV TAB 0.514700002331500 RIVA-AMLODIPINE 10 MG TABLET ORL TAB RIV TAB 0.358700002331489 RIVA-AMLODIPINE 2.5 MG TABLET ORL TAB RIV TAB 0.138000002242093 RIVA-ATENOLOL 100 MG TABLET ORL TAB RIV TAB 0.236200002242094 RIVA-ATENOLOL 50 MG TABLET ORL TAB RIV TAB 0.143700002422751 RIVA-ATORVASTATIN 10 MG TABLET ORL TAB RIV TAB 0.313800002422778 RIVA-ATORVASTATIN 20 MG TABLET ORL TAB RIV TAB 0.392200002422786 RIVA-ATORVASTATIN 40 MG TABLET ORL TAB RIV TAB 0.421600002422794 RIVA-ATORVASTATIN 80 MG TABLET ORL TAB RIV TAB 0.421600002242077 RIVA-CLONAZEPAM 0.5 MG TABLET ORL TAB RIV TAB 0.049500002247306 RIVA-FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP RIV CAP 0.272300002251167 RIVA-GABAPENTIN 100 MG CAPSULE ORL CAP RIV CAP 0.104000002251175 RIVA-GABAPENTIN 300 MG CAPSULE ORL CAP RIV CAP 0.253000002251183 RIVA-GABAPENTIN 400 MG CAPSULE ORL CAP RIV CAP 0.301500002239081 RIVA-METFORMIN 500 MG TABLET ORL TAB RIV TAB 0.058600002242783 RIVA-METFORMIN 850 MG TABLET ORL TAB RIV TAB 0.084700002265265 RIVA-MIRTAZAPINE 30 MG TABLET ORL TAB RIV TAB 0.233800002240788 RIVA-NAPROXEN 500 MG TABLET ORL TAB RIV TAB 0.211000002228300 RIVANASE AQ 50 MCG/DOSE METER DOSE NASAL SPRAY NAS SPM RIV DOSE 0.049000002402416 RIVA-OMEPRAZOLE DR 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT RIV TAB 0.411700002316463 RIVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.505400002330083 RIVA-RABEPRAZOLE EC 10 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.120300002330091 RIVA-RABEPRAZOLE EC 20 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.240700002202352 RIVASA CROQUABLE 80 MG TABLET ORL CTB RIV TAB 0.056000002240112 RIVASOL-HC RECTAL SUPPOSITORY RT SUP RIV SUP 0.583300001940112 RIVASONE SCALP 0.1% TOPICAL LOTION TOP LOT RIV ML 0.0853

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 90 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242157 RIVA-SOTALOL 160 MG TABLET ORL TAB RIV TAB 0.162300002416999 RIVASTIGMINE 1.5 MG CAPSULE ORL CAP PDL CAP 0.651400002417006 RIVASTIGMINE 3 MG CAPSULE ORL CAP PDL CAP 0.651400002417014 RIVASTIGMINE 4.5 MG CAPSULE ORL CAP PDL CAP 0.651400002417022 RIVASTIGMINE 6 MG CAPSULE ORL CAP PDL CAP 0.651400002248082 RIVA-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT RIV TAB 0.507500002415801 RIZATRIPTAN ODT 10 MG ORALLY DISINTEG TAB ORL DISNTAB PDL TAB 3.705000002415798 RIZATRIPTAN ODT 5 MG ORALLY DISINTEG TAB ORL DISNTAB PDL TAB 3.705000002247147 ROBAX PLATINUM TABLET ORL TAB PDH TAB 0.657800002026805 ROBAXACET CAPLET ORL TAB PDH TAB 0.484400002231176 ROBAXACET EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.532200001934767 ROBAXACET-8 TABLET ORL TAB PDH TAB 0.742600001930990 ROBAXIN 500 MG TABLET ORL TAB PDH TAB 0.511600001932187 ROBAXIN-750 750 MG TABLET ORL TAB PDH TAB 0.844600002026783 ROBAXISAL CAPLET ORL TAB WCH TAB 0.402200002230949 ROBAXISAL EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.532200001934791 ROBAXISAL-C 1/2 TABLET ORL TAB PDH TAB 1.249600001934783 ROBAXISAL-C 1/4 TABLET ORL TAB PDH TAB 1.045800001931032 ROBITUSSIN 20 MG ORAL SYRUP ORL SYR PDH ML 0.052500002142783 ROBITUSSIN 200 MG/5 ML EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.052500001934740 ROBITUSSIN A-C ORAL SYRUP ORL SYR PDH ML 0.108100002068419 ROBITUSSIN COUGH AND COLD ORAL SYRUP ORL SYR PDH ML 0.052500002142775 ROBITUSSIN DM EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.052500001931024 ROBITUSSIN DM ORAL SYRUP ORL SYR PDH ML 0.052500000824291 ROCALTROL 1 MCG/ML ORAL SOLUTION ORL SOL HLR ML 2.956000002318415 ROCURONIUM BROMIDE 10MG/ML INJECTION INJ DEFAUL SDZ ML 1.026000000393444 ROFACT 150 MG CAPSULE ORL CAP VCL CAP 0.706700000343617 ROFACT 300 MG CAPSULE ORL CAP VCL CAP 1.124500000708925 ROGAINE 20 MG/ML TOPICAL SOLUTION TOP SOL UPJ ML 0.646800002368684 ROGAINE FOAM 50 MG/G AEROSOL FOAM TOP FOA JJI G 0.754600002242979 ROGITINE 10 MG/ML INJECTION INJ DEFAUL PAL ML 39.442000002242919 ROSASOL 1% TOPICAL CREAM TOP CRM GSK G 0.525700002381184 ROSUVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.340000002389045 ROSUVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.340000002389053 ROSUVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.425000002381192 ROSUVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.425000002389061 ROSUVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.4977

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002381206 ROSUVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.497700002381176 ROSUVASTATIN 5 MG TABLET ORL TAB PDL TAB 0.322700002389037 ROSUVASTATIN 5 MG TABLET ORL TAB SIV TAB 0.322700002300591 ROTARIX 1 000 000 CCID50 DOSE (1.5ML) ORAL SUSP ORL SUS GSK DOSE 78.570000002284413 ROTATEQ (2 ML/DOSE) ORAL SOLUTION ORL SOL MFC ML 30.770000000466425 ROUGIER CALCIUM ORAL LIQUID ORL LIQ ROG ML 0.022200002248563 RUB A535 DUAL ACTION TOP CRM CHD G 0.061600002222116 RUB A-535 EXTRA STRENGTH TOP CRM CHD G 0.061600080015240 RUGBY NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM APH PIECE 0.165000002224828 RYTHMODAN 150 MG CAPSULE ORL CAP SAV CAP 0.392400002245735 SAB-SODIUM CHLORIDE 5% OPTHALMIC SOLUTION USP OPH SOL SDZ ML 0.563300000623571 SALIJECT 570 MG/ML INJECTION INJ DEFAUL OMG ML 1.430000080024381 SALINEX 9 MG/ML NASAL SPRAY NAS SPR SDZ ML 0.138000000779296 SALINEX NASAL LUBRICANT GEL NAS GEL SDZ G 0.148300001910701 SALINEX NASAL LUBRICANT SPRAY NAS SPR SDZ ML 0.169700080004542 SALMON & FISH OILS 1000 MG SOFTGEL ORL TAB WNP TAB 0.071500002370468 SAMSCA 15 MG TABLET ORL TAB OTS TAB 250.000000002370476 SAMSCA 30 MG TABLET ORL TAB OTS TAB 250.000000000593257 SANDIMMUNE I.V. 50 MG/ML INJECTION INJ DEFAUL NOV ML 4.800000002288079 SANDOZ ALENDRONATE 5 MG TABLET ORL TAB SDZ TAB 1.068000002338467 SANDOZ ANASTROZOLE 1 MG TABLET ORL TAB SDZ TAB 2.766700002247692 SANDOZ ANUZINC HC PLUS OINTMENT RT ONT SDZ G 0.883300002231733 SANDOZ ATENOLOL 100 MG TABLET ORL TAB SDZ TAB 0.568700002231731 SANDOZ ATENOLOL 50 MG TABLET ORL TAB SDZ TAB 0.346000002386410 SANDOZ ATOMOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 2.383300002386429 SANDOZ ATOMOXETINE 18 MG CAPSULE ORL CAP SDZ CAP 2.732000002386437 SANDOZ ATOMOXETINE 25 MG CAPSULE ORL CAP SDZ CAP 3.016000002386445 SANDOZ ATOMOXETINE 40 MG CAPSULE ORL CAP SDZ CAP 3.437300002386453 SANDOZ ATOMOXETINE 60 MG CAPSULE ORL CAP SDZ CAP 3.813300002276089 SANDOZ BICALUTAMIDE 50 MG TABLET ORL TAB SDZ TAB 4.057300002386283 SANDOZ BOSENTAN 125 MG TABLET ORL TAB SDZ TAB 52.304800002386275 SANDOZ BOSENTAN 62.5 MG TABLET ORL TAB SDZ TAB 52.304800002326957 SANDOZ CANDESARTAN 4 MG TABLET ORL TAB SDZ TAB 0.350200002421917 SANDOZ CAPECITABINE 150 MG TABLET ORL TAB SDZ TAB 1.464000002421925 SANDOZ CAPECITABINE 500 MG TABLET ORL TAB SDZ TAB 4.880000002261855 SANDOZ CARBAMAZEPINE 100 MG CHEWABLE TABLET ORL CTB SDZ TAB 0.038000002261863 SANDOZ CARBAMAZEPINE 200 MG CHEWABLE TABLET ORL CTB SDZ TAB 0.0749

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002303426 SANDOZ CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS SDZ ML 0.059200002303434 SANDOZ CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS SDZ ML 0.122100002233960 SANDOZ CLONAZEPAM 0.5 MG TABLET ORL TAB SDZ TAB 0.049500002233985 SANDOZ CLONAZEPAM 2 MG TABLET ORL TAB SDZ TAB 0.085400002242485 SANDOZ CORTIMYXIN OPH OINTMENT OPH ONT SDZ G 3.614300002230386 SANDOZ CORTIMYXIN OTIC SOLUTION OT SOL SDZ ML 1.140000000739839 SANDOZ DEXAMETHASONE SOD PHOSPHATE 0.1% OT/OPH SOL OT/OPH SOL SDZ ML 1.378000002241224 SANDOZ DICLOFENAC 50 MG RECTAL SUPPOSITORY RT SUP SDZ SUP 0.623600002400596 SANDOZ DICLOFENAC MISOPROSTOL 50 MG/200 MCG ECT ORL ECT SDZ TAB 0.454100002400618 SANDOZ DICLOFENAC MISOPROSTOL 75 MG/200 MCG ECT ORL ECT SDZ TAB 0.617900002261774 SANDOZ DICLOFENAC RAPIDE 50 MG TABLET ORL TAB SDZ TAB 0.393700002367696 SANDOZ DONEPEZIL ODT 10 MG TABLET ORL DISNTAB SDZ TAB 3.726300002367688 SANDOZ DONEPEZIL ODT 5 MG TABLET ORL DISNTAB SDZ TAB 3.726300002278634 SANDOZ FAMCICLOVIR 125 MG TABLET ORL TAB SDZ TAB 2.085000002278642 SANDOZ FAMCICLOVIR 250 MG TABLET ORL TAB SDZ TAB 2.801700002278650 SANDOZ FAMCICLOVIR 500 MG TABLET ORL TAB SDZ TAB 4.354800002390701 SANDOZ FENOFIBRATE E 145 MG TABLET ORL TAB SDZ TAB 0.990300002390698 SANDOZ FENOFIBRATE E 48 MG TABLET ORL TAB SDZ TAB 0.387000002327139 SANDOZ FENTANYL PATCH 37 MCG/HR TRANSDERMAL PATCH TRD PTH SDZ PTH 9.236000002339471 SANDOZ FINASTERIDE A 1 MG TABLET ORL TAB SDZ TAB 1.244700002243486 SANDOZ FLUOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 0.459500002247055 SANDOZ FLUVOXAMINE 100 MG TABLET ORL TAB SDZ TAB 0.378300002247054 SANDOZ FLUVOXAMINE 50 MG TABLET ORL TAB SDZ TAB 0.216800002230888 SANDOZ GENTAMICIN SULFATE 0.3% OPH OINTMENT OPH ONT SDZ G 1.500000002229440 SANDOZ GENTAMICIN SULFATE 0.3% OPH SOLUTION OPH SOL SDZ ML 0.406000002229441 SANDOZ GENTAMICIN SULFATE 0.3% OTIC SOLUTION OT SOL SDZ ML 1.032000002237187 SANDOZ IDOXURIDINE 0.1% TOPICAL SOLUTION TOP SOL SDZ ML 4.990000002344815 SANDOZ LETROZOLE 2.5 MG TABLET ORL TAB SDZ TAB 2.838700002241716 SANDOZ LEVOBUNOLOL 0.5% OPH SOLUTION OPH SOL SDZ ML 1.152000002257564 SANDOZ LOPERAMIDE 2 MG TABLET ORL TAB SDZ TAB 0.265900002247057 SANDOZ LOVASTATIN 40 MG TABLET ORL TAB SDZ TAB 0.898500002344807 SANDOZ MEMANTINE 10 MG TABLET ORL TAB SDZ TAB 1.684800002375532 SANDOZ MEMANTINE FCT 10 MG TABLET ORL TAB SDZ TAB 1.635700002247876 SANDOZ METOPROLOL (TYPE L) 100 MG TABLET ORL TAB SDZ TAB 0.222300002250594 SANDOZ MIRTAZAPINE 15 MG TABLET ORL TAB SDZ TAB 0.407400002320630 SANDOZ MYCOPHENOLATE MOFETIL 250 MG CAPSULE ORL CAP SDZ CAP 1.120300002313855 SANDOZ MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB SDZ TAB 2.9734

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002234007 SANDOZ NITRAZEPAM 10 MG TABLET ORL TAB SDZ TAB 0.053400002234003 SANDOZ NITRAZEPAM 5 MG TABLET ORL TAB SDZ TAB 0.035700002247189 SANDOZ OFLOXACIN 0.3% OPHTHALMIC SOLUTION OPH SOL SDZ ML 1.468000002327791 SANDOZ OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 5.819300002327805 SANDOZ OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 8.256000002358913 SANDOZ OLOPATADINE 0.1% OPH SOLUTION OPH SOL SDZ ML 5.382000002420171 SANDOZ OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL SDZ ML 11.356000002247920 SANDOZ OPTICORT OTIC OPH SOLUTION OT/OPH SOL SDZ ML 1.467500002301075 SANDOZ PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SDZ TAB 1.313200002269422 SANDOZ PAROXETINE 10 MG TABLET ORL TAB SDZ TAB 1.074300002254778 SANDOZ PAROXETINE 30 MG TABLET ORL TAB SDZ TAB 1.064700002244999 SANDOZ PENTASONE 0.1%/0.3% OTIC OPH SOL OT/OPH SOL SDZ ML 1.281300002261790 SANDOZ PINDOLOL 10 MG TABLET ORL TAB SDZ TAB 0.232300002261804 SANDOZ PINDOLOL 15 MG TABLET ORL TAB SDZ TAB 0.337000002261782 SANDOZ PINDOLOL 5 MG TABLET ORL TAB SDZ TAB 0.136100002297906 SANDOZ PIOGLITAZONE 15 MG TABLET ORL TAB SDZ TAB 0.598300002297914 SANDOZ PIOGLITAZONE 30 MG TABLET ORL TAB SDZ TAB 0.838300002297922 SANDOZ PIOGLITAZONE 45 MG TABLET ORL TAB SDZ TAB 1.260400002239234 SANDOZ POLYTRIMETHOPRIM OPH SOLUTION OPH SOL SDZ ML 2.797000002315270 SANDOZ PRAMIPEXOLE 0.5 MG TABLET ORL TAB SDZ TAB 1.427600002247856 SANDOZ PRAVASTATIN 10 MG TABLET ORL TAB SDZ TAB 0.405000002247857 SANDOZ PRAVASTATIN 20 MG TABLET ORL TAB SDZ TAB 0.477700002247858 SANDOZ PRAVASTATIN 40 MG TABLET ORL TAB SDZ TAB 0.575500001916181 SANDOZ PREDNISOLONE ACETATE 0.12% OPH SUSPENSION OPH SUS SDZ ML 1.345000001916203 SANDOZ PREDNISOLONE ACETATE 1% OPH SUSPENSION OPH SUS SDZ ML 1.998000002390841 SANDOZ PREGABALIN 150 MG CAPSULE ORL CAP SDZ CAP 1.778800002390817 SANDOZ PREGABALIN 25 MG CAPSULE ORL CAP SDZ CAP 0.635700002390868 SANDOZ PREGABALIN 300 MG CAPSULE ORL CAP SDZ CAP 1.778800002390825 SANDOZ PREGABALIN 50 MG CAPSULE ORL CAP SDZ CAP 0.997200002390833 SANDOZ PREGABALIN 75 MG CAPSULE ORL CAP SDZ CAP 1.290400080024148 SANDOZ SENNOSIDES 8.6 MG TABLET ORL TAB SDZ TAB 0.050500002318822 SANDOZ SILDENAFIL 100 MG TABLET ORL TAB SDZ TAB 9.997500002318806 SANDOZ SILDENAFIL 25 MG TABLET ORL TAB SDZ TAB 8.537500002318814 SANDOZ SILDENAFIL 50 MG TABLET ORL TAB SDZ TAB 9.112500002247828 SANDOZ SIMVASTATIN 10 MG TABLET ORL TAB SDZ TAB 0.505700002247830 SANDOZ SIMVASTATIN 20 MG TABLET ORL TAB SDZ TAB 0.625100002247831 SANDOZ SIMVASTATIN 40 MG TABLET ORL TAB SDZ TAB 0.4501

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247833 SANDOZ SIMVASTATIN 80 MG TABLET ORL TAB SDZ TAB 0.625100002234013 SANDOZ SOTALOL 160 MG TABLET ORL TAB SDZ TAB 0.208700002416816 SANDOZ TACROLIMUS 0.5 MG CAPSULE ORL CAP SDZ CAP 1.521800002416824 SANDOZ TACROLIMUS 1 MG CAPSULE ORL CAP SDZ CAP 2.053800002416832 SANDOZ TACROLIMUS 5 MG CAPSULE ORL CAP SDZ CAP 9.749000002262177 SANDOZ TERBINAFINE 250 MG TABLET ORL TAB SDZ TAB 1.852500002248529 SANDOZ TRIFLURIDINE 1% OPH SOLUTION OPH SOL SDZ ML 3.266700002239714 SANDOZ VALPROIC 250 MG CAPSULE ORL CAP SDZ CAP 0.140700002356740 SANDOZ VALSARTAN 40 MG TABLET ORL TAB SDZ TAB 0.569400002257580 SANDOZ ZOPICLONE 7.5 MG TABLET ORL TAB SDZ TAB 0.468500000578541 SARNA HC 1% TOPICAL LOTION TOP LOT GSK ML 0.093800000856711 SARNA HC 2.5% TOPICAL LOTION TOP LOT GSK ML 0.181300000874825 SARNA-P TOPICAL LOTION TOP LOT STI ML 0.054700002266121 SATIVEX BUCCAL SPRAY BUC SPR BHP ML 22.809000080041540 SCHINOUSSA PROBIOTIC WHEY ISOLATE ORAL POWDER ORL PWR QUA G 0.035700001919245 SCHOLL ATHLETE'S FOOT SPRAY 1% TOPICAL POWDER TOP PWR SCH G 0.049000002020939 SCLERODEX INJECTION INJ DEFAUL OMG ML 1.304000002020793 SCLERODINE 6 INJECTION INJ DEFAUL OMG ML 2.710000000541869 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL HSP ML 5.314000000541877 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL HSP ML 5.824000002242811 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL OMG ML 5.000000002296659 SEASONALE (91 DAY) TABLET ORL TAB ASC TAB 0.668700002346176 SEASONIQUE (91 DAY) TABLET ORL TAB ASC TAB 0.668700000666106 SEBCUR 4% TOPICAL SHAMPOO TOP SHP DPT ML 0.062100000666114 SEBCUR-T TOPICAL SHAMPOO TOP SHP DPT ML 0.068200002288389 SEBIVO 600 MG TABLET ORL TAB NOV TAB 17.688900000551805 SECARIS NASAL GEL NAS GEL PMS G 0.341400000633380 SELENIUM 100 MCG TABLET ORL TAB JAM TAB 0.074200000554987 SELENIUM 50 MCG TABLET ORL TAB JAM TAB 0.065900000243000 SELSUN 2.5% TOPICAL SOLUTION TOP SOL ABB ML 0.048400000483796 SELSUN BLUE 1% TOPICAL LOTION TOP LOT ABB ML 0.025100000709069 SELSUN BLUE EXTRA CONDITIONING 1% TOPICAL SHAMPOO TOP SHP ABB ML 0.025100002247134 SENNA LAXATIVE & DOCUSATE SODIUM 8.6MG/50MG TABLET ORL TAB VTH TAB 0.053200002237105 SENNA LAXATIVE 8.6 MG TABLET ORL TAB SDR TAB 0.024900002257130 SENSIPAR 30 MG TABLET ORL TAB AMG TAB 12.613700002257149 SENSIPAR 60 MG TABLET ORL TAB AMG TAB 24.437000002257157 SENSIPAR 90 MG TABLET ORL TAB AMG TAB 33.4697

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002357704 SEPTA-AMLODIPINE 2.5 MG TABLET ORL TAB SEP TAB 0.138000002368633 SEPTA-ATENOLOL 25 MG TABLET ORL TAB SEP TAB 0.173000002247998 SERC 24 MG TABLET ORL TAB ABB TAB 0.760700002239046 SEROSTIM 5 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 1633.000000002241304 SERTRALINE 100 MG CAPSULE ORL CAP PDL CAP 0.420000002241302 SERTRALINE 25 MG CAPSULE ORL CAP PDL CAP 0.200400002241303 SERTRALINE 50 MG CAPSULE ORL CAP PDL CAP 0.400000002240344 SIALOR 25 MG TABLET ORL TAB PMS TAB 0.978000080039305 SIERRASIL JOINT FORMULA 14 CAPSULE ORL CAP SMM CAP 0.224200002413299 SIGNIFOR 0.3 MG/ML INJECTION INJ DEFAUL NOV ML 80.513000002413302 SIGNIFOR 0.6 MG /ML INJECTION INJ DEFAUL NOV ML 85.516000002413310 SIGNIFOR 0.9 MG /ML INJECTION INJ DEFAUL NOV ML 85.516000002317583 SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.475000002424320 SILDENAFIL 100 MG TABLET ORL TAB PDL TAB 9.200000002406160 SILDENAFIL 100 MG TABLET ORL TAB SNS TAB 9.200000002317559 SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.537500002406152 SILDENAFIL 50 MG TABLET ORL TAB SNS TAB 8.847500002317575 SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 9.112500002424312 SILDENAFIL 50 MG TABLET ORL TAB PDL TAB 8.847500002398257 SILENOR 3 MG TABLET ORL TAB PAL TAB 0.630300002398265 SILENOR 6 MG TABLET ORL TAB PAL TAB 1.260700080012979 SILICA WITH ZINC CAPLET ORL TAB JAM TAB 0.206200002338572 SILKIS 3 MCG/G TOPICAL OINTMENT TOP ONT GAL G 1.358300002239548 SIMPLY SLEEP 25 MG CAPLET ORL TAB MCL TAB 0.201500002413183 SIMPONI 100 MG/1 ML INJECTION AUTO INJECTOR INJ NDL JAI SYR 1610.320000002413175 SIMPONI 100 MG/1 ML INJECTION SYRINGE INJ NDL JAI SYR 1610.320000002417472 SIMPONI I.V. 50 MG/4.0 ML VIAL INJECTION INJ DEFAUL JAI ML 224.627500002247224 SIMVASTATIN-80 80 MG TABLET ORL TAB PDL TAB 0.625000000326925 SINEQUAN 100 MG CAPSULE ORL CAP ERF CAP 1.192100000400750 SINEQUAN 75 MG CAPSULE ORL CAP ERF CAP 0.904700001926055 SINUTAB N.D. REGULAR STRENGTH TABLET ORL TAB WLA TAB 0.180800001938371 SINUTAB NO DROWSINESS EXTRA STRENGTH TABLET ORL TAB WLA TAB 0.287500001926004 SINUTAB REGULAR STRENGTH TABLET ORL TAB WLA TAB 0.239200001938363 SINUTAB WITH CODEINE TABLET ORL TAB PDH TAB 0.406300001994247 SLEEP AID (REGULAR STRENGTH) 25 MGTABLET ORL TAB TAN TAB 0.095000000623520 SLOW-FE 160 MG TABLET ORL SRT CGS TAB 0.289000002245456 SODIUM AUROTHIOMALATE INJECTION B.P. 10 MG/ ML INJ DEFAUL SDZ ML 9.9500

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 96 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002245457 SODIUM AUROTHIOMALATE INJECTION B.P. 25 MG/ML INJ DEFAUL SDZ ML 14.050000000481912 SODIUM BICARBONATE 325 MG TABLET ORL TAB SLW TAB 0.032800080022194 SODIUM BICARBONATE 500 MG TABLET ORL TAB SDZ TAB 0.075400000261998 SODIUM BICARBONATE 8.4 % INJECTION INJ DEFAUL HSP ML 0.593400000037842 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.022000000060208 SODIUM CHLORIDE 0.9% INJECTION USP INJ DEFAUL BAX ML 0.006200000851388 SODIUM CHLORIDE 0.9% NASAL SPRAY NAS SPR SFY ML 0.053000000392499 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL SDZ ML 4.279000002139510 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL PPC ML 0.326000000402230 SODIUM CHLORIDE 234 MG/ML INJECTION USP INJ DEFAUL OMG ML 0.325000002150204 SODIUM CHLORIDE 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.325000000037834 SODIUM CHLORIDE 9 MG/ML IRRIGATION SOLUTION IR SOL HSP ML 0.022400000402249 SODIUM CHLORIDE BACTERIOSTATIC 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.161700000268313 SODIUM EDECRIN 50 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 480.240000000896187 SODIUM PHOSPHATE INJECTION INJ DEFAUL SDZ ML 0.984700000028053 SODIUM SULAMYD 10% OPH SOLUTION OPH SOL SDZ ML 0.493300002006758 SOFLAX 4 MG/ML ORAL SYRUP ORL SYR PMS ML 0.024600002224895 SOFRAMYCIN 0.5% OPH OINTMENT OPH ONT ERF G 4.216000002224887 SOFRAMYCIN 0.5% OPH SOLUTION OPH SOL ERF ML 1.468800002224879 SOFRAMYCIN 15 MG/50 MCG TOPICAL OINTMENT TOP ONT ERF G 1.089300002224860 SOFRAMYCIN NASAL SPRAY NAS SPR ERF ML 2.934000001988840 SOFRA-TULLE (10 X 10 CM) TOPICAL GAUZE TOP GAU ERF DRE 1.684000001987682 SOFRA-TULLE STRIP (10 X 30 CM) TOPICAL GAUZE TOP GAU AVE DRE 3.870000002243257 SOLAGE 0.01%/ 2% TOPICAL SOLUTION TOP SOL GAL ML 1.693300001923986 SOLARCAINE FIRST AID LIDOCAINE 0.5% TOPICAL AEROSO TOP AER SCH G 0.038500001975382 SOLUGEL 4% TOPICAL GEL TOP GEL GSK G 0.226900002019825 SOLUGEL 8% TOPICAL GEL TOP GEL GSK G 0.348000002230211 SOLU-MEDROL 40MG/VIAL INJECTION INJ DEFAUL PFI VIAL 5.267200000690333 SOLUVER 20% TOPICAL SOLUTION TOP SOL DPT ML 0.810000000837733 SOLUVER PLUS LIQ 27% TOP SOL DPT ML 1.296000000769533 SOLYSTAT 250 MG/ML RECTAL SUSPENSION RT RTNENM PPH ENM 13.640000002272199 SOMAVERT 10 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 118.400000002272202 SOMAVERT 15 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 177.420000002272210 SOMAVERT 20 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 236.440000000483818 SOMNOL 30 MG TABLET ORL TAB AXS TAB 0.114500002418355 SOVALDI 400 MG TABLET ORL TAB GIL TAB 711.496800002237578 SPASMHALT-8 CAPLET ORL TAB PPH TAB 0.3693

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002237580 SPASMHALT-ASA-8 CAPLET ORL TAB WAM TAB 0.330000000999031 SPECIAL ACCESS DRUG - DEFLAZACORT DEFAUL DEFAUL XXX 0.315800000999033 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 SOFTGEL ORL CAP XXX CAP 0.470500002214415 SPECTRO ECZEMACARE MEDICATED CREAM TOP CRM GKC G 0.440000002435381 SPIRIVA RESPIMAT 2.5 MCG/ACTUATION INH SOLUTION INH CTG BOE CTG 65.000000002320193 SPRYCEL 100 MG TABLET ORL TAB BMS TAB 161.298300002293129 SPRYCEL 20 MG TABLET ORL TAB BMS TAB 37.338700002293137 SPRYCEL 50 MG TABLET ORL TAB BMS TAB 75.147300002293145 SPRYCEL 70 MG TABLET ORL TAB BMS TAB 89.383700001938991 STANHEXIDINE 2% SOL WITH 4% ISOPROPYL ALCOHOL TOP SOL OMG ML 0.010300001938983 STANHEXIDINE 4% WITH 4% ISOPROPYL ALCOHOL SOLUTION TOP SOL OMG ML 0.016300002245439 STARLIX 120 MG TABLET ORL TAB NOV TAB 0.606500002245438 STARLIX 60 MG TABLET ORL TAB NOV TAB 0.600100002372436 STAXYN 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BAI TAB 7.172500002230192 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL HSP VIAL 78.890000002139383 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL PPC VIAL 102.303000002139243 STERILE VANCOMYCIN HCL 5 G/VIAL INJECTION INJ DEFAUL PPC VIAL 509.790000002139375 STERILE VANCOMYCIN HCL 500 MG/VIAL INJ USP INJ DEFAUL PPC VIAL 47.704000002230191 STERILE VANCOMYCIN HCL 500 MG/VIAL INJECTION INJ DEFAUL HSP VIAL 45.118000002142546 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.201000000038245 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.095000000402257 STERILE WATER FOR INJECTION DEFAUL INJ OMG ML 0.350000002247228 STIEPROX 1.5 % TOPICAL SHAMPOO TOP SHP GSK ML 0.146400000587966 STIEVA-A 0.025% TOPICAL GEL TOP GEL GSK G 0.299600000578568 STIEVA-A 0.025% TOPICAL SOLUTION TOP SOL GSK ML 0.183600000641863 STIEVA-A 0.05% TOPICAL GEL TOP GEL GSK G 0.299600002125277 STILAMIN 3 MG/AMPOULE INJECTION INJ DEFAUL SRO VIAL 210.000000002403390 STIVARGA 40 MG TABLET ORL TAB BAI TAB 80.683800002262800 STRATTERA 10 MG CAPSULE ORL CAP LIL CAP 2.924300002279355 STRATTERA 100 MG CAPSULE ORL CAP LIL CAP 5.555400002262819 STRATTERA 18 MG CAPSULE ORL CAP LIL CAP 3.330700002262827 STRATTERA 25 MG CAPSULE ORL CAP LIL CAP 3.737100002262835 STRATTERA 40 MG CAPSULE ORL CAP LIL CAP 4.205000002262843 STRATTERA 60 MG CAPSULE ORL CAP LIL CAP 4.710700002279347 STRATTERA 80 MG CAPSULE ORL CAP LIL CAP 5.057100002243660 STREPTOMYCIN 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 89.000000000613959 STRESS FORMULA VITAMIN WITH ZINC CAPSULE ORL CAP WAM CAP 0.0617

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002174383 STRESSEASE MULTIVITAMIN AND MINERAL CAPLET ORL TAB JAM TAB 0.112700002166615 STRESSTABS + ZINC-COPPER TABLET ORL TAB WCH TAB 0.107100080009625 STRESSTABS FOR WOMEN TABLET ORL TAB PDH TAB 0.104200002167948 STRESSTABS PLUS IRON TABLET ORL TAB WCH TAB 0.107100002397137 STRIBILD TABLET ORL TAB GIL TAB 49.464300002370433 SUBLINOX 10 MG SUBLINGUAL DISINTEGRATING TABLET SLG DISNTAB MED TAB 1.451000002391678 SUBLINOX 5 MG SUBLINGUAL DISINTEGRATING TAB SLG DISNTAB MED TAB 1.437000002130939 SUCRALFATE-1 1 G TABLET ORL TAB PDL TAB 0.130900002238099 SUDAFED DECONGESTANT 12-HOUR 120 MG CAPLET ORL TAB WLA TAB 0.514000002237793 SUDAFED DECONGESTANT EXTRA STRENGTH 60 MG TABLET ORL TAB WLA TAB 0.290800002250217 SUDAFED PE DECONGESTANT 10 MG TABLET ORL TAB MCL TAB 0.300000001951319 SUFENTA 50 MCG/ML INJECTION INJ DEFAUL JAI ML 6.932000002244147 SUFENTANIL CITRATE USP 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 11.783000000187534 SULFUR TOPICAL SOAP TOP SOP VCL G 0.077700002324660 SUMATRIPTAN 100 MG TABLET ORL TAB PDL TAB 7.860000002324652 SUMATRIPTAN 50 MG TABLET ORL TAB PDL TAB 7.135000000678996 SUPER B COMPLEX CAPSULE ORL CAP SIS CAP 0.258100080002944 SUPER CALCIUM 600 MG WITH VITAMIN D 400 IU ORL TAB JAM TAB 0.155700080011269 SUPER MULTI IRON FREE TABLET ORL TAB NFN TAB 0.214300080023127 SUPER STRAIN ACIDOPHILUS PROBIOTIC 2 BILLION ORL CAP JAM CAP 0.127000002242658 SUPER STRENGTH MOTRIN IB 400 MG TABLET ORL TAB MCL TAB 0.195600080017929 SUPER VITA VIM CAPLET ORL TAB JAM TAB 0.136600002242595 SUPER VITA-VIM CAPLET ORL TAB JAM TAB 0.133400002240749 SUPREFACT DEPOT 9.45 MG IMPLANT INJECTION INJ IMP SAV SYS 1222.550000002239888 SUSTIVA 200 MG CAPSULE ORL CAP BMS CAP 5.414000002239886 SUSTIVA 50 MG CAPSULE ORL CAP BMS CAP 1.245700002246045 SUSTIVA 600 MG TABLET ORL TAB BMS TAB 16.242000002280795 SUTENT 12.5 MG CAPSULE ORL CAP PFI CAP 66.906800002280809 SUTENT 25 MG CAPSULE ORL CAP PFI CAP 133.813200002280817 SUTENT 50 MG CAPSULE ORL CAP PFI CAP 267.626800002245890 SYNAGIS 100 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1504.510000002245889 SYNAGIS 50 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 752.260000002162504 SYNALAR 0.01% TOPICAL SOLUTION TOP SOL VCL ML 0.412800002162512 SYNALAR 0.025% TOPICAL OINTMENT TOP ONT VCL G 0.468200000990010 SYNVISC DEFAUL DEV GZB ML 65.275000000999331 SYNVISC ONE DEFAUL DEV GZB ML 66.333300002248967 SYSTANE OPHTHALMIC SOLUTION OPH SOL ALC ML 0.8350

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080032792 SYSTANE VITAMIN- OMEGA 3 CAPSULE ORL CAP ALC CAP 0.228700002239122 T.R. SWISS ONE 50 MULTIVITAMIN & MINERAL TABLET ORL TAB SWS TAB 0.217000002365871 TACTUPUMP 0.1%/2.5% TOPICAL GEL TOP GEL GAL G 1.673800002409607 TAFINLAR 50 MG CAPSULE ORL CAP GSK CAP 45.388900002409615 TAFINLAR 75 MG CAPSULE ORL CAP GSK CAP 68.083300001966200 TAMBOCOR 100 MG TABLET ORL TAB VCL TAB 1.077000001966197 TAMBOCOR 50 MG TABLET ORL TAB VCL TAB 0.538400002304848 TAMIFLU 30 MG CAPSULE ORL CAP HLR CAP 2.194000002304856 TAMIFLU 45 MG CAPSULE ORL CAP HLR CAP 3.376000002381842 TAMIFLU 6 MG/ML ORAL SUSPENSION ORL SUS HLR ML 0.337500002241472 TAMIFLU 75 MG CAPSULE ORL CAP HLR CAP 4.389000001926624 TAMOFEN 10 MG TABLET ORL TAB SAV TAB 0.175000002413612 TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.150000002429667 TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.150000001962353 TANTAPHEN EXTRA STRENGTH 500 MG CAPLET ORL TAB TAN TAB 0.021400002296039 TAPAZOLE 10 MG TABLET ORL TAB PAL TAB 0.580200002269015 TARCEVA 100 MG TABLET ORL TAB HLR TAB 57.333300002269023 TARCEVA 150 MG TABLET ORL TAB HLR TAB 86.000000002269007 TARCEVA 25 MG TABLET ORL TAB HLR TAB 13.333300000510335 TARGEL SA TOPICAL LIQUID TOP LIQ ODN G 0.184400000344508 TARGEL TOPICAL GEL TOP GEL ODN G 0.169600002339609 TARGIN 10 MG/ 5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.049700002339617 TARGIN 20 MG/ 10 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.574500002339625 TARGIN 40 MG/ 20 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 2.727500002387425 TARGIN 5 MG/ 2.5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.753000002240945 TARKA 1 MG/ 240 MG TABLET ORL TAB ABB TAB 1.540000002238096 TARKA 2 MG/ 180 MG TABLET ORL TAB ABB TAB 1.550000002240946 TARKA 2 MG/ 240 MG TABLET ORL TAB ABB TAB 1.902500002238097 TARKA 4 MG/ 240 MG TABLET ORL TAB ABB TAB 2.111300002365650 TARO-ANASTROZOLE 1 MG TABLET ORL TAB TAR TAB 1.273000002244403 TARO-CARBAMAZEPINE 100 MG CHEWABLE TABLET ORL CTB TAR TAB 0.122400002244404 TARO-CARBAMAZEPINE 200 MG CHEWABLE TABLET ORL CTB TAR TAB 0.255800002353288 TARO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL TAR G 8.415000002266938 TARO-CLINDAMYCIN 1% (BASE) TOPICAL SOLUTION TOP SOL TAR ML 0.284000002420988 TARO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL TAR ML 0.676600002264749 TARO-MOMETASONE 0.1% OINTMENT TOP ONT TAR G 0.280200001925350 TARO-SONE 0.05% TOPICAL CREAM TOP CRM TAR G 0.2110

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247651 TARO-TERCONAZOLE 0.4% VAGINAL CREAM VAG CRM TAR G 0.495300002368250 TASIGNA 150 MG CAPSULE ORL CAP NOV CAP 30.027300002315874 TASIGNA 200 MG CAPSULE ORL CAP NOV CAP 42.242500002016796 TAXOL 6 MG/ML INJECTION INJ DEFAUL BMS ML 1.980200002177099 TAXOTERE 40 MG/ML (20 MG/0.5 ML) INJECTION INJ DEFAUL SAV ML 456.940000002177080 TAXOTERE 40 MG/ML (80 MG/2 ML) INJECTION INJ DEFAUL SAV ML 456.940000002243894 TAZORAC 0.05% TOPICAL CREAM TOP CRM ALL G 1.478000002243895 TAZORAC 0.1% TOPICAL CREAM TOP CRM ALL G 1.462000000615358 TD POLIO ADSORBED FOR ADULT INJECTION INJ DEFAUL AVE VIAL 59.044000001950010 TEARS ENCORE 1.4% OPH SOLUTION OPH SOL AKN ML 0.971000002246397 TEARS NATURAL FORTE OPH SOLUTION OPH SOL ALC ML 0.414000001943308 TEARS NATURALE FREE OPH SOLUTION OPH SOL ALC ML 0.504200000743445 TEARS NATURALE II OPH SOLUTION OPH SOL ALC ML 0.430700000390291 TEARS NATURALE OPH DROPS OPH DPS ALC ML 0.419300002082519 TEARS NATURALE P.M. OPH OINTMENT OPH ONT ALC G 1.574300000579408 TEARS PLUS 1.4% OPH SOLUTION OPH SOL ALL ML 0.494000000283991 TEBRAZID 500 MG TABLET ORL TAB VCL TAB 0.498000002420201 TECFIDERA 240 MG DELAYED-RELEASE CAPSULE ORL DRC BIO CAP 35.191100002432897 TELMISARTAN 40 MG TABLET ORL TAB PMS TAB 0.282400002395223 TELMISARTAN 40 MG TABLET ORL TAB PDL TAB 0.282400002432900 TELMISARTAN 80 MG TABLET ORL TAB PMS TAB 0.282400002395231 TELMISARTAN 80 MG TABLET ORL TAB PDL TAB 0.282400002395525 TELMISARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.282400002395533 TELMISARTAN-HCTZ 80 MG/25 MG TABLET ORL TAB PDL TAB 0.282400002261553 TELZIR 50 MG/ML ORAL SUSPENSION ORL SUS GSK ML 0.591200002261545 TELZIR 700 MG TABLET ORL TAB GSK TAB 8.692800002241095 TEMODAL 100 MG CAPSULE ORL CAP MFC CAP 164.910000002321262 TEMODAL 100 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 411.260000002312794 TEMODAL 140 MG CAPSULE ORL CAP MFC CAP 230.876000002312816 TEMODAL 180 MG CAPSULE ORL CAP MFC CAP 264.380500002241094 TEMODAL 20 MG CAPSULE ORL CAP MFC CAP 32.984000002241096 TEMODAL 250 MG CAPSULE ORL CAP MFC CAP 412.262000002241093 TEMODAL 5 MG CAPSULE ORL CAP MFC CAP 8.384000000875988 TEMPRA INFANT 80 MG/ML ORAL DROPS ORL DPS PAL ML 0.265300000894710 TERAZOL 3 80 MG VAGINAL OVULE VAG OVL JAI OVL 6.376700002130874 TERAZOL 3 DUAL PAK KIT VAG/TOP OVL/CRM JAI KIT 30.400000000894729 TERAZOL 7 0.4% VAGINAL CREAM VAG CRM JAI G 0.6976

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242735 TERBINAFINE-250 MG TABLET ORL TAB PDL TAB 1.852700000632317 TERSASEPTIC 0.5% TOPICAL SHAMPOO TOP SHP GSK ML 0.027300000632309 TERSA-TAR 3% TOPICAL SHAMPOO TOP SHP TCD ML 0.039300000632295 TERSA-TAR MILD 1% TOPICAL SHAMPOO TOP SHP GSK ML 0.036700002280248 TESTIM 1% TOPICAL GEL TOP GEL PAL G 0.783100000514462 TETANUS & DIPHTHERIA TOXOIDS ADULT INJECTION INJ LIQ CNG ML 45.224000002148528 TETRACAINE 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 7.245000002248251 TEVA-ALENDRONATE 5 MG TABLET ORL TAB TEV TAB 1.068100002403633 TEVA-ALENDRONATE/CHOLECALCIFEROL 70 MG/2800 U TAB ORL TAB TEV TAB 4.052500002326043 TEVA-AMITRIPTYLINE 10 MG TABLET ORL TAB TEV TAB 0.066400002326051 TEVA-AMITRIPTYLINE 25 MG TABLET ORL TAB TEV TAB 0.121100002326078 TEVA-AMITRIPTYLINE 50 MG TABLET ORL TAB TEV TAB 0.234700002313049 TEVA-ANASTROZOLE 1 MG TABLET ORL TAB TEV TAB 2.622400001912054 TEVA-ATENOLOL 100 MG TABLET ORL TAB TEV TAB 0.236300001912062 TEVA-ATENOLOL 50 MG TABLET ORL TAB TEV TAB 0.143700002314541 TEVA-ATOMOXETINE 10 MG CAPSULE ORL CAP TEV CAP 2.514700002362538 TEVA-ATOMOXETINE 100 MG CAPSULE ORL CAP TEV CAP 4.482600002314568 TEVA-ATOMOXETINE 18 MG CAPSULE ORL CAP TEV CAP 2.882000002314576 TEVA-ATOMOXETINE 25 MG CAPSULE ORL CAP TEV CAP 3.181700002314584 TEVA-ATOMOXETINE 40 MG CAPSULE ORL CAP TEV CAP 3.437700002314592 TEVA-ATOMOXETINE 60 MG CAPSULE ORL CAP TEV CAP 3.813300002362511 TEVA-ATOMOXETINE 80 MG CAPSULE ORL CAP TEV CAP 4.115900002380927 TEVA-ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB TEV TAB 4.489200002280205 TEVA-BETAHISTINE 24 MG TABLET ORL TAB TEV TAB 0.513200002280183 TEVA-BETAHISTINE 8 MG TABLET ORL TAB TEV TAB 0.213200002398419 TEVA-BOSENTAN 125 MG TABLET ORL TAB TEV TAB 49.578000002398400 TEVA-BOSENTAN 62.5 MG TABLET ORL TAB TEV TAB 49.578000002424851 TEVA-BUPRENORPHINE/NALOXONE 2 MG/0.5 MG SUB TAB ORL SLT TEV TAB 2.269500002424878 TEVA-BUPRENORPHINE/NALOXONE 8 MG/2 MG SUB TAB ORL SLT TEV TAB 4.020500002395576 TEVA-CANDESARTAN/HCTZ 32 MG/25 MG TABLET ORL TAB TEV TAB 0.898500002400022 TEVA-CAPECITABINE 150 MG TABLET ORL TAB TEV TAB 1.590800002400030 TEVA-CAPECITABINE 500 MG TABLET ORL TAB TEV TAB 5.302800002239355 TEVA-DIFENAC-K 50 MG TABLET ORL TAB TEV TAB 0.405500002389762 TEVA-EFAVIRENZ 600 MG TABLET ORL TAB TEV TAB 11.546700002382091 TEVA-ELETRIPTAN 20 MG TABLET ORL TAB TEV TAB 10.388300002382105 TEVA-ELETRIPTAN 40 MG TABLET ORL TAB TEV TAB 10.388300002330601 TEVA-ENALAPRIL 40 MG TABLET ORL TAB TEV TAB 1.2560

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002377705 TEVA-ERLOTINIB 100 MG TABLET ORL TAB TEV TAB 47.466700002377713 TEVA-ERLOTINIB 150 MG TABLET ORL TAB TEV TAB 71.200000002377691 TEVA-ERLOTINIB 25 MG TABLET ORL TAB TEV TAB 11.866700002408473 TEVA-EXEMESTANE 25 MG TABLET ORL TAB TEV TAB 4.017700002230089 TEVA-FLUTAMIDE 250 MG TABLET ORL TAB TEV TAB 1.353000002248457 TEVA-GABAPENTIN 600 MG TABLET ORL TAB TEV TAB 1.343600002247346 TEVA-GABAPENTIN 800 MG TABLET ORL TAB TEV TAB 1.791500002377969 TEVA-GALANTAMINE ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC TEV CAP 1.246700002377977 TEVA-GALANTAMINE ER 24 MG EXTENDED-RELEASE CAPSULE ORL ERC TEV CAP 1.246700002377950 TEVA-GALANTAMINE ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC TEV CAP 1.246700002399806 TEVA-IMATINIB 100 MG TABLET ORL TAB TEV TAB 21.069300002399814 TEVA-IMATINIB 400 MG TABLET ORL TAB TEV TAB 84.277300002316005 TEVA-IRBESARTAN 300 MG TABLET ORL TAB TEV TAB 0.302500002387247 TEVA-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB TEV TAB 8.065800002343657 TEVA-LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.838700002258323 TEVA-MELOXICAM 15 MG TABLET ORL TAB TEV TAB 0.584000002258315 TEVA-MELOXICAM 7.5 MG TABLET ORL TAB TEV TAB 0.506100002315068 TEVA-METHYLPHENIDATE ER-C 18 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.551300002315076 TEVA-METHYLPHENIDATE ER-C 27 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.790300002315084 TEVA-METHYLPHENIDATE ER-C 36 MG EXTEND RELEASE TAB ORL ERT TEV TAB 2.029200002315092 TEVA-METHYLPHENIDATE ER-C 54 MG EXTEND RELEASE TAB ORL ERT TEV TAB 2.507100002261898 TEVA-METOPROL 25 MG TABLET ORL TAB TEV TAB 0.066200002279894 TEVA-MIRTAZAPINE OD 15 MG ORALLY DISINTEGRATING TA ORL DISNTAB TEV TAB 0.296700002279908 TEVA-MIRTAZAPINE OD 30MG ORALLY DISINTEGRATING TAB ORL DISNTAB TEV TAB 0.593300002279916 TEVA-MIRTAZAPINE OD 45MG ORALLY DISINTEGRATING TAB ORL DISNTAB TEV TAB 0.843700002420260 TEVA-MODAFINIL 100 MG TABLET ORL TAB TEV TAB 1.029000002392925 TEVA-NABILONE 0.25 MG CAPSULE ORL CAP TEV CAP 1.438000002352893 TEVA-NEVIRAPINE 200 MG TABLET ORL TAB TEV TAB 2.543200002359707 TEVA-OLANZAPINE 20 MG TABLET ORL TAB TEV TAB 10.309300002321378 TEVA-OLANZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 5.516000002321386 TEVA-OLANZAPINE OD 20 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 7.825700002285479 TEVA-PANTOPRAZOLE 20MG ENTERIC-COATED ORAL TAB ORL ECT TEV TAB 1.313200002248556 TEVA-PAROXETINE 10 MG TABLET ORL TAB TEV TAB 1.074300000869015 TEVA-PINDOLOL 10 MG TABLET ORL TAB TEV TAB 0.239300000869023 TEVA-PINDOLOL 15 MG TABLET ORL TAB TEV TAB 0.337000000869007 TEVA-PINDOLOL 5 MG TABLET ORL TAB TEV TAB 0.140200002274914 TEVA-PIOGLITAZONE 15 MG TABLET ORL TAB TEV TAB 0.5983

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 103 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002274922 TEVA-PIOGLITAZONE 30 MG TABLET ORL TAB TEV TAB 0.838300002274930 TEVA-PIOGLITAZONE 45 MG TABLET ORL TAB TEV TAB 1.329700002269317 TEVA-PRAMIPEXOLE 0.5 MG TABLET ORL TAB TEV TAB 1.427600002361205 TEVA-PREGABALIN 150 MG CAPSULE ORL CAP TEV CAP 1.778800002361221 TEVA-PREGABALIN 225 MG CAPSULE ORL CAP TEV CAP 1.778800002361159 TEVA-PREGABALIN 25 MG CAPSULE ORL CAP TEV CAP 0.635800002361248 TEVA-PREGABALIN 300 MG CAPSULE ORL CAP TEV CAP 1.778800002361175 TEVA-PREGABALIN 50 MG CAPSULE ORL CAP TEV CAP 0.997300002361183 TEVA-PREGABALIN 75 MG CAPSULE ORL CAP TEV CAP 1.290500002388359 TEVA-RAMIPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB TEV TAB 0.263300002388340 TEVA-RAMIPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.207000002413809 TEVA-RISEDRONATE 150 MG TABLET ORL TAB TEV TAB 42.180000002396688 TEVA-RIZATRIPTAN ODT 10 MG ORALLY DISINT TABLET ORL DISNTAB TEV TAB 3.705000002396661 TEVA-RIZATRIPTAN ODT 5 MG ORALLY DISINT TABLET ORL DISNTAB TEV TAB 3.705000002308754 TEVA-SILDENAFIL 100 MG TABLET ORL TAB TEV TAB 9.476600002308738 TEVA-SILDENAFIL 25 MG TABLET ORL TAB TEV TAB 8.537500002308746 TEVA-SILDENAFIL 50 MG TABLET ORL TAB TEV TAB 9.615000002286815 TEVA-SUMATRIPTAN DF 25 MG TABLET ORL TAB TEV TAB 9.260000000851965 TEVA-TAMOXIFEN 10 MG TABLET ORL TAB TEV TAB 0.180300000851973 TEVA-TAMOXIFEN 20 MG TABLET ORL TAB TEV TAB 0.380300002230085 TEVA-THEOPHYLLINE SR 100 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.141300002230086 TEVA-THEOPHYLLINE SR 200 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.139000002230087 TEVA-THEOPHYLLINE SR 300 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.144200001947818 TEVA-TIMOLOL 10 MG TABLET ORL TAB TEV TAB 0.271700001947826 TEVA-TIMOLOL 20 MG TABLET ORL TAB TEV TAB 0.515500001947796 TEVA-TIMOLOL 5 MG TABLET ORL TAB TEV TAB 0.169800002347180 TEVA-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB TEV TAB 0.645200002357542 TEVA-VALACYCLOVIR 1000 MG TABLET (CAPLET) ORL TAB TEV TAB 3.053100002356643 TEVA-VALSARTAN 40 MG TABLET ORL TAB TEV TAB 0.539700002355205 THALOMID 100 MG CAPSULE ORL CAP CLG CAP 58.940000002355221 THALOMID 200 MG CAPSULE ORL CAP CLG CAP 117.880000002355191 THALOMID 50 MG CAPSULE ORL CAP CLG CAP 29.470000002360101 THEO ER 400 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.373500002360128 THEO ER 600 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.452400080015438 THERA TEARS NUTRITION CAPSULE ORL CAP AVR CAP 0.114000002242082 THERATEARS (PRESERVATIVE-FREE) 0.25% OPH SOLUTION OPH SOL AVR ML 0.647900002248854 THERATEARS 0.25% OPH SOLUTION OPH SOL AVR ML 0.4927

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 104 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002409356 TIGECYCLINE 50 MG/VIAL INJECTION INJ DEFAUL APX VIAL 71.422500001916939 TIMENTIN 3.1G INJECTION INJ DEFAUL GSK VIAL 10.752000002242275 TIMOLOL MALEATE-EX 0.25% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.312000002242276 TIMOLOL MALEATE-EX 0.5% OPHTHALMIC SOLUTION OPH LAS ALC ML 4.182000000576050 TINACTIN 1% TOPICAL AEROSOL TOP AER SCH G 0.055400000576034 TINACTIN 1% TOPICAL CREAM TOP CRM SCH G 0.369300000576042 TINACTIN 1% TOPICAL POWDER TOP PWR SCH G 0.068800002414945 TIVICAY 50 MG TABLET ORL TAB VIV TAB 19.887300002244826 TNKASE 50 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2700.000000000533688 TOBRAMYCIN 1.2 G/VIAL INJECTION INJ DEFAUL PPC VIAL 199.000000002230640 TOBRAMYCIN 40 MG/ML INJECTION INJ DEFAUL PPC ML 3.531000002337630 TOCTINO 10 MG CAPSULE ORL CAP GST CAP 23.639300002337649 TOCTINO 30 MG CAPSULE ORL CAP GST CAP 23.895300000312762 TOLBUTAMIDE 500 MG TABLET ORL TAB AAP TAB 0.118300002229566 TOMUDEX 2 MG/VIAL INJECTION INJ DEFAUL AZC VIAL 324.620000002221926 TOPICORT 0.05% TOPICAL GEL TOP GEL VCL G 0.531800002221934 TOPICORT 0.25% TOPICAL OINTMENT TOP ONT VCL G 0.685700000749834 TOPIDERM HC 2% TOPICAL CREAM TOP CRM PAL G 0.360300002390981 TOPOTECAN 4 MG / VIAL INJECTION INJ DEFAUL SDZ VIAL 567.000000002304104 TORISEL 25 MG/ML INJECTION INJ DEFAUL PFI VIAL 1261.250000002244982 TRACLEER 125 MG TABLET ORL TAB ACT TAB 69.739600002244981 TRACLEER 62.5 MG TABLET ORL TAB ACT TAB 68.992000002264846 TRAMACET 37.5 MG/325 MG TABLET ORL TAB JAI TAB 0.830200002426803 TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB SNS TAB 0.626400002429969 TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB SIV TAB 0.626400002417502 TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PDL TAB 0.626400002388294 TRAMAPHEN-ODAN 37.5 MG/325 MG TABLET ORL TAB ODN TAB 0.626400002246365 TRANEXAMIC ACID 100 MG/ML INJECTION INJ DEFAUL SDZ ML 3.886000080044392 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 14 MG TRD PTH APH PTH 2.150000080044389 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 21 MG TRD PTH APH PTH 2.150000080044393 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 7 MG TRD PTH APH PTH 2.150000080024336 TRANSDERM-V 1.5 MG TOPICAL PATCH TOP PTH NOV PTH 3.925000000605786 TRAVEL AID 50 MG TABLET ORL TAB WTR TAB 0.072000002164361 TRAZODONE-100 100 MG TABLET ORL TAB PDL TAB 0.098900002164388 TRAZODONE-150 D 150 MG TABLET ORL TAB PDL TAB 0.145300002164353 TRAZODONE-50 50 MG TABLET ORL TAB PDL TAB 0.055400002230285 TRAZOREL 100 MG TABLET ORL TAB ICN TAB 0.3956

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002230284 TRAZOREL 50 MG TABLET ORL TAB ICN TAB 0.221400002392569 TREANDA 100 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL LUI VIAL 1250.000000002392550 TREANDA 25 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL LUI VIAL 312.500000002240000 TRELSTAR 3.75 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 366.060000002243856 TRELSTAR LA 11.25 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1098.220000000896179 TRIAMINIC DM NIGHTIME ORAL SYRUP ORL SYR NVC ML 0.050200000789828 TRIATEC-30 TABLET ORL TAB TLI TAB 0.130000000852163 TRIATEC-8 TABLET ORL TAB TLI TAB 0.047300002296381 TRIDURAL 100 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 1.326300002296403 TRIDURAL 200 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 2.418100002296411 TRIDURAL 300 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 3.513700002242067 TRILEPTAL 150 MG TABLET ORL TAB NOV TAB 0.899600002242068 TRILEPTAL 300 MG TABLET ORL TAB NOV TAB 0.989000002244673 TRILEPTAL 60 MG/ML ORAL SUSPENSION ORL SUS NOV ML 0.359700002242069 TRILEPTAL 600 MG TABLET ORL TAB NOV TAB 1.978200000517895 TRINALIN REPETABS SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.653500002432927 TRINTELLIX 10 MG TABLET ORL TAB LBC TAB 2.754000002432943 TRINTELLIX 20 MG TABLET ORL TAB LBC TAB 2.990000002432919 TRINTELLIX 5 MG TABLET ORL TAB LBC TAB 2.629000080002067 TRIPLE STRENGTH ODOURLESS GARLIC SOFTGEL CAPSULE ORL CAP VCL CAP 0.046000002430932 TRIUMEQ TABLET ORL TAB VIV TAB 41.383300002244757 TRIZIVIR TABLET ORL TAB GSK TAB 19.205200000511226 TROMBOJECT 30 MG/ML INJECTION INJ DEFAUL OMG ML 4.971500080015078 TROPHIC KRILL OIL CAPSULE ORL CAP MTA CAP 0.423700002148536 TROPICAMIDE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700080000383 TRUEHOPE EMP CAPSULE ORL CAP TRU CAP 0.208700002274906 TRUVADA 200 MG/300 MG TABLET ORL TAB GIL TAB 29.202300000317268 TUBERSOL TUBERCULIN PPD 5 TUB INJECTION INJ DEFAUL AVE ML 155.400000001967932 TUMS EXTRA STRENGTH 750 MG CHEWABLE TABLET ORL CTB SKB TAB 0.044400001970240 TUMS REGULAR 500 MG CHEWABLE TABLET ORL CTB SKB TAB 0.046100002151138 TUMS ULTRA STRENGTH 1G CHEWABLE TABLET ORL CTB SKB TAB 0.050000001916971 TUSSIONEX ORAL SUSTAINED-RELEASE SUSPENSION ORL SRSUS SAV ML 0.353600001916963 TUSSIONEX TABLET ORL SRT SAV TAB 1.767900080019103 TUZEN CAPSULE ORL CAP FEI CAP 0.826000002230578 TWINRIX INJECTION SYRINGE INJ NDL GSK SYR 50.860000002237548 TWINRIX JUNIOR 0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 25.430000002285401 TYGACIL 50 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 86.2690

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002326442 TYKERB 250 MG TABLET ORL TAB GSK TAB 25.262600002246060 TYLENOL 8 HOUR 650 MG EXTENDED-RELIEF CAPLET ORL ERT MCL TAB 0.176200001933728 TYLENOL ALLERGY SINUS EXTRA STRENGTH CAPLET ORL TAB MCL TAB 0.285000002238885 TYLENOL ARTHRITIS PAIN 650 MG EXT-RELIEF CAPLET ORL ERT MCL TAB 0.166200000743224 TYLENOL CHILDRENS COLD CHEWABLE TABLET ORL CTB MCL TAB 0.176300000890677 TYLENOL COLD DM JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.273000000743275 TYLENOL COLD EXTRA STRENGTH CAPLET ORL TAB MCL TAB 0.285000000743267 TYLENOL COLD EXTRA STRENGTH N.D. CAPLET ORL TAB MCL TAB 0.285000002276259 TYLENOL COLD EXTRA STRENGTH NIGHTTIME TABLET ORL TAB MCL TAB 0.300000000574007 TYLENOL COLD REGULAR STRENGTH CAPLET ORL TAB MCL TAB 0.200400000743283 TYLENOL COLD REGULAR STRENGTH N.D. CAPLET ORL TAB MCL TAB 0.201200002290510 TYLENOL EXTRA STR. BACK PAIN 400 MG/500 MG TABLET ORL TAB MCL TAB 0.510000000863270 TYLENOL EXTRA-STRENGTH GELCAPS 500 MG CAPSULE ORL CAP MCL CAP 0.138300000663980 TYLENOL EXTRA-STRENGTH SINUS MEDICATION CAPLET ORL TAB MCL TAB 0.478300002347792 TYLENOL FASTMELTS JUNIOR STRENGTH 160 MG CHEW TAB ORL CTB MCL TAB 0.286000002241361 TYLENOL JUNIOR STRENGTH 160 MG SOFT CHEW TABLET ORL CTB MCL TAB 0.270000002181061 TYLENOL NO.1 WITH CODEINE TABLET ORL TAB MCL TAB 0.173000000559393 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.150000000723894 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.127900000778400 TYLENOL SINUS CAPLET ORL TAB MCL TAB 0.200400002163942 TYLENOL WITH CODEINE ELIXIR ORL ELX JAI ML 0.105900002242727 TYPHERIX 25 MCG/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 23.800000002130955 TYPHIM VI 50 MCG/ML INJECTION INJ DEFAUL CNG ML 52.700000080022377 UDO'S CHOICE SUPER 8 PLUS PROBIOTIC ORL CAP FMD CAP 0.990000001966294 ULONE 5 MG ORAL SYRUP ORL SYR MMH ML 0.140600002418282 ULTIBRO BREEZHALER 110 MCG/50 MCG INH CAPSULE INH CAP NOV CAP 2.912300080015173 ULTIMATE FLORA CRITICAL CARE 50 BILLION ORL CAP RLC CAP 1.166500080006259 ULTIMATE OMEGA FACTORS 3-6-9 SOFT GEL CAPSULE ORL CAP NFN CAP 0.238700080033880 ULTRA C 1000 TABLET ORL TAB MTG TAB 0.313500080011779 ULTRA FLORA PLUS CAPSULE ORL CAP MTG CAP 0.411600080011780 ULTRA FLORA PLUS; ULTRA FLORA BALANCE ORL CAP MTG CAP 0.416700002237698 ULTRA STRENGTH PHAZYME 180 MG CAPSULE ORL CAP CBF CAP 0.222100080044443 ULTRACLEAR SUSTAIN ORAL POWDER ORL PWR MTG G 0.067600080004965 ULTRA-FIBER SUPPLEMENT CHEWABLE TABLET ORL TAB AAM TAB 0.091700002349469 ULTRAM 50 MG TABLET ORL TAB JAI TAB 0.779700000626724 ULTRAQUIN 4% TOPICAL GEL TOP GEL SAH G 1.060000000632783 ULTRAQUIN PLAIN 4% CREAM TOP CRM SAH G 0.8667

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001962728 ULTRAVATE 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.961200001946994 UNISOM-2 NIGHTTIME SLEEP AID TAB 25 MG ORL TAB PDH TAB 0.204000000116866 URASAL GRANULES ORAL EFFERVESCENT POWDER ORL EVP AXS G 0.113800001946099 UREMOL 10 10% TOPICAL CREAM TOP CRM GKC G 0.076100000398179 UREMOL 20% TOPICAL CREAM TOP CRM GKC G 0.080000001946102 UREMOL-10 10% TOPICAL LOTION TOP LOT GKC ML 0.043000000503134 UREMOL-HC TOPICAL CREAM TOP CRM GSK G 0.174600000560022 UREMOL-HC TOPICAL LOTION TOP LOT GSK ML 0.098200080005531 URISEC 40 40% TOPICAL CREAM TOP CRM ODN G 1.400000002353997 UROCIT-K 10 MEQ EXTENDED-RELEASE TABLET ORL ERT PAL TAB 0.559300001914022 UROCIT-K 5 MEQ TABLET ORL SRT SFD TAB 0.365600002273578 UROMAX 10 MG CONTROLLED RELEASE TABLET ORL ERT PUR TAB 1.365500002273586 UROMAX 15 MG CONTROLLED RELEASE TABLET ORL ERT PUR TAB 1.471000002241411 UROMITEXAN 100 MG/ML INJECTION INJ DEFAUL AST ML 6.489000080030062 UTI CLEANSE TABLET ORL TAB AOR TAB 0.441600002241332 VAGIFEM 25 MCG VAGINAL TABLET VAG TAB NNA TAB 3.213300000177016 VALISONE-G TOPICAL CREAM TOP CRM VCL G 1.083000000232351 VALISONE-G TOPICAL OINTMENT TOP ONT VCL G 1.083000000013285 VALIUM 5 MG TABLET ORL TAB HLR TAB 0.172500002367742 VALSARTAN 160 MG TABLET ORL TAB PDL TAB 0.333000002367750 VALSARTAN 320 MG TABLET ORL TAB PDL TAB 0.333000002384523 VALSARTAN 40 MG TABLET ORL TAB SIV TAB 0.524000002366940 VALSARTAN 40 MG TABLET ORL TAB SNS TAB 0.523900002367726 VALSARTAN 40 MG TABLET ORL TAB PDL TAB 0.408000002367734 VALSARTAN 80 MG TABLET ORL TAB PDL TAB 0.333000002384760 VALSARTAN HCT 320 MG/12.5 MG TABLET ORL TAB SIV TAB 0.325300002384779 VALSARTAN HCT 320 MG/25 MG TABLET ORL TAB SIV TAB 0.325300002367777 VALSARTAN-HCTZ 160 MG/12.5 MG TABLET ORL TAB PDL TAB 0.333000002367785 VALSARTAN-HCTZ 160 MG/25 MG TABLET ORL TAB PDL TAB 0.333000002367769 VALSARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.333000002246559 VALTREX 1000 MG CAPLET ORL TAB GSK TAB 7.483300002394634 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJ USP INJ DEFAUL SDZ VIAL 60.760000002407922 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJECTION INJ DEFAUL MYP VIAL 95.713000002407930 VANCOMYCIN HYDROCHLORIDE 5 G/VIAL INJECTION INJ DEFAUL MYP VIAL 509.790000002394626 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 31.982000002407914 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 50.375000002243837 VANIQA 13.9% TOPICAL CREAM TOP CRM ALM G 2.5990

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002229702 VAQTA 50 U/ML INJECTION INJ DEFAUL MSD ML 47.540000002241047 VARILRIX 2000 UNITS/(0.5 ML) VIAL INJECTION INJ DEFAUL GSK VIAL 62.790000002246081 VARIVAX III VACCINE 1350 U/VIAL INJECTION INJ DEFAUL MFC VIAL 76.720000002139502 VASOPRESSIN 20 UNIT/ML INJECTION INJ DEFAUL PPC ML 19.830000002223929 VAXIGRIP INFLUENZA VACCINE INJECTION INJ DEFAUL CNG ML 15.214000002308487 VECTIBIX 20 MG/ML (5 ML VIAL) INJECTION INJ DEFAUL AMG ML 124.990000002273985 VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 0.357300002339269 VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.886800002339242 VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.420000002339250 VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.839900002243716 VENOFER 20 MG/ML INJECTION INJ DEFAUL LPI ML 8.149800002226286 VENOMIL YELLOW JACKET VENOM PROTEIN 120 MCG INJ INJ DEFAUL BAI VIAL 195.000000002243115 VENTOLIN DISKUS 200 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.209500000616192 VEPESID 50 MG CAPSULE ORL CAP BMS CAP 40.567500080033844 VERALAC HYDROSOLUBLE NAIL LACQUER TOP SOL VLP ML 3.747000000839299 VERAPAMIL HYDROCHLORIDE 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 19.150000002166739 VERAPAMIL HYDROCHLORIDE USP 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 20.755000002348489 VERDESO 0.05% TOPICAL FOAM TOP FOA GSK G 0.319900002411849 VEREGEN 10% TOPICAL OINTMENT TOP ONT PAL G 4.363300000594601 VERSEL 2.5% TOPICAL LOTION TOP LOT VLP ML 0.075900002145839 VESANOID 10 MG CAPSULE ORL CAP CAG CAP 17.615300002163691 VEXOL 1% OPH SOLUTION OPH SUS ALC ML 3.870000000717002 VIADERM K.C. TOPICAL CREAM TOP CRM TAR G 0.460000000717029 VIADERM K.C. TOPICAL OINTMENT TOP ONT TAR G 0.677300002239768 VIAGRA 100 MG TABLET ORL TAB PFI TAB 9.997500002239766 VIAGRA 25 MG TABLET ORL TAB PFI TAB 9.007500002239767 VIAGRA 50 MG TABLET ORL TAB PFI TAB 9.615000002273330 VICKS CHILDREN'S NYQUIL COLD & COUGH ORAL LIQUID ORL LIQ PGI ML 0.026500001938959 VICKS FORMULA 44 ORAL LIQUID ORL LIQ PGI ML 0.034100002050684 VICKS NYQUIL ADULT NIGHTTIME COLD MEDICINE ORL LIQ ORL LIQ PGI ML 0.027600001935747 VICKS VAPORUB TOPICAL OINTMENT TOP ONT PGI G 0.077900002351064 VICTOZA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 28.928300002336707 VIDAZA 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 628.000000002244596 VIDEX EC 125 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 3.989300002244597 VIDEX EC 200 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 6.383700002244598 VIDEX EC 250 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 7.907300002244599 VIDEX EC 400 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 12.7920

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002417685 VIDEXTRA 10,000 UNIT TABLET ORL TAB ORI TAB 0.250000002252260 VIGAMOX 0.5% OPHTHALMIC SOLUTION OPH SOL ALC ML 4.723300002427184 VIMIZIM 5MG/5ML (SINGLE-USE) VIAL INJECTION INJ DEFAUL BMI VIAL 1199.000000002361701 VIMOVO 375 MG/20 MG TABLET ORL TAB AZC TAB 1.151800002361728 VIMOVO 500 MG/20 MG TABLET ORL TAB AZC TAB 1.151800002401460 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 17.679000002183056 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL MNP ML 11.500000002183013 VINCRISTINE SULFATE 1 MG/ML INJECTION INJ DEFAUL HSP ML 63.365000002143305 VINCRISTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 31.000000000074500 VIOFORM HC TOPICAL CREAM TOP CRM PAL G 0.937700002238617 VIRACEPT 250 MG TABLET ORL TAB AGR TAB 2.027600002248761 VIRACEPT 625 MG TABLET ORL TAB PFI TAB 5.068900002238748 VIRAMUNE 200 MG TABLET ORL TAB BOE TAB 5.366200002367289 VIRAMUNE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT BOE TAB 2.469000080030855 VISION CARE CAPSULE ORL CAP PLT CAP 0.899100000568627 VISKAZIDE 10/25 MG TABLET ORL TAB NOV TAB 0.973400000568635 VISKAZIDE 10/50 MG TABLET ORL TAB NOV TAB 0.973400000443174 VISKEN 10 MG TABLET ORL TAB NOV TAB 0.997900000417289 VISKEN 15 MG TABLET ORL TAB NOV TAB 1.447600000417270 VISKEN 5 MG TABLET ORL TAB NOV TAB 0.628100002242367 VISUDYNE 15 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 1850.670000080016590 VITALUX CAPLET ORL TAB ALC TAB 0.237400080016683 VITALUX PLUS OMEGA 3 CAPSULE ORL CAP ALC CAP 0.226800002245911 VITALUX TABLET ORL TAB NOV TAB 0.243000002240199 VITALUX TR MULTIVITAMIN/MULTIMINERAL TABLET ORL TAB NCI TAB 0.243000080028004 VITALUX-S PLUS OMEGA-3 CAPSULE ORL CAP ALC CAP 0.305900080016576 VITALUX-S TABLET ORL TAB ALC TAB 0.237400000123137 VITAMIN A & D FORTIFIED CAPSULE ORL CAP JAM CAP 0.048200002245311 VITAMIN A 10,000 IU CAPSULE ORL CAP WNP CAP 0.026000000297720 VITAMIN A 10,000 IU CAPSULE ORL CAP JAM CAP 0.045300080035590 VITAMIN B 100 MG TIME RELEASE TABLET ORL TAB WNP TAB 0.157500000487082 VITAMIN B CMPD 100 SUSTAINED-RELEASE TABLET ORL SRT SWS TAB 0.173200002239350 VITAMIN B1 100 MG TABLET ORL TAB PMT TAB 0.021400000407011 VITAMIN B1 100 MG TABLET ORL TAB JAM TAB 0.091000000294853 VITAMIN B1 100 MG TABLET ORL TAB VCL TAB 0.090000000816078 VITAMIN B1 100 MG/ML INJECTION USP INJ DEFAUL SDZ ML 2.771000000610267 VITAMIN B1 50 MG TABLET ORL TAB LEA TAB 0.0740

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 110 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080009633 VITAMIN B1 50 MG TABLET ORL TAB JPC TAB 0.073700000450642 VITAMIN B12 100 MCG TABLET ORL TAB VTH TAB 0.070000000331015 VITAMIN B12 100 MCG TABLET ORL TAB JAM TAB 0.059200002023598 VITAMIN B12 100 MCG TABLET ORL TAB PMT TAB 0.056800002241500 VITAMIN B12 100 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.113000002230932 VITAMIN B12 1000 MCG TABLET ORL TAB WES TAB 0.077100002237736 VITAMIN B12 1000 MCG TABLET ORL TAB SWS TAB 0.090700080012952 VITAMIN B12 1000 MCG TABLET ORL TAB JAM TAB 0.143900080006939 VITAMIN B12 1000 MCG TABLET ORL TAB WNP TAB 0.136000080003575 VITAMIN B12 1000 MCG TIME RELEASE TABLET ORL ERT PMT TAB 0.051200000626112 VITAMIN B12 1000 MCG/ML INJ DEFAUL OMG ML 0.310000000335940 VITAMIN B12 250 MCG TABLET ORL TAB JAM TAB 0.067500000502758 VITAMIN B12 250 MCG TABLET ORL TAB SWS TAB 0.139700000305243 VITAMIN B12 50 MCG TABLET ORL TAB JAM TAB 0.054800000689726 VITAMIN B12 500 MCG TABLET ORL TAB SNS TAB 0.074100002243767 VITAMIN B12 500 MCG TABLET ORL TAB VTH TAB 0.046500000528846 VITAMIN B6 100 MG TABLET ORL TAB HAL TAB 0.030000002239348 VITAMIN B6 100 MG TABLET ORL TAB PMT TAB 0.022800000329185 VITAMIN B6 100 MG TABLET ORL TAB JAM TAB 0.067500000122645 VITAMIN B6 25 MG TABLET ORL TAB JAM TAB 0.033600000331031 VITAMIN B6 250 MG TABLET ORL TAB JAM TAB 0.109600000305227 VITAMIN B6 50 MG TABLET ORL TAB JAM TAB 0.049600000341207 VITAMIN C 1000 MG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.110800000305235 VITAMIN C 1000 MG TABLET ORL TAB JAM TAB 0.085400080040321 VITAMIN C 125 MG GUMMY ORL DEFAUL JAM PIECE 0.128000001922378 VITAMIN C 500 MG TABLET ORL TAB SWS TAB 0.047900002243893 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB PMT TAB 0.033300001994336 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB JAM TAB 0.063100000237116 VITAMIN C 500 MG ORANGE FLAVORED CHEWABLE TABLET ORL CTB TEV TAB 0.025700000373699 VITAMIN C 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC JAM CAP 0.101000002240883 VITAMIN C 500 MG TABLET ORL TAB WNP TAB 0.035900002163268 VITAMIN C 500 MG TABLET ORL TAB JAM TAB 0.050300000036188 VITAMIN C 500 MG TABLET ORL TAB WAM TAB 0.040000000463108 VITAMIN C CHEWABLE TABLET ORL TAB GAH TAB 0.097000080001870 VITAMIN D 1,000 IU TAB ORL TAB SIS TAB 0.044000080017530 VITAMIN D 1000 IU CAPSULE ORL CAP JAM CAP 0.042900080000436 VITAMIN D 1000 IU TABLET ORL TAB JAM TAB 0.0444

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 111 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080006264 VITAMIN D 1000 IU TABLET ORL TAB GFR TAB 0.050000000323179 VITAMIN D 1000 UNIT TABLET ORL TAB SWS TAB 0.030500002229879 VITAMIN D 400 IU TABLET ORL TAB SWS TAB 0.039800002240624 VITAMIN D 400 IU TABLET ORL TAB WAM TAB 0.016100002240858 VITAMIN D 400 IU TABLET ORL TAB PMT TAB 0.011700080002452 VITAMIN D 400 IU TABLET ORL TAB WNP TAB 0.028400000765384 VITAMIN D 400 IU TABLET ORL TAB LCO TAB 0.040000080009578 VITAMIN D 400 IU TABLET ORL TAB VCL TAB 0.025000002242175 VITAMIN D 400 IU TABLET ORL TAB JAM TAB 0.046500080018025 VITAMIN D DROPS 400 IU ORL LIQ JAM ML 0.931600080015280 VITAMIN D3 1000 IU CAPSULE ORL GEL VTH CAP 0.082200080012124 VITAMIN D3 1000 IU ORAL LIQUID ORL LIQ WBP ML 0.200400002245842 VITAMIN D3 1000 IU TABLET ORL TAB PMT TAB 0.017800080003663 VITAMIN D3 1000 IU TABLET ORL TAB WNP TAB 0.034200000480924 VITAMIN E 100 IU NATURAL SOURCE CAPSULE ORL CAP VTH CAP 0.046800000122823 VITAMIN E 100 IU OBLONG AMBER CAPSULE ORL CAP JAM CAP 0.067200000332348 VITAMIN E 200 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.062900000122831 VITAMIN E 200 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.086500000782181 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.081600000480940 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.074100002240967 VITAMIN E 400 IU CAPSULE ORL CAP WNP CAP 0.110000000266108 VITAMIN E 400 IU CAPSULE ORL CAP PMT CAP 0.054200000332356 VITAMIN E 400 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.053900000122858 VITAMIN E 400 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.130700000330191 VITAMIN E 800 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.296600002015293 VITAMIN E NATURAL SOURCE 400 UNIT CAPSULE ORL CAP QVS CAP 0.059200000201995 VITAMIN E NF NATURAL SOURCE 400 IU CAPSULE ORL CAP WAM CAP 0.116500080030153 VITAMIN K2 100 MCG CAPSULE ORL CAP NFN CAP 0.124800000480878 VITAMINE B12 1200 MCG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.138200000816175 VITAMINE C 600 MG CAPSULE ORL CAP SIS CAP 0.211200002417995 VITAMINE D 10 000 10000 UNIT TABLET ORL TAB PDL TAB 0.210000002248361 VIVAXIM INJECTION INJ DEFAUL SFP SYR 87.690000000013765 VIVOL 5 MG TABLET ORL TAB AXS TAB 0.085800000885975 VIVOTIF BERNA 6 B CAPSULE ORL CAP SSV CAP 6.367500002307073 VOLIBRIS 10 MG TABLET ORL TAB GSK TAB 122.520000002307065 VOLIBRIS 5 MG TABLET ORL TAB GSK TAB 122.520000002290375 VOLTAREN EMULGEL 1.16% TOPICAL GEL TOP GEL NVC G 0.1297

Page 112: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 112 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002338580 VOLTAREN EMULGEL JOINT PAIN 1.16% TOPICAL GEL TOP GEL NVC G 0.119200000881635 VOLTAREN RAPIDE 50 MG TABLET ORL TAB NOV TAB 0.975400002381966 VORICONAZOLE 200 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 141.350000002352303 VOTRIENT 200 MG TABLET ORL TAB GSK TAB 36.990800002357119 VPRIV 400 UNIT/VIAL INJECTION INJ DEFAUL SHG VIAL 1955.000000080037590 VSL #3 ORAL POWDER ORL PWR FEI PCKT 3.348000002365561 VYLOMA 3.75% TOPICAL CREAM TOP CRM VCL G 45.918600080006877 WAMPOLE MINERAL CALCIUM ORAL LIQUID ORL LIQ JPC ML 0.037800080008041 WAMPOLE MULTIVITAMIN LIQUID ORL LIQ WAM ML 0.037800001948970 WASP VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 41.483300080002343 WELLESSE JOINT MOVEMENT GLUCOSAMINE LIQUID ORL LIQ BOT ML 0.028400001949004 WHITE FACED HORNET VENOM 120 MCG INJ DEFAUL ALG VIAL 35.683300002136740 WOBENZYM N TABLET ORL TAB MUC TAB 0.349700002384256 XALKORI 200 MG CAPSULE ORL CAP PFI CAP 157.666700002384264 XALKORI 250 MG CAPSULE ORL CAP PFI CAP 157.666700000723770 XANAX 1 MG TABLET ORL TAB PFI TAB 0.592400000813958 XANAX TS 2 MG TABLET ORL TAB PFI TAB 1.041600002423898 XELJANZ 5 MG TABLET ORL TAB PFI TAB 25.097800002238453 XELODA 150 MG TABLET ORL TAB HLR TAB 1.988500002238454 XELODA 500 MG TABLET ORL TAB HLR TAB 6.628600002240325 XENICAL 120 MG CAPSULE ORL CAP HLR CAP 1.749900002404044 XERESE 5%/1% TOPICAL CREAM TOP CRM VCL G 7.594000002368153 XGEVA 120 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 600.670000002388316 XIAFLEX 0.9 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 1120.000000000866598 X-SEB PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.063900000866601 X-SEB T PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.063900000509906 X-SEB T TOPICAL SHAMPOO TOP SHP PMS ML 0.063900002407329 XTANDI 40 MG CAPSULE ORL CAP ASP CAP 30.470800000800694 X-TAR TOPICAL SHAMPOO TOP SHP DLX ML 0.067600000001791 XYLOCAINE 1% W EPINEPHRINE 1:100,000 INJ INJ DEFAUL AZC ML 0.371500000385484 XYLOCAINE 2% TOPICAL JELLY URH JEL AZC ML 0.953500000001821 XYLOCAINE 2% W EPINEPHRINE 1:100,000 INJ INJ DEFAUL AZC ML 0.267000002373130 XYLOCAINE 2% W EPINEPHRINE 1:200,000 INJECTION ORL DEFAUL AZC VIAL 0.394400000001732 XYLOCAINE HCL 1% LIQUID (BLOCK OR INFILTRATION) INJ LIQ AZC ML 0.957300000036641 XYLOCAINE HCL 2% PLAIN LIQ (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.146400000049816 XYLOCAINE HYDROCHLORIDE 4% TOPICAL SOLUTION TOP SOL AZC ML 0.170000002268272 XYREM 500 MG/ML ORAL SOLUTION ORL SOL VCL ML 2.6370

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 113 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002321157 YAZ 28 TABLET ORL TB BAI TAB 0.611800002387433 YAZ PLUS 28 TABLET ORL TB BAI TAB 0.459600001948954 YELLOW JACKET VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 35.683300001948962 YELLOW JACKET VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 35.683300000428833 YF-VAX 109648 U/0.5 ML INJECTION INJ DEFAUL SFP VIAL 128.208000000795283 YOCON 5.4 MG TABLET ORL TAB GLE TAB 0.556800000885533 YOHIMBINE-ODAN 2 MG TABLET ORL TAB ODN TAB 0.471000001901885 YOHIMBINE-ODAN 5.4 MG TABLET ORL TAB ODN TAB 0.676500000600784 ZADITEN 0.2 MG/ML ORAL SYRUP ORL SYR TEV ML 0.488600002279223 ZADITOR (PRESERVATIVE FREE) 0.25 MG/ML OPH SOL OPH SOL NOV ML 3.528300002242324 ZADITOR 0.25 MG/ML OPH SOLUTION OPH SOL NOV ML 5.750000002230287 ZANTAC 75 MG TABLET ORL TAB GSK TAB 0.430000000568392 ZAPEX 10 MG TABLET ORL TAB RIV TAB 0.035000000568406 ZAPEX 15 MG TABLET ORL TAB RIV TAB 0.055000000568414 ZAPEX 30 MG TABLET ORL TAB RIV TAB 0.075000002250519 ZAVESCA 100 MG CAPSULE ORL CAP ACT CAP 108.550000002410702 ZAXINE 550 MG TABLET ORL TAB SLX TAB 17.160000002246740 Z-BEC STRESSTABS TABLET ORL TAB WCH TAB 0.165300000237213 ZEASORB MEDICATED TOPICAL POWDER TOP PWR GSK G 0.145000002380242 ZELBORAF 240 MG FILM-COATED TABLET ORL TAB HLR TAB 50.032700002361752 ZENHALE 100 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.787300002361760 ZENHALE 200 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.954200002361744 ZENHALE 50 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.613800002216086 ZERIT 15 MG CAPSULE ORL CAP BMS CAP 4.864000002216094 ZERIT 20 MG CAPSULE ORL CAP BMS CAP 5.057500002216108 ZERIT 30 MG CAPSULE ORL CAP BMS CAP 5.275500002216116 ZERIT 40 MG CAPSULE ORL CAP BMS CAP 5.528200002240358 ZIAGEN 20 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.456800002240357 ZIAGEN 300 MG TABLET ORL TAB GSK TAB 7.384500000297666 ZINC 10 MG TABLET ORL TAB JAM TAB 0.049400000441589 ZINC 25 MG TABLET ORL TAB JAM TAB 0.065900000505463 ZINC 50 MG TABLET ORL TAB JAM TAB 0.074200001922351 ZINC 50 MG TABLET ORL TAB SWS TAB 0.046600000480886 ZINC 50 MG TIMED RELEASE TABLET ORL TAB JAM TAB 0.091400002239162 ZINCOFAX 15% TOPICAL OINTMENT TOP ONT PDH G 0.079200002239160 ZINCOFAX EXTRA STRENGTH 40% TOPICAL OINTMENT TOP ONT PDH G 0.063100002153432 ZINECARD 250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 137.0600

Page 114: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 114 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002153440 ZINECARD 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 274.140000002239952 ZITHROMAX 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 22.831000002231143 ZITHROMAX 600 MG TABLET ORL TAB PFI TAB 12.069300002354802 ZMAX SR 27 MG/ML ORAL SUPENSION ORL SUS PFI ML 0.578300002240332 ZOCOR 80 MG TABLET ORL TAB MFC TAB 2.611400002421550 ZOLEDRONIC ACID 4 MG/5 ML INJECTION INJ DEFAUL HSP ML 415.560000002327619 ZOLINZA 100 MG CAPSULE ORL CAP MFC CAP 76.179500002379929 ZOLMITRIPTAN 2.5 MG TABLET ORL TAB PDL TAB 5.333300002379988 ZOLMITRIPTAN ODT 2.5 MG ORALLY DISPERSIBLE TABLET ORL DISPTAB PDL TAB 5.333300002248992 ZOMIG 2.5 MG NASAL SPRAY NAS SPU AZC DOSE 15.375000002315939 ZOSTAVAX 19,400 UNITS/(0.65 ML) VIAL INJECTION INJ DEFAUL MFC VIAL 157.500000002375516 ZOSTAVAX II 19,400 UNITS/(0.65 ML) VIAL INJECTION INJ DEFAUL MFC VIAL 179.940000000740306 ZOSTRIX 0.025% TOPICAL CREAM TOP CRM GEU G 0.231200002004240 ZOSTRIX H.P. 0.075% TOPICAL CREAM TOP CRM GEU G 0.295300000634506 ZOVIRAX 200 MG TABLET ORL TAB GSK TAB 1.325900001911627 ZOVIRAX 400 MG TABLET ORL TAB GSK TAB 2.671500002039524 ZOVIRAX 5% TOPICAL CREAM TOP CRM VCL G 14.322000000569771 ZOVIRAX 5% TOPICAL OINTMENT TOP ONT VCL G 14.322500000800686 Z-PLUS TOPICAL SHAMPOO TOP SHP DLX ML 0.100900002354772 ZUACTA 0.075% TOPICAL CREAM TOP CRM SAV G 1.893000002340445 ZYCLARA 3.75% TOPICAL CREAM TOP CRM VCL G 46.368600002342804 ZYM-AMLODIPINE 10 MG TABLET ORL TAB ZMC TAB 0.358700002342790 ZYM-AMLODIPINE 5 MG TABLET ORL TAB ZMC TAB 0.241700002257270 ZYMAR 0.3% OPHTHALMIC SOLUTION OPH SOL ALL ML 2.820000002338106 ZYM-CARVEDILOL 12.5 MG TABLET ORL TAB ZMC TAB 0.800100002338114 ZYM-CARVEDILOL 25 MG TABLET ORL TAB ZMC TAB 0.800100002338068 ZYM-CARVEDILOL 3.125 MG TABLET ORL TAB ZMC TAB 0.800100002338092 ZYM-CARVEDILOL 6.25 MG TABLET ORL TAB ZMC TAB 0.800100002345676 ZYM-CLONAZEPAM 0.5 MG TABLET ORL TAB ZMC TAB 0.116600002303329 ZYM-CLONAZEPAM 1 MG TABLET ORL TAB ZMC TAB 0.186000002303337 ZYM-CLONAZEPAM 2 MG TABLET ORL TAB ZMC TAB 0.201000002302659 ZYM-FLUOXETINE 10 MG CAPSULE ORL CAP ZMC CAP 1.177300002302667 ZYM-FLUOXETINE 20 MG CAPSULE ORL CAP ZMC CAP 1.011200002325179 ZYM-MIRTAZAPINE 15 MG TABLET ORL TAB ZMC TAB 0.375000002325187 ZYM-MIRTAZAPINE 30 MG TABLET ORL TAB ZMC TAB 0.780000002344440 ZYM-ONDANSETRON 4 MG TABLET ORL TAB ZMC TAB 7.545300002344459 ZYM-ONDANSETRON 8 MG TABLET ORL TAB ZMC TAB 11.5170

Page 115: Products and Pricing on the Alberta Blue Cross Drug Price ...163.8080 00002395274 act temozolomide 20 mg capsule; orl cap; aph cap; 23.4020 00002395312 act temozolomide 250 mg capsule;

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 13, 2015

This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 115 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002320754 ZYM-PIOGLITAZONE 15 MG TABLET ORL TAB ZMC TAB 1.571600002320762 ZYM-PIOGLITAZONE 30 MG TABLET ORL TAB ZMC TAB 2.201700002320770 ZYM-PIOGLITAZONE 45 MG TABLET ORL TAB ZMC TAB 3.310500002303817 ZYM-SERTRALINE 100 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.102500002303779 ZYM-SERTRALINE 25 MG (BASE) CAPSULE ORL CAP ZMC CAP 0.504000002303809 ZYM-SERTRALINE 50 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.008000002325144 ZYM-TOPIRAMATE 100 MG TABLET ORL TAB ZMC TAB 1.253700002325152 ZYM-TOPIRAMATE 200 MG TABLET ORL TAB ZMC TAB 1.984500002325136 ZYM-TOPIRAMATE 25 MG TABLET ORL TAB ZMC TAB 0.661500002238851 ZYPREXA 20 MG TABLET ORL TAB LIL TAB 15.455700002243088 ZYPREXA ZYDIS 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 11.639300002243089 ZYPREXA ZYDIS 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 15.197500002371065 ZYTIGA 250 MG TABLET ORL TAB JAI TAB 31.372100002360349 ZYTRAM XL 100 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.171700002286424 ZYTRAM XL 150 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 1.738700002286432 ZYTRAM XL 200 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 2.282000002286440 ZYTRAM XL 300 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 3.314300002286459 ZYTRAM XL 400 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 4.346700002360322 ZYTRAM XL 75 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.912800002243685 ZYVOXAM 2 MG/ML INJECTION INJ DEFAUL PFI ML 0.342600002243686 ZYVOXAM 20 MG/ML ORAL SUSPENSION ORL SUS PFI ML 2.7023