products and pricing on the alberta blue cross drug price list (abcdpl) effective ... ·...

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective March 14, 2016 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 0.3183 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 4.9035 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 9.8070 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.2080 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 0.0030 00080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.2000 00002414570 ABBOTT-CITALOPRAM 10 MG TABLET ORL TAB ABB TAB 0.1432 00002414589 ABBOTT-CITALOPRAM 20 MG TABLET ORL TAB ABB TAB 0.2397 00002414597 ABBOTT-CITALOPRAM 40 MG TABLET ORL TAB ABB TAB 0.2397 00002412942 ABBOTT-CLOPIDOGREL 75 MG TABLET ORL TAB ABB TAB 0.4735 00002414805 ABBOTT-LEVETIRACETAM 250 MG TABLET ORL TAB ABB TAB 0.8000 00002414791 ABBOTT-LEVETIRACETAM 500 MG TABLET ORL TAB ABB TAB 0.9750 00002414783 ABBOTT-LEVETIRACETAM 750 MG TABLET ORL TAB ABB TAB 1.3500 00002414546 ABBOTT-OLANZAPINE ODT 10 MG TABLET ORL DISNTAB ABB TAB 1.2857 00002414538 ABBOTT-OLANZAPINE ODT 5 MG TABLET ORL DISNTAB ABB TAB 0.6434 00002412969 ABBOTT-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.3628 00002412985 ABBOTT-QUETIAPINE 100 MG TABLET ORL TAB ABB TAB 0.3295 00002412993 ABBOTT-QUETIAPINE 200 MG TABLET ORL TAB ABB TAB 0.6617 00002412977 ABBOTT-QUETIAPINE 25 MG TABLET ORL TAB ABB TAB 0.1235 00002413000 ABBOTT-QUETIAPINE 300 MG TABLET ORL TAB ABB TAB 0.9656 00002422638 ABBOTT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.1204 00002422646 ABBOTT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.2408 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 00002231590 ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML 8.6795 00001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.5417 00001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.6692 00001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.7683 00002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.0000 00002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.0000 00002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.0060 00002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 12.4590 00002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 14.9410 00002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 16.9760 00002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 22.6450 00002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 28.3030 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

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Page 1: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 0.318300002192683 3TC 150 MG TABLET ORL TAB GSK TAB 4.903500002247825 3TC 300 MG TABLET ORL TAB GSK TAB 9.807000002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.208000002166607 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 0.003000080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.200000002414570 ABBOTT-CITALOPRAM 10 MG TABLET ORL TAB ABB TAB 0.143200002414589 ABBOTT-CITALOPRAM 20 MG TABLET ORL TAB ABB TAB 0.239700002414597 ABBOTT-CITALOPRAM 40 MG TABLET ORL TAB ABB TAB 0.239700002412942 ABBOTT-CLOPIDOGREL 75 MG TABLET ORL TAB ABB TAB 0.473500002414805 ABBOTT-LEVETIRACETAM 250 MG TABLET ORL TAB ABB TAB 0.800000002414791 ABBOTT-LEVETIRACETAM 500 MG TABLET ORL TAB ABB TAB 0.975000002414783 ABBOTT-LEVETIRACETAM 750 MG TABLET ORL TAB ABB TAB 1.350000002414546 ABBOTT-OLANZAPINE ODT 10 MG TABLET ORL DISNTAB ABB TAB 1.285700002414538 ABBOTT-OLANZAPINE ODT 5 MG TABLET ORL DISNTAB ABB TAB 0.643400002412969 ABBOTT-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.362800002412985 ABBOTT-QUETIAPINE 100 MG TABLET ORL TAB ABB TAB 0.329500002412993 ABBOTT-QUETIAPINE 200 MG TABLET ORL TAB ABB TAB 0.661700002412977 ABBOTT-QUETIAPINE 25 MG TABLET ORL TAB ABB TAB 0.123500002413000 ABBOTT-QUETIAPINE 300 MG TABLET ORL TAB ABB TAB 0.965600002422638 ABBOTT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.120400002422646 ABBOTT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.240800002414619 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 0.312800002231590 ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML 8.679500001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.541700001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.669200001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.768300002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.000000002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.000000002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.006000002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 12.459000002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 14.941000002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 16.976000002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 22.645000002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 28.303000001922246 AC & C 8 MG TABLET ORL TAB PPH TAB 0.051000000095494 AC WITH CODEINE 8 MG TABLET ORL TAB DTC TAB 0.0592

Page 2: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002401126 ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB 0.398900002401134 ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB 2.012500002341107 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 0.963700002419866 ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB 0.963700002400391 ACCEL-FLUOXETINE 10 MG CAPSULE ORL CAP ACP CAP 0.367600002400405 ACCEL-FLUOXETINE 20 MG CAPSULE ORL CAP ACP CAP 0.367900002400359 ACCEL-QUETIAPINE 100 MG TABLET ORL TAB ACP TAB 0.255500002400375 ACCEL-QUETIAPINE 200 MG TABLET ORL TAB ACP TAB 0.509500002400340 ACCEL-QUETIAPINE 25 MG TABLET ORL TAB ACP TAB 0.096000002400383 ACCEL-QUETIAPINE 300 MG TABLET ORL TAB ACP TAB 0.755000002435349 ACCEL-TOPIRAMATE 100 MG TABLET ORL TAB ACP TAB 0.474300002435357 ACCEL-TOPIRAMATE 200 MG TABLET ORL TAB ACP TAB 0.708300002435330 ACCEL-TOPIRAMATE 25 MG TABLET ORL TAB ACP TAB 0.250200002164396 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 0.621700001999648 ACET CODEINE 30 TABLET ORL TAB PMS TAB 0.132000002154234 ACETAMINOPHEN 300MG/15MG CAFFEINE/8MG COD. CAPLET ORL TAB VTH TAB 0.034800001977415 ACETAMINOPHEN 325 MG CAPLET ORL TAB TLI TAB 0.059200000789801 ACETAMINOPHEN 325 MG TABLET ORL TAB TLI TAB 0.059200000605751 ACETAMINOPHEN 325 MG TABLET ORL TAB VTH TAB 0.027200000374148 ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB 0.018400000789798 ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB 0.024300001905864 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 0.039800001905856 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 0.030600002252813 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB 0.062100002285797 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB VTH TAB 0.060000001904132 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 0.039800002251914 ACETAMINOPHEN, CAFFEINE & 8 MG CODEINE PHOS. TAB ORL TAB PMT TAB 0.0396

Page 3: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002362228 ACETAMINOPHENE 500 MG CAPLET ORL TAB RIV TAB 0.014900002017458 ACETAMINOPHENE 80MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB 0.100000000834319 ACETAZONE FORTE C-8 TABLET ORL TAB RPH TAB 0.449500000834300 ACETAZONE FORTE TABLET ORL TAB RPH TAB 0.339900001999656 ACET-CODEINE 60 MG TABLET ORL TAB PMS TAB 0.140500002300435 ACETYLCYSTEINE 20% INHALATION SOLUTION INH SOL ALV ML 1.950000000718831 ACETYLSALICYLIC ACID 325 MG TABLET ORL TAB PHH TAB 0.062100002426757 ACH-CAPECITABINE 150 MG TABLET ORL TAB AHI TAB 1.464000002426765 ACH-CAPECITABINE 500 MG TABLET ORL TAB AHI TAB 4.880000002247551 ACID REDUCER 75 MG TABLET ORL TAB PMS TAB 0.106700080042609 ACIDOPHILUS PROBIOTIC COMPLETE CAPSULE ORL CAP WNP CAP 0.289200080011789 ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP 0.108200002439247 ACT AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.075800002439255 ACT AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.325000002439263 ACT AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.574300002439271 ACT AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.823500002439298 ACT AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 3.072900002439239 ACT AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 1.826600002394898 ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB 2.546000002374765 ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB 0.498300002376520 ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB 0.340000002244816 ACT CLOMIPRAMINE 10 MG TABLET ORL TAB APH TAB 0.129000002397625 ACT DONEPEZIL ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 3.617600002397617 ACT DONEPEZIL ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 3.617600002423855 ACT ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APH TAB 1.869000002423863 ACT ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT APH TAB 1.869000002305682 ACT FAMCICLOVIR 125 MG TABLET ORL TAB APH TAB 2.024000002305690 ACT FAMCICLOVIR 250 MG TABLET ORL TAB APH TAB 2.720000002305704 ACT FAMCICLOVIR 500 MG TABLET ORL TAB APH TAB 4.228100002397285 ACT IMATINIB 100 MG TABLET ORL TAB COB TAB 20.455700002397293 ACT IMATINIB 400 MG TABLET ORL TAB COB TAB 81.822800002250020 ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB 0.567000002250012 ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB 0.491400002404656 ACT MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL APH ML 3.976700002325713 ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB 10.309300002327589 ACT OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 5.355300002327597 ACT OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 7.597700002404095 ACT OLAPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APH ML 10.452000002403986 ACT OLOPATADINE 0.1% OPH SOLUTION OPH SOL APH ML 5.226000002394189 ACT OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.4390

Page 4: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002394197 ACT OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.658500002394200 ACT OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 1.141300002394170 ACT OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.315000002394219 ACT OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 2.108000002262746 ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB 1.043000002297310 ACT PRAMIPEXOLE 0.5 MG TABLET ORL TAB APH TAB 1.386000002402955 ACT PREGABALIN 150 MG CAPSULE ORL CAP APH CAP 1.727000002402971 ACT PREGABALIN 225 MG CAPSULE ORL CAP APH CAP 1.727000002402912 ACT PREGABALIN 25 MG CAPSULE ORL CAP APH CAP 0.617300002402998 ACT PREGABALIN 300 MG CAPSULE ORL CAP APH CAP 1.727000002402920 ACT PREGABALIN 50 MG CAPSULE ORL CAP APH CAP 0.968300002402939 ACT PREGABALIN 75 MG CAPSULE ORL CAP APH CAP 1.252800002372088 ACT SILDENAFIL 100 MG TABLET ORL TAB APH TAB 9.200000002372053 ACT SILDENAFIL 25 MG TABLET ORL TAB APH TAB 8.290000002372061 ACT SILDENAFIL 50 MG TABLET ORL TAB APH TAB 8.847500002257882 ACT SUMATRIPTAN 25 MG TABLET ORL TAB APH TAB 8.990000002395282 ACT TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APH CAP 113.596600002395290 ACT TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APH CAP 159.036000002395274 ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP 22.720000002395312 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP 283.984000002441160 ACT TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APH CAP 6.630000002337487 ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB 0.582300002238302 ACTIFED 60 MG/2.5 MG TABLET ORL TAB MCL TAB 0.324600002249405 ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB 2.301400002309009 ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB 2.301400002316838 ACTONEL 150 MG TABLET ORL TAB ASC TAB 55.800000002370417 ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB 13.187500002248722 ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML 3.394000002286556 ACYCLOVIR 200 MG TABLET ORL TAB SNS TAB 0.639700002286564 ACYCLOVIR 400 MG TABLET ORL TAB SNS TAB 1.270000002286572 ACYCLOVIR 800 MG TABLET ORL TAB SNS TAB 1.267300002236916 ACYCLOVIR SODIUM 25 MG/ML INJECTION INJ DEFAUL HSP ML 4.862000002236926 ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL FKC ML 12.584000002281074 ACZONE 5% TOPICAL GEL TOP GEL VCL G 1.059000002240255 ADACEL INJECTION INJ DEFAUL SFP ML 58.000000002352044 ADACEL-POLIO INJECTION INJ DEFAUL SFP ML 79.900000002313766 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 0.0290

Page 5: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002290081 ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML 0.170000002401347 ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL 4840.000000002338327 ADCIRCA 20 MG TABLET ORL TAB LIL TAB 13.497000002248809 ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.442100002248810 ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.735300002248811 ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.028600002248812 ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.321800002248813 ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.615200002248808 ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.148900002412764 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 2 MG/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 2.520000002331667 ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 7.560000002296489 ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 12.620000080025646 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 0.187000002036312 ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB 0.375000002248645 ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB 0.412000002244577 ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB 0.270600002248231 ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP 0.360800001933531 ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB 0.143300002246403 ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB 0.307000002241769 ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP 0.246900002242522 ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML 0.316000002243919 AERIUS 5 MG TABLET ORL TAB SCH TAB 0.956000002339528 AFINITOR 10 MG TABLET ORL TAB NOV TAB 188.790000002369257 AFINITOR 2.5 MG TABLET ORL TAB NOV TAB 188.790000002339501 AFINITOR 5 MG TABLET ORL TAB NOV TAB 188.790000002425645 AFINITOR DISPERZ 2 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 186.000000002425653 AFINITOR DISPERZ 3 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 186.000000002425661 AFINITOR DISPERZ 5 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 186.000000002432692 AG-DONEPEZIL 10 MG TABLET ORL TAB AGP TAB 0.875200002432684 AG-DONEPEZIL 5 MG TABLET ORL TAB AGP TAB 0.8752

Page 6: Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective ... · 2016-03-07 · Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective

Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002243542 AGENERASE 150 MG CAPSULE ORL CAP GSK CAP 1.920000002346850 AGRIFLU INJECTION SYRINGE INJ DEFAUL NVD SYR 9.300000002428881 AGRIFLU MULTI-DOSE VIAL INJECTION INJ DEFAUL NOV ML 16.200000002236859 AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP 5.857600002410265 AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB 0.364700002410273 AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB 0.556700000888230 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 0.593300000433519 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 0.224000002447576 ALFUZOSIN 10 MG EXTENDED-RELEASE TABLET ORL SRT SIV TAB 0.496600002414759 ALFUZOSIN 10 MG PROLONGED-RELEASE TABLET ORL SRT PDL TAB 0.496600080014418 ALIGN PROBIOTIC CAPSULE ORL CAP PGI CAP 0.900700002253437 ALIMTA 500 MG/VIAL INJECTION INJ DEFAUL LIL VIAL 2750.000000000004715 ALKERAN 2 MG TABLET ORL TAB ASN TAB 1.684600002231462 ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB 0.379200002242819 ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB 0.741700002239853 ALLEGRA-D SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.508000002146142 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 0.130300000299987 ALLERGENIC EXTRACT POLLENS 100000 UNIT/ML INJ INJ DEFAUL ALK ML 7.500000001949454 ALLERGY 25 MG TABLET ORL TAB TAN TAB 0.093800000764647 ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML 0.177300000833266 ALLERGY ELIXIR 2.5 MG/ML ORAL ELIXIR ORL ELX TAN ML 0.018000002141728 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 0.049900002097583 ALLERNIX 25 MG CAPLET ORL TAB ROG TAB 0.241300002097575 ALLERNIX EXTRA STRENGTH 50 MG CAPLET ORL TAB ROG TAB 0.440000002369656 ALLERNIX MULTI SYMPTOM 5 MG TABLET ORL TAB ROG TAB 0.512000002240265 ALLER-RELIEF 10 MG TABLET ORL TAB APX TAB 0.408300002364689 ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB 0.408000000555681 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 0.2125

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000569801 ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML 0.017900002424029 ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB 7.043300002241407 ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML 6.490000000893560 ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL ALC ML 1.162000002381710 ALOXI 0.05 MG/ML INJECTION INJ DEFAUL EIS ML 18.000000002381729 ALOXI 0.5 MG CAPSULE ORL CAP EIS CAP 66.000000080005881 ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP 0.105500002248151 ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML 3.464000001908189 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 5.562000002281112 ALTACE 15 MG CAPSULE ORL CAP/TAB VCL CAP 1.171000002245272 AMARYL 1 MG TABLET ORL TAB SAV TAB 0.921700002245273 AMARYL 2 MG TABLET ORL TAB SAV TAB 1.003000002245274 AMARYL 4 MG TABLET ORL TAB SAV TAB 1.073700002241630 AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 121.000000002230575 AMETOP 4% TOPICAL GEL TOP GEL SNE G 2.651100000870943 AMI-HYDRO TABLET ORL TAB PDL TAB 0.083800002242971 AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML 33.557000002374684 AMIODARONE SYRINGE 50 MG/ML INJECTION INJ NDL SDZ SYR 66.450000000370991 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 0.138000002378779 AMLODIPINE-ODAN 10 MG TABLET ORL TAB ODN TAB 0.358700002378760 AMLODIPINE-ODAN 5 MG TABLET ORL TAB ODN TAB 0.241700000638064 AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML 0.334000002401576 AMOXICILLIN SUGAR-REDUCED 50 MG/ML ORAL SUSPENSION ORL SUS SIV ML 0.054000002326515 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 0.017900002124971 AMPHOJEL 600 MG TABLET ORL TAB AUP TAB 0.125000080006771 A-MULSION ORAL LIQUID ORL LIQ SRL ML 0.400000002221861 ANANDRON 50 MG TABLET ORL TAB SAV TAB 2.271900002442736 ANASTROZOLE 1 MG TABLET ORL TAB SNS TAB 2.546000002245345 ANDROGEL (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.892000002245346 ANDROGEL (5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.788700002249499 ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL BGP G 0.9013

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000874019 ANEXATE 0.1 MG/ ML INJECTION INJ DEFAUL HLR ML 5.695600002268825 ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB 0.782100002280361 ANTHELIOS XL SPF 60 TOPICAL CREAM TOP CRM LRP G 0.168800000566756 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 0.700000002230251 ANTIBIOTIC TOPICAL OINTMENT USP TOP ONT TAR G 0.150000002241532 ANTI-NAUSEANT 50 MG TABLET ORL TAB VTH TAB 0.079000002222132 ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G 0.057000000990104 ANTI-STATIC COMPACT SPACE CHAMBER PLUS MOUTHPIECE DEFAUL DEV MPI DEV 23.550000000990107 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ LG MASK DEFAUL ADUDEV MPI DEV 39.860000000990106 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ MED MASK DEFAUL PEDDEV MPI DEV 37.670000000990105 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ SM MASK DEFAUL INFDEV MPI DEV 37.670000001945939 ANUSOL 0.5% RECTAL OINTMENT RT ONT MCL G 0.153000001945920 ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP MCL SUP 0.418300001945912 ANUSOL PLUS RECTAL OINTMENT RT ONT MCL G 0.191700001945904 ANUSOL PLUS RECTAL SUPPOSITORY RT SUP MCL SUP 0.559200000621447 ANUZINC 0.5% W/W TOPICAL OINTMENT TOP ONT SDZ G 0.125000000621439 ANUZINC 10 MG RECTAL SUPPOSITORY RT SUP SDZ SUP 0.408300002248424 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 0.137500002416255 APO-ABACAVIR-LAMIVUDINE-ZIDOVUDINE TABLET ORL TAB APX TAB 15.461300002229873 APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB 0.032600000544981 APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB 0.032600002248727 APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB 1.037000002243611 APO-ALPRAZ 1 MG TABLET ORL TAB APX TAB 0.309900002243612 APO-ALPRAZ TS 2 MG TABLET ORL TAB APX TAB 0.550800002411318 APO-AMLODIPINE-ATORVASTATIN 10 MG/10 MG TABLET ORL TAB APX TAB 0.919400002411326 APO-AMLODIPINE-ATORVASTATIN 10 MG/20 MG TABLET ORL TAB APX TAB 1.023400002411334 APO-AMLODIPINE-ATORVASTATIN 10 MG/40 MG TABLET ORL TAB APX TAB 1.062400002411342 APO-AMLODIPINE-ATORVASTATIN 10 MG/80 MG TABLET ORL TAB APX TAB 1.062400002411253 APO-AMLODIPINE-ATORVASTATIN 5 MG/10 MG TABLET ORL TAB APX TAB 0.755100002411261 APO-AMLODIPINE-ATORVASTATIN 5 MG/20 MG TABLET ORL TAB APX TAB 0.859100002411288 APO-AMLODIPINE-ATORVASTATIN 5 MG/40 MG TABLET ORL TAB APX TAB 0.898100002411296 APO-AMLODIPINE-ATORVASTATIN 5 MG/80 MG TABLET ORL TAB APX TAB 0.898100002288559 APO-AMOXI CLAV 80 MG/11.4 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.196900002374420 APO-ANASTROZOLE 1 MG TABLET ORL TAB APX TAB 2.546000000510696 APO-ASEN ECT 325 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.0304

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000472476 APO-ASEN ECT 650 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.250000002318024 APO-ATOMOXETINE 10 MG CAPSULE ORL CAP APX CAP 2.314000002318083 APO-ATOMOXETINE 100 MG CAPSULE ORL CAP APX CAP 4.352000002318032 APO-ATOMOXETINE 18 MG CAPSULE ORL CAP APX CAP 2.652300002318040 APO-ATOMOXETINE 25 MG CAPSULE ORL CAP APX CAP 2.928100002318059 APO-ATOMOXETINE 40 MG CAPSULE ORL CAP APX CAP 3.337700002318067 APO-ATOMOXETINE 60 MG CAPSULE ORL CAP APX CAP 3.702400002318075 APO-ATOMOXETINE 80 MG CAPSULE ORL CAP APX CAP 3.996000002247423 APO-AZITHROMYCIN 250 MG TABLET ORL TAB APX TAB 1.231700002296063 APO-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB 4.057300002399210 APO-BOSENTAN 125 MG TABLET ORL TAB APX TAB 22.462500002399202 APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB 22.462500000682047 APO-CAL 250 625 MG TABLET ORL TAB APX TAB 0.026600000682039 APO-CAL 500 MG TABLET ORL TAB APX TAB 0.064500002365340 APO-CANDESARTAN 4 MG TABLET ORL TAB APX TAB 0.340000000893625 APO-CAPTO 100 MG TABLET ORL TAB APX TAB 1.039500000893595 APO-CAPTO 12.5 MG TABLET ORL TAB APX TAB 0.212000000893609 APO-CAPTO 25 MG TABLET ORL TAB APX TAB 0.300000000893617 APO-CAPTO 50 MG TABLET ORL TAB APX TAB 0.559000001999559 APO-CAPTO 6.25 MG TABLET ORL TAB APX TAB 0.123700002293943 APO-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.118700002293951 APO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.236700002231603 APO-CETIRIZINE 10 MG TABLET ORL TAB APX TAB 0.408300000399302 APO-CHLORPROPAMIDE 100 MG TABLET ORL TAB APX TAB 0.080300000312711 APO-CHLORPROPAMIDE 250 MG TABLET ORL TAB APX TAB 0.162400002298953 APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G 7.743300000749494 APO-CIMETIDINE 800 MG TABLET ORL TAB APX TAB 0.243000002263130 APO-CIPROFLOX 0.3% OPHTHALMIC SOL. OPH SOL APX ML 1.760000002274744 APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB 0.420900002274752 APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB 1.629300002040786 APO-CLOMIPRAMINE 10 MG TABLET ORL TAB APX TAB 0.129000002243433 APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB 0.393700002354403 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 10.0850

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002386062 APO-ELETRIPTAN 40 MG TABLET ORL TAB APX TAB 10.085000002339099 APO-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APX TAB 1.869000002339102 APO-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT APX TAB 1.869000002419726 APO-EXEMESTANE 25 MG TABLET ORL TAB APX TAB 3.900800002292025 APO-FAMCICLOVIR 125 MG TABLET ORL TAB APX TAB 2.024000002292041 APO-FAMCICLOVIR 250 MG TABLET ORL TAB APX TAB 2.720000002292068 APO-FAMCICLOVIR 500 MG TABLET ORL TAB APX TAB 4.228000000545031 APO-FERROUS GLUCONATE 300 MG TABLET ORL TAB APX TAB 0.040400001912518 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 0.183100002426471 APO-FROVATRIPTAN 2.5 MG TABLET ORL TAB APX TAB 12.503300002293358 APO-GABAPENTIN 600 MG TABLET ORL TAB APX TAB 1.304500002293366 APO-GABAPENTIN 800 MG TABLET ORL TAB APX TAB 1.739300000885754 APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML 0.495600002295377 APO-GLIMEPIRIDE 1 MG TABLET ORL TAB APX TAB 0.490000002295385 APO-GLIMEPIRIDE 2 MG TABLET ORL TAB APX TAB 0.490000002295393 APO-GLIMEPIRIDE 4 MG TABLET ORL TAB APX TAB 0.490000000396818 APO-HALOPERIDOL 1 MG TABLET ORL TAB APX TAB 0.183900000463698 APO-HALOPERIDOL 10 MG TABLET ORL TAB APX TAB 0.637800002327856 APO-HYDRO 12.5 MG TABLET ORL TAB APX TAB 0.033800000441643 APO-IBUPROFEN 200 MG TABLET ORL TAB APX TAB 0.052800002355337 APO-IMATINIB 100 MG TABLET ORL TAB APX TAB 20.455700002355345 APO-IMATINIB 400 MG TABLET ORL TAB APX TAB 81.822800002369052 APO-LAMIVUDINE 150 MG TABLET ORL TAB APX TAB 3.626900002369060 APO-LAMIVUDINE 300 MG TABLET ORL TAB APX TAB 7.253800002375540 APO-LAMIVUDINE-ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB APX TAB 7.830900002358514 APO-LETROZOLE 2.5 MG TABLET ORL TAB APX TAB 2.756000002261979 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 0.350600002243880 APO-LORATADINE 10 MG TABLET ORL TAB APX TAB 0.626700002248974 APO-MELOXICAM 15 MG TABLET ORL TAB APX TAB 0.567000002248973 APO-MELOXICAM 7.5 MG TABLET ORL TAB APX TAB 0.491400002366487 APO-MEMANTINE 10 MG TABLET ORL TAB APX TAB 1.635700002273950 APO-METHYLPHENIDATE 5 MG TABLET ORL TAB APX TAB 0.099500002286610 APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB 0.375000002286637 APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB 1.125000002406373 APO-MOXIFLOXACIN 0.5 % OPHTHALMIC SOLUTION OPH SOL APX ML 3.757000002404923 APO-MOXIFLOXACIN 400 MG TABLET ORL TAB APX TAB 1.523000002352559 APO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP APX CAP 1.0310

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002352567 APO-MYCOPHENOLATE 500 MG TABLET ORL TAB APX TAB 2.062000002372738 APO-MYCOPHENOLIC ACID 180 MG ENTERIC-COATED TAB ORL ECT APX TAB 1.698000002372746 APO-MYCOPHENOLIC ACID 360 MG ENTERIC-COATED TAB ORL ECT APX TAB 3.396000002444275 APO-NALTREXONE 50 MG TABLET ORL TAB APX TAB 7.302700002246699 APO-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.208700002365499 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 0.380200002223511 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 10.309300002360632 APO-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB 5.355300002360640 APO-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB 7.597700002305054 APO-OLOPATADINE 0.1% OPH SOLUTION OPH SOL APX ML 5.226100002402823 APO-OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APX ML 10.452200002243661 APO-OXAPROZIN 600 MG TABLET ORL TAB APX TAB 0.689200002284294 APO-OXCARBAZEPINE 150 MG TABLET ORL TAB APX TAB 0.620900002284308 APO-OXCARBAZEPINE 300 MG TABLET ORL TAB APX TAB 0.910200002284316 APO-OXCARBAZEPINE 600 MG TABLET ORL TAB APX TAB 1.820400002366754 APO-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.439000002394766 APO-OXYCODONE CR 15 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.530000002366762 APO-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.658500002394774 APO-OXYCODONE CR 30 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.870000002306530 APO-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.141300002366746 APO-OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.315000002394782 APO-OXYCODONE CR 60 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.575000002366789 APO-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 2.108000002292912 APO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB 1.275000002240907 APO-PAROXETINE 10 MG TABLET ORL TAB APX TAB 1.043000000755885 APO-PINDOL 10 MG TABLET ORL TAB APX TAB 0.232300000755893 APO-PINDOL 15 MG TABLET ORL TAB APX TAB 0.337000000755877 APO-PINDOL 5 MG TABLET ORL TAB APX TAB 0.136100002292386 APO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB APX TAB 1.386000002394278 APO-PREGABALIN 150 MG CAPSULE ORL CAP APX CAP 1.727000002394286 APO-PREGABALIN 225 MG CAPSULE ORL CAP APX CAP 1.727000002394235 APO-PREGABALIN 25 MG CAPSULE ORL CAP APX CAP 0.617300002394294 APO-PREGABALIN 300 MG CAPSULE ORL CAP APX CAP 1.7270

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002394243 APO-PREGABALIN 50 MG CAPSULE ORL CAP APX CAP 0.968300002394251 APO-PREGABALIN 75 MG CAPSULE ORL CAP APX CAP 1.252900000504335 APO-PROPRANOLOL 120 MG TABLET ORL TAB APX TAB 0.309100002325381 APO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP 0.855000002404680 APO-RASAGILINE 0.5 MG TABLET ORL TAB APX TAB 6.128500002404699 APO-RASAGILINE 1 MG TABLET ORL TAB APX TAB 6.128500002377721 APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB 40.950000002248203 APO-SILDENAFIL 100 MG TABLET ORL TAB APX TAB 9.200700002248201 APO-SILDENAFIL 25 MG TABLET ORL TAB APX TAB 8.290000002248202 APO-SILDENAFIL 50 MG TABLET ORL TAB APX TAB 8.848100002418118 APO-SILDENAFIL R 20 MG TABLET ORL TAB APX TAB 7.294000000778354 APO-SULIN 150 MG TABLET ORL TAB APX TAB 0.382400000778362 APO-SULIN 200 MG TABLET ORL TAB APX TAB 0.392000002421933 APO-TADALAFIL PAH 20 MG TABLET ORL TAB APX TAB 11.472500000812404 APO-TAMOX 10 MG TABLET ORL TAB APX TAB 0.175000000812390 APO-TAMOX 20 MG TABLET ORL TAB APX TAB 0.350000002413094 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 5.850000000755850 APO-TIMOL 10 MG TABLET ORL TAB APX TAB 0.323900000755869 APO-TIMOL 20 MG TABLET ORL TAB APX TAB 0.630400000755842 APO-TIMOL 5 MG TABLET ORL TAB APX TAB 0.207700002290812 APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML 2.730000002426153 APO-TRAMADOL 50 MG TABLET ORL TAB APX TAB 0.638600002336790 APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB 0.626400002147653 APO-TRAZODONE 150 MG TABLET ORL TAB APX TAB 0.461300002371510 APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB 0.582300001946323 APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP 1.397700002381575 APO-ZOLMITRIPTAN RAPID 2.5 MG ORALLY DISP. TABLET ORL DISPTAB APX TAB 4.605000002434946 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 1.182700002375885 APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP 2.607100000723754 APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL 11.650000002273322 APTIVUS 250 MG CAPSULE ORL CAP BOE CAP 8.250000002162075 AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML 0.848800002269465 ARICEPT RDT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 4.867100002269457 ARICEPT RDT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 4.8671

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002224135 ARIMIDEX 1 MG TABLET ORL TAB AZC TAB 5.186300080008677 ARNICA 7% GEL TOP GEL BCI G 0.131400080015109 ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G 0.097100002446588 ARNUITY ELLIPTA 200 MCG/DOSE POWDER FOR INHALATION INH MIP GSK DOSE 2.536700002242705 AROMASIN 25 MG TABLET ORL TAB PFI TAB 5.279000002286653 ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB 0.079200002371146 ARTHRITIS PAIN RELIEF 650 MG EXTENDED-RELEASE TAB ORL ERT VTH TAB 0.049800002229632 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 NOV VIAL 336.000000002381567 ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL NOV VIAL 3360.000000000180041 ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB 0.039600000530336 ASA 325 MG TABLET ORL TAB VTH TAB 0.021500000230324 ASA 325 MG TABLET ORL TAB TEV TAB 0.062100000036145 ASA 325 MG TABLET ORL TAB WAM TAB 0.013600002372177 ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB 0.053000002433044 ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.056000002244993 ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.036100002426811 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 0.056000002243974 ASAPHEN 81 MG CHEWABLE TABLET ORL CTB PMS TAB 0.071300002238545 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 0.071300002280167 ASATAB 80 MG CHEWABLE TABLET ORL CTB ODN TAB 0.058000002352427 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 SAH G 0.058100002150328 ASPIRIN 325 MG TABLET ORL TAB BAI TAB 0.092900002316897 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 0.096000002239090 ATACAND 4 MG TABLET ORL TAB AZC TAB 0.723300000013668 ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB 0.054300000293504 ATASOL-15 TABLET ORL TAB CHD TAB 0.091000000293512 ATASOL-30 TABLET ORL TAB CHD TAB 0.133800000293490 ATASOL-8 TABLET ORL TAB CHD TAB 0.070300002326701 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 1.4040

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002445883 ATOMOXETINE 10 MG CAPSULE ORL CAP SIV CAP 2.314000002396912 ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP 1.609300002445905 ATOMOXETINE 18 MG CAPSULE ORL CAP SIV CAP 2.652300002445913 ATOMOXETINE 25 MG CAPSULE ORL CAP SIV CAP 2.928000002396920 ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP 1.776700002445948 ATOMOXETINE 40 MG CAPSULE ORL CAP SIV CAP 3.337300002396939 ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP 2.025000002396947 ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP 2.246300002445956 ATOMOXETINE 60 MG CAPSULE ORL CAP SIV CAP 3.702300002396424 ATORVASTATIN 10 MG TABLET ORL TAB APX TAB 0.313800002346486 ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.313800002387891 ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.416000002346494 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 0.392200002396440 ATORVASTATIN 40 MG TABLET ORL TAB APX TAB 0.421600002387913 ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.559000002346508 ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.421600002387921 ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB 0.559000002346516 ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB 0.421600002396459 ATORVASTATIN 80 MG TABLET ORL TAB APX TAB 0.421600002421429 ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB 4.130800002299925 ATRIANCE 5 MG/ML INJECTION INJ DEFAUL NOV ML 9.689200002300699 ATRIPLA TABLET ORL TAB BMG TAB 42.334000002094703 ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML 2.500000002148358 ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002163713 ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML 1.986000002332477 AURALGAN OTIC SOLUTION OT SOL PAL ML 0.523600002407256 AURO-ATORVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.313800002407264 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 0.421600002449153 AURO-BETAHISTINE 16 MG TABLET ORL TAB AUR TAB 0.177000002449161 AURO-BETAHISTINE 24 MG TABLET ORL TAB AUR TAB 0.498300002449145 AURO-BETAHISTINE 8 MG TABLET ORL TAB AUR TAB 0.211100002445808 AURO-CANDESARTAN 16 MG TABLET ORL TAB AUR TAB 0.300800002445816 AURO-CANDESARTAN 32 MG TABLET ORL TAB AUR TAB 0.300800002445786 AURO-CANDESARTAN 4 MG TABLET ORL TAB AUR TAB 0.180800002445794 AURO-CANDESARTAN 8 MG TABLET ORL TAB AUR TAB 0.300800002347261 AURO-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS AUR ML 0.0593

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002347245 AURO-CEFPROZIL 250 MG TABLET ORL TAB AUR TAB 0.433200002347288 AURO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS AUR ML 0.118500002347253 AURO-CEFPROZIL 500 MG TABLET ORL TAB AUR TAB 0.849400002445670 AURO-CELECOXIB 100 MG CAPSULE ORL CAP AUR CAP 0.177600002445689 AURO-CELECOXIB 200 MG CAPSULE ORL CAP AUR CAP 0.355300002418428 AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB 11.210300002448777 AURO-ENTECAVIR 0.5 MG TABLET ORL TAB AUR TAB 5.500000002385627 AURO-FLUOXETINE 10 MG CAPSULE ORL CAP AUR CAP 0.459500002447878 AURO-IRBESARTAN HCT 150/12.5 MG TABLET ORL TAB AUR TAB 0.316800002447886 AURO-IRBESARTAN HCT 300/12.5 MG TABLET ORL TAB AUR TAB 0.316800002447894 AURO-IRBESARTAN HCT 300/25 MG TABLET ORL TAB AUR TAB 0.305200002414414 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 0.273000002299828 AURO-MIRTAZAPINE OD 30 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.546000002299836 AURO-MIRTAZAPINE OD 45 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.819000002430487 AURO-MODAFINIL 100 MG TABLET ORL TAB AUR TAB 0.929300002318601 AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB 2.469200002422212 AURO-OMEPRAZOLE 10 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT AUR CAP 0.816600002384906 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 1.223700002424061 AURO-PRAMIPEXOLE 0.25 MG TABLET ORL TAB AUR TAB 0.262800002424096 AURO-PRAMIPEXOLE 1 MG TABLET ORL TAB AUR TAB 0.525700002424118 AURO-PRAMIPEXOLE 1.5 MG TABLET ORL TAB AUR TAB 0.525700002433907 AURO-PREGABALIN 150 MG CAPSULE ORL CAP AUR CAP 1.727000002433869 AURO-PREGABALIN 25 MG CAPSULE ORL CAP AUR CAP 0.617200002433877 AURO-PREGABALIN 50 MG CAPSULE ORL CAP AUR CAP 0.968200002433885 AURO-PREGABALIN 75 MG CAPSULE ORL CAP AUR CAP 1.252800002442582 AURO-ROSUVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.243700002442590 AURO-ROSUVASTATIN 20 MG TABLET ORL TAB AUR TAB 0.304600002442604 AURO-ROSUVASTATIN 40 MG TABLET ORL TAB AUR TAB 0.358200002442574 AURO-ROSUVASTATIN 5 MG TABLET ORL TAB AUR TAB 0.231100002405156 AURO-SIMVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.505700002405164 AURO-SIMVASTATIN 20 MG TABLET ORL TAB AUR TAB 0.6250

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002405172 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 0.450100002446383 AURO-SOLIFENACIN 10 MG TABLET ORL TAB AUR TAB 0.422300002446375 AURO-SOLIFENACIN 5 MG TABLET ORL TAB AUR TAB 0.422300002439050 AURO-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB AUR TAB 0.626400002414201 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 0.173000002363364 AVA-AZITHROMYCIN 250 MG TABLET ORL TAB AVA TAB 2.965000002371413 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 0.152300002366665 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 0.4172

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002363496 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 0.495200002364573 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 0.2094

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002365820 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 0.584200002366304 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 125.000000002366266 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 0.5240

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002367122 AVA-VALSARTAN 80 MG TABLET ORL TAB AVA TAB 0.572400002367084 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 42.450000002243741 AVAXIM-PEDIATRIC 80 UNIT/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 21.230000002363534 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 0.046100002382369 AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML 1.525900002343002 AZATHIOPRINE 50 MG TABLET ORL TAB SNS TAB 0.240500002284642 AZILECT 0.5 MG TABLET ORL TAB TMP TAB 7.210000002284650 AZILECT 1.0 MG TABLET ORL TAB TMP TAB 7.210000002274388 AZITHROMYCIN 20 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.372700002274396 AZITHROMYCIN 40 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.528000002330911 AZITHROMYCIN 600 MG TABLET ORL TAB SNS TAB 6.000000000598577 B COMPLEX 50 TABLET ORL TAB JAM TAB 0.081000000598569 B COMPLEX 75 TABLET ORL TAB JAM TAB 0.161600000123803 B COMPLEX PLUS C TABLET ORL TAB JAM TAB 0.081000080007498 B&C VITAMINS TABLET ORL TAB WBP TAB 0.063100080002409 B12 1000 MCG TABLET ORL TAB WNP TAB 0.085000002245512 B50 COMPLEX CAPSULE ORL CAP WNP CAP 0.089500001927906 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 0.193300000030708 BACITRACIN 50,000 U/VIAL INJECTION INJ DEFAUL PFI VIAL 11.520000002152584 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 0.196000002243425 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 0.0332

00001908855 BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML 0.049600002060841 BARRIERE 20% TOPICAL CREAM TOP CRM WSP G 0.066000002444844 BASAGLAR 100 UNIT/ML INJECTION CARTRIDGE INJ DEFAUL LIL ML 5.261300002444852 BASAGLAR 100 UNIT/ML INJECTION KWIKPEN INJ DEFAUL LIL ML 5.2613

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 20 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002135620 BASALJEL 500 MG CAPSULE ORL CAP AUP CAP 0.150000000658413 BAXEDIN 20% SOLUTION TOP SOL OMG ML 0.052000002243966 BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML 0.048500000075124 BCG VACCINE (FREEZE-DRIED) 1 MG INJECTION INJ DEFAUL SFP VIAL 193.300000000498815 B-COMPLEX 100 SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.215800002237567 BEANO 150 UNIT TABLET ORL TAB GSK TAB 0.180000080043158 BEDUZIL 1500 1500 MCG TABLET ORL ERT ORI TAB 0.115800002019736 BENADRYL 12.5 MG/5 ML ORAL ELIXIR ORL ELX MCL ML 0.054000002019701 BENADRYL 2% TOPICAL CREAM TOP CRM MCL G 0.270300002017849 BENADRYL 25 MG CAPLET ORL TAB MCL TAB 0.388300002019671 BENADRYL 50 MG CAPSULE ORL CAP MCL CAP 0.251400002061287 BENADRYL ALLERGY JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.448300002229367 BENADRYL ALLERGY SINUS HEADACHE CAPLET ORL TAB MCL TAB 0.317500002019698 BENADRYL CHILDREN'S 1.25 MG/ML ORAL LIQUID ORL LIQ MCL ML 0.054000002239138 BENADRYL EXTRA STRENGTH 50 MG CAPLET ORL TAB MCL TAB 0.409600002370050 BENLYSTA 120 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 293.570000002370069 BENLYSTA 400 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 978.560000002245709 BENYLIN 2 COLD AND FLU WITH CODEINE ORAL SYRUP ORL SYR MCL ML 0.057000002003317 BENYLIN COUGH AND CHEST CONGESTION WARMING SYRUP ORL SYR MCL ML 0.036600001944738 BENYLIN DM 3 MG/ML ORAL SYRUP ORL SYR MCL ML 0.049400002215268 BENYLIN DM FOR CHILDREN 1.5 MG/ML ORAL SYRUP ORL SYR MCL ML 0.049400002245383 BENYLIN DM FREEZER POPS 7.5 MG/ PACKET ORAL LIQUID ORL LIQ MCL PCKT 0.592500001944746 BENYLIN DM-D FOR CHILDREN ORAL SYRUP ORL SYR MCL ML 0.049400001944711 BENYLIN DM-D ORAL SYRUP ORL SYR MCL ML 0.047400001944673 BENYLIN DM-D-E ORAL SYRUP ORL SYR MCL ML 0.049400001944762 BENYLIN DM-E ORAL SYRUP ORL SYR MCL ML 0.049400002265427 BENYLIN E EXTRA STR W/ MENTHACTIN 40/3MG/ML SYR ORL SYR MCL ML 0.036600001912437 BENZAC AC 10% TOPICAL COPOLYMER GEL TOP COPGEL GAL G 0.333300001925199 BENZAC W10 10% TOPICAL WASH TOP WAS GAL G 0.335100002162121 BENZAGEL 5 5% WASH TOP WAS NVC ML 0.058400002225271 BENZAMYCIN TOPICAL GEL TOP GEL VCL G 1.129200002336847 BESIVANCE 0.6% OPHTHALMIC SOLUTION OPH SOL BSH ML 2.678000000716634 BETADERM 0.1% SCALP LOTION SCP LOT TAR ML 0.085200000158348 BETADINE 10% TOPICAL SOLUTION TOP SOL PUR ML 0.029300002237835 BETAJECT INJECTION INJ DEFAUL SDZ ML 10.483000002417030 BEXSERO 0.5 ML INJECTION SYRINGE INJ NDL NOV SYR 101.000000002359685 BIACNA 1.2%/0.025% TOPICAL GEL TOP GEL VCL G 1.058200002382423 BICALUTAMIDE 50 MG TABLET ORL TAB SIV TAB 4.057300002325985 BICALUTAMIDE 50 MG TABLET ORL TAB AHI TAB 4.057300002291924 BICILLIN L-A 1,200,000 IU/2 ML INJ SYR INJ NDL PFI SYR 42.5130

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000297763 BICNU 100 MG/VIAL INJECTION INJ DEFAUL BMS VIAL 120.040000002230897 BILTRICIDE 600 MG TABLET ORL TAB BAI TAB 6.290000080026265 BIO K 20 POTASSIUM 20 MEQ TABLET ORL TAB BMD TAB 0.199500002392143 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 0.360000002425211 BIO-EZETIMIBE 10 MG TABLET ORL TAB BMD TAB 0.454900002448424 BIO-FLUOXETINE 10 MG CAPSULE ORL CAP BMD CAP 0.459500002448432 BIO-FLUOXETINE 20 MG CAPSULE ORL CAP BMD CAP 0.459500002247371 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 4.280000002247170 BIO-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.015700002247171 BIO-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.021700080015104 BIO-K EXTRA STRENGTH PROBIOTIC CAPSULE ORL CAP BKP CAP 1.562700000989995 BIO-K PLUS RICE PROBIOTIC DRINK ORL LIQ BKP G 0.053600080006533 BIOMEDIC MULTIVITAMIN ORL CAP VTH CAP 0.060700002216051 BION TEARS OPH SOLUTION OPH SOL ALC ML 0.960400000116785 BIONET TABLET ORL TAB CHD TAB 0.193800080003128 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 0.056700002326302 BI-PEGLYTE KIT ORL ECT/PWR PPH KIT 19.990000002361450 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 421.380000080053068 BLOOD PRESSURE FORMULATION COMBO CAPSULE ORL CAP BEL CAP 0.348300002247600 BOOSTRIX INJECTION SYRINGE INJ DEFAUL GSK SYR 28.622000002423405 BORTEZOMIB FOR INJECTION 3.5 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 1402.420000002419149 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 74.000000002444186 BREO ELLIPTA 200 MCG/25 MCG POWDER FOR INHALATION INH MIP GSK DOSE 4.291300002301334 BRIMONIDINE P 0.15% OPHTHALMIC SOLUTION OPH SOL AAP ML 1.7330

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002220520 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 0.027500000512990 BSS BALANCED SALT OPH SOLUTION OPH SOL ALC ML 0.438700000729655 BUCKLEY'S DM ORAL LIQUID ORL LIQ BUA ML 0.048900002247970 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 0.086900002331616 BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.266700000728284 BURINEX 1 MG TABLET ORL TAB LEO TAB 0.790700000728276 BURINEX 5 MG TABLET ORL TAB LEO TAB 3.018300000579947 BURO-SOL TOPICAL POWDER TOP PWR GSK G 0.751000002223163 BUSPIRONE 10 MG TABLET ORL TAB PDL TAB 0.352100002242504 BUTORPHANOL 10 MG/ML NASAL SPRAY NAS SPR AAP ML 22.612000002341212 BUTRANS 10 (10 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 22.700000002341220 BUTRANS 20 (20 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 41.260000002341174 BUTRANS 5 (5 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 12.360000002361817 BYETTA 10 MCG/DOSE (2.4 ML) INJECTION SYRINGE INJ NDL AZC SYR 143.670000002361809 BYETTA 5 MCG/DOSE (1.2 ML) INJECTION SYRINGE INJ NDL AZC SYR 143.670000002399016 BYSTOLIC 10 MG TABLET ORL TAB FLC TAB 1.260700002398990 BYSTOLIC 2.5 MG TABLET ORL TAB FLC TAB 1.260700002399024 BYSTOLIC 20 MG TABLET ORL TAB FLC TAB 1.260700002399008 BYSTOLIC 5 MG TABLET ORL TAB FLC TAB 1.260700002273284 CADUET 10 MG/10 MG TABLET ORL TAB PFI TAB 2.450000002273292 CADUET 10 MG/20 MG TABLET ORL TAB PFI TAB 3.054400002273306 CADUET 10 MG/40 MG TABLET ORL TAB PFI TAB 3.200000002273314 CADUET 10 MG/80 MG TABLET ORL TAB PFI TAB 3.200000002273233 CADUET 5 MG/10 MG TABLET ORL TAB PFI TAB 2.320600002273241 CADUET 5 MG/20 MG TABLET ORL TAB PFI TAB 2.736600002273268 CADUET 5 MG/40 MG TABLET ORL TAB PFI TAB 2.892600002273276 CADUET 5 MG/80 MG TABLET ORL TAB PFI TAB 2.892600002238389 CAELYX 2 MG/ML PEGYLATED LIPOSOME INJECTION INJ DEFAUL SCH ML 69.256000002241460 CAL MAG 2:1 WITH D TABLET ORL TAB WNP TAB 0.053600000730602 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 0.075000000621722 CALCIUM 500 MG TABLET ORL TAB HAL TAB 0.027400002240977 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.044900080003658 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.024300002240240 CALCIUM 500 MG TABLET ORL TAB PMT TAB 0.085000080009369 CALCIUM 650 MG TABLET ORL TAB PMT TAB 0.034200080000248 CALCIUM 650 MG TABLET ORL TAB JAM TAB 0.0609

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00080007105 CALCIUM 650 MG WITH VITAMIN D 400 IU CAPLET ORL TAB JMS TAB 0.060900002040875 CALCIUM AND MAGNESIUM CAPLET ORL TAB JAM TAB 0.034500002245170 CALCIUM AND MAGNESIUM CITRATE WITH VITAMIN D TAB ORL TAB WNP TAB 0.046700080006568 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 0.064200002243766 CALCIUM CITRATE 300 MG TABLET ORL TAB PMT TAB 0.079100002158728 CALCIUM CITRATE 350 MG TABLET ORL TAB SWS TAB 0.094500080003662 CALCIUM CITRATE W/ VITAMIN D 300 MG/200 IU TABLET ORL TAB WNP TAB 0.066900002237590 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB JAM TAB 0.067700002243669 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB WNP TAB 0.083300002141019 CALCIUM GLUCONATE 94 MG/ML INJECTION INJ DEFAUL FKC ML 1.036400080007103 CALCIUM MAGNESIUM WITH VITAMIN D CAPLET ORL TAB JMS TAB 0.034500002040905 CALCIUM MAGNESIUM WITH VITAMIN D TABLET ORL TAB JAM TAB 0.068500080007265 CALCIUM SOFT CHEWS WITH VITAMIN D ORL CAP JAM CAP 0.178700001906828 CAL-MAG WITH ZINC & VITAMIN D CAPLET ORL TAB SWS TAB 0.090200080027151 CALMOSEPTINE OINTMENT TOP ONT CAL G 0.061900002198630 CALMYLIN ACE 2 MG/ML SYRUP ORL SYR RPH ML 0.096000000535230 CALMYLIN WITH CODEINE COUGH ORAL LIQUID ORL LIQ RPH ML 0.051500002172917 CALMYLIN WITH CODEINE ORAL SYRUP ORL SYR ROG ML 0.054900002007134 CALTINE 100 UNIT/ML INJECTION INJ DEFAUL FEI ML 8.0550

00002242997 CALTRATE 600 MG WITH VITAMIN D SOFT CHEWS TABLET ORL CTB WCH TAB 0.1825

00002231948 CALTRATE 600 MG WITH VITAMIN D TABLET ORL TAB WCH TAB 0.173800080003751 CALTRATE 600 TABLET ORL TAB PDH TAB 0.1738

00002240959 CALTRATE PLUS CHEWABLE TABLET ORL CTB WCH TAB 0.219000080009423 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 0.2198

00002247976 CALTRATE SELECT 600 MG/400 IU TABLET ORL TAB WCH TAB 0.208600080033741 CALTRATE WITH VITAMIN D 600 MG/800 IU TABLET ORL TAB PDH TAB 0.173800080012593 CALTRATE WITH VITAMIN D SOFT CHEWS ORL CTB WAY TAB 0.1922

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002381680 CAMBIA 50 MG ORAL POWDER PACKET ORL PWDPKT TRI PCKT 9.900000002293269 CAMPRAL 333 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 0.800000002231622 CAMPTOSAR 20 MG/ML INJECTION INJ DEFAUL PFI ML 111.198000002377942 CANDESARTAN 16 MG TABLET ORL TAB PDL TAB 0.342000002422069 CANDESARTAN 32 MG TABLET ORL TAB PDL TAB 0.285000002388693 CANDESARTAN 4 MG TABLET ORL TAB SIV TAB 0.340000002388901 CANDESARTAN 4 MG TABLET ORL TAB SNS 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 15.420000002311739 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 0.369300080028872 CANTHACUR 0.7% TOPICAL SOLUTION TOP SOL PMS ML 7.132000000589500 CANTHACUR-PS TOPICAL SOLUTION TOP SOL PMS ML 8.560000000619035 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL BAK ML 6.660000080023975 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL DLX ML 6.660000000772011 CANTHARONE PLUS TOPICAL SOLUTION TOP SOL DLX ML 7.993300000619027 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 VCL G 0.191700002157128 CAPSAICIN 0.075% TOPICAL CREAM TOP CRM VCL G 0.232500002060043 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 0.120000002011239 CARBOLITH 600 MG CAPSULE ORL CAP VCL CAP 0.184800002126680 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 0.635000002184478 CASODEX 50 MG TABLET ORL TAB AZC TAB 6.9733

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000259527 CATAPRES 0.1 MG TABLET ORL TAB BOE TAB 0.185300000291889 CATAPRES 0.2 MG TABLET ORL TAB BOE TAB 0.330600002245859 CATHFLO 1 MG/ML POWDER FOR SOLUTION INJ DEFAUL HLR ML 32.288000002215756 CAVERJECT 20 MCG INJECTION INJ DEFAUL PFI VIAL 24.300000000465208 CECLOR 25 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.118300000465186 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 0.216600000465194 CECLOR 500 MG CAPSULE ORL CAP PPH CAP 2.177700000360430 CEENU 10 MG CAPSULE ORL CAP BMS CAP 7.295000000360414 CEENU 100 MG CAPSULE ORL CAP BMS CAP 20.762500000360422 CEENU 40 MG CAPSULE ORL CAP BMS CAP 12.577500002237138 CEFAZOLIN 1 G/VIAL USP INJECTION INJ DEFAUL FKC VIAL 6.000000002437120 CEFAZOLIN 10 G/VIAL INJECTION INJ DEFAUL STM VIAL 30.150000002437112 CEFAZOLIN FOR INJECTION 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 3.230000002437104 CEFAZOLIN FOR INJECTION 500 MG/VIAL INJECTION INJ DEFAUL STM VIAL 2.500000002319039 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 0.236600002437848 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 22.927000000886971 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 31.970000000886955 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 60.810000002437856 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL STM VIAL 45.077000002439522 CEFTAZIDIME 3 G/VIAL INJECTION INJ DEFAUL STM VIAL 67.500000002437864 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL STM VIAL 135.300000000886963 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL FKC VIAL 190.990000002212307 CEFTIN 125 MG/5ML ORAL SUSPENSION ORL SUS GSK ML 0.170000002409968 CEFTRIAXONE 100 G/SMARTPAK BULK PACKAGE INJECTION INJ DEFAUL FKC 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 35.250000002422301 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 39.790000002241639 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 39.790000002241640 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 149.200000002422328 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 149.200000002422298 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL STM VIAL 19.890000002241638 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL FKC VIAL 19.890000002424371 CELECOXIB 100 MG CAPSULE ORL CAP PDL CAP 0.177600002424398 CELECOXIB 200 MG CAPSULE ORL CAP PDL CAP 0.3553

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002357844 CELESTODERM-V 0.1% TOPICAL CREAM TOP CRM VCL G 0.091100002357852 CELESTODERM-V 0.1% TOPICAL OINTMENT TOP ONT VCL G 0.091100002357860 CELESTODERM-V/2 0.05% TOPICAL CREAM TOP CRM VCL G 0.061100002357879 CELESTODERM-V/2 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.061100002242145 CELLCEPT 200 MG/ ML ORAL SUSPENSION ORL SUS HLR ML 1.765300002192748 CELLCEPT 250 MG ORAL CAPSULE ORL CAP HLR CAP 2.080600002237484 CELLCEPT 500 MG TABLET ORL TAB HLR TAB 4.161200002240347 CELLCEPT I.V. 500 MG/VIAL INJECTION POWDER FOR SOL INJ DEFAUL HLR VIAL 32.000000000870153 CELLUVISC 1% OPH SOLUTION OPH SOL ALL ML 0.821700002299844 CELSENTRI 150 MG TABLET ORL TAB PFI TAB 16.648500002299852 CELSENTRI 300 MG TABLET ORL TAB PFI TAB 16.648500080013657 CENTRUM ADVANTAGE TABLET ORL TAB PDH TAB 0.186300080022930 CENTRUM CARDIO TABLET ORL TAB PDH TAB 0.222600080024482 CENTRUM FOR WOMEN ORL TAB PDH TAB 0.144000080005174 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.170000080020794 CENTRUM JUNIOR COMPLETE CHEWABLE TABLET ORL CTB PDH TAB 0.1238

00002246440 CENTRUM SELECT CHEWABLE TABLET ORL CTB WCH TAB 0.2223

00080005153 CENTRUM SELECT TABLET ORL TAB WCH TAB 0.156300080021452 CENTRUM TABLET ORL TAB PDH TAB 0.132800002246362 CENTRUM TABLET ORL TAB PDH TAB 0.091900002099365 CEPACOL MINT WITH FLUORIDE MOUTHWASH ORL MWH RBC 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 7.600000002230694 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 0.490000002342227 CERVARIX 0.5 ML INJECTION INJ DEFAUL GSK ML 187.060000002312263 CESAMET 0.25 MG ORAL CAPSULE ORL CAP VCL CAP 1.738400002247766 CETROTIDE 0.25 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 90.000000002247767 CETROTIDE 3 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 340.000000000496685 CHELATED CHROMIUM 200 MCG TABLET ORL TAB JAM TAB 0.072100080009742 CHEWABLE PEPPERMINT VITAMIN D 1000 IU ORL TAB SWS TAB 0.047900002248435 CHILDREN'S ADVIL COLD ORAL SUSPENSION ORL SUS PDH ML 0.059000002354799 CHILDREN'S EUROPROFEN 20 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.052800002238626 CHILDREN'S MOTRIN 40 MG/ML SUSPENSION DROPS ORL DPS MCL ML 0.1907

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002238295 CHILDRENS TYLENOL 80 MG CHEWABLE TABLET ORL CTB MCL TAB 0.170800000870455 CHILDRENS TYLENOL COLD DM CHEWABLE TABLET ORL CTB MCL TAB 0.176300002039990 CHILDREN'S TYLENOL COLD DM ORAL SUSPENSION ORL SUS MCL ML 0.054000002229538 CHILDRENS TYLENOL DECONGESTANT LIQUID ORL LIQ MCL ML 0.054000002046040 CHILDREN'S TYLENOL GRAPE 32 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.054000002247621 CHLORAL HYDRATE-ODAN 100 MG/ML ORAL SYRUP ORL SYR ODN ML 0.043300000743518 CHLORPROMAZINE HCL 25 MG/ML (BASE) INJECTION INJ DEFAUL SDZ ML 1.835000000738972 CHLOR-TRIPOLON 4 MG TABLET ORL TAB SCH TAB 0.211700001970399 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 0.321300080015373 CHONDROCARE TABLET ORL TAB MTG TAB 0.450000002247459 CHORIONIC GONADOTROPIN 10,000 UNIT/VIAL INJECTION INJ DEFAUL FKC VIAL 126.000000080005091 CHROMIUM GTF TABLET ORL TAB WNP TAB 0.041200002248088 CIALIS 10 MG TABLET ORL TAB LIL TAB 14.030000002296888 CIALIS 2.5 MG TABLET ORL TAB LIL TAB 4.290700002248089 CIALIS 20 MG TABLET ORL TAB LIL TAB 14.537500002296896 CIALIS 5 MG TABLET ORL TAB LIL TAB 4.290700002238274 CI-CAL + D TABLET ORL TAB EUP TAB 0.144200002238273 CI-CAL 250 MG TABLET ORL TAB EUP TAB 0.136800002410346 CICLOPIROX 8% TOPICAL SOLUTION TOP SOL STM G 7.743300002350963 CILAZAPRIL 1 MG TABLET ORL TAB SNS TAB 0.155700002350998 CILAZAPRIL 5 MG TABLET ORL TAB SNS TAB 0.208500002200864 CILOXAN 0.3% OPH OINTMENT OPH ONT ALC G 3.094300080005972 CINNAMON 500 MG CAPSULE ORL CAP VTH CAP 0.060000002391449 CIPRALEX MELTZ 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.717000002391457 CIPRALEX MELTZ 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.828000002251787 CIPRO XL 1000 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.112000002247916 CIPRO XL 500 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.112000002353334 CIPROFLOXACIN 750 MG TABLET ORL TAB SNS TAB 1.278000002304759 CIPROFLOXACIN INTRAVENOUS INFUSION BP 2 MG/ML INJ INJ DEFAUL SDZ ML 0.154000002403188 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL TEV ML 6.152400002126613 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL MNP ML 6.460000002301822 CITALOPRAM 10 MG TABLET ORL TAB MEL TAB 0.446400002301830 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 0.143200002306247 CITALOPRAM-ODAN 40 MG TABLET ORL TAB ODN TAB 0.239700002257521 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 0.1535

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002150158 CITRACAL PLUS D CAPLET ORL TAB SFD TAB 0.154800000701416 CITRAMINS CAPSULE ORL CAP XXX CAP 0.185600080007797 CITRAMINS II CAPSULE ORL CAP XXX CAP 0.185600000262609 CITRO MAG 50 MG ORAL LIQUID ORL LIQ ROG ML 0.014600002324482 CLARITHROMYCIN 250 MG TABLET ORL TAB PDL TAB 0.412200002442485 CLARITHROMYCIN 500 MG TABLET ORL TAB SIV TAB 1.629200002324490 CLARITHROMYCIN 500 MG TABLET ORL TAB PDL TAB 1.629700002237734 CLARITIN 10 MG RAPID DISSOLVE TONGUE TABLET ORL DISPTAB BIC TAB 0.670000000782696 CLARITIN 10 MG TABLET ORL TAB BIC TAB 0.835600001945157 CLARITIN EXTRA SUSTAINED-RELEASE TABLET ORL SRT BIC TAB 0.670000000442968 CLEARASIL BP PLUS 5% TOPICAL LOTION TOP LOT RBC ML 0.170700002324989 CLEARLAX ORAL POWDER ORL PWR PRI G 0.027500002250616 CLIMARA PRO 4.40 MG/1.39 MG TRANSDERMAL PATCH TRD PTH BAI PTH 6.695000002408511 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 0.518600002248525 CLINDAMYCINE-150 150 MG TABLET ORL TAB PDL TAB 0.221700002248526 CLINDAMYCINE-300 300 MG CAPSULE ORL CAP PDL CAP 0.443400002243050 CLINDETS PLEDGET 1% TOPICAL PAD TOP PAD GSK PAD 0.669800080007070 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 0.876300002256371 CLOBEX 0.05% TOPICAL SHAMPOO TOP SHP GAL ML 0.876300002299739 CLOBEX 0.05% TOPICAL SPRAY TOP SPR GAL ML 1.782200002442027 CLONAZEPAM 0.25 MG TABLET ORL TAB SIV TAB 0.077400002442043 CLONAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.148700001910396 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 0.306500002229380 CLOTRIMAZOLE 1% TOPICAL CREAM USP TOP CRM TAR G 0.210000002274337 CO BICALUTAMIDE 50 MG TABLET ORL TAB APH TAB 4.057300002285215 CO CILAZAPRIL 2.5 MG TABLET ORL TAB APH TAB 0.179500002390183 CO EXEMESTANE 25 MG TABLET ORL TAB APH TAB 3.900800080006266 CO Q10 100 MG CAPSULE ORL CAP SIS CAP 0.166600080007078 CO Q10 LIQUID ORL LIQ INN ML 0.794100002244814 CO TEMAZEPAM 15 MG CAPSULE ORL CAP APH CAP 0.043800002244815 CO TEMAZEPAM 30 MG CAPSULE ORL CAP APH CAP 0.052600002383209 CO TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APH TAB 0.626400000068594 COACTIFED ORAL SYRUP ORL SYR GSK ML 0.164300000068608 COACTIFED TABLET ORL TAB GSK TAB 1.001200002150417 COATED ASPIRIN 325 MG CAPLET ORL ECT BAI TAB 0.0802

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002237726 COATED ASPIRIN DAILY LOW DOSE 81 MG ECT ORL ECT BIC TAB 0.108700002150425 COATED ASPIRIN EXTRA STRENGTH 500 MG CAPLET ORL ECT BAI TAB 0.075500002243897 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 0.666000002163780 CODEINE CONTIN 150 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.999000002163799 CODEINE CONTIN 200 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.332000002230302 CODEINE CONTIN 50 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.333000000050024 CODEINE PHOSPHATE 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.056900002248644 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 0.123700080006674 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.247300002245926 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.254000002231735 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.300000080006505 COENZYME Q10 SOFTGEL ORL TAB WNP TAB 0.139000000287873 COLCHICINE 0.6 MG TABLET ORL TAB EUP TAB 0.256500000476420 COLY-MYCIN M 150 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 39.500000001944363 COMBANTRIN 125 MG TABLET ORL TAB MCL TAB 1.108300001944355 COMBANTRIN 50 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.278900002419106 COMBIVENT RESPIMAT 20 MCG/100 MCG INH SOLUTION INH SOL BOE DOSE 28.700000002239213 COMBIVIR TABLET ORL TAB GSK TAB 10.587300002374129 COMPLERA 200 MG/25 MG/300 MG TABLET ORL TAB GIL TAB 41.574100002229633 COMPLETE MULTI-ADULT TABLET ORL TAB WAM TAB 0.060700000999760 COMPLEX 15 DAILY FACE CREAM TOP CRM MFC ML 0.063200002247732 CONCERTA 18 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.098500002250241 CONCERTA 27 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.421800002247733 CONCERTA 36 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.745100002247734 CONCERTA 54 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.391500001945149 CONDYLINE 0.5% TOPICAL SOLUTION TOP SOL SAV ML 11.577100002417162 CONSTELLA 145 MCG CAPSULE ORL CAP FLC CAP 3.300000002417170 CONSTELLA 290 MCG CAPSULE ORL CAP FLC CAP 5.300000002224577 COPHYLAC ORAL SOLUTION ORL SOL VCL ML 2.268700002176955 COQ10 30 MG CAPSULE ORL CAP JAM CAP 0.224800080012965 COQ10 MRB 60 MG SOFTGEL CAPSULE ORL CAP INN CAP 0.795000002036282 CORDARONE 200 MG TABLET ORL TAB PFI TAB 2.058900000513288 CORTATE 0.5% TOPICAL CREAM TOP CRM MFC G 0.133300000022381 CORTROSYN 0.25 MG/VIAL INJECTION INJ DEFAUL LYN VIAL 98.760000002438070 COSENTYX 150 MG/ML INJECTION SYRINGE INJ NDL NOV SYR 822.5000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002181215 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 BMS TAB 0.486500002243063 COVAN ORAL SYRUP ORL SYR PMS ML 0.057300002246568 COVERSYL PLUS LD 2 MG/0.625 MG TABLET ORL TAB SEV TAB 0.847700080018683 CRANBERRY 500 MG CAPSULE ORL CAP VCL CAP 0.051600080027158 CRANBERRY COMPLEX 500 MG CAPSULE ORL CAP JAM CAP 0.196500002239007 CREON 5 MINIMICROSPHERES CAPSULE ORL CAP/ENCP ABB CAP 0.170300002415194 CREON MINIMICROSPHERES 6 CAPSULE ORL CAP/ENCP BGP CAP 0.170300000299561 CREO-RECTAL ADULT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.750000000299596 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.750000000299588 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.602000002241013 CRINONE 8% VAGINAL GEL VAG GEL SRO G 8.275900002277778 CRITIC-AID CLEAR OINTMENT TOP ONT COC G 0.088500002229161 CRIXIVAN 200 MG CAPSULE ORL CAP MFC CAP 1.346700002229196 CRIXIVAN 400 MG CAPSULE ORL CAP MFC CAP 2.693300002089912 CUTIVATE 0.05% TOPICAL CREAM TOP CRM GKC G 0.725000002424584 CYCLOBENZAPRINE 10 MG TABLET ORL TAB SIV TAB 0.372700002220644 CYCLOBENZAPRINE 10 MG TABLET ORL TAB PDL TAB 0.372700002148331 CYCLOPENTOLATE HCL 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002148382 CYCLOPENTOLATE HCL 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002290308 CYESTRA-35 TABLET ORL TAB PMS TAB 1.111400002443805 CYRAMZA 10 MG/ ML INJECTION INJ DEFAUL LIL ML 8.485800002238526 CYSTADANE 1 G/SCOOP ORAL POWDER ORL PWR ORP G 4.552400080038525 CYSTA-Q CAPSULE ORL CAP TPI CAP 0.490000002126656 CYTARABINE 100MG/ ML INJECTION INJ DEFAUL MNP ML 12.670000000386715 CYTOSAR 100 MG/5 ML INJECTION INJ DEFAUL PFI VIAL 10.724000002444747 DAKLINZA 30 MG TABLET ORL TAB BMS TAB 428.571400002444755 DAKLINZA 60 MG TABLET ORL TAB BMS TAB 428.571400002060604 DALACIN 2% VAGINAL CREAM VAG CRM PAL G 0.799800000582301 DALACIN T 1% (BASE) TOPICAL SOLUTION TOP SOL PFI ML 0.339700000507415 DAN-GARD 2% TOPICAL SHAMPOO TOP SHP VLP ML 0.040000001997653 DANTRIUM 100 MG CAPSULE ORL CAP PAR CAP 0.768400002359456 DAXAS 500 MCG TABLET ORL TAB TAK TAB 2.100000002027860 DAYPRO 600 MG TABLET ORL TAB PFI TAB 0.725500002285002 DDAVP MELT 120 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 1.982300002285010 DDAVP MELT 240 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 3.568300002284995 DDAVP MELT 60 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 0.991000080001791 DDROPS 1,000 IU/DROP ORAL LIQUID ORL LIQ DDR ML 1.380000002389282 DECAPEPTYL 0.1 MG/ML INJECTION SYRINGE INJ DEFAUL FEI SYR 12.0000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000791172 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 0.174600000681997 DERMAFLEX HC 1% TOPICAL LOTION TOP LOT PAL ML 0.103700002247093 DERMAL THERAPY- HEEL CARE CREAM TOP CRM DTR ML 0.079200002239903 DERMALAC 12% CREAM TOP CRM TAR G 0.057100002060345 DERMAREST DRICORT 0.5% TOPICAL CREAM TOP CRM DEL G 0.165700000873292 DERMA-SMOOTHE/FS 0.01% TOPICAL OIL TOP OIL HDI ML 0.280900002230642 DERMATOP 0.1% EMOLLIENT CREAM TOP EMCRM VCL G 1.763500002227517 DERMATOP 0.1% TOPICAL OINTMENT TOP ONT VCL G 1.554700002238407 DERMAZINC 0.25% TOPICAL SPRAY TOP SPR DPI ML 0.233300002300559 DERMOTIC OIL EAR DROPS 0.01% OTIC SOLUTION OT SOL HDI ML 1.600000002216280 DESIPRAMINE 100 MG TABLET ORL TAB AAP TAB 0.909300001942417 DESITIN DIAPER RASH OINTMENT TOP ONT JJI G 0.058800002298155 DESLORATADINE ALLERGY CONTROL 5 MG TABLET ORL TAB PMS TAB 0.519300002239064 DETROL 1 MG TABLET ORL TAB PFI TAB 0.992800002239065 DETROL 2 MG TABLET ORL TAB PFI TAB 0.992800002204274 DEXAMETHASONE OMEGA 10 MG/ML INJECTION INJ DEFAUL OMG ML 1.283000002204266 DEXAMETHASONE OMEGA 4 MG/ML INJECTION INJ DEFAUL OMG ML 1.606000000489158 DEXASONE 4 MG TABLET ORL TAB VCL TAB 0.814000000832030 DEXIDIN 20 MG TOPICAL SOLUTION TOP LIQ ATL ML 0.038300000832111 DEXIDIN 4 % TOPICAL LIQUID TOP LIQ ATL ML 0.026100002354950 DEXILANT 30 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.200000002354969 DEXILANT 60 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.200000000833231 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 0.056700002237450 D-FORTE 50000 IU CAPSULE ORL CAP EUP CAP 0.198600080028781 DIAMINE TABLET ORL TAB EUP TAB 0.063100002245391 DIAMINE TABLET ORL TAB EUP TAB 0.063100002233542 DIANE-35 2 MG/0.035 MG TABLET ORL TAB BHP TAB 1.638100002337452 DIAPER RASH 15% TOPICAL CREAM TOP CRM HJS G 0.009300002229552 DIARR-EZE 2 MG CAPLET ORL TAB PMS TAB 0.300000002248994 DIARRHEA RELIEF 2 MG TABLET ORL TAB PMS TAB 0.177800002238162 DIASTAT RECTAL DELIVERY SYS 5 MG/ML RECTAL GEL RT GEL VCL SYS 79.090000000434388 DIAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.086700000313580 DIAZEPAM 5 TABLET ORL TAB PDL TAB 0.065000002434571 DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL STM ML 0.622600000870978 DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.202400002351684 DICLOFENAC POTASSIUM 50 MG TABLET ORL TAB SNS TAB 0.3937

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002224127 DICLOFENAC-SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.404800002224119 DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.234300000392812 DICYCLOMINE HYDROCHLORIDE 10 MG/ML INJECTION INJ DEFAUL SDZ ML 4.308000002231592 DIFFERIN 0.1% TOPICAL CREAM TOP CRM GAL G 1.863500002148749 DIFFERIN 0.1% TOPICAL GEL TOP GEL GAL G 1.863500002274000 DIFFERIN XP 0.3% TOPICAL GEL TOP GEL GAL G 2.228700002039486 DIFLUNISAL 250 MG TABLET ORL TAB AAP TAB 0.564600002039494 DIFLUNISAL 500 MG TABLET ORL TAB AAP TAB 0.715000002048264 DIGOXIN 0.25 MG/ML INJECTION INJ DEFAUL SDZ ML 6.682000002048272 DIGOXIN PEDIATRIC 0.05 MG/ML INJECTION INJ DEFAUL SDZ ML 11.170000002241163 DIHYDROERGOTAMINE MESYLATE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 3.793300000627100 DILAUDID 2 MG/ML INJECTION INJ DEFAUL PUR ML 1.083200000622133 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 0.711800002325330 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 2.500000002244079 DIMETANE EXPECTORANT C ORAL SYRUP ORL SYR PDH ML 0.091900002244080 DIMETANE EXPECTORANT DC ORAL SYRUP ORL SYR PDH ML 0.124200002243969 DIMETAPP DM COUGH & COLD ORAL LIQUID ORL LIQ PDH ML 0.0513

00002243091 DIMETAPP NIGHTTIME COLD EXTRA STRENGTH CAPLET ORL TAB WCH TAB 0.312500002244078 DIMETAPP-C ORAL SYRUP ORL SYR PDH ML 0.111100001997769 DIODOQUIN 210 MG TABLET ORL TAB GLE TAB 0.753300001997750 DIODOQUIN 650 MG TABLET ORL TAB GLE TAB 0.934700002027100 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 1.167100002157624 DIOVOL PLUS AF CHEWABLE TABLET ORL CTB CHD TAB 0.118800002157616 DIOVOL PLUS AF-SUSPENSION ORL SUS CHD ML 0.017000000116815 DIOVOL PLUS ORAL SUSPENSION ORL SUS CHD ML 0.017000000116882 DIOVOL PLUS TABLET ORL TAB CHD TAB 0.118800002257548 DIPHENHYDRAMINE HYDROCHLORIDE 25 MG CAPLET ORL TAB JPC TAB 0.1379

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 33 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002257556 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG CAPLET ORL TAB JPC TAB 0.165900002369567 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG/ML INJECTION INJ DEFAUL FKC ML 4.390000002219336 DIPHENIST 50 MG/ML INJECTION INJ DEFAUL OMG ML 4.150000000417262 DIPROGEN TOPICAL CREAM TOP CRM SCH G 0.855600002243961 DITROPAN XL 10 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.300000002243960 DITROPAN XL 5 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.300000002240341 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 0.260400002228335 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 0.128300000870218 DOCUSATE SODIUM 10 MG/ML ORAL DROPS ORL DPS ROG ML 0.199600002246036 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP ROG CAP 0.040500000830267 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TLI CAP 0.033800000794406 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP VTH CAP 0.033400002245946 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP JPC CAP 0.025000002246854 DOCUSATE SODIUM 4 MG/ML ORAL SYRUP ORL SYR ROG ML 0.024500000614491 DOLORAL 1 MG ORAL SYRUP ORL SYR ATL ML 0.033500000614505 DOLORAL 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.057300002130963 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 0.159500002232564 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 0.1538

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 34 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002130998 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 0.463300002246109 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 0.0594

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002238046 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 0.805700002299003 DOM-QUETIAPINE 100 MG TABLET ORL TAB DPC TAB 0.329500002299038 DOM-QUETIAPINE 200 MG TABLET ORL TAB DPC TAB 0.661700002298996 DOM-QUETIAPINE 25 MG TABLET ORL TAB DPC TAB 0.123500002299046 DOM-QUETIAPINE 300 MG TABLET ORL TAB DPC TAB 0.965600002320460 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 DISINT. TABLET 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 1.234000002240978 DOXAZOSIN-1 1MG TABLET ORL TAB PDL TAB 0.141600002240979 DOXAZOSIN-2 2 MG TABLET ORL TAB PDL TAB 0.169900002240980 DOXAZOSIN-4 4 MG TABLET ORL TAB PDL TAB 0.2209

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002230108 DOXORUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL TEV ML 11.400000002375710 DOXORUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 13.042000002413973 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 0.317300001929372 DRISTAN LONG LASTING 0.05% NASAL MIST SOLUTION NAS SOL PDH ML 0.317300001929380 DRISTAN LONG LASTING MENTHOLATED 0.05% NASAL SPRAY NAS SPR PDH ML 0.317300000740861 DRIXORAL DESCONGESTANT 0.05% NASAL SOLUTION NAS SOL SCH ML 0.159300000298433 DRIXORAL SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.402000000342742 DRYSOL 20% TOPICAL SOLUTION TOP SOL SFD ML 0.420300000821772 D-TAB 10,000 UNIT TABLET ORL TAB RIV TAB 0.210000002247208 DUKORAL ORAL SUSPENSION ORL SUS AVE DOSE 35.990000002292165 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 1.477100000656747 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 0.826400002275848 DURAGESIC MAT 75 (75 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 39.138000002275856 DURAGESIC MAT 100 (100 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 48.714000002334186 DURAGESIC MAT 12 (12 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 5.736000002275813 DURAGESIC MAT 25 (25 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 14.786000002275821 DURAGESIC MAT 50 (50 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 27.830000002373017 DURELA 100 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 1.140000002373025 DURELA 200 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.080000002373033 DURELA 300 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.880000002415534 DUREZOL 0.05% OPHTHALMIC EMULSION OPH EML ALC ML 5.400000000999010 DUROLANE DEFAUL DEV QMD ML 143.330000002421712 DUTASTERIDE 0.5 MG CAPSULE ORL CAP PDL CAP 0.962400001947958 DUVOID 10 MG TABLET ORL TAB PAL TAB 0.313700001947931 DUVOID 25 MG TABLET ORL TAB PAL TAB 0.508100001947923 DUVOID 50 MG TABLET ORL TAB PAL TAB 0.669300002432889 DYMISTA 50 MCG/137 MCG METERED DOSE NASAL SPRAY NAS SPM MDP DOSE 0.787500002260638 EBIXA 10 MG TABLET ORL TAB LBC TAB 2.440300002381389 EDARBI 40 MG TABLET ORL TAB VCL TAB 1.209000002381397 EDARBI 80 MG TABLET ORL TAB VCL TAB 1.209000002397749 EDARBYCLOR 40 MG/12.5 MG TABLET ORL TAB TAK TAB 1.2090

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002397765 EDARBYCLOR 40 MG/25 MG TABLET ORL TAB TAK TAB 1.209000002397757 EDARBYCLOR 80 MG/12.5 MG TABLET ORL TAB TAK TAB 1.209000002370603 EDURANT 25 MG TABLET ORL TAB JAI TAB 14.698000080009719 EFAMOL 1000 MG CAPSULE ORL CAP FMD CAP 0.166700002349124 EFFIENT 10 MG TABLET ORL TAB LIL TAB 2.737700002209764 EGOZINC-HC RECTAL OINTMENT RT ONT PMS G 0.416000002210517 EGOZINC-HC RECTAL SUPPOSITORY RT SUP PMS SUP 0.607500002438712 EGRIFTA 1 MG/VIAL INJECTION INJ DEFAUL THE VIAL 51.417000002425637 ELELYSO 200 UNIT/VIAL INJECTION INJ DEFAUL PFI VIAL 648.360000002247238 ELIDEL 1 % TOPICAL CREAM TOP CRM VCL G 2.322300002248239 ELIGARD 10.2 MG/SYR INJECTION INJ NDL SAV SYR 310.720000002248240 ELIGARD 28.2 MG/SYR INJECTION INJ NDL SAV SYR 891.000000002248999 ELIGARD 35.8 MG/SYR INJECTION INJ NDL SAV SYR 1285.200000002268892 ELIGARD 58.2 MG/SYR INJECTION INJ NDL SAV SYR 1450.000000000627410 ELIXIR DE THEOPHYLLINE ORL ELX ATL ML 0.005200002436329 ELLA 30 MG TABLET ORL TAB ASC TAB 25.000000002296284 ELOXATIN 5 MG/ML INJECTION INJ DEFAUL SAV ML 51.816000002103109 ELTOR-120 120 MG SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.274200002298805 EMEND 125 MG CAPSULE ORL CAP MFC CAP 31.213300002324679 EMEND IV 115 MG/VIAL INJ DEFAUL MFC VIAL 30.180000000886858 EMLA TOPICAL CREAM TOP CRM AZC G 1.880000002057794 EMLA TOPICAL PATCH TOP PTH AZC PTH 2.700000002374137 EMOLAX ORAL POWDER ORL PWR JPC G 0.025200080008611 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 4.000000002296454 ENGERIX-B 10 MCG/0.5 ML SUSPENSION INJ DEFAUL GSK ML 21.320000002010526 ENTERIC COATED ASA 325 MG TABLET ORL ECT WTR TAB 0.028000000794244 ENTERIC COATED ASA 650 MG TABLET ORL ECT VTH TAB 0.055000002246971 ENTEX LA SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.442500002446928 ENTRESTO 24.3 MG/25.7 MG TABLET ORL TAB NOV TAB 3.620000002446936 ENTRESTO 48.6 MG/51.4 MG TABLET ORL TAB NOV TAB 3.620000002446944 ENTRESTO 97.2 MG/102.8 MG TABLET ORL TAB NOV TAB 3.620000000010340 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 0.050300000010332 ENTROPHEN REGULAR STRENGTH 325 MG ECT ORL ECT PPH TAB 0.050300002436841 ENTYVIO 300 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 3290.0000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 38 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000880183 EPI-LYT TOP LOT VCL ML 0.112700000721891 EPINEPHRINE 1 MG/ML INJECTION USP INJ NDL HSP SYR 3.850000002264927 EPIRUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL HSP ML 13.319600002396971 EPURIS 10 MG CAPSULE ORL CAP CIP CAP 1.071000002396998 EPURIS 20 MG CAPSULE ORL CAP CIP CAP 1.442300002397005 EPURIS 30 MG CAPSULE ORL CAP CIP CAP 1.814000002397013 EPURIS 40 MG CAPSULE ORL CAP CIP CAP 2.185300002243801 EQUATE DAILY LOW-DOSE 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.109600002271249 ERBITUX 2 MG/ML INJECTION INJ DEFAUL LIL ML 7.292400002409267 ERIVEDGE 150 MG CAPSULE ORL CAP HLR CAP 294.223800000726672 ERYTHRO-EC 250 MG ENTERIC-COATED CAPSULE ORL CAP/ENCP AAP CAP 0.390000001925938 ERYTHRO-EC 333 MG ENTERIC-COATED CAPSULE ORL CAP/ENCP AAP CAP 0.433200002393751 ESBRIET 267 MG CAPSULE ORL CAP HLR CAP 13.030200002424401 ESCITALOPRAM 10 MG TABLET ORL TAB PDL TAB 1.468000002424428 ESCITALOPRAM 20 MG TABLET ORL TAB PDL TAB 1.563000002394839 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.588700002442493 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT SIV TAB 1.869000002394847 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.429800002431173 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT SNS TAB 1.869000002442507 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT SIV TAB 1.869000002244990 ESSENTIAL VITAMINS AND MINERALS TABLET ORL TAB WNP TAB 0.021400002237515 ESTER C 1000 MG TABLET ORL TAB SIS TAB 0.159800002247480 ESTER-C 250 MG CHEWABLE TABLET ORL CTB WNP TAB 0.079900080003499 ESTER-C CAPSULE ORL CAP BPC CAP 0.149600000727369 ESTRAGYN 1MG/G VAGINAL CREAM VAG CRM SLP G 0.666700002403404 ESTROGEL PROPAK 0.06% TRANSDERM. GEL/100MG CAPSULE TRD/ORL GEL/CAP MFC KIT 51.000000000247960 ETIBI 100 MG TABLET ORL TAB VCL TAB 0.205800000247979 ETIBI 400 MG TABLET ORL TAB VCL TAB 0.617500002353210 ETIDROCAL 400 MG/500 MG TABLET ORL TAB SNS TAB 0.222100002080036 ETOPOSIDE 20 MG/ML INJECTION INJ DEFAUL TEV ML 15.000000000637726 EUFLEX 250 MG TABLET ORL TAB MFC TAB 1.413100000999330 EUFLEXXA DEFAUL DEV FEI ML 56.833300080013021 EUPHORBIUM COMPOSITUM SN ORAL DROPS ORL DPS HEE ML 0.765000000623377 EURAX 10% TOPICAL CREAM TOP CRM CLC G 0.358400002242291 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 0.032800080011428 EURO K 975 975 MG (25 MEQ) EFFERVESCENT TABLET ORL EVT EUP TAB 0.555000002245668 EURO-CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP ORL SYR EUP ML 0.062400002242651 EURO-D VITAMIN D3 400 IU CAPSULE ORL CAP EUP CAP 0.0300

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 39 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247385 EURO-DOCUSATE 100 MG CAPSULE ORL CAP EUP CAP 0.032800002246590 EURO-FER 20 MG/ML ORAL SUSPENSION ORL SUS EUP ML 0.078000002237556 EURO-FER 300 MG CAPSULE ORL CAP EUP CAP 0.139700002241802 EURO-FER CF CAPSULE ORL CAP EUP CAP 0.233000002246733 EURO-FERROUS SULFATE 300 MG TABLET ORL TAB EUP TAB 0.015700002412926 EURO-HYDROCORTISONE 1% CREAM TOP CRM EUP G 0.200000002247383 EURO-LAC 667 MG/ML SOLUTION ORL SOL PMS ML 0.014500002247389 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 0.113500002264374 EUTHYROX 100 MCG TABLET ORL TAB SRO TAB 0.030600002264390 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 0.064400002248297 EVRA 6 MG/0.6 MG TRANSDERMAL PATCH TRD PTH JAI PTH 5.576700002377179 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 0.058800002302853 EXELON PATCH 10 (9.5 MG/24 H) TRD PTH NOV PTH 4.538700002432803 EXELON PATCH 15 (13.3 MG/24 H) TRD PTH NOV PTH 4.387700002302845 EXELON PATCH 5 (4.6 MG/24 H) TRD PTH NOV PTH 4.538700002226030 EX-LAX CHOCOLATED TABLET ORL TAB NVC TAB 0.200600002237524 EX-LAX EXTRA STRENGHT 25 MG TABLET ORL TAB NVC TAB 0.235400002184672 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 0.173000002242632 EXTRA STRENGTH MOTRIN IB 300 MG TABLET ORL TAB MCL TAB 0.130700002244142 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 0.0930

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 40 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002415992 EYLEA 2 MG/VIAL INJECTION INJ DEFAUL BHP VIAL 1418.000000002422549 EZETIMIBE 10 MG TABLET ORL TAB PDL TAB 0.461200002248968 FACTIVE 320 MG TABLET ORL TAB ABB TAB 7.000000002324865 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 9.357000002229110 FAMVIR 125 MG TABLET ORL TAB NOV TAB 2.944000002229129 FAMVIR 250 MG TABLET ORL TAB NOV TAB 3.993000002177102 FAMVIR 500 MG TABLET ORL TAB NOV TAB 7.112900002248624 FASLODEX 250 MG/5 ML INJECTION INJ NDL AZC SYR 565.250000002231384 FEMARA 2.5 MG TABLET ORL TAB NOV TAB 6.307300002242531 FEMHRT 1/5 TABLET ORL TAB PFI TAB 0.840000002286092 FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP SNS CAP 0.272300002240360 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 9.682000002384124 FENTANYL CITRATE SDZ 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.598800002408007 FENTORA 100 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.896800002408015 FENTORA 200 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.896800002408023 FENTORA 400 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.896800002408031 FENTORA 600 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.896800002408058 FENTORA 800 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.896800002377217 FERAHEME 30 MG/ML INJECTION INJ DEFAUL TAK ML 11.029400080033717 FERAMAX 15/1/4 TSP POWDER ORL PWR BIS G 0.216900080013210 FERAMAX 150 150 MG CAPSULE ORL CAP BIS CAP 0.463300000232599 FERMALAC VAGINAL CAPSULE VAG CAP ROG CAP 1.931000002248699 FERODAN 300 MG TABLET ORL TAB ODN TAB 0.019900002436558 FERRIPROX 1000 MG TABLET ORL TAB APP TAB 30.360000002243333 FERRLECIT 12.5 MG/ ML INJECTION INJ DEFAUL SAV ML 5.272000002138751 FERROUS FUMARATE 200 MG TABLET ORL TAB VTH TAB 0.020900000031089 FERROUS FUMARATE 300 MG TABLET ORL TAB WAM TAB 0.062500000031097 FERROUS GLUCONATE 300 MG TABLET ORL TAB WAM TAB 0.021200000041157 FERROUS GLUCONATE 300 MG TABLET ORL TAB ADA TAB 0.037100002244532 FERROUS GLUCONATE 300 MG TABLET ORL TAB PMT TAB 0.040000080009681 FERROUS GLUCONATE 300 MG TABLET ORL TAB WAM TAB 0.062500000582727 FERROUS GLUCONATE 324 MG TABLET ORL TAB VTH TAB 0.0231

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 41 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002245389 FERROUS GLUCONATE 35 MG TABLET ORL TAB WNP TAB 0.078500000782114 FERROUS SULFATE 300 MG TABLET ORL TAB WTR TAB 0.034600000346918 FERROUS SULFATE 300 MG TABLET ORL TAB PMT TAB 0.038500080005803 FIBER PLUS CAPSULE ORL CAP PLT CAP 0.200000002207230 FIBRE LAXATIVE 3.4 G/12 G ORAL POWDER ORL PWR PRI G 0.006000080009650 FIBRE LAXATIVE SMOOTH TEXTURE ORANGE FLAVOUR ORL PWR ACV G 0.010300080009651 FIBRE LAXATIVE UNFLAVOURED ORAL POWDER ORL PWR APH G 0.010900002447568 FINASTERIDE 1 MG TABLET ORL TAB SIV TAB 1.145300002447541 FINASTERIDE 5 MG TABLET ORL TAB SIV TAB 0.463300002350270 FINASTERIDE 5 MG TABLET ORL TAB PDL TAB 0.463300002337037 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 1.074200080000193 FLAX SEED OIL ORL LIQ WNP CAP 0.041000002149133 FLAX SEED OIL 500 MG CAPSULE ORL CAP JAM CAP 0.062200080000580 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 0.083800000999052 FLEXI-T +300 IUD 1 DEFAUL DEFAUL TSN DEV 76.130000000999053 FLEXI-T +380 IUD 1 DEFAUL DEFAUL TSN DEV 76.130000000999051 FLEXI-T 300 IUD 1 DEFAUL DEFAUL TSN DEV 67.600000080021934 FLINTSTONES MULTI VITAMINS COMPLETE CHEWABLE TAB ORL CTB BAI TAB 0.137000002230845 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 0.258900080011335 FLORASMART TABLET ORL TAB RLC TAB 0.542100080013321 FLORASTOR 250 MG CAPSULE ORL CAP BCX CAP 1.015000002237245 FLOVENT DISKUS 100 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.398800002237244 FLOVENT DISKUS 50 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.252200002434881 FLUAD PEDIATRIC INJECTION SYRINGE INJ DEFAUL NOV SYR 12.450000002261472 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL BAX ML 0.163500002248443 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.469500002388448 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 40.076000002249561 FLUMAZENIL 0.1 MG/ML INJECTION INJ DEFAUL SDZ ML 5.040000002352621 FLUMIST INFLUENZA VACCINE NASAL SPRAY NAS SPR AZC ML 72.000000002426544 FLUMIST QUADRIVALENT NASAL SPRAY NAS SPR AZC ML 90.000000001977857 FLUOR A DAY 1.1 MG CHEWABLE TABLET ORL CTB PMS TAB 0.084900002090139 FLUOR-A-DAY 0.56 MG CHEWABLE TABLET ORL CTB PMS TAB 0.0849

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000012882 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 26.750000000578479 FLURAZEPAM 15 MG CAPSULE ORL CAP PDL CAP 0.067500000578487 FLURAZEPAM 30 MG CAPSULE ORL CAP PDL CAP 0.077500002015986 FLUVIRAL S/F SPLIT-VIRION INFLUENZA VACCINE INJ INJ DEFAUL IAF ML 16.000000002420686 FLUVIRAL SUSPENSION FOR INJECTION 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 3.212000080000549 FOLAPRO 0.8 MG TABLET ORL TAB MTG TAB 0.191600000647039 FOLIC ACID 1 MG TABLET ORL TAB VTH TAB 0.007900000318973 FOLIC ACID 1 MG TABLET ORL TAB JAM TAB 0.040400002048841 FOLIC ACID USP 1 MG TABLET ORL TAB PMT TAB 0.017100002435667 FOMEPIZOLE FOR INJECTION 1 G/ML INJ INJ DEFAUL STM ML 820.623300002254689 FORTEO 250 MCG/ML INJECTION INJ DEFAUL LIL ML 373.854200002435470 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 0.162800002276429 FOSAVANCE 70 MG/2800 UNIT TABLET ORL TAB MFC TAB 4.687500002332566 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 4.524300002287145 FOSRENOL 250 MG CHEWABLE TABLET ORL CTB SHB TAB 1.133800002287153 FOSRENOL 500 MG CHEWABLE TABLET ORL CTB SHB TAB 2.267800002287161 FOSRENOL 750 MG CHEWABLE TABLET ORL CTB SHB TAB 3.412600002377454 FRAGMIN 2,500 IU/ML INJECTION INJ DEFAUL PFI ML 4.078500002221799 FRISIUM 10 MG TABLET ORL TAB LUI TAB 0.439300002257084 FROVA 2.5 MG TABLET ORL TAB TMP TAB 14.048600000989993 FRUCTOSE USP POWDER ORL PWR GNA G 0.069300002264625 FSME-IMMUN 2.4 MCG/0.5 ML INJECTION SYRINGE INJ NDL BAX SYR 51.000000002238578 FUCIDIN H TOPICAL CREAM TOP CRM LEO G 1.381300002243862 FUCITHALMIC 1% VISCOUS OPH DROPS (PRESERVED) OPH GEL AMD G 2.120000002243861 FUCITHALMIC 1% VISCOUS OPH DROPS (UNPRESERVED) OPH GEL AMD G 4.779000002360365 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 0.1220

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002247725 FUZEON 108 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 40.117800002431289 GABAPENTIN 600 MG TABLET ORL TAB SNS TAB 1.304500002388200 GABAPENTIN 600 MG TABLET ORL TAB SIV TAB 1.304500002392526 GABAPENTIN 600 MG TABLET USP ORL TAB AHI TAB 0.325600002388219 GABAPENTIN 800 MG TABLET ORL TAB SIV TAB 1.739300002431297 GABAPENTIN 800 MG TABLET ORL TAB SNS TAB 1.739300002392534 GABAPENTIN 800 MG TABLET USP ORL TAB AHI TAB 0.434100002416581 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 1.246700002404761 GANCICLOVIR 500 MG/VIAL INJECTION USP INJ DEFAUL FKC VIAL 42.030000002283190 GARDASIL 0.5 ML INJECTION INJ DEFAUL MFC ML 287.460000002437058 GARDASIL 9 0.5 ML INJECTION INJ DEFAUL MFC ML 310.500000000896675 GAS X EXTRA STRENGTH TABLET ORL TAB NVC TAB 0.236100002300761 GAS X ULTRA STRENGTH 180 MG CAPSULE ORL CAP NVC CAP 0.209300002159791 GAVISCON HEARTBURN RELIEF CHEWABLE TABLET ORL CTB SKB TAB 0.145500002231538 GAVISCON HEARTBURN RELIEF EXTRA STRENGTH TABLET ORL TAB SKB TAB 0.285000002159775 GAVISCON HEARTBURN RELIEF ORAL LIQUID - FRUIT ORL LIQ SKB ML 0.021400002434806 GAZYVA 25 MG/ML INJECTION INJ DEFAUL HLR ML 5275.500000002362791 GD-AMLODIPINE/ATORVASTATIN 10 MG/10 MG TABLET ORL TAB GMD TAB 0.919400002362805 GD-AMLODIPINE/ATORVASTATIN 10 MG/20 MG TABLET ORL TAB GMD TAB 1.023400002362813 GD-AMLODIPINE/ATORVASTATIN 10 MG/40 MG TABLET ORL TAB GMD TAB 1.062400002362821 GD-AMLODIPINE/ATORVASTATIN 10 MG/80 MG TABLET ORL TAB GMD TAB 1.062400002362759 GD-AMLODIPINE/ATORVASTATIN 5 MG/10 MG TABLET ORL TAB GMD TAB 0.755100002362767 GD-AMLODIPINE/ATORVASTATIN 5 MG/20 MG TABLET ORL TAB GMD TAB 0.859100002362775 GD-AMLODIPINE/ATORVASTATIN 5 MG/40 MG TABLET ORL TAB GMD TAB 0.898100002362783 GD-AMLODIPINE/ATORVASTATIN 5 MG/80 MG TABLET ORL TAB GMD TAB 0.898100002342235 GD-ELETRIPTAN 20 MG TABLET ORL TAB GMD TAB 10.085000002342243 GD-ELETRIPTAN 40 MG TABLET ORL TAB GMD TAB 10.085000002285843 GD-GABAPENTIN 600 MG TABLET ORL TAB GMD TAB 1.304500002285851 GD-GABAPENTIN 800 MG TABLET ORL TAB GMD TAB 1.739300002360179 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 1.252800002273705 GD-SERTRALINE 100 MG CAPSULE ORL CAP GMD CAP 0.420000002273683 GD-SERTRALINE 25 MG CAPSULE ORL CAP GMD CAP 0.200400002273691 GD-SERTRALINE 50 MG CAPSULE ORL CAP GMD CAP 0.4008

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 44 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002028107 GEL-KAM 0.4% DENTAL GEL DEN GEL COL G 0.070500002366150 GELNIQUE 100 MG/G TOPICAL GEL TOP GEL ASC G 1.976300001945831 GELUSIL EXTRA STRENGTH CHEWABLE TABLET ORL CTB WLA TAB 0.148400001933906 GELUSIL TABLET ORL TAB WSP TAB 0.059800002324210 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 61.090000080020663 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 0.432700002242977 GENTEAL 0.3% OPHTHALMIC GEL OPH GEL ALC ML 0.811000080044443 GI SUSTAIN ORAL POWDER ORL PWR MTG G 0.067600002415666 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 27.683300002253283 GLEEVEC 400 MG TABLET ORL TAB NOV TAB 110.733300002248453 GLICLAZIDE-80 MG TABLET ORL TAB PDL TAB 0.093100080000015 GLUCOSAMINE SULFATE 500 MG CAPLET ORL TAB JAM TAB 0.044800080000082 GLUCOSAMINE SULFATE 500 MG CAPSULE ORL CAP WBP CAP 0.043200080000083 GLUCOSAMINE SULFATE 500 MG TABLET ORL TAB WBP TAB 0.036000002300451 GLUMETZA 1000 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.176900002268493 GLUMETZA 500 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 0.586100080009026 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 0.151700000873462 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 14, 2016

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 45 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002229516 GLYCON 500 MG TABLET ORL TAB VCL TAB 0.044400002239214 GLYCON 850 MG TABLET ORL TAB VCL TAB 0.061000002382857 GLYCOPYRROLATE 0.2 MG/ML INJECTION INJ DEFAUL OMG ML 3.975000002382849 GLYCOPYRROLATE 0.2 MG/ML MULTIDOSE INJECTION INJ DEFAUL OMG ML 3.112500002247884 GLYQUIN XM TOPICAL CREAM TOP CRM VCL G 1.250000000652512 GOLYTELY POWDER FOR ORAL LAVAGE SOLUTION ORL PWR BAX G 0.004100002248156 GONAL-F 33 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 425.250000002248154 GONAL-F 5.5 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 70.880000002248157 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 283.500000002270390 GONAL-F PEN 450 IU/0.75 ML INJECTION SYRINGE INJ NDL SRO SYR 425.250000002270382 GONAL-F PEN 900 IU/1.5 ML INJECTION SYRINGE INJ NDL SRO SYR 850.500000000999578 GOOD START STAGE 2 INFANT FORMULA ORL PWR NHN G 0.040400002232483 GRAMCAL 1000 MG EFFERVESCENT TABLET ORL EVT NVC TAB 0.729500080006061 GRAPE SEED CAPLET ORL TAB JAM TAB 0.312200002418304 GRASTEK 2800 UNIT SUBLINGUAL TABLET SLG DISNTAB MFC TAB 3.800000000116858 GRAVERGOL CAPSULE ORL CAP AXS CAP 1.010800002254409 GRAVOL 100 MG LONG ACTING SUSTAINED-RELEASE CAPLET ORL SRT CHD TAB 0.468800000511196 GRAVOL 15 MG CHEWABLE TABLET ORL CTB CHD TAB 0.243300000230197 GRAVOL 3 MG/ML ORAL LIQUID ORL SYR CHD ML 0.070800000013803 GRAVOL 50 MG TABLET ORL TAB CHD TAB 0.222000000013609 GRAVOL ADULT 100 MG RECTAL SUPPOSITORY RT SUP CHD SUP 0.563000000783595 GRAVOL CHILDREN 25 MG RECTAL SUPPOSITORIES RT SUP CHD SUP 0.496000002248180 GRAVOL GINGER LOZENGE ORL LOZ CHD LOZ 0.227500000013579 GRAVOL I.M. 50 MG/ML INJECTION INJ DEFAUL CHD ML 1.208000002245718 GRAVOL NATURAL SOURCE 500 MG TABLET ORL TAB CHD TAB 0.227500080014526 GREEN TEA PHYTOSOME COMPLEX CAPSULE ORL CAP JAM CAP 0.214300080012417 GREENS+ BONE BUILDER ORAL POWDER ORL PWR GNH G 0.094800002384272 GUM PAROEX 0.12% ORAL RINSE ORL MWH SUA ML 0.015300080003089 HAIR & NAILS CAPSULE ORL CAP VTH CAP 0.093300002377438 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 4.900000000587796 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 13.690000002187078 HAVRIX 1,440 U/ML INJECTION INJ DEFAUL GSK ML 45.940000002231056 HAVRIX JUNIOR 720 U/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 22.750000000740578 HEPALEAN-LOK 100 IU/ML LOCK FLUSH INJECTION USP INJ LOCFLUSH ORG ML 0.3275

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 46 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000579718 HEPARIN LEO 10,000 IU/ML INJECTION INJ DEFAUL LEO ML 1.100000000640468 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 FKC ML 2.673600002382296 HEPARIN SODIUM 1,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 0.501000002264307 HEPARIN SODIUM 10,000 IU/ML INJECTION USP INJ DEFAUL FKC ML 5.644400002382326 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 5.270000002303108 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 0.230000002175622 HERBAL WATER TABLET ORL TAB VCL TAB 0.062100002240692 HERCEPTIN 440 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2724.300000002244784 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 0.180000001948903 HONEY BEE VENOM 1.1 MG INJ DEFAUL ALG VIAL 30.866700001948911 HONEY BEE VENOM 120 MCG INJ DEFAUL ALG VIAL 30.866700002078759 HUMATIN 250 MG CAPSULE ORL CAP PFI CAP 2.700000000745626 HUMATROPE 1 MG/ML INJECTION INJ DEFAUL LIL VIAL 233.350000002243079 HUMATROPE 24 MG INJECTION INJ DEFAUL LIL VIAL 1120.080000000999015 HYALGAN DEFAUL DEV MDX ML 25.000000001916580 HYCODAN 1 MG/ML ORAL SYRUP ORL SYR BMS ML 0.128900001916599 HYCODAN 5 MG TABLET ORL TAB BMS TAB 1.079500001916564 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 0.059800000465283 HYDREA 500 MG CAPSULE ORL CAP BMS CAP 1.020300000341975 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 67.620000000564281 HYDROSONE 0.5% CREAM TOP CRM RPH G 0.126700002343096 HYDROXYUREA 500 MG CAPSULE ORL CAP SNS CAP 1.020300000742813 HYDROXYZINE HCL 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 8.963000002229868 HYOSCINE BUTYLBROMIDE 20 MG/ML INJECTION INJ DEFAUL SDZ ML 4.520000002230697 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 9.9000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 47 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002275872 HYPURIN REGULAR INSULIN PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.900000080022866 IBEROGAST ORAL SOLUTION ORL SOL STA ML 0.195100002357275 IBUPROFEN 200 MG LIQUID CAPSULE ORL CAP VTH CAP 0.068100002257912 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 0.037200002437333 ICLUSIG 15 MG TABLET ORL TAB ARI TAB 142.844600002437341 ICLUSIG 45 MG TABLET ORL TAB ARI TAB 331.639800002344939 ILARIS 150 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 16000.000000002411393 ILEVRO 0.3% OPHTHALMIC SUSPENSION OPH SUS ALC ML 7.310000002434407 IMBRUVICA 140 MG CAPSULE ORL CAP JAI CAP 90.650000002376016 IMODIUM 2 MG CAPSULE ORL CAP MCL CAP 0.820000002245185 IMODIUM ADVANCED CAPLET ORL TAB MCL TAB 0.634500002237297 IMODIUM ADVANCED CHEWABLE TABLET ORL CTB MCL TAB 0.928000002230542 IMODIUM QUICK DISSOLVE 2 MG TABLET ORL TAB MCL TAB 0.820000001959042 IMOVAX POLIO INJECTION SYRINGE INJ NDL SFP SYR 44.320000001908286 IMOVAX RABIES VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL SFP VIAL 194.390000002240713 IMUNOVIR 500 MG TABLET ORL TAB RIP TAB 1.950700002244895 IMURAN 50 MG/VIAL INJECTION INJ DEFAUL ASN VIAL 98.270000002371553 INCIVEK 375 MG TABLET ORL TAB VER TAB 69.381000002042266 INDERAL-LA 120 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.993800002042274 INDERAL-LA 160 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.175300002042231 INDERAL-LA 60 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.572400002042258 INDERAL-LA 80 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.645500000558079 INFANTOL ORAL LIQUID ORL LIQ CHD ML 0.019100002046059 INFANTS' TYLENOL 80 MG/ML ORAL SUSPENSION DROPS ORL DPS MCL ML 0.289300002419475 INFLECTRA 100 MG/VIAL INJECTION INJ DEFAUL CHH VIAL 650.000000002269562 INFLUVAC VACCINE INJECTION SYRINGE INJ DEFAUL ABB SYR 7.440000002221780 INFUFER 50 MG/ML INJECTION INJ DEFAUL SDZ ML 14.750000002389630 INLYTA 1 MG TABLET ORL TAB PFI TAB 18.600000002389649 INLYTA 5 MG TABLET ORL TAB PFI TAB 93.000000080013031 INNO-Q-NOL 100 MG SOFT GEL CAPSULE ORL CAP INN CAP 1.132500002441888 INSPIOLTO RESPIMAT 2.5MCG/ACTUATION INH SOLUTION INH SOL BOE DOSE 1.050000080026628 INSTAFLEX JOINT SUPPORT CAPSULE ORL CAP DDI CAP 0.333200000762040 INSTA-GLUCOSE (1 DOSE PER TUBE) ORAL LIQUID ORL LIQ VCL DOSE 3.830000002294990 INSTILLAGEL 2% /0.05% TOPICAL GEL TOP GEL PPH ML 0.966700002348756 INTANZA INJECTION SYRINGE INJ DEFAUL SFP SYR 12.000000002306778 INTELENCE 100 MG TABLET ORL TAB JAI TAB 5.886000002375931 INTELENCE 200 MG TABLET ORL TAB JAI TAB 11.532000002238675 INTRON A 10 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 120.9400

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 48 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002223406 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 217.690000002240694 INTRON A MULTI-DOSE PEN 25 MIU/ML INJECTION SYR INJ NDL MFC SYR 362.780000002240695 INTRON A MULTI-DOSE PEN 50 MIU/ML INJECTION SYR INJ NDL MFC SYR 725.610000002409100 INTUNIV XR 1 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.000000002409119 INTUNIV XR 2 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.650000002409127 INTUNIV XR 3 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.300000002409135 INTUNIV XR 4 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.950000002216965 INVIRASE 200 MG CAPSULE ORL CAP HLR CAP 1.902100002279320 INVIRASE 500 MG TABLET ORL TAB HLR TAB 4.389500000888354 IOPIDINE 1% OPH SOLUTION (UNIT DOSE) OPH SOL ALC ML 60.845800002246084 IPRAVENT 0.06% NASAL SPRAY NAS SPR AAP ML 1.490000002365200 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 13.500000000897639 ISOPROTERENOL HYDROCHLORIDE 0.2 MG/ML INJECTION INJ DEFAUL SDZ ML 8.818000000000809 ISOPTO TEARS 0.5% OPH DROPS OPH DPS ALC ML 0.514700000000817 ISOPTO TEARS 1.0% OPH DROPS OPH DPS ALC ML 0.514700000272655 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 193.250000002434814 JAKAVI 10 MG TABLET ORL TAB NOV TAB 82.191800002388014 JAKAVI 15 MG TABLET ORL TAB NOV TAB 82.191800002388022 JAKAVI 20 MG TABLET ORL TAB NOV TAB 82.191800002388006 JAKAVI 5 MG TABLET ORL TAB NOV TAB 82.191800002372010 JALYN 0.5 MG/0.4 MG MODIFIED RELEASE CAPSULE ORL MRC GSK CAP 1.657000002246040 JAMP CALCIUM 500 MG TABLET ORL TAB JPC TAB 0.021600002417308 JAMP OLANZAPINE FC 20 MG TABLET ORL TAB JPC TAB 10.309300002388308 JAMP-ACET-TRAMADOL 37.5 MG/325 MG TABLET ORL TAB JPC TAB 0.626400080037789 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 0.1300

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002421615 JAMP-ALLOPURINOL 300 MG TABLET ORL TAB JPC TAB 0.212500002400154 JAMP-ALPRAZOLAM 2 MG TABLET ORL TAB JPC TAB 0.550800002435527 JAMP-AMITRIPTYLINE 10 MG TABLET ORL TAB JPC TAB 0.043500002435535 JAMP-AMITRIPTYLINE 25 MG TABLET ORL TAB JPC TAB 0.082900002435543 JAMP-AMITRIPTYLINE 50 MG TABLET ORL TAB JPC TAB 0.154000002435551 JAMP-AMITRIPTYLINE 75 MG TABLET ORL TAB JPC TAB 0.363400002331098 JAMP-AMLODIPINE 10 MG TABLET ORL TAB JPC TAB 0.358700002331071 JAMP-AMLODIPINE 5 MG TABLET ORL TAB JPC TAB 0.241700002433060 JAMP-AMOXICILLIN 250 MG CAPSULE ORL CAP JPC CAP 0.175000002433079 JAMP-AMOXICILLIN 500 MG CAPSULE ORL CAP JPC CAP 0.341700002339080 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 4.057300002410893 JAMP-BISACODYL 5 MG SUPPOSITORY RT SUP JPC SUP 0.436700002246039 JAMP-BISACODYL 5 MG TABLET ORL TAB JPC TAB 0.042600080028892 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 0.256500002391619 JAMP-DICYCLOMINE HCL 10 MG TABLET ORL TAB JPC TAB 0.420000002366088 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 0.147400080024232 JAMP-FER 300 MG CAPSULE ORL CAP JPC CAP 0.130000080025200 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 0.399700000031100 JAMP-FERROUS SULFATE 300 MG TABLET ORL TAB JPC TAB 0.016500080053274 JAMP-FOLIC ACID 1 MG TABLET ORL TAB JPC TAB 0.015200002366061 JAMP-FOLIC ACID 5 MG TABLET ORL TAB JPC TAB 0.040400002402289 JAMP-GABAPENTIN 600 MG TABLET ORL TAB JPC TAB 1.304500002402297 JAMP-GABAPENTIN 800 MG TABLET ORL TAB JPC TAB 1.739300080057189 JAMP-HYDROCORTISONE CREAM 1% TOPICAL CREAM TOP CRM JPC G 0.125100002401290 JAMP-IBUPROFEN 400 MG TABLET ORL TAB JPC TAB 0.037200080047136 JAMP-IRON POLYPEPTIDE 11 MG TABLET ORL TAB JPC TAB 0.642000080023817 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 2.756000002386836 JAMP-LIDOCAINE 5% TOPICAL OINTMENT TOP ONT JPC G 0.280000080041590 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 5.6250

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 50 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002427745 JAMPOCAINE 2% VISCOUS TOPICAL SOLUTION TOP SOL JPC ML 0.052600002406640 JAMP-OLANZAPINE 15 MG ORALLY DISINT. TABLET ORL DISNTAB JPC TAB 5.355300002406659 JAMP-OLANZAPINE 20 MG ORALLY DISINT. TABLET ORL DISNTAB JPC TAB 7.597700002440717 JAMP-OXCARBAZEPINE 150 MG TABLET ORL TAB JPC TAB 0.620900002440725 JAMP-OXCARBAZEPINE 300 MG TABLET ORL TAB JPC TAB 0.724200002440733 JAMP-OXCARBAZEPINE 600 MG TABLET ORL TAB JPC TAB 1.448400002408414 JAMP-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT JPC TAB 1.275000002420430 JAMP-PIP/TAZ 4 G/500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 12.110000002436000 JAMP-PREGABALIN 150 MG CAPSULE ORL CAP JPC CAP 1.727000002435977 JAMP-PREGABALIN 25 MG CAPSULE ORL CAP JPC CAP 0.617300002436019 JAMP-PREGABALIN 300 MG CAPSULE ORL CAP JPC CAP 1.727000002435985 JAMP-PREGABALIN 50 MG CAPSULE ORL CAP JPC CAP 0.968300002435993 JAMP-PREGABALIN 75 MG CAPSULE ORL CAP JPC CAP 1.252900002380617 JAMP-PYRANTEL PAMOATE 125 MG TABLET ORL TAB JPC TAB 0.941000002445190 JAMP-QUININE 200 MG CAPSULE ORL CAP JPC CAP 0.239000080040279 JAMP-QUININE 200 MG CAPSULE ORL CAP JPC CAP 0.239000002445204 JAMP-QUININE 300 MG CAPSULE ORL CAP JPC CAP 0.375000080040277 JAMP-QUININE 300 MG CAPSULE ORL CAP JPC CAP 0.375000002440334 JAMP-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB JPC CAP 0.855000002405687 JAMP-SILDENAFIL 100 MG TABLET ORL TAB JPC TAB 9.200000002405660 JAMP-SILDENAFIL 25 MG TABLET ORL TAB JPC TAB 8.290000002405679 JAMP-SILDENAFIL 50 MG TABLET ORL TAB JPC TAB 8.847500080034416 JAMP-SODIUM PHOSPHATE 0.891 G -2.4 G/5 ML SOLUTION ORL SOL JPC ML 0.094700002435616 JAMP-TOPIRAMATE 100 MG TABLET ORL TAB JPC TAB 0.592900002435624 JAMP-TOPIRAMATE 200 MG TABLET ORL TAB JPC TAB 0.885400002435608 JAMP-TOPIRAMATE 25 MG TABLET ORL TAB JPC TAB 0.312800002420309 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 31.050000080054130 JAMP-VITAMIN A 10, 000 IU CAPSULE ORL CAP JPC CAP 0.043100080028902 JAMP-VITAMIN B12 1000 MCG RAPID DISSOLVE TABLET ORL TAB JPC TAB 0.088400002379007 JAMP-VITAMIN D 10000 UNIT TABLET ORL TAB JPC TAB 0.210000080054585 JAMP-VITAMIN K + VITAMIN D TABLET ORL TAB JPC TAB 0.062700080055096 JAMP-VITAMIN K 100 MCG TABLET ORL TAB JPC TAB 0.062700002416808 JANUMET XR 100 MG/1000 MG EXTENDED-RELEASE TABLET ORL ERT MFC TAB 3.203800002416794 JANUMET XR 50 MG/1000 MG EXTENDED-RELEASE TABLET ORL ERT MFC TAB 1.602000002416786 JANUMET XR 50 MG/500 MG EXTENDED-RELEASE TABLET ORL ERT MFC TAB 1.602000002443937 JARDIANCE 10 MG TABLET ORL TAB BOE TAB 2.617700002443945 JARDIANCE 25 MG TABLET ORL TAB BOE TAB 2.6177

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 51 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002048744 JE-VAX INJECTION INJ DEFAUL CNG VIAL 131.663300002369524 JEVTANA 40 MG/ML INJECTION INJ DEFAUL SAV VIAL 5800.000000002437503 JINARC 45 MG/15 MG COMBINATION PACK ORL TAB OTS TAB 45.205700002437511 JINARC 60 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 45.205700002437538 JINARC 90 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 45.205700002413388 JUBLIA 10% TOPICAL SOLUTION TOP SOL VCL ML 10.976700002247344 JUNIOR STRENGTH MOTRIN 100 MG CHEWABLE TABLET ORL CTB MCL TAB 0.225000002337282 JURNISTA 16 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 5.065000002337290 JURNISTA 32 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 10.130000002337266 JURNISTA 4 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.266000002337274 JURNISTA 8 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.532000002420376 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 403.600000002312301 KALETRA 100 MG/25 MG TABLET ORL TAB ABV TAB 2.759800002285533 KALETRA 200 MG/50 MG TABLET ORL TAB ABV TAB 5.519700002243644 KALETRA 80 MG/ML/20MG/ML ORAL SOLUTION ORL SOL ABV ML 2.208400002442612 KALYDECO 50 MG GRANULES ORL GRNUL VER PCKT 420.000000002442620 KALYDECO 75 MG GRANULES ORL GRNUL VER PCKT 420.000000002417235 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 0.269900000376167 KEMSOL 70% TOPICAL SOLUTION TOP SOL AXS ML 0.278600000224391 KETALAR 10 MG/ML INJECTION INJ DEFAUL ERF ML 1.600000000224405 KETALAR 50 MG/ML INJECTION INJ DEFAUL ERF ML 5.300000002246796 KETAMINE 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 4.950000002246795 KETAMINE HYDROCHLORIDE 10 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.645000002244947 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL FKC ML 5.145200002400871 KETOTIFEN 0.25 MG/ML OPH SOLUTION OPH SOL STM ML 4.234000002441152 KEYTRUDA 50 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 2200.000000001926438 KIDROLASE 10,000 UNIT/VIAL INJECTION INJ DEFAUL AVE VIAL 134.790000080020666 KID'S LIQUID VITAMIN D 400 IU ORL LIQ WBP ML 0.130600002269341 KIVEXA 600 MG/300 MG TABLET ORL TAB GSK TAB 23.595700001928783 KOFFEX SIROP 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.019000002389185 KOMBOGLYZE 2.5 MG/1000 MG TABLET ORL TAB AZC TAB 1.270000002389169 KOMBOGLYZE 2.5 MG/500 MG TABLET ORL TAB AZC TAB 1.270000002389177 KOMBOGLYZE 2.5 MG/850 MG TABLET ORL TAB AZC TAB 1.2700

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 52 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080052499 KRILL OIL CAPSULE ORL CAP WNP CAP 0.438300080022006 KRILL OIL SOFTGEL CAPSULE ORL CAP WBP CAP 0.219200002350580 KUVAN 100 MG TABLET ORL TAB BMI TAB 33.0000

00080004073 KYOLIC AGED GARLIC EXTRACT ORAL CAPLET ORL TAB WKG TAB 0.599100002387468 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL MYP ML 1.293000002231689 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL SDZ ML 1.390000000210889 LACRI-LUBE OPH OINTMENT OPH ONT ALL G 2.054300002250624 LACRISERT 5 MG OPHTHALMIC INSERT OPH INS ATP DEV 3.186800080012831 LACTOBACILLUS ACIDOPHILUS & BIFIDUS ORL CAP SWS CAP 0.112300000468401 LAIT DE MAGNESIE ORL SUSP (MILK OF MAGNESIA) ORL SUS ATL ML 0.006800002243803 LAMICTAL 2 MG CHEWABLE TABLET ORL CTB GSK TAB 0.170000002385775 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC SIV CAP 0.500000002366282 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.600000000608734 LANSOYL JELLY 78% ORL GEL AUP G 0.046700002186926 LANSOYL SUGAR FREE JELLY 78% ORL GEL AUP G 0.046700000282081 LANVIS 40 MG TABLET ORL TAB ASN TAB 4.538000002375508 LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL RIV ML 3.632000002415828 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 11964.000000002061562 LESCOL 20 MG CAPSULE ORL CAP NOV CAP 0.900300002061570 LESCOL 40 MG CAPSULE ORL CAP NOV CAP 1.264200002338459 LETROZOLE 2.5 MG TABLET ORL TAB AHI TAB 3.061700002402025 LETROZOLE 2.5 MG TABLET ORL TAB PDL TAB 1.378000002347997 LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.756000002348969 LETROZOLE 2.5 MG TABLET ORL TAB APH TAB 2.756000002183005 LEUCOVORIN CALCIUM 10 MG/ML INJECTION INJ DEFAUL MNP ML 14.008000000004626 LEUKERAN 2 MG TABLET ORL TAB ASN TAB 1.468000002236840 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 0.457800002236842 LEVAQUIN 500 MG TABLET ORL TAB JAI TAB 5.678400002246804 LEVAQUIN 750 MG TABLET ORL TAB JAI TAB 10.047400002442531 LEVETIRACETAM 250 MG TABLET ORL TAB SIV TAB 0.800000002442558 LEVETIRACETAM 500 MG TABLET ORL TAB SIV TAB 0.975000002442566 LEVETIRACETAM 750 MG TABLET ORL TAB SIV TAB 1.350000002250470 LEVITRA 10 MG TABLET ORL TAB BAI TAB 12.232500002250489 LEVITRA 20 MG TABLET ORL TAB BAI TAB 13.312500002250462 LEVITRA 5 MG TABLET ORL TAB BAI TAB 10.9650

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 53 of 115

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 FKC VIAL 253.970000002243933 LEVULAN KERASTICK 20% TOPICAL SOLUTION TOP SOL DSP ML 166.000000000999056 LIBERTE COPPER IUD TT380 STANDARD 10 YEARS DEFAUL DEFAUL MDI DEV 59.000000000999054 LIBERTE UT380 COPPER IUD 380MG SHORT DEFAUL DEFAUL MDI DEV 51.000000000999055 LIBERTE UT380 COPPER IUD 380MG STANDARD DEFAUL DEFAUL MDI DEV 51.000000002296187 LIDOCAINE HCL 2% INJECTION (BLOCK OR INFILTRATION) INJ LIQ ALV ML 1.050000000436208 LIDOCAINE HYDROCHLORIDE 2% INJECTION INJ DEFAUL HSP ML 5.460000002143879 LIDODAN 2% TOPICAL JELLY TOP JEL ODN ML 0.406700002231147 LIDODAN ENDOTRACHEAL 10 MG/DOSE NON-AEROSOL SPRAY TOP SPR ODN DOSE 0.188300000874949 LIDOMYXIN OTIC LIQUID OT LIQ SDZ ML 0.596000002243101 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 3.019000002402637 LINEZOLID 2 MG/ML INJECTION INJ DEFAUL TEV ML 0.295800002269082 LIPIDIL EZ 145 MG TABLET ORL TAB BGP TAB 1.097700002269074 LIPIDIL EZ 48 MG TABLET ORL TAB BGP TAB 0.428700002146959 LIPIDIL MICRO 200 MG CAPSULE ORL CAP FAB CAP 1.089000080006893 LIQUID CALCIUM WITH VITAMIN D ORL LIQ WBP ML 0.016800080001853 LIQUID GLUCOSAMINE ORL LIQ JAM ML 0.031000080001800 LIQUID GLUCOSAMINE/CHONDROITIN & MSM LIQUID ORL LIQ WBP ML 0.033400080007222 LIQUID OMEGA-3 PLUS VITAMIN A & D ORL LIQ WNP ML 0.093900002266695 LITHMAX 300 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.254500002020017 LIVOSTIN 50 MCG PER DOSE NASAL SPRAY NAS SPR JAI ML 1.966700000074462 LOCACORTEN VIOFORM TOPICAL CREAM TOP CRM PAL G 0.960300002417456 LOLO (28 DAY) TABLET ORL TB ASC TAB 0.611100000590819 LOPRESOR 1.0 MG/ML INJECTION INJ DEFAUL NOV ML 1.246000002221810 LOPROX 1% TOPICAL LOTION TOP LOT VCL ML 0.302200002244692 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.444200002280159 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.154000002429810 LORAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.044700002429829 LORAZEPAM 2 MG TABLET ORL TAB SIV TAB 0.069900002243278 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 0.314600002435853 LOTEMAX 0.5% OPHTHALMIC GEL OPH GEL BSH G 4.4000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 54 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002421941 LOTEMAX 0.5% OPHTHALMIC OINTMENT OPH ONT BSH G 6.285700002321114 LOTEMAX 0.5% OPHTHALMIC SUSPENSION OPH SUS BSH ML 4.400000002169991 LOXAPAC 50 MG/ML INJECTION INJ DEFAUL SDZ ML 16.759000002179709 LOZIDE 1.25 MG TABLET ORL TAB SEV TAB 0.298000002425629 LUCENTIS 1.65 MG/SYRINGE INJECTION INJ DEFAUL NOV SYR 1575.000000002239833 LUPRON DEPOT 30 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1428.000000002242934 LUSTRA-AF TOPICAL CREAM TOP CRM MEI G 1.197200002046210 LUTREPULSE 0.8 MG/VIAL INJECTION INJ DEFAUL FEI VIAL 115.000000002269066 LUVERIS 75 IU/VIAL INJECTION INJ DEFAUL SRO VIAL 26.490000002366924 LUXIQ 0.12% TOPICAL FOAM TOP FOA GSK G 0.753100002268450 LYRICA 150 MG CAPSULE ORL CAP PFI CAP 2.302700002268477 LYRICA 225 MG CAPSULE ORL CAP PFI CAP 2.302700002268418 LYRICA 25 MG CAPSULE ORL CAP PFI CAP 0.823000002268485 LYRICA 300 MG CAPSULE ORL CAP PFI CAP 2.302700002268426 LYRICA 50 MG CAPSULE ORL CAP PFI CAP 1.291000002268434 LYRICA 75 MG CAPSULE ORL CAP PFI CAP 1.670500000463221 LYSODREN 500 MG TABLET ORL TAB BMS TAB 4.635500002009765 M.O.S. SULPHATE 10 MG TABLET ORL TAB VCL TAB 0.175100002009749 M.O.S. SULPHATE 25 MG TABLET ORL TAB VCL TAB 0.231700002009773 M.O.S. SULPHATE 5 MG TABLET ORL TAB VCL TAB 0.113300002009706 M.O.S. SULPHATE 50 MG TABLET ORL TAB VCL TAB 0.355300000776181 M.O.S.-SR 30 MG SUSTAINED-RELEASE TABLET ORL SRT VCL TAB 0.467000000776203 M.O.S.-SR 60 MG SUSTAINED-RELEASE TABLET ORL SRT VCL TAB 0.823200002244690 MAALOX ANTACID WITH ANTI-GAS EXTRA STRENGTH SUSP ORL SUS NVC ML 0.021100002244689 MAALOX ANTACID WITH ANTI-GAS ORAL SUSPENSION ORL SUS NVC ML 0.018100002238291 MAALOX QUICK DISSOVE EXTRA STR. CHEWABLE TABLET ORL TAB NVC TAB 0.103100002267225 MACUGEN 0.3 MG/SYR INJECTION SYRINGE INJ NDL PFI SYR 995.000000002068400 MAGNESIUM 100 MG TABLET ORL TAB JAM TAB 0.069700080025339 MAGNESIUM 250 MG TABLET ORL TAB WNP TAB 0.030600002040921 MAGNESIUM 50 MG TABLET ORL TAB JAM TAB 0.054200080005581 MAGNESIUM CITRATE 150 MG CAPSULE ORL CAP WBP CAP 0.075500080005079 MAGNESIUM COMPLEX 250 MG CAPLET ORL TAB JAM TAB 0.089200002247017 MAGNESIUM COMPLEX 250 MG TABLET ORL TAB JAM TAB 0.045000080013414 MAGNESIUM EXTRA STRENGTH 500 MG TABLET ORL TAB WNP TAB 0.075500000299448 MAGNESIUM OXIDE 420 MG TABLET ORL TAB VCL TAB 0.032800080014800 MAGNESIUM PLUS CALCIUM POWDER FOR SUSPENSION ORL PWRSUS NCC G 0.097300000392618 MAGNESIUM SULFATE 20% INJECTION INJ DEFAUL SDZ ML 0.704800000602264 MAGNESIUM SULFATE 50% INJECTION USP INJ DEFAUL BAX ML 1.489000002139499 MAGNESIUM SULFATE 500 MG/ML INJECTION USP INJ DEFAUL FKC ML 0.431000000202045 MAGNOLAX ORAL EMULSION ORL EML PPH ML 0.0134

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 55 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002264935 MALARONE PEDIATRIC TABLET ORL TAB GSK TAB 1.552500002238151 MALARONE TABLET ORL TAB GSK TAB 4.659200002243459 MALTLEVOL-12 ORAL LIQUID ORL LIQ CHD ML 0.020600000499013 MANDELAMINE 500 MG TABLET ORL TAB ERF TAB 0.380000000899356 MANERIX 150 MG TABLET ORL TAB MED TAB 0.661200002166747 MANERIX 300 MG TABLET ORL TAB MED TAB 1.298500002429861 MAR-AMITRIPTYLINE 10 MG TABLET ORL TAB MAR TAB 0.066400002429888 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 0.750500002305909 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.892200002241919 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.893000002241917 MARCAINE 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 1.814500002241915 MARCAINE E 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 0.778000002241914 MARCAINE SPINAL 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 11.835000000611190 MARINOL 2.5 MG CAPSULE ORL CAP ABB CAP 2.031000000611204 MARINOL 5 MG CAPSULE ORL CAP ABB CAP 4.061800002373424 MAR-LETROZOLE 2.5 MG TABLET ORL TAB MAR TAB 3.061700002432560 MAR-MODAFINIL 100 MG TABLET ORL TAB MAR TAB 0.929300002389118 MAR-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB MAR TAB 6.962300002389126 MAR-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET 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 1.043000002417561 MAR-PREGABALIN 150 MG CAPSULE ORL CAP MAR CAP 1.865200002417529 MAR-PREGABALIN 25 MG CAPSULE ORL CAP MAR CAP 0.666700002417537 MAR-PREGABALIN 50 MG CAPSULE ORL CAP MAR CAP 1.045800002417545 MAR-PREGABALIN 75 MG CAPSULE ORL CAP MAR CAP 1.353200002420503 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 56.795800002244533 MAXILENE 4% TOPICAL CREAM TOP CRM RGR G 1.780000002245939 MAXILENE 5 % TOPICAL CREAM TOP CRM RGR G 1.620000002163632 MAXIPIME 1 G/VIAL INJECTION INJ DEFAUL BMS VIAL 17.765000002163640 MAXIPIME 2 G/VIAL INJECTION INJ DEFAUL BMS VIAL 35.5250

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002379104 MED-ANASTROZOLE 1 MG TABLET ORL TAB GMP TAB 3.328000002426935 MED-LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL GMP ML 3.632000002253550 MEDROXY-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.041600002253577 MEDROXY-5 5MG TABLET ORL TAB PDL TAB 0.082300002244366 MEFLOQUINE 250 MG TABLET ORL TAB AAP TAB 3.695000002040891 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 NOV TAB 72.500000002409658 MEKINIST 2 MG TABLET ORL TAB NOV TAB 290.000000080006449 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 0.491300002446049 MEMANTINE 10 MG TABLET ORL TAB SIV TAB 1.635700002443082 MEMANTINE 10 MG TABLET ORL TAB SNS TAB 1.635700002279924 MENACTRA A/C/Y/W-135 (0.5ML SINGLE-DOSE) INJECTION INJ DEFAUL SFP ML 220.000000002248649 MENINGITEC (10 MCG/15 MCG) 0.5 ML INJECTION INJ DEFAUL NBV ML 130.040000002243820 MENJUGATE VACCINE (10 MCG/25 MCG) .5 ML INJECTION INJ DEFAUL NOV VIAL 89.000000000588490 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 184.510000002283093 MENOPUR 75 IU/VIAL INJECTION INJ DEFAUL FEI VIAL 74.000000002347393 MENVEO 0.5 ML INJECTION INJ DEFAUL NOV ML 202.000000002415275 MERCAPTOPURINE 50 MG TABLET ORL TAB STM TAB 2.861200002378795 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 0.211300002244931 MESNA 100 MG/ML INJECTION INJ DEFAUL FKC ML 10.185500002241615 METAMUCIL FIBRE APPLE CRISP 3.4 G/2 WAFERS ORL WAF PGI WAF 0.171700002241614 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 0.024600002247034 METAMUCIL FIBRE THERAPY CAPSULE ORL CAP PGI CAP 0.122000002174782 METAMUCIL FIBRE THERAPY-SMOOTH TEXTURE-ORANGE S.F. ORL PWR PGI G 0.068600002174790 METAMUCIL SMOOTH TEXTURE-ORANGE 3 G/TBSP ORAL PWDR ORL PWR PGI G 0.015700002174804 METAMUCIL SMOOTH UNFLAVORED SUGAR FREE POWDER ORL PWR PGI G 0.032000002182971 METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL MNP ML 7.875500002422174 METHOTREXATE 10 MG/0.4ML INJECTION SYRINGE BP INJ NDL PMS SYR 7.000000002422182 METHOTREXATE 15 MG/0.6 ML INJECTION SYRINGE BP INJ NDL PMS SYR 8.400000002422190 METHOTREXATE 20 MG/0.8 ML INJECTION SYRINGE BP INJ NDL PMS SYR 11.200000002417626 METHOTREXATE 25 MG/ML INJECTION (UNPRESERVED) INJ DEFAUL MYP ML 6.250000002327236 METHOTREXATE 25 MG/ML INJECTION BP (UNPRESERVED) INJ DEFAUL AHI ML 8.000000002422204 METHOTREXATE 25 MG/ML INJECTION SYRINGE BP INJ NDL PMS SYR 14.0000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002422166 METHOTREXATE 7.5 ML/0.3 ML INJECTION SYRINGE BP INJ NDL PMS SYR 5.600000002182947 METHOTREXATE SODIUM (UNPRESERVED) 10 MG/ML INJ INJ DEFAUL MNP ML 8.265000002230521 METHOXACET CAPLET ORL TAB RPH TAB 0.158300002236872 METHOXACET-C 1/8 CAPLET ORL TAB RPH TAB 0.582800000868868 METHOXISAL CAPLET ORL TAB RPH TAB 0.277200001966375 METHOXISAL-C 1/2 TABLET ORL TAB RPH TAB 0.952500001966367 METHOXISAL-C 1/4 TABLET ORL TAB RPH TAB 0.820800001941895 METHOXISAL-C 1/8 CAPLET ORL TAB RPH TAB 0.527200002326248 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 0.094700002245407 METHYLPREDNISOLONE ACETATE (PRES.) 40 MG/ML INJ INJ DEFALT SDZ ML 4.100000002245408 METHYLPREDNISOLONE ACETATE (PRES.) 80 MG/ML INJ. INJ DEFALT SDZ ML 6.990000002245400 METHYLPREDNISOLONE ACETATE 40 MG/ML INJECTION USP INJ DEFAUL SDZ ML 4.100000002245406 METHYLPREDNISOLONE ACETATE 80 MG/ML INJECTION USP INJ DEFAUL SDZ ML 8.200000002243563 METOCLOPRAMIDE OMEGA 5MG/ML INJECTION INJ DEFAUL OMG ML 10.250000002320037 METOJECT 10 MG/1 ML INJECTION SYRINGE INJ NDL MDX SYR 49.400000002320045 METOJECT 15 MG/1.5 ML INJECTION SYRINGE INJ NDL MDX SYR 54.600000002304767 METOJECT 20 MG/2 ML INJECTION SYRINGE INJ NDL MDX SYR 59.800000002320053 METOJECT 25 MG/2.5 ML INJECTION SYRINGE INJ NDL MDX SYR 65.000000002320029 METOJECT 7.5 MG/0.75 ML INJECTION SYRINGE INJ NDL MDX SYR 46.800000002296713 METOPROLOL - 25 25 MG TABLET ORL TAB PDL TAB 0.643000002351404 METOPROLOL SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.141500002351412 METOPROLOL SR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.249900002267853 METOPROLOL TARTRATE 1 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.416200000648027 METOPROLOL-100 MG TABLET ORL TAB PDL TAB 0.125000000648019 METOPROLOL-50 MG TABLET ORL TAB PDL TAB 0.062400002442116 METOPROLOL-L 25 MG TABLET ORL TAB SIV TAB 0.064300002092832 METROGEL 0.75% TOPICAL GEL TOP GEL GAL G 1.333300002248562 METRONIDAZOLE 500 MG CAPSULE ORL CAP AAP CAP 0.702800002323273 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 CONCENTRATE 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 1.205000000787000 MICRO-ZN 5 MG/ML INJECTION INJ DEFAUL SDZ ML 2.404200000487805 MIDAMOR 5 MG TABLET ORL TAB OPI TAB 0.2860

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002240285 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.780000002242904 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL FKC ML 1.145000002423758 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL PFI ML 0.820000002242905 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL FKC ML 4.100000002423766 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL PFI ML 4.100000002382873 MIDAZOLAM INJECTION SDZ 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.780000002244622 MILRINONE LACTATE 1 MG/ML INJECTION INJ DEFAUL FKC ML 5.3692

00001935348 MINERAL OIL (HEAVY) ORL LIQ RBW ML 0.009200000485802 MINERAL OIL 100% ORAL LIQUID ORL LIQ RPH ML 0.012200002246500 MINIRIN 0.1 MG TABLET ORL TAB FEI TAB 1.321600002394863 MINT-ALENDRONATE 10 MG TABLET ORL TAB MPI TAB 0.498600002393573 MINT-ANASTROZOLE 1 MG TABLET ORL TAB MPI TAB 1.782100002317427 MINT-CIPROFLOXACIN 250 MG TABLET ORL TAB MPI TAB 0.618600002317435 MINT-CIPROFLOXACIN 500 MG TABLET ORL TAB MPI TAB 0.697900002429691 MINT-CITALOPRAM 10 MG TABLET ORL TAB MPI TAB 0.143200002425947 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 0.021700002388766 MINT-METFORMIN 500 MG TABLET ORL TAB MPI TAB 0.044400002388774 MINT-METFORMIN 850 MG TABLET ORL TAB MPI TAB 0.061000002436981 MINT-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB MPI TAB 1.928000002437007 MINT-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB MPI TAB 7.597700002422727 MINT-OLOPATADINE 0.1% OPHTHALMIC SOLUTION OPH SOL MPI ML 5.226000002424207 MINT-PREGABALIN 150 MG CAPSULE ORL CAP MPI CAP 1.727000002423804 MINT-PREGABALIN 25 MG CAPSULE ORL CAP MPI CAP 0.617300002423812 MINT-PREGABALIN 50 MG CAPSULE ORL CAP MPI CAP 0.968300002424185 MINT-PREGABALIN 75 MG CAPSULE ORL CAP MPI CAP 1.252900002421348 MINT-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB MPI CAP 0.855100002393085 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 8.847500002423308 MINT-TOLTERODINE 1 MG TABLET ORL TAB MPI TAB 0.491000002423316 MINT-TOLTERODINE 2 MG TABLET ORL TAB MPI TAB 0.491000002389800 MINT-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MPI TAB 0.626400000042544 MIOSTAT 0.01% OPH SOLUTION OPH SOL ALC ML 13.056100002297256 MIRAPEX 0.125 MG TABLET ORL TAB BOE TAB 1.083300002241594 MIRAPEX 0.5 MG TABLET ORL TAB BOE TAB 2.167200002312786 MIRTAZAPINE-30 30 MG TABLET ORL TAB PDL TAB 0.195000002248846 MISOPROSTOL-200 200 MCG TABLET ORL TAB PDL TAB 0.2850

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002230451 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 71.383300080025624 MK 20 A LIBERATION PROLONGEE 20 MEQ TABLET ORL TAB MTR TAB 0.199500080035346 MK 8 8 MEQ TABLET ORL TAB MTR TAB 0.225000000466085 M-M-R II VIRUS VACCINE LIVE ATTENUATED INJECTION INJ DEFAUL MSD VIAL 30.498000002242786 MOBICOX 15 MG TABLET ORL TAB BOE TAB 0.924300002242785 MOBICOX 7.5 MG TABLET ORL TAB BOE TAB 0.801100002238696 MOI-STIR SPRAY ORAL LIQUID ORL LIQ PMS ML 0.0637

00001909142 MOISTUREL TOPICAL CREAM TOP CRM WSD G 0.0567

00001909169 MOISTUREL TOPICAL LOTION TOP LOT WSD ML 0.020800000999058 MONA LISA 10 IUD COPPER STERILE DEFAUL DEFAUL BSN DEV 61.500000000999057 MONA LISA 5 IUD COPPER STERILE DEFAUL DEFAUL BSN DEV 48.000000002239601 MONISTAT 1 1200 MG VAGINAL OVULE VAG OVL MCL OVL 12.020000002244005 MONISTAT 3 4% VAGINAL CREAM VAG CRM MCL G 0.801300002126605 MONISTAT 3 400 MG VAGINAL OVULE VAG OVL MCL OVL 4.006700002126249 MONISTAT 3 DUAL-PAK KIT VAG/TOP OVL/CRM MCL KIT 13.760000002084309 MONISTAT 7 2% VAGINAL CREAM VAG CRM MCL G 0.343400002126257 MONISTAT 7 DUAL-PAK VAGINAL OVULE/TOPICAL CREAM VAG/TOP OVL/CRM MCL KIT 13.760000002126567 MONISTAT DERM 2% TOPICAL CREAM TOP CRM MCL G 0.393300002239600 MONISTAT-1 COMBINATION PACK VAG OVULE/TOP CREAM VAG/TOP OVL/CRM MCL KIT 13.760000000999332 MONOVISC DEFAUL DEV PMS ML 75.000000002379856 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 3.613000002021056 MORPHINE LP EPIDURAL 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 2.618700001964437 MORPHINE SULFATE 2 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.252800001964429 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 2.144000002382997 MORPHINE SULFATE INJECTION SDZ 10 MG/ML INJ INJ DEFAUL SDZ ML 2.272000080028360 MOTION MEDICINE TOPICAL CREAM TOP CRM NDP G 0.121200002186934 MOTRIN IB 200 MG TABLET ORL TAB MCL TAB 0.122900002442167 MOVANTIK 12.5 MG TABLET ORL TAB AZC TAB 5.950000002442175 MOVANTIK 25 MG TABLET ORL TAB AZC TAB 5.950000002359499 MOVIPREP POWDER FOR ORAL LAVAGE SOLUTION ORL PWDPKT MFI PCKT 5.5800

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00080001844 MSM 1000 MG ORL TAB WNP TAB 0.065400002125013 MUCAINE ORAL SUSPENSION ORL SUS AXC ML 0.024300000599875 MUCILLIUM 500 MG/G ORAL POWDER ORL PWR PMS G 0.017500002091526 MUCOMYST 20% INHALATION SOLUTION INH SOL WSP ML 0.720000002330989 MULTAQ 400 MG TABLET ORL TAB SAV TAB 2.166700000782203 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 1.229600002100606 MULTI-12 INJECTION INJ DEFAUL SDZ ML 1.046200002244898 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 0.085000002248778 MULTISURE FOR WOMEN OVER 50 GELATIN CAPSULE ORL CAP WBP CAP 0.085000002240942 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 0.035100002242779 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 2.948600000750824 MURO-128 5% OPH SOLUTION OPH SOL BSH ML 0.688000002238595 MUSE 1000 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 38.090000002238593 MUSE 250 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 38.090000002238594 MUSE 500 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 38.090000000016063 MUSTARGEN HCL TRITURATION 10 MG/VIAL INJECTION INJ DEFAUL LUI VIAL 7.950000002415380 MYA 28 TABLET ORL TB APX TAB 0.422900002311054 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 1.997700002264579 MYFORTIC 360 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 3.995300002270129 MYLAN-ALENDRONATE 10 MG TABLET ORL TAB MYP TAB 0.513400002270110 MYLAN-ALENDRONATE 5 MG TABLET ORL TAB MYP TAB 1.037000002229813 MYLAN-ALPRAZOLAM 1 MG TABLET ORL TAB MYP TAB 0.309900002229814 MYLAN-ALPRAZOLAM 2 MG TABLET ORL TAB MYP TAB 0.550800002253054 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 2.9281

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002378957 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 3.996000002373203 MYLAN-ATORVASTATIN 10 MG TABLET ORL TAB MYP TAB 0.313800002373211 MYLAN-ATORVASTATIN 20 MG TABLET ORL TAB MYP TAB 0.392200002373238 MYLAN-ATORVASTATIN 40 MG TABLET ORL TAB MYP TAB 0.421600002373246 MYLAN-ATORVASTATIN 80 MG TABLET ORL TAB MYP TAB 0.421600002402165 MYLAN-ATOVAQUONE/PROGUANIL 250 MG/ 100 MG TABLET ORL TAB MYP TAB 4.130800002302403 MYLAN-BICALUTAMIDE 50 MG TABLET ORL TAB MYP TAB 4.057300002383500 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 0.084300002379120 MYLAN-CANDESARTAN 4 MG TABLET ORL TAB MYP TAB 0.340000002163594 MYLAN-CAPTOPRIL 100 MG TABLET ORL TAB MYP TAB 0.519800002163551 MYLAN-CAPTOPRIL 12.5 MG TABLET ORL TAB MYP TAB 0.106000002163578 MYLAN-CAPTOPRIL 25 MG TABLET ORL TAB MYP TAB 0.150000002163586 MYLAN-CAPTOPRIL 50 MG TABLET ORL TAB MYP TAB 0.279500002241882 MYLAN-CARBAMAZEPINE CR 200 MG SUSTAIN RELEASE TAB ORL SRT MYP TAB 0.093000002241883 MYLAN-CARBAMAZEPINE CR 400 MG SUSTAIN RELEASE TAB ORL SRT MYP TAB 0.185900002227444 MYLAN-CIMETIDINE 300 MG TABLET ORL TAB MYP TAB 0.086000002278669 MYLAN-DOMPERIDONE 10 MG TABLET ORL TAB MYP TAB 0.059400002240498 MYLAN-DOXAZOSIN 1 MG TABLET ORL TAB MYP TAB 0.141600002240499 MYLAN-DOXAZOSIN 2 MG TABLET ORL TAB MYP TAB 0.169900002240500 MYLAN-DOXAZOSIN 4 MG TABLET ORL TAB MYP TAB 0.220900002381524 MYLAN-EFAVIRENZ 600 MG TABLET ORL TAB MYP TAB 11.210300002383039 MYLAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 1.869000002383047 MYLAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 1.869000002247323 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 1.145400002397471 MYLAN-GABAPENTIN 600 MG TABLET ORL TAB MYP TAB 1.304500002397498 MYLAN-GABAPENTIN 800 MG TABLET ORL TAB MYP TAB 1.739300000808733 MYLAN-GLYBE 2.5 MG TABLET ORL TAB MYP TAB 0.032100000808741 MYLAN-GLYBE 5 MG TABLET ORL TAB MYP TAB 0.057300002242920 MYLAN-HYDROXYUREA 500 MG CAPSULE ORL CAP MYP CAP 1.020300002319225 MYLAN-LEFLUNOMIDE 10 MG TABLET ORL TAB MYP TAB 6.041700002319233 MYLAN-LEFLUNOMIDE 20 MG TABLET ORL TAB MYP TAB 6.041700002297736 MYLAN-LISINOPRIL HCTZ 10 MG/12.5 MG TABLET ORL TAB MYP TAB 0.208300002297744 MYLAN-LISINOPRIL HCTZ 20 MG/12.5 MG TABLET ORL TAB MYP TAB 0.250300002297752 MYLAN-LISINOPRIL HCTZ 20 MG/25 MG TABLET ORL TAB MYP TAB 0.250300002255995 MYLAN-MELOXICAM 15 MG TABLET ORL TAB MYP TAB 0.5670

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002255987 MYLAN-MELOXICAM 7.5 MG TABLET ORL TAB MYP TAB 0.491400002430371 MYLAN-MEMANTINE 10 MG TABLET ORL TAB MYP TAB 1.635700002371154 MYLAN-MYCOPHENOLATE 250 MG CAPSULE ORL CAP MYP CAP 1.031000002370549 MYLAN-MYCOPHENOLATE 500 MG TABLET ORL TAB MYP TAB 2.062000002244563 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 DISINT. TABLET ORL DISNTAB MYP TAB 4.124000002382733 MYLAN-OLANZAPINE ODT 20 MG ORALLY DISINT. 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 0.580900002298287 MYLAN-PIOGLITAZONE 30 MG TABLET ORL TAB MYP TAB 0.813900002298295 MYLAN-PIOGLITAZONE 45 MG TABLET ORL TAB MYP TAB 1.223700002376369 MYLAN-PRAMIPEXOLE 0.5 MG TABLET ORL TAB MYP TAB 1.051400002245372 MYLAN-PROPAFENONE 150 MG TABLET ORL TAB MYP TAB 0.296500002245373 MYLAN-PROPAFENONE 300 MG TABLET ORL TAB MYP TAB 0.522700002397773 MYLAN-RISEDRONATE 150 MG TABLET ORL TAB MYP TAB 40.950000002229779 MYLAN-SOTALOL 160 MG TABLET ORL TAB MYP TAB 0.162300002229778 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 0.237500002396289 MYLAN-TERAZOSIN 1 MG TABLET ORL TAB MYP TAB 0.183500002396319 MYLAN-TERAZOSIN 10 MG TABLET ORL TAB MYP TAB 0.463700002396297 MYLAN-TERAZOSIN 2 MG TABLET ORL TAB MYP TAB 0.233300002396300 MYLAN-TERAZOSIN 5 MG TABLET ORL TAB MYP TAB 0.316800002242503 MYLAN-TERBINAFINE 250 MG TABLET ORL TAB MYP TAB 1.852500002239744 MYLAN-TICLOPIDINE 250 MG TABLET ORL TAB MYP TAB 0.313900002272059 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 0.098900002231683 MYLAN-TRAZODONE 50 MG TABLET ORL TAB MYP TAB 0.055400002383527 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 ASN TAB 1.557600002372169 MYL-LETROZOLE 2.5 MG TABLET ORL TAB MYP TAB 2.756000002408694 MYL-PREGABALIN 150 MG CAPSULE ORL CAP MYP CAP 1.7270

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002408651 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 1.252900002367378 MYL-RANITIDINE 150 MG TABLET ORL TAB MYP TAB 0.180000002367386 MYL-RANITIDINE 300 MG TABLET ORL TAB MYP TAB 0.360000002392593 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 8.847500001927612 MYOCHRYSINE 25 MG/ML INJECTION INJ DEFAUL AVE ML 15.000000002226022 MYOFLEX EXTRA STRENGTH 15% CREAM TOP CRM BIC G 0.059800000828815 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 13.745000002382482 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJ USP INJ DEFAUL ALV ML 15.000000002148706 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJECTION INJ DEFAUL SDZ ML 13.745000002148714 NALOXONE HYDROCHLORIDE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 20.147500002393034 NALOXONE HYDROCHLORIDE INJECTION 0.4 MG/ML INJ INJ DEFAUL OMG ML 13.750000000390283 NAPHCON FORTE 0.1% OPH SOLUTION OPH SOL ALC ML 0.506000000481408 NAPHCON-A OPH SOLUTION OPH SOL ALC ML 0.474700002242505 NAPRELAN 375 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 0.960400002242506 NAPRELAN 500 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 1.579000000618721 NAPROXEN 500 MG TABLET ORL TAB PDL TAB 0.211000002362430 NAPROXEN 220 MG TABLET ORL TAB PMS TAB 0.069600000590762 NAPROXEN 250 MG TABLET ORL TAB PDL TAB 0.106800000655686 NAPROXEN-375 375 MG TABLET ORL TAB PDL TAB 0.145800000887056 NAPROXEN-NA 275 MG TABLET ORL TAB PDL TAB 0.344000002153386 NAPROXEN-NA DF 550 MG TABLET ORL TAB PDL TAB 0.666700002229415 NAROPIN 5 MG/ML INJECTION INJ DEFAUL AZC ML 0.379800002213834 NASACORT AQ 55 MCG NASAL METERED DOSE SPRAY NAS SPM SAV DOSE 0.200000002192799 NASAL + SINUS DECONGESTANT RELIEF 60 MG TABLET ORL TAB VTH TAB 0.124200000788503 NASAL DECONGESTANT SPRAY 0.1% NAS LIQ CNF ML 0.092000002417855 NAT-ANASTROZOLE 1 MG TABLET ORL TAB NTP TAB 2.900000002421585 NAT-LETROZOLE 2.5 MG TABLET ORL TAB NTP TAB 3.130000000024430 NAVANE 2 MG CAPSULE ORL CAP ERF CAP 0.317100080029758 NEBUSAL 7% INHALATION SOLUTION MIS DEFAUL STM ML 0.243100080027142 NEILMED NASAL SINUS RINSE NAS PWS NPI PCKT 0.235000002245057 NEISVAC-C 10 MCG/20 MCG INJECTION SYRINGE INJ NDL PFI SYR 80.185000000147680 NEO-BEX (LIDOCAINE HCL) INJECTION VIAL INJ DEFAUL BRO ML 5.585000000666157 NEOSPORIN IRRIGATING SOLUTION IR SOL GSK ML 1.6860

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000874957 NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 0.884400000885282 NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.969000001915436 NEOSTIGMINE METHYLSULFATE 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 3.434200002230593 NEOSTIGMINE OMEGA 0.5 MG/ML INJECTION INJ DEFAUL OMG ML 0.960000002230592 NEOSTIGMINE OMEGA 1 MG/ML INJECTION INJ DEFAUL OMG ML 1.070000001958690 NEOSTRATA HQ 2% GEL TOP GEL CDX G 0.766700000999459 NEOVISC DEFAUL DEV STL ML 47.740000000999922 NEPRO ORAL LIQUID ORL LIQ ABN ML 0.009000000587826 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 3.540000002403900 NEUPRO 2 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.540000002403919 NEUPRO 3 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 6.500000002403927 NEUPRO 4 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 6.500000002403935 NEUPRO 6 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.270000002403943 NEUPRO 8 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.270000002239717 NEURONTIN 600 MG TABLET ORL TAB PFI TAB 1.889700002239718 NEURONTIN 800 MG TABLET ORL TAB PFI TAB 2.522000080006269 NEUTROGENA BODY CLEAR BODY WASH PINK GRAPEFRUIT TOP GEL JJI ML 0.027000002308983 NEVANAC 0.1% OPHTHALMIC SUSPENSION OPH SUS ALC ML 4.036000080039670 NEW NORDIC HAIR VOLUME TABLET ORL TAB NNO TAB 0.931300002284227 NEXAVAR 200 MG TABLET ORL TAB BAI TAB 46.008800002300524 NEXIUM 10 MG/DOSE DEL REL GRANULES FOR ORAL SUSP ORL DRGRNUL AZC PCKT 2.200000002244521 NEXIUM 20 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.200000002244522 NEXIUM 40 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.200000000232459 NIACIN 100 MG TABLET ORL TAB ADA TAB 0.083000000779806 NIACIN 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC VTH CAP 0.850000000309737 NIACIN 500 MG TABLET ORL TAB JAM TAB 0.056700002244702 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB JAM TAB 0.196200002242138 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB QVS TAB 0.127700002262339 NIASPAN 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.221300002262347 NIASPAN 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.264700002262355 NIASPAN 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.418000002309289 NIASPAN FCT 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.330000002309254 NIASPAN FCT 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.330000002309262 NIASPAN FCT 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.3300

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002247347 NICORETTE MINI LOZENGE 2 MG ORL LOZ MCL LOZ 0.471400002247348 NICORETTE MINI LOZENGE 4 MG ORL LOZ MCL LOZ 0.471400002065762 NICORETTE PATCH 15MG; NICORETTE COMBOQUIT TOP PTH MCL PTH 3.477100080007461 NICOTINE LOZENGES; THRIVE LOZENGES 1 MG ORL LOZ NOV LOZ 0.254200080007464 NICOTINE LOZENGES; THRIVE LOZENGES 2 MG ORL LOZ NOV LOZ 0.288900080000117 NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM PRI PIECE 0.210400080000118 NICOTINE POLACRILEX; NIC-ASSIST 4 MG GUM ORL GUM PER PIECE 0.253900080000402 NICOTINELL/THRIVE 4 MG ORAL GUM ORL GUM NVC PIECE 0.288900080000396 NICOTINELL; THRIVE 2 MG ORAL GUM ORL GUM NOV PIECE 0.254200002125226 NIDAGEL 0.75% VAGINAL GEL VAG GEL VCL G 0.301700002421631 NIFEDIPINE 30 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.617100002421658 NIFEDIPINE 60 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.937400002442930 NIFEDIPINE ER 30 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.617100002442949 NIFEDIPINE ER 60 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.937400002325926 NIMOTOP 30 MG TABLET ORL TAB BAI TAB 10.077600002229655 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 0.097000002397927 NOCDURNA 25 MCG SL ORALLY DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.320000002431076 NOCDURNA 50 MCG SL ORALLY DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.320000002048485 NOLVADEX-D 20 MG (BASE) TABLET ORL TAB AZC TAB 0.386700080016396 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 0.082700002334860 NORDITROPIN NORDIFLEX 10 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 389.400000002334879 NORDITROPIN NORDIFLEX 15 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 584.100000002334852 NORDITROPIN NORDIFLEX 5 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 194.700000001966162 NORFLEX 30 MG/ML INJECTION INJ DEFAUL GRC ML 5.664200002285576 NORLEVO 0.75 MG TABLET ORL TAB BAI TAB 8.600000000023760 NORLUTATE 5 MG TABLET ORL TAB PFI TAB 1.416700002357593 NORVIR 100 MG FILM-COATED TABLET ORL TAB ABV TAB 1.467000002229145 NORVIR 80 MG/ML ORAL SOLUTION ORL SOL ABV ML 1.195800002241480 NORVIR SEC 100 MG CAPSULE ORL CAP ABB CAP 1.467100002049481 NOVAHISTEX DH ADULT ORAL LIQUID ORL LIQ SAV ML 0.174000002049473 NOVAHISTINE DH CHILDREN ORAL LIQUID ORL LIQ SAV ML 0.143200000216666 NOVASEN 325 MG ENTERIC-COATED TABLET ORL ECT TEV TAB 0.030400000229296 NOVASEN 650 MG ENTERIC COATED TABLET ORL ECT NOP TAB 0.065000002315157 NOVO-AZITHROMYCIN 20 MG/ML PEDIATRIC SUSPENSION ORL SUS TEV ML 0.372700002315165 NOVO-AZITHROMYCIN 40 MG/ML PEDIATRIC SUSPENSION ORL SUS TEV ML 0.5280

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002270226 NOVO-BICALUTAMIDE 50 MG TABLET ORL TAB TEV TAB 4.057300002266377 NOVO-CILAZAPRIL 5 MG TABLET ORL TAB TEV TAB 0.208500000582417 NOVO-CIMETINE 300 MG TABLET ORL TAB TEV TAB 0.086000000603678 NOVO-CIMETINE 400 MG TABLET ORL TAB TEV TAB 0.135000000603686 NOVO-CIMETINE 600 MG TABLET ORL TAB TEV TAB 0.172000002248138 NOVO-CLAVAMOXIN 875 MG/125 MG TABLET ORL TAB TEV TAB 0.555000002309556 NOVO-CYPROTERONE/ETHINYL ESTRADIOL 2MG/0.035MG TAB ORL TAB TEV TAB 1.111400002048698 NOVO-DIFENAC SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT TEV TAB 0.404800002048493 NOVO-DIFLUNISAL FC 250 MG TABLET ORL TAB TEV TAB 0.564700000842044 NOVO-DOCUSATE CALCIUM 240 MG CAPSULE ORL CAP TEV CAP 0.088600002020084 NOVO-DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TEV CAP 0.048100001913468 NOVO-DOXEPIN 100 MG CAPSULE ORL CAP TEV CAP 0.345000001913476 NOVO-DOXEPIN 150 MG CAPSULE ORL CAP TEV CAP 1.212700001913425 NOVO-DOXEPIN 25 MG CAPSULE ORL CAP TEV CAP 0.098500001913433 NOVO-DOXEPIN 50 MG CAPSULE ORL CAP TEV CAP 0.182700001913441 NOVO-DOXEPIN 75 MG CAPSULE ORL CAP TEV CAP 0.367300002300230 NOVO-ENALAPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB TEV TAB 0.548000002300222 NOVO-ENALAPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.492700002243551 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 0.097900080042720 NOVO-FIBRE 469 MG TABLET ORL TAB TEV TAB 0.097900000389218 NOVO-GESIC 325 MG TABLET ORL TAB TEV TAB 0.032600002273756 NOVO-GLIMEPIRIDE 1 MG TABLET ORL TAB TEV TAB 0.490000002273764 NOVO-GLIMEPIRIDE 2 MG TABLET ORL TAB TEV TAB 0.490000002273772 NOVO-GLIMEPIRIDE 4 MG TABLET ORL TAB TEV TAB 0.490000002210479 NOVO-IPRAMIDE 0.25% INHALATION SOLUTION INH SOL TEV ML 0.315500002158612 NOVO-MAPROTILINE 25 MG TABLET ORL TAB TEV TAB 0.568700002158620 NOVO-MAPROTILINE 50 MG TABLET ORL TAB TEV TAB 1.076900002158639 NOVO-MAPROTILINE 75 MG TABLET ORL TAB TEV TAB 1.470700002265435 NOVOMIX 30 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.691300002265443 NOVOMIX 30 FLEXPEN 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.183300002364883 NOVO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP TEV CAP 1.031000002348675 NOVO-MYCOPHENOLATE 500 MG TABLET ORL TAB TEV TAB 2.062000002240868 NOVO-NABUMETONE 750 MG TABLET ORL TAB TEV TAB 0.919200002231781 NOVO-NORTRIPTYLINE 10 MG CAPSULE ORL CAP TEV CAP 0.050000002231782 NOVO-NORTRIPTYLINE 25 MG CAPSULE ORL CAP TEV CAP 0.101100000021288 NOVO-PHENIRAM 4 MG TABLET ORL TAB TEV TAB 0.064500000021695 NOVO-PREDNISONE 5 MG TABLET ORL TAB TEV TAB 0.040100000232378 NOVO-PREDNISONE 50 MG TABLET ORL TAB TEV TAB 0.1735

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002283891 NOVO-RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB TEV CAP 0.420000002326450 NOVO-SALBUTAMOL HFA 100 MCG/DOSE MDA INH AEM TEV DOSE 0.032500002231181 NOVO-SOTALOL 80 MG TABLET ORL TAB TEV TAB 0.296600002100630 NOVO-VALPROIC 250 MG CAPSULE ORL CAP TEV CAP 0.136600002211920 NOVO-VERAMIL SR 240MG SUSTAINED-RELEASE TABLET ORL SRT TEV TAB 0.507500002251469 NOVO-ZOPICLONE 7.5 MG TABLET ORL TAB TEV TAB 0.312500002322854 NPLATE 250 MCG/0.5 ML VIAL INJECTION INJ DEFAUL AMG VIAL 970.800000002322862 NPLATE 500 MCG/1 ML VIAL INJECTION INJ DEFAUL AMG VIAL 1941.610000001913980 NUBAIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 12.223000001913972 NUBAIN 20 MG/ML INJECTION INJ DEFAUL SDZ ML 6.085000002415585 NUCYNTA 100 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.494000002415593 NUCYNTA 150 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.999500002415607 NUCYNTA 200 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.592000002415615 NUCYNTA 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.589500002415577 NUCYNTA 50 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 0.996500002360381 NUCYNTA CR 100 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.473000002360403 NUCYNTA CR 150 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.972000002360411 NUCYNTA CR 200 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.556500002360438 NUCYNTA CR 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.589500002360373 NUCYNTA CR 50 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 0.983000002378299 NUCYNTA IR 100 MG TABLET ORL TAB JAI TAB 1.493600002378272 NUCYNTA IR 50 MG TABLET ORL TAB JAI TAB 0.996800002378280 NUCYNTA IR 75 MG TABLET ORL TAB JAI TAB 1.245000000623385 NUPERCAINAL ANESTHETIC 1% RECTAL OINTMENT RT ONT NVC G 0.140700002249002 NUTROPIN AQ 5 MG/ML PEN CARTRIDGE INJ CTG HLR ML 197.735000002376393 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 392.945000002399091 NUTROPIN AQ NUSPIN 5 5 MG/2 ML SOLUTION INJ DEFAUL HLR ML 98.235000002253186 NUVARING 11.4 MG/2.6 MG SLOW-RELEASE VAGINAL RING VAG SDE MFC RNG 15.150000000716901 NYADERM 25,000 U/G VAGINAL CREAM VAG CRM TAR G 0.125000002239742 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 23.4000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002248639 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 0.264400080053047 ODAN POLYSACCHARIDE IRON COMPLEX 150 150 MG CAP ORL CAP ODN CAP 0.390000000358495 ODANS LIQUOR CARBONIS DETERGENS TOP LIQ ODN ML 0.089000080046696 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC OINTMENT OPH ONT ODN G 2.568600080046737 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC SOLUTION OPH SOL ODN ML 0.599300002443066 OFEV 100 MG CAPSULE ORL CAP BOE CAP 27.180000002443074 OFEV 150 MG CAPSULE ORL CAP BOE CAP 54.360000002231529 OFLOXACIN 200 MG TABLET ORL TAB AAP TAB 1.369300002231531 OFLOXACIN 300 MG TABLET ORL TAB AAP TAB 1.608900002231532 OFLOXACIN 400 MG TABLET ORL TAB AAP TAB 1.608900002311992 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 5.355300002352990 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SNS TAB 5.355300002338661 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 2.677700002343703 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SIV TAB 7.597700002425114 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 5.937700002338645 OLANZAPINE ODT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 0.893700002365677 OLEX 20 MG DELAYED-RELEASE TABLET ORL DRT PPH TAB 0.653600002344408 OLUX-E 0.05% TOPICAL FOAM TOP FOA GSK G 1.444900002239144 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 0.104900002239016 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 0.307800080015284 OMEGA 3 LIQUID ORL LIQ WNP ML 0.026100080002435 OMEGA 3 PREMIUM FISH OIL 1000 MG CAPSULE ORL CAP WNP CAP 0.059300080002596 OMEGA 3 SELECT CAPSULE ORL CAP JAM CAP 0.113100080019234 OMEGA 3 TRIPLE STRENGTH 900 MG SOFTGEL ORL CAP WBP CAP 0.255200080000884 OMEGA 3-6-9 CAPSULE ORL CAP JMS CAP 0.1608

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002240743 OMEGA 3-6-9 CAPSULE ORL CAP JAM CAP 0.164700080003127 OMEGA-3 ELITE SOFTGEL ORL CAP WBP CAP 0.051100080003179 OMEGA-3 TABLET ORL TAB JAM TAB 0.154200002385384 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT SIV CAP 0.550000002339927 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT PDL CAP 0.411700002303671 OMNARIS 50 MCG/DOSE METERED DOSE NASAL SPRAY NAS SPM TAK DOSE 0.214800002153513 ONCOTICE 800 M UNIT/VIAL FOR BLADDER INSTILLATION BLDIR PWS MFC VIAL 273.140000002325160 ONDANSETRON 8 MG TABLET ORL TAB PDL TAB 4.993000002271761 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 3.350000002306220 ONDANSETRON-ODAN 8 MG TABLET ORL TAB ODN TAB 4.993000080020211 ONE A DAY FRUITI-SSENTIAL GUMMIES ORL CTB BAI TAB 0.156300002248292 ONE A DAY MEN 50 PLUS TABLET ORL TAB BIC TAB 0.103700002248319 ONE A DAY WEIGHTSMART TABLET ORL TAB BAI TAB 0.121300002375842 ONGLYZA 2.5 MG TABLET ORL TAB AZC TAB 2.365000002421208 ONRELTEA 0.33 % TOPICAL GEL TOP GEL GAL G 3.518000000750794 OPCON-A OPH SOLUTION OPH SOL BSH ML 0.280000002415690 OPSUMIT 10 MG FILM COATED TABLET ORL TAB ACT TAB 132.055000000990059 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 1.454300000701785 OPTIMYXIN OTIC OPH DROPS OT/OPH DPS SDZ ML 0.925000002371189 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 1.120000001985396 ORAJEL MAXIMUM STRENGTH GEL ORL GEL CHD G 0.406300002381885 ORALAIR 100 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 1.260000002381893 ORALAIR 300 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 3.800000000313815 ORAP 2 MG TABLET ORL TAB PPH TAB 0.318600002047535 ORFENACE 100 MG TABLET ORL TAB STM TAB 0.470000002245641 ORGALUTRAN 250 MCG/ 0.5 ML INJECTION SYRINGE INJ NDL MFC SYR 94.710000002451379 ORKAMBI 125 MG/200 MG TABLET ORL TAB VER TAB 170.535700002209055 ORO-CLENSE 0.12% ORAL RINSE ORL MWH GER ML 0.016500080023808 ORTHO BONE CAPSULE ORL CAP AOR CAP 0.156500002042533 ORTHO-CEPT (28 DAY) TABLET ORL TB JAI TAB 0.7850

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 70 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000999460 ORTHOVISC DEFAUL DEV PMS ML 50.000000000999490 OSTENIL DEFAUL DEV TRB ML 50.260000002247548 OSTEOCIT D PLUS TABLET ORL TAB SFD TAB 0.168300002301911 OSTO-D2 50000 IU CAPSULE ORL CAP TPI CAP 0.213700002434318 OTEZLA 10 MG/20 MG/30 MG TABLET STARTER PACK ORL TAB CLG TAB 19.282200002434334 OTEZLA 30 MG TABLET ORL TAB CLG TAB 19.282100002238867 OTRIVIN 0.05% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.234000000653330 OTRIVIN 0.1% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.234000000741043 OTRIVIN 0.1% METERED DOSE SPRAY DEFAUL SPM CGS ML 0.234000002331403 OTRIVIN MOIST 0.1% NASAL SPRAY NAS SPR NVC ML 0.307500000857777 OTRIVIN-SALINE 0.7% NASAL DROPS NAS SOL NVC ML 0.134800000810436 OTRIVIN-SALINE 0.7% NASAL SPRAY NAS SPR NVC ML 0.118700002262088 OVIDREL 250 MCG INJECTION SYRINGE INJ NDL SRO SYR 72.000000002371588 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 0.339300002239298 OVOL-180 ULTRA STRENGTH 180 MG CAPSULE ORL CAP CHD CAP 0.185000000292990 OVOL-80 80 MG TABLET ORL TAB CHD TAB 0.130000002435071 OXALIPLATIN 5 MG/ML INJECTION INJ DEFAUL TEV ML 46.634500002436957 OXALIPLATIN INJECTION 5 MG/ML INJECTION INJ DEFAUL SDZ ML 46.635000000497754 OXAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.035000000497762 OXAZEPAM 15 MG TABLET ORL TAB PDL TAB 0.055000000497770 OXAZEPAM 30 MG TABLET ORL TAB PDL TAB 0.075000002220636 OXYBUTYNINE-5 5 MG TABLET ORL TAB PDL TAB 0.098600002231934 OXY-IR 5 MG TABLET ORL TAB PUR TAB 0.264000002139561 OXYTOCIN 10 UNIT/ML INJECTION INJ DEFAUL FKC ML 6.864000002254735 OXYTROL 36 MG TRANSDERMAL PATCH TRD PTH ASC PTH 6.745000080001408 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 0.026600002363445 OZURDEX 0.7 MG INTRAVITREAL IMPLANT OPH IMP ALL SYS 1352.500000002130947 PACIS 120 MG INJECTION INJ DEFAUL IAF VIAL 113.600000002320150 PACLITAXEL 6 MG/ML INJECTION USP INJ DEFAUL SDZ ML 74.800000001923420 PALAFER 300 MG CAPSULE ORL CAP GKC CAP 0.229300001923455 PALAFER-CF CAPSULE ORL CAP GKC CAP 0.313300002246597 PAMIDRONATE DISODIUM 30 MG/10 ML VIAL INJECTION INJ DEFAUL FKC ML 15.750000002246598 PAMIDRONATE DISODIUM 60 MG/10 ML INJECTION INJ DEFAUL FKC ML 29.900000002246599 PAMIDRONATE DISODIUM 90 MG/10 ML VIAL INJECTION INJ DEFAUL FKC 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 0.206300002188708 PANOXYL 4% CREAMY WASH TOP WAS GSK G 0.067100000483184 PANOXYL 5 5% TOPICAL BAR TOP BAR GSK G 0.0853

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 71 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002239616 PANTO IV 40 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 13.700000002241804 PANTOLOC 20 MG ENTERIC-COATED TABLET ORL ECT TAK TAB 1.808900002385740 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 10.960000002428172 PANTOPRAZOLE-20 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.275000002428180 PANTOPRAZOLE-40 40 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 0.362800000009881 PAPAVERINE HCL 32.5 MG/ML INJECTION INJ DEFAUL SDZ ML 4.423000002282844 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 12.104000002233143 PATANOL 0.1% OPH SOLUTION OPH SOL ALC ML 6.052000000886327 PATE D'IHLE ZINC OXIDE 25% PASTE TOP PST ATL G 0.023400000532576 PATE D'IHLE ZINC OXIDE PASTE TOP PST ROG G 0.030600002381737 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 1.692000002248503 PAXIL CR 12.5 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.723000002248504 PAXIL CR 25 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.882700000577790 PDP-ISONIAZID 100 MG TABLET ORL TAB PPH TAB 0.731400000577804 PDP-ISONIAZID 300 MG TABLET ORL TAB PPH TAB 0.753300000577812 PDP-ISONIAZID 50 MG/5ML ORAL LIQUID ORL LIQ PPH ML 0.236900002242863 PEDIAFER 30 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.027200002232202 PEDIAFER 75 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.143200002245747 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 0.110000002358034 PEG 3350 ORAL POWDER ORL PWR MES G 0.066800002328232 PEGALAX ORAL POWDER ORL PWR MFI G 0.038700002246030 PEGETRON 200 MG CAP/150 MCG/0.5 ML INJ KIT INJ VIAL/CAP MFC KIT 851.230000002246026 PEGETRON 200 MG CAP/50 MCG/0.5ML INJ KIT INJ VIAL/CAP MFC KIT 770.350000000468029 PENICILLINE V 300 TABLET ORL TAB PDL TAB 0.071000002250535 PENLAC NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL VCL G 13.366700002247265 PENNSAID 1.5% TOPICAL SOLUTION TOP SOL PAL ML 0.889000001980602 PENTA-3B PLUS VITAMIN C TABLET ORL TAB SDZ TAB 0.5820

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 72 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001980599 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 MCL TAB 0.321700000728128 PEPCID IV 10 MG/ML INJECTION INJ DEFAUL MFC ML 1.995500002097079 PEPTO-BISMOL 17.6 MG/ML ORAL LIQUID ORL LIQ PGI ML 0.022300002177994 PEPTO-BISMOL CAPLET ORL TAB PGI TAB 0.152100002237315 PEPTO-BISMOL CHEWABLES CHEWABLE TABLET ORL CTB PGI TAB 0.152100000999423 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 0.018100002237452 PERIDEX 0.12% ORAL RINSE ORL MWH ZIL ML 0.022400002207796 PERIOGARD 0.12% ORAL RINSE ORL MWH COL ML 0.016400002247104 PERIOSTAT 20 MG CAPSULE ORL CAP PPH CAP 1.250000002229501 PERI-WASH II ANTISEPTIC 0.1% CLEANSER TOP WAS COC ML 0.014700080017389 PGX 750 DAILY CAPSULE ORL CAP NFN CAP 0.080500080001122 PHARMA-CAL 500 MG ORL CAP PPH CAP 0.021600080004281 PHARMA-CAL D 500 MG/125 IU TABLET ORL TAB PMS TAB 0.068000002371499 PHARMA-D 10,000 UNIT CAPSULE ORL CAP PMS CAP 0.210000080001145 PHARMA-D 400 IU GELCAP ORL CAP PPH CAP 0.030000002371502 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 0.765300002436663 PHEBURANE 483 MG/G ORAL GRANULES ORL GRNUL MDK G 9.269000002304090 PHENOBARBITAL SODIUM 120 MG/ML INJECTION USP INJ DEFAUL SDZ ML 14.273000002304082 PHENOBARBITAL SODIUM 30 MG/ML INJECTION USP INJ DEFAUL SDZ ML 12.817000002148455 PHENYLEPHRINE HCL 10% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002148447 PHENYLEPHRINE HYDROCHLORIDE OPH SOLUTION (MINIMS) OPH SOL OPT ML 6.666700000780626 PHENYTOIN 50 MG/ML INJECTION INJ DEFAUL SDZ ML 6.078500002431378 PHENYTOIN SODIUM 50 MG/ML INJECTION USP INJ DEFAUL STM ML 5.285600002150638 PHILLIPS MAGNESIA 300 MG CHEWABLE TABLET ORL CTB BAI TAB 0.048700002150646 PHILLIPS MILK OF MAGNESIA 80 MG/ML ORAL LIQUID ORL LIQ BAI ML 0.013900002243578 PHISODERM FACIAL CLEANSER TOP WAS MNT G 0.022500002017733 PHISOHEX 3% TOPICAL CLEANSER TOP CLR SAV ML 0.071400002245781 PHL-AMIODARONE 200 MG TABLET ORL TAB PHH TAB 1.297100002326787 PHL-AMLODIPINE 10 MG TABLET ORL TAB PHH TAB 0.3587

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 73 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002326760 PHL-AMLODIPINE 2.5 MG TABLET ORL TAB PHH TAB 0.138000002326779 PHL-AMLODIPINE 5 MG TABLET ORL TAB PHH TAB 0.241700002278588 PHL-AZITHROMYCIN 250 MG TABLET ORL TAB PHH TAB 1.231300002236964 PHL-BACLOFEN 20 MG TABLET ORL TAB PHH TAB 0.310400002273543 PHL-CITALOPRAM 10 MG TABLET ORL TAB PHH TAB 0.143200002248944 PHL-CITALOPRAM 20 MG TABLET ORL TAB PHH TAB 0.239700002248945 PHL-CITALOPRAM 40 MG TABLET ORL TAB PHH TAB 0.239700002145227 PHL-CLONAZEPAM 0.5 MG TABLET ORL TAB PHH TAB 0.049500002145235 PHL-CLONAZEPAM 1 MG TABLET ORL TAB PHH TAB 0.148700002236948 PHL-CLONAZEPAM-R 0.5 MG TABLET ORL TAB PHH TAB 0.049500002249359 PHL-CYCLOBENZAPRINE 10 MG TABLET ORL TAB PHH TAB 0.376500002223481 PHL-FLUOXETINE 10 MG CAPSULE ORL CAP PHH CAP 0.459500002223503 PHL-FLUOXETINE 20 MG CAPSULE ORL CAP PHH CAP 0.459800002248608 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 0.375000002278618 PHL-ONDANSETRON 4 MG TABLET ORL TAB PHH TAB 3.272000002278626 PHL-ONDANSETRON 8 MG TABLET ORL TAB PHH TAB 4.993000002307669 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 0.668900002249782 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 2.703800002245782 PHL-RANITIDINE 150 MG TABLET ORL TAB PHH TAB 0.180000002245783 PHL-RANITIDINE 300 MG TABLET ORL TAB PHH TAB 0.360000002258439 PHL-RISPERIDONE 0.25 MG TABLET ORL TAB PHH TAB 0.125200002258447 PHL-RISPERIDONE 0.5 MG TABLET ORL TAB PHH TAB 0.209700002258455 PHL-RISPERIDONE 1 MG TABLET ORL TAB PHH TAB 0.289600002258463 PHL-RISPERIDONE 2 MG TABLET ORL TAB PHH TAB 0.578200002258471 PHL-RISPERIDONE 3 MG TABLET ORL TAB PHH TAB 0.867300002258498 PHL-RISPERIDONE 4 MG TABLET ORL TAB PHH TAB 1.156500002245826 PHL-SERTRALINE 100 MG CAPSULE ORL CAP PHH CAP 0.420000002245824 PHL-SERTRALINE 25 MG CAPSULE ORL CAP PHH CAP 0.200400002245825 PHL-SERTRALINE 50 MG CAPSULE ORL CAP PHH CAP 0.400000002281554 PHL-SIMVASTATIN 10 MG TABLET ORL TAB PHH TAB 0.3642

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 74 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002281562 PHL-SIMVASTATIN 20 MG TABLET ORL TAB PHH TAB 0.450100002281570 PHL-SIMVASTATIN 40 MG TABLET ORL TAB PHH TAB 0.450100002281546 PHL-SIMVASTATIN 5 MG TABLET ORL TAB PHH TAB 0.184100002281589 PHL-SIMVASTATIN 80 MG TABLET ORL TAB PHH TAB 0.450100002271192 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 0.085600002019876 PHOTOFRIN 75MG/ VIAL INJECTION INJ DEFAUL AXC VIAL 19255.100000002400987 PICATO 0.015% TOPICAL GEL TOP GEL LEO DOSE 127.666700002400995 PICATO 0.05% TOPICAL GEL TOP GEL LEO DOSE 191.500000002254794 PICO SALAX ORAL POWDER ORL PWR FEI PCKT 7.000000002300583 PICODAN ORL PWDPKT ODN PCKT 3.600000002402483 PILOCARPINE HYDROCHLORIDE 5 MG TABLET ORL TAB STM TAB 0.780500002148463 PILOCARPINE NITRATE 2% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700000828424 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 HSP VIAL 9.500000002248939 PIPERACILLIN 2 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 15.280000002246641 PIPERACILLIN 3 G/VIAL INJECTION INJ DEFAUL HSP VIAL 22.820000002248940 PIPERACILLIN 3 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 22.930000002246642 PIPERACILLIN 4 G/VIAL INJECTION INJ DEFAUL HSP VIAL 19.000000002248941 PIPERACILLIN 4 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 30.550000002330547 PIPERACILLIN SOD/TAZOBACTAM SOD 12G/1500 MG VL INJ INJ DEFAUL SDZ VIAL 67.500000002391511 PIPERACILLIN/TAZOBACTAM 2 G/250 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 9.612000002391538 PIPERACILLIN/TAZOBACTAM 3 G/375 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 9.080000002391546 PIPERACILLIN/TAZOBACTAM 4 G/500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 12.110000001926667 PIPORTIL L4 25 MG/ML INJECTION INJ DEFAUL SAV ML 16.440000000501190 PLACEBO 100 MG TABLET ORL TAB ODN TAB 0.0750

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002293854 PLAN B 1.5 MG TABLET ORL TAB PAL TAB 17.200000002237405 PLANTE GUMMI BEAR MULTIPLE VITAMINS ORAL GUM ORL GUM PLI PIECE 0.156600002444399 PLEGRIDY 125 MCG/ 0.5 ML PS/PEN INJECTION INJ NDL BIO SYR 830.155000002444402 PLEGRIDY 63 MCG/94 MCG PS/PEN INJ STARTER PACK INJ NDL BIO SYR 1660.310000001946897 PMS DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR ORL ELX PMS ML 0.378500000792691 PMS-ACETAMINOPHEN 32 MG/ML ORAL SOLUTION ORL SOL PPH ML 0.025800002243435 PMS-ADENOSINE 3 MG/ML INJECTION INJ DEFAUL PMS ML 19.500000000654523 PMS-AMITRIPTYLINE 10 MG TABLET ORL TAB PMS TAB 0.066400000654515 PMS-AMITRIPTYLINE 25 MG TABLET ORL TAB PMS TAB 0.121100002247304 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.234600000654507 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.234700002274949 PMS-ANAGRELIDE 0.5 MG CAPSULE ORL CAP PMS CAP 3.349100002320738 PMS-ANASTROZOLE 1 MG TABLET ORL TAB PMS TAB 2.546000002284529 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 0.053800002381028 PMS-ATOMOXETINE 10 MG CAPSULE ORL CAP PMS CAP 2.314000002381036 PMS-ATOMOXETINE 18 MG CAPSULE ORL CAP PMS CAP 2.652300002381044 PMS-ATOMOXETINE 25 MG CAPSULE ORL CAP PMS CAP 2.928100002381052 PMS-ATOMOXETINE 40 MG CAPSULE ORL CAP PMS CAP 3.337700002381060 PMS-ATOMOXETINE 60 MG CAPSULE ORL CAP PMS CAP 3.702400002330237 PMS-BETAHISTINE 24 MG TABLET ORL TAB PMS TAB 0.498300002275589 PMS-BICALUTAMIDE 50 MG TABLET ORL TAB PMS TAB 4.057300002383020 PMS-BOSENTAN 125 MG TABLET ORL TAB PMS TAB 48.134000002383012 PMS-BOSENTAN 62.5 MG TABLET ORL TAB PMS TAB 48.134000002391171 PMS-CANDESARTAN 4 MG TABLET ORL TAB PMS TAB 0.340000002185830 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 0.753500002413574 PMS-CICLOPIROX NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL PMS G 7.743300002416433 PMS-CIPROFLOXACIN XL 500 MG EXTENDED-RELEASE TAB ORL ERT PMS TAB 2.311000002244474 PMS-CLOBAZAM 10 MG TABLET ORL TAB PMS TAB 0.109700002232195 PMS-CLOBETASOL 0.05% SCALP LOTION SCP LOT PMS ML 0.227300002232191 PMS-CLOBETASOL 0.05% TOPICAL CREAM TOP CRM PMS G 0.364800002232193 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.406800002309548 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.260600002243450 PMS-DEFEROXAMINE 2G/VIAL INJECTION INJ DEFAUL PMS VIAL 20.220000002242055 PMS-DEFEROXAMINE 500 MG/VIAL INJ INJ DEFAUL PMS VIAL 8.1750

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000891797 PMS-DIAZEPAM 1 MG/ML ORAL SOLUTION ORL SOL PMS ML 0.105300002247492 PMS-DIAZEPAM 10 MG TABLET ORL TAB PMS TAB 0.086700002247490 PMS-DIAZEPAM 2 MG TABLET ORL TAB PMS TAB 0.050800002247491 PMS-DIAZEPAM 5 MG TABLET ORL TAB PMS TAB 0.065000000721344 PMS-DICITRATE ORAL SOLUTION ORL SOL PMS ML 0.047400002356783 PMS-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL PMS ML 0.622700002239753 PMS-DICLOFENAC-K 50 MG TABLET ORL TAB PMS TAB 0.393700000757683 PMS-DIPHENHYDRAMINE 25 MG CAPSULE ORL CAP PPH CAP 0.086600000757691 PMS-DIPHENHYDRAMINE 50 MG CAPSULE ORL CAP PPH CAP 0.107600002434342 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 1.869000002278081 PMS-FAMCICLOVIR 125 MG TABLET ORL TAB PMS TAB 2.024000002278103 PMS-FAMCICLOVIR 250 MG TABLET ORL TAB PMS TAB 2.720000002278111 PMS-FAMCICLOVIR 500 MG TABLET ORL TAB PMS TAB 4.228100000586323 PMS-FERROUS SULFATE 300 MG TABLET ORL TAB PPH TAB 0.029600002222574 PMS-FERROUS SULFATE INFANT DROPS 75 MG/ML ORL DPS PMS ML 0.190000002320169 PMS-FINASTERIDE 1 MG TABLET ORL TAB PMS TAB 1.145500000726354 PMS-FLUPHENAZINE 5 MG TABLET ORL TAB PMS TAB 0.172000002247493 PMS-FUROSEMIDE 20 MG TABLET ORL TAB PMS TAB 0.037300002247494 PMS-FUROSEMIDE 40 MG TABLET ORL TAB PMS TAB 0.074600002255898 PMS-GABAPENTIN 600 MG TABLET ORL TAB PMS TAB 1.304500002255901 PMS-GABAPENTIN 800 MG TABLET ORL TAB PMS TAB 1.739300002239951 PMS-GEMFIBROZIL 300 MG CAPSULE ORL CAP PMS CAP 0.296400002247386 PMS-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.047400002247387 PMS-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.055100002324253 PMS-HYDROCODONE 1 MG/ML ORAL SYRUP ORL SYR PMS ML 0.122400000836133 PMS-IBUPROFEN 400 MG TABLET ORL TAB PMS TAB 0.101000002431114 PMS-IMATINIB 100 MG TABLET ORL TAB PMS TAB 20.455700002431122 PMS-IMATINIB 400 MG TABLET ORL TAB PMS TAB 81.822700002395258 PMS-LANSOPRAZOLE 15 MG DELAYED-RELEASE CAPSULE ORL DRC PMS CAP 0.500000002395266 PMS-LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PMS CAP 0.500000002288265 PMS-LEFLUNOMIDE 10 MG TABLET ORL TAB PMS TAB 6.041700002288273 PMS-LEFLUNOMIDE 20 MG TABLET ORL TAB PMS TAB 6.041700002309114 PMS-LETROZOLE 2.5 MG TABLET ORL TAB PMS TAB 2.756000000811874 PMS-LIDOCAINE VISCOUS 2% ORAL LIQUID ORL LIQ PMS ML 0.095000002074834 PMS-LITHIUM CITRATE 8 MMO/5ML ORAL SYRUP ORL SYR PMS ML 0.070800002248268 PMS-MELOXICAM 15 MG TABLET ORL TAB PMS TAB 0.567000002248267 PMS-MELOXICAM 7.5 MG TABLET ORL TAB PMS TAB 0.491400002321130 PMS-MEMANTINE 10 MG TABLET ORL TAB PMS TAB 1.6357

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002382830 PMS-MEMANTINE 5 MG TABLET ORL TAB PMS TAB 1.635700002413728 PMS-METHYLPHENIDATE 18 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.427600002413736 PMS-METHYLPHENIDATE 27 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.647500002413744 PMS-METHYLPHENIDATE 36 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.867400002413752 PMS-METHYLPHENIDATE 54 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 2.307200000783137 PMS-METRONIDAZOLE 500 MG CAPSULE ORL CAP PMS CAP 0.702800002432218 PMS-MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL PMS ML 3.757000002405776 PMS-NEVIRAPINE 200 MG TABLET ORL TAB PMS TAB 2.469200002418630 PMS-NIFEDIPINE ER 30 MG EXTENDED-RELEASE TABLET ORL ERT PMS TAB 0.617100002416301 PMS-NIFEDIPINE ER 60 MG EXTENDED-RELEASE TABLET ORL ERT PMS TAB 0.937400002177714 PMS-NIZATIDINE 150 MG CAPSULE ORL CAP PMS CAP 0.209800002177722 PMS-NIZATIDINE 300 MG CAPSULE ORL CAP PMS CAP 0.380200002177692 PMS-NORTRIPTYLINE 10 MG CAPSULE ORL CAP PMS CAP 0.050000002177706 PMS-NORTRIPTYLINE 25 MG CAPSULE ORL CAP PMS CAP 0.101100002367483 PMS-OLANZAPINE 20 MG TABLET ORL TAB PMS TAB 10.309300002303213 PMS-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB PMS TAB 5.355300002423944 PMS-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB PMS TAB 7.597700002309882 PMS-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.439000002309890 PMS-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.658500002309904 PMS-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 1.141300002309912 PMS-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 2.108000002247750 PMS-PAROXETINE 10 MG TABLET ORL TAB PMS TAB 1.043000002231537 PMS-PINDOLOL 10 MG TABLET ORL TAB PMS TAB 0.232300002231539 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 0.580900002303132 PMS-PIOGLITAZONE 30 MG TABLET ORL TAB PMS TAB 0.813900002303140 PMS-PIOGLITAZONE 45 MG TABLET ORL TAB PMS TAB 1.223700002154463 PMS-PIROXICAM 20 MG RECTAL SUPPOSITORY RT SUP PMS SUP 2.211700002240363 PMS-POLYTRIMETHOPRIM OPHTHALMIC SOLUTION OPH SOL PMS ML 2.388000002290138 PMS-PRAMIPEXOLE 0.5 MG TABLET ORL TAB PMS TAB 1.386000002359634 PMS-PREGABALIN 150 MG CAPSULE ORL CAP PMS CAP 1.727000002398079 PMS-PREGABALIN 225 MG CAPSULE ORL CAP PMS CAP 1.727000002359596 PMS-PREGABALIN 25 MG CAPSULE ORL CAP PMS CAP 0.617300002359642 PMS-PREGABALIN 300 MG CAPSULE ORL CAP PMS CAP 1.727000002359618 PMS-PREGABALIN 50 MG CAPSULE ORL CAP PMS CAP 0.968300002359626 PMS-PREGABALIN 75 MG CAPSULE ORL CAP PMS CAP 1.252900000753661 PMS-PROCHLORPERAZINE 5 MG TABLET ORL TAB PMS TAB 0.165900002294559 PMS-PROPAFENONE 150 MG TABLET ORL TAB PMS TAB 0.427500002294575 PMS-PROPAFENONE 300 MG TABLET ORL TAB PMS TAB 0.7537

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000815993 PMS-PSEUDOEPHEDRINE HCL 6 MG/ML ORAL SYRUP ORL SYR PMS ML 0.044300000618810 PMS-PYRAZINAMIDE 500 MG TABLET ORL TAB PMS TAB 1.240800002340569 PMS-QUINAPRIL 10 MG TABLET ORL TAB PMS TAB 0.686700002340577 PMS-QUINAPRIL 20 MG TABLET ORL TAB PMS TAB 0.686700002340585 PMS-QUINAPRIL 40 MG TABLET ORL TAB PMS TAB 0.686700002340550 PMS-QUINAPRIL 5 MG TABLET ORL TAB PMS TAB 0.686700002343932 PMS-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB PMS CAP 0.813300002424177 PMS-RISEDRONATE 150 MG TABLET ORL TAB PMS TAB 40.950000002069571 PMS-SALBUTAMOL 5 MG/ML INHALATION SOLUTION INH SOL PMS ML 0.351000002371642 PMS-SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.200600002371626 PMS-SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.289400002371634 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 0.450000002256428 PMS-SUMATRIPTAN 25 MG TABLET ORL TAB PMS TAB 8.990000002237460 PMS-TAMOXIFEN 20 MG TABLET ORL TAB PMS TAB 0.350000002391236 PMS-TELMISARTAN 40 MG TABLET ORL TAB PMS TAB 0.282100002391244 PMS-TELMISARTAN 80 MG TABLET ORL TAB PMS TAB 0.282100002401665 PMS-TELMISARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PMS TAB 0.282100002083353 PMS-TIMOLOL 0.25% (BASE) OPH SOLUTION OPH SOL PMS ML 0.968000002401657 PMS-TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PMS TAB 0.626400002312999 PMS-VALSARTAN 40 MG TABLET ORL TAB PMS TAB 0.524000002241821 PMS-VANCOMYCIN 1 G/VIAL INJECTION INJ DEFAUL PMS VIAL 58.990000002241820 PMS-VANCOMYCIN 500 MG/VIAL INJECTION INJ DEFAUL PMS VIAL 31.050000001954504 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 0.785000002231259 PNEUMO 23 25 MCG/0.5ML INJECTION SYRINGE INJ DEFAUL CNG SYR 19.240000000431648 PNEUMOVAX 23 25 MCG/VIAL INJECTION INJ DEFAUL MSD VIAL 18.360000000990067 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 1.516800000464988 POLLINEX R INJECTION INJ VIAL/SYR BEE VL/SYR 96.470000000999389 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 JJI G 0.363300002237227 POLYSPORIN ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.363300002239155 POLYSPORIN PLUS PAIN RELIEF EAR DROPS OT SOL JJI ML 0.696700002239201 POLYSPORIN PLUS PAIN RELIEF TOPICAL CREAM TOP CRM JJI G 0.3940

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002239157 POLYSPORIN STERILE OPHTHALMIC OINTMENT OPH ONT JJI G 1.688600002239156 POLYSPORIN STERILE OTIC OPH DROPS OT/OPH DPS JJI ML 0.696700002237226 POLYSPORIN TRIPLE ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.394000001981021 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 0.333300002011956 POLYTRIM OPH SOLUTION OPH SOL ALL ML 3.290000002419580 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 46.723000002293404 POSANOL 40 MG/ML ORAL SUSPENSION ORL SUS MFC ML 9.344600000611271 POTABA 0.5 G CAPSULE ORL CAP GLE CAP 0.331100000550175 POTABA 0.5 G TABLET ORL TAB GLE TAB 0.431900000316121 POTASSIUM 50 MG TABLET ORL TAB JAM TAB 0.056300080028233 POTASSIUM CHLORIDE 20 MEQ TABLET ORL TAB/SRT OPU TAB 0.199500080026332 POTASSIUM CITRATE 10 MMOL 10 MEQ TABLET ORL TAB MTR TAB 0.154500000804789 POTASSIUM PHOSPHATE 224 MG/ML/ 236 MG/ML INJECTION INJ DEFAUL SDZ ML 0.524800002139545 POTASSIUM PHOSPHATES 224 MG/ML/236 MG/ML INJECTION INJ DEFAUL FKC ML 0.508500002312433 PRADAXA 75 MG CAPSULE ORL CAP BOE CAP 1.600000002367610 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SNS TAB 1.386000002309130 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SIV TAB 1.386000000770957 PRAMOX H.C. TOPICAL CREAM TOP CRM DPT G 0.444400001954210 PRAMOX H.C. TOPICAL LOTION TOP LOT DPT ML 0.183300002243824 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 6.666700000156876 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 0.418100002405539 PREGABALIN 25 MG CAPSULE ORL CAP SNS CAP 0.617300002403692 PREGABALIN 25 MG CAPSULE ORL CAP SIV CAP 0.617300002396548 PREGABALIN 300 MG CAPSULE ORL CAP PDL CAP 1.169800002405598 PREGABALIN 300 MG CAPSULE ORL CAP SNS CAP 1.7270

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002403730 PREGABALIN 300 MG CAPSULE ORL CAP SIV CAP 1.727000002405547 PREGABALIN 50 MG CAPSULE ORL CAP SNS CAP 0.968300002403706 PREGABALIN 50 MG CAPSULE ORL CAP SIV CAP 0.968300002396505 PREGABALIN 50 MG CAPSULE ORL CAP PDL CAP 0.655800002396513 PREGABALIN 75 MG CAPSULE ORL CAP PDL CAP 0.848600002405555 PREGABALIN 75 MG CAPSULE ORL CAP SNS CAP 1.252800002403714 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 72.000000002276194 PREGVIT FOLIC 5 TABLET ORL TAB DUI TAB 0.531200002246067 PREGVIT TABLET ORL TAB DUI TAB 0.379500002043394 PREMARIN 0.3 MG TABLET ORL TAB PFI TAB 0.302700002043408 PREMARIN 0.625 MG TABLET ORL TAB PFI TAB 0.302700002043424 PREMARIN 1.25 MG TABLET ORL TAB PFI TAB 0.302700002043386 PREMARIN 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 42.150000002244574 PRENATAL VITAMIN AND MINERAL SUPPLEMENT CAPLET ORL TAB WNP TAB 0.076600000886750 PREPARATION H TOPICAL CREAM TOP CRM PDH G 0.254400001926217 PREPARATION H TOPICAL OINTMENT TOP ONT PDH G 0.220800000999899 PRESIDENT'S CHOICE ORAL LIQUID ORL LIQ XXX ML 0.007100000693820 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 BGP TAB 2.000000002249472 PREVACID FASTAB 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BGP TAB 2.000000000635189 PREVEX 67% TOPICAL CREAM TOP CRM GSK G 0.156500002210754 PREVIDENT 5000 PLUS DENTAL CREAM DEN CRM COL G 0.201300002335204 PREVNAR 13 SUSPENSION 0.5 ML SYRINGE INJECTION INJ NDL PFI SYR 91.350000002244081 PREVNAR VACCINE 0.5 ML INJECTION INJ DEFAUL PFI ML 180.180000002426501 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 10.858000002324024 PREZISTA 600 MG TABLET ORL TAB JAI TAB 15.439000002338432 PREZISTA 75 MG TABLET ORL TAB JAI TAB 1.893000002393050 PREZISTA 800 MG TABLET ORL TAB JAI TAB 21.716000080033655 PRIMADOPHILUS OPTIMA MAX BIFIDO 90 BILLION CAPSULE ORL CAP ENT CAP 1.428300000839388 PRINIVIL 5 MG TABLET ORL TAB MFC TAB 0.607300000884413 PRINZIDE 20 MG/12.5 MG TABLET ORL TB MFC TAB 0.903800002239208 PRIORIX VIAL INJECTION INJ DEFAUL GSK VIAL 27.7760

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 81 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002321106 PRISTIQ 100 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.725000002321092 PRISTIQ 50 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.725000002426366 PRIVA-CELECOXIB 100 MG CAPSULE ORL CAP PMI CAP 0.173000002426374 PRIVA-CELECOXIB 200 MG CAPSULE ORL CAP PMI CAP 0.349700002425238 PRIVA-EZETIMIBE 10 MG TABLET ORL TAB PMI TAB 0.461200002425378 PRIVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT PMI TAB 0.362800002425874 PRIVA-ZOPICLONE 5 MG TABLET ORL TAB PMI TAB 0.223100002425882 PRIVA-ZOPICLONE 7.5 MG TABLET ORL TAB PMI TAB 0.468500000644315 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 3.238400080008566 PRO-CAL-D 400 IU ORAL CAPLET ORL DEFAUL PDL TAB 0.120000002311062 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 0.697900002311593 PRO-CLONAZEPAM 0.5 MG TABLET ORL TAB PDL TAB 0.049500002311607 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 1.175800002241799 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 0.498600002241796 PROCYTOX 50 MG TABLET ORL TAB ASM TAB 0.669000002241800 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 0.161400002246576 PRODIEM OVERNIGHT RELIEF THERAPY 15 MG TABLET ORL TAB NVC TAB 0.203000002311429 PRO-ENALAPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.264700002311402 PRO-ENALAPRIL-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.1863

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002311437 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 0.699000002310686 PRO-FLUCONAZOLE 100 MG TABLET ORL TAB PDL TAB 2.289000002310694 PRO-FLUCONAZOLE 150 MG CAPSULE ORL CAP PDL CAP 3.940000002314991 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 1.680200002243144 PROGRAF 0.5 MG CAPSULE ORL CAP ASP CAP 1.970000002175991 PROGRAF 1 MG CAPSULE ORL CAP ASP CAP 2.520000002175983 PROGRAF 5 MG CAPSULE ORL CAP ASP CAP 12.620000002311011 PRO-HYDROXYQUINE-200 200 MG TABLET ORL TAB PDL TAB 0.262000000646261 PRO-INDO 25 MG CAPSULE ORL CAP PDL CAP 0.087100000646288 PRO-INDO 50 MG CAPSULE ORL CAP PDL CAP 0.151100080053887 PRO-K 20 20 MEQ SUSTAINED-RELEASE TABLET ORL TAB PDL TAB 0.199500002204606 PROLASTIN-C 1 G/VIAL INJECTION INJ DEFAUL GRL VIAL 429.060000002439123 PROLENSA 0.07% OPHTHALMIC SOLUTION OPH SOL BSH ML 7.670000002310988 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 0.084700002310953 PRO-NAPROXEN EC - 500 500 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 2.110000002343053 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 1.798900002317354 PRO-QUETIAPINE 100 MG TABLET ORL TAB PDL TAB 0.329500002317362 PRO-QUETIAPINE 200 MG TABLET ORL TAB PDL TAB 0.6617

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 83 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002317346 PRO-QUETIAPINE 25 MG TABLET ORL TAB PDL TAB 0.123500002317370 PRO-QUETIAPINE 300 MG TABLET ORL TAB PDL TAB 0.965600002311224 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 0.060900000513059 PROTYLOL 20 MG TABLET ORL TAB PDL TAB 0.169000002239656 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 0.013700000466409 PULMOPHYLLINE 5.3 MG/ML ORAL ELIXIR ORL ELX RIV ML 0.008600002046733 PULMOZYME 1 ML AMPOULE INHALATION SOLUTION INH SOL HLR ML 15.446800002242439 PUREGON 100 IU/ML INJECTION INJ DEFAUL MFC ML 97.000000002242441 PUREGON 200 IU/ML INJECTION INJ DEFAUL MFC ML 194.000000002243948 PUREGON 833 IU/ML INJECTION CARTRIDGE INJ CTG MFC ML 808.333300002317966 PURG-ODAN ORL POWDER ORL PWDPKT ODN PCKT 5.300000000004723 PURINETHOL 50 MG TABLET ORL TAB TEV TAB 2.861000080009682 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 1.166300080015945 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 1.7505

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 84 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002417820 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 2.376300002417391 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 2.096000002417359 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.395000002417782 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.444500002415925 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 0.239000000695459 QUININE-ODAN 300 MG CAPSULE ORL CAP ODN CAP 0.375000000695432 QUININE-ODAN 300 MG TABLET ORL TAB ODN TAB 0.375000080039114 Q-UROL TABLET ORL TAB TPI TAB 0.741500002267667 RABAVERT VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL MFC VIAL 171.880000002423723 RAGWITEK 12 UNIT SUBLINGUAL TABLET SLG TAB MFC TAB 3.800000002299194 RALIVIA 100 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.254600002299208 RALIVIA 200 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 2.288800002299216 RALIVIA 300 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 3.316000002415852 RALOXIFENE 60 MG TABLET ORL TAB PDL TAB 0.458500002308363 RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB SIV CAP 0.127400002287943 RAMIPRIL 10 MG CAPSULE ORL CAP/TAB SIV CAP 0.186200002287927 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 0.206700002384701 RAN-ALENDRONATE 10 MG TABLET ORL TAB RAN TAB 0.498600002384698 RAN-ALENDRONATE 5 MG TABLET ORL TAB RAN TAB 1.037000002398877 RAN-AMLODIPINE 2.5 MG TABLET ORL TAB RAN TAB 0.138000002328690 RAN-ANASTROZOLE 1 MG TABLET ORL TAB RAN TAB 2.545700002371324 RAN-BICALUTAMIDE 50 MG TABLET ORL TAB RAN TAB 4.057300002380684 RAN-CANDESARTAN 4 MG TABLET ORL TAB RAN TAB 0.340000002361434 RAN-CLARITHROMYCIN 500 MG TABLET ORL TAB RAN TAB 1.629300002423979 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 21.940000002363208 RAN-IRBESARTAN HCTZ 150/12.5 MG TABLET ORL TAB RAN TAB 0.314700002363216 RAN-IRBESARTAN HCTZ 300/12.5 MG TABLET ORL TAB RAN TAB 0.314700002363224 RAN-IRBESARTAN HCTZ 300/25 MG TABLET ORL TAB RAN TAB 0.3147

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 85 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000740748 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 2.756000002404486 RAN-LOSARTAN 100 MG TABLET ORL TAB RAN TAB 0.314700002404451 RAN-LOSARTAN 25 MG TABLET ORL TAB RAN TAB 0.314700002404478 RAN-LOSARTAN 50 MG TABLET ORL TAB RAN TAB 0.314700002421364 RAN-MEMANTINE 10 MG TABLET ORL TAB RAN TAB 1.635700002358077 RAN-NABILONE 0.25 MG CAPSULE ORL CAP RAN CAP 1.396200002414112 RAN-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB RAN TAB 5.355400002414120 RAN-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB RAN TAB 7.597900002305038 RAN-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RAN TAB 1.275000002375850 RAN-PIOGLITAZONE 15 MG TABLET ORL TAB RAN TAB 0.580900002375869 RAN-PIOGLITAZONE 30 MG TABLET ORL TAB RAN TAB 0.813900002375877 RAN-PIOGLITAZONE 45 MG TABLET ORL TAB RAN TAB 1.223700002392844 RAN-PREGABALIN 150 MG CAPSULE ORL CAP RAN CAP 1.727000002392852 RAN-PREGABALIN 225 MG CAPSULE ORL CAP RAN CAP 1.727000002392801 RAN-PREGABALIN 25 MG CAPSULE ORL CAP RAN CAP 0.617300002392860 RAN-PREGABALIN 300 MG CAPSULE ORL CAP RAN CAP 1.727000002392828 RAN-PREGABALIN 50 MG CAPSULE ORL CAP RAN CAP 0.968300002392836 RAN-PREGABALIN 75 MG CAPSULE ORL CAP RAN CAP 1.252800002425548 RAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RAN CAP 0.855000002383136 RAN-SILDENAFIL 100 MG TABLET ORL TAB RAN TAB 9.200000002383101 RAN-SILDENAFIL 25 MG TABLET ORL TAB RAN TAB 8.290000002383128 RAN-SILDENAFIL 50 MG TABLET ORL TAB RAN TAB 8.847700002396084 RAN-TOPIRAMATE 100 MG TABLET ORL TAB RAN TAB 0.592800002396092 RAN-TOPIRAMATE 200 MG TABLET ORL TAB RAN TAB 0.885300002396076 RAN-TOPIRAMATE 25 MG TABLET ORL TAB RAN TAB 0.312800002388197 RAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB RAN TAB 0.626400002363062 RAN-VALSARTAN 40 MG TABLET ORL TAB RAN TAB 0.523900002361663 RAPAFLO 4 MG CAPSULE ORL CAP ASC CAP 1.896700002361671 RAPAFLO 8 MG CAPSULE ORL CAP ASC CAP 1.896800002247111 RAPAMUNE 1 MG TABLET ORL TAB PFI TAB 7.914000002243237 RAPAMUNE 1 MG/ML ORAL LIQUID ORL LIQ PFI ML 7.914000002302063 RASILEZ 150 MG TABLET ORL TAB NOV TAB 1.258900002302071 RASILEZ 300 MG TABLET ORL TAB NOV TAB 1.258900002332728 RASILEZ HCT 150 MG/12.5 MG TABLET ORL TAB NOV TAB 1.264300002332736 RASILEZ HCT 150 MG/25 MG TABLET ORL TAB NOV TAB 1.264300002332744 RASILEZ HCT 300 MG/12.5 MG TABLET ORL TAB NOV TAB 1.264300002332752 RASILEZ HCT 300 MG/25 MG TABLET ORL TAB NOV TAB 1.264300002244646 RATIO-ACLAVULANATE 125F 25 MG/6.25 MG ORAL SUSP ORL SUS RPH ML 0.0543

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 86 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002244647 RATIO-ACLAVULANATE 250F 50 MG/12.5 MG ORAL SUSP ORL SUS RPH ML 0.183000002259613 RATIO-AMLODIPINE 10 MG TABLET ORL TAB RPH TAB 0.358700002259605 RATIO-AMLODIPINE 5 MG TABLET ORL TAB RPH TAB 0.241700002275287 RATIO-AZITHROMYCIN 250 MG TABLET ORL TAB RPH TAB 1.231700002277700 RATIO-BICALUTAMIDE 50 MG TABLET ORL TAB RPH TAB 4.057300002243026 RATIO-BRIMONIDINE 0.2% OPHTHALMIC SOLUTION OPH SOL RPH ML 1.156000000550477 RATIO-CALMYDONE ORAL SYRUP ORL SYR RPH ML 0.059600002242657 RATIO-CEFUROXIME 500 MG TABLET ORL TAB RPH TAB 1.433700002252120 RATIO-CITALOPRAM 40 MG TABLET ORL TAB RPH TAB 0.239700002053403 RATIO-COTRIDIN EXPECTORANT ORAL SYRUP ORL SYR RPH ML 0.061000002169126 RATIO-COTRIDIN ORAL SYRUP ORL SYR RPH ML 0.055000002229781 RATIO-DILTIAZEM CD 120 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.352900002229782 RATIO-DILTIAZEM CD 180 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.468400002229783 RATIO-DILTIAZEM CD 240 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.621300002229784 RATIO-DILTIAZEM CD 300 MG CONTROLLED-DELIVERY CAP ORL CDC RPH CAP 0.776600002306905 RATIO-FINASTERIDE 5 MG TABLET ORL TAB RPH TAB 0.463300002241371 RATIO-FLUOXETINE HYDROCHLORIDE 10 MG CAPSULE ORL CAP RPH CAP 0.459500002241374 RATIO-FLUOXETINE HYDROCHLORIDE 20 MG CAPSULE ORL CAP RPH CAP 0.459800002296071 RATIO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM RPH DOSE 0.183100002218461 RATIO-FLUVOXAMINE 100 MG TABLET ORL TAB RPH TAB 0.378300002218453 RATIO-FLUVOXAMINE 50 MG TABLET ORL TAB RPH TAB 0.210500002275252 RATIO-FOSINOPRIL 10 MG TABLET ORL TAB RPH TAB 0.497700002275260 RATIO-FOSINOPRIL 20 MG TABLET ORL TAB RPH TAB 0.598500002260883 RATIO-GABAPENTIN 100 MG CAPSULE ORL CAP RPH CAP 0.074900002260905 RATIO-GABAPENTIN 400 MG CAPSULE ORL CAP RPH CAP 0.217100000805025 RATIO-GENTAMYCIN SULFATE 0.1% TOPICAL OINTMENT TOP ONT RPH G 0.427300002273101 RATIO-GLIMEPIRIDE 1 MG TABLET ORL TAB RPH TAB 0.490000002273128 RATIO-GLIMEPIRIDE 2 MG TABLET ORL TAB RPH TAB 0.490000002273136 RATIO-GLIMEPIRIDE 4 MG TABLET ORL TAB RPH TAB 0.490000002097168 RATIO-IPRATROPIUM UDV 250 MCG/ML INHALATION SOL'N INH UDSOL RPH ML 0.659000002243353 RATIO-LAMOTRIGINE 100 MG TABLET ORL TAB RPH TAB 0.573900002243352 RATIO-LAMOTRIGINE 25 MG TABLET ORL TAB RPH TAB 0.093600000653233 RATIO-LENOLTEC NO.1 TABLET ORL TAB RPH TAB 0.051700002031159 RATIO-LEVOBUNOLOL 0.25% OPH SOLUTION OPH SOL RPH ML 3.900000002031167 RATIO-LEVOBUNOLOL 0.5% OPH SOLUTION OPH SOL RPH ML 1.152000002248031 RATIO-MELOXICAM 15 MG TABLET ORL TAB RPH TAB 0.567000002247889 RATIO-MELOXICAM 7.5 MG TABLET ORL TAB RPH TAB 0.491400002320908 RATIO-MEMANTINE 10 MG TABLET ORL TAB RPH TAB 1.635700002194163 RATIO-NYSTATIN 100,000 UNIT/G VAGINAL CREAM VAG CRM RPH G 0.319100002278529 RATIO-ONDANSETRON 4 MG TABLET ORL TAB RPH TAB 3.3500

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002278537 RATIO-ONDANSETRON 8 MG TABLET ORL TAB RPH TAB 5.187700002308681 RATIO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RPH TAB 1.275000002247810 RATIO-PAROXETINE 10 MG TABLET ORL TAB RPH TAB 1.043000002301423 RATIO-PIOGLITAZONE 15 MG TABLET ORL TAB RPH TAB 0.580900002301431 RATIO-PIOGLITAZONE 30 MG TABLET ORL TAB RPH TAB 0.813900002301458 RATIO-PIOGLITAZONE 45 MG TABLET ORL TAB RPH TAB 1.223700002311194 RATIO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RPH CAP 0.813300002311291 RATIO-RIVASTIGMINE 3 MG CAPSULE ORL CAP RPH CAP 0.651400001986864 RATIO-SALBUTAMOL SULFATE U.D. P.F. 1 MG/ML INH SOL INH SOL RPH ML 0.144600002239366 RATIO-SALBUTAMOL SULFATE U.D. P.F. 2MG/ML INH SOL INH UDSOL RPH ML 0.274800002319500 RATIO-SILDENAFIL R 20 MG TABLET ORL TAB RPH TAB 7.294000000550507 RATIO-TRIACOMB REGULAR TOPICAL CREAM TOP CRM RPH G 0.402700000989994 RCF SOY FREE FORMULA ORL LIQ ABN ML 0.021100002223554 REACTINE 10 MG TABLET ORL TAB MCL TAB 0.704000001900978 REACTINE 20 MG TABLET ORL TAB MCL TAB 0.859500002223546 REACTINE 5 MG TABLET ORL TAB MCL TAB 0.498100002246162 REACTINE ALLERGY & SINUS EXTENDED-RELEASE TABLET ORL ERT MCL TAB 0.704000002368064 REACTINE ALLERGY LIQUID GELS 10 MG CAPSULE ORL CAP MCL CAP 0.717200002358352 REACTINE FAST MELT 10 MG ODT ORL ODT MCL TAB 0.636700002243676 RECOMBIVAX HB (PRESERVATIVE FREE) 5MCG/0.5ML INJ INJ DEFAUL MFC ML 22.800000000897221 REDOXON (LEMON) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.264000000897256 REDOXON (ORANGE) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.236700002138670 REFRESH 1.4% OPH SOLUTION OPH SOL ALL ML 0.853300002244650 REFRESH LIQUIGEL 1% OPH SOLUTION OPH SOL ALL ML 0.514000002399148 REFRESH OPTIVE ADVANCED NAS SOL ALL ML 0.895000002435578 REFRESH OPTIVE FUSION OPH SOLUTION OPH SOL ALL ML 0.950000002049260 REFRESH PLUS 0.5% OPH SOLUTION OPH SOL ALL ML 0.759200002231008 REFRESH TEARS 0.5% OPH SOLUTION OPH SOL ALL ML 0.416700002239405 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 1.841000002240863 RELENZA 5 MG/DOSE INHALATION DISK INH DSK GSK DISC 7.308000002308215 RELISTOR 20 MG/ML INJECTION INJ DEFAUL SLX ML 63.333300002256290 RELPAX 20 MG TABLET ORL TAB PFI TAB 13.880000002256304 RELPAX 40 MG TABLET ORL TAB PFI TAB 13.880000002248542 REMERON RD 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.424300002248543 REMERON RD 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.848300002248544 REMERON RD 45 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 1.272700002246552 REMODULIN 1 MG/ML INJECTION INJ DEFAUL NTH ML 45.000000002246555 REMODULIN 10 MG/ML INJECTION INJ DEFAUL NTH ML 450.0000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 88 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002246553 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 1.642600002354586 RENVELA 800 MG TABLET ORL TAB SAV TAB 1.550300002415968 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 0.107500002446057 REPATHA 140 MG/ML INJECTION SYRINGE/AUTOINJECTOR INJ NDL AMG SYR 279.360000002249057 REPLAGAL 1 MG/ML INJECTION INJ DEFAUL PAL ML 657.142900002247790 REPRONEX 75 UNIT/VIAL INJECTION INJ DEFAUL FEI VIAL 74.000000002377012 RESOTRAN 1 MG FILM-COATED TABLET ORL TAB JAI TAB 2.270000002377020 RESOTRAN 2 MG FILM-COATED TABLET ORL TAB JAI TAB 3.485000000999551 RESOURCE KID ESSENTIALS ORAL LIQUID ORL LIQ NHN ML 0.008700002355655 RESTASIS 0.05% OPH EMULSION OPH EML ALL ML 8.483300002318164 RESTORALAX ORAL POWDER ORL PWR SPL G 0.060300000443816 RETIN-A 0.025% TOPICAL GEL TOP GEL JJI G 0.399300000443794 RETIN-A 0.05% TOPICAL CREAM TOP CRM JJI G 0.399300002264633 RETIN-A MICRO 0.04% TOPICAL GEL TOP GEL VCL G 1.130500002243914 RETIN-A MICRO 0.1% GEL TOP GEL VCL G 1.130500002306980 RETISERT 0.59 MG INTRAVITREAL IMPLANT OPH IMP BSH SYS 16000.000000002008726 RETISOL-A 0.01% TOPICAL CREAM TOP CRM GSK G 0.735300002008696 RETISOL-A 0.025% TOPICAL CREAM TOP CRM GSK G 0.711600002008718 RETISOL-A 0.05% TOPICAL CREAM TOP CRM GSK G 0.711600002008688 RETISOL-A O.1% TOPICAL CREAM TOP CRM GSK G 0.711600001902660 RETROVIR 100 MG CAPSULE ORL CAP GSK CAP 1.889700001902652 RETROVIR 50 MG/5ML ORAL SYRUP ORL SYR GSK ML 0.197500002279401 REVATIO 20 MG TABLET ORL TAB PFI TAB 11.122000002445727 REVESTIVE 5 MG/VIAL INJECTION INJ DEFAUL NPS VIAL 904.000000002213826 REVIA 50 MG TABLET ORL TAB BAR TAB 8.591200002035871 REVITONUS C-1000 ORAL LIQUID ORL LIQ SDZ AMP 0.787500002304902 REVLIMID 10 MG CAPSULE ORL CAP CLG CAP 361.000000002317699 REVLIMID 15 MG CAPSULE ORL CAP CLG CAP 382.000000002440601 REVLIMID 20 MG CAPSULE ORL CAP CLG CAP 403.000000002317710 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 NOV TAB 62.500000002361833 REVOLADE 50 MG TABLET ORL TAB NOV TAB 125.000000002248610 REYATAZ 150 MG CAPSULE ORL CAP BMS CAP 11.058700002248611 REYATAZ 200 MG CAPSULE ORL CAP BMS CAP 11.058700002294176 REYATAZ 300 MG CAPSULE ORL CAP BMS CAP 22.1173

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002220806 RHINARIS LUBRICATING NASAL GEL NAS GEL PMS G 0.268900000732230 RHINARIS NASAL AEROSOL NAS AER PMS DOSE 0.193300080058002 RHINARIS NOZOIL NASAL SPRAY NAS SPR PPH ML 1.799000001950541 RHINARIS-CS 2% NASAL SOLUTION NAS SOL PPH ML 0.767700002231923 RHINOCORT AQUA 64 MCG/DOSE METERED DOSE NAS. SPRAY NAS SPM AZC DOSE 0.092000080026370 RHODIOLA ROSEA CAPSULE ORL CAP AOR CAP 0.254600002260107 RHOXAL-ANAGRELIDE 0.5 MG CAPSULE ORL CAP SDZ CAP 3.349100002269589 RHOXAL-GLIMEPIRIDE 1 MG TABLET ORL TAB SDZ TAB 0.490000002269597 RHOXAL-GLIMEPIRIDE 2 MG TABLET ORL TAB SDZ TAB 0.490000002269619 RHOXAL-GLIMEPIRIDE 4 MG TABLET ORL TAB SDZ TAB 0.490000002243559 RHOXAL-ORPHENADRINE 100 MG EXTENDED-RELEASE TABLET ORL ERT SDZ TAB 0.985600000309702 RIBOFLAVINE 100 MG TABLET ORL TAB JAM TAB 0.064700002091887 RIFADIN 150 MG CAPSULE ORL CAP SAV CAP 0.839500002092808 RIFADIN 300 MG CAPSULE ORL CAP SAV CAP 1.321100002347474 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 78.590000002247217 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 0.049500002388529 RIVA-CLOPIDOGREL 75 MG TABLET ORL TAB RIV TAB 0.473700002242468 RIVACOCET 5 MG/325 MG TABLET ORL TAB RIV TAB 0.128500002424436 RIVA-EZETIMIBE 10 MG TABLET ORL TAB RIV TAB 0.454900002247306 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 0.049000002337150 RIVA-OLANZAPINE 10 MG TABLET ORL TAB RIV TAB 1.2757

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002337169 RIVA-OLANZAPINE 15 MG TABLET ORL TAB RIV TAB 1.913600002337126 RIVA-OLANZAPINE 2.5 MG TABLET ORL TAB RIV TAB 0.318900002337134 RIVA-OLANZAPINE 5 MG TABLET ORL TAB RIV TAB 0.637900002337142 RIVA-OLANZAPINE 7.5 MG TABLET ORL TAB RIV TAB 0.956800002339838 RIVA-OLANZAPINE ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 1.275700002339846 RIVA-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 1.913700002392399 RIVA-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 2.544700002339811 RIVA-OLANZAPINE ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 0.638000002402416 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 0.240700002380056 RIVA-ROSUVASTATIN 10 MG TABLET ORL TAB RIV TAB 0.243700002380064 RIVA-ROSUVASTATIN 20 MG TABLET ORL TAB RIV TAB 0.304600002380102 RIVA-ROSUVASTATIN 40 MG TABLET ORL TAB RIV TAB 0.358200002202352 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 0.085300002242157 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 0.651400002307790 RIVA-VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAP ORL ERC RIV CAP 0.346900002307774 RIVA-VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAP ORL ERC RIV CAP 0.164300002307782 RIVA-VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC RIV CAP 0.328500002248082 RIVA-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT RIV TAB 0.507500002278030 RIVA-ZOPICLONE 5 MG TABLET ORL TAB RIV TAB 0.223100002278049 RIVA-ZOPICLONE 7.5 MG TABLET ORL TAB RIV TAB 0.468500002415801 RIZATRIPTAN ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB PDL TAB 3.705000002415798 RIZATRIPTAN ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB PDL TAB 3.705000002247147 ROBAX PLATINUM TABLET ORL TAB PDH TAB 0.636100002026805 ROBAXACET CAPLET ORL TAB PDH TAB 0.468900002231176 ROBAXACET EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.515000001934767 ROBAXACET-8 TABLET ORL TAB PDH TAB 0.708100001930990 ROBAXIN 500 MG TABLET ORL TAB PDH TAB 0.482600001932187 ROBAXIN-750 750 MG TABLET ORL TAB PDH TAB 0.7966

00002026783 ROBAXISAL CAPLET ORL TAB WCH TAB 0.402200002230949 ROBAXISAL EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.5150

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 91 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001934791 ROBAXISAL-C 1/2 TABLET ORL TAB PDH TAB 1.178800001934783 ROBAXISAL-C 1/4 TABLET ORL TAB PDH TAB 0.986700001931032 ROBITUSSIN 20 MG ORAL SYRUP ORL SYR PDH ML 0.050800002142783 ROBITUSSIN 200 MG/5 ML EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.050800001934740 ROBITUSSIN A-C ORAL SYRUP ORL SYR PDH ML 0.101900002068419 ROBITUSSIN COUGH AND COLD ORAL SYRUP ORL SYR PDH ML 0.050800002142775 ROBITUSSIN DM EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.050800001931024 ROBITUSSIN DM ORAL SYRUP ORL SYR PDH ML 0.050800002318415 ROCURONIUM BROMIDE 10MG/ML INJECTION INJ DEFAUL SDZ ML 1.026000000393444 ROFACT 150 MG CAPSULE ORL CAP VCL CAP 0.676500000343617 ROFACT 300 MG CAPSULE ORL CAP VCL CAP 1.064900000708925 ROGAINE 20 MG/ML TOPICAL SOLUTION TOP SOL JJI ML 0.610200002368684 ROGAINE FOAM 50 MG/G AEROSOL FOAM TOP FOA JJI G 0.492600002242979 ROGITINE 10 MG/ML INJECTION INJ DEFAUL PAL ML 46.996000002353067 ROPINIROLE 2 MG TABLET ORL TAB SNS TAB 0.312200002353075 ROPINIROLE 5 MG TABLET ORL TAB SNS TAB 0.859600002242919 ROSASOL 1% TOPICAL CREAM TOP CRM GSK G 0.525700002440342 ROSIVER 1% TOPICAL CREAM TOP CRM GAL G 2.719800002381184 ROSUVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.340000002389045 ROSUVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.340000002381192 ROSUVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.425000002389053 ROSUVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.425000002381206 ROSUVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.497700002389061 ROSUVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.497700002389037 ROSUVASTATIN 5 MG TABLET ORL TAB SIV TAB 0.322700002381176 ROSUVASTATIN 5 MG TABLET ORL TAB PDL TAB 0.322700002300591 ROTARIX 1 000 000 CCID50/DOSE (1.5ML) ORAL SUSP ORL SUS GSK DOSE 81.260000002284413 ROTATEQ (2 ML/DOSE) ORAL SOLUTION ORL SOL MFC ML 29.025000000466425 ROUGIER CALCIUM ORAL LIQUID ORL LIQ ROG ML 0.021000002248563 RUB A535 DUAL ACTION TOP CRM CHD G 0.057000002222116 RUB A-535 EXTRA STRENGTH TOP CRM CHD G 0.057000080015240 RUGBY NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM APH PIECE 0.165000002245735 SAB-SODIUM CHLORIDE 5% OPTHALMIC SOLUTION USP OPH SOL SDZ ML 0.563300000623571 SALIJECT 570 MG/ML INJECTION INJ DEFAUL OMG ML 1.800000080024381 SALINEX 9 MG/ML NASAL SPRAY NAS SPR SDZ ML 0.130700000779296 SALINEX NASAL LUBRICANT GEL NAS GEL SDZ G 0.140700001910701 SALINEX NASAL LUBRICANT SPRAY NAS SPR SDZ ML 0.169700080004542 SALMON & FISH OILS 1000 MG SOFTGEL ORL TAB WNP TAB 0.056800080003356 SALMON AND FISH OILS ORAL CAPSULE ORL CAP JAM CAP 0.092300002370468 SAMSCA 15 MG TABLET ORL TAB OTS TAB 90.4110

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 92 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002370476 SAMSCA 30 MG TABLET ORL TAB OTS TAB 90.411000000593257 SANDIMMUNE I.V. 50 MG/ML INJECTION INJ DEFAUL NOV ML 4.417000002288079 SANDOZ ALENDRONATE 5 MG TABLET ORL TAB SDZ TAB 1.037000002338467 SANDOZ ANASTROZOLE 1 MG TABLET ORL TAB SDZ TAB 2.545700002386410 SANDOZ ATOMOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 2.314000002386429 SANDOZ ATOMOXETINE 18 MG CAPSULE ORL CAP SDZ CAP 2.652300002386437 SANDOZ ATOMOXETINE 25 MG CAPSULE ORL CAP SDZ CAP 2.928000002386445 SANDOZ ATOMOXETINE 40 MG CAPSULE ORL CAP SDZ CAP 3.337300002386453 SANDOZ ATOMOXETINE 60 MG CAPSULE ORL CAP SDZ CAP 3.702300002386461 SANDOZ ATOMOXETINE 80 MG CAPSULE ORL CAP SDZ CAP 3.996300002276089 SANDOZ BICALUTAMIDE 50 MG TABLET ORL TAB SDZ TAB 4.057300002386283 SANDOZ BOSENTAN 125 MG TABLET ORL TAB SDZ TAB 48.134000002386275 SANDOZ BOSENTAN 62.5 MG TABLET ORL TAB SDZ TAB 48.134000002392267 SANDOZ CANDESARTAN 32 MG TABLET ORL TAB SDZ TAB 0.300900002326957 SANDOZ CANDESARTAN 4 MG TABLET ORL TAB SDZ TAB 0.340000002421917 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 0.074900002303426 SANDOZ CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS SDZ ML 0.059200002303434 SANDOZ CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS SDZ ML 0.118500002387131 SANDOZ CIPROFLOXACIN 0.3% OPHTHALMIC SOLUTION OPH SOL SDZ ML 1.860000002233960 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 1.140000002400596 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 ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 3.617700002367688 SANDOZ DONEPEZIL ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 3.617700002278634 SANDOZ FAMCICLOVIR 125 MG TABLET ORL TAB SDZ TAB 2.024000002278642 SANDOZ FAMCICLOVIR 250 MG TABLET ORL TAB SDZ TAB 2.720000002278650 SANDOZ FAMCICLOVIR 500 MG TABLET ORL TAB SDZ TAB 4.228100002390701 SANDOZ FENOFIBRATE E 145 MG TABLET ORL TAB SDZ TAB 0.911300002390698 SANDOZ FENOFIBRATE E 48 MG TABLET ORL TAB SDZ TAB 0.356000002327139 SANDOZ FENTANYL PATCH 37 MCG/HR TRANSDERMAL PATCH TRD PTH SDZ PTH 8.500000002339471 SANDOZ FINASTERIDE A 1 MG TABLET ORL TAB SDZ TAB 1.145500002243486 SANDOZ FLUOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 0.459500002243487 SANDOZ FLUOXETINE 20 MG CAPSULE ORL CAP SDZ CAP 0.4598

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 93 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002248009 SANDOZ GLYBURIDE 5 MG TABLET ORL TAB SDZ TAB 0.057300002237187 SANDOZ IDOXURIDINE 0.1% TOPICAL SOLUTION TOP SOL SDZ ML 4.990000002344815 SANDOZ LETROZOLE 2.5 MG TABLET ORL TAB SDZ TAB 2.756000002241716 SANDOZ LEVOBUNOLOL 0.5% OPH SOLUTION OPH SOL SDZ ML 1.152000002247056 SANDOZ LOVASTATIN 20 MG TABLET ORL TAB SDZ TAB 0.491900002344807 SANDOZ MEMANTINE 10 MG TABLET ORL TAB SDZ TAB 1.635700002375532 SANDOZ MEMANTINE FCT 10 MG TABLET ORL TAB SDZ TAB 1.635700002250594 SANDOZ MIRTAZAPINE 15 MG TABLET ORL TAB SDZ TAB 0.375000002411520 SANDOZ MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL SDZ ML 3.756700002320630 SANDOZ MYCOPHENOLATE MOFETIL 250 MG CAPSULE ORL CAP SDZ CAP 1.031000002313855 SANDOZ MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB SDZ TAB 2.062000002234007 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 5.355300002327805 SANDOZ OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 7.597700002358913 SANDOZ OLOPATADINE 0.1% OPH SOLUTION OPH SOL SDZ ML 5.226000002420171 SANDOZ OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL SDZ ML 10.452000002301075 SANDOZ PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SDZ TAB 1.275000002269422 SANDOZ PAROXETINE 10 MG TABLET ORL TAB SDZ TAB 1.043000002269449 SANDOZ PAROXETINE 30 MG TABLET ORL TAB SDZ TAB 0.479600002261790 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 0.136100002239234 SANDOZ POLYTRIMETHOPRIM OPH SOLUTION OPH SOL SDZ ML 2.904000002315270 SANDOZ PRAMIPEXOLE 0.5 MG TABLET ORL TAB SDZ TAB 1.386000002247856 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 0.575500002390841 SANDOZ PREGABALIN 150 MG CAPSULE ORL CAP SDZ CAP 1.727000002390817 SANDOZ PREGABALIN 25 MG CAPSULE ORL CAP SDZ CAP 0.617200002390868 SANDOZ PREGABALIN 300 MG CAPSULE ORL CAP SDZ CAP 1.727000002390825 SANDOZ PREGABALIN 50 MG CAPSULE ORL CAP SDZ CAP 0.968200002390833 SANDOZ PREGABALIN 75 MG CAPSULE ORL CAP SDZ CAP 1.252800002154412 SANDOZ SALBUTAMOL 5 MG/ML INHALATION SOLUTION INH SOL SDZ ML 0.351000002089645 SANDOZ SENNOSIDES 12 MG TABLET ORL TAB SDZ TAB 0.060400080024148 SANDOZ SENNOSIDES 8.6 MG TABLET ORL TAB SDZ TAB 0.050500002318822 SANDOZ SILDENAFIL 100 MG TABLET ORL TAB SDZ TAB 9.200600002318806 SANDOZ SILDENAFIL 25 MG TABLET ORL TAB SDZ TAB 8.290000002318814 SANDOZ SILDENAFIL 50 MG TABLET ORL TAB SDZ TAB 8.8481

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 94 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247828 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 0.450100002247833 SANDOZ SIMVASTATIN 80 MG TABLET ORL TAB SDZ TAB 0.625100002416816 SANDOZ TACROLIMUS 0.5 MG CAPSULE ORL CAP SDZ CAP 1.477500002416824 SANDOZ TACROLIMUS 1 MG CAPSULE ORL CAP SDZ CAP 1.890000002416832 SANDOZ TACROLIMUS 5 MG CAPSULE ORL CAP SDZ CAP 9.465000002295121 SANDOZ TAMSULOSIN 0.4 MG SUSTAINED-RELEASE CAPSULE ORL SRC SDZ CAP 0.150000002262177 SANDOZ TERBINAFINE 250 MG TABLET ORL TAB SDZ TAB 1.852500002260069 SANDOZ TOPIRAMATE 100 MG TABLET ORL TAB SDZ TAB 0.623500002267837 SANDOZ TOPIRAMATE 200 MG TABLET ORL TAB SDZ TAB 0.885300002260050 SANDOZ TOPIRAMATE 25 MG TABLET ORL TAB SDZ TAB 0.312800002413817 SANDOZ TRAVOPROST/TIMOLOL PQ 0.004%/0.5% OPH SOL OPH SOL SDZ ML 11.288000002356740 SANDOZ VALSARTAN 40 MG TABLET ORL TAB SDZ TAB 0.524000000578541 SARNA HC 1% TOPICAL LOTION TOP LOT GSK ML 0.093800000856711 SARNA HC 2.5% TOPICAL LOTION TOP LOT GSK ML 0.181300002266121 SATIVEX BUCCAL SPRAY BUC SPR BHP ML 20.990000002437899 SAXENDA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 22.830000080041540 SCHINOUSSA PROBIOTIC WHEY ISOLATE ORAL POWDER ORL PWR QUA G 0.035700001919245 SCHOLL ATHLETE'S FOOT SPRAY 1% TOPICAL POWDER TOP PWR SCH G 0.046200002020939 SCLERODEX INJECTION INJ DEFAUL OMG ML 1.650000002020793 SCLERODINE 6 INJECTION INJ DEFAUL OMG ML 3.180000000541869 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL HSP ML 4.890000002242811 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL OMG ML 5.450000000541877 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL HSP ML 5.360000002296659 SEASONALE (91 DAY) TABLET ORL TAB ASC TAB 0.642600002346176 SEASONIQUE (91 DAY) TABLET ORL TAB ASC TAB 0.642600000666106 SEBCUR 4% TOPICAL SHAMPOO TOP SHP DPT ML 0.057500000666114 SEBCUR-T TOPICAL SHAMPOO TOP SHP DPT ML 0.066700002288389 SEBIVO 600 MG TABLET ORL TAB NOV TAB 17.731100000551805 SECARIS NASAL GEL NAS GEL PMS G 0.324000000633380 SELENIUM 100 MCG TABLET ORL TAB JAM TAB 0.072100000554987 SELENIUM 50 MCG TABLET ORL TAB JAM TAB 0.064100000243000 SELSUN 2.5% TOPICAL SOLUTION TOP SOL ABB ML 0.044800000483796 SELSUN BLUE 1% TOPICAL LOTION TOP LOT ABB ML 0.023600000709069 SELSUN BLUE EXTRA CONDITIONING 1% TOPICAL SHAMPOO TOP SHP ABB ML 0.023600002247134 SENNA LAXATIVE & DOCUSATE SODIUM 8.6MG/50MG TABLET ORL TAB VTH TAB 0.115200002237105 SENNA LAXATIVE 8.6 MG TABLET ORL TAB SDR TAB 0.024900002257130 SENSIPAR 30 MG TABLET ORL TAB AMG TAB 12.005300002257149 SENSIPAR 60 MG TABLET ORL TAB AMG TAB 21.8913

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 95 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002257157 SENSIPAR 90 MG TABLET ORL TAB AMG TAB 31.855700002357704 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 BGP TAB 0.700000002239046 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 0.900000080039305 SIERRASIL JOINT FORMULA 14 CAPSULE ORL CAP SMM CAP 0.212700002413299 SIGNIFOR 0.3 MG/ML INJECTION INJ DEFAUL NOV ML 76.679000002413302 SIGNIFOR 0.6 MG /ML INJECTION INJ DEFAUL NOV ML 85.516000002413310 SIGNIFOR 0.9 MG /ML INJECTION INJ DEFAUL NOV ML 85.516000002437260 SIGNIFOR LAR 40 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4840.000000002437279 SIGNIFOR LAR 60 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4840.000000002317583 SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.200700002406160 SILDENAFIL 100 MG TABLET ORL TAB SNS TAB 9.200000002424320 SILDENAFIL 100 MG TABLET ORL TAB PDL TAB 9.200000002317559 SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.290000002424312 SILDENAFIL 50 MG TABLET ORL TAB PDL TAB 8.847500002406152 SILDENAFIL 50 MG TABLET ORL TAB SNS TAB 8.847500002317575 SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 8.848000002398257 SILENOR 3 MG TABLET ORL TAB PAL TAB 0.600300002398265 SILENOR 6 MG TABLET ORL TAB PAL TAB 1.201300080012979 SILICA WITH ZINC CAPLET ORL TAB JAM TAB 0.193700002338572 SILKIS 3 MCG/G TOPICAL OINTMENT TOP ONT GAL G 1.250000000999793 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED BOTTLE ORL LIQ ABN ML 0.009900000999794 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED CAN ORL LIQ ABN ML 0.011700000999792 SIMILAC ADVANCE OMEGA-3 & 6 CONCENTRATED LIQUID ORL LIQ ABN ML 0.010400000999791 SIMILAC ADVANCE OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.041500000999788 SIMILAC ALIMENTUM OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.038100000999789 SIMILAC ISOMIL OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.030600000999790 SIMILAC ISOMIL STEP 2 INFANT FORMULA POWDER ORL PWR ABN G 0.030600000999797 SIMILAC PARTIALLY BROKEN DOWN PROTEIN POWDER ORL PWR ABN G 0.005700000999796 SIMILAC SENSITIVE INFANT FORMULA CONCENTRATED LIQ ORL LIQ ABN ML 0.010400000999795 SIMILAC SENSITIVE INFANT FORMULA POWDER ORL PWR ABN G 0.037500002239548 SIMPLY SLEEP 25 MG CAPLET ORL TAB MCL TAB 0.201500002413183 SIMPONI 100 MG/1 ML INJECTION AUTO INJECTOR INJ NDL JAI SYR 1481.910000002413175 SIMPONI 100 MG/1 ML INJECTION SYRINGE INJ NDL JAI SYR 1481.910000002417472 SIMPONI I.V. 50 MG/4.0 ML VIAL INJECTION INJ DEFAUL JAI ML 206.7150

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002247224 SIMVASTATIN-80 80 MG TABLET ORL TAB PDL TAB 0.625000002378892 SIMVASTATIN-ODAN 10 MG TABLET ORL TAB ODN TAB 0.364200002378906 SIMVASTATIN-ODAN 20 MG TABLET ORL TAB ODN TAB 0.450100002378914 SIMVASTATIN-ODAN 40 MG TABLET ORL TAB ODN TAB 0.450100002378884 SIMVASTATIN-ODAN 5 MG TABLET ORL TAB ODN TAB 0.184100002378922 SIMVASTATIN-ODAN 80 MG TABLET ORL TAB ODN TAB 0.450100001926055 SINUTAB N.D. REGULAR STRENGTH TABLET ORL TAB MCL TAB 0.180800001938371 SINUTAB NO DROWSINESS EXTRA STRENGTH TABLET ORL TAB MCL TAB 0.262900001926004 SINUTAB REGULAR STRENGTH TABLET ORL TAB MCL TAB 0.198800001938363 SINUTAB WITH CODEINE TABLET ORL TAB MCL TAB 0.406300001994247 SLEEP AID (REGULAR STRENGTH) 25 MGTABLET ORL TAB TAN TAB 0.095000000074225 SLOW K 8 MEQ SUSTAINED-RELEASE TABLET ORL SRT NOV TAB 0.147500000623520 SLOW-FE 160 MG TABLET ORL SRT CGS TAB 0.267700000481912 SODIUM BICARBONATE 325 MG TABLET ORL TAB SLW TAB 0.030400080022194 SODIUM BICARBONATE 500 MG TABLET ORL TAB SDZ TAB 0.075400000261998 SODIUM BICARBONATE 8.4 % INJECTION INJ DEFAUL HSP ML 0.546000000037842 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.099400000060208 SODIUM CHLORIDE 0.9% INJECTION USP INJ DEFAUL BAX ML 0.121200000851388 SODIUM CHLORIDE 0.9% NASAL SPRAY NAS SPR SFY ML 0.035700002139510 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL FKC ML 0.335600000392499 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL SDZ ML 4.279000000402230 SODIUM CHLORIDE 234 MG/ML INJECTION USP INJ DEFAUL OMG ML 0.366700002150204 SODIUM CHLORIDE 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.335000000037834 SODIUM CHLORIDE 9 MG/ML IRRIGATION SOLUTION IR SOL HSP ML 0.022400000402249 SODIUM CHLORIDE BACTERIOSTATIC 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.165000000268313 SODIUM EDECRIN 50 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 494.640000000896187 SODIUM PHOSPHATE INJECTION INJ DEFAUL SDZ ML 1.125900000028053 SODIUM SULAMYD 10% OPH SOLUTION OPH SOL SDZ ML 0.493300002006758 SOFLAX 4 MG/ML ORAL SYRUP ORL SYR PMS ML 0.023200002224887 SOFRAMYCIN 0.5% OPH SOLUTION OPH SOL ERF ML 1.366300002224879 SOFRAMYCIN 15 MG/50 MCG TOPICAL OINTMENT TOP ONT ERF G 1.089300002224860 SOFRAMYCIN NASAL SPRAY NAS SPR ERF ML 2.866700001988840 SOFRA-TULLE (10 X 10 CM) TOPICAL GAUZE TOP GAU ERF DRE 1.550000001987682 SOFRA-TULLE STRIP (10 X 30 CM) TOPICAL GAUZE TOP GAU AVE DRE 3.600000002243257 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 40 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 5.267200000690333 SOLUVER 20% TOPICAL SOLUTION TOP SOL DPT ML 0.7500

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 97 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000837733 SOLUVER PLUS LIQ 27% TOP SOL DPT ML 1.200000002272199 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 0.114500002237578 SPASMHALT-8 CAPLET ORL TAB PPH TAB 0.343300002237580 SPASMHALT-ASA-8 CAPLET ORL TAB WAM TAB 0.330000000999031 SPECIAL ACCESS DRUG - DEFLAZACORT ORL TAB XXX TAB 0.315800000999034 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 CHEW TAB ORL CTB MVW TAB 0.516800000999033 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 SOFTGEL ORL CAP MVW CAP 0.470500000999035 SPECIAL ACCESS DRUG - MVW COMPLETE FORMULATION DRP ORL DPS MVW ML 0.875700000999036 SPECIAL ACCESS DRUG - OSPOLOT DEFAUL DEFAUL XXX 0.422100000999037 SPECIAL ACCESS DRUG - STEROGYL 15 INJECTION INJ DEFAUL XXX ML 48.353300002214415 SPECTRO ECZEMACARE MEDICATED CREAM TOP CRM GKC G 0.440000002435381 SPIRIVA RESPIMAT 2.5 MCG/ACTUATION INH SOLUTION INH SOL BOE DOSE 1.083300002320193 SPRYCEL 100 MG TABLET ORL TAB BMS TAB 152.955300002293129 SPRYCEL 20 MG TABLET ORL TAB BMS TAB 38.405300002293137 SPRYCEL 50 MG TABLET ORL TAB BMS TAB 77.294300002293145 SPRYCEL 70 MG TABLET ORL TAB BMS TAB 84.760500001938991 STANHEXIDINE 2% SOL WITH 4% ISOPROPYL ALCOHOL TOP SOL OMG ML 0.009700001938983 STANHEXIDINE 4% WITH 4% ISOPROPYL ALCOHOL SOLUTION TOP SOL OMG ML 0.015300002245439 STARLIX 120 MG TABLET ORL TAB NOV TAB 0.558200002245438 STARLIX 60 MG TABLET ORL TAB NOV TAB 0.558200002372436 STAXYN 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BAI TAB 6.632500002230192 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL HSP VIAL 78.890000002139383 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 95.166000002139243 STERILE VANCOMYCIN HCL 5 G/VIAL INJECTION INJ DEFAUL FKC VIAL 509.790000002139375 STERILE VANCOMYCIN HCL 500 MG/VIAL INJ USP INJ DEFAUL FKC VIAL 47.704000002230191 STERILE VANCOMYCIN HCL 500 MG/VIAL INJECTION INJ DEFAUL HSP VIAL 41.520000000038245 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.095000002142546 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.185000000402257 STERILE WATER FOR INJECTION DEFAUL INJ OMG ML 0.350000002247228 STIEPROX 1.5 % TOPICAL SHAMPOO TOP SHP GSK ML 0.134700001945262 STIEVAMYCIN FORTE TOPICAL GEL TOP GEL GSK G 0.842700002015994 STIEVAMYCIN MILD TOPICAL GEL TOP GEL GSK G 0.842700001905112 STIEVAMYCIN REGULAR TOPICAL GEL TOP GEL GSK G 0.842700002125277 STILAMIN 3 MG/AMPOULE INJECTION INJ DEFAUL SRO VIAL 210.000000002403390 STIVARGA 40 MG TABLET ORL TAB BAI TAB 72.620000002262800 STRATTERA 10 MG CAPSULE ORL CAP LIL CAP 2.836400002279355 STRATTERA 100 MG CAPSULE ORL CAP LIL CAP 5.3529

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 98 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002262819 STRATTERA 18 MG CAPSULE ORL CAP LIL CAP 3.193600002262827 STRATTERA 25 MG CAPSULE ORL CAP LIL CAP 3.566400002262835 STRATTERA 40 MG CAPSULE ORL CAP LIL CAP 4.093900002262843 STRATTERA 60 MG CAPSULE ORL CAP LIL CAP 4.495400002279347 STRATTERA 80 MG CAPSULE ORL CAP LIL CAP 4.877100002444615 STRENSIQ 18 MG/VIAL INJECTION INJ DEFAUL APG VIAL 1836.000000002444623 STRENSIQ 28 MG/VIAL INJECTION INJ DEFAUL APG VIAL 2856.000000002444631 STRENSIQ 40 MG/VIAL INJECTION INJ DEFAUL APG VIAL 4080.000000002444658 STRENSIQ 80 MG/VIAL INJECTION INJ DEFAUL APG VIAL 8160.000000002243660 STREPTOMYCIN 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 89.000000000613959 STRESS FORMULA VITAMIN WITH ZINC CAPSULE ORL CAP WAM CAP 0.061700002174383 STRESSEASE MULTIVITAMIN AND MINERAL CAPLET ORL TAB JAM TAB 0.1080

00002166615 STRESSTABS + ZINC-COPPER TABLET ORL TAB WCH TAB 0.101700080009625 STRESSTABS FOR WOMEN TABLET ORL TAB PDH TAB 0.1042

00002167948 STRESSTABS PLUS IRON TABLET ORL TAB WCH TAB 0.101700002397137 STRIBILD TABLET ORL TAB GIL TAB 46.389400002370433 SUBLINOX 10 MG SUBLINGUAL DISINTEGRATING TABLET SLG DISNTAB MED TAB 1.353700002391678 SUBLINOX 5 MG SUBLINGUAL DISINTEGRATING TAB SLG DISNTAB MED TAB 1.353700002130939 SUCRALFATE-1 1 G TABLET ORL TAB PDL TAB 0.130900002238099 SUDAFED DECONGESTANT 12-HOUR 120 MG CAPLET ORL TAB MCL TAB 0.485000002237793 SUDAFED DECONGESTANT EXTRA STRENGTH 60 MG TABLET ORL TAB MCL TAB 0.290800002250217 SUDAFED PE DECONGESTANT 10 MG TABLET ORL TAB MCL TAB 0.300000001951319 SUFENTA 50 MCG/ML INJECTION INJ DEFAUL JAI ML 6.448000002244147 SUFENTANIL CITRATE USP 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 13.550000002220407 SULFACET-R TOPICAL LOTION TOP LOT VCL G 1.030000000187534 SULFUR TOPICAL SOAP TOP SOP VCL G 0.073300002324660 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 0.125100080011269 SUPER MULTI IRON FREE TABLET ORL TAB NFN TAB 0.214300080023127 SUPER STRAIN ACIDOPHILUS PROBIOTIC 2 BILLION ORL CAP JAM CAP 0.125800002242658 SUPER STRENGTH MOTRIN IB 400 MG TABLET ORL TAB MCL TAB 0.184400080017929 SUPER VITA VIM CAPLET ORL TAB JMS TAB 0.128300002242595 SUPER VITA-VIM CAPLET ORL TAB JAM TAB 0.133400002240749 SUPREFACT DEPOT 9.45 MG IMPLANT INJECTION INJ IMP SAV SYS 1154.310000002239888 SUSTIVA 200 MG CAPSULE ORL CAP BMS CAP 4.982300002239886 SUSTIVA 50 MG CAPSULE ORL CAP BMS CAP 1.2457

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 99 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002246045 SUSTIVA 600 MG TABLET ORL TAB BMS TAB 14.947000002280795 SUTENT 12.5 MG CAPSULE ORL CAP PFI CAP 63.720700002280809 SUTENT 25 MG CAPSULE ORL CAP PFI CAP 127.441100002280817 SUTENT 50 MG CAPSULE ORL CAP PFI CAP 254.882500000253952 SYNACTHEN DEPOT 1 MG/ML INJECTION INJ DEFAUL QST VIAL 680.000000002245890 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 0.443300000990010 SYNVISC DEFAUL DEV GZB ML 67.910000000999331 SYNVISC ONE DEFAUL DEV GZB ML 69.011700002248967 SYSTANE OPHTHALMIC SOLUTION OPH SOL ALC ML 0.526700000999333 SYSTANE ULTRA OPH DPS ALC ML 0.959800080032792 SYSTANE VITAMIN- OMEGA 3 CAPSULE ORL CAP ALC CAP 0.219700002239122 T.R. SWISS ONE 50 MULTIVITAMIN & MINERAL TABLET ORL TAB SWS TAB 0.204800002365871 TACTUPUMP 0.1%/2.5% TOPICAL GEL TOP GEL GAL G 1.412900002446235 TACTUPUMP FORTE 0.3%/2.5% TOPICAL GEL TOP GEL GAL G 2.342900002409607 TAFINLAR 50 MG CAPSULE ORL CAP NOV CAP 42.222300002409615 TAFINLAR 75 MG CAPSULE ORL CAP NOV CAP 63.333300002304848 TAMIFLU 30 MG CAPSULE ORL CAP HLR CAP 2.037000002304856 TAMIFLU 45 MG CAPSULE ORL CAP HLR CAP 3.135000002381842 TAMIFLU 6 MG/ML ORAL SUSPENSION ORL SUS HLR ML 0.313400002241472 TAMIFLU 75 MG CAPSULE ORL CAP HLR CAP 4.075000001926624 TAMOFEN 10 MG TABLET ORL TAB SAV TAB 0.175000002413612 TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.150000001962353 TANTAPHEN EXTRA STRENGTH 500 MG CAPLET ORL TAB TAN TAB 0.021400002296039 TAPAZOLE 10 MG TABLET ORL TAB PAL TAB 0.560900002269015 TARCEVA 100 MG TABLET ORL TAB HLR TAB 53.813300002269023 TARCEVA 150 MG TABLET ORL TAB HLR TAB 80.720000002269007 TARCEVA 25 MG TABLET ORL TAB HLR TAB 13.333300000510335 TARGEL SA TOPICAL LIQUID TOP LIQ ODN G 0.188000000344508 TARGEL TOPICAL GEL TOP GEL ODN G 0.168000002339609 TARGIN 10 MG/ 5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.966000002339617 TARGIN 20 MG/ 10 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.449000002339625 TARGIN 40 MG/ 20 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 2.510000002387425 TARGIN 5 MG/ 2.5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.693000002240945 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 BGP TAB 1.769800002238097 TARKA 4 MG/ 240 MG TABLET ORL TAB BGP TAB 1.9640

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 100 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002365650 TARO-ANASTROZOLE 1 MG TABLET ORL TAB TAR TAB 1.273000002244403 TARO-CARBAMAZEPINE 100 MG CHEWABLE TABLET ORL CTB TAR TAB 0.118800002244404 TARO-CARBAMAZEPINE 200 MG CHEWABLE TABLET ORL CTB TAR TAB 0.235400002353288 TARO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL TAR G 7.743300002266938 TARO-CLINDAMYCIN 1% (BASE) TOPICAL SOLUTION TOP SOL TAR ML 0.261300002420988 TARO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL TAR ML 0.622700002264749 TARO-MOMETASONE 0.1% OINTMENT TOP ONT TAR G 0.272000001925350 TARO-SONE 0.05% TOPICAL CREAM TOP CRM TAR G 0.204800002443511 TARO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP TAR CAP 113.596500002443538 TARO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP TAR CAP 159.036000002443481 TARO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP TAR CAP 22.720000002443554 TARO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP TAR CAP 283.984000002443473 TARO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP TAR CAP 6.630000002247651 TARO-TERCONAZOLE 0.4% VAGINAL CREAM VAG CRM TAR G 0.529600002368250 TASIGNA 150 MG CAPSULE ORL CAP NOV CAP 27.932400002315874 TASIGNA 200 MG CAPSULE ORL CAP NOV CAP 39.295400002177099 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 456.940000002170817 TAZOCIN 2 G/250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 11.922000002170795 TAZOCIN 3 G/375 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 17.883000002170809 TAZOCIN 4 G/500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 23.845000002243894 TAZORAC 0.05% TOPICAL CREAM TOP CRM ALL G 1.360000002243895 TAZORAC 0.1% TOPICAL CREAM TOP CRM ALL G 1.360000000615358 TD POLIO ADSORBED FOR ADULT INJECTION INJ DEFAUL SFP VIAL 60.224000001950010 TEARS ENCORE 1.4% OPH SOLUTION OPH SOL AKN ML 0.971000002246397 TEARS NATURAL FORTE OPH SOLUTION OPH SOL ALC ML 0.408700001943308 TEARS NATURALE FREE OPH SOLUTION OPH SOL ALC ML 0.494400000743445 TEARS NATURALE II OPH SOLUTION OPH SOL ALC ML 0.422000000390291 TEARS NATURALE OPH DROPS OPH DPS ALC ML 0.422000002082519 TEARS NATURALE P.M. OPH OINTMENT OPH ONT ALC G 1.545700000579408 TEARS PLUS 1.4% OPH SOLUTION OPH SOL ALL ML 0.480000000283991 TEBRAZID 500 MG TABLET ORL TAB VCL TAB 0.498000002420201 TECFIDERA 240 MG DELAYED-RELEASE CAPSULE ORL DRC BIO CAP 33.032900002447711 TECHNIVIE TABLET ORL TAB ABV TAB 332.500000002395223 TELMISARTAN 40 MG TABLET ORL TAB PDL 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 8.0863

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 101 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002241095 TEMODAL 100 MG CAPSULE ORL CAP MFC CAP 153.404500002321262 TEMODAL 100 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 411.260000002312794 TEMODAL 140 MG CAPSULE ORL CAP MFC CAP 214.768000002312816 TEMODAL 180 MG CAPSULE ORL CAP MFC CAP 264.380500002241094 TEMODAL 20 MG CAPSULE ORL CAP MFC CAP 30.682000002241096 TEMODAL 250 MG CAPSULE ORL CAP MFC CAP 383.500000002241093 TEMODAL 5 MG CAPSULE ORL CAP MFC CAP 7.670500000875988 TEMPRA INFANT 80 MG/ML ORAL DROPS ORL DPS PAL ML 0.250000000894710 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 0.706000002242735 TERBINAFINE-250 MG TABLET ORL TAB PDL TAB 1.852700000632317 TERSASEPTIC 0.5% TOPICAL SHAMPOO TOP SHP GSK ML 0.027300000632295 TERSA-TAR MILD 1% TOPICAL SHAMPOO TOP SHP GSK ML 0.036700002280248 TESTIM 1% TOPICAL GEL TOP GEL PAL G 0.744400002246063 TESTOSTERONE CYPIONATE 100 MG/ML INJECTION USP INJ DEFAUL SDZ ML 2.358000000514462 TETANUS & DIPHTHERIA TOXOIDS ADULT INJECTION INJ LIQ CNG ML 43.380000002148528 TETRACAINE 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002248251 TEVA-ALENDRONATE 5 MG TABLET ORL TAB TEV TAB 1.037000002403633 TEVA-ALENDRONATE/CHOLECALCIFEROL 70 MG/2800 U TAB ORL TAB TEV TAB 3.730000002326043 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 2.546000001912054 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 2.314000002362538 TEVA-ATOMOXETINE 100 MG CAPSULE ORL CAP TEV CAP 4.352000002314568 TEVA-ATOMOXETINE 18 MG CAPSULE ORL CAP TEV CAP 2.652300002314576 TEVA-ATOMOXETINE 25 MG CAPSULE ORL CAP TEV CAP 2.928000002314584 TEVA-ATOMOXETINE 40 MG CAPSULE ORL CAP TEV CAP 3.337700002314592 TEVA-ATOMOXETINE 60 MG CAPSULE ORL CAP TEV CAP 3.702300002362511 TEVA-ATOMOXETINE 80 MG CAPSULE ORL CAP TEV CAP 3.996000002380927 TEVA-ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB TEV TAB 4.131000002280205 TEVA-BETAHISTINE 24 MG TABLET ORL TAB TEV TAB 0.498300002280183 TEVA-BETAHISTINE 8 MG TABLET ORL TAB TEV TAB 0.211100002398419 TEVA-BOSENTAN 125 MG TABLET ORL TAB TEV TAB 48.134000002398400 TEVA-BOSENTAN 62.5 MG TABLET ORL TAB TEV TAB 48.134000002395576 TEVA-CANDESARTAN/HCTZ 32 MG/25 MG TABLET ORL TAB TEV TAB 0.898500002400022 TEVA-CAPECITABINE 150 MG TABLET ORL TAB TEV TAB 1.4640

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 102 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002400030 TEVA-CAPECITABINE 500 MG TABLET ORL TAB TEV TAB 4.880000002239355 TEVA-DIFENAC-K 50 MG TABLET ORL TAB TEV TAB 0.393700002389762 TEVA-EFAVIRENZ 600 MG TABLET ORL TAB TEV TAB 11.210300002382091 TEVA-ELETRIPTAN 20 MG TABLET ORL TAB TEV TAB 10.085000002382105 TEVA-ELETRIPTAN 40 MG TABLET ORL TAB TEV TAB 10.085000002300680 TEVA-ENALAPRIL 2.5 MG TABLET ORL TAB TEV TAB 0.186300002330601 TEVA-ENALAPRIL 40 MG TABLET ORL TAB TEV TAB 1.256000002377705 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 3.900700002289091 TEVA-FENOFIBRATE-S 160 MG TABLET ORL CAP/TAB TEV TAB 0.272300002230089 TEVA-FLUTAMIDE 250 MG TABLET ORL TAB TEV TAB 1.353000002415844 TEVA-FROVATRIPTAN 2.5 MG TABLET ORL TAB TEV TAB 12.502900002248457 TEVA-GABAPENTIN 600 MG TABLET ORL TAB TEV TAB 1.304500002247346 TEVA-GABAPENTIN 800 MG TABLET ORL TAB TEV TAB 1.739300002377969 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 20.455700002399814 TEVA-IMATINIB 400 MG TABLET ORL TAB TEV TAB 81.822800002316005 TEVA-IRBESARTAN 300 MG TABLET ORL TAB TEV TAB 0.302500002316013 TEVA-IRBESARTAN/HCTZ 150/12.5 MG TABLET ORL TAB TEV TAB 0.302400002316021 TEVA-IRBESARTAN/HCTZ 300/12.5 MG TABLET ORL TAB TEV TAB 0.302400002316048 TEVA-IRBESARTAN/HCTZ 300/25 MG TABLET ORL TAB TEV TAB 0.300400002387247 TEVA-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB TEV TAB 7.830900002343657 TEVA-LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.756000002246542 TEVA-LOVASTATIN 20 MG TABLET ORL TAB TEV TAB 0.491900002246543 TEVA-LOVASTATIN 40 MG TABLET ORL TAB TEV TAB 0.898500002258323 TEVA-MELOXICAM 15 MG TABLET ORL TAB TEV TAB 0.567000002258315 TEVA-MELOXICAM 7.5 MG TABLET ORL TAB TEV TAB 0.491400002315068 TEVA-METHYLPHENIDATE ER-C 18 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.427600002315076 TEVA-METHYLPHENIDATE ER-C 27 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.647500002315084 TEVA-METHYLPHENIDATE ER-C 36 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.867400002315092 TEVA-METHYLPHENIDATE ER-C 54 MG EXTEND RELEASE TAB ORL ERT TEV TAB 2.307200002261898 TEVA-METOPROL 25 MG TABLET ORL TAB TEV TAB 0.064300002279894 TEVA-MIRTAZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.273000002279908 TEVA-MIRTAZAPINE OD 30MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.546000002279916 TEVA-MIRTAZAPINE OD 45MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.819000002420260 TEVA-MODAFINIL 100 MG TABLET ORL TAB TEV TAB 0.9293

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002392925 TEVA-NABILONE 0.25 MG CAPSULE ORL CAP TEV CAP 1.396200002352893 TEVA-NEVIRAPINE 200 MG TABLET ORL TAB TEV TAB 2.469200002359707 TEVA-OLANZAPINE 20 MG TABLET ORL TAB TEV TAB 10.309300002321378 TEVA-OLANZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 5.355300002321386 TEVA-OLANZAPINE OD 20 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 7.597700002285479 TEVA-PANTOPRAZOLE 20MG ENTERIC-COATED ORAL TAB ORL ECT TEV TAB 1.275000002248556 TEVA-PAROXETINE 10 MG TABLET ORL TAB TEV TAB 1.043000000869015 TEVA-PINDOLOL 10 MG TABLET ORL TAB TEV TAB 0.232300000869023 TEVA-PINDOLOL 15 MG TABLET ORL TAB TEV TAB 0.337000000869007 TEVA-PINDOLOL 5 MG TABLET ORL TAB TEV TAB 0.136100002274914 TEVA-PIOGLITAZONE 15 MG TABLET ORL TAB TEV TAB 0.580900002274922 TEVA-PIOGLITAZONE 30 MG TABLET ORL TAB TEV TAB 0.813900002274930 TEVA-PIOGLITAZONE 45 MG TABLET ORL TAB TEV TAB 1.223700002269317 TEVA-PRAMIPEXOLE 0.5 MG TABLET ORL TAB TEV TAB 1.386000002361205 TEVA-PREGABALIN 150 MG CAPSULE ORL CAP TEV CAP 1.727000002361221 TEVA-PREGABALIN 225 MG CAPSULE ORL CAP TEV CAP 1.727000002361159 TEVA-PREGABALIN 25 MG CAPSULE ORL CAP TEV CAP 0.617300002361248 TEVA-PREGABALIN 300 MG CAPSULE ORL CAP TEV CAP 1.727000002361175 TEVA-PREGABALIN 50 MG CAPSULE ORL CAP TEV CAP 0.968300002361183 TEVA-PREGABALIN 75 MG CAPSULE ORL CAP TEV CAP 1.252900002388359 TEVA-RAMIPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB TEV TAB 0.263300002388375 TEVA-RAMIPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB TEV TAB 0.263300002388332 TEVA-RAMIPRIL/HCTZ 2.5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.169400002388340 TEVA-RAMIPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.207000002388367 TEVA-RAMIPRIL/HCTZ 5 MG/25 MG TABLET ORL TAB TEV TAB 0.207000002413809 TEVA-RISEDRONATE 150 MG TABLET ORL TAB TEV TAB 40.950000002308754 TEVA-SILDENAFIL 100 MG TABLET ORL TAB TEV TAB 9.200600002308738 TEVA-SILDENAFIL 25 MG TABLET ORL TAB TEV TAB 8.290000002308746 TEVA-SILDENAFIL 50 MG TABLET ORL TAB TEV TAB 8.847500002286815 TEVA-SUMATRIPTAN DF 25 MG TABLET ORL TAB TEV TAB 8.990000000851965 TEVA-TAMOXIFEN 10 MG TABLET ORL TAB TEV TAB 0.175000000851973 TEVA-TAMOXIFEN 20 MG TABLET ORL TAB TEV TAB 0.350000002230102 TEVA-TEMAZEPAM 30 MG CAPSULE ORL CAP TEV CAP 0.052600002230085 TEVA-THEOPHYLLINE SR 100 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.130000002230086 TEVA-THEOPHYLLINE SR 200 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.135000002230087 TEVA-THEOPHYLLINE SR 300 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.140000002236848 TEVA-TICLOPIDINE 250 MG TABLET ORL TAB TEV TAB 0.313900001947818 TEVA-TIMOLOL 10 MG TABLET ORL TAB TEV TAB 0.257200001947826 TEVA-TIMOLOL 20 MG TABLET ORL TAB TEV TAB 0.500500001947796 TEVA-TIMOLOL 5 MG TABLET ORL TAB TEV TAB 0.1649

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002389622 TEVA-TOBRAMYCIN 60 MG/ML INHALATION SOLUTION ORL SOL TEV ML 9.309600002299593 TEVA-TOLTERODINE 1 MG TABLET ORL TAB TEV TAB 0.883800002299607 TEVA-TOLTERODINE 2 MG TABLET ORL TAB TEV TAB 0.883800002347180 TEVA-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB TEV TAB 0.626400002357542 TEVA-VALACYCLOVIR 1000 MG TABLET (CAPLET) ORL TAB TEV TAB 3.053100002356643 TEVA-VALSARTAN 40 MG TABLET ORL TAB TEV TAB 0.524000002355205 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 0.336200002360128 THEO ER 600 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.407200080015438 THERA TEARS NUTRITION CAPSULE ORL CAP AVR CAP 0.105600002242082 THERATEARS (PRESERVATIVE-FREE) 0.25% OPH SOLUTION OPH SOL AVR ML 0.641700002248854 THERATEARS 0.25% OPH SOLUTION OPH SOL AVR ML 0.490000002343045 TICLOPIDINE 250 MG TABLET ORL TAB SNS TAB 0.313900002409356 TIGECYCLINE 50 MG/VIAL INJECTION INJ DEFAUL APX VIAL 71.423000001916939 TIMENTIN 3.1G INJECTION INJ DEFAUL GSK VIAL 10.752000002242275 TIMOLOL MALEATE-EX 0.25% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.216000002242276 TIMOLOL MALEATE-EX 0.5% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.848000000576050 TINACTIN 1% TOPICAL AEROSOL TOP AER SCH G 0.052300000576034 TINACTIN 1% TOPICAL CREAM TOP CRM SCH G 0.348700000576042 TINACTIN 1% TOPICAL POWDER TOP PWR SCH G 0.064900002414945 TIVICAY 50 MG TABLET ORL TAB VIV TAB 18.666700002259893 TIZANIDINE 4 MG TABLET ORL TAB AAP TAB 0.688400002244826 TNKASE 50 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2724.300000000533688 TOBRAMYCIN 1.2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 199.000000002241209 TOBRAMYCIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 5.158500002230640 TOBRAMYCIN 40 MG/ML INJECTION INJ DEFAUL FKC ML 3.531000002337630 TOCTINO 10 MG CAPSULE ORL CAP GST CAP 21.990000002337649 TOCTINO 30 MG CAPSULE ORL CAP GST CAP 21.990000000312762 TOLBUTAMIDE 500 MG TABLET ORL TAB AAP TAB 0.111100002229566 TOMUDEX 2 MG/VIAL INJECTION INJ DEFAUL AZC VIAL 324.620000002221926 TOPICORT 0.05% TOPICAL GEL TOP GEL VCL G 0.503700002221934 TOPICORT 0.25% TOPICAL OINTMENT TOP ONT VCL G 0.649300000749834 TOPIDERM HC 2% TOPICAL CREAM TOP CRM PAL G 0.331700002390981 TOPOTECAN 4 MG / VIAL INJECTION INJ DEFAUL SDZ VIAL 567.000000002304104 TORISEL 25 MG/ML INJECTION INJ DEFAUL PFI VIAL 1278.910000002441829 TOUJEO SOLOSTAR 300 UNIT/ML INJECTION INJ DEFAUL SAV ML 17.622700002244982 TRACLEER 125 MG TABLET ORL TAB ACT TAB 64.178600002244981 TRACLEER 62.5 MG TABLET ORL TAB ACT TAB 64.1786

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 105 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002264846 TRAMACET 37.5 MG/325 MG TABLET ORL TAB JAI TAB 0.764000002426803 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 0.048800002164361 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 0.395600002230284 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 312.500000002412322 TRELSTAR 22.5 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1650.000000002240000 TRELSTAR 3.75 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 347.330000002243856 TRELSTAR LA 11.25 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1042.030000002229540 TRIAMCINOLONE ACETONIDE 10 MG/ML INJ. INJ DEFAUL SDZ ML 2.860000002229550 TRIAMCINOLONE ACETONIDE 40MG/ML INJ. INJ DEFAUL SDZ ML 5.500000080015032 TRIAMEG H OMEGA 3 500 MG CAPSULE ORL CAP LLN CAP 0.300000000896179 TRIAMINIC DM NIGHTIME ORAL SYRUP ORL SYR NVC ML 0.047400000789828 TRIATEC-30 TABLET ORL TAB TLI TAB 0.130000000852163 TRIATEC-8 TABLET ORL TAB TLI TAB 0.047300000808563 TRIAZO 0.125 MG TABLET ORL TAB AAP TAB 0.149600002296381 TRIDURAL 100 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 1.220500002296403 TRIDURAL 200 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 2.225300002296411 TRIDURAL 300 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 3.233500002242067 TRILEPTAL 150 MG TABLET ORL TAB NOV TAB 0.827800002242068 TRILEPTAL 300 MG TABLET ORL TAB NOV TAB 0.910200002244673 TRILEPTAL 60 MG/ML ORAL SUSPENSION ORL SUS NOV ML 0.331000002242069 TRILEPTAL 600 MG TABLET ORL TAB NOV TAB 1.820400000517895 TRINALIN REPETABS SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.653500002432927 TRINTELLIX 10 MG TABLET ORL TAB LBC TAB 2.833900002432943 TRINTELLIX 20 MG TABLET ORL TAB LBC TAB 3.076800002432919 TRINTELLIX 5 MG TABLET ORL TAB LBC TAB 2.705400080002067 TRIPLE STRENGTH ODOURLESS GARLIC SOFTGEL CAPSULE ORL CAP VCL CAP 0.0460

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 106 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002407833 TRISENOX 1 MG/ML AMPOULE INJECTION INJ DEFAUL LBC ML 53.000000002430932 TRIUMEQ TABLET ORL TAB VIV TAB 41.383300002244757 TRIZIVIR TABLET ORL TAB GSK TAB 17.921200000511226 TROMBOJECT 30 MG/ML INJECTION INJ DEFAUL OMG ML 8.500000080015078 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 0.208700002448599 TRULICITY 0.75 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 95.900000002448602 TRULICITY 1.5 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 95.900000002274906 TRUVADA 200 MG/300 MG TABLET ORL TAB GIL TAB 27.387000000317268 TUBERSOL TUBERCULIN PPD 5 TUB INJECTION INJ DEFAUL AVE ML 177.710000001967932 TUMS EXTRA STRENGTH 750 MG CHEWABLE TABLET ORL CTB SKB TAB 0.044200001970240 TUMS REGULAR 500 MG CHEWABLE TABLET ORL CTB SKB TAB 0.031100002151138 TUMS ULTRA STRENGTH 1G CHEWABLE TABLET ORL CTB SKB TAB 0.049600001916971 TUSSIONEX ORAL SUSTAINED-RELEASE SUSPENSION ORL SRSUS SAV ML 0.330300001916963 TUSSIONEX TABLET ORL SRT SAV TAB 1.651300080019103 TUZEN CAPSULE ORL CAP FEI CAP 0.760000002230578 TWINRIX INJECTION SYRINGE INJ NDL GSK SYR 48.880000002237548 TWINRIX JUNIOR 0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 24.440000002285401 TYGACIL 50 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 81.374000002326442 TYKERB 250 MG TABLET ORL TAB NOV TAB 23.500000002246060 TYLENOL 8 HOUR 650 MG EXTENDED-RELIEF CAPLET ORL ERT MCL TAB 0.166300001933728 TYLENOL ALLERGY SINUS EXTRA STRENGTH CAPLET ORL TAB MCL TAB 0.285000002238885 TYLENOL ARTHRITIS PAIN 650 MG EXT-RELIEF CAPLET ORL ERT MCL TAB 0.156700000743224 TYLENOL CHILDRENS COLD CHEWABLE TABLET ORL CTB MCL TAB 0.176300000890677 TYLENOL COLD DM JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.259000000743275 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 0.481100000863270 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 0.270000002241361 TYLENOL JUNIOR STRENGTH 160 MG SOFT CHEW TABLET ORL CTB MCL TAB 0.270000002181061 TYLENOL NO.1 WITH CODEINE TABLET ORL TAB MCL TAB 0.139600000559393 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.141700000723894 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.120800000778400 TYLENOL SINUS CAPLET ORL TAB MCL TAB 0.2004

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 107 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242727 TYPHERIX 25 MCG/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 22.140000002130955 TYPHIM VI 50 MCG/ML INJECTION INJ DEFAUL CNG ML 48.500000080022377 UDO'S CHOICE SUPER 8 PLUS PROBIOTIC ORL CAP FMD CAP 0.990000001966294 ULONE 5 MG ORAL SYRUP ORL SYR MMH ML 0.140600080015173 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 0.313500080032885 ULTRA C TM 500 500 MG TABLET ORL TAB MTG TAB 0.281700080011779 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 0.222100080025550 ULTRA-FIBER BALANCED CAPLET ORL TAB AAM TAB 0.080200080004965 ULTRA-FIBER SUPPLEMENT CHEWABLE TABLET ORL TAB AAM TAB 0.091700002349469 ULTRAM 50 MG TABLET ORL TAB JAI TAB 0.727500002324113 ULTRAQUIN 4% HYDROQUINONE CREAM WITH SUNSCREENS TOP CRM SAH G 1.000000000626724 ULTRAQUIN 4% TOPICAL GEL TOP GEL SAH G 1.000000000632783 ULTRAQUIN PLAIN 4% CREAM TOP CRM SAH G 0.866700001962728 ULTRAVATE 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.910200001946994 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 0.076900000398179 UREMOL 20% TOPICAL CREAM TOP CRM GKC G 0.081100001946102 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 1.250000002353997 UROCIT-K 10 MEQ EXTENDED-RELEASE TABLET ORL ERT PAL TAB 0.535500001914022 UROCIT-K 5 MEQ TABLET ORL SRT SFD TAB 0.358800002241411 UROMITEXAN 100 MG/ML INJECTION INJ DEFAUL AST ML 6.489000080030062 UTI CLEANSE TABLET ORL TAB AOR TAB 0.441600080046888 UXOR 7.5% GEL TOP GEL JPC G 0.178700002442019 VALACYCLOVIR 1000 MG CAPLET ORL TAB SIV TAB 5.853800000177016 VALISONE-G TOPICAL CREAM TOP CRM VCL G 1.025300000232351 VALISONE-G TOPICAL OINTMENT TOP ONT VCL G 1.025300000013285 VALIUM 5 MG TABLET ORL TAB HLR TAB 0.166600002367742 VALSARTAN 160 MG TABLET ORL TAB PDL TAB 0.333000002367750 VALSARTAN 320 MG TABLET ORL TAB PDL TAB 0.333000002366940 VALSARTAN 40 MG TABLET ORL TAB SNS TAB 0.523900002384523 VALSARTAN 40 MG TABLET ORL TAB SIV TAB 0.524000002367726 VALSARTAN 40 MG TABLET ORL TAB PDL TAB 0.4080

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 108 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002367734 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 6.886700002394634 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJ USP INJ DEFAUL SDZ VIAL 58.990000002407922 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJECTION INJ DEFAUL MYP VIAL 58.990000002407930 VANCOMYCIN HYDROCHLORIDE 5 G/VIAL INJECTION INJ DEFAUL MYP VIAL 509.790000002394626 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 31.050000002407914 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 31.050000002432544 VAN-GABAPENTIN 600 MG TABLET ORL TAB VAN TAB 1.304500002432552 VAN-GABAPENTIN 800 MG TABLET ORL TAB VAN TAB 1.739300002243837 VANIQA 13.9% TOPICAL CREAM TOP CRM ALM G 2.391700002229702 VAQTA 50 U/ML INJECTION INJ DEFAUL MSD ML 45.540000002241047 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 72.720000002139502 VASOPRESSIN 20 UNIT/ML INJECTION INJ DEFAUL FKC ML 19.830000002223929 VAXIGRIP INFLUENZA VACCINE INJECTION INJ DEFAUL CNG ML 8.350000002308487 VECTIBIX 20 MG/ML (5 ML VIAL) INJECTION INJ DEFAUL AMG ML 128.364000002273985 VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 0.346900002339269 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 7.500000002226286 VENOMIL YELLOW JACKET VENOM PROTEIN 120 MCG INJ INJ DEFAUL BAI VIAL 195.000000002243115 VENTOLIN DISKUS 200 MCG/DOSE POWDER FOR INHALATION INH MIP GSK DOSE 0.192800000616192 VEPESID 50 MG CAPSULE ORL CAP BMS CAP 38.452500080033844 VERALAC HYDROSOLUBLE NAIL LACQUER TOP SOL VCL ML 3.660600000839299 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 19.100000002348489 VERDESO 0.05% TOPICAL FOAM TOP FOA GSK G 0.294400002411849 VEREGEN 10% TOPICAL OINTMENT TOP ONT PAL G 4.015300000594601 VERSEL 2.5% TOPICAL LOTION TOP LOT VCL ML 0.071600002145839 VESANOID 10 MG CAPSULE ORL CAP CAG CAP 16.386300002163691 VEXOL 1% OPH SOLUTION OPH SUS ALC ML 3.562000000717002 VIADERM K.C. TOPICAL CREAM TOP CRM TAR G 0.423300000717029 VIADERM K.C. TOPICAL OINTMENT TOP ONT TAR G 0.623300002239768 VIAGRA 100 MG TABLET ORL TAB PFI TAB 9.2000

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 109 of 115

DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002239766 VIAGRA 25 MG TABLET ORL TAB PFI TAB 8.290000002239767 VIAGRA 50 MG TABLET ORL TAB PFI TAB 8.847500002273330 VICKS CHILDREN'S NYQUIL COLD & COUGH ORAL LIQUID ORL LIQ PGI ML 0.025000001938959 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 0.070400002351064 VICTOZA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 27.500000002336707 VIDAZA 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 628.000000002244596 VIDEX EC 125 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 3.783000002244597 VIDEX EC 200 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 6.053300002244598 VIDEX EC 250 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 7.498300002244599 VIDEX EC 400 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 12.130700002417685 VIDEXTRA 10,000 UNIT TABLET ORL TAB ORI TAB 0.250000002252260 VIGAMOX 0.5% OPHTHALMIC SOLUTION OPH SOL ALC ML 4.406700002427184 VIMIZIM 5MG/5ML (SINGLE-USE) VIAL INJECTION INJ DEFAUL BMI VIAL 1199.000000002361701 VIMOVO 375 MG/20 MG TABLET ORL TAB AZC TAB 1.073700002361728 VIMOVO 500 MG/20 MG TABLET ORL TAB AZC TAB 1.069500002183056 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL MNP ML 18.563000002401460 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 17.679000002183013 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 0.910300002238617 VIRACEPT 250 MG TABLET ORL TAB AGR TAB 1.884200002248761 VIRACEPT 625 MG TABLET ORL TAB PFI TAB 4.710600002238748 VIRAMUNE 200 MG TABLET ORL TAB BOE TAB 4.938300002367289 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 TRI TAB 0.895600000568635 VISKAZIDE 10/50 MG TABLET ORL TAB TRI TAB 0.895600000443174 VISKEN 10 MG TABLET ORL TAB TRI TAB 0.997900000417289 VISKEN 15 MG TABLET ORL TAB TRI TAB 1.447600000417270 VISKEN 5 MG TABLET ORL TAB TRI TAB 0.584300002242367 VISUDYNE 15 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 1703.100000080044606 VITALUX ADVANCED CAPLET ORL TAB ALC TAB 0.208300080016590 VITALUX CAPLET ORL TAB ALC TAB 0.235300080016683 VITALUX PLUS OMEGA 3 CAPSULE ORL CAP ALC CAP 0.210000002245911 VITALUX TABLET ORL TAB NOV TAB 0.239800002240199 VITALUX TR MULTIVITAMIN/MULTIMINERAL TABLET ORL TAB NCI TAB 0.239800080028004 VITALUX-S PLUS OMEGA-3 CAPSULE ORL CAP ALC CAP 0.210000080016576 VITALUX-S TABLET ORL TAB ALC TAB 0.2374

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000123137 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 0.044400080035590 VITAMIN B 100 MG TIME RELEASE TABLET ORL TAB WNP TAB 0.157500000487082 VITAMIN B CMPD 100 SUSTAINED-RELEASE TABLET ORL SRT SWS TAB 0.173200000294853 VITAMIN B1 100 MG TABLET ORL TAB VCL TAB 0.090000002239350 VITAMIN B1 100 MG TABLET ORL TAB PMT TAB 0.021400000407011 VITAMIN B1 100 MG TABLET ORL TAB JAM TAB 0.056700000816078 VITAMIN B1 100 MG/ML INJECTION USP INJ DEFAUL SDZ ML 2.465000080009633 VITAMIN B1 50 MG TABLET ORL TAB JPC TAB 0.073700000610267 VITAMIN B1 50 MG TABLET ORL TAB LEA TAB 0.074000002247479 VITAMIN B100 COMPLEX TABLET ORL TAB WBP TAB 0.108200000450642 VITAMIN B12 100 MCG TABLET ORL TAB VTH TAB 0.070000002023598 VITAMIN B12 100 MCG TABLET ORL TAB PMT TAB 0.056800000331015 VITAMIN B12 100 MCG TABLET ORL TAB JAM TAB 0.056700002241500 VITAMIN B12 100 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.324000080006939 VITAMIN B12 1000 MCG TABLET ORL TAB WNP TAB 0.097400080012952 VITAMIN B12 1000 MCG TABLET ORL TAB JAM TAB 0.089300002237736 VITAMIN B12 1000 MCG TABLET ORL TAB SWS TAB 0.042000080003575 VITAMIN B12 1000 MCG TIME RELEASE TABLET ORL ERT PMT TAB 0.047000000626112 VITAMIN B12 1000 MCG/ML INJ DEFAUL OMG ML 0.310000000502758 VITAMIN B12 250 MCG TABLET ORL TAB SWS TAB 0.139700000335940 VITAMIN B12 250 MCG TABLET ORL TAB JAM TAB 0.064700000305243 VITAMIN B12 50 MCG TABLET ORL TAB JAM TAB 0.052500000689726 VITAMIN B12 500 MCG TABLET ORL TAB SNS TAB 0.074100002243767 VITAMIN B12 500 MCG TABLET ORL TAB VTH TAB 0.046500002239348 VITAMIN B6 100 MG TABLET ORL TAB PMT TAB 0.022800000528846 VITAMIN B6 100 MG TABLET ORL TAB HAL TAB 0.030000000329185 VITAMIN B6 100 MG TABLET ORL TAB JAM TAB 0.064700000122645 VITAMIN B6 25 MG TABLET ORL TAB JAM TAB 0.033600000331031 VITAMIN B6 250 MG TABLET ORL TAB JAM TAB 0.105100000305227 VITAMIN B6 50 MG TABLET ORL TAB JAM TAB 0.048500000341207 VITAMIN C 1000 MG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.108700000305235 VITAMIN C 1000 MG TABLET ORL TAB JAM TAB 0.081800080040321 VITAMIN C 125 MG GUMMY ORL DEFAUL JAM PIECE 0.125000001922378 VITAMIN C 500 MG TABLET ORL TAB SWS TAB 0.047900001994336 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB JAM TAB 0.060400002243893 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB PMT TAB 0.033300000237116 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 0.0967

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00000036188 VITAMIN C 500 MG TABLET ORL TAB WAM TAB 0.040000002163268 VITAMIN C 500 MG TABLET ORL TAB JAM TAB 0.040300002240883 VITAMIN C 500 MG TABLET ORL TAB WNP TAB 0.035900080020803 VITAMIN C 500 MG TIMED RELEASE CAPLET ORL SRT JAM TAB 0.080400000463108 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 0.035100080006264 VITAMIN D 1000 IU TABLET ORL TAB GFR TAB 0.050000080000436 VITAMIN D 1000 IU TABLET ORL TAB JAM TAB 0.044400000323179 VITAMIN D 1000 UNIT TABLET ORL TAB SWS TAB 0.030500000765384 VITAMIN D 400 IU TABLET ORL TAB LCO TAB 0.040000002242175 VITAMIN D 400 IU TABLET ORL TAB JAM TAB 0.043300080002452 VITAMIN D 400 IU TABLET ORL TAB WNP TAB 0.018000002229879 VITAMIN D 400 IU TABLET ORL TAB SWS TAB 0.039800002240624 VITAMIN D 400 IU TABLET ORL TAB WAM TAB 0.016100080009578 VITAMIN D 400 IU TABLET ORL TAB VCL TAB 0.023600002240858 VITAMIN D 400 IU TABLET ORL TAB PMT TAB 0.011700080018025 VITAMIN D DROPS 400 IU ORL LIQ JAM ML 0.931600080015280 VITAMIN D3 1000 IU CAPSULE ORL GEL VTH CAP 0.041500080012124 VITAMIN D3 1000 IU ORAL LIQUID ORL LIQ WBP ML 0.194800080003663 VITAMIN D3 1000 IU TABLET ORL TAB WNP TAB 0.032700002245842 VITAMIN D3 1000 IU TABLET ORL TAB PMT TAB 0.017800080027799 VITAMIN D3 DROPS 1000 IU ORAL LIQUID ORL DPS JMS ML 0.936000000480924 VITAMIN E 100 IU NATURAL SOURCE CAPSULE ORL CAP VTH CAP 0.046800000122823 VITAMIN E 100 IU OBLONG AMBER CAPSULE ORL CAP JAM CAP 0.063800000332348 VITAMIN E 200 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.062900000122831 VITAMIN E 200 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.082100000266108 VITAMIN E 400 IU CAPSULE ORL CAP PMT CAP 0.054200000480940 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.074100002240967 VITAMIN E 400 IU CAPSULE ORL CAP WNP CAP 0.054100000782181 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.081600000332356 VITAMIN E 400 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.053900000122858 VITAMIN E 400 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.105800080013178 VITAMIN E 400 IU SOFTGEL CAPSULE ORL CAP JMS CAP 0.105800000330191 VITAMIN E 800 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.281400002015293 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 0.101300000816175 VITAMINE C 600 MG CAPSULE ORL CAP SIS CAP 0.2112

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002417995 VITAMINE D 10 000 10000 UNIT TABLET ORL TAB PDL TAB 0.210000002248361 VIVAXIM INJECTION INJ DEFAUL SFP SYR 80.700000080028217 VIVISCAL MAXIMUM STRENGTH TABLET ORL TAB IRI TAB 0.999800000013765 VIVOL 5 MG TABLET ORL TAB AXS TAB 0.085800000885975 VIVOTIF BERNA 6 B CAPSULE ORL CAP SSV CAP 5.860000002307073 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 0.129700002338580 VOLTAREN EMULGEL JOINT PAIN 1.16% TOPICAL GEL TOP GEL NVC G 0.112400000881635 VOLTAREN RAPIDE 50 MG TABLET ORL TAB NOV TAB 0.913700002381966 VORICONAZOLE 200 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 130.080000002352303 VOTRIENT 200 MG TABLET ORL TAB NOV TAB 34.410000002357119 VPRIV 400 UNIT/VIAL INJECTION INJ DEFAUL SHG VIAL 1955.000000080037590 VSL #3 ORAL POWDER ORL PWR FEI PCKT 3.100000002365561 VYLOMA 3.75% TOPICAL CREAM TOP CRM VCL G 38.666700002439603 VYVANSE 10 MG CAPSULE ORL CAP SHB CAP 2.141100080006877 WAMPOLE MINERAL CALCIUM ORAL LIQUID ORL LIQ JPC ML 0.035000080008041 WAMPOLE MULTIVITAMIN LIQUID ORL LIQ WAM ML 0.035000002344025 WARFARIN 1 MG TABLET ORL TAB SNS TAB 0.078000002344114 WARFARIN 10 MG TABLET ORL TAB SNS TAB 0.118700002344033 WARFARIN 2 MG TABLET ORL TAB SNS TAB 0.082500002344041 WARFARIN 2.5 MG TABLET ORL TAB SNS TAB 0.066000002344068 WARFARIN 3 MG TABLET ORL TAB SNS TAB 0.102300002344076 WARFARIN 4 MG TABLET ORL TAB SNS TAB 0.102300002344084 WARFARIN 5 MG TABLET ORL TAB SNS TAB 0.066200001948970 WASP VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 41.483300001910787 WEBBER OINTMENT VITAMIN E 30 IU/G TOPICAL OINTMENT TOP ONT JLF G 0.111600080002343 WELLESSE JOINT MOVEMENT GLUCOSAMINE LIQUID ORL LIQ BOT ML 0.028400080024468 WESTCOAST NATURALS CALCIUM MAGNES. PHOS. VIT D LIQ ORL LIQ WES ML 0.034700080018599 WESTCOAST NATURALS VITAMIN B12 1000 MCG TABLET ORL TAB WES TAB 0.127700001949004 WHITE FACED HORNET VENOM 120 MCG INJ DEFAUL ALG VIAL 35.683300002136740 WOBENZYM N TABLET ORL TAB MUC TAB 0.349700002424703 WOMEN'S ROGAINE FOAM 5% AEROSOL FOAM TOP FOA JJI G 0.769700002384256 XALKORI 200 MG CAPSULE ORL CAP PFI CAP 146.666700002384264 XALKORI 250 MG CAPSULE ORL CAP PFI CAP 146.666700000723770 XANAX 1 MG TABLET ORL TAB PFI TAB 0.556100000813958 XANAX TS 2 MG TABLET ORL TAB PFI TAB 0.988300002441535 XARELTO 15 MG / 20 MG TABLET STARTER PACK ORL TAB BAI TAB 2.840000002423898 XELJANZ 5 MG TABLET ORL TAB PFI TAB 23.096500002238453 XELODA 150 MG TABLET ORL TAB HLR TAB 1.8465

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002238454 XELODA 500 MG TABLET ORL TAB HLR TAB 6.154900002240325 XENICAL 120 MG CAPSULE ORL CAP HLR CAP 1.624900002404044 XERESE 5%/1% TOPICAL CREAM TOP CRM VCL G 7.148000002368153 XGEVA 120 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 567.330000002388316 XIAFLEX 0.9 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 1120.000000080036707 X-PUR 100% XYLITOL GUM 1.06 G ORAL GUM ORL GUM ORS PIECE 0.142200000866598 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 28.345000000800694 X-TAR TOPICAL SHAMPOO TOP SHP DLX ML 0.067600000001791 XYLOCAINE 1% W EPINEPHRINE 1:100,000 INJ INJ DEFAUL AZC ML 0.360000000385484 XYLOCAINE 2% TOPICAL JELLY URH JEL AZC ML 0.917000002373130 XYLOCAINE 2% W EPINEPHRINE 1:200,000 INJECTION ORL DEFAUL AZC VIAL 0.382000000001732 XYLOCAINE HCL 1% LIQUID (BLOCK OR INFILTRATION) INJ LIQ AZC ML 0.925000000036641 XYLOCAINE HCL 2% PLAIN LIQ (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.108000002268272 XYREM 500 MG/ML ORAL SOLUTION ORL SOL VCL ML 2.686800002321157 YAZ 28 TABLET ORL TB BAI TAB 0.565700002387433 YAZ PLUS 28 TABLET ORL TB BAI TAB 0.422900001948954 YELLOW JACKET VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 35.683300001948962 YELLOW JACKET VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 35.683300002379384 YERVOY INTRAVENOUS INFUSION 5 MG/ML INJECTION INJ DEFAUL BMS ML 5800.000000000428833 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 0.501000001901885 YOHIMBINE-ODAN 5.4 MG TABLET ORL TAB ODN TAB 0.765000000600784 ZADITEN 0.2 MG/ML ORAL SYRUP ORL SYR TEV ML 0.463600002279223 ZADITOR (PRESERVATIVE FREE) 0.25 MG/ML OPH SOL OPH SOL NOV ML 3.528300002242324 ZADITOR 0.25 MG/ML OPH SOLUTION OPH SOL LTH ML 5.292000002239170 ZANAFLEX 4 MG TABLET ORL TAB PAL TAB 0.786200002230287 ZANTAC 75 MG TABLET ORL TAB GSK TAB 0.406000000568392 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 7.6775

00002246740 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 46.5420

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002361752 ZENHALE 100 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.731100002361760 ZENHALE 200 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.886100002361744 ZENHALE 50 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.576200002216086 ZERIT 15 MG CAPSULE ORL CAP BMS CAP 4.612200002216094 ZERIT 20 MG CAPSULE ORL CAP BMS CAP 4.795800002216108 ZERIT 30 MG CAPSULE ORL CAP BMS CAP 5.002500002216116 ZERIT 40 MG CAPSULE ORL CAP BMS CAP 5.186200002240358 ZIAGEN 20 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.456800002240357 ZIAGEN 300 MG TABLET ORL TAB GSK TAB 6.965500000297666 ZINC 10 MG TABLET ORL TAB JAM TAB 0.047300000441589 ZINC 25 MG TABLET ORL TAB JAM TAB 0.063100001922351 ZINC 50 MG TABLET ORL TAB SWS TAB 0.046600000505463 ZINC 50 MG TABLET ORL TAB JAM TAB 0.071100000480886 ZINC 50 MG TIMED RELEASE TABLET ORL TAB JAM TAB 0.087700080012983 ZINC COPPER BALANCE 15 MG/2 MG CAPSULE ORL CAP AOR CAP 0.155000002239162 ZINCOFAX 15% TOPICAL OINTMENT TOP ONT PAL G 0.074800002239160 ZINCOFAX EXTRA STRENGTH 40% TOPICAL OINTMENT TOP ONT PDH G 0.059500002153432 ZINECARD 250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 137.060000002153440 ZINECARD 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 274.140000002239952 ZITHROMAX 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 21.535000002354802 ZMAX SR 27 MG/ML ORAL SUPENSION ORL SUS PFI ML 0.532200000884324 ZOCOR 5 MG TABLET ORL TAB MFC TAB 1.083900002240332 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 14.330000002315939 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 173.300000000740306 ZOSTRIX 0.025% TOPICAL CREAM TOP CRM GEU G 0.219200002004240 ZOSTRIX H.P. 0.075% TOPICAL CREAM TOP CRM GEU G 0.280000000634506 ZOVIRAX 200 MG TABLET ORL TAB GSK TAB 1.325900002039524 ZOVIRAX 5% TOPICAL CREAM TOP CRM VCL G 13.562000000569771 ZOVIRAX 5% TOPICAL OINTMENT TOP ONT VCL G 13.564000000800686 Z-PLUS TOPICAL SHAMPOO TOP SHP DLX ML 0.095600002354772 ZUACTA 0.075% TOPICAL CREAM TOP CRM SAV G 1.847800002340445 ZYCLARA 3.75% TOPICAL CREAM TOP CRM VCL G 39.826700002438798 ZYDELIG 100 MG TABLET ORL TAB GIL TAB 85.350000002438801 ZYDELIG 150 MG TABLET ORL TAB GIL TAB 85.3500

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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective March 14, 2016

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 Price00002436779 ZYKADIA 150 MG CAPSULE ORL CAP NOV CAP 67.466600002342804 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 2.710000002338106 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 11.517000002320754 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 14.377500002243088 ZYPREXA ZYDIS 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 10.711100002243089 ZYPREXA ZYDIS 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 14.264300002371065 ZYTIGA 250 MG TABLET ORL TAB JAI TAB 29.591000002360349 ZYTRAM XL 100 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.144000002286424 ZYTRAM XL 150 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 1.680000002286432 ZYTRAM XL 200 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 2.205000002286440 ZYTRAM XL 300 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 3.200000002286459 ZYTRAM XL 400 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 4.200000002360322 ZYTRAM XL 75 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.882000002243685 ZYVOXAM 2 MG/ML INJECTION INJ DEFAUL PFI ML 0.344600002243686 ZYVOXAM 20 MG/ML ORAL SUSPENSION ORL SUS PFI ML 2.5287