LCA Spreadsheet - Excel by yA52wCF

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									LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                 Full / Partial   Plan B
             DIN             Chemical Name                    Drug Name                                    MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                        LCA Benefit       Only

       1208        1997580 5-AMINOSALICYLIC ACID TAB 400MG    ASACOL                                        14339         P                                 0.5713      0.4277
       1208        2171929 5-AMINOSALICYLIC ACID TAB 400MG    NOVO-5 ASA - ECT 400MG                         4773         F                                 0.4277

          1        1926543   ACEBUTOLOL TAB 100MG             SECTRAL                                       12538         P                                 0.3624      0.1428
          1        1910140   ACEBUTOLOL TAB 100MG             RHOTRAL 100                                   12538         F                                 0.1428
          1        2147602   ACEBUTOLOL TAB 100MG             APO-ACEBUTOLOL                                 3636         F                                 0.1428
          1        2165546   ACEBUTOLOL TAB 100MG             NU-ACEBUTOLOL - TAB 100MG                      4828         F                                 0.1428
          1        2204517   ACEBUTOLOL TAB 100MG             TEVA-ACEBUTOLOL                               14318         F                                 0.1428
          1        2237721   ACEBUTOLOL TAB 100MG             MYLAN-ACEBUTOLOL                              13930         F                                 0.1428
          1        2237885   ACEBUTOLOL TAB 100MG             MYLAN-ACEBUTOLOL (TYPE S)                     13930         F                                 0.1428
          1        2286246   ACEBUTOLOL TAB 100MG             ACEBUTOLOL                                    14236         F                                 0.1428

          2        1926551   ACEBUTOLOL TAB 200MG             SECTRAL                                       12538         P                                 0.5438      0.2141
          2        1910159   ACEBUTOLOL TAB 200MG             RHOTRAL 200                                   12538         F                                 0.2141
          2        2147610   ACEBUTOLOL TAB 200MG             APO-ACEBUTOLOL                                 3636         F                                 0.2141
          2        2165554   ACEBUTOLOL TAB 200MG             NU-ACEBUTOLOL - TAB 200MG                      4828         F                                 0.2141
          2        2204525   ACEBUTOLOL TAB 200MG             TEVA-ACEBUTOLOL                               14318         F                                 0.2141
          2        2237722   ACEBUTOLOL TAB 200MG             MYLAN-ACEBUTOLOL                              13930         F                                 0.2141
          2        2237886   ACEBUTOLOL TAB 200MG             MYLAN-ACEBUTOLOL (TYPE S)                     13930         F                                 0.2141
          2        2286254   ACEBUTOLOL TAB 200MG             ACEBUTOLOL                                    14236         F                                 0.2141

          3        1926578   ACEBUTOLOL TAB 400MG             SECTRAL                                       12538         P                                 1.0821      0.4261
          3        1910167   ACEBUTOLOL TAB 400MG             RHOTRAL 400                                   12538         F                                 0.4261
          3        2147629   ACEBUTOLOL TAB 400MG             APO-ACEBUTOLOL                                 3636         F                                 0.4261
          3        2165562   ACEBUTOLOL TAB 400MG             NU-ACEBUTOLOL - TAB 400MG                      4828         F                                 0.4261
          3        2204533   ACEBUTOLOL TAB 400MG             TEVA-ACEBUTOLOL                               14318         F                                 0.4261
          3        2237723   ACEBUTOLOL TAB 400MG             MYLAN-ACEBUTOLOL                              13930         F                                 0.4261
          3        2237887   ACEBUTOLOL TAB 400MG             MYLAN-ACEBUTOLOL (TYPE S)                     13930         F                                 0.4261
          3        2286262   ACEBUTOLOL TAB 400MG             ACEBUTOLOL                                    14236         F                                 0.4261

        740         559393   ACETAMINOPHEN TAB 325MG          TYLENOL REGULAR STRENGTH TAB 325MG             4569         P                                 0.0949      0.0131
        740         723894   ACETAMINOPHEN TAB 325MG          TYLENOL REGULAR STRENGTH CAPLETS 325MG         4569         P                                 0.0949      0.0131
        740         389218   ACETAMINOPHEN TAB 325MG          NOVO-GESIC TAB 325MG                           4773         F                                 0.0131
        740         891177   ACETAMINOPHEN TAB 325MG          PMS-ACETAMINOPHEN TAB 325MG                    3550         F                                 0.0131
        740        1938088   ACETAMINOPHEN TAB 325MG          ACETAMINOPHEN 325MG TAB                        4415         F                                 0.0131

        595          13668   ACETAMINOPHEN TAB/CAPLET 500MG   ATASOL FORTE TAB 500MG                         3893         P                         X       0.0921      0.0174
        595         559407   ACETAMINOPHEN TAB/CAPLET 500MG   TYLENOL EXTRA STRENGTH TAB 500MG               4569         P                         X       0.1323      0.0174
        595         723908   ACETAMINOPHEN TAB/CAPLET 500MG   TYLENOL EXTRA-STRENGTH CAPLETS 500MG           4569         P                         X       0.1323      0.0174
        595         863270   ACETAMINOPHEN TAB/CAPLET 500MG   TYLENOL EXTRA STRENGTH GELCAPS TAB 500MG       4569         P                         X       0.1268      0.0174
        595        2142732   ACETAMINOPHEN TAB/CAPLET 500MG   PANADOL TABLET 500MG                          10114         P                         X       0.0707      0.0174
        595         482323   ACETAMINOPHEN TAB/CAPLET 500MG   NOVO-GESIC FORTE TAB 500MG                     4773         F                         X       0.0174
        595        1939122   ACETAMINOPHEN TAB/CAPLET 500MG   ACETAMINOPHEN EXTRA STRENGTH TAB 500MG USP     4415         F                         X       0.0174
        595        2241201   ACETAMINOPHEN TAB/CAPLET 500MG   ACETAMINOPHEN-ODAN TABLETS 500MG               4835         F                         X       0.0161

          4         545015 ACETAZOLAMIDE TAB 250MG            ACETAZOLAMIDE                                 14412         F                                 0.1336

          6         634506   ACYCLOVIR TAB 200MG              ZOVIRAX TAB 200MG                              9985         P                                 1.3818      0.6909
          6        2078627   ACYCLOVIR TAB 200MG              RATIO-ACYCLOVIR                               10402         F                                 0.6909
          6        2207621   ACYCLOVIR TAB 200MG              APO-ACYCLOVIR - TAB 200MG                      3636         F                                 0.6909
          6        2242784   ACYCLOVIR TAB 200MG              MYLAN-ACYCLOVIR                               13930         F                                 0.6909
          6        2285959   ACYCLOVIR TAB 200MG              TEVA-ACYCLOVIR                                14318         F                                 0.6909
          6        2286556   ACYCLOVIR TAB 200MG              ACYCLOVIR                                     14236         F                                 0.6909

          7        1911627   ACYCLOVIR TAB 400MG              ZOVIRAX 400                                    9985         P                                 2.7841      1.3716
          7        2078635   ACYCLOVIR TAB 400MG              RATIO-ACYCLOVIR                               10402         F                                 1.3716
          7        2207648   ACYCLOVIR TAB 400MG              APO-ACYCLOVIR - TAB 400MG                      3636         F                                 1.3716
          7        2242463   ACYCLOVIR TAB 400MG              MYLAN-ACYCLOVIR                               13930         F                                 1.3716
          7        2285967   ACYCLOVIR TAB 400MG              TEVA-ACYCLOVIR                                14318         F                                 1.3716
          7        2286564   ACYCLOVIR TAB 400MG              ACYCLOVIR                                     14236         F                                 1.3716

          8        1911635   ACYCLOVIR TAB 800MG              ZOVIRAX 800                                    9985         P                                 5.4747      2.1899
          8        2078651   ACYCLOVIR TAB 800MG              RATIO-ACYCLOVIR                               10402         F                                 2.1899
          8        2197421   ACYCLOVIR TAB 800MG              NU-ACYCLOVIR - TAB 800MG                       4828         F                                 2.1899
          8        2207656   ACYCLOVIR TAB 800MG              APO-ACYCLOVIR - TAB 800MG                      3636         F                                 2.1899
          8        2242464   ACYCLOVIR TAB 800MG              MYLAN-ACYCLOVIR                               13930         F                                 2.1899
          8        2285975   ACYCLOVIR TAB 800MG              TEVA-ACYCLOVIR                                14318         F                                 2.1899
          8        2286572   ACYCLOVIR TAB 800MG              ACYCLOVIR                                     14236         F                                 2.1899

        975        2201011   ALENDRONATE SODIUM TAB 10MG      FOSAMAX                                       12250         P                         X       2.2179      0.8617
        975        2247373   ALENDRONATE SODIUM TAB 10MG      TEVA-ALENDRONATE                              14318         F                         X       0.8617
        975        2248728   ALENDRONATE SODIUM TAB 10MG      APO-ALENDRONATE                                3636         F                         X       0.8617
        975        2270129   ALENDRONATE SODIUM TAB 10MG      MYLAN-ALENDRONATE                             13930         F                         X       0.8617
        975        2288087   ALENDRONATE SODIUM TAB 10MG      SANDOZ ALENDRONATE                            12027         F                         X       0.8617

       1045        2201038 ALENDRONATE SODIUM TAB 40MG        FOSAMAX                                       12250         P                         X       4.4002      2.2001
       1045        2258102 ALENDRONATE SODIUM TAB 40MG        CO ALENDRONATE                                10028         F                         X       2.2001

       1044        2245329   ALENDRONATE SODIUM TAB 70MG      FOSAMAX                                       12250         P                         X      10.8621      4.3448
       1044        2314940   ALENDRONATE SODIUM TAB 70MG      FOSAVANCE                                     12250         P                         X       4.7790      4.3448
       1044        2248730   ALENDRONATE SODIUM TAB 70MG      APO-ALENDRONATE                                3636         F                         X       4.3448
       1044        2258110   ALENDRONATE SODIUM TAB 70MG      CO ALENDRONATE                                10028         F                         X       4.3448
       1044        2261715   ALENDRONATE SODIUM TAB 70MG      TEVA-ALENDRONATE                              14318         F                         X       4.3448
       1044        2275279   ALENDRONATE SODIUM TAB 70MG      RATIO ALENDRONATE                             10402         F                         X       4.3448
       1044        2284006   ALENDRONATE SODIUM TAB 70MG      PMS-ALENDRONATE-FC                             3550         F                         X       4.3448
       1044        2286335   ALENDRONATE SODIUM TAB 70MG      MYLAN-ALENDRONATE                             13930         F                         X       4.3448
       1044        2288109   ALENDRONATE SODIUM TAB 70MG      SANDOZ ALENDRONATE                            12027         F                         X       4.3448
       1044        2352966   ALENDRONATE SODIUM TAB 70MG      ALENDRONATE                                   14236         F                         X       4.3448

          9         402818 ALLOPURINOL TAB 100MG              ZYLOPRIM                                      14412         F                                 0.0842
          9         415731 ALLOPURINOL TAB 100MG              PURINOL TAB 100MG                                 0         F                                 0.0510

         10         415758 ALLOPURINOL TAB 200MG              PURINOL TAB 200MG                                 0         F                                 0.0942
         10         479799 ALLOPURINOL TAB 200MG              ZYLOPRIM                                      14412         F                                 0.1404

         11         294322 ALLOPURINOL TAB 300MG              ALLOPURINOL                                    3636         P                                 0.3171      0.2295
         11         402796 ALLOPURINOL TAB 300MG              ZYLOPRIM                                      14412         F                                 0.2295
         11         415766 ALLOPURINOL TAB 300MG              PURINOL TAB 300MG                                 0         F                                 0.1307

         12         548359   ALPRAZOLAM TAB 0.25MG            XANAX TAB 0.25MG                               4908         P                                 0.2685      0.0821
         12         865397   ALPRAZOLAM TAB 0.25MG            APO-ALPRAZ TAB 0.25MG                          3636         F                                 0.0821
         12        1913484   ALPRAZOLAM TAB 0.25MG            NOVO-ALPRAZOL TAB 0.25MG USP                   4773         F                                 0.0821
         12        2137534   ALPRAZOLAM TAB 0.25MG            MYLAN-ALPRAZOLAM                              13930         F                                 0.0821
         12        2349191   ALPRAZOLAM TAB 0.25MG            ALPRAZOLAM                                    14236         F                                 0.0821

         13         548367 ALPRAZOLAM TAB 0.5MG               XANAX TAB 0.5MG                                4908         P                                 0.3211      0.0994
                                                                                   Page 1 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                  Full / Partial   Plan B
             DIN             Chemical Name                     Drug Name                                    MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                         LCA Benefit       Only
         13         865400   ALPRAZOLAM TAB 0.5MG              APO-ALPRAZ TAB 0.5MG                           3636         F                                 0.0994
         13        1913492   ALPRAZOLAM TAB 0.5MG              NOVO-ALPRAZOL TAB 0.5MG USP                    4773         F                                 0.0994
         13        2137542   ALPRAZOLAM TAB 0.5MG              MYLAN-ALPRAZOLAM                              13930         F                                 0.0994
         13        2349205   ALPRAZOLAM TAB 0.5MG              ALPRAZOLAM                                    14236         F                                 0.0994

        653         723770 ALPRAZOLAM TAB 1MG                  XANAX TAB 1MG                                  4908         P                                 0.5835      0.2264
        653        2229813 ALPRAZOLAM TAB 1MG                  MYLAN-ALPRAZOLAM                              13930         F                                 0.2264
        653        2243611 ALPRAZOLAM TAB 1MG                  APO-ALPRAZ                                     3636         F                                 0.2264

        654         813958 ALPRAZOLAM TAB 2MG                  XANAX TS TAB 2MG                               4908         P                                 1.0371      0.4023
        654        2229814 ALPRAZOLAM TAB 2MG                  MYLAN-ALPRAZOLAM                              13930         F                                 0.4023
        654        2243612 ALPRAZOLAM TAB 2MG                  APO-ALPRAZ TS                                  3636         F                                 0.4023

         14        1990403 AMANTADINE CAP 100MG                PMS-AMANTADINE HYDROCHLORIDE CAP 100MG         3550         F                                 0.5593
         14        2139200 AMANTADINE CAP 100MG                MYLAN-AMANTADINE                              13930         F                                 0.5593

         15        1913999 AMANTADINE SYR 10MG                 SYMMETREL SYRUP 10MG/ML                        3798         F                                 0.0875
         15        2022826 AMANTADINE SYR 10MG                 PMS-AMANTADINE HYDROCHLORIDE SYRUP 10MG/ML     3550         F                                 0.1015

        965        2192284 AMCINONIDE CREAM 0.1%               CYCLOCORT                                      9985         P                                 0.5889      0.2355
        965        2246714 AMCINONIDE CREAM 0.1%               TARO-AMCINONIDE                                5241         F                                 0.2355
        965        2247098 AMCINONIDE CREAM 0.1%               RATIO-AMCINONIDE CREAM 0.1%                   10402         F                                 0.2355

       1015        2192276 AMCINONIDE LOT 0.1%                 CYCLOCORT                                      9985         P                                 0.4952      0.2452
       1015        2247097 AMCINONIDE LOT 0.1%                 RATIO-AMCINONIDE LOTION 0.1%                  10402         F                                 0.2452

       1014        2192268 AMCINONIDE ONT 0.1%                 CYCLOCORT                                      9985         P                                 0.5889      0.2945
       1014        2247096 AMCINONIDE ONT 0.1%                 RATIO-AMCINONIDE OINTMENT 0.1%                10402         F                                 0.2945

       1019        2249510 AMILORIDE HCL TAB 5MG               MIDAMOR                                       14412         F                                 0.2934

         16         784400   AMILORIDE/HYDROCHLOR TAB 5/50MG   APO-AMILZIDE TAB                               3636         F                                 0.1596
         16         886106   AMILORIDE/HYDROCHLOR TAB 5/50MG   NU-AMILZIDE 5/50 MG TAB                        4828         F                                 0.1596
         16        1937219   AMILORIDE/HYDROCHLOR TAB 5/50MG   NOVAMILOR TAB USP                              4773         F                                 0.1596
         16        2257378   AMILORIDE/HYDROCHLOR TAB 5/50MG   MYLAN-AMILAZIDE                               13930         F                                 0.1596

        834        2036282   AMIODARONE TAB 200MG              CORDARONE                                      4908         P                                 2.2236      0.8895
        834        2239835   AMIODARONE TAB 200MG              TEVA-AMIODARONE                               14318         F                                 0.8895
        834        2240071   AMIODARONE TAB 200MG              RATIO-AMIODARONE                              10402         F                                 0.8895
        834        2240604   AMIODARONE TAB 200MG              MYLAN-AMIODARONE                              13930         F                                 0.8895
        834        2242472   AMIODARONE TAB 200MG              PMS-AMIODARONE                                 3550         F                                 0.8895
        834        2243836   AMIODARONE TAB 200MG              SANDOZ AMIODARONE                             12027         F                                 0.8895
        834        2245781   AMIODARONE TAB 200MG              PHL-AMIODARONE                                 4917         F                                 0.8895
        834        2246194   AMIODARONE TAB 200MG              APO-AMIODARONE TABLETS                         3636         F                                 0.8895
        834        2364336   AMIODARONE TAB 200MG              AMIODARONE 200MG TABLET                       14236         F                                 0.8895

         17         335053 AMITRIPTYLINE TAB 10MG              ELAVIL                                        14412         F                                 0.0717

         18         335061 AMITRIPTYLINE TAB 25MG              ELAVIL                                        14412         F                                 0.1308

         19         335088 AMITRIPTYLINE TAB 50MG              ELAVIL                                        14412         F                                 0.2535

         20         754129 AMITRIPTYLINE TAB 75MG              ELAVIL                                        14412         F                                 0.3925

         23         878936   AMLODIPINE TAB 10MG               NORVASC TAB 10MG                               4908        P                    RDP           2.0917      0.8195
         23        2250500   AMLODIPINE TAB 10MG               TEVA-AMLODIPINE                               14318        P*                   RDP           0.8195
         23        2259613   AMLODIPINE TAB 10MG               RATIO-AMLODIPINE TABLETS 10MG                 10402        P*                   RDP           0.8195
         23        2272121   AMLODIPINE TAB 10MG               MYLAN-AMLODIPINE                              13930        P*                   RDP           0.8195
         23        2273381   AMLODIPINE TAB 10MG               APO-AMLODIPINE                                 3636        P*                   RDP           0.8195
         23        2280140   AMLODIPINE TAB 10MG               GD-AMLODIPINE                                 12463        P*                   RDP           0.8195
         23        2284073   AMLODIPINE TAB 10MG               PMS-AMLODIPINE                                 3550        P*                   RDP           0.8195
         23        2284391   AMLODIPINE TAB 10MG               SANDOZ AMLODIPINE                             12027        P*                   RDP           0.8195
         23        2297493   AMLODIPINE TAB 10MG               CO AMLODIPINE                                 10028        P*                   RDP           0.8195
         23        2321866   AMLODIPINE TAB 10MG               RAN-AMLODIPINE                                11271        P*                   RDP           0.8195
         23        2326787   AMLODIPINE TAB 10MG               PHL-AMLODIPINE                                 4917        P*                   RDP           0.8195
         23        2331098   AMLODIPINE TAB 10MG               JAMP-AMLODIPINE                                4415        P*                   RDP           0.8195
         23        2331292   AMLODIPINE TAB 10MG               AMLODIPINE                                    14236        P*                   RDP           0.8195
         23        2331942   AMLODIPINE TAB 10MG               AMLODIPINE 10 MG TABLET                       11271        P*                   RDP           0.8195
         23        2342804   AMLODIPINE TAB 10MG               ZYM-AMLODIPINE                                 6860        P*                   RDP           0.8195
         23        2357720   AMLODIPINE TAB 10MG               SEPTA-AMLODIPINE                              14461        P*                   RDP           0.8195
         23        2362678   AMLODIPINE TAB 10MG               MINT-AMLODIPINE                               13221        P*                   RDP           0.8195

       1180        2297477   AMLODIPINE TAB 2.5MG              CO AMLODIPINE                                 10028        P*                   RDP           0.2899
       1180        2326760   AMLODIPINE TAB 2.5MG              PHL-AMLODIPINE                                 4917        P*                   RDP           0.2899
       1180        2330474   AMLODIPINE TAB 2.5MG              SANDOZ AMLODIPINE                             12027        P*                   RDP           0.2899
       1180        2357186   AMLODIPINE TAB 2.5MG              JAMP-AMLODIPINE 2.5 MG TABLET                  4415        P*                   RDP           0.2814
       1180        2357704   AMLODIPINE TAB 2.5MG              SEPTA-AMLODIPINE                              14461        P*                   RDP           0.2899

         24         878928   AMLODIPINE TAB 5MG                NORVASC TAB 5MG                                4908        P                    RDP           1.4092      0.5521
         24        2250497   AMLODIPINE TAB 5MG                TEVA-AMLODIPINE                               14318        P*                   RDP           0.5521
         24        2259605   AMLODIPINE TAB 5MG                RATIO-AMLODIPINE TABLETS 5MG                  10402        P*                   RDP           0.5521
         24        2272113   AMLODIPINE TAB 5MG                MYLAN-AMLODIPINE                              13930        P*                   RDP           0.5521
         24        2273373   AMLODIPINE TAB 5MG                APO-AMLODIPINE                                 3636        P*                   RDP           0.5521
         24        2280132   AMLODIPINE TAB 5MG                GD-AMLODIPINE                                 12463        P*                   RDP           0.5521
         24        2284065   AMLODIPINE TAB 5MG                PMS-AMLODIPINE                                 3550        P*                   RDP           0.5521
         24        2284383   AMLODIPINE TAB 5MG                SANDOZ AMLODIPINE                             12027        P*                   RDP           0.5521
         24        2297485   AMLODIPINE TAB 5MG                CO AMLODIPINE                                 10028        P*                   RDP           0.5521
         24        2321858   AMLODIPINE TAB 5MG                RAN-AMLODIPINE                                11271        P*                   RDP           0.5521
         24        2326779   AMLODIPINE TAB 5MG                PHL-AMLODIPINE                                 4917        P*                   RDP           0.5521
         24        2331071   AMLODIPINE TAB 5MG                JAMP-AMLODIPINE                                4415        P*                   RDP           0.5521
         24        2331284   AMLODIPINE TAB 5MG                AMLODIPINE                                    14236        P*                   RDP           0.5521
         24        2331934   AMLODIPINE TAB 5MG                AMLODIPINE 5 MG TABLET                        11271        P*                   RDP           0.5521
         24        2342790   AMLODIPINE TAB 5MG                ZYM-AMLODIPINE                                 6860        P*                   RDP           0.5521
         24        2357712   AMLODIPINE TAB 5MG                SEPTA-AMLODIPINE                              14461        P*                   RDP           0.5521
         24        2362651   AMLODIPINE TAB 5MG                MINT-AMLODIPINE                               13221        P*                   RDP           0.5521

         25         406724   AMOXICILLIN CAP 250MG             NOVAMOXIN CAP 250MG                            4773         F                                 0.1890
         25         628115   AMOXICILLIN CAP 250MG             APO-AMOXI CAP 250MG                            3636         F                                 0.1890
         25         865567   AMOXICILLIN CAP 250MG             NU-AMOXI CAP 250MG                             4828         F                                 0.1890
         25        2230243   AMOXICILLIN CAP 250MG             PMS-AMOXICILLIN                                3550         F                                 0.1890
         25        2238171   AMOXICILLIN CAP 250MG             MYLAN-AMOXICILLIN                             13930         F                                 0.1890
         25        2352710   AMOXICILLIN CAP 250MG             AMOXICILLIN                                   14236         F                                 0.1890

         26         406716   AMOXICILLIN CAP 500MG             NOVAMOXIN CAP 500MG                            4773         F                                 0.3690
         26         628123   AMOXICILLIN CAP 500MG             APO-AMOXI CAP 500MG                            3636         F                                 0.3690
         26         865575   AMOXICILLIN CAP 500MG             NU-AMOXI CAP 500MG                             4828         F                                 0.3690
         26        2230244   AMOXICILLIN CAP 500MG             PMS-AMOXICILLIN                                3550         F                                 0.3690
                                                                                    Page 2 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                      Full / Partial   Plan B
             DIN             Chemical Name                            Drug Name                                 MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                             LCA Benefit       Only
         26        2238172 AMOXICILLIN CAP 500MG                      MYLAN-AMOXICILLIN                          13930         F                                 0.3690
         26        2352729 AMOXICILLIN CAP 500MG                      AMOXICILLIN                                14236         F                                 0.3690

         27         452149   AMOXICILLIN SUS/PWR 25MG                 NOVAMOXIN SUS 125MG/5ML                     4773         F                                 0.0381
         27         628131   AMOXICILLIN SUS/PWR 25MG                 APO-AMOXI PWR FOR SUSP 125MG/5ML            3636         F                                 0.0381
         27         865540   AMOXICILLIN SUS/PWR 25MG                 NU-AMOXI SUS 125/5ML                        4828         F                                 0.0381
         27        1934171   AMOXICILLIN SUS/PWR 25MG                 NOVAMOXIN 125 SUS 25MG/ML SUGAR REDUCED     4773         F                                 0.0381
         27        2230245   AMOXICILLIN SUS/PWR 25MG                 PMS-AMOXICILLIN                             3550         F                                 0.0381
         27        2352745   AMOXICILLIN SUS/PWR 25MG                 AMOXICILLIN                                14236         F                                 0.0381

         28         452130   AMOXICILLIN SUS/PWR 50MG                 NOVAMOXIN SUS 250MG/5ML                     4773         F                                 0.0583
         28         628158   AMOXICILLIN SUS/PWR 50MG                 APO-AMOXI PWR FOR SUSP 250MG/5ML            3636         F                                 0.0583
         28         865559   AMOXICILLIN SUS/PWR 50MG                 NU-AMOXI SUS 250MG/5ML                      4828         F                                 0.0583
         28        1934163   AMOXICILLIN SUS/PWR 50MG                 NOVAMOXIN 250 SUS 50MG/ML SUGAR REDUCED     4773         F                                 0.0583
         28        2230246   AMOXICILLIN SUS/PWR 50MG                 PMS-AMOXICILLIN                             3550         F                                 0.0583
         28        2352753   AMOXICILLIN SUS/PWR 50MG                 AMOXICILLIN                                14236         F                                 0.0583

         29        2036347 AMOXICILLIN TAB 125MG                      NOVAMOXIN CHEWABLE TABLETS 125MG            4773         F                                 0.4500
         29        2041685 AMOXICILLIN TAB 125MG                      AMOXIL CHEWABLE TABLETS 125MG               4003         F                                 0.3123

         30         714895   AMOXICILLIN TAB 250MG                    AMOXIL CHEWABLE TAB 250MG                   3691         F                                 0.5337
         30        2036355   AMOXICILLIN TAB 250MG                    NOVAMOXIN CHEWABLE TABLETS 250MG            4773         F                                 0.6629
         30        2041286   AMOXICILLIN TAB 250MG                    AMOXIL CHEWABLE TABLETS 250MG               4003         F                                 0.4748
         30        2352737   AMOXICILLIN TAB 250MG                    AMOXICILLIN                                14236         F                                 0.6629

        934        1916882 AMOXICILLIN/CLAVULANATE 125MG/31.25MG      CLAVULIN 125 F ORAL SUS                     9985         P                                 0.1264      0.0558
        934        2244646 AMOXICILLIN/CLAVULANATE 125MG/31.25MG      RATIO-ACLAVULANATE 125 F                   10402         F                                 0.0558

        935        1916874 AMOXICILLIN/CLAVULANATE 250MG/62.5MG/5ML   CLAVULIN 250 F ORAL SUS                     9985         P                                 0.2172      0.0939
        935        2244647 AMOXICILLIN/CLAVULANATE 250MG/62.5MG/5ML   RATIO-ACLAVULANATE 250 F                   10402         F                                 0.0939

       1123        2238830 AMOXICILLIN/CLAVULANATE 400MG/57MG/5ML     CLAVULIN 400                                9985         P                                 0.2973      0.2127
       1123        2288559 AMOXICILLIN/CLAVULANATE 400MG/57MG/5ML     APO-AMOXI CLAV                              3636         F                                 0.2127

        890        2243350 AMOXICILLIN/CLAVULANATE TAB 250MG          APO-AMOXI CLAV 250/125                      3636         F                                 1.0125

        891        1916858 AMOXICILLIN/CLAVULANATE TAB 500MG          CLAVULIN 500 F TAB                          9985         P                                 1.5986      0.7207
        891        2243351 AMOXICILLIN/CLAVULANATE TAB 500MG          APO-AMOXI CLAV 500/125                      3636         F                                 0.7207
        891        2243771 AMOXICILLIN/CLAVULANATE TAB 500MG          RATIO-ACLAVULANATE                         10402         F                                 0.7207

        964        2238829   AMOXICILLIN/CLAVULANATE TAB 875/125MG    CLAVULIN 875                                9985         P                                 2.3980      0.9593
        964        2245623   AMOXICILLIN/CLAVULANATE TAB 875/125MG    APO-AMOXI CLAV 875/125                      3636         F                                 0.9593
        964        2247021   AMOXICILLIN/CLAVULANATE TAB 875/125MG    RATIO-ACLAVULANATE                         10402         F                                 0.9593
        964        2248138   AMOXICILLIN/CLAVULANATE TAB 875/125MG    NOVO-CLAVAMOXIN 875                         4773         F                                 0.9593

         31           2003 AMPICILLIN CAP 250MG                       PENBRITIN CAP 250MG                         3691         F                                 0.1981
         31          20877 AMPICILLIN CAP 250MG                       NOVO-AMPICILLIN CAP 250MG                   4773         F                                 0.3496
         31        2043122 AMPICILLIN CAP 250MG                       PENBRITIN 250MG CAPSULE                     4003         F                                 0.1701

         32           2011 AMPICILLIN CAP 500MG                       PENBRITIN CAP 500MG                         3691         F                                 0.3830
         32          20885 AMPICILLIN CAP 500MG                       NOVO-AMPICILLIN CAP 500MG                   4773         F                                 0.6779
         32        2043130 AMPICILLIN CAP 500MG                       PENBRITIN 500MG CAPSULE                     4003         F                                 0.3401

         37          10332   ASA EC TAB 325MG                         ENTROPHEN 325MG TABLETS                    11656         P            X      REF           0.0604      0.0328
         37         216666   ASA EC TAB 325MG                         NOVASEN TAB 325MG                           4773         F            X      REF           0.0328
         37        2010526   ASA EC TAB 325MG                         ENTERIC COATED ASA TABLETS 325MG            8541         F            X      REF           0.0328
         37        2046253   ASA EC TAB 325MG                         ASADOL 325MG                               11656         F            X      REF           0.0135
         37        2284529   ASA EC TAB 325MG                         PMS-ASA EC                                  3550         F            X      REF           0.0328
         37        2352427   ASA EC TAB 325MG                         ASATAB EC 325MG                             4835         F            X      REF           0.0328

        741         852015 ASA EC TAB 500MG                           ENTROPHEN ECT 500MG                        11656         F                   REF           0.0823
        741         852015 ASA EC TAB 500MG                           ENTROPHEN ECT 500MG                        11656         F                   REF           0.0823

         36        1905392 ASA EC TAB/CAP 650MG                       ENTROPHEN 650MG CAPLET ECT                 11656         P                   REF           0.1035      0.0594
         36         794244 ASA EC TAB/CAP 650MG                       ENTERIC COATED ASA TAB 650MG                8541         F                   REF           0.0594
         36        2352435 ASA EC TAB/CAP 650MG                       ASATAB EC 650MG                             4835         F                   REF           0.0594

         35         226327 ASA/CAFFEINE/BUTALBITAL CAP 330MG          FIORINAL CAP                                7277         P                                 1.6822      0.6258
         35         608238 ASA/CAFFEINE/BUTALBITAL CAP 330MG          RATIO-TECNAL                               10402         F                                 0.6258

         39         275328 ASA/CAFFEINE/BUTALBITAL TAB 330MG          FIORINAL TAB                                7277         P                                 1.4847      0.6276
         39         608211 ASA/CAFFEINE/BUTALBITAL TAB 330MG          RATIO-TECNAL                               10402         F                                 0.6276

       1022        2049988 ATENOLOL / CHLORTH TAB 100/25MG            TENORETIC 100/25MG TAB                      9307         P                                 1.1632      0.5655
       1022        2248764 ATENOLOL / CHLORTH TAB 100/25MG            APO-ATENIDONE                               3636         F                                 0.5655
       1022        2302926 ATENOLOL / CHLORTH TAB 100/25MG            TEVA-ATENOLOL/CHLORTHALIDONE               14318         F                                 0.5655

       1021        2049961 ATENOLOL / CHLORTH TAB 50/25MG             TENORETIC 50/25MG TAB                       9307         P                                 0.7099      0.3451
       1021        2248763 ATENOLOL / CHLORTH TAB 50/25MG             APO-ATENIDONE                               3636         F                                 0.3451
       1021        2302918 ATENOLOL / CHLORTH TAB 50/25MG             TEVA-ATENOLOL/CHLORTHALIDONE               14318         F                                 0.3451

         40        2039540   ATENOLOL TAB 100MG                       TENORMIN 100MG                              9307         P                                 1.0494      0.4081
         40         773697   ATENOLOL TAB 100MG                       APO-ATENOL TAB 100MG                        3636         F                                 0.4081
         40         886122   ATENOLOL TAB 100MG                       NU-ATENOL TAB 100MG                         4828         F                                 0.4081
         40        1912054   ATENOLOL TAB 100MG                       TEVA-ATENOLOL                              14318         F                                 0.4081
         40        2147432   ATENOLOL TAB 100MG                       MYLAN-ATENOLOL                             13930         F                                 0.4081
         40        2171805   ATENOLOL TAB 100MG                       RATIO-ATENOLOL                             10402         F                                 0.4081
         40        2231733   ATENOLOL TAB 100MG                       SANDOZ ATENOLOL                            12027         F                                 0.4081
         40        2237601   ATENOLOL TAB 100MG                       PMS-ATENOLOL                                3550         F                                 0.4081
         40        2255553   ATENOLOL TAB 100MG                       CO ATENOLOL                                10028         F                                 0.4081
         40        2267993   ATENOLOL TAB 100MG                       RAN-ATENOLOL                               11271         F                                 0.4081
         40        2367572   ATENOLOL TAB 100MG                       JAMP-ATENOLOL                               4415         F                                 0.4081
         40        2368048   ATENOLOL TAB 100MG                       MINT-ATENOL 100 MG TABLET                  13221         F                                 0.4081
         40        2371995   ATENOLOL TAB 100MG                       MAR-ATENOLOL 100 MG TABLET                 14907         F                                 0.4081

       1134        2266660   ATENOLOL TAB 25MG                        TEVA-ATENOLOL                              14318         F                                 0.1462
       1134        2303647   ATENOLOL TAB 25MG                        MYLAN-ATENOLOL                             13930         F                                 0.1462
       1134        2367556   ATENOLOL TAB 25MG                        JAMP-ATENOLOL                               4415         F                                 0.1462
       1134        2368013   ATENOLOL TAB 25MG                        MINT-ATENOL 25 MG TABLET                   13221         F                                 0.1462
       1134        2371979   ATENOLOL TAB 25MG                        MAR-ATENOLOL 25 MG TABLET                  14907         F                                 0.1462

         41        2039532   ATENOLOL TAB 50MG                        TENORMIN 50MG                               9307         P                                 0.6383      0.2483
         41         773689   ATENOLOL TAB 50MG                        APO-ATENOL TAB 50MG                         3636         F                                 0.2483
         41         886114   ATENOLOL TAB 50MG                        NU-ATENOL TAB 50MG                          4828         F                                 0.2483
         41        1912062   ATENOLOL TAB 50MG                        TEVA-ATENOLOL                              14318         F                                 0.2483
         41        2146894   ATENOLOL TAB 50MG                        MYLAN-ATENOLOL                             13930         F                                 0.2483
         41        2171791   ATENOLOL TAB 50MG                        RATIO-ATENOLOL                             10402         F                                 0.2483
                                                                                            Page 3 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                   Full / Partial   Plan B
             DIN             Chemical Name                    Drug Name                                      MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                          LCA Benefit       Only
         41        2231731   ATENOLOL TAB 50MG                SANDOZ ATENOLOL                                 12027         F                                 0.2483
         41        2237600   ATENOLOL TAB 50MG                PMS-ATENOLOL                                     3550         F                                 0.2483
         41        2255545   ATENOLOL TAB 50MG                CO ATENOLOL                                     10028         F                                 0.2483
         41        2267985   ATENOLOL TAB 50MG                RAN-ATENOLOL                                    11271         F                                 0.2483
         41        2367564   ATENOLOL TAB 50MG                JAMP-ATENOLOL                                    4415         F                                 0.2483
         41        2368021   ATENOLOL TAB 50MG                MINT-ATENOL 50 MG TABLET                        13221         F                                 0.2483
         41        2371987   ATENOLOL TAB 50MG                MAR-ATENOLOL 50 MG TABLET                       14907         F                                 0.2483

       1193        2230711   ATORVASTATIN TAB 10MG            LIPITOR                                          4908         P                                 1.8295      0.7188
       1193        2288346   ATORVASTATIN TAB 10MG            GD-ATORVASTATIN                                 12463         F                                 0.7188
       1193        2295261   ATORVASTATIN TAB 10MG            APO-ATORVASTATIN                                 3636         F                                 0.7188
       1193        2302675   ATORVASTATIN TAB 10MG            NOVO-ATORVASTATIN                                4773         F                                 0.7188
       1193        2310899   ATORVASTATIN TAB 10MG            CO ATORVASTATIN                                 10028         F                                 0.7188
       1193        2313448   ATORVASTATIN TAB 10MG            PMS-ATORVASTATIN                                 3550         F                                 0.7188
       1193        2313707   ATORVASTATIN TAB 10MG            RAN-ATORVASTATIN                                11271         F                                 0.7188
       1193        2324946   ATORVASTATIN TAB 10MG            SANDOZ ATORVASTATIN                             12027         F                                 0.7188
       1193        2348624   ATORVASTATIN TAB 10MG            ATORVASTATIN                                    10402         F                                 0.7188
       1193        2348705   ATORVASTATIN TAB 10MG            ATORVASTATIN                                    14236         F                                 0.7188
       1193        2350297   ATORVASTATIN TAB 10MG            RATIO-ATORVASTATIN                              14318         F                                 0.7188

       1194        2230713   ATORVASTATIN TAB 20MG            LIPITOR                                          4908         P                                 2.2868      0.8986
       1194        2288354   ATORVASTATIN TAB 20MG            GD-ATORVASTATIN                                 12463         F                                 0.8986
       1194        2295288   ATORVASTATIN TAB 20MG            APO-ATORVASTATIN                                 3636         F                                 0.8986
       1194        2302683   ATORVASTATIN TAB 20MG            NOVO-ATORVASTATIN                                4773         F                                 0.8986
       1194        2310902   ATORVASTATIN TAB 20MG            CO ATORVASTATIN                                 10028         F                                 0.8986
       1194        2313456   ATORVASTATIN TAB 20MG            PMS-ATORVASTATIN                                 3550         F                                 0.8986
       1194        2313715   ATORVASTATIN TAB 20MG            RAN-ATORVASTATIN                                11271         F                                 0.8986
       1194        2324954   ATORVASTATIN TAB 20MG            SANDOZ ATORVASTATIN                             12027         F                                 0.8986
       1194        2348632   ATORVASTATIN TAB 20MG            ATORVASTATIN                                    10402         F                                 0.8986
       1194        2348713   ATORVASTATIN TAB 20MG            ATORVASTATIN                                    14236         F                                 0.8986
       1194        2350319   ATORVASTATIN TAB 20MG            RATIO-ATORVASTATIN                              14318         F                                 0.8986

       1195        2230714   ATORVASTATIN TAB 40MG            LIPITOR                                          4908         P                                 2.4583      0.9660
       1195        2288362   ATORVASTATIN TAB 40MG            GD-ATORVASTATIN                                 12463         F                                 0.9660
       1195        2295296   ATORVASTATIN TAB 40MG            APO-ATORVASTATIN                                 3636         F                                 0.9660
       1195        2302691   ATORVASTATIN TAB 40MG            NOVO-ATORVASTATIN                                4773         F                                 0.9660
       1195        2310910   ATORVASTATIN TAB 40MG            CO ATORVASTATIN                                 10028         F                                 0.9660
       1195        2313464   ATORVASTATIN TAB 40MG            PMS-ATORVASTATIN                                 3550         F                                 0.9660
       1195        2313723   ATORVASTATIN TAB 40MG            RAN-ATORVASTATIN                                11271         F                                 0.9660
       1195        2324962   ATORVASTATIN TAB 40MG            SANDOZ ATORVASTATIN                             12027         F                                 0.9660
       1195        2348640   ATORVASTATIN TAB 40MG            ATORVASTATIN                                    10402         F                                 0.9660
       1195        2348721   ATORVASTATIN TAB 40MG            ATORVASTATIN                                    14236         F                                 0.9660
       1195        2350327   ATORVASTATIN TAB 40MG            RATIO-ATORVASTATIN                              14318         F                                 0.9660

       1196        2243097   ATORVASTATIN TAB 80MG            LIPITOR                                          4908         P                                 2.4584      0.9660
       1196        2288370   ATORVASTATIN TAB 80MG            GD-ATORVASTATIN                                 12463         F                                 0.9660
       1196        2295318   ATORVASTATIN TAB 80MG            APO-ATORVASTATIN                                 3636         F                                 0.9660
       1196        2302713   ATORVASTATIN TAB 80MG            NOVO-ATORVASTATIN                                4773         F                                 0.9660
       1196        2310929   ATORVASTATIN TAB 80MG            CO ATORVASTATIN                                 10028         F                                 0.9660
       1196        2313472   ATORVASTATIN TAB 80MG            PMS-ATORVASTATIN                                 3550         F                                 0.9660
       1196        2313758   ATORVASTATIN TAB 80MG            RAN-ATORVASTATIN                                11271         F                                 0.9660
       1196        2324970   ATORVASTATIN TAB 80MG            SANDOZ ATORVASTATIN                             12027         F                                 0.9660
       1196        2348659   ATORVASTATIN TAB 80MG            ATORVASTATIN                                    10402         F                                 0.9660
       1196        2348748   ATORVASTATIN TAB 80MG            ATORVASTATIN                                    14236         F                                 0.9660
       1196        2350335   ATORVASTATIN TAB 80MG            RATIO-ATORVASTATIN                              14318         F                                 0.9660

        677           4596   AZATHIOPRINE TAB 50MG            IMURAN                                          11026         P                                 1.0387      0.4155
        677        2231491   AZATHIOPRINE TAB 50MG            MYLAN-AZATHIOPRINE                              13930         F                                 0.4155
        677        2236819   AZATHIOPRINE TAB 50MG            TEVA-AZATHIOPRINE                               14318         F                                 0.4155
        677        2242907   AZATHIOPRINE TAB 50MG            APO-AZATHIOPRINE                                 3636         F                                 0.4155
        677        2343002   AZATHIOPRINE TAB 50MG            AZATHIOPRINE                                    14236         F                                 0.4155

       1066        2223716   AZITHROMYCIN PWS ORL 100MG/5ML   ZITHROMAX - PWS ORL 100MG/5ML                    4908         P                                 1.1743      0.4600
       1066        2274388   AZITHROMYCIN PWS ORL 100MG/5ML   PMS-AZITHROMYCIN                                 3550         F                                 0.4600
       1066        2315157   AZITHROMYCIN PWS ORL 100MG/5ML   NOVO-AZITHROMYCIN PEDIATRIC                      4773         F                                 0.4600
       1066        2332388   AZITHROMYCIN PWS ORL 100MG/5ML   SANDOZ AZITHROMYCIN                             12027         F                                 0.4600

       1067        2223724   AZITHROMYCIN PWS ORL 200MG/5ML   ZITHROMAX - PWS ORL 200MG/5ML                    4908         P                                 1.6636      0.6518
       1067        2274396   AZITHROMYCIN PWS ORL 200MG/5ML   PMS-AZITHROMYCIN                                 3550         F                                 0.6518
       1067        2315165   AZITHROMYCIN PWS ORL 200MG/5ML   NOVO-AZITHROMYCIN PEDIATRIC                      4773         F                                 0.6518
       1067        2332396   AZITHROMYCIN PWS ORL 200MG/5ML   SANDOZ AZITHROMYCIN                             12027         F                                 0.6518

       1061        2212021   AZITHROMYCIN TAB 250MG           ZITHROMAX - TAB 250MG                            4908         P                                 5.4313      2.1277
       1061        2247423   AZITHROMYCIN TAB 250MG           APO-AZITHROMYCIN                                 3636         F                                 2.1277
       1061        2255340   AZITHROMYCIN TAB 250MG           CO AZITHROMYCIN                                 10028         F                                 2.1277
       1061        2261634   AZITHROMYCIN TAB 250MG           PMS-AZITHROMYCIN                                 3550         F                                 2.1277
       1061        2265826   AZITHROMYCIN TAB 250MG           SANDOZ AZITHROMYCIN                             12027         F                                 2.1277
       1061        2267845   AZITHROMYCIN TAB 250MG           NOVO-AZITHROMYCIN                                4773         F                                 2.1277
       1061        2274531   AZITHROMYCIN TAB 250MG           GD-AZITHROMYCIN                                 12463         F                                 2.1277
       1061        2275287   AZITHROMYCIN TAB 250MG           RATIO AZITHROMYCIN                              10402         F                                 2.1277
       1061        2278359   AZITHROMYCIN TAB 250MG           MYLAN-AZITHROMYCIN                              13930         F                                 2.1277
       1061        2330881   AZITHROMYCIN TAB 250MG           AZITHROMYCIN                                    14236         F                                 2.1277

         45         455881   BACLOFEN TAB 10MG                LIORESAL TAB 10MG                                7277         P                                 0.7414      0.2756
         45        2063735   BACLOFEN TAB 10MG                PMS-BACLOFEN TAB 10MG                            3550         F                                 0.2756
         45        2088398   BACLOFEN TAB 10MG                MYLAN-BACLOFEN                                  13930         F                                 0.2756
         45        2136090   BACLOFEN TAB 10MG                NU-BACLO - TAB 10MG                              4828         F                                 0.2756
         45        2139332   BACLOFEN TAB 10MG                APO-BACLOFEN TABLETS - 10MG                      3636         F                                 0.2756
         45        2236507   BACLOFEN TAB 10MG                RATIO-BACLOFEN                                  10402         F                                 0.2756
         45        2236963   BACLOFEN TAB 10MG                PHL-BACLOFEN                                     4917         F                                 0.2756
         45        2287021   BACLOFEN TAB 10MG                BACLOFEN                                        14236         F                                 0.2756

         46         636576   BACLOFEN TAB 20MG                LIORESAL D.S. TAB 20MG                           7277         P                                 1.4430      0.5363
         46        2063743   BACLOFEN TAB 20MG                PMS-BACLOFEN TAB 20MG                            3550         F                                 0.5363
         46        2088401   BACLOFEN TAB 20MG                MYLAN-BACLOFEN                                  13930         F                                 0.5363
         46        2136104   BACLOFEN TAB 20MG                NU-BACLO-TAB 20MG                                4828         F                                 0.5363
         46        2139391   BACLOFEN TAB 20MG                APO-BACLOFEN TABLETS - 20MG                      3636         F                                 0.5363
         46        2236508   BACLOFEN TAB 20MG                RATIO-BACLOFEN                                  10402         F                                 0.5363
         46        2236964   BACLOFEN TAB 20MG                PHL-BACLOFEN                                     4917         F                                 0.5363
         46        2287048   BACLOFEN TAB 20MG                BACLOFEN                                        14236         F                                 0.5363

         49        2172712 BECLOMETHASONE AQ NAS SPR 50MCG    MYLAN-BECLO AQ                                  13930         F                                 0.0662
         49        2238577 BECLOMETHASONE AQ NAS SPR 50MCG    NU-BECLOMETHASONE 50 MCG/METERED NASAL SPRAY     4828         F                                 0.0662
         49        2238796 BECLOMETHASONE AQ NAS SPR 50MCG    APO-BECLOMETHASONE NASAL SPRAY                   3636         F                                 0.0662

         51         885843 BENAZEPRIL TAB 10MG                LOTENSIN 10MG                                    7277        P                    RDP           1.0221      0.7123
         51        2290340 BENAZEPRIL TAB 10MG                BENAZEPRIL                                      14412        P*                   RDP           0.7123
                                                                                    Page 4 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                            Full / Partial   Plan B
             DIN             Chemical Name                                   Drug Name                               MAN                                 RDP   SA   Max Price   LCA Price
Category no.                                                                                                                   LCA Benefit       Only


         52         885851 BENAZEPRIL TAB 20MG                               LOTENSIN 20MG                             7277         P                    RDP           1.1730      0.8172
         52        2273918 BENAZEPRIL TAB 20MG                               BENAZEPRIL                               14412         P*                   RDP           0.8172

         53         885835 BENAZEPRIL TAB 5MG                                LOTENSIN 5MG                              7277         P                    RDP           0.8231      0.6023
         53        2290332 BENAZEPRIL TAB 5MG                                BENAZEPRIL                               14412         P*                   RDP           0.6023

        880          16128 BENZTROPINE INJ 1MG/ML                            COGENTIN INJ 1MG/ML                       4662          F                                 2.6820
        880        2238903 BENZTROPINE INJ 1MG/ML                            BENZTROPINE OMEGA                         4852          F                                 4.3200

         54         426857 BENZTROPINE TAB 2MG                               APO BENZTROPINE MESYLATE TAB 2MG          3636          F                                 0.0583
         54         587265 BENZTROPINE TAB 2MG                               PMS-BENZTROPINE 2MG/TAB                   3550          F                                 0.0583

        596        1966065   BENZYDAMINE RINSE 0.15%                         TANTUM LIQ 0.15%                         12934          P                         X       0.1002      0.0313
        596        2229777   BENZYDAMINE RINSE 0.15%                         PMS-BENZYDAMINE - ORAL RINSE              3550          F                         X       0.0313
        596        2239044   BENZYDAMINE RINSE 0.15%                         APO-BENZYDAMINE ORAL RINSE                3636          F                         X       0.0313
        596        2310422   BENZYDAMINE RINSE 0.15%                         NOVO-BENZYDAMINE                          4773          F                         X       0.0313

       1094        2243878 BETAHISTINE DIHYDROCHLORIDE TAB 16MG              SERC                                      3525          P                                 0.4864      0.3911
       1094        2280191 BETAHISTINE DIHYDROCHLORIDE TAB 16MG              NOVO-BETAHISTINE                          4773          F                                 0.3911
       1094        2374757 BETAHISTINE DIHYDROCHLORIDE TAB 16MG              CO BETAHISTINE                           10028          F                                 0.1912

       1095        2247998 BETAHISTINE DIHYDROCHLORIDE TAB 24MG              SERC                                      3525          P                                 0.7295      0.5479
       1095        2280205 BETAHISTINE DIHYDROCHLORIDE TAB 24MG              NOVO-BETAHISTINE                          4773          F                                 0.5479
       1095        2374765 BETAHISTINE DIHYDROCHLORIDE TAB 24MG              CO BETAHISTINE                           10028          F                                 0.2866

       1211        2240601 BETAHISTINE DIHYDROCHLORIDE TAB 8MG               SERC 8 MG                                 7085          P                                 0.2660      0.2173
       1211        2280183 BETAHISTINE DIHYDROCHLORIDE TAB 8MG               NOVO-BETAHISTINE                          4773          F                                 0.2173

        926         682217 BETAMETHASONE AND GENTAMICIN OTIC/OPTH 1-3MG/ML   GARASONE OPHTHALMIC AND OTIC SOLUTION    12250          P                                 1.3838      1.2917
        926        2244999 BETAMETHASONE AND GENTAMICIN OTIC/OPTH 1-3MG/ML   SANDOZ PENTASONE                         12027          F                                 1.2917

         55          27898 BETAMETHASONE CRM 0.05%                           CELESTODERM V/2 CREAM .05%                7016          F                                 0.0166
         55         535427 BETAMETHASONE CRM 0.05%                           RATIO-ECTOSONE MILD CREAM 0.05%          10402          F                                 0.0660
         55         716618 BETAMETHASONE CRM 0.05%                           BETADERM CRM 0.05%                        5241          F                                 0.0660

         56         804541   BETAMETHASONE CRM 0.1%                          PREVEX B CREAM 0.1%                       9985          P                                 0.3798      0.1070
         56          27901   BETAMETHASONE CRM 0.1%                          CELESTODERM V CRM 0.1%                    7016          F                                 0.0246
         56         535435   BETAMETHASONE CRM 0.1%                          RATIO-ECTOSONE REGULAR CREAM 0.1%        10402          F                                 0.1070
         56         716626   BETAMETHASONE CRM 0.1%                          BETADERM CRM 0.1%                         5241          F                                 0.1070

         57         323071 BETAMETHASONE DIPROP CRM 0.05%                    DIPROSONE CREAM 0.05%                    12250          F                                 0.2212
         57         804991 BETAMETHASONE DIPROP CRM 0.05%                    RATIO-TOPISONE                           10402          F                                 0.2212
         57        1925350 BETAMETHASONE DIPROP CRM 0.05%                    TARO-SONE CREAM 0.05%                     5241          F                                 0.2212

         58         417246 BETAMETHASONE DIPROP LOT 0.05%                    DIPROSONE LOTION 0.05%                   12250          F                                 0.2138

         59         344923 BETAMETHASONE DIPROP ONT 0.05%                    DIPROSONE OINTMENT 0.05%                 12250          F                                 0.2327

         60         688622 BETAMETHASONE DIPROP/LENE CRM 0.05%               DIPROLENE                                12250          F                                 0.5602

         61         862975 BETAMETHASONE DIPROP/LENE LOT .05%                DIPROLENE                                12250          F                                 0.2912

         62         629367 BETAMETHASONE DIPROP/LENE ONT 0.5%                DIPROLENE                                12250          F                                 0.5602

        936         578428 BETAMETHASONE DIPROP/SALIC ACID LOT 0.05-2%       DIPROSALIC                               12250          P                                 0.4828      0.4566
        936        2245688 BETAMETHASONE DIPROP/SALIC ACID LOT 0.05-2%       RATIO-TOPISALIC                          10402          F                                 0.4566

         63         653209 BETAMETHASONE LOT 0.05%                           RATIO-ECTOSONE MILD LOTION 0.05%         10402          F                                 0.2732
         63        2100185 BETAMETHASONE LOT 0.05%                           BETNOVATE 0.05% LOTION                       0          F                                 0.2052

         64        2100193 BETAMETHASONE LOT 0.1%                            BETNOVATE LOTION 0.1%                         0         F                                 0.2700

         65          28355 BETAMETHASONE ONT 0.05%                           CELESTODERM V/2 OINTMENT 0.05%            7016          F                                 0.0166
         65         716642 BETAMETHASONE ONT 0.05%                           BETADERM ONT 0.05%                        5241          F                                 0.0654

         66          28363 BETAMETHASONE ONT 0.1%                            CELESTODERM V ONT 0.1%                    7016          F                                 0.0246
         66         716650 BETAMETHASONE ONT 0.1%                            BETADERM ONT 0.1%                         5241          F                                 0.0975

         67          27944 BETAMETHASONE SCALP LOT 0.1%                      VALISONE SCALP LOTION 0.1%               11211          F                                 0.0921
         67         653217 BETAMETHASONE SCALP LOT 0.1%                      RATIO-ECTOSONE SCALP LOTION 0.1%         10402          F                                 0.0921
         67         716634 BETAMETHASONE SCALP LOT 0.1%                      BETADERM LOTION 0.1%                      5241          F                                 0.0921

        850         695688 BETAXOLOL SOL 0.5%                                BETOPTIC LIQ                              3594          F                                 2.4343

         70         254142   BISACODYL EC TAB 5MG                            DULCOLAX ECT 5MG                          3617          P                                 0.2074      0.0525
         70         545023   BISACODYL EC TAB 5MG                            APO BISACODYL TAB 5MG                     3636          F                                 0.0525
         70         587273   BISACODYL EC TAB 5MG                            PMS-BISACODYL                             3550          F                                 0.0525
         70        2273411   BISACODYL EC TAB 5MG                            BISACODYL-ODAN                            4835          F                                 0.0437

         71         404802 BISACODYL SUP 10MG                                RATIO-BISACODYL                          10402          F                                 0.5055
         71         754595 BISACODYL SUP 10MG                                APO-BISACODYL SUP 10MG                    3636          F                                 0.5055

        981        2247440   BISOPROLOL FUMARATE TAB 10MG                    SANDOZ BISOPROLOL                        12027          F                                 0.2506
        981        2256177   BISOPROLOL FUMARATE TAB 10MG                    APO-BISOPROLOL                            3636          F                                 0.2506
        981        2267489   BISOPROLOL FUMARATE TAB 10MG                    NOVO-BISOPROLOL                           4773          F                                 0.2506
        981        2302640   BISOPROLOL FUMARATE TAB 10MG                    PMS-BISOPROLOL                            3550          F                                 0.2506

        980        2247439   BISOPROLOL FUMARATE TAB 5MG                     SANDOZ BISOPROLOL                        12027          F                                 0.1717
        980        2256134   BISOPROLOL FUMARATE TAB 5MG                     APO-BISOPROLOL                            3636          F                                 0.1717
        980        2267470   BISOPROLOL FUMARATE TAB 5MG                     NOVO-BISOPROLOL                           4773          F                                 0.1717
        980        2302632   BISOPROLOL FUMARATE TAB 5MG                     PMS-BISOPROLOL                            3550          F                                 0.1717

        937        2236876   BRIMONIDINE TARTRATE DPS 0.2%                   ALPHAGAN                                  3574          P                                 3.5640      1.4256
        937        2243026   BRIMONIDINE TARTRATE DPS 0.2%                   RATIO-BRIMONIDINE                        10402          F                                 1.4256
        937        2246284   BRIMONIDINE TARTRATE DPS 0.2%                   PMS-BRIMONIDINE                           3550          F                                 1.4256
        937        2260077   BRIMONIDINE TARTRATE DPS 0.2%                   APO-BRIMONIDINE                           3636          F                                 1.4256
        937        2305429   BRIMONIDINE TARTRATE DPS 0.2%                   SANDOZ BRIMONIDINE                       12027          F                                 1.4256

       1151        2248151 BRIMONIDINE TARTRATE SOL 0.15%                    ALPHAGAN P                                3574          P                                 2.4948      1.8706
       1151        2301334 BRIMONIDINE TARTRATE SOL 0.15%                    APO-BRIMONIDINE P                         3636          F                                 1.8706

         72        2177153 BROMAZEPAM TAB 1.5MG                              APO-BROMAZEPAM - TAB 1.5MG                3636          F                                 0.0556

         73         518123 BROMAZEPAM TAB 3MG                                LECTOPAM TAB 3MG                          4328          P                                 0.1619      0.0648
         73        2177161 BROMAZEPAM TAB 3MG                                APO-BROMAZEPAM - TAB 3MG                  3636          F                                 0.0648
         73        2230584 BROMAZEPAM TAB 3MG                                NOVO-BROMAZEPAM                           4773          F                                 0.0648
                                                                                                   Page 5 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                               Full / Partial   Plan B
             DIN             Chemical Name                   Drug Name                                   MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                      LCA Benefit       Only


         74         518131 BROMAZEPAM TAB 6MG                LECTOPAM TAB 6MG                              4328         P                                 0.2365      0.0946
         74        2177188 BROMAZEPAM TAB 6MG                APO-BROMAZEPAM - TAB 6MG                      3636         F                                 0.0946
         74        2230585 BROMAZEPAM TAB 6MG                NOVO-BROMAZEPAM                               4773         F                                 0.0946

        617        2230454 BROMOCRIPTINE CAP 5MG             APO-BROMOCRIPTINE                             3636         F                                 0.7923

         75        2087324 BROMOCRIPTINE TAB 2.5MG           APO-BROMOCRIPTINE TAB 2.5MG                   3636         F                                 0.4674
         75        2231702 BROMOCRIPTINE TAB 2.5MG           PMS-BROMOCRIPTINE                             3550         F                                 0.4674

        892        2231923 BUDESONIDE AQ NAS SPR 64MCG/AEM   RHINOCORT AQUA                                9307         P                                 0.0945      0.0910
        892        2241003 BUDESONIDE AQ NAS SPR 64MCG/AEM   MYLAN-BUDESONIDE AQ                          13930         F                                 0.0910

        686        2230648 BUDESONIDE NASAL SPR 100MCG       MYLAN-BUDESONIDE AQ                          13930         F                                 0.1035

       1090        2275074 BUPROPION HCL TAB 100MG           SANDOZ BUPROPION SR                          12027         F                         X       0.2674
       1090        2285657 BUPROPION HCL TAB 100MG           RATIO-BUPROPION SR                           10402         F                         X       0.2674
       1090        2325373 BUPROPION HCL TAB 100MG           PMS-BUPROPION SR                              3550         F                         X       0.2674

       1023        2237825   BUPROPION HCL TAB 150MG         WELLBUTRIN SR                                11902         P                         X       0.9986      0.3971
       1023        2275082   BUPROPION HCL TAB 150MG         SANDOZ BUPROPION SR                          12027         F                         X       0.3971
       1023        2285665   BUPROPION HCL TAB 150MG         RATIO-BUPROPION SR                           10402         F                         X       0.3971
       1023        2313421   BUPROPION HCL TAB 150MG         PMS-BUPROPION SR                              3550         F                         X       0.3971

         76        2207672   BUSPIRONE TAB 10MG              NU-BUSPIRONE - TAB 10MG                       4828         F                                 0.4595
         76        2211076   BUSPIRONE TAB 10MG              APO-BUSPIRONE - TAB 10MG                      3636         F                                 0.4595
         76        2230942   BUSPIRONE TAB 10MG              PMS-BUSPIRONE                                 3550         F                                 0.4595
         76        2231492   BUSPIRONE TAB 10MG              NOVO-BUSPIRONE                                4773         F                                 0.4595

       1245        2239092 CANDESARTAN CILEXETIL TAB 16MG    ATACAND TAB 16 MG                             9307         P                         X       1.2665      0.4925
       1245        2326973 CANDESARTAN CILEXETIL TAB 16MG    SANDOZ CANDESARTAN 16MG TAB                  12027         F                         X       0.4925
       1245        2365367 CANDESARTAN CILEXETIL TAB 16MG    APO-CANDESARTAN 16MG TAB                      3636         F                         X       0.4925

       1244        2239091 CANDESARTAN CILEXETIL TAB 8MG     ATACAND TAB 8MG                               9307         P                         X       1.2665      0.4925
       1244        2326965 CANDESARTAN CILEXETIL TAB 8MG     SANDOZ CANDESARTAN 8MG TAB                   12027         F                         X       0.4925
       1244        2365359 CANDESARTAN CILEXETIL TAB 8MG     APO-CANDESARTAN 8MG TAB                       3636         F                         X       0.4925

         77         893625   CAPTOPRIL TAB 100MG             APO-CAPTO TAB 100MG                           3636         F                   REF           0.5614
         77        1913859   CAPTOPRIL TAB 100MG             NU-CAPTO TAB 100MG                            4828         F                   REF           0.5614
         77        1942999   CAPTOPRIL TAB 100MG             NOVO-CAPTORIL TAB 100MG                       4773         F                   REF           0.5614
         77        2163594   CAPTOPRIL TAB 100MG             MYLAN-CAPTOPRIL                              13930         F                   REF           0.5614

         78         893595   CAPTOPRIL TAB 12.5MG            APO-CAPTO TAB 12.5MG                          3636         F                   REF           0.1145
         78        1913824   CAPTOPRIL TAB 12.5MG            NU-CAPTO TAB 12.5MG                           4828         F                   REF           0.1145
         78        1942964   CAPTOPRIL TAB 12.5MG            NOVO-CAPTORIL TAB 12.5MG                      4773         F                   REF           0.1145
         78        2163551   CAPTOPRIL TAB 12.5MG            MYLAN-CAPTOPRIL                              13930         F                   REF           0.1145

         79         546283   CAPTOPRIL TAB 25MG              CAPOTEN TAB 25MG                              3798         P                   REF           0.3240      0.1620
         79         893609   CAPTOPRIL TAB 25MG              APO-CAPTO TAB 25MG                            3636         F                   REF           0.1620
         79        1913832   CAPTOPRIL TAB 25MG              NU-CAPTO TAB 25MG                             4828         F                   REF           0.1620
         79        1942972   CAPTOPRIL TAB 25MG              NOVO-CAPTORIL TAB 25MG                        4773         F                   REF           0.1620
         79        2163578   CAPTOPRIL TAB 25MG              MYLAN-CAPTOPRIL                              13930         F                   REF           0.1620

         80         546291   CAPTOPRIL TAB 50MG              CAPOTEN TAB 50MG                              3798         P                   REF           0.6037      0.3019
         80         893617   CAPTOPRIL TAB 50MG              APO-CAPTO TAB 50MG                            3636         F                   REF           0.3019
         80        1913840   CAPTOPRIL TAB 50MG              NU-CAPTO TAB 50MG                             4828         F                   REF           0.3019
         80        1942980   CAPTOPRIL TAB 50MG              NOVO-CAPTORIL TAB 50MG                        4773         F                   REF           0.3019
         80        2163586   CAPTOPRIL TAB 50MG              MYLAN-CAPTOPRIL                              13930         F                   REF           0.3019

         81        1999559 CAPTOPRIL TAB 6.25MG              APO-CAPTO TAB 6.25MG                          3636         F                   REF           0.1336

        929         369810   CARBAMAZEPINE CHEW TAB 100MG    TEGRETOL CHEWTABS 100MG                       7277         P                                 0.1765      0.0656
        929        2231542   CARBAMAZEPINE CHEW TAB 100MG    PMS-CARBAMAZEPINE                             3550         F                                 0.0656
        929        2244403   CARBAMAZEPINE CHEW TAB 100MG    TARO-CARBAMAZEPINE CHEWABLE TABLETS 100MG     5241         F                                 0.0656
        929        2261855   CARBAMAZEPINE CHEW TAB 100MG    SANDOZ-CARBAMAZEPINE CHEWTABS                12027         F                                 0.0656

        928         665088   CARBAMAZEPINE CHEW TAB 200MG    TEGRETOL CHEWTABS 200MG                       7277         P                                 0.3482      0.1294
        928        2231540   CARBAMAZEPINE CHEW TAB 200MG    PMS-CARBAMAZEPINE                             3550         F                                 0.1294
        928        2244404   CARBAMAZEPINE CHEW TAB 200MG    TARO-CARBAMAZEPINE CHEWABLE TABLETS 200MG     5241         F                                 0.1294
        928        2261863   CARBAMAZEPINE CHEW TAB 200MG    SANDOZ-CARBAMAZEPINE CHEWTABS                12027         F                                 0.1294

        769         773611   CARBAMAZEPINE CR TAB 200MG      TEGRETOL CR TAB 200MG                         7277         P                                 0.4322      0.1606
        769        2231543   CARBAMAZEPINE CR TAB 200MG      PMS-CARBAMAZEPINE-CR                          3550         F                                 0.1606
        769        2237907   CARBAMAZEPINE CR TAB 200MG      TARO-CARBAMAZEPINE CR 200 MG                  5241         F                                 0.1606
        769        2241882   CARBAMAZEPINE CR TAB 200MG      MYLAN-CARBAMAZEPINE CR                       13930         F                                 0.1606
        769        2261839   CARBAMAZEPINE CR TAB 200MG      SANDOZ-CARBAMAZEPINE CR                      12027         F                                 0.1606

        770         755583   CARBAMAZEPINE CR TAB 400MG      TEGRETOL CR TAB 400MG                         7277         P                                 0.8642      0.3212
        770        2231544   CARBAMAZEPINE CR TAB 400MG      PMS-CARBAMAZEPINE-CR                          3550         F                                 0.3212
        770        2237908   CARBAMAZEPINE CR TAB 400MG      TARO-CARBAMAZEPINE CR 400 MG                  5241         F                                 0.3212
        770        2241883   CARBAMAZEPINE CR TAB 400MG      MYLAN-CARBAMAZEPINE CR                       13930         F                                 0.3212
        770        2261847   CARBAMAZEPINE CR TAB 400MG      SANDOZ-CARBAMAZEPINE CR                      12027         F                                 0.3212

         82          10405   CARBAMAZEPINE TAB 200MG         TEGRETOL 200MG                                7277         P                                 0.4287      0.0859
         82         402699   CARBAMAZEPINE TAB 200MG         APO CARBAMAZEPINE TAB 200MG                   3636         F                                 0.0859
         82         782718   CARBAMAZEPINE TAB 200MG         TEVA-CARBAMAZEPINE                           14318         F                                 0.0859
         82        2042568   CARBAMAZEPINE TAB 200MG         NU-CARBAMAZEPINE TAB 200MG                    4828         F                                 0.0859

        985        2245916   CARVEDILOL TAB 12.5MG           PMS-CARVEDILOL                                3550         F                         X       0.5835
        985        2247935   CARVEDILOL TAB 12.5MG           APO-CARVEDILOL                                3636         F                         X       0.5835
        985        2248754   CARVEDILOL TAB 12.5MG           PHL-CARVEDILOL                                4917         F                         X       0.5835
        985        2252325   CARVEDILOL TAB 12.5MG           RATIO-CARVEDILOL TABLETS 12.5MG              10402         F                         X       0.5835
        985        2268043   CARVEDILOL TAB 12.5MG           RAN-CARVEDILOL                               11271         F                         X       0.5835
        985        2338106   CARVEDILOL TAB 12.5MG           ZYM-CARVEDILOL                                6860         F                         X       0.5835
        985        2347555   CARVEDILOL TAB 12.5MG           MYLAN-CARVEDILOL                             13930         F                         X       0.5835
        985        2364948   CARVEDILOL TAB 12.5MG           CARVEDILOL 12.5MG TABLET                     14236         F                         X       0.5835

        986        2245917   CARVEDILOL TAB 25MG             PMS-CARVEDILOL                                3550         F                         X       0.5835
        986        2247936   CARVEDILOL TAB 25MG             APO-CARVEDILOL                                3636         F                         X       0.5835
        986        2248755   CARVEDILOL TAB 25MG             PHL-CARVEDILOL                                4917         F                         X       0.5835
        986        2252333   CARVEDILOL TAB 25MG             RATIO-CARVEDILOL TABLETS 25MG                10402         F                         X       0.5835
        986        2268051   CARVEDILOL TAB 25MG             RAN-CARVEDILOL                               11271         F                         X       0.5835
        986        2338114   CARVEDILOL TAB 25MG             ZYM-CARVEDILOL                                6860         F                         X       0.5835
        986        2347571   CARVEDILOL TAB 25MG             MYLAN-CARVEDILOL                             13930         F                         X       0.5835
        986        2364956   CARVEDILOL TAB 25MG             CARVEDILOL 25MG TABLET                       14236         F                         X       0.5835

        983        2245914 CARVEDILOL TAB 3.125MG            PMS-CARVEDILOL                                3550         F                         X       0.5835
                                                                                    Page 6 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                        Full / Partial   Plan B
             DIN             Chemical Name                          Drug Name                                     MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                               LCA Benefit       Only
        983        2247933   CARVEDILOL TAB 3.125MG                 APO-CARVEDILOL                                  3636         F                         X       0.5835
        983        2248752   CARVEDILOL TAB 3.125MG                 PHL-CARVEDILOL                                  4917         F                         X       0.5835
        983        2252309   CARVEDILOL TAB 3.125MG                 RATIO-CARVEDILOL TABLETS 3.125MG               10402         F                         X       0.5835
        983        2268027   CARVEDILOL TAB 3.125MG                 RAN-CARVEDILOL                                 11271         F                         X       0.5835
        983        2338068   CARVEDILOL TAB 3.125MG                 ZYM-CARVEDILOL                                  6860         F                         X       0.5835
        983        2347512   CARVEDILOL TAB 3.125MG                 MYLAN-CARVEDILOL                               13930         F                         X       0.5835
        983        2364913   CARVEDILOL TAB 3.125MG                 CARVEDILOL 3.125MG TABLET                      14236         F                         X       0.5835

        984        2245915   CARVEDILOL TAB 6.25MG                  PMS-CARVEDILOL                                  3550         F                         X       0.5835
        984        2247934   CARVEDILOL TAB 6.25MG                  APO-CARVEDILOL                                  3636         F                         X       0.5835
        984        2248753   CARVEDILOL TAB 6.25MG                  PHL-CARVEDILOL                                  4917         F                         X       0.5835
        984        2252317   CARVEDILOL TAB 6.25MG                  RATIO-CARVEDILOL TABLETS 6.25MG                10402         F                         X       0.5835
        984        2268035   CARVEDILOL TAB 6.25MG                  RAN-CARVEDILOL                                 11271         F                         X       0.5835
        984        2338092   CARVEDILOL TAB 6.25MG                  ZYM-CARVEDILOL                                  6860         F                         X       0.5835
        984        2347520   CARVEDILOL TAB 6.25MG                  MYLAN-CARVEDILOL                               13930         F                         X       0.5835
        984        2364921   CARVEDILOL TAB 6.25MG                  CARVEDILOL 6.25MG TABLET                       14236         F                         X       0.5835

        684         465186 CEFACLOR CAP 250MG                       CECLOR                                          9864         F                                 1.1024

        685         465194 CEFACLOR CAP 500MG                       CECLOR                                          9864         F                                 2.1643

       1177        2108127 CEFAZOLIN SODIUM VIAL 1.0GM              CEFAZOLIN FOR INJECTION - 1GM PWS               4773         F                                 6.4800
       1177        2297205 CEFAZOLIN SODIUM VIAL 1.0GM              CEFAZOLIN FOR INJECTION                        11642         F                                 6.4800
       1177        2308959 CEFAZOLIN SODIUM VIAL 1.0GM              CEFAZOLIN FOR INJECTION USP                    12027         F                                 6.4800

       1178        2108135 CEFAZOLIN SODIUM VIAL 10GM               CEFAZOLIN FOR INJECTION -10GM PWS               4773         F                                60.4800
       1178        2297213 CEFAZOLIN SODIUM VIAL 10GM               CEFAZOLIN FOR INJECTION                        11642         F                                60.4800
       1178        2308967 CEFAZOLIN SODIUM VIAL 10GM               CEFAZOLIN FOR INJECTION USP                    12027         F                                60.4800

       1149        2128187 CEFOXITIN SODIUM VIAL 1G                 CEFOXITIN FOR INJECTION, USP                    4773         F                                11.4480
       1149        2291711 CEFOXITIN SODIUM VIAL 1G                 CEFOXITIN FOR INJECTION, USP                   11642         F                                11.4480

       1150        2128195 CEFOXITIN SODIUM VIAL 2G                 CEFOXITIN FOR INJECTION, USP                    4773         F                                22.9500
       1150        2291738 CEFOXITIN SODIUM VIAL 2G                 CEFOXITIN FOR INJECTION, USP                   11642         F                                22.9500

       1115         657417 CEFTRIAXONE SODIUM VIAL 1G               ROCEPHIN PWS 1GM/VIAL                           4328         P                                38.5560     15.4224
       1115        2292270 CEFTRIAXONE SODIUM VIAL 1G               CEFTRIAXONE FOR INJECTION USP                  12027         F                                15.4224
       1115        2292874 CEFTRIAXONE SODIUM VIAL 1G               CEFTRIAXONE FOR INJECTION USP                  11642         F                                15.4224

       1161         657387 CEFTRIAXONE SODIUM VIAL 250MG            ROCEPHIN PWS INJ 0.25GM/VIAL                    4328         P                                12.1889      4.8756
       1161        2292866 CEFTRIAXONE SODIUM VIAL 250MG            CEFTRIAXONE FOR INJECTION USP                  11642         F                                 4.8756

       1116         657409 CEFTRIAXONE SODIUM VIAL 2G               ROCEPHIN PWS 2GM/VIAL                           4328         P                                74.4876     29.7950
       1116        2292289 CEFTRIAXONE SODIUM VIAL 2G               CEFTRIAXONE FOR INJECTION USP                  12027         F                                29.7950
       1116        2292882 CEFTRIAXONE SODIUM VIAL 2G               CEFTRIAXONE FOR INJECTION USP                  11642         F                                29.7950

        893        2212277 CEFUROXIME TAB 250MG                     CEFTIN - TAB 250MG                              9985         P                                 1.7482      0.7816
        893        2242656 CEFUROXIME TAB 250MG                     RATIO-CEFUROXIME                               10402         F                                 0.7816
        893        2244393 CEFUROXIME TAB 250MG                     APO-CEFUROXIME                                  3636         F                                 0.7816

        894        2212285 CEFUROXINE TAB 500MG                     CEFTIN - TAB 500MG                              9985         P                                 3.4631      1.5484
        894        2242657 CEFUROXINE TAB 500MG                     RATIO-CEFUROXIME                               10402         F                                 1.5484
        894        2244394 CEFUROXINE TAB 500MG                     APO-CEFUROXIME                                  3636         F                                 1.5484

         83         342084 CEPHALEXIN CAP 250MG                     NOVO-LEXIN CAP 250MG                            4773         F                                 0.2430

         84         342114 CEPHALEXIN CAP 500MG                     NOVO-LEXIN CAP 500MG                            4773         F                                 0.4860

         85          15547 CEPHALEXIN SUSP 25MG/ML                  KEFLEX                                          9864         F                                 0.0484
         85         342106 CEPHALEXIN SUSP 25MG/ML                  NOVO-LEXIN 125 ORAL SUSP 125MG/5ML              4773         F                                 0.0913

         86         342092 CEPHALEXIN SUSP 50MG/ML                  NOVO-LEXIN 250 ORAL SUSP 250MG/5ML              4773         F                                 0.1433

         87         403628   CEPHALEXIN TAB 250MG                   KEFLEX                                          9864         P                                 0.3452      0.2430
         87         583413   CEPHALEXIN TAB 250MG                   NOVO-LEXIN TAB 250MG                            4773         F                                 0.2430
         87         768723   CEPHALEXIN TAB 250MG                   APO-CEPHALEX TAB 250MG                          3636         F                                 0.2430
         87         865877   CEPHALEXIN TAB 250MG                   NU-CEPHALEX TAB 250MG                           4828         F                                 0.2430

         88         244392   CEPHALEXIN TAB 500MG                   KEFLEX                                          9864         P                                 0.6922      0.4860
         88         583421   CEPHALEXIN TAB 500MG                   NOVO-LEXIN TAB 500MG                            4773         F                                 0.4860
         88         768715   CEPHALEXIN TAB 500MG                   APO-CEPHALEX TAB 500MG                          3636         F                                 0.4860
         88         865885   CEPHALEXIN TAB 500MG                   NU-CEPHALEX TAB 500MG                           4828         F                                 0.4860

        742          29327 CHLORAL HYDRATE SYR 100MG                NOCTEC SYR 500MG/5ML                            5180         F                                 0.0261
        742         792659 CHLORAL HYDRATE SYR 100MG                PMS-CHLORAL HYDRATE SYRUP 100MG/ML              3550         F                                 0.0468
        742        2247621 CHLORAL HYDRATE SYR 100MG                CHLORAL HYDRATE SYRUP ODAN                      4835         F                                 0.0453

         90           1341   CHLORAMPHENICOL ONT 1%                 CHLOROPTIC OPH ONT 1%                           3574         P                                 1.8483      1.6169
         90           1058   CHLORAMPHENICOL ONT 1%                 FENICOL ONT 1%                                  3594         F                                 1.1782
         90          24066   CHLORAMPHENICOL ONT 1%                 CHLOROMYCETIN OPH ONT 1%                           0         F                                 1.0862
         90         725536   CHLORAMPHENICOL ONT 1%                 SPERSANICOL OPH ONT 10MG/GM                        0         F                                 1.0779
         90        1980564   CHLORAMPHENICOL ONT 1%                 PENTAMYCETIN ONT 10MG/GM                       12027         F                                 1.6169

         91           1082   CHLORAMPHENICOL OPTH SOL 0.5%          CHLOROPTIC DPS 0.5%                             3574         P                                 0.5476      0.4774
         91         221678   CHLORAMPHENICOL OPTH SOL 0.5%          CHLOROMYCETIN OPH SOLN 0.5%                        0         F                                 0.4579
         91         403474   CHLORAMPHENICOL OPTH SOL 0.5%          ISOPTO FENICOL LIQ 0.5%                         3594         F                                 0.4219
         91        2164051   CHLORAMPHENICOL OPTH SOL 0.5%          PENTAMYCETIN OPHTHALMIC SOLUTION 0.5% - LIQ    12027         F                                 0.4774

        619         156175 CHLORAMPHENICOL/PLUS ONT 1%              OPHTHOCORT ONT                                     0         F                                 2.4562
        619         704563 CHLORAMPHENICOL/PLUS ONT 1%              PENTAMYCETIN HC ONT                             3737         F                                 2.7202
        619        1980580 CHLORAMPHENICOL/PLUS ONT 1%              PENTAMYCETIN/HC                                12027         F                                 3.0549

         92          12637 CHLORDIAZEPOXIDE CAP 10MG                LIBRIUM CAP 10MG                                4328         F                                 0.0869
         92          13471 CHLORDIAZEPOXIDE CAP 10MG                SOLIUM 10 MG                                       0         F                                 0.1121
         92         522988 CHLORDIAZEPOXIDE CAP 10MG                CHLORDIAZEPOXIDE                               14412         F                                 0.1156

         93          12645 CHLORDIAZEPOXIDE CAP 25MG                LIBRIUM CAP 25MG                                4328         F                                 0.1339
         93          13498 CHLORDIAZEPOXIDE CAP 25MG                SOLIUM 25 MG                                       0         F                                 0.1486
         93         522996 CHLORDIAZEPOXIDE CAP 25MG                CHLORDIAZEPOXIDE                               14412         F                                 0.1791

         94         522724 CHLORDIAZEPOXIDE CAP 5MG                 CHLORDIAZEPOXIDE                               14412         F                                 0.0733

         95         115630 CHLORDIAZEPOXIDE/CLIDINIUM CAP 2.5/5MG   LIBRAX                                         11902         P                                 0.3235      0.2388
         95         391077 CHLORDIAZEPOXIDE/CLIDINIUM CAP 2.5/5MG   CORIUM CAP                                      4372         F                                 0.1171
         95         618454 CHLORDIAZEPOXIDE/CLIDINIUM CAP 2.5/5MG   APO-CHLORAX CAP                                 3636         F                                 0.2388

         96          21261 CHLOROQUINE TAB 250MG                    TEVA-CHLOROQUINE                               14318         F                         X       0.3696
                                                                                           Page 7 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                              Full / Partial   Plan B
             DIN             Chemical Name                       Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                     LCA Benefit       Only


         98          25496 CHLORPROMAZINE TAB 100MG              LARGACTIL 111.6MG                           0         F                                 0.0324
         98         232831 CHLORPROMAZINE TAB 100MG              TEVA-CHLORPROMAZINE                     14318         F                                 0.3578
         98        1929933 CHLORPROMAZINE TAB 100MG              LARGACTIL TAB 100MG                         0         F                                 0.0324

        100          25461 CHLORPROMAZINE TAB 25MG               LARGACTIL 27.9MG                            0         F                                 0.0126
        100         232823 CHLORPROMAZINE TAB 25MG               TEVA-CHLORPROMAZINE                     14318         F                                 0.1873
        100        1929917 CHLORPROMAZINE TAB 25MG               LARGACTIL TAB 25MG                          0         F                                 0.0123

         99          25488 CHLORPROMAZINE TAB 50MG               LARGACTIL 55.8MG                            0         F                                 0.0196
         99         232807 CHLORPROMAZINE TAB 50MG               TEVA-CHLORPROMAZINE                     14318         F                                 0.2142
         99        1929925 CHLORPROMAZINE TAB 50MG               LARGACTIL TAB 50MG                          0         F                                 0.0190

        101         399302 CHLORPROPAMIDE TAB 100MG              APO CHLORPROPAMIDE TAB 100MG             3636         F                                 0.0805

        102         312711 CHLORPROPAMIDE TAB 250MG              APO CHLORPROPAMIDE TAB 250MG             3636         F                                 0.0467

        104         298964 CHLORTHALIDONE TAB 50MG               URIDON TAB 50MG                          4372         F                                 0.0292
        104         360279 CHLORTHALIDONE TAB 50MG               CHLORTHALIDONE                          14412         F                                 0.1341

        105         890960 CHOLESTYRAMINE LIGHT PWR              OLESTYR                                  9864         F                                 1.5016
        105        1918486 CHOLESTYRAMINE LIGHT PWR              QUESTRAN LIGHT PWS 4GM/PCK               3801         F                                 0.6919

        106         464880 CHOLESTYRAMINE REG PWR                QUESTRAN PWR 4GM/9GM                     3801         F                                 0.6919
        106         634093 CHOLESTYRAMINE REG PWR                QUESTRAN PWR 378GM/CAN                   3801         F                                 0.5122
        106        2210320 CHOLESTYRAMINE REG PWR                OLESTYR                                  9864         F                                 1.5016

        107        1911465   CILAZAPRIL TAB 1MG                  INHIBACE TAB 1MG                         4328         P                   REF           0.6727      0.3502
        107        2266350   CILAZAPRIL TAB 1MG                  NOVO-CILAZAPRIL                          4773         F                   REF           0.3502
        107        2280442   CILAZAPRIL TAB 1MG                  PMS-CILAZAPRIL                           3550         F                   REF           0.3502
        107        2283778   CILAZAPRIL TAB 1MG                  MYLAN-CILAZAPRIL                        13930         F                   REF           0.3502
        107        2291134   CILAZAPRIL TAB 1MG                  APO-CILAZAPRIL                           3636         F                   REF           0.3502
        107        2350963   CILAZAPRIL TAB 1MG                  CILAZAPRIL                              14236         F                   REF           0.3502

        108        1911473   CILAZAPRIL TAB 2.5MG                INHIBACE TAB 2.5MG                       4328         P                   REF           0.7753      0.3102
        108        2266369   CILAZAPRIL TAB 2.5MG                NOVO-CILAZAPRIL                          4773         F                   REF           0.3102
        108        2280450   CILAZAPRIL TAB 2.5MG                PMS-CILAZAPRIL                           3550         F                   REF           0.3102
        108        2283786   CILAZAPRIL TAB 2.5MG                MYLAN-CILAZAPRIL                        13930         F                   REF           0.3102
        108        2285215   CILAZAPRIL TAB 2.5MG                CO CILAZAPRIL                           10028         F                   REF           0.3102
        108        2291142   CILAZAPRIL TAB 2.5MG                APO-CILAZAPRIL                           3636         F                   REF           0.3102
        108        2350971   CILAZAPRIL TAB 2.5MG                CILAZAPRIL                              14236         F                   REF           0.3102

        109        1911481   CILAZAPRIL TAB 5.0MG                INHIBACE TAB 5MG                         4328         P                   REF           0.9008      0.3603
        109        2266377   CILAZAPRIL TAB 5.0MG                NOVO-CILAZAPRIL                          4773         F                   REF           0.3603
        109        2280469   CILAZAPRIL TAB 5.0MG                PMS-CILAZAPRIL                           3550         F                   REF           0.3603
        109        2283794   CILAZAPRIL TAB 5.0MG                MYLAN-CILAZAPRIL                        13930         F                   REF           0.3603
        109        2285223   CILAZAPRIL TAB 5.0MG                CO CILAZAPRIL                           10028         F                   REF           0.3603
        109        2291150   CILAZAPRIL TAB 5.0MG                APO-CILAZAPRIL                           3636         F                   REF           0.3603
        109        2350998   CILAZAPRIL TAB 5.0MG                CILAZAPRIL                              14236         F                   REF           0.3603

        845        2181479 CILAZAPRIL/HYDROCHLORO TAB 5/12.5MG   INHIBACE PLUS - TAB                      4328         P                   REF           0.9006      0.4504
        845        2284987 CILAZAPRIL/HYDROCHLORO TAB 5/12.5MG   APO-CILAZAPRIL/HCTZ                      3636         F                   REF           0.4504
        845        2313731 CILAZAPRIL/HYDROCHLORO TAB 5/12.5MG   NOVO-CILAZAPRIL/HCTZ                     4773         F                   REF           0.4504

        110         546232 CIMETIDINE TAB 200MG                  PEPTOL TAB 200MG                         7012         F                   REF           0.0796
        110         584215 CIMETIDINE TAB 200MG                  APO CIMETIDINE TAB 200MG                 3636         F                   REF           0.0929

        111         487872   CIMETIDINE TAB 300MG                APO CIMETIDINE TAB 300MG                 3636         F                   REF           0.0929
        111         546240   CIMETIDINE TAB 300MG                PEPTOL TAB 300MG                         7012         F                   REF           0.0929
        111         582417   CIMETIDINE TAB 300MG                NOVO-CIMETINE TAB 300MG                  4773         F                   REF           0.0929
        111         865818   CIMETIDINE TAB 300MG                NU-CIMET TAB 300MG                       4828         F                   REF           0.0929
        111        2227444   CIMETIDINE TAB 300MG                MYLAN-CIMETIDINE                        13930         F                   REF           0.0929

        112         600059   CIMETIDINE TAB 400MG                APO CIMETIDINE TAB 400MG                 3636         F                   REF           0.1458
        112         603678   CIMETIDINE TAB 400MG                NOVO-CIMETINE TAB 400MG                  4773         F                   REF           0.1458
        112         865826   CIMETIDINE TAB 400MG                NU-CIMET TAB 400MG                       4828         F                   REF           0.1458
        112        2227452   CIMETIDINE TAB 400MG                MYLAN-CIMETIDINE                        13930         F                   REF           0.1458

        113         600067 CIMETIDINE TAB 600MG                  APO CIMETIDINE TAB 600MG                 3636         F                   REF           0.1838
        113         603686 CIMETIDINE TAB 600MG                  NOVO-CIMETINE TAB 600MG                  4773         F                   REF           0.1838
        113        2227460 CIMETIDINE TAB 600MG                  MYLAN-CIMETIDINE                        13930         F                   REF           0.1838

        114         618616 CIMETIDINE TAB 800MG                  PEPTOL TAB 800MG                         7012         F                   REF           0.2732
        114         749494 CIMETIDINE TAB 800MG                  APO-CIMETIDINE TAB 800MG                 3636         F                   REF           0.2732
        114        2227479 CIMETIDINE TAB 800MG                  MYLAN-CIMETIDINE                        13930         F                   REF           0.2732

       1028        1945270 CIPROFLOXACIN HCL DROPS 0.3%          CILOXAN                                  3594         P                         X       2.1371      0.8381
       1028        2253933 CIPROFLOXACIN HCL DROPS 0.3%          PMS-CIPROFLOXACIN 0.3%                   3550         F                         X       0.8381
       1028        2263130 CIPROFLOXACIN HCL DROPS 0.3%          APO-CIPROFLOX                            3636         F                         X       0.8381

       1005        2155958   CIPROFLOXACIN HCL TAB 250MG         CIPRO 250 - TAB 250MG                   10774         P                                 2.6721      1.0689
       1005        2161737   CIPROFLOXACIN HCL TAB 250MG         NOVO-CIPROFLOXACIN                       4773         F                                 1.0689
       1005        2229521   CIPROFLOXACIN HCL TAB 250MG         APO-CIPROFLOX                            3636         F                                 1.0689
       1005        2245647   CIPROFLOXACIN HCL TAB 250MG         MYLAN-CIPROFLOXACIN                     13930         F                                 1.0689
       1005        2246825   CIPROFLOXACIN HCL TAB 250MG         RATIO-CIPROFLOXACIN                     10402         F                                 1.0689
       1005        2247339   CIPROFLOXACIN HCL TAB 250MG         CO CIPROFLOXACIN TABLET, 250MG          10028         F                                 1.0689
       1005        2248437   CIPROFLOXACIN HCL TAB 250MG         PMS-CIPROFLOXACIN                        3550         F                                 1.0689
       1005        2248756   CIPROFLOXACIN HCL TAB 250MG         SANDOZ CIPROFLOXACIN                    12027         F                                 1.0689
       1005        2303728   CIPROFLOXACIN HCL TAB 250MG         RAN-CIPROFLOX                           11271         F                                 1.0689
       1005        2317427   CIPROFLOXACIN HCL TAB 250MG         MINT-CIPROFLOXACIN                      13221         F                                 1.0689
       1005        2332132   CIPROFLOXACIN HCL TAB 250MG         CIPROFLOXACIN 250 MG TABLET             11271         F                                 1.0689
       1005        2353318   CIPROFLOXACIN HCL TAB 250MG         CIPROFLOXACIN                           14236         F                                 1.0689

       1006        2155966   CIPROFLOXACIN HCL TAB 500MG         CIPRO 500 - TAB 500MG                   10774         P                                 3.0148      1.2059
       1006        2161745   CIPROFLOXACIN HCL TAB 500MG         NOVO-CIPROFLOXACIN                       4773         F                                 1.2059
       1006        2229522   CIPROFLOXACIN HCL TAB 500MG         APO-CIPROFLOX                            3636         F                                 1.2059
       1006        2245648   CIPROFLOXACIN HCL TAB 500MG         MYLAN-CIPROFLOXACIN                     13930         F                                 1.2059
       1006        2246826   CIPROFLOXACIN HCL TAB 500MG         RATIO-CIPROFLOXACIN                     10402         F                                 1.2059
       1006        2247340   CIPROFLOXACIN HCL TAB 500MG         CO CIPROFLOXACIN TABLET, 500MG          10028         F                                 1.2059
       1006        2248438   CIPROFLOXACIN HCL TAB 500MG         PMS-CIPROFLOXACIN                        3550         F                                 1.2059
       1006        2248757   CIPROFLOXACIN HCL TAB 500MG         SANDOZ CIPROFLOXACIN                    12027         F                                 1.2059
       1006        2303736   CIPROFLOXACIN HCL TAB 500MG         RAN-CIPROFLOX                           11271         F                                 1.2059
       1006        2317435   CIPROFLOXACIN HCL TAB 500MG         MINT-CIPROFLOXACIN                      13221         F                                 1.2059
       1006        2332140   CIPROFLOXACIN HCL TAB 500MG         CIPROFLOXACIN 500 MG TABLET             11271         F                                 1.2059
       1006        2353326   CIPROFLOXACIN HCL TAB 500MG         CIPROFLOXACIN                           14236         F                                 1.2059

       1007        2155974 CIPROFLOXACIN HCL TAB 750MG           CIPRO 750 - TAB 750MG                   10774         P                                 5.5207      2.2083
                                                                                         Page 8 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                    Full / Partial   Plan B
             DIN             Chemical Name                      Drug Name                                     MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                           LCA Benefit       Only
       1007        2161753   CIPROFLOXACIN HCL TAB 750MG        NOVO-CIPROFLOXACIN                              4773         F                                 2.2083
       1007        2229523   CIPROFLOXACIN HCL TAB 750MG        APO-CIPROFLOX                                   3636         F                                 2.2083
       1007        2245649   CIPROFLOXACIN HCL TAB 750MG        MYLAN-CIPROFLOXACIN                            13930         F                                 2.2083
       1007        2246827   CIPROFLOXACIN HCL TAB 750MG        RATIO-CIPROFLOXACIN                            10402         F                                 2.2083
       1007        2247341   CIPROFLOXACIN HCL TAB 750MG        CO CIPROFLOXACIN TABLET, 750MG                 10028         F                                 2.2083
       1007        2248439   CIPROFLOXACIN HCL TAB 750MG        PMS-CIPROFLOXACIN                               3550         F                                 2.2083
       1007        2248758   CIPROFLOXACIN HCL TAB 750MG        SANDOZ CIPROFLOXACIN                           12027         F                                 2.2083
       1007        2303744   CIPROFLOXACIN HCL TAB 750MG        RAN-CIPROFLOX                                  11271         F                                 2.2083
       1007        2317443   CIPROFLOXACIN HCL TAB 750MG        MINT-CIPROFLOXACIN                             13221         F                                 2.2083
       1007        2332159   CIPROFLOXACIN HCL TAB 750MG        CIPROFLOXACIN 750 MG TABLET                    11271         F                                 2.2083
       1007        2353334   CIPROFLOXACIN HCL TAB 750MG        CIPROFLOXACIN                                  14236         F                                 2.2083

       1160        2270609   CITALOPRAM HYDROBROMIDE TAB 10MG   PMS-CITALOPRAM                                  3550         F                                 0.4821
       1160        2312336   CITALOPRAM HYDROBROMIDE TAB 10MG   TEVA-CITALOPRAM                                14318         F                                 0.4821
       1160        2355248   CITALOPRAM HYDROBROMIDE TAB 10MG   ACCEL-CITALOPRAM 10MG TABLET                   13829         F                                 0.4821
       1160        2370077   CITALOPRAM HYDROBROMIDE TAB 10MG   MINT-CITALOPRAM 10 MG TABLET                   13221         F                                 0.4821
       1160        2370085   CITALOPRAM HYDROBROMIDE TAB 10MG   JAMP-CITALOPRAM 10 MG TABLET                    4415         F                                 0.4821

        991        2239607   CITALOPRAM HYDROBROMIDE TAB 20MG   CELEXA 20 MG                                    5362         P                                 1.4382      0.5753
        991        2246056   CITALOPRAM HYDROBROMIDE TAB 20MG   APO-CITALOPRAM                                  3636         F                                 0.5753
        991        2246594   CITALOPRAM HYDROBROMIDE TAB 20MG   MYLAN-CITALOPRAM                               13930         F                                 0.5753
        991        2248010   CITALOPRAM HYDROBROMIDE TAB 20MG   PMS-CITALOPRAM                                  3550         F                                 0.5753
        991        2248050   CITALOPRAM HYDROBROMIDE TAB 20MG   CO CITALOPRAM                                  10028         F                                 0.5753
        991        2248170   CITALOPRAM HYDROBROMIDE TAB 20MG   SANDOZ CITALOPRAM                              12027         F                                 0.5753
        991        2248944   CITALOPRAM HYDROBROMIDE TAB 20MG   PHL-CITALOPRAM                                  4917         F                                 0.5753
        991        2252112   CITALOPRAM HYDROBROMIDE TAB 20MG   RATIO-CITALOPRAM                               10402         F                                 0.5753
        991        2285622   CITALOPRAM HYDROBROMIDE TAB 20MG   RAN-CITALO                                     11271         F                                 0.5753
        991        2293218   CITALOPRAM HYDROBROMIDE TAB 20MG   TEVA-CITALOPRAM                                14318         F                                 0.5753
        991        2304686   CITALOPRAM HYDROBROMIDE TAB 20MG   MINT-CITALOPRAM                                13221         F                                 0.5753
        991        2306239   CITALOPRAM HYDROBROMIDE TAB 20MG   CITALOPRAM-ODAN                                 4835         F                                 0.5753
        991        2313405   CITALOPRAM HYDROBROMIDE TAB 20MG   JAMP-CITALOPRAM                                 4415         F                                 0.5753
        991        2331950   CITALOPRAM HYDROBROMIDE TAB 20MG   CITALOPRAM 20 MG TABLET                        11271         F                                 0.5753
        991        2353660   CITALOPRAM HYDROBROMIDE TAB 20MG   CITALOPRAM                                     14236         F                                 0.5753
        991        2355256   CITALOPRAM HYDROBROMIDE TAB 20MG   ACCEL-CITALOPRAM 20 MG TABLET                  13829         F                                 0.5753
        991        2355272   CITALOPRAM HYDROBROMIDE TAB 20MG   SEPTA-CITALOPRAM                               14461         F                                 0.5753

        992        2239608   CITALOPRAM HYDROBROMIDE TAB 40MG   CELEXA 40 MG                                    5362         P                                 1.4382      0.5753
        992        2246057   CITALOPRAM HYDROBROMIDE TAB 40MG   APO-CITALOPRAM                                  3636         F                                 0.5753
        992        2246595   CITALOPRAM HYDROBROMIDE TAB 40MG   MYLAN-CITALOPRAM                               13930         F                                 0.5753
        992        2248011   CITALOPRAM HYDROBROMIDE TAB 40MG   PMS-CITALOPRAM                                  3550         F                                 0.5753
        992        2248051   CITALOPRAM HYDROBROMIDE TAB 40MG   CO CITALOPRAM                                  10028         F                                 0.5753
        992        2248171   CITALOPRAM HYDROBROMIDE TAB 40MG   SANDOZ CITALOPRAM                              12027         F                                 0.5753
        992        2248945   CITALOPRAM HYDROBROMIDE TAB 40MG   PHL-CITALOPRAM                                  4917         F                                 0.5753
        992        2252120   CITALOPRAM HYDROBROMIDE TAB 40MG   RATIO-CITALOPRAM                               10402         F                                 0.5753
        992        2285630   CITALOPRAM HYDROBROMIDE TAB 40MG   RAN-CITALO                                     11271         F                                 0.5753
        992        2293226   CITALOPRAM HYDROBROMIDE TAB 40MG   TEVA-CITALOPRAM                                14318         F                                 0.5753
        992        2304694   CITALOPRAM HYDROBROMIDE TAB 40MG   MINT-CITALOPRAM                                13221         F                                 0.5753
        992        2306247   CITALOPRAM HYDROBROMIDE TAB 40MG   CITALOPRAM-ODAN                                 4835         F                                 0.5753
        992        2313413   CITALOPRAM HYDROBROMIDE TAB 40MG   JAMP-CITALOPRAM                                 4415         F                                 0.5753
        992        2331977   CITALOPRAM HYDROBROMIDE TAB 40MG   CITALOPRAM 40 MG TABLET                        11271         F                                 0.5753
        992        2353679   CITALOPRAM HYDROBROMIDE TAB 40MG   CITALOPRAM                                     14236         F                                 0.5753
        992        2355264   CITALOPRAM HYDROBROMIDE TAB 40MG   ACCEL-CITALOPRAM 40 MG TABLET                  13829         F                                 0.5753
        992        2355280   CITALOPRAM HYDROBROMIDE TAB 40MG   SEPTA-CITALOPRAM                               14461         F                                 0.5753

       1119        1984853   CLARITHROMYCIN TAB 250MG           BIAXIN BID 250MG                                3525         P                                 1.7806      0.7123
       1119        2247573   CLARITHROMYCIN TAB 250MG           PMS-CLARITHROMYCIN                              3550         F                                 0.7123
       1119        2247818   CLARITHROMYCIN TAB 250MG           RATIO-CLARITHROMYCIN                           10402         F                                 0.7123
       1119        2248856   CLARITHROMYCIN TAB 250MG           MYLAN-CLARITHROMYCIN                           13930         F                                 0.7123
       1119        2266539   CLARITHROMYCIN TAB 250MG           SANDOZ CLARITHROMYCIN                          12027         F                                 0.7123
       1119        2274744   CLARITHROMYCIN TAB 250MG           APO-CLARITHROMYCIN                              3636         F                                 0.7123
       1119        2361426   CLARITHROMYCIN TAB 250MG           RAN-CLARITHROMYCIN 250MG TABLET                11271         F                                 0.7123

       1120        2126710   CLARITHROMYCIN TAB 500MG           BIAXIN BID 500MG                                3525         P                                 3.5194      1.7596
       1120        2247819   CLARITHROMYCIN TAB 500MG           RATIO-CLARITHROMYCIN                           10402         F                                 1.7596
       1120        2248857   CLARITHROMYCIN TAB 500MG           MYLAN-CLARITHROMYCIN                           13930         F                                 1.7596
       1120        2266547   CLARITHROMYCIN TAB 500MG           SANDOZ CLARITHROMYCIN                          12027         F                                 1.7596
       1120        2274752   CLARITHROMYCIN TAB 500MG           APO-CLARITHROMYCIN                              3636         F                                 1.7596
       1120        2361434   CLARITHROMYCIN TAB 500MG           RAN-CLARITHROMYCIN 500MG TABLET                11271         F                                 1.7596

        877          30570   CLINDAMYCIN CAP 150MG              DALACIN C 150 MG                                4908         P                                 1.0165      0.4054
        877        2241709   CLINDAMYCIN CAP 150MG              TEVA-CLINDAMYCIN                               14318         F                                 0.4054
        877        2245232   CLINDAMYCIN CAP 150MG              APO-CLINDAMYCIN                                 3636         F                                 0.4054
        877        2258331   CLINDAMYCIN CAP 150MG              MYLAN-CLINDAMYCIN                              13930         F                                 0.4054

        878        2182866   CLINDAMYCIN CAP 300MG              DALACIN C 300 MG                                4908         P                                 2.0329      0.8108
        878        2241710   CLINDAMYCIN CAP 300MG              TEVA-CLINDAMYCIN                               14318         F                                 0.8108
        878        2245233   CLINDAMYCIN CAP 300MG              APO-CLINDAMYCIN                                 3636         F                                 0.8108
        878        2258358   CLINDAMYCIN CAP 300MG              MYLAN-CLINDAMYCIN                              13930         F                                 0.8108

        858         260436 CLINDAMYCIN INJ 150MG/ML             DALACIN C PHOSPHATE                             4908         P                                 4.4283      2.4700
        858        2230540 CLINDAMYCIN INJ 150MG/ML             CLINDAMYCIN INJECTION USP                      12027         F                                 2.4700

        766        2221799   CLOBAZAM TAB 10MG                  FRISIUM TABLET 10MG                            14097         P                                 0.4744      0.1898
        766        2238334   CLOBAZAM TAB 10MG                  NOVO-CLOBAZAM                                   4773         F                                 0.1898
        766        2244474   CLOBAZAM TAB 10MG                  PMS-CLOBAZAM                                    3550         F                                 0.1898
        766        2244638   CLOBAZAM TAB 10MG                  APO-CLOBAZAM TABLETS                            3636         F                                 0.1898

        115        2213265   CLOBETASOL CRM 0.05%               DERMOVATE CREAM                                11314         P                                 0.8092      0.3237
        115        1910272   CLOBETASOL CRM 0.05%               RATIO-CLOBETASOL                               10402         F                                 0.3237
        115        2024187   CLOBETASOL CRM 0.05%               MYLAN-CLOBETASOL CREAM                         13930         F                                 0.3237
        115        2093162   CLOBETASOL CRM 0.05%               NOVO-CLOBETASOL CRM 0.05%                       4773         F                                 0.3237
        115        2232191   CLOBETASOL CRM 0.05%               PMS-CLOBETASOL CREAM                            3550         F                                 0.3237
        115        2245523   CLOBETASOL CRM 0.05%               TARO-CLOBETASOL CREAM USP, 0.05%                5241         F                                 0.3237

        116        2213273   CLOBETASOL ONT 0.05%               DERMOVATE OINTMENT                             11314         P                                 0.8092      0.3237
        116        1910280   CLOBETASOL ONT 0.05%               RATIO-CLOBETASOL                               10402         F                                 0.3237
        116        2026767   CLOBETASOL ONT 0.05%               MYLAN-CLOBETASOL OINTMENT                      13930         F                                 0.3237
        116        2126192   CLOBETASOL ONT 0.05%               NOVO-CLOBETASOL OINTMENT - 0.05%                4773         F                                 0.3237
        116        2232193   CLOBETASOL ONT 0.05%               PMS-CLOBETASOL OINTMENT                         3550         F                                 0.3237
        116        2245524   CLOBETASOL ONT 0.05%               TARO-CLOBETASOL OINTMENT USP, 0.05%             5241         F                                 0.3237
        116        2309548   CLOBETASOL ONT 0.05%               PMS-CLOBETASOL                                  3550         F                                 0.3237

        117        2213281   CLOBETASOL SOL 0.05%               DERMOVATE SCALP APPLICATION                    11314         P                                 0.7798      0.3119
        117        1910299   CLOBETASOL SOL 0.05%               RATIO-CLOBETASOL                               10402         F                                 0.3119
        117        2216213   CLOBETASOL SOL 0.05%               MYLAN-CLOBETASOL SCALP APPLICATION             13930         F                                 0.3119
        117        2232195   CLOBETASOL SOL 0.05%               PMS-CLOBETASOL SCALP APPLICATION                3550         F                                 0.3119
        117        2245522   CLOBETASOL SOL 0.05%               TARO-CLOBETASOL TOPICAL SOLUTION USP, 0.05%     5241         F                                 0.3119
                                                                                     Page 9 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                            Full / Partial   Plan B
             DIN             Chemical Name                       Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                   LCA Benefit       Only


        777        1984845 CLODRONATE DISODIUM CAP 400MG         BONEFOS                               10774         P                                 2.0207      1.3050
        777        2245828 CLODRONATE DISODIUM CAP 400MG         CLASTEON                              13843         F                                 1.3050

        120         330566 CLOMIPRAMINE TAB 10MG                 ANAFRANIL                             13843         P                                 0.3057      0.1393
        120        2040786 CLOMIPRAMINE TAB 10MG                 APO-CLOMIPRAMINE TABLETS 10MG          3636         F                                 0.1393
        120        2244816 CLOMIPRAMINE TAB 10MG                 CO CLOMIPRAMINE TABLETS 10MG          10028         F                                 0.1393

        121         324019 CLOMIPRAMINE TAB 25MG                 ANAFRANIL                             13843         P                                 0.3088      0.1899
        121        2040778 CLOMIPRAMINE TAB 25MG                 APO-CLOMIPRAMINE TABLETS 25MG          3636         F                                 0.1899
        121        2244817 CLOMIPRAMINE TAB 25MG                 CO CLOMIPRAMINE TABLETS 25MG          10028         F                                 0.1899

        122         402591 CLOMIPRAMINE TAB 50MG                 ANAFRANIL                             13843         P                                 0.7342      0.3496
        122        2040751 CLOMIPRAMINE TAB 50MG                 APO-CLOMIPRAMINE TABLETS 50MG          3636         F                                 0.3496
        122        2244818 CLOMIPRAMINE TAB 50MG                 CO CLOMIPRAMINE TABLETS 50MG          10028         F                                 0.3496

        123         382825   CLONAZEPAM TAB 0.5MG                RIVOTRIL 0.5TAB                        4328         P                                 0.2141      0.0856
        123        2048701   CLONAZEPAM TAB 0.5MG                PMS-CLONAZEPAM TAB 0.5MG               3550         F                                 0.0856
        123        2103656   CLONAZEPAM TAB 0.5MG                RATIO-CLONAZEPAM                      10402         F                                 0.0856
        123        2177889   CLONAZEPAM TAB 0.5MG                APO-CLONAZEPAM - TAB 0.5MG             3636         F                                 0.0856
        123        2207818   CLONAZEPAM TAB 0.5MG                PMS-CLONAZEPAM-R TAB 0.5MG             3550         F                                 0.0856
        123        2230950   CLONAZEPAM TAB 0.5MG                MYLAN-CLONAZEPAM                      13930         F                                 0.0856
        123        2233960   CLONAZEPAM TAB 0.5MG                SANDOZ CLONAZEPAM                     12027         F                                 0.0856
        123        2239024   CLONAZEPAM TAB 0.5MG                NOVO-CLONAZEPAM                        4773         F                                 0.0856
        123        2270641   CLONAZEPAM TAB 0.5MG                CO CLONAZEPAM                         10028         F                                 0.0856
        123        2345676   CLONAZEPAM TAB 0.5MG                ZYM-CLONAZEPAM                         6860         F                                 0.0856

        124        2048728   CLONAZEPAM TAB 1MG                  PMS-CLONAZEPAM TAB 1.0MG               3550         F                                 0.1606
        124        2233982   CLONAZEPAM TAB 1MG                  SANDOZ CLONAZEPAM                     12027         F                                 0.1606
        124        2270668   CLONAZEPAM TAB 1MG                  CO CLONAZEPAM                         10028         F                                 0.1606
        124        2303329   CLONAZEPAM TAB 1MG                  ZYM-CLONAZEPAM                         6860         F                                 0.1606

        125         382841   CLONAZEPAM TAB 2MG                  RIVOTRIL 2TAB                          4328         P                                 0.3690      0.1476
        125        2048736   CLONAZEPAM TAB 2MG                  PMS-CLONAZEPAM TAB 2MG                 3550         F                                 0.1476
        125        2103737   CLONAZEPAM TAB 2MG                  RATIO-CLONAZEPAM                      10402         F                                 0.1476
        125        2177897   CLONAZEPAM TAB 2MG                  APO-CLONAZEPAM - TAB 2MG               3636         F                                 0.1476
        125        2230951   CLONAZEPAM TAB 2MG                  MYLAN-CLONAZEPAM                      13930         F                                 0.1476
        125        2233985   CLONAZEPAM TAB 2MG                  SANDOZ CLONAZEPAM                     12027         F                                 0.1476
        125        2239025   CLONAZEPAM TAB 2MG                  NOVO-CLONAZEPAM                        4773         F                                 0.1476
        125        2270676   CLONAZEPAM TAB 2MG                  CO CLONAZEPAM                         10028         F                                 0.1476
        125        2303337   CLONAZEPAM TAB 2MG                  ZYM-CLONAZEPAM                         6860         F                                 0.1476

       1027         519251   CLONIDINE TAB 0.025MG               DIXARIT TAB 0.025MG                    3617         P                                 0.2938      0.1645
       1027        2248732   CLONIDINE TAB 0.025MG               APO-CLONIDINE                          3636         F                                 0.1645
       1027        2304163   CLONIDINE TAB 0.025MG               NOVO-CLONIDINE                         4773         F                                 0.1645
       1027        2361299   CLONIDINE TAB 0.025MG               CLONIDINE 0.025MG TABLET              14236         F                                 0.1645

        126         259527   CLONIDINE TAB 0.1MG                 CATAPRES TAB 0.1MG                     3617         P                                 0.2001      0.1467
        126         868949   CLONIDINE TAB 0.1MG                 APO-CLONIDINE TAB 0.1MG                3636         F                                 0.1467
        126        2046121   CLONIDINE TAB 0.1MG                 NOVO-CLONIDINE TABLETS 0.1MG           4773         F                                 0.1467
        126        2361302   CLONIDINE TAB 0.1MG                 CLONIDINE 0.1MG TABLET                14236         F                                 0.1467

        127         291889   CLONIDINE TAB 0.2MG                 CATAPRES TAB 0.2MG                     3617         P                                 0.3570      0.2618
        127         868957   CLONIDINE TAB 0.2MG                 APO-CLONIDINE TAB 0.2MG                3636         F                                 0.2618
        127        2046148   CLONIDINE TAB 0.2MG                 NOVO-CLONIDINE TABLETS 0.2MG           4773         F                                 0.2618
        127        2361310   CLONIDINE TAB 0.2MG                 CLONIDINE 0.2MG TABLET                14236         F                                 0.2618

        128         264911 CLORAZEPATE CAP 15MG                  TRANXENE CAP 15MG                      3525         F                                 0.3704
        128         860697 CLORAZEPATE CAP 15MG                  APO-CLORAZEPATE                        3636         F                                 0.4164

        129         860689 CLORAZEPATE CAP 3.75MG                APO-CLORAZEPATE                        3636         F                                 0.1594

        130         264946 CLORAZEPATE CAP 7.5MG                 TRANXENE CAP 7.5MG                     3525         F                                 0.2057
        130         860700 CLORAZEPATE CAP 7.5MG                 APO-CLORAZEPATE                        3636         F                                 0.2080

        131        2150867 CLOTRIMAZOLE TOP CRM 10MG/GM          CANESTEN 1% TOPICAL CREAM              5348         P                         X       0.3311      0.1324
        131        2239432 CLOTRIMAZOLE TOP CRM 10MG/GM          CANESTEN EXTERNAL CREAM REFILL         5348         P                         X       0.2268      0.1324
        131         812382 CLOTRIMAZOLE TOP CRM 10MG/GM          CLOTRIMADERM CREAM 1%                  5241         F                         X       0.1324

        133        2150905 CLOTRIMAZOLE VAG CRM 20MG/GM          CANESTEN CREAM 3                       5348         P                                 0.4303      0.3780
        133         812374 CLOTRIMAZOLE VAG CRM 20MG/GM          CLOTRIMADERM VAG CREAM 2%              5241         F                                 0.3780

        134        2150891 CLOTRIMAZOLE VAG CRM 50MG/GM          CANESTEN CREAM 6                       5348         P                                 0.2151      0.1890
        134         812366 CLOTRIMAZOLE VAG CRM 50MG/GM          CLOTRIMADERM VAG CREAM 1%              5241         F                                 0.1890

        136         337765 CLOXACILLIN CAP 250MG                 NOVO-CLOXIN CAP 250MG                  4773         F                                 0.1998
        136         618292 CLOXACILLIN CAP 250MG                 APO CLOXI CAP 250MG                    3636         F                                 0.1998

        137         337773 CLOXACILLIN CAP 500MG                 NOVO-CLOXIN CAP 500MG                  4773         F                                 0.3778
        137         618284 CLOXACILLIN CAP 500MG                 APO CLOXI CAP 500MG                    3636         F                                 0.3778

        138         337757 CLOXACILLIN PWR/SOL 25MG/ML           NOVO-CLOXIN FOR ORAL SOLUTION 1        4773         F                                 0.0486
        138         644633 CLOXACILLIN PWR/SOL 25MG/ML           APO CLOXI FOR ORAL SOLN 125MG/5ML      3636         F                                 0.0486

       1018         894745 CLOZAPINE 100MG TAB                   CLOZARIL TAB 100MG                     7277         P                                 4.0802      2.8562
       1018        2247244 CLOZAPINE 100MG TAB                   GEN-CLOZAPINE                         13930         F                                 2.8562
       1018        2248035 CLOZAPINE 100MG TAB                   APO-CLOZAPINE                          3636         F                                 2.8562

       1017         894737 CLOZAPINE 25MG                        CLOZARIL TAB 25MG                      7277         P                                 1.0174      0.7122
       1017        2247243 CLOZAPINE 25MG                        GEN-CLOZAPINE                         13930         F                                 0.7122
       1017        2248034 CLOZAPINE 25MG                        APO-CLOZAPINE                          3636         F                                 0.7122

        139        2163942 CODEINE 8/ACET 160 ELX/5ML            TYLENOL WITH CODEINE ELIXIR            7259         P                                 0.1126      0.0758
        139         816027 CODEINE 8/ACET 160 ELX/5ML            PMS-ACETAMINOPHEN W CODEINE ELIXIR     3550         F                                 0.0758

        141         653241 CODEINE 15/ACET 300/CAFF 15 TAB       RATIO-LENOLTEC NO 2                   10402         F                                 0.0745
        141        2163934 CODEINE 15/ACET 300/CAFF 15 TAB       TYLENOL WITH CODEINE NO. 2 - TAB       7259         F                                 0.0745

        142         293504 CODEINE 15/ACET 300/CAFF 30 TAB       ATASOL 15 TAB                          3893         P                                 0.0961      0.0822
        142        2232388 CODEINE 15/ACET 300/CAFF 30 TAB       EXDOL-15 TABLETS                      11656         F                                 0.0822

        140         176192 CODEINE 15/ASA/BARBITURATE/CAFF CAP   FIORINAL C1/4 CAP                      7277         P                                 1.8039      0.6707
        140         608203 CODEINE 15/ASA/BARBITURATE/CAFF CAP   RATIO-TECNAL C1/4                     10402         F                                 0.6707

        145         653276 CODEINE 30/ACET 300/CAFF 15 TAB       RATIO-LENOLTEC NO 3                   10402         F                                 0.0821
        145        2163926 CODEINE 30/ACET 300/CAFF 15 TAB       TYLENOL WITH CODEINE NO. 3 - TAB       7259         F                                 0.0821
                                                                                      Page 10 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                         Full / Partial   Plan B
             DIN             Chemical Name                                  Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                LCA Benefit       Only
        146         293512 CODEINE 30/ACET 300/CAFF 30 TAB                  ATASOL 30 TAB                            3893         F                                 0.1722
        146         372358 CODEINE 30/ACET 300/CAFF 30 TAB                  EXDOL 30TAB                                 0         F                                 0.1722
        146        2232389 CODEINE 30/ACET 300/CAFF 30 TAB                  EXDOL-30 TABLETS                        11656         F                                 0.1722

        143         608882 CODEINE 30/ACET 300/TAB                          RATIO-EMTEC-30                          10402         F                                 0.1404
        143        1999648 CODEINE 30/ACET 300/TAB                          ACET CODEINE 30 TAB                      3550         F                                 0.1404

        144         176206 CODEINE 30/ASA/BARBITURATE /CAFF CAP             FIORINAL C1/2                            7277         P                                 2.2089      0.8216
        144         608181 CODEINE 30/ASA/BARBITURATE /CAFF CAP             RATIO-TECNAL C 1/2                      10402         F                                 0.8216

        147         396516   CODEINE 60/ACET 300 TAB                        TYLENOL W CODEINE NO4 TAB                4570         F                                 0.1495
        147         621463   CODEINE 60/ACET 300 TAB                        RATIO-LENOLTEC NO 4                     10402         F                                 0.1495
        147        1999656   CODEINE 60/ACET 300 TAB                        ACET CODEINE 60 TAB                      3550         F                                 0.1495
        147        2163918   CODEINE 60/ACET 300 TAB                        TYLENOL WITH CODEINE NO. 4 - TAB         7259         F                                 0.1495

        148          50024 CODEINE PHOS SYR 5MG/ML                          CODEINE PHOSPHATE SIROP DE               3659         P                                 0.0343      0.0212
        148         779474 CODEINE PHOS SYR 5MG/ML                          RATIO-CODEINE                           10402         F                                 0.0212

        149         593435 CODEINE PHOS TAB 15MG                            RATIO-CODEINE                           10402         F                                 0.0746

        150         593451 CODEINE PHOS TAB 30MG                            RATIO-CODEINE                           10402         F                                 0.0900

        152         287873 COLCHICINE TAB 0.6MG                             COLCHICINE                               7555         F                                 0.2770
        152         572349 COLCHICINE TAB 0.6MG                             COLCHICINE TAB 0.6MG                     4835         F                                 0.2770

       1212         621374 COLCHICINE TAB 1MG                               COLCHICINE TAB 1MG                       4835         F                                 0.5486

        938         476420 COLISTIMETHATE SODIUM INJ 150MG                  COLY-MYCIN M PARENTERAL                  9484         P                                41.0400     35.9100
        938        2244849 COLISTIMETHATE SODIUM INJ 150MG                  COLISTIMETHATE FOR INJECTION U.S.P.      8892         F                                35.9100

        153        2043408 CONJUGATED ESTROGENS TAB 0.625MG                 PREMARIN                                 4908         P                                 0.3024      0.1050
        153         265470 CONJUGATED ESTROGENS TAB 0.625MG                 C.E.S. TABLETS                          11902         F                                 0.1050

        679        2043416 CONJUGATED ESTROGENS TAB 0.9MG                   PREMARIN TABLETS 0.9MG                  11115         F                                 0.2787

        155         280437 CORTISONE TAB 25MG                               CORTISONE ACETATE TAB 25MG              11902         F                                 0.3311

        156         521515 CYANOCOBALAMIN INJ 1000MCG/ML                    VITAMIN B12                             12027         F                                 0.3348
        156        1987003 CYANOCOBALAMIN INJ 1000MCG/ML                    CYANOCOBALAMIN INJECTION 1000MCG/ML      4001         F                                 0.3348

        157        2080052   CYCLOBENZAPRINE TAB 10MG                       NOVO-CYCLOPRINE TABLETS 10MG             4773         F                                 0.4029
        157        2177145   CYCLOBENZAPRINE TAB 10MG                       APO-CYCLOBENZAPRINE - TAB 10MG           3636         F                                 0.4029
        157        2231353   CYCLOBENZAPRINE TAB 10MG                       MYLAN-CYCLOBENZAPRINE                   13930         F                                 0.4029
        157        2236506   CYCLOBENZAPRINE TAB 10MG                       RATIO-CYCLOBENZAPRINE                   10402         F                                 0.4029
        157        2287064   CYCLOBENZAPRINE TAB 10MG                       CYCLOBENZAPRINE                         14236         F                                 0.4029
        157        2348853   CYCLOBENZAPRINE TAB 10MG                       AURO-CYCLOBENZAPRINE 10 MG TABLET       11979         F                                 0.4025

       1057        2150662 CYCLOSPORINE CAP 50MG                            NEORAL 50MG                              7277         P                         X       3.0532      2.0952
       1057        2247074 CYCLOSPORINE CAP 50MG                            SANDOZ CYCLOSPORINE                     12027         F                         X       2.0952

        927        2150670 CYCLOSPORINE CAP 100MG                           NEORAL 100MG                             7277         P                         X       6.1085      4.1922
        927        2242821 CYCLOSPORINE CAP 100MG                           SANDOZ CYCLOSPORINE                     12027         F                         X       4.1922

       1056        2150689 CYCLOSPORINE CAP 25MG                            NEORAL 25MG                              7277         P                         X       1.5660      1.0749
       1056        2247073 CYCLOSPORINE CAP 25MG                            SANDOZ CYCLOSPORINE                     12027         F                         X       1.0749

        939        2150697 CYCLOSPORINE SOLUTION 100MG/ML                   NEORAL ORAL SOLUTION 100MG/ML            7277         P                         X       5.4298      4.0725
        939        2244324 CYCLOSPORINE SOLUTION 100MG/ML                   APO-CYCLOSPORINE ORAL SOLUTION           3636         F                         X       4.0725

        701         704431 CYPROTERONE ACETATE TAB 50MG TAB                 ANDROCUR                                10774         F                         X       1.5212
        701        2245898 CYPROTERONE ACETATE TAB 50MG TAB                 CYPROTERONE                             14412         F                         X       1.5213

        895        1981250 DEFEROXAMINE INJ 2MG/ML                          DESFERAL 2G                              7277         P                                59.1948     45.3600
        895        2243450 DEFEROXAMINE INJ 2MG/ML                          PMS-DEFEROXAMINE                         3550         F                                45.3600

        879        1981242 DEFEROXAMINE PWS INJ 500MG/VIAL                  DESFERAL 500MG                           7277         P                                14.7377      8.8290
        879        2242055 DEFEROXAMINE PWS INJ 500MG/VIAL                  PMS-DEFEROXAMINE                         3550         F                                 8.8290

        160        2216280 DESIPRAMINE TAB 100MG                            APO-DESIPRAMINE - TAB 100MG              3636         F                                 0.9628

        159         776157   DESIPRAMINE TAB 10MG                           NORPRAMIN TAB 10MG                          0         F                                 0.3665
        159        2024888   DESIPRAMINE TAB 10MG                           NORPRAMIN TAB 10MG                       4657         F                                 0.3052
        159        2103583   DESIPRAMINE TAB 10MG                           NORPRAMIN 10MG TAB                       9522         F                                 0.3052
        159        2216248   DESIPRAMINE TAB 10MG                           APO-DESIPRAMINE - TAB 10MG               3636         F                                 0.4108

        161          10448 DESIPRAMINE TAB 25MG                             PERTOFRANE 25MG                          7277         F                                 0.4071
        161        2024896 DESIPRAMINE TAB 25MG                             NORPRAMIN TAB 25MG                       4657         F                                 0.3974
        161        2216256 DESIPRAMINE TAB 25MG                             APO-DESIPRAMINE - TAB 25MG               3636         F                                 0.4108

        162         893765 DESIPRAMINE TAB 50MG                             PERTOFRANE TAB 50MG                         0         F                                 0.6967
        162        2024918 DESIPRAMINE TAB 50MG                             NORPRAMIN TAB 50MG                       4657         F                                 0.7005
        162        2216264 DESIPRAMINE TAB 50MG                             APO-DESIPRAMINE - TAB 50MG               3636         F                                 0.7240

        163        2216272 DESIPRAMINE TAB 75MG                             APO-DESIPRAMINE - TAB 75MG               3636         F                                 0.9628

        896         836362 DESMOPRESSIN ACETATE NAS SPR 0.1MG/ML            DDAVP SPRAY                              4174         P                                20.3904     15.2928
        896        2242465 DESMOPRESSIN ACETATE NAS SPR 0.1MG/ML            DESMOPRESSIN SPRAY                      14412         F                                15.2928

       1113         824305   DESMOPRESSIN ACETATE TAB 0.1MG                 DDAVP TABLETS 0.1MG                      4174         P                         X       1.4274      0.5710
       1113        2284030   DESMOPRESSIN ACETATE TAB 0.1MG                 APO-DESMOPRESSIN                         3636         F                         X       0.5710
       1113        2287730   DESMOPRESSIN ACETATE TAB 0.1MG                 NOVO-DESMOPRESSIN                        4773         F                         X       0.5710
       1113        2304368   DESMOPRESSIN ACETATE TAB 0.1MG                 PMS-DESMOPRESSIN                         3550         F                         X       0.5710

       1114         824143   DESMOPRESSIN ACETATE TAB 0.2MG                 DDAVP TABLETS 0.2MG                      4174         P                         X       2.8549      1.1420
       1114        2284049   DESMOPRESSIN ACETATE TAB 0.2MG                 APO-DESMOPRESSIN                         3636         F                         X       1.1420
       1114        2287749   DESMOPRESSIN ACETATE TAB 0.2MG                 NOVO-DESMOPRESSIN                        4773         F                         X       1.1420
       1114        2304376   DESMOPRESSIN ACETATE TAB 0.2MG                 PMS-DESMOPRESSIN                         3550         F                         X       1.1420

       1136        2285002 DESMOPRESSIN ACETATE TABLET 120MCG               DDAVP MELT                               4174         P                         X       2.1409      1.1420

       1135        2284995 DESMOPRESSIN ACETATE TABLET 60MCG                DDAVP MELT                               4174         P                         X       1.0703      0.5710

       1166        2042487 DESOGESTREL ETHINYL ESTRA 21 TAB 0.15MG/0.03MG   MARVELON 21                             12250         P                                 0.7827      0.4725
       1166        2317192 DESOGESTREL ETHINYL ESTRA 21 TAB 0.15MG/0.03MG   APRI 21                                  7948         F                                 0.4725

       1167        2042479 DESOGESTREL ETHINYL ESTRA 28 TAB 0.15MG/0.03MG   MARVELON 28                             12250         P                                 0.5871      0.3543
       1167        2317206 DESOGESTREL ETHINYL ESTRA 28 TAB 0.15MG/0.03MG   APRI 28                                  7948         F                                 0.3543
                                                                                                   Page 11 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                         Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                                       MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                LCA Benefit       Only


        164        2154862 DESONIDE CRM 0.05%                      TRIDESILON 0.05% DESONIDE CREAM                   4412         P                                 0.4190      0.3231
        164        2048639 DESONIDE CRM 0.05%                      DESOCORT CREAM 0.05%                              4225         F                                 0.3132
        164        2229315 DESONIDE CRM 0.05%                      PMS-DESONIDE                                      3550         F                                 0.3231

        165        2115522 DESONIDE ONT 0.05%                      DESOCORT OINTMENT - 0.05%                         4225         P                                 0.7200      0.3231
        165        2154870 DESONIDE ONT 0.05%                      TRIDESILON 0.05% DESONIDE OINTMENT                4412         P                                 0.4175      0.3231
        165        2229323 DESONIDE ONT 0.05%                      PMS-DESONIDE                                      3550         F                                 0.3231

        940         783900 DEXAMETHASONE INJ 10MG/ML               PMS-DEXAMETHASONE SOD PHOSPHATE INJ 10MG/ML       3550         F                                 1.3856
        940        2204274 DEXAMETHASONE INJ 10MG/ML               DEXAMETHASONE-OMEGA                               4852         F                                 1.3856

        717         664227 DEXAMETHASONE INJ 4MG/ML                DEXAMETHASONE SODIUM PHOSPHATE INJ USP 4MG/ML    12027         F                                 1.7345

        166          42560 DEXAMETHASONE LIQ 0.1%                  MAXIDEX SUS 0.1%                                  3594         P                                 1.6632      1.4882

        167          16217 DEXAMETHASONE SOL 0.1%                  DECADRON PHOSPHATE EYE EAR SOL 0.1%                  0         P                                 2.0175      1.4882
        167         739839 DEXAMETHASONE SOL 0.1%                  SANDOZ DEXAMETHASONE                             12027         F                                 1.4882
        167        1995022 DEXAMETHASONE SOL 0.1%                  OCUDEX LIQ 0.1%                                      0         F                                 1.0584

        628        1964968 DEXAMETHASONE TAB .75MG                 PMS DEXAMETHASONE TAB 0.75MG USP                  3550         F                                 0.5006

        168         501050   DEXAMETHASONE TAB 0.5MG               DERONIL TAB 0.5MG                                 7016         F                                 0.1157
        168        1964976   DEXAMETHASONE TAB 0.5MG               PMS DEXAMETHASONE TAB 0.5MG USP                   3550         F                                 0.1351
        168        2240684   DEXAMETHASONE TAB 0.5MG               RATIO-DEXAMETHASONE TABLETS, USP                 10402         F                                 0.1351
        168        2261081   DEXAMETHASONE TAB 0.5MG               APO-DEXAMETHASONE                                 3636         F                                 0.1351

        169         489158   DEXAMETHASONE TAB 4MG                 DEXASONE 4MG                                     11902         F                                 0.5264
        169        1964070   DEXAMETHASONE TAB 4MG                 PMS DEXAMETHASONE TAB 4MG                         3550         F                                 0.5264
        169        2240687   DEXAMETHASONE TAB 4MG                 RATIO-DEXAMETHASONE TABLETS, USP                 10402         F                                 0.5264
        169        2250055   DEXAMETHASONE TAB 4MG                 APO-DEXAMETHASONE                                 3636         F                                 0.5264

        629          12874   DIAZEPAM INJ 5MG/ML                   VALIUM INJ ROCHE 5MG/ML                           4328         F                                 0.3899
        629         399728   DIAZEPAM INJ 5MG/ML                   DIAZEPAM INJECTION USP                           12027         F                                 1.5984
        629         602825   DIAZEPAM INJ 5MG/ML                   DIAZEMULS EML 5MG/ML INJ                             0         F                                 0.9554
        629        2005492   DIAZEPAM INJ 5MG/ML                   DIAZEMULS 5MG/ML AMPOULE                             0         F                                 1.0528
        629        2065614   DIAZEPAM INJ 5MG/ML                   DIAZEMULS                                        13001         F                                 1.2220

        170         405337 DIAZEPAM TAB 10MG                       APO DIAZEPAM TAB 10MG                             3636         F                                 0.0936
        170        2247492 DIAZEPAM TAB 10MG                       PMS-DIAZEPAM                                     10997         F                                 0.0936

        171         272647 DIAZEPAM TAB 2MG                        E PAM TAB 2MG                                     4372         F                                 0.0065
        171         405329 DIAZEPAM TAB 2MG                        APO DIAZEPAM TAB 2MG                              3636         F                                 0.0549
        171        2247490 DIAZEPAM TAB 2MG                        PMS-DIAZEPAM                                     10997         F                                 0.0549

        172          13285   DIAZEPAM TAB 5MG                      VALIUM 5 TAB                                      4328         P                                 0.1655      0.0702
        172          13765   DIAZEPAM TAB 5MG                      VIVOL                                             9174         P                                 0.0927      0.0702
        172         280429   DIAZEPAM TAB 5MG                      E PAM TAB 5MG                                     4372         F                                 0.0058
        172         362158   DIAZEPAM TAB 5MG                      APO DIAZEPAM TAB 5MG                              3636         F                                 0.0702
        172        2247491   DIAZEPAM TAB 5MG                      PMS-DIAZEPAM                                     10997         F                                 0.0702

        173         590827   DICLOFENAC SR TAB 100MG               VOLTAREN SR TAB 100MG                             7277        P                    RDP           1.7859      0.7143
        173        2048698   DICLOFENAC SR TAB 100MG               TEVA-DICLOFENAC SR                               14318        P*                   RDP           0.7143
        173        2231505   DICLOFENAC SR TAB 100MG               PMS-DICLOFENAC-SR                                 3550        P*                   RDP           0.7143
        173        2261944   DICLOFENAC SR TAB 100MG               SANDOZ-DICLOFENAC SR                             12027        P*                   RDP           0.7143

        174         782459   DICLOFENAC SR TAB 75MG                VOLTAREN SR 75 TAB                                7277        P                    RDP           1.2529      0.5011
        174        2158582   DICLOFENAC SR TAB 75MG                TEVA-DICLOFENAC SR                               14318        P*                   RDP           0.5011
        174        2231504   DICLOFENAC SR TAB 75MG                PMS-DICLOFENAC-SR                                 3550        P*                   RDP           0.5011
        174        2261901   DICLOFENAC SR TAB 75MG                SANDOZ-DICLOFENAC SR                             12027        P*                   RDP           0.5011
        174        2352400   DICLOFENAC SR TAB 75MG                DICLOFENAC SR                                    14236        P*                   RDP           0.5011

        175         632732 DICLOFENAC SUP 100MG                    VOLTAREN SUP 100MG                                7277         P                                 1.9397      0.7209
        175        2231508 DICLOFENAC SUP 100MG                    PMS-DICLOFENAC                                    3550         F                                 0.7209
        175        2261936 DICLOFENAC SUP 100MG                    SANDOZ-DICLOFENAC                                12027         F                                 0.7209

        176         632724 DICLOFENAC SUP 50MG                     VOLTAREN SUP 50MG                                 7277         P                                 1.4411      0.5355
        176        2231506 DICLOFENAC SUP 50MG                     PMS-DICLOFENAC                                    3550         F                                 0.5355
        176        2261928 DICLOFENAC SUP 50MG                     SANDOZ-DICLOFENAC                                12027         F                                 0.5355

        177         808539   DICLOFENAC TAB 25MG                   TEVA-DICLOFENAC EC                               14318        P*                   RDP           0.1350
        177         839175   DICLOFENAC TAB 25MG                   APO-DICLO TAB 25MG                                3636        P*                   RDP           0.1350
        177         886017   DICLOFENAC TAB 25MG                   NU-DICLO ENTERIC COATED TAB 25MG                  4828        P*                   RDP           0.1350
        177        2261952   DICLOFENAC TAB 25MG                   SANDOZ-DICLOFENAC                                12027        P*                   RDP           0.1350
        177        2302616   DICLOFENAC TAB 25MG                   PMS-DICLOFENAC                                    3550        P*                   RDP           0.1350

        178         514012   DICLOFENAC TAB 50MG                   VOLTAREN TAB 50MG                                 7277        P                    RDP           0.9596      0.3566
        178         808547   DICLOFENAC TAB 50MG                   TEVA-DICLOFENAC EC                               14318        P*                   RDP           0.3566
        178         839183   DICLOFENAC TAB 50MG                   APO-DICLO TAB 50MG                                3636        P*                   RDP           0.3566
        178         886025   DICLOFENAC TAB 50MG                   NU-DICLO ENTERIC COATED TAB 50MG                  4828        P*                   RDP           0.3566
        178        2261960   DICLOFENAC TAB 50MG                   SANDOZ-DICLOFENAC                                12027        P*                   RDP           0.3566
        178        2302624   DICLOFENAC TAB 50MG                   PMS-DICLOFENAC                                    3550        P*                   RDP           0.3566
        178        2352397   DICLOFENAC TAB 50MG                   DICLOFENAC EC                                    14236        P*                   RDP           0.3566

        179        1917056 DICLOFENAC/MISOPROSTOL TAB 50/0.2MG     ARTHROTEC 50                                      4908        P*                   RDP           0.6353

        688        2229837 DICLOFENAC/MISOPROSTOL TAB 75MG/0.2MG   ARTHROTEC 75                                      4908        P*                   RDP           0.8647

        180         392820 DICYCLOMINE CAP 10MG                    DICYCLOMINE HYDROCHLORIDE USP                    12027         F                                 0.0780

        182        2039486 DIFLUNISAL TAB 250MG                    APO-DIFLUNISAL TAB 250MG                          3636        P*                   RDP           0.5795
        182        2048493 DIFLUNISAL TAB 250MG                    NOVO-DIFLUNISAL TAB 250MG                         4773        P*                   RDP           0.5795

        183         576131 DIFLUNISAL TAB 500MG                    DOLOBID TAB 500MG                                    0        P*                   RDP           0.7620
        183        2039494 DIFLUNISAL TAB 500MG                    APO-DIFLUNISAL TAB 500MG                          3636        P*                   RDP           0.7722

        859          27243 DIHYDROERGOTAMINE INJ 1MG/ML            DIHYDROERGOTAMINE (DHE), 1MG/ML                   8892         P                                 4.5576      4.0176
        859        2241163 DIHYDROERGOTAMINE INJ 1MG/ML            DIHYDROERGOTAMINE MESYLATE INJECTION USP         12027         F                                 4.0176

        184        2097249   DILTIAZEM CD CAP 120MG                CARDIZEM CD                                      11902         P                                 1.5967      0.6098
        184        2229781   DILTIAZEM CD CAP 120MG                RATIO-DILTIAZEM CD                               10402         F                                 0.6098
        184        2230997   DILTIAZEM CD CAP 120MG                APO-DILTIAZ CD                                    3636         F                                 0.6098
        184        2231052   DILTIAZEM CD CAP 120MG                NU-DILTIAZ-CD CAPSULES 120MG                      4828         F                                 0.6098
        184        2242538   DILTIAZEM CD CAP 120MG                TEVA-DILTIAZEM CD                                14318         F                                 0.6098
        184        2243338   DILTIAZEM CD CAP 120MG                SANDOZ DILTIAZEM CD                              12027         F                                 0.6098
        184        2355752   DILTIAZEM CD CAP 120MG                PMS-DILTIAZEM CD                                  3550         F                                 0.6098
                                                                                        Page 12 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                       Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                                     MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                              LCA Benefit       Only
        185        2097257   DILTIAZEM CD CAP 180MG                CARDIZEM CD                                    11902         P                                 2.1195      0.8094
        185        2229782   DILTIAZEM CD CAP 180MG                RATIO-DILTIAZEM CD                             10402         F                                 0.8094
        185        2230998   DILTIAZEM CD CAP 180MG                APO-DILTIAZ CD                                  3636         F                                 0.8094
        185        2231053   DILTIAZEM CD CAP 180MG                NU-DILTIAZ-CD CAPSULES 180MG                    4828         F                                 0.8094
        185        2242539   DILTIAZEM CD CAP 180MG                TEVA-DILTIAZEM CD                              14318         F                                 0.8094
        185        2243339   DILTIAZEM CD CAP 180MG                SANDOZ DILTIAZEM CD                            12027         F                                 0.8094
        185        2355760   DILTIAZEM CD CAP 180MG                PMS-DILTIAZEM CD                                3550         F                                 0.8094

        186        2097265   DILTIAZEM CD CAP 240MG                CARDIZEM CD                                    11902         P                                 2.8113      1.0735
        186        2229783   DILTIAZEM CD CAP 240MG                RATIO-DILTIAZEM CD                             10402         F                                 1.0735
        186        2230999   DILTIAZEM CD CAP 240MG                APO-DILTIAZ CD                                  3636         F                                 1.0735
        186        2231054   DILTIAZEM CD CAP 240MG                NU-DILTIAZ-CD CAPSULES 240MG                    4828         F                                 1.0735
        186        2242540   DILTIAZEM CD CAP 240MG                TEVA-DILTIAZEM CD                              14318         F                                 1.0735
        186        2243340   DILTIAZEM CD CAP 240MG                SANDOZ DILTIAZEM CD                            12027         F                                 1.0735
        186        2355779   DILTIAZEM CD CAP 240MG                PMS-DILTIAZEM CD                                3550         F                                 1.0735

        187        2097273   DILTIAZEM CD CAP 300MG                CARDIZEM CD                                    11902         P                                 3.5141      1.3419
        187        2229526   DILTIAZEM CD CAP 300MG                APO-DILTIAZ CD - CAP 300MG                      3636         F                                 1.3419
        187        2229784   DILTIAZEM CD CAP 300MG                RATIO-DILTIAZEM CD                             10402         F                                 1.3419
        187        2242541   DILTIAZEM CD CAP 300MG                TEVA-DILTIAZEM CD                              14318         F                                 1.3419
        187        2243341   DILTIAZEM CD CAP 300MG                SANDOZ DILTIAZEM CD                            12027         F                                 1.3419
        187        2355787   DILTIAZEM CD CAP 300MG                PMS-DILTIAZEM CD                                3550         F                                 1.3419

        830        2231150   DILTIAZEM ER CAP 120MG                TIAZAC                                         11902         P                                 0.8947      0.3686
        830        2245918   DILTIAZEM ER CAP 120MG                SANDOZ DILTIAZEM T                             12027         F                                 0.3686
        830        2271605   DILTIAZEM ER CAP 120MG                TEVA-DILTIAZEM HCL ER CAPSULES                 11902         F                                 0.3686
        830        2291037   DILTIAZEM ER CAP 120MG                APO-DILTIAZ TZ                                  3636         F                                 0.3686

        831        2231151   DILTIAZEM ER CAP 180MG                TIAZAC                                         11902         P                                 1.2480      0.4992
        831        2245919   DILTIAZEM ER CAP 180MG                SANDOZ DILTIAZEM T                             12027         F                                 0.4992
        831        2271613   DILTIAZEM ER CAP 180MG                TEVA-DILTIAZEM HCL ER CAPSULES                 11902         F                                 0.4992
        831        2291045   DILTIAZEM ER CAP 180MG                APO-DILTIAZ TZ                                  3636         F                                 0.4992

        832        2231152   DILTIAZEM ER CAP 240MG                TIAZAC                                         11902         P                                 1.6554      0.6621
        832        2245920   DILTIAZEM ER CAP 240MG                SANDOZ DILTIAZEM T                             12027         F                                 0.6621
        832        2271621   DILTIAZEM ER CAP 240MG                TEVA-DILTIAZEM HCL ER CAPSULES                 11902         F                                 0.6621
        832        2291053   DILTIAZEM ER CAP 240MG                APO-DILTIAZ TZ                                  3636         F                                 0.6621

        833        2231154   DILTIAZEM ER CAP 300MG                TIAZAC                                         11902         P                                 1.9794      0.8155
        833        2245921   DILTIAZEM ER CAP 300MG                SANDOZ DILTIAZEM T                             12027         F                                 0.8155
        833        2271648   DILTIAZEM ER CAP 300MG                TEVA-DILTIAZEM HCL ER CAPSULES                 11902         F                                 0.8155
        833        2291061   DILTIAZEM ER CAP 300MG                APO-DILTIAZ TZ                                  3636         F                                 0.8155

       1064        2231155   DILTIAZEM ER CAP 360MG                TIAZAC                                         11902         P                                 2.4961      0.9985
       1064        2245922   DILTIAZEM ER CAP 360MG                SANDOZ DILTIAZEM T                             12027         F                                 0.9985
       1064        2271656   DILTIAZEM ER CAP 360MG                TEVA-DILTIAZEM HCL ER CAPSULES                 11902         F                                 0.9985
       1064        2291088   DILTIAZEM ER CAP 360MG                APO-DILTIAZ TZ                                  3636         F                                 0.9985

        191         771376 DILTIAZEM TAB 30MG                      APO DILTIAZ TAB 30MG                            3636         F                                 0.2015
        191         862924 DILTIAZEM TAB 30MG                      TEVA-DILTIAZEM                                 14318         F                                 0.2015

        192         771384 DILTIAZEM TAB 60MG                      APO DILTIAZ TAB 60MG                            3636         F                                 0.3535
        192         862932 DILTIAZEM TAB 60MG                      TEVA-DILTIAZEM                                 14318         F                                 0.3535

        746          13579 DIMENHYDRINATE INJ 50MG                 GRAVOL IM                                       3893         P                                 0.9296      0.7754
        746         392537 DIMENHYDRINATE INJ 50MG                 DIMENHYDRINATE INJ 50MG USP                    12027         F                                 0.7754

       1189         363766 DIMENHYDRINATE TAB 50MG                 APO DIMENHYDRINATE TAB 50MG                     3636         F                                 0.0243
       1189        2245416 DIMENHYDRINATE TAB 50MG                 MOTION SICKNESS TABLET 50 MG                    4415         F                                 0.0243

        702         596612 DIPHENHYDRAMINE HCL INJ 50MG/ML         DIPHENHYDRAMINE HYDROCHLORIDE INJECTION USP    12027         F                                 4.1580
        702        2019744 DIPHENHYDRAMINE HCL INJ 50MG/ML         BENADRYL INJ. 50MG/ML                              0         F                                 3.5337

        195         895644 DIPYRIDAMOLE TAB 25MG                   APO-DIPYRIDAMOLE-FC TAB 25MG                    3636         F                                 0.2844

        196          67393 DIPYRIDAMOLE TAB 50MG                   PERSANTINE TAB 50MG                             3617         P                                 0.4189      0.3167
        196         895652 DIPYRIDAMOLE TAB 50MG                   APO-DIPYRIDAMOLE-FC TAB 50MG                    3636         F                                 0.3167

        197         895660 DIPYRIDAMOLE TAB 75MG                   APO-DIPYRIDAMOLE-FC TAB 75MG                    3636         F                                 0.4749

        835         596418   DIVALPROEX SODIUM TAB 125MG           EPIVAL ECT 125MG                                3525         P                                 0.3184      0.1191
        835        2239517   DIVALPROEX SODIUM TAB 125MG           NU-DIVALPROEX 125MG                             4828         F                                 0.1191
        835        2239698   DIVALPROEX SODIUM TAB 125MG           APO-DIVALPROEX                                  3636         F                                 0.1191
        835        2239701   DIVALPROEX SODIUM TAB 125MG           NOVO-DIVALPROEX                                 4773         F                                 0.1191
        835        2265133   DIVALPROEX SODIUM TAB 125MG           MYLAN-DIVALPROEX                               13930         F                                 0.1191

        836         596426   DIVALPROEX SODIUM TAB 250MG           EPIVAL ECT 250MG                                3525         P                                 0.5723      0.2142
        836        2239518   DIVALPROEX SODIUM TAB 250MG           NU-DIVALPROEX 250MG                             4828         F                                 0.2142
        836        2239699   DIVALPROEX SODIUM TAB 250MG           APO-DIVALPROEX                                  3636         F                                 0.2142
        836        2239702   DIVALPROEX SODIUM TAB 250MG           NOVO-DIVALPROEX                                 4773         F                                 0.2142
        836        2265141   DIVALPROEX SODIUM TAB 250MG           MYLAN-DIVALPROEX                               13930         F                                 0.2142

        837         596434   DIVALPROEX SODIUM TAB 500MG           EPIVAL ECT 500MG                                3525         P                                 1.1451      0.4285
        837        2239519   DIVALPROEX SODIUM TAB 500MG           NU-DIVALPROEX 500MG                             4828         F                                 0.4285
        837        2239700   DIVALPROEX SODIUM TAB 500MG           APO-DIVALPROEX                                  3636         F                                 0.4285
        837        2239703   DIVALPROEX SODIUM TAB 500MG           NOVO-DIVALPROEX                                 4773         F                                 0.4285
        837        2265168   DIVALPROEX SODIUM TAB 500MG           MYLAN-DIVALPROEX                               13930         F                                 0.4285

        202        1912070   DOMPERIDONE TAB 10MG                  RATIO-DOMPERIDONE                              10402         F                                 0.1026
        202        2103613   DOMPERIDONE TAB 10MG                  APO-DOMPERIDONE - TAB 10MG                      3636         F                                 0.1026
        202        2157195   DOMPERIDONE TAB 10MG                  TEVA-DOMPERIDONE                               14318         F                                 0.1026
        202        2231477   DOMPERIDONE TAB 10MG                  NU-DOMPERIDONE 10 MG TABLETS                    4828         F                                 0.1026
        202        2236466   DOMPERIDONE TAB 10MG                  PMS-DOMPERIDONE                                 3550         F                                 0.1026
        202        2268078   DOMPERIDONE TAB 10MG                  RAN-DOMPERIDONE                                11271         F                                 0.1026
        202        2278669   DOMPERIDONE TAB 10MG                  MYLAN-DOMPERIDONE                              13930         F                                 0.1026
        202        2350440   DOMPERIDONE TAB 10MG                  DOMPERIDONE                                    14236         F                                 0.1026

       1204        2240113 DORZOLAMIDE HCL/TIMOLOL DRP (2%/0.5%)   COSOPT -(2%/0.5% OPH DPS)                      12250         P                                 6.2014      2.4546
       1204        2299615 DORZOLAMIDE HCL/TIMOLOL DRP (2%/0.5%)   APO-DORZO-TIMOP                                 3636         F                                 2.4546
       1204        2344351 DORZOLAMIDE HCL/TIMOLOL DRP (2%/0.5%)   SANDOZ DORZOLAMIDE/TIMOLOL                     12027         F                                 2.4546

       1205        2216205 DORZOLAMIDE HYDROCHLORIDE DRP (2%)      TRUSOPT                                        12250         P                                 4.0975      1.6200
       1205        2296055 DORZOLAMIDE HYDROCHLORIDE DRP (2%)      APO-DORZOLAMIDE 2 % EYE DROPS                   3636         F                                 1.6200
       1205        2316307 DORZOLAMIDE HYDROCHLORIDE DRP (2%)      SANDOZ DORZOLAMIDE                             12027         F                                 1.6200

        846        1958100 DOXAZOSIN MESYLATE TAB 1MG              CARDURA-1 TAB 1MG                               4908         P                                 0.6247      0.2447
        846        2240498 DOXAZOSIN MESYLATE TAB 1MG              MYLAN-DOXAZOSIN                                13930         F                                 0.2447
                                                                                          Page 13 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                             Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                           MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                    LCA Benefit       Only
        846        2240588 DOXAZOSIN MESYLATE TAB 1MG              APO-DOXAZOSIN                         3636         F                                 0.2447
        846        2242728 DOXAZOSIN MESYLATE TAB 1MG              NOVO-DOXAZOSIN                        4773         F                                 0.2447
        846        2244527 DOXAZOSIN MESYLATE TAB 1MG              PMS-DOXAZOSIN                         3550         F                                 0.2447

        847        1958097   DOXAZOSIN MESYLATE TAB 2MG            CARDURA-2 TAB 2MG                     4908         P                                 0.7493      0.2935
        847        2240499   DOXAZOSIN MESYLATE TAB 2MG            MYLAN-DOXAZOSIN                      13930         F                                 0.2935
        847        2240589   DOXAZOSIN MESYLATE TAB 2MG            APO-DOXAZOSIN                         3636         F                                 0.2935
        847        2242729   DOXAZOSIN MESYLATE TAB 2MG            NOVO-DOXAZOSIN                        4773         F                                 0.2935
        847        2244528   DOXAZOSIN MESYLATE TAB 2MG            PMS-DOXAZOSIN                         3550         F                                 0.2935

        848        1958119   DOXAZOSIN MESYLATE TAB 4MG            CARDURA-4 TAB 4MG                     4908         P                                 0.9744      0.3817
        848        2240500   DOXAZOSIN MESYLATE TAB 4MG            MYLAN-DOXAZOSIN                      13930         F                                 0.3817
        848        2240590   DOXAZOSIN MESYLATE TAB 4MG            APO-DOXAZOSIN                         3636         F                                 0.3817
        848        2242730   DOXAZOSIN MESYLATE TAB 4MG            NOVO-DOXAZOSIN                        4773         F                                 0.3817
        848        2244529   DOXAZOSIN MESYLATE TAB 4MG            PMS-DOXAZOSIN                         3550         F                                 0.3817

        204         326925 DOXEPIN CAP 100MG                       SINEQUAN CAP 100MG                    9484         P                                 1.4904      0.5962
        204        1913468 DOXEPIN CAP 100MG                       NOVO-DOXEPIN CAP 100MG USP            4773         F                                 0.5962
        204        2050048 DOXEPIN CAP 100MG                       APO-DOXEPIN CAP 100MG                 3636         F                                 0.5962

        203          24325 DOXEPIN CAP 10MG                        SINEQUAN CAP 10MG                     9484         P                                 0.3469      0.2040
        203         842745 DOXEPIN CAP 10MG                        TRIADAPIN CAP 10MG                    9522         F                                 0.1280
        203        2049996 DOXEPIN CAP 10MG                        APO-DOXEPIN CAP 10MG                  3636         F                                 0.2040

        205        1913476 DOXEPIN CAP 150MG                       NOVO-DOXEPIN CAP 150MG USP            4773         F                                 1.2208

        206          24333   DOXEPIN CAP 25MG                      SINEQUAN CAP 25MG                     9484         P                                 0.4255      0.1702
        206         842753   DOXEPIN CAP 25MG                      TRIADAPIN CAP 25MG                    9522         F                                 0.1544
        206        1913425   DOXEPIN CAP 25MG                      NOVO-DOXEPIN CAP 25MG USP             4773         F                                 0.1702
        206        2050005   DOXEPIN CAP 25MG                      APO-DOXEPIN CAP 25MG                  3636         F                                 0.1702

        207          24341   DOXEPIN CAP 50MG                      SINEQUAN CAP 50MG                     9484         P                                 0.7893      0.3157
        207         842761   DOXEPIN CAP 50MG                      TRIADAPIN CAP 50MG                    9522         F                                 0.2406
        207        1913433   DOXEPIN CAP 50MG                      NOVO-DOXEPIN CAP 50MG USP             4773         F                                 0.3157
        207        2050013   DOXEPIN CAP 50MG                      APO-DOXEPIN CAP 50MG                  3636         F                                 0.3157

        208         400750 DOXEPIN CAP 75MG                        SINEQUAN CAP 75MG                     9484         P                                 1.1332      0.4533
        208        1913441 DOXEPIN CAP 75MG                        NOVO-DOXEPIN CAP 75MG USP             4773         F                                 0.4533
        208        2050021 DOXEPIN CAP 75MG                        APO-DOXEPIN CAP 75MG                  3636         F                                 0.4533

        209          24368   DOXYCYCLINE CAP 100MG                 VIBRAMYCIN CAP 100MG                  4908         P                                 1.8688      0.6329
        209         725250   DOXYCYCLINE CAP 100MG                 NOVO-DOXYLIN CAP 100MG                4773         F                                 0.6329
        209         740713   DOXYCYCLINE CAP 100MG                 APO-DOXY CAP 100MG                    3636         F                                 0.6329
        209         817120   DOXYCYCLINE CAP 100MG                 DOXYCIN CAP 100MG                     5034         F                                 0.6329
        209        2044668   DOXYCYCLINE CAP 100MG                 NU-DOXYCYCLINE CAP 100MG              4828         F                                 0.6329
        209        2351234   DOXYCYCLINE CAP 100MG                 DOXYCYCLINE CAPSULES                 14236         F                                 0.6329

        210         860751   DOXYCYCLINE TAB 100MG                 DOXYCIN TAB 100MG                     5034         F                                 0.6329
        210         874256   DOXYCYCLINE TAB 100MG                 APO-DOXY TABS 100MG                   3636         F                                 0.6329
        210        2044676   DOXYCYCLINE TAB 100MG                 NU-DOXYCYCLINE TAB 100MG              4828         F                                 0.6329
        210        2158574   DOXYCYCLINE TAB 100MG                 NOVO-DOXYLIN -TAB 100MG               4773         F                                 0.6329
        210        2351242   DOXYCYCLINE TAB 100MG                 DOXYCYCLINE TABLETS                  14236         F                                 0.6329

        211         657298 ENALAPRIL MALEATE HCTZ TAB 10MG/25MG    VASERETIC                            12250        P                    RDP           1.2370      0.8330
        211        2300230 ENALAPRIL MALEATE HCTZ TAB 10MG/25MG    NOVO-ENALAPRIL/HCTZ                   4773        P*                   RDP           0.8330
        211        2352931 ENALAPRIL MALEATE HCTZ TAB 10MG/25MG    APO-ENALAPRIL/HCTZ 10-25 MG TB        3636        P*                   RDP           0.8330

        990        2300222 ENALAPRIL MALEATE HCTZ TAB 5MG/12.5MG   NOVO-ENALAPRIL/HCTZ                   4773        P*                   RDP           0.6930
        990        2352923 ENALAPRIL MALEATE HCTZ TAB 5MG/12.5MG   APO-ENALAPRIL/HCTZ 5-12.5 MG          3636        P*                   RDP           0.6930

        212         670901   ENALAPRIL MALEATE TAB 10MG            VASOTEC                              12250        P                    RDP           1.2009      0.4713
        212        2019892   ENALAPRIL MALEATE TAB 10MG            APO-ENALAPRIL TAB 10MG                3636        P*                   RDP           0.4713
        212        2233006   ENALAPRIL MALEATE TAB 10MG            NOVO-ENALAPRIL                        4773        P*                   RDP           0.4713
        212        2291894   ENALAPRIL MALEATE TAB 10MG            CO ENALAPRIL                         10028        P*                   RDP           0.4713
        212        2299968   ENALAPRIL MALEATE TAB 10MG            SANDOZ ENALAPRIL                     12027        P*                   RDP           0.4713
        212        2300001   ENALAPRIL MALEATE TAB 10MG            RATIO-ENALAPRIL                      10402        P*                   RDP           0.4713
        212        2300052   ENALAPRIL MALEATE TAB 10MG            MYLAN-ENALAPRIL                      13930        P*                   RDP           0.4713
        212        2300095   ENALAPRIL MALEATE TAB 10MG            PMS-ENALAPRIL                         3550        P*                   RDP           0.4713
        212        2352257   ENALAPRIL MALEATE TAB 10MG            RAN-ENALAPRIL                        11271        P*                   RDP           0.4713

        213         851795   ENALAPRIL MALEATE TAB 2.5MG           VASOTEC                              12250        P                    RDP           0.8449      0.3316
        213        2020025   ENALAPRIL MALEATE TAB 2.5MG           APO-ENALAPRIL TAB 2.5MG               3636        P*                   RDP           0.3316
        213        2291878   ENALAPRIL MALEATE TAB 2.5MG           CO ENALAPRIL                         10028        P*                   RDP           0.3316
        213        2299933   ENALAPRIL MALEATE TAB 2.5MG           SANDOZ ENALAPRIL                     12027        P*                   RDP           0.3316
        213        2299984   ENALAPRIL MALEATE TAB 2.5MG           RATIO-ENALAPRIL                      10402        P*                   RDP           0.3316
        213        2300036   ENALAPRIL MALEATE TAB 2.5MG           MYLAN-ENALAPRIL                      13930        P*                   RDP           0.3316
        213        2300079   ENALAPRIL MALEATE TAB 2.5MG           PMS-ENALAPRIL                         3550        P*                   RDP           0.3316
        213        2300680   ENALAPRIL MALEATE TAB 2.5MG           NOVO-ENALAPRIL                        4773        P*                   RDP           0.3316
        213        2352230   ENALAPRIL MALEATE TAB 2.5MG           RAN-ENALAPRIL                        11271        P*                   RDP           0.3316

        214         670928   ENALAPRIL MALEATE TAB 20MG            VASOTEC                              12250        P                    RDP           1.4491      0.5687
        214        2019906   ENALAPRIL MALEATE TAB 20MG            APO-ENALAPRIL TAB 20MG                3636        P*                   RDP           0.5687
        214        2233007   ENALAPRIL MALEATE TAB 20MG            NOVO-ENALAPRIL                        4773        P*                   RDP           0.5687
        214        2291908   ENALAPRIL MALEATE TAB 20MG            CO ENALAPRIL                         10028        P*                   RDP           0.5687
        214        2299976   ENALAPRIL MALEATE TAB 20MG            SANDOZ ENALAPRIL                     12027        P*                   RDP           0.5687
        214        2300028   ENALAPRIL MALEATE TAB 20MG            RATIO-ENALAPRIL                      10402        P*                   RDP           0.5687
        214        2300060   ENALAPRIL MALEATE TAB 20MG            MYLAN-ENALAPRIL                      13930        P*                   RDP           0.5687
        214        2300109   ENALAPRIL MALEATE TAB 20MG            PMS-ENALAPRIL                         3550        P*                   RDP           0.5687
        214        2352265   ENALAPRIL MALEATE TAB 20MG            RAN-ENALAPRIL                        11271        P*                   RDP           0.5687

        215         708879   ENALAPRIL MALEATE TAB 5MG             VASOTEC                              12250        P                    RDP           0.9994      0.3921
        215        2019884   ENALAPRIL MALEATE TAB 5MG             APO-ENALAPRIL TAB 5MG                 3636        P*                   RDP           0.3921
        215        2233005   ENALAPRIL MALEATE TAB 5MG             NOVO-ENALAPRIL                        4773        P*                   RDP           0.3921
        215        2291886   ENALAPRIL MALEATE TAB 5MG             CO ENALAPRIL                         10028        P*                   RDP           0.3921
        215        2299941   ENALAPRIL MALEATE TAB 5MG             SANDOZ ENALAPRIL                     12027        P*                   RDP           0.3921
        215        2299992   ENALAPRIL MALEATE TAB 5MG             RATIO-ENALAPRIL                      10402        P*                   RDP           0.3921
        215        2300044   ENALAPRIL MALEATE TAB 5MG             MYLAN-ENALAPRIL                      13930        P*                   RDP           0.3921
        215        2300087   ENALAPRIL MALEATE TAB 5MG             PMS-ENALAPRIL                         3550        P*                   RDP           0.3921
        215        2352249   ENALAPRIL MALEATE TAB 5MG             RAN-ENALAPRIL                        11271        P*                   RDP           0.3921

        216         607142 ERYTHROMYCIN CAP 250MG                  ERYC DELAYED-RELEASE CAPSULES         4908         P                                 0.5309      0.4212
        216         726672 ERYTHROMYCIN CAP 250MG                  APO-ERYTHRO E-C CAP 250MG             3636         F                                 0.4212

        217         873454 ERYTHROMYCIN CAP 333MG                  ERYC DELAYED-RELEASE CAPSULES         4908         P                                 0.6008      0.4679
        217        1925938 ERYTHROMYCIN CAP 333MG                  APO ERYTHRO E-C CAP 333MG             3636         F                                 0.4679

        219          15474 ERYTHROMYCIN ESTOLATE SUS 25MG/ML       ILOSONE LIQUID 125MG/5ML              7005         F                                 0.0379
                                                                                       Page 14 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                                    Full / Partial   Plan B
             DIN             Chemical Name                             Drug Name                                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                           LCA Benefit       Only


        220         210641 ERYTHROMYCIN ESTOLATE SUS 50MG/ML           ILOSONE LIQUID 250MG/5ML                                 7005         F                                 0.0734
        220         262595 ERYTHROMYCIN ESTOLATE SUS 50MG/ML           NOVO-RYTHRO ESTOLATE SUS                                 4773         F                                 0.1309

        222            299 ERYTHROMYCIN ETHYLSUCCINATE PWS 40MG/ML     EES-200                                                 13965         F                                 0.0860
        222         605859 ERYTHROMYCIN ETHYLSUCCINATE PWS 40MG/ML     NOVO-RYTHRO ETHYLSUCCINATE PWS                           4773         F                                 0.0997

        223         453617 ERYTHROMYCIN ETHYLSUCCINATE PWS 80MG/ML     EES-400                                                 13965         F                                 0.1304
        223         652318 ERYTHROMYCIN ETHYLSUCCINATE PWS 80MG/ML     NOVO-RYTHRO ETHYLSUCCINATE PWR 400MG/5ML                 4773         F                                 0.1510

        633         583782 ERYTHROMYCIN ETHYLSUCCINATE TAB 600MG       EES 600 TABLETS 600MG                                   13965         P                                 0.4054      0.3632
        633         637416 ERYTHROMYCIN ETHYLSUCCINATE TAB 600MG       ERYTHRO-ES                                              14412         F                                 0.3632

        224        1912755 ERYTHROMYCIN OPTH ONT 5MG/GM                PMS-ERYTHROMYCIN                                         3550         F                                 1.3608

        225            434 ERYTHROMYCIN STEARATE TAB 250MG             ERYTHROCIN FILMTAB 250MG                                 3525         F                                 0.1280
        225         545678 ERYTHROMYCIN STEARATE TAB 250MG             ERYTHRO-S                                               14412         F                                 0.2287

        226         266515 ERYTHROMYCIN STEARATE TAB 500MG             ERYTHROCIN FILMTAB 500MG                                 3525         F                                 0.5821
        226         688568 ERYTHROMYCIN STEARATE TAB 500MG             ERYTHRO-S                                               14412         F                                 0.5859

        227          30899 ERYTHROMYCIN TAB 250MG                      EMYCIN ECT 250MG                                            0         F                                 0.1668
        227         244635 ERYTHROMYCIN TAB 250MG                      ERYTHROMID TAB 250MG                                     3525         F                                 0.0490
        227         682020 ERYTHROMYCIN TAB 250MG                      APO-ERYTHRO-BASE TAB 250MG                               3636         F                                 0.1974

        995        2246969 ESTRADIOL PATCH 100MCG                      SANDOZ ESTRADIOL DERM 100                               12027         F                         X       2.1155

        993        2246967 ESTRADIOL PATCH 50MCG                       SANDOZ ESTRADIOL DERM 50                                12027         F                         X       1.8738

        994        2246968 ESTRADIOL PATCH 75MCG                       SANDOZ ESTRADIOL DERM 75                                12027         F                         X       2.0115

        997        2245330 ETIDRONATE DISODIUM TAB 200MG               MYLAN-ETIDRONATE                                        13930         F                                 0.6167
        997        2248686 ETIDRONATE DISODIUM TAB 200MG               CO ETIDRONATE, 200MG                                    10028         F                                 0.6167

       1143        2176017   ETIDRONATE DISODIUM/CALCIUM 400MG/500MG   DIDROCAL                                                14339         P                                 0.5037      0.2399
       1143        2247323   ETIDRONATE DISODIUM/CALCIUM 400MG/500MG   MYLAN-ETI-CAL CAREPAC                                   13930         F                                 0.2399
       1143        2263866   ETIDRONATE DISODIUM/CALCIUM 400MG/500MG   CO ETIDROCAL                                            10028         F                                 0.2399
       1143        2324199   ETIDRONATE DISODIUM/CALCIUM 400MG/500MG   NOVO-ETIDRONATECAL                                       4773         F                                 0.2399

       1091        2229110   FAMCICLOVIR TAB 125MG                     FAMVIR TABLETS 125MG                                     7277         P                                 3.0920      1.5055
       1091        2278081   FAMCICLOVIR TAB 125MG                     PMS-FAMCICLOVIR                                          3550         F                                 1.5055
       1091        2278634   FAMCICLOVIR TAB 125MG                     SANDOZ FAMCICLOVIR                                      12027         F                                 1.5055
       1091        2292025   FAMCICLOVIR TAB 125MG                     APO-FAMCICLOVIR                                          3636         F                                 1.5055
       1091        2305682   FAMCICLOVIR TAB 125MG                     CO FAMCICLOVIR                                          10028         F                                 1.5055

       1092        2229129   FAMCICLOVIR TAB 250MG                     FAMVIR TABLETS 250MG                                     7277         P                                 4.1936      2.0232
       1092        2278103   FAMCICLOVIR TAB 250MG                     PMS-FAMCICLOVIR                                          3550         F                                 2.0232
       1092        2278642   FAMCICLOVIR TAB 250MG                     SANDOZ FAMCICLOVIR                                      12027         F                                 2.0232
       1092        2292041   FAMCICLOVIR TAB 250MG                     APO-FAMCICLOVIR                                          3636         F                                 2.0232
       1092        2305690   FAMCICLOVIR TAB 250MG                     CO FAMCICLOVIR                                          10028         F                                 2.0232

       1093        2177102   FAMCICLOVIR TAB 500MG                     FAMVIR TABLETS 500MG                                     7277         P                                 7.4859      2.9213
       1093        2278111   FAMCICLOVIR TAB 500MG                     PMS-FAMCICLOVIR                                          3550         F                                 2.9213
       1093        2278650   FAMCICLOVIR TAB 500MG                     SANDOZ FAMCICLOVIR                                      12027         F                                 2.9213
       1093        2292068   FAMCICLOVIR TAB 500MG                     APO-FAMCICLOVIR                                          3636         F                                 2.9213
       1093        2305704   FAMCICLOVIR TAB 500MG                     CO FAMCICLOVIR                                          10028         F                                 2.9213

        998        2247745 FAMOTIDINE INJ 10MG/ML (W/PRESERVATIVE)     FAMOTIDINE OMEGA -(WITH PRESERVATIVE,BENZYL ALCOHOL)     4852         F                                 1.6740

        229         710121   FAMOTIDINE TAB 20MG                       PEPCID TAB 20MG                                         12250        P                    RDP           1.1641      0.4593
        229        1953842   FAMOTIDINE TAB 20MG                       APO-FAMOTIDINE TAB 20MG USP                              3636        P*                   RDP           0.4593
        229        2022133   FAMOTIDINE TAB 20MG                       NOVO-FAMOTIDINE TAB 20MG                                 4773        P*                   RDP           0.4593
        229        2024195   FAMOTIDINE TAB 20MG                       NU-FAMOTIDINE TAB 20MG                                   4828        P*                   RDP           0.4593
        229        2196018   FAMOTIDINE TAB 20MG                       MYLAN-FAMOTIDINE                                        13930        P*                   RDP           0.4593
        229        2351102   FAMOTIDINE TAB 20MG                       FAMOTIDINE TABLETS                                      14236        P*                   RDP           0.4593

        230         710113   FAMOTIDINE TAB 40MG                       PEPCID TAB 40MG                                         12250        P                    RDP           2.1507      0.8353
        230        1953834   FAMOTIDINE TAB 40MG                       APO-FAMOTIDINE TAB 40MG USP                              3636        P*                   RDP           0.8353
        230        2022141   FAMOTIDINE TAB 40MG                       NOVO-FAMOTIDINE TAB 40MG                                 4773        P*                   RDP           0.8353
        230        2024209   FAMOTIDINE TAB 40MG                       NU-FAMOTIDINE TAB 40MG                                   4828        P*                   RDP           0.8353
        230        2196026   FAMOTIDINE TAB 40MG                       MYLAN-FAMOTIDINE                                        13930        P*                   RDP           0.8353
        230        2351110   FAMOTIDINE TAB 40MG                       FAMOTIDINE TABLETS                                      14236        P*                   RDP           0.8353

        231         851787 FELODIPINE ER TAB 10MG                      PLENDIL 10 MG                                            9307         P                   REF           1.1326      0.7479
        231        2222000 FELODIPINE ER TAB 10MG                      RENEDIL                                                 12538         P                   REF           1.1701      0.7479
        231        2280272 FELODIPINE ER TAB 10MG                      SANDOZ FELODIPINE                                       12027         F                   REF           0.7479

        232        2221985 FELODIPINE ER TAB 2.5MG                     RENEDIL                                                 12538         P                   REF           0.5814      0.5494
        232        2057778 FELODIPINE ER TAB 2.5MG                     PLENDIL 2.5 MG                                           9307         F                   REF           0.5648

        233         851779 FELODIPINE ER TAB 5MG                       PLENDIL 5 MG                                             9307         P                   REF           0.7549      0.4990
        233        2221993 FELODIPINE ER TAB 5MG                       RENEDIL                                                 12538         P                   REF           0.7805      0.4990
        233        2280264 FELODIPINE ER TAB 5MG                       SANDOZ FELODIPINE                                       12027         F                   REF           0.4990

        234        2225980 FENOFIBRATE CAP 100MG                       APO-FENOFIBRATE                                          3636         F                                 0.6593

        748        2146959   FENOFIBRATE CAP 200MG                     LIPIDIL MICRO - CAP 200MG                                3624         P                                 1.1761      0.4704
        748        2239864   FENOFIBRATE CAP 200MG                     APO-FENO-MICRO                                           3636         F                                 0.4704
        748        2240210   FENOFIBRATE CAP 200MG                     MYLAN-FENOFIBRATE MICRO                                 13930         F                                 0.4704
        748        2243552   FENOFIBRATE CAP 200MG                     NOVO-FENOFIBRATE MICRONIZED                              4773         F                                 0.4704
        748        2250039   FENOFIBRATE CAP 200MG                     RATIO-FENOFIBRATE MC                                    10402         F                                 0.4704
        748        2273551   FENOFIBRATE CAP 200MG                     PMS-FENOFIBRATE MICRO                                    3550         F                                 0.4704
        748        2286092   FENOFIBRATE CAP 200MG                     FENOFIBRATE MICRO                                       14236         F                                 0.4704

        865        2243180 FENOFIBRATE CAP 67MG                        APO-FENO-MICRO CAPSULES                                  3636         F                                 0.4671
        865        2243551 FENOFIBRATE CAP 67MG                        NOVO-FENOFIBRATE MICRONIZED                              4773         F                                 0.4671

        886        2241601   FENOFIBRATE FC TAB 100MG                  LIPIDIL SUPRA 100 MG                                     3624         P                                 1.1682      0.5841
        886        2246859   FENOFIBRATE FC TAB 100MG                  APO-FENO-SUPER                                           3636         F                                 0.5841
        886        2288044   FENOFIBRATE FC TAB 100MG                  SANDOZ FENOFIBRATE S                                    12027         F                                 0.5841
        886        2289083   FENOFIBRATE FC TAB 100MG                  NOVO-FENOFIBRATE-S                                       4773         F                                 0.5841
        886        2356570   FENOFIBRATE FC TAB 100MG                  FENOFIBRATE-S                                           14236         F                                 0.5841

        887        2241602   FENOFIBRATE FC TAB 160MG                  LIPIDIL SUPRA 160 MG                                     3624         P                                 1.3461      0.5385
        887        2246860   FENOFIBRATE FC TAB 160MG                  APO-FENO-SUPER                                           3636         F                                 0.5385
        887        2288052   FENOFIBRATE FC TAB 160MG                  SANDOZ FENOFIBRATE S                                    12027         F                                 0.5385
        887        2289091   FENOFIBRATE FC TAB 160MG                  NOVO-FENOFIBRATE-S                                       4773         F                                 0.5385
                                                                                              Page 15 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                               Full / Partial   Plan B
             DIN             Chemical Name                  Drug Name                                   MAN                                 RDP   SA   Max Price   LCA Price
Category no.                                                                                                      LCA Benefit       Only
        887        2356589 FENOFIBRATE FC TAB 160MG         FENOFIBRATE-S                                14236          F                                 0.5385

       1138        2269082 FENOFIBRATE TAB 145MG            LIPIDIL EZ                                    3625          P                                 1.1340      0.5385

       1137        2269074 FENOFIBRATE TAB 48MG             LIPIDIL EZ                                    3625          P                                 0.4428      0.1783

        235         328642 FENOPROFEN CAP 300MG             NALFON CAP 300MG                              7005         P*                   RDP           0.3090

        236         345504 FENOPROFEN TAB 600MG             NALFON TAB 600MG                              7005         P*                   RDP           0.5602

       1099        2275856   FENTANYL PATCH 100MCG          DURAGESIC MAT                                 7259          P                         X      40.9039     14.8746
       1099        2249448   FENTANYL PATCH 100MCG          RAN-FENTANYL TRANSDERMAL SYSTEM              11271          F                         X      14.8746
       1099        2282984   FENTANYL PATCH 100MCG          RATIO-FENTANYL                               10402          F                         X      14.8746
       1099        2314665   FENTANYL PATCH 100MCG          NOVO-FENTANYL 100                             4773          F                         X      14.8746
       1099        2327163   FENTANYL PATCH 100MCG          SANDOZ FENTANYL PATCH                        12027          F                         X      14.8746
       1099        2330156   FENTANYL PATCH 100MCG          RAN-FENTANYL MATRIX PATCH                    11271          F                         X      14.8746
       1099        2341417   FENTANYL PATCH 100MCG          PMS-FENTANYL MTX                              3550          F                         X      14.8746

       1145        2311925   FENTANYL PATCH 12MCG           RATIO-FENTANYL                               10402          F                         X       2.4095
       1145        2327112   FENTANYL PATCH 12MCG           SANDOZ FENTANYL PATCH                        12027          F                         X       2.4095
       1145        2330105   FENTANYL PATCH 12MCG           RAN-FENTANYL MATRIX PATCH                    11271          F                         X       2.4095
       1145        2334186   FENTANYL PATCH 12MCG           DURAGESIC MAT                                 7259          F                         X       4.8190      2.4095

       1096        2275813   FENTANYL PATCH 25MCG           DURAGESIC MAT                                 7259          P                         X      12.4157      4.5153
       1096        2249391   FENTANYL PATCH 25MCG           RAN-FENTANYL TRANSDERMAL SYSTEM              11271          F                         X       4.5153
       1096        2282941   FENTANYL PATCH 25MCG           RATIO-FENTANYL                               10402          F                         X       4.5153
       1096        2314630   FENTANYL PATCH 25MCG           NOVO-FENTANYL 25                              4773          F                         X       4.5153
       1096        2327120   FENTANYL PATCH 25MCG           SANDOZ FENTANYL PATCH                        12027          F                         X       4.5153
       1096        2330113   FENTANYL PATCH 25MCG           RAN-FENTANYL MATRIX PATCH                    11271          F                         X       4.5153
       1096        2341387   FENTANYL PATCH 25MCG           PMS-FENTANYL MTX                              3550          F                         X       4.5153

       1097        2275821   FENTANYL PATCH 50MCG           DURAGESIC MAT                                 7259          P                         X      23.3647      8.4966
       1097        2249413   FENTANYL PATCH 50MCG           RAN-FENTANYL TRANSDERMAL SYSTEM              11271          F                         X       8.4966
       1097        2282968   FENTANYL PATCH 50MCG           RATIO-FENTANYL                               10402          F                         X       8.4966
       1097        2314649   FENTANYL PATCH 50MCG           NOVO-FENTANYL 50                              4773          F                         X       8.4966
       1097        2327147   FENTANYL PATCH 50MCG           SANDOZ FENTANYL PATCH                        12027          F                         X       8.4966
       1097        2330121   FENTANYL PATCH 50MCG           RAN-FENTANYL MATRIX PATCH                    11271          F                         X       8.4966
       1097        2341395   FENTANYL PATCH 50MCG           PMS-FENTANYL MTX                              3550          F                         X       8.4966

       1098        2275848   FENTANYL PATCH 75MCG           DURAGESIC MAT                                 7259          P                         X      32.8622     11.9500
       1098        2249421   FENTANYL PATCH 75MCG           RAN-FENTANYL TRANSDERMAL SYSTEM              11271          F                         X      11.9500
       1098        2282976   FENTANYL PATCH 75MCG           RATIO-FENTANYL                               10402          F                         X      11.9500
       1098        2314657   FENTANYL PATCH 75MCG           NOVO-FENTANYL 75                              4773          F                         X      11.9500
       1098        2327155   FENTANYL PATCH 75MCG           SANDOZ FENTANYL PATCH                        12027          F                         X      11.9500
       1098        2330148   FENTANYL PATCH 75MCG           RAN-FENTANYL MATRIX PATCH                    11271          F                         X      11.9500
       1098        2341409   FENTANYL PATCH 75MCG           PMS-FENTANYL MTX                              3550          F                         X      11.9500

        238          31089 FERROUS FUMARATE TAB 300MG       FERROUS FUMARATE TAB 300MG                   11498          F                                 0.0779

        239       31097 FERROUS GLUCONATE TAB 300MG         FERROUS GLUCONATE TAB 300MG                  11498          F                                 0.0274
        239    80000435 FERROUS GLUCONATE TAB 300MG         NOVO-FERROGLUC 300MG TAB                      4773          F                                 0.0274

        657      762954 FERROUS SULFATE ORAL SOL 75MG/ML    FER IN SOL DROPS                              4616          P                                 0.2631      0.2002
        657     2237385 FERROUS SULFATE ORAL SOL 75MG/ML    FERODAN INFANT DROPS                          4835          F                                 0.2002
        657    80008309 FERROUS SULFATE ORAL SOL 75MG/ML    JAMP FERROUS SULPHATE INFANT DROPS 75MG/M     4415          F                                 0.2002

        637      758469 FERROUS SULFATE SOL 30MG/ML         FERODAN SYRUP 150MG/5ML                       4835          F                                 0.0309
        637    80008295 FERROUS SULFATE SOL 30MG/ML         JAMP FERROUS SULPHATE LIQUID 150MG/5ML        4415          F                                 0.0309

        243          31100 FERROUS SULFATE TAB 300MG        FERROUS SULFATE TAB 300MG                    11498          F                                 0.0170
        243        2248699 FERROUS SULFATE TAB 300MG        FERODAN TABLETS 300MG                         4835          F                                 0.0170

       1197        2010909   FINASTERIDE TAB 5MG            PROSCAR                                      12250          P                         X       2.0153      0.8005
       1197        2306905   FINASTERIDE TAB 5MG            RATIO-FINASTERIDE                            10402          F                         X       0.8005
       1197        2310112   FINASTERIDE TAB 5MG            PMS-FINASTERIDE                               3550          F                         X       0.8005
       1197        2322579   FINASTERIDE TAB 5MG            SANDOZ FINASTERIDE                           12027          F                         X       0.8005
       1197        2348500   FINASTERIDE TAB 5MG            NOVO-FINASTERIDE                             14318          F                         X       0.8005
       1197        2354462   FINASTERIDE TAB 5MG            CO FINASTERIDE                               10028          F                         X       0.8005
       1197        2356058   FINASTERIDE TAB 5MG            MYLAN-FINASTERIDE                            13930          F                         X       0.8005
       1197        2357224   FINASTERIDE TAB 5MG            JAMP-FINASTERIDE                              4415          F                         X       0.6980

       1078        1966200 FLECAINIDE ACETATE TAB 100MG     TAMBOCOR TAB 100MG                           12934          P                                 1.2004      0.8545
       1078        2275546 FLECAINIDE ACETATE TAB 100MG     FLECAINIDE                                   14412          F                                 0.8545

       1077        1966197 FLECAINIDE ACETATE TAB 50MG      TAMBOCOR TAB 50MG                            12934          P                                 0.6000      0.4272
       1077        2275538 FLECAINIDE ACETATE TAB 50MG      FLECAINIDE                                   14412          F                                 0.4272

        941        2244680 FLOCTAFENINE TAB 200MG           FLOCTAFENINE                                 14412          F                                 0.4509

        942        2244681 FLOCTAFENINE TAB 400MG           FLOCTAFENINE                                 14412          F                                 0.8773

        885        2141442 FLUCONAZOLE CAP 150MG            DIFLUCAN ONE                                 14624          P                         X      15.7680      6.2884
        885        2241895 FLUCONAZOLE CAP 150MG            APO-FLUCONAZOLE-150                           3636          F                         X       6.2884
        885        2282348 FLUCONAZOLE CAP 150MG            PMS-FLUCONAZOLE                               3550          F                         X       6.2884

        820        2236979   FLUCONAZOLE TAB 100MG          NOVO-FLUCONAZOLE                              4773          F                         X       3.9555
        820        2237371   FLUCONAZOLE TAB 100MG          APO-FLUCONAZOLE                               3636          F                         X       3.9555
        820        2245293   FLUCONAZOLE TAB 100MG          MYLAN-FLUCONAZOLE                            13930          F                         X       3.9555
        820        2245644   FLUCONAZOLE TAB 100MG          PMS-FLUCONAZOLE                               3550          F                         X       3.9555
        820        2281279   FLUCONAZOLE TAB 100MG          CO FLUCONAZOLE                               10028          F                         X       3.9555

        821        2236978   FLUCONAZOLE TAB 50MG           NOVO-FLUCONAZOLE                              4773          F                         X       2.2298
        821        2237370   FLUCONAZOLE TAB 50MG           APO-FLUCONAZOLE                               3636          F                         X       2.2298
        821        2245292   FLUCONAZOLE TAB 50MG           MYLAN-FLUCONAZOLE                            13930          F                         X       2.2298
        821        2245643   FLUCONAZOLE TAB 50MG           PMS-FLUCONAZOLE                               3550          F                         X       2.2298
        821        2281260   FLUCONAZOLE TAB 50MG           CO FLUCONAZOLE                               10028          F                         X       2.2298

        735        2246082 FLUNARIZINE CAP 5MG              FLUNARIZINE                                  14412          F                                 0.7780

        246        2162687 FLUNISOLIDE NASAL SPRAY 0.025%   RHINALAR NASAL MIST                          12255          P                                 0.8554      0.6415
        246        2239288 FLUNISOLIDE NASAL SPRAY 0.025%   APO-FLUNISOLIDE NASAL SPRAY                   4828          F                                 0.6415

        640          30414 FLUOCINOLONE ACETON CRM 0.01%    SYNALAR CRM MILD 0.01%                           0          F                                 0.2654
        640        2162547 FLUOCINOLONE ACETON CRM 0.01%    SYNALAR CRM MILD 0.01%                        8784          F                                 0.2654
        640        2163489 FLUOCINOLONE ACETON CRM 0.01%    SYNAMOL 0.01% CREAM                           4328          F                                 0.2773

        641          30422 FLUOCINOLONE ACETON CRM 0.025%   SYNALAR CRM 0.025%                                0         F                                 0.4497
                                                                                  Page 16 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                         Full / Partial   Plan B
             DIN             Chemical Name                  Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                LCA Benefit       Only
        641         424935 FLUOCINOLONE ACETON CRM 0.025%   SYNAMOL REGULAR 0.025% CRM                  0         F                                 0.5882
        641        2162539 FLUOCINOLONE ACETON CRM 0.025%   SYNALAR CRM 0.025%                       8784         F                                 0.4497
        641        2163470 FLUOCINOLONE ACETON CRM 0.025%   SYNAMOL 0.025% CREAM                     4328         F                                 0.5883

        719         598933   FLUOCINONIDE CRM 0.05%         TIAMOL CREAM 0.05%                      11314         F                                 0.2638
        719         716863   FLUOCINONIDE CRM 0.05%         LYDERM CREAM 0.05%                      11314         F                                 0.2638
        719        2161923   FLUOCINONIDE CRM 0.05%         LIDEX CREAM 0.05%                       11211         F                                 0.4986
        719        2163152   FLUOCINONIDE CRM 0.05%         LIDEMOL EMOLLIENT CREAM 0.05%           11211         F                                 0.6011

        723        2161974 FLUOCINONIDE GEL 0.05%           LIDEX GEL 0.05%                         11211         F                                 0.5535

        724        2161966 FLUOCINONIDE ONT 0.05%           LIDEX OINTMENT 0.05%                    11211         F                                 0.5463

        247         247855 FLUOROMETHOLONE DRP 0.1%         FML 0.1%                                 3574         P                                 3.3026      1.8733
        247         756784 FLUOROMETHOLONE DRP 0.1%         FLAREX OPH SUSP 0.1%                     3594         P                                 1.9168      1.8733
        247        2238568 FLUOROMETHOLONE DRP 0.1%         PMS-FLUOROMETHOLONE                      3550         F                                 1.8733

        248        2018985   FLUOXETINE CAP 10MG            PROZAC CAPSULES 10MG                     7005         P                                 1.9849      0.9342
        248        2177579   FLUOXETINE CAP 10MG            PMS-FLUOXETINE - CAP 10MG                3550         F                                 0.9342
        248        2216353   FLUOXETINE CAP 10MG            APO-FLUOXETINE                           3636         F                                 0.9342
        248        2216582   FLUOXETINE CAP 10MG            TEVA-FLUOXETINE                         14318         F                                 0.9342
        248        2223481   FLUOXETINE CAP 10MG            PHL-FLUOXETINE - CAP 10MG                4917         F                                 0.9342
        248        2237813   FLUOXETINE CAP 10MG            MYLAN-FLUOXETINE                        13930         F                                 0.9342
        248        2241371   FLUOXETINE CAP 10MG            RATIO-FLUOXETINE                        10402         F                                 0.9342
        248        2242177   FLUOXETINE CAP 10MG            CO FLUOXETINE 10MG                      10225         F                                 0.9342
        248        2243486   FLUOXETINE CAP 10MG            SANDOZ FLUOXETINE                       12027         F                                 0.9342
        248        2286068   FLUOXETINE CAP 10MG            FLUOXETINE                              14236         F                                 0.9342
        248        2302659   FLUOXETINE CAP 10MG            ZYM-FLUOXETINE                           6860         F                                 0.9342

        249         636622   FLUOXETINE CAP 20MG            PROZAC CAPSULES 20MG                     7005         P                                 2.0050      0.7946
        249        2177587   FLUOXETINE CAP 20MG            PMS-FLUOXETINE - CAP 20MG                3550         F                                 0.7946
        249        2192764   FLUOXETINE CAP 20MG            NU-FLUOXETINE                            4828         F                                 0.7946
        249        2216361   FLUOXETINE CAP 20MG            APO-FLUOXETINE                           3636         F                                 0.7946
        249        2216590   FLUOXETINE CAP 20MG            TEVA-FLUOXETINE                         14318         F                                 0.7946
        249        2223503   FLUOXETINE CAP 20MG            PHL-FLUOXETINE - CAP 20MG                4917         F                                 0.7946
        249        2237814   FLUOXETINE CAP 20MG            MYLAN-FLUOXETINE                        13930         F                                 0.7946
        249        2241374   FLUOXETINE CAP 20MG            RATIO-FLUOXETINE                        10402         F                                 0.7946
        249        2242178   FLUOXETINE CAP 20MG            CO FLUOXETINE 20MG                      10225         F                                 0.7946
        249        2243487   FLUOXETINE CAP 20MG            SANDOZ FLUOXETINE                       12027         F                                 0.7946
        249        2286076   FLUOXETINE CAP 20MG            FLUOXETINE                              14236         F                                 0.7946
        249        2302667   FLUOXETINE CAP 20MG            ZYM-FLUOXETINE                           6860         F                                 0.7946

        930        2245283 FLUOXETINE CAP 40MG              FXT 40                                  13843         P                                 2.2026      1.5891

        647        2231328 FLUOXETINE ORL SOL 20MG/5ML      APO-FLUOXETINE ORAL SOLUTION             3636         F                                 0.6328

        672         755575 FLUPHENAZINE CONC INJ 100MG/ML   MODECATE CONCENTRATE                     3798         F                                32.1624
        672        2242570 FLUPHENAZINE CONC INJ 100MG/ML   FLUPHENAZINE OMEGA                       4852         F                                32.1624

        250         349917 FLUPHENAZINE INJ 25MG/ML         MODECATE INJ 25MG/ML                     5180         F                                 5.0025
        250        2239636 FLUPHENAZINE INJ 25MG/ML         FLUPHENAZINE OMEGA                       4852         F                                 5.0026

        251         405345 FLUPHENAZINE TAB 1MG             APO FLUPHENAZINE TAB 1MG                 3636         F                                 0.1878
        251         504424 FLUPHENAZINE TAB 1MG             PERMITIL TAB 1MG                         7016         F                                 0.1464

        252         410632 FLUPHENAZINE TAB 2MG             APO FLUPHENAZINE TAB 2MG                 3636         F                                 0.2432

        253         405361 FLUPHENAZINE TAB 5MG             APO FLUPHENAZINE TAB 5MG                 3636         F                                 0.1858
        253         726354 FLUPHENAZINE TAB 5MG             PMS FLUPHENAZINE TAB 5MG                 3550         F                                 0.1858

        254          12696 FLURAZEPAM CAP 15MG              DALMANE                                 11902         P                                 0.1389      0.0875
        254         521698 FLURAZEPAM CAP 15MG              APO FLURAZEPAM HCL CAP 15MG              3636         F                                 0.0875

        255          12718 FLURAZEPAM CAP 30MG              DALMANE                                 11902         P                                 0.1628      0.1004
        255         521701 FLURAZEPAM CAP 30MG              APO FLURAZEPAM HCL CAP 30MG              3636         F                                 0.1004

        256         863882 FLURBIPROFEN SR CAP 200MG        FROBEN-SR CAP 200MG                      4827        P*                   RDP           1.2668
        256        2223082 FLURBIPROFEN SR CAP 200MG        FROBEN SR                                3525        P*                   RDP           1.6257

        257         600792 FLURBIPROFEN TAB 100MG           ANSAID TABLETS 100 MG                    4908        P                    RDP           0.7266      0.3282
        257        1912038 FLURBIPROFEN TAB 100MG           APO-FLURBIPROFEN FC TABLETS 100MG        3636        P*                   RDP           0.3282
        257        2100517 FLURBIPROFEN TAB 100MG           NOVO-FLURPROFEN FC TABLET 100MG          4773        P*                   RDP           0.3282

        258         647942 FLURBIPROFEN TAB 50MG            ANSAID TABLETS 50 MG                     4908        P                    RDP           0.5550      0.2399
        258        1912046 FLURBIPROFEN TAB 50MG            APO-FLURBIPROFEN FC TABLETS 50MG         3636        P*                   RDP           0.2399
        258        2100509 FLURBIPROFEN TAB 50MG            NOVO-FLURPROFEN FC TABLET 50MG           4773        P*                   RDP           0.2399

        668        1919369   FLUVOXAMINE TAB 100MG          LUVOX                                    3525         P                                 1.4262      0.6538
        668        2218461   FLUVOXAMINE TAB 100MG          RATIO-FLUVOXAMINE                       10402         F                                 0.6538
        668        2231193   FLUVOXAMINE TAB 100MG          NU-FLUVOXAMINE 100 MG TAB                4828         F                                 0.6538
        668        2231330   FLUVOXAMINE TAB 100MG          APO-FLUVOXAMINE TABLETS                  3636         F                                 0.6538
        668        2239954   FLUVOXAMINE TAB 100MG          NOVO-FLUVOXAMINE                         4773         F                                 0.6538
        668        2240683   FLUVOXAMINE TAB 100MG          PMS-FLUVOXAMINE                          3550         F                                 0.6538
        668        2247055   FLUVOXAMINE TAB 100MG          SANDOZ FLUVOXAMINE                      12027         F                                 0.6538
        668        2255537   FLUVOXAMINE TAB 100MG          CO FLUVOXAMINE                          10028         F                                 0.6538

        667        1919342   FLUVOXAMINE TAB 50MG           LUVOX                                    3525         P                                 0.9256      0.3637
        667        2218453   FLUVOXAMINE TAB 50MG           RATIO-FLUVOXAMINE                       10402         F                                 0.3637
        667        2231192   FLUVOXAMINE TAB 50MG           NU-FLUVOXAMINE 50 MG TAB                 4828         F                                 0.3637
        667        2231329   FLUVOXAMINE TAB 50MG           APO-FLUVOXAMINE TABLETS                  3636         F                                 0.3637
        667        2239953   FLUVOXAMINE TAB 50MG           NOVO-FLUVOXAMINE                         4773         F                                 0.3637
        667        2240682   FLUVOXAMINE TAB 50MG           PMS-FLUVOXAMINE                          3550         F                                 0.3637
        667        2247054   FLUVOXAMINE TAB 50MG           SANDOZ FLUVOXAMINE                      12027         F                                 0.3637
        667        2255529   FLUVOXAMINE TAB 50MG           CO FLUVOXAMINE                          10028         F                                 0.3637

        259         426849 FOLIC ACID TAB 5MG               APO FOLIC ACID TAB 5MG                   3636         F                                 0.0280
        259        2366061 FOLIC ACID TAB 5MG               JAMP-FOLIC ACID                          4415         F                                 0.0280

        260        1907107   FOSINOPRIL TAB 10MG            MONOPRIL TAB 10MG                        3798        P                    RDP           0.9695      0.3763
        260        2247802   FOSINOPRIL TAB 10MG            TEVA-FOSINOPRIL                         14318        P*                   RDP           0.3763
        260        2262401   FOSINOPRIL TAB 10MG            MYLAN-FOSINOPRIL                        13930        P*                   RDP           0.3763
        260        2266008   FOSINOPRIL TAB 10MG            APO-FOSINOPRIL                           3636        P*                   RDP           0.3763
        260        2294524   FOSINOPRIL TAB 10MG            RAN-FOSINOPRIL                          11271        P*                   RDP           0.3763
        260        2331004   FOSINOPRIL TAB 10MG            JAMP-FOSINOPRIL                          4415        P*                   RDP           0.3763
        260        2332566   FOSINOPRIL TAB 10MG            FOSINOPRIL 10 MG TABLET                 11271        P*                   RDP           0.3763

        261        1907115 FOSINOPRIL TAB 20MG              MONOPRIL TAB 20MG                        3798         P                   RDP           1.1664      0.4526
                                                                                   Page 17 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                              Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                     LCA Benefit       Only
        261        2247803   FOSINOPRIL TAB 20MG                   TEVA-FOSINOPRIL                       14318        P*                   RDP           0.4526
        261        2262428   FOSINOPRIL TAB 20MG                   MYLAN-FOSINOPRIL                      13930        P*                   RDP           0.4526
        261        2266016   FOSINOPRIL TAB 20MG                   APO-FOSINOPRIL                         3636        P*                   RDP           0.4526
        261        2294532   FOSINOPRIL TAB 20MG                   RAN-FOSINOPRIL                        11271        P*                   RDP           0.4526
        261        2331012   FOSINOPRIL TAB 20MG                   JAMP-FOSINOPRIL                        4415        P*                   RDP           0.4526
        261        2332574   FOSINOPRIL TAB 20MG                   FOSINOPRIL 20 MG TABLET               11271        P*                   RDP           0.4526

        996        2224623 FRAMYCETIN/GRAMICID/DEXAMETHASONE DPS   SOFRACORT STERILE EAR/EYE DROPS       12538         P                                 1.9602      1.0584
        996        2247920 FRAMYCETIN/GRAMICID/DEXAMETHASONE DPS   SANDOZ OPTICORT                       12027         F                                 1.0584

        753         217743   FUROSEMIDE INJ 10MG                   LASIX PARENTERAL INJ                      0         F                                 0.5639
        753         380024   FUROSEMIDE INJ 10MG                   LASIX SPECIAL INJ 10MG/ML                 0         F                                 0.8167
        753         527033   FUROSEMIDE INJ 10MG                   FUROSEMIDE INJ USP                    12027         F                                 0.8802
        753        1987550   FUROSEMIDE INJ 10MG                   LASIX SPECIAL 10MG/ML AMP              3727         F                                 0.8167
        753        1988832   FUROSEMIDE INJ 10MG                   LASIX PARENTERAL INJECTION 10MG/ML     3727         F                                 0.4741
        753        1996436   FUROSEMIDE INJ 10MG                   LASIX INJECTION 10MG/ML                3727         F                                 0.4414
        753        2224739   FUROSEMIDE INJ 10MG                   LASIX INJECTION 10MG/ML - IM IV        3727         F                                 0.4414
        753        2224747   FUROSEMIDE INJ 10MG                   LASIX 10MG/ML AMPOULE                  3727         F                                 0.4741
        753        2224763   FUROSEMIDE INJ 10MG                   LASIX SPECIAL 10MG/ML AMP              3727         F                                 0.8167

        262        2224690   FUROSEMIDE TAB 20MG                   LASIX                                 12538         P                                 0.0918      0.0403
        262         337730   FUROSEMIDE TAB 20MG                   NOVO-SEMIDE TAB 20MG                   4773         F                                 0.0403
        262         353612   FUROSEMIDE TAB 20MG                   FUROSIDE TAB 20MG                      4372         F                                 0.0106
        262         396788   FUROSEMIDE TAB 20MG                   APO FUROSEMIDE TAB 20MG                3636         F                                 0.0403
        262        2247493   FUROSEMIDE TAB 20MG                   PMS-FUROSEMIDE                        10997         F                                 0.0403
        262        2351420   FUROSEMIDE TAB 20MG                   FUROSEMIDE                            14236         F                                 0.0403

        263        2224704   FUROSEMIDE TAB 40MG                   LASIX                                 12538         P                                 0.1411      0.0603
        263         332275   FUROSEMIDE TAB 40MG                   FUROSIDE TAB 40MG                      4372         F                                 0.0113
        263         337749   FUROSEMIDE TAB 40MG                   NOVO-SEMIDE TAB 40MG                   4773         F                                 0.0603
        263         362166   FUROSEMIDE TAB 40MG                   APO FUROSEMIDE TAB 40MG                3636         F                                 0.0603
        263        2247494   FUROSEMIDE TAB 40MG                   PMS-FUROSEMIDE                        10997         F                                 0.0603
        263        2351439   FUROSEMIDE TAB 40MG                   FUROSEMIDE                            14236         F                                 0.0603

        264         707570 FUROSEMIDE TAB 80MG                     APO FUROSEMIDE TAB 80MG                3636         F                                 0.1318
        264         765953 FUROSEMIDE TAB 80MG                     NOVO-SEMIDE TAB 80MG                   4773         F                                 0.1318
        264        2351447 FUROSEMIDE TAB 80MG                     FUROSEMIDE                            14236         F                                 0.1318

        897        2084260   GABAPENTIN CAP 100MG                  NEURONTIN CAP 100MG                    4908         P                                 0.4587      0.1797
        897        2243446   GABAPENTIN CAP 100MG                  PMS-GABAPENTIN                         3550         F                                 0.1797
        897        2244304   GABAPENTIN CAP 100MG                  APO-GABAPENTIN CAPSULES                3636         F                                 0.1797
        897        2244513   GABAPENTIN CAP 100MG                  TEVA-GABAPENTIN                       14318         F                                 0.1797
        897        2246314   GABAPENTIN CAP 100MG                  GABAPENTIN                            14308         F                                 0.1797
        897        2248259   GABAPENTIN CAP 100MG                  MYLAN-GABAPENTIN                      13930         F                                 0.1797
        897        2256142   GABAPENTIN CAP 100MG                  CO GABAPENTIN CAPSULES 100MG          10028         F                                 0.1797
        897        2260883   GABAPENTIN CAP 100MG                  RATIO-GABAPENTIN                      10402         F                                 0.1797
        897        2285819   GABAPENTIN CAP 100MG                  GD-GABAPENTIN                         12463         F                                 0.1797
        897        2319055   GABAPENTIN CAP 100MG                  RAN-GABAPENTIN                        11271         F                                 0.1797
        897        2321203   GABAPENTIN CAP 100MG                  AURO-GABAPENTIN 100 MG CAPSULE        11979         F                                 0.1795
        897        2353245   GABAPENTIN CAP 100MG                  GABAPENTIN                            14236         F                                 0.1797

        898        2084279   GABAPENTIN CAP 300MG                  NEURONTIN CAP 300MG                    4908         P                                 1.1159      0.4372
        898        2243447   GABAPENTIN CAP 300MG                  PMS-GABAPENTIN                         3550         F                                 0.4372
        898        2244305   GABAPENTIN CAP 300MG                  APO-GABAPENTIN CAPSULES                3636         F                                 0.4372
        898        2244514   GABAPENTIN CAP 300MG                  TEVA-GABAPENTIN                       14318         F                                 0.4372
        898        2246315   GABAPENTIN CAP 300MG                  GABAPENTIN                            14308         F                                 0.4372
        898        2248260   GABAPENTIN CAP 300MG                  MYLAN-GABAPENTIN                      13930         F                                 0.4372
        898        2256150   GABAPENTIN CAP 300MG                  CO GABAPENTIN CAPSULES 300MG          10028         F                                 0.4372
        898        2260891   GABAPENTIN CAP 300MG                  RATIO-GABAPENTIN                      10402         F                                 0.4372
        898        2285827   GABAPENTIN CAP 300MG                  GD-GABAPENTIN                         12463         F                                 0.4372
        898        2319063   GABAPENTIN CAP 300MG                  RAN-GABAPENTIN                        11271         F                                 0.4372
        898        2321211   GABAPENTIN CAP 300MG                  AURO-GABAPENTIN 300 MG CAPSULE        11979         F                                 0.4368
        898        2353253   GABAPENTIN CAP 300MG                  GABAPENTIN                            14236         F                                 0.4372

        899        2084287   GABAPENTIN CAP 400MG                  NEURONTIN CAP 400MG                    4908         P                                 1.3298      0.5210
        899        2243448   GABAPENTIN CAP 400MG                  PMS-GABAPENTIN                         3550         F                                 0.5210
        899        2244306   GABAPENTIN CAP 400MG                  APO-GABAPENTIN CAPSULES                3636         F                                 0.5210
        899        2244515   GABAPENTIN CAP 400MG                  TEVA-GABAPENTIN                       14318         F                                 0.5210
        899        2246316   GABAPENTIN CAP 400MG                  GABAPENTIN                            14308         F                                 0.5210
        899        2248261   GABAPENTIN CAP 400MG                  MYLAN-GABAPENTIN                      13930         F                                 0.5210
        899        2256169   GABAPENTIN CAP 400MG                  CO GABAPENTIN CAPSULES 400MG          10028         F                                 0.5210
        899        2260905   GABAPENTIN CAP 400MG                  RATIO-GABAPENTIN                      10402         F                                 0.5210
        899        2285835   GABAPENTIN CAP 400MG                  GD-GABAPENTIN                         12463         F                                 0.5210
        899        2319071   GABAPENTIN CAP 400MG                  RAN-GABAPENTIN                        11271         F                                 0.5210
        899        2321238   GABAPENTIN CAP 400MG                  AURO-GABAPENTIN 400 MG CAPSULE        11979         F                                 0.5205
        899        2353261   GABAPENTIN CAP 400MG                  GABAPENTIN                            14236         F                                 0.5210

       1001        2239717 GABAPENTIN TAB 600MG                    NEURONTIN 600MG                        4908         P                                 1.9948      0.7815
       1001        2285843 GABAPENTIN TAB 600MG                    GD-GABAPENTIN                         12463         F                                 0.7815

        978        2239718 GABAPENTIN TAB 800MG                    NEURONTIN 800MG                        4908         P                                 2.6622      1.0419
        978        2285851 GABAPENTIN TAB 800MG                    GD-GABAPENTIN                         12463         F                                 1.0419

        265         599026   GEMFIBROZIL CAP 300MG                 LOPID CAP 300MG                        4908         P                                 0.5681      0.2226
        265        1979574   GEMFIBROZIL CAP 300MG                 APO-GEMFIBROZIL CAP 300MG USP          3636         F                                 0.2226
        265        2058456   GEMFIBROZIL CAP 300MG                 NU-GEMFIBROZIL CAP 300MG               4828         F                                 0.2226
        265        2185407   GEMFIBROZIL CAP 300MG                 MYLAN-GEMFIBROZIL                     13930         F                                 0.2226
        265        2239951   GEMFIBROZIL CAP 300MG                 PMS-GEMFIBROZIL                        3550         F                                 0.2226
        265        2241704   GEMFIBROZIL CAP 300MG                 NOVO-GEMFIBROZIL                       4773         F                                 0.2226

        266         659606   GEMFIBROZIL TAB 600MG                 LOPID 600MG                            4908         P                                 1.1172      0.5570
        266        1979582   GEMFIBROZIL TAB 600MG                 APO-GEMFIBROZIL                        3636         F                                 0.5570
        266        2142074   GEMFIBROZIL TAB 600MG                 NOVO-GEMFIBROZIL - TAB 600MG           4773         F                                 0.5570
        266        2230183   GEMFIBROZIL TAB 600MG                 PMS-GEMFIBROZIL                        3550         F                                 0.5570
        266        2230476   GEMFIBROZIL TAB 600MG                 MYLAN-GEMFIBROZIL                     13930         F                                 0.5570

        267          27928 GENTAMICIN CRM 0.01%                    GARAMYCIN CREAM 0.1%                   7016         F                                 0.3845
        267         805386 GENTAMICIN CRM 0.01%                    RATIO-GENTAMICIN                      10402         F                                 0.4614

        900         223824 GENTAMICIN INJ 40MG/ML                  GARAMYCIN INJ 40MG/ML                  7016         F                                 2.1384
        900        2242652 GENTAMICIN INJ 40MG/ML                  GENTAMICIN INJECTION USP              12027         F                                 2.9052

        268          28371 GENTAMICIN ONT 0.1%                     GARAMYCIN ONT 0.1%                     7016         F                                 0.3845
        268         805025 GENTAMICIN ONT 0.1%                     RATIO-GENTAMICIN                      10402         F                                 0.4614

        736          28339 GENTAMICIN OPH ONT 0.3%                 GARAMYCIN OPHTHALMIC OINTMENT 0.3%    12250         F                                 1.2343
        736        2230888 GENTAMICIN OPH ONT 0.3%                 SANDOZ GENTAMICIN                     12027         F                                 1.5429
                                                                                        Page 18 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                            Full / Partial   Plan B
             DIN             Chemical Name                      Drug Name                             MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                   LCA Benefit       Only


        269         512192 GENTAMICIN OPH SOL 0.3%              GARAMYCIN OPHTHALMIC DROPS 0.3%        12250         F                                 0.4385
        269        2229440 GENTAMICIN OPH SOL 0.3%              SANDOZ GENTAMICIN                      12027         F                                 0.4385

        270         512184 GENTAMICIN OTIC SOL 0.3%             GARAMYCIN OTIC DROPS 0.3%              12250         F                                 1.1146
        270        2229441 GENTAMICIN OTIC SOL 0.3%             SANDOZ GENTAMICIN                      12027         F                                 1.1146

        889        2242987 GLICLAZIDE SR TAB 30MG               DIAMICRON MR                            5096         F                         X       0.1517
        889        2297795 GLICLAZIDE SR TAB 30MG               GLICLAZIDE MR                          14412         F                         X       0.1517

        768         765996   GLICLAZIDE TAB 80MG                DIAMICRON TAB 80MG                      5096         P                         X       0.4023      0.1517
        768        2229519   GLICLAZIDE TAB 80MG                MYLAN-GLICLAZIDE                       13930         F                         X       0.1517
        768        2238103   GLICLAZIDE TAB 80MG                NOVO-GLICLAZIDE                         4773         F                         X       0.1517
        768        2245247   GLICLAZIDE TAB 80MG                APO-GLICLAZIDE                          3636         F                         X       0.1517
        768        2287072   GLICLAZIDE TAB 80MG                GLICLAZIDE                             14236         F                         X       0.1517

        271        2224550   GLYBURIDE TAB 2.5MG                DIABETA                                12538         P                                 0.1408      0.0424
        271         808733   GLYBURIDE TAB 2.5MG                MYLAN-GLYBE                            13930         F                                 0.0424
        271        1900927   GLYBURIDE TAB 2.5MG                RATIO-GLYBURIDE                        10402         F                                 0.0424
        271        1913654   GLYBURIDE TAB 2.5MG                APO GLYBURIDE TAB 2.5MG                 3636         F                                 0.0424
        271        1913670   GLYBURIDE TAB 2.5MG                TEVA-GLYBURIDE                         14318         F                                 0.0424
        271        2020734   GLYBURIDE TAB 2.5MG                NU-GLYBURIDE TAB 2.5MG                  4828         F                                 0.0424
        271        2248008   GLYBURIDE TAB 2.5MG                SANDOZ GLYBURIDE                       12027         F                                 0.0424
        271        2350459   GLYBURIDE TAB 2.5MG                GLYBURIDE                              14236         F                                 0.0424

        272        2224569   GLYBURIDE TAB 5MG                  DIABETA                                12538         P                                 0.2520      0.0738
        272         808741   GLYBURIDE TAB 5MG                  MYLAN-GLYBE                            13930         F                                 0.0738
        272        1900935   GLYBURIDE TAB 5MG                  RATIO-GLYBURIDE                        10402         F                                 0.0738
        272        1913662   GLYBURIDE TAB 5MG                  APO GLYBURIDE TAB 5MG                   3636         F                                 0.0738
        272        1913689   GLYBURIDE TAB 5MG                  TEVA-GLYBURIDE                         14318         F                                 0.0738
        272        2020742   GLYBURIDE TAB 5MG                  NU-GLYBURIDE TAB 5MG                    4828         F                                 0.0738
        272        2236734   GLYBURIDE TAB 5MG                  PMS-GLYBURIDE                           3550         F                                 0.0738
        272        2248009   GLYBURIDE TAB 5MG                  SANDOZ GLYBURIDE                       12027         F                                 0.0738
        272        2350467   GLYBURIDE TAB 5MG                  GLYBURIDE                              14236         F                                 0.0738

        943        1927620 GOLD SODIUM THIOMALATE INJ 10MG/ML   MYOCHRYSINE                            12538         P                                12.6252      6.8148
        943        2245456 GOLD SODIUM THIOMALATE INJ 10MG/ML   SODIUM AUROTHIOMALATE INJECTION BP     12027         F                                 6.8148

        944        1927612 GOLD SODIUM THIOMALATE INJ 25MG/ML   MYOCHRYSINE                            12538         P                                15.3036      8.2728
        944        2245457 GOLD SODIUM THIOMALATE INJ 25MG/ML   SODIUM AUROTHIOMALATE INJECTION BP     12027         F                                 8.2728

        945        1927604 GOLD SODIUM THIOMALATE INJ 50MG/ML   MYOCHRYSINE                            12538         P                                23.7816     12.8412
        945        2245458 GOLD SODIUM THIOMALATE INJ 50MG/ML   SODIUM AUROTHIOMALATE INJECTION BP     12027         F                                12.8412

       1165        2185881 GRANISETRON TAB 1MG                  KYTRIL TABLETS 1MG                      4328         P                         X      19.4400     14.5800
       1165        2308894 GRANISETRON TAB 1MG                  GRANISETRON                            14412         F                         X      14.5800

        273        2130300 HALOPERIDOL INJ 100MG/ML             HALOPERIDOL LA                         12027         F                                12.6000
        273        2239640 HALOPERIDOL INJ 100MG/ML             HALOPERIDOL-LA OMEGA                    4852         F                                12.6000

        275        2130297 HALOPERIDOL INJ 50MG/ML              HALOPERIDOL LA                         12027         F                                 6.3763
        275        2239639 HALOPERIDOL INJ 50MG/ML              HALOPERIDOL-LA OMEGA                    4852         F                                 6.3763

        274          17574 HALOPERIDOL INJ 5MG/ML               HALDOL INJECTION 5MG/ML                 4570         F                                 3.5867
        274         808652 HALOPERIDOL INJ 5MG/ML               HALOPERIDOL INJ 5MG/ML USP             12027         F                                 4.5900

        277         363685 HALOPERIDOL TAB 0.5MG                NOVO-PERIDOL TAB 0.5MG                  4773         F                                 0.0389
        277         396796 HALOPERIDOL TAB 0.5MG                APO HALOPERIDOL TAB 0.5MG               3636         F                                 0.0389

        279         463698 HALOPERIDOL TAB 10MG                 APO-HALOPERIDOL TAB 10MG                3636         F                                 0.1436
        279         713449 HALOPERIDOL TAB 10MG                 NOVO-PERIDOL TAB 10MG                   4773         F                                 0.1436

        278         363677 HALOPERIDOL TAB 1MG                  NOVO-PERIDOL TAB 1MG                    4773         F                                 0.0663
        278         396818 HALOPERIDOL TAB 1MG                  APO HALOPERIDOL TAB 1MG                 3636         F                                 0.0663

        280         363669 HALOPERIDOL TAB 2MG                  NOVO-PERIDOL TAB 2MG                    4773         F                                 0.1134
        280         396826 HALOPERIDOL TAB 2MG                  APO-HALOPERIDOL TAB 2MG                 3636         F                                 0.1134

        282         363650 HALOPERIDOL TAB 5MG                  NOVO-PERIDOL TAB 5MG                    4773         F                                 0.1606
        282         396834 HALOPERIDOL TAB 5MG                  APO-HALOPERIDOL TAB 5MG                 3636         F                                 0.1606

        283         441619 HYDRALAZINE TAB 10MG                 APO-HYDRALAZINE TABLETS 10MG            3636         F                                 0.1455

        284         441627 HYDRALAZINE TAB 25MG                 APO-HYDRALAZINE TABLETS 25MG            3636         F                                 0.2499

        285         441635 HYDRALAZINE TAB 50MG                 APO-HYDRALAZINE TABLETS 50MG            3636         F                                 0.3924

        286         644552 HYDROCHLOROTHIAZIDE TAB 100MG        APO HYDRO TAB 100MG                     3636         F                                 0.1331

       1065        2274086 HYDROCHLOROTHIAZIDE TAB 12.5MG       PMS-HYDROCHLOROTHIAZIDE                10997         F                                 0.0348
       1065        2327856 HYDROCHLOROTHIAZIDE TAB 12.5MG       APO-HYDRO                               3636         F                                 0.0348

        287          21474   HYDROCHLOROTHIAZIDE TAB 25MG       TEVA-HYDROCHLOROTHIAZIDE               14318         F                                 0.0315
        287         326844   HYDROCHLOROTHIAZIDE TAB 25MG       APO HYDRO TAB 25MG                      3636         F                                 0.0315
        287        2247386   HYDROCHLOROTHIAZIDE TAB 25MG       PMS-HYDROCHLOROTHIAZIDE                10997         F                                 0.0315
        287        2360594   HYDROCHLOROTHIAZIDE TAB 25MG       HYDROCHLOROTHIAZIDE 25 MG TABLET       14236         F                                 0.0315

        288          21482   HYDROCHLOROTHIAZIDE TAB 50MG       TEVA-HYDROCHLOROTHIAZIDE               14318         F                                 0.0441
        288         312800   HYDROCHLOROTHIAZIDE TAB 50MG       APO HYDRO TAB 50MG                      3636         F                                 0.0441
        288        2247387   HYDROCHLOROTHIAZIDE TAB 50MG       PMS-HYDROCHLOROTHIAZIDE                10997         F                                 0.0441
        288        2360608   HYDROCHLOROTHIAZIDE TAB 50MG       HYDROCHLOROTHIAZIDE 50MG TABLET        14236         F                                 0.0441

        289         513288 HYDROCORTISONE CRM 0.5%              CORTATE CRM 0.5%                        7016         F                                 0.1436

        290         192597   HYDROCORTISONE CRM 1%              EMO CORT CREAM 1%                       9985         P                                 0.1812      0.1129
        290         502200   HYDROCORTISONE CRM 1%              CORTATE CRM 1%                          7016         P                                 0.1167      0.1129
        290         770957   HYDROCORTISONE CRM 1%              PRAMOX HC CREAM                         4068         P                                 0.2520      0.1129
        290         804533   HYDROCORTISONE CRM 1%              PREVEX HC CREAM 1%                      9985         P                                 0.2822      0.1129
        290         716839   HYDROCORTISONE CRM 1%              HYDERM CRM 1%                           5241         F                                 0.1129

        291        2112736 HYDROCORTISONE ENEMA 100MG/60ML      CORTENEMA SUS 100MG/60ML                3741         P                                 0.1175      0.0926
        291         230316 HYDROCORTISONE ENEMA 100MG/60ML      HYCORT RETENTION ENEMA 100MG/60ML      11902         F                                 0.0926

        292         513261 HYDROCORTISONE ONT 0.5%              CORTATE ONT 0.5%                        7016         F                                 0.1436

        294         502197 HYDROCORTISONE ONT 1%                CORTATE ONT 1%                          7016         F                                 0.0211
        294         716693 HYDROCORTISONE ONT 1%                CORTODERM ONT 1%                        5241         F                                 0.0421
                                                                                      Page 19 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                           Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                                         MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                  LCA Benefit       Only


        720        2223252 HYDROCORTISONE/FRAMYCETIN ONT 0.5/1%    PROCTOSEDYL OINTMENT                                3741         P                                 0.9310      0.4703
        720        2247322 HYDROCORTISONE/FRAMYCETIN ONT 0.5/1%    PROCTOL OINTMENT                                    4835         F                                 0.4703

        721        2223260 HYDROCORTISONE/FRAMYCETIN SUP 0.5%/1%   PROCTOSEDYL SUPPOSITORIES                           3741         P                                 1.1637      0.6786
        721        2247882 HYDROCORTISONE/FRAMYCETIN SUP 0.5%/1%   PROCTOL SUPPOSITORIES                               4835         F                                 0.6786

        774         505781 HYDROCORTISONE/PRAMOX ONT 0.5%/ 1%      ANUGESIC-HC OINTMENT                                4569         P                                 1.1232      0.7902
        774        2247692 HYDROCORTISONE/PRAMOX ONT 0.5%/ 1%      SANDOZ ANUZINC HC PLUS                             12027         F                                 0.7902

        864         476242 HYDROCORTISONE/PRAMOX/HCL SUPP 20MG     ANUGESIC-HC SUPPOSITORIES                           4569         P                                 1.4040      1.1745
        864        2240851 HYDROCORTISONE/PRAMOX/HCL SUPP 20MG     PROCTODAN-HC SUPPOSITORIES                          4835         F                                 1.1745
        864        2242797 HYDROCORTISONE/PRAMOX/HCL SUPP 20MG     SANDOZ ANUZINC HC PLUS SUPPOSITORIES               12027         F                                 1.1745

        293         505773 HYDROCORTISONE/ZINC ONT 0.5%            ANUSOL-HC OINTMENT                                  4569         P                                 0.8986      0.4158
        293        2128446 HYDROCORTISONE/ZINC ONT 0.5%            ANODAN-HC OINTMENT                                  4835         F                                 0.4158

        295         476285 HYDROCORTISONE/ZINC SUP 10MG            ANUSOL-HC SUPPOSITORIES                             4569         P                                 1.1232      0.6300
        295        2236399 HYDROCORTISONE/ZINC SUP 10MG            ANODAN-HC 10MG SUPPOSITORIES                        4835         F                                 0.6300

        693        2146118 HYDROMORPHONE INJ 20MG/ML               DILAUDID-HP-PLUS                                    7054         P                                 4.7355      3.9614
        693        2145936 HYDROMORPHONE INJ 20MG/ML               HYDROMORPHONE HP 20                                12027         F                                 3.9614

        690         622133 HYDROMORPHONE INJ 10MG/ML               DILAUDID HP                                         7054         P                                 3.0089      2.5250
        690        2145928 HYDROMORPHONE INJ 10MG/ML               HYDROMORPHONE HP 10                                12027         F                                 2.5250

        691         627100 HYDROMORPHONE INJ 2MG/ML                DILAUDID                                            7054         P                                 1.2290      1.0206
        691        2145901 HYDROMORPHONE INJ 2MG/ML                HYDROMORPHONE HYDROCHLORIDE INJECTION USP          12027         F                                 1.0206

        692        2145863 HYDROMORPHONE INJ 50MG/ML               DILAUDID-XP                                         7054         F                                10.2201
        692        2146126 HYDROMORPHONE INJ 50MG/ML               HYDROMORPHONE HP 50                                12027         F                                10.2201

        296         125105 HYDROMORPHONE SUP 3MG                   DILAUDID                                            7054         F                                 2.5578
        296        1916394 HYDROMORPHONE SUP 3MG                   PMS HYDROMORPHONE SUPPOSITOIRE 3MG                  3550         F                                 3.1050

        297         705438 HYDROMORPHONE TAB 1MG                   DILAUDID                                            7054         F                                 0.1036
        297         885444 HYDROMORPHONE TAB 1MG                   PMS-HYDROMORPHONE TAB 1MG                           3550         F                                 0.1036

        298         125083 HYDROMORPHONE TAB 2MG                   DILAUDID                                            7054         F                                 0.1530
        298         885436 HYDROMORPHONE TAB 2MG                   PMS-HYDROMORPHONE TAB 2MG                           3550         F                                 0.1530

        299         125121 HYDROMORPHONE TAB 4MG                   DILAUDID                                            7054         F                                 0.2419
        299         885401 HYDROMORPHONE TAB 4MG                   PMS-HYDROMORPHONE TAB 4MG                           3550         F                                 0.2419

        300         786543 HYDROMORPHONE TAB 8MG                   DILAUDID                                            7054         F                                 0.3810
        300         885428 HYDROMORPHONE TAB 8MG                   PMS-HYDROMORPHONE TAB 8MG                           3550         F                                 0.3810
        300        2245705 HYDROMORPHONE TAB 8MG                   HYDROMORPH.IR - 8MG                                 7054         F                                 0.3428

        954        2017709 HYDROXYCHLOROQUINE SULFATE TAB 200MG    PLAQUENIL                                          12538         P                                 0.6466      0.2830
        954        2246691 HYDROXYCHLOROQUINE SULFATE TAB 200MG    APO-HYDROXYQUINE                                    3636         F                                 0.2830
        954        2252600 HYDROXYCHLOROQUINE SULFATE TAB 200MG    MYLAN-HYDROXYCHLOROQUINE                           13930         F                                 0.2830

        946         465283   HYDROXYUREA CAP 500MG                 HYDREA CAP 500MG                                    3798         F                         X       1.1019
        946        2242920   HYDROXYUREA CAP 500MG                 MYLAN-HYDROXYUREA                                  13930         F                         X       1.1019
        946        2247937   HYDROXYUREA CAP 500MG                 APO-HYDROXYUREA                                     3636         F                         X       1.1019
        946        2343096   HYDROXYUREA CAP 500MG                 HYDROXYUREA                                        14236         F                         X       1.1019

        825         646059 HYDROXYZINE CAP 10MG                    APO HYDROXYZINE CAP 10MG                            3636         F                                 0.1205
        825         738824 HYDROXYZINE CAP 10MG                    NOVO-HYDROXYZIN CAP 10MG                            4773         F                                 0.1205

        754         646024 HYDROXYZINE CAP 25MG                    APO HYDROXYZINE CAP 25MG                            3636         F                                 0.1539
        754         738832 HYDROXYZINE CAP 25MG                    NOVO-HYDROXYZIN CAP 25MG                            4773         F                                 0.1539

        755         646016 HYDROXYZINE CAP 50MG                    APO HYDROXYZINE CAP 50MG                            3636         F                                 0.2233
        755         738840 HYDROXYZINE CAP 50MG                    NOVO-HYDROXYZIN CAP 50MG                            4773         F                                 0.2233

        756          24694 HYDROXYZINE SYR 2MG                     ATARAX SYRUP 2MG/ML                                 9484         P                                 0.0571      0.0457
        756         741817 HYDROXYZINE SYR 2MG                     PMS HYDROXYZINE SYR 10MG/5ML                        3550         F                                 0.0457

        704         363839 HYOSCINE BUTYLBROMIDE INJ 20MG/ML       BUSCOPAN INJ 20MG/ML                                3617         F                                 4.6440
        704        2229868 HYOSCINE BUTYLBROMIDE INJ 20MG/ML       HYOSCINE BUTYLBROMIDE INJECTION SANDOZ STANDARD    12027         F                                 4.6440

        301        1933531   IBUPROFEN TAB 200MG                   ADVIL CAPLETS                                      14624         P                   REF           0.1350      0.0302
        301        1933558   IBUPROFEN TAB 200MG                   ADVIL TABLETS                                      14624         P                   REF           0.1701      0.0302
        301        2186934   IBUPROFEN TAB 200MG                   MOTRIN IB TABLET - 200MG                            4569         P                   REF           0.1336      0.0302
        301        2187124   IBUPROFEN TAB 200MG                   MOTRIN IB CAPLET - 200MG                            4569         P                   REF           0.1336      0.0302
        301         441643   IBUPROFEN TAB 200MG                   APO-IBUPROFEN TAB 200MG                             3636         F                   REF           0.0302
        301         629324   IBUPROFEN TAB 200MG                   NOVO-PROFEN TAB 200MG                               4773         F                   REF           0.0302

        302         441651 IBUPROFEN TAB 300MG                     APO IBUPROFEN TAB 300MG                             3636         F                   REF           0.1174

        303         506052 IBUPROFEN TAB 400MG                     APO IBUPROFEN TAB 400MG                             3636         F                   REF           0.0486
        303         629340 IBUPROFEN TAB 400MG                     NOVO-PROFEN TAB 400MG                               4773         F                   REF           0.0486
        303        2317338 IBUPROFEN TAB 400MG                     IBUPROFEN CAPLETS                                   4933         F                   REF           0.0486

        304         585114 IBUPROFEN TAB 600MG                     APO IBUPROFEN TAB 600MG                             3636         F                   REF           0.1418
        304         629359 IBUPROFEN TAB 600MG                     NOVO-PROFEN TAB 600MG                               4773         F                   REF           0.1418
        304        2020726 IBUPROFEN TAB 600MG                     NU-IBUPROFEN TAB 600MG                              4828         F                   REF           0.1418

        860           1317 IDOXURIDINE DPS/SOL 0.1%                HERPLEX D                                           3574         F                                 4.1061
        860        2237187 IDOXURIDINE DPS/SOL 0.1%                SANDOZ IDOXURIDINE                                 12027         F                                 5.1300

        305         360201 IMIPRAMINE HCL TAB 10MG                 IMIPRAMINE                                         14412         F                                 0.1480

        308          10480 IMIPRAMINE TAB 50MG                     TOFRANIL 50MG                                       7277         P                                 0.5482      0.5208
        308         326852 IMIPRAMINE TAB 50MG                     IMIPRAMINE                                         14412         F                                 0.5208

        307         644579 IMIPRAMINE TAB 75MG                     IMIPRAMINE                                         14412         F                                 0.6813

        694        2179709   INDAPAMIDE TAB 1.25MG                 LOZIDE - TAB 1.25MG                                 5096         P                         X       0.3218      0.1287
        694        2239619   INDAPAMIDE TAB 1.25MG                 PMS-INDAPAMIDE                                      3550         F                         X       0.1287
        694        2240067   INDAPAMIDE TAB 1.25MG                 MYLAN-INDAPAMIDE                                   13930         F                         X       0.1287
        694        2245246   INDAPAMIDE TAB 1.25MG                 APO-INDAPAMIDE 1.25 MG TABLETS                      3636         F                         X       0.1287

        598         564966 INDAPAMIDE TAB 2.5MG                    LOZIDE TAB 2.5MG                                    5096         P                         X       0.5263      0.2105
        598        2153483 INDAPAMIDE TAB 2.5MG                    MYLAN-INDAPAMIDE                                   13930         F                         X       0.2105
        598        2223597 INDAPAMIDE TAB 2.5MG                    NU-INDAPAMIDE - TAB 2.5MG                           4828         F                         X       0.2105
                                                                                        Page 20 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                 Full / Partial   Plan B
             DIN             Chemical Name                        Drug Name                                MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                        LCA Benefit       Only
        598        2223678 INDAPAMIDE TAB 2.5MG                   APO-INDAPAMIDE 2.5MG TABLETS               3636         F                         X       0.2105
        598        2231184 INDAPAMIDE TAB 2.5MG                   NOVO-INDAPAMIDE TAB 2.5 MG                 4773         F                         X       0.2105
        598        2239620 INDAPAMIDE TAB 2.5MG                   PMS-INDAPAMIDE                             3550         F                         X       0.2105

        309         337420 INDOMETHACIN CAP 25MG                  NOVO-METHACIN CAP 25MG                     4773        P*                   RDP           0.0941
        309         611158 INDOMETHACIN CAP 25MG                  APO INDOMETHACIN CAP 25MG                  3636        P*                   RDP           0.0941
        309         865850 INDOMETHACIN CAP 25MG                  NU-INDO CAP 25MG                           4828        P*                   RDP           0.0941

        310         337439 INDOMETHACIN CAP 50MG                  NOVO-METHACIN CAP 50MG                     4773        P*                   RDP           0.1632
        310         611166 INDOMETHACIN CAP 50MG                  APO INDOMETHACIN CAP 50MG                  3636        P*                   RDP           0.1632
        310         865869 INDOMETHACIN CAP 50MG                  NU-INDO CAP 50MG                           4828        P*                   RDP           0.1632

        312        1934139 INDOMETHACIN SUP 100MG                 RATIO-INDOMETHACIN                        10402         F                                 0.9623
        312        2231800 INDOMETHACIN SUP 100MG                 SANDOZ INDOMETHACIN                       12027         F                                 0.9623

        313        2231799 INDOMETHACIN SUP 50MG                  SANDOZ INDOMETHACIN                       12027         F                                 0.8856

        714        2026759 IPRATROPIUM SOL 0.125MG/ML UDV         ATROVENT UDV 125MCG/ML                     3617         F                         X       0.1462
        714        2097176 IPRATROPIUM SOL 0.125MG/ML UDV         RATIO-IPRATROPIUM UDV                     10402         F                         X       0.3559
        714        2231135 IPRATROPIUM SOL 0.125MG/ML UDV         PMS-IPRATROPIUM                            3550         F                         X       0.3559

        314        2216221 IPRATROPIUM SOL 0.25MG/ML (WOP)        MYLAN-IPRATROPIUM STERINEBS               13930         F                         X       0.7117
        314        2231244 IPRATROPIUM SOL 0.25MG/ML (WOP)        PMS-IPRATROPIUM   (1ML UNIT DOSE)          3550         F                         X       0.7117
        314        2231245 IPRATROPIUM SOL 0.25MG/ML (WOP)        PMS-IPRATROPIUM    (2ML UNIT DOSE)         3550         F                         X       0.7117

        315         731439   IPRATROPIUM SOL 0.25MG/ML (WP)       ATROVENT                                   3617         F                         X       0.0974
        315        2126222   IPRATROPIUM SOL 0.25MG/ML (WP)       APO-IPRAVENT SOLUTION - INH 250MCG/ML      3636         F                         X       0.3897
        315        2210479   IPRATROPIUM SOL 0.25MG/ML (WP)       NOVO-IPRAMIDE - LIQ 0.25MG/ML              4773         F                         X       0.3897
        315        2231136   IPRATROPIUM SOL 0.25MG/ML (WP)       PMS-IPRATROPIUM        (20 ML BOTTLE)      3550         F                         X       0.3897
        315        2239131   IPRATROPIUM SOL 0.25MG/ML (WP)       MYLAN-IPRATROPIUM SOLUTION                13930         F                         X       0.3897

       1231        2241818   IRBESARTAN HCTZ TAB 150MG/12.5MG     AVALIDE 150/12.5 MG                       12538         P                         X       1.3274      0.5226
       1231        2316013   IRBESARTAN HCTZ TAB 150MG/12.5MG     TEVA-IRBESARTAN/HCTZ                      14318         F                         X       0.5226
       1231        2328518   IRBESARTAN HCTZ TAB 150MG/12.5MG     PMS-IRBESARTAN-HCTZ                        3550         F                         X       0.5226
       1231        2330512   IRBESARTAN HCTZ TAB 150MG/12.5MG     RATIO-IRBESARTAN HCTZ                     14318         F                         X       0.5226
       1231        2337428   IRBESARTAN HCTZ TAB 150MG/12.5MG     IRBESARTAN HCT 150-12.5 MG TAB            12027         F                         X       0.5226
       1231        2357399   IRBESARTAN HCTZ TAB 150MG/12.5MG     CO IRBESARTAN/HCT 150-12.5 MG             10028         F                         X       0.5226
       1231        2363208   IRBESARTAN HCTZ TAB 150MG/12.5MG     RAN-IRBESARTAN HCTZ 150-12.5MG TAB        11271         F                         X       0.5226

       1232        2241819   IRBESARTAN HCTZ TAB 300MG/12.5MG     AVALIDE 300/12.5 MG                       12538         P                         X       1.3274      0.5226
       1232        2316021   IRBESARTAN HCTZ TAB 300MG/12.5MG     TEVA-IRBESARTAN/HCTZ                      14318         F                         X       0.5226
       1232        2328526   IRBESARTAN HCTZ TAB 300MG/12.5MG     PMS-IRBESARTAN-HCTZ                        3550         F                         X       0.5226
       1232        2330520   IRBESARTAN HCTZ TAB 300MG/12.5MG     RATIO-IRBESARTAN HCTZ                     14318         F                         X       0.5226
       1232        2337436   IRBESARTAN HCTZ TAB 300MG/12.5MG     IRBESARTAN HCT 300-12.5 MG TAB            12027         F                         X       0.5226
       1232        2357402   IRBESARTAN HCTZ TAB 300MG/12.5MG     CO IRBESARTAN/HCT 300-12.5 MG             10028         F                         X       0.5226
       1232        2363216   IRBESARTAN HCTZ TAB 300MG/12.5MG     RAN-IRBESARTAN HCTZ 300-12.5MG TAB        11271         F                         X       0.5226

       1233        2280213   IRBESARTAN HCTZ TAB 300MG/25MG       AVALIDE                                   12538         P                         X       1.3184      0.5190
       1233        2316048   IRBESARTAN HCTZ TAB 300MG/25MG       TEVA-IRBESARTAN/HCTZ                      14318         F                         X       0.5190
       1233        2328534   IRBESARTAN HCTZ TAB 300MG/25MG       PMS-IRBESARTAN-HCTZ                        3550         F                         X       0.5190
       1233        2330539   IRBESARTAN HCTZ TAB 300MG/25MG       RATIO-IRBESARTAN HCTZ                     14318         F                         X       0.5190
       1233        2337444   IRBESARTAN HCTZ TAB 300MG/25MG       SANDOZ IRBESARTAN HCT 300-25MG            12027         F                         X       0.5190
       1233        2357410   IRBESARTAN HCTZ TAB 300MG/25MG       CO IRBESARTAN/HCT 300-25MG TAB            10028         F                         X       0.5190
       1233        2363224   IRBESARTAN HCTZ TAB 300MG/25MG       RAN-IRBESARTAN HCTZ 300-25 MG TAB         11271         F                         X       0.5190

       1230        2237924   IRBESARTAN TAB 150MG                 AVAPRO                                    12538         P                         X       1.3274      0.5226
       1230        2315998   IRBESARTAN TAB 150MG                 TEVA-IRBESARTAN                           14318         F                         X       0.5226
       1230        2316404   IRBESARTAN TAB 150MG                 RATIO-IRBESARTAN                          14318         F                         X       0.5226
       1230        2317079   IRBESARTAN TAB 150MG                 PMS-IRBESARTAN                             3550         F                         X       0.5226
       1230        2328089   IRBESARTAN TAB 150MG                 CO IRBESARTAN 150 MG TABLET               10028         F                         X       0.5226
       1230        2328488   IRBESARTAN TAB 150MG                 SANDOZ IRBESARTAN                         12027         F                         X       0.5226

       1229        2237925   IRBESARTAN TAB 300MG                 AVAPRO                                    12538         P                         X       1.3274      0.5226
       1229        2316005   IRBESARTAN TAB 300MG                 TEVA-IRBESARTAN                           14318         F                         X       0.5226
       1229        2316412   IRBESARTAN TAB 300MG                 RATIO-IRBESARTAN                          14318         F                         X       0.5226
       1229        2317087   IRBESARTAN TAB 300MG                 PMS-IRBESARTAN                             3550         F                         X       0.5226
       1229        2328100   IRBESARTAN TAB 300MG                 CO IRBESARTAN 300 MG TABLET               10028         F                         X       0.5226
       1229        2328496   IRBESARTAN TAB 300MG                 SANDOZ IRBESARTAN                         12027         F                         X       0.5226

       1228        2237923   IRBESARTAN TAB 75MG                  AVAPRO                                    12538         P                         X       1.3274      0.5226
       1228        2315971   IRBESARTAN TAB 75MG                  TEVA-IRBESARTAN                           14318         F                         X       0.5226
       1228        2316390   IRBESARTAN TAB 75MG                  RATIO-IRBESARTAN                          14318         F                         X       0.5226
       1228        2317060   IRBESARTAN TAB 75MG                  PMS-IRBESARTAN                             3550         F                         X       0.5226
       1228        2328070   IRBESARTAN TAB 75MG                  CO IRBESARTAN 75 MG TABLET                10028         F                         X       0.5226
       1228        2328461   IRBESARTAN TAB 75MG                  SANDOZ IRBESARTAN                         12027         F                         X       0.5226

        947        2205963 IRON DEXTRAN COMPLEX 50MG/ML           DEXIRON - LIQ IM IV 50MG/ML                4533         F                                14.8500
        947        2221780 IRON DEXTRAN COMPLEX 50MG/ML           INFUFER                                   12027         F                                14.8500

        320        2126559 ISOSORBIDE 5 MONONITRATE SR TAB 60MG   IMDUR - EXTENDED RELEASE TABLETS 60 MG     9307        P                    RDP           0.7331      0.3805
        320        2272830 ISOSORBIDE 5 MONONITRATE SR TAB 60MG   APO-ISMN                                   3636        P*                   RDP           0.3805
        320        2301288 ISOSORBIDE 5 MONONITRATE SR TAB 60MG   PMS-ISMN                                   3550        P*                   RDP           0.3805

        321        2058472 ISOSORBIDE 5 MONONITRATE TAB 20MG      ISMO TAB 20MG                              4003        P*                   RDP           0.5131

        316         441686 ISOSORBIDE DINITRATE TAB 10MG          ISDN                                      14412         F                   REF           0.0394

        318         441694 ISOSORBIDE DINITRATE TAB 30MG          ISDN                                      14412         F                   REF           0.0926

        319         243116 ISOSORBIDE DINITRATE TAB 5MG           ISORDIL SUBLINGUAL TAB 5MG                    0         F                   REF           0.0604
        319         670944 ISOSORBIDE DINITRATE TAB 5MG           ISDN                                      14412         F                   REF           0.0671
        319        2042606 ISOSORBIDE DINITRATE TAB 5MG           ISORDIL SUBLINGUAL TABLETS 5MG             4003         F                   REF           0.0401

       1062         582344 ISOTRETINOIN CAP 10MG                  ACCUTANE ROCHE                             4328         F                                 1.0058
       1062        2257955 ISOTRETINOIN CAP 10MG                  CLARUS                                    13930         F                                 1.0058

       1063         582352 ISOTRETINOIN CAP 40MG                  ACCUTANE ROCHE                             4328         P                                 2.0524      2.0523
       1063        2257963 ISOTRETINOIN CAP 40MG                  CLARUS                                    13930         F                                 2.0523

        732        2122197 KETOCONAZOLE TAB 200MG                 NU-KETOCON TABLETS - 200MG                 4828         F                                 1.0144
        732        2231061 KETOCONAZOLE TAB 200MG                 NOVO-KETOCONAZOLE                          4773         F                                 1.0144
        732        2237235 KETOCONAZOLE TAB 200MG                 APO-KETOCONAZOLE                           3636         F                                 1.0144

        322         790427 KETOPROFEN CAP 50MG                    KETOPROFEN                                14412        P*                   RDP           0.3643

        323         761680 KETOPROFEN EC TAB 100MG                RHODIS EC                                 12538        P*                   RDP           0.3324
        323         842664 KETOPROFEN EC TAB 100MG                KETOPROFEN-E                              14412        P*                   RDP           0.7369
                                                                                       Page 21 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                               Full / Partial   Plan B
             DIN             Chemical Name                        Drug Name                                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                      LCA Benefit       Only


        324         761672 KETOPROFEN EC TAB 50 MG                RHODIS EC                                               12538        P*                   RDP           0.1795
        324         790435 KETOPROFEN EC TAB 50 MG                KETOPROFEN-E                                            14412        P*                   RDP           0.3643

        328        2172577 KETOPROFEN SR TAB 200MG                KETOPROFEN SR                                           14412        P*                   RDP           1.5001

        329         761699 KETOPROFEN SUP 100MG                   RHODIS                                                  12538         F                                 1.0724
        329        2015951 KETOPROFEN SUP 100MG                   PMS-KETOPROFEN                                           3550         F                                 1.2000

        979        1968300 KETOROLAC TROMETHAMINE OPH SOL 0.5%    ACULAR LIQ 0.5%                                          3574         P                                 3.6288      1.7280
        979        2245821 KETOROLAC TROMETHAMINE OPH SOL 0.5%    APO-KETOROLAC OPHTHALMIC SOLUTION -(WITH SURFACTANT)     3636         F                                 1.7280
        979        2247461 KETOROLAC TROMETHAMINE OPH SOL 0.5%    RATIO-KETOROLAC                                         10402         F                                 1.7280

        330         600784 KETOTIFEN FUMARATE SYR 1MG/5ML         ZADITEN                                                 14318         P                                 0.1916      0.1436
        330        2176084 KETOTIFEN FUMARATE SYR 1MG/5ML         NOVO-KETOTIFEN - SYR 1MG/5ML                             4773         F                                 0.1436

        643         577308 KETOTIFEN TAB 1MG                      ZADITEN                                                 14318         P                                 0.9030      0.6842
        643        2230730 KETOTIFEN TAB 1MG                      NOVO-KETOTIFEN TAB 1MG                                   4773         F                                 0.6842

       1109         703486   LACTULOSE SYRUP 10G/15ML             PMS-LACTULOSE SYR 667MG/ML                               3550         F                         X       0.0157
       1109         854409   LACTULOSE SYRUP 10G/15ML             RATIO-LACTULOSE                                         10402         F                         X       0.0157
       1109        2242814   LACTULOSE SYRUP 10G/15ML             APO-LACTULOSE                                            3636         F                         X       0.0157
       1109        2295881   LACTULOSE SYRUP 10G/15ML             JAMP-LACTULOSE                                           4415         F                         X       0.0157
       1109        2331551   LACTULOSE SYRUP 10G/15ML             TEVA-LACTULOSE                                           4773         F                         X       0.0157

        948        2142104   LAMOTRIGINE TAB 100MG                LAMICTAL                                                 9985         P                                 1.6135      0.6454
        948        2243353   LAMOTRIGINE TAB 100MG                RATIO-LAMOTRIGINE                                       10402         F                                 0.6454
        948        2245209   LAMOTRIGINE TAB 100MG                APO-LAMOTRIGINE                                          3636         F                                 0.6454
        948        2246898   LAMOTRIGINE TAB 100MG                PMS-LAMOTRIGINE                                          3550         F                                 0.6454
        948        2248233   LAMOTRIGINE TAB 100MG                TEVA-LAMOTRIGINE                                        14318         F                                 0.6454
        948        2265508   LAMOTRIGINE TAB 100MG                MYLAN-LAMOTRIGINE                                       13930         F                                 0.6454
        948        2343029   LAMOTRIGINE TAB 100MG                LAMOTRIGINE                                             14236         F                                 0.6454

        949        2142112   LAMOTRIGINE TAB 150MG                LAMICTAL                                                 9985         P                                 2.3781      0.9513
        949        2245210   LAMOTRIGINE TAB 150MG                APO-LAMOTRIGINE                                          3636         F                                 0.9513
        949        2246899   LAMOTRIGINE TAB 150MG                PMS-LAMOTRIGINE                                          3550         F                                 0.9513
        949        2246963   LAMOTRIGINE TAB 150MG                RATIO-LAMOTRIGINE                                       10402         F                                 0.9513
        949        2248234   LAMOTRIGINE TAB 150MG                TEVA-LAMOTRIGINE                                        14318         F                                 0.9513
        949        2265516   LAMOTRIGINE TAB 150MG                MYLAN-LAMOTRIGINE                                       13930         F                                 0.9513
        949        2343037   LAMOTRIGINE TAB 150MG                LAMOTRIGINE                                             14236         F                                 0.9513

        950        2142082   LAMOTRIGINE TAB 25MG                 LAMICTAL                                                 9985         P                                 0.4041      0.1617
        950        2243352   LAMOTRIGINE TAB 25MG                 RATIO-LAMOTRIGINE                                       10402         F                                 0.1617
        950        2245208   LAMOTRIGINE TAB 25MG                 APO-LAMOTRIGINE                                          3636         F                                 0.1617
        950        2246897   LAMOTRIGINE TAB 25MG                 PMS-LAMOTRIGINE                                          3550         F                                 0.1617
        950        2248232   LAMOTRIGINE TAB 25MG                 TEVA-LAMOTRIGINE                                        14318         F                                 0.1617
        950        2265494   LAMOTRIGINE TAB 25MG                 MYLAN-LAMOTRIGINE                                       13930         F                                 0.1617
        950        2343010   LAMOTRIGINE TAB 25MG                 LAMOTRIGINE                                             14236         F                                 0.1617

       1170        2165503   LANSOPRAZOLE CAP 15MG                PREVACID - SRC 15MG                                     13687         P                         X       2.1600      0.8640
       1170        2280515   LANSOPRAZOLE CAP 15MG                NOVO-LANSOPRAZOLE                                        4773         F                         X       0.8640
       1170        2293811   LANSOPRAZOLE CAP 15MG                APO-LANSOPRAZOLE                                         3636         F                         X       0.8640
       1170        2353830   LANSOPRAZOLE CAP 15MG                MYLAN-LANSOPRAZOLE                                      13930         F                         X       0.8640
       1170        2357682   LANSOPRAZOLE CAP 15MG                LANSOPRAZOLE                                            14236         F                         X       0.8640

       1171        2165511   LANSOPRAZOLE CAP 30MG                PREVACID - SRC 30MG                                     13687         P                         X       2.1600      0.8640
       1171        2280523   LANSOPRAZOLE CAP 30MG                NOVO-LANSOPRAZOLE                                        4773         F                         X       0.8640
       1171        2293838   LANSOPRAZOLE CAP 30MG                APO-LANSOPRAZOLE                                         3636         F                         X       0.8640
       1171        2353849   LANSOPRAZOLE CAP 30MG                MYLAN-LANSOPRAZOLE                                      13930         F                         X       0.8640
       1171        2357690   LANSOPRAZOLE CAP 30MG                LANSOPRAZOLE                                            14236         F                         X       0.8640

       1046        2241888   LEFLUNOMIDE TAB 10MG                 ARAVA 10MG                                              12538         P                         X      11.6014      4.5675
       1046        2256495   LEFLUNOMIDE TAB 10MG                 APO-LEFLUNOMIDE                                          3636         F                         X       4.5675
       1046        2261251   LEFLUNOMIDE TAB 10MG                 NOVO-LEFLUNOMIDE                                         4773         F                         X       4.5675
       1046        2283964   LEFLUNOMIDE TAB 10MG                 SANDOZ LEFLUNOMIDE                                      12027         F                         X       4.5675
       1046        2288265   LEFLUNOMIDE TAB 10MG                 PMS-LEFLUNOMIDE                                          3550         F                         X       4.5675
       1046        2319225   LEFLUNOMIDE TAB 10MG                 MYLAN-LEFLUNOMIDE                                       13930         F                         X       4.5675
       1046        2351668   LEFLUNOMIDE TAB 10MG                 LEFLUNOMIDE                                             14236         F                         X       4.5675

       1047        2241889   LEFLUNOMIDE TAB 20MG                 ARAVA 20 MG                                             12538         P                         X      11.6014      4.5675
       1047        2256509   LEFLUNOMIDE TAB 20MG                 APO-LEFLUNOMIDE                                          3636         F                         X       4.5675
       1047        2261278   LEFLUNOMIDE TAB 20MG                 NOVO-LEFLUNOMIDE                                         4773         F                         X       4.5675
       1047        2283972   LEFLUNOMIDE TAB 20MG                 SANDOZ LEFLUNOMIDE                                      12027         F                         X       4.5675
       1047        2288273   LEFLUNOMIDE TAB 20MG                 PMS-LEFLUNOMIDE                                          3550         F                         X       4.5675
       1047        2319233   LEFLUNOMIDE TAB 20MG                 MYLAN-LEFLUNOMIDE                                       13930         F                         X       4.5675
       1047        2351676   LEFLUNOMIDE TAB 20MG                 LEFLUNOMIDE                                             14236         F                         X       4.5675

       1074        2247027   LEVETIRACETAM TAB 250MG              KEPPRA                                                  13175         P                         X       1.7851      0.8640
       1074        2274183   LEVETIRACETAM TAB 250MG              CO LEVETIRACETAM                                        10028         F                         X       0.8640
       1074        2285924   LEVETIRACETAM TAB 250MG              APO-LEVETIRACETAM                                        3636         F                         X       0.8640
       1074        2296101   LEVETIRACETAM TAB 250MG              PMS-LEVETIRACETAM                                        3550         F                         X       0.8640
       1074        2353342   LEVETIRACETAM TAB 250MG              LEVETIRACETAM                                           14236         F                         X       0.8640

       1075        2247028   LEVETIRACETAM TAB 500MG              KEPPRA                                                  13175         P                         X       2.1755      1.0530
       1075        2274191   LEVETIRACETAM TAB 500MG              CO LEVETIRACETAM                                        10028         F                         X       1.0530
       1075        2285932   LEVETIRACETAM TAB 500MG              APO-LEVETIRACETAM                                        3636         F                         X       1.0530
       1075        2296128   LEVETIRACETAM TAB 500MG              PMS-LEVETIRACETAM                                        3550         F                         X       1.0530
       1075        2353350   LEVETIRACETAM TAB 500MG              LEVETIRACETAM                                           14236         F                         X       1.0530

       1076        2247029   LEVETIRACETAM TAB 750MG              KEPPRA                                                  13175         P                         X       3.0122      1.4580
       1076        2274205   LEVETIRACETAM TAB 750MG              CO LEVETIRACETAM                                        10028         F                         X       1.4580
       1076        2285940   LEVETIRACETAM TAB 750MG              APO-LEVETIRACETAM                                        3636         F                         X       1.4580
       1076        2296136   LEVETIRACETAM TAB 750MG              PMS-LEVETIRACETAM                                        3550         F                         X       1.4580
       1076        2353369   LEVETIRACETAM TAB 750MG              LEVETIRACETAM                                           14236         F                         X       1.4580

        331        2031159 LEVOBUNOLOL SOL 0.25%                  RATIO-LEVOBUNOLOL                                       10402         F                                 1.0076
        331        2241715 LEVOBUNOLOL SOL 0.25%                  SANDOZ LEVOBUNOLOL                                      12027         F                                 1.0076

        332         637661   LEVOBUNOLOL SOL 0.5%                 BETAGAN 0.5% OPHTHALMIC SOL                              3574         P                                 3.5532      1.4213
        332        2031167   LEVOBUNOLOL SOL 0.5%                 RATIO-LEVOBUNOLOL                                       10402         F                                 1.4213
        332        2237991   LEVOBUNOLOL SOL 0.5%                 PMS-LEVOBUNOLOL                                          3550         F                                 1.4213
        332        2241716   LEVOBUNOLOL SOL 0.5%                 SANDOZ LEVOBUNOLOL                                      12027         F                                 1.4213

       1168        2028786 LEVODOPA/CARBIDOPA CR TAB 100MG/25MG   SINEMET CR 100/25                                       12250         P                                 0.7771      0.5536
       1168        2272873 LEVODOPA/CARBIDOPA CR TAB 100MG/25MG   LEVOCARB CR                                             14412         F                                 0.5536

        333         355658 LEVODOPA/CARBIDOPA TAB 100/10MG        SINEMET 100/10                                          12250         P                                 0.5048      0.2027
                                                                                        Page 22 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                                    Full / Partial   Plan B
             DIN             Chemical Name                                     Drug Name                                      MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                           LCA Benefit       Only
        333        2195933 LEVODOPA/CARBIDOPA TAB 100/10MG                     APO-LEVOCARB - TAB 10MG/100MG                    3636         F                                 0.2027

        334         513997 LEVODOPA/CARBIDOPA TAB 100/25MG                     SINEMET 100/25                                  12250         P                                 0.7537      0.3027
        334        2195941 LEVODOPA/CARBIDOPA TAB 100/25MG                     APO-LEVOCARB-TAB 25MG/100MG                      3636         F                                 0.3027

        335         328219 LEVODOPA/CARBIDOPA TAB 250/25MG                     SINEMET 250/25                                  12250         P                                 0.8414      0.3379
        335        2195968 LEVODOPA/CARBIDOPA TAB 250/25MG                     APO-LEVOCARB - TAB 25MG/250MG                    3636         F                                 0.3379
        335        2244496 LEVODOPA/CARBIDOPA TAB 250/25MG                     NOVO-LEVOCARBIDOPA                               4773         F                                 0.3379

       1132        2236974 LEVONORGESTREL ETHINYL ESTRA 21 TAB 0.10MG/0.02MG   ALESSE 21                                        4908         P                                 0.7591      0.5007
       1132        2298538 LEVONORGESTREL ETHINYL ESTRA 21 TAB 0.10MG/0.02MG   AVIANE 21                                        7948         F                                 0.5007

       1133        2236975 LEVONORGESTREL ETHINYL ESTRA 28 TAB 0.10MG/0.02MG   ALESSE 28                                        4908         P                                 0.5693      0.3755
       1133        2298546 LEVONORGESTREL ETHINYL ESTRA 28 TAB 0.10MG/0.02MG   AVIANE 28                                        7948         F                                 0.3755

       1121        2042320 LEVONORGESTREL-ETHINYL ESTRA 21 TAB 0.15MG/0.03MG   MIN-OVRAL 21                                     4908         P                                 0.7591      0.5007
       1121        2295946 LEVONORGESTREL-ETHINYL ESTRA 21 TAB 0.15MG/0.03MG   PORTIA 21                                        7948         F                                 0.5007

       1122        2042339 LEVONORGESTREL-ETHINYL ESTRA 28 TAB 0.15MG/0.03MG   MIN-OVRAL 28                                     4908         P                                 0.5693      0.3755
       1122        2295954 LEVONORGESTREL-ETHINYL ESTRA 28 TAB 0.15MG/0.03MG   PORTIA 28                                        7948         F                                 0.3755

        336           1686 LIDOCAINE HCL SOL 20MG/ML                           XYLOCAINE VISCOUS 2%                             9307         P                                 0.0999      0.0734
        336         811874 LIDOCAINE HCL SOL 20MG/ML                           PMS-LIDOCAINE VISCOUS 2%                         3550         F                                 0.0734

        339         839396   LISINOPRIL TAB 10MG                               PRINIVIL                                        12250        P                    RDP           0.7784      0.2966
        339        2049376   LISINOPRIL TAB 10MG                               ZESTRIL TAB 10MG                                 9307        P                    RDP           0.7193      0.2966
        339        2217503   LISINOPRIL TAB 10MG                               APO-LISINOPRIL TABLET 10 MG                      3636        P*                   RDP           0.2966
        339        2256800   LISINOPRIL TAB 10MG                               RATIO-LISINOPRIL P                              10402        P*                   RDP           0.2966
        339        2271451   LISINOPRIL TAB 10MG                               CO LISINOPRIL                                   10028        P*                   RDP           0.2966
        339        2274841   LISINOPRIL TAB 10MG                               MYLAN-LISINOPRIL                                13930        P*                   RDP           0.2966
        339        2285088   LISINOPRIL TAB 10MG                               TEVA-LISINOPRIL (TYPE P)                        14318        P*                   RDP           0.2966
        339        2285126   LISINOPRIL TAB 10MG                               TEVA-LISINOPRIL (TYPE Z)                        14318        P*                   RDP           0.2966
        339        2289202   LISINOPRIL TAB 10MG                               SANDOZ LISINOPRIL                               12027        P*                   RDP           0.2966
        339        2292211   LISINOPRIL TAB 10MG                               PMS-LISINOPRIL                                   3550        P*                   RDP           0.2966
        339        2294249   LISINOPRIL TAB 10MG                               RAN-LISINOPRIL                                  11271        P*                   RDP           0.2966
        339        2299887   LISINOPRIL TAB 10MG                               RATIO-LISINOPRIL Z                              10402        P*                   RDP           0.2966
        339        2332175   LISINOPRIL TAB 10MG                               LISINOPRIL 10 MG TABLET                         11271        P*                   RDP           0.2966

        340         839418   LISINOPRIL TAB 20MG                               PRINIVIL                                        12250        P                    RDP           0.9359      0.3565
        340        2049384   LISINOPRIL TAB 20MG                               ZESTRIL TAB 20MG                                 9307        P                    RDP           0.8640      0.3565
        340        2217511   LISINOPRIL TAB 20MG                               APO-LISINOPRIL TABLET 20 MG                      3636        P*                   RDP           0.3565
        340        2256819   LISINOPRIL TAB 20MG                               RATIO-LISINOPRIL P                              10402        P*                   RDP           0.3565
        340        2271478   LISINOPRIL TAB 20MG                               CO LISINOPRIL                                   10028        P*                   RDP           0.3565
        340        2274868   LISINOPRIL TAB 20MG                               MYLAN-LISINOPRIL                                13930        P*                   RDP           0.3565
        340        2285096   LISINOPRIL TAB 20MG                               TEVA-LISINOPRIL (TYPE P)                        14318        P*                   RDP           0.3565
        340        2285134   LISINOPRIL TAB 20MG                               TEVA-LISINOPRIL (TYPE Z)                        14318        P*                   RDP           0.3565
        340        2289229   LISINOPRIL TAB 20MG                               SANDOZ LISINOPRIL                               12027        P*                   RDP           0.3565
        340        2292238   LISINOPRIL TAB 20MG                               PMS-LISINOPRIL                                   3550        P*                   RDP           0.3565
        340        2294257   LISINOPRIL TAB 20MG                               RAN-LISINOPRIL                                  11271        P*                   RDP           0.3565
        340        2299895   LISINOPRIL TAB 20MG                               RATIO-LISINOPRIL Z                              10402        P*                   RDP           0.3565
        340        2332183   LISINOPRIL TAB 20MG                               LISINOPRIL 20 MG TABLET                         11271        P*                   RDP           0.3565

        341         839388   LISINOPRIL TAB 5MG                                PRINIVIL                                        12250        P                    RDP           0.6480      0.2469
        341        2049333   LISINOPRIL TAB 5MG                                ZESTRIL TAB 5MG                                  9307        P                    RDP           0.5986      0.2469
        341        2217481   LISINOPRIL TAB 5MG                                APO-LISINOPRIL TABLET 5 MG                       3636        P*                   RDP           0.2469
        341        2256797   LISINOPRIL TAB 5MG                                RATIO-LISINOPRIL P                              10402        P*                   RDP           0.2469
        341        2271443   LISINOPRIL TAB 5MG                                CO LISINOPRIL                                   10028        P*                   RDP           0.2469
        341        2274833   LISINOPRIL TAB 5MG                                MYLAN-LISINOPRIL                                13930        P*                   RDP           0.2469
        341        2285061   LISINOPRIL TAB 5MG                                TEVA-LISINOPRIL (TYPE P)                        14318        P*                   RDP           0.2469
        341        2285118   LISINOPRIL TAB 5MG                                TEVA-LISINOPRIL (TYPE Z)                        14318        P*                   RDP           0.2469
        341        2289199   LISINOPRIL TAB 5MG                                SANDOZ LISINOPRIL                               12027        P*                   RDP           0.2469
        341        2292203   LISINOPRIL TAB 5MG                                PMS-LISINOPRIL                                   3550        P*                   RDP           0.2469
        341        2294230   LISINOPRIL TAB 5MG                                RAN-LISINOPRIL                                  11271        P*                   RDP           0.2469
        341        2299879   LISINOPRIL TAB 5MG                                RATIO-LISINOPRIL Z                              10402        P*                   RDP           0.2469
        341        2332167   LISINOPRIL TAB 5MG                                LISINOPRIL 5 MG TABLET                          11271        P*                   RDP           0.2469

        342        2103729   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              ZESTORETIC TAB 10/12.5MG                         9307        P                    RDP           0.9259      0.3601
        342        2108194   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              PRINZIDE                                        12250        P                    RDP           0.8022      0.3601
        342        2261979   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              APO-LISINOPRIL/HCTZ                              3636        P*                   RDP           0.3601
        342        2297736   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              MYLAN-LISINOPRIL HCTZ                           13930        P*                   RDP           0.3601
        342        2301768   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              TEVA-LISINOPRIL/HCTZ (TYPE Z)                   14318        P*                   RDP           0.3601
        342        2302136   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              TEVA-LISINOPRIL/HCTZ (TYPE P)                   14318        P*                   RDP           0.3601
        342        2302365   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              SANDOZ LISINOPRIL HCT                           12027        P*                   RDP           0.3601
        342        2362945   LISINOPRIL/HYDROCHLORO TAB 10/12.5MG              LISINOPRIL/HCTZ (TYPE Z) 10/12.5MG TABLET       14236        P*                   RDP           0.3601

        343         884413   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              PRINZIDE                                        12250        P                    RDP           0.9639      0.4326
        343        2045737   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              ZESTORETIC TAB 20/12.5MG                         9307        P                    RDP           1.1125      0.4326
        343        2261987   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              APO-LISINOPRIL/HCTZ                              3636        P*                   RDP           0.4326
        343        2301776   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              TEVA-LISINOPRIL/HCTZ (TYPE Z)                   14318        P*                   RDP           0.4326
        343        2302144   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              TEVA-LISINOPRIL/HCTZ (TYPE P)                   14318        P*                   RDP           0.4326
        343        2302373   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              SANDOZ LISINOPRIL HCT                           12027        P*                   RDP           0.4326
        343        2362953   LISINOPRIL/HYDROCHLORO TAB 20/12.5MG              LISINOPRIL/HCTZ (TYPE Z) 20/12.5MG TABLET       14236        P*                   RDP           0.4326

        344        2045729   LISINOPRIL/HYDROCHLORO TAB 20/25MG                ZESTORETIC TAB 20/25MG                           9307        P                    RDP           1.1125      0.4326
        344        2297752   LISINOPRIL/HYDROCHLORO TAB 20/25MG                MYLAN-LISINOPRIL HCTZ                           13930        P*                   RDP           0.4326
        344        2302381   LISINOPRIL/HYDROCHLORO TAB 20/25MG                SANDOZ LISINOPRIL HCT                           12027        P*                   RDP           0.4326
        344        2362961   LISINOPRIL/HYDROCHLORO TAB 20/25MG                LISINOPRIL/HCTZ (TYPE Z) 20/25MG TABLET         14236        P*                   RDP           0.4326

        705        2013231 LITHIUM CARBONATE CAP 150MG                         LITHANE                                          9484         P                                 0.1385      0.0554
        705        2216132 LITHIUM CARBONATE CAP 150MG                         PMS-LITHIUM CARBONATE - CAP 150MG                3550         F                                 0.0554
        705        2242837 LITHIUM CARBONATE CAP 150MG                         APO-LITHIUM CARBONATE                            3636         F                                 0.0554

        706         406775 LITHIUM CARBONATE CAP 300MG                         LITHANE                                          9484         P                                 0.1379      0.0552
        706        2216140 LITHIUM CARBONATE CAP 300MG                         PMS-LITHIUM CARBONATE - CAP 300MG                3550         F                                 0.0552
        706        2242838 LITHIUM CARBONATE CAP 300MG                         APO-LITHIUM CARBONATE                            3636         F                                 0.0552

        645        2216159 LITHIUM CARBONATE CAP 600MG                         PMS-LITHIUM CARBONATE - CAP 600MG                3550         F                                 0.1469

        757        2183862   LOPERAMIDE HCL CAP/TAB 2MG                        IMODIUM - CAPLET 2MG                             4569         P                         X       0.8622      0.2403
        757        2132591   LOPERAMIDE HCL CAP/TAB 2MG                        NOVO-LOPERAMIDE TABLETS-2MG                      4773         F                         X       0.2403
        757        2212005   LOPERAMIDE HCL CAP/TAB 2MG                        APO-LOPERAMIDE - TAB 2MG                         3636         F                         X       0.2403
        757        2228351   LOPERAMIDE HCL CAP/TAB 2MG                        PMS-LOPERAMIDE - CAPLET 2MG                      3550         F                         X       0.2403
        757        2256452   LOPERAMIDE HCL CAP/TAB 2MG                        DIARRHEA RELIEF                                  8541         F                         X       0.2403
        757        2257564   LOPERAMIDE HCL CAP/TAB 2MG                        SANDOZ LOPERAMIDE                               12027         F                         X       0.2403

        758        2016095 LOPERAMIDE HCL LIQ 0.2MG/ML                         PMS-LOPERAMIDE HYDROCHLORIDE SOLUTION.2MG/ML     3550         F                         X       0.1035
                                                                                                     Page 23 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                                              Full / Partial   Plan B
             DIN             Chemical Name                                      Drug Name                                               MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                                     LCA Benefit       Only
        903        2041405 LORAZEPAM INJ 4MG/ML                                 ATIVAN INJECTION LIQ 4MG/ML                              11115         F                                 2.1600
        903        2243278 LORAZEPAM INJ 4MG/ML                                 LORAZEPAM INJECTION USP                                  12027         F                                 2.9268

        347        2041413   LORAZEPAM TAB 0.5MG                                ATIVAN                                                    4908         P                                 0.0810      0.0388
        347         655740   LORAZEPAM TAB 0.5MG                                APO-LORAZEPAM TAB 0.5MG                                   3636         F                                 0.0388
        347         711101   LORAZEPAM TAB 0.5MG                                NOVO-LORAZEM TAB 0.5MG                                    4773         F                                 0.0388
        347         728187   LORAZEPAM TAB 0.5MG                                PMS-LORAZEPAM TAB 0.5MG                                   3550         F                                 0.0388
        347        2351072   LORAZEPAM TAB 0.5MG                                LORAZEPAM                                                14236         F                                 0.0388

        348        2041421   LORAZEPAM TAB 1MG                                  ATIVAN                                                    4908         P                                 0.1004      0.0483
        348         637742   LORAZEPAM TAB 1MG                                  NOVO-LORAZEM TAB 1MG                                      4773         F                                 0.0483
        348         655759   LORAZEPAM TAB 1MG                                  APO-LORAZEPAM TAB 1MG                                     3636         F                                 0.0483
        348         728195   LORAZEPAM TAB 1MG                                  PMS-LORAZEPAM TAB 1MG                                     3550         F                                 0.0483
        348        2351080   LORAZEPAM TAB 1MG                                  LORAZEPAM                                                14236         F                                 0.0483

        349        2041448   LORAZEPAM TAB 2MG                                  ATIVAN                                                    4908         P                                 0.1577      0.0755
        349         637750   LORAZEPAM TAB 2MG                                  NOVO-LORAZEM TAB 2MG                                      4773         F                                 0.0755
        349         655767   LORAZEPAM TAB 2MG                                  APO-LORAZEPAM TAB 2MG                                     3636         F                                 0.0755
        349         728209   LORAZEPAM TAB 2MG                                  PMS-LORAZEPAM TAB 2MG                                     3550         F                                 0.0755
        349        2351099   LORAZEPAM TAB 2MG                                  LORAZEPAM                                                14236         F                                 0.0755

        663         795860   LOVASTATIN TAB 20MG                                MEVACOR                                                  12250         P                                 2.2314      0.8500
        663        2220172   LOVASTATIN TAB 20MG                                APO-LOVASTATIN - TAB 20MG                                 3636         F                                 0.8500
        663        2243127   LOVASTATIN TAB 20MG                                MYLAN-LOVASTATIN                                         13930         F                                 0.8500
        663        2245822   LOVASTATIN TAB 20MG                                RATIO-LOVASTATIN                                         10402         F                                 0.8500
        663        2246013   LOVASTATIN TAB 20MG                                PMS-LOVASTATIN                                            3550         F                                 0.8500
        663        2246542   LOVASTATIN TAB 20MG                                NOVO-LOVASTATIN                                           4773         F                                 0.8500
        663        2247056   LOVASTATIN TAB 20MG                                SANDOZ LOVASTATIN                                        12027         F                                 0.8500
        663        2248572   LOVASTATIN TAB 20MG                                CO LOVASTATIN                                            10028         F                                 0.8500
        663        2267969   LOVASTATIN TAB 20MG                                RAN-LOVASTATIN                                           11271         F                                 0.8500
        663        2353229   LOVASTATIN TAB 20MG                                LOVASTATIN                                               14236         F                                 0.8500

        664         795852   LOVASTATIN TAB 40MG                                MEVACOR                                                  12250         P                                 4.0755      1.5526
        664        2220180   LOVASTATIN TAB 40MG                                APO-LOVASTATIN - TAB 40MG                                 3636         F                                 1.5526
        664        2243129   LOVASTATIN TAB 40MG                                MYLAN-LOVASTATIN                                         13930         F                                 1.5526
        664        2245823   LOVASTATIN TAB 40MG                                RATIO-LOVASTATIN                                         10402         F                                 1.5526
        664        2246014   LOVASTATIN TAB 40MG                                PMS-LOVASTATIN                                            3550         F                                 1.5526
        664        2246543   LOVASTATIN TAB 40MG                                NOVO-LOVASTATIN                                           4773         F                                 1.5526
        664        2247057   LOVASTATIN TAB 40MG                                SANDOZ LOVASTATIN                                        12027         F                                 1.5526
        664        2248573   LOVASTATIN TAB 40MG                                CO LOVASTATIN                                            10028         F                                 1.5526
        664        2267977   LOVASTATIN TAB 40MG                                RAN-LOVASTATIN                                           11271         F                                 1.5526
        664        2353237   LOVASTATIN TAB 40MG                                LOVASTATIN                                               14236         F                                 1.5526

        838         361364 LOXAPINE ORL CONC 25MG/ML                            LOXAPAC ORL CONC 25MG/ML                                     0         F                                 0.8073
        838        2170000 LOXAPINE ORL CONC 25MG/ML                            LOXAPAC ORAL CONCENTRATE-LIQ 25MG/ML                      4003         F                                 0.8073
        838        2239101 LOXAPINE ORL CONC 25MG/ML                            XYLAC                                                     9864         F                                 0.5650

        650        2230838 LOXAPINE TAB 10MG                                    XYLAC                                                     9864         F                                 0.2875

        651        2230839 LOXAPINE TAB 25MG                                    XYLAC                                                     9864         F                                 0.4457

        652        2230840 LOXAPINE TAB 50MG                                    XYLAC                                                     9864         F                                 0.5941

        649        2230837 LOXAPINE TAB 5MG                                     XYLAC                                                     9864         F                                 0.1727

        352         360481 MAPROTILINE TAB 25MG                                 LUDIOMIL TAB 25MG                                         7277         F                                 0.2978
        352        2158612 MAPROTILINE TAB 25MG                                 NOVO-MAPROTILINE - TAB 25MG                               4773         F                                 0.6142

        353         360503 MAPROTILINE TAB 50MG                                 LUDIOMIL TAB 50MG                                         7277         F                                 0.5632
        353        2158620 MAPROTILINE TAB 50MG                                 NOVO-MAPROTILINE - TAB 50MG                               4773         F                                 1.1631

        354         360511 MAPROTILINE TAB 75MG                                 LUDIOMIL TAB 75MG                                         7277         F                                 0.7693
        354        2158639 MAPROTILINE TAB 75MG                                 NOVO-MAPROTILINE - TAB 75MG                               4773         F                                 1.5884

       1052          30945 MEDROXYPROGESTERONE TAB 100MG                        PROVERA 100MG TABLETS                                     4908         P                                 1.3490      0.9885
       1052        2267640 MEDROXYPROGESTERONE TAB 100MG                        APO-MEDROXY                                               3636         F                                 0.9885

        355         729973   MEDROXYPROGESTERONE TAB 10MG                       PROVERA 10MG TABLETS                                      4908         P                                 0.7084      0.2762
        355        2010933   MEDROXYPROGESTERONE TAB 10MG                       PROVERA PAK 10MG TABLETS                                  4908         P                                 0.6903      0.2762
        355        2221306   MEDROXYPROGESTERONE TAB 10MG                       TEVA-MEDROXYPROGESTERONE                                 14318         F                                 0.2762
        355        2277298   MEDROXYPROGESTERONE TAB 10MG                       APO-MEDROXY                                               3636         F                                 0.2762

        356         708917 MEDROXYPROGESTERONE TAB 2.5MG                        PROVERA 2.5MG TABLETS                                     4908         P                                 0.1764      0.0691
        356        2221284 MEDROXYPROGESTERONE TAB 2.5MG                        TEVA-MEDROXYPROGESTERONE                                 14318         F                                 0.0691
        356        2244726 MEDROXYPROGESTERONE TAB 2.5MG                        APO-MEDROXY TABLETS                                       3636         F                                 0.0691

        357          30937   MEDROXYPROGESTERONE TAB 5MG                        PROVERA 5MG TABLETS                                       4908         P                                 0.3491      0.1367
        357        2010739   MEDROXYPROGESTERONE TAB 5MG                        PROVERA PAK 5MG TABLETS                                   4908         P                                 0.3417      0.1367
        357        2221292   MEDROXYPROGESTERONE TAB 5MG                        TEVA-MEDROXYPROGESTERONE                                 14318         F                                 0.1367
        357        2244727   MEDROXYPROGESTERONE TAB 5MG                        APO-MEDROXY TABLETS                                       3636         F                                 0.1367

       1172         585092 MEDROXYPROGESTRONE ACETATE INJECTION SUSP 150MG/ML   DEPO-PROVERA STERILE AQUEOUS SUSPENSION 150 MG/ML         4908         P                                29.7454     19.4400
       1172        2322250 MEDROXYPROGESTRONE ACETATE INJECTION SUSP 150MG/ML   MEDROXYPROGESTERONE ACETATE INJECTABLE SUSPENSION USP    12027         F                                19.4400

        671         155225 MEFENAMIC ACID CAP 250MG                             PONSTAN                                                   9484         P                                 0.6087      0.5387
        671        2229452 MEFENAMIC ACID CAP 250MG                             MEFENAMIC                                                14412         F                                 0.5387

        358         731323 MEGESTROL TAB 160MG                                  MEGACE                                                    3798         P                                 6.5719      4.6040
        358        2195925 MEGESTROL TAB 160MG                                  MEGESTROL                                                14412         F                                 4.6040

        359        2195917 MEGESTROL TAB 40MG                                   MEGESTROL                                                14412         F                                 1.0879

       1000        2242786   MELOXICAM TAB 15MG                                 MOBICOX                                                   3617         P                         X       0.9982      0.3993
       1000        2248031   MELOXICAM TAB 15MG                                 RATIO-MELOXICAM                                          10402         F                         X       0.3993
       1000        2248268   MELOXICAM TAB 15MG                                 PMS-MELOXICAM                                             3550         F                         X       0.3993
       1000        2248608   MELOXICAM TAB 15MG                                 PHL-MELOXICAM                                             4917         F                         X       0.3993
       1000        2248974   MELOXICAM TAB 15MG                                 APO-MELOXICAM                                             3636         F                         X       0.3993
       1000        2250020   MELOXICAM TAB 15MG                                 CO MELOXICAM TABLET 15MG                                 10028         F                         X       0.3993
       1000        2255995   MELOXICAM TAB 15MG                                 MYLAN-MELOXICAM                                          13930         F                         X       0.3993
       1000        2258323   MELOXICAM TAB 15MG                                 TEVA-MELOXICAM                                           14318         F                         X       0.3993
       1000        2353156   MELOXICAM TAB 15MG                                 MELOXICAM                                                14236         F                         X       0.3993

        999        2242785   MELOXICAM TAB 7.5MG                                MOBICOX                                                   3617         P                         X       0.8652      0.3460
        999        2247889   MELOXICAM TAB 7.5MG                                RATIO-MELOXICAM                                          10402         F                         X       0.3460
        999        2248267   MELOXICAM TAB 7.5MG                                PMS-MELOXICAM                                             3550         F                         X       0.3460
        999        2248607   MELOXICAM TAB 7.5MG                                PHL-MELOXICAM                                             4917         F                         X       0.3460
        999        2248973   MELOXICAM TAB 7.5MG                                APO-MELOXICAM                                             3636         F                         X       0.3460
                                                                                                    Page 24 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                                                      Full / Partial   Plan B
             DIN             Chemical Name                                     Drug Name                                                        MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                                             LCA Benefit       Only
        999        2250012   MELOXICAM TAB 7.5MG                               CO MELOXICAM TABLET 7.5 MG                                        10028         F                         X       0.3460
        999        2255987   MELOXICAM TAB 7.5MG                               MYLAN-MELOXICAM                                                   13930         F                         X       0.3460
        999        2258315   MELOXICAM TAB 7.5MG                               TEVA-MELOXICAM                                                    14318         F                         X       0.3460
        999        2353148   MELOXICAM TAB 7.5MG                               MELOXICAM                                                         14236         F                         X       0.3460

        876         725749 MEPERIDINE (PETHIDINE) HCL INJ 100MG/ML             MEPERIDINE HYDROCHLORIDE INJECTION USP                            12027         F                                 1.0476
        876        2139030 MEPERIDINE (PETHIDINE) HCL INJ 100MG/ML             DEMEROL 10%-LIQ IM IV SC                                              0         F                                 0.3543

        861          36242   MEPERIDINE (PETHIDINE) HCL INJ 50MG/ML            DEMEROL HCL 5% SOLUTION                                               0         F                                 0.3544
        861         725765   MEPERIDINE (PETHIDINE) HCL INJ 50MG/ML            MEPERIDINE HYDROCHLORIDE INJECTION USP                            12027         F                                 0.9396
        861        2137992   MEPERIDINE (PETHIDINE) HCL INJ 50MG/ML            DEMEROL 50MG - LIQ IM SC 50MG/ML                                      0         F                                 0.2128
        861        2139022   MEPERIDINE (PETHIDINE) HCL INJ 50MG/ML            DEMEROL 50MG - LIQ IM IV SC 50MG/ML                                   0         F                                 0.3003

        862         725757 MEPERIDINE (PETHIDINE) HCL INJ 75MG/ML              MEPERIDINE HYDROCHLORIDE INJECTION USP                            12027         F                                 0.9936

        361        2099233   METFORMIN TAB 500MG                               GLUCOPHAGE                                                        12538         P                                 0.2933      0.1156
        361        2045710   METFORMIN TAB 500MG                               NOVO-METFORMIN TAB 500MG                                           4773         F                                 0.1156
        361        2148765   METFORMIN TAB 500MG                               MYLAN-METFORMIN                                                   13930         F                                 0.1156
        361        2162822   METFORMIN TAB 500MG                               NU-METFORMIN - TAB 500MG                                           4828         F                                 0.1156
        361        2167786   METFORMIN TAB 500MG                               APO-METFORMIN - TAB 500MG                                          3636         F                                 0.1156
        361        2223562   METFORMIN TAB 500MG                               PMS-METFORMIN - TAB 500MG                                          3550         F                                 0.1156
        361        2242974   METFORMIN TAB 500MG                               RATIO-METFORMIN                                                   10402         F                                 0.1156
        361        2246820   METFORMIN TAB 500MG                               SANDOZ METFORMIN FC                                               12027         F                                 0.1156
        361        2257726   METFORMIN TAB 500MG                               CO METFORMIN, 500MG                                               10028         F                                 0.1156
        361        2269031   METFORMIN TAB 500MG                               RAN-METFORMIN                                                     11271         F                                 0.1156
        361        2353377   METFORMIN TAB 500MG                               METFORMIN                                                         14236         F                                 0.1156

        644        2162849   METFORMIN TAB 850MG                               GLUCOPHAGE                                                        12538         P                                 0.3717      0.1659
        644        2229656   METFORMIN TAB 850MG                               MYLAN-METFORMIN                                                   13930         F                                 0.1659
        644        2229785   METFORMIN TAB 850MG                               APO-METFORMIN 850 MG TABLETS                                       3636         F                                 0.1659
        644        2230475   METFORMIN TAB 850MG                               NOVO-METFORMIN TAB 850MG                                           4773         F                                 0.1659
        644        2242931   METFORMIN TAB 850MG                               RATIO-METFORMIN                                                   10402         F                                 0.1659
        644        2246821   METFORMIN TAB 850MG                               SANDOZ METFORMIN FC                                               12027         F                                 0.1659
        644        2257734   METFORMIN TAB 850MG                               CO METFORMIN, 850MG                                               10028         F                                 0.1659
        644        2269058   METFORMIN TAB 850MG                               RAN-METFORMIN                                                     11271         F                                 0.1659
        644        2353385   METFORMIN TAB 850MG                               METFORMIN                                                         14236         F                                 0.1659

        823        1934783 METHOCARB/ASA/COD 400/325/16.2MG TAB                ROBAXISAL C 1/4                                                   14624         P                                 0.7515      0.7164
        823         172421 METHOCARB/ASA/COD 400/325/16.2MG TAB                ROBAXISAL C-1/4 TAB                                                   0         F                                 0.6881
        823        1966367 METHOCARB/ASA/COD 400/325/16.2MG TAB                METHOXISAL-C 1/4                                                   5003         F                                 0.7164

        824        1934791 METHOCARB/ASA/COD 400/325/32.4MG TAB                ROBAXISAL C 1/2                                                   14624         P                                 1.1043      0.8455
        824        1966375 METHOCARB/ASA/COD 400/325/32.4MG TAB                METHOXISAL-C 1/2                                                   5003         F                                 0.8455

        791        2099705 METHOTREXATE INJ 25MG/ML                            METHOTREXATE NA INJ.IM IV IAR INT IVR25MG/ML                       4773         F                         X       6.7500

       1198        2182777 METHOTREXATE INJ 25MG/ML W/PRESERVATIVE             METHOTREXATE INJECTION, USP                                       11642         F                         X       6.7500

        362        2170698 METHOTREXATE TAB 2.5MG                              METHOTREXATE                                                       4908         F                                 0.6831
        362        2182963 METHOTREXATE TAB 2.5MG                              APO-METHOTREXATE TABLETS - 2.5MG                                  11642         F                                 0.6831
        362        2244798 METHOTREXATE TAB 2.5MG                              RATIO-METHOTREXATE SODIUM                                         10402         F                                 0.6831

        363        1927663 METHOTRIMEPRAZINE TAB 25MG                          NOZINAN TAB 25MG                                                  12538         F                                 0.1221
        363        2238405 METHOTRIMEPRAZINE TAB 25MG                          APO-METHOPRAZINE                                                   3636         F                                 0.2751

        792        1927647 METHOTRIMEPRAZINE TAB 2MG                           NOZINAN TAB 2MG                                                    9522         F                                 0.0545
        792        2238403 METHOTRIMEPRAZINE TAB 2MG                           APO-METHOPRAZINE                                                   3636         F                                 0.0740

        365        1927671 METHOTRIMEPRAZINE TAB 50MG                          NOZINAN TAB 50MG                                                  12538         F                                 0.1664
        365        2238406 METHOTRIMEPRAZINE TAB 50MG                          APO-METHOPRAZINE                                                   3636         F                                 0.4166

        364        1927655 METHOTRIMEPRAZINE TAB 5MG                           NOZINAN 5MG TAB                                                   12538         F                                 0.0570
        364        2238404 METHOTRIMEPRAZINE TAB 5MG                           APO-METHOPRAZINE                                                   3636         F                                 0.1070

        366         353620 METHYLDOPA TAB 125MG                                DOPAMET TAB 125MG                                                  4372         F                                 0.0533
        366         360252 METHYLDOPA TAB 125MG                                METHYLDOPA                                                        14412         F                                 0.1068

        367         360260 METHYLDOPA TAB 250MG                                METHYLDOPA                                                        14412         F                                 0.1548

        368         426830 METHYLDOPA TAB 500MG                                METHYLDOPA                                                        14412         F                                 0.2740

       1050         632775 METHYLPHENIDATE HCL TAB 20MG SR                     RITALIN-SR TAB 20MG                                                7277         P                                 0.6882      0.3046
       1050        2266687 METHYLPHENIDATE HCL TAB 20MG SR                     APO-METHYLPHENIDATE SR                                             3636         F                                 0.3046
       1050        2320312 METHYLPHENIDATE HCL TAB 20MG SR                     SANDOZ METHYLPHENIDATE SR                                         12027         F                                 0.3046

        371           5606 METHYLPHENIDATE TAB 10MG                            RITALIN 10MG                                                       7277         P                                 0.3923      0.1410
        371         584991 METHYLPHENIDATE TAB 10MG                            PMS-METHYLPHENIDATE TABLETS 10MG                                   3550         F                                 0.1410
        371        2249324 METHYLPHENIDATE TAB 10MG                            APO-METHYLPHENIDATE                                                3636         F                                 0.1410

        372           5614 METHYLPHENIDATE TAB 20MG                            RITALIN 20MG                                                       7277         P                                 0.6854      0.2548
        372         585009 METHYLPHENIDATE TAB 20MG                            PMS-METHYLPHENIDATE TABLETS 20MG                                   3550         F                                 0.2548
        372        2249332 METHYLPHENIDATE TAB 20MG                            APO-METHYLPHENIDATE                                                3636         F                                 0.2548

        707        2234749 METHYLPHENIDATE TAB 5MG                             PMS-METHYLPHENIDATE                                                3550         F                                 0.1023
        707        2273950 METHYLPHENIDATE TAB 5MG                             APO-METHYLPHENIDATE                                                3636         F                                 0.1023

        971          30759 METHYLPREDNISOLONE ACETATE 40MG/ML                  DEPO-MEDROL 40 MG/ML                                               4908         P                                 5.7672      3.4830
        971        2245400 METHYLPREDNISOLONE ACETATE 40MG/ML                  METHYLPREDNISOLONE ACETATE INJECTABLE SUSPENSION USP              12027         F                                 3.4830

        973        1934333 METHYLPREDNISOLONE ACETATE 40MG/ML W/PRESERVATIVE   DEPO-MEDROL (WITH PRESERVATIVE) 40 MG/ML                           4908         P                                 5.5739      4.4280
        973        2245407 METHYLPREDNISOLONE ACETATE 40MG/ML W/PRESERVATIVE   METHYLPREDNISOLONE ACETATE INJECTABLE SUSPENSION USP -(40MG/ML    12027         F                                 4.4280

        972          30767 METHYLPREDNISOLONE ACETATE 80MG/ML                  DEPO-MEDROL 80 MG/ML                                               4908         P                                11.1478      6.9660
        972        2245406 METHYLPREDNISOLONE ACETATE 80MG/ML                  METHYLPREDNISOLONE ACETATE INJECTABLE SUSPENSION USP              12027         F                                 6.9660

        974        1934341 METHYLPREDNISOLONE ACETATE 80MG/ML W/PRESERVATIVE   DEPO-MEDROL (WITH PRESERVATIVE) 80 MG/ML                           4908         P                                 8.5277      6.8429
        974        2245408 METHYLPREDNISOLONE ACETATE 80MG/ML W/PRESERVATIVE   METHYLPREDNISOLONE ACETATE INJECTABLE SUSPENSION USP -(80MG/ML    12027         F                                 6.8429

        882        2063727 METHYLPREDNISOLONE INJ 125MG                        SOLU-MEDROL - (ACT-O-VIAL 125MG STERILE POWDER AND DILUENT)        4908         P                                 15.566      9.1800
        882        2231894 METHYLPREDNISOLONE INJ 125MG                        METHYLPREDNISOLONE SODIUM SUCCINATE FOR INJECTION                  4773         F                                 9.1800

        883        2063719 METHYLPREDNISOLONE INJ 40MG                         SOLU-MEDROL - (ACT-O-VIAL 40MG STERILE POWDER AND DILUENT)         4908         P                                 6.5567      3.8880
        883        2231893 METHYLPREDNISOLONE INJ 40MG                         METHYLPREDNISOLONE SODIUM SUCCINATE FOR INJECTION                  4773         F                                 3.8880

        884        2063700 METHYLPREDNISOLONE INJ 500MG                        SOLU-MEDROL - (ACT-O-VIAL 500MG STERILE POWDER AND DILUENT)        4908         P                                39.0118     20.0880
        884        2231895 METHYLPREDNISOLONE INJ 500MG                        METHYLPREDNISOLONE SODIUM SUCCINATE FOR INJECTION                  4773         F                                20.0880
                                                                                                     Page 25 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                          Full / Partial   Plan B
             DIN             Chemical Name                 Drug Name                                MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                 LCA Benefit       Only
        817        2043556 METOCLOPRAMIDE INJ 5MG/ML       REGLAN INJECTABLE LIQ 5MG/ML               4003         F                                 1.2960
        817        2185431 METOCLOPRAMIDE INJ 5MG/ML       METOCLOPRAMIDE HYDROCHLORIDE INJECTION    12027         F                                 1.4580

        655         314714   METOCLOPRAMIDE SOL 1MG/ML     MAXERAN LIQ 1MG/ML                         4657         F                                 0.0364
        655        2043548   METOCLOPRAMIDE SOL 1MG/ML     REGLAN SYR 1MG/ML                          4003         F                                 0.0322
        655        2099160   METOCLOPRAMIDE SOL 1MG/ML     MAXERAN LIQ                                4657         F                                 0.0364
        655        2230433   METOCLOPRAMIDE SOL 1MG/ML     PMS-METOCLOPRAMIDE                         3550         F                                 0.0457

        373         842834 METOCLOPRAMIDE TAB 10MG         APO-METOCLOP TAB 10MG                      3636         F                                 0.0630
        373        2143283 METOCLOPRAMIDE TAB 10MG         NU-METOCLOPRAMIDE-TAB 10MG                 4828         F                                 0.0630
        373        2230432 METOCLOPRAMIDE TAB 10MG         PMS-METOCLOPRAMIDE                         3550         F                                 0.0630

        374         842826 METOCLOPRAMIDE TAB 5MG          APO-METOCLOP TAB 5MG                       3636         F                                 0.0600
        374        2143275 METOCLOPRAMIDE TAB 5MG          NU-METOCLOPRAMIDE-TAB 5MG                  4828         F                                 0.0600
        374        2230431 METOCLOPRAMIDE TAB 5MG          PMS-METOCLOPRAMIDE                         3550         F                                 0.0600

        375         397431   METOPROLOL TAB 100MG          LOPRESOR 100MG                             7277         P                                 0.6326      0.2401
        375         618640   METOPROLOL TAB 100MG          APO METOPROLOL TAB 100MG                   3636         F                                 0.2401
        375         648043   METOPROLOL TAB 100MG          TEVA-METOPROLOL                           14318         F                                 0.2401
        375         751170   METOPROLOL TAB 100MG          APO-METOPROLOL (TYPE L) TAB 100MG          3636         F                                 0.2401
        375         842656   METOPROLOL TAB 100MG          TEVA-METOPROLOL                           14318         F                                 0.2401
        375         865613   METOPROLOL TAB 100MG          NU-METOP TAB 100MG                         4828         F                                 0.2401
        375        2174553   METOPROLOL TAB 100MG          MYLAN-METOPROLOL (TYPE L)                 13930         F                                 0.2401
        375        2230804   METOPROLOL TAB 100MG          PMS-METOPROLOL-L                           3550         F                                 0.2401
        375        2247876   METOPROLOL TAB 100MG          SANDOZ METOPROLOL (TYPE L)                12027         F                                 0.2401
        375        2350408   METOPROLOL TAB 100MG          METOPROLOL                                14236         F                                 0.2401
        375        2354195   METOPROLOL TAB 100MG          SANDOZ METOPROLOL(L) 100MG TAB            14236         F                                 0.2401
        375        2356848   METOPROLOL TAB 100MG          JAMP-METOPROLOL-L                          4415         F                                 0.2401

       1013        2246010 METOPROLOL TAB 25MG             APO-METOPROLOL                             3636         F                                 0.0694
       1013        2248855 METOPROLOL TAB 25MG             PMS-METOPROLOL-L                           3550         F                                 0.0694
       1013        2302055 METOPROLOL TAB 25MG             MYLAN-METOPROLOL (TYPE L)                 13930         F                                 0.0694

        376         397423   METOPROLOL TAB 50MG           LOPRESOR 50MG                              7277         P                                 0.3083      0.1078
        376         618632   METOPROLOL TAB 50MG           APO METOPROLOL TAB 50MG                    3636         F                                 0.1078
        376         648035   METOPROLOL TAB 50MG           TEVA-METOPROLOL                           14318         F                                 0.1078
        376         749354   METOPROLOL TAB 50MG           APO METOPROLOL (TYPE L) TAB 50MG           3636         F                                 0.1078
        376         842648   METOPROLOL TAB 50MG           TEVA-METOPROLOL                           14318         F                                 0.1078
        376         865605   METOPROLOL TAB 50MG           NU-METOP TAB 50MG                          4828         F                                 0.1078
        376        2174545   METOPROLOL TAB 50MG           MYLAN-METOPROLOL (TYPE L)                 13930         F                                 0.1078
        376        2230803   METOPROLOL TAB 50MG           PMS-METOPROLOL-L                           3550         F                                 0.1078
        376        2247875   METOPROLOL TAB 50MG           SANDOZ METOPROLOL (TYPE L)                12027         F                                 0.1078
        376        2350394   METOPROLOL TAB 50MG           METOPROLOL                                14236         F                                 0.1078
        376        2354187   METOPROLOL TAB 50MG           SANDOZ METOPROLOL 50 MG TAB               12027         F                                 0.1078

       1125         658855 METOPROLOL TARTRATE TAB 100MG   LOPRESOR SR 100MG                          7277         P                                 0.3454      0.1487
       1125        2285169 METOPROLOL TARTRATE TAB 100MG   APO-METOPROLOL SR                          3636         F                                 0.1487

       1126         534560 METOPROLOL TARTRATE TAB 200MG   LOPRESOR SR 200 MG                         7277         P                                 0.6268      0.2699
       1126        2285177 METOPROLOL TARTRATE TAB 200MG   APO-METOPROLOL SR                          3636         F                                 0.2699

        377        1926853   METRONIDAZOLE CAP/TAB 500MG   FLAGYL                                    12538         P                                 1.0424      0.7590
        377          25887   METRONIDAZOLE CAP/TAB 500MG   FLAGYL 500MG                                  0         F                                 0.5630
        377        1926888   METRONIDAZOLE CAP/TAB 500MG   FLAGYL 500 500MG                              0         F                                 0.4773
        377        2248562   METRONIDAZOLE CAP/TAB 500MG   METRONIDAZOLE                             14412         F                                 0.7590

        378         545066 METRONIDAZOLE TAB 250MG         METRONIDAZOLE                             14412         F                                 0.0643
        378        1926896 METRONIDAZOLE TAB 250MG         FLAGYL 250 TAB 250MG                          0         F                                 0.0607

        680         599956 MEXILETINE CAP 100MG            MEXITIL CAP 100MG                          3617         F                                 0.5382
        680        2230359 MEXILETINE CAP 100MG            NOVO-MEXILETINE CAP 100MG                  4773         F                                 0.9401

        681         599964 MEXILETINE CAP 200MG            MEXITIL CAP 200MG                          3617         F                                 0.7207
        681        2230360 MEXILETINE CAP 200MG            NOVO-MEXILETINE CAP 200MG                  4773         F                                 1.2590

        658        2084309 MICONAZOLE 7 VAG CRM 2%         MONISTAT 7 VAGINAL CREAM                   4402         P                                 0.3607      0.1632
        658        2231106 MICONAZOLE 7 VAG CRM 2%         MICOZOLE                                   5241         F                                 0.1632

        718        2126567 MICONAZOLE TOP CRM 2%           MONISTAT DERM CREAM                        4402         P                         X       0.4133      0.4033
        718        2085852 MICONAZOLE TOP CRM 2%           MICATIN CREAM - 2%                        10170         F                         X       0.4033

       1080        1934392 MIDODRINE HCL TAB 2.5MG         AMATINE                                    9504         P                                 0.5747      0.3648
       1080        2278677 MIDODRINE HCL TAB 2.5MG         MIDODRINE                                 14412         F                                 0.3648

       1081        1934406 MIDODRINE HCL TAB 5MG           AMATINE                                    9504         P                                 0.9708      0.6080
       1081        2278685 MIDODRINE HCL TAB 5MG           MIDODRINE                                 14412         F                                 0.6080

        379        2173506   MINOCYCLINE CAP 100MG         MINOCIN                                    9985         P                                 1.2770      0.6385
        379        2084104   MINOCYCLINE CAP 100MG         APO-MINOCYCLINE CAP 100MG                  3636         F                                 0.6385
        379        2108151   MINOCYCLINE CAP 100MG         NOVO-MINOCYCLINE                           4773         F                                 0.6385
        379        2230736   MINOCYCLINE CAP 100MG         MYLAN-MINOCYCLINE                         13930         F                                 0.6385
        379        2237314   MINOCYCLINE CAP 100MG         SANDOZ MINOCYCLINE                        12027         F                                 0.6385
        379        2287234   MINOCYCLINE CAP 100MG         MINOCYCLINE                               14236         F                                 0.6385
        379        2294427   MINOCYCLINE CAP 100MG         PMS-MINOCYCLINE                            3550         F                                 0.6385

        380        2173514   MINOCYCLINE CAP 50MG          MINOCIN                                    9985         P                                 0.6618      0.3309
        380        2084090   MINOCYCLINE CAP 50MG          APO-MINOCYCLINE CAP 50MG                   3636         F                                 0.3309
        380        2108143   MINOCYCLINE CAP 50MG          NOVO-MINOCYCLINE                           4773         F                                 0.3309
        380        2230735   MINOCYCLINE CAP 50MG          MYLAN-MINOCYCLINE                         13930         F                                 0.3309
        380        2237313   MINOCYCLINE CAP 50MG          SANDOZ MINOCYCLINE                        12027         F                                 0.3309
        380        2287226   MINOCYCLINE CAP 50MG          MINOCYCLINE                               14236         F                                 0.3309
        380        2294419   MINOCYCLINE CAP 50MG          PMS-MINOCYCLINE                            3550         F                                 0.3309

       1041        2248542   MIRTAZAPINE TAB 15MG          REMERON RD                                12250         P                                 0.4338      0.2106
       1041        2250594   MIRTAZAPINE TAB 15MG          SANDOZ MIRTAZAPINE                        12027         F                                 0.2106
       1041        2256096   MIRTAZAPINE TAB 15MG          MYLAN-MIRTAZAPINE                         13930         F                                 0.2106
       1041        2273942   MIRTAZAPINE TAB 15MG          PMS-MIRTAZAPINE                            3550         F                                 0.2106
       1041        2279894   MIRTAZAPINE TAB 15MG          NOVO-MIRTAZAPINE OD TABLETS                4773         F                                 0.2106
       1041        2286610   MIRTAZAPINE TAB 15MG          APO-MIRTAZAPINE                            3636         F                                 0.2106
       1041        2299801   MIRTAZAPINE TAB 15MG          AURO-MIRTAZAPINE OD                       11979         F                                 0.2106

       1002        2243910   MIRTAZAPINE TAB 30MG          REMERON                                   12250         P                                 1.4062      0.5357
       1002        2248543   MIRTAZAPINE TAB 30MG          REMERON RD                                12250         P                                 0.8676      0.5357
       1002        2248762   MIRTAZAPINE TAB 30MG          PMS-MIRTAZAPINE                            3550         F                                 0.5357
       1002        2250608   MIRTAZAPINE TAB 30MG          SANDOZ MIRTAZAPINE                        12027         F                                 0.5357
       1002        2256118   MIRTAZAPINE TAB 30MG          MYLAN-MIRTAZAPINE                         13930         F                                 0.5357
       1002        2259354   MIRTAZAPINE TAB 30MG          NOVO-MIRTAZAPINE TABLETS                   4773         F                                 0.5357
                                                                                  Page 26 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                       Full / Partial   Plan B
             DIN             Chemical Name                 Drug Name                             MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                              LCA Benefit       Only
       1002        2270927   MIRTAZAPINE TAB 30MG          RATIO-MIRTAZAPINE                      10402         F                                 0.5357
       1002        2279908   MIRTAZAPINE TAB 30MG          NOVO-MIRTAZAPINE OD TABLETS             4773         F                                 0.5357
       1002        2286629   MIRTAZAPINE TAB 30MG          APO-MIRTAZAPINE                         3636         F                                 0.5357
       1002        2299828   MIRTAZAPINE TAB 30MG          AURO-MIRTAZAPINE OD                    11979         F                                 0.5357
       1002        2325187   MIRTAZAPINE TAB 30MG          ZYM-MIRTAZAPINE                         6860         F                                 0.5357
       1002        2370689   MIRTAZAPINE TAB 30MG          MIRTAZAPINE 30 MG TABLET               14236         F                                 0.5357

       1042        2248544   MIRTAZAPINE TAB 45MG          REMERON RD                             12250         P                                 1.3014      0.6318
       1042        2256126   MIRTAZAPINE TAB 45MG          MYLAN-MIRTAZAPINE                      13930         F                                 0.6318
       1042        2279916   MIRTAZAPINE TAB 45MG          NOVO-MIRTAZAPINE OD TABLETS             4773         F                                 0.6318
       1042        2286637   MIRTAZAPINE TAB 45MG          APO-MIRTAZAPINE                         3636         F                                 0.6318
       1042        2299836   MIRTAZAPINE TAB 45MG          AURO-MIRTAZAPINE OD                    11979         F                                 0.6318

        904        2244022 MISOPROSTOL TAB 100MCG          MISOPROSTOL                            14412         F                                 0.2791

        905        2244023 MISOPROSTOL TAB 200MCG          MISOPROSTOL                            14412         F                                 0.4647

        728        2232148 MOCLOBEMIDE TAB 100MG           APO-MOCLOBEMIDE                         3636         F                                 0.2722
        728        2237111 MOCLOBEMIDE TAB 100MG           NU-MOCLOBEMIDE                          4828         F                                 0.2722
        728        2239746 MOCLOBEMIDE TAB 100MG           NOVO-MOCLOBEMIDE                        4773         F                                 0.2722

        708         899356   MOCLOBEMIDE TAB 150MG         MANERIX                                14175         P                                 0.6543      0.2617
        708        2232150   MOCLOBEMIDE TAB 150MG         APO-MOCLOBEMIDE                         3636         F                                 0.2617
        708        2237112   MOCLOBEMIDE TAB 150MG         NU-MOCLOBEMIDE                          4828         F                                 0.2617
        708        2239747   MOCLOBEMIDE TAB 150MG         NOVO-MOCLOBEMIDE                        4773         F                                 0.2617

        759        2166747 MOCLOBEMIDE TAB 300MG           MANERIX                                14175         P                                 1.2848      0.5139
        759        2239748 MOCLOBEMIDE TAB 300MG           NOVO-MOCLOBEMIDE                        4773         F                                 0.5139
        759        2240456 MOCLOBEMIDE TAB 300MG           APO-MOCLOBEMIDE                         3636         F                                 0.5139

       1142        2239665 MODAFINIL TAB 100MG             ALERTEC                                 9504         P                         X       1.3936      1.0036
       1142        2285398 MODAFINIL TAB 100MG             MODAFINIL                              14412         F                         X       1.0036

       1253        2367157 MOMETASONE FUROATE 0.1% CREAM   TARO-MOMETASONE CREAM 0.1%              5241         F                                 0.5684

       1003         851736 MOMETASONE FUROATE OINT 0.1%    ELOCOM OINTMENT                        12250         P                                 0.7296      0.2587
       1003        2248130 MOMETASONE FUROATE OINT 0.1%    RATIO-MOMETASONE OINTMENT 0.1%         10402         F                                 0.2587
       1003        2264749 MOMETASONE FUROATE OINT 0.1%    TARO-MOMETASONE OINTMENT                5241         F                                 0.2587

       1186         871095 MOMETASONE LOTION 0.1%          ELOCOM LOTION                          12250         P                                 0.5440      0.3374
       1186        2266385 MOMETASONE LOTION 0.1%          TARO-MOMETASONE LOTION                  5241         F                                 0.3374

        806         392588 MORPHINE INJ 10MG/ML            MORPHINE SULFATE INJ 10MG/ML USP       12027         F                                 0.9720
        806         497355 MORPHINE INJ 10MG/ML            MORPHINE SULFATE INJ 10MG/ML            3525         F                                 0.7129

        808         392561 MORPHINE INJ 15MG/ML            MORPHINE SULFATE INJ 15MG/ML USP       12027         F                                 0.9720
        808         497363 MORPHINE INJ 15MG/ML            MORPHINE SULFATE INJ 15MG/ML            3525         F                                 0.7883

        807        2242484 MORPHINE INJ 2MG/ML             MORPHINE SULFATE INJECTION USP         12027         F                                 0.9504

        799        2014319   MORPHINE SR CAP/TAB 100MG     MS CONTIN SRT 100MG                     7054         P                                 2.9268      1.0154
        799        2019965   MORPHINE SR CAP/TAB 100MG     M-ESLON                                 8060         F                                 1.3245
        799        2302799   MORPHINE SR CAP/TAB 100MG     NOVO-MORPHINE SR                        4773         F                                 1.0154
        799        2350920   MORPHINE SR CAP/TAB 100MG     MORPHINE SR                            14236         F                                 1.0154

        800        2015439   MORPHINE SR CAP/TAB 15MG      MS CONTIN SRT 15MG                      7054         P                                 0.7150      0.2503
        800        2177749   MORPHINE SR CAP/TAB 15MG      M-ESLON                                 8060         F                                 0.3054
        800        2244790   MORPHINE SR CAP/TAB 15MG      SANDOZ MORPHINE SR                     12027         F                                 0.2503
        800        2302764   MORPHINE SR CAP/TAB 15MG      NOVO-MORPHINE SR                        4773         F                                 0.2503
        800        2350815   MORPHINE SR CAP/TAB 15MG      MORPHINE SR                            14236         F                                 0.2503

        802        2014327   MORPHINE SR CAP/TAB 200MG     MS CONTIN SRT 200MG                     7054         P                                 5.4410      1.8878
        802        2177757   MORPHINE SR CAP/TAB 200MG     M-ESLON                                 8060         F                                 2.4624
        802        2302802   MORPHINE SR CAP/TAB 200MG     NOVO-MORPHINE SR                        4773         F                                 1.8878
        802        2350947   MORPHINE SR CAP/TAB 200MG     MORPHINE SR                            14236         F                                 1.8878

        803         776181   MORPHINE SR CAP/TAB 30MG      M.O.S. SR TABLETS 30MG                 11902         P                                 0.4855      0.3780
        803        2014297   MORPHINE SR CAP/TAB 30MG      MS CONTIN SRT 30MG                      7054         P                                 1.0897      0.3780
        803        2019949   MORPHINE SR CAP/TAB 30MG      M-ESLON                                 8060         F                                 0.4612
        803        2244791   MORPHINE SR CAP/TAB 30MG      SANDOZ MORPHINE SR                     12027         F                                 0.3780
        803        2302772   MORPHINE SR CAP/TAB 30MG      NOVO-MORPHINE SR                        4773         F                                 0.3780
        803        2350890   MORPHINE SR CAP/TAB 30MG      MORPHINE SR                            14236         F                                 0.3780

        805         776203   MORPHINE SR CAP/TAB 60MG      M.O.S. SR TABLETS 60MG                 11902         P                                 0.8558      0.6661
        805        2014300   MORPHINE SR CAP/TAB 60MG      MS CONTIN SRT 60MG                      7054         P                                 1.9192      0.6661
        805        2019957   MORPHINE SR CAP/TAB 60MG      M-ESLON                                 8060         F                                 0.8130
        805        2244792   MORPHINE SR CAP/TAB 60MG      SANDOZ MORPHINE SR                     12027         F                                 0.6661
        805        2302780   MORPHINE SR CAP/TAB 60MG      NOVO-MORPHINE SR                        4773         F                                 0.6661
        805        2350912   MORPHINE SR CAP/TAB 60MG      MORPHINE SR                            14236         F                                 0.6661

        793         647217 MORPHINE SYR 10MG/ML            STATEX SYRUP 10MG/ML                    8481         F                                 0.1985
        793         690783 MORPHINE SYR 10MG/ML            RATIO-MORPHINE                         10402         F                                 0.1985

        794         591467 MORPHINE SYR 1MG/ML             STATEX SYRUP 1MG/ML                     8481         P                                 0.0216      0.0156
        794         614491 MORPHINE SYR 1MG/ML             DOLORAL 1                               3659         P                                 0.0212      0.0156
        794         607762 MORPHINE SYR 1MG/ML             RATIO-MORPHINE                         10402         F                                 0.0156

        795         621935 MORPHINE SYR 20MG/ML            STATEX DROPS 20MG/ML                    8481         P                                 0.5378      0.5227
        795         690791 MORPHINE SYR 20MG/ML            RATIO-MORPHINE                         10402         F                                 0.5227

        797         591475 MORPHINE SYR 5MG/ML             STATEX SYRUP 5MG/ML                     8481         P                                 0.0867      0.0416
        797         614505 MORPHINE SYR 5MG/ML             DOLORAL 5 SIROP 5MG/ML                  3659         P                                 0.0821      0.0416
        797         607770 MORPHINE SYR 5MG/ML             RATIO-MORPHINE                         10402         F                                 0.0416

        809        2014211 MORPHINE TAB 10MG               MS IR TAB 10MG                          7054         P                                 0.2063      0.1836
        809         594644 MORPHINE TAB 10MG               STATEX TAB 10MG                         8481         F                                 0.1836
        809        2009765 MORPHINE TAB 10MG               M.O.S. SULPHATE 10MG TAB               11902         F                                 0.1836

        813        2014203 MORPHINE TAB 5MG                MS IR TAB 5MG                           7054         P                                 0.1328      0.1188
        813         594652 MORPHINE TAB 5MG                STATEX TAB 5MG                          8481         F                                 0.1188
        813        2009773 MORPHINE TAB 5MG                M.O.S. SULPHATE 5MG TAB                11902         F                                 0.1188

        844        2238639   NABUMETONE TAB 500MG          APO-NABUMETONE                          3636         F                         X       0.3915
        844        2240867   NABUMETONE TAB 500MG          NOVO-NABUMETONE 500MG                   4773         F                         X       0.3915
        844        2244563   NABUMETONE TAB 500MG          MYLAN-NABUMETONE                       13930         F                         X       0.3915
        844        2343282   NABUMETONE TAB 500MG          NABUMETONE                             14236         F                         X       0.3915
                                                                                 Page 27 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                Full / Partial   Plan B
             DIN             Chemical Name                         Drug Name                              MAN                                RDP    SA   Max Price   LCA Price
Category no.                                                                                                       LCA Benefit       Only
        381         782475 NADOLOL TAB 160MG                       APO-NADOL TAB 160MG                      3636         F                                  1.3010

        382         782505 NADOLOL TAB 40MG                        APO-NADOL TAB 40MG                       3636         F                                  0.2662
        382        2126753 NADOLOL TAB 40MG                        NOVO-NADOLOL TABLETS-40MG                4773         F                                  0.2662

        383         463256 NADOLOL TAB 80MG                        CORGARD TAB 80MG                         3798         F                                  0.3796
        383         782467 NADOLOL TAB 80MG                        APO-NADOL TAB 80MG                       3636         F                                  0.3796
        383        2126761 NADOLOL TAB 80MG                        NOVO-NADOLOL TABLETS-80MG                4773         F                                  0.3796

        384        2162792   NAPROXEN E TAB 250MG                  NAPROSYN E 250MG TABLETS - ECT           4328        P                    RDP            0.4426      0.1770
        384        2243312   NAPROXEN E TAB 250MG                  TEVA-NAPROXEN EC                        14318        P*                   RDP            0.1770
        384        2246699   NAPROXEN E TAB 250MG                  APO-NAPROXEN EC TABLETS                  3636        P*                   RDP            0.1770
        384        2350785   NAPROXEN E TAB 250MG                  NAPROXEN EC                             14236        P*                   RDP            0.1770

        385        2162415   NAPROXEN E TAB 375MG                  NAPROSYN E 375MG TABLETS - ECT           4328        P                    RDP            0.5803      0.2321
        385        2243313   NAPROXEN E TAB 375MG                  TEVA-NAPROXEN EC                        14318        P*                   RDP            0.2321
        385        2243432   NAPROXEN E TAB 375MG                  MYLAN-NAPROXEN EC                       13930        P*                   RDP            0.2321
        385        2246700   NAPROXEN E TAB 375MG                  APO-NAPROXEN EC TABLETS                  3636        P*                   RDP            0.2321
        385        2294702   NAPROXEN E TAB 375MG                  PMS-NAPROXEN EC                          3550        P*                   RDP            0.2321
        385        2350793   NAPROXEN E TAB 375MG                  NAPROXEN EC                             14236        P*                   RDP            0.2321

        386        2162423   NAPROXEN E TAB 500MG                  NAPROSYN E 500MG TABLETS - ECT           4328        P                    RDP            1.0480      0.4193
        386        2241024   NAPROXEN E TAB 500MG                  MYLAN-NAPROXEN EC                       13930        P*                   RDP            0.4193
        386        2243314   NAPROXEN E TAB 500MG                  TEVA-NAPROXEN EC                        14318        P*                   RDP            0.4193
        386        2246701   NAPROXEN E TAB 500MG                  APO-NAPROXEN EC TABLETS                  3636        P*                   RDP            0.4193
        386        2294710   NAPROXEN E TAB 500MG                  PMS-NAPROXEN EC                          3550        P*                   RDP            0.4193
        386        2350807   NAPROXEN E TAB 500MG                  NAPROXEN EC                             14236        P*                   RDP            0.4193

        387        2162466 NAPROXEN SR TAB 750MG                   NAPROSYN SR 750MG TABLETS                4328        P                    RDP            1.3988      1.0852
        387        2177072 NAPROXEN SR TAB 750MG                   APO-NAPROXEN SR TABLETS 750MG            3636        P*                   RDP            1.0852

        388        2017237 NAPROXEN SUP 500MG                      PMS-NAPROXEN                             3550         F                                  0.9306

        389         522678 NAPROXEN TAB 125MG                      APO NAPROXEN TAB 125MG                   3636         F                    REF           0.0843

        390         522651   NAPROXEN TAB 250MG                    APO NAPROXEN TAB 250MG                   3636         F                    REF           0.1153
        390         565350   NAPROXEN TAB 250MG                    TEVA-NAPROXEN                           14318         F                    REF           0.1153
        390         865648   NAPROXEN TAB 250MG                    NU-NAPROX TAB 250MG                      4828         F                    REF           0.1153
        390        2350750   NAPROXEN TAB 250MG                    NAPROXEN                                14236         F                    REF           0.1153

        391         600806   NAPROXEN TAB 375MG                    APO NAPROXEN TAB 375MG                   3636         F                    REF           0.1575
        391         627097   NAPROXEN TAB 375MG                    TEVA-NAPROXEN                           14318         F                    REF           0.1575
        391         865656   NAPROXEN TAB 375MG                    NU-NAPROX TAB 375MG                      4828         F                    REF           0.1575
        391        2350769   NAPROXEN TAB 375MG                    NAPROXEN                                14236         F                    REF           0.1575

        392         589861   NAPROXEN TAB 500MG                    TEVA-NAPROXEN                           14318         F                    REF           0.2279
        392         592277   NAPROXEN TAB 500MG                    APO NAPROXEN TAB 500MG                   3636         F                    REF           0.2279
        392         865664   NAPROXEN TAB 500MG                    NU-NAPROX TAB 500MG                      4828         F                    REF           0.2279
        392        2350777   NAPROXEN TAB 500MG                    NAPROXEN                                14236         F                    REF           0.2279

       1187        2237820 NARATRIPTAN TAB 1MG                     AMERGE                                   9985         P                                 14.9917      8.4186
       1187        2314290 NARATRIPTAN TAB 1MG                     NOVO-NARATRIPTAN                         4773         F                                  8.4186

       1188        2237821 NARATRIPTAN TAB 2.5MG                   AMERGE                                   9985         P                                 15.7977      6.6351
       1188        2314304 NARATRIPTAN TAB 2.5MG                   NOVO-NARATRIPTAN                         4773         F                                  6.6351

        739         807435 NEOMYCIN SUL/POLYMYXIN B SOL            OPTIMYXIN PLUS OTO-OPHT GTTE            12027         F                                  0.7830

        660        1912828 NEOMYCIN/POLYMIXIN/HC OTIC SOL          CORTISPORIN                              9985         P                                  1.3835      1.1070
        660        2230386 NEOMYCIN/POLYMIXIN/HC OTIC SOL          SANDOZ CORTIMYXIN                       12027         F                                  1.1070

        395         557412 NIACIN TAB 500MG                        NIACIN TAB 500MG YEAST FREE              8541         F                                  0.0486

        396         791695 NICARDIPINE CAP 20MG                    CARDENE CAP 20MG                            0        P*                   RDP            0.5184
        396        1911813 NICARDIPINE CAP 20MG                    CARDENE CAP 20MG                            0        P*                   RDP            0.5940
        396        2162741 NICARDIPINE CAP 20MG                    CARDENE 20MG CAPSULES                    4328        P*                   RDP            0.5184

        397         791709 NICARDIPINE CAP 30MG                    CARDENE CAP 30MG                            0        P*                   RDP            0.7344
        397        1911805 NICARDIPINE CAP 30MG                    CARDENE CAP 30MG                         3691        P*                   RDP            0.7560
        397        2162733 NICARDIPINE CAP 30MG                    CARDENE 30MG CAPSULES                    4328        P*                   RDP            0.7344

        827        2237618 NIFEDIPINE TAB 20MG                     ADALAT XL - SRT 20MG                    10774        P*                   RDP            1.3328

        399        2155907 NIFEDIPINE TAB 30MG                     ADALAT XL - SRT 30MG                    10774        P*                   RDP            0.6665
        399        2349167 NIFEDIPINE TAB 30MG                     MYLAN-NIFEDIPINE EXTENDED RELEASE       13930        P*                   RDP            0.6665

        400        2155990 NIFEDIPINE TAB 60MG                     ADALAT XL - SRT 60MG                    10774        P                    RDP            1.0125      1.0124
        400        2321149 NIFEDIPINE TAB 60MG                     MYLAN-NIFEDIPINE EXTENDED RELEASE       13930        P*                   RDP            1.0124

        675         511536   NITRAZEPAM TAB 10MG                   MOGADON TAB 10MG                        11902         P                                  0.2347      0.0923
        675        2229655   NITRAZEPAM TAB 10MG                   NITRAZADON - 10MG                       11902         F                                  0.0923
        675        2234007   NITRAZEPAM TAB 10MG                   SANDOZ NITRAZEPAM                       12027         F                                  0.0923
        675        2245231   NITRAZEPAM TAB 10MG                   APO-NITRAZEPAM TABLETS BP                3636         F                                  0.0923

        674         511528   NITRAZEPAM TAB 5MG                    MOGADON TAB 5MG                         11902         P                                  0.1568      0.0617
        674        2229654   NITRAZEPAM TAB 5MG                    NITRAZADON - 5MG                        11902         F                                  0.0617
        674        2234003   NITRAZEPAM TAB 5MG                    SANDOZ NITRAZEPAM                       12027         F                                  0.0617
        674        2245230   NITRAZEPAM TAB 5MG                    APO-NITRAZEPAM TABLETS BP                3636         F                                  0.0617

        670        1997645 NITROFURANTOIN CAP 100MG                MACRODANTIN (100 MG)                     4914         F                                  0.6658
        670        2231016 NITROFURANTOIN CAP 100MG                NOVO-FURANTOIN                           4773         F                                  0.6832

        669        2231015 NITROFURANTOIN CAP 50MG                 NOVO-FURANTOIN                           4773         F                                  0.3564

        920        2231441 NITROGLYCERINE SPR 0.4MG/METERED DOSE   NITROLINGUAL PUMPSPRAY                  12538         P                                  0.0767      0.0457
        920        2238998 NITROGLYCERINE SPR 0.4MG/METERED DOSE   RHO-NITRO PUMPSPRAY                     12027         F                                  0.0457
        920        2243588 NITROGLYCERINE SPR 0.4MG/METERED DOSE   MYLAN-NITRO SUBLINGUAL SPRAY            13930         F                                  0.0457

        413         778338   NIZATIDINE CAP 150MG                  AXID                                     9864        P                    RDP            0.9063      0.3626
        413        2177714   NIZATIDINE CAP 150MG                  PMS-NIZATIDINE 150MG CAPSULES            3550        P*                    RDP           0.3626
        413        2220156   NIZATIDINE CAP 150MG                  APO-NIZATIDINE                           3636        P*                    RDP           0.3626
        413        2240457   NIZATIDINE CAP 150MG                  NOVO-NIZATIDINE                          4773        P*                    RDP           0.3626

        414         778346   NIZATIDINE CAP 300MG                  AXID                                     9864        P                    RDP            1.6422      0.6569
        414        2177722   NIZATIDINE CAP 300MG                  PMS-NIZATIDINE                           3550        P*                    RDP           0.6569
        414        2220164   NIZATIDINE CAP 300MG                  APO-NIZATIDINE                           3636        P*                    RDP           0.6569
        414        2240458   NIZATIDINE CAP 300MG                  NOVO-NIZATIDINE                          4773        P*                    RDP           0.6569
                                                                                          Page 28 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                              Full / Partial   Plan B
             DIN             Chemical Name                     Drug Name                                MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                     LCA Benefit       Only


        773        2229524   NORFLOXACIN TAB 400MG             APO-NORFLOX - 400MG                        3636         F                                 0.9792
        773        2237682   NORFLOXACIN TAB 400MG             NOVO-NORFLOXACIN                           4773         F                                 0.9792
        773        2246596   NORFLOXACIN TAB 400MG             PMS-NORFLOXACIN                            3550         F                                 0.9792
        773        2269627   NORFLOXACIN TAB 400MG             CO NORFLOXACIN                            10028         F                                 0.9792

        415          15229   NORTRIPTYLINE CAP 10MG            AVENTYL                                    9864         P                                 0.2381      0.0953
        415        2177692   NORTRIPTYLINE CAP 10MG            PMS-NORTRIPTYLINE                          3550         F                                 0.0953
        415        2223139   NORTRIPTYLINE CAP 10MG            NU-NORTRIPTYLINE - CAP 10MG                4828         F                                 0.0953
        415        2223511   NORTRIPTYLINE CAP 10MG            APO-NORTRIPTYLINE - CAP 10MG               3636         F                                 0.0953
        415        2231781   NORTRIPTYLINE CAP 10MG            NOVO-NORTRIPTYLINE 10MG                    4773         F                                 0.0953

        416        2177706   NORTRIPTYLINE CAP 25MG            PMS-NORTRIPTYLINE                          3550         F                                 0.1926
        416        2223147   NORTRIPTYLINE CAP 25MG            NU-NORTRIPTYLINE - CAP 25MG                4828         F                                 0.1926
        416        2223538   NORTRIPTYLINE CAP 25MG            APO-NORTRIPTYLINE - CAP 25MG               3636         F                                 0.1926
        416        2231782   NORTRIPTYLINE CAP 25MG            NOVO-NORTRIPTYLINE                         4773         F                                 0.1926

        419         792667 NYSTATIN ORL SUS 100,000U/ML        PMS-NYSTATIN SUSPENSION 100000 UNIT/ML     3550         F                                 0.0563
        419        2194201 NYSTATIN ORL SUS 100,000U/ML        RATIO-NYSTATIN                            10402         F                                 0.0563

        420          14974 NYSTATIN ORL TAB 500,000U           NILSTAT ORL TAB 500000UNIT                 5208         F                                 0.0853
        420          29416 NYSTATIN ORL TAB 500,000U           MYCOSTATIN ORAL TAB 500000IU               5180         F                                 0.2441
        420        2194198 NYSTATIN ORL TAB 500,000U           RATIO-NYSTATIN                            10402         F                                 0.2670

        603         716901 NYSTATIN VAG CRM 25,000U/GM         NYADERM VAG CRM 25000UNIT/GM               5241         F                                 0.0495

       1035         839205 OCTREOTIDE ACETATE VIAL 100MCG/ML   SANDOSTATIN 100MCG/ML                      7277         P                                10.0884      4.0694
       1035        2248640 OCTREOTIDE ACETATE VIAL 100MCG/ML   OCTREOTIDE ACETATE OMEGA 100MCG/ML         4852         F                                 4.0694

       1036        2049392 OCTREOTIDE ACETATE VIAL 200MCG/ML   SANDOSTATIN 200MCG/ML                      7277         P                                19.9606      7.8278
       1036        2248642 OCTREOTIDE ACETATE VIAL 200MCG/ML   OCTREOTIDE ACETATE OMEGA 200MCG/ML         4852         F                                 7.8278

       1037         839213 OCTREOTIDE ACETATE VIAL 500MCG/ML   SANDOSTATIN 500MCG/ML                      7277         P                                48.7685     19.1246
       1037        2248641 OCTREOTIDE ACETATE VIAL 500MCG/ML   OCTREOTIDE ACETATE OMEGA 500MCG/ML         4852         F                                19.1246

       1034         839191 OCTREOTIDE ACETATE VIAL 50MCG/ML    SANDOSTATIN 50MCG/ML                       7277         P                                 5.4972      2.1557
       1034        2248639 OCTREOTIDE ACETATE VIAL 50MCG/ML    OCTREOTIDE ACETATE OMEGA 50MCG/ML          4852         F                                 2.1557

       1008        2143291 OFLOXACIN OPH SOLUTION 0.3%         OCUFLOX - LIQ OPH 0.3%                     3574         P                         X       2.6417      1.0567
       1008        2248398 OFLOXACIN OPH SOLUTION 0.3%         APO-OFLOXACIN OPHTHALMIC SOLUTION          3636         F                         X       1.0567
       1008        2252570 OFLOXACIN OPH SOLUTION 0.3%         PMS-OFLOXACIN                              3550         F                         X       1.0567

        729        2231529 OFLOXACIN TAB 200MG                 OFLOXACIN TABLETS                         14412         F                                 1.4084

        730        2231531 OFLOXACIN TAB 300MG                 OFLOXACIN TABLETS                         14412         F                                 1.6549

        731        2231532 OFLOXACIN TAB 400MG                 OFLOXACIN TABLETS                         14412         F                                 1.6549

       1183        2243087   OLANZAPINE ODT 10MG               ZYPREXA ZYDIS                              7005         P                         X       7.7143      3.0858
       1183        2303205   OLANZAPINE ODT 10MG               PMS-OLANZAPINE ODT                         3550         F                         X       3.0858
       1183        2321351   OLANZAPINE ODT 10MG               TEVA-OLANZAPINE OD                        14318         F                         X       3.0858
       1183        2327570   OLANZAPINE ODT 10MG               CO OLANZAPINE ODT                         10028         F                         X       3.0858
       1183        2327783   OLANZAPINE ODT 10MG               SANDOZ OLANZAPINE ODT                     12027         F                         X       3.0858
       1183        2360624   OLANZAPINE ODT 10MG               APO-OLANZAPINE ODT 10 MG TAB               3636         F                         X       3.0858

       1184        2243088   OLANZAPINE ODT 15MG               ZYPREXA ZYDIS                              7005         P                         X      11.5679      4.6272
       1184        2303213   OLANZAPINE ODT 15MG               PMS-OLANZAPINE ODT                         3550         F                         X       4.6272
       1184        2321378   OLANZAPINE ODT 15MG               TEVA-OLANZAPINE OD                        14318         F                         X       4.6272
       1184        2327589   OLANZAPINE ODT 15MG               CO OLANZAPINE ODT                         10028         F                         X       4.6272
       1184        2327791   OLANZAPINE ODT 15MG               SANDOZ OLANZAPINE ODT                     12027         F                         X       4.6272
       1184        2360632   OLANZAPINE ODT 15MG               APO-OLANZAPINE ODT 15 MG TAB               3636         F                         X       4.6272

       1185        2243089   OLANZAPINE ODT 20MG               ZYPREXA ZYDIS                              7005         P                         X      15.2681      6.4126
       1185        2321386   OLANZAPINE ODT 20MG               TEVA-OLANZAPINE OD                        14318         F                         X       6.4126
       1185        2327597   OLANZAPINE ODT 20MG               CO OLANZAPINE ODT                         10028         F                         X       6.4126
       1185        2327805   OLANZAPINE ODT 20MG               SANDOZ OLANZAPINE ODT                     12027         F                         X       6.4126
       1185        2360640   OLANZAPINE ODT 20MG               APO-OLANZAPINE ODT 20 MG TAB               3636         F                         X       6.4126

       1182        2243086   OLANZAPINE ODT 5MG                ZYPREXA ZYDIS                              7005         P                         X       3.8607      1.5443
       1182        2303191   OLANZAPINE ODT 5MG                PMS-OLANZAPINE ODT                         3550         F                         X       1.5443
       1182        2321343   OLANZAPINE ODT 5MG                TEVA-OLANZAPINE OD                        14318         F                         X       1.5443
       1182        2327562   OLANZAPINE ODT 5MG                CO OLANZAPINE ODT                         10028         F                         X       1.5443
       1182        2327775   OLANZAPINE ODT 5MG                SANDOZ OLANZAPINE ODT                     12027         F                         X       1.5443
       1182        2360616   OLANZAPINE ODT 5MG                APO-OLANZAPINE ODT 5 MG TABLET             3636         F                         X       1.5443

       1202        2229285   OLANZAPINE TAB 10MG               ZYPREXA - 10MG                             7005         P                         X       7.7639      3.1055
       1202        2276747   OLANZAPINE TAB 10MG               TEVA-OLANZAPINE                           14318         F                         X       3.1055
       1202        2281821   OLANZAPINE TAB 10MG               APO-OLANZAPINE                             3636         F                         X       3.1055
       1202        2303175   OLANZAPINE TAB 10MG               PMS-OLANZAPINE                             3550         F                         X       3.1055
       1202        2310384   OLANZAPINE TAB 10MG               SANDOZ OLANZAPINE                         12027         F                         X       3.1055
       1202        2325683   OLANZAPINE TAB 10MG               CO OLANZAPINE                             10028         F                         X       3.1055
       1202        2337908   OLANZAPINE TAB 10MG               MYLAN-OLANZAPINE 10 MG TABLET             13930         F                         X       3.1055

       1203        2238850   OLANZAPINE TAB 15MG               ZYPREXA 15MG                               7005         P                         X      11.6457      4.6583
       1203        2276755   OLANZAPINE TAB 15MG               TEVA-OLANZAPINE                           14318         F                         X       4.6583
       1203        2281848   OLANZAPINE TAB 15MG               APO-OLANZAPINE                             3636         F                         X       4.6583
       1203        2303183   OLANZAPINE TAB 15MG               PMS-OLANZAPINE                             3550         F                         X       4.6583
       1203        2310392   OLANZAPINE TAB 15MG               SANDOZ OLANZAPINE                         12027         F                         X       4.6583
       1203        2325691   OLANZAPINE TAB 15MG               CO OLANZAPINE                             10028         F                         X       4.6583
       1203        2337916   OLANZAPINE TAB 15MG               MYLAN-OLANZAPINE 15 MG TABLET             13930         F                         X       4.6583

       1199        2229250   OLANZAPINE TAB 2.5MG              ZYPREXA -2.5MG                             7005         P                         X       1.9410      0.7764
       1199        2276712   OLANZAPINE TAB 2.5MG              TEVA-OLANZAPINE                           14318         F                         X       0.7764
       1199        2281791   OLANZAPINE TAB 2.5MG              APO-OLANZAPINE                             3636         F                         X       0.7764
       1199        2303116   OLANZAPINE TAB 2.5MG              PMS-OLANZAPINE                             3550         F                         X       0.7764
       1199        2310341   OLANZAPINE TAB 2.5MG              SANDOZ OLANZAPINE                         12027         F                         X       0.7764
       1199        2325659   OLANZAPINE TAB 2.5MG              CO OLANZAPINE                             10028         F                         X       0.7764
       1199        2337878   OLANZAPINE TAB 2.5MG              MYLAN-OLANZAPINE 2.5 MG TABLET            13930         F                         X       0.7764

       1181        2238851   OLANZAPINE TAB 20MG               ZYPREXA 20MG                               7005         P                         X      15.5277      7.7638
       1181        2325713   OLANZAPINE TAB 20MG               CO OLANZAPINE                             10028         F                         X       7.7638
       1181        2333015   OLANZAPINE TAB 20MG               APO-OLANZAPINE                             3636         F                         X       7.7638
       1181        2359707   OLANZAPINE TAB 20MG               TEVA-OLANZAPINE                           14318         F                         X       6.2111

       1200        2229269 OLANZAPINE TAB 5MG                  ZYPREXA - 5MG                              7005         P                         X       3.8819      1.5528
       1200        2276720 OLANZAPINE TAB 5MG                  TEVA-OLANZAPINE                           14318         F                         X       1.5528
       1200        2281805 OLANZAPINE TAB 5MG                  APO-OLANZAPINE                             3636         F                         X       1.5528
                                                                                     Page 29 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                  Full / Partial   Plan B
             DIN             Chemical Name                 Drug Name                                        MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                         LCA Benefit       Only
       1200        2303159   OLANZAPINE TAB 5MG            PMS-OLANZAPINE                                     3550         F                         X       1.5528
       1200        2310368   OLANZAPINE TAB 5MG            SANDOZ OLANZAPINE                                 12027         F                         X       1.5528
       1200        2325667   OLANZAPINE TAB 5MG            CO OLANZAPINE                                     10028         F                         X       1.5528
       1200        2337886   OLANZAPINE TAB 5MG            MYLAN-OLANZAPINE 5 MG TABLET                      13930         F                         X       1.5528

       1201        2229277   OLANZAPINE TAB 7.5MG          ZYPREXA -7.5MG                                     7005         P                         X       5.8229      2.3291
       1201        2276739   OLANZAPINE TAB 7.5MG          TEVA-OLANZAPINE                                   14318         F                         X       2.3291
       1201        2281813   OLANZAPINE TAB 7.5MG          APO-OLANZAPINE                                     3636         F                         X       2.3291
       1201        2303167   OLANZAPINE TAB 7.5MG          PMS-OLANZAPINE                                     3550         F                         X       2.3291
       1201        2310376   OLANZAPINE TAB 7.5MG          SANDOZ OLANZAPINE                                 12027         F                         X       2.3291
       1201        2325675   OLANZAPINE TAB 7.5MG          CO OLANZAPINE                                     10028         F                         X       2.3291
       1201        2337894   OLANZAPINE TAB 7.5MG          MYLAN-OLANZAPINE 7.5 MG TABLET                    13930         F                         X       2.3291

       1141        2119579   OMEPRAZOLE TAB/CAP 10MG       LOSEC CAPSULES 10MG                                9307         P                         X       0.9450      0.8819
       1141        2230737   OMEPRAZOLE TAB/CAP 10MG       LOSEC 10 MG                                        9307         P                         X       1.9440      0.8819
       1141        2296438   OMEPRAZOLE TAB/CAP 10MG       SANDOZ OMEPRAZOLE                                 12027         F                         X       0.8819
       1141        2329425   OMEPRAZOLE TAB/CAP 10MG       MYLAN-OMEPRAZOLE                                  13930         F                         X       0.8819

       1004         846503   OMEPRAZOLE TAB/CAP 20MG       LOSEC CAPSULES 20MG                                9307         P                         X       1.1880      0.9504
       1004        2190915   OMEPRAZOLE TAB/CAP 20MG       LOSEC 20 MG                                        9307         P                         X       2.4444      0.9504
       1004        2245058   OMEPRAZOLE TAB/CAP 20MG       APO-OMEPRAZOLE                                     3636         F                         X       0.9504
       1004        2260867   OMEPRAZOLE TAB/CAP 20MG       RATIO-OMEPRAZOLE 20MG                             10402         F                         X       0.9504
       1004        2295415   OMEPRAZOLE TAB/CAP 20MG       TEVA-OMEPRAZOLE 20 MG TAB EC                      14318         F                         X       0.9504
       1004        2296446   OMEPRAZOLE TAB/CAP 20MG       SANDOZ OMEPRAZOLE                                 12027         F                         X       0.9504
       1004        2310260   OMEPRAZOLE TAB/CAP 20MG       PMS-OMEPRAZOLE DR                                  3550         F                         X       0.9504
       1004        2320851   OMEPRAZOLE TAB/CAP 20MG       PMS-OMEPRAZOLE                                     3550         F                         X       0.9504
       1004        2329433   OMEPRAZOLE TAB/CAP 20MG       MYLAN-OMEPRAZOLE                                  13930         F                         X       0.9504
       1004        2348691   OMEPRAZOLE TAB/CAP 20MG       OMEPRAZOLE                                        14236         F                         X       0.9504

       1070        2213745   ONDANSETRON INJ 2MG/ML        ZOFRAN                                             9985         P                         X      10.6607      6.4184
       1070        2265524   ONDANSETRON INJ 2MG/ML        ONDANSETRON INJECTION -(PRESERVATIVE-FREE)         4773         F                         X       6.4184
       1070        2265532   ONDANSETRON INJ 2MG/ML        ONDANSETRON INJECTION -(WITH PRESERVATIVE)         4773         F                         X       6.4184
       1070        2279428   ONDANSETRON INJ 2MG/ML        ONDANSETRON INJECTION USP -(PRESERVATIVE FREE)    12027         F                         X       6.4184
       1070        2279436   ONDANSETRON INJ 2MG/ML        ONDANSETRON INJECTION USP -(WITH PRESERVATIVE)    12027         F                         X       6.4184

       1140        2229639 ONDANSETRON SOLUTION 4MG/5MG    ZOFRAN                                             9985         P                         X       2.2077      1.5783
       1140        2291967 ONDANSETRON SOLUTION 4MG/5MG    ONDANSETRON                                       14412         F                         X       1.5783

       1068        2213567   ONDANSETRON TAB 4MG           ZOFRAN                                             9985         P                         X      14.4698      5.7879
       1068        2239372   ONDANSETRON TAB 4MG           ZOFRAN ODT                                         9985         P                         X      14.1361      5.7879
       1068        2258188   ONDANSETRON TAB 4MG           PMS-ONDANSETRON                                    3550         F                         X       5.7879
       1068        2264056   ONDANSETRON TAB 4MG           TEVA-ONDANSETRON                                  14318         F                         X       5.7879
       1068        2274310   ONDANSETRON TAB 4MG           SANDOZ ONDANSETRON                                12027         F                         X       5.7879
       1068        2278529   ONDANSETRON TAB 4MG           RATIO-ONDANSETRON                                 10402         F                         X       5.7879
       1068        2278618   ONDANSETRON TAB 4MG           PHL-ONDANSETRON                                    4917         F                         X       5.7879
       1068        2288184   ONDANSETRON TAB 4MG           APO-ONDANSETRON                                    3636         F                         X       5.7879
       1068        2296349   ONDANSETRON TAB 4MG           CO ONDANSETRON                                    10028         F                         X       5.7879
       1068        2297868   ONDANSETRON TAB 4MG           MYLAN-ONDANSETRON                                 13930         F                         X       5.7879
       1068        2305259   ONDANSETRON TAB 4MG           MINT-ONDANSETRON                                  13221         F                         X       5.7879
       1068        2306212   ONDANSETRON TAB 4MG           ONDANSETRON-ODAN                                   4835         F                         X       5.7879
       1068        2312247   ONDANSETRON TAB 4MG           RAN-ONDANSETRON                                   11271         F                         X       5.7879
       1068        2313685   ONDANSETRON TAB 4MG           JAMP-ONDANSETRON                                   4415         F                         X       5.7879
       1068        2344440   ONDANSETRON TAB 4MG           ZYM-ONDANSETRON                                    6860         F                         X       5.7879
       1068        2371731   ONDANSETRON TAB 4MG           MAR-ONDANSETRON 4 MG TABLET                       14907         F                         X       5.7879

       1069        2213575   ONDANSETRON TAB 8MG           ZOFRAN                                             9985         P                         X      22.0795      8.8318
       1069        2239373   ONDANSETRON TAB 8MG           ZOFRAN ODT                                         9985         P                         X      21.5698      8.8318
       1069        2258196   ONDANSETRON TAB 8MG           PMS-ONDANSETRON                                    3550         F                         X       8.8318
       1069        2264064   ONDANSETRON TAB 8MG           TEVA-ONDANSETRON                                  14318         F                         X       8.8318
       1069        2274329   ONDANSETRON TAB 8MG           SANDOZ ONDANSETRON                                12027         F                         X       8.8318
       1069        2278537   ONDANSETRON TAB 8MG           RATIO-ONDANSETRON                                 10402         F                         X       8.8318
       1069        2278626   ONDANSETRON TAB 8MG           PHL-ONDANSETRON                                    4917         F                         X       8.8318
       1069        2288192   ONDANSETRON TAB 8MG           APO-ONDANSETRON                                    3636         F                         X       8.8318
       1069        2296357   ONDANSETRON TAB 8MG           CO ONDANSETRON                                    10028         F                         X       8.8318
       1069        2297876   ONDANSETRON TAB 8MG           MYLAN-ONDANSETRON                                 13930         F                         X       8.8318
       1069        2305267   ONDANSETRON TAB 8MG           MINT-ONDANSETRON                                  13221         F                         X       8.8318
       1069        2306220   ONDANSETRON TAB 8MG           ONDANSETRON-ODAN                                   4835         F                         X       8.8318
       1069        2312255   ONDANSETRON TAB 8MG           RAN-ONDANSETRON                                   11271         F                         X       8.8318
       1069        2313693   ONDANSETRON TAB 8MG           JAMP-ONDANSETRON                                   4415         F                         X       8.8318
       1069        2344459   ONDANSETRON TAB 8MG           ZYM-ONDANSETRON                                    6860         F                         X       8.8318
       1069        2371758   ONDANSETRON TAB 8MG           MAR-ONDANSETRON 8 MG TABLET                       14907         F                         X       8.8318

         50        1901869 OPIUM/BELLADONNA SUP 60/15MG    SANDOZ OPIUM + BELLADONNA                         12027         F                                 2.9610

        673        2236783 ORCIPRENALINE SULF SYR 2MG/ML   APO-ORCIPRENALINE SYRUP                            3636         F                                 0.0620

        421         402680 OXAZEPAM TAB 10MG               APO OXAZEPAM TAB 10MG                              3636         F                                 0.0378

        422         402745 OXAZEPAM TAB 15MG               APO OXAZEPAM TAB 15MG                              3636         F                                 0.0594

        423         402737 OXAZEPAM TAB 30MG               APO OXAZEPAM TAB 30MG                              3636         F                                 0.0810

        425         476366 OXTRIPHYLLINE ELX 100MG/5ML     CHOLEDYL ELIXIR 100MG/5ML                          9484         P                                 0.0400      0.0340
        425         792942 OXTRIPHYLLINE ELX 100MG/5ML     PMS-OXTRIPHYLLINE ELIXIR                           3550         F                                 0.0340

        429        2223376 OXYBUTYNIN SYR 5MG/5ML          PMS-OXYBUTYNIN                                     3550         F                                 0.1074

        430        2158590   OXYBUTYNIN TAB 5MG            NU-OXYBUTYN - TAB 5MG                              4828         F                                 0.1861
        430        2163543   OXYBUTYNIN TAB 5MG            APO-OXYBUTYNIN - TAB 5MG                           3636         F                                 0.1861
        430        2230394   OXYBUTYNIN TAB 5MG            NOVO-OXYBUTYNIN                                    4773         F                                 0.1861
        430        2230800   OXYBUTYNIN TAB 5MG            MYLAN-OXYBUTYNIN                                  13930         F                                 0.1861
        430        2240550   OXYBUTYNIN TAB 5MG            PMS-OXYBUTYNIN                                     3550         F                                 0.1861
        430        2350238   OXYBUTYNIN TAB 5MG            OXYBUTYNIN                                        14236         F                                 0.1861

        923         443948 OXYCODONE HCL TAB 10MG          SUPEUDOL 10                                       12027         P                                 0.2048      0.1638
        923        2240131 OXYCODONE HCL TAB 10MG          OXY.IR                                             7054         P                                 0.4169      0.1638
        923        2319985 OXYCODONE HCL TAB 10MG          PMS-OXYCODONE                                      3550         F                                 0.1638

       1043        2240132 OXYCODONE HCL TAB 20MG          OXY.IR                                             7054         P                                 0.7247      0.2845
       1043        2262983 OXYCODONE HCL TAB 20MG          SUPEUDOL                                          12027         P                                 0.3556      0.2845
       1043        2319993 OXYCODONE HCL TAB 20MG          PMS-OXYCODONE                                      3550         F                                 0.2845

        922         789739 OXYCODONE HCL TAB 5MG           SUPEUDOL 5                                        12027         P                                 0.1390      0.1112
        922        2231934 OXYCODONE HCL TAB 5MG           OXY.IR                                             7054         P                                 0.2830      0.1112
        922        2319977 OXYCODONE HCL TAB 5MG           PMS-OXYCODONE                                      3550         F                                 0.1112

        431        1916475 OXYCODONE/ACET TAB 5/325MG      PERCOCET                                           3798         P                                 0.8321      0.1388
                                                                                 Page 30 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                             Full / Partial   Plan B
             DIN             Chemical Name                       Drug Name                            MAN                                 RDP   SA   Max Price   LCA Price
Category no.                                                                                                    LCA Benefit       Only
        431         574384   OXYCODONE/ACET TAB 5/325MG          ENDOCET TAB                               0          F                                 0.1276
        431         608165   OXYCODONE/ACET TAB 5/325MG          RATIO-OXYCOCET                        10402          F                                 0.1388
        431        1916327   OXYCODONE/ACET TAB 5/325MG          ROXICET TAB                               0          F                                 0.1143
        431        1916548   OXYCODONE/ACET TAB 5/325MG          ENDOCET                                3798          F                                 0.1388
        431        2307898   OXYCODONE/ACET TAB 5/325MG          SANDOZ OXYCODONE/ACETAMINOPHEN        12027          F                                 0.1388
        431        2324628   OXYCODONE/ACET TAB 5/325MG          APO-OXYCODONE/ACET                     3636          F                                 0.1388
        431        2361361   OXYCODONE/ACET TAB 5/325MG          OXYCODONE/ACET 5 MG/ 325 MG TABLET    14236          F                                 0.1388

        432         608157 OXYCODONE/ASA TAB 5/325MG             RATIO-OXYCODAN                        10402          F                                 0.3478
        432        1916483 OXYCODONE/ASA TAB 5/325MG             ENDODAN                                3798          F                                 0.1205

        931        2059762 PAMIDRONATE DISODIUM 30MG/10ML VIAL   AREDIA 30MG                            7277          P                         X     175.2084     93.7224

        933        2059789 PAMIDRONATE DISODIUM 90MG/10MG VIAL   AREDIA 90MG                            7277          P                         X     525.6144    281.1672

        961        2249669 PAMIDRONATE DISODIUM INJ 3MG/ML       PAMIDRONATE DISODIUM OMEGA 3 MG/ML     4852          F                         X       9.3722

        962        2249677 PAMIDRONATE DISODIUM INJ 6MG/ML       PAMIDRONATE DISODIUM OMEGA 6 MG/ML     4852          F                         X      19.0836
        962        2264978 PAMIDRONATE DISODIUM INJ 6MG/ML       PAMIDRONATE DISODIUM FOR INJECTION    12027          F                         X      19.0836

        963        2249685 PAMIDRONATE DISODIUM INJ 9MG/ML       PAMIDRONATE DISODIUM OMEGA 9 MG/ML     4852          F                         X      28.1204
        963        2264986 PAMIDRONATE DISODIUM INJ 9MG/ML       PAMIDRONATE DISODIUM FOR INJECTION    12027          F                         X      28.1204

       1148        2229453   PANTOPRAZOLE TAB 40MG               PANTOLOC                              13170          P                         X       2.1834      0.8708
       1148        2285487   PANTOPRAZOLE TAB 40MG               TEVA-PANTOPRAZOLE                     14318          F                         X       0.8708
       1148        2292920   PANTOPRAZOLE TAB 40MG               APO-PANTOPRAZOLE                       3636          F                         X       0.8708
       1148        2299585   PANTOPRAZOLE TAB 40MG               MYLAN-PANTOPRAZOLE                    13930          F                         X       0.8708
       1148        2300486   PANTOPRAZOLE TAB 40MG               CO PANTOPRAZOLE                       10028          F                         X       0.8708
       1148        2301083   PANTOPRAZOLE TAB 40MG               SANDOZ PANTOPRAZOLE                   12027          F                         X       0.8708
       1148        2305046   PANTOPRAZOLE TAB 40MG               RAN-PANTOPRAZOLE                      11271          F                         X       0.8708
       1148        2307871   PANTOPRAZOLE TAB 40MG               PMS-PANTOPRAZOLE                       3550          F                         X       0.8708
       1148        2308703   PANTOPRAZOLE TAB 40MG               RATIO-PANTOPRAZOLE                    10402          F                         X       0.8708
       1148        2370808   PANTOPRAZOLE TAB 40MG               PANTOPRAZOLE                          14236          F                         X       0.8708

        988        1940481   PAROXETINE HCL TAB 20MG             PAXIL TAB 20MG                         9985          P                                 1.9500      0.7800
        988        2240908   PAROXETINE HCL TAB 20MG             APO-PAROXETINE                         3636          F                                 0.7800
        988        2247751   PAROXETINE HCL TAB 20MG             PMS-PAROXETINE                         3550          F                                 0.7800
        988        2247811   PAROXETINE HCL TAB 20MG             RATIO-PAROXETINE                      10402          F                                 0.7800
        988        2248013   PAROXETINE HCL TAB 20MG             MYLAN-PAROXETINE                      13930          F                                 0.7800
        988        2248557   PAROXETINE HCL TAB 20MG             TEVA-PAROXETINE                       14318          F                                 0.7800
        988        2262754   PAROXETINE HCL TAB 20MG             CO PAROXETINE                         10028          F                                 0.7800
        988        2269430   PAROXETINE HCL TAB 20MG             SANDOZ PAROXETINE                     12027          F                                 0.7800
        988        2282852   PAROXETINE HCL TAB 20MG             PAROXETINE                            14236          F                                 0.7800

        989        1940473   PAROXETINE HCL TAB 30MG             PAXIL TAB 30MG                         9985          P                                 2.0718      0.8287
        989        2240909   PAROXETINE HCL TAB 30MG             APO-PAROXETINE                         3636          F                                 0.8287
        989        2247752   PAROXETINE HCL TAB 30MG             PMS-PAROXETINE                         3550          F                                 0.8287
        989        2247812   PAROXETINE HCL TAB 30MG             RATIO-PAROXETINE                      10402          F                                 0.8287
        989        2248014   PAROXETINE HCL TAB 30MG             MYLAN-PAROXETINE                      13930          F                                 0.8287
        989        2248558   PAROXETINE HCL TAB 30MG             TEVA-PAROXETINE                       14318          F                                 0.8287
        989        2262762   PAROXETINE HCL TAB 30MG             CO PAROXETINE                         10028          F                                 0.8287
        989        2269449   PAROXETINE HCL TAB 30MG             SANDOZ PAROXETINE                     12027          F                                 0.8287
        989        2282860   PAROXETINE HCL TAB 30MG             PAROXETINE                            14236          F                                 0.8287

       1124        2293749 PAROXETINE TAB 40MG                   PMS-PAROXETINE                         3550          F                                 2.3521

        435         391603 PENICILLIN V PWS 100,000U             NOVO-PEN VK SYR 500000/5ML             4773          F                                 0.0510
        435         642231 PENICILLIN V PWS 100,000U             APO PEN VK PWS 500000UNIT/5ML          3636          F                                 0.0510

        436          15563 PENICILLIN V PWS 40,000U              V CILLIN K PEDIATRIC 125MG/5ML         7005          F                                 0.0444
        436         642223 PENICILLIN V PWS 40,000U              APO PEN VK PWS 200000UNIT/5ML USP      3636          F                                 0.0578

        439          21202 PENICILLIN V TAB 300MG                NOVO-PEN-VK 500 TAB                    4773          F                                 0.0767
        439         642215 PENICILLIN V TAB 300MG                APO PEN VK TAB 500000UNIT USP          3636          F                                 0.0767
        439         717568 PENICILLIN V TAB 300MG                NU-PEN-VK TABLETS 300MG                4828          F                                 0.0767

        440         476587 PENTAERYTHRITOL SR TAB 80MG           PERITRATE SA 80MG TAB                      0        P*                   RDP           0.4104

        441         476595 PENTAERYTHRITOL TAB 10MG              PERITRATE TAB 10MG                         0        P*                   RDP           0.1333

        442         476609 PENTAERYTHRITOL TAB 20 & 30MG         PERITRATE TAB 20MG                         0        P*                   RDP           0.1799

        443         476579 PENTAERYTHRITOL TAB 80MG              PERITRATE FORTE TAB 80MG                   0        P*                   RDP           0.3192

        661        2221977 PENTOXIFYLLINE SR TAB 400MG           TRENTAL                               12538          P                                 0.8552      0.6314
        661        2230090 PENTOXIFYLLINE SR TAB 400MG           APO-PENTOXIFYLLINE SR                  3636          F                                 0.6314

        969        2123274 PERINDOPRIL TAB 2MG                   COVERSYL - 2MG TAB                     5096         P*                   RDP           0.6898

        970        2123282 PERINDOPRIL TAB 4MG                   COVERSYL - 4MG TAB                     5096         P*                   RDP           0.8633

       1079        2246624 PERINDOPRIL TAB 8MG                   COVERSYL (8MG TABLET)                  5096         P*                   RDP           1.2085

        445          28320 PERPHENAZINE TAB 16MG                 TRILAFON TAB 16MG                      7016          F                                 0.1213
        445         335096 PERPHENAZINE TAB 16MG                 PERPHENAZINE                          14412          F                                 0.1376

        446          28290 PERPHENAZINE TAB 2MG                  TRILAFON TAB 2MG                       7016          F                                 0.0623
        446         296309 PERPHENAZINE TAB 2MG                  PHENAZINE 2 TAB                        4372          F                                 0.0219
        446         335134 PERPHENAZINE TAB 2MG                  PERPHENAZINE                          14412          F                                 0.0676

        447          28304 PERPHENAZINE TAB 4MG                  TRILAFON TAB 4MG                       7016          F                                 0.0780
        447         296317 PERPHENAZINE TAB 4MG                  PHENAZINE 4 TAB                        4372          F                                 0.0346
        447         335126 PERPHENAZINE TAB 4MG                  PERPHENAZINE                          14412          F                                 0.0819

        448         335118 PERPHENAZINE TAB 8MG                  PERPHENAZINE                          14412          F                                 0.0899

        449         476714 PHENAZOPYRIDINE TAB 100MG             PYRIDIUM 100MG                         9484          F                                 0.1275

       1051          23450 PHENYTOIN ORAL SUSP 125               DILANTIN-125 SUSPENSION                4908          P                                 0.0509      0.0336
       1051        2250896 PHENYTOIN ORAL SUSP 125               TARO-PHENYTOIN                         5241          F                                 0.0336

        976         313815 PIMOZIDE TAB 2MG                      ORAP                                   9864          F                                 0.2461
        976        2245432 PIMOZIDE TAB 2MG                      APO-PIMOZIDE                           3636          F                                 0.3340

        977         313823 PIMOZIDE TAB 4MG                      ORAP                                   9864          F                                 0.4467
        977        2245433 PIMOZIDE TAB 4MG                      APO-PIMOZIDE                           3636          F                                 0.4467
                                                                                      Page 31 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                           Full / Partial   Plan B
             DIN             Chemical Name                     Drug Name                             MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                  LCA Benefit       Only
        456         443174   PINDOLOL TAB 10MG                 VISKEN TAB 10MG                         7277         P                                 1.0801      0.4014
        456         755885   PINDOLOL TAB 10MG                 APO-PINDOL TAB 10MG                     3636         F                                 0.4014
        456         869015   PINDOLOL TAB 10MG                 NOVO-PINDOL TAB 10MG                    4773         F                                 0.4014
        456         886009   PINDOLOL TAB 10MG                 NU-PINDOL TAB 10MG                      4828         F                                 0.4014
        456        2057816   PINDOLOL TAB 10MG                 MYLAN-PINDOLOL                         13930         F                                 0.4014
        456        2231537   PINDOLOL TAB 10MG                 PMS-PINDOLOL                            3550         F                                 0.4014
        456        2261790   PINDOLOL TAB 10MG                 SANDOZ-PINDOLOL                        12027         F                                 0.4014

        457         417289   PINDOLOL TAB 15MG                 VISKEN TAB 15MG                         7277         P                                 1.5670      0.5823
        457         755893   PINDOLOL TAB 15MG                 APO-PINDOL TAB 15MG                     3636         F                                 0.5823
        457         869023   PINDOLOL TAB 15MG                 NOVO-PINDOL TAB 15MG                    4773         F                                 0.5823
        457         886130   PINDOLOL TAB 15MG                 NU-PINDOL TAB 15MG                      4828         F                                 0.5823
        457        2231539   PINDOLOL TAB 15MG                 PMS-PINDOLOL                            3550         F                                 0.5823
        457        2261804   PINDOLOL TAB 15MG                 SANDOZ-PINDOLOL                        12027         F                                 0.5823

        458         417270   PINDOLOL TAB 5MG                  VISKEN TAB 5MG                          7277         P                                 0.6326      0.2351
        458         755877   PINDOLOL TAB 5MG                  APO-PINDOL TAB 5MG                      3636         F                                 0.2351
        458         869007   PINDOLOL TAB 5MG                  NOVO-PINDOL TAB 5MG                     4773         F                                 0.2351
        458         886149   PINDOLOL TAB 5MG                  NU-PINDOL TAB 5MG                       4828         F                                 0.2351
        458        2057808   PINDOLOL TAB 5MG                  MYLAN-PINDOLOL                         13930         F                                 0.2351
        458        2231536   PINDOLOL TAB 5MG                  PMS-PINDOLOL                            3550         F                                 0.2351
        458        2261782   PINDOLOL TAB 5MG                  SANDOZ-PINDOLOL                        12027         F                                 0.2351

       1129        2242572 PIOGLITAZONE HCL TAB 15MG           ACTOS (15MG)                           14108         P                         X       2.5685      1.0039
       1129        2303442 PIOGLITAZONE HCL TAB 15MG           ACCEL PIOGLITAZONE                     13829         F                         X       1.0039
       1129        2326477 PIOGLITAZONE HCL TAB 15MG           MINT-PIOGLITAZONE                      13221         F                         X       1.0039

       1130        2242573   PIOGLITAZONE HCL TAB 30MG         ACTOS (30MG)                           14108         P                         X       3.5984      1.4064
       1130        2303450   PIOGLITAZONE HCL TAB 30MG         ACCEL PIOGLITAZONE                     13829         F                         X       1.4064
       1130        2326485   PIOGLITAZONE HCL TAB 30MG         MINT-PIOGLITAZONE                      13221         F                         X       1.4064
       1130        2365529   PIOGLITAZONE HCL TAB 30MG         JAMP-PIOGLITAZONE 30 MG TABLET          4415         F                         X       1.3654

       1131        2242574   PIOGLITAZONE HCL TAB 45MG         ACTOS (45MG)                           14108         P                         X       5.4106      2.1146
       1131        2303469   PIOGLITAZONE HCL TAB 45MG         ACCEL PIOGLITAZONE                     13829         F                         X       2.1146
       1131        2326493   PIOGLITAZONE HCL TAB 45MG         MINT-PIOGLITAZONE                      13221         F                         X       2.1146
       1131        2365537   PIOGLITAZONE HCL TAB 45MG         JAMP-PIOGLITAZONE 45 MG TABLET          4415         F                         X       2.0531

        605         642886 PIROXICAM CAP 10MG                  APO PIROXICAM CAP 10MG                  3636         F                         X       0.3963
        605         695718 PIROXICAM CAP 10MG                  NOVO-PIROCAM CAP 10MG                   4773         F                         X       0.3963

        606         642894 PIROXICAM CAP 20MG                  APO PIROXICAM CAP 20MG                  3636         F                         X       0.6412
        606         695696 PIROXICAM CAP 20MG                  NOVO-PIROCAM CAP 20MG                   4773         F                         X       0.6412
        606         865788 PIROXICAM CAP 20MG                  NU-PIROX CAP 20MG                       4828         F                         X       0.6412

        608         632716 PIROXICAM SUP 20MG                  FELDENE SUP 20MG                        4908         F                         X       1.9321
        608        2154463 PIROXICAM SUP 20MG                  PMS-PIROXICAM SUPPOSITORIES -20MG       3550         F                         X       2.1558

        863        2011956 POLYMIXIN TRIMETH OPH SOL 1MG/ML    POLYTRIM OPHTHALMIC SOLUTION            3574         P                                 3.2864      2.4289
        863        2240363 POLYMIXIN TRIMETH OPH SOL 1MG/ML    PMS-POLYTRIMETHOPRIM                    3550         F                                 2.4289

        921         701904 POLYMIXIN/NEO/HC OPTH ONT           CORTISPORIN                                0         F                                 2.9901
        921        2242485 POLYMIXIN/NEO/HC OPTH ONT           SANDOZ CORTIMYXIN                      12027         F                                 3.4683

        841        1918303 POTASSIUM CHLORIDE LIQ 20MEQ/15ML   K10                                     9985         P                                 0.0166      0.0144
        841        2238604 POTASSIUM CHLORIDE LIQ 20MEQ/15ML   PMS-POTASSIUM CHLORIDE                  3550         F                                 0.0144

        463          74225 POTASSIUM CHLORIDE TAB 600MG        SLOW K                                  7277         P                                 0.1634      0.0809
        463         602884 POTASSIUM CHLORIDE TAB 600MG        APO K TAB 600MG                         3636         F                                 0.0809

       1105        2237145   PRAMIPEXOLE TAB .25MG             MIRAPEX                                 3617         P                         X       1.1354      0.4541
       1105        2269309   PRAMIPEXOLE TAB .25MG             NOVO-PRAMIPEXOLE                        4773         F                         X       0.4541
       1105        2290111   PRAMIPEXOLE TAB .25MG             PMS-PRAMIPEXOLE                         3550         F                         X       0.4541
       1105        2292378   PRAMIPEXOLE TAB .25MG             APO-PRAMIPEXOLE                         3636         F                         X       0.4541
       1105        2297302   PRAMIPEXOLE TAB .25MG             CO PRAMIPEXOLE                         10028         F                         X       0.4541
       1105        2315262   PRAMIPEXOLE TAB .25MG             SANDOZ PRAMIPEXOLE                     12027         F                         X       0.4541
       1105        2367602   PRAMIPEXOLE TAB .25MG             PRAMIPEXOLE                            14236         F                         X       0.4541

       1106        2241594   PRAMIPEXOLE TAB .5MG              MIRAPEX                                 3617         P                         X       2.2710      1.1355
       1106        2269317   PRAMIPEXOLE TAB .5MG              NOVO-PRAMIPEXOLE                        4773         F                         X       1.1355
       1106        2290138   PRAMIPEXOLE TAB .5MG              PMS-PRAMIPEXOLE                         3550         F                         X       1.1355
       1106        2292386   PRAMIPEXOLE TAB .5MG              APO-PRAMIPEXOLE                         3636         F                         X       1.1355
       1106        2297310   PRAMIPEXOLE TAB .5MG              CO PRAMIPEXOLE                         10028         F                         X       1.1355
       1106        2315270   PRAMIPEXOLE TAB .5MG              SANDOZ PRAMIPEXOLE                     12027         F                         X       1.1355
       1106        2367610   PRAMIPEXOLE TAB .5MG              PRAMIPEXOLE                            14236         F                         X       1.1355

       1108        2237147   PRAMIPEXOLE TAB 1.5MG             MIRAPEX                                 3617         P                         X       2.2710      0.9084
       1108        2269333   PRAMIPEXOLE TAB 1.5MG             NOVO-PRAMIPEXOLE                        4773         F                         X       0.9084
       1108        2290154   PRAMIPEXOLE TAB 1.5MG             PMS-PRAMIPEXOLE                         3550         F                         X       0.9084
       1108        2292408   PRAMIPEXOLE TAB 1.5MG             APO-PRAMIPEXOLE                         3636         F                         X       0.9084
       1108        2297337   PRAMIPEXOLE TAB 1.5MG             CO PRAMIPEXOLE                         10028         F                         X       0.9084
       1108        2315297   PRAMIPEXOLE TAB 1.5MG             SANDOZ PRAMIPEXOLE                     12027         F                         X       0.9084
       1108        2367645   PRAMIPEXOLE TAB 1.5MG             PRAMIPEXOLE                            14236         F                         X       0.9084

       1107        2237146   PRAMIPEXOLE TAB 1MG               MIRAPEX                                 3617         P                         X       2.2710      0.9084
       1107        2269325   PRAMIPEXOLE TAB 1MG               NOVO-PRAMIPEXOLE                        4773         F                         X       0.9084
       1107        2290146   PRAMIPEXOLE TAB 1MG               PMS-PRAMIPEXOLE                         3550         F                         X       0.9084
       1107        2292394   PRAMIPEXOLE TAB 1MG               APO-PRAMIPEXOLE                         3636         F                         X       0.9084
       1107        2297329   PRAMIPEXOLE TAB 1MG               CO PRAMIPEXOLE                         10028         F                         X       0.9084
       1107        2315289   PRAMIPEXOLE TAB 1MG               SANDOZ PRAMIPEXOLE                     12027         F                         X       0.9084
       1107        2367629   PRAMIPEXOLE TAB 1MG               PRAMIPEXOLE                            14236         F                         X       0.9084

        870         893749   PRAVASTATIN TAB 10MG              PRAVACHOL - TAB 10MG                    3798         P                                 0.9738      0.6998
        870        2243506   PRAVASTATIN TAB 10MG              APO-PRAVASTATIN                         3636         F                                 0.6998
        870        2244350   PRAVASTATIN TAB 10MG              NU-PRAVASTATIN TABLETS                  4828         F                                 0.6998
        870        2246930   PRAVASTATIN TAB 10MG              RATIO-PRAVASTATIN                      10402         F                                 0.6998
        870        2247008   PRAVASTATIN TAB 10MG              NOVO-PRAVASTATIN TABLETS                4773         F                                 0.6998
        870        2247655   PRAVASTATIN TAB 10MG              PMS-PRAVASTATIN                         3550         F                                 0.6998
        870        2247856   PRAVASTATIN TAB 10MG              SANDOZ PRAVASTATIN                     12027         F                                 0.6998
        870        2248182   PRAVASTATIN TAB 10MG              CO PRAVASTATIN TABLET 10MG             10028         F                                 0.6998
        870        2257092   PRAVASTATIN TAB 10MG              MYLAN-PRAVASTATIN                      13930         F                                 0.6998
        870        2284421   PRAVASTATIN TAB 10MG              RAN-PRAVASTATIN                        11271         F                                 0.6998
        870        2317451   PRAVASTATIN TAB 10MG              MINT-PRAVASTATIN                       13221         F                                 0.6998
        870        2330954   PRAVASTATIN TAB 10MG              JAMP-PRAVASTATIN                        4415         F                                 0.6998
        870        2332191   PRAVASTATIN TAB 10MG              PRAVASTATIN 10 MG TABLET               11271         F                                 0.6998
        870        2356546   PRAVASTATIN TAB 10MG              PRAVASTATIN                            14236         F                                 0.6998

        871         893757 PRAVASTATIN TAB 20MG                PRAVACHOL - TAB 20MG                    3798         P                                 1.1507      0.8256
                                                                                     Page 32 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                         Full / Partial   Plan B
             DIN             Chemical Name                  Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                LCA Benefit       Only
        871        2243507   PRAVASTATIN TAB 20MG           APO-PRAVASTATIN                          3636         F                                 0.8256
        871        2244351   PRAVASTATIN TAB 20MG           NU-PRAVASTATIN TABLETS                   4828         F                                 0.8256
        871        2246931   PRAVASTATIN TAB 20MG           RATIO-PRAVASTATIN                       10402         F                                 0.8256
        871        2247009   PRAVASTATIN TAB 20MG           NOVO-PRAVASTATIN TABLETS                 4773         F                                 0.8256
        871        2247656   PRAVASTATIN TAB 20MG           PMS-PRAVASTATIN                          3550         F                                 0.8256
        871        2247857   PRAVASTATIN TAB 20MG           SANDOZ PRAVASTATIN                      12027         F                                 0.8256
        871        2248183   PRAVASTATIN TAB 20MG           CO PRAVASTATIN TABLET 20MG              10028         F                                 0.8256
        871        2257106   PRAVASTATIN TAB 20MG           MYLAN-PRAVASTATIN                       13930         F                                 0.8256
        871        2284448   PRAVASTATIN TAB 20MG           RAN-PRAVASTATIN                         11271         F                                 0.8256
        871        2317478   PRAVASTATIN TAB 20MG           MINT-PRAVASTATIN                        13221         F                                 0.8256
        871        2330962   PRAVASTATIN TAB 20MG           JAMP-PRAVASTATIN                         4415         F                                 0.8256
        871        2332205   PRAVASTATIN TAB 20MG           PRAVASTATIN 20 MG TABLET                11271         F                                 0.8256
        871        2356554   PRAVASTATIN TAB 20MG           PRAVASTATIN                             14236         F                                 0.8256

        872        2222051   PRAVASTATIN TAB 40MG           PRAVACHOL - TAB 40MG                     3798         P                                 1.3893      0.9945
        872        2243508   PRAVASTATIN TAB 40MG           APO-PRAVASTATIN                          3636         F                                 0.9945
        872        2244352   PRAVASTATIN TAB 40MG           NU-PRAVASTATIN TABLETS                   4828         F                                 0.9945
        872        2246932   PRAVASTATIN TAB 40MG           RATIO-PRAVASTATIN                       10402         F                                 0.9945
        872        2247010   PRAVASTATIN TAB 40MG           NOVO-PRAVASTATIN TABLETS                 4773         F                                 0.9945
        872        2247657   PRAVASTATIN TAB 40MG           PMS-PRAVASTATIN                          3550         F                                 0.9945
        872        2247858   PRAVASTATIN TAB 40MG           SANDOZ PRAVASTATIN                      12027         F                                 0.9945
        872        2248184   PRAVASTATIN TAB 40MG           CO PRAVASTATIN TABLET 40MG              10028         F                                 0.9945
        872        2257114   PRAVASTATIN TAB 40MG           MYLAN-PRAVASTATIN                       13930         F                                 0.9945
        872        2284456   PRAVASTATIN TAB 40MG           RAN-PRAVASTATIN                         11271         F                                 0.9945
        872        2317486   PRAVASTATIN TAB 40MG           MINT-PRAVASTATIN                        13221         F                                 0.9945
        872        2330970   PRAVASTATIN TAB 40MG           JAMP-PRAVASTATIN                         4415         F                                 0.9945
        872        2332213   PRAVASTATIN TAB 40MG           PRAVASTATIN 40 MG TABLET                11271         F                                 0.9945
        872        2356562   PRAVASTATIN TAB 40MG           PRAVASTATIN                             14236         F                                 0.9945

        466         560952 PRAZOSIN TAB 1MG                 MINIPRESS                                9484         P                                 0.3192      0.1481
        466         882801 PRAZOSIN TAB 1MG                 APO-PRAZO TAB 1MG                        3636         F                                 0.1481
        466        1934198 PRAZOSIN TAB 1MG                 NOVO-PRAZIN TAB 1MG                      4773         F                                 0.1481

        467         560960 PRAZOSIN TAB 2MG                 MINIPRESS                                9484         P                                 0.4335      0.2011
        467         882828 PRAZOSIN TAB 2MG                 APO-PRAZO TAB 2MG                        3636         F                                 0.2011
        467        1934201 PRAZOSIN TAB 2MG                 NOVO-PRAZIN TAB 2MG                      4773         F                                 0.2011

        468         560979 PRAZOSIN TAB 5MG                 MINIPRESS                                9484         P                                 0.5959      0.2765
        468         882836 PRAZOSIN TAB 5MG                 APO-PRAZO TAB 5MG                        3636         F                                 0.2765
        468        1934228 PRAZOSIN TAB 5MG                 NOVO-PRAZIN TAB 5MG                      4773         F                                 0.2765

        696         299405 PREDNISOLONE ACETATE DPS 0.12%   PRED MILD 0.12%                          3574         P                                 3.8794      1.4526
        696        1916181 PREDNISOLONE ACETATE DPS 0.12%   SANDOZ PREDNISOLONE                     12027         F                                 1.4526

        469         301175   PREDNISOLONE ACETATE DPS 1%    PRED FORTE 1%                            3574         P                                 5.7110      2.0952
        469         700401   PREDNISOLONE ACETATE DPS 1%    RATIO-PREDNISOLONE                      10402         F                                 2.0952
        469         764639   PREDNISOLONE ACETATE DPS 1%    BALPRED OPH SUSP 1%                      3807         F                                 1.1027
        469        1916203   PREDNISOLONE ACETATE DPS 1%    SANDOZ PREDNISOLONE                     12027         F                                 2.0952
        469        2023768   PREDNISOLONE ACETATE DPS 1%    DIOPRED SUSPENSION 1%                   12027         F                                 2.0952

        470         271373 PREDNISONE TAB 1MG               WINPRED TAB 1MG                         11902         F                                 0.1118

        472         232378 PREDNISONE TAB 50MG              NOVO-PREDNISONE TAB 50MG                 4773         F                                 0.1874
        472         550957 PREDNISONE TAB 50MG              APO PREDNISONE TAB 50MG                  3636         F                                 0.1874

        471          21695 PREDNISONE TAB 5MG               NOVO-PREDNISONE 5MG                      4773         F                                 0.0433
        471         312770 PREDNISONE TAB 5MG               APO PREDNISONE TAB 5MG                   3636         F                                 0.0433

        473         399310 PRIMIDONE TAB 125MG              PRIMIDONE                               14412         F                                 0.0597

        474         396761 PRIMIDONE TAB 250MG              PRIMIDONE                               14412         F                                 0.0940

        475         294926 PROBENECID TAB 500MG             BENURYL                                 11902         F                                 0.2035

        697         789747 PROCHLORPERAZINE INJ 5MG/ML      PROCHLORPERAZINE MESYLATE INJ 5MG/ML    12027         F                                 0.8100

        479         789720 PROCHLORPERAZINE SUP 10MG        SANDOZ PROCHLORPERAZINE                 12027         F                                 0.8964
        479        1927795 PROCHLORPERAZINE SUP 10MG        STEMETIL                                12538         F                                 0.8964

        480         753637 PROCHLORPERAZINE TAB 10MG        PMS-PROCHLORPERAZINE TAB 10MG            3550         F                                 0.2187
        480         886432 PROCHLORPERAZINE TAB 10MG        APO-PROCHLORAZINE TAB 10MG               3636         F                                 0.2187
        480        1927760 PROCHLORPERAZINE TAB 10MG        STEMETIL TAB 10MG                        9522         F                                 0.1393

        481         753661 PROCHLORPERAZINE TAB 5MG         PMS-PROCHLORPERAZINE TAB 5MG             3550         F                                 0.1792
        481         886440 PROCHLORPERAZINE TAB 5MG         APO-PROCHLORAZINE TAB 5MG                3636         F                                 0.1792
        481        1927752 PROCHLORPERAZINE TAB 5MG         STEMETIL TAB 5MG                         9522         F                                 0.1140

        482         587362 PROCYCLIDINE ELX 0.5MG           PMS-PROCYCLIDINE ELX 2.5MG/5ML           3550         F                                 0.0409

        483         587354 PROCYCLIDINE TAB 5MG             PMS-PROCYCLIDINE TAB 5MG                 3550         F                                 0.1348

        924         603708   PROPAFENONE TAB 150MG          RYTHMOL TAB 150MG                        3525         P                                 1.3042      0.4617
        924        2243324   PROPAFENONE TAB 150MG          APO-PROPAFENONE                          3636         F                                 0.4617
        924        2245372   PROPAFENONE TAB 150MG          MYLAN-PROPAFENONE                       13930         F                                 0.4617
        924        2294559   PROPAFENONE TAB 150MG          PMS-PROPAFENONE                          3550         F                                 0.4617
        924        2343053   PROPAFENONE TAB 150MG          PROPAFENONE                             14236         F                                 0.4617

        925         603716   PROPAFENONE TAB 300MG          RYTHMOL TAB 300MG                        3525         P                                 2.2988      0.8140
        925        2243325   PROPAFENONE TAB 300MG          APO-PROPAFENONE                          3636         F                                 0.8140
        925        2245373   PROPAFENONE TAB 300MG          MYLAN-PROPAFENONE                       13930         F                                 0.8140
        925        2294575   PROPAFENONE TAB 300MG          PMS-PROPAFENONE                          3550         F                                 0.8140
        925        2343061   PROPAFENONE TAB 300MG          PROPAFENONE                             14236         F                                 0.8140

        484         402788 PROPRANOLOL TAB 10MG             APO PROPRANOLOL TAB 10MG                 3636         F                                 0.0207
        484         496480 PROPRANOLOL TAB 10MG             NOVO-PRANOL TAB 10MG                     4773         F                                 0.0207
        484        2044684 PROPRANOLOL TAB 10MG             NU-PROPRANOLOL TAB 10MG                  4828         F                                 0.0207

        485         504335 PROPRANOLOL TAB 120MG            APO PROPRANOLOL TAB 120MG                3636         F                                 0.3338

        486         663719 PROPRANOLOL TAB 20MG             APO-PROPRANOLOL TAB 20MG                 3636         F                                 0.0374
        486         740675 PROPRANOLOL TAB 20MG             NOVO-PRANOL TAB 20MG                     4773         F                                 0.0374
        486        2044692 PROPRANOLOL TAB 20MG             NU-PROPRANOLOL TAB 20MG                  4828         F                                 0.0374

        487         402753 PROPRANOLOL TAB 40MG             APO PROPRANOLOL TAB 40MG                 3636         F                                 0.0376
        487         496499 PROPRANOLOL TAB 40MG             NOVO-PRANOL TAB 40MG                     4773         F                                 0.0376
        487        2044706 PROPRANOLOL TAB 40MG             NU-PROPRANOLOL TAB 40MG                  4828         F                                 0.0376
                                                                                  Page 33 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                        Full / Partial   Plan B
             DIN             Chemical Name                                 Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                               LCA Benefit       Only
        488         402761 PROPRANOLOL TAB 80MG                            APO PROPRANOLOL TAB 80MG                 3636         F                                 0.0632
        488         496502 PROPRANOLOL TAB 80MG                            NOVO-PRANOL TAB 80MG                     4773         F                                 0.0632

       1155        2236952   QUETIAPINE FUMARATE TAB 100MG                 SEROQUEL TAB 100MG                       9307         P                                 1.4645      0.5694
       1155        2284243   QUETIAPINE FUMARATE TAB 100MG                 TEVA-QUETIAPINE                         14318         F                                 0.5694
       1155        2296578   QUETIAPINE FUMARATE TAB 100MG                 PMS-QUETIAPINE                           3550         F                                 0.5694
       1155        2299062   QUETIAPINE FUMARATE TAB 100MG                 PHL-QUETIAPINE                           4917         F                                 0.5694
       1155        2307812   QUETIAPINE FUMARATE TAB 100MG                 MYLAN-QUETIAPINE                        13930         F                                 0.5694
       1155        2311712   QUETIAPINE FUMARATE TAB 100MG                 RATIO-QUETIAPINE                        10402         F                                 0.5694
       1155        2313928   QUETIAPINE FUMARATE TAB 100MG                 APO-QUETIAPINE                           3636         F                                 0.5694
       1155        2314002   QUETIAPINE FUMARATE TAB 100MG                 SANDOZ QUETIAPINE                       12027         F                                 0.5694
       1155        2316099   QUETIAPINE FUMARATE TAB 100MG                 CO QUETIAPINE                           10028         F                                 0.5694
       1155        2330423   QUETIAPINE FUMARATE TAB 100MG                 JAMP-QUETIAPINE                          4415         F                                 0.5694
       1155        2353172   QUETIAPINE FUMARATE TAB 100MG                 QUETIAPINE                              14236         F                                 0.5694

       1156        2236953   QUETIAPINE FUMARATE TAB 200MG                 SEROQUEL TAB 200MG                       9307         P                                 2.9406      1.1435
       1156        2284278   QUETIAPINE FUMARATE TAB 200MG                 TEVA-QUETIAPINE                         14318         F                                 1.1435
       1156        2296594   QUETIAPINE FUMARATE TAB 200MG                 PMS-QUETIAPINE                           3550         F                                 1.1435
       1156        2299089   QUETIAPINE FUMARATE TAB 200MG                 PHL-QUETIAPINE                           4917         F                                 1.1435
       1156        2307839   QUETIAPINE FUMARATE TAB 200MG                 MYLAN-QUETIAPINE                        13930         F                                 1.1435
       1156        2311747   QUETIAPINE FUMARATE TAB 200MG                 RATIO-QUETIAPINE                        10402         F                                 1.1435
       1156        2313936   QUETIAPINE FUMARATE TAB 200MG                 APO-QUETIAPINE                           3636         F                                 1.1435
       1156        2314010   QUETIAPINE FUMARATE TAB 200MG                 SANDOZ QUETIAPINE                       12027         F                                 1.1435
       1156        2316110   QUETIAPINE FUMARATE TAB 200MG                 CO QUETIAPINE                           10028         F                                 1.1435
       1156        2330458   QUETIAPINE FUMARATE TAB 200MG                 JAMP-QUETIAPINE                          4415         F                                 1.1435
       1156        2353199   QUETIAPINE FUMARATE TAB 200MG                 QUETIAPINE                              14236         F                                 1.1435

       1154        2236951   QUETIAPINE FUMARATE TAB 25MG                  SEROQUEL TAB 25MG                        9307         P                                 0.5490      0.2134
       1154        2284235   QUETIAPINE FUMARATE TAB 25MG                  TEVA-QUETIAPINE                         14318         F                                 0.2134
       1154        2296551   QUETIAPINE FUMARATE TAB 25MG                  PMS-QUETIAPINE                           3550         F                                 0.2134
       1154        2299054   QUETIAPINE FUMARATE TAB 25MG                  PHL-QUETIAPINE                           4917         F                                 0.2134
       1154        2307804   QUETIAPINE FUMARATE TAB 25MG                  MYLAN-QUETIAPINE                        13930         F                                 0.2134
       1154        2311704   QUETIAPINE FUMARATE TAB 25MG                  RATIO-QUETIAPINE                        10402         F                                 0.2134
       1154        2313901   QUETIAPINE FUMARATE TAB 25MG                  APO-QUETIAPINE                           3636         F                                 0.2134
       1154        2313995   QUETIAPINE FUMARATE TAB 25MG                  SANDOZ QUETIAPINE                       12027         F                                 0.2134
       1154        2316080   QUETIAPINE FUMARATE TAB 25MG                  CO QUETIAPINE                           10028         F                                 0.2134
       1154        2330415   QUETIAPINE FUMARATE TAB 25MG                  JAMP-QUETIAPINE                          4415         F                                 0.2134
       1154        2353164   QUETIAPINE FUMARATE TAB 25MG                  QUETIAPINE                              14236         F                                 0.2134

       1157        2244107   QUETIAPINE FUMARATE TAB 300MG                 SEROQUEL 300 MG                          9307         P                                 4.2908      1.6686
       1157        2284286   QUETIAPINE FUMARATE TAB 300MG                 TEVA-QUETIAPINE                         14318         F                                 1.6686
       1157        2296608   QUETIAPINE FUMARATE TAB 300MG                 PMS-QUETIAPINE                           3550         F                                 1.6686
       1157        2299097   QUETIAPINE FUMARATE TAB 300MG                 PHL-QUETIAPINE                           4917         F                                 1.6686
       1157        2307847   QUETIAPINE FUMARATE TAB 300MG                 MYLAN-QUETIAPINE                        13930         F                                 1.6686
       1157        2311755   QUETIAPINE FUMARATE TAB 300MG                 RATIO-QUETIAPINE                        10402         F                                 1.6686
       1157        2313944   QUETIAPINE FUMARATE TAB 300MG                 APO-QUETIAPINE                           3636         F                                 1.6686
       1157        2314029   QUETIAPINE FUMARATE TAB 300MG                 SANDOZ QUETIAPINE                       12027         F                                 1.6686
       1157        2316129   QUETIAPINE FUMARATE TAB 300MG                 CO QUETIAPINE                           10028         F                                 1.6686
       1157        2330466   QUETIAPINE FUMARATE TAB 300MG                 JAMP-QUETIAPINE                          4415         F                                 1.6686
       1157        2353202   QUETIAPINE FUMARATE TAB 300MG                 QUETIAPINE                              14236         F                                 1.6686

       1252        2361892 QUETIAPINE FUMARATE TAB 50MG                    PMS-QUETIAPINE                           3550         F                                 0.3914

        490        1947672 QUINAPRIL TAB 10MG                              ACCUPRIL TAB 10MG                        4908         F                   REF           0.9402

        491        1947680 QUINAPRIL TAB 20MG                              ACCUPRIL TAB 20MG                        4908         F                   REF           0.9402

        492        1947699 QUINAPRIL TAB 40MG                              ACCUPRIL TAB 40MG                        4908         F                   REF           0.9402

        493        1947664 QUINAPRIL TAB 5MG                               ACCUPRIL 5MG TAB                         4908         F                   REF           0.9402

       1163        2237367 QUINAPRIL/HYDROCHLOROTHIAZIDE TAB 10/12.5MG     ACCURETIC 10/12.5 MG                     4908         F                   REF           0.9400

       1164        2237368 QUINAPRIL/HYDROCHLOROTHIAZIDE TAB 20/12.5MG     ACCURETIC 20/12.5 MG                     4908         F                   REF           0.9400

       1127        2243796   RABEPRAZOLE SODIUM TAB 10MG                   PARIET, ENTERIC-COATED TABLET 10MG       7259         P                         X       0.7223      0.2808
       1127        2296632   RABEPRAZOLE SODIUM TAB 10MG                   TEVA-RABEPRAZOLE EC                     14318         F                         X       0.2808
       1127        2298074   RABEPRAZOLE SODIUM TAB 10MG                   RAN-RABEPRAZOLE                         11271         F                         X       0.2808
       1127        2310805   RABEPRAZOLE SODIUM TAB 10MG                   PMS-RABEPRAZOLE EC                       3550         F                         X       0.2808
       1127        2314177   RABEPRAZOLE SODIUM TAB 10MG                   SANDOZ RABEPRAZOLE                      12027         F                         X       0.2808
       1127        2345579   RABEPRAZOLE SODIUM TAB 10MG                   APO-RABEPRAZOLE 10 MG TAB DR             3636         F                         X       0.2808
       1127        2356511   RABEPRAZOLE SODIUM TAB 10MG                   RABEPRAZOLE EC                          14236         F                         X       0.2808

       1128        2243797   RABEPRAZOLE SODIUM TAB 20MG                   PARIET, ENTERIC-COATED TABLET 20MG       7259         P                         X       1.4447      0.5616
       1128        2296640   RABEPRAZOLE SODIUM TAB 20MG                   TEVA-RABEPRAZOLE EC                     14318         F                         X       0.5616
       1128        2298082   RABEPRAZOLE SODIUM TAB 20MG                   RAN-RABEPRAZOLE                         11271         F                         X       0.5616
       1128        2310813   RABEPRAZOLE SODIUM TAB 20MG                   PMS-RABEPRAZOLE EC                       3550         F                         X       0.5616
       1128        2314185   RABEPRAZOLE SODIUM TAB 20MG                   SANDOZ RABEPRAZOLE                      12027         F                         X       0.5616
       1128        2345587   RABEPRAZOLE SODIUM TAB 20MG                   APO-RABEPRAZOLE 20 MG TAB DR             3636         F                         X       0.5616
       1128        2356538   RABEPRAZOLE SODIUM TAB 20MG                   RABEPRAZOLE EC                          14236         F                         X       0.5616

       1169        2239028   RALOXIFENE HYDROCHLORIDE TAB 60MG             EVISTA (60MG)                            7005         P                         X       1.9803      1.4852
       1169        2279215   RALOXIFENE HYDROCHLORIDE TAB 60MG             APO-RALOXIFENE                           3636         F                         X       1.4852
       1169        2312298   RALOXIFENE HYDROCHLORIDE TAB 60MG             NOVO-RALOXIFENE                          4773         F                         X       1.4852
       1169        2358921   RALOXIFENE HYDROCHLORIDE TAB 60MG             PMS-RALOXIFENE 60 MG TABLET              3550         F                         X       1.4852

       1179        2281112 RAMIPRIL CAP 15MG                               ALTACE                                  12538         P                   REF           1.2118      0.6323
       1179        2311194 RAMIPRIL CAP 15MG                               RATIO-RAMIPRIL                          10402         F                   REF           0.6323
       1179        2325381 RAMIPRIL CAP 15MG                               APO-RAMIPRIL                             3636         F                   REF           0.6323

       1209        2283166 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 10MG/12.5MG    ALTACE HCT                              12538         P                   REF           0.5238      0.3094
       1209        2342154 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 10MG/12.5MG    PMS-RAMIPRIL-HCTZ                        3550         F                   REF           0.3094

       1210        2283182 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 10MG/25MG      ALTACE HCT                              12538         P                   REF           0.5238      0.3094
       1210        2342170 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 10MG/25MG      PMS-RAMIPRIL-HCTZ                        3550         F                   REF           0.3094

       1241        2283131 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 2.5MG/12.5MG   ALTACE HCT                              12538         P                   REF           0.4049      0.2430
       1241        2342138 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 2.5MG/12.5MG   PMS-RAMIPRIL-HCTZ                        3550         F                   REF           0.2430

       1242        2283158 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 5MG/12.5MG     ALTACE HCT                              12538         P                   REF           0.4135      0.2444
       1242        2342146 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 5MG/12.5MG     PMS-RAMIPRIL-HCTZ                        3550         F                   REF           0.2444

       1243        2283174 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 5MG/25MG       ALTACE HCT                              12538         P                   REF           0.4135      0.2444
       1243        2342162 RAMIPRIL HYDROCHLOROTHIAZIDE TAB 5MG/25MG       PMS-RAMIPRIL-HCTZ                        3550         F                   REF           0.2444

        495        2221829 RAMIPRIL TAB 1.25MG                             ALTACE                                  12538         P                   REF           0.7489      0.2996
        495        2251515 RAMIPRIL TAB 1.25MG                             APO-RAMIPRIL                             3636         F                   REF           0.2996
                                                                                                  Page 34 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                        Full / Partial   Plan B
             DIN             Chemical Name                   Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                               LCA Benefit       Only
        495        2287692   RAMIPRIL TAB 1.25MG             RATIO-RAMIPRIL                        10402         F                   REF           0.2996
        495        2291398   RAMIPRIL TAB 1.25MG             SANDOZ RAMIPRIL                       12027         F                   REF           0.2996
        495        2295369   RAMIPRIL TAB 1.25MG             PMS-RAMIPRIL                           3550         F                   REF           0.2996
        495        2295482   RAMIPRIL TAB 1.25MG             CO RAMIPRIL                           10028         F                   REF           0.2996
        495        2301148   RAMIPRIL TAB 1.25MG             MYLAN-RAMIPRIL                        13930         F                   REF           0.2996
        495        2310503   RAMIPRIL TAB 1.25MG             RAN-RAMIPRIL                          11271         F                   REF           0.2996
        495        2331101   RAMIPRIL TAB 1.25MG             JAMP-RAMIPRIL                          4415         F                   REF           0.2996
        495        2332299   RAMIPRIL TAB 1.25MG             RAMIPRIL 1.25 MG CAPSULE              11271         F                   REF           0.2996

        496        2221853   RAMIPRIL TAB 10MG               ALTACE                                12538         P                   REF           1.0945      0.4378
        496        2247919   RAMIPRIL TAB 10MG               PMS-RAMIPRIL                           3550         F                   REF           0.4378
        496        2247947   RAMIPRIL TAB 10MG               TEVA-RAMIPRIL                         14318         F                   REF           0.4378
        496        2251582   RAMIPRIL TAB 10MG               APO-RAMIPRIL                           3636         F                   REF           0.4378
        496        2287722   RAMIPRIL TAB 10MG               RATIO-RAMIPRIL                        10402         F                   REF           0.4378
        496        2291436   RAMIPRIL TAB 10MG               SANDOZ RAMIPRIL                       12027         F                   REF           0.4378
        496        2295512   RAMIPRIL TAB 10MG               CO RAMIPRIL                           10028         F                   REF           0.4378
        496        2301172   RAMIPRIL TAB 10MG               MYLAN-RAMIPRIL                        13930         F                   REF           0.4378
        496        2310546   RAMIPRIL TAB 10MG               RAN-RAMIPRIL                          11271         F                   REF           0.4378
        496        2331144   RAMIPRIL TAB 10MG               JAMP-RAMIPRIL                          4415         F                   REF           0.4378
        496        2332329   RAMIPRIL TAB 10MG               RAMIPRIL 10 MG CAPSULE                11271         F                   REF           0.4378

        497        2221837   RAMIPRIL TAB 2.5MG              ALTACE                                12538         P                   REF           0.8640      0.3456
        497        2247917   RAMIPRIL TAB 2.5MG              PMS-RAMIPRIL                           3550         F                   REF           0.3456
        497        2247945   RAMIPRIL TAB 2.5MG              TEVA-RAMIPRIL                         14318         F                   REF           0.3456
        497        2251531   RAMIPRIL TAB 2.5MG              APO-RAMIPRIL                           3636         F                   REF           0.3456
        497        2287706   RAMIPRIL TAB 2.5MG              RATIO-RAMIPRIL                        10402         F                   REF           0.3456
        497        2291401   RAMIPRIL TAB 2.5MG              SANDOZ RAMIPRIL                       12027         F                   REF           0.3456
        497        2295490   RAMIPRIL TAB 2.5MG              CO RAMIPRIL                           10028         F                   REF           0.3456
        497        2301156   RAMIPRIL TAB 2.5MG              MYLAN-RAMIPRIL                        13930         F                   REF           0.3456
        497        2310511   RAMIPRIL TAB 2.5MG              RAN-RAMIPRIL                          11271         F                   REF           0.3456
        497        2331128   RAMIPRIL TAB 2.5MG              JAMP-RAMIPRIL                          4415         F                   REF           0.3456
        497        2332302   RAMIPRIL TAB 2.5MG              RAMIPRIL 2.5 MG CAPSULE               11271         F                   REF           0.3456

        498        2221845   RAMIPRIL TAB 5MG                ALTACE                                12538         P                   REF           0.8640      0.3456
        498        2247918   RAMIPRIL TAB 5MG                PMS-RAMIPRIL                           3550         F                   REF           0.3456
        498        2247946   RAMIPRIL TAB 5MG                TEVA-RAMIPRIL                         14318         F                   REF           0.3456
        498        2251574   RAMIPRIL TAB 5MG                APO-RAMIPRIL                           3636         F                   REF           0.3456
        498        2287714   RAMIPRIL TAB 5MG                RATIO-RAMIPRIL                        10402         F                   REF           0.3456
        498        2291428   RAMIPRIL TAB 5MG                SANDOZ RAMIPRIL                       12027         F                   REF           0.3456
        498        2295504   RAMIPRIL TAB 5MG                CO RAMIPRIL                           10028         F                   REF           0.3456
        498        2301164   RAMIPRIL TAB 5MG                MYLAN-RAMIPRIL                        13930         F                   REF           0.3456
        498        2310538   RAMIPRIL TAB 5MG                RAN-RAMIPRIL                          11271         F                   REF           0.3456
        498        2331136   RAMIPRIL TAB 5MG                JAMP-RAMIPRIL                          4415         F                   REF           0.3456
        498        2332310   RAMIPRIL TAB 5MG                RAMIPRIL 5 MG CAPSULE                 11271         F                   REF           0.3456

       1029        2212366 RANITIDINE HCL INJ 25MG/ML        ZANTAC                                 9985         P                                 1.5115      1.3694
       1029        2256711 RANITIDINE HCL INJ 25MG/ML        RANITIDINE INJECTION USP              12027         F                                 1.3694

       1012        2212374 RANITIDINE HCL ORAL SOL 15MG/ML   ZANTAC                                 9985         P                                 0.2252      0.1007
       1012        2242940 RANITIDINE HCL ORAL SOL 15MG/ML   TEVA-RANITIDINE SOLUTION              14318         F                                 0.1007
       1012        2280833 RANITIDINE HCL ORAL SOL 15MG/ML   APO-RANITIDINE                         3636         F                                 0.1007

        500         733059   RANITIDINE TAB 150MG            APO-RANITIDINE TABLET 150MG            3636         F                   REF           0.1944
        500         828564   RANITIDINE TAB 150MG            TEVA-RANITIDINE                       14318         F                   REF           0.1944
        500         828823   RANITIDINE TAB 150MG            RATIO-RANITIDINE                      10402         F                   REF           0.1944
        500         865737   RANITIDINE TAB 150MG            NU-RANIT TAB 150MG                     4828         F                   REF           0.1944
        500        2207761   RANITIDINE TAB 150MG            MYLAN-RANITIDINE                      13930         F                   REF           0.1944
        500        2212331   RANITIDINE TAB 150MG            ZANTAC                                 9985         F                   REF           0.1944
        500        2242453   RANITIDINE TAB 150MG            PMS-RANITIDINE 150 MG                  3550         F                   REF           0.1944
        500        2243229   RANITIDINE TAB 150MG            SANDOZ RANITIDINE                     12027         F                   REF           0.1944
        500        2248570   RANITIDINE TAB 150MG            CO RANITIDINE                         10028         F                   REF           0.1944
        500        2336480   RANITIDINE TAB 150MG            RAN-RANITIDINE                        11271         F                   REF           0.1944
        500        2353016   RANITIDINE TAB 150MG            RANITIDINE                            14236         F                   REF           0.1944
        500        2367378   RANITIDINE TAB 150MG            MYL-RANITIDINE 150 MG TABLET          13930         F                   REF           0.1944

        501         733067   RANITIDINE TAB 300MG            APO-RANITIDINE TABLET 300MG            3636         F                   REF           0.3888
        501         828556   RANITIDINE TAB 300MG            TEVA-RANITIDINE                       14318         F                   REF           0.3888
        501         828688   RANITIDINE TAB 300MG            RATIO-RANITIDINE                      10402         F                   REF           0.3888
        501         865745   RANITIDINE TAB 300MG            NU-RANIT TAB 300MG                     4828         F                   REF           0.3888
        501        2207788   RANITIDINE TAB 300MG            MYLAN-RANITIDINE                      13930         F                   REF           0.3888
        501        2212358   RANITIDINE TAB 300MG            ZANTAC                                 9985         F                   REF           0.3888
        501        2242454   RANITIDINE TAB 300MG            PMS-RANITIDINE 300 MG                  3550         F                   REF           0.3888
        501        2243230   RANITIDINE TAB 300MG            SANDOZ RANITIDINE                     12027         F                   REF           0.3888
        501        2248571   RANITIDINE TAB 300MG            CO RANITIDINE                         10028         F                   REF           0.3888
        501        2336502   RANITIDINE TAB 300MG            RAN-RANITIDINE                        11271         F                   REF           0.3888
        501        2353024   RANITIDINE TAB 300MG            RANITIDINE                            14236         F                   REF           0.3888
        501        2367386   RANITIDINE TAB 300MG            MYL-RANITIDINE 300 MG TABLET          13930         F                   REF           0.3888

       1191        2239146 RISEDRONATE SODIUM TAB 30MG       ACTONEL                               14339         P                         X      12.7440      5.3525
       1191        2298384 RISEDRONATE SODIUM TAB 30MG       NOVO-RISEDRONATE                       4773         F                         X       5.3525

       1192        2246896   RISEDRONATE SODIUM TAB 35MG     ACTONEL                               14339         P                         X      10.7541      4.1969
       1192        2298392   RISEDRONATE SODIUM TAB 35MG     NOVO-RISEDRONATE                       4773         F                         X       4.1969
       1192        2302209   RISEDRONATE SODIUM TAB 35MG     PMS-RISEDRONATE                        3550         F                         X       4.1969
       1192        2319861   RISEDRONATE SODIUM TAB 35MG     RATIO-RISEDRONATE                     10402         F                         X       4.1969
       1192        2327295   RISEDRONATE SODIUM TAB 35MG     SANDOZ RISEDRONATE                    12027         F                         X       4.1969
       1192        2353687   RISEDRONATE SODIUM TAB 35MG     APO-RISEDRONATE                        3636         F                         X       4.1969

       1190        2242518 RISEDRONATE SODIUM TAB 5MG        ACTONEL                               14339         P                         X       1.9671      0.8262
       1190        2298376 RISEDRONATE SODIUM TAB 5MG        NOVO-RISEDRONATE                       4773         F                         X       0.8262

       1089        2236950 RISPERIDONE ORAL SOL 1MG/ML       RISPERDAL ORAL SOLUTION                7259         P                                 0.5963      0.5754
       1089        2279266 RISPERIDONE ORAL SOL 1MG/ML       PMS-RISPERIDONE                        3550         F                                 0.5754
       1089        2280396 RISPERIDONE ORAL SOL 1MG/ML       APO-RISPERIDONE                        3636         F                                 0.5754

       1083        2240551   RISPERIDONE TAB 0.25MG          RISPERDAL                              7259         P                                 0.2241      0.2163
       1083        2252007   RISPERIDONE TAB 0.25MG          PMS-RISPERIDONE                        3550         F                                 0.2163
       1083        2280906   RISPERIDONE TAB 0.25MG          RAN-RISPERIDONE                       11271         F                                 0.2163
       1083        2282119   RISPERIDONE TAB 0.25MG          APO-RISPERIDONE                        3636         F                                 0.2163
       1083        2282240   RISPERIDONE TAB 0.25MG          MYLAN-RISPERIDONE                     13930         F                                 0.2163
       1083        2282585   RISPERIDONE TAB 0.25MG          CO RISPERIDONE                        10028         F                                 0.2163
       1083        2282690   RISPERIDONE TAB 0.25MG          NOVO-RISPERIDONE                       4773         F                                 0.2163
       1083        2303655   RISPERIDONE TAB 0.25MG          SANDOZ RISPERIDONE                    12027         F                                 0.2163
       1083        2328305   RISPERIDONE TAB 0.25MG          RBX-RISPERIDONE                       11271         F                                 0.2163
       1083        2332051   RISPERIDONE TAB 0.25MG          RISPERIDONE 0.25 MG TABLET            11271         F                                 0.2163
       1083        2356880   RISPERIDONE TAB 0.25MG          RISPERIDONE                           14236         F                                 0.2163
       1083        2359529   RISPERIDONE TAB 0.25MG          JAMP-RISPERIDONE                       4415         F                                 0.2163
                                                                                  Page 35 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                   Full / Partial   Plan B
             DIN             Chemical Name               Drug Name                           MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                          LCA Benefit       Only
       1083        2359790 RISPERIDONE TAB 0.25MG        MINT-RISPERIDON                      13221         F                                 0.2163
       1083        2371766 RISPERIDONE TAB 0.25MG        MAR-RISPERIDONE 0.25 MG TABLET       14907         F                                 0.2163

       1084        2240552   RISPERIDONE TAB 0.5MG       RISPERDAL                             7259         P                                 0.3753      0.3623
       1084        2252015   RISPERIDONE TAB 0.5MG       PMS-RISPERIDONE                       3550         F                                 0.3623
       1084        2264188   RISPERIDONE TAB 0.5MG       NOVO-RISPERIDONE                      4773         F                                 0.3623
       1084        2280914   RISPERIDONE TAB 0.5MG       RAN-RISPERIDONE                      11271         F                                 0.3623
       1084        2282127   RISPERIDONE TAB 0.5MG       APO-RISPERIDONE                       3636         F                                 0.3623
       1084        2282259   RISPERIDONE TAB 0.5MG       MYLAN-RISPERIDONE                    13930         F                                 0.3623
       1084        2282593   RISPERIDONE TAB 0.5MG       CO RISPERIDONE                       10028         F                                 0.3623
       1084        2303663   RISPERIDONE TAB 0.5MG       SANDOZ RISPERIDONE                   12027         F                                 0.3623
       1084        2328313   RISPERIDONE TAB 0.5MG       RBX-RISPERIDONE                      11271         F                                 0.3623
       1084        2332078   RISPERIDONE TAB 0.5MG       RISPERIDONE 0.5 MG TABLET            11271         F                                 0.3623
       1084        2356899   RISPERIDONE TAB 0.5MG       RISPERIDONE                          14236         F                                 0.3623
       1084        2359537   RISPERIDONE TAB 0.5MG       JAMP-RISPERIDONE                      4415         F                                 0.3623
       1084        2359804   RISPERIDONE TAB 0.5MG       MINT-RISPERIDON                      13221         F                                 0.3623
       1084        2371774   RISPERIDONE TAB 0.5MG       MAR-RISPERIDONE 0.5 MG TABLET        14907         F                                 0.3623

       1085        2025280   RISPERIDONE TAB 1MG         RISPERDAL                             7259         P                                 0.5184      0.5005
       1085        2252023   RISPERIDONE TAB 1MG         PMS-RISPERIDONE                       3550         F                                 0.5005
       1085        2264196   RISPERIDONE TAB 1MG         NOVO-RISPERIDONE                      4773         F                                 0.5005
       1085        2279800   RISPERIDONE TAB 1MG         SANDOZ RISPERIDONE                   12027         F                                 0.5005
       1085        2280922   RISPERIDONE TAB 1MG         RAN-RISPERIDONE                      11271         F                                 0.5005
       1085        2282135   RISPERIDONE TAB 1MG         APO-RISPERIDONE                       3636         F                                 0.5005
       1085        2282267   RISPERIDONE TAB 1MG         MYLAN-RISPERIDONE                    13930         F                                 0.5005
       1085        2282607   RISPERIDONE TAB 1MG         CO RISPERIDONE                       10028         F                                 0.5005
       1085        2328321   RISPERIDONE TAB 1MG         RBX-RISPERIDONE                      11271         F                                 0.5005
       1085        2332086   RISPERIDONE TAB 1MG         RISPERIDONE 1 MG TABLET              11271         F                                 0.5005
       1085        2356902   RISPERIDONE TAB 1MG         RISPERIDONE                          14236         F                                 0.5005
       1085        2359545   RISPERIDONE TAB 1MG         JAMP-RISPERIDONE                      4415         F                                 0.5005
       1085        2359812   RISPERIDONE TAB 1MG         MINT-RISPERIDON                      13221         F                                 0.5005
       1085        2371782   RISPERIDONE TAB 1MG         MAR-RISPERIDONE 1 MG TABLET          14907         F                                 0.5005

       1086        2025299   RISPERIDONE TAB 2MG         RISPERDAL                             7259         P                                 1.0350      0.9992
       1086        2252031   RISPERIDONE TAB 2MG         PMS-RISPERIDONE                       3550         F                                 0.9992
       1086        2264218   RISPERIDONE TAB 2MG         NOVO-RISPERIDONE                      4773         F                                 0.9992
       1086        2279819   RISPERIDONE TAB 2MG         SANDOZ RISPERIDONE                   12027         F                                 0.9992
       1086        2280930   RISPERIDONE TAB 2MG         RAN-RISPERIDONE                      11271         F                                 0.9992
       1086        2282143   RISPERIDONE TAB 2MG         APO-RISPERIDONE                       3636         F                                 0.9992
       1086        2282275   RISPERIDONE TAB 2MG         MYLAN-RISPERIDONE                    13930         F                                 0.9992
       1086        2282615   RISPERIDONE TAB 2MG         CO RISPERIDONE                       10028         F                                 0.9992
       1086        2328348   RISPERIDONE TAB 2MG         RBX-RISPERIDONE                      11271         F                                 0.9992
       1086        2332094   RISPERIDONE TAB 2MG         RISPERIDONE 2 MG TABLET              11271         F                                 0.9992
       1086        2356910   RISPERIDONE TAB 2MG         RISPERIDONE                          14236         F                                 0.9992
       1086        2359553   RISPERIDONE TAB 2MG         JAMP-RISPERIDONE                      4415         F                                 0.9992
       1086        2359820   RISPERIDONE TAB 2MG         MINT-RISPERIDON                      13221         F                                 0.9992
       1086        2371790   RISPERIDONE TAB 2MG         MAR-RISPERIDONE 2 MG TABLET          14907         F                                 0.9992

       1087        2025302   RISPERIDONE TAB 3MG         RISPERDAL                             7259         P                                 1.5525      1.4988
       1087        2252058   RISPERIDONE TAB 3MG         PMS-RISPERIDONE                       3550         F                                 1.4988
       1087        2264226   RISPERIDONE TAB 3MG         NOVO-RISPERIDONE                      4773         F                                 1.4988
       1087        2279827   RISPERIDONE TAB 3MG         SANDOZ RISPERIDONE                   12027         F                                 1.4988
       1087        2280949   RISPERIDONE TAB 3MG         RAN-RISPERIDONE                      11271         F                                 1.4988
       1087        2282151   RISPERIDONE TAB 3MG         APO-RISPERIDONE                       3636         F                                 1.4988
       1087        2282283   RISPERIDONE TAB 3MG         MYLAN-RISPERIDONE                    13930         F                                 1.4988
       1087        2282623   RISPERIDONE TAB 3MG         CO RISPERIDONE                       10028         F                                 1.4988
       1087        2328364   RISPERIDONE TAB 3MG         RBX-RISPERIDONE                      11271         F                                 1.4988
       1087        2332108   RISPERIDONE TAB 3MG         RISPERIDONE 3 MG TABLET              11271         F                                 1.4988
       1087        2356929   RISPERIDONE TAB 3MG         RISPERIDONE                          14236         F                                 1.4988
       1087        2359561   RISPERIDONE TAB 3MG         JAMP-RISPERIDONE                      4415         F                                 1.4988
       1087        2359839   RISPERIDONE TAB 3MG         MINT-RISPERIDON                      13221         F                                 1.4988
       1087        2371804   RISPERIDONE TAB 3MG         MAR-RISPERIDONE 3 MG TABLET          14907         F                                 1.4988

       1088        2025310   RISPERIDONE TAB 4MG         RISPERDAL                             7259         P                                 2.0700      1.9984
       1088        2252066   RISPERIDONE TAB 4MG         PMS-RISPERIDONE                       3550         F                                 1.9984
       1088        2264234   RISPERIDONE TAB 4MG         NOVO-RISPERIDONE                      4773         F                                 1.9984
       1088        2279835   RISPERIDONE TAB 4MG         SANDOZ RISPERIDONE                   12027         F                                 1.9984
       1088        2280957   RISPERIDONE TAB 4MG         RAN-RISPERIDONE                      11271         F                                 1.9984
       1088        2282178   RISPERIDONE TAB 4MG         APO-RISPERIDONE                       3636         F                                 1.9984
       1088        2282291   RISPERIDONE TAB 4MG         MYLAN-RISPERIDONE                    13930         F                                 1.9984
       1088        2282631   RISPERIDONE TAB 4MG         CO RISPERIDONE                       10028         F                                 1.9984
       1088        2328372   RISPERIDONE TAB 4MG         RBX-RISPERIDONE                      11271         F                                 1.9984
       1088        2332116   RISPERIDONE TAB 4MG         RISPERIDONE 4 MG TABLET              11271         F                                 1.9984
       1088        2356937   RISPERIDONE TAB 4MG         RISPERIDONE                          14236         F                                 1.9984
       1088        2359588   RISPERIDONE TAB 4MG         JAMP-RISPERIDONE                      4415         F                                 1.9984
       1088        2359847   RISPERIDONE TAB 4MG         MINT-RISPERIDON                      13221         F                                 1.9984
       1088        2371812   RISPERIDONE TAB 4MG         MAR-RISPERIDONE 4 MG TABLET          14907         F                                 1.9984

       1173        2232565   ROPINIROLE HCL TAB 0.25MG   REQUIP                                9985         P                         X       0.3065      0.1226
       1173        2314037   ROPINIROLE HCL TAB 0.25MG   RAN-ROPINIROLE                       11271         F                         X       0.1226
       1173        2316846   ROPINIROLE HCL TAB 0.25MG   CO ROPINIROLE                        10028         F                         X       0.1226
       1173        2326590   ROPINIROLE HCL TAB 0.25MG   PMS-ROPINIROLE                        3550         F                         X       0.1226
       1173        2332361   ROPINIROLE HCL TAB 0.25MG   ROPINIROLE 0.25 MG TABLET            11271         F                         X       0.1226
       1173        2337746   ROPINIROLE HCL TAB 0.25MG   APO-ROPINIROLE 0.25 MG TABLET         3636         F                         X       0.1226
       1173        2352338   ROPINIROLE HCL TAB 0.25MG   JAMP-ROPINIROLE                       4415         F                         X       0.1226
       1173        2353040   ROPINIROLE HCL TAB 0.25MG   ROPINIROLE                           14236         F                         X       0.1226

       1174        2232567   ROPINIROLE HCL TAB 1MG      REQUIP                                9985         P                         X       1.2261      0.4904
       1174        2314053   ROPINIROLE HCL TAB 1MG      RAN-ROPINIROLE                       11271         F                         X       0.4904
       1174        2316854   ROPINIROLE HCL TAB 1MG      CO ROPINIROLE                        10028         F                         X       0.4904
       1174        2326612   ROPINIROLE HCL TAB 1MG      PMS-ROPINIROLE                        3550         F                         X       0.4904
       1174        2332426   ROPINIROLE HCL TAB 1MG      ROPINIROLE 1 MG TABLET               11271         F                         X       0.4904
       1174        2337762   ROPINIROLE HCL TAB 1MG      APO-ROPINIROLE 1 MG TABLET            3636         F                         X       0.4904
       1174        2352346   ROPINIROLE HCL TAB 1MG      JAMP-ROPINIROLE                       4415         F                         X       0.4904
       1174        2353059   ROPINIROLE HCL TAB 1MG      ROPINIROLE                           14236         F                         X       0.4904

       1175        2232568   ROPINIROLE HCL TAB 2MG      REQUIP                                9985         P                         X       1.3488      0.5396
       1175        2314061   ROPINIROLE HCL TAB 2MG      RAN-ROPINIROLE                       11271         F                         X       0.5396
       1175        2316862   ROPINIROLE HCL TAB 2MG      CO ROPINIROLE                        10028         F                         X       0.5396
       1175        2326620   ROPINIROLE HCL TAB 2MG      PMS-ROPINIROLE                        3550         F                         X       0.5396
       1175        2332434   ROPINIROLE HCL TAB 2MG      ROPINIROLE 2 MG TABLET               11271         F                         X       0.5396
       1175        2337770   ROPINIROLE HCL TAB 2MG      APO-ROPINIROLE 2 MG TABLET            3636         F                         X       0.5396
       1175        2352354   ROPINIROLE HCL TAB 2MG      JAMP-ROPINIROLE                       4415         F                         X       0.5396
       1175        2353067   ROPINIROLE HCL TAB 2MG      ROPINIROLE                           14236         F                         X       0.5396

       1176        2232569 ROPINIROLE HCL TAB 5MG        REQUIP                                9985         P                         X       3.7135      1.4854
       1176        2314088 ROPINIROLE HCL TAB 5MG        RAN-ROPINIROLE                       11271         F                         X       1.4854
                                                                             Page 36 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                     Full / Partial   Plan B
             DIN             Chemical Name                              Drug Name                              MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                            LCA Benefit       Only
       1176        2316870   ROPINIROLE HCL TAB 5MG                     CO ROPINIROLE                           10028         F                         X       1.4854
       1176        2326639   ROPINIROLE HCL TAB 5MG                     PMS-ROPINIROLE                           3550         F                         X       1.4854
       1176        2332442   ROPINIROLE HCL TAB 5MG                     ROPINIROLE 5 MG TABLET                  11271         F                         X       1.4854
       1176        2337800   ROPINIROLE HCL TAB 5MG                     APO-ROPINIROLE 5 MG TABLET               3636         F                         X       1.4854
       1176        2352362   ROPINIROLE HCL TAB 5MG                     JAMP-ROPINIROLE                          4415         F                         X       1.4854
       1176        2353075   ROPINIROLE HCL TAB 5MG                     ROPINIROLE                              14236         F                         X       1.4854

        502        2241497   SALBUTAMOL AER INH 100MCG                  VENTOLIN HFA                             9985         P                                 0.0351      0.0324
        502        2232570   SALBUTAMOL AER INH 100MCG                  AIROMIR                                 12934         F                                 0.0324
        502        2245669   SALBUTAMOL AER INH 100MCG                  APO-SALVENT CFC FREE                     3636         F                                 0.0324
        502        2326450   SALBUTAMOL AER INH 100MCG                  NOVO-SALBUTAMOL HFA                      4773         F                                 0.0324

        503        2208245 SALBUTAMOL NEBULE PF SOL 0.5MG/ML            PMS-SALBUTAMOL                           3550         F                         X       0.1160
        503        2239365 SALBUTAMOL NEBULE PF SOL 0.5MG/ML            RATIO-SALBUTAMOL                        10402         F                         X       0.1160

        504        2213419   SALBUTAMOL NEBULE PF SOL 1MG/ML            VENTOLIN NEBULES P.F. - 2.5MG/2.5ML      9985         P                         X       1.1162      0.2629
        504        1926934   SALBUTAMOL NEBULE PF SOL 1MG/ML            MYLAN-SALBUTAMOL STERINEBS P.F.         13930         F                         X       0.2629
        504        1986864   SALBUTAMOL NEBULE PF SOL 1MG/ML            RATIO-SALBUTAMOL                        10402         F                         X       0.2629
        504        2208229   SALBUTAMOL NEBULE PF SOL 1MG/ML            PMS-SALBUTAMOL                           3550         F                         X       0.2629

        505        2213427   SALBUTAMOL NEBULE PF SOL 2MG/ML            VENTOLIN NEBULES P.F. - 5MG/2.5ML        9985         P                         X       2.1200      0.4992
        505        2173360   SALBUTAMOL NEBULE PF SOL 2MG/ML            MYLAN-SALBUTAMOL STERINEBS P.F.         13930         F                         X       0.4992
        505        2208237   SALBUTAMOL NEBULE PF SOL 2MG/ML            PMS-SALBUTAMOL                           3550         F                         X       0.4992
        505        2239366   SALBUTAMOL NEBULE PF SOL 2MG/ML            RATIO-SALBUTAMOL                        10402         F                         X       0.4992

        506        2213486   SALBUTAMOL SOL 5MG/ML                      VENTOLIN RESPIRATOR SOLUTION             9985         P                         X       1.0832      0.4333
        506         860808   SALBUTAMOL SOL 5MG/ML                      RATIO-SALBUTAMOL                        10402         F                         X       0.4333
        506        2069571   SALBUTAMOL SOL 5MG/ML                      PMS-SALBUTAMOL                           3550         F                         X       0.4333
        506        2154412   SALBUTAMOL SOL 5MG/ML                      SANDOZ SALBUTAMOL                       12027         F                         X       0.4333
        506        2232987   SALBUTAMOL SOL 5MG/ML                      MYLAN-SALBUTAMOL RESPIRATOR SOLUTION    13930         F                         X       0.4333

        987        2212390 SALBUTAMOL SULPHATE LIQ 0.4MG/ML             VENTOLIN ORAL LIQUID                     9985         F                                 0.0767

        507        2146843 SALBUTAMOL TAB 2MG                           APO-SALVENT TABLETS - 2MG                3636         F                                 0.1376

        951        2231675 SALBUTAMOL/IPRATROPIUM BROMIDE 2.5MG/0.5MG   COMBIVENT UDV                            3617         P                         X       0.6512      0.3171
        951        2243789 SALBUTAMOL/IPRATROPIUM BROMIDE 2.5MG/0.5MG   RATIO-IPRA SAL UDV                      10402         F                         X       0.3171
        951        2272695 SALBUTAMOL/IPRATROPIUM BROMIDE 2.5MG/0.5MG   MYLAN-COMBO STERINEBS                   13930         F                         X       0.3171

        510        2027909 SALSALATE TAB 500MG                          DISALCID TAB 500MG                       4550        P*                   RDP           0.2341
        510        2186829 SALSALATE TAB 500MG                          DISALCID - TAB 500MG                     4550        P*                   RDP           0.2341

        511        2027917 SALSALATE TAB 750MG                          DISALCID TAB 750MG                       4550        P*                   RDP           0.3511
        511        2186837 SALSALATE TAB 750MG                          DISALCID - TAB 750MG                     4550        P*                   RDP           0.3511

        512        2068087   SELEGILINE TAB 5MG                         NOVO-SELEGILINE TAB 5MG                  4773         F                                 0.8677
        512        2230641   SELEGILINE TAB 5MG                         APO-SELEGILINE                           3636         F                                 0.8677
        512        2230717   SELEGILINE TAB 5MG                         NU-SELEGILINE                            4828         F                                 0.8677
        512        2231036   SELEGILINE TAB 5MG                         MYLAN-SELEGILINE                        13930         F                                 0.8677

        513      896403 SENNOSIDES TAB 12MG                             PMS-SENNOSIDES TAB 12MG                  3550         F                                 0.0750
        513     2089645 SENNOSIDES TAB 12MG                             SANDOZ SENNOSIDES                       12027         F                                 0.0750
        513    80009183 SENNOSIDES TAB 12MG                             JAMP SENNOSIDES 12MG TAB                 4415         F                                 0.0750

        514       26158      SENNOSIDES TAB 8.6MG                       SENOKOT TABLETS                          7054         P                                 0.1728      0.0529
        514      896411      SENNOSIDES TAB 8.6MG                       PMS-SENNOSIDES TAB 8.6MG                 3550         F                                 0.0529
        514     2089653      SENNOSIDES TAB 8.6MG                       SANDOZ SENNOSIDES                       12027         F                                 0.0529
        514    80009182      SENNOSIDES TAB 8.6MG                       JAMP SENNOSIDES 8.6MG TAB                4415         F                                 0.0529

        857        1962779   SERTRALINE CAP 100MG                       ZOLOFT CAP 100MG                         4908         P                                 1.8525      0.7258
        857        2238282   SERTRALINE CAP 100MG                       APO-SERTRALINE                           3636         F                                 0.7258
        857        2240481   SERTRALINE CAP 100MG                       TEVA-SERTRALINE                         14318         F                                 0.7258
        857        2242521   SERTRALINE CAP 100MG                       MYLAN-SERTRALINE                        13930         F                                 0.7258
        857        2244840   SERTRALINE CAP 100MG                       PMS-SERTRALINE                           3550         F                                 0.7258
        857        2245161   SERTRALINE CAP 100MG                       SANDOZ SERTRALINE                       12027         F                                 0.7258
        857        2245789   SERTRALINE CAP 100MG                       RATIO-SERTRALINE                        10402         F                                 0.7258
        857        2273705   SERTRALINE CAP 100MG                       GD-SERTRALINE                           12463         F                                 0.7258
        857        2287412   SERTRALINE CAP 100MG                       CO SERTRALINE                           10028         F                                 0.7258
        857        2353547   SERTRALINE CAP 100MG                       SERTRALINE                              14236         F                                 0.7258

        855        2132702   SERTRALINE CAP 25MG                        ZOLOFT                                   4908         P                                 0.8840      0.3462
        855        2238280   SERTRALINE CAP 25MG                        APO-SERTRALINE                           3636         F                                 0.3462
        855        2240485   SERTRALINE CAP 25MG                        TEVA-SERTRALINE                         14318         F                                 0.3462
        855        2242519   SERTRALINE CAP 25MG                        MYLAN-SERTRALINE                        13930         F                                 0.3462
        855        2244838   SERTRALINE CAP 25MG                        PMS-SERTRALINE                           3550         F                                 0.3462
        855        2245159   SERTRALINE CAP 25MG                        SANDOZ SERTRALINE                       12027         F                                 0.3462
        855        2245787   SERTRALINE CAP 25MG                        RATIO-SERTRALINE                        10402         F                                 0.3462
        855        2273683   SERTRALINE CAP 25MG                        GD-SERTRALINE                           12463         F                                 0.3462
        855        2287390   SERTRALINE CAP 25MG                        CO SERTRALINE                           10028         F                                 0.3462
        855        2353520   SERTRALINE CAP 25MG                        SERTRALINE                              14236         F                                 0.3462

        856        1962817   SERTRALINE CAP 50MG                        ZOLOFT CAP 50MG                          4908         P                                 1.7679      0.6926
        856        2238281   SERTRALINE CAP 50MG                        APO-SERTRALINE                           3636         F                                 0.6926
        856        2240484   SERTRALINE CAP 50MG                        TEVA-SERTRALINE                         14318         F                                 0.6926
        856        2242520   SERTRALINE CAP 50MG                        MYLAN-SERTRALINE                        13930         F                                 0.6926
        856        2244839   SERTRALINE CAP 50MG                        PMS-SERTRALINE                           3550         F                                 0.6926
        856        2245160   SERTRALINE CAP 50MG                        SANDOZ SERTRALINE                       12027         F                                 0.6926
        856        2245788   SERTRALINE CAP 50MG                        RATIO-SERTRALINE                        10402         F                                 0.6926
        856        2273691   SERTRALINE CAP 50MG                        GD-SERTRALINE                           12463         F                                 0.6926
        856        2287404   SERTRALINE CAP 50MG                        CO SERTRALINE                           10028         F                                 0.6926
        856        2353539   SERTRALINE CAP 50MG                        SERTRALINE                              14236         F                                 0.6926

        956         884332   SIMVASTATIN TAB 10MG                       ZOCOR                                   12250         P                                 2.1851      0.8740
        956        2246583   SIMVASTATIN TAB 10MG                       MYLAN-SIMVASTATIN                       13930         F                                 0.8740
        956        2247012   SIMVASTATIN TAB 10MG                       APO-SIMVASTATIN                          3636         F                                 0.8740
        956        2247068   SIMVASTATIN TAB 10MG                       RATIO-SIMVASTATIN                       10402         F                                 0.8740
        956        2247828   SIMVASTATIN TAB 10MG                       SANDOZ SIMVASTATIN                      12027         F                                 0.8740
        956        2248104   SIMVASTATIN TAB 10MG                       CO SIMVASTATIN TABLET 10MG              10028         F                                 0.8740
        956        2250152   SIMVASTATIN TAB 10MG                       TEVA-SIMVASTATIN                        14318         F                                 0.8740
        956        2269260   SIMVASTATIN TAB 10MG                       PMS-SIMVASTATIN                          3550         F                                 0.8740
        956        2281554   SIMVASTATIN TAB 10MG                       PHL-SIMVASTATIN                          4917         F                                 0.8740
        956        2284731   SIMVASTATIN TAB 10MG                       SIMVASTATIN                             14236         F                                 0.8740
        956        2329158   SIMVASTATIN TAB 10MG                       RAN-SIMVASTATIN                         11271         F                                 0.8740
        956        2331039   SIMVASTATIN TAB 10MG                       JAMP-SIMVASTATIN                         4415         F                                 0.8740
        956        2331985   SIMVASTATIN TAB 10MG                       SIMVASTATIN 10 MG TABLET                11271         F                                 0.8740
        956        2372940   SIMVASTATIN TAB 10MG                       MINT-SIMVASTATIN 10 MG TABLET           13221         F                                 0.8740
                                                                                               Page 37 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                            Full / Partial   Plan B
             DIN             Chemical Name                       Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                   LCA Benefit       Only
        957         884340   SIMVASTATIN TAB 20MG                ZOCOR                                 12250         P                                 2.7004      1.0802
        957        2246737   SIMVASTATIN TAB 20MG                MYLAN-SIMVASTATIN                     13930         F                                 1.0802
        957        2247013   SIMVASTATIN TAB 20MG                APO-SIMVASTATIN                        3636         F                                 1.0802
        957        2247069   SIMVASTATIN TAB 20MG                RATIO-SIMVASTATIN                     10402         F                                 1.0802
        957        2247830   SIMVASTATIN TAB 20MG                SANDOZ SIMVASTATIN                    12027         F                                 1.0802
        957        2248105   SIMVASTATIN TAB 20MG                CO SIMVASTATIN TABLET 20MG            10028         F                                 1.0802
        957        2250160   SIMVASTATIN TAB 20MG                TEVA-SIMVASTATIN                      14318         F                                 1.0802
        957        2269279   SIMVASTATIN TAB 20MG                PMS-SIMVASTATIN                        3550         F                                 1.0802
        957        2281562   SIMVASTATIN TAB 20MG                PHL-SIMVASTATIN                        4917         F                                 1.0802
        957        2284758   SIMVASTATIN TAB 20MG                SIMVASTATIN                           14236         F                                 1.0802
        957        2329166   SIMVASTATIN TAB 20MG                RAN-SIMVASTATIN                       11271         F                                 1.0802
        957        2331047   SIMVASTATIN TAB 20MG                JAMP-SIMVASTATIN                       4415         F                                 1.0802
        957        2331993   SIMVASTATIN TAB 20MG                SIMVASTATIN 20 MG TABLET              11271         F                                 1.0802
        957        2372959   SIMVASTATIN TAB 20MG                MINT-SIMVASTATIN 20 MG TABLET         13221         F                                 1.0802

        958         884359   SIMVASTATIN TAB 40MG                ZOCOR                                 12250         P                                 2.7004      1.0802
        958        2246584   SIMVASTATIN TAB 40MG                MYLAN-SIMVASTATIN                     13930         F                                 1.0802
        958        2247014   SIMVASTATIN TAB 40MG                APO-SIMVASTATIN                        3636         F                                 1.0802
        958        2247070   SIMVASTATIN TAB 40MG                RATIO-SIMVASTATIN                     10402         F                                 1.0802
        958        2247831   SIMVASTATIN TAB 40MG                SANDOZ SIMVASTATIN                    12027         F                                 1.0802
        958        2248106   SIMVASTATIN TAB 40MG                CO SIMVASTATIN TABLET 40MG            10028         F                                 1.0802
        958        2250179   SIMVASTATIN TAB 40MG                TEVA-SIMVASTATIN                      14318         F                                 1.0802
        958        2269287   SIMVASTATIN TAB 40MG                PMS-SIMVASTATIN                        3550         F                                 1.0802
        958        2281570   SIMVASTATIN TAB 40MG                PHL-SIMVASTATIN                        4917         F                                 1.0802
        958        2284766   SIMVASTATIN TAB 40MG                SIMVASTATIN                           14236         F                                 1.0802
        958        2329174   SIMVASTATIN TAB 40MG                RAN-SIMVASTATIN                       11271         F                                 1.0802
        958        2331055   SIMVASTATIN TAB 40MG                JAMP-SIMVASTATIN                       4415         F                                 1.0802
        958        2332000   SIMVASTATIN TAB 40MG                SIMVASTATIN 40 MG TABLET              11271         F                                 1.0802
        958        2372967   SIMVASTATIN TAB 40MG                MINT-SIMVASTATIN 40 MG TABLET         13221         F                                 1.0802

        955         884324   SIMVASTATIN TAB 5MG                 ZOCOR                                 12250         P                                 1.1109      0.4417
        955        2246582   SIMVASTATIN TAB 5MG                 MYLAN-SIMVASTATIN                     13930         F                                 0.4417
        955        2247011   SIMVASTATIN TAB 5MG                 APO-SIMVASTATIN                        3636         F                                 0.4417
        955        2248103   SIMVASTATIN TAB 5MG                 CO SIMVASTATIN TABLET 5MG             10028         F                                 0.4417
        955        2250144   SIMVASTATIN TAB 5MG                 TEVA-SIMVASTATIN                      14318         F                                 0.4417
        955        2269252   SIMVASTATIN TAB 5MG                 PMS-SIMVASTATIN                        3550         F                                 0.4417
        955        2281546   SIMVASTATIN TAB 5MG                 PHL-SIMVASTATIN                        4917         F                                 0.4417
        955        2284723   SIMVASTATIN TAB 5MG                 SIMVASTATIN                           14236         F                                 0.4417
        955        2329131   SIMVASTATIN TAB 5MG                 RAN-SIMVASTATIN                       11271         F                                 0.4417
        955        2331020   SIMVASTATIN TAB 5MG                 JAMP-SIMVASTATIN                       4415         F                                 0.4417
        955        2331969   SIMVASTATIN TAB 5MG                 SIMVASTATIN 5 MG TABLET               11271         F                                 0.4417
        955        2372932   SIMVASTATIN TAB 5MG                 MINT-SIMVASTATIN 5 MG TABLET          13221         F                                 0.4417

        959        2240332   SIMVASTATIN TAB 80MG                ZOCOR                                 12250         P                                 2.7004      1.0802
        959        2246585   SIMVASTATIN TAB 80MG                MYLAN-SIMVASTATIN                     13930         F                                 1.0802
        959        2247015   SIMVASTATIN TAB 80MG                APO-SIMVASTATIN                        3636         F                                 1.0802
        959        2247071   SIMVASTATIN TAB 80MG                RATIO-SIMVASTATIN                     10402         F                                 1.0802
        959        2247833   SIMVASTATIN TAB 80MG                SANDOZ SIMVASTATIN                    12027         F                                 1.0802
        959        2248107   SIMVASTATIN TAB 80MG                CO SIMVASTATIN TABLET 80MG            10028         F                                 1.0802
        959        2250187   SIMVASTATIN TAB 80MG                TEVA-SIMVASTATIN                      14318         F                                 1.0802
        959        2269295   SIMVASTATIN TAB 80MG                PMS-SIMVASTATIN                        3550         F                                 1.0802
        959        2281589   SIMVASTATIN TAB 80MG                PHL-SIMVASTATIN                        4917         F                                 1.0802
        959        2284774   SIMVASTATIN TAB 80MG                SIMVASTATIN                           14236         F                                 1.0802
        959        2329182   SIMVASTATIN TAB 80MG                RAN-SIMVASTATIN                       11271         F                                 1.0802
        959        2331063   SIMVASTATIN TAB 80MG                JAMP-SIMVASTATIN                       4415         F                                 1.0802
        959        2332019   SIMVASTATIN TAB 80MG                SIMVASTATIN 80 MG TABLET              11271         F                                 1.0802
        959        2372975   SIMVASTATIN TAB 80MG                MINT-SIMVASTATIN 80 MG TABLET         13221         F                                 1.0802

        519         750824   SODIUM CHLORIDE OPHTHALMIC SOL 5%   MURO 128 SOLN 5%                       5661         P                                 0.7077      0.5220
        519         505021   SODIUM CHLORIDE OPHTHALMIC SOL 5%   ADSORBO NAC 5%                         3594         F                                 0.4492
        519         514667   SODIUM CHLORIDE OPHTHALMIC SOL 5%   NACL OPH SOLN 5%                          0         F                                 0.4313
        519         749672   SODIUM CHLORIDE OPHTHALMIC SOL 5%   CORDEMA SOLUTION 5%                       0         F                                 0.3211
        519        2245735   SODIUM CHLORIDE OPHTHALMIC SOL 5%   SANDOZ SODIUM CHLORIDE                12027         F                                 0.5220

        772         534609 SODIUM CROMOGLYCATE LIQ 1%            INTAL NEBULIZER 1%                     9522         F                         X       0.2617
        772        2046113 SODIUM CROMOGLYCATE LIQ 1%            PMS-SODIUM CROMOGLYCATE                3550         F                         X       0.3318

        521        2026961 SODIUM POLYSTYRENE SULFONATE PWR      KAYEXALATE                            12538         P                                 0.1928      0.1601
        521         755338 SODIUM POLYSTYRENE SULFONATE PWR      PMS-SODIUM POLYSTERENE SULFONATE       3550         F                                 0.1601

        522        2084236   SOTALOL TAB 160MG                   RATIO-SOTALOL                         10402         F                                 0.2805
        522        2163772   SOTALOL TAB 160MG                   NU-SOTALOL - TAB 160 MG                4828         F                                 0.2805
        522        2167794   SOTALOL TAB 160MG                   APO-SOTALOL - TAB 160MG                3636         F                                 0.2805
        522        2229779   SOTALOL TAB 160MG                   MYLAN-SOTALOL                         13930         F                                 0.2805
        522        2231182   SOTALOL TAB 160MG                   NOVO-SOTALOL TAB 160MG                 4773         F                                 0.2805
        522        2238327   SOTALOL TAB 160MG                   PMS-SOTALOL - 160 MG                   3550         F                                 0.2805

        523        2084228   SOTALOL TAB 80MG                    RATIO-SOTALOL                         10042         F                                 0.3203
        523        2229778   SOTALOL TAB 80MG                    MYLAN-SOTALOL                         13930         F                                 0.3203
        523        2231181   SOTALOL TAB 80MG                    NOVO-SOTALOL TAB 80MG                  4773         F                                 0.3203
        523        2238326   SOTALOL TAB 80MG                    PMS-SOTALOL - 80 MG                    3550         F                                 0.3203

        524         285455 SPIRONOLACTONE TAB 100MG              ALDACTONE 100 MG                       4908         P                                 0.3326      0.2658
        524         613223 SPIRONOLACTONE TAB 100MG              NOVO-SPIROTON TAB 100MG                4773         F                                 0.2658

        525          28606 SPIRONOLACTONE TAB 25MG               ALDACTONE 25 MG                        4908         P                                 0.1412      0.1142
        525         613215 SPIRONOLACTONE TAB 25MG               NOVO-SPIROTON TAB 25MG                 4773         F                                 0.1142

        526         180408 SPIRONOLACTONE TAB 25MG/PLUS          ALDACTAZIDE 25                         4908         P                                 0.1412      0.1162
        526         613231 SPIRONOLACTONE TAB 25MG/PLUS          NOVO-SPIROZINE TAB 25MG                4773         F                                 0.1162

        527         594377 SPIRONOLACTONE TAB 50MG/PLUS          ALDACTAZIDE 50                         4908         P                                 0.2993      0.2415
        527         657182 SPIRONOLACTONE TAB 50MG/PLUS          NOVO-SPIROZINE-50 TAB                  4773         F                                 0.2415

        528        2100622   SUCRALFATE TAB 1GM                  SULCRATE TABLETS 1GM                   3741         P                                 0.5993      0.2262
        528        2045702   SUCRALFATE TAB 1GM                  NOVO-SUCRALATE TAB 1GM                 4773         F                                 0.2262
        528        2125250   SUCRALFATE TAB 1GM                  APO-SUCRALFATE - TAB 1G                3636         F                                 0.2262
        528        2134829   SUCRALFATE TAB 1GM                  NU-SUCRALFATE - TAB 1GM                4828         F                                 0.2262

        952        2244147 SUFENTANIL CITRATE INJ 50MCG/ML       SUFENTANIL CITRATE INJECTION USP      12027         F                                 7.2360

        529            965   SULFACETAMIDE SOD LIQ 10%           ISOPTO CETAMIDE DPS 10%                3594         F                                 0.2497
        529           1287   SULFACETAMIDE SOD LIQ 10%           BLEPH 10 DPS                           3574         F                                 0.0785
        529          28053   SULFACETAMIDE SOD LIQ 10%           SODIUM SULAMYD 10%                    12027         F                                 0.3780
        529         554022   SULFACETAMIDE SOD LIQ 10%           SULFEX 10%                                0         F                                 0.0785
        529         707465   SULFACETAMIDE SOD LIQ 10%           OPHTHO-SULF LIQ 10%                       0         F                                 0.0785
        529         772313   SULFACETAMIDE SOD LIQ 10%           BALSULPH OPH LIQ 10.0%                 3807         F                                 0.1736
                                                                                      Page 38 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                Full / Partial   Plan B
             DIN             Chemical Name                           Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                       LCA Benefit       Only


        531        2064472 SULFASALAZINE EC TAB 500MG                SALAZOPYRIN EN-TABS 500 MG             4908         P                                 0.4349      0.3542
        531         598488 SULFASALAZINE EC TAB 500MG                PMS-SULFASALAZINE-E.C. TAB 500MG       3550         F                                 0.3542

        532        2064480   SULFASALAZINE TAB 500MG                 SALAZOPYRIN TAB 500MG                  4908         P                                 0.2762      0.2326
        532         263869   SULFASALAZINE TAB 500MG                 SAS TAB 500MG                          4372         F                                 0.1699
        532         598461   SULFASALAZINE TAB 500MG                 PMS-SULFASALAZINE 500MG/TAB USP        3550         F                                 0.2326
        532        2004658   SULFASALAZINE TAB 500MG                 SALAZOPYRIN TAB 500MG                     0         F                                 0.1808

        534         441767 SULFINPYRAZONE TAB 200MG                  SULFINPYRAZONE                        14412         F                                 0.3237

        610         745588 SULINDAC TAB 150MG                        NOVO-SUNDAC TAB 150MG                  4773         F                         X       0.4130
        610         778354 SULINDAC TAB 150MG                        APO-SULIN TAB 150MG                    3636         F                         X       0.4130
        610        2042576 SULINDAC TAB 150MG                        NU-SULINDAC TAB 150MG                  4828         F                         X       0.4130

        611         745596 SULINDAC TAB 200MG                        NOVO-SUNDAC TAB 200MG                  4773         F                         X       0.4234

       1055        2212161   SUMATRIPTAN SUCCINATE TAB 100MG         IMITREX DF - TAB 100MG                 9985         P                                17.6607      8.4888
       1055        2239367   SUMATRIPTAN SUCCINATE TAB 100MG         NOVO-SUMATRIPTAN                       4773         F                                 8.4888
       1055        2256444   SUMATRIPTAN SUCCINATE TAB 100MG         PMS-SUMATRIPTAN                        3550         F                                 8.4888
       1055        2257904   SUMATRIPTAN SUCCINATE TAB 100MG         CO SUMATRIPTAN                        10028         F                                 8.4888
       1055        2263033   SUMATRIPTAN SUCCINATE TAB 100MG         SANDOZ SUMATRIPTAN                    12027         F                                 8.4888
       1055        2268396   SUMATRIPTAN SUCCINATE TAB 100MG         APO-SUMATRIPTAN                        3636         F                                 8.4888
       1055        2268922   SUMATRIPTAN SUCCINATE TAB 100MG         MYLAN-SUMATRIPTAN                     13930         F                                 8.4888
       1055        2286548   SUMATRIPTAN SUCCINATE TAB 100MG         SUMATRIPTAN                           14236         F                                 8.4888
       1055        2286831   SUMATRIPTAN SUCCINATE TAB 100MG         NOVO-SUMATRIPTAN DF                    4773         F                                 8.4888

       1053        2256428   SUMATRIPTAN SUCCINATE TAB 25MG          PMS-SUMATRIPTAN                        3550         F                         X       7.4322
       1053        2257882   SUMATRIPTAN SUCCINATE TAB 25MG          CO SUMATRIPTAN                        10028         F                         X       7.4322
       1053        2268906   SUMATRIPTAN SUCCINATE TAB 25MG          MYLAN-SUMATRIPTAN                     13930         F                         X       7.4322
       1053        2286513   SUMATRIPTAN SUCCINATE TAB 25MG          SUMATRIPTAN                           14236         F                         X       7.4322
       1053        2286815   SUMATRIPTAN SUCCINATE TAB 25MG          NOVO-SUMATRIPTAN DF                    4773         F                         X       7.4322

       1054        2212153   SUMATRIPTAN SUCCINATE TAB 50MG          IMITREX DF - TAB 50MG                  9985         P                                16.0322      7.7058
       1054        2256436   SUMATRIPTAN SUCCINATE TAB 50MG          PMS-SUMATRIPTAN                        3550         F                                 7.7058
       1054        2257890   SUMATRIPTAN SUCCINATE TAB 50MG          CO SUMATRIPTAN                        10028         F                                 7.7058
       1054        2263025   SUMATRIPTAN SUCCINATE TAB 50MG          SANDOZ SUMATRIPTAN                    12027         F                                 7.7058
       1054        2268388   SUMATRIPTAN SUCCINATE TAB 50MG          APO-SUMATRIPTAN                        3636         F                                 7.7058
       1054        2268914   SUMATRIPTAN SUCCINATE TAB 50MG          MYLAN-SUMATRIPTAN                     13930         F                                 7.7058
       1054        2286521   SUMATRIPTAN SUCCINATE TAB 50MG          SUMATRIPTAN                           14236         F                                 7.7058
       1054        2286823   SUMATRIPTAN SUCCINATE TAB 50MG          NOVO-SUMATRIPTAN DF                    4773         F                                 7.7058

       1213        2270102   TAMSULOSIN HYDROCHLORIDE CR TAB 0.4MG   FLOMAX CR                              3617         P                                 0.6480      0.2592
       1213        2340208   TAMSULOSIN HYDROCHLORIDE CR TAB 0.4MG   SANDOZ TAMSULOSIN CR                  12027         F                                 0.2592
       1213        2362406   TAMSULOSIN HYDROCHLORIDE CR TAB 0.4MG   APO-TAMSULOSIN CR 0.4MG TABLET         3636         F                                 0.2592
       1213        2368242   TAMSULOSIN HYDROCHLORIDE CR TAB 0.4MG   TEVA-TAMSULOSIN CR 0.4 MG TAB         14318         F                                 0.2592

       1144        2281392   TAMSULOSIN TAB/CAP 0.4MG                NOVO-TAMSULOSIN                        4773         F                                 0.4215
       1144        2294265   TAMSULOSIN TAB/CAP 0.4MG                RATIO-TAMSULOSIN                      10402         F                                 0.4215
       1144        2294885   TAMSULOSIN TAB/CAP 0.4MG                RAN-TAMSULOSIN                        11271         F                                 0.4215
       1144        2295121   TAMSULOSIN TAB/CAP 0.4MG                SANDOZ TAMSULOSIN                     12027         F                                 0.4215
       1144        2298570   TAMSULOSIN TAB/CAP 0.4MG                MYLAN-TAMSULOSIN                      13930         F                                 0.4215
       1144        2331780   TAMSULOSIN TAB/CAP 0.4MG                TAMSULOSIN 0.4 MG CAPSULE SR          11271         F                                 0.4215
       1144        2352419   TAMSULOSIN TAB/CAP 0.4MG                JAMP-TAMSULOSIN                        4415         F                                 0.4215

        537         604453   TEMAZEPAM CAP 15MG                      RESTORIL                              13843         P                                 0.2158      0.0821
        537        2225964   TEMAZEPAM CAP 15MG                      APO-TEMAZEPAM                          3636         F                                 0.0821
        537        2230095   TEMAZEPAM CAP 15MG                      NOVO-TEMAZEPAM                         4773         F                                 0.0821
        537        2243023   TEMAZEPAM CAP 15MG                      RATIO-TEMAZEPAM                       10402         F                                 0.0821
        537        2244814   TEMAZEPAM CAP 15MG                      CO TEMAZEPAM CAPSULES 15MG            10028         F                                 0.0821

        538         604461   TEMAZEPAM CAP 30MG                      RESTORIL                              13843         P                                 0.2613      0.0994
        538        2225972   TEMAZEPAM CAP 30MG                      APO-TEMAZEPAM                          3636         F                                 0.0994
        538        2230102   TEMAZEPAM CAP 30MG                      NOVO-TEMAZEPAM                         4773         F                                 0.0994
        538        2243024   TEMAZEPAM CAP 30MG                      RATIO-TEMAZEPAM                       10402         F                                 0.0994
        538        2244815   TEMAZEPAM CAP 30MG                      CO TEMAZEPAM CAPSULES 30MG            10028         F                                 0.0994

        760        2230661 TENOXICAM TAB 20MG                        TENOXICAM TABLETS                     14412         F                         X       1.2476

        712         818674   TERAZOSIN TAB 10MG                      HYTRIN TAB 10MG                        3525         P                                 2.0394      0.7631
        712        2218984   TERAZOSIN TAB 10MG                      RATIO-TERAZOSIN - TAB 10MG            10402         F                                 0.7631
        712        2230808   TERAZOSIN TAB 10MG                      TEVA-TERAZOSIN                        14318         F                                 0.7631
        712        2233050   TERAZOSIN TAB 10MG                      NU-TERAZOSIN 10 MG TABLETS             4828         F                                 0.7631
        712        2234505   TERAZOSIN TAB 10MG                      APO-TERAZOSIN TABLETS                  3636         F                                 0.7631
        712        2243521   TERAZOSIN TAB 10MG                      PMS-TERAZOSIN                          3550         F                                 0.7631
        712        2350505   TERAZOSIN TAB 10MG                      TERAZOSIN                             14236         F                                 0.7631

        709         818658   TERAZOSIN TAB 1MG                       HYTRIN TAB 1MG                         3525         P                                 0.8071      0.3020
        709        2218941   TERAZOSIN TAB 1MG                       RATIO-TERAZOSIN - TAB 1MG             10402         F                                 0.3020
        709        2230805   TERAZOSIN TAB 1MG                       TEVA-TERAZOSIN                        14318         F                                 0.3020
        709        2233047   TERAZOSIN TAB 1MG                       NU-TERAZOSIN                           4828         F                                 0.3020
        709        2234502   TERAZOSIN TAB 1MG                       APO-TERAZOSIN TABLETS                  3636         F                                 0.3020
        709        2243518   TERAZOSIN TAB 1MG                       PMS-TERAZOSIN                          3550         F                                 0.3020
        709        2350475   TERAZOSIN TAB 1MG                       TERAZOSIN                             14236         F                                 0.3020

        710         818682   TERAZOSIN TAB 2MG                       HYTRIN TAB 2MG                         3525         P                                 1.0259      0.3839
        710        2218968   TERAZOSIN TAB 2MG                       RATIO-TERAZOSIN - TAB 2MG             10402         F                                 0.3839
        710        2230806   TERAZOSIN TAB 2MG                       TEVA-TERAZOSIN                        14318         F                                 0.3839
        710        2233048   TERAZOSIN TAB 2MG                       NU-TERAZOSIN                           4828         F                                 0.3839
        710        2234503   TERAZOSIN TAB 2MG                       APO-TERAZOSIN TABLETS                  3636         F                                 0.3839
        710        2243519   TERAZOSIN TAB 2MG                       PMS-TERAZOSIN                          3550         F                                 0.3839
        710        2350483   TERAZOSIN TAB 2MG                       TERAZOSIN                             14236         F                                 0.3839

        711         818666   TERAZOSIN TAB 5MG                       HYTRIN TAB 5MG                         3525         P                                 1.3932      0.5214
        711        2218976   TERAZOSIN TAB 5MG                       RATIO-TERAZOSIN - TAB 5MG             10402         F                                 0.5214
        711        2230807   TERAZOSIN TAB 5MG                       TEVA-TERAZOSIN                        14318         F                                 0.5214
        711        2233049   TERAZOSIN TAB 5MG                       NU-TERAZOSIN                           4828         F                                 0.5214
        711        2234504   TERAZOSIN TAB 5MG                       APO-TERAZOSIN TABLETS                  3636         F                                 0.5214
        711        2243520   TERAZOSIN TAB 5MG                       PMS-TERAZOSIN                          3550         F                                 0.5214
        711        2350491   TERAZOSIN TAB 5MG                       TERAZOSIN                             14236         F                                 0.5214

        854        2031116   TERBINAFINE TAB 250MG                   LAMISIL TAB 250MG                      7277         P                         X       4.5946      2.0029
        854        2239893   TERBINAFINE TAB 250MG                   APO-TERBINAFINE                        3636         F                         X       2.0029
        854        2240346   TERBINAFINE TAB 250MG                   NOVO-TERBINAFINE                       4773         F                         X       2.0029
        854        2242503   TERBINAFINE TAB 250MG                   MYLAN-TERBINAFINE                     13930         F                         X       2.0029
        854        2254727   TERBINAFINE TAB 250MG                   CO TERBINAFINE                        10028         F                         X       2.0029
        854        2262177   TERBINAFINE TAB 250MG                   SANDOZ-TERBINAFINE                    12027         F                         X       2.0029
                                                                                          Page 39 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                             Full / Partial   Plan B
             DIN             Chemical Name                 Drug Name                                   MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                    LCA Benefit       Only
        854        2294273   TERBINAFINE TAB 250MG         PMS-TERBINAFINE                               3550         F                         X       2.0029
        854        2320134   TERBINAFINE TAB 250MG         AURO-TERBINAFINE 250 MG TABLET               11979         F                         X       2.0009
        854        2353121   TERBINAFINE TAB 250MG         TERBINAFINE                                  14236         F                         X       2.0029
        854        2357070   TERBINAFINE TAB 250MG         JAMP-TERBINAFINE                              4415         F                         X       2.0029

        852          30783 TESTOSTERONE INJ 100MG          DEPO-TESTOSTERONE INJ 100MG/ML                4908         P                         X       2.9138      2.4257
        852        2246063 TESTOSTERONE INJ 100MG          TESTOSTERONE CYPIONATE INJECTION USP         12027         F                         X       2.4257

        539         580929 TETRACYCLINE CAP 250MG          TETRACYCLINE                                 14412         F                                 0.0710

        761         692697 THEOPHYLLINE SR TAB/CAP 200MG   APO-THEO-LA SRT 200MG                         3636         F                                 0.0980
        761        2230086 THEOPHYLLINE SR TAB/CAP 200MG   NOVO-THEOPHYL SR                              4773         F                                 0.0980

        725         692689 THEOPHYLLINE TAB/CAP 100MG SR   APO-THEO-LA SRT 100MG                         3636         F                                 0.1404
        725        2230085 THEOPHYLLINE TAB/CAP 100MG SR   NOVO-THEOPHYL SR                              4773         F                                 0.1404

        726         692700 THEOPHYLLINE TAB/CAP 300MG SR   APO-THEO-LA SRT 300MG                         3636         F                                 0.1512
        726        2230087 THEOPHYLLINE TAB/CAP 300MG SR   NOVO-THEOPHYL SR                              4773         F                                 0.1512

        953        2193221 THIAMINE HCL INJ USP 100MG/ML   THIAMIJECT INJECTION - LIQ IM IV 100MG/ML     4852         F                                 1.2830

        612        2221942   TIAPROFENIC TAB 200MG         SURGAM 200MG TABLET                           3727         P                         X       0.5891      0.3712
        612        1924613   TIAPROFENIC TAB 200MG         ALBERT TIAFEN TAB 200MG                       9522         F                         X       0.3712
        612        2136112   TIAPROFENIC TAB 200MG         APO-TIAPROFENIC TABLETS-200MG                 3636         F                         X       0.3712
        612        2179679   TIAPROFENIC TAB 200MG         NOVO-TIAPROFENIC - TAB 200MG                  4773         F                         X       0.3712

        613        2136120 TIAPROFENIC TAB 300MG           APO-TIAPROFENIC TABLETS -300MG                3636         F                         X       0.3518
        613        2179687 TIAPROFENIC TAB 300MG           NOVO-TIAPROFENIC - TAB 300MG                  4773         F                         X       0.3518

        764        2236848   TICLOPIDINE TAB 250MG         NOVO-TICLOPIDINE TABLETS                      4773         F                         X       0.5428
        764        2237560   TICLOPIDINE TAB 250MG         NU-TICLOPIDINE 250 MG                         4828         F                         X       0.5428
        764        2237701   TICLOPIDINE TAB 250MG         APO-TICLOPIDINE TABLETS                       3636         F                         X       0.5428
        764        2239744   TICLOPIDINE TAB 250MG         MYLAN-TICLOPIDINE                            13930         F                         X       0.5428
        764        2243587   TICLOPIDINE TAB 250MG         SANDOZ TICLOPIDINE                           12027         F                         X       0.5428
        764        2343045   TICLOPIDINE TAB 250MG         TICLOPIDINE                                  14236         F                         X       0.5428

        545         755826   TIMOLOL OPH DPS 0.25%         APO-TIMOP OPH SOLN 0.25%                      3636         F                                 1.1945
        545         893773   TIMOLOL OPH DPS 0.25%         MYLAN-TIMOLOL                                13930         F                                 1.1945
        545        2083353   TIMOLOL OPH DPS 0.25%         PMS-TIMOLOL                                   3550         F                                 1.1945
        545        2166712   TIMOLOL OPH DPS 0.25%         SANDOZ TIMOLOL                               12027         F                                 1.1945

        547         451207   TIMOLOL OPH DPS 0.5%          TIMOPTIC                                     12250         P                                 3.9355      1.4990
        547         755834   TIMOLOL OPH DPS 0.5%          APO-TIMOP LIQ 0.5%                            3636         F                                 1.4990
        547         893781   TIMOLOL OPH DPS 0.5%          MYLAN-TIMOLOL                                13930         F                                 1.4990
        547        2083345   TIMOLOL OPH DPS 0.5%          PMS-TIMOLOL                                   3550         F                                 1.4990
        547        2166720   TIMOLOL OPH DPS 0.5%          SANDOZ TIMOLOL                               12027         F                                 1.4990

        549         755850 TIMOLOL TAB 10MG                APO-TIMOL TABLETS 10MG                        3636         F                                 0.2778
        549        1947818 TIMOLOL TAB 10MG                NOVO-TIMOL TAB 10MG USP                       4773         F                                 0.2778

        550         755869 TIMOLOL TAB 20MG                APO-TIMOL TABLETS 20MG                        3636         F                                 0.5405
        550        1947826 TIMOLOL TAB 20MG                NOVO-TIMOL TAB 20MG USP                       4773         F                                 0.5405

        551         755842 TIMOLOL TAB 5MG                 APO-TIMOL TABLETS 5MG                         3636         F                                 0.1781
        551        1947796 TIMOLOL TAB 5MG                 NOVO-TIMOL TAB 5MG USP                        4773         F                                 0.1781

        548        2171899 TIMOLOL XE GEL 0.5%             TIMOPTIC-XE                                  12250         P                                 5.0263      2.5138
        548        2242276 TIMOLOL XE GEL 0.5%             TIMOLOL MALEATE-EX                            3594         F                                 2.9484
        548        2290812 TIMOLOL XE GEL 0.5%             APO-TIMOP GEL                                 3636         F                                 2.5138

        546        2171880 TIMOLOL XE OPH DRP 0.25%        TIMOPTIC-XE                                  12250         P                                 4.2012      2.9484
        546        2242275 TIMOLOL XE OPH DRP 0.25%        TIMOLOL MALEATE-EX                            3594         F                                 2.4646

       1020        2239170 TIZANIDINE HCL TAB 4MG          ZANAFLEX                                      8481         P                         X       0.8407      0.3981
       1020        2259893 TIZANIDINE HCL TAB 4MG          APO-TIZANIDINE                                3636         F                         X       0.3981
       1020        2272059 TIZANIDINE HCL TAB 4MG          MYLAN-TIZANIDINE                             13930         F                         X       0.3981

        853         513962 TOBRAMYCIN OPH DPS 0.3%         TOBREX 0.3% OPHTHALMIC SOL                    3594         P                                 1.7993      0.7197
        853        2239577 TOBRAMYCIN OPH DPS 0.3%         PMS-TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION       3550         F                                 0.7197
        853        2241755 TOBRAMYCIN OPH DPS 0.3%         SANDOZ TOBRAMYCIN 0.3%                       12027         F                                 0.7197

        665         325449 TOBRAMYCIN SULF INJ 40MG/ML     NEBCIN INJ 40MG/ML                            7005         P                                 3.7184      2.4300
        665        2230640 TOBRAMYCIN SULF INJ 40MG/ML     TOBRAMYCIN INJECTION, USP                     8641         P                                 3.7206      2.4300
        665        2241210 TOBRAMYCIN SULF INJ 40MG/ML     TOBRAMYCIN INJECTION USP                     12027         F                                 2.4300

        552         312762 TOLBUTAMIDE TAB 500MG           TOLBUTAMIDE                                  14412         F                                 0.1176

       1059        2230894   TOPIRAMATE TAB 100MG          TOPAMAX 100MG                                 7259         P                                 2.5612      1.0245
       1059        2248861   TOPIRAMATE TAB 100MG          NOVO-TOPIRAMATE -(100MG)                      4773         F                                 1.0245
       1059        2256835   TOPIRAMATE TAB 100MG          RATIO-TOPIRAMATE                             10402         F                                 1.0245
       1059        2260069   TOPIRAMATE TAB 100MG          SANDOZ TOPIRAMATE                            12027         F                                 1.0245
       1059        2263009   TOPIRAMATE TAB 100MG          PMS-TOPIRAMATE                                3550         F                                 1.0245
       1059        2263378   TOPIRAMATE TAB 100MG          MYLAN-TOPIRAMATE                             13930         F                                 1.0245
       1059        2271192   TOPIRAMATE TAB 100MG          PHL-TOPIRAMATE                                4917         F                                 1.0245
       1059        2279630   TOPIRAMATE TAB 100MG          APO-TOPIRAMATE                                3636         F                                 1.0245
       1059        2287773   TOPIRAMATE TAB 100MG          CO TOPIRAMATE                                10028         F                                 1.0245
       1059        2315653   TOPIRAMATE TAB 100MG          MINT-TOPIRAMATE                              13221         F                                 1.0245
       1059        2325144   TOPIRAMATE TAB 100MG          ZYM-TOPIRAMATE                                6860         F                                 1.0245
       1059        2351315   TOPIRAMATE TAB 100MG          ACCEL-TOPIRAMATE 100 MG TABLET               13829         F                                 1.0245
       1059        2356864   TOPIRAMATE TAB 100MG          TOPIRAMATE                                   14236         F                                 1.0245

       1060        2230896   TOPIRAMATE TAB 200MG          TOPAMAX 200MG                                 7259         P                                 3.8248      1.5299
       1060        2248862   TOPIRAMATE TAB 200MG          NOVO-TOPIRAMATE -(200MG)                      4773         F                                 1.5299
       1060        2256843   TOPIRAMATE TAB 200MG          RATIO-TOPIRAMATE                             10402         F                                 1.5299
       1060        2263017   TOPIRAMATE TAB 200MG          PMS-TOPIRAMATE                                3550         F                                 1.5299
       1060        2263386   TOPIRAMATE TAB 200MG          MYLAN-TOPIRAMATE                             13930         F                                 1.5299
       1060        2267837   TOPIRAMATE TAB 200MG          SANDOZ TOPIRAMATE                            12027         F                                 1.5299
       1060        2271206   TOPIRAMATE TAB 200MG          PHL-TOPIRAMATE                                4917         F                                 1.5299
       1060        2279649   TOPIRAMATE TAB 200MG          APO-TOPIRAMATE                                3636         F                                 1.5299
       1060        2287781   TOPIRAMATE TAB 200MG          CO TOPIRAMATE                                10028         F                                 1.5299
       1060        2315661   TOPIRAMATE TAB 200MG          MINT-TOPIRAMATE                              13221         F                                 1.5299
       1060        2351323   TOPIRAMATE TAB 200MG          ACCEL-TOPIRAMATE 200 MG TABLET               13829         F                                 1.5299
       1060        2356872   TOPIRAMATE TAB 200MG          TOPIRAMATE                                   14236         F                                 1.5299

       1058        2230893 TOPIRAMATE TAB 25MG             TOPAMAX 25MG                                  7259         P                                 1.3513      0.5405
       1058        2248860 TOPIRAMATE TAB 25MG             NOVO-TOPIRAMATE -(25MG)                       4773         F                                 0.5405
       1058        2256827 TOPIRAMATE TAB 25MG             RATIO-TOPIRAMATE                             10402         F                                 0.5405
                                                                                Page 40 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                               Full / Partial   Plan B
             DIN             Chemical Name                           Drug Name                                           MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                      LCA Benefit       Only
       1058        2260050   TOPIRAMATE TAB 25MG                     SANDOZ TOPIRAMATE                                    12027         F                                 0.5405
       1058        2262991   TOPIRAMATE TAB 25MG                     PMS-TOPIRAMATE                                        3550         F                                 0.5405
       1058        2263351   TOPIRAMATE TAB 25MG                     MYLAN-TOPIRAMATE                                     13930         F                                 0.5405
       1058        2271184   TOPIRAMATE TAB 25MG                     PHL-TOPIRAMATE                                        4917         F                                 0.5405
       1058        2279614   TOPIRAMATE TAB 25MG                     APO-TOPIRAMATE                                        3636         F                                 0.5405
       1058        2287765   TOPIRAMATE TAB 25MG                     CO TOPIRAMATE                                        10028         F                                 0.5405
       1058        2315645   TOPIRAMATE TAB 25MG                     MINT-TOPIRAMATE                                      13221         F                                 0.5405
       1058        2325136   TOPIRAMATE TAB 25MG                     ZYM-TOPIRAMATE                                        6860         F                                 0.5405
       1058        2351307   TOPIRAMATE TAB 25MG                     ACCEL-TOPIRAMATE 25 MG TABLET                        13829         F                                 0.5405
       1058        2356856   TOPIRAMATE TAB 25MG                     TOPIRAMATE                                           14236         F                                 0.5405

        966        2231459 TRANDOLAPRIL CAP 1MG                      MAVIK (1MG)                                           3525         F                   REF           0.7236

        967        2231460 TRANDOLAPRIL CAP 2MG                      MAVIK (2MG)                                           3525         F                   REF           0.8316

        968        2239267 TRANDOLAPRIL CAP 4MG                      MAVIK (4MG)                                           3525         F                   REF           1.0260

        553         579378   TRAZODONE TAB 100MG                     DESYREL TAB 100MG                                     3798         P                                 0.4272      0.1709
        553        1937235   TRAZODONE TAB 100MG                     PMS TRAZODONE HCL TAB 100MG                           3550         F                                 0.1709
        553        2144271   TRAZODONE TAB 100MG                     NOVO-TRAZODONE - TAB 100MG                            4773         F                                 0.1709
        553        2147645   TRAZODONE TAB 100MG                     APO-TRAZODONE TABLETS 100MG                           3636         F                                 0.1709
        553        2165392   TRAZODONE TAB 100MG                     NU-TRAZODONE - TAB 100MG                              4828         F                                 0.1709
        553        2231684   TRAZODONE TAB 100MG                     MYLAN-TRAZODONE                                      13930         F                                 0.1709
        553        2236942   TRAZODONE TAB 100MG                     PHL-TRAZODONE                                         4917         F                                 0.1709
        553        2277352   TRAZODONE TAB 100MG                     RATIO TRAZODONE                                      10402         F                                 0.1709
        553        2348780   TRAZODONE TAB 100MG                     TRAZODONE                                            14236         F                                 0.1709

        554        2144298   TRAZODONE TAB 150MG                     NOVO-TRAZODONE - TAB 150MG                            4773         F                                 0.2511
        554        2147653   TRAZODONE TAB 150MG                     APO-TRAZODONE D TABLETS 150MG                         3636         F                                 0.2511
        554        2165406   TRAZODONE TAB 150MG                     NU-TRAZODONE-D - TAB 150MG                            4828         F                                 0.2511
        554        2277360   TRAZODONE TAB 150MG                     RATIO TRAZODONE                                      10402         F                                 0.2511
        554        2348799   TRAZODONE TAB 150MG                     TRAZODONE                                            14236         F                                 0.2511

        555        1937227   TRAZODONE TAB 50MG                      PMS TRAZODONE HCL TAB 50MG                            3550         F                                 0.0957
        555        2144263   TRAZODONE TAB 50MG                      NOVO-TRAZODONE-TAB 50MG                               4773         F                                 0.0957
        555        2147637   TRAZODONE TAB 50MG                      APO-TRAZODONE TABLETS 50MG                            3636         F                                 0.0957
        555        2165384   TRAZODONE TAB 50MG                      NU-TRAZODONE - TAB 50MG                               4828         F                                 0.0957
        555        2231683   TRAZODONE TAB 50MG                      MYLAN-TRAZODONE                                      13930         F                                 0.0957
        555        2236941   TRAZODONE TAB 50MG                      PHL-TRAZODONE                                         4917         F                                 0.0957
        555        2277344   TRAZODONE TAB 50MG                      RATIO TRAZODONE                                      10402         F                                 0.0957
        555        2348772   TRAZODONE TAB 50MG                      TRAZODONE                                            14236         F                                 0.0957

        559          14621 TRIAMCINOLONE ACETON CRM 0.1%             ARISTOCORT R CRM 0.1%                                 5208         F                                 0.1404
        559         716960 TRIAMCINOLONE ACETON CRM 0.1%             TRIADERM CRM 0.1%                                     5241         F                                 0.1404
        559        2194058 TRIAMCINOLONE ACETON CRM 0.1%             ARISTOCORT R                                         11211         F                                 0.1404

        561        1964054 TRIAMCINOLONE ACETON DENTAL PASTE 0.1%    ORACORT DENTAL PASTE 0.1%                             5241         F                                 1.1664

        682        1999761 TRIAMCINOLONE ACETON INJ 10MG/ML          KENALOG-10 INJECTION 10MG/ML                          3798         P                                 3.5100      2.2205
        682        2229540 TRIAMCINOLONE ACETON INJ 10MG/ML          TRIAMCINOLONE ACETONIDE INJECTABLE SUSPENSION USP    12027         F                                 2.2205

        683        1999869 TRIAMCINOLONE ACETON INJ 40MG/ML          KENALOG-40 INJECTION 40MG/ML                          3798         P                                 8.1000      5.1516
        683        2229550 TRIAMCINOLONE ACETON INJ 40MG/ML          TRIAMCINOLONE ACETONIDE INJECTABLE SUSPENSION USP    12027         F                                 5.1516

        562         441775   TRIAMTERENE HCL PLUS TAB 50/25MG        APO TRIAZIDE TAB                                      3636         F                                 0.0657
        562         532657   TRIAMTERENE HCL PLUS TAB 50/25MG        NOVO-TRIAMZIDE                                        4773         F                                 0.0657
        562         865532   TRIAMTERENE HCL PLUS TAB 50/25MG        NU-TRIAZIDE TAB 50 MG/25 MG                           4828         F                                 0.0657
        562        1919547   TRIAMTERENE HCL PLUS TAB 50/25MG        DYAZIDE TAB                                              0         F                                 0.0515

        563         808563 TRIAZOLAM TAB 0.125MG                     APO-TRIAZO                                            3636         F                                 0.1616

        564         808571 TRIAZOLAM TAB 0.25MG                      APO-TRIAZO                                            3636         F                                 0.2702

        567         326836 TRIFLUOPERAZINE TAB 10MG                  TRIFLUOPERAZINE                                      14412         F                                 0.3013

        566         345539 TRIFLUOPERAZINE TAB 1MG                   TRIFLUOPERAZINE                                      14412         F                                 0.1447

        569         595942 TRIFLUOPERAZINE TAB 20MG                  TRIFLUOPERAZINE                                      14412         F                                 0.6026

        568          13900 TRIFLUOPERAZINE TAB 2MG                   SOLAZINE 2 MG                                            0         F                                 0.1322
        568         312754 TRIFLUOPERAZINE TAB 2MG                   TRIFLUOPERAZINE                                      14412         F                                 0.1899

        570         312746 TRIFLUOPERAZINE TAB 5MG                   TRIFLUOPERAZINE                                      14412         F                                 0.2514

       1016         687456 TRIFLURIDINE OPH DROPS 0.1%               VIROPTIC                                              9228         F                                 3.2818
       1016        2248529 TRIFLURIDINE OPH DROPS 0.1%               SANDOZ TRIFLURIDINE                                  12027         F                                 3.2818

        571         280445 TRIHEXYPHENIDYL TAB 2MG                   APARKANE TAB 2MG                                      4372         F                                 0.0135
        571         545058 TRIHEXYPHENIDYL TAB 2MG                   TRIHEXYPHENIDYL                                      14412         F                                 0.0399

        572         271314 TRIHEXYPHENIDYL TAB 5MG                   APARKANE TAB 5MG                                      4372         F                                 0.0297
        572         545074 TRIHEXYPHENIDYL TAB 5MG                   TRIHEXYPHENIDYL                                      14412         F                                 0.0721

        960         803499 TRIMEBUTINE MALEATE TAB 200MG             MODULON TABLETS 200MG                                 3741         P                                 0.6950      0.5654
        960        2245664 TRIMEBUTINE MALEATE TAB 200MG             TRIMEBUTINE                                          14412         F                                 0.5654

        906        2243116 TRIMETHOPRIM TAB 100MG                    TRIMETHOPRIM TABLETS                                 14412         F                                 0.2771

        907        2243117 TRIMETHOPRIM TAB 200MG                    TRIMETHOPRIM TABLETS                                 14412         F                                 0.5695

        573         270644 TRIMETHOPRIM/SULFAMETH SUS 200/40MG/5ML   SEPTRA PEDIATRIC SUSPENSION                              0         F                                 0.0215
        573         272485 TRIMETHOPRIM/SULFAMETH SUS 200/40MG/5ML   BACTRIM ROCHE SUSPENSION PAEDIATRIC                   4328         F                                 0.0215
        573         726540 TRIMETHOPRIM/SULFAMETH SUS 200/40MG/5ML   NOVO-TRIMEL ORAL SUS                                  4773         F                                 0.0984

        574         368040   TRIMETHOPRIM/SULFAMETH TAB 160/800MG    SEPTRA DS TABLETS                                     9985         F                                 0.1319
        574         445282   TRIMETHOPRIM/SULFAMETH TAB 160/800MG    APO SULFATRIM DS TAB                                  3636         F                                 0.1319
        574         510645   TRIMETHOPRIM/SULFAMETH TAB 160/800MG    NOVO-TRIMEL DS TAB                                    4773         F                                 0.1319
        574         865729   TRIMETHOPRIM/SULFAMETH TAB 160/800MG    NU-COTRIMOX-DS TAB 800/160MG                          4828         F                                 0.1319

        575         270636   TRIMETHOPRIM/SULFAMETH TAB 80/400MG     SEPTRA                                                9985         F                                 0.0521
        575         445274   TRIMETHOPRIM/SULFAMETH TAB 80/400MG     APO SULFATRIM TAB                                     3636         F                                 0.0521
        575         510637   TRIMETHOPRIM/SULFAMETH TAB 80/400MG     NOVO-TRIMEL TAB                                       4773         F                                 0.0521
        575         865710   TRIMETHOPRIM/SULFAMETH TAB 80/400MG     NU-COTRIMOX TAB 400/80MG                              4828         F                                 0.0521

        576         761656 TRIMIPRAMINE CAP 75MG                     RHOTRIMINE                                           12538         F                                 0.5613
        576        2070987 TRIMIPRAMINE CAP 75MG                     TRIMIPRAMINE                                         14412         F                                 0.7899
                                                                                           Page 41 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                                                  Full / Partial   Plan B
             DIN             Chemical Name                                    Drug Name                                     MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                                                         LCA Benefit       Only
        577         740829 TRIMIPRAMINE TAB 100MG                             TRIMIPRAMINE                                   14412         F                                 1.0015
        577         761648 TRIMIPRAMINE TAB 100MG                             RHOTRIMINE                                     12538         F                                 0.3691

        578         740799 TRIMIPRAMINE TAB 12.5MG                            TRIMIPRAMINE                                   14412         F                                 0.2328
        578         761605 TRIMIPRAMINE TAB 12.5MG                            RHOTRIMINE                                     12538         F                                 0.0885

        579         740802 TRIMIPRAMINE TAB 25MG                              TRIMIPRAMINE                                   14412         F                                 0.2998
        579         761613 TRIMIPRAMINE TAB 25MG                              RHOTRIMINE                                     12538         F                                 0.1123

        580         740810 TRIMIPRAMINE TAB 50MG                              TRIMIPRAMINE                                   14412         F                                 0.5869
        580         761621 TRIMIPRAMINE TAB 50MG                              RHOTRIMINE                                     12538         F                                 0.2159

        581           1007 TROPICAMIDE OPH LIQ 1%                             MYDRIACYL LIQ 1%                                3594         P                                 1.1627      0.6156
        581        2023679 TROPICAMIDE OPH LIQ 1%                             DIOTROPE 1% SOLUTION                            4047         F                                 0.6156

        874         718149 TRYPTOPHAN CAP 500MG                               TRYPTAN CAP 500MG                              11902         P                                 0.7826      0.3848
        874        2240334 TRYPTOPHAN CAP 500MG                               RATIO-TRYPTOPHAN                               10402         F                                 0.3848
        874        2248540 TRYPTOPHAN CAP 500MG                               APO-TRYPTOPHAN                                  3636         F                                 0.3848

        662         654531 TRYPTOPHAN TAB 1000MG                              TRYPTAN TAB 1000MG                             11902         P                                 1.5652      0.7696
        662        2237250 TRYPTOPHAN TAB 1000MG                              RATIO-TRYPTOPHAN                               10402         F                                 0.7696
        662        2248539 TRYPTOPHAN TAB 1000MG                              APO-TRYPTOPHAN                                  3636         F                                 0.7696

        875        2029456 TRYPTOPHAN TAB 500MG                               TRYPTAN TAB 500MG                              11902         P                                 0.7826      0.3848
        875        2240333 TRYPTOPHAN TAB 500MG                               RATIO-TRYPTOPHAN                               10402         F                                 0.3848
        875        2248538 TRYPTOPHAN TAB 500MG                               APO-TRYPTOPHAN                                  3636         F                                 0.3848

       1072        2238984 URSODIOL TAB 250MG                                 URSO                                            3741         P                                 1.4380      0.9849
       1072        2273497 URSODIOL TAB 250MG                                 PMS-URSODIOL C                                  3550         F                                 0.9849

       1073        2245894 URSODIOL TAB 500MG                                 URSO DS                                         3741         P                                 2.7276      1.8682
       1073        2273500 URSODIOL TAB 500MG                                 PMS-URSODIOL C                                  3550         F                                 1.8682

       1146        2219492   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             VALTREX                                         9985         P                                 3.6637      1.4655
       1146        2295822   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             APO-VALACYCLOVIR                                3636         F                                 1.4655
       1146        2298457   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             PMS-VALACYCLOVIR                                3550         F                                 1.4655
       1146        2307944   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             PHL-VALACYCLOVIR                                4917         F                                 1.4655
       1146        2331748   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             CO VALACYCLOVIR                                10028         F                                 1.4655
       1146        2351579   VALACYCLOVIR HYDROCHLORIDE TAB 500MG             MYLAN-VALACYCLOVIR                             13930         F                                 1.4655

        582         443840   VALPROIC ACID CAP 250MG                          DEPAKENE CAP 250MG                              3525         P                                 0.6007      0.2249
        582        2100630   VALPROIC ACID CAP 250MG                          NOVO-VALPROIC SOFT GEL CAP - ANTICONVULSANT     4773         F                                 0.2249
        582        2140047   VALPROIC ACID CAP 250MG                          RATIO-VALPROIC-CAP 250MG                       10402         F                                 0.2249
        582        2184648   VALPROIC ACID CAP 250MG                          MYLAN-VALPROIC                                 13930         F                                 0.2249
        582        2230768   VALPROIC ACID CAP 250MG                          PMS-VALPROIC ACID                               3550         F                                 0.2249
        582        2237830   VALPROIC ACID CAP 250MG                          NU-VALPROIC                                     4828         F                                 0.2249
        582        2238048   VALPROIC ACID CAP 250MG                          APO-VALPROIC                                    3636         F                                 0.2249
        582        2239714   VALPROIC ACID CAP 250MG                          SANDOZ VALPROIC                                12027         F                                 0.2249

        583        2229628 VALPROIC ACID CAP 500MG                            PMS-VALPROIC ACID E.C.                          3550         F                                 0.4282

        713         443832   VALPROIC ACID SYR 250MG/5ML                      DEPAKENE SYR 50MG/ML                            3525         P                                 0.1251      0.0469
        713        2140063   VALPROIC ACID SYR 250MG/5ML                      RATIO-VALPROIC 50MG/ML SYRUP                   10402         F                                 0.0469
        713        2236807   VALPROIC ACID SYR 250MG/5ML                      PMS-VALPROIC ACID                               3550         F                                 0.0469
        713        2238370   VALPROIC ACID SYR 250MG/5ML                      APO-VALPROIC SYRUP                              3636         F                                 0.0469

       1223        2241901 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/12.5MG     DIOVAN-HCT 160MG/12.5MG                         7277         P                         X       1.2929      0.5112
       1223        2356708 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/12.5MG     SANDOZ VALSARTAN HCT                           12027         F                         X       0.5112
       1223        2357003 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/12.5MG     TEVA-VALSARTAN/HCTZ                            14318         F                         X       0.5112

       1224        2246955 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/25MG TAB   DIOVAN-HCT 160/25MG                             7277         P                         X       1.2972      0.5112
       1224        2356716 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/25MG TAB   SANDOZ VALSARTAN HCT                           12027         F                         X       0.5112
       1224        2357011 VALSARTAN HYDROCHLOROTHIAZIDE TAB 160MG/25MG TAB   TEVA-VALSARTAN/HCTZ                            14318         F                         X       0.5112

       1225        2308908 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/12.5MG     DIOVAN-HCT                                      7277         P                         X       1.2894      0.4912
       1225        2356724 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/12.5MG     SANDOZ VALSARTAN HCT                           12027         F                         X       0.4912
       1225        2357038 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/12.5MG     TEVA-VALSARTAN/HCTZ                            14318         F                         X       0.4912

       1226        2308916 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/25MG       DIOVAN-HCT                                      7277         P                         X       1.2894      0.4912
       1226        2356732 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/25MG       SANDOZ VALSARTAN HCT                           12027         F                         X       0.4912
       1226        2357046 VALSARTAN HYDROCHLOROTHIAZIDE TAB 320MG/25MG       TEVA-VALSARTAN/HCTZ                            14318         F                         X       0.4912

       1222        2241900 VALSARTAN HYDROCHLOROTHIAZIDE TAB 80MG/12.5MG      DIOVAN-HCT 80MG/12.5MG                          7277         P                         X       1.2894      0.5112
       1222        2356694 VALSARTAN HYDROCHLOROTHIAZIDE TAB 80MG/12.5MG      SANDOZ VALSARTAN HCT                           12027         F                         X       0.5112
       1222        2356996 VALSARTAN HYDROCHLOROTHIAZIDE TAB 80MG/12.5MG      TEVA-VALSARTAN/HCTZ                            14318         F                         X       0.5112

       1220        2244782   VALSARTAN TAB 160MG                              DIOVAN 160MG TABLETS                            7277         P                         X       1.2952      0.5112
       1220        2337509   VALSARTAN TAB 160MG                              CO VALSARTAN                                   10028         F                         X       0.5112
       1220        2356678   VALSARTAN TAB 160MG                              TEVA-VALSARTAN                                 14318         F                         X       0.5112
       1220        2356767   VALSARTAN TAB 160MG                              SANDOZ VALSARTAN                               12027         F                         X       0.5112
       1220        2363119   VALSARTAN TAB 160MG                              RAN-VALSARTAN                                  11271         F                         X       0.5112
       1220        2371537   VALSARTAN TAB 160MG                              APO-VALSARTAN 160 MG TABLET                     3636         F                         X       0.5112

       1221        2289504   VALSARTAN TAB 320MG                              DIOVAN                                          7277         P                         X       1.2590      0.4912
       1221        2337517   VALSARTAN TAB 320MG                              CO VALSARTAN                                   10028         F                         X       0.4912
       1221        2356686   VALSARTAN TAB 320MG                              TEVA-VALSARTAN                                 14318         F                         X       0.4912
       1221        2356775   VALSARTAN TAB 320MG                              SANDOZ VALSARTAN                               12027         F                         X       0.4912
       1221        2371545   VALSARTAN TAB 320MG                              APO-VALSARTAN 320 MG TABLET                     3636         F                         X       0.4912

       1218        2270528   VALSARTAN TAB 40MG                               DIOVAN                                          7277         P                         X       1.2574      0.5030
       1218        2337487   VALSARTAN TAB 40MG                               CO VALSARTAN                                   10028         F                         X       0.5030
       1218        2356643   VALSARTAN TAB 40MG                               TEVA-VALSARTAN                                 14318         F                         X       0.5030
       1218        2356740   VALSARTAN TAB 40MG                               SANDOZ VALSARTAN                               12027         F                         X       0.5030
       1218        2363062   VALSARTAN TAB 40MG                               RAN-VALSARTAN                                  11271         F                         X       0.5030
       1218        2371510   VALSARTAN TAB 40MG                               APO-VALSARTAN 40 MG TABLET                      3636         F                         X       0.5030

       1219        2244781   VALSARTAN TAB 80MG                               DIOVAN 80MG TABLETS                             7277         P                         X       1.2956      0.5112
       1219        2337495   VALSARTAN TAB 80MG                               CO VALSARTAN                                   10028         F                         X       0.5112
       1219        2356651   VALSARTAN TAB 80MG                               TEVA-VALSARTAN                                 14318         F                         X       0.5112
       1219        2356759   VALSARTAN TAB 80MG                               SANDOZ VALSARTAN                               12027         F                         X       0.5112
       1219        2363100   VALSARTAN TAB 80MG                               RAN-VALSARTAN                                  11271         F                         X       0.5112
       1219        2371529   VALSARTAN TAB 80MG                               APO-VALSARTAN 80 MG TABLET                      3636         F                         X       0.5112

       1032        2139383 VANCOMYCIN HCL VIAL 1G                             VANCOMYCIN HYDROCHLORIDE FOR INJECTION, USP     8641         P                                78.7860     63.7092
       1032        2241821 VANCOMYCIN HCL VIAL 1G                             PMS-VANCOMYCIN 1 G                              3550         F                                63.7092

       1033        2139375 VANCOMYCIN HCL VIAL 500MG                          VANCOMYCIN HYDROCHLORIDE FOR INJECTION, USP     8641         P                                39.4848     33.5340
                                                                                                   Page 42 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                        Full / Partial   Plan B
             DIN             Chemical Name                   Drug Name                            MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                               LCA Benefit       Only
       1033        2241820 VANCOMYCIN HCL VIAL 500MG         PMS-VANCOMYCIN 500 MG                  3550         F                                33.5340

       1104        2237282   VENLAFAXINE XR TAB/CAP 150MG    EFFEXOR XR                             4908         P                                 2.1082      0.8283
       1104        2273985   VENLAFAXINE XR TAB/CAP 150MG    RATIO-VENLAFAXINE XR                  10402         F                                 0.8283
       1104        2275058   VENLAFAXINE XR TAB/CAP 150MG    TEVA-VENLAFAXINE XR                   14318         F                                 0.8283
       1104        2278561   VENLAFAXINE XR TAB/CAP 150MG    PMS-VENLAFAXINE XR                     3550         F                                 0.8283
       1104        2304333   VENLAFAXINE XR TAB/CAP 150MG    CO VENLAFAXINE XR                     10028         F                                 0.8283
       1104        2310295   VENLAFAXINE XR TAB/CAP 150MG    MYLAN-VENLAFAXINE XR                  13930         F                                 0.8283
       1104        2310333   VENLAFAXINE XR TAB/CAP 150MG    SANDOZ VENLAFAXINE XR                 12027         F                                 0.8283
       1104        2331705   VENLAFAXINE XR TAB/CAP 150MG    APO-VENLAFAXINE XR 150 MG CAP          3636         F                                 0.8283
       1104        2354748   VENLAFAXINE XR TAB/CAP 150MG    VENLAFAXINE XR                        14236         F                                 0.8283

       1102        2237279   VENLAFAXINE XR TAB/CAP 37.5MG   EFFEXOR XR                             4908         P                                 0.9986      0.3923
       1102        2273969   VENLAFAXINE XR TAB/CAP 37.5MG   RATIO-VENLAFAXINE XR                  10402         F                                 0.3923
       1102        2275023   VENLAFAXINE XR TAB/CAP 37.5MG   TEVA-VENLAFAXINE XR                   14318         F                                 0.3923
       1102        2278545   VENLAFAXINE XR TAB/CAP 37.5MG   PMS-VENLAFAXINE XR                     3550         F                                 0.3923
       1102        2304317   VENLAFAXINE XR TAB/CAP 37.5MG   CO VENLAFAXINE XR                     10028         F                                 0.3923
       1102        2310279   VENLAFAXINE XR TAB/CAP 37.5MG   MYLAN-VENLAFAXINE XR                  13930         F                                 0.3923
       1102        2310317   VENLAFAXINE XR TAB/CAP 37.5MG   SANDOZ VENLAFAXINE XR                 12027         F                                 0.3923
       1102        2331683   VENLAFAXINE XR TAB/CAP 37.5MG   APO-VENLAFAXINE XR 37.5 MG CAP         3636         F                                 0.3923
       1102        2354713   VENLAFAXINE XR TAB/CAP 37.5MG   VENLAFAXINE XR                        14236         F                                 0.3923

       1103        2237280   VENLAFAXINE XR TAB/CAP 75MG     EFFEXOR XR                             4908         P                                 1.9967      0.7845
       1103        2273977   VENLAFAXINE XR TAB/CAP 75MG     RATIO-VENLAFAXINE XR                  10402         F                                 0.7845
       1103        2275031   VENLAFAXINE XR TAB/CAP 75MG     TEVA-VENLAFAXINE XR                   14318         F                                 0.7845
       1103        2278553   VENLAFAXINE XR TAB/CAP 75MG     PMS-VENLAFAXINE XR                     3550         F                                 0.7845
       1103        2304325   VENLAFAXINE XR TAB/CAP 75MG     CO VENLAFAXINE XR                     10028         F                                 0.7845
       1103        2310287   VENLAFAXINE XR TAB/CAP 75MG     MYLAN-VENLAFAXINE XR                  13930         F                                 0.7845
       1103        2310325   VENLAFAXINE XR TAB/CAP 75MG     SANDOZ VENLAFAXINE XR                 12027         F                                 0.7845
       1103        2331691   VENLAFAXINE XR TAB/CAP 75MG     APO-VENLAFAXINE XR 75 MG CAP           3636         F                                 0.7845
       1103        2354721   VENLAFAXINE XR TAB/CAP 75MG     VENLAFAXINE XR                        14236         F                                 0.7845

        866        2100479 VERAPAMIL SR CAP 120MG            VERELAN SRC 120MG                      4018         F                                 0.7452

        867        2100487 VERAPAMIL SR CAP 180MG            VERELAN SRC 180MG                      4018         F                                 0.8424

        868        2100495 VERAPAMIL SR CAP 240MG            VERELAN 240MG SRC                      4018         F                                 0.9418

        584        1907123 VERAPAMIL SR TAB 120MG            ISOPTIN SR                             3525         P                                 1.4821      0.5546
        584        2210347 VERAPAMIL SR TAB 120MG            MYLAN-VERAPAMIL SR                    13930         F                                 0.5546
        584        2246893 VERAPAMIL SR TAB 120MG            APO-VERAP SR                           3636         F                                 0.5546

        585        1934317 VERAPAMIL SR TAB 180MG            ISOPTIN SR                             3525         P                                 1.6374      0.6263
        585        2210355 VERAPAMIL SR TAB 180MG            MYLAN-VERAPAMIL SR                    13930         F                                 0.6263
        585        2246894 VERAPAMIL SR TAB 180MG            APO-VERAP SR                           3636         F                                 0.6263

        586         742554   VERAPAMIL SR TAB 240MG          ISOPTIN SR                             3525         P                                 2.2318      0.8352
        586        2210363   VERAPAMIL SR TAB 240MG          MYLAN-VERAPAMIL SR                    13930         F                                 0.8352
        586        2211920   VERAPAMIL SR TAB 240MG          NOVO-VERAMIL SR - SRT 240 MG           4773         F                                 0.8352
        586        2237791   VERAPAMIL SR TAB 240MG          PMS-VERAPAMIL SR                       3550         F                                 0.8352
        586        2246895   VERAPAMIL SR TAB 240MG          APO-VERAP SR                           3636         F                                 0.8352

        587         782491 VERAPAMIL TAB 120MG               APO-VERAP TABLET 120MG                 3636         F                                 0.4590
        587         886041 VERAPAMIL TAB 120MG               NU-VERAP TAB 120MG                     4828         F                                 0.4590
        587        2237922 VERAPAMIL TAB 120MG               MYLAN-VERAPAMIL                       13930         F                                 0.4590

        588         554316   VERAPAMIL TAB 80MG              ISOPTIN TAB 80MG                       3525         F                                 0.2953
        588         782483   VERAPAMIL TAB 80MG              APO-VERAP TAB 80MG                     3636         F                                 0.2954
        588         886033   VERAPAMIL TAB 80MG              NU-VERAP TAB 80MG                      4828         F                                 0.2954
        588        2237921   VERAPAMIL TAB 80MG              MYLAN-VERAPAMIL                       13930         F                                 0.2954

        914        1918362   WARFARIN TAB 10MG               COUMADIN TAB 10MG                      3798         P                                 0.5389      0.2051
        914        2242687   WARFARIN TAB 10MG               TARO-WARFARIN                          5241         F                                 0.2051
        914        2242929   WARFARIN TAB 10MG               APO-WARFARIN                           3636         F                                 0.2051
        914        2244467   WARFARIN TAB 10MG               MYLAN-WARFARIN                        13930         F                                 0.2051
        914        2344114   WARFARIN TAB 10MG               WARFARIN                              14236         F                                 0.2051

        908        1918311   WARFARIN TAB 1MG                COUMADIN TAB 1MG                       3798         P                                 0.3542      0.1348
        908        2242680   WARFARIN TAB 1MG                TARO-WARFARIN                          5241         F                                 0.1348
        908        2242924   WARFARIN TAB 1MG                APO-WARFARIN                           3636         F                                 0.1348
        908        2244462   WARFARIN TAB 1MG                MYLAN-WARFARIN                        13930         F                                 0.1348
        908        2265273   WARFARIN TAB 1MG                NOVO-WARFARIN                          4773         F                                 0.1348
        908        2344025   WARFARIN TAB 1MG                WARFARIN                              14236         F                                 0.1348

        910        1918346   WARFARIN TAB 2.5MG              COUMADIN TAB 2.5MG                     3798         P                                 0.2997      0.1140
        910        2242682   WARFARIN TAB 2.5MG              TARO-WARFARIN                          5241         F                                 0.1140
        910        2242926   WARFARIN TAB 2.5MG              APO-WARFARIN                           3636         F                                 0.1140
        910        2244464   WARFARIN TAB 2.5MG              MYLAN-WARFARIN                        13930         F                                 0.1140
        910        2265303   WARFARIN TAB 2.5MG              NOVO-WARFARIN                          4773         F                                 0.1140
        910        2344041   WARFARIN TAB 2.5MG              WARFARIN                              14236         F                                 0.1140

        909        1918338   WARFARIN TAB 2MG                COUMADIN TAB 2MG                       3798         P                                 0.3748      0.1426
        909        2242681   WARFARIN TAB 2MG                TARO-WARFARIN                          5241         F                                 0.1426
        909        2242925   WARFARIN TAB 2MG                APO-WARFARIN                           3636         F                                 0.1426
        909        2244463   WARFARIN TAB 2MG                MYLAN-WARFARIN                        13930         F                                 0.1426
        909        2265281   WARFARIN TAB 2MG                NOVO-WARFARIN                          4773         F                                 0.1426
        909        2344033   WARFARIN TAB 2MG                WARFARIN                              14236         F                                 0.1426

        911        2240205   WARFARIN TAB 3MG                COUMADIN TAB 3MG                       3798         P                                 0.4644      0.1767
        911        2242683   WARFARIN TAB 3MG                TARO-WARFARIN                          5241         F                                 0.1767
        911        2245618   WARFARIN TAB 3MG                APO-WARFARIN                           3636         F                                 0.1767
        911        2265311   WARFARIN TAB 3MG                NOVO-WARFARIN                          4773         F                                 0.1767
        911        2287498   WARFARIN TAB 3MG                MYLAN-WARFARIN                        13930         F                                 0.1767
        911        2344068   WARFARIN TAB 3MG                WARFARIN                              14236         F                                 0.1767

        912        2007959   WARFARIN TAB 4MG                COUMADIN TAB 4MG                       3798         P                                 0.4644      0.1767
        912        2242684   WARFARIN TAB 4MG                TARO-WARFARIN                          5241         F                                 0.1767
        912        2242927   WARFARIN TAB 4MG                APO-WARFARIN                           3636         F                                 0.1767
        912        2244465   WARFARIN TAB 4MG                MYLAN-WARFARIN                        13930         F                                 0.1767
        912        2265338   WARFARIN TAB 4MG                NOVO-WARFARIN                          4773         F                                 0.1767
        912        2344076   WARFARIN TAB 4MG                WARFARIN                              14236         F                                 0.1767

        913        1918354   WARFARIN TAB 5MG                COUMADIN TAB 5MG                       3798         P                                 0.3002      0.1143
        913        2242685   WARFARIN TAB 5MG                TARO-WARFARIN                          5241         F                                 0.1143
        913        2242928   WARFARIN TAB 5MG                APO-WARFARIN                           3636         F                                 0.1143
        913        2244466   WARFARIN TAB 5MG                MYLAN-WARFARIN                        13930         F                                 0.1143
        913        2265346   WARFARIN TAB 5MG                NOVO-WARFARIN                          4773         F                                 0.1143
                                                                                  Page 43 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                                      Full / Partial   Plan B
             DIN             Chemical Name                Drug Name                             MAN                                RDP   SA   Max Price   LCA Price
Category no.                                                                                             LCA Benefit       Only
        913        2344084 WARFARIN TAB 5MG               WARFARIN                               14236         F                                 0.1143

       1100        2242686 WARFARIN TAB 6MG               TARO-WARFARIN                           5241         F                                 0.1893

       1101        2242697 WARFARIN TAB 7.5MG             TARO-WARFARIN                           5241         F                                 0.2038

        591         885533 YOHIMBINE TAB 2MG              YOHIMBINE HYDROCHLORIDE TAB 2MG         4835         F                                 0.3186

        592        1901885 YOHIMBINE TAB 5.4MG            YOHIMBINE TAB 5.4MG                     4835         F                                 0.4590

        593        1985604 YOHIMBINE TAB 6MG              YOHIMBINE-ODAN 6MG                      4835         F                                 0.4925

       1251        2243045   ZOLMITRIPTAN ODT TAB 2.5MG   ZOMIG RAPIMELT                          9307         P                                14.8230      5.7629
       1251        2324768   ZOLMITRIPTAN ODT TAB 2.5MG   PMS-ZOLMITRIPTAN ODT 2.5MG TAB          3550         F                                 5.7629
       1251        2342545   ZOLMITRIPTAN ODT TAB 2.5MG   TEVA-ZOLMITRIPTAN OD 2.5MG TAB         14318         F                                 5.7629
       1251        2362996   ZOLMITRIPTAN ODT TAB 2.5MG   SANDOZ ZOLMITRIPTAN ODT 2.5 MG         12027         F                                 5.7629

       1250        2238660   ZOLMITRIPTAN TAB 2.5MG       ZOMIG TAB 2.5 MG                        9307         P                                14.8140      5.7601
       1250        2313960   ZOLMITRIPTAN TAB 2.5MG       TEVA-ZOLMITRIPTAN 2.5 MG TAB           14318         F                                 5.7601
       1250        2324229   ZOLMITRIPTAN TAB 2.5MG       PMS-ZOLMITRIPTAN 2.5 MG TABLET          3550         F                                 5.7601
       1250        2362988   ZOLMITRIPTAN TAB 2.5MG       SANDOZ ZOLMITRIPTAN 2.5 MG TAB         12027         F                                 5.7601
       1250        2369036   ZOLMITRIPTAN TAB 2.5MG       MYLAN-ZOLMITRIPTAN 2.5 MG TAB          13930         F                                 5.7601

        915        2216167   ZOPICLONE TAB 5MG            IMOVANE - TAB 5MG                      12538         P                         X       1.0863      0.2409
        915        2243426   ZOPICLONE TAB 5MG            PMS-ZOPICLONE                           3550         F                         X       0.2409
        915        2245077   ZOPICLONE TAB 5MG            APO-ZOPICLONE                           3636         F                         X       0.2409
        915        2246534   ZOPICLONE TAB 5MG            RATIO-ZOPICLONE                        10402         F                         X       0.2409
        915        2251450   ZOPICLONE TAB 5MG            NOVO-ZOPICLONE                          4773         F                         X       0.2409
        915        2257572   ZOPICLONE TAB 5MG            SANDOZ ZOPICLONE                       12027         F                         X       0.2409
        915        2267918   ZOPICLONE TAB 5MG            RAN-ZOPICLONE                          11271         F                         X       0.2409
        915        2271931   ZOPICLONE TAB 5MG            CO ZOPICLONE                           10028         F                         X       0.2409
        915        2294052   ZOPICLONE TAB 5MG            PHL-ZOPICLONE                           4917         F                         X       0.2409
        915        2296616   ZOPICLONE TAB 5MG            MYLAN-ZOPICLONE                        13930         F                         X       0.2409
        915        2344122   ZOPICLONE TAB 5MG            ZOPICLONE                              14236         F                         X       0.2409

        594        1926799   ZOPICLONE TAB 7.5MG          IMOVANE 7.5 - TAB 7.5MG                12538         P                         X       1.3716      0.5060
        594        2008203   ZOPICLONE TAB 7.5MG          RHOVANE                                12027         F                         X       0.5060
        594        2218313   ZOPICLONE TAB 7.5MG          APO-ZOPICLONE - TAB 7.5MG               3636         F                         X       0.5060
        594        2228270   ZOPICLONE TAB 7.5MG          NU-ZOPICLONE TABLETS - 7.5MG            4828         F                         X       0.5060
        594        2238596   ZOPICLONE TAB 7.5MG          MYLAN-ZOPICLONE                        13930         F                         X       0.5060
        594        2240606   ZOPICLONE TAB 7.5MG          PMS-ZOPICLONE                           3550         F                         X       0.5060
        594        2242481   ZOPICLONE TAB 7.5MG          RATIO-ZOPICLONE                        10402         F                         X       0.5060
        594        2251469   ZOPICLONE TAB 7.5MG          NOVO-ZOPICLONE                          4773         F                         X       0.5060
        594        2257580   ZOPICLONE TAB 7.5MG          SANDOZ ZOPICLONE                       12027         F                         X       0.5060
        594        2267926   ZOPICLONE TAB 7.5MG          RAN-ZOPICLONE                          11271         F                         X       0.5060
        594        2271958   ZOPICLONE TAB 7.5MG          CO ZOPICLONE                           10028         F                         X       0.5060
        594        2282445   ZOPICLONE TAB 7.5MG          ZOPICLONE                              14236         F                         X       0.5060
        594        2294060   ZOPICLONE TAB 7.5MG          PHL-ZOPICLONE                           4917         F                         X       0.5060




                                                                                Page 44 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 45 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 46 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 47 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 48 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 49 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 50 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 51 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 52 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 53 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 54 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 55 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 56 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 57 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 58 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 59 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 60 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 61 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 62 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 63 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 64 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 65 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 66 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 67 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 68 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 69 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 70 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 71 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 72 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 73 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 74 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 75 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 76 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 77 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 78 of 79
LCA (Low Cost Alternative) Master Spreadsheet Published on November 3, 2011
LCA                                                                                 Full / Partial   Plan B
             DIN   Chemical Name                Drug Name                     MAN                             RDP   SA   Max Price   LCA Price
Category no.                                                                        LCA Benefit       Only




                                                            Page 79 of 79

								
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