Information for Vermont Prescribers of Prescription Drugs
`
`Information for Vermont Prescribers of Prescription Drugs:
`
`Pomalyst® (pomalidomide) capsules
`
`* This list provides pricing information for oral products listed in the antineoplastic drug
` classification.
`
`* This list does not imply that the products on this chart are interchangeable or have the same
` efficacy or safety. Please refer to each product's FDA-approved label and indication for further
` information.
`
` * The prices listed below are Average Wholesale Prices (AWP) as established and made available
` to the public by a third party publisher, or as calculated from data made available to the public
` by a third party publisher. The price paid by consumers may be higher or lower than the prices
` listed below. Information about AWP of these drugs is being provided to Vermont prescribers
` pursuant to Vermont law, to give you information about the relative prices of marketed drugs and
` other drugs in the same therapeutic class.
`
` * The prices listed here do not necessarily reflect price per dosage, price per course of
` treatment, or the cost effectiveness of all the products listed. For simplicity, only the smallest
` package sizes available for each product are included.
`
`
`
`Product Name
`
`Manufacturer
`
`NDC or UPC Pkg Size Per Pack
`
`Per Unit
`
`Marketed Product
`
`POMALYST CAP 1MG
`POMALYST CAP 2MG
`POMALYST CAP 3MG
`POMALYST CAP 4MG
`
`Other Products
`
`AFINITOR TAB 2.5MG
`AFINITOR TAB 5MG
`AFINITOR TAB 7.5MG
`AFINITOR TAB 10MG
`AFINITOR DIS TAB 2MG
`AFINITOR DIS TAB 3MG
`AFINITOR DIS TAB 5MG
`ALKERAN TAB 2MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ANASTROZOLE TAB 1MG
`ARIMIDEX TAB 1MG
`AROMASIN TAB 25MG
`BICALUTAMIDE TAB 50MG
`
`CELGENE CORP
`CELGENE CORP
`CELGENE CORP
`CELGENE CORP
`
`NOVARTIS
`NOVARTIS
`NOVARTIS
`NOVARTIS
`NOVARTIS
`NOVARTIS
`NOVARTIS
`APO PHARMA USA
`ROXANE
`TEVA PHARMACEUTICALS USA
`MYLAN
`SANDOZ
`MAJOR PHARMACEUTICALS
`PACK PHARMACEUTICALS, LLC
`ACCORD HEALTHCARE
`ORCHIDPHARMA
`BRECKENRIDGE
`DR.REDDY'S LABORATORIES, INC.
`CYPRESS PHARMACEUTICAL
`APOTEX
`SUN PHARMACEUTICAL
`FRESENIUS KABI USA
`KADMON PHARMACEUTICALS
`ASCEND LABORATORIES
`BLUE POINT LABORATORIES
`ZYDUS PHARMACEUTICALS (USA)
`ASTRAZENECA
`PFIZER U.S.
`TEVA PHARMACEUTICALS USA
`
`59572050121
`59572050221
`59572050321
`59572050421
`
`00078059451
`00078056651
`00078062051
`00078056751
`00078062651
`00078062751
`00078062851
`52609000105
`00054016413
`00093753656
`00378603477
`00781535631
`00904619546
`16571042103
`16729003510
`42043018003
`51991062033
`55111064730
`60258086603
`60505298503
`62756025083
`63323012930
`66435041530
`67877017130
`68001015504
`68382020906
`00310020130
`00009766304
`00093022056
`
`Page 1 of 5
`
`21
`21
`21
`21
`
`28
`28
`28
`28
`28
`28
`28
`50
`30
`30
`90
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`30
`
`$14,107.67
`$14,107.67
`$14,107.67
`$14,107.67
`
`$12,089.11
`$12,645.00
`$12,645.00
`$12,645.00
`$12,028.82
`$12,149.32
`$12,645.00
`$610.37
`$404.87
`$404.87
`$1,213.27
`$404.87
`$359.89
`$404.42
`$399.11
`$404.85
`$400.38
`$404.83
`$403.99
`$446.36
`$404.85
`$9.54
`$20.40
`$398.95
`$404.36
`$404.36
`$572.84
`$841.86
`$556.79
`
`$671.79
`$671.79
`$671.79
`$671.79
`
`$431.75
`$451.61
`$451.61
`$451.61
`$429.60
`$433.90
`$451.61
`$12.21
`$13.50
`$13.50
`$13.48
`$13.50
`$12.00
`$13.48
`$13.30
`$13.50
`$13.35
`$13.49
`$13.47
`$14.88
`$13.50
`$0.32
`$0.68
`$13.30
`$13.48
`$13.48
`$19.09
`$28.06
`$18.56
`
`CFAD VI 1038 - 0001
`CFAD VI v. CELGENE
`IPR2015-01102
`
`

`

`Product Name
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BICALUTAMIDE TAB 50MG
`BOSULIF TAB 100MG
`BOSULIF TAB 500MG
`CAPECITABINE TAB 150MG
`CAPECITABINE TAB 150MG
`CAPECITABINE TAB 150MG
`CAPECITABINE TAB 150MG
`CAPECITABINE TAB 500MG
`CAPECITABINE TAB 500MG
`CAPECITABINE TAB 500MG
`CAPECITABINE TAB 500MG
`CAPRELSA TAB 100MG
`CAPRELSA TAB 300MG
`CASODEX TAB 50MG
`COMETRIQ KIT 60MG
`COMETRIQ KIT 100MG
`COMETRIQ KIT 140MG
`CYCLOPHOSPH CAP 25MG
`CYCLOPHOSPH CAP 50MG
`DROXIA CAP 200MG
`DROXIA CAP 300MG
`DROXIA CAP 400MG
`EMCYT CAP 140MG
`ERIVEDGE CAP 150MG
`ETOPOSIDE CAP 50MG
`EXEMESTANE TAB 25MG
`EXEMESTANE TAB 25MG
`EXEMESTANE TAB 25MG
`FARESTON TAB 60MG
`FARYDAK CAP 10MG
`FARYDAK CAP 15MG
`FARYDAK CAP 20MG
`FEMARA TAB 2.5MG
`FLUTAMIDE CAP 125MG
`FLUTAMIDE CAP 125MG
`FLUTAMIDE CAP 125MG
`GILOTRIF TAB 20MG
`GILOTRIF TAB 30MG
`GILOTRIF TAB 40MG
`GLEEVEC TAB 100MG
`GLEEVEC TAB 400MG
`GLEOSTINE CAP 10MG
`GLEOSTINE CAP 40MG
`GLEOSTINE CAP 100MG
`HEXALEN CAP 50MG
`HYCAMTIN CAP 0.25MG
`HYCAMTIN CAP 1MG
`HYDREA CAP 500MG
`HYDROXYUREA CAP 500MG
`HYDROXYUREA CAP 500MG
`HYDROXYUREA CAP 500MG
`IBRANCE CAP 75MG
`
`Information for Vermont Prescribers of Prescription Drugs
`
`NDC or UPC Pkg Size Per Pack
`Manufacturer
`00378701793
`30
`MYLAN
`00781540931
`30
`SANDOZ
`00904601946
`30
`MAJOR PHARMACEUTICALS
`16714057101
`30
`NORTHSTAR RX
`16729002310
`30
`ACCORD HEALTHCARE
`41616048583
`30
`SUN PHARMACEUTICAL
`42291016830
`30
`AVKARE
`51991056001
`100
`BRECKENRIDGE
`60505264203
`30
`APOTEX
`62175013232
`30
`KREMERS URBAN
`68382022406
`30
`ZYDUS PHARMACEUTICALS (USA)
`00069013501
`120
`PFIZER U.S.
`00069013601
`30
`PFIZER U.S.
`00093747306
`60
`TEVA PHARMACEUTICALS USA
`00378251191
`60
`MYLAN
`16729007212
`60
`ACCORD HEALTHCARE
`42291019060
`60
`AVKARE
`00093747489
`120
`TEVA PHARMACEUTICALS USA
`00378251278
`120
`MYLAN
`16729007329
`120
`ACCORD HEALTHCARE
`42291019112
`120
`AVKARE
`00310782030
`30
`ASTRAZENECA
`00310784030
`30
`ASTRAZENECA
`00310070530
`30
`ASTRAZENECA
`42388001314
`84
`EXELIXIS
`42388001214
`56
`EXELIXIS
`42388001114
`112
`EXELIXIS
`00054038225
`100
`ROXANE
`00054038325
`100
`ROXANE
`B-M SQUIBB ONCOLOGY/IMMUNOLOGY 00003633517
`60
`B-M SQUIBB ONCOLOGY/IMMUNOLOGY 00003633617
`60
`B-M SQUIBB ONCOLOGY/IMMUNOLOGY 00003633717
`60
`PFIZER U.S.
`00013013202
`100
`GENENTECH
`50242014001
`28
`MYLAN
`00378326694
`20
`ROXANE
`00054008013
`30
`ALVOGEN
`47781010830
`30
`GREENSTONE
`59762285801
`30
`PROSTRAKAN
`42747032730
`30
`NOVARTIS
`00078065006
`6
`NOVARTIS
`00078065106
`6
`NOVARTIS
`00078065206
`6
`NOVARTIS
`00078024915
`30
`IVAX PHARMACEUTICALS, INC.
`00172496058
`180
`ACTAVIS PHARMA
`00591246618
`180
`PAR
`49884075313
`180
`BOEHRINGER INGELHEIM
`00597014130
`30
`BOEHRINGER INGELHEIM
`00597013730
`30
`BOEHRINGER INGELHEIM
`00597013830
`30
`NOVARTIS
`00078040134
`90
`NOVARTIS
`00078043815
`30
`NEXTSOURCE BIOTECHNOLOGY
`58181304005
`5
`NEXTSOURCE BIOTECHNOLOGY
`58181304105
`5
`NEXTSOURCE BIOTECHNOLOGY
`58181304205
`5
`EISAI
`62856000110
`100
`NOVARTIS
`00007420511
`10
`NOVARTIS
`00007420711
`10
`B-M SQUIBB ONCOLOGY/IMMUNOLOGY 00003083050
`100
`TEVA PHARMACEUTICALS USA
`00555088202
`100
`AVKARE
`42291032101
`100
`PAR
`49884072401
`100
`PFIZER U.S.
`00069018721
`21
`
`$556.11
`$556.79
`$493.95
`$556.11
`$550.61
`$556.00
`$556.75
`$1,856.06
`$556.79
`$550.61
`$556.17
`$13,077.68
`$13,077.68
`$704.22
`$703.44
`$704.22
`$704.20
`$4,694.24
`$4,689.02
`$4,694.24
`$4,689.02
`$7,217.62
`$14,434.98
`$630.08
`$15,594.00
`$15,594.00
`$15,594.00
`$843.42
`$1,547.85
`$54.49
`$54.49
`$58.31
`$1,225.50
`$10,835.38
`$1,707.46
`$606.94
`$606.94
`$606.94
`$1,295.16
`$8,232.00
`$8,232.00
`$8,232.00
`$802.38
`$899.04
`$376.18
`$376.60
`$7,768.22
`$7,768.22
`$7,768.22
`$9,201.94
`$11,052.70
`$158.94
`$640.26
`$1,600.44
`$1,735.20
`$1,170.79
`$4,683.08
`$163.81
`$147.40
`$102.18
`$127.73
`$11,820.00
`
`Page 2 of 5
`
`Per Unit
`
`$18.54
`$18.56
`$16.47
`$18.54
`$18.35
`$18.53
`$18.56
`$18.56
`$18.56
`$18.35
`$18.54
`$108.98
`$435.92
`$11.74
`$11.72
`$11.74
`$11.74
`$39.12
`$39.08
`$39.12
`$39.08
`$240.59
`$481.17
`$21.00
`$185.64
`$278.46
`$139.23
`$8.43
`$15.48
`$0.91
`$0.91
`$0.97
`$12.26
`$386.98
`$85.37
`$20.23
`$20.23
`$20.23
`$43.17
`$1,372.00
`$1,372.00
`$1,372.00
`$26.75
`$4.99
`$2.09
`$2.09
`$258.94
`$258.94
`$258.94
`$102.24
`$368.42
`$31.79
`$128.05
`$320.09
`$17.35
`$117.08
`$468.31
`$1.64
`$1.47
`$1.02
`$1.28
`$562.86
`
`CFAD VI 1038 - 0002
`
`

`

`Product Name
`IBRANCE CAP 100MG
`IBRANCE CAP 125MG
`ICLUSIG TAB 15MG
`ICLUSIG TAB 45MG
`IMBRUVICA CAP 140MG
`INLYTA TAB 1MG
`INLYTA TAB 5MG
`JAKAFI TAB 5MG
`JAKAFI TAB 10MG
`JAKAFI TAB 15MG
`JAKAFI TAB 20MG
`JAKAFI TAB 25MG
`LENVIMA CAP 10MG
`LENVIMA CAP 20MG
`LENVIMA CAP 14MG
`LENVIMA CAP 24MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LETROZOLE TAB 2.5MG
`LEUKERAN TAB 2MG
`LOMUSTINE CAP 10MG
`LOMUSTINE CAP 40MG
`LOMUSTINE CAP 100MG
`LYNPARZA CAP 50MG
`LYSODREN TAB 500MG
`MATULANE CAP 50MG
`MEGESTROL AC TAB 20MG
`MEGESTROL AC TAB 20MG
`MEGESTROL AC TAB 20MG
`MEGESTROL AC TAB 40MG
`MEGESTROL AC TAB 40MG
`MEGESTROL AC TAB 40MG
`MEKINIST TAB 0.5MG
`MEKINIST TAB 2MG
`MERCAPTOPUR TAB 50MG
`MERCAPTOPUR TAB 50MG
`METHOTREXATE TAB 2.5MG
`METHOTREXATE TAB 2.5MG
`METHOTREXATE TAB 2.5MG
`METHOTREXATE TAB 2.5MG
`METHOTREXATE TAB 2.5MG
`MYLERAN TAB 2MG
`NEXAVAR TAB 200MG
`NILANDRON TAB 150MG
`REVLIMID CAP 2.5MG
`REVLIMID CAP 5MG
`REVLIMID CAP 10MG
`REVLIMID CAP 15MG
`REVLIMID CAP 20MG
`REVLIMID CAP 25MG
`RHEUMATREX TAB 2.5MG
`SPRYCEL TAB 20MG
`SPRYCEL TAB 50MG
`SPRYCEL TAB 70MG
`SPRYCEL TAB 80MG
`
`Information for Vermont Prescribers of Prescription Drugs
`
`NDC or UPC Pkg Size Per Pack
`Manufacturer
`00069018821
`21
`$11,820.00
`PFIZER U.S.
`00069018921
`21
`$11,820.00
`PFIZER U.S.
`76189053530
`30
`$13,536.00
`ARIAD PHARMACEUTICALS
`76189053430
`30
`$13,536.00
`ARIAD PHARMACEUTICALS
`57962014009
`90
`$11,002.60
`PHARMACYCLICS
`00069014501
`180
`$13,635.58
`PFIZER U.S.
`00069015111
`60
`$13,635.58
`PFIZER U.S.
`50881000560
`60
`$11,523.60
`INCYTE CORPORATION
`50881001060
`60
`$11,523.60
`INCYTE CORPORATION
`50881001560
`60
`$11,523.60
`INCYTE CORPORATION
`50881002060
`60
`$11,523.60
`INCYTE CORPORATION
`50881002560
`60
`$11,523.60
`INCYTE CORPORATION
`62856071005
`5
`$2,500.00
`EISAI
`62856072005
`10
`$2,790.00
`EISAI
`62856071405
`10
`$2,500.00
`EISAI
`62856072405
`15
`$2,790.00
`EISAI
`00054026913
`30
`$544.04
`ROXANE
`00093762056
`30
`$544.04
`TEVA PHARMACEUTICALS USA
`00378207193
`30
`$543.44
`MYLAN
`00603418016
`30
`$543.43
`QUALITEST
`16729003410
`30
`$541.55
`ACCORD HEALTHCARE
`42291037490
`90
`$1,690.31
`AVKARE
`51991075933
`30
`$543.44
`BRECKENRIDGE
`60505325503
`30
`$544.03
`APOTEX
`62756051183
`30
`$543.44
`SUN PHARMACEUTICAL
`63323077230
`30
`$60.44
`FRESENIUS KABI USA
`76388063550
`50
`$640.32
`PRASCO LABORATORIES
`58181303005
`5
`$102.82
`NEXTSOURCE BIOTECHNOLOGY
`58181303105
`5
`$266.44
`NEXTSOURCE BIOTECHNOLOGY
`58181303205
`5
`$508.44
`NEXTSOURCE BIOTECHNOLOGY
`00310065758
`112
`$13,440.00
`ASTRAZENECA
`B-M SQUIBB ONCOLOGY/IMMUNOLOGY 00015308060
`100
`$575.94
`SIGMA-TAU
`54482005301
`100
`$6,756.54
`ROXANE
`00054460325
`100
`$65.48
`TEVA PHARMACEUTICALS USA
`00555060602
`100
`$104.04
`PAR
`49884028901
`100
`$69.20
`ROXANE
`00054460425
`100
`$116.80
`TEVA PHARMACEUTICALS USA
`00555060702
`100
`$170.83
`PAR
`49884029001
`100
`$123.00
`NOVARTIS
`00173084913
`30
`$3,021.41
`NOVARTIS
`00173084813
`30
`$12,085.61
`ROXANE
`00054458111
`25
`$204.62
`MYLAN
`00378354752
`25
`$102.25
`ROXANE
`00054455015
`36
`$145.80
`MYLAN
`00378001401
`100
`$623.70
`TEVA PHARMACEUTICALS USA
`00555057235
`36
`$145.80
`AVKARE
`42291059401
`100
`$356.40
`DAVA PHARMACEUTICALS
`67253032036
`36
`$145.80
`PRASCO LABORATORIES
`76388071325
`25
`$369.84
`BAYER HEALTHCARE PHARMA
`50419048858
`120
`$14,799.00
`CONCORDIA PHARMACEUTICALS
`24987011114
`30
`$5,483.14
`CELGENE CORP
`59572040228
`28
`$16,240.78
`CELGENE CORP
`59572040528
`28
`$16,240.78
`CELGENE CORP
`59572041028
`28
`$16,240.78
`CELGENE CORP
`59572041521
`21
`$12,180.59
`CELGENE CORP
`59572042021
`21
`$12,180.59
`CELGENE CORP
`59572042521
`21
`$12,180.59
`DAVA PHARMACEUTICALS
`67253058042
`8
`$93.58
`B-M SQUIBB U.S. (PRIMARY CARE)
`00003052711
`60
`$6,895.70
`B-M SQUIBB U.S. (PRIMARY CARE)
`00003052811
`60
`$13,791.38
`B-M SQUIBB U.S. (PRIMARY CARE)
`00003052411
`60
`$13,791.38
`B-M SQUIBB U.S. (PRIMARY CARE)
`00003085522
`30
`$12,428.33
`
`Page 3 of 5
`
`Per Unit
`
`$562.86
`$562.86
`$451.20
`$451.20
`$122.25
`$75.75
`$227.26
`$192.06
`$192.06
`$192.06
`$192.06
`$192.06
`$500.00
`$279.00
`$250.00
`$186.00
`$18.13
`$18.13
`$18.11
`$18.11
`$18.05
`$18.78
`$18.11
`$18.13
`$18.11
`$2.01
`$12.81
`$20.56
`$53.29
`$101.69
`$30.00
`$5.76
`$67.57
`$0.65
`$1.04
`$0.69
`$1.17
`$1.71
`$1.23
`$100.71
`$402.85
`$8.18
`$4.09
`$4.05
`$6.24
`$4.05
`$3.56
`$4.05
`$14.79
`$123.33
`$182.77
`$580.03
`$580.03
`$580.03
`$580.03
`$580.03
`$580.03
`$11.70
`$114.93
`$229.86
`$229.86
`$414.28
`
`CFAD VI 1038 - 0003
`
`

`

`Information for Vermont Prescribers of Prescription Drugs
`
`Product Name
`SPRYCEL TAB 100MG
`SPRYCEL TAB 140MG
`STIVARGA TAB 40MG
`SUTENT CAP 12.5MG
`SUTENT CAP 25MG
`SUTENT CAP 37.5MG
`SUTENT CAP 50MG
`TABLOID TAB 40MG
`TAFINLAR CAP 50MG
`TAFINLAR CAP 75MG
`TAMOXIFEN TAB 10MG
`TAMOXIFEN TAB 10MG
`TAMOXIFEN TAB 10MG
`TAMOXIFEN TAB 20MG
`TAMOXIFEN TAB 20MG
`TAMOXIFEN TAB 20MG
`TARCEVA TAB 25MG
`TARCEVA TAB 100MG
`TARCEVA TAB 150MG
`TARGRETIN CAP 75MG
`TASIGNA CAP 150MG
`TASIGNA CAP 200MG
`TEMODAR CAP 20MG
`TEMODAR CAP 140MG
`TEMODAR CAP 180MG
`TEMOZOLOMIDE CAP 5MG
`TEMOZOLOMIDE CAP 5MG
`TEMOZOLOMIDE CAP 5MG
`TEMOZOLOMIDE CAP 5MG
`TEMOZOLOMIDE CAP 20MG
`TEMOZOLOMIDE CAP 20MG
`TEMOZOLOMIDE CAP 20MG
`TEMOZOLOMIDE CAP 20MG
`TEMOZOLOMIDE CAP 100MG
`TEMOZOLOMIDE CAP 100MG
`TEMOZOLOMIDE CAP 100MG
`TEMOZOLOMIDE CAP 100MG
`TEMOZOLOMIDE CAP 140MG
`TEMOZOLOMIDE CAP 140MG
`TEMOZOLOMIDE CAP 140MG
`TEMOZOLOMIDE CAP 140MG
`TEMOZOLOMIDE CAP 180MG
`TEMOZOLOMIDE CAP 180MG
`TEMOZOLOMIDE CAP 180MG
`TEMOZOLOMIDE CAP 180MG
`TEMOZOLOMIDE CAP 250MG
`TEMOZOLOMIDE CAP 250MG
`TEMOZOLOMIDE CAP 250MG
`TEMOZOLOMIDE CAP 250MG
`TRETINOIN CAP 10MG
`TRETINOIN CAP 10MG
`TREXALL TAB 5MG
`TREXALL TAB 7.5MG
`TREXALL TAB 10MG
`TREXALL TAB 15MG
`TYKERB TAB 250MG
`VOTRIENT TAB 200MG
`XALKORI CAP 200MG
`XALKORI CAP 250MG
`XELODA TAB 150MG
`XELODA TAB 500MG
`XTANDI CAP 40MG
`
`Manufacturer
`B-M SQUIBB U.S. (PRIMARY CARE)
`B-M SQUIBB U.S. (PRIMARY CARE)
`BAYER HEALTHCARE PHARMA
`PFIZER U.S.
`PFIZER U.S.
`PFIZER U.S.
`PFIZER U.S.
`PRASCO LABORATORIES
`NOVARTIS
`NOVARTIS
`TEVA PHARMACEUTICALS USA
`MYLAN
`ACTAVIS PHARMA
`TEVA PHARMACEUTICALS USA
`MYLAN
`ACTAVIS PHARMA
`GENENTECH
`GENENTECH
`GENENTECH
`VALEANT
`NOVARTIS
`NOVARTIS
`MERCK SHARP & DOHME
`MERCK SHARP & DOHME
`MERCK SHARP & DOHME
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`SANDOZ
`SUN PHARMACEUTICAL
`AMNEAL PHARMACEUTICALS
`TEVA PHARMACEUTICALS USA
`PAR
`TEVA/WOMENS HEALTH
`TEVA/WOMENS HEALTH
`TEVA/WOMENS HEALTH
`TEVA/WOMENS HEALTH
`NOVARTIS
`NOVARTIS
`PFIZER U.S.
`PFIZER U.S.
`GENENTECH
`GENENTECH
`ASTELLAS
`
`NDC or UPC Pkg Size Per Pack
`00003085222
`30
`$12,428.33
`00003085722
`30
`$12,428.33
`50419017101
`28
`$4,720.42
`00069055038
`28
`$4,640.18
`00069077038
`28
`$9,280.38
`00069083038
`28
`$13,920.59
`00069098038
`28
`$16,155.85
`76388088025
`25
`$433.32
`00173084608
`120
`$7,038.83
`00173084708
`120
`$10,557.54
`00093078406
`60
`$113.77
`00378014491
`60
`$113.65
`00591247260
`60
`$113.64
`00093078256
`30
`$113.77
`00378027493
`30
`$113.65
`00591247330
`30
`$113.64
`50242006201
`30
`$2,591.45
`50242006301
`30
`$7,117.85
`50242006401
`30
`$8,050.79
`00187552675
`100
`$29,849.51
`00078059251
`28
`$2,901.05
`00078052651
`28
`$2,901.05
`00085151901
`14
`$976.93
`00085142501
`5
`$2,442.29
`00085143001
`5
`$3,140.08
`00093759957
`5
`$60.19
`00781269175
`5
`$62.70
`47335089080
`5
`$62.60
`65162080151
`5
`$71.43
`00093760057
`5
`$242.51
`00781269275
`5
`$252.61
`47335089180
`5
`$252.30
`65162080251
`5
`$287.81
`00093760157
`5
`$1,212.35
`00781269375
`5
`$1,262.87
`47335089280
`5
`$1,261.45
`65162080351
`5
`$1,438.80
`00093763857
`5
`$1,697.31
`00781269475
`5
`$1,768.03
`47335092980
`5
`$1,766.05
`65162080451
`5
`$2,014.33
`00093763957
`5
`$2,182.25
`00781269575
`5
`$2,273.18
`47335093080
`5
`$2,270.65
`65162080551
`5
`$2,589.84
`00093760257
`5
`$3,031.73
`00781269675
`5
`$3,158.06
`47335089380
`5
`$3,154.55
`65162080651
`5
`$3,598.00
`00555080802
`100
`$2,988.16
`10370026801
`100
`$2,988.16
`51285036601
`30
`$420.85
`51285036701
`30
`$631.28
`51285036801
`30
`$841.70
`51285036901
`30
`$1,262.58
`00173075200
`150
`$6,328.46
`00173080409
`120
`$9,980.21
`00069814120
`60
`$16,158.77
`00069814020
`60
`$16,158.77
`00004110020
`60
`$852.90
`00004110150
`120
`$5,685.25
`00469012599
`120
`$10,617.58
`
`Page 4 of 5
`
`Per Unit
`
`$414.28
`$414.28
`$168.59
`$165.72
`$331.44
`$497.16
`$576.99
`$17.33
`$58.66
`$87.98
`$1.90
`$1.89
`$1.89
`$3.79
`$3.79
`$3.79
`$86.38
`$237.26
`$268.36
`$298.50
`$103.61
`$103.61
`$69.78
`$488.46
`$628.02
`$12.04
`$12.54
`$12.52
`$14.29
`$48.50
`$50.52
`$50.46
`$57.56
`$242.47
`$252.57
`$252.29
`$287.76
`$339.46
`$353.61
`$353.21
`$402.87
`$436.45
`$454.64
`$454.13
`$517.97
`$606.35
`$631.61
`$630.91
`$719.60
`$29.88
`$29.88
`$14.03
`$21.04
`$28.06
`$42.09
`$42.19
`$83.17
`$269.31
`$269.31
`$14.22
`$47.38
`$88.48
`
`CFAD VI 1038 - 0004
`
`

`

`Information for Vermont Prescribers of Prescription Drugs
`
`Product Name
`ZELBORAF TAB 240MG
`ZOLINZA CAP 100MG
`ZYDELIG TAB 100MG
`ZYDELIG TAB 150MG
`ZYKADIA CAP 150MG
`ZYTIGA TAB 250MG
`
`Manufacturer
`GENENTECH
`MERCK SHARP & DOHME
`GILEAD SCIENCES
`GILEAD SCIENCES
`NOVARTIS
`JANSSEN BIOTECH
`
`Per Unit
`
`NDC or UPC Pkg Size Per Pack
`50242009001
`120
`$6,510.48
`00006056840
`120
`$14,067.47
`61958170101
`60
`$9,495.36
`61958170201
`60
`$9,495.36
`00078064070
`70
`$7,558.80
`57894015012
`120
`$9,595.58
`
`$54.25
`$117.23
`$158.26
`$158.26
`$107.98
`$79.96
`
`Medi-Span is the source of this information: July 1, 2015
`
`(c) 2014 Celgene Corporation 01/14 Us-CELG140004
`
`Page 5 of 5
`
`CFAD VI 1038 - 0005
`
`