`
`TRAVATAN Z° and Other Prostaglandin Analog Drugs
`Formulary Placement for Commercial Plans 2017-2018
`
`Branded Drugs
`Generic Drugs
`
`LUMIGAN®0.01%
`Travoprost
`TRAVATAN Z°
`ZIOPTAN®
`XALATAN®
`Latanoprost
`Bimatoprost 0.03%
`Plan
`
`
`
`
`
`
`CVSiCaremark Performance Standard wiExclusions Tier1PreferredTier 2 Preferred Not Covered Tier 2 Preferred Tier 3 Non-Preferred Not Available Not Available
`
`
`
`Preferred Prescriptions Tier1Preferred Tier1PreferredTier 2 Preferred Tier 2 Preferred Not Covered Tier 3 Non-Preferred Tier 1 Preferred
`
`
`
`
`
`
`
`
`
`
`
`UnitedHealthcare Advantage Tier1PreferredTier 2 Preferred* Tier 2 Preferred* Tier 3 Non-Preferred*® Tier 3 Non-Preferred Tier 3 Non-Preferred* Not Covered*
`
`
`
`Tricare Uniform Formulary Tier1Preferred Tier1PreferredTier 3 Non-Preferred Tier 2 Preferred Tier 3 Non-Preferred Tier 2 Preferredt Tier 3 Non-Preferred
`
`
`
`
`
`
`
`Express Scripts National Preferred Tier1Preferred Tier1PreferredTier 2 Preferred Tier 2 Preferred Not Covered Tier 3 Non-Preferred Tier 1 Preferred
`
`
`
`
`
`
`
`
`
`
`
`VAPriority Group 2 - 8 Tier1PreferredTier 3 Non-Preferred* Tier 2 Preferred Tier 3 Non-Preferred Tier 3 Non-Preferred’ Tier 3 Non-Preferred Tier 2 Preferred
`
`
`
`Cigna Standard 3-Tier (National) Tier1Preferred Tier1PreferredTier 2 Preferred Tier 3 Non-Preferred Tier 3 Non-Preferred? Tier 3 Non-Preferred Not Available
`
`
`
`
`
`
`
`Federal Employee Program Standard Tier1Preferred Tier1PreferredTier 2 Preferred Tier 2 Preferred Tier 3 Non-Preferred Tier 3 Non-Preferred Tier 1 Preferred
`
`
`
`
`
`
`
`
`
`
`
`Kaiser Permanente Northern California Tier1PreferredNat Covered Tier 2 Preferred Not Covered Not Covered Not Available Not Available
`
`
`
`
`
`
`
`Kaiser Permanente Southern California Tier1PreferredNot Covered Tier 2 Preferred Not Covered Not Covered Not Available Not Covered
`
`
`
`Anthem (BC California) Tier1Preferred Tier1PreferredTier 2 Preferred Tier 3 Non-Preferred Tier 3 Non-Preferred Tier 3 Non-Preferred Tier 1 Preferred
`
`
`
`
`
`
`
`Federal Employee Program Basic Tier1Preferred Tier1PreferredTier 2 Preferred Not Covered Tier 3 Non-Preferred Tier 3 Non-Preferred Tier 1 Preferred
`
`
`
`
`
`
`
`
`
`
`
`VA National Formulary Priority Group 1 Tier1PreferredTier 1 Preferred’ Tier 1 Preferred! Tier 1 Preferred’ Tier 1 Preferred’ Tier 1 Preferred Tier 1 Preferred’
`
`BlueCross BlueShield Illinois
`Tier 2 Preferred**
`Tier 2 Preferred**
`Tier 3 Non-Preferred**
`Tier 3 Non-Preferred**
`Tier 1 Preferred*
`Tier 1 Preferred?
`Tier 3 Non-Preferred
`BlueCross BlueShield Texas
`Tier 1 Preferred*
`Tier 3 Non-Preferred*
`Tier 2 Preferred**
`Tier 2 Preferred**
`Tier 3 Non-Preferred**
`Tier 3 Non-Preferred**
`Tier 3 Non-Preferred**
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Source: CVS/Caremark, Decision Resources Group; SECFilings
`Note: Plans sorted by the numberoflives covered and represent the 15 largest commercialplansin the U.S. Formulary placementis for years 2017-2018. TRAVATAN® wasdiscontinued in July 2010. RESCULA® wasdiscontinued in March 2015. * denotes quantity limit restriction.
`+ denotesprior authorization requirement. + denotes step therapy.
`
`CONFIDENTIAL-PROTECTIVE ORDER MATERIAL
`
`ALCON 2055
`Argentum Pharm. LLC v. Alcon Research, Ltd.
`Case IPR2017-01053
`
`
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