<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="width:415.65pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span style="font-weight:bold">Prescribed and substitute pharmaceutical benefits</span></p></td></tr><tr><td style="width:46.5pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span style="font-weight:bold">Item</span></p></td><td style="width:148.05pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:normal"><span style="font-size:10pt; font-weight:bold">Column 1</span><br><span style="font-size:10pt; font-weight:bold">Prescribed pharmaceutical benefit</span></p></td><td style="width:199.5pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; line-height:normal"><span style="font-size:10pt; font-weight:bold">Column 2</span><br><span style="font-size:10pt; font-weight:bold">Substitute pharmaceutical benefit</span></p></td></tr></thead><tbody><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>1.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 390 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Estradot 25</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 750 micrograms (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 25</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>2.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 750 micrograms (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 25</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 390 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Estradot 25</span></p><p style="margin-top:3pt; line-height:normal"><span></span></p></td></tr><tr style="height:34.95pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>3.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Estradot 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 50</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span></span></p></td></tr><tr style="height:34.95pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>4.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Estradot 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 390 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estradot 25</span></p></td></tr><tr style="height:34.95pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>5.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Estradot 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 750 micrograms (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 25</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>6.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estradot 50</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>7.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 390 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estradot 25</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>8.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 50</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 750 micrograms (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 25</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal"><span>9.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.17 mg, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estradot 75</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 585 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>(a)</span><span> </span><span>Estradot 37.5</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>(b)</span><span> </span><span>Estradiol Transdermal System (Sandoz, USA)</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>10.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.56 mg, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estradot 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 3 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 100</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>11.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.56 mg, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estradot 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estradot 50</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>12.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.56 mg, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estradot 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 50</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>13.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 3 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.56 mg, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>(a)</span><span> </span><span>Estradot 100</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>(b)</span><span> </span><span>Estradiol Transdermal System (Sandoz, USA)</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>14.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 3 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 780 micrograms, 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estradot 50</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>15.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 3 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span></span><span>Estraderm MX 100</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Estradiol</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Transdermal patches 1.5 mg (as hemihydrate), 8</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Transdermal</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Estraderm MX 50</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>16.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Insulin isophane</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Injections (human), cartridges, 100 units per mL, 3 mL, 5</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Injection</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span></span><span>Protaphane InnoLet</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Insulin isophane</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Injections (human), cartridges, 100 units per mL, 3 mL, 5</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Injection</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand: Protaphane Penfill 3 mL</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>17.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 10 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 20 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Ikotab</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>18.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 10 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>Ikotab</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 20 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Ikotab</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>19.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 20 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 10 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Ikotab</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>20.</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 20 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>Ikotab</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Nicorandil</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablets 10 mg, 60</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO</span><span>‑</span><span>Nicorandil</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Ikotab</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>21</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Simvastatin</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablet 5 mg</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>Zimstat</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>Listed drug: Simvastatin</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>Form: Tablet 10 mg</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO-Simvastatin</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>SIMVASTATIN-WGR</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>c)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>Simvar 10</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>d)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Simvastatin Sandoz</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>e)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>Zimstat</span></p></td></tr><tr style="height:89.7pt"><td style="width:46.5pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>22</span></p></td><td style="width:148.05pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Clonidine</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablet containing clonidine hydrochloride 150 micrograms</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>Catapres</span></p></td><td style="width:199.5pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Listed drug: Clonidine</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Form: Tablet containing clonidine hydrochloride 100 micrograms</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Manner of administration: Oral</span></p><p style="margin-top:3pt; line-height:normal; font-size:10pt"><span>Brand:</span><span> </span><span>any of the following:</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>a)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>APO-Clonidine</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>b)</span><span style="width:9.67pt; text-indent:0pt; display:inline-block"> </span><span>Catapres 100</span></p><p style="margin-top:3pt; margin-left:18pt; text-indent:-18pt; line-height:normal; font-size:10pt"><span>c)</span><span style="width:10.23pt; text-indent:0pt; display:inline-block"> </span><span>Clonidine Lupin</span></p></td></tr></tbody></table>