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City of Milwaukee Choice Plan - Police Association cont' Therapeutic Interchange List Note: Suggested interchange is product appropriate for MOST indications. Last Updated * 1 2008 Non-Preferred Not Covered Alternative * PANDEL hydrocortisone PANNAZ OTC Alternatives PANOXYL benzoyl peroxide OTC ; PCE erythromycin amphetamine dextroamp pemoline methylphenidate PENETREX ciprofloxacin smx-tmp clotrimazole betamethasone cr PENLAC econazole cr LOPROX GEL terbinafine PERCOCET 2.5 325, 7.5 ; oxycodone acetaminophen PERFOROMIST NEB FORADIL AEROLIZER PERIOSTAT doxycycline 100mg PEXEVA citalopram paroxetine phentermine Plan Exclusion POLYCITRA sodium citrate and citric acid soln PONDIMIN Plan Exclusion PONSTEL diclofenac ibuprofen naproxen PRANDIN glipizide glyburide PRECISION QID METERS & STRIPS ACCU-CHEK METER ACCU-CHEK TEST STRIPS FREESTYLE FLASH METER FREESTYLE TEST STRIPS PRECISION TEST STRIPS PRECISION XTRA METER PRENATE ULTRA Prenatal 1mg with Iron PREVACID CAP ACIPHEX PRILOSEC OTC PROTONIX PREVPAC ACIPHEX PRILOSEC OTC PROTONIX PRILOSEC ACIPHEX PRILOSEC OTC PROTONIX PROAMATINE fludrocortisone PROCARDIA XL amlodipine nifedipine ER promethazine DM OTC Alternatives PROPECIA Plan Exclusion PROQUIN XR ciprofloxacin PROSED EC DS ; phenazopyridine USEPT. 8 Table 1 Estimated cost to bring a "new chemical entity" into the market Study Hansen, 1979 Wiggins, 1987 DiMasi et. al., 1991 OTA, 1993 Myers and Howe, 1997 Years 1 1963-75 Total costs millions $ 1997 ; 138 156 312.
I. GENERAL MANAGEMENT .43 II. IMMINENT DELIVERY: .43 III. PROLAPSED UMBILICAL CORD: .44 IV. POST PARTUM HEMORRHAGE .44 V. SEIZURE .44 OBSTRUCTED AIRWAY .45 I. MANAGEMENT-ADEQUATE AIR EXCHANGE .45 II. MANAGEMENT-POOR AIR EXCHANGE .45 POISONING OVERDOSE .47 I. MANAGEMENT .47 PULMONARY EDEMA .49 I. MANAGEMENT .49 SEIZURES .51 I. IF THE PATIENT IS ACTIVELY SEIZING OR IS POSTICTAL: .51 II. IF THE PATIENT IS NOT SEIZING AND IS NOT POSTICTAL: .51 STROKE .53 I. MANAGEMENT .53 VAGINAL BLEEDING .55 I. MANAGEMENT .55 TRAUMA .57 MAJOR TRAUMA .59 I. MANAGEMENT .59 ABDOMINAL TRAUMA .61 I. MANAGEMENT .61 CHEST TRAUMA.63 I. MANAGEMENT .63 DISLOCATIONS-DELAYED TRANSPORT .65 I. GENERAL TREATMENT .65 II. SHOULDER .65 III. PATELLA .66 IV. DIGITS .66 EXTREMITY TRAUMA .67 I. MANAGEMENT .67 HEAD TRAUMA .69 I. MANAGEMENT .69 SOFT TISSUE TRAUMA .71 I. MANAGEMENT .71 ENVIRONMENTAL.73 AVALANCHE BURIAL .75 I. EVALUATION AND TREATMENT .75 COLD WATER NEAR DROWNING: .77 I. EVALUATION AND TREATMENT .77 DIVING EMERGENCIES .79 I. GENERAL TREATMENT .79 II. MANAGEMENT-ACUTELY SICK DIVE EMERGENCY PATIENTS .79 III. MANAGEMENT-STABLE DIVE EMERGENCY PATIENTS .79 FROSTBITE .81 I. MANAGEMENT .81 HEAT EMERGENCIES .83 I. MANAGEMENT .83 HYPOTHERMIA .85 I. ALL COLD PATIENTS: .85 II. MILD HYPOTHERMIA: .85 III. SEVERE HYPOTHERMIA WITH SIGNS OF LIFE: .85. Drug misuse and abuse potential. Otherwise know as the `date-rape' drug.

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Symptoms of GERD. Nothing in the discharge summary indicates any symptoms of GERD, nor a diagnosis of GERD, nor any referral for treatment of a GERD condition. While Portonix is an acid blocker, as is Nexium, there is no medical evidence indicating that Protknix was prescribed for a GERD condition. It is pure speculation that claimant suffered any symptoms of GERD during the initial hospitalization. We conclude no evidence supports the commission's determination of causation and further conclude the commission applied an incorrect analysis concerning compensable consequences. We reverse the commission's award of medical benefits. Reversed. Another large area of medical management that may impact on divers are the endocrine metabolic systems and bentyl. All Pharmacies September 30, 2002 Page 4 numbers do not use the NABP number ; . Overall, to submit CSHS claims, simply copy the specifications from your current ND Medicaid billing parameters to your new third party file for the above BIN number. When you submit your first claim, you will be prompted to call the switch and register for Medicaid. After you call them and provide them with your provider number, you will be able to submit claims and receive responses from Medicaid as before. Quantity Limits * The DUR Board has reviewed the quantity limitations and they have stated that no exceptions should be made. Following is a complete list of limits. If the strength is not specified, it applies for all strengths e.g. Prevacid ; . If the strength is specified, only the specified strengths are affected e.g. Zoloft ; . All acetaminophen containing products are limited to 4 grams of acetaminophen per day e.g. Darvocet-N 100 ; . Drug Aciphex Actos Allegra 180 mg Allegra others ; Ambien 5 mg Aricept Axid Celebrex Celexa 40 mg Celexa others ; Clarinex Claritin 10 mg Claritin 5 mg combinations Coreg Qty Day Drug 2 Detrol 1 Detrol LA 1 Ditropan XL 10 & 15 mg 2 Ditropan XL 5 mg 1 Geodon 1 Imdur 2 Lipitor 2 Lisinopril 1.5 Nexium 1 Norvasc 2.5 & 5 mg 1 Paxil 40 mg 1 Paxil others ; 2 Paxil CR 25 mg 2 Paxil CR others ; Qty Day Drug 2 Pepcid 1 Plavix 2 Prevacid 1 2 1 Prilosec Protobix 20 mg Protoniix 40 mg Remeron Serzone Singulair Ultram Vioxx Zocor 10 mg Zocor others ; Zoloft 25 & 50 mg Qty Day 2 1 2.

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Example, Zantac r , Tagament r , Pepcid r , and Axid r , are related drugs that treat acid reflux; Prilosec r , Prevacid r , Aciphex r and Protonix r are a different type of drug but treat the same indication. Viagra r , Cialis r , and Letriva r all treat erectile dysfunction. Lipitor r , Zocor r and Lovastatin r are all statins that lower cholesterol. 42 For example, worldwide sales of Lipitor exceeded billion in 2001, sales of Zocor topped .6 billion. See Donald L. Barlett & James B. Steele, "Why We Pay So Much for Drugs, " Time, February 2, 2004, p. 44 and carafate.
Proton-pump Inhibitors Single Entity Agents AHFS 562836 Manufacturer comments on behalf of these products: None Dr. Ferris stated that the proton-pump inhibitors PPIs ; were previously reviewed in August 2004. Zegerid, an immediate-release formulation of omeprazole, was reviewed as a new drug in October 2005. Since the last review, no new brand products had been introduced to the market. New injectable formulations for esomeprazole and lansoprazole became available. Omeprazole was available generically, but required PA. Prilosec OTC, Zegerid and Protonix were on the PDL. Current treatment guidelines utilizing the single entity PPIs were discussed. PPIs were recommended as first-line therapy for symptomatic gastroesophageal reflux disease GERD ; , the treatment and maintenance of healed erosive esophagitis, and peptic ulcer disease PUD ; caused by nonsteroidal anti-inflammatory drugs NSAID ; . Triple and quadruple combination therapy with antibiotics and a PPI were considered firstline therapy for PUD caused by H. pylori. None of the treatment guidelines gave preference to one particular PPI over another. New FDA indications were briefly mentioned. Dr. Ferris commented that there were no major differences in the pharmacokinetic, drug interaction or adverse reaction profiles of the single entity PPIs. All PPIs were available in delayed-release oral formulations and can be dosed once daily. Key pivotal trials comparing the safety and effectiveness of the PPIs were summarized. In meta-analyses and direct comparator trials, lansoprazole, omeprazole, pantoprazole and rabeprazole all demonstrated comparable healing rates, maintenance of healing, or symptomatic relief of GERD. Faster and greater symptomatic relief of GERD has been reported with lansoprazole compared to omeprazole; however, the absolute differences were small and the full clinical impact of the difference was not measured. Meta-analyses and several clinical trials reported that esomeprazole provided higher healing rates for erosive esophagitis and or symptomatic relief of GERD compared to standard doses of other PPIs. Close analysis of these studies show that the overall differences were small. While the results were statistically significant, the clinical significance of these differences was not clear. In addition, the results of these trials have not been consistently replicated in other trials. Dr. Ferris also pointed out that most trials comparing esomeprazole to omeprazole did not use comparable doses of the PPIs. One study investigated the long-term effect on health-care consumption when double doses of omeprazole were utilized. Complete symptom relief and relapse rates were comparable after 2-week therapy with daily omeprazole 40 mg and 20 mg. Meta-analyses comparing PPIs for the treatment of peptic ulcer disease with H. pylori have shown comparable rates of eradication when paired with comparable antibiotic regimens. There were no statistically or clinically significant differences between the treatment regimens. Dr. Ferris concluded that comparative data regarding the PPIs has not demonstrated distinct, clinically significant differences regarding safety and tolerability. Overall, no one PPI offered a significant clinical advantage over another. Therefore, all brand products within the class reviewed were comparable to each other and to the generics and OTC products in this class, and offered no significant clinical advantage over the other alternatives in general use. No brand single entity PPI was recommended for preferred status. Alabama Medicaid should accept cost proposals from manufacturers to determine cost effective products and possibly designate one or more preferred brands. Dr. Culpepper mentioned some difficulty in getting a PA approved for Prevacid in a child. Ms. Littlejohn responded that over the past year, they have worked with their administrative contractor, Health Information.
I want to briefly discuss the changing market dynamics in the ppi market, starting first with the current situation with protonix and recent generic launches of that drug and metoclopramide.
DRUGS WITH SPECIAL LIMITATIONS Step Therapy Step Therapy promotes appropriate utilization of first-line drugs and or therapeutic categories. Step Therapy requires that participants receive one or more first-line drug s ; , as defined by program criteria, before prescriptions are covered for second-line drugs in defined cases where a step approach to drug therapy is clinically justified. To promote use of cost-effective first-line therapy, AccessWV uses step therapy in the following therapeutic classes: Angiotensin-Converting Enzyme ACE ; Inhibitors Accuretic, Accupril, Aceon, Altace, Capoten, Capozide, Lexxel, Lotesin HCT, Lotrel, Mavik, Monopril HCT, Prinivil, Prinizide, Tarka, Uniretic, Univasc, Vasotec, Vaseretic ; Angiotensin II Receptor Antagonists Atacand HCT, Teveten HCT, Avapro, Cozaar, Benicar HCT, Micardis HCT, Diovan HCT, Avalide, Hyzaar ; Anti-depressants Cymbalta, Effexor XR, Symbyax, Wellbutrin XL ; Anti-hypertensives Covera HS, Verelan PM, Norvasc, Cardene SR, Sular, DynaCirc CR ; Beta Blockers Sectral, Tenormin, Kerlone, Zebeta, Coreg Trandate, Lopressor, Toprol XL, Corgard, Levatol, Visken, Inderal, Inderal LA, InnoPran XL, Blocadren, Tenoretic, Ziac, Lopressor HCT, Corzide, Inderide, Timolide ; Bisphosphonates Fosamax, Fosamax Plus DTM, Actonel, Actonel with Calcium, Boniva ; Cholesterol-lowering medications Advicor, Altoprev, Caduet, Crestor, Lescol, Lipitor, Pravachol, Vytorin, Zetia ; Inspra Leukotriene Inhibitors e.g., Accolate, Singulair ; Lyrica Nasal Steroids Rhinocort AquaTM, Flonase, Beconase AQ, Nasacort AQ, Nasarel, Nasonex ; Non Sedating Antihistamines Zyrtec, Allegra, Clarinex, Clarinex Reditabs ; Non-Steroidal Anti-Inflammatory Drugs brand-name NSAID e.g., Celebrex, Arthrotec, Mobic ; Overactive Bladder Ditropan, Ditropan XL, Oxytrol, Detrol, Detrol LA, Sanctura, Vesicare, Enablex ; Proton Pump Inhibitors e.g., Prilosec, Prevacid, Nexium, Aciphex, Protonix ; , Zegerid ; Sedative Hypnotics Ambien, Ambien CRTM, Sonata, LunestaTM, RozeremTM. In the first study, a and d were active drug and b and c were placebo, but this was not disclosed until the study was completed and the data tabulated and allopurinol.
INDEX OF DRUGS Prolastin .77 Proleukin 19 Prolixin 30, 66 Prolixin Decanoate 66 Proloprim 16 Prometrium 87 Pronestyl 24 Pronestyl 250mg Cap 24 Pronestyl-SR 24 Propafenone HCl 24 Propine 73 Propranolol HCl 22 Propranolol Hydrochlorothiazid 22 Propylthiouracil 48 Proquad 66 Proquin XR .15 Proscar 81 Prostigmin 33 Prostigmine 66 Protonix 56 Protonix IV .66 Protopic 43 Proventil 76, 77 Proventil HFA 76 Provera 87 Provigil 31 Prozac 29 Prozac Weekly 29 Psorcon 0.05% Ointment 42 Psorcon E Cream 41 Psorcon E Ointment 41 Psoriatec 40 Pulmicort 76 Pulmozyme 77 Purinethol 17 Pylera 55 Pyrazinamide 12 Pyridium .81 Pyridostigmine Bromide 33. Element 5 -- Strength Enter the strength of the drug listed in Element 4. Element 6 -- Date Prescription Written Enter the date the prescription was written. Element 7 -- Directions for Use Enter the directions for use of the drug. Element 8 -- Diagnosis -- Primary Code and or Description Enter the appropriate International Classification of Diseases, Ninth Edition, Clinical Modification ICD-9-CM ; diagnosis code and or description most relevant to the drug or biologic requested. The ICD-9-CM diagnosis code must match the ICD-9-CM description. The diagnosis code for PPIs must be one of the PPI-approved codes. Element 9 -- Name -- Prescriber Enter the name of the prescriber. Element 10 -- Drug Enforcement Agency Number Enter the nine-character Drug Enforcement Agency DEA ; number of the prescribing provider. This number must be two alpha characters followed by seven numeric characters. If the DEA number cannot be obtained or the prescriber does not have a DEA number, use one of the following default codes: XX5555555 -- Prescriber's DEA number cannot be obtained. XX9999991 -- Prescriber does not have a DEA number. These default codes must not be used for prescriptions for controlled substances. Element 11 -- Address -- Prescriber Enter the complete address of the prescriber's practice location, including the street, city, state, and zip code. Element 12 -- Telephone Number -- Prescriber Enter the telephone number, including the area code, of the office, clinic, facility, or place of business of the prescriber. SECTION IIIA -- CLINICAL INFORMATION FOR PROTONIX Include diagnostic and clinical information explaining the need for the product requested. In Elements 13 through 16, check "yes" to all that apply. Element 13 Check the appropriate box to indicate if the recipient has experienced a treatment failure or had an adverse reaction to Prilosec OTC. If "yes" is checked, indicate the failed drug s ; or adverse reaction that is attributed to Prilosec OTC and the dates the drug s ; was taken. Element 14 Check the box to indicate if the recipient is a pregnant woman. SECTION IIIB -- CLINICAL INFORMATION FOR NON-PREFERRED PPI DRUGS Element 15 Check the appropriate box to indicate if the recipient has experienced a treatment failure or had an adverse reaction with Prilosec OTC and Protonix. If "yes" is checked, indicate the failed drug s ; or adverse reaction that is attributed to Prilosec OTC and Protonix and the dates the drug s ; was taken. Element 16 Check the box to indicate if the recipient is a child who weighs less than 20 kilograms. Element 17 -- Signature -- Prescriber The prescriber is required to complete and sign this form. Element 18 -- Date Signed Enter the month, day, and year the PA PDL for PPI Drugs was signed in MM DD YYYY format and ranitidine. PHOSLO PHOSPHOLINE IODIDE PILOPINE H.S. PLAVIX PLENDIL PLEXION CLEANSING CLOTHS polyethylene glycol generic POLYGAM PONSTEL PRANDIN PRAVACHOL pravastatin generic PRAVIGARD PAC PRECOSE PREMARIN PREMPHASE PREMPRO PREVACID CAPSULES, SUSPENSION PREVACID NAPRAPAC PREVACID SOLUTAB PREVEN PREVPAC PRILOSEC PRINIVIL PRINZIDE PROAMATINE PROCARDIA, -XL PROCRIT PROCTOFOAM-HC PROGRAF PROLEUKIN PROMETRIUM PROQUIN XR PROSCAR PROSTIGMIN PROTONIX PROTOPIC PROTROPIN PROVENTIL FOR NEBULIZATION PROVENTIL HFA PROVIGIL PROZAC. History of insect sting, food or medication allergy and has any of the following: dyspena, hives, facial swelling, or wheezing and prevacid. Hi, i have been having chest pains since some time.
Protonix consumed a significant portion of our selling effort and zyloprim. EXECUTIVE SUMMARY On April 29, 2004, the Bush Administration began publishing prices for new Medicare prescription drug cards on the Medicare web site, Medicare.gov. A staff analysis of the card prices released by Rep. Henry A. Waxman found that the initial published prices would not provide significant discounts for seniors. Other analyses reached similar conclusions. In response to these analyses, Administration officials and Republican leaders promised that drug card prices would drop before June 1, the day the cards were scheduled to become active. They predicted "downward changes over the next couple of weeks, " and they claimed that "since the enrollment period for the discount cards began, we have already seen market forces at work to significantly lower drug prices for seniors." At the request of Rep. Waxman, this report examines the changes in prices available with the drug cards between May 3, 2004, and June 1, 2004, for the ten most popular brand-name drugs used by seniors. It finds that claims of price reductions have not materialized. In fact, the lowest prices available to seniors for two of the most popular brand-name drugs used by seniors Nexium and Protonix ; have actually increased by 13% and 19%. The claims about declining prices made by Administration officials and Republican leaders have been based primarily on analyses that show a reduction in the prices charged by the most expensive drug cards since May 3. However, the key issue for seniors is not how much they would pay if they chose the most expensive drug cards but how little they would pay if they chose the least expensive drug cards. This report finds that there has been virtually no change between May 3 and June 1 in the prices charged by the least expensive cards. On May 3, 2004, the drug card offering the lowest total price charged 7.62 for the ten most popular brand-name drugs used by seniors. By June 1, 2004, the lowest priced card that could be widely used at local pharmacies charged 3.75 for these drugs, a 2% increase. Moreover, the report finds that drug card prices continue to exceed other drug prices. Even the least expensive drug cards charge prices that are far higher than the prices that the federal government has negotiated on the Federal Supply Schedule or the prices available to consumers in Canada. The drug cards also fail to offer prices that are significantly better than options currently available to seniors. The report shows that "market baskets" containing popular brand-name drugs that might typically be used by seniors can be less expensive if purchased from Drugstore than if purchased from pharmacies using Medicare discount cards. 1.
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To apprehend these estimated values, we need to first understand the meaning of the marginal cost of detailing. We think that the marginal cost of detailing reflects the economic opportunity cost of visiting a physician, which is defined as the largest possible revenue that could have been brought in if a different physician was visited during the same time period. The estimation results show that Protonix has a lower value of marginal cost of detailing comparing to the other three brands. This can be explained by the fact that Protonix is the weakest brand lowest market share and lowest detailing efforts ; in this competition extensive category. In the reality, Wyeth's the manufacturer of Protonix ; strategy is actually not going after the top physicians. In this case, if a sales rep for Protonix did visit a top physician, given the vigorous competitors' in this category, Protonix would still not have got revenue as high as the other brands. Therefore, the marginal cost of detailing for Protonix is lower than the other three brands. Thus far, we have presented all the model parameters from estimating both the prescription and detailing models simultaneously. To solve the objective function in equation 3 ; , we need to check the SOC using these model estimates. To do that, we substitute the individual level parameter estimates for the prescription model into equation 8 ; , and evaluate the left hand side of the SOC at the data level dtl pbt for each brand at each observation. The results show that all the four brands have over 90% of the observations satisfying the SOC. Given the stochastic property of the parameter estimates, this finding appears reasonable. 13 apotex argues that the district court improperly invalidated the '780 and '962 patents because merck failed to prove by clear and convincing evidence that it did not suppress or conceal the patented process and prednisolone. Click here for link scroll down through this record to where it reads: examples of therapeutic agents with toxic side effects that may be administered with galactomannan to reduce their toxicity include the following: anti-infectives including antibiotics, antivirals and vaccines, antineoplastics, cardiovascular drugs including antiarrythmics, antihypertensives etc, central nervous system drugs including analgesics, anorectics, anticonvulsants, anti-inflammatories and tranquilizers etc otics, opthalmics, gastrointestinal including anti-ulcer drugs, anticholinergic drugs etc hormones, respiratory drugs including allergy medications, bronchodilators and decongestants, topical drugs and vitamins and minerals. Public Comment: None Board Discussion: Mr. Brown inquired if there was any discussion surrounding cimetidine and its potential risk of drug-drug interactions. Mr. Musial informed the Board of extensive discussions related to proton pump inhibitors during the executive session. Mr. Musial also stated that Prilosec OTC claims would be denied, based on the T-Committee recommendations, and proposed a motion to change Prilosec OTC to preferred status. Dr. Wernert inquired about Nexium, asking if it was covered by the other managed care organizations. Board Action: Dr. Wernert requested a motion to approve all gastrointestinal agents except the PPI class. It was moved and seconded that the recommendations for gastrointestinal agents be approved. The motion passed unanimously. Dr. Wernert moved to add legend omeprazole to preferred status, maintain Prilosec OTC as preferred, maintain Protonix as preferred, but change the step to a "trial of omeprazole or Prilosec OTC within past 90 days", add Prevacid solutabs to preferred status with age restriction 12 years of age and limit of 1 tab day, move Prevacid suspension to non-preferred status, and move Nexium to non-preferred status with the following step: "must fail omeprazole or Prilosec OTC and then a preferred PPI", maintain the non-preferred status of Prevacid, Aciphex, Prilosec and Zegerid all dosage forms and strengths ; but change the step edit to "must fail omperazole or Prilosec OTC and then a preferred PPI". Mr. Musial seconded the motion. The motion passed unanimously.

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Medicine categories. capture the number of physicians whose board certification is active in pediatrics not inclusive of pediatric subspecialties.

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Gastrointestinals: Histamine-2 Receptor Antagonists H2RA's ; Famotidine Ranitidine Zantac Syrup Gastrointestinals: Proton Pump Inhibitors PPI's ; Nexium Protonix Prilosec OTC Note: Clinical criteria are in effect for this class. Once criteria are met, the PPI's listed on the PDL will be preferred. Patients age 12 and younger may receive the PPI, Prevacid. without PA and buy bentyl.

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Rain fed upland rice cultivation is almost exclusively traditional swidden. Picture Australian Centre for International Agriculture research. References: AACP Member Colleges and Schools of Pharmacy in the United States. American Association of Colleges of Pharmacy. : apha public health CEPH 05 AAMC Member Medical Schools. : services.aamc memberlistings index ?fuseaction home arch&search type MS&s tate criteria ALL American Dental Directory. Chicago: American Dental Association, 2005. Associated American Dental Schools Application Service. Web site: s: aadsas.adea. ACTIQ APTIVUS AVITA AZILECT BARACLUDE CAMPRAL CRESTOR 40 mg DIFLUCAN except 150mg and suspension ; EMEND EMSAM EXUBERA FAZACLO GEODON GLEEVEC HEPSERA LAMISIL LOTRONIX MARINOL NIZORAL PA Required for Oral dosage only ; PREVPAK PROTONIX RETIN-A PA Required if age 35 ; REVATIO REVLIMID SENSIPAR SPORANOX SUBUTEX SUBOXONE THALOMID TRACLEER TRETINOIN e.g. RETIN-A, AVITA VENTAVIS VFEND ZELNORM ZEMPLAR.
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A : Okay, next question. Operator: Our next question is from Tim Anderson with Prudential Securities. Please go ahead. Q Timothy Anderson : Thank you. A couple of questions. Can you kind of give us an update how you plan to defend Effexor versus Cymbalta apart from adding more reps, what are going to be the key differentiating points in favor of Effexor in terms of product profile as you see everything shaping up today and then on Protonix, is the rebating and discounting just to clarify that is fully reflected in the sales this quarter and do you expect any further increase in rebates or discounts in the future or are we pretty much done with that revision? A : Okay, Tim, before I turn it over to Bernard let me just say that obviously, you know, we have marketing plans and we have a way that we consider that we should market our products and defend against competitors and we're not going to be all that forthcoming yet because, first of all, Cymbalta is not even on the market and we don't know when it's going to be on the market, we don't even know what the exact profile of the product is going to be so we're limited in how we're going to answer that question but if Bernard would like to make a general comment and then answer your second question, I would turn it over to him. A Bernard Poussot : Okay, on the Cymbalta front we have been waiting for Cymbalta now for a while, and the points are that, we have seen the studies published largely at BID dosage and, you know, Effexor in contrast offers very good efficacy and safety in depression at once a day so we're very encouraged by that. We are ready. I mean we have, you know, prepared for this introduction and we are confident that we can continue to sustain a growth higher than the market going forward. On Protonix for the rebates, my answer is that the quarter reflects, you know, both our volume development and our rebates and, as I said, you know, they are obviously complementary to each other but these are the numbers I mentioned earlier. w w w Cal l Street. co m 212. 931. 6 Copyri ght 2004 Cal l St reet 10!

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