| 02475669 | Ach-Fingolimod(Off-Formulary Interchangeable) | 73.9100 | 73.9100 |
| 02469936 | Apo-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02365480 | Gilenya(Off-Formulary Interchangeable) | 86.9525 | 73.9100 |
| 02487772 | Jamp Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02474743 | Mar-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02469715 | Mylan-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02469782 | PMS-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02482606 | Sandoz Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02469618 | Taro-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |
| 02469561 | Teva-Fingolimod(Off-Formulary Interchangeable) | 73.9096 | 73.9096 |