| 02520451 | Apo-Pomalidomide(Off-Formulary Interchangeable) | 425.0000 | 425.0000 |
| 02538091 | Jamp Pomalidomide(Off-Formulary Interchangeable) | 425.0000 | 425.0000 |
| 02506424 | Nat-Pomalidomide(Off-Formulary Interchangeable) | 425.0000 | 425.0000 |
| 02419610 | Pomalyst(Off-Formulary Interchangeable) | 500.0000 | 425.0000 |
| 02504111 | Reddy-Pomalidomide(Off-Formulary Interchangeable) | 425.0000 | 425.0000 |
| 02524015 | Sandoz Pomalidomide(Off-Formulary Interchangeable) | 425.0000 | 425.0000 |