| 02495368 | Ach-Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02505770 | Apo-Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02540754 | Auro-Dimethyl Fumarate(Off-Formulary Interchangeable) | 8.6888 | 8.6888 |
| 02494817 | GLN-Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02516055 | Jamp Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02502704 | Mar-Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02497034 | PMS-Dimethyl Fumarate(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02513803 | Sandoz Dimethyl Fumarate DR Capsules(Off-Formulary Interchangeable) | 18.3867 | 18.3867 |
| 02420201 | Tecfidera(Off-Formulary Interchangeable) | 36.7734 | 18.3867 |