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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Inter- change- able	Limited Use	Thera- peutic Notes
02437570	CELECOXIB	AG-Celecoxib 100mg Cap	ANG	0.1279	0.1279	YES	YES	YES
02437589	CELECOXIB	AG-Celecoxib 200mg Cap	ANG	0.2558	0.2558	YES	YES	YES
02420155	CELECOXIB	Act Celecoxib 100mg Cap	ACV	0.1279	0.1279	YES	YES	YES
02420163	CELECOXIB	Act Celecoxib 200mg Cap	ACV	0.2558	0.2558	YES	YES	YES
02418940	CELECOXIB	Apo-Celecoxib 200mg Cap	APX	0.2558	0.2558	YES	YES	YES
02418932	CELECOXIB	Apo-Celecoxib 100mg Cap	APX	0.1279	0.1279	YES	YES	YES
02445670	CELECOXIB	Auro-Celecoxib 100mg Cap	AUR	0.1279	0.1279	YES	YES	YES
02445689	CELECOXIB	Auro-Celecoxib 200mg Cap	AUR	0.2558	0.2558	YES	YES	YES
02426382	CELECOXIB	Bio-Celecoxib 100mg Cap	BMP	0.1279	0.1279	YES	YES	YES
02426390	CELECOXIB	Bio-Celecoxib 200mg Cap	BMP	0.2558	0.2558	YES	YES	YES
02239941	CELECOXIB	Celebrex 100mg Cap	UJC	0.8299	0.1279	YES	YES	YES
02239942	CELECOXIB	Celebrex 200mg Cap	UJC	1.6601	0.2558	YES	YES	YES
02429675	CELECOXIB	Celecoxib 100mg Cap	SIV	0.1279	0.1279	YES	YES	YES
02429683	CELECOXIB	Celecoxib 200mg Cap	SIV	0.2558	0.2558	YES	YES	YES
02436302	CELECOXIB	Celecoxib 200mg Cap	SAI	0.2558	0.2558	YES	YES	YES
02436299	CELECOXIB	Celecoxib 100mg Cap	SAI	0.1279	0.1279	YES	YES	YES
02424541	CELECOXIB	Jamp-Celecoxib 200mg Cap	JPC	0.2558	0.2558	YES	YES	YES
02424533	CELECOXIB	Jamp-Celecoxib 100mg Cap	JPC	0.1279	0.1279	YES	YES	YES
02495465	CELECOXIB	M-Celecoxib 100mg Cap	MAT	0.1279	0.1279	YES	YES	YES
02495473	CELECOXIB	M-Celecoxib 200mg Cap	MAT	0.2558	0.2558	YES	YES	YES
02420058	CELECOXIB	Mar-Celecoxib 100mg Cap	MAR	0.1279	0.1279	YES	YES	YES
02420066	CELECOXIB	Mar-Celecoxib 200mg Cap	MAR	0.2558	0.2558	YES	YES	YES
02412497	CELECOXIB	Mint-Celecoxib 100mg Cap	MIN	0.1279	0.1279	YES	YES	YES
02412500	CELECOXIB	Mint-Celecoxib 200mg Cap	MIN	0.2558	0.2558	YES	YES	YES
02479737	CELECOXIB	NRA-Celecoxib 100mg Cap	NRA	0.1279	0.1279	YES	YES	YES
02479745	CELECOXIB	NRA-Celecoxib 200mg Cap	NRA	0.2558	0.2558	YES	YES	YES
02355450	CELECOXIB	PMS-Celecoxib 200mg Cap	PMS	0.2558	0.2558	YES	YES	YES
02355442	CELECOXIB	PMS-Celecoxib 100mg Cap	PMS	0.1279	0.1279	YES	YES	YES
02517116	CELECOXIB	PMSC-Celecoxib 100mg Cap	PMS	0.1279	0.1279	YES	YES	YES
02517124	CELECOXIB	PMSC-Celecoxib 200mg Cap	PMS	0.2558	0.2558	YES	YES	YES
02412381	CELECOXIB	Ran-Celecoxib 200mg Cap	RAN	0.2558	0.2558	YES	YES	YES
02412373	CELECOXIB	Ran-Celecoxib 100mg Cap	RAN	0.1279	0.1279	YES	YES	YES
02442639	CELECOXIB	Sdz Celecoxib 100mg Cap	SDZ	0.1279	0.1279	YES	YES	YES
02442647	CELECOXIB	Sdz Celecoxib 200mg Cap	SDZ	0.2558	0.2558	YES	YES	YES
02288923	CELECOXIB	Teva-Celecoxib 200mg Cap	TEV	0.2558	0.2558	YES	YES	YES
02288915	CELECOXIB	Teva-Celecoxib 100mg Cap	TEV	0.1279	0.1279	YES	YES	YES
02243433	DICLOFENAC POTASSIUM	Apo-Diclo Rapide (Off-Formulary Interchangeable) 50mg Tab	APX	0.3937	N/A	YES	NO	YES
02239753	DICLOFENAC POTASSIUM	PMS-Diclofenac K (Off-Formulary Interchangeable) 50mg Tab	PMS	0.3937	N/A	YES	NO	YES
02261774	DICLOFENAC POTASSIUM	Sandoz Diclofenac Rapide (Off-Formulary Interchangeable) 50mg Tab	SDZ	0.3937	N/A	YES	NO	YES
02239355	DICLOFENAC POTASSIUM	Teva-Diclofenac-K (Off-Formulary Interchangeable) 50mg Tab	TEV	0.3937	N/A	YES	NO	YES
00881635	DICLOFENAC POTASSIUM	Voltaren Rapide (Off-Formulary Interchangeable) 50mg Tab	NOV	N/A	N/A	YES	NO	YES
00839183	DICLOFENAC SODIUM	Apo-Diclo 50mg Ent Tab	APX	0.2064	0.2064	YES	NO	YES
00839175	DICLOFENAC SODIUM	Apo-Diclo 25mg Ent Tab	APX	0.0781	0.0781	YES	NO	YES
02302624	DICLOFENAC SODIUM	PMS-Diclofenac 50mg Ent Tab	PMS	0.2064	0.2064	YES	NO	YES
02302616	DICLOFENAC SODIUM	PMS-Diclofenac 25mg Ent Tab	PMS	0.0781	0.0781	YES	NO	YES
02261960	DICLOFENAC SODIUM	Sandoz Diclofenac 50mg Ent Tab	SDZ	0.2064	0.2064	YES	NO	YES
00808539	DICLOFENAC SODIUM	Teva-Diclofenac 25mg Ent Tab	TEV	0.0781	0.0781	YES	NO	YES
00808547	DICLOFENAC SODIUM	Teva-Diclofenac 50mg Ent Tab	TEV	0.2064	0.2064	YES	NO	YES
00514004	DICLOFENAC SODIUM	Voltaren (Not a Benefit) 25mg Ent Tab	GEI	N/A	N/A	YES	NO	YES
00514012	DICLOFENAC SODIUM	Voltaren 50mg Ent Tab	NOV	1.1384	0.2064	YES	NO	YES
02162814	DICLOFENAC SODIUM	Apo-Diclo SR 75mg LA Tab	APX	0.4529	0.4529	YES	NO	YES
02091194	DICLOFENAC SODIUM	Apo-Diclo SR 100mg LA Tab	APX	0.6502	0.6502	YES	NO	YES
02261944	DICLOFENAC SODIUM	Sandoz Diclofenac SR 100mg LA Tab	SDZ	0.6502	0.6502	YES	NO	YES
02158582	DICLOFENAC SODIUM	Teva-Diclofenac SR 75mg LA Tab	TEV	0.4529	0.4529	YES	NO	YES
00782459	DICLOFENAC SODIUM	Voltaren SR (Not a Benefit) 75mg LA Tab	NOV	N/A	N/A	YES	NO	YES
00590827	DICLOFENAC SODIUM	Voltaren SR (Not a Benefit) 100mg LA Tab	NOV	N/A	N/A	YES	NO	YES
02231508	DICLOFENAC SODIUM	PMS-Diclofenac 100mg Sup	PMS	0.5840	0.5840	YES	NO	YES
02261936	DICLOFENAC SODIUM	Sandoz Diclofenac 100mg Sup	SDZ	0.5840	0.5840	YES	NO	YES
02261928	DICLOFENAC SODIUM	Sandoz Diclofenac 50mg Sup	SDZ	1.2818	1.2818	YES	NO	YES
00632732	DICLOFENAC SODIUM	Voltaren (Not a Benefit) 100mg Sup	NOV	N/A	N/A	YES	NO	YES
00632724	DICLOFENAC SODIUM	Voltaren 50mg Sup	NOV	2.0130	1.2818	YES	NO	YES
02476134	DICLOFENAC SODIUM	Diclofenac Sodium Solution (Off-Formulary Interchangeable) 1.5% W/W Top Sol	TEL	0.6226	N/A	YES	NO	NO
02434571	DICLOFENAC SODIUM	Diclofenac Topical Solution (Off-Formulary Interchangeable) 1.5% W/W Top Sol	STE	0.6226	N/A	YES	NO	NO
02472309	DICLOFENAC SODIUM	Jamp-Diclofenac (Off-Formulary Interchangeable) 1.5% W/W Top Sol	JPC	0.6226	N/A	YES	NO	NO
02356783	DICLOFENAC SODIUM	PMS-Diclofenac (Off-Formulary Interchangeable) 1.5% W/W Top Sol	PMS	0.6227	N/A	YES	NO	NO
02247265	DICLOFENAC SODIUM	Pennsaid (Off-Formulary Interchangeable) 1.5% W/W Top Sol	PAL	N/A	N/A	YES	NO	NO
02420988	DICLOFENAC SODIUM	Taro-Diclofenac (Off-Formulary Interchangeable) 1.5% W/W Top Sol	TAR	0.6226	N/A	YES	NO	NO
01917056	DICLOFENAC SODIUM & MISOPROSTOL	Arthrotec 50 50mg & 200mcg Tab	PFI	0.7643	0.3149	YES	NO	YES
02229837	DICLOFENAC SODIUM & MISOPROSTOL	Arthrotec 75 75mg & 200mcg Tab	PFI	1.0402	0.4286	YES	NO	YES
02341689	DICLOFENAC SODIUM & MISOPROSTOL	Gd-Diclofenac/Misoprostol 50 50mg & 200mcg Tab	GEM	0.3149	0.3149	YES	NO	YES
02341697	DICLOFENAC SODIUM & MISOPROSTOL	Gd-Diclofenac/Misoprostol 75 75mg & 200mcg Tab	GEM	0.4286	0.4286	YES	NO	YES
02413469	DICLOFENAC SODIUM & MISOPROSTOL	PMS-Diclofenac-Misoprostol 50mg & 200mcg Tab	PMS	0.3149	0.3149	YES	NO	YES
02413477	DICLOFENAC SODIUM & MISOPROSTOL	PMS-Diclofenac-Misoprostol 75mg & 200mcg Tab	PMS	0.4286	0.4286	YES	NO	YES
00647942	FLURBIPROFEN	Ansaid (Not a Benefit) 50mg Tab	PFI	N/A	N/A	YES	NO	YES
00600792	FLURBIPROFEN	Ansaid (Not a Benefit) 100mg Tab	PFI	N/A	N/A	YES	NO	YES
01912046	FLURBIPROFEN	Flurbiprofen 50mg Tab	AAP	0.4530	0.4530	YES	NO	YES
01912038	FLURBIPROFEN	Flurbiprofen 100mg Tab	AAP	0.5930	0.5930	YES	NO	YES
00441651	IBUPROFEN	Apo-Ibuprofen 300mg Tab	APX	0.1377	0.1377	YES	NO	YES
00506052	IBUPROFEN	Apo-Ibuprofen 400mg Tab	APX	0.0468	0.0468	YES	NO	YES
00585114	IBUPROFEN	Apo-Ibuprofen 600mg Tab	APX	0.1313	0.1313	YES	NO	YES
00441643	IBUPROFEN	Apo-Ibuprofen 200mg Tab	APX	0.0309	0.0309	YES	NO	YES
02317338	IBUPROFEN	Ibuprofen 400mg Tab	JPC	0.0468	0.0468	YES	NO	YES
02257912	IBUPROFEN	Ibuprofen 200mg Tab	JPC	0.0309	0.0309	YES	NO	YES
00364142	IBUPROFEN	Motrin 400mg Tab	UPJ	0.1871	0.0468	YES	NO	YES
00327794	IBUPROFEN	Motrin (Not a Benefit) 300mg Tab	UPJ	N/A	N/A	YES	NO	YES
00484911	IBUPROFEN	Motrin (Not a Benefit) 600mg Tab	UPJ	N/A	N/A	YES	NO	YES
00252409	IBUPROFEN	Motrin (Not a Benefit) 200mg Tab	UPJ	N/A	N/A	YES	NO	YES
00629359	IBUPROFEN	Novo-Profen 600mg Tab	NOP	0.1313	0.1313	YES	NO	YES
02499223	INDOMETHACIN	Auro-Indomethacin 50mg Cap	AUR	0.1234	0.1234	YES	NO	YES
00016047	INDOMETHACIN	Indocid (Not a Benefit) 50mg Cap	MSD	N/A	N/A	YES	NO	YES
00016039	INDOMETHACIN	Indocid (Not a Benefit) 25mg Cap	MSD	N/A	N/A	YES	NO	YES
02461811	INDOMETHACIN	Mint-Indomethacin 25mg Cap	MIN	0.1519	0.1519	YES	NO	YES
02461536	INDOMETHACIN	Mint-Indomethacin 50mg Cap	MIN	0.1234	0.1234	YES	NO	YES
00337420	INDOMETHACIN	Teva-Indomethacin 25mg Cap	TEV	0.1519	0.1519	YES	NO	YES
00337439	INDOMETHACIN	Teva-Indomethacin 50mg Cap	TEV	0.1234	0.1234	YES	NO	YES
00016233	INDOMETHACIN	Indocid (Not a Benefit) 100mg Sup	MSD	N/A	N/A	YES	NO	YES
00594466	INDOMETHACIN	Indocid (Not a Benefit) 50mg Sup	MSD	N/A	N/A	YES	NO	YES
02231800	INDOMETHACIN	Odan-Indomethacin 100mg Sup	ODN	1.2033	1.2033	YES	NO	YES
02231799	INDOMETHACIN	Odan-Indomethacin 50mg Sup	ODN	0.8840	0.8840	YES	NO	YES
00790427	KETOPROFEN	Ketoprofen 50mg Cap	AAP	0.3440	0.3440	YES	NO	YES
01926403	KETOPROFEN	Orudis (Not a Benefit) 50mg Cap	RPP	N/A	N/A	YES	NO	YES
00842664	KETOPROFEN	Ketoprofen-E 100mg Ent Tab	AAP	0.6959	0.6959	YES	NO	YES
00790435	KETOPROFEN	Ketoprofen-E 50mg Ent Tab	AAP	0.3379	0.3379	YES	NO	YES
01926365	KETOPROFEN	Orudis E-100 (Not a Benefit) 100mg Ent Tab	RPP	N/A	N/A	YES	NO	YES
01926381	KETOPROFEN	Orudis E-50 (Not a Benefit) 50mg Ent Tab	RPP	N/A	N/A	YES	NO	YES
00761680	KETOPROFEN	Rhodis-EC (Not a Benefit) 100mg Ent Tab	SAV	N/A	N/A	YES	NO	YES
02172577	KETOPROFEN	Ketoprofen SR 200mg LA Tab	AAP	1.3925	1.3925	YES	NO	YES
01926373	KETOPROFEN	Orudis SR-200 (Not a Benefit) 200mg LA Tab	RPP	N/A	N/A	YES	NO	YES
02229080	KETOROLAC TROMETHAMINE	Apo-Ketorolac (Off-Formulary Interchangeable) 10mg Tab	APX	0.6028	N/A	YES	NO	YES
02510855	KETOROLAC TROMETHAMINE	Jamp Ketorolac (Off-Formulary Interchangeable) 10mg Tab	JPC	0.6028	N/A	YES	NO	YES
02465124	KETOROLAC TROMETHAMINE	Mar-Ketorolac (Off-Formulary Interchangeable) 10mg Tab	MAR	0.6028	N/A	YES	NO	YES
02461455	KETOROLAC TROMETHAMINE	Mint-Ketorolac (Off-Formulary Interchangeable) 10mg Tab	MIN	0.6028	N/A	YES	NO	YES
02162660	KETOROLAC TROMETHAMINE	Toradol (Off-Formulary Interchangeable) 10mg Tab	AAP	N/A	N/A	YES	NO	YES
02229452	MEFENAMIC ACID	Mefenamic 250mg Cap	AAP	0.4988	0.4988	YES	NO	YES
00155225	MEFENAMIC ACID	Ponstan (Not a Benefit) 250mg Cap	AAP	N/A	N/A	YES	NO	YES
02248974	MELOXICAM	Apo-Meloxicam 15mg Tab	APX	0.2311	0.2311	YES	NO	YES
02248973	MELOXICAM	Apo-Meloxicam 7.5mg Tab	APX	0.2003	0.2003	YES	NO	YES
02390892	MELOXICAM	Auro-Meloxicam 15mg Tab	AUR	0.2311	0.2311	YES	NO	YES
02390884	MELOXICAM	Auro-Meloxicam 7.5mg Tab	AUR	0.2003	0.2003	YES	NO	YES
02250012	MELOXICAM	Co Meloxicam 7.5mg Tab	COB	0.2003	0.2003	YES	NO	YES
02250020	MELOXICAM	Co Meloxicam 15mg Tab	COB	0.2311	0.2311	YES	NO	YES
02353156	MELOXICAM	Meloxicam 15mg Tab	SAI	0.2311	0.2311	YES	NO	YES
02353148	MELOXICAM	Meloxicam 7.5mg Tab	SAI	0.2003	0.2003	YES	NO	YES
02242785	MELOXICAM	Mobicox (Not a Benefit) 7.5mg Tab	BOE	N/A	N/A	YES	NO	YES
02242786	MELOXICAM	Mobicox (Not a Benefit) 15mg Tab	BOE	N/A	N/A	YES	NO	YES
02248268	MELOXICAM	PMS-Meloxicam 15mg Tab	PMS	0.2311	0.2311	YES	NO	YES
02248267	MELOXICAM	PMS-Meloxicam 7.5mg Tab	PMS	0.2003	0.2003	YES	NO	YES
02258315	MELOXICAM	Teva-Meloxicam 7.5mg Tab	TEV	0.2003	0.2003	YES	NO	YES
02258323	MELOXICAM	Teva-Meloxicam 15mg Tab	TEV	0.2311	0.2311	YES	NO	YES
02238639	NABUMETONE	Nabumetone (Off-Formulary Interchangeable) 500mg Tab	AAP	0.7363	N/A	YES	NO	YES
02083531	NABUMETONE	Relafen (Off-Formulary Interchangeable) 500mg Tab	GSK	N/A	N/A	YES	NO	YES
02246701	NAPROXEN	Apo-Naproxen EC (Off-Formulary Interchangeable) 500mg Ent Tab	APX	0.6894	N/A	YES	NO	YES
02246700	NAPROXEN	Apo-Naproxen EC (Off-Formulary Interchangeable) 375mg Ent Tab	APX	0.3675	N/A	YES	NO	YES
02246699	NAPROXEN	Apo-Naproxen EC (Off-Formulary Interchangeable) 250mg Ent Tab	APX	0.2835	N/A	YES	NO	YES
02162415	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 375mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02162792	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 250mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02162423	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 500mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02294702	NAPROXEN	PMS-Naproxen EC (Off-Formulary Interchangeable) 375mg Ent Tab	PMS	0.3675	N/A	YES	NO	YES
02294710	NAPROXEN	PMS-Naproxen EC (Off-Formulary Interchangeable) 500mg Ent Tab	PMS	0.6894	N/A	YES	NO	YES
02243313	NAPROXEN	Teva-Naproxen EC (Off-Formulary Interchangeable) 375mg Ent Tab	TEV	0.3675	N/A	YES	NO	YES
02243312	NAPROXEN	Teva-Naproxen EC (Off-Formulary Interchangeable) 250mg Ent Tab	TEV	0.2835	N/A	YES	NO	YES
02243314	NAPROXEN	Teva-Naproxen EC (Off-Formulary Interchangeable) 500mg Ent Tab	TEV	0.6894	N/A	YES	NO	YES
02162431	NAPROXEN	Pediapharm Naproxen Suspension 25mg/mL O/L	MPI	0.0949	0.0949	NO	NO	YES
02162458	NAPROXEN	Naprosyn (Not a Benefit) 500mg Sup	HLR	N/A	N/A	YES	NO	YES
02017237	NAPROXEN	PMS-Naproxen 500mg Sup	PMS	0.9567	0.9567	YES	NO	YES
00592277	NAPROXEN	Apo-Naproxen 500mg Tab	APX	0.2244	0.2244	YES	NO	YES
00522678	NAPROXEN	Apo-Naproxen 125mg Tab	APX	0.0781	0.0781	YES	NO	YES
00522651	NAPROXEN	Apo-Naproxen 250mg Tab	APX	0.1068	0.1068	YES	NO	YES
00600806	NAPROXEN	Apo-Naproxen 375mg Tab	APX	0.1458	0.1458	YES	NO	YES
02162474	NAPROXEN	Naprosyn (Not a Benefit) 250mg Tab	HLR	N/A	N/A	YES	NO	YES
02162482	NAPROXEN	Naprosyn (Not a Benefit) 375mg Tab	HLR	N/A	N/A	YES	NO	YES
00299413	NAPROXEN	Naprosyn (Not a Benefit) 125mg Tab	SYN	N/A	N/A	YES	NO	YES
02162490	NAPROXEN	Naprosyn (Not a Benefit) 500mg Tab	HLR	N/A	N/A	YES	NO	YES
00627097	NAPROXEN	Teva-Naproxen 375mg Tab	TEV	0.1458	0.1458	YES	NO	YES
00565350	NAPROXEN	Teva-Naproxen 250mg Tab	TEV	0.1068	0.1068	YES	NO	YES
00589861	NAPROXEN	Teva-Naproxen 500mg Tab	TEV	0.2244	0.2244	YES	NO	YES
02443449	NAPROXEN & ESOMEPRAZOLE MAGNESIUM	Mylan-Naproxen & Esomeprazole MR (Off-Formulary Interchangeable) 500mg & 20mg MR Tab	MYL	0.9274	N/A	YES	NO	YES
02458608	NAPROXEN & ESOMEPRAZOLE MAGNESIUM	Mylan-Naproxen & Esomeprazole MR (Off-Formulary Interchangeable) 375mg & 20mg MR Tab	MYL	0.9308	N/A	YES	NO	YES
02361728	NAPROXEN & ESOMEPRAZOLE MAGNESIUM	Vimovo (Off-Formulary Interchangeable) 500mg & 20mg MR Tab	XED	N/A	N/A	YES	NO	YES
02361701	NAPROXEN & ESOMEPRAZOLE MAGNESIUM	Vimovo (Off-Formulary Interchangeable) 375mg & 20mg MR Tab	XED	N/A	N/A	YES	NO	YES
02162725	NAPROXEN SODIUM	Anaprox (Off-Formulary Interchangeable) 275mg Tab	HLR	N/A	N/A	YES	NO	YES
02162717	NAPROXEN SODIUM	Anaprox DS (Off-Formulary Interchangeable) 550mg Tab	HLR	N/A	N/A	YES	NO	YES
00784354	NAPROXEN SODIUM	Apo-Napro-Na (Off-Formulary Interchangeable) 275mg Tab	APX	0.3422	N/A	YES	NO	YES
01940309	NAPROXEN SODIUM	Apo-Napro-Na DS (Off-Formulary Interchangeable) 550mg Tab	APX	0.6667	N/A	YES	NO	YES
00778389	NAPROXEN SODIUM	Teva-Naproxen Sodium (Off-Formulary Interchangeable) 275mg Tab	TEV	0.3422	N/A	YES	NO	YES
02026600	NAPROXEN SODIUM	Teva-Naproxen Sodium DS (Off-Formulary Interchangeable) 550mg Tab	TEV	0.6667	N/A	YES	NO	YES
02243661	OXAPROZIN.	Apo-Oxaprozin (Off-Formulary Interchangeable) 600mg Tab	APX	0.6892	N/A	YES	NO	YES
02027860	OXAPROZIN.	Daypro (Off-Formulary Interchangeable) 600mg Tab	HLR	N/A	N/A	YES	NO	YES
00642886	PIROXICAM	Apo-Piroxicam 10mg Cap	APX	0.4426	0.4426	YES	NO	YES
00642894	PIROXICAM	Apo-Piroxicam 20mg Cap	APX	0.7422	0.7422	YES	NO	YES
00525618	PIROXICAM	Feldene (Not a Benefit) 20mg Cap	PFI	N/A	N/A	YES	NO	YES
00525596	PIROXICAM	Feldene (Not a Benefit) 10mg Cap	PFI	N/A	N/A	YES	NO	YES
00695696	PIROXICAM	Teva-Piroxicam 20mg Cap	TEV	0.7422	0.7422	YES	NO	YES
00695718	PIROXICAM	Teva-Piroxicam 10mg Cap	TEV	0.4426	0.4426	YES	NO	YES
00456888	SULINDAC	Clinoril (Not a Benefit) 150mg Tab	FRS	N/A	N/A	YES	NO	YES
00432369	SULINDAC	Clinoril (Not a Benefit) 200mg Tab	FRS	N/A	N/A	YES	NO	YES
00745588	SULINDAC	Teva-Sulindac 150mg Tab	TEV	0.4427	0.4427	YES	NO	YES
00745596	SULINDAC	Teva-Sulindac 200mg Tab	TEV	0.5253	0.5253	YES	NO	YES
02230828	TIAPROFENIC ACID	PMS-Tiaprofenic (Not a Benefit) 300mg Tab	PMS	N/A	N/A	YES	NO	YES
02221950	TIAPROFENIC ACID	Surgam (Not a Benefit) 300mg Tab	SAV	N/A	N/A	YES	NO	YES
01989782	TIAPROFENIC ACID	Surgam (Not a Benefit) 200mg Tab	HRU	N/A	N/A	YES	NO	YES
02179687	TIAPROFENIC ACID	Teva-Tiaprofenic 300mg Tab	TEV	0.8070	0.8070	YES	NO	YES
02179679	TIAPROFENIC ACID	Teva-Tiaprofenic 200mg Tab	TEV	0.5728	0.5728	YES	NO	YES

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