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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Interchangeable	Limited Use	Therapeutic Notes
00545015	ACETAZOLAMIDE	Acetazolamide 250mg Tab	AAP	0.1414	0.1414	YES	NO	NO
02238072	ACETAZOLAMIDE	Diamox (Not a Benefit) 250mg Tab	WAY	N/A	N/A	YES	NO	NO
02554178	AFLIBERCEPT	Aflivu 2mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	APX	850.8000	850.8000	NO	YES	NO
02562510	AFLIBERCEPT	Enzeevu 2mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	SDZ	850.8000	850.8000	NO	YES	NO
02563045	AFLIBERCEPT	Eydenzelt 2mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	CEI	850.8000	850.8000	NO	YES	NO
02505355	AFLIBERCEPT	Eylea 40mg/mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	BAH	1418.0000	1418.0000	NO	YES	NO
02558238	AFLIBERCEPT	Yesafili 2mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	BCL	850.8000	850.8000	NO	YES	NO
02563037	AFLIBERCEPT	Eydenzelt 2mg/0.05mL Inj Sol-0.05mL Vial Pk (Preservative-Free)	CEI	850.8000	850.8000	NO	YES	NO
02554798	AFLIBERCEPT	Eylea HD 8mg/0.07mL Inj Sol-0.07mL Pref Syr	BAH	1250.0000	1250.0000	NO	YES	NO
02545004	AFLIBERCEPT	Eylea HD 8mg/0.07mL Inj Sol-0.07mL Vial Pk	BAH	1250.0000	1250.0000	NO	YES	NO
02554194	AFLIBERCEPT	Aflivu 2mg/0.05mL Sol for Intravitreal Inj-0.05mL Vial Pk	APX	850.8000	850.8000	NO	YES	NO
02415992	AFLIBERCEPT	Eylea 40mg/mL Sol for Intravitreal Inj-0.05mL Vial Pk	BAH	1418.0000	1418.0000	NO	YES	NO
02535858	AFLIBERCEPT	Yesafili 2mg/0.05mL Sol for Intravitreal Inj-0.05mL Vial Pk	BCL	850.8000	850.8000	NO	YES	NO
02023695	ATROPINE SULFATE	Atropine 1% Oph Sol	PHS	0.5490	0.5490	YES	NO	NO
00035017	ATROPINE SULFATE	Isopto Atropine 1% Oph Sol	ALC	0.8900	0.5490	YES	NO	NO
02540886	AZELASTINE HCL & FLUTICASONE PROPIONATE	Apo-Azelastine/Fluticasone (Off-Formulary Interchangeable) 137mcg/Actuation&50mcg/Actuation Nas-Sp-120 Dose Pk	APX	89.9215	N/A	YES	NO	YES
02432889	AZELASTINE HCL & FLUTICASONE PROPIONATE	Dymista (Off-Formulary Interchangeable) 137mcg/Actuation&50mcg/Actuation Nas-Sp-120 Dose Pk	BGP	N/A	N/A	YES	NO	YES
02530341	AZELASTINE HCL & FLUTICASONE PROPIONATE	Mylan-Azelastine/Fluticasone (Off-Formulary Interchangeable) 137mcg/Actuation&50mcg/Actuation Nas-Sp-120 Dose Pk	MYL	89.9215	N/A	YES	NO	YES
02238796	BECLOMETHASONE DIPROPIONATE	Apo-Beclomethasone Nasal Spray 50mcg Nas-Sp-200 Dose Pk	APX	12.2600	12.2600	YES	NO	YES
02213702	BECLOMETHASONE DIPROPIONATE	Beconase Aqueous (Not a Benefit) 50mcg Nas-Sp-200 Dose Pk	GLW	N/A	N/A	YES	NO	YES
02172712	BECLOMETHASONE DIPROPIONATE	Mylan-Beclo AQ 50mcg Nas-Sp-200 Dose Pk	MYL	12.2600	12.2600	YES	NO	YES
02463105	BENZYDAMINE HCL	Odan-Benzydamine (Off-Formulary Interchangeable) 0.15% Oral Rinse	ODN	0.0960	N/A	YES	NO	NO
02239537	BENZYDAMINE HCL	PMS-Benzydamine (Off-Formulary Interchangeable) 0.15% Oral Rinse	PMS	0.0960	N/A	YES	NO	NO
02229777	BENZYDAMINE HCL	Pharixia (Not a Benefit) 0.15% Oral Rinse	PEN	N/A	N/A	YES	NO	NO
01966065	BENZYDAMINE HCL	Tantum (Not a Benefit) 0.15% Oral Rinse	GRA	N/A	N/A	YES	NO	NO
01908448	BETAXOLOL HCL	Betoptic S 0.25% Oph Susp	NOV	2.5580	2.5580	NO	NO	NO
02245860	BIMATOPROST	Lumigan (Not a Benefit) 0.03% Oph Sol	ALL	N/A	N/A	YES	NO	NO
02429063	BIMATOPROST	Vistitan 0.03% Oph Sol	SDZ	9.1936	9.1936	YES	YES	NO
09857368	BIMATOPROST	Lumigan RC 0.01% Oph Sol-5mL Pk	ALL	60.1892	60.1892	NO	YES	NO
09857398	BIMATOPROST	Lumigan RC 0.01% Oph Sol-7.5mL Pk	ALL	90.2838	90.2838	NO	YES	NO
02236876	BRIMONIDINE	Alphagan 0.2% Oph Sol	ALL	3.7970	1.1550	YES	YES	NO
02248151	BRIMONIDINE	Alphagan P 0.15% Oph Sol	ALL	2.6017	2.0305	YES	YES	NO
02301334	BRIMONIDINE	Brimonidine P 0.15% Oph Sol	AAP	2.0305	2.0305	YES	YES	NO
02515377	BRIMONIDINE	Brimonidine Tartrate Ophthalmic Solution 0.2% Oph Sol	TCI	1.1550	1.1550	YES	YES	NO
02449226	BRIMONIDINE	Jamp-Brimonidine 0.2% Oph Sol	JPC	1.1550	1.1550	YES	YES	NO
02507811	BRIMONIDINE	Med-Brimonidine 0.2% Oph Sol	GMP	1.1550	1.1550	YES	YES	NO
02305429	BRIMONIDINE	Sandoz Brimonidine 0.2% Oph Sol	SDZ	1.1550	1.1550	YES	YES	NO
02375311	BRIMONIDINE TARTRATE & TIMOLOL MALEATE	Apo-Brimonidine-Timop 0.2% & 0.5% Oph Sol-10mL Pk	APX	23.2900	23.2900	YES	YES	NO
09857298	BRIMONIDINE TARTRATE & TIMOLOL MALEATE	Combigan 0.2% & 0.5% Oph Sol-10mL Pk	ALL	46.5800	23.2900	YES	YES	NO
02531704	BRIMONIDINE TARTRATE & TIMOLOL MALEATE	Jamp Brimonidine/Timolol 0.2% & 0.5% Oph Sol-10mL Pk	JPC	23.2900	23.2900	YES	YES	NO
02238873	BRINZOLAMIDE	Azopt 1% Oph Susp	NOV	3.5560	3.5560	NO	YES	NO
02435411	BRINZOLAMIDE & BRIMONIDINE TARTRATE	Simbrinza 1.0% & 0.2% Oph Susp-10mL Pk	NOV	50.6900	50.6900	NO	YES	NO
02331624	BRINZOLAMIDE & TIMOLOL MALEATE	Azarga 1% & 0.5% Oph Susp-5mL Pk	NOV	20.4000	20.4000	NO	YES	NO
02496976	BROLUCIZUMAB	Beovu 6mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	NOV	1390.0000	1390.0000	NO	YES	NO
02537788	BROMFENAC	Apo-Bromfenac (Off-Formulary Interchangeable) 0.07% w/v Oph Sol (With Preservative)	APX	8.5000	N/A	YES	NO	YES
02439123	BROMFENAC	Prolensa (Off-Formulary Interchangeable) 0.07% w/v Oph Sol (With Preservative)	BSH	N/A	N/A	YES	NO	YES
02231923	BUDESONIDE	Rhinocort Aqua 64mcg/Metered Dose Nas Sp-120 Dose Pk	MCL	11.0400	11.0400	NO	NO	YES
02230648	BUDESONIDE	Mylan-Budesonide AQ 100mcg/Metered Dose Nas Sp-165 Dose Pk	MYL	12.7400	12.7400	YES	NO	YES
01974432	BUDESONIDE	Rhinocort Aqua (Not a Benefit) 100mcg/Metered Dose Nas Sp-165 Dose Pk	AST	N/A	N/A	YES	NO	YES
02240433	CHLORHEXIDINE GLUCONATE	PMS-Chlorhexidine (Off-Formulary Interchangeable) 0.12% Oral Rinse	PMS	0.0253	N/A	YES	NO	NO
02493160	CHLORHEXIDINE GLUCONATE	PMS-Chlorhexidine Without Alcohol (Off-Formulary Interchangeable) 0.12% Oral Rinse	PMS	0.0253	N/A	YES	NO	NO
02237452	CHLORHEXIDINE GLUCONATE	Peridex (Off-Formulary Interchangeable) 0.12% Oral Rinse	ZIL	N/A	N/A	YES	NO	NO
02263130	CIPROFLOXACIN	Apo-Ciproflox (Off-Formulary Interchangeable) 0.3% Oph Sol-5mL Pk	APX	1.7600	N/A	YES	NO	YES
01945270	CIPROFLOXACIN	Ciloxan (Off-Formulary Interchangeable) 0.3% Oph Sol-5mL Pk	NOV	N/A	N/A	YES	NO	YES
02387131	CIPROFLOXACIN	Sandoz Ciprofloxacin (Off-Formulary Interchangeable) 0.3% Oph Sol-5mL Pk	SDZ	9.3000	N/A	YES	NO	YES
02252716	CIPROFLOXACIN AND DEXAMETHASONE	Ciprodex 0.3% w/v & 0.1% w/v Otic Susp-7.5mL Pk (With Preservative)	NOV	31.9700	14.4203	YES	YES	NO
02506882	CIPROFLOXACIN AND DEXAMETHASONE	Sandoz Ciprofloxacin/Dexamethasone 0.3% w/v & 0.1% w/v Otic Susp-7.5mL Pk (With Preservative)	SDZ	14.4203	14.4203	YES	YES	NO
02481901	CIPROFLOXACIN AND DEXAMETHASONE	Taro-Ciprofloxacin/Dexamethasone 0.3% w/v & 0.1% w/v Otic Susp-7.5mL Pk (With Preservative)	TAR	14.4203	14.4203	YES	YES	NO
00252506	CYCLOPENTOLATE HCL	Cyclogyl (Off-Formulary Interchangeable) 1% Oph Sol	NOV	N/A	N/A	YES	NO	NO
00626627	CYCLOPENTOLATE HCL	Odan-Cyclopentolate (Off-Formulary Interchangeable) 1% Oph Sol	ODN	0.8925	N/A	YES	NO	NO
02355655	CYCLOSPORINE	Restasis (Off-Formulary Interchangeable) 0.05% w/v Oph Emuls-0.4mL Pk	ALL	N/A	N/A	YES	NO	NO
02462486	CYCLOSPORINE	Teva-Cyclosporine (Off-Formulary Interchangeable) 0.05% w/v Oph Emuls-0.4mL Pk	TEV	4.1658	N/A	YES	NO	NO
00042579	DEXAMETHASONE	Maxidex 0.1% Oph Oint-3.5g Pk	NOV	9.7200	9.7200	NO	NO	YES
00042560	DEXAMETHASONE	Maxidex 0.1% Oph Susp	NOV	1.7900	1.7900	NO	NO	YES
00743445	DEXTRAN 70 & HYDROXYPROPYL METHYLCELLULOSE & POLYQUAD	Tears Naturale II 0.1%/0.3%/0.001% Oph Sol	ALC	0.4647	0.4647	NO	YES	NO
02441020	DICLOFENAC SODIUM	Apo-Diclofenac Ophthalmic 0.1% Oph Sol	APX	1.2397	1.2397	YES	NO	YES
02475065	DICLOFENAC SODIUM	Diclofenac 0.1% Oph Sol	PHS	1.2397	1.2397	YES	NO	YES
02534525	DICLOFENAC SODIUM	Jamp Diclofenac 0.1% Oph Sol	JPC	1.2397	1.2397	YES	NO	YES
02475197	DICLOFENAC SODIUM	Mint-Diclofenac 0.1% Oph Sol	MIN	1.2397	1.2397	YES	NO	YES
02454807	DICLOFENAC SODIUM	Sandoz Diclofenac Ophtha 0.1% Oph Sol	SDZ	1.2397	1.2397	YES	NO	YES
01940414	DICLOFENAC SODIUM	Voltaren Ophtha 0.1% Oph Sol	NOV	4.3500	1.2397	YES	NO	YES
02522373	DORZOLAMIDE HCL	Dorzolamide 2% Oph Sol	JPC	1.4757	1.4757	YES	YES	NO
02453347	DORZOLAMIDE HCL	Jamp-Dorzolamide 2% Oph Sol	JPC	1.4757	1.4757	YES	YES	NO
02457210	DORZOLAMIDE HCL	Med-Dorzolamide 2% Oph Sol	GMP	1.4757	1.4757	YES	YES	NO
02316307	DORZOLAMIDE HCL	Sandoz Dorzolamide 2% Oph Sol	SDZ	1.4757	1.4757	YES	YES	NO
02216205	DORZOLAMIDE HCL	Trusopt 2% Oph Sol	ELV	6.1267	1.4757	YES	YES	NO
02299615	DORZOLAMIDE HCL & TIMOLOL MALEATE	Apo-Dorzo-Timop 2% & 0.5% Oph Sol	APX	2.0951	2.0951	YES	YES	NO
02404389	DORZOLAMIDE HCL & TIMOLOL MALEATE	Co Dorzotimolol 2% & 0.5% Oph Sol	COB	2.0951	2.0951	YES	YES	NO
02240113	DORZOLAMIDE HCL & TIMOLOL MALEATE	Cosopt 2% & 0.5% Oph Sol	ELV	9.8639	2.0951	YES	YES	NO
02522020	DORZOLAMIDE HCL & TIMOLOL MALEATE	Dorzolamide-Timolol 2% & 0.5% Oph Sol	JPC	2.0951	2.0951	YES	YES	NO
02457539	DORZOLAMIDE HCL & TIMOLOL MALEATE	Jamp Dorzolamide-Timolol 2% & 0.5% Oph Sol	JPC	2.0951	2.0951	YES	YES	NO
02537796	DORZOLAMIDE HCL & TIMOLOL MALEATE	M-Dorzolamide-Timolol 2% & 0.5% Oph Sol	MAT	2.0951	2.0951	YES	YES	NO
02437686	DORZOLAMIDE HCL & TIMOLOL MALEATE	Med-Dorzolamide-Timolol 2% & 0.5% Oph Sol	GMP	2.0951	2.0951	YES	YES	NO
02443090	DORZOLAMIDE HCL & TIMOLOL MALEATE	Mint-Dorzolamide/Timolol 2% & 0.5% Oph Sol	MIN	2.0951	2.0951	YES	YES	NO
02441659	DORZOLAMIDE HCL & TIMOLOL MALEATE	Riva-Dorzolamide/Timolol 2% & 0.5% Oph Sol	RIA	2.0951	2.0951	YES	YES	NO
02344351	DORZOLAMIDE HCL & TIMOLOL MALEATE	Sandoz Dorzolamide/Timolol 2% & 0.5% Oph Sol	SDZ	2.0951	2.0951	YES	YES	NO
02258692	DORZOLAMIDE HCL & TIMOLOL MALEATE	Cosopt Preservative Free 2% & 0.5% Oph Sol-0.2mL Pk	ELV	0.8930	0.8930	NO	YES	NO
02554003	FARICIMAB	Vabysmo 6mg/0.05mL Inj Sol-0.05mL Pref Syr (Preservative-Free)	HLR	1350.0000	1350.0000	NO	YES	NO
02527618	FARICIMAB	Vabysmo 6mg/0.05mL Inj Sol-0.24mL Vial Pk (Preservative-Free)	HLR	1350.0000	1350.0000	NO	YES	NO
00074454	FLUMETHASONE PIVALATE & IODOCHLORHYDROXYQUIN	Locacorten Vioform Eardrops 0.02% & 1% Ot Sol	PPI	2.6300	2.6300	NO	NO	YES
00247855	FLUOROMETHOLONE	FML 0.1% Oph Susp	ALL	3.6858	3.6858	NO	NO	YES
00756784	FLUOROMETHOLONE ACETATE	Flarex 0.1% Oph Susp	NOV	2.0240	2.0240	NO	NO	YES
02294745	FLUTICASONE PROPIONATE	Apo-Fluticasone (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose Pk	APX	21.9700	N/A	YES	NO	YES
02213672	FLUTICASONE PROPIONATE	Flonase (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose Pk	GSK	N/A	N/A	YES	NO	YES
02296071	FLUTICASONE PROPIONATE	Ratio-Fluticasone (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose Pk	RPH	21.9700	N/A	YES	NO	YES
02453738	FLUTICASONE PROPIONATE	Teva-Fluticasone (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose Pk	TEV	21.9700	N/A	YES	NO	YES
02224895	FRAMYCETIN SULFATE	Soframycin 0.5% Oph Oint-5g Pk	SLP	19.6100	19.6100	NO	NO	NO
02224887	FRAMYCETIN SULFATE	Soframycin 0.5% Oph Sol	SLP	1.3663	1.3663	NO	NO	NO
02224623	FRAMYCETIN SULFATE & GRAMICIDIN & DEXAMETHASONE	Sofracort 5mg & 50mcg & 0.5mg/mL Oph/Ot Sol	SAV	2.2212	2.2212	NO	NO	YES
02327260	GATIFLOXACIN	Apo-Gatifloxacin (with preservative) (Off-Formulary Interchangeable) 0.3% w/v Oph Sol	APX	2.0320	N/A	YES	NO	NO
02533235	GATIFLOXACIN	Jamp Gatifloxacin (Off-Formulary Interchangeable) 0.3% w/v Oph Sol	JPC	2.0320	N/A	YES	NO	NO
02257270	GATIFLOXACIN	Zymar (with preservative) (Off-Formulary Interchangeable) 0.3% w/v Oph Sol	ALL	N/A	N/A	YES	NO	NO
00682217	GENTAMICIN & BETAMETHASONE SODIUM PHOSPHATE	Garasone 3mg & 1mg/mL Oph/Ot Drops	SCH	1.2813	1.2813	NO	NO	YES
00028339	GENTAMICIN SULFATE	Garamycin 0.3% Oph Oint-3.5g Pk	SCH	4.0000	4.0000	NO	NO	NO
02163705	IPRATROPIUM BROMIDE	Atrovent (Not a Benefit) 0.03% Nasal Spray	BOE	N/A	N/A	YES	NO	NO
02163713	IPRATROPIUM BROMIDE	Atrovent (Off-Formulary Interchangeable) 0.06% Nasal Spray	BOE	N/A	N/A	YES	NO	NO
02246084	IPRATROPIUM BROMIDE	Ipravent (Off-Formulary Interchangeable) 0.06% Nasal Spray	AAP	2.9700	N/A	YES	NO	NO
02239627	IPRATROPIUM BROMIDE	PMS-Ipratropium 0.03% Nasal Spray	PMS	0.9127	0.9127	YES	YES	NO
01968300	KETOROLAC TROMETHAMINE	Acular 0.5% Oph Sol	ALL	3.6780	2.8997	YES	NO	YES
02245821	KETOROLAC TROMETHAMINE	Ketorolac 0.5% Oph Sol	AAP	2.8997	2.8997	YES	NO	YES
02369362	KETOROLAC TROMETHAMINE	Acuvail 0.45% w/v Oph Sol-0.4mL Vial Pk (Preservative-Free)	ABV	0.2593	0.2593	NO	NO	YES
02542722	KETOTIFEN	Jamp Ketotifen Ophthalmic (Off-Formulary Interchangeable) 0.25mg/mL Oph Sol-5mL Pk	JPC	25.7800	N/A	YES	NO	NO
02400871	KETOTIFEN	Ketotifen Ophthalmic Solution (Off-Formulary Interchangeable) 0.25mg/mL Oph Sol-5mL Pk	STE	21.1700	N/A	YES	NO	NO
02242324	KETOTIFEN	Zaditor (Off-Formulary Interchangeable) 0.25mg/mL Oph Sol-5mL Pk	LBT	N/A	N/A	YES	NO	NO
02296527	LATANOPROST	Apo-Latanoprost 0.005% Oph Sol-2.5mL Pk	APX	9.5830	9.5830	YES	YES	NO
02254786	LATANOPROST	Co Latanoprost 0.005% Oph Sol-2.5mL Pk	COB	9.5830	9.5830	YES	YES	NO
02373041	LATANOPROST	Gd-Latanoprost 0.005% Oph Sol-2.5mL Pk	UJC	9.5830	9.5830	YES	YES	NO
02453355	LATANOPROST	Jamp Latanoprost 0.005% Oph Sol-2.5mL Pk	JPC	9.5830	9.5830	YES	YES	NO
02513285	LATANOPROST	M-Latanoprost 0.005% Oph Sol-2.5mL Pk	MAT	9.5830	9.5830	YES	YES	NO
02426935	LATANOPROST	Med-Latanoprost 0.005% Oph Sol-2.5mL Pk	GMP	9.5830	9.5830	YES	YES	NO
02341085	LATANOPROST	Riva-Latanoprost 0.005% Oph Sol-2.5mL Pk	RIA	9.5830	9.5830	YES	YES	NO
02367335	LATANOPROST	Sandoz Latanoprost 0.005% Oph Sol-2.5mL Pk	SDZ	9.5830	9.5830	YES	YES	NO
02231493	LATANOPROST	Xalatan 0.005% Oph Sol-2.5mL Pk	UJC	36.2736	9.5830	YES	YES	NO
02436256	LATANOPROST & TIMOLOL MALEATE	Act Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	ACV	11.0700	11.0670	YES	YES	NO
02414155	LATANOPROST & TIMOLOL MALEATE	Apo-Latanoprost-Timop 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	APX	11.0700	11.0670	YES	YES	NO
02373068	LATANOPROST & TIMOLOL MALEATE	Gd-Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	UJC	11.0700	11.0670	YES	YES	NO
02453770	LATANOPROST & TIMOLOL MALEATE	Jamp-Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	JPC	11.0700	11.0670	YES	YES	NO
02514516	LATANOPROST & TIMOLOL MALEATE	M-Latanoprost-Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	MAT	11.0670	11.0670	YES	YES	NO
02454505	LATANOPROST & TIMOLOL MALEATE	Med-Latanoprost-Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	GMP	11.0700	11.0670	YES	YES	NO
02394685	LATANOPROST & TIMOLOL MALEATE	Sandoz Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	SDZ	11.0700	11.0670	YES	YES	NO
02246619	LATANOPROST & TIMOLOL MALEATE	Xalacom 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	UJC	41.0578	11.0670	YES	YES	NO
02484218	LATANOPROSTENE BUNOD	Vyzulta 0.024%w/v Oph Sol	BSH	5.2500	5.2500	NO	YES	NO
00637661	LEVOBUNOLOL HCL	Betagan 0.5% Oph Sol	ALL	3.8153	3.8153	NO	NO	NO
00893560	LODOXAMIDE TROMETHAMINE	Alomide 0.1% Oph Sol	NOV	1.4890	1.4890	NO	NO	YES
02245882	METHAZOLAMIDE	Methazolamide 50mg Tab	AAP	0.4913	0.4913	YES	NO	NO
02238071	METHAZOLAMIDE	Neptazane (Not a Benefit) 50mg Tab	WAY	N/A	N/A	YES	NO	NO
00000809	METHYLCELLULOSE	Isopto Tears 0.5% Oph Sol	ALC	0.5454	0.5454	NO	YES	NO
00000817	METHYLCELLULOSE	Isopto Tears 1% Oph-Sol	ALC	0.5147	0.5147	NO	YES	NO
02403587	MOMETASONE FUROATE	Apo-Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	APX	21.6900	N/A	YES	NO	YES
02551756	MOMETASONE FUROATE	Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	SIV	21.6860	N/A	YES	NO	YES
02519127	MOMETASONE FUROATE	Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	SAI	21.6900	N/A	YES	NO	YES
02238465	MOMETASONE FUROATE	Nasonex (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	OCI	N/A	N/A	YES	NO	YES
02449811	MOMETASONE FUROATE	Sandoz Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	SDZ	21.6860	N/A	YES	NO	YES
02475863	MOMETASONE FUROATE	Teva-Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	TEV	21.6900	N/A	YES	NO	YES
02484757	MOXIFLOXACIN HYDROCHLORIDE	AG-Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	ANG	11.2700	N/A	YES	NO	NO
02404656	MOXIFLOXACIN HYDROCHLORIDE	Act Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	ACV	11.2700	N/A	YES	NO	NO
02406373	MOXIFLOXACIN HYDROCHLORIDE	Apo-Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	APX	11.2700	N/A	YES	NO	NO
02472120	MOXIFLOXACIN HYDROCHLORIDE	Jamp-Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	JPC	11.2700	N/A	YES	NO	NO
02529076	MOXIFLOXACIN HYDROCHLORIDE	Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	SAI	11.2700	N/A	YES	NO	NO
02432218	MOXIFLOXACIN HYDROCHLORIDE	PMS-Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	PMS	11.2701	N/A	YES	NO	NO
02411520	MOXIFLOXACIN HYDROCHLORIDE	Sandoz Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	SDZ	11.2700	N/A	YES	NO	NO
02252260	MOXIFLOXACIN HYDROCHLORIDE	Vigamox (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	NOV	N/A	N/A	YES	NO	NO
00001147	NAPHAZOLINE HCL	Albalon (Not a Benefit) 0.1% Oph Sol	ALL	N/A	N/A	YES	NO	NO
00390283	NAPHAZOLINE HCL	Naphcon Forte (Not a Benefit) 0.1% Oph Sol	ALC	N/A	N/A	YES	NO	NO
00759880	NAPHAZOLINE HCL	Vasocon (Not a Benefit) 0.1% Oph Sol	IOB	N/A	N/A	YES	NO	NO
02143291	OFLOXACIN	Ocuflox 0.3% Oph Sol	ALL	2.8720	2.8720	NO	YES	NO
02404095	OLOPATADINE HCL	Act Olopatadine 0.2% (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	ACV	26.1300	N/A	YES	NO	NO
02402823	OLOPATADINE HCL	Apo-Olopatadine (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	APX	26.1300	N/A	YES	NO	NO
02508605	OLOPATADINE HCL	Mint-Olopatadine 0.2% (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	MIN	26.1300	N/A	YES	NO	NO
02541653	OLOPATADINE HCL	Olopatadine 0.2% (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	SAI	26.1300	N/A	YES	NO	NO
02362171	OLOPATADINE HCL	Pataday (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	NOV	N/A	N/A	YES	NO	NO
02420171	OLOPATADINE HCL	Sandoz Olopatadine 0.2% (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	SDZ	26.1300	N/A	YES	NO	NO
02305054	OLOPATADINE HCL	Apo-Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	APX	26.1300	N/A	YES	NO	NO
02403986	OLOPATADINE HCL	Co Olopatadine 0.1% (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	COB	26.1300	N/A	YES	NO	NO
02458411	OLOPATADINE HCL	Jamp-Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	JPC	26.1300	N/A	YES	NO	NO
02422727	OLOPATADINE HCL	Mint-Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	MIN	26.1300	N/A	YES	NO	NO
02521172	OLOPATADINE HCL	Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	SAI	26.1300	N/A	YES	NO	NO
02233143	OLOPATADINE HCL	Patanol (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	NOV	N/A	N/A	YES	NO	NO
02358913	OLOPATADINE HCL	Sandoz Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	SDZ	26.1300	N/A	YES	NO	NO
00210889	PETROLATUM/MINERAL OIL	Lacri-Lube 55% & 42.5% Oph Oint-3.5g Pk	ALL	7.9000	7.9000	NO	YES	NO
02125706	PETROLATUM/MINERAL OIL	Soothe Night Time 80%/20% Oph Oint-3.5g Pk	BLI	5.7800	5.7800	NO	YES	NO
00000884	PILOCARPINE HCL	Isopto Carpine 4% Oph Sol	NOV	0.3360	0.3360	NO	NO	NO
00000868	PILOCARPINE HCL	Isopto Carpine 2% Oph Sol	NOV	0.3320	0.3320	YES	NO	NO
02023741	PILOCARPINE HCL	Pilocarpine (Not a Benefit) 2% Oph Sol	PHS	N/A	N/A	YES	NO	NO
02239157	POLYMYXIN B SULFATE & BACITRACIN (ZINC)	Polysporin 10000U & 500U/g Oph Oint 3.5g Pk	PFI	5.5400	5.5400	NO	NO	NO
02239156	POLYMYXIN B SULFATE & GRAMICIDIN	Polysporin Eye and Ear Drops Sterile 10000U & 0.025mg/mL Oph/Ot Sol	JAJ	0.9139	0.9139	NO	NO	NO
00045616	POLYVINYL ALCOHOL	Liquifilm Tears 1.4% Oph-Sol	ALL	0.6373	0.6373	NO	YES	NO
00579408	POLYVINYL ALCOHOL & POLYVINYLPYRROLIDONE	Tears Plus Oph-Sol	ALL	0.3840	0.3840	NO	YES	NO
00301175	PREDNISOLONE ACETATE	Pred Forte (Not a Benefit) 1% Oph Susp	ALL	N/A	N/A	YES	NO	YES
00700401	PREDNISOLONE ACETATE	Ratio-Prednisolone 1% Oph Susp	RPH	1.9400	1.9400	YES	NO	YES
02525852	RANIBIZUMAB	Byooviz 10mg/mL Inj Sol-0.23mL Vial Pk (Preservative-Free)	SAM	900.0000	900.0000	NO	YES	NO
02542250	RANIBIZUMAB	Ranopto 10mg/mL Inj Sol-0.23mL Vial Pk (Preservative-Free)	TEI	900.0000	900.0000	NO	YES	NO
02009277	SODIUM CROMOGLYCATE	Cromolyn Eye Drops 2% Oph Sol	PEN	0.9500	0.9500	YES	NO	NO
02230621	SODIUM CROMOGLYCATE	Opticrom (Not a Benefit) 2% Oph Sol	ALL	N/A	N/A	YES	NO	NO
02242275	TIMOLOL MALEATE	Timolol Maleate-EX 0.25% Oph Gellan Sol	ALC	2.9540	2.9540	YES	NO	YES
02242276	TIMOLOL MALEATE	Timolol Maleate-EX 0.5% Oph Gellan Sol	ALC	3.5320	3.5320	YES	NO	YES
02171880	TIMOLOL MALEATE	Timoptic-XE (Not a Benefit) 0.25% Oph Gellan Sol	PFP	N/A	N/A	YES	NO	YES
02171899	TIMOLOL MALEATE	Timoptic-XE 0.5% Oph Gellan Sol	ELV	9.3115	3.5320	YES	NO	YES
00755834	TIMOLOL MALEATE	Apo-Timop 0.5% Oph Sol	APX	1.2145	1.2145	YES	NO	YES
02447800	TIMOLOL MALEATE	Jamp-Timolol 0.5% Oph Sol	JPC	1.2145	1.2145	YES	NO	YES
02166720	TIMOLOL MALEATE	Sandoz Timolol 0.5% Oph Sol	SDZ	1.2145	1.2145	YES	NO	YES
02166712	TIMOLOL MALEATE	Sandoz Timolol 0.25% Oph Sol	SDZ	2.3503	2.3503	YES	NO	YES
00451207	TIMOLOL MALEATE	Timoptic 0.5% Oph Sol	ELV	7.2910	1.2145	YES	NO	YES
00451193	TIMOLOL MALEATE	Timoptic (Not a Benefit) 0.25% Oph Sol	MFC	N/A	N/A	YES	NO	YES
02415305	TIMOLOL MALEATE & TRAVOPROST	Apo-Travoprost-Timop 0.5% & 0.004% Oph Sol	APX	8.8425	8.8425	YES	YES	NO
02278251	TIMOLOL MALEATE & TRAVOPROST	DuoTrav (Not a Benefit) 0.5% & 0.004% Oph Sol	ALC	N/A	N/A	YES	NO	NO
09857644	TIMOLOL MALEATE & TRAVOPROST	Apo-Travoprost-Timop PQ 0.5% & 0.004% Oph Sol-5mL Pk	APX	44.2125	44.2125	YES	YES	YES
09857513	TIMOLOL MALEATE & TRAVOPROST	DuoTrav PQ 0.5% & 0.004% Oph Sol-5mL Pk	NOV	56.7000	44.2125	YES	YES	YES
00614254	TOBRAMYCIN	Tobrex 0.3% Oph Oint	NOV	2.7514	2.7514	NO	NO	NO
02241755	TOBRAMYCIN	Sandoz Tobramycin 0.3% Oph Sol	SDZ	1.3620	1.3620	YES	NO	NO
00513962	TOBRAMYCIN	Tobrex 0.3% Oph Sol	NOV	1.9400	1.3620	YES	NO	NO
00778915	TOBRAMYCIN & DEXAMETHASONE	TobraDex 0.3% & 0.1% Oph Oint	NOV	3.3171	3.3171	NO	NO	NO
00778907	TOBRAMYCIN & DEXAMETHASONE	TobraDex 0.3% & 0.1% Oph Susp	NOV	2.2500	2.2500	NO	NO	NO
02457997	TRAVOPROST	IZBA 0.003% Oph Sol (with Preservative)	NOV	3.9400	3.9400	NO	YES	NO
02548089	TRAVOPROST	Jamp Travoprost Z 0.004% Oph Sol-5mL Pk	JPC	28.7600	28.7600	YES	YES	NO
02413167	TRAVOPROST	Sandoz Travoprost 0.004% Oph Sol-5mL Pk	SDZ	28.7600	28.7600	YES	YES	NO
09857332	TRAVOPROST	Travatan Z 0.004% Oph Sol-5mL Pk	NOV	58.9600	28.7600	YES	YES	NO
02437635	TRIAMCINOLONE ACETONIDE	Apo-Triamcinolone AQ (Off-Formulary Interchangeable) 55mcg/Metered Dose Nas Sp-120 Dose Pk (with Preservative)	APX	18.0000	18.0000	YES	NO	YES
02213834	TRIAMCINOLONE ACETONIDE	Nasacort AQ (Off-Formulary Interchangeable) 55mcg/Metered Dose Nas Sp-120 Dose Pk (with Preservative)	SCO	N/A	N/A	YES	NO	YES

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