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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
02456117	ABOBOTULINUM TOXIN A	Dysport Therapeutic 500U/Vial Pd Inj-Vial Pk	IPS	642.6000	642.6000	NO	YES	NO
02460203	ABOBOTULINUM TOXIN A	Dysport Therapeutic 300U/Vial Pd Inj-Vial Pk	IPS	385.5600	385.5600	NO	YES	NO
02542315	ADALIMUMAB	Hyrimoz 20mg/0.2mL Inj Sol-0.2mL Pref Syr (Preservative-Free)	SDZ	235.6350	235.6350	NO	YES	NO
02533480	ADALIMUMAB	Hadlima PushTouch 40mg/0.4mL Inj Sol-0.4mL Autoinj (Preservative-Free)	SAM	471.2700	471.2700	NO	YES	NO
02523779	ADALIMUMAB	Yuflyma 40mg/0.4mL Inj Sol-0.4mL Pref Autoinj Pen (Preservative-Free)	CEH	471.2700	471.2700	NO	YES	NO
02523957	ADALIMUMAB	Simlandi 40mg/0.4mL Inj Sol-0.4mL Pref Autoinj Syr (Preservative-Free)	JPC	471.2700	471.2700	NO	YES	NO
02542331	ADALIMUMAB	Hyrimoz 40mg/0.4mL Inj Sol-0.4mL Pref Pen (Preservative-Free)	SDZ	471.2700	471.2700	NO	YES	NO
02511061	ADALIMUMAB	Abrilada 20mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	PFI	235.6300	235.6300	NO	YES	NO
02459310	ADALIMUMAB	Amgevita 20mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	AMG	235.6400	235.6400	NO	YES	NO
02533472	ADALIMUMAB	Hadlima 40mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	SAM	471.2700	471.2700	NO	YES	NO
02502380	ADALIMUMAB	Hulio 20mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	BGP	235.6350	235.6350	NO	YES	NO
02542323	ADALIMUMAB	Hyrimoz 40mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	SDZ	471.2700	471.2700	NO	YES	NO
02505258	ADALIMUMAB	Hyrimoz 20mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	SDZ	235.6350	235.6350	NO	YES	NO
02523949	ADALIMUMAB	Simlandi 40mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	JPC	471.2700	471.2700	NO	YES	NO
02523760	ADALIMUMAB	Yuflyma 40mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	CEH	471.2700	471.2700	NO	YES	NO
02459302	ADALIMUMAB	Amgevita 40mg/0.8mL Inj Sol-0.8mL Pref Autoinj (Preservative-Free)	AMG	471.2700	471.2700	NO	YES	NO
02473100	ADALIMUMAB	Hadlima PushTouch 40mg/0.8mL Inj Sol-0.8mL Pref Autoinj (Preservative-Free)	SAM	471.2700	471.2700	NO	YES	NO
02492156	ADALIMUMAB	Hyrimoz 40mg/0.8mL Inj Sol-0.8mL Pref Autoinj (Preservative-Free)	SDZ	471.2700	471.2700	NO	YES	NO
02511045	ADALIMUMAB	Abrilada 40mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	PFI	471.2700	471.2700	NO	YES	NO
02502402	ADALIMUMAB	Hulio 40mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	BGP	471.2700	471.2700	NO	YES	NO
02542366	ADALIMUMAB	Hyrimoz 80mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	SDZ	942.5400	942.5400	NO	YES	NO
02502674	ADALIMUMAB	Idacio 40mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	FKC	471.2700	471.2700	NO	YES	NO
02535084	ADALIMUMAB	Yuflyma 80mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	CEH	942.5400	942.5400	NO	YES	NO
02511053	ADALIMUMAB	Abrilada 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	PFI	471.2700	471.2700	NO	YES	NO
02459299	ADALIMUMAB	Amgevita 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	AMG	471.2700	471.2700	NO	YES	NO
02473097	ADALIMUMAB	Hadlima 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	SAM	471.2700	471.2700	NO	YES	NO
02502399	ADALIMUMAB	Hulio 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	BGP	471.2700	471.2700	NO	YES	NO
02542358	ADALIMUMAB	Hyrimoz 80mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	SDZ	942.5400	942.5400	NO	YES	NO
02492164	ADALIMUMAB	Hyrimoz 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	SDZ	471.2700	471.2700	NO	YES	NO
02502682	ADALIMUMAB	Idacio 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	FKC	471.2700	471.2700	NO	YES	NO
02523965	ADALIMUMAB	Simlandi 80mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	JPC	942.5400	942.5400	NO	YES	NO
02535076	ADALIMUMAB	Yuflyma 80mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	CEH	942.5400	942.5400	NO	YES	NO
02485184	ALENDRONATE	AG-Alendronate 70mg Tab	ANG	1.7804	1.7804	YES	NO	NO
02352966	ALENDRONATE	Alendronate 70mg Tab	SAI	1.7804	1.7804	YES	NO	NO
02299712	ALENDRONATE	Alendronate 70mg Tab	SIV	1.7804	1.7804	YES	NO	NO
02381486	ALENDRONATE	Alendronate Sodium Tablets 10mg Tab	ACH	0.4987	0.4987	YES	NO	NO
02381478	ALENDRONATE	Alendronate Sodium Tablets (Off-Formulary Interchangeable) 5mg Tab	ACH	1.0370	N/A	YES	NO	NO
02381494	ALENDRONATE	Alendronate Sodium Tablets 70mg Tab	ACH	1.7804	1.7804	YES	NO	NO
02248727	ALENDRONATE	Apo-Alendronate (Off-Formulary Interchangeable) 5mg Tab	APX	1.0370	N/A	YES	NO	NO
02248728	ALENDRONATE	Apo-Alendronate 10mg Tab	APX	0.4987	0.4987	YES	NO	NO
02248730	ALENDRONATE	Apo-Alendronate 70mg Tab	APX	1.7804	1.7804	YES	NO	NO
02388553	ALENDRONATE	Auro-Alendronate 70mg Tab	AUR	1.7804	1.7804	YES	NO	NO
02388545	ALENDRONATE	Auro-Alendronate 10mg Tab	AUR	0.4987	0.4987	YES	NO	NO
02233055	ALENDRONATE	Fosamax (Off-Formulary Interchangeable) 5mg Tab	MFC	N/A	N/A	YES	NO	NO
02201011	ALENDRONATE	Fosamax (Not a Benefit) 10mg Tab	MFC	N/A	N/A	YES	NO	NO
02245329	ALENDRONATE	Fosamax 70mg Tab	OCI	12.6250	1.7804	YES	NO	NO
02500175	ALENDRONATE	Jamp Alendronate Sodium 70mg Tab	JPC	1.7804	1.7804	YES	NO	NO
02385031	ALENDRONATE	Jamp-Alendronate 70mg Tab	JPC	1.7804	1.7804	YES	NO	NO
02529394	ALENDRONATE	M-Alendronate 70mg Tab	MAT	1.7804	1.7804	YES	NO	NO
02394863	ALENDRONATE	Mint-Alendronate 10mg Tab	MIN	0.4987	0.4987	YES	NO	NO
02394871	ALENDRONATE	Mint-Alendronate 70mg Tab	MIN	1.7804	1.7804	YES	NO	NO
02523116	ALENDRONATE	NRA-Alendronate 70mg Tab	NRA	1.7804	1.7804	YES	NO	NO
02284006	ALENDRONATE	PMS-Alendronate-FC 70mg Tab	PMS	1.7804	1.7804	YES	NO	NO
02384701	ALENDRONATE	Ran-Alendronate 10mg Tab	RAN	0.4987	0.4987	YES	NO	NO
02270889	ALENDRONATE	Riva-Alendronate 70mg Tab	RIA	1.7804	1.7804	YES	NO	NO
02288109	ALENDRONATE	Sandoz Alendronate 70mg Tab	SDZ	1.7804	1.7804	YES	NO	NO
02288087	ALENDRONATE	Sandoz Alendronate 10mg Tab	SDZ	0.4987	0.4987	YES	NO	NO
02247373	ALENDRONATE	Teva-Alendronate 10mg Tab	TEV	0.4987	0.4987	YES	NO	NO
02261715	ALENDRONATE	Teva-Alendronate 70mg Tab	TEV	1.7804	1.7804	YES	NO	NO
02248251	ALENDRONATE	Teva-Alendronate (Off-Formulary Interchangeable) 5mg Tab	TEV	1.0370	N/A	YES	NO	NO
02454475	ALENDRONATE & CHOLECALCIFEROL	Apo-Alendronate/Vitamin D3 70mg & 140mcg Tab	APX	2.4348	2.4348	YES	NO	NO
02454467	ALENDRONATE & CHOLECALCIFEROL	Apo-Alendronate/Vitamin D3 70mg & 70mcg Tab	APX	2.4348	2.4348	YES	NO	YES
02276429	ALENDRONATE & CHOLECALCIFEROL	Fosavance 70mg & 70mcg Tab	OCI	5.5335	2.4348	YES	NO	YES
02314940	ALENDRONATE & CHOLECALCIFEROL	Fosavance 70mg & 140mcg Tab	OCI	5.4250	2.4348	YES	NO	NO
02519828	ALENDRONATE & CHOLECALCIFEROL	Jamp Alendronate/Vitamin D3 70mg & 70mcg Tab	JPC	2.4348	2.4348	YES	NO	NO
02519836	ALENDRONATE & CHOLECALCIFEROL	Jamp Alendronate/Vitamin D3 70mg & 140mcg Tab	JPC	2.4348	2.4348	YES	NO	NO
02447576	ALFUZOSIN HYDROCHLORIDE	Alfuzosin 10mg Prolong-Rel Tab	SIV	0.2601	0.2601	YES	YES	NO
02519844	ALFUZOSIN HYDROCHLORIDE	Alfuzosin 10mg Prolong-Rel Tab	SAI	0.2601	0.2601	YES	YES	NO
02315866	ALFUZOSIN HYDROCHLORIDE	Apo-Alfuzosin 10mg Prolong-Rel Tab	APX	0.2601	0.2601	YES	YES	NO
02443201	ALFUZOSIN HYDROCHLORIDE	Auro-Alfuzosin 10mg Prolong-Rel Tab	AUR	0.2601	0.2601	YES	YES	NO
02304678	ALFUZOSIN HYDROCHLORIDE	Sandoz Alfuzosin 10mg Prolong-Rel Tab	SDZ	0.2601	0.2601	YES	YES	NO
02245565	ALFUZOSIN HYDROCHLORIDE	Xatral 10mg Prolong-Rel Tab	SAV	1.1352	0.2601	YES	YES	NO
02402785	ALLOPURINOL	Apo-Allopurinol (Not a Benefit) 300mg Tab	APX	N/A	N/A	YES	NO	YES
02402777	ALLOPURINOL	Apo-Allopurinol (Not a Benefit) 200mg Tab	APX	N/A	N/A	YES	NO	YES
02402769	ALLOPURINOL	Apo-Allopurinol (Not a Benefit) 100mg Tab	APX	N/A	N/A	YES	NO	YES
00402796	ALLOPURINOL	Apo-Allopurinol Tablets 300mg Tab	APX	0.2125	0.2125	YES	NO	YES
00402818	ALLOPURINOL	Apo-Allopurinol Tablets 100mg Tab	APX	0.0780	0.0780	YES	NO	YES
00479799	ALLOPURINOL	Apo-Allopurinol Tablets 200mg Tab	APX	0.1300	0.1300	YES	NO	YES
02396327	ALLOPURINOL	Mar-Allopurinol 100mg Tab	MAR	0.0780	0.0780	YES	NO	YES
02396343	ALLOPURINOL	Mar-Allopurinol 300mg Tab	MAR	0.2125	0.2125	YES	NO	YES
02396335	ALLOPURINOL	Mar-Allopurinol 200mg Tab	MAR	0.1300	0.1300	YES	NO	YES
00294322	ALLOPURINOL	Zyloprim (Not a Benefit) 300mg Tab	BWE	N/A	N/A	YES	NO	YES
01990403	AMANTADINE HCL	PDP-Amantadine Hydrochloride Capsules 100mg Cap	PEN	0.5662	0.5662	YES	NO	YES
01914006	AMANTADINE HCL	Symmetrel (Not a Benefit) 100mg Cap	BQU	N/A	N/A	YES	NO	YES
02538601	AMANTADINE HCL	Odan-Amantadine Syrup 10mg/mL O/L	ODN	0.0988	0.0988	YES	NO	YES
02022826	AMANTADINE HCL	PDP-Amantadine Hydrochloride Syrup 10mg/mL O/L	PEN	0.0988	0.0988	YES	NO	YES
01913999	AMANTADINE HCL	Symmetrel (Not a Benefit) 10mg/mL O/L	BQU	N/A	N/A	YES	NO	YES
02236859	ANAGRELIDE HCL	Agrylin (Not a Benefit) 0.5mg Cap	TAK	N/A	N/A	YES	NO	NO
09858363	ANAGRELIDE HCL	Anagride (Temporary Benefit) 0.5mg Cap	SET	5.9696	5.9696	NO	NO	NO
02274949	ANAGRELIDE HCL	PMS-Anagrelide 0.5mg Cap	PMS	4.6997	4.6997	YES	YES	NO
02538180	APREMILAST	Apo-Apremilast (Off-Formulary Interchangeable) 30mg Tab	APX	18.7238	N/A	YES	NO	NO
02524104	APREMILAST	Auro-Apremilast (Off-Formulary Interchangeable) 30mg Tab	AUR	18.7237	N/A	YES	NO	NO
02518910	APREMILAST	GLN-Apremilast (Off-Formulary Interchangeable) 30mg Tab	GLP	18.7238	N/A	YES	NO	NO
02528959	APREMILAST	Jamp Apremilast (Off-Formulary Interchangeable) 30mg Tab	JPC	18.7238	N/A	YES	NO	NO
02525747	APREMILAST	Mint-Apremilast (Off-Formulary Interchangeable) 30mg Tab	MIN	18.7238	N/A	YES	NO	NO
02434334	APREMILAST	Otezla (Off-Formulary Interchangeable) 30mg Tab	AMG	N/A	N/A	YES	NO	NO
02521733	APREMILAST	PMS-Apremilast (Off-Formulary Interchangeable) 30mg Tab	PMS	18.7238	N/A	YES	NO	NO
02529084	APREMILAST	Sandoz Apremilast (Off-Formulary Interchangeable) 30mg Tab	SDZ	18.7238	N/A	YES	NO	NO
02524120	APREMILAST	Auro-Apremilast (Off-Formulary Interchangeable) 10mg & 20mg & 30mg Tab-27 Blister Starter Pk	AUR	505.5426	N/A	YES	NO	NO
02528967	APREMILAST	Jamp Apremilast (Off-Formulary Interchangeable) 10mg & 20mg & 30mg Tab-27 Blister Starter Pk	JPC	505.5426	N/A	YES	NO	NO
02434318	APREMILAST	Otezla (Off-Formulary Interchangeable) 10mg & 20mg & 30mg Tab-27 Blister Starter Pk	AMG	N/A	N/A	YES	NO	NO
02529092	APREMILAST	Sandoz Apremilast (Off-Formulary Interchangeable) 10mg & 20mg & 30mg Tab-27 Blister Starter Pk	SDZ	505.5426	N/A	YES	NO	NO
02242907	AZATHIOPRINE	Apo-Azathioprine 50mg Tab	APX	0.5185	0.5185	YES	NO	YES
00004596	AZATHIOPRINE	Imuran 50mg Tab	ASN	1.4511	0.5185	YES	NO	YES
02236819	AZATHIOPRINE	Teva-Azathioprine 50mg Tab	TEV	0.5185	0.5185	YES	NO	YES
02544768	BARICITINIB	Olumiant 4mg Tab	LIL	59.4367	59.4367	NO	YES	NO
02480018	BARICITINIB	Olumiant 2mg Tab	LIL	59.4367	59.4367	NO	YES	NO
01981501	BOTULINUM TOXIN TYPE A	Botox 100U/Vial Pd Inj-100U Vial Pk	ABV	389.8440	389.8440	NO	YES	NO
09857387	BOTULINUM TOXIN TYPE A	Botox 200U/Vial Pd Inj-200U Vial Pk	ABV	779.6880	779.6880	NO	YES	NO
02531585	BOTULINUM TOXIN TYPE A	Botox 200U/Vial Pd Inj-200U Vial Pk	ABV	779.6880	779.6880	NO	YES	NO
09857386	BOTULINUM TOXIN TYPE A	Botox 50U/Vial Pd Inj-50U Vial Pk	ABV	194.9220	194.9220	NO	YES	NO
02531577	BOTULINUM TOXIN TYPE A	Botox 50U/Vial Pd Inj-50U Vial Pk	ABV	194.9220	194.9220	NO	YES	NO
02230454	BROMOCRIPTINE	Bromocriptine 5mg Cap	AAP	1.7097	1.7097	YES	NO	NO
00568643	BROMOCRIPTINE	Parlodel (Not a Benefit) 5mg Cap	NOV	N/A	N/A	YES	NO	NO
02087324	BROMOCRIPTINE	Bromocriptine 2.5mg Tab	AAP	1.0800	1.0800	YES	NO	NO
00371033	BROMOCRIPTINE	Parlodel (Not a Benefit) 2.5mg Tab	NOV	N/A	N/A	YES	NO	NO
02238441	BUPROPION HCL	Zyban 150mg SR Tab	VAL	1.3541	1.3541	NO	YES	NO
02455897	CABERGOLINE	Apo-Cabergoline 0.5mg Tab	APX	7.2907	7.2907	YES	YES	NO
02242471	CABERGOLINE	Dostinex 0.5mg Tab	PMJ	23.5199	7.2907	YES	YES	NO
02549611	CABERGOLINE	Jamp Cabergoline 0.5mg Tab	JPC	7.2907	7.2907	YES	YES	NO
02244266	CASPOFUNGIN	Cancidas (Off-Formulary Interchangeable) 70mg/Vial Inj Pd-Vial Pk	FRS	N/A	N/A	YES	NO	NO
02486997	CASPOFUNGIN	Caspofungin for Injection (Off-Formulary Interchangeable) 70mg/Vial Inj Pd-Vial Pk	FKC	222.5000	222.5000	YES	NO	NO
02460955	CASPOFUNGIN	Caspofungin for Injection (Off-Formulary Interchangeable) 70mg/Vial Inj Pd-Vial Pk	JUN	222.0000	222.0000	YES	NO	NO
02452707	CINACALCET	Apo-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	APX	18.5900	18.5900	YES	NO	NO
02452693	CINACALCET	Apo-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	APX	10.1947	10.1947	YES	NO	NO
02452715	CINACALCET	Apo-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	APX	27.0517	27.0517	YES	NO	NO
02478919	CINACALCET	Auro-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	AUR	18.5900	18.5900	YES	NO	NO
02478943	CINACALCET	Auro-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	AUR	27.0517	27.0517	YES	NO	NO
02478900	CINACALCET	Auro-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	AUR	10.1947	10.1947	YES	NO	NO
02524880	CINACALCET	Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	SAI	10.1947	10.1947	YES	NO	NO
02500116	CINACALCET	Jamp Cinacalcet Tablets (Off-Formulary Interchangeable) 90mg Tab	JPC	27.0517	27.0517	YES	NO	NO
02500108	CINACALCET	Jamp Cinacalcet Tablets (Off-Formulary Interchangeable) 60mg Tab	JPC	18.5900	18.5900	YES	NO	NO
02500094	CINACALCET	Jamp Cinacalcet Tablets (Off-Formulary Interchangeable) 30mg Tab	JPC	10.1947	10.1947	YES	NO	NO
02481987	CINACALCET	M-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	MAT	10.1947	10.1947	YES	NO	NO
02482002	CINACALCET	M-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	MAT	27.0517	27.0517	YES	NO	NO
02481995	CINACALCET	M-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	MAT	18.5900	18.5900	YES	NO	NO
02480301	CINACALCET	Mar-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	MAR	18.5900	18.5900	YES	NO	NO
02480298	CINACALCET	Mar-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	MAR	10.1947	10.1947	YES	NO	NO
02480328	CINACALCET	Mar-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	MAR	27.0517	27.0517	YES	NO	NO
02434539	CINACALCET	Mylan-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	MYL	10.1947	10.1947	YES	NO	NO
02434547	CINACALCET	Mylan-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	MYL	18.5900	18.5900	YES	NO	NO
02434555	CINACALCET	Mylan-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	MYL	27.0517	27.0517	YES	NO	NO
02517620	CINACALCET	PMS-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	PMS	27.0517	27.0517	YES	NO	NO
02517612	CINACALCET	PMS-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	PMS	18.5900	18.5900	YES	NO	NO
02517604	CINACALCET	PMS-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	PMS	10.1947	10.1947	YES	NO	NO
02257130	CINACALCET	Sensipar (Off-Formulary Interchangeable) 30mg Tab	AMG	N/A	N/A	YES	NO	NO
02257157	CINACALCET	Sensipar (Off-Formulary Interchangeable) 90mg Tab	AMG	N/A	N/A	YES	NO	NO
02257149	CINACALCET	Sensipar (Off-Formulary Interchangeable) 60mg Tab	AMG	N/A	N/A	YES	NO	NO
02441632	CINACALCET	Teva-Cinacalcet (Off-Formulary Interchangeable) 60mg Tab	TEV	18.5900	18.5900	YES	NO	NO
02441624	CINACALCET	Teva-Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	TEV	10.1947	10.1947	YES	NO	NO
02441640	CINACALCET	Teva-Cinacalcet (Off-Formulary Interchangeable) 90mg Tab	TEV	27.0517	27.0517	YES	NO	NO
02553295	CLADRIBINE	Apo-Cladribine (Off-Formulary Interchangeable) 10mg Tab	APX	1606.0000	1606.0000	YES	NO	NO
02566443	CLADRIBINE	Auro-Cladribine (Off-Formulary Interchangeable) 10mg Tab	AUR	1606.0000	1606.0000	YES	NO	NO
02470179	CLADRIBINE	Mavenclad (Off-Formulary Interchangeable) 10mg Tab	EMS	3212.0000	1606.0000	YES	NO	NO
02245828	CLODRONATE DISODIUM	Clasteon 400mg Cap	KNT	1.2083	1.2083	YES	YES	NO
01927078	CLODRONATE DISODIUM	Ostac (Not a Benefit) 400mg Cap	HLR	N/A	N/A	YES	NO	NO
02398591	CLOPIDOGREL BISULFATE	Apo-Clopidogrel (Off-Formulary Interchangeable) 300mg Tab	APX	9.5447	N/A	YES	NO	NO
02252767	CLOPIDOGREL BISULFATE	Apo-Clopidogrel 75mg Tab	APX	0.2631	0.2631	YES	NO	NO
02416387	CLOPIDOGREL BISULFATE	Auro-Clopidogrel 75mg Tab	AUR	0.2631	0.2631	YES	NO	NO
02444895	CLOPIDOGREL BISULFATE	Bio-Clopidogrel 75mg Tab	BMP	0.2631	0.2631	YES	NO	NO
02400553	CLOPIDOGREL BISULFATE	Clopidogrel 75mg Tab	SAI	0.2631	0.2631	YES	NO	NO
02385813	CLOPIDOGREL BISULFATE	Clopidogrel 75mg Tab	SIV	0.2631	0.2631	YES	NO	NO
02303027	CLOPIDOGREL BISULFATE	Co Clopidogrel 75mg Tab	COB	0.2631	0.2631	YES	NO	NO
02415550	CLOPIDOGREL BISULFATE	Jamp-Clopidogrel 75mg Tab	JPC	0.2631	0.2631	YES	NO	NO
02502283	CLOPIDOGREL BISULFATE	M-Clopidogrel 75mg Tab	MAT	0.2631	0.2631	YES	NO	NO
02422255	CLOPIDOGREL BISULFATE	Mar-Clopidogrel 75mg Tab	MAR	0.2631	0.2631	YES	NO	NO
02408910	CLOPIDOGREL BISULFATE	Mint-Clopidogrel 75mg Tab	MIN	0.2631	0.2631	YES	NO	NO
02482037	CLOPIDOGREL BISULFATE	NRA-Clopidogrel 75mg Tab	NRA	0.2631	0.2631	YES	NO	NO
02348004	CLOPIDOGREL BISULFATE	PMS-Clopidogrel 75mg Tab	PMS	0.2631	0.2631	YES	NO	NO
02238682	CLOPIDOGREL BISULFATE	Plavix 75mg Tab	SAV	2.9350	0.2631	YES	NO	NO
02330555	CLOPIDOGREL BISULFATE	Plavix (Off-Formulary Interchangeable) 300mg Tab	SAV	N/A	N/A	YES	NO	NO
02379813	CLOPIDOGREL BISULFATE	Ran-Clopidogrel 75mg Tab	RAN	0.2631	0.2631	YES	NO	NO
02359316	CLOPIDOGREL BISULFATE	Sandoz Clopidogrel 75mg Tab	SDZ	0.2631	0.2631	YES	NO	NO
02388065	CLOPIDOGREL BISULFATE	Teva-Clopidogrel (Off-Formulary Interchangeable) 300mg Tab	TEV	9.5447	N/A	YES	NO	NO
02293161	CLOPIDOGREL BISULFATE	Teva-Clopidogrel 75mg Tab	TEV	0.2631	0.2631	YES	NO	NO
02237671	CYCLOSPORINE	Neoral 10mg Cap	NOV	0.7829	0.7829	NO	NO	NO
02150689	CYCLOSPORINE	Neoral 25mg Cap	NOV	1.8207	0.8657	YES	NO	NO
02150670	CYCLOSPORINE	Neoral 100mg Cap	NOV	7.1073	3.3792	YES	NO	NO
02150662	CYCLOSPORINE	Neoral 50mg Cap	NOV	3.5512	1.6885	YES	NO	NO
02247073	CYCLOSPORINE	Sandoz Cyclosporine 25mg Cap	SDZ	0.8657	0.8657	YES	NO	NO
02247074	CYCLOSPORINE	Sandoz Cyclosporine 50mg Cap	SDZ	1.6885	1.6885	YES	NO	NO
02242821	CYCLOSPORINE	Sandoz Cyclosporine 100mg Cap	SDZ	3.3792	3.3792	YES	NO	NO
02150697	CYCLOSPORINE	Neoral 100mg/mL O/L	NOV	6.3191	6.3191	NO	NO	NO
02452510	DARIFENACIN	Apo-Darifenacin 7.5mg ER Tab	APX	0.8058	0.8058	YES	YES	NO
02452529	DARIFENACIN	Apo-Darifenacin 15mg ER Tab	APX	0.8058	0.8058	YES	YES	NO
02273225	DARIFENACIN	Enablex 15mg ER Tab	SLP	1.6116	0.8058	YES	YES	NO
02273217	DARIFENACIN	Enablex 7.5mg ER Tab	SLP	1.6116	0.8058	YES	YES	NO
02491877	DARIFENACIN	Jamp Darifenacin 15mg ER Tab	JPC	0.8058	0.8058	YES	YES	NO
02491869	DARIFENACIN	Jamp Darifenacin 7.5mg ER Tab	JPC	0.8058	0.8058	YES	YES	NO
02560917	DENOSUMAB	Stoboclo 60mg/mL Inj Sol-1.0mL Pref Syr Pk (Preservative-Free)	CEI	194.7000	194.7000	NO	YES	NO
02545411	DENOSUMAB	Jubbonti (Preservative Free) 60mg/mL Inj Sol-Pref Syr	SDZ	181.0700	181.0700	NO	YES	NO
02343541	DENOSUMAB	Prolia (Preservative Free) 60mg/mL Inj Sol-Pref Syr	AMG	440.1000	440.1000	NO	YES	NO
02545764	DENOSUMAB	Wyost (Preservative Free) 120mg/1.7mL Inj Sol-Vial Pk	SDZ	290.1600	290.1600	NO	YES	NO
02560895	DENOSUMAB	Osenvelt 120mg/1.7mL Inj Sol-Vial Pk (Preservative-Free)	CEI	312.0000	312.0000	NO	YES	NO
02404206	DUTASTERIDE	Apo-Dutasteride 0.5mg Cap	APX	0.2565	0.2565	YES	YES	NO
02469308	DUTASTERIDE	Auro-Dutasteride 0.5mg Cap	AUR	0.2565	0.2565	YES	YES	NO
02247813	DUTASTERIDE	Avodart 0.5mg Cap	GSK	2.2717	0.2565	YES	YES	NO
02429012	DUTASTERIDE	Dutasteride 0.5mg Cap	SIV	0.2565	0.2565	YES	YES	NO
02443058	DUTASTERIDE	Dutasteride 0.5mg Cap	SAI	0.2565	0.2565	YES	YES	NO
02484870	DUTASTERIDE	Jamp Dutasteride 0.5mg Cap	JPC	0.2565	0.2565	YES	YES	NO
02546167	DUTASTERIDE	Jamp Dutasteride Capsules 0.5mg Cap	JPC	0.2565	0.2565	YES	YES	NO
02416298	DUTASTERIDE	Med-Dutasteride 0.5mg Cap	GMP	0.2565	0.2565	YES	YES	NO
02428873	DUTASTERIDE	Mint-Dutasteride 0.5mg Cap	MIN	0.2565	0.2565	YES	YES	NO
02490587	DUTASTERIDE	Priva-Dutasteride 0.5mg Cap	PHP	0.2565	0.2565	YES	YES	NO
02424444	DUTASTERIDE	Sandoz Dutasteride 0.5mg Cap	SDZ	0.2565	0.2565	YES	YES	NO
02408287	DUTASTERIDE	Teva-Dutasteride 0.5mg Cap	TEV	0.2565	0.2565	YES	YES	NO
02462877	ETANERCEPT	Erelzi 25mg/0.5mL Inj Sol-0.5mL Pref Syr Pk	SDZ	120.5000	120.5000	NO	YES	NO
02462869	ETANERCEPT	Erelzi 50mg/mL Inj Sol-1mL Pref Syr Pk	SDZ	241.0000	241.0000	NO	YES	NO
02462850	ETANERCEPT	Erelzi 50mg/mL Inj Sol-1mL Prefilled SensoReady Pen Pk	SDZ	241.0000	241.0000	NO	YES	NO
02530309	ETANERCEPT	Rymti 50mg/mL Inj Sol-Pref Autoinj Pen	LUP	236.1800	236.1800	NO	YES	NO
02455323	ETANERCEPT	Brenzys 50mg/mL Inj Sol-Pref Syr	SAM	236.1800	236.1800	NO	YES	NO
02530295	ETANERCEPT	Rymti 50mg/mL Inj Sol-Pref Syr	LUP	236.1800	236.1800	NO	YES	NO
02455331	ETANERCEPT	Brenzys 50mg/mL Sol- Pref AutoInj	SAM	236.1800	236.1800	NO	YES	NO
02248686	ETIDRONATE DISODIUM	Co Etidronate 200mg Tab	COB	0.3569	0.3569	YES	YES	NO
01997629	ETIDRONATE DISODIUM	Didronel (Not a Benefit) 200mg Tab	PGP	N/A	N/A	YES	NO	NO
02379910	FAMPRIDINE	Fampyra (Off-Formulary Interchangeable) 10mg ER Tab	BIG	N/A	N/A	YES	NO	NO
02496216	FAMPRIDINE	PMS-Fampridine (Off-Formulary Interchangeable) 10mg ER Tab	PMS	8.4730	N/A	YES	NO	NO
02482398	FAMPRIDINE	Taro-Fampridine (Off-Formulary Interchangeable) 10mg ER Tab	TAR	8.4730	N/A	YES	NO	NO
02533243	FEBUXOSTAT	Auro-Febuxostat (Off-Formulary Interchangeable) 80mg Tab	AUR	1.3515	1.3515	YES	NO	NO
02539837	FEBUXOSTAT	Febuxostat (Off-Formulary Interchangeable) 80mg Tab	SAI	1.3515	1.3515	YES	NO	NO
02490870	FEBUXOSTAT	Jamp-Febuxostat (Off-Formulary Interchangeable) 80mg Tab	JPC	1.3515	1.3515	YES	NO	NO
02473607	FEBUXOSTAT	Mar-Febuxostat (Off-Formulary Interchangeable) 80mg Tab	MAR	1.3515	1.3515	YES	NO	NO
02466198	FEBUXOSTAT	Teva-Febuxostat (Off-Formulary Interchangeable) 80mg Tab	TEV	1.3515	1.3515	YES	NO	NO
02357380	FEBUXOSTAT	Uloric (Off-Formulary Interchangeable) 80mg Tab	TAK	N/A	N/A	YES	NO	NO
02365383	FINASTERIDE	Apo-Finasteride 5mg Tab	APX	0.3506	0.3506	YES	YES	NO
02405814	FINASTERIDE	Auro-Finasteride 5mg Tab	AUR	0.3506	0.3506	YES	YES	NO
02428148	FINASTERIDE	Auro-Finasteride 1mg (Off-Formulary Interchangeable) 1mg Tab	AUR	1.1455	N/A	YES	NO	NO
02447541	FINASTERIDE	Finasteride 5mg Tab	SIV	0.3506	0.3506	YES	YES	NO
02447568	FINASTERIDE	Finasteride (Off-Formulary Interchangeable) 1mg Tab	SIV	1.1455	N/A	YES	NO	NO
02445085	FINASTERIDE	Finasteride (Off-Formulary Interchangeable) 1mg Tab	SAI	1.1453	N/A	YES	NO	NO
02445077	FINASTERIDE	Finasteride 5mg Tab	SAI	0.3506	0.3506	YES	YES	NO
02355043	FINASTERIDE	Finasteride Tablets USP 5mg Tab	ACH	0.3506	0.3506	YES	YES	NO
02554461	FINASTERIDE	Jamp Finasteride Tablets (Off-Formulary Interchangeable) 1mg Tab	JPC	1.1453	N/A	YES	NO	NO
02357224	FINASTERIDE	Jamp-Finasteride 5mg Tab	JPC	0.3506	0.3506	YES	YES	NO
02522489	FINASTERIDE	M-Finasteride 5mg Tab	MAT	0.3506	0.3506	YES	YES	NO
02537427	FINASTERIDE	Mint-Finasteride (Off-Formulary Interchangeable) 1mg Tab	MIN	1.1453	N/A	YES	NO	NO
02389878	FINASTERIDE	Mint-Finasteride 5mg Tab	MIN	0.3506	0.3506	YES	YES	NO
02535637	FINASTERIDE	NRA-Finasteride 5mg Tab	NRA	0.3506	0.3506	YES	YES	NO
02348500	FINASTERIDE	Novo-Finasteride 5mg Tab	TEV	0.3506	0.3506	YES	YES	NO
02320169	FINASTERIDE	PMS-Finasteride (Off-Formulary Interchangeable) 1mg Tab	PMS	1.1453	N/A	YES	NO	NO
02310112	FINASTERIDE	PMS-Finasteride 5mg Tab	PMS	0.3506	0.3506	YES	YES	NO
02238213	FINASTERIDE	Propecia (Off-Formulary Interchangeable) 1mg Tab	OCI	N/A	N/A	YES	NO	NO
02010909	FINASTERIDE	Proscar 5mg Tab	OCI	2.6891	0.3506	YES	YES	NO
02306905	FINASTERIDE	Ratio-Finasteride 5mg Tab	RPH	0.3506	0.3506	YES	YES	NO
02455013	FINASTERIDE	Riva-Finasteride 5mg Tab	RIA	0.3506	0.3506	YES	YES	NO
02322579	FINASTERIDE	Sandoz Finasteride 5mg Tab	SDZ	0.3506	0.3506	YES	YES	NO
02339471	FINASTERIDE	Sandoz Finasteride A (Off-Formulary Interchangeable) 1mg Tab	SDZ	1.1453	N/A	YES	NO	NO
02475669	FINGOLIMOD	Ach-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	ACH	73.9100	73.9100	YES	NO	NO
02469936	FINGOLIMOD	Apo-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	APX	73.9096	73.9096	YES	NO	NO
02365480	FINGOLIMOD	Gilenya (Off-Formulary Interchangeable) 0.5mg Cap	NOV	86.9525	73.9100	YES	NO	NO
02487772	FINGOLIMOD	Jamp Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	JPC	73.9096	73.9096	YES	NO	NO
02474743	FINGOLIMOD	Mar-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	MAR	73.9096	73.9096	YES	NO	NO
02469715	FINGOLIMOD	Mylan-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	MYL	73.9096	73.9096	YES	NO	NO
02469782	FINGOLIMOD	PMS-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	PMS	73.9096	73.9096	YES	NO	NO
02482606	FINGOLIMOD	Sandoz Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	SDZ	73.9096	73.9096	YES	NO	NO
02469618	FINGOLIMOD	Taro-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	TAR	73.9096	73.9096	YES	NO	NO
02469561	FINGOLIMOD	Teva-Fingolimod (Off-Formulary Interchangeable) 0.5mg Cap	TEV	73.9096	73.9096	YES	NO	NO
02246082	FLUNARIZINE HCL	Flunarizine 5mg Cap	AAP	0.8503	0.8503	YES	YES	NO
00846341	FLUNARIZINE HCL	Sibelium (Not a Benefit) 5mg Cap	PMS	N/A	N/A	YES	NO	NO
02245619	GLATIRAMER ACETATE	Copaxone 20mg/mL Inj Sol Pref Syr-1mL Pk	TEI	50.6522	27.8587	YES	YES	NO
02541440	GLATIRAMER ACETATE	Glatiramer Acetate Injection 20mg/mL Inj Sol Pref Syr-1mL Pk	MYL	27.8587	27.8587	YES	YES	NO
02460661	GLATIRAMER ACETATE	Glatect 20mg/mL Inj Sol-Pref Syr 1mL Pk	PMS	35.8400	35.8400	NO	YES	NO
09858279	GLUCAGON	Glucagon Injection Kit (Temporary Benefit) 1mg/Vial Inj Pd-1mL Vial Pk (Kit)	AMP	280.0000	280.0000	NO	NO	NO
02492415	GLUCAGON	Baqsimi 3mg Nas Pd Device	AMP	160.5200	160.5200	NO	YES	NO
02333627	GLUCAGON RDNA ORIGIN	GlucaGen HypoKit 1mg/Vial Inj Pd-Syr Pk	NOO	112.6700	112.6700	NO	NO	NO
02333619	GLUCAGON RDNA ORIGIN	GlucaGen 1mg/Vial Inj Pd-Vial Pk	NOO	108.3300	108.3300	NO	NO	NO
02381893	GRASS POLLEN ALLERGEN EXTRACT	Oralair 300IR SL Tab	STL	4.1895	4.1895	NO	YES	NO
02381885	GRASS POLLEN ALLERGEN EXTRACT	Oralair 100IR SL Tab	STL	1.3892	1.3892	NO	YES	NO
02425696	ICATIBANT	Firazyr (Off-Formulary Interchangeable) 30mg/3mL Inj Sol-Pref Syr 3mL Pk	TAK	2700.0000	1485.0000	YES	NO	NO
02547562	ICATIBANT	Icatibant Injection (Off-Formulary Interchangeable) 30mg/3mL Inj Sol-Pref Syr 3mL Pk	JPC	1485.0000	1485.0000	YES	NO	NO
02324032	INCOBOTULINUMTOXINA	Xeomin 100 LD50 Units Pd for Inj-Vial Pk	MEZ	338.9100	338.9100	NO	YES	NO
02371081	INCOBOTULINUMTOXINA	Xeomin 50 LD50 Units Pd for Inj-Vial Pk	MEZ	169.4550	169.4550	NO	YES	NO
02556227	INCOBOTULINUMTOXINA	Xeomin 200 Units/Vial Pd for Inj-Vial Pk (Preservative-Free)	MEZ	677.8200	677.8200	NO	YES	NO
02523191	INFLIXIMAB	Ixifi 100mg/Vial Inj Pd-Vial Pk	PFI	493.0000	493.0000	NO	YES	NO
02419475	INFLIXIMAB	Remdantry 100mg/Vial Inj Pd-Vial Pk	CEI	493.0000	493.0000	NO	YES	NO
02470373	INFLIXIMAB	Renflexis 100mg/Vial Inj Pd-Vial Pk	SAM	493.0000	493.0000	NO	YES	NO
02511584	INFLIXIMAB	Remsima SC 120mg/mL Inj Sol-1mL Pref Pen Pk (Preservative-Free)	CEH	474.5100	474.5100	NO	YES	NO
02511576	INFLIXIMAB	Remsima SC 120mg/mL Inj Sol-1mL Pref Syr Pk (Preservative-Free)	CEH	474.5100	474.5100	NO	YES	NO
02496933	INFLIXIMAB	Avsola 100mg/Vial Pd for Sol-Vial Pk	AMG	493.0000	493.0000	NO	YES	NO
02555867	LANREOTIDE ACETATE	Mytolac 60mg/Syr ER Pref Syr Pk	ADV	760.0056	760.0056	YES	NO	NO
02555875	LANREOTIDE ACETATE	Mytolac 90mg/Syr ER Pref Syr Pk	ADV	1013.7962	1013.7962	YES	NO	NO
02555883	LANREOTIDE ACETATE	Mytolac 120mg/Syr ER Pref Syr Pk	ADV	1268.9722	1268.9722	YES	NO	NO
02283409	LANREOTIDE ACETATE	Somatuline Autogel 90mg/Syr ER Pref Syr Pk	IPS	1935.4291	1013.7962	YES	NO	NO
02283417	LANREOTIDE ACETATE	Somatuline Autogel 120mg/Syr ER Pref Syr Pk	IPS	2422.5832	1268.9722	YES	NO	NO
02283395	LANREOTIDE ACETATE	Somatuline Autogel 60mg/Syr ER Pref Syr Pk	IPS	1450.9198	760.0056	YES	NO	NO
02478870	LEFLUNOMIDE	Accel-Leflunomide 20mg Tab	ACC	2.0000	2.0000	YES	NO	NO
02478862	LEFLUNOMIDE	Accel-Leflunomide 10mg Tab	ACC	2.0000	2.0000	YES	NO	NO
02256495	LEFLUNOMIDE	Apo-Leflunomide 10mg Tab	APX	2.6433	2.0000	YES	NO	NO
02256509	LEFLUNOMIDE	Apo-Leflunomide 20mg Tab	APX	2.6433	2.0000	YES	NO	NO
02241888	LEFLUNOMIDE	Arava 10mg Tab	SAV	11.4440	2.0000	YES	NO	NO
02241889	LEFLUNOMIDE	Arava 20mg Tab	SAV	11.4443	2.0000	YES	NO	NO
02351676	LEFLUNOMIDE	Leflunomide 20mg Tab	SAI	2.6433	2.0000	YES	NO	NO
02351668	LEFLUNOMIDE	Leflunomide 10mg Tab	SAI	2.6433	2.0000	YES	NO	NO
02543583	LEFLUNOMIDE	Leflunomide 20mg Tab	SIV	2.6433	2.0000	YES	NO	NO
02543575	LEFLUNOMIDE	Leflunomide 10mg Tab	SIV	2.6433	2.0000	YES	NO	NO
02551926	LEFLUNOMIDE	Mar-Leflunomide 20mg Tab	MAR	2.6433	2.0000	YES	NO	NO
02551918	LEFLUNOMIDE	Mar-Leflunomide 10mg Tab	MAR	2.6433	2.0000	YES	NO	NO
02283972	LEFLUNOMIDE	Sandoz Leflunomide 20mg Tab	SDZ	2.6433	2.0000	YES	NO	NO
02283964	LEFLUNOMIDE	Sandoz Leflunomide 10mg Tab	SDZ	2.6433	2.0000	YES	NO	NO
02261278	LEFLUNOMIDE	Teva-Leflunomide 20mg Tab	TEV	2.6433	2.0000	YES	NO	NO
02261251	LEFLUNOMIDE	Teva-Leflunomide 10mg Tab	TEV	2.6433	2.0000	YES	NO	NO
02507927	LENALIDOMIDE	Apo-Lenalidomide 2.5mg Cap	APX	82.3750	82.3750	YES	YES	NO
02507951	LENALIDOMIDE	Apo-Lenalidomide 15mg Cap	APX	95.5000	95.5000	YES	YES	NO
02507943	LENALIDOMIDE	Apo-Lenalidomide 10mg Cap	APX	90.2500	90.2500	YES	YES	NO
02507986	LENALIDOMIDE	Apo-Lenalidomide 25mg Cap	APX	106.0000	106.0000	YES	YES	NO
02507935	LENALIDOMIDE	Apo-Lenalidomide 5mg Cap	APX	85.0000	85.0000	YES	YES	NO
02507978	LENALIDOMIDE	Apo-Lenalidomide 20mg Cap	APX	100.7500	100.7500	YES	YES	NO
02506149	LENALIDOMIDE	Jamp Lenalidomide 5mg Cap	JPC	85.0000	85.0000	YES	YES	NO
02506157	LENALIDOMIDE	Jamp Lenalidomide 10mg Cap	JPC	90.2500	90.2500	YES	YES	NO
02506181	LENALIDOMIDE	Jamp Lenalidomide 25mg Cap	JPC	106.0000	106.0000	YES	YES	NO
02506173	LENALIDOMIDE	Jamp Lenalidomide 20mg Cap	JPC	100.7500	100.7500	YES	YES	NO
02506165	LENALIDOMIDE	Jamp Lenalidomide 15mg Cap	JPC	95.5000	95.5000	YES	YES	NO
02506130	LENALIDOMIDE	Jamp Lenalidomide 2.5mg Cap	JPC	82.3750	82.3750	YES	YES	NO
02493837	LENALIDOMIDE	Nat-Lenalidomide 2.5mg Cap	NAT	82.3750	82.3750	YES	YES	NO
02493888	LENALIDOMIDE	Nat-Lenalidomide 15mg Cap	NAT	95.5000	95.5000	YES	YES	NO
02493896	LENALIDOMIDE	Nat-Lenalidomide 20mg Cap	NAT	100.7500	100.7500	YES	YES	NO
02493918	LENALIDOMIDE	Nat-Lenalidomide 25mg Cap	NAT	106.0000	106.0000	YES	YES	NO
02493845	LENALIDOMIDE	Nat-Lenalidomide 5mg Cap	NAT	85.0000	85.0000	YES	YES	NO
02493861	LENALIDOMIDE	Nat-Lenalidomide 10mg Cap	NAT	90.2500	90.2500	YES	YES	NO
02484714	LENALIDOMIDE	Reddy-Lenalidomide 2.5mg Cap	DRR	82.3750	82.3750	YES	YES	NO
02483033	LENALIDOMIDE	Reddy-Lenalidomide 15mg Cap	DRR	95.5000	95.5000	YES	YES	NO
02483041	LENALIDOMIDE	Reddy-Lenalidomide 20mg Cap	DRR	100.7500	100.7500	YES	YES	NO
02483068	LENALIDOMIDE	Reddy-Lenalidomide 25mg Cap	DRR	106.0000	106.0000	YES	YES	NO
02483017	LENALIDOMIDE	Reddy-Lenalidomide 5mg Cap	DRR	85.0000	85.0000	YES	YES	NO
02483025	LENALIDOMIDE	Reddy-Lenalidomide 10mg Cap	DRR	90.2500	90.2500	YES	YES	NO
02459418	LENALIDOMIDE	Revlimid 2.5mg Cap	BQU	329.5000	82.3750	YES	YES	NO
02304902	LENALIDOMIDE	Revlimid 10mg Cap	BQU	361.0000	90.2500	YES	YES	NO
02304899	LENALIDOMIDE	Revlimid 5mg Cap	BQU	340.0000	85.0000	YES	YES	NO
02317710	LENALIDOMIDE	Revlimid 25mg Cap	BQU	424.0000	106.0000	YES	YES	NO
02440601	LENALIDOMIDE	Revlimid 20mg Cap	BQU	403.0000	100.7500	YES	YES	NO
02317699	LENALIDOMIDE	Revlimid 15mg Cap	BQU	382.0000	95.5000	YES	YES	NO
02518562	LENALIDOMIDE	Sandoz Lenalidomide 2.5mg Cap	SDZ	82.3750	82.3750	YES	YES	NO
02518597	LENALIDOMIDE	Sandoz Lenalidomide 15mg Cap	SDZ	95.5000	95.5000	YES	YES	NO
02518600	LENALIDOMIDE	Sandoz Lenalidomide 20mg Cap	SDZ	100.7500	100.7500	YES	YES	NO
02518619	LENALIDOMIDE	Sandoz Lenalidomide 25mg Cap	SDZ	106.0000	106.0000	YES	YES	NO
02518570	LENALIDOMIDE	Sandoz Lenalidomide 5mg Cap	SDZ	85.0000	85.0000	YES	YES	NO
02518589	LENALIDOMIDE	Sandoz Lenalidomide 10mg Cap	SDZ	90.2500	90.2500	YES	YES	NO
02507870	LENALIDOMIDE	Taro-Lenalidomide 5mg Cap	TAR	85.0000	85.0000	YES	YES	NO
02507900	LENALIDOMIDE	Taro-Lenalidomide 20mg Cap	TAR	100.7500	100.7500	YES	YES	NO
02507897	LENALIDOMIDE	Taro-Lenalidomide 15mg Cap	TAR	95.5000	95.5000	YES	YES	NO
02507862	LENALIDOMIDE	Taro-Lenalidomide 2.5mg Cap	TAR	82.3750	82.3750	YES	YES	NO
02507919	LENALIDOMIDE	Taro-Lenalidomide 25mg Cap	TAR	106.0000	106.0000	YES	YES	NO
02507889	LENALIDOMIDE	Taro-Lenalidomide 10mg Cap	TAR	90.2500	90.2500	YES	YES	NO
02144336	LEVOCARNITINE	Carnitor (Off-Formulary Interchangeable) 100mg/mL Oral Sol (with preservative)	LBI	0.3809	0.3809	YES	NO	NO
02492105	LEVOCARNITINE	Odan Levocarnitine (Off-Formulary Interchangeable) 100mg/mL Oral Sol (with preservative)	ODN	0.3809	0.3809	YES	NO	NO
00386464	LEVODOPA & BENSERAZIDE	Prolopa 100-25 100mg & 25mg Cap	HLR	0.5777	0.5777	NO	NO	NO
00386472	LEVODOPA & BENSERAZIDE	Prolopa 200-50 200mg & 50mg Cap	HLR	0.9699	0.9699	NO	NO	NO
00522597	LEVODOPA & BENSERAZIDE	Prolopa 50-12.5 50mg & 12.5mg Cap	HLR	0.3508	0.3508	NO	NO	NO
02272873	LEVODOPA & CARBIDOPA	AA-Levocarb CR 100mg & 25mg CR Tab	AAP	0.7974	0.7974	YES	YES	NO
02245211	LEVODOPA & CARBIDOPA	AA-Levocarb CR 200mg & 50mg CR Tab	AAP	1.4282	1.4282	YES	YES	NO
02028786	LEVODOPA & CARBIDOPA	Sinemet CR (Not a Benefit) 100mg & 25mg CR Tab	MFC	N/A	N/A	YES	NO	NO
00870935	LEVODOPA & CARBIDOPA	Sinemet CR (Not a Benefit) 200mg & 50mg CR Tab	MFC	N/A	N/A	YES	NO	NO
02195933	LEVODOPA & CARBIDOPA	Apo-Levocarb 100mg & 10mg Tab	APX	0.1479	0.1479	YES	NO	NO
02195941	LEVODOPA & CARBIDOPA	Apo-Levocarb 100mg & 25mg Tab	APX	0.2209	0.2209	YES	NO	NO
02195968	LEVODOPA & CARBIDOPA	Apo-Levocarb 250mg & 25mg Tab	APX	0.2466	0.2466	YES	NO	NO
02531593	LEVODOPA & CARBIDOPA	Auro-Levocarb 100mg & 10mg Tab	AUR	0.1479	0.1479	YES	NO	NO
02531607	LEVODOPA & CARBIDOPA	Auro-Levocarb 100mg & 25mg Tab	AUR	0.2209	0.2209	YES	NO	NO
02531615	LEVODOPA & CARBIDOPA	Auro-Levocarb 250mg & 25mg Tab	AUR	0.2466	0.2466	YES	NO	NO
02546426	LEVODOPA & CARBIDOPA	Jamp Levocarb 250mg & 25mg Tab	JPC	0.2466	0.2466	YES	NO	NO
02546418	LEVODOPA & CARBIDOPA	Jamp Levocarb 100mg & 25mg Tab	JPC	0.2209	0.2209	YES	NO	NO
02546396	LEVODOPA & CARBIDOPA	Jamp Levocarb 100mg & 10mg Tab	JPC	0.1479	0.1479	YES	NO	NO
02457962	LEVODOPA & CARBIDOPA	Mint-Levocarb 100mg & 25mg Tab	MIN	0.2209	0.2209	YES	NO	NO
02457970	LEVODOPA & CARBIDOPA	Mint-Levocarb 250mg & 25mg Tab	MIN	0.2466	0.2466	YES	NO	NO
02457954	LEVODOPA & CARBIDOPA	Mint-Levocarb 100mg & 10mg Tab	MIN	0.1479	0.1479	YES	NO	NO
02549719	LEVODOPA & CARBIDOPA	PMS-Levodopa-Carbidopa 100mg & 10mg Tab	PMS	0.1479	0.1479	YES	NO	NO
02549727	LEVODOPA & CARBIDOPA	PMS-Levodopa-Carbidopa 100mg & 25mg Tab	PMS	0.2209	0.2209	YES	NO	NO
02549735	LEVODOPA & CARBIDOPA	PMS-Levodopa-Carbidopa 250mg & 25mg Tab	PMS	0.2466	0.2466	YES	NO	NO
00513997	LEVODOPA & CARBIDOPA	Sinemet (Not a Benefit) 100mg & 25mg Tab	OCI	N/A	N/A	YES	NO	NO
00355658	LEVODOPA & CARBIDOPA	Sinemet (Not a Benefit) 100mg & 10mg Tab	MFC	N/A	N/A	YES	NO	NO
00328219	LEVODOPA & CARBIDOPA	Sinemet (Not a Benefit) 250mg & 25mg Tab	OCI	N/A	N/A	YES	NO	NO
02244496	LEVODOPA & CARBIDOPA	Teva-Levocarbidopa 250mg & 25mg Tab	TEV	0.2466	0.2466	YES	NO	NO
02244494	LEVODOPA & CARBIDOPA	Teva-Levocarbidopa 100mg & 10mg Tab	TEV	0.1479	0.1479	YES	NO	NO
02244495	LEVODOPA & CARBIDOPA	Teva-Levocarbidopa 100mg & 25mg Tab	TEV	0.2209	0.2209	YES	NO	NO
02337827	LEVODOPA & CARBIDOPA & ENTACAPONE	Stalevo 75 & 18.75 & 200mg Tab	SDZ	1.7471	1.7471	NO	YES	NO
02305968	LEVODOPA & CARBIDOPA & ENTACAPONE	Stalevo 150 & 37.5 & 200mg Tab	SDZ	1.7471	1.7471	NO	YES	NO
02305941	LEVODOPA & CARBIDOPA & ENTACAPONE	Stalevo 100 & 25 & 200mg Tab	SDZ	1.7471	1.7471	NO	YES	NO
02305933	LEVODOPA & CARBIDOPA & ENTACAPONE	Stalevo 50 & 12.5 & 200mg Tab	SDZ	1.7471	1.7471	NO	YES	NO
02337835	LEVODOPA & CARBIDOPA & ENTACAPONE	Stalevo 125 & 31.25 & 200mg Tab	SDZ	1.7471	1.7471	NO	YES	NO
02560569	MIFEPRISTONE & MISOPROSTOL	Femyso (Off-Formulary Interchangeable) 200mg & 200mcg Tab Kit Pk	LUP	165.0000	N/A	YES	NO	NO
02444038	MIFEPRISTONE & MISOPROSTOL	Mifegymiso (Off-Formulary Interchangeable) 200mg & 200mcg Tab Kit Pk	LIN	N/A	N/A	YES	NO	NO
02456257	MIGLUSTAT	Sandoz Miglustat (Off-Formulary Interchangeable) 100mg Cap	SDZ	81.4125	81.4125	YES	NO	NO
02250519	MIGLUSTAT	Zavesca (Off-Formulary Interchangeable) 100mg Cap	ACT	128.9600	81.4125	YES	NO	NO
02377608	MONTELUKAST SODIUM	Apo-Montelukast 4mg Chew Tab	APX	0.2758	0.2758	YES	YES	NO
02377616	MONTELUKAST SODIUM	Apo-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	APX	1.2075	1.2075	YES	NO	NO
02422875	MONTELUKAST SODIUM	Auro-Montelukast Chewable Tablet (Off-Formulary Interchangeable) 5mg Chew Tab	AUR	1.2077	1.2077	YES	NO	NO
02422867	MONTELUKAST SODIUM	Auro-Montelukast Chewable Tablet 4mg Chew Tab	AUR	0.2758	0.2758	YES	YES	NO
02514885	MONTELUKAST SODIUM	Jamp Montelukast Chewable Tablets (Off-Formulary Interchangeable) 5mg Chew Tab	JPC	1.2075	1.2075	YES	NO	NO
02514877	MONTELUKAST SODIUM	Jamp Montelukast Chewable Tablets 4mg Chew Tab	JPC	0.2758	0.2758	YES	YES	NO
02442361	MONTELUKAST SODIUM	Jamp-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	JPC	1.2075	1.2075	YES	NO	NO
02442353	MONTELUKAST SODIUM	Jamp-Montelukast 4mg Chew Tab	JPC	0.2758	0.2758	YES	YES	NO
02399865	MONTELUKAST SODIUM	Mar-Montelukast 4mg Chew Tab	MAR	0.2758	0.2758	YES	YES	NO
02399873	MONTELUKAST SODIUM	Mar-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	MAR	1.2075	1.2075	YES	NO	NO
02408627	MONTELUKAST SODIUM	Mint-Montelukast 4mg Chew Tab	MIN	0.2758	0.2758	YES	YES	NO
02408635	MONTELUKAST SODIUM	Mint-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	MIN	1.2075	1.2075	YES	NO	NO
02382458	MONTELUKAST SODIUM	Montelukast 4mg Chew Tab	SIV	0.2758	0.2758	YES	YES	NO
02382466	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	SIV	1.2075	1.2075	YES	NO	NO
02379325	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	SAI	1.2075	1.2075	YES	NO	NO
02522128	MONTELUKAST SODIUM	Nat-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	NAT	1.2077	1.2077	YES	NO	NO
02522101	MONTELUKAST SODIUM	Nat-Montelukast 4mg Chew Tab	NAT	0.2758	0.2758	YES	YES	NO
02354977	MONTELUKAST SODIUM	PMS-Montelukast 4mg Chew Tab	PMS	0.2758	0.2758	YES	YES	NO
02354985	MONTELUKAST SODIUM	PMS-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	PMS	1.2075	1.2075	YES	NO	NO
02402807	MONTELUKAST SODIUM	Ran-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	RAN	1.2075	1.2075	YES	NO	NO
02330385	MONTELUKAST SODIUM	Sandoz Montelukast 4mg Chew Tab	SDZ	0.2758	0.2758	YES	YES	NO
02330393	MONTELUKAST SODIUM	Sandoz Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	SDZ	1.2075	1.2075	YES	NO	NO
02243602	MONTELUKAST SODIUM	Singulair 4mg Chew Tab	OCI	1.8503	0.2758	YES	YES	NO
02238216	MONTELUKAST SODIUM	Singulair (Off-Formulary Interchangeable) 5mg Chew Tab	OCI	N/A	N/A	YES	NO	NO
02355515	MONTELUKAST SODIUM	Teva-Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	TEV	1.2077	1.2077	YES	NO	NO
02355507	MONTELUKAST SODIUM	Teva-Montelukast 4mg Chew Tab	TEV	0.2758	0.2758	YES	YES	NO
02358611	MONTELUKAST SODIUM	Sandoz Montelukast (Off-Formulary Interchangeable) 4mg Gran Pk	SDZ	1.3440	N/A	YES	NO	NO
02247997	MONTELUKAST SODIUM	Singulair (Off-Formulary Interchangeable) 4mg Gran Pk	OCI	N/A	N/A	YES	NO	NO
02379236	MONTELUKAST SODIUM	Ach-Montelukast (Off-Formulary Interchangeable) 10mg Tab	ACH	1.7735	1.7735	YES	NO	NO
02374609	MONTELUKAST SODIUM	Apo-Montelukast (Off-Formulary Interchangeable) 10mg Tab	APX	1.7735	1.7735	YES	NO	NO
02401274	MONTELUKAST SODIUM	Auro-Montelukast (Off-Formulary Interchangeable) 10mg Tab	AUR	1.7735	1.7735	YES	NO	NO
02391422	MONTELUKAST SODIUM	Jamp-Montelukast (Off-Formulary Interchangeable) 10mg Tab	JPC	1.7735	1.7735	YES	NO	NO
02488183	MONTELUKAST SODIUM	M-Montelukast (Off-Formulary Interchangeable) 10mg Tab	MAT	1.7735	1.7735	YES	NO	NO
02399997	MONTELUKAST SODIUM	Mar-Montelukast (Off-Formulary Interchangeable) 10mg Tab	MAR	1.7735	1.7735	YES	NO	NO
02408643	MONTELUKAST SODIUM	Mint-Montelukast (Off-Formulary Interchangeable) 10mg Tab	MIN	1.7735	1.7735	YES	NO	NO
02379333	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 10mg Tab	SAI	1.7735	1.7735	YES	NO	NO
02382474	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 10mg Tab	SIV	1.7735	1.7735	YES	NO	NO
02489821	MONTELUKAST SODIUM	NRA-Montelukast (Off-Formulary Interchangeable) 10mg Tab	NRA	1.7735	1.7735	YES	NO	NO
02522136	MONTELUKAST SODIUM	Nat-Montelukast (Off-Formulary Interchangeable) 10mg Tab	NAT	1.7737	1.7737	YES	NO	NO
02373947	MONTELUKAST SODIUM	PMS-Montelukast FC (Off-Formulary Interchangeable) 10mg Tab	PMS	1.7735	1.7735	YES	NO	NO
02389517	MONTELUKAST SODIUM	Ran-Montelukast (Off-Formulary Interchangeable) 10mg Tab	RAN	1.7735	1.7735	YES	NO	NO
02328593	MONTELUKAST SODIUM	Sandoz Montelukast (Off-Formulary Interchangeable) 10mg Tab	SDZ	1.7735	1.7735	YES	NO	NO
02238217	MONTELUKAST SODIUM	Singulair (Off-Formulary Interchangeable) 10mg Tab	OCI	N/A	N/A	YES	NO	NO
02355523	MONTELUKAST SODIUM	Teva-Montelukast (Off-Formulary Interchangeable) 10mg Tab	TEV	1.7737	1.7737	YES	NO	NO
02352559	MYCOPHENOLATE MOFETIL	Apo-Mycophenolate 250mg Cap	APX	0.3712	0.3712	YES	NO	NO
02192748	MYCOPHENOLATE MOFETIL	CellCept 250mg Cap	HLR	2.2833	0.3712	YES	NO	NO
02386399	MYCOPHENOLATE MOFETIL	Jamp-Mycophenolate Capsules 250mg Cap	JPC	0.3712	0.3712	YES	NO	NO
02457369	MYCOPHENOLATE MOFETIL	Mycophenolate Mofetil 250mg Cap	SAI	0.3712	0.3712	YES	NO	NO
02383780	MYCOPHENOLATE MOFETIL	Mycophenolate Mofetil Capsules 250mg Cap	ACH	0.3712	0.3712	YES	NO	NO
02320630	MYCOPHENOLATE MOFETIL	Sandoz Mycophenolate Mofetil 250mg Cap	SDZ	0.3712	0.3712	YES	NO	NO
02364883	MYCOPHENOLATE MOFETIL	Teva-Mycophenolate 250mg Cap	TEV	0.3712	0.3712	YES	NO	NO
02242145	MYCOPHENOLATE MOFETIL	CellCept 200mg/mL Pd for Oral Susp-175mL Pk	HLR	358.0600	244.7025	YES	YES	NO
02522233	MYCOPHENOLATE MOFETIL	Mar-Mycophenolate Mofetil 200mg/mL Pd for Oral Susp-175mL Pk	MAR	244.7025	244.7025	YES	YES	NO
02378574	MYCOPHENOLATE MOFETIL	Ach-Mycophenolate 500mg Tab	ACH	0.7423	0.7423	YES	NO	NO
02352567	MYCOPHENOLATE MOFETIL	Apo-Mycophenolate 500mg Tab	APX	0.7423	0.7423	YES	NO	NO
02237484	MYCOPHENOLATE MOFETIL	CellCept 500mg Tab	HLR	4.5666	0.7423	YES	NO	NO
02380382	MYCOPHENOLATE MOFETIL	Jamp-Mycophenolate 500mg Tab	JPC	0.7423	0.7423	YES	NO	NO
02457377	MYCOPHENOLATE MOFETIL	Mycophenolate Mofetil 500mg Tab	SAI	0.7423	0.7423	YES	NO	NO
02313855	MYCOPHENOLATE MOFETIL	Sandoz Mycophenolate Mofetil 500mg Tab	SDZ	0.7423	0.7423	YES	NO	NO
02348675	MYCOPHENOLATE MOFETIL	Teva-Mycophenolate 500mg Tab	TEV	0.7423	0.7423	YES	NO	NO
02372746	MYCOPHENOLATE SODIUM	Apo-Mycophenolic Acid 360mg Ent Tab	APX	0.9988	0.9988	YES	NO	NO
02372738	MYCOPHENOLATE SODIUM	Apo-Mycophenolic Acid 180mg Ent Tab	APX	0.4994	0.4994	YES	NO	NO
02518511	MYCOPHENOLATE SODIUM	Jamp Mycophenolic Acid 360mg Ent Tab	JPC	0.9988	0.9988	YES	NO	NO
02518538	MYCOPHENOLATE SODIUM	Jamp Mycophenolic Acid 180mg Ent Tab	JPC	0.4994	0.4994	YES	NO	NO
02511673	MYCOPHENOLATE SODIUM	Mar-Mycophenolic Acid 180mg Ent Tab	MAR	0.4994	0.4994	YES	NO	NO
02511681	MYCOPHENOLATE SODIUM	Mar-Mycophenolic Acid 360mg Ent Tab	MAR	0.9988	0.9988	YES	NO	NO
02264579	MYCOPHENOLATE SODIUM	Myfortic 360mg Ent Tab	NOV	4.1710	0.9988	YES	NO	NO
02264560	MYCOPHENOLATE SODIUM	Myfortic 180mg Ent Tab	NOV	2.0855	0.4994	YES	NO	NO
02503786	OCTREOTIDE	Octreotide for Injectable Suspension 30mg Inj Kit Pk	TEV	1642.1400	1642.1400	YES	NO	NO
02239325	OCTREOTIDE	Sandostatin LAR 30mg Inj Kit Pk	NOV	2189.5200	1642.1400	YES	NO	NO
02239324	OCTREOTIDE	Sandostatin LAR 20mg Inj Kit Pk	NOV	1706.5800	1706.5800	NO	NO	NO
02239323	OCTREOTIDE	Sandostatin LAR 10mg Inj Kit Pk	NOV	1320.9300	1320.9300	NO	NO	NO
02248640	OCTREOTIDE	Octreotide Acetate Omega 100mcg/mL Inj Sol	OMG	5.0440	5.0440	YES	NO	NO
02248641	OCTREOTIDE	Octreotide Acetate Omega 500mcg/mL Inj Sol	OMG	23.7070	23.7070	YES	NO	NO
02560291	OCTREOTIDE	Octreotide Injection 500mcg/mL Inj Sol	STE	23.7070	23.7070	YES	NO	NO
02560240	OCTREOTIDE	Octreotide Injection 100mcg/mL Inj Sol	STE	5.0440	5.0440	YES	NO	NO
00839205	OCTREOTIDE	Sandostatin 100mcg/mL Inj Sol	NOV	10.0880	5.0440	YES	NO	NO
00839213	OCTREOTIDE	Sandostatin (Not a Benefit) 500mcg/mL Inj Sol	NOV	N/A	N/A	YES	NO	NO
02248639	OCTREOTIDE	Octreotide Acetate Omega 50mcg/mL Inj Sol - 1mL Amp Pk	OMG	4.0080	4.0080	YES	NO	NO
00839191	OCTREOTIDE	Sandostatin 50mcg/mL Inj Sol - 1mL Amp Pk	NOV	5.3440	4.0080	YES	NO	NO
02248642	OCTREOTIDE	Octreotide Acetate Omega 200mcg/mL Inj Sol - 5mL Vial Pk	OMG	48.5150	48.5150	YES	NO	NO
02560283	OCTREOTIDE	Octreotide Injection 200mcg/mL Inj Sol - 5mL Vial Pk	STE	48.5150	48.5150	YES	NO	NO
02049392	OCTREOTIDE	Sandostatin 200mcg/mL Inj Sol - 5mL Vial Pk	NOV	97.0300	48.5150	YES	NO	NO
02561018	OMALIZUMAB	Omlyclo 75mg/0.5mL Inj Sol-0.5mL Pref Pen Pk	CEI	168.7440	168.7440	NO	YES	NO
02553805	OMALIZUMAB	Omlyclo 75mg/0.5mL Inj Sol-0.5mL Pref Syr Pk	CEI	168.7440	168.7440	NO	YES	NO
02561026	OMALIZUMAB	Omlyclo 150mg/mL Inj Sol-1mL Pref Pen Pk	CEI	384.9600	384.9600	NO	YES	NO
02553813	OMALIZUMAB	Omlyclo 150mg/mL Inj Sol-1mL Pref Syr Pk	CEI	384.9600	384.9600	NO	YES	NO
02059770	PAMIDRONATE DISODIUM	Aredia (Off-Formulary Interchangeable) 6mg/mL Inj Sol-10mL Vial	NOV	N/A	N/A	YES	NO	NO
02059789	PAMIDRONATE DISODIUM	Aredia (Off-Formulary Interchangeable) 9mg/mL Inj Sol-10mL Vial	NOV	N/A	N/A	YES	NO	NO
02059762	PAMIDRONATE DISODIUM	Aredia (Off-Formulary Interchangeable) 3mg/mL Inj Sol-10mL Vial	NOV	N/A	N/A	YES	NO	NO
02249677	PAMIDRONATE DISODIUM	Pamidronate Disodium Omega (Off-Formulary Interchangeable) 6mg/mL Inj Sol-10mL Vial	OMG	176.7000	176.7000	YES	NO	NO
02249685	PAMIDRONATE DISODIUM	Pamidronate Disodium Omega (Off-Formulary Interchangeable) 9mg/mL Inj Sol-10mL Vial	OMG	260.3300	260.3300	YES	NO	NO
02249669	PAMIDRONATE DISODIUM	Pamidronate Disodium Omega (Off-Formulary Interchangeable) 3mg/mL Inj Sol-10mL Vial	OMG	86.7800	86.7800	YES	NO	NO
02246598	PAMIDRONATE DISODIUM	Pamidronate Disodium for Injection (Off-Formulary Interchangeable) 6mg/mL Inj Sol-10mL Vial	FKC	176.7000	176.7000	YES	NO	NO
02246599	PAMIDRONATE DISODIUM	Pamidronate Disodium for Injection (Off-Formulary Interchangeable) 9mg/mL Inj Sol-10mL Vial	FKC	260.3300	260.3300	YES	NO	NO
02246597	PAMIDRONATE DISODIUM	Pamidronate Disodium for Injection (Off-Formulary Interchangeable) 3mg/mL Inj Sol-10mL Vial	FKC	86.7800	86.7800	YES	NO	NO
02230684	PINAVERIUM BROMIDE	Dicetel (Off-Formulary Interchangeable) 100mg Tab	BGP	N/A	N/A	YES	NO	NO
01950592	PINAVERIUM BROMIDE	Dicetel (Off-Formulary Interchangeable) 50mg Tab	BGP	N/A	N/A	YES	NO	NO
02469677	PINAVERIUM BROMIDE	Pinaverium (Off-Formulary Interchangeable) 50mg Tab	AAP	0.3100	0.3100	YES	NO	NO
02469685	PINAVERIUM BROMIDE	Pinaverium (Off-Formulary Interchangeable) 100mg Tab	AAP	0.5405	0.5405	YES	NO	NO
02393751	PIRFENIDONE	Esbriet (Off-Formulary Interchangeable) 267mg Cap	INT	N/A	N/A	YES	NO	NO
02509938	PIRFENIDONE	Jamp Pirfenidone (Off-Formulary Interchangeable) 267mg Cap	JPC	6.7120	6.7120	YES	NO	NO
02488833	PIRFENIDONE	Sandoz Pirfenidone Capsules (Off-Formulary Interchangeable) 267mg Cap	SDZ	6.7120	6.7120	YES	NO	NO
02223775	QUINAGOLIDE HCL	Norprolac 0.15mg Tab	FEI	1.7294	1.7294	NO	YES	NO
02358840	RALOXIFENE HCL	Act Raloxifene 60mg Tab	TEV	0.5134	0.5134	YES	YES	NO
02279215	RALOXIFENE HCL	Apo-Raloxifene 60mg Tab	APX	0.5134	0.5134	YES	YES	NO
02239028	RALOXIFENE HCL	Evista 60mg Tab	LIL	2.3757	0.5134	YES	YES	NO
02540681	RALOXIFENE HCL	Jamp Raloxifene 60mg Tab	JPC	0.5134	0.5134	YES	YES	NO
02352583	RILUZOLE	Apo-Riluzole (Off-Formulary Interchangeable) 50mg Tab	APX	7.3630	7.3630	YES	NO	NO
02390299	RILUZOLE	Mylan-Riluzole (Off-Formulary Interchangeable) 50mg Tab	MYL	7.3630	7.3630	YES	NO	NO
02242763	RILUZOLE	Rilutek (Off-Formulary Interchangeable) 50mg Tab	SAC	10.5500	7.3630	YES	NO	NO
02493268	RISEDRONATE SODIUM	AA-Risedronate DR 35mg DR Tab	AAP	2.9663	2.9663	YES	NO	NO
02370417	RISEDRONATE SODIUM	Actonel DR 35mg DR Tab	WAR	11.8653	2.9663	YES	NO	NO
02316838	RISEDRONATE SODIUM	Actonel 150mg Tab	WAR	47.3370	11.1875	YES	NO	NO
02242518	RISEDRONATE SODIUM	Actonel (Not a Benefit) 5mg Tab	WAR	N/A	N/A	YES	NO	NO
02246896	RISEDRONATE SODIUM	Actonel (Not a Benefit) 35mg Tab	WAR	N/A	N/A	YES	NO	NO
02239146	RISEDRONATE SODIUM	Actonel (Not a Benefit) 30mg Tab	WAR	N/A	N/A	YES	NO	NO
02353687	RISEDRONATE SODIUM	Apo-Risedronate 35mg Tab	APX	1.6764	1.6764	YES	NO	NO
02377721	RISEDRONATE SODIUM	Apo-Risedronate 150mg Tab	APX	11.1875	11.1875	YES	NO	NO
02442760	RISEDRONATE SODIUM	Auro-Risedronate 150mg Tab	AUR	11.1875	11.1875	YES	NO	NO
02406306	RISEDRONATE SODIUM	Auro-Risedronate 35mg Tab	AUR	1.6764	1.6764	YES	NO	NO
02368552	RISEDRONATE SODIUM	Jamp-Risedronate 35mg Tab	JPC	1.6764	1.6764	YES	NO	NO
02424177	RISEDRONATE SODIUM	PMS-Risedronate 150mg Tab	PMS	11.1875	11.1875	YES	NO	NO
02302209	RISEDRONATE SODIUM	PMS-Risedronate 35mg Tab	PMS	1.6764	1.6764	YES	NO	NO
02319861	RISEDRONATE SODIUM	Ratio-Risedronate 35mg Tab	RPH	1.6764	1.6764	YES	NO	NO
02411407	RISEDRONATE SODIUM	Risedronate 35mg Tab	SIV	1.6764	1.6764	YES	NO	NO
02528460	RISEDRONATE SODIUM	Risedronate 150mg Tab	SAI	11.1875	11.1875	YES	NO	NO
02370255	RISEDRONATE SODIUM	Risedronate 35mg Tab	SAI	1.6764	1.6764	YES	NO	NO
02341077	RISEDRONATE SODIUM	Riva-Risedronate 35mg Tab	RIA	1.6764	1.6764	YES	NO	NO
02327295	RISEDRONATE SODIUM	Sandoz Risedronate 35mg Tab	SDZ	1.6764	1.6764	YES	NO	NO
02413809	RISEDRONATE SODIUM	Teva-Risedronate 150mg Tab	TEV	11.1875	11.1875	YES	NO	NO
02298376	RISEDRONATE SODIUM	Teva-Risedronate 5mg Tab	TEV	1.8445	1.8445	YES	NO	NO
02298384	RISEDRONATE SODIUM	Teva-Risedronate 30mg Tab	TEV	11.3807	11.3807	YES	NO	NO
02298392	RISEDRONATE SODIUM	Teva-Risedronate 35mg Tab	TEV	1.6764	1.6764	YES	NO	NO
02314053	ROPINIROLE	Ran-Ropinirole 1mg Tab	RAN	0.5762	0.5762	YES	NO	NO
02314037	ROPINIROLE	Ran-Ropinirole 0.25mg Tab	RAN	0.1441	0.1441	YES	NO	NO
02314088	ROPINIROLE	Ran-Ropinirole 5mg Tab	RAN	1.7450	1.7450	YES	NO	NO
02314061	ROPINIROLE	Ran-Ropinirole 2mg Tab	RAN	0.6338	0.6338	YES	NO	NO
02232569	ROPINIROLE	ReQuip (Not a Benefit) 5mg Tab	GSK	N/A	N/A	YES	NO	NO
02232568	ROPINIROLE	ReQuip (Not a Benefit) 2mg Tab	GSK	N/A	N/A	YES	NO	NO
02232565	ROPINIROLE	ReQuip (Not a Benefit) 0.25mg Tab	GSK	N/A	N/A	YES	NO	NO
02232567	ROPINIROLE	ReQuip (Not a Benefit) 1mg Tab	GSK	N/A	N/A	YES	NO	NO
02316846	ROPINIROLE	Teva-Ropinirole 0.25mg Tab	TEV	0.1441	0.1441	YES	NO	NO
02316862	ROPINIROLE	Teva-Ropinirole 2mg Tab	TEV	0.6338	0.6338	YES	NO	NO
02316870	ROPINIROLE	Teva-Ropinirole 5mg Tab	TEV	1.7450	1.7450	YES	NO	NO
02316854	ROPINIROLE	Teva-Ropinirole 1mg Tab	TEV	0.5762	0.5762	YES	NO	NO
02482207	SAPROPTERIN DIHYDROCHLORIDE	Kuvan (Off-Formulary Interchangeable) 100mg Pd for Sol (Sachet Pk)	BIM	N/A	N/A	YES	NO	NO
02482215	SAPROPTERIN DIHYDROCHLORIDE	Kuvan (Off-Formulary Interchangeable) 500mg Pd for Sol (Sachet Pk)	BIM	N/A	N/A	YES	NO	NO
02534533	SAPROPTERIN DIHYDROCHLORIDE	Reddy-Sapropterin (Off-Formulary Interchangeable) 100mg Pd for Sol (Sachet Pk)	DRR	24.7500	N/A	YES	NO	NO
02535610	SAPROPTERIN DIHYDROCHLORIDE	Reddy-Sapropterin (Off-Formulary Interchangeable) 500mg Pd for Sol (Sachet Pk)	DRR	123.7500	N/A	YES	NO	NO
02123312	SELEGILINE HCL	Eldepryl (Not a Benefit) 5mg Tab	BJH	N/A	N/A	YES	NO	NO
02230641	SELEGILINE HCL	Selegiline 5mg Tab	AAP	1.7072	1.7072	YES	NO	NO
02479826	SILDENAFIL	Accel-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	ACC	3.5350	3.5350	YES	NO	NO
02479796	SILDENAFIL	Accel-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	ACC	3.1850	3.1850	YES	NO	NO
02479818	SILDENAFIL	Accel-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	ACC	3.4000	3.4000	YES	NO	NO
02248202	SILDENAFIL	Apo-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	APX	8.8481	8.8481	YES	NO	NO
02248203	SILDENAFIL	Apo-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	APX	9.2006	9.2006	YES	NO	NO
02248201	SILDENAFIL	Apo-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	APX	8.2894	8.2894	YES	NO	NO
02418118	SILDENAFIL	Apo-Sildenafil R (Off-Formulary Interchangeable) 20mg Tab	APX	7.2940	7.2940	YES	NO	NO
02414368	SILDENAFIL	Auro-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	AUR	8.2894	8.2894	YES	NO	NO
02414384	SILDENAFIL	Auro-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	AUR	9.2000	9.2000	YES	NO	NO
02414376	SILDENAFIL	Auro-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	AUR	8.8475	8.8475	YES	NO	NO
02372088	SILDENAFIL	Co Sildenafil (Off-Formulary Interchangeable) 100mg Tab	COB	9.2016	9.2016	YES	NO	NO
02372061	SILDENAFIL	Co Sildenafil (Off-Formulary Interchangeable) 50mg Tab	COB	8.8481	8.8481	YES	NO	NO
02372053	SILDENAFIL	Co Sildenafil (Off-Formulary Interchangeable) 25mg Tab	COB	8.2894	8.2894	YES	NO	NO
02503506	SILDENAFIL	Jamp Sildenafil Tablets (Off-Formulary Interchangeable) 100mg Tab	JPC	9.2000	9.2000	YES	NO	NO
02405679	SILDENAFIL	Jamp-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	JPC	8.8475	8.8475	YES	NO	NO
02405687	SILDENAFIL	Jamp-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	JPC	9.2000	9.2000	YES	NO	NO
02405660	SILDENAFIL	Jamp-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	JPC	8.2900	8.2894	YES	NO	NO
02469669	SILDENAFIL	Jamp-Sildenafil R (Off-Formulary Interchangeable) 20mg Tab	JPC	7.2940	7.2940	YES	NO	NO
02430037	SILDENAFIL	M-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	MAT	9.2000	9.2000	YES	NO	NO
02402548	SILDENAFIL	Mar-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	MAR	9.2006	9.2006	YES	NO	NO
02393077	SILDENAFIL	Mint-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	MIN	8.8475	8.8475	YES	NO	NO
02393085	SILDENAFIL	Mint-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	MIN	9.2000	9.2000	YES	NO	NO
02393069	SILDENAFIL	Mint-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	MIN	8.2900	8.2894	YES	NO	NO
02476819	SILDENAFIL	NRA-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	NRA	9.2006	9.2006	YES	NO	NO
02412179	SILDENAFIL	PMS-Sildenafil R (Off-Formulary Interchangeable) 20mg Tab	PMS	7.2940	7.2940	YES	NO	NO
02505169	SILDENAFIL	PRZ-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	PRZ	8.8475	8.8475	YES	NO	NO
02468557	SILDENAFIL	PRZ-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	PRZ	9.2006	9.2006	YES	NO	NO
02505150	SILDENAFIL	PRZ-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	PRZ	8.2894	8.2894	YES	NO	NO
02279401	SILDENAFIL	Revatio (Off-Formulary Interchangeable) 20mg Tab	UJC	13.5314	7.2940	YES	NO	NO
02452413	SILDENAFIL	Riva-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	RIA	9.2006	9.2006	YES	NO	NO
02317559	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 25mg Tab	PMS	8.2894	8.2894	YES	NO	NO
02406152	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 50mg Tab	SAI	8.8475	8.8475	YES	NO	NO
02317583	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 100mg Tab	PMS	9.2006	9.2006	YES	NO	NO
02317575	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 50mg Tab	PMS	8.8481	8.8481	YES	NO	NO
02406160	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 100mg Tab	SAI	9.2006	9.2006	YES	NO	NO
02540770	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 25mg Tab	SAI	8.2894	8.2894	YES	NO	NO
02400693	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 25mg Tab	SIV	8.2900	8.2894	YES	NO	NO
02400707	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 50mg Tab	SIV	8.8481	8.8481	YES	NO	NO
02400715	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 100mg Tab	SIV	9.2006	9.2006	YES	NO	NO
02308738	SILDENAFIL	Teva-Sildenafil (Off-Formulary Interchangeable) 25mg Tab	TEV	8.2900	8.2894	YES	NO	NO
02308754	SILDENAFIL	Teva-Sildenafil (Off-Formulary Interchangeable) 100mg Tab	TEV	9.2006	9.2006	YES	NO	NO
02308746	SILDENAFIL	Teva-Sildenafil (Off-Formulary Interchangeable) 50mg Tab	TEV	8.8481	8.8481	YES	NO	NO
02319500	SILDENAFIL	Teva-Sildenafil R (Off-Formulary Interchangeable) 20mg Tab	TEV	7.2940	7.2940	YES	NO	NO
02239766	SILDENAFIL	Viagra (Off-Formulary Interchangeable) 25mg Tab	UJC	N/A	N/A	YES	NO	NO
02239767	SILDENAFIL	Viagra (Off-Formulary Interchangeable) 50mg Tab	UJC	N/A	N/A	YES	NO	NO
02239768	SILDENAFIL	Viagra (Off-Formulary Interchangeable) 100mg Tab	UJC	N/A	N/A	YES	NO	NO
02478501	SILODOSIN	Auro-Silodosin 4mg Cap	AUR	0.4742	0.4742	YES	YES	NO
02478528	SILODOSIN	Auro-Silodosin 8mg Cap	AUR	0.4742	0.4742	YES	YES	NO
02539519	SILODOSIN	Jamp Silodosin 4mg Cap	JPC	0.4742	0.4742	YES	YES	NO
02539527	SILODOSIN	Jamp Silodosin 8mg Cap	JPC	0.4742	0.4742	YES	YES	NO
02517779	SILODOSIN	PMS-Silodosin 4mg Cap	PMS	0.4742	0.4742	YES	YES	NO
02517787	SILODOSIN	PMS-Silodosin 8mg Cap	PMS	0.4742	0.4742	YES	YES	NO
02361663	SILODOSIN	Rapaflo (Not a Benefit) 4mg Cap	WAT	N/A	N/A	YES	NO	NO
02361671	SILODOSIN	Rapaflo (Not a Benefit) 8mg Cap	WAT	N/A	N/A	YES	NO	NO
02475448	SILODOSIN	Sandoz Silodosin 8mg Cap	SDZ	0.4742	0.4742	YES	YES	NO
02475421	SILODOSIN	Sandoz Silodosin 4mg Cap	SDZ	0.4742	0.4742	YES	YES	NO
02243237	SIROLIMUS	Rapamune 1mg/mL O/L	WAY	9.8695	9.8695	NO	YES	NO
02247111	SIROLIMUS	Rapamune 1mg Tab	WAY	9.8695	9.8695	NO	YES	NO
02439352	SOLIFENACIN SUCCINATE	Ach-Solifenacin Succinate 10mg Tab	ACH	0.3041	0.3041	YES	YES	NO
02439344	SOLIFENACIN SUCCINATE	Ach-Solifenacin Succinate 5mg Tab	ACH	0.3041	0.3041	YES	YES	NO
02422239	SOLIFENACIN SUCCINATE	Act Solifenacin 5mg Tab	ACV	0.3041	0.3041	YES	YES	NO
02422247	SOLIFENACIN SUCCINATE	Act Solifenacin 10mg Tab	ACV	0.3041	0.3041	YES	YES	NO
02423383	SOLIFENACIN SUCCINATE	Apo-Solifenacin 10mg Tab	APX	0.3041	0.3041	YES	YES	NO
02423375	SOLIFENACIN SUCCINATE	Apo-Solifenacin 5mg Tab	APX	0.3041	0.3041	YES	YES	NO
02446375	SOLIFENACIN SUCCINATE	Auro-Solifenacin 5mg Tab	AUR	0.3041	0.3041	YES	YES	NO
02446383	SOLIFENACIN SUCCINATE	Auro-Solifenacin 10mg Tab	AUR	0.3041	0.3041	YES	YES	NO
02428938	SOLIFENACIN SUCCINATE	Jamp Solifenacin Succinate 10mg Tab	JPC	0.3041	0.3041	YES	YES	NO
02428911	SOLIFENACIN SUCCINATE	Jamp Solifenacin Succinate 5mg Tab	JPC	0.3041	0.3041	YES	YES	NO
02424339	SOLIFENACIN SUCCINATE	Jamp-Solifenacin 5mg Tab	JPC	0.3041	0.3041	YES	YES	NO
02424347	SOLIFENACIN SUCCINATE	Jamp-Solifenacin 10mg Tab	JPC	0.3041	0.3041	YES	YES	NO
02529718	SOLIFENACIN SUCCINATE	M-Solifenacin Succinate 10mg Tab	MAT	0.3041	0.3041	YES	YES	NO
02529696	SOLIFENACIN SUCCINATE	M-Solifenacin Succinate 5mg Tab	MAT	0.3041	0.3041	YES	YES	NO
02417731	SOLIFENACIN SUCCINATE	PMS-Solifenacin 10mg Tab	PMS	0.3041	0.3041	YES	YES	NO
02417723	SOLIFENACIN SUCCINATE	PMS-Solifenacin 5mg Tab	PMS	0.3041	0.3041	YES	YES	NO
02493047	SOLIFENACIN SUCCINATE	PRZ-Solifenacin 10mg Tab	PRZ	0.3041	0.3041	YES	YES	NO
02493039	SOLIFENACIN SUCCINATE	PRZ-Solifenacin 5mg Tab	PRZ	0.3041	0.3041	YES	YES	NO
02437988	SOLIFENACIN SUCCINATE	Ran-Solifenacin 5mg Tab	RAN	0.3041	0.3041	YES	YES	NO
02437996	SOLIFENACIN SUCCINATE	Ran-Solifenacin 10mg Tab	RAN	0.3041	0.3041	YES	YES	NO
02399040	SOLIFENACIN SUCCINATE	Sandoz Solifenacin 10mg Tab	SDZ	0.3041	0.3041	YES	YES	NO
02399032	SOLIFENACIN SUCCINATE	Sandoz Solifenacin 5mg Tab	SDZ	0.3041	0.3041	YES	YES	NO
02458241	SOLIFENACIN SUCCINATE	Solifenacin 5mg Tab	SAI	0.3041	0.3041	YES	YES	NO
02458268	SOLIFENACIN SUCCINATE	Solifenacin 10mg Tab	SAI	0.3041	0.3041	YES	YES	NO
02448335	SOLIFENACIN SUCCINATE	Solifenacin Succinate Tablets 5mg Tab	MDI	0.3041	0.3041	YES	YES	NO
02448343	SOLIFENACIN SUCCINATE	Solifenacin Succinate Tablets 10mg Tab	MDI	0.3041	0.3041	YES	YES	NO
02397900	SOLIFENACIN SUCCINATE	Teva-Solifenacin 5mg Tab	TEV	0.3041	0.3041	YES	YES	NO
02397919	SOLIFENACIN SUCCINATE	Teva-Solifenacin 10mg Tab	TEV	0.3041	0.3041	YES	YES	NO
02277263	SOLIFENACIN SUCCINATE	Vesicare 5mg Tab	ASE	1.6892	0.3041	YES	YES	NO
02277271	SOLIFENACIN SUCCINATE	Vesicare 10mg Tab	ASE	1.6892	0.3041	YES	YES	NO
02423723	STANDARDIZED SHORT RAGWEED POLLEN ALLERGENIC EXTRACT	Ragwitek 12U SL Tab	ALK	5.1186	5.1186	NO	YES	NO
02532220	SUNITINIB MALATE	Auro-Sunitinib (Off-Formulary Interchangeable) 50mg Cap	AUR	221.4208	221.4208	YES	NO	NO
02532204	SUNITINIB MALATE	Auro-Sunitinib (Off-Formulary Interchangeable) 25mg Cap	AUR	110.7100	110.7100	YES	NO	NO
02532190	SUNITINIB MALATE	Auro-Sunitinib (Off-Formulary Interchangeable) 12.5mg Cap	AUR	55.3553	55.3553	YES	NO	NO
02552892	SUNITINIB MALATE	Nat-Sunitinib (Off-Formulary Interchangeable) 12.5mg Cap	NAT	55.3553	55.3553	YES	NO	NO
02539284	SUNITINIB MALATE	Nat-Sunitinib (Off-Formulary Interchangeable) 50mg Cap	NAT	221.4208	221.4208	YES	NO	NO
02552906	SUNITINIB MALATE	Nat-Sunitinib (Off-Formulary Interchangeable) 25mg Cap	NAT	110.7100	110.7100	YES	NO	NO
02532840	SUNITINIB MALATE	Sandoz Sunitinib (Off-Formulary Interchangeable) 12.5mg Cap	SDZ	55.3553	55.3553	YES	NO	NO
02532867	SUNITINIB MALATE	Sandoz Sunitinib (Off-Formulary Interchangeable) 25mg Cap	SDZ	110.7100	110.7100	YES	NO	NO
02532883	SUNITINIB MALATE	Sandoz Sunitinib (Off-Formulary Interchangeable) 50mg Cap	SDZ	221.4208	221.4208	YES	NO	NO
02280809	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 25mg Cap	PFI	132.7216	110.7100	YES	NO	NO
02280795	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 12.5mg Cap	PFI	66.3613	55.3553	YES	NO	NO
02280817	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 50mg Cap	PFI	265.4444	221.4208	YES	NO	NO
02524082	SUNITINIB MALATE	Taro-Sunitinib (Off-Formulary Interchangeable) 50mg Cap	TAR	221.4208	221.4208	YES	NO	NO
02524066	SUNITINIB MALATE	Taro-Sunitinib (Off-Formulary Interchangeable) 25mg Cap	TAR	110.7100	110.7100	YES	NO	NO
02524058	SUNITINIB MALATE	Taro-Sunitinib (Off-Formulary Interchangeable) 12.5mg Cap	TAR	55.3553	55.3553	YES	NO	NO
02526212	SUNITINIB MALATE	Teva-Sunitinib (Off-Formulary Interchangeable) 25mg Cap	TEV	110.7100	110.7100	YES	NO	NO
02526204	SUNITINIB MALATE	Teva-Sunitinib (Off-Formulary Interchangeable) 12.5mg Cap	TEV	55.3553	55.3553	YES	NO	NO
02526220	SUNITINIB MALATE	Teva-Sunitinib (Off-Formulary Interchangeable) 50mg Cap	TEV	221.4208	221.4208	YES	NO	NO
02176009	TACROLIMUS	Prograf 5mg/mL Amp	ASE	128.2350	128.2350	NO	YES	NO
02456095	TACROLIMUS	Ach-Tacrolimus 1mg Cap	ACH	1.2978	1.2978	YES	YES	NO
02456109	TACROLIMUS	Ach-Tacrolimus 5mg Cap	ACH	6.4993	6.4993	YES	YES	NO
02454068	TACROLIMUS	Ach-Tacrolimus 0.5mg Cap	ACH	1.0146	1.0146	YES	YES	NO
02175983	TACROLIMUS	Prograf 5mg Cap	ASE	12.9986	6.4993	YES	YES	NO
02175991	TACROLIMUS	Prograf 1mg Cap	ASE	2.5956	1.2978	YES	YES	NO
02243144	TACROLIMUS	Prograf 0.5mg Cap	ASE	2.0291	1.0146	YES	YES	NO
02416816	TACROLIMUS	Sandoz Tacrolimus 0.5mg Cap	SDZ	1.0146	1.0146	YES	YES	NO
02416824	TACROLIMUS	Sandoz Tacrolimus 1mg Cap	SDZ	1.2978	1.2978	YES	YES	NO
02416832	TACROLIMUS	Sandoz Tacrolimus 5mg Cap	SDZ	6.4993	6.4993	YES	YES	NO
02296489	TACROLIMUS	Advagraf 5mg ER Cap	ASE	14.2205	7.8213	YES	YES	NO
02296462	TACROLIMUS	Advagraf 0.5mg ER Cap	ASE	2.2199	1.6649	YES	YES	NO
02296470	TACROLIMUS	Advagraf 1mg ER Cap	ASE	2.8396	1.5618	YES	YES	NO
02331667	TACROLIMUS	Advagraf 3mg ER Cap	ASE	8.5188	4.6853	YES	YES	NO
02528606	TACROLIMUS	Sandoz Tacrolimus XR 1mg ER Cap	SDZ	1.5618	1.5618	YES	YES	NO
02528622	TACROLIMUS	Sandoz Tacrolimus XR 3mg ER Cap	SDZ	4.6853	4.6853	YES	YES	NO
02528630	TACROLIMUS	Sandoz Tacrolimus XR 5mg ER Cap	SDZ	7.8213	7.8213	YES	YES	NO
02528592	TACROLIMUS	Sandoz Tacrolimus XR 0.5mg ER Cap	SDZ	1.6649	1.6649	YES	YES	NO
02485893	TACROLIMUS	Envarsus PA 4mg ER Tab	EVL	10.9719	10.9719	NO	YES	NO
02485877	TACROLIMUS	Envarsus PA 0.75mg ER Tab	EVL	2.0999	2.0999	NO	YES	NO
02485885	TACROLIMUS	Envarsus PA 1mg ER Tab	EVL	2.7430	2.7430	NO	YES	NO
02244149	TACROLIMUS	Protopic 0.03% Oint	LEO	3.4301	3.4301	NO	YES	NO
02244148	TACROLIMUS	Protopic 0.1% Oint	LEO	3.6691	3.6691	NO	YES	NO
02362406	TAMSULOSIN HCL	Apo-Tamsulosin CR Tab 0.4mg	APX	0.1500	0.1500	YES	NO	YES
02545179	TAMSULOSIN HCL	Auro-Tamsulosin CR Tab 0.4mg	AUR	0.1500	0.1500	YES	NO	NO
02270102	TAMSULOSIN HCL	Flomax CR Tab 0.4mg	BOE	0.6700	0.1500	YES	NO	YES
02340208	TAMSULOSIN HCL	Sandoz Tamsulosin CR Tab 0.4mg	SDZ	0.1500	0.1500	YES	NO	YES
02429667	TAMSULOSIN HCL	Tamsulosin CR Tab 0.4mg	SIV	0.1500	0.1500	YES	NO	YES
02427117	TAMSULOSIN HCL	Tamsulosin CR Tab 0.4mg	SAI	0.1500	0.1500	YES	NO	YES
02368242	TAMSULOSIN HCL	Teva-Tamsulosin CR Tab 0.4mg	TEV	0.1500	0.1500	YES	NO	YES
02238123	TAMSULOSIN HCL	Flomax (Not a Benefit) 0.4mg ER Cap	BOE	N/A	N/A	YES	NO	YES
02352419	TAMSULOSIN HCL	Jamp Tamsulosin 0.4mg ER Cap	JPC	0.4750	0.4750	YES	NO	YES
02319217	TAMSULOSIN HCL	Sandoz Tamsulosin 0.4mg ER Cap	SDZ	0.4750	0.4750	YES	NO	YES
02502933	TERIFLUNOMIDE	Ach-Teriflunomide 14mg Tab	ACH	14.9300	14.9300	YES	YES	NO
02500639	TERIFLUNOMIDE	Apo-Teriflunomide 14mg Tab	APX	14.9300	14.9300	YES	YES	NO
02416328	TERIFLUNOMIDE	Aubagio (Not a Benefit) 14mg Tab	SAG	N/A	N/A	YES	NO	NO
02504170	TERIFLUNOMIDE	Jamp Teriflunomide 14mg Tab	JPC	14.9300	14.9300	YES	YES	NO
02523833	TERIFLUNOMIDE	M-Teriflunomide 14mg Tab	MAT	14.9300	14.9300	YES	YES	NO
02500469	TERIFLUNOMIDE	Mar-Teriflunomide 14mg Tab	MAR	14.9300	14.9300	YES	YES	NO
02500310	TERIFLUNOMIDE	Nat-Teriflunomide 14mg Tab	NAT	14.9300	14.9300	YES	YES	NO
02500434	TERIFLUNOMIDE	PMS-Teriflunomide 14mg Tab	PMS	14.9300	14.9300	YES	YES	NO
02505843	TERIFLUNOMIDE	Sandoz Teriflunomide 14mg Tab	SDZ	14.9300	14.9300	YES	YES	NO
02501090	TERIFLUNOMIDE	Teva-Teriflunomide 14mg Tab	TEV	14.9300	14.9300	YES	YES	NO
02407590	TETRABENAZINE	Apo-Tetrabenazine (Off-Formulary Interchangeable) 25mg Tab	APX	4.8551	4.8551	YES	NO	NO
02199270	TETRABENAZINE	Nitoman (Off-Formulary Interchangeable) 25mg Tab	VAL	N/A	N/A	YES	NO	NO
02402424	TETRABENAZINE	PMS-Tetrabenazine (Off-Formulary Interchangeable) 25mg Tab	PMS	4.8551	4.8551	YES	NO	NO
02410338	TETRABENAZINE	Tetrabenazine Tablets (Off-Formulary Interchangeable) 25mg Tab	STE	4.8551	4.8551	YES	NO	NO
02162776	TICLOPIDINE HCL	Ticlid (Not a Benefit) 250mg Tab	HLR	N/A	N/A	YES	NO	NO
02237701	TICLOPIDINE HCL	Ticlopidine 250mg Tab	AAP	1.0679	1.0679	YES	YES	NO
02552469	TOCILIZUMAB	Tyenne 200mg/10mL Inj Sol-10mL Vial Pk	FKC	311.9025	311.9025	NO	YES	NO
02562030	TOCILIZUMAB	Avtozma 200mg/10mL Inj Sol-10mL Vial Pk (Preservative-Free)	CEI	311.9025	311.9025	NO	YES	NO
02552477	TOCILIZUMAB	Tyenne 400mg/20mL Inj Sol-20mL Vial Pk	FKC	623.8050	623.8050	NO	YES	NO
02562049	TOCILIZUMAB	Avtozma 400mg/20mL Inj Sol-20mL Vial Pk (Preservative-Free)	CEI	623.8050	623.8050	NO	YES	NO
02552450	TOCILIZUMAB	Tyenne 80mg/4mL Inj Sol-4mL Vial Pk	FKC	124.7610	124.7610	NO	YES	NO
02562022	TOCILIZUMAB	Avtozma 80mg/4mL Inj Sol-4mL Vial Pk (Preservative-Free)	CEI	124.7610	124.7610	NO	YES	NO
02552485	TOCILIZUMAB	Tyenne 162mg/0.9mL Inj Sol-Pref Autoinj	FKC	242.2875	242.2875	NO	YES	NO
02562065	TOCILIZUMAB	Avtozma 162mg/0.9mL Inj Sol-Pref Autoinj (Preservative-Free)	CEI	242.2875	242.2875	NO	YES	NO
02552493	TOCILIZUMAB	Tyenne 162mg/0.9mL Inj Sol-Pref Syr	FKC	244.9525	244.9525	NO	YES	NO
02562057	TOCILIZUMAB	Avtozma 162mg/0.9mL Inj Sol-Pref Syr (Preservative-Free)	CEI	244.9525	244.9525	NO	YES	NO
02530007	TOFACITINIB	Auro-Tofacitinib 5mg Tab	AUR	5.9897	5.9897	YES	YES	NO
02530015	TOFACITINIB	Auro-Tofacitinib 10mg Tab	AUR	10.5859	10.5859	YES	YES	NO
02522896	TOFACITINIB	Jamp Tofacitinib 5mg Tab	JPC	5.9897	5.9897	YES	YES	NO
02522799	TOFACITINIB	PMS-Tofacitinib 5mg Tab	PMS	5.9897	5.9897	YES	YES	NO
02551705	TOFACITINIB	Sandoz Tofacitinib 10mg Tab	SDZ	10.5859	10.5859	YES	YES	NO
02551691	TOFACITINIB	Sandoz Tofacitinib 5mg Tab	SDZ	5.9897	5.9897	YES	YES	NO
02511312	TOFACITINIB	Taro-Tofacitinib 10mg Tab	TAR	10.5859	10.5859	YES	YES	NO
02511304	TOFACITINIB	Taro-Tofacitinib 5mg Tab	TAR	5.9897	5.9897	YES	YES	NO
02423898	TOFACITINIB	Xeljanz 5mg Tab	PFI	24.7733	5.9897	YES	YES	NO
02480786	TOFACITINIB	Xeljanz 10mg Tab	PFI	43.7833	10.5859	YES	YES	NO
02553988	TOFACITINIB CITRATE	Taro-Tofacitinib XR 11mg ER Tab	TAR	27.2507	27.2507	YES	YES	NO
02470608	TOFACITINIB CITRATE	Xeljanz XR 11mg ER Tab	PFI	49.5467	27.2507	YES	YES	NO
02244612	TOLTERODINE L-TARTRATE	Detrol LA 2mg SR Cap	UJC	2.3698	0.9822	YES	YES	NO
02244613	TOLTERODINE L-TARTRATE	Detrol LA 4mg SR Cap	UJC	2.3698	0.9822	YES	YES	NO
02413140	TOLTERODINE L-TARTRATE	Sandoz Tolterodine LA 2mg SR Cap	SDZ	0.9822	0.9822	YES	YES	NO
02413159	TOLTERODINE L-TARTRATE	Sandoz Tolterodine LA 4mg SR Cap	SDZ	0.9822	0.9822	YES	YES	NO
02412209	TOLTERODINE L-TARTRATE	Teva-Tolterodine LA 4mg SR Cap	TEV	0.9822	0.9822	YES	YES	NO
02412195	TOLTERODINE L-TARTRATE	Teva-Tolterodine LA 2mg SR Cap	TEV	0.9822	0.9822	YES	YES	NO
02239064	TOLTERODINE L-TARTRATE	Detrol 1mg Tab	UJC	1.1847	0.4910	YES	YES	NO
02239065	TOLTERODINE L-TARTRATE	Detrol 2mg Tab	UJC	1.1847	0.4910	YES	YES	NO
02496844	TOLTERODINE L-TARTRATE	Jamp Tolterodine 2mg Tab	JPC	0.4910	0.4910	YES	YES	NO
02496836	TOLTERODINE L-TARTRATE	Jamp Tolterodine 1mg Tab	JPC	0.4910	0.4910	YES	YES	NO
02423308	TOLTERODINE L-TARTRATE	Mint-Tolterodine 1mg Tab	MIN	0.4910	0.4910	YES	YES	NO
02423316	TOLTERODINE L-TARTRATE	Mint-Tolterodine 2mg Tab	MIN	0.4910	0.4910	YES	YES	NO
02520036	TRETINOIN	Jamp Tretinoin (Off-Formulary Interchangeable) 10mg Cap	JPC	13.9284	13.9284	YES	NO	NO
02145839	TRETINOIN	Vesanoid (Off-Formulary Interchangeable) 10mg Cap	HLR	N/A	N/A	YES	NO	NO
02506661	TROSPIUM CHLORIDE	Jamp Trospium 20mg Tab	JPC	0.4072	0.4072	YES	YES	NO
02488353	TROSPIUM CHLORIDE	Mar-Trospium 20mg Tab	MAR	0.4072	0.4072	YES	YES	NO
02275066	TROSPIUM CHLORIDE	Trosec (Not a Benefit) 20mg Tab	SUO	N/A	N/A	YES	NO	NO
02495155	UPADACITINIB	Rinvoq 15mg ER Tab	ABV	51.6810	51.6810	NO	YES	NO
02520893	UPADACITINIB	Rinvoq 30mg ER Tab	ABV	80.0384	80.0384	NO	YES	NO
02539721	UPADACITINIB	Rinvoq 45mg ER Tab	ABV	105.8824	105.8824	NO	YES	NO
02505363	URSODIOL	AG-Ursodiol 250mg Tab	ANG	0.3818	0.3818	YES	YES	NO
02505371	URSODIOL	AG-Ursodiol 500mg Tab	ANG	0.7242	0.7242	YES	YES	NO
02426900	URSODIOL	GLN-Ursodiol 250mg Tab	GLP	0.3818	0.3818	YES	YES	NO
02426919	URSODIOL	GLN-Ursodiol 500mg Tab	GLP	0.7242	0.7242	YES	YES	NO
02472406	URSODIOL	Jamp-Ursodiol 500mg Tab	JPC	0.7242	0.7242	YES	YES	NO
02472392	URSODIOL	Jamp-Ursodiol 250mg Tab	JPC	0.3818	0.3818	YES	YES	NO
02544024	URSODIOL	NRA-Ursodiol 500mg Tab	NRA	0.7242	0.7242	YES	YES	NO
02544032	URSODIOL	NRA-Ursodiol 250mg Tab	NRA	0.3818	0.3818	YES	YES	NO
02273497	URSODIOL	PMS-Ursodiol C 250mg Tab	PMS	0.3818	0.3818	YES	YES	NO
02273500	URSODIOL	PMS-Ursodiol C 500mg Tab	PMS	0.7242	0.7242	YES	YES	NO
02238984	URSODIOL	Urso (Not a Benefit) 250mg Tab	BFI	N/A	N/A	YES	NO	NO
02245894	URSODIOL	Urso DS 500mg Tab	BFI	3.1751	0.7242	YES	YES	NO
02515539	URSODIOL	Ursodiol C 500mg Tab	SAI	0.7242	0.7242	YES	YES	NO
02515520	URSODIOL	Ursodiol C 250mg Tab	SAI	0.3818	0.3818	YES	YES	NO
02553317	USTEKINUMAB	Wezlana 45mg/0.5mL Inj Sol-0.5mL Pref Autoinj (Preservative-Free)	AMG	2755.8840	2755.8840	NO	YES	NO
02543036	USTEKINUMAB	Jamteki 45mg/0.5mL Inj Sol-0.5mL Pref Syr Pk	JPC	2755.8840	2755.8840	NO	YES	NO
02544180	USTEKINUMAB	Wezlana 45mg/0.5mL Inj Sol-0.5mL Pref Syr Pk	AMG	2755.8840	2755.8840	NO	YES	NO
02550245	USTEKINUMAB	Steqeyma 45mg/0.5mL Inj Sol-0.5mL Pref Syr Pk (Preservative-Free)	CEH	2755.8840	2755.8840	NO	YES	NO
02554283	USTEKINUMAB	Otulfi 45mg/0.5mL Inj Sol-0.5mL Pref Syr Pk (Preservative-Free)	FKC	2755.8840	2755.8840	NO	YES	NO
02562081	USTEKINUMAB	Yesintek 45mg/0.5mL Inj Sol-0.5mL Pref Syr Pk (Preservative-Free)	BCL	2755.8840	2755.8840	NO	YES	NO
02544202	USTEKINUMAB	Wezlana 45mg/0.5mL Inj Sol-0.5mL Vial Pk	AMG	2755.8840	2755.8840	NO	YES	NO
09858364	USTEKINUMAB	Jamteki 45mg/0.5mL Inj Sol-0.5mL Vial Pk (Preservative-Free)	JPC	2755.8840	2755.8840	NO	YES	NO
02558270	USTEKINUMAB	Steqeyma 45mg/0.5mL Inj Sol-0.5mL Vial Pk (Preservative-Free)	CEH	2755.8840	2755.8840	NO	YES	NO
02550253	USTEKINUMAB	Steqeyma 90mg/1.0mL Inj Sol-1.0mL Pref Syr Pk (Preservative-Free)	CEH	2755.8840	2755.8840	NO	YES	NO
02554291	USTEKINUMAB	Otulfi 90mg/mL Inj Sol-1.0mL Pref Syr Pk (Preservative-Free)	FKC	2755.8840	2755.8840	NO	YES	NO
02562103	USTEKINUMAB	Yesintek 90mg/1.0mL Inj Sol-1.0mL Pref Syr Pk (Preservative-Free)	BCL	2755.8840	2755.8840	NO	YES	NO
02553309	USTEKINUMAB	Wezlana 90mg/mL Inj Sol-1mL Pref Autoinj (Preservative-Free)	AMG	2755.8840	2755.8840	NO	YES	NO
02543044	USTEKINUMAB	Jamteki 90mg/mL Inj Sol-1mL Pref Syr Pk	JPC	2755.8840	2755.8840	NO	YES	NO
02544199	USTEKINUMAB	Wezlana 90mg/mL Inj Sol-1mL Pref Syr Pk	AMG	2755.8840	2755.8840	NO	YES	NO
02544210	USTEKINUMAB	Wezlana I.V. 130mg/26mL Inj Sol-26mL Vial Pk	AMG	1248.0000	1248.0000	NO	YES	NO
02553120	USTEKINUMAB	Jamteki I.V. 5mg/mL Inj Sol-26mL Vial Pk (Preservative-Free)	JPC	1248.0000	1248.0000	NO	YES	NO
02550261	USTEKINUMAB	Steqeyma I.V. 5mg/mL Inj Sol-26mL Vial Pk (Preservative-Free)	CEH	1248.0000	1248.0000	NO	YES	NO
02562111	USTEKINUMAB	Yesintek I.V. 130mg/26mL Inj Sol-26mL Vial Pk (Preservative-Free)	BCL	1248.0000	1248.0000	NO	YES	NO
02554305	USTEKINUMAB	Otulfi 5mg/mL Inj Sol-Vial Pk (Preservative-Free)	FKC	1248.0000	1248.0000	NO	YES	NO
02419882	VARENICLINE TARTRATE	Apo-Varenicline 0.5mg Tab	APX	0.4618	0.4618	YES	YES	NO
02419890	VARENICLINE TARTRATE	Apo-Varenicline 1.0mg Tab	APX	0.4618	0.4618	YES	YES	NO
02554445	VARENICLINE TARTRATE	Auro-Varenicline 0.5mg Tab	AUR	0.4618	0.4618	YES	YES	NO
02554453	VARENICLINE TARTRATE	Auro-Varenicline 1.0mg Tab	AUR	0.4618	0.4618	YES	YES	NO
02291185	VARENICLINE TARTRATE	Champix (Not a Benefit) 1.0mg Tab	PFI	N/A	N/A	YES	NO	NO
02291177	VARENICLINE TARTRATE	Champix (Not a Benefit) 0.5mg Tab	PFI	N/A	N/A	YES	NO	NO
02546949	VARENICLINE TARTRATE	Mint-Varenicline 0.5mg Tab	MIN	0.4618	0.4618	YES	YES	NO
02546957	VARENICLINE TARTRATE	Mint-Varenicline 1.0mg Tab	MIN	0.4618	0.4618	YES	YES	NO
02542951	VARENICLINE TARTRATE	NRA-Varenicline 0.5mg Tab	NRA	0.4618	0.4618	YES	YES	NO
02542978	VARENICLINE TARTRATE	NRA-Varenicline 1.0mg Tab	NRA	0.4618	0.4618	YES	YES	NO
02426226	VARENICLINE TARTRATE	Teva-Varenicline 0.5mg Tab	TEV	0.4618	0.4618	YES	YES	NO
02426234	VARENICLINE TARTRATE	Teva-Varenicline 1.0mg Tab	TEV	0.4618	0.4618	YES	YES	NO
02559900	VARENICLINE TARTRATE	ZDS-Varenicline 1.0mg Tab	ZDS	0.4618	0.4618	YES	YES	NO
02559897	VARENICLINE TARTRATE	ZDS-Varenicline 0.5mg Tab	ZDS	0.4618	0.4618	YES	YES	NO
02435675	VARENICLINE TARTRATE	Apo-Varenicline 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	APX	24.3853	24.3853	YES	YES	NO
09857519	VARENICLINE TARTRATE	Champix (Not a Benefit) 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	PFI	N/A	N/A	YES	NO	NO
02546965	VARENICLINE TARTRATE	Mint-Varenicline 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	MIN	24.3853	24.3853	YES	YES	NO
02542986	VARENICLINE TARTRATE	NRA-Varenicline 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	NRA	24.3853	24.3853	YES	YES	NO
09857631	VARENICLINE TARTRATE	Teva-Varenicline 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	TEV	24.3853	24.3853	YES	YES	YES
02269198	ZOLEDRONIC ACID	Aclasta 5mg/100mL Inj Sol-100mL Pk (Preservative-Free)	SDZ	899.7300	391.6110	YES	YES	NO
02422433	ZOLEDRONIC ACID	Zoledronic Acid Injection 5mg/100mL Inj Sol-100mL Pk (Preservative-Free)	DRR	391.6110	391.6110	YES	YES	NO
02482525	ZOLEDRONIC ACID	Jamp-Zoledronic Acid (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	JPC	415.5600	415.5600	YES	NO	NO
02415186	ZOLEDRONIC ACID	Taro-Zoledronic Acid Concentrate (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	TAR	415.5600	415.5600	YES	NO	NO
02413701	ZOLEDRONIC ACID	Zoledronic Acid for Inj. Concentrate (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	OMG	415.0000	415.0000	YES	NO	NO
02422425	ZOLEDRONIC ACID	Zoledronic Acid for Inj. Concentrate (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	DRR	415.5600	415.5600	YES	NO	NO
02472805	ZOLEDRONIC ACID	Zoledronic Acid for Injection (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	MAR	415.5600	415.5600	YES	NO	NO
02407639	ZOLEDRONIC ACID	Zoledronic Acid for Injection (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	TEV	415.5600	415.5600	YES	NO	NO
02444739	ZOLEDRONIC ACID	Zoledronic Acid for Injection (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	MDI	415.5600	415.5600	YES	NO	NO
02434458	ZOLEDRONIC ACID	Zoledronic Acid for Injection (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	FKC	415.5600	415.5600	YES	NO	NO
02401606	ZOLEDRONIC ACID	Zoledronic Acid-Z (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	SDZ	415.5600	415.5600	YES	NO	NO
02248296	ZOLEDRONIC ACID	Zometa Concentrate (Off-Formulary Interchangeable) 4mg/5mL Inj Sol-5mL Pk (Preservative-Free)	NOV	N/A	N/A	YES	NO	NO

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