| 02244266 | CASPOFUNGIN | Cancidas (Off-Formulary Interchangeable) 70mg/Vial Inj Pd-Vial Pk | FRS | N/A | N/A | YES | NO | NO |
| 02244265 | CASPOFUNGIN ACETATE | Cancidas (Off-Formulary Interchangeable) 50mg/Vial Inj-Vial Pk | FRS | N/A | N/A | YES | NO | NO |
| 00782742 | CYCLOBENZAPRINE HCL | Flexeril (Not a Benefit) 10mg Tab | FRS | N/A | N/A | YES | NO | YES |
| 00248843 | PENICILLIN V (POTASSIUM) | PVF-K 500 (Not a Benefit) 300mg Tab | FRS | N/A | N/A | YES | NO | NO |
| 02240520 | RIZATRIPTAN | Maxalt (Off-Formulary Interchangeable) 5mg Tab | FRS | N/A | N/A | YES | NO | NO |
| 00432369 | SULINDAC | Clinoril (Not a Benefit) 200mg Tab | FRS | N/A | N/A | YES | NO | YES |
| 00456888 | SULINDAC | Clinoril (Not a Benefit) 150mg Tab | FRS | N/A | N/A | YES | NO | YES |
| 00495611 | TIMOLOL MALEATE | Blocadren (Not a Benefit) 20mg Tab | FRS | N/A | N/A | YES | NO | NO |
| 00353922 | TIMOLOL MALEATE | Blocadren (Not a Benefit) 10mg Tab | FRS | N/A | N/A | YES | NO | NO |
| 00353914 | TIMOLOL MALEATE | Blocadren (Not a Benefit) 5mg Tab | FRS | N/A | N/A | YES | NO | NO |