| 02371065 | ABIRATERONE ACETATE | Zytiga (Off-Formulary Interchangeable) 250mg Tab | JAN | 31.4150 | 26.0313 | YES | NO | NO |
| 02457113 | ABIRATERONE ACETATE | Zytiga (Off-Formulary Interchangeable) 500mg Tab | JAN | 62.8300 | 52.0625 | YES | NO | NO |
| 02163934 | ACETAMINOPHEN & CAFFEINE & CODEINE PHOSPHATE | Tylenol with Codeine No. 2 (Not a Benefit) 300mg & 15mg & 15mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02163926 | ACETAMINOPHEN & CAFFEINE & CODEINE PHOSPHATE | Tylenol with Codeine No. 3 (Not a Benefit) 300mg & 15mg & 30mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02163942 | ACETAMINOPHEN & CODEINE PHOSPHATE | Tylenol With Codeine Elixir (Not a Benefit) 160mg & 8mg/5mL O/L | JAN | N/A | N/A | YES | NO | YES |
| 02163918 | ACETAMINOPHEN & CODEINE PHOSPHATE | Tylenol with Codeine No. 4 (Not a Benefit) 300mg & 60mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02244981 | BOSENTAN MONOHYDRATE | Tracleer (Off-Formulary Interchangeable) 62.5mg Tab | JAN | 78.4500 | 32.0893 | YES | NO | NO |
| 02244982 | BOSENTAN MONOHYDRATE | Tracleer (Off-Formulary Interchangeable) 125mg Tab | JAN | 78.4500 | 32.0893 | YES | NO | NO |
| 02425491 | CANAGLIFLOZIN | Invokana 300mg Tab | JAN | 2.8910 | 2.8910 | NO | NO | YES |
| 02425483 | CANAGLIFLOZIN | Invokana 100mg Tab | JAN | 2.8910 | 2.8910 | NO | NO | YES |
| 02369753 | DARUNAVIR | Prezista 150mg Tab | JAN | 4.0080 | 4.0080 | NO | NO | YES |
| 02393050 | DARUNAVIR | Prezista 800mg Tab | JAN | 23.3180 | 5.8295 | YES | NO | YES |
| 02338432 | DARUNAVIR | Prezista 75mg Tab | JAN | 1.8930 | 1.8930 | NO | NO | YES |
| 02324024 | DARUNAVIR | Prezista 600mg Tab | JAN | 17.7030 | 4.2970 | YES | NO | YES |
| 02426501 | DARUNAVIR & COBICISTAT | Prezcobix 800mg & 150mg Tab | JAN | 25.1870 | 25.1870 | NO | NO | YES |
| 00855820 | DOMPERIDONE MALEATE | Motilium (Not a Benefit) 10mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 02231587 | EPOETIN ALFA | Eprex 10,000IU/mL Pref Syr - 1mL Pk | JAN | 142.5000 | 142.5000 | NO | YES | NO |
| 02240722 | EPOETIN ALFA | Eprex 40,000IU/mL Pref Syr - 1mL Pk | JAN | 486.7900 | 486.7900 | NO | YES | NO |
| 02243239 | EPOETIN ALFA | Eprex 20,000IU/0.5mL Pref Syr-0.5mL Pk | JAN | 325.0900 | 325.0900 | NO | YES | NO |
| 02375931 | ETRAVIRINE | Intelence 200mg Tab | JAN | 12.6195 | 12.6195 | NO | NO | YES |
| 02306778 | ETRAVIRINE | Intelence 100mg Tab | JAN | 6.5710 | 6.5710 | NO | NO | YES |
| 02275848 | FENTANYL TRANSDERMAL SYSTEM | Duragesic (Off-Formulary Interchangeable) 75mcg/hr Trans Patch | JAN | N/A | N/A | YES | NO | YES |
| 02275821 | FENTANYL TRANSDERMAL SYSTEM | Duragesic (Not a Benefit) 50mcg/hr Trans Patch | JAN | N/A | N/A | YES | NO | YES |
| 02275813 | FENTANYL TRANSDERMAL SYSTEM | Duragesic (Not a Benefit) 25mcg/hr Trans Patch | JAN | N/A | N/A | YES | NO | YES |
| 02275856 | FENTANYL TRANSDERMAL SYSTEM | Duragesic (Off-Formulary Interchangeable) 100mcg/hr Trans Patch | JAN | N/A | N/A | YES | NO | YES |
| 02266725 | GALANTAMINE HYDROBROMIDE | Reminyl ER (Not a Benefit) 16mg ER Cap | JAN | N/A | N/A | YES | NO | NO |
| 02266733 | GALANTAMINE HYDROBROMIDE | Reminyl ER (Not a Benefit) 24mg ER Cap | JAN | N/A | N/A | YES | NO | NO |
| 02266717 | GALANTAMINE HYDROBROMIDE | Reminyl ER (Not a Benefit) 8mg ER Cap | JAN | N/A | N/A | YES | NO | NO |
| 02047454 | ITRACONAZOLE | Sporanox 100mg Cap | JAN | 5.9810 | 3.9270 | YES | NO | NO |
| 02231347 | ITRACONAZOLE | Sporanox 10mg/mL Oral Sol | JAN | 1.1164 | 0.4111 | YES | YES | NO |
| 00703974 | KETOCONAZOLE | Nizoral (Not a Benefit) 2% Cr | JAN | N/A | N/A | YES | NO | YES |
| 00633836 | KETOCONAZOLE | Nizoral (Not a Benefit) 200mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02236842 | LEVOFLOXACIN | Levaquin (Not a Benefit) 500mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 02246804 | LEVOFLOXACIN | Levaquin (Off-Formulary Interchangeable) 750mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 02236841 | LEVOFLOXACIN | Levaquin (Not a Benefit) 250mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 00860743 | LOPERAMIDE HCL | Imodium (Not a Benefit) 2mg Caplet | JAN | N/A | N/A | YES | NO | NO |
| 00556734 | MEBENDAZOLE | Vermox 100mg Tab | JAN | 9.2650 | 9.2650 | NO | NO | NO |
| 02250241 | METHYLPHENIDATE HCL | Concerta 27mg SR Tab | JAN | 3.4819 | 1.2109 | YES | NO | YES |
| 02247732 | METHYLPHENIDATE HCL | Concerta 18mg SR Tab | JAN | 3.0171 | 1.0493 | YES | NO | YES |
| 02247733 | METHYLPHENIDATE HCL | Concerta 36mg SR Tab | JAN | 3.9468 | 1.3726 | YES | NO | YES |
| 02247734 | METHYLPHENIDATE HCL | Concerta 54mg SR Tab | JAN | 4.8761 | 1.6958 | YES | NO | YES |
| 00037605 | NORETHINDRONE | Micronor (Not a Benefit) 0.35mg Tab-28 Pk | JAN | N/A | N/A | YES | NO | NO |
| 02028700 | NORGESTIMATE & ETHINYL ESTRADIOL | Tri-Cyclen (Not a Benefit) 3 Phase Tab-21 Pk | JAN | N/A | N/A | YES | NO | NO |
| 02258560 | NORGESTIMATE & ETHINYL ESTRADIOL | Tri-Cyclen Lo (Not a Benefit) 3 Phase Tab-21 Pk | JAN | N/A | N/A | YES | NO | NO |
| 02029421 | NORGESTIMATE & ETHINYL ESTRADIOL | Tri-Cyclen (Not a Benefit) 3 Phase Tab-28 Pk | JAN | N/A | N/A | YES | NO | NO |
| 02258587 | NORGESTIMATE & ETHINYL ESTRADIOL | Tri-Cyclen Lo (Not a Benefit) 3 Phase Tab-28 Pk | JAN | N/A | N/A | YES | NO | NO |
| 02300281 | PALIPERIDONE | Invega 6mg ER Tab | JAN | 5.9560 | 5.9560 | NO | NO | NO |
| 02300273 | PALIPERIDONE | Invega 3mg ER Tab | JAN | 3.9820 | 3.9820 | NO | NO | NO |
| 02300303 | PALIPERIDONE | Invega 9mg ER Tab | JAN | 7.9390 | 7.9390 | NO | NO | NO |
| 02354241 | PALIPERIDONE PALMITATE | Invega Sustenna 150mg Inj Pref Syr | JAN | 654.9000 | 654.9000 | NO | NO | YES |
| 02354233 | PALIPERIDONE PALMITATE | Invega Sustenna 100mg Inj Pref Syr | JAN | 491.1800 | 491.1800 | NO | NO | YES |
| 02354217 | PALIPERIDONE PALMITATE | Invega Sustenna 50mg Inj Pref Syr | JAN | 327.4500 | 327.4500 | NO | NO | YES |
| 02354225 | PALIPERIDONE PALMITATE | Invega Sustenna 75mg Inj Pref Syr | JAN | 491.1800 | 491.1800 | NO | NO | YES |
| 02456001 | PALIPERIDONE PALMITATE | Invega Trinza 525mg/2.625mL Inj Susp-Pref Syr | JAN | 1907.4900 | 1907.4900 | NO | NO | YES |
| 02455994 | PALIPERIDONE PALMITATE | Invega Trinza 350mg/1.75mL Inj Susp-Pref Syr | JAN | 1430.6100 | 1430.6100 | NO | NO | YES |
| 02455986 | PALIPERIDONE PALMITATE | Invega Trinza 263mg/1.315mL Inj Susp-Pref Syr | JAN | 1430.6100 | 1430.6100 | NO | NO | YES |
| 02455943 | PALIPERIDONE PALMITATE | Invega Trinza 175mg/0.875mL Inj Susp-Pref Syr | JAN | 953.7300 | 953.7300 | NO | NO | YES |
| 02377020 | PRUCALOPRIDE | Resotran (Off-Formulary Interchangeable) 2mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 02377012 | PRUCALOPRIDE | Resotran (Off-Formulary Interchangeable) 1mg Tab | JAN | N/A | N/A | YES | NO | NO |
| 02243796 | RABEPRAZOLE SODIUM | Pariet 10mg Tab | JAN | 1.4651 | 0.0669 | YES | NO | NO |
| 02243797 | RABEPRAZOLE SODIUM | Pariet 20mg Tab | JAN | 2.9301 | 0.1338 | YES | NO | NO |
| 02370603 | RILPIVIRINE HYDROCHLORIDE | Edurant 25mg Tab | JAN | 16.2870 | 16.2870 | NO | NO | YES |
| 02236950 | RISPERIDONE | Risperdal 1mg/mL O/L | JAN | 1.5430 | 0.7080 | YES | NO | NO |
| 02268094 | RISPERIDONE | Risperdal M-Tab (Not a Benefit) 4mg Orally Disintegrating Tab | JAN | N/A | N/A | YES | NO | NO |
| 02268086 | RISPERIDONE | Risperdal M-Tab (Not a Benefit) 3mg Orally Disintegrating Tab | JAN | N/A | N/A | YES | NO | NO |
| 02247706 | RISPERIDONE | Risperdal M-Tab (Not a Benefit) 2mg Orally Disintegrating Tab | JAN | N/A | N/A | YES | NO | NO |
| 02247705 | RISPERIDONE | Risperdal M-Tab (Not a Benefit) 1mg Orally Disintegrating Tab | JAN | N/A | N/A | YES | NO | NO |
| 02247704 | RISPERIDONE | Risperdal M-Tab (Not a Benefit) 0.5mg Orally Disintegrating Tab | JAN | N/A | N/A | YES | NO | NO |
| 02255707 | RISPERIDONE | Risperdal Consta 25mg Pd for Inj-Vial Pk | JAN | 191.1500 | 191.1500 | NO | NO | YES |
| 02255723 | RISPERIDONE | Risperdal Consta 37.5mg Pd for Inj-Vial Pk | JAN | 286.7100 | 286.7100 | NO | NO | YES |
| 02255758 | RISPERIDONE | Risperdal Consta 50mg Pd for Inj-Vial Pk | JAN | 382.2800 | 382.2800 | NO | NO | YES |
| 02240552 | RISPERIDONE | Risperdal 0.5mg Tab | JAN | 0.9641 | 0.1470 | YES | NO | NO |
| 02025280 | RISPERIDONE | Risperdal 1mg Tab | JAN | 1.3315 | 0.2031 | YES | NO | NO |
| 02025299 | RISPERIDONE | Risperdal 2mg Tab | JAN | 2.6640 | 0.4062 | YES | NO | NO |
| 02025302 | RISPERIDONE | Risperdal 3mg Tab | JAN | 3.9890 | 0.6083 | YES | NO | NO |
| 02025310 | RISPERIDONE | Risperdal 4mg Tab | JAN | 5.3190 | 0.8111 | YES | NO | NO |
| 02240551 | RISPERIDONE | Risperdal 0.25mg Tab | JAN | 0.5755 | 0.0878 | YES | NO | NO |
| 00894729 | TERCONAZOLE | Terazol 7 (Not a Benefit) 0.4% Vag Cr | JAN | N/A | N/A | YES | NO | YES |
| 02349469 | TRAMADOL HCL | Ultram (Off-Formulary Interchangeable) 50mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02264846 | TRAMADOL HCL & ACETAMINOPHEN | Tramacet (Off-Formulary Interchangeable) 37.5mg & 325mg Tab | JAN | N/A | N/A | YES | NO | YES |
| 02320673 | USTEKINUMAB | Stelara 45mg/0.5mL Inj Sol-Pref Syr Pk | JAN | 4593.1400 | 4593.1400 | NO | YES | NO |
| 02320681 | USTEKINUMAB | Stelara 90mg/mL Inj Sol-Pref Syr Pk | JAN | 4593.1400 | 4593.1400 | NO | YES | NO |