| 02201011 | ALENDRONATE | Fosamax (Not a Benefit) 10mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 02233055 | ALENDRONATE | Fosamax (Off-Formulary Interchangeable) 5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00851795 | ENALAPRIL MALEATE | Vasotec (Not a Benefit) 2.5mg Tab | MFC | N/A | N/A | YES | NO | YES |
| 02242826 | ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE | Vaseretic (Off-Formulary Interchangeable) 5mg & 12.5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 02247437 | ERTAPENEM | Invanz (Off-Formulary Interchangeable) 1g/Vial Inj Pd-Vial Pk | MFC | N/A | N/A | YES | NO | NO |
| 00710121 | FAMOTIDINE | Pepcid (Not a Benefit) 20mg Tab | MFC | N/A | N/A | YES | NO | YES |
| 00710113 | FAMOTIDINE | Pepcid (Not a Benefit) 40mg Tab | MFC | N/A | N/A | YES | NO | YES |
| 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 |
| 00355658 | LEVODOPA & CARBIDOPA | Sinemet (Not a Benefit) 100mg & 10mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00839396 | LISINOPRIL | Prinivil 10mg Tab | MFC | 0.9489 | 0.1716 | YES | NO | NO |
| 00839418 | LISINOPRIL | Prinivil 20mg Tab | MFC | 1.1408 | 0.2063 | YES | NO | NO |
| 00839388 | LISINOPRIL | Prinivil (Not a Benefit) 5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00884413 | LISINOPRIL & HYDROCHLOROTHIAZIDE | Prinzide (Not a Benefit) 20mg & 12.5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00884421 | LISINOPRIL & HYDROCHLOROTHIAZIDE | Prinzide (Off-Formulary Interchangeable) 20mg/25mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 02108194 | LISINOPRIL & HYDROCHLOROTHIAZIDE | Prinzide (Not a Benefit) 10mg & 12.5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00795852 | LOVASTATIN | Mevacor (Not a Benefit) 40mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00795860 | LOVASTATIN | Mevacor (Not a Benefit) 20mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 02301881 | RALTEGRAVIR POTASSIUM | Isentress 400mg Tab | MFC | 14.0301 | 14.0301 | NO | NO | NO |
| 02240332 | SIMVASTATIN | Zocor (Not a Benefit) 80mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 00884324 | SIMVASTATIN | Zocor (Not a Benefit) 5mg Tab | MFC | N/A | N/A | YES | NO | NO |
| 02388847 | SITAGLIPTIN | Januvia 50mg Tab | MFC | 3.2787 | 0.8197 | YES | NO | YES |
| 02388839 | SITAGLIPTIN | Januvia 25mg Tab | MFC | 3.2787 | 0.8197 | YES | NO | YES |
| 02303922 | SITAGLIPTIN | Januvia 100mg Tab | MFC | 3.2787 | 0.8197 | YES | NO | YES |
| 00451193 | TIMOLOL MALEATE | Timoptic (Not a Benefit) 0.25% Oph Sol | MFC | N/A | N/A | YES | NO | YES |