| 02060884 | BETAMETHASONE DISODIUM PHOSPHATE | Betnesol 5mg/100mL Enema-100mL Pk | PAL | 14.3357 | 14.3357 | NO | NO | NO |
| 01947923 | BETHANECHOL CHLORIDE | Duvoid 50mg Tab | PAL | 0.9449 | 0.9449 | NO | NO | NO |
| 01947931 | BETHANECHOL CHLORIDE | Duvoid 25mg Tab | PAL | 0.7175 | 0.7175 | NO | NO | NO |
| 01947958 | BETHANECHOL CHLORIDE | Duvoid 10mg Tab | PAL | 0.4431 | 0.4431 | NO | NO | NO |
| 02290308 | CYPROTERONE ACETATE & ETHINYL ESTRADIOL | Cyestra-35 (Off-Formulary Interchangeable) 2mg & 0.035mg Tab-21 Pk | PAL | 23.3394 | N/A | YES | NO | NO |
| 01924567 | DEXTROAMPHETAMINE SULFATE | Dexedrine Spansules 15mg SR Cap | PAL | 1.4067 | 0.9898 | YES | NO | YES |
| 01924559 | DEXTROAMPHETAMINE SULFATE | Dexedrine Spansules 10mg SR Cap | PAL | 1.1506 | 0.8096 | YES | NO | YES |
| 01924516 | DEXTROAMPHETAMINE SULFATE | Dexedrine 5mg Tab | PAL | 0.7792 | 0.5081 | YES | NO | YES |
| 02247265 | DICLOFENAC SODIUM | Pennsaid (Off-Formulary Interchangeable) 1.5% W/W Top Sol | PAL | N/A | N/A | YES | NO | NO |
| 00728179 | FLAVOXATE HCL | Urispas (Not a Benefit) 200mg Tab | PAL | N/A | N/A | YES | NO | NO |
| 02086026 | FLUDROCORTISONE ACETATE | Florinef 0.1mg Tab | PAL | 0.5213 | 0.5213 | NO | NO | NO |
| 00074454 | FLUMETHASONE PIVALATE & IODOCHLORHYDROXYQUIN | Locacorten-Vioform 0.02% & 1% Ot Sol | PAL | 2.3836 | 2.3836 | NO | NO | YES |
| 02240335 | FOSFOMYCIN TROMETHAMINE | Monurol Sachet-3g Pk | PAL | 21.6700 | 14.0250 | YES | NO | YES |
| 02106280 | LABETALOL HCL | Trandate 200mg Tab | PAL | 0.7148 | 0.3504 | YES | NO | NO |
| 02106272 | LABETALOL HCL | Trandate 100mg Tab | PAL | 0.4044 | 0.1983 | YES | NO | NO |
| 02244290 | METHADONE HCL | Metadol-D 10mg/mL Oral Concentrate | PAL | 0.1500 | 0.1500 | NO | NO | YES |
| 00015741 | METHIMAZOLE | Tapazole 5mg Tab | PAL | 0.3588 | 0.1531 | YES | NO | NO |
| 02296039 | METHIMAZOLE | Tapazole (Off-Formulary Interchangeable) 10mg Tab | PAL | N/A | N/A | YES | NO | NO |
| 00591467 | MORPHINE SULFATE | Statex 1mg/mL O/L | PAL | 0.0200 | 0.0200 | NO | NO | YES |
| 00591475 | MORPHINE SULFATE | Statex 5mg/mL O/L | PAL | 0.0803 | 0.0803 | NO | NO | YES |
| 00594636 | MORPHINE SULFATE | Statex 25mg Tab | PAL | 0.2388 | 0.2388 | NO | NO | YES |
| 00675962 | MORPHINE SULFATE | Statex 50mg Tab | PAL | 0.3661 | 0.3661 | NO | NO | YES |
| 00594652 | MORPHINE SULFATE | Statex 5mg Tab | PAL | 0.1251 | 0.1251 | NO | NO | YES |
| 00594644 | MORPHINE SULFATE | Statex 10mg Tab | PAL | 0.1934 | 0.1934 | NO | NO | YES |
| 02230734 | NITROGLYCERIN | Trinipatch 0.6mg/Hr/21 Sq Cm Patch | PAL | 0.8110 | 0.8110 | NO | NO | NO |
| 02230733 | NITROGLYCERIN | Trinipatch 0.4mg/Hr/14 Sq Cm Patch | PAL | 0.8110 | 0.8110 | NO | NO | NO |
| 00511552 | PIZOTYLINE | Sandomigran DS 1mg Tab | PAL | 1.1026 | 1.1026 | NO | NO | NO |
| 02280248 | TESTOSTERONE | Testim 1% Top Gel-5g Pk | PAL | 4.3180 | 4.3180 | NO | YES | NO |
| 02296411 | TRAMADOL HCL | Tridural (Off-Formulary Interchangeable) 300mg ER Tab | PAL | N/A | N/A | YES | NO | YES |
| 02296381 | TRAMADOL HCL | Tridural (Off-Formulary Interchangeable) 100mg ER Tab | PAL | N/A | N/A | YES | NO | YES |
| 02296403 | TRAMADOL HCL | Tridural (Off-Formulary Interchangeable) 200mg ER Tab | PAL | N/A | N/A | YES | NO | YES |