| 02163780 | CODEINE SULFATE TRIHYDRATE & MONOHYDRATE | Codeine Contin 150mg CR Tab | PFP | 1.3990 | 1.3990 | NO | YES | YES |
| 02163748 | CODEINE SULFATE TRIHYDRATE & MONOHYDRATE | Codeine Contin 100mg CR Tab | PFP | 0.9320 | 0.9320 | NO | YES | YES |
| 02230302 | CODEINE SULFATE TRIHYDRATE & MONOHYDRATE | Codeine Contin 50mg CR Tab | PFP | 0.4660 | 0.4660 | NO | YES | YES |
| 02163799 | CODEINE SULFATE TRIHYDRATE & MONOHYDRATE | Codeine Contin 200mg CR Tab | PFP | 1.8650 | 1.8650 | NO | YES | YES |
| 02125323 | HYDROMORPHONE HCL | Hydromorph Contin 3mg CR Cap | PFP | 0.7320 | 0.7320 | NO | NO | YES |
| 02359510 | HYDROMORPHONE HCL | Hydromorph Contin 9mg CR Cap | PFP | 1.4435 | 1.4435 | NO | NO | YES |
| 02359502 | HYDROMORPHONE HCL | Hydromorph Contin 4.5mg CR Cap | PFP | 0.8840 | 0.8840 | NO | NO | YES |
| 02125331 | HYDROMORPHONE HCL | Hydromorph Contin 6mg CR Cap | PFP | 1.0940 | 1.0940 | NO | NO | YES |
| 02125390 | HYDROMORPHONE HCL | Hydromorph Contin (Off-Formulary Interchangeable) 30mg CR Cap | PFP | 4.7690 | 4.7690 | NO | NO | YES |
| 02125382 | HYDROMORPHONE HCL | Hydromorph Contin (Off-Formulary Interchangeable) 24mg CR Cap | PFP | 3.9820 | 3.7925 | NO | NO | YES |
| 02125366 | HYDROMORPHONE HCL | Hydromorph Contin 12mg CR Cap | PFP | 1.9025 | 1.9025 | NO | NO | YES |
| 02243562 | HYDROMORPHONE HCL | Hydromorph Contin 18mg CR Cap | PFP | 2.7450 | 2.7450 | NO | NO | YES |
| 00627100 | HYDROMORPHONE HCL | Dilaudid (Not a Benefit) 2mg/mL Inj Sol-1mL Pk | PFP | N/A | N/A | YES | NO | YES |
| 00622133 | HYDROMORPHONE HCL | Dilaudid-HP (Not a Benefit) 10mg/mL Inj Sol-1mL Pk | PFP | N/A | N/A | YES | NO | YES |
| 00786535 | HYDROMORPHONE HCL | Dilaudid (Not a Benefit) 1mg/mL Oral Sol | PFP | N/A | N/A | YES | NO | YES |
| 00705438 | HYDROMORPHONE HCL | Dilaudid 1mg Tab | PFP | 0.0959 | 0.0959 | YES | NO | YES |
| 00786543 | HYDROMORPHONE HCL | Dilaudid 8mg Tab | PFP | 0.3528 | 0.3528 | YES | NO | YES |
| 00125121 | HYDROMORPHONE HCL | Dilaudid 4mg Tab | PFP | 0.2240 | 0.2240 | YES | NO | YES |
| 00125083 | HYDROMORPHONE HCL | Dilaudid 2mg Tab | PFP | 0.1417 | 0.1417 | YES | NO | YES |
| 02015439 | MORPHINE SULFATE | MS Contin 15mg SR Tab | PFP | 0.9140 | 0.4145 | YES | NO | YES |
| 02014297 | MORPHINE SULFATE | MS Contin 30mg SR Tab | PFP | 1.3815 | 0.6580 | YES | NO | YES |
| 02014300 | MORPHINE SULFATE | MS Contin 60mg SR Tab | PFP | 2.4360 | 0.6167 | YES | NO | YES |
| 02014319 | MORPHINE SULFATE | MS Contin 100mg SR Tab | PFP | 3.7085 | 1.5395 | YES | NO | YES |
| 02014327 | MORPHINE SULFATE | MS Contin (Off-Formulary Interchangeable) 200mg SR Tab | PFP | 6.9145 | 4.5738 | YES | NO | YES |
| 02014238 | MORPHINE SULFATE | MS-IR 20mg Tab | PFP | 0.4260 | 0.4260 | NO | NO | YES |
| 02014254 | MORPHINE SULFATE | MS-IR 30mg Tab | PFP | 0.5470 | 0.5470 | NO | NO | YES |
| 02231934 | OXYCODONE HCL | Oxy.IR (Off-Formulary Interchangeable) 5mg Tab | PFP | N/A | N/A | YES | NO | YES |
| 02240131 | OXYCODONE HCL | Oxy.IR (Off-Formulary Interchangeable) 10mg Tab | PFP | N/A | N/A | YES | NO | YES |
| 02240132 | OXYCODONE HCL | Oxy.IR (Off-Formulary Interchangeable) 20mg Tab | PFP | N/A | N/A | YES | NO | YES |
| 00158348 | POVIDONE - IODINE | Betadine (Not a Benefit) 10% Top Sol | PFP | N/A | N/A | YES | NO | NO |
| 00026158 | SENNOSIDES A & B | Senokot 8.6mg Tab | PFP | 0.0595 | 0.0464 | YES | NO | NO |
| 02171880 | TIMOLOL MALEATE | Timoptic-XE (Not a Benefit) 0.25% Oph Gellan Sol | PFP | N/A | N/A | YES | NO | YES |