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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Inter- change- able	Limited Use	Thera- peutic Notes
02352966	ALENDRONATE	Alendronate 70mg Tab	SAI	1.7804	1.7804	YES	NO	NO
02519844	ALFUZOSIN HYDROCHLORIDE	Alfuzosin 10mg Prolong-Rel Tab	SAI	0.2601	0.2601	YES	YES	NO
02466821	ALMOTRIPTAN	Almotriptan (Off-Formulary Interchangeable) 12.5mg Tab	SAI	9.7833	9.7833	YES	NO	NO
02364336	AMIODARONE HCL	Amiodarone 200mg Tab	SAI	0.3706	0.3706	YES	NO	YES
02331292	AMLODIPINE	Amlodipine 10mg Tab	SAI	0.1993	0.1993	YES	NO	NO
02331284	AMLODIPINE	Amlodipine 5mg Tab	SAI	0.1343	0.1343	YES	NO	NO
02525356	AMOXICILLIN	Amoxicillin Capsules BP 500mg Cap	SAI	0.1308	0.1308	YES	NO	NO
02525348	AMOXICILLIN	Amoxicillin Capsules BP 250mg Cap	SAI	0.0672	0.0672	YES	NO	NO
02352753	AMOXICILLIN	Amoxicillin 50mg/mL O/L	SAI	0.0540	0.0540	YES	NO	NO
02352788	AMOXICILLIN	Amoxicillin (Sugar Reduced) 50mg/mL O/L	SAI	0.0540	0.0540	YES	NO	NO
02442736	ANASTROZOLE	Anastrozole 1mg Tab	SAI	0.9522	0.9522	YES	NO	NO
02506785	ARIPIPRAZOLE	Aripiprazole 30mg Tab	SAI	1.0017	1.0017	YES	NO	YES
02506750	ARIPIPRAZOLE	Aripiprazole 20mg Tab	SAI	1.0017	1.0017	YES	NO	YES
02506734	ARIPIPRAZOLE	Aripiprazole 15mg Tab	SAI	1.2692	1.2692	YES	NO	YES
02506726	ARIPIPRAZOLE	Aripiprazole 10mg Tab	SAI	1.0754	1.0754	YES	NO	YES
02506688	ARIPIPRAZOLE	Aripiprazole 2mg Tab	SAI	0.8092	0.8092	YES	NO	YES
02506718	ARIPIPRAZOLE	Aripiprazole 5mg Tab	SAI	0.9046	0.9046	YES	NO	YES
02466473	ATENOLOL	Atenolol 100mg Tab	SAI	0.1543	0.1543	YES	NO	NO
02466465	ATENOLOL	Atenolol 50mg Tab	SAI	0.0938	0.0938	YES	NO	NO
02467771	ATOMOXETINE HCL	Atomoxetine 40mg Cap	SAI	0.7369	0.7369	YES	NO	NO
02467763	ATOMOXETINE HCL	Atomoxetine 25mg Cap	SAI	0.6420	0.6420	YES	NO	NO
02467755	ATOMOXETINE HCL	Atomoxetine 18mg Cap	SAI	0.5748	0.5748	YES	NO	NO
02467747	ATOMOXETINE HCL	Atomoxetine 10mg Cap	SAI	0.5106	0.5106	YES	NO	NO
02467798	ATOMOXETINE HCL	Atomoxetine 60mg Cap	SAI	0.8092	0.8092	YES	NO	NO
02467828	ATOMOXETINE HCL	Atomoxetine (Off-Formulary Interchangeable) 100mg Cap	SAI	4.3520	N/A	YES	NO	NO
02467801	ATOMOXETINE HCL	Atomoxetine (Off-Formulary Interchangeable) 80mg Cap	SAI	3.9960	N/A	YES	NO	NO
02348705	ATORVASTATIN CALCIUM	Atorvastatin 10mg Tab	SAI	0.1743	0.1743	YES	NO	NO
02348713	ATORVASTATIN CALCIUM	Atorvastatin 20mg Tab	SAI	0.2179	0.2179	YES	NO	NO
02348721	ATORVASTATIN CALCIUM	Atorvastatin 40mg Tab	SAI	0.2342	0.2342	YES	NO	NO
02348748	ATORVASTATIN CALCIUM	Atorvastatin 80mg Tab	SAI	0.2342	0.2342	YES	NO	NO
02421429	ATOVAQUONE & PROGUANIL HCL	Atovaquone Proguanil (Off-Formulary Interchangeable) 250mg & 100mg Tab	SAI	4.1308	4.1308	YES	NO	NO
02330881	AZITHROMYCIN	Azithromycin 250mg Tab	SAI	0.9410	0.9410	YES	NO	YES
02287021	BACLOFEN	Baclofen 10mg Tab	SAI	0.1595	0.1595	YES	NO	YES
02287048	BACLOFEN	Baclofen 20mg Tab	SAI	0.3104	0.3104	YES	NO	YES
02466449	BETAHISTINE DIHYDROCHLORIDE	Betahistine (Off-Formulary Interchangeable) 16mg Tab	SAI	0.3557	0.3557	YES	NO	NO
02466457	BETAHISTINE DIHYDROCHLORIDE	Betahistine (Off-Formulary Interchangeable) 24mg Tab	SAI	0.4983	N/A	YES	NO	NO
02519178	BICALUTAMIDE	Bicalutamide 50mg Tab	SAI	1.2690	1.2690	YES	NO	NO
02391589	BISOPROLOL FUMARATE	Bisoprolol 5mg Tab	SAI	0.0606	0.0606	YES	NO	NO
02391597	BISOPROLOL FUMARATE	Bisoprolol 10mg Tab	SAI	0.0885	0.0885	YES	NO	NO
02447851	BUSPIRONE HYDROCHLORIDE	Buspirone 10mg Tab	SAI	0.2713	0.2713	YES	NO	NO
02388936	CANDESARTAN CILEXETIL	Candesartan 16mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02435845	CANDESARTAN CILEXETIL	Candesartan 32mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02388928	CANDESARTAN CILEXETIL	Candesartan 8mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02388901	CANDESARTAN CILEXETIL	Candesartan 4mg Tab	SAI	0.1700	0.1700	YES	NO	NO
02394804	CANDESARTAN CILEXETIL & HYDROCHLOROTHIAZIDE	Candesartan/HCTZ 16mg & 12.5mg Tab	SAI	0.2156	0.2156	YES	NO	NO
02514990	CAPECITABINE	Capecitabine 500mg Tab	SAI	1.5250	1.5250	YES	NO	NO
02514982	CAPECITABINE	Capecitabine 150mg Tab	SAI	0.4575	0.4575	YES	NO	NO
02364913	CARVEDILOL	Carvedilol 3.125mg Tab	SAI	0.2060	0.2060	YES	YES	NO
02364921	CARVEDILOL	Carvedilol 6.25mg Tab	SAI	0.2060	0.2060	YES	YES	NO
02364948	CARVEDILOL	Carvedilol 12.5mg Tab	SAI	0.2060	0.2060	YES	YES	NO
02364956	CARVEDILOL	Carvedilol 25mg Tab	SAI	0.2060	0.2060	YES	YES	NO
02436299	CELECOXIB	Celecoxib 100mg Cap	SAI	0.1279	0.1279	YES	YES	YES
02436302	CELECOXIB	Celecoxib 200mg Cap	SAI	0.2558	0.2558	YES	YES	YES
02521261	CEPHALEXIN MONOHYDRATE	Cephalexin 500mg Tab	SAI	0.1731	0.1731	YES	NO	NO
02521253	CEPHALEXIN MONOHYDRATE	Cephalexin 250mg Tab	SAI	0.0866	0.0866	YES	NO	NO
02515695	CETIRIZINE HYDROCHLORIDE	Cetirizine (Off-Formulary Interchangeable) 20mg Tab	SAI	0.7535	N/A	YES	NO	NO
02524880	CINACALCET	Cinacalcet (Off-Formulary Interchangeable) 30mg Tab	SAI	10.1947	10.1947	YES	NO	NO
02353326	CIPROFLOXACIN	Ciprofloxacin 500mg Tab	SAI	0.5025	0.5025	YES	NO	YES
02353318	CIPROFLOXACIN	Ciprofloxacin 250mg Tab	SAI	0.4454	0.4454	YES	NO	YES
02353660	CITALOPRAM HYDROBROMIDE	Citalopram 20mg Tab	SAI	0.1332	0.1332	YES	NO	NO
02353679	CITALOPRAM HYDROBROMIDE	Citalopram 40mg Tab	SAI	0.1332	0.1332	YES	NO	NO
02466139	CLARITHROMYCIN	Clarithromycin (Off-Formulary Interchangeable) 500mg Tab	SAI	2.2009	N/A	YES	NO	YES
02466120	CLARITHROMYCIN	Clarithromycin 250mg Tab	SAI	0.4122	0.4122	YES	NO	YES
02400529	CLINDAMYCIN HCL	Clindamycin 150mg Cap	SAI	0.2217	0.2217	YES	NO	NO
02400537	CLINDAMYCIN HCL	Clindamycin 300mg Cap	SAI	0.4434	0.4434	YES	NO	NO
02400553	CLOPIDOGREL BISULFATE	Clopidogrel 75mg Tab	SAI	0.2631	0.2631	YES	NO	NO
02287064	CYCLOBENZAPRINE HCL	Cyclobenzaprine (Not a Benefit) 10mg Tab	SAI	N/A	N/A	YES	NO	YES
02535106	DESVENLAFAXINE	Desvenlafaxine (Off-Formulary Interchangeable) 50mg ER Tab	SAI	2.3409	N/A	YES	NO	NO
02535114	DESVENLAFAXINE	Desvenlafaxine (Off-Formulary Interchangeable) 100mg ER Tab	SAI	2.3409	N/A	YES	NO	NO
02400464	DILTIAZEM HCL	Diltiazem CD 300mg LA Cap	SAI	0.7999	0.7999	YES	NO	NO
02400456	DILTIAZEM HCL	Diltiazem CD 240mg LA Cap	SAI	0.6399	0.6399	YES	NO	NO
02400448	DILTIAZEM HCL	Diltiazem CD 180mg LA Cap	SAI	0.4824	0.4824	YES	NO	NO
02400421	DILTIAZEM HCL	Diltiazem CD 120mg LA Cap	SAI	0.3634	0.3634	YES	NO	NO
02516144	DILTIAZEM HCL	Diltiazem T 300mg SR Cap	SAI	0.4720	0.4720	YES	NO	NO
02516152	DILTIAZEM HCL	Diltiazem T 360mg SR Cap	SAI	0.5778	0.5778	YES	NO	NO
02516136	DILTIAZEM HCL	Diltiazem T 240mg SR Cap	SAI	0.3832	0.3832	YES	NO	NO
02516128	DILTIAZEM HCL	Diltiazem T 180mg SR Cap	SAI	0.2889	0.2889	YES	NO	NO
02516101	DILTIAZEM HCL	Diltiazem T 120mg SR Cap	SAI	0.2133	0.2133	YES	NO	NO
02350440	DOMPERIDONE MALEATE	Domperidone 10mg Tab	SAI	0.0428	0.0428	YES	NO	NO
02426854	DONEPEZIL HCL	Donepezil 10mg Tab	SAI	0.4586	0.4586	YES	YES	NO
02426846	DONEPEZIL HCL	Donepezil 5mg Tab	SAI	0.4586	0.4586	YES	YES	NO
02351242	DOXYCYCLINE HYCLATE	Doxycycline Tablets 100mg Tab	SAI	0.4560	0.4560	YES	NO	NO
02490897	DULOXETINE	Duloxetine 60mg DR Cap	SAI	0.9769	0.7327	YES	NO	NO
02490889	DULOXETINE	Duloxetine 30mg DR Cap	SAI	0.4814	0.3611	YES	NO	NO
02443058	DUTASTERIDE	Dutasteride 0.5mg Cap	SAI	0.2565	0.2565	YES	YES	NO
02511274	ELETRIPTAN	Eletriptan (Off-Formulary Interchangeable) 40mg Tab	SAI	10.0850	N/A	YES	NO	NO
02511266	ELETRIPTAN	Eletriptan (Off-Formulary Interchangeable) 20mg Tab	SAI	10.0850	N/A	YES	NO	NO
02400669	ENALAPRIL MALEATE	Enalapril 5mg Tab	SAI	0.2203	0.2203	YES	NO	NO
02400677	ENALAPRIL MALEATE	Enalapril 10mg Tab	SAI	0.2647	0.2647	YES	NO	NO
02400685	ENALAPRIL MALEATE	Enalapril 20mg Tab	SAI	0.3195	0.3195	YES	NO	NO
02400650	ENALAPRIL MALEATE	Enalapril 2.5mg Tab	SAI	0.1863	0.1863	YES	NO	NO
02527154	ENTECAVIR	Entecavir 0.5mg Tab	SAI	5.5000	4.4000	YES	YES	NO
02430118	ESCITALOPRAM	Escitalopram 10mg Tab	SAI	0.3109	0.3109	YES	NO	NO
02430126	ESCITALOPRAM	Escitalopram 20mg Tab	SAI	0.3310	0.3310	YES	NO	NO
02431173	ESOMEPRAZOLE	Esomeprazole DR Tab (Off-Formulary Interchangeable) 40mg	SAI	1.8690	N/A	YES	NO	NO
02535335	ESOMEPRAZOLE	Esomeprazole (Off-Formulary Interchangeable) 20mg DR Tab	SAI	1.8690	N/A	YES	NO	NO
02431300	EZETIMIBE	Ezetimibe 10mg Tab	SAI	0.1811	0.1811	YES	YES	NO
02539837	FEBUXOSTAT	Febuxostat (Off-Formulary Interchangeable) 80mg Tab	SAI	1.3515	1.3515	YES	NO	NO
02445077	FINASTERIDE	Finasteride 5mg Tab	SAI	0.3506	0.3506	YES	YES	NO
02445085	FINASTERIDE	Finasteride (Off-Formulary Interchangeable) 1mg Tab	SAI	1.1453	N/A	YES	NO	NO
02534819	FLECAINIDE ACETATE	Flecainide 100mg Tab	SAI	0.2779	0.2779	YES	NO	NO
02534800	FLECAINIDE ACETATE	Flecainide 50mg Tab	SAI	0.1389	0.1389	YES	NO	NO
02521229	FLUCONAZOLE	Fluconazole-150 150mg Cap	SAI	3.9424	3.9424	YES	YES	YES
02517418	FLUCONAZOLE	Fluconazole 100mg Tab	SAI	2.2891	2.2891	YES	NO	NO
02517396	FLUCONAZOLE	Fluconazole 50mg Tab	SAI	1.2904	1.2904	YES	NO	NO
02286068	FLUOXETINE HCL	Fluoxetine (Off-Formulary Interchangeable) 10mg Cap	SAI	1.1773	N/A	YES	NO	YES
02286076	FLUOXETINE HCL	Fluoxetine 20mg Cap	SAI	0.3311	0.3311	YES	NO	YES
02459396	FOSINOPRIL SODIUM	Fosinopril 20mg Tab	SAI	0.2619	0.2619	YES	NO	NO
02459388	FOSINOPRIL SODIUM	Fosinopril 10mg Tab	SAI	0.2178	0.2178	YES	NO	NO
02535475	FROVATRIPTAN SUCCINATE	Frovatriptan (Off-Formulary Interchangeable) 2.5mg Tab	SAI	12.5033	N/A	YES	NO	NO
02351420	FUROSEMIDE	Furosemide 20mg Tab	SAI	0.0218	0.0218	YES	NO	NO
02351439	FUROSEMIDE	Furosemide 40mg Tab	SAI	0.0327	0.0327	YES	NO	NO
02353245	GABAPENTIN	Gabapentin 100mg Cap	SAI	0.0416	0.0416	YES	NO	NO
02353253	GABAPENTIN	Gabapentin 300mg Cap	SAI	0.1012	0.1012	YES	NO	NO
02353261	GABAPENTIN	Gabapentin 400mg Cap	SAI	0.1206	0.1206	YES	NO	NO
02431289	GABAPENTIN	Gabapentin (Off-Formulary Interchangeable) 600mg Tab	SAI	1.3045	N/A	YES	NO	NO
02431297	GABAPENTIN	Gabapentin (Off-Formulary Interchangeable) 800mg Tab	SAI	1.7393	N/A	YES	NO	NO
02443031	GALANTAMINE HYDROBROMIDE	Galantamine ER 24mg ER Cap	SAI	1.2465	1.2465	YES	YES	NO
02443023	GALANTAMINE HYDROBROMIDE	Galantamine ER 16mg ER Cap	SAI	1.2465	1.2465	YES	YES	NO
02443015	GALANTAMINE HYDROBROMIDE	Galantamine ER 8mg ER Cap	SAI	1.2465	1.2465	YES	YES	NO
02524864	GLICLAZIDE	Gliclazide MR 60mg ER Tab	SAI	0.0632	0.0632	YES	NO	NO
02524856	GLICLAZIDE	Gliclazide MR 30mg SR Tab	SAI	0.0931	0.0931	YES	NO	NO
02287072	GLICLAZIDE	Gliclazide 80mg Tab	SAI	0.0931	0.0931	YES	NO	NO
02350459	GLYBURIDE	Glyburide 2.5mg Tab	SAI	0.0321	0.0321	YES	NO	NO
02350467	GLYBURIDE	Glyburide 5mg Tab	SAI	0.0573	0.0573	YES	NO	NO
02519348	HYDROXYCHLOROQUINE SULFATE	Hydroxychloroquine 200mg Tab	SAI	0.1576	0.1576	YES	NO	NO
02504596	IMATINIB MESYLATE	Imatinib 100mg Tab	SAI	5.2079	5.2079	YES	NO	YES
02504618	IMATINIB MESYLATE	Imatinib 400mg Tab	SAI	20.8314	20.8314	YES	NO	YES
02372347	IRBESARTAN	Irbesartan 75mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02372371	IRBESARTAN	Irbesartan 150mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02372398	IRBESARTAN	Irbesartan 300mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02372886	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan/HCTZ 150mg & 12.5mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02372894	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan/HCTZ 300mg & 12.5mg Tab	SAI	0.2281	0.2281	YES	NO	NO
02372908	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan/HCTZ 300mg & 25mg Tab	SAI	0.2184	0.2184	YES	NO	NO
02512874	LACOSAMIDE	Lacosamide 50mg Tab	SAI	0.6313	0.6313	YES	YES	NO
02512882	LACOSAMIDE	Lacosamide 100mg Tab	SAI	0.8750	0.8750	YES	YES	NO
02512890	LACOSAMIDE	Lacosamide 150mg Tab	SAI	1.1763	1.1763	YES	YES	NO
02512904	LACOSAMIDE	Lacosamide 200mg Tab	SAI	1.4500	1.4500	YES	YES	NO
02412268	LACTULOSE	Lactulose 667mg/mL O/L	SAI	0.0145	0.0145	YES	NO	NO
02343029	LAMOTRIGINE	Lamotrigine 100mg Tab	SAI	0.2787	0.2787	YES	NO	NO
02343010	LAMOTRIGINE	Lamotrigine 25mg Tab	SAI	0.0698	0.0698	YES	NO	NO
02343037	LAMOTRIGINE	Lamotrigine 150mg Tab	SAI	0.4107	0.4107	YES	NO	NO
02357682	LANSOPRAZOLE	Lansoprazole 15mg DR Cap	SAI	0.5000	0.5000	YES	YES	NO
02357690	LANSOPRAZOLE	Lansoprazole 30mg DR Cap	SAI	0.5000	0.5000	YES	YES	NO
02351668	LEFLUNOMIDE	Leflunomide 10mg Tab	SAI	2.6433	2.0000	YES	NO	NO
02351676	LEFLUNOMIDE	Leflunomide 20mg Tab	SAI	2.6433	2.0000	YES	NO	NO
02504472	LETROZOLE	Letrozole 2.5mg Tab	SAI	1.3780	1.3780	YES	NO	NO
02353350	LEVETIRACETAM	Levetiracetam 500mg Tab	SAI	0.3911	0.3911	YES	YES	NO
02353342	LEVETIRACETAM	Levetiracetam 250mg Tab	SAI	0.3210	0.3210	YES	YES	NO
02353369	LEVETIRACETAM	Levetiracetam 750mg Tab	SAI	0.5416	0.5416	YES	YES	NO
02525186	LISINOPRIL	Lisinopril 5mg Tab	SAI	0.1347	0.1347	YES	NO	NO
02525194	LISINOPRIL	Lisinopril 10mg Tab	SAI	0.1619	0.1619	YES	NO	NO
02525208	LISINOPRIL	Lisinopril 20mg Tab	SAI	0.1945	0.1945	YES	NO	NO
02362945	LISINOPRIL & HYDROCHLOROTHIAZIDE	Lisinopril/HCTZ (Type Z) 10mg & 12.5mg Tab	SAI	0.2084	0.2084	YES	NO	NO
02362953	LISINOPRIL & HYDROCHLOROTHIAZIDE	Lisinopril/HCTZ (Type Z) 20mg & 12.5mg Tab	SAI	0.2504	0.2504	YES	NO	NO
02362961	LISINOPRIL & HYDROCHLOROTHIAZIDE	Lisinopril/HCTZ (Type Z) (Off-Formulary Interchangeable) 20mg & 25mg Tab	SAI	0.7011	N/A	YES	NO	NO
02388863	LOSARTAN POTASSIUM	Losartan 25mg Tab	SAI	0.3147	0.3147	YES	NO	NO
02388871	LOSARTAN POTASSIUM	Losartan 50mg Tab	SAI	0.3147	0.3147	YES	NO	NO
02388898	LOSARTAN POTASSIUM	Losartan 100mg Tab	SAI	0.3147	0.3147	YES	NO	NO
02427656	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan/HCTZ 100mg & 12.5mg Tab	SAI	0.3082	0.3082	YES	NO	NO
02427648	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan/HCTZ 50mg & 12.5mg Tab	SAI	0.3147	0.3147	YES	NO	NO
02427664	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan/HCTZ 100mg & 25mg Tab	SAI	0.3147	0.3147	YES	NO	NO
02353148	MELOXICAM	Meloxicam 7.5mg Tab	SAI	0.2003	0.2003	YES	NO	YES
02353156	MELOXICAM	Meloxicam 15mg Tab	SAI	0.2311	0.2311	YES	NO	YES
02443082	MEMANTINE HCL	Memantine (Off-Formulary Interchangeable) 10mg Tab	SAI	1.6357	N/A	YES	NO	NO
02353385	METFORMIN HCL	Metformin (Off-Formulary Interchangeable) 850mg Tab	SAI	0.2090	N/A	YES	NO	NO
02353377	METFORMIN HCL	Metformin 500mg Tab	SAI	0.0247	0.0247	YES	NO	NO
02350408	METOPROLOL TARTRATE	Metoprolol 100mg Tab	SAI	0.1361	0.1361	YES	NO	NO
02350394	METOPROLOL TARTRATE	Metoprolol 50mg Tab	SAI	0.0624	0.0624	YES	NO	NO
02534592	METRONIDAZOLE	Metronidazole 500mg Cap	SAI	0.2739	0.2739	YES	NO	NO
02533219	MIDODRINE HCL	Midodrine 5mg Tab	SAI	0.1921	0.1921	YES	YES	NO
02533200	MIDODRINE HCL	Midodrine 2.5mg Tab	SAI	0.1153	0.1153	YES	YES	NO
02370689	MIRTAZAPINE	Mirtazapine 30mg Tab	SAI	0.3100	0.3100	YES	NO	NO
02530244	MODAFINIL	Modafinil (Off-Formulary Interchangeable) 100mg Tab	SAI	0.9293	0.9293	YES	NO	YES
02519127	MOMETASONE FUROATE	Mometasone (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose Pk	SAI	21.6900	N/A	YES	NO	YES
02379325	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	SAI	1.2075	1.2075	YES	NO	NO
02379333	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 10mg Tab	SAI	1.7735	1.7735	YES	NO	NO
02529076	MOXIFLOXACIN HYDROCHLORIDE	Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	SAI	11.2700	N/A	YES	NO	NO
02520710	MOXIFLOXACIN HYDROCHLORIDE	Moxifloxacin 400mg Tab	SAI	1.5230	1.5230	YES	NO	NO
02457369	MYCOPHENOLATE MOFETIL	Mycophenolate Mofetil 250mg Cap	SAI	0.3712	0.3712	YES	NO	NO
02457377	MYCOPHENOLATE MOFETIL	Mycophenolate Mofetil 500mg Tab	SAI	0.7423	0.7423	YES	NO	NO
02350785	NAPROXEN	Naproxen EC (Off-Formulary Interchangeable) 250mg Ent Tab	SAI	0.2835	N/A	YES	NO	YES
02350793	NAPROXEN	Naproxen EC (Off-Formulary Interchangeable) 375mg Ent Tab	SAI	0.3675	N/A	YES	NO	YES
02350807	NAPROXEN	Naproxen EC (Off-Formulary Interchangeable) 500mg Ent Tab	SAI	0.6894	N/A	YES	NO	YES
02350750	NAPROXEN	Naproxen 250mg Tab	SAI	0.1068	0.1068	YES	NO	YES
02350777	NAPROXEN	Naproxen 500mg Tab	SAI	0.2244	0.2244	YES	NO	YES
02350769	NAPROXEN	Naproxen 375mg Tab	SAI	0.1458	0.1458	YES	NO	YES
02351013	NAPROXEN SODIUM	Naproxen Sodium (Off-Formulary Interchangeable) 275mg Tab	SAI	0.3422	N/A	YES	NO	YES
02351021	NAPROXEN SODIUM	Naproxen Sodium DS (Off-Formulary Interchangeable) 550mg Tab	SAI	0.6667	N/A	YES	NO	YES
02352974	OLANZAPINE	Olanzapine ODT 5mg Rapid Dissolve Tab	SAI	0.3574	0.3574	YES	NO	NO
02352982	OLANZAPINE	Olanzapine ODT 10mg Rapid Dissolve Tab	SAI	0.7143	0.7143	YES	NO	NO
02352990	OLANZAPINE	Olanzapine ODT 15mg Rapid Dissolve Tab	SAI	1.0711	1.0711	YES	NO	NO
02372819	OLANZAPINE	Olanzapine 2.5mg Tab	SAI	0.1772	0.1772	YES	NO	NO
02372827	OLANZAPINE	Olanzapine 5mg Tab	SAI	0.3544	0.3544	YES	NO	NO
02372851	OLANZAPINE	Olanzapine 15mg Tab	SAI	1.0631	1.0631	YES	NO	NO
02372835	OLANZAPINE	Olanzapine 7.5mg Tab	SAI	0.5316	0.5316	YES	NO	NO
02372843	OLANZAPINE	Olanzapine 10mg Tab	SAI	0.7088	0.7088	YES	NO	NO
02481065	OLMESARTAN MEDOXOMIL	Olmesartan 40mg Tab	SAI	0.3019	0.3019	YES	NO	NO
02481057	OLMESARTAN MEDOXOMIL	Olmesartan 20mg Tab	SAI	0.3019	0.3019	YES	NO	NO
02509636	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	Olmesartan/HCTZ 40mg & 12.5mg Tab	SAI	0.3019	0.3019	YES	NO	NO
02509628	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	Olmesartan/HCTZ 40mg & 25mg Tab	SAI	0.3019	0.3019	YES	NO	NO
02509601	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	Olmesartan/HCTZ 20mg & 12.5mg Tab	SAI	0.3019	0.3019	YES	NO	NO
02521172	OLOPATADINE HCL	Olopatadine (Off-Formulary Interchangeable) 0.1% Oph Sol-5mL Pk	SAI	26.1300	N/A	YES	NO	NO
02348691	OMEPRAZOLE	Omeprazole DR Cap 20mg	SAI	0.2287	0.2287	YES	YES	NO
02504294	OMEPRAZOLE	Omeprazole Magnesium Delayed Release Tab 20mg	SAI	0.2287	0.2287	YES	YES	NO
09857656	OMEPRAZOLE MAGNESIUM	Omeprazole Magnesium Delayed Release Tab 20mg	SAI	0.2287	0.2287	YES	YES	NO
02524287	ONDANSETRON HYDROCHLORIDE	Ondansetron ODT (Tablet) 8mg	SAI	4.9930	3.8840	YES	YES	NO
02524279	ONDANSETRON HYDROCHLORIDE	Ondansetron ODT (Tablet) 4mg	SAI	3.2720	2.5450	YES	YES	NO
02421410	ONDANSETRON HYDROCHLORIDE	Ondansetron 8mg Tab	SAI	4.9930	3.8840	YES	YES	NO
02421402	ONDANSETRON HYDROCHLORIDE	Ondansetron 4mg Tab	SAI	3.2720	2.5450	YES	YES	NO
02350238	OXYBUTYNIN CHLORIDE	Oxybutynin 5mg Tab	SAI	0.0986	0.0986	YES	NO	NO
02466147	PANTOPRAZOLE MAGNESIUM	Pantoprazole T 40mg Ent Coated Tab	SAI	0.1875	0.1875	YES	NO	NO
02536137	PANTOPRAZOLE SODIUM	Pantoprazole (Off-Formulary Interchangeable) 20mg Ent Tab	SAI	1.2750	N/A	YES	NO	NO
02370808	PANTOPRAZOLE SODIUM	Pantoprazole 40mg Ent Tab	SAI	0.2016	0.2016	YES	YES	NO
02282860	PAROXETINE HCL	Paroxetine 30mg Tab	SAI	0.3453	0.3453	YES	NO	NO
02282844	PAROXETINE HCL	Paroxetine (Off-Formulary Interchangeable) 10mg Tab	SAI	1.0430	N/A	YES	NO	NO
02282852	PAROXETINE HCL	Paroxetine 20mg Tab	SAI	0.3250	0.3250	YES	NO	NO
02481650	PERINDOPRIL ERBUMINE	Perindopril Erbumine 8mg Tab	SAI	0.2831	0.2831	YES	NO	NO
02481634	PERINDOPRIL ERBUMINE	Perindopril Erbumine 2mg Tab	SAI	0.1632	0.1632	YES	NO	NO
02481642	PERINDOPRIL ERBUMINE	Perindopril Erbumine 4mg Tab	SAI	0.2042	0.2042	YES	NO	NO
02519720	PERINDOPRIL ERBUMINE & INDAPAMIDE	Perindopril/Indapamide 4mg & 1.25mg Tab	SAI	0.2556	0.2556	YES	NO	NO
02519739	PERINDOPRIL ERBUMINE & INDAPAMIDE	Perindopril/Indapamide 8mg & 2.5mg Tab	SAI	0.2859	0.2859	YES	NO	NO
02367645	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 1.5mg Tab	SAI	0.3901	0.3901	YES	NO	NO
02367610	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole (Off-Formulary Interchangeable) 0.5mg Tab	SAI	1.3860	N/A	YES	NO	NO
02367602	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 0.25mg Tab	SAI	0.1950	0.1950	YES	NO	NO
02367629	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 1mg Tab	SAI	0.3901	0.3901	YES	NO	NO
02356562	PRAVASTATIN SODIUM	Pravastatin 40mg Tab	SAI	0.4143	0.4143	YES	NO	NO
02356554	PRAVASTATIN SODIUM	Pravastatin 20mg Tab	SAI	0.3440	0.3440	YES	NO	NO
02356546	PRAVASTATIN SODIUM	Pravastatin 10mg Tab	SAI	0.2916	0.2916	YES	NO	NO
02405539	PREGABALIN	Pregabalin 25mg Cap	SAI	0.1481	0.1481	YES	NO	NO
02405563	PREGABALIN	Pregabalin 150mg Cap	SAI	0.4145	0.4145	YES	NO	NO
02405598	PREGABALIN	Pregabalin 300mg Cap	SAI	0.4145	0.4145	YES	NO	NO
02405555	PREGABALIN	Pregabalin 75mg Cap	SAI	0.3007	0.3007	YES	NO	NO
02405547	PREGABALIN	Pregabalin 50mg Cap	SAI	0.2324	0.2324	YES	NO	NO
02516187	PROGESTERONE	Progesterone (Off-Formulary Interchangeable) 100mg Cap	SAI	1.4358	1.4358	YES	NO	NO
02343061	PROPAFENONE HCL	Propafenone 300mg Tab	SAI	0.5227	0.5227	YES	NO	NO
02343053	PROPAFENONE HCL	Propafenone 150mg Tab	SAI	0.2966	0.2966	YES	NO	NO
02516616	QUETIAPINE	Quetiapine Fumarate XR 50mg ER Tab	SAI	0.2501	0.2501	YES	NO	NO
02516624	QUETIAPINE	Quetiapine Fumarate XR 150mg ER Tab	SAI	0.4926	0.4926	YES	NO	NO
02516632	QUETIAPINE	Quetiapine Fumarate XR 200mg ER Tab	SAI	0.6661	0.6661	YES	NO	NO
02516640	QUETIAPINE	Quetiapine Fumarate XR 300mg ER Tab	SAI	0.9776	0.9776	YES	NO	NO
02516659	QUETIAPINE	Quetiapine Fumarate XR 400mg ER Tab	SAI	1.3270	1.3270	YES	NO	NO
02353164	QUETIAPINE	Quetiapine 25mg Tab	SAI	0.0494	0.0494	YES	NO	NO
02353172	QUETIAPINE	Quetiapine 100mg Tab	SAI	0.1318	0.1318	YES	NO	NO
02353199	QUETIAPINE	Quetiapine 200mg Tab	SAI	0.2647	0.2647	YES	NO	NO
02353202	QUETIAPINE	Quetiapine 300mg Tab	SAI	0.3863	0.3863	YES	NO	NO
02356538	RABEPRAZOLE SODIUM	Rabeprazole EC 20mg Tab	SAI	0.1338	0.1338	YES	NO	NO
02356511	RABEPRAZOLE SODIUM	Rabeprazole EC 10mg Tab	SAI	0.0669	0.0669	YES	NO	NO
02374854	RAMIPRIL	Ramipril Cap 5mg	SAI	0.0817	0.0817	YES	NO	NO
02374862	RAMIPRIL	Ramipril Cap 10mg	SAI	0.1034	0.1034	YES	NO	NO
02374846	RAMIPRIL	Ramipril Cap 2.5mg	SAI	0.0817	0.0817	YES	NO	NO
02370255	RISEDRONATE SODIUM	Risedronate 35mg Tab	SAI	1.6764	1.6764	YES	NO	NO
02528460	RISEDRONATE SODIUM	Risedronate 150mg Tab	SAI	11.1875	11.1875	YES	NO	NO
02356937	RISPERIDONE	Risperidone 4mg Tab	SAI	0.8111	0.8111	YES	NO	NO
02356910	RISPERIDONE	Risperidone 2mg Tab	SAI	0.4062	0.4062	YES	NO	NO
02356902	RISPERIDONE	Risperidone 1mg Tab	SAI	0.2031	0.2031	YES	NO	NO
02356929	RISPERIDONE	Risperidone 3mg Tab	SAI	0.6083	0.6083	YES	NO	NO
02356880	RISPERIDONE	Risperidone 0.25mg Tab	SAI	0.0878	0.0878	YES	NO	NO
02356899	RISPERIDONE	Risperidone 0.5mg Tab	SAI	0.1470	0.1470	YES	NO	NO
02442906	RIZATRIPTAN	Rizatriptan ODT (Off-Formulary Interchangeable) 5mg Orally Disintegrating Tab	SAI	11.1150	11.1150	YES	NO	NO
02442914	RIZATRIPTAN	Rizatriptan ODT (Off-Formulary Interchangeable) 10mg Orally Disintegrating Tab	SAI	11.1150	11.1150	YES	NO	NO
02516756	RIZATRIPTAN	Rizatriptan (Off-Formulary Interchangeable) 10mg Tab	SAI	11.1150	11.1150	YES	NO	NO
02405628	ROSUVASTATIN CALCIUM	Rosuvastatin 5mg Tab	SAI	0.1284	0.1284	YES	NO	NO
02405636	ROSUVASTATIN CALCIUM	Rosuvastatin 10mg Tab	SAI	0.1354	0.1354	YES	NO	NO
02405652	ROSUVASTATIN CALCIUM	Rosuvastatin 40mg Tab	SAI	0.1990	0.1990	YES	NO	NO
02405644	ROSUVASTATIN CALCIUM	Rosuvastatin 20mg Tab	SAI	0.1692	0.1692	YES	NO	NO
02419858	SALBUTAMOL	Salbutamol HFA 100mcg/Metered Dose Inh-200 dose Pk	SAI	5.0000	5.0000	YES	NO	NO
02353520	SERTRALINE HCL	Sertraline 25mg Cap	SAI	0.1516	0.1516	YES	NO	YES
02353539	SERTRALINE HCL	Sertraline 50mg Cap	SAI	0.3032	0.3032	YES	NO	YES
02353547	SERTRALINE HCL	Sertraline 100mg Cap	SAI	0.3303	0.3303	YES	NO	YES
02406160	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 100mg Tab	SAI	9.2006	9.2006	YES	NO	NO
02406152	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 50mg Tab	SAI	8.8475	8.8475	YES	NO	NO
02284766	SIMVASTATIN	Simvastatin 40mg Tab	SAI	0.2501	0.2501	YES	NO	NO
02284774	SIMVASTATIN	Simvastatin 80mg Tab	SAI	0.2501	0.2501	YES	NO	NO
02284758	SIMVASTATIN	Simvastatin 20mg Tab	SAI	0.2501	0.2501	YES	NO	NO
02284731	SIMVASTATIN	Simvastatin 10mg Tab	SAI	0.2023	0.2023	YES	NO	NO
02284723	SIMVASTATIN	Simvastatin 5mg Tab	SAI	0.1023	0.1023	YES	NO	NO
02458268	SOLIFENACIN SUCCINATE	Solifenacin 10mg Tab	SAI	0.3041	0.3041	YES	YES	NO
02458241	SOLIFENACIN SUCCINATE	Solifenacin 5mg Tab	SAI	0.3041	0.3041	YES	YES	NO
02286521	SUMATRIPTAN SUCCINATE	Sumatriptan (Off-Formulary Interchangeable) 50mg Tab	SAI	9.0650	9.0650	YES	NO	NO
02286548	SUMATRIPTAN SUCCINATE	Sumatriptan (Off-Formulary Interchangeable) 100mg Tab	SAI	9.9867	9.9867	YES	NO	NO
02457024	TADALAFIL	Tadalafil (Off-Formulary Interchangeable) 10mg Tab	SAI	11.9250	11.9250	YES	NO	NO
02457016	TADALAFIL	Tadalafil (Off-Formulary Interchangeable) 5mg Tab	SAI	3.6471	3.6471	YES	NO	NO
02457032	TADALAFIL	Tadalafil (Off-Formulary Interchangeable) 20mg Tab	SAI	12.3569	12.3569	YES	NO	NO
02427117	TAMSULOSIN HCL	Tamsulosin CR Tab 0.4mg	SAI	0.1500	0.1500	YES	NO	YES
02388944	TELMISARTAN	Telmisartan 40mg Tab	SAI	0.2161	0.2161	YES	NO	NO
02388952	TELMISARTAN	Telmisartan 80mg Tab	SAI	0.2161	0.2161	YES	NO	NO
02395363	TELMISARTAN & HYDROCHLOROTHIAZIDE	Telmisartan/HCTZ 80mg & 25mg Tab	SAI	0.2098	0.2098	YES	NO	NO
02395355	TELMISARTAN & HYDROCHLOROTHIAZIDE	Telmisartan/HCTZ 80mg & 12.5mg Tab	SAI	0.2098	0.2098	YES	NO	NO
02512327	TENOFOVIR DISOPROXIL	Tenofovir 300mg Tab	SAI	4.8884	4.8884	YES	YES	NO
02353121	TERBINAFINE HCL	Terbinafine 250mg Tab	SAI	0.7714	0.7714	YES	NO	NO
02356872	TOPIRAMATE	Topiramate 200mg Tab	SAI	0.6748	0.6748	YES	NO	NO
02356856	TOPIRAMATE	Topiramate 25mg Tab	SAI	0.2433	0.2433	YES	NO	NO
02356864	TOPIRAMATE	Topiramate 100mg Tab	SAI	0.4583	0.4583	YES	NO	NO
02525046	TRANDOLAPRIL	Trandolapril 1mg Cap	SAI	0.1762	0.1762	YES	NO	NO
02525070	TRANDOLAPRIL	Trandolapril 4mg Cap	SAI	0.2498	0.2498	YES	NO	NO
02525054	TRANDOLAPRIL	Trandolapril 2mg Cap	SAI	0.2025	0.2025	YES	NO	NO
02348799	TRAZODONE HYDROCHLORIDE	Trazodone 150mg Tab	SAI	0.1453	0.1453	YES	NO	NO
02348780	TRAZODONE HYDROCHLORIDE	Trazodone 100mg Tab	SAI	0.0989	0.0989	YES	NO	NO
02348772	TRAZODONE HYDROCHLORIDE	Trazodone 50mg Tab	SAI	0.0554	0.0554	YES	NO	NO
02515539	URSODIOL	Ursodiol C 500mg Tab	SAI	0.7242	0.7242	YES	YES	NO
02515520	URSODIOL	Ursodiol C 250mg Tab	SAI	0.3818	0.3818	YES	YES	NO
02519585	VALACYCLOVIR	Valacyclovir (Off-Formulary Interchangeable) 1000mg Tab	SAI	5.8537	N/A	YES	NO	NO
02454645	VALACYCLOVIR	Valacyclovir 500mg Tab	SAI	0.6198	0.6198	YES	NO	NO
02366940	VALSARTAN	Valsartan (Off-Formulary Interchangeable) 40mg Tab	SAI	0.5823	N/A	YES	NO	NO
02366975	VALSARTAN	Valsartan 320mg Tab	SAI	0.2098	0.2098	YES	NO	NO
02366967	VALSARTAN	Valsartan 160mg Tab	SAI	0.2159	0.2159	YES	NO	NO
02366959	VALSARTAN	Valsartan 80mg Tab	SAI	0.2159	0.2159	YES	NO	NO
02367009	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 80mg & 12.5mg Tab	SAI	0.2213	0.2213	YES	NO	NO
02367017	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 160mg & 12.5mg Tab	SAI	0.2240	0.2240	YES	NO	NO
02367041	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 320mg & 25mg Tab	SAI	0.2231	0.2231	YES	NO	NO
02367033	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 320mg & 12.5mg Tab	SAI	0.2235	0.2235	YES	NO	NO
02367025	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 160mg & 25mg Tab	SAI	0.2238	0.2238	YES	NO	NO
02520397	VARDENAFIL HCL	Vardenafil (Off-Formulary Interchangeable) 10mg Tab	SAI	10.3976	N/A	YES	NO	NO
02520400	VARDENAFIL HCL	Vardenafil (Off-Formulary Interchangeable) 20mg Tab	SAI	11.6811	N/A	YES	NO	NO
02354713	VENLAFAXINE HCL	Venlafaxine XR 37.5mg ER Cap	SAI	0.0913	0.0913	YES	NO	NO
02354721	VENLAFAXINE HCL	Venlafaxine XR 75mg ER Cap	SAI	0.1825	0.1825	YES	NO	NO
02354748	VENLAFAXINE HCL	Venlafaxine XR 150mg ER Cap	SAI	0.1927	0.1927	YES	NO	NO
02442671	ZOLMITRIPTAN	Zolmitriptan ODT (Off-Formulary Interchangeable) 2.5mg Orally Disintegrating Tab	SAI	6.8633	6.8633	YES	NO	NO
02442655	ZOLMITRIPTAN	Zolmitriptan (Off-Formulary Interchangeable) 2.5mg Tab	SAI	6.8583	6.8583	YES	NO	NO
02344122	ZOPICLONE	Zopiclone (Off-Formulary Interchangeable) 5mg Tab	SAI	0.2231	0.2231	YES	NO	NO
02282445	ZOPICLONE	Zopiclone (Off-Formulary Interchangeable) 7.5mg Tab	SAI	0.4685	0.4685	YES	NO	NO

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