00569771 | ACYCLOVIR | Zovirax (Off-Formulary Interchangeable) 5% Top Oint | VAL | N/A | N/A | YES | NO | NO |
02089602 | BECLOMETHASONE DIPROPIONATE | Propaderm 0.025% Cr | VAL | 0.5969 | 0.5969 | NO | NO | NO |
02473623 | BRODALUMAB | Siliq 210mg/1.5mL Inj Sol-Pref Syr | VAL | 645.0000 | 645.0000 | NO | YES | NO |
02275090 | BUPROPION HCL | Wellbutrin XL 150mg ER Tab | VAL | 0.6211 | 0.2926 | YES | YES | NO |
02275104 | BUPROPION HCL | Wellbutrin XL 300mg ER Tab | VAL | 1.2425 | 0.5853 | YES | YES | NO |
02238441 | BUPROPION HCL | Zyban 150mg SR Tab | VAL | 1.3275 | 1.3275 | NO | YES | NO |
02237825 | BUPROPION HCL | Wellbutrin SR (Not a Benefit) 150mg Tab | VAL | N/A | N/A | YES | NO | NO |
02250535 | CICLOPIROX | Penlac (Off-Formulary Interchangeable) 8% W/W Top Sol | VAL | N/A | N/A | YES | NO | YES |
02248472 | CLINDAMYCIN PHOSPHATE & BENZOYL PEROXIDE | BenzaClin Topical Gel 1% & 5% Top Gel | VAL | 1.3169 | 0.7422 | YES | NO | NO |
02373955 | COLESEVELAM HYDROCHLORIDE | Lodalis 625mg Tab | VAL | 1.3906 | 0.5931 | YES | NO | YES |
02238162 | DIAZEPAM | Diastat 5mg/mL Rect Gel-2x 5mg Pk | VAL | 214.0310 | 214.0310 | NO | NO | NO |
09853340 | DIAZEPAM | Diastat 5mg/mL Rect Gel-2x10mg Pk | VAL | 214.0310 | 214.0310 | NO | NO | NO |
09853430 | DIAZEPAM | Diastat 5mg/mL Rect Gel-2x15mg Pk | VAL | 214.0310 | 214.0310 | NO | NO | NO |
02097273 | DILTIAZEM HCL | Cardizem CD 300mg LA Cap | VAL | 3.5755 | 0.7999 | YES | NO | NO |
02097249 | DILTIAZEM HCL | Cardizem CD 120mg LA Cap | VAL | 1.6244 | 0.3634 | YES | NO | NO |
02097257 | DILTIAZEM HCL | Cardizem CD 180mg LA Cap | VAL | 2.1565 | 0.4824 | YES | NO | NO |
02097265 | DILTIAZEM HCL | Cardizem CD 240mg LA Cap | VAL | 2.8604 | 0.6399 | YES | NO | NO |
02231152 | DILTIAZEM HCL | Tiazac 240mg SR Cap | VAL | 2.1304 | 0.3832 | YES | NO | NO |
02231151 | DILTIAZEM HCL | Tiazac 180mg SR Cap | VAL | 1.6062 | 0.2889 | YES | NO | NO |
02231150 | DILTIAZEM HCL | Tiazac 120mg SR Cap | VAL | 1.2023 | 0.2133 | YES | NO | NO |
02231155 | DILTIAZEM HCL | Tiazac 360mg SR Cap | VAL | 3.2124 | 0.5778 | YES | NO | NO |
02231154 | DILTIAZEM HCL | Tiazac 300mg SR Cap | VAL | 2.6682 | 0.4720 | YES | NO | NO |
00247960 | ETHAMBUTOL HCL | Etibi 100mg Tab | VAL | 0.2784 | 0.2784 | YES | NO | NO |
00247979 | ETHAMBUTOL HCL | Etibi 400mg Tab | VAL | 0.8355 | 0.8355 | YES | NO | NO |
00330582 | FLUOROURACIL | Efudex 5% Cr | VAL | 1.1341 | 1.1341 | NO | NO | NO |
00012696 | FLURAZEPAM | Dalmane (Not a Benefit) 15mg Cap | VAL | N/A | N/A | YES | NO | NO |
00012718 | FLURAZEPAM | Dalmane (Not a Benefit) 30mg Cap | VAL | N/A | N/A | YES | NO | NO |
09857622 | IMIQUIMOD | Aldara P (Off-Formulary Interchangeable) 5% Top Cr | VAL | N/A | N/A | YES | NO | NO |
00236683 | LITHIUM CARBONATE | Carbolith 300mg Cap | VAL | 0.1212 | 0.0657 | YES | NO | NO |
00461733 | LITHIUM CARBONATE | Carbolith 150mg Cap | VAL | 0.1560 | 0.0667 | YES | NO | NO |
02300451 | METFORMIN HCL | Glumetza (Off-Formulary Interchangeable) 1000mg ER Tab | VAL | N/A | N/A | YES | NO | NO |
02156091 | METRONIDAZOLE | Noritate 1% Top Cr | VAL | 0.7989 | 0.7989 | NO | NO | NO |
02312263 | NABILONE | Cesamet (Off-Formulary Interchangeable) 0.25mg Cap | VAL | N/A | N/A | YES | NO | NO |
00548375 | NABILONE | Cesamet 1mg Cap | VAL | 8.3582 | 3.6669 | YES | NO | NO |
02256193 | NABILONE | Cesamet 0.5mg Cap | VAL | 4.1793 | 1.8886 | YES | NO | NO |
00268593 | NICOTINIC ACID | Niacin-ICN (Not a Benefit) 50mg Tab | VAL | N/A | N/A | YES | NO | YES |
02247238 | PIMECROLIMUS | Elidel 1% Cr | VAL | 2.9720 | 2.9720 | NO | YES | NO |
00869953 | PYRIDOSTIGMINE BROMIDE | Mestinon 180mg LA Tab | VAL | 1.4239 | 1.4239 | NO | NO | NO |
00869961 | PYRIDOSTIGMINE BROMIDE | Mestinon 60mg Tab | VAL | 0.6384 | 0.2673 | YES | NO | NO |
00393444 | RIFAMPIN | Rofact 150mg Cap | VAL | 0.9001 | 0.9001 | NO | NO | YES |
00343617 | RIFAMPIN | Rofact 300mg Cap | VAL | 1.4169 | 1.4169 | NO | NO | YES |
00029246 | TESTOSTERONE ENANTHATE | Delatestryl 1000mg/5mL Oily Inj Sol-5mL Pk | VAL | 68.8536 | 35.5943 | YES | YES | NO |
02199270 | TETRABENAZINE | Nitoman (Off-Formulary Interchangeable) 25mg Tab | VAL | N/A | N/A | YES | NO | NO |
00268631 | THIAMINE HCL | Vitamin B1-ICN (Not a Benefit) 50mg Tab | VAL | N/A | N/A | YES | NO | NO |
01926489 | TRETINOIN | Vitamin A Acid 0.05% Gel | VAL | 0.4266 | 0.4266 | NO | YES | NO |
01926462 | TRETINOIN | Vitamin A Acid 0.01% Gel | VAL | 0.4266 | 0.4266 | NO | YES | NO |
02194058 | TRIAMCINOLONE ACETONIDE | Aristocort R (Not a Benefit) 0.1% Cr | VAL | N/A | N/A | YES | NO | NO |
00718149 | TRYPTOPHAN | Tryptan (Off-Formulary Interchangeable) 500mg Cap | VAL | N/A | N/A | YES | NO | NO |
02029456 | TRYPTOPHAN | Tryptan (Off-Formulary Interchangeable) 500mg Tab | VAL | N/A | N/A | YES | NO | NO |
02239327 | TRYPTOPHAN | Tryptan (Off-Formulary Interchangeable) 750mg Tab | VAL | N/A | N/A | YES | NO | NO |
00654531 | TRYPTOPHAN | Tryptan (Off-Formulary Interchangeable) 1g Tab | VAL | N/A | N/A | YES | NO | NO |
02370433 | ZOLPIDEM TARTRATE | Sublinox (Off-Formulary Interchangeable) 10mg SL Tab | VAL | N/A | N/A | YES | NO | NO |
02391678 | ZOLPIDEM TARTRATE | Sublinox (Off-Formulary Interchangeable) 5mg SL Tab | VAL | N/A | N/A | YES | NO | NO |