$

product A least expensive

$$

product B more expensive than A

$$$

product C more expensive than B

$$$$

product D more expensive than C

$$$$$

product E more expensive than D

!!!!!

product F is substantially more expensive than A-E

Non-Formulary

product G not part of the formulary

MAC

Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand.

Drug Name (Generic Name)

The BRAND NAME of the drug followed by generic in parentheses or the generic name only.

Strength and/or Dosage

The dosage of a drug covered if not all strengths are formulary as in half-strength program.