A blue card with white and blue text that reads "Save up to $60 every time you fill or refill your prescription". Under the text there is a telephone number for a pharmacy locator the URL for the Exalgo website and instructions to see the important risk information. The text on the right side of the card reads "Cardholder ID: XXXXXExpiration Date: 9/30/13 Claims Processor: RESTAT BIN No: 600471 Group No: X4771 Rx PCN No: 7777 Person Code: 001." The card also has the Exalgo logo on the bottom right corner.
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![A screenshot of the Formulary update page of the Xartemis™ XR (oxycodone HCI and acetaminophen Extended-Release Tablets (CII) website. The page has a white background with a green and purple color scheme. The header reads "Formulary update" in bold purple font. Below the header there is a text box that reads "XARTEMIS XR is available unrestricted on Tier 3 for State of Connecticut EMP (CT) Commercial Patients. No PA/Step therapy requirement. Patients will have an average co-pay of [S]." <br /><br />At the bottom of the page there are four buttons each reading "Formulary Update". The website appears to be a mock-up and it appears that some placeholder text exists between brackets.<br /><br />The page also has a navigation bar at the bottom of the page which shows that the "Formulary Updates" section is selected.](https://oida-resources-images.azureedge.net/public/full/c4b34ebc-dbfb-4b3f-b1f4-387298601786.jpeg)
