Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
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| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 11089P | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11096B | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11651F | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11660Q | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11661R | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11664X | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 12632W | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 12646N | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 12656D | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 12657E | BRENTUXIMAB VEDOTINbrentuximab vedotin 50 mg injection, 1 vial | 1 | $0.00 | TK |
| 11980M | BRIGATINIBbrigatinib 30 mg tablet, 28 | 28 | $1701.72 | TK |
| 4150K | BROMAZEPAMbromazepam 3 mg tablet, 30 | 30 | $12.34 | PB |
| 4151L | BROMAZEPAMbromazepam 6 mg tablet, 30 | 30 | $15.21 | PB |
| 13979R | BROMOCRIPTINEbromocriptine 2.5 mg tablet, 30 | 30 | $10.79 | SZ |
| 1443Y | BROMOCRIPTINEbromocriptine 2.5 mg tablet, 30 | 30 | $11.94 | SZ |
| 10024N | BUDESONIDE + FORMOTEROLbudesonide 50 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.06 | AP |
| 12100W | BUDESONIDE + FORMOTEROLbudesonide 50 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.06 | AP |
| 10015D | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 10015D | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 12042T | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 12042T | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 12089G | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 12089G | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 10018G | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $26.03 | XT |
| 10018G | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $28.51 | AP |
| 12082X | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $26.03 | XT |
| 12082X | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $28.51 | AP |
| 13258T | BUDESONIDE + FORMOTEROLbudesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations | 1 | $26.04 | EV,XT |
| 13258T | BUDESONIDE + FORMOTEROLbudesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations | 1 | $28.04 | AP |
| 13336X | BUPRENORPHINEbuprenorphine 2 mg sublingual tablet, 7 | 7 | $8.82 | IR |
| 13337Y | BUPRENORPHINEbuprenorphine 8 mg sublingual tablet, 7 | 7 | $24.95 | IR |
| 10959T | BUPRENORPHINEbuprenorphine 40 microgram/hour patch, 2 | 2 | $37.20 | MF,SZ,TX |
| 13297W | BUPRENORPHINEbuprenorphine 16 mg/0.32 mL modified release injection, 0.32 mL syringe | 1 | $91.29 | UR |
| 13296T | BUPRENORPHINEbuprenorphine 24 mg/0.48 mL modified release injection, 0.48 mL syringe | 1 | $91.29 | UR |
| 10948F | BUPRENORPHINEbuprenorphine 10 microgram/hour patch, 2 | 2 | $15.88 | IU,MF,SZ,TX |
| 10970J | BUPRENORPHINEbuprenorphine 20 microgram/hour patch, 2 | 2 | $23.24 | IU,MF,SZ,TX |
| 10957Q | BUPRENORPHINEbuprenorphine 5 microgram/hour patch, 2 | 2 | $9.85 | IU,MF,SZ,TX |
| 13310M | BUPRENORPHINEbuprenorphine 400 microgram sublingual tablet, 7 | 7 | $5.48 | IR |
| 10953L | BUPRENORPHINEbuprenorphine 15 microgram/hour patch, 2 | 2 | $19.56 | IU,MF,SZ,TX |
| 13314R | BUPRENORPHINEbuprenorphine 32 mg/0.64 mL modified release injection, 0.64 mL syringe | 1 | $91.29 | UR |
| 13328L | BUPRENORPHINEbuprenorphine 8 mg/0.16 mL modified release injection, 0.16 mL syringe | 1 | $91.29 | UR |
| 10964C | BUPRENORPHINEbuprenorphine 25 microgram/hour patch, 2 | 2 | $26.73 | MF,SZ,TX |
| 10949G | BUPRENORPHINEbuprenorphine 30 microgram/hour patch, 2 | 2 | $30.21 | MF,SZ,TX |
| 13322E | BUPRENORPHINE + NALOXONEbuprenorphine 2 mg + naloxone 500 microgram sublingual film, 28 | 28 | $48.05 | IR |
| 13321D | BUPRENORPHINE + NALOXONEbuprenorphine 8 mg + naloxone 2 mg sublingual film, 28 | 28 | $123.97 | IR |
| 4376H | CABAZITAXELcabazitaxel 60 mg/3 mL injection, 3 mL vial | 1 | $0.00 | IT,JU,OC,RQ |
| 7236W | CABAZITAXELcabazitaxel 60 mg/3 mL injection, 3 mL vial | 1 | $0.00 | IT,JU,OC,RQ |
| 13901P | CABERGOLINEcabergoline 500 microgram tablet, 8 | 8 | $55.94 | PF |
| 13577N | CALCIPOTRIOL + BETAMETHASONE DIPROPIONATEcalcipotriol 0.005% + betamethasone (as dipropionate) 0.05% ointment, 30 g | 1 | $28.32 | LO,SZ |
| 13520N | CALCIPOTRIOL + BETAMETHASONE DIPROPIONATEcalcipotriol 0.005% + betamethasone (as dipropionate) 0.05% foam, 60 g | 1 | $75.66 | LO |
| 2997R | CALCITONIN SALMONcalcitonin salmon 100 units/mL injection, 5 x 1 mL ampoules | 5 | $39.85 | EU |
| 13457G | CALCITRIOLcalcitriol 0.25 microgram capsule, 100 | 100 | $18.43 | AF,RW,TX,XT,ZS |
| 13457G | CALCITRIOLcalcitriol 0.25 microgram capsule, 100 | 100 | $20.72 | IX |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $9.20 | PP |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $7.88 | CR |
| 13547B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 240 | 240 | $10.98 | AE |
| 11726E | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.35 | PP |
| 11845K | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.35 | PP |
| 13485R | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $9.20 | PP |
| 13565Y | CANDESARTANcandesartan cilexetil 16 mg tablet, 30 | 30 | $6.44 | AF,BG,IB,RF,SZ,TX,VO |
| 13565Y | CANDESARTANcandesartan cilexetil 16 mg tablet, 30 | 30 | $19.91 | LM |
| 13438G | CANDESARTANcandesartan cilexetil 32 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13438G | CANDESARTANcandesartan cilexetil 32 mg tablet, 30 | 30 | $18.22 | LM |
| 13592J | CANDESARTANcandesartan cilexetil 4 mg tablet, 30 | 30 | $5.02 | AF,BG,IB,RF,SZ,TX,VO |
| 13592J | CANDESARTANcandesartan cilexetil 4 mg tablet, 30 | 30 | $18.47 | LM |
| 13436E | CANDESARTANcandesartan cilexetil 8 mg tablet, 30 | 30 | $5.02 | AF,BG,IB,RF,SZ,TX,VO |
| 13436E | CANDESARTANcandesartan cilexetil 8 mg tablet, 30 | 30 | $18.47 | LM |
| 13391T | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 16 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13391T | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 16 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $19.70 | LM |
| 13452B | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13452B | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $17.79 | LM |
| 13392W | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $7.15 | AF,BG,IB,RF,SZ,TX,VO |
| 13392W | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $18.00 | LM |
| 14051M | CARBAMAZEPINEcarbamazepine 100 mg/5 mL oral liquid, 300 mL | 1 | $15.29 | NV |
| 2422L | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $7.52 | NM |
| 2422L | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $8.85 | NV |
| 5039F | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $7.52 | NM |
| 5039F | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $8.85 | NV |
| 1706T | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $11.02 | NM |
| 1706T | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $12.33 | NV |
| 1724R | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $11.02 | NM |
| 1724R | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $12.33 | NV |
| 14050L | CARBAMAZEPINEcarbamazepine 200 mg modified release tablet, 200 | 200 | $20.09 | NV |
| 13918M | CARBAMAZEPINEcarbamazepine 400 mg modified release tablet, 200 | 200 | $36.09 | NV |
| 1153Q | CARBIMAZOLEcarbimazole 5 mg tablet, 100 | 100 | $12.65 | GH,NB,TN |
| 13967D | CARBIMAZOLEcarbimazole 5 mg tablet, 100 | 100 | $11.50 | GH,NB,TN |
| 8369L | CARBOHYDRATE, FAT, VITAMINS, MINERALS AND TRACE ELEMENTScarbohydrate, fat, vitamins, minerals and trace elements powder for oral liquid, 400 g | 1 | $31.27 | SB |
| 10039J | CARBOHYDRATES, FAT, VITAMINS, MINERALS, TRACE ELEMENTS AND SUPPLEMENTED WITH ARACHIDONIC ACID AND DOCOSAHEXAENOIC ACIDcarbohydrates, fat, vitamins, minerals, trace elements and supplemented with arachidonic acid and docosahexaenoic acid providing 200 kilocalories powder for oral liquid, 30 x 43 g sachets | 1 | $105.99 | VF |
| 5504Q | CARBOMER-980carbomer-980 0.2% eye drops, 30 x 600 mg ampoules | 1 | $7.43 | UO |
| 8578L | CARBOMER-980carbomer-980 0.2% eye drops, 30 x 600 mg ampoules | 1 | $7.43 | UO |
| 4309T | CARBOPLATINcarboplatin 450 mg/45 mL injection, 45 mL vial | 1 | $0.00 | OC |
| 7222D | CARBOPLATINcarboplatin 450 mg/45 mL injection, 45 mL vial | 1 | $0.00 | OC |
| 11229B | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 11230C | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 12243J | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 12244K | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 13637R | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 13638T | CARFILZOMIBcarfilzomib 60 mg injection, 1 vial | 1 | $0.00 | AN |
| 2324H | CARMELLOSE SODIUMcarmellose sodium 1% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 5505R | CARMELLOSE SODIUMcarmellose sodium 1% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 2338C | CARMELLOSE SODIUMcarmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 5506T | CARMELLOSE SODIUMcarmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 13418F | CARVEDILOLcarvedilol 12.5 mg tablet, 60 | 60 | $7.74 | AF,PB,RF,RW,SZ,TX,ZS |
| 13387N | CARVEDILOLcarvedilol 25 mg tablet, 60 | 60 | $9.09 | AF,PB,RF,RW,SZ,TX,ZS |
| 13417E | CARVEDILOLcarvedilol 6.25 mg tablet, 60 | 60 | $6.65 | AF,PB,RF,RW,SZ,TX,ZS |
| 11963P | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $5.02 | AF,TX |
| 11963P | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $9.74 | AS |
| 2655R | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $5.02 | AF,TX |
| 2655R | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $9.74 | AS |
| 10778G | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $5.02 | AF,BG,CR,GQ,SZ,TX,VO |
| 10778G | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $11.30 | AS |
| 11934D | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $5.02 | AF,BG,CR,GQ,SZ,TX,VO |
| 11934D | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $11.30 | AS |
| 1797N | CEFAZOLINcefazolin 1 g injection, 5 vials | 5 | $6.61 | AE |
| 1799Q | CEFAZOLINcefazolin 1 g injection, 5 vials | 5 | $6.61 | AE |
| 1256D | CEFAZOLINcefazolin 500 mg injection, 5 vials | 5 | $6.00 | AE |
| 5477G | CEFAZOLINcefazolin 500 mg injection, 5 vials | 5 | $6.00 | AE |
| 8315P | CEFEPIMEcefepime 1 g injection, 1 vial | 1 | $4.47 | OE,PK |
| 8316Q | CEFEPIMEcefepime 2 g injection, 1 vial | 1 | $4.76 | OE,PK |
| 1783W | CEFTRIAXONEceftriaxone 500 mg injection, 1 vial | 1 | $3.61 | AE |
| 12112L | CEFTRIAXONEceftriaxone 2 g injection, 10 vials | 10 | $36.87 | AF,AL |
| 12114N | CEFTRIAXONEceftriaxone 1 g injection, 10 vials | 10 | $36.66 | AF,AL |
| 13643C | CEFUROXIMEcefuroxime 125 mg/5 mL powder for oral liquid, 70 mL | 1 | $52.04 | RQ |
| 13653N | CEFUROXIMEcefuroxime 125 mg/5 mL powder for oral liquid, 70 mL | 1 | $52.04 | RQ |
| 13135H | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13152F | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13153G | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13159N | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13160P | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13161Q | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13162R | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 13169D | CEMIPLIMABcemiplimab 350 mg/7 mL injection, 7 mL vial | 1 | $0.00 | WM |
| 11319R | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 11322X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 11323Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 12027B | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 10904X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 10905Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 10909E | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 12063X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 9599F | CETRORELIXcetrorelix 250 microgram injection [1 vial] (&) inert substance diluent [1 mL syringe], 1 pack | 1 | $40.98 | SG |
| 10262D | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 10265G | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 12816M | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 12817N | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 12820R | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 12821T | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 4312Y | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 4435K | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 4436L | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 4731B | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 7223E | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 7240C | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 7242E | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 7273T | CETUXIMABcetuximab 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | SG |
| 1163F | CHLORAMBUCILchlorambucil 2 mg tablet, 25 | 25 | $31.97 | AS |
| 13500M | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $5.10 | GH |
| 1585K | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $6.25 | GH |
| 13300B | CHORIOGONADOTROPIN ALFAchoriogonadotropin alfa 250 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $52.79 | SG |
| 14001X | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $345.70 | NV |
| 5633L | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $315.79 | NV |
| 6125J | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $325.79 | NV |
| 8661W | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $345.61 | NV |
| 13999T | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $41.91 | NV |
| 5632K | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $37.20 | NV |
| 6232B | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $39.20 | NV |
| 8657P | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $42.31 | NV |
| 13911E | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.41 | NM,NV,TX |
| 5636P | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $93.45 | NM,NV,TX |
| 6354K | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $97.19 | NM,NV,TX |
| 8660T | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.31 | NM,NV,TX |
| 13883Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $24.86 | NM,NV,TX |
| 5634M | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $22.04 | NM,NV,TX |
| 6352H | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $23.04 | NM,NV,TX |
| 8658Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $26.01 | NM,NV,TX |
| 13910D | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.69 | NM,NV,TX |
| 5635N | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $45.87 | NM,NV,TX |
| 6353J | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $47.70 | NM,NV,TX |
| 8659R | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.63 | NM,NV,TX |
| 11887P | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $23.72 | AL,CR |
| 11891W | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $25.72 | AL,CR |
| 5621W | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $23.72 | AL,CR |
| 9625N | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $25.72 | AL,CR |
| 11886N | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $47.44 | AL,CR |
| 11889R | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $49.44 | AL,CR |
| 5622X | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $47.44 | AL,CR |
| 9626P | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $49.44 | AL,CR |
| 11885M | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $71.16 | AF,AL,CR |
| 11888Q | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $74.01 | AF,AL,CR |
| 5623Y | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $71.16 | AF,AL,CR |
| 9627Q | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $74.01 | AF,AL,CR |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $11.90 | NM |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $14.08 | NV |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $11.90 | NM |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $14.08 | NV |
| 4319H | CISPLATINcisplatin 100 mg/100 mL injection, 100 mL vial | 1 | $0.00 | OC |
| 7224F | CISPLATINcisplatin 100 mg/100 mL injection, 100 mL vial | 1 | $0.00 | OC |
| 2091C | CITRIC ACID + LAURYL SULFOACETATE SODIUM + SORBITOLsodium citrate dihydrate 450 mg/5 mL + lauryl sulfoacetate sodium 45 mg/5 mL + sorbitol 3.125 g/5 mL enema, 12 x 5 mL | 1 | $14.18 | AE |
| 5331N | CITRIC ACID + LAURYL SULFOACETATE SODIUM + SORBITOLsodium citrate dihydrate 450 mg/5 mL + lauryl sulfoacetate sodium 45 mg/5 mL + sorbitol 3.125 g/5 mL enema, 12 x 5 mL | 1 | $14.18 | AE |
| 5481L | CITRULLINE WITH CARBOHYDRATEcitrulline with carbohydrate containing 1 g citrulline powder for oral liquid, 30 x 4 g sachets | 1 | $109.88 | VF |
| 11604R | CLADRIBINEcladribine 10 mg tablet, 4 | 4 | $14642.44 | SG |
| 4326Q | CLADRIBINEcladribine 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AF,IX |
| 7225G | CLADRIBINEcladribine 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AF,IX |
| 3138E | CLINDAMYCINclindamycin 150 mg capsule, 24 | 24 | $6.79 | AF,BZ,PF,RW,TX,XT |
| 1808E | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $6.07 | PB |
| 5339B | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $6.07 | PB |
| 1806C | CLONAZEPAMclonazepam 2 mg tablet, 100 | 100 | $11.80 | AF |
| 1805B | CLONAZEPAMclonazepam 500 microgram tablet, 100 | 100 | $9.08 | AF |
| 11520H | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $6.62 | PB |
| 11559J | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $5.47 | PB |
| 13578P | CLONIDINEclonidine hydrochloride 100 microgram tablet, 100 | 100 | $14.64 | IX,TX |
| 13548C | CLONIDINEclonidine hydrochloride 150 microgram tablet, 100 | 100 | $20.81 | IX |
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