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 |
|---|---|---|---|---|
| 13551F | NICORANDILnicorandil 20 mg tablet, 60 | 1 | $14.55 | AF |
| 13502P | NIFEDIPINEnifedipine 30 mg modified release tablet, 30 | 30 | $9.35 | TX |
| 13376B | NIFEDIPINEnifedipine 60 mg modified release tablet, 30 | 30 | $11.12 | TX |
| 2732T | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.17 | AF,IL |
| 5359C | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.17 | AF,IL |
| 11900H | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 11906P | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 13240W | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 13246E | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 14231B | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 14232C | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 14233D | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 14260M | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 15224G | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 15238B | NIVOLUMABnivolumab 40 mg/4 mL injection, 4 mL vial | 1 | $0.00 | BQ |
| 14664T | NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BQ |
| 14676K | NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BQ |
| 14677L | NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BQ |
| 14678M | NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BQ |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $12.90 | AF,RF |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $20.49 | RW |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $12.90 | AF,RF |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $20.49 | RW |
| 13873E | NORETHISTERONEnorethisterone 5 mg tablet, 30 | 30 | $24.67 | BN |
| 10407R | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 10418H | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11455X | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11456Y | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11457B | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11458C | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11460E | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11462G | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11468N | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11473W | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 12193R | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 12204H | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 13787P | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 13793Y | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 15251Q | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 15265K | OBINUTUZUMABobinutuzumab 1 g/40 mL injection, 40 mL vial | 1 | $0.00 | RO |
| 11237K | OCRELIZUMABocrelizumab 300 mg/10 mL injection, 10 mL vial | 1 | $8348.18 | RO |
| 11242Q | OCRELIZUMABocrelizumab 300 mg/10 mL injection, 10 mL vial | 1 | $8328.18 | RO |
| 14178F | OCTREOTIDEoctreotide 50 microgram/mL injection, 5 x 1 mL vials | 5 | $36.45 | GQ |
| 14213C | OCTREOTIDEoctreotide 50 microgram/mL injection, 5 x 1 mL vials | 5 | $37.91 | GQ |
| 14201K | OCTREOTIDEoctreotide 500 microgram/mL injection, 5 x 1 mL vials | 5 | $106.13 | GQ |
| 14218H | OCTREOTIDEoctreotide 500 microgram/mL injection, 5 x 1 mL vials | 5 | $103.91 | GQ |
| 14177E | OCTREOTIDEoctreotide 100 microgram/mL injection, 5 x 1 mL vials | 5 | $38.24 | GQ |
| 14219J | OCTREOTIDEoctreotide 100 microgram/mL injection, 5 x 1 mL vials | 5 | $36.77 | GQ |
| 10550G | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $603.66 | NV,TB |
| 10558Q | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $623.66 | NV,TB |
| 11512X | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $623.66 | NV,TB |
| 11893Y | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $603.66 | NV,TB |
| 11894B | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $623.66 | NV,TB |
| 11896D | OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $623.66 | NV,TB |
| 10543X | OCTREOTIDEoctreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $394.58 | NV,TB |
| 10566D | OCTREOTIDEoctreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $410.36 | NV,TB |
| 11501H | OCTREOTIDEoctreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $410.36 | NV,TB |
| 10533J | OCTREOTIDEoctreotide 20 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $525.31 | NV,TB |
| 10549F | OCTREOTIDEoctreotide 20 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $545.31 | NV,TB |
| 11537F | OCTREOTIDEoctreotide 20 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $545.31 | NV,TB |
| 6227R | OCTREOTIDEoctreotide 50 microgram/mL injection, 5 x 1 mL ampoules | 5 | $14.56 | HQ,NV,RA |
| 9508K | OCTREOTIDEoctreotide 50 microgram/mL injection, 5 x 1 mL ampoules | 5 | $14.00 | HQ,NV,RA |
| 6228T | OCTREOTIDEoctreotide 100 microgram/mL injection, 5 x 1 mL ampoules | 5 | $29.12 | HQ,NV,RA |
| 9509L | OCTREOTIDEoctreotide 100 microgram/mL injection, 5 x 1 mL ampoules | 5 | $28.00 | HQ,NV,RA |
| 6229W | OCTREOTIDEoctreotide 500 microgram/mL injection, 5 x 1 mL ampoules | 5 | $106.13 | HQ,NV,RA |
| 9510M | OCTREOTIDEoctreotide 500 microgram/mL injection, 5 x 1 mL ampoules | 5 | $103.91 | HQ,NV,RA |
| 15134M | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15150J | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15163C | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15165E | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15182C | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15196T | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15135N | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15136P | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15157R | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15185F | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15192N | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15195R | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15151K | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15167G | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15174P | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15183D | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15184E | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15186G | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15158T | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15164D | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15166F | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15181B | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15193P | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15194Q | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 12642J | OFATUMUMABofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device | 1 | $2109.64 | NV |
| 5567B | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 8383F | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 9294E | OLANZAPINEolanzapine 210 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $157.31 | PB |
| 9295F | OLANZAPINEolanzapine 300 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $256.01 | PB |
| 11503K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11522K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12169L | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12170M | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12921C | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12932P | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13782J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13783K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14181J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14216F | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14689D | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11528R | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 11539H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12157W | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12161C | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12913P | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12929L | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13800H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13807Q | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14208T | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14215E | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14687B | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $6.58 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $10.58 | AL |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $8.56 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $13.06 | AL |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $8.03 | AF,CR,RW,SZ,TY,WG |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $12.03 | AL |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $6.35 | AF,CR,RW,SZ,TY,WG |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $10.35 | AL |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $8.44 | AF,CR,RW,SZ,TY,WG |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $12.44 | AL |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.70 | AL,TX |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.96 | AF |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.85 | AL,TX |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $16.85 | AF |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.23 | AL,TX |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $17.23 | AF |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.45 | AL,TX |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $12.45 | AF |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.29 | AL,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.29 | AF |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $8.19 | AF,CR,RW,SZ,TX,TY,WG |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.06 | AL |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.76 | AF,CR,RW,SZ,TX,TY,WG |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.76 | AL |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $7.53 | AF,CR,RW,SZ,TX,TY,WG |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.39 | AL |
| 14903J | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL pen device | 1 | $217.43 | NV |
| 14937E | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL pen device | 1 | $209.07 | NV |
| 14938F | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL pen device | 1 | $217.43 | NV |
| 14945N | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL pen device | 1 | $209.07 | NV |
| 11163M | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $217.43 | EW |
| 11168T | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $209.07 | EW |
| 11175E | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $217.43 | EW |
| 11176F | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $209.07 | EW |
| 14911T | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $217.43 | EW |
| 14946P | OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe | 1 | $209.07 | EW |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 12272X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | FJ,FQ,SZ |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $12.68 | PB |
| 14364B | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14533X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14558F | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | AF,RW,TX,WG |
| 14432N | OMEPRAZOLEomeprazole 10 mg enteric tablet, 30 | 30 | $6.22 | PB |
| 12281J | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14464G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14465H | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $5.53 | AF,CR,HX,SZ,TX,WG |
| 14559G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 15268N | OPICAPONEopicapone 50 mg capsule, 30 | 30 | $143.19 | XY |
| 4542C | OXALIPLATINoxaliplatin 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BX,OC,RA |
| 7253R | OXALIPLATINoxaliplatin 100 mg/20 mL injection, 20 mL vial | 1 | $0.00 | BX,OC,RA |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.17 | AF,TX,WG |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $6.01 | RW |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $9.09 | AS |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.17 | AF,TX,WG |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $6.01 | RW |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $9.09 | AS |
| 3134Y | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $5.17 | AF,AS |
| 5371Q | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $5.17 | AF,AS |
| 13936L | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.36 | NV |
| 8588B | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.68 | NV |
| 14562K | OXCARBAZEPINEoxcarbazepine 150 mg tablet, 100 | 100 | $45.68 | NV |
| 14033N | OXCARBAZEPINEoxcarbazepine 300 mg tablet, 100 | 100 | $74.85 | NV |
| 13935K | OXCARBAZEPINEoxcarbazepine 600 mg tablet, 100 | 100 | $125.09 | NV |
| 13984B | OXYBUTYNINoxybutynin 3.9 mg/24 hours patch, 8 | 1 | $28.79 | TT |
| 13957N | OXYBUTYNINoxybutynin hydrochloride 5 mg tablet, 100 | 100 | $11.30 | SW |
| 12031F | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 12074L | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 12518W | OXYCODONEoxycodone hydrochloride 10 mg modified release tablet, 28 | 28 | $13.46 | MF,SZ |
| 12545G | OXYCODONEoxycodone hydrochloride 15 mg modified release tablet, 28 | 28 | $21.70 | MF |
| 12510K | OXYCODONEoxycodone hydrochloride 20 mg modified release tablet, 28 | 28 | $21.94 | MF,SZ |
| 12538X | OXYCODONEoxycodone hydrochloride 30 mg modified release tablet, 28 | 28 | $35.28 | MF |
| 12525F | OXYCODONEoxycodone hydrochloride 40 mg modified release tablet, 28 | 28 | $31.92 | MF,SZ |
| 12527H | OXYCODONEoxycodone hydrochloride 80 mg modified release tablet, 28 | 28 | $50.73 | MF,SZ |
| 12511L | OXYCODONE + NALOXONEoxycodone hydrochloride 60 mg + naloxone hydrochloride 30 mg modified release tablet, 28 | 28 | $68.86 | MF,TX |
| 12498T | OXYCODONE + NALOXONEoxycodone hydrochloride 80 mg + naloxone hydrochloride 40 mg modified release tablet, 28 | 28 | $72.52 | MF,TX |
| 12471J | OXYCODONE + NALOXONEoxycodone hydrochloride 2.5 mg + naloxone hydrochloride 1.25 mg modified release tablet, 28 | 28 | $12.32 | MF,TX |
| 12540B | OXYCODONE + NALOXONEoxycodone hydrochloride 15 mg + naloxone hydrochloride 7.5 mg modified release tablet, 28 | 28 | $25.54 | MF,TX |
| 12532N | OXYCODONE + NALOXONEoxycodone hydrochloride 30 mg + naloxone hydrochloride 15 mg modified release tablet, 28 | 28 | $41.83 | MF,TX |
| 12523D | OXYCODONE + NALOXONEoxycodone hydrochloride 10 mg + naloxone hydrochloride 5 mg modified release tablet, 28 | 28 | $16.51 | MF,TX |
| 12486E | OXYCODONE + NALOXONEoxycodone hydrochloride 20 mg + naloxone hydrochloride 10 mg modified release tablet, 28 | 28 | $27.38 | MF,TX |
| 12475N | OXYCODONE + NALOXONEoxycodone hydrochloride 40 mg + naloxone hydrochloride 20 mg modified release tablet, 28 | 28 | $40.12 | MF,TX |
| 12522C | OXYCODONE + NALOXONEoxycodone hydrochloride 5 mg + naloxone hydrochloride 2.5 mg modified release tablet, 28 | 28 | $15.66 | MF,TX |
| 4567J | PACLITAXELpaclitaxel 300 mg/50 mL injection, 50 mL vial | 1 | $0.00 | OC,SZ |
| 7254T | PACLITAXELpaclitaxel 300 mg/50 mL injection, 50 mL vial | 1 | $0.00 | OC,SZ |
| 15087C | PALOVAROTENEpalovarotene 10 mg capsule, 28 | 28 | $99981.03 | IS |
| 12595X | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.65 | GO |
| 13407P | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.67 | GO |
| 13560Q | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.48 | GO |
| 8020D | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.47 | GO |
| 13470Y | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.77 | GO |
| 8021E | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.74 | GO |
| 13375Y | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.97 | GO |
| 5453B | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.96 | GO |
| 10069Y | PANITUMUMABpanitumumab 400 mg/20 mL injection, 20 mL vial | 1 | $0.00 | AN |
| 10082P | PANITUMUMABpanitumumab 400 mg/20 mL injection, 20 mL vial | 1 | $0.00 | AN |
| 10508C | PANITUMUMABpanitumumab 400 mg/20 mL injection, 20 mL vial | 1 | $0.00 | AN |
| 10513H | PANITUMUMABpanitumumab 400 mg/20 mL injection, 20 mL vial | 1 | $0.00 | AN |
| 12282K | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | BG,CR,TW,TX |
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