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 |
|---|---|---|---|---|
| 13498K | SIMVASTATINsimvastatin 80 mg tablet, 30 | 30 | $6.22 | AF,RW,SZ,TX,WG |
| 13528B | SIMVASTATINsimvastatin 10 mg tablet, 30 | 30 | $5.17 | AF,RW,SZ,TX,WG |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $5.34 | AF,RW,SZ,WG |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $14.58 | MQ |
| 13559P | SIMVASTATINsimvastatin 5 mg tablet, 30 | 30 | $5.17 | AF,SZ |
| 13885T | SIROLIMUSsirolimus 1 mg/mL oral liquid, 60 mL | 1 | $513.49 | PF |
| 6437T | SIROLIMUSsirolimus 1 mg/mL oral liquid, 60 mL | 1 | $480.49 | PF |
| 9550P | SIROLIMUSsirolimus 1 mg/mL oral liquid, 60 mL | 1 | $462.01 | PF |
| 13860L | SIROLIMUSsirolimus 500 microgram tablet, 100 | 100 | $331.61 | PF |
| 9747B | SIROLIMUSsirolimus 500 microgram tablet, 100 | 100 | $293.77 | PF |
| 9748C | SIROLIMUSsirolimus 500 microgram tablet, 100 | 100 | $305.52 | PF |
| 14072P | SIROLIMUSsirolimus 1 mg tablet, 100 | 100 | $645.27 | PF |
| 6436R | SIROLIMUSsirolimus 1 mg tablet, 100 | 100 | $607.52 | PF |
| 9549N | SIROLIMUSsirolimus 1 mg tablet, 100 | 100 | $587.52 | PF |
| 13886W | SIROLIMUSsirolimus 2 mg tablet, 100 | 100 | $1252.09 | PF |
| 6457W | SIROLIMUSsirolimus 2 mg tablet, 100 | 100 | $1195.06 | PF |
| 9548M | SIROLIMUSsirolimus 2 mg tablet, 100 | 100 | $1175.06 | PF |
| 14058X | SITAGLIPTINsitagliptin 50 mg tablet, 28 | 28 | $20.18 | AF,CR,GQ,RA,SZ,XT,XW |
| 13871C | SITAGLIPTINsitagliptin 100 mg tablet, 28 | 28 | $20.18 | AF,CR,GQ,RA,SZ,XT,XW |
| 14021Y | SITAGLIPTINsitagliptin 25 mg tablet, 28 | 28 | $20.18 | AF,CR,GQ,RA,SZ,XT,XW |
| 13990H | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $35.22 | AL,SZ,XW |
| 13994M | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 500 mg tablet, 56 | 56 | $24.32 | AF,CR,RA,SZ,XT,XW |
| 14064F | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 850 mg tablet, 56 | 56 | $25.05 | AF,CR,RA,SZ,XT,XW |
| 14031L | SITAGLIPTIN + METFORMINsitagliptin 100 mg + metformin hydrochloride 1 g modified release tablet, 28 | 28 | $34.16 | AL,SZ,XW |
| 14035Q | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 1 g tablet, 56 | 56 | $25.37 | AF,CR,RA,SZ,XT,XW |
| 11049M | SODIUM CHLORIDE + POTASSIUM CHLORIDE + GLUCOSE + CITRIC ACIDsodium chloride 470 mg + potassium chloride 300 mg (potassium 4 mmol) + glucose monohydrate 3.56 g + sodium acid citrate 530 mg powder for oral liquid, 10 x 4.9 g sachets | 1 | $5.05 | XT |
| 11865L | SODIUM PHENYLBUTYRATEsodium phenylbutyrate 483 mg/g granules, 174 g | 1 | $517.67 | OH |
| 10226F | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 10242C | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 9380Q | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 8577K | SOY PROTEIN AND FAT FORMULA WITH VITAMINS AND MINERALS CARBOHYDRATE FREEsoy protein and fat formula with vitamins and minerals carbohydrate free oral liquid, 384 mL can | 1 | $4.54 | AB |
| 14042C | SPIRONOLACTONEspironolactone 100 mg tablet, 100 | 100 | $17.27 | AL,PF |
| 14042C | SPIRONOLACTONEspironolactone 100 mg tablet, 100 | 100 | $21.77 | AF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $13.87 | PF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $10.87 | AF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $6.22 | AL |
| 12103B | STIRIPENTOLstiripentol 250 mg capsule, 60 | 60 | $330.74 | EU |
| 12106E | STIRIPENTOLstiripentol 250 mg powder for oral liquid, 60 sachets | 60 | $330.74 | EU |
| 12107F | STIRIPENTOLstiripentol 500 mg capsule, 60 | 60 | $643.68 | EU |
| 12088F | STIRIPENTOLstiripentol 500 mg powder for oral liquid, 60 sachets | 60 | $643.68 | EU |
| 10230K | SUCROFERRIC OXYHYDROXIDEsucroferric oxyhydroxide 2.5 g (iron 500 mg) chewable tablet, 90 | 90 | $353.60 | CS |
| 10233N | SUCROFERRIC OXYHYDROXIDEsucroferric oxyhydroxide 2.5 g (iron 500 mg) chewable tablet, 90 | 90 | $340.00 | CS |
| 13985C | SUCROFERRIC OXYHYDROXIDEsucroferric oxyhydroxide 2.5 g (iron 500 mg) chewable tablet, 90 | 90 | $383.80 | CS |
| 13557M | SULFASALAZINEsulfasalazine 500 mg tablet, 100 | 100 | $20.91 | PF |
| 2093E | SULFASALAZINEsulfasalazine 500 mg tablet, 100 | 100 | $22.14 | PF |
| 13433B | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $22.90 | FZ |
| 13433B | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $24.90 | PF |
| 2096H | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $24.13 | FZ |
| 2096H | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $26.13 | PF |
| 14016Q | SULTHIAMEsulthiame 200 mg tablet, 200 | 200 | $154.82 | FF |
| 13916K | SULTHIAMEsulthiame 50 mg tablet, 200 | 200 | $58.92 | FF |
| 8144P | SUMATRIPTANsumatriptan 50 mg tablet, 2 | 2 | $5.58 | AL,GQ,OW,TX |
| 11907Q | TACROLIMUStacrolimus 3 mg modified release capsule, 50 | 50 | $329.10 | LQ,SZ |
| 11920J | TACROLIMUStacrolimus 3 mg modified release capsule, 50 | 50 | $342.26 | LQ,SZ |
| 13996P | TACROLIMUStacrolimus 3 mg modified release capsule, 50 | 50 | $371.50 | LQ,SZ |
| 10860N | TACROLIMUStacrolimus 2 mg capsule, 100 | 100 | $234.65 | SZ |
| 10879N | TACROLIMUStacrolimus 2 mg capsule, 100 | 100 | $244.04 | SZ |
| 13995N | TACROLIMUStacrolimus 2 mg capsule, 100 | 100 | $264.87 | SZ |
| 10859M | TACROLIMUStacrolimus 750 microgram capsule, 100 | 100 | $82.07 | SZ |
| 10875J | TACROLIMUStacrolimus 750 microgram capsule, 100 | 100 | $85.35 | SZ |
| 14066H | TACROLIMUStacrolimus 750 microgram capsule, 100 | 100 | $92.61 | SZ |
| 13909C | TACROLIMUStacrolimus 5 mg capsule, 50 | 50 | $290.42 | CR,LL,RW,SZ |
| 6217F | TACROLIMUStacrolimus 5 mg capsule, 50 | 50 | $267.57 | CR,LL,RW,SZ |
| 9561F | TACROLIMUStacrolimus 5 mg capsule, 50 | 50 | $257.28 | CR,LL,RW,SZ |
| 14039X | TACROLIMUStacrolimus 5 mg modified release capsule, 30 | 30 | $422.36 | LQ,SZ |
| 9666R | TACROLIMUStacrolimus 5 mg modified release capsule, 30 | 30 | $375.22 | LQ,SZ |
| 9683P | TACROLIMUStacrolimus 5 mg modified release capsule, 30 | 30 | $390.23 | LQ,SZ |
| 13908B | TACROLIMUStacrolimus 500 microgram capsule, 100 | 100 | $58.07 | AF,CR,LL,RW,SZ |
| 6328C | TACROLIMUStacrolimus 500 microgram capsule, 100 | 100 | $53.54 | AF,CR,LL,RW,SZ |
| 9558C | TACROLIMUStacrolimus 500 microgram capsule, 100 | 100 | $51.48 | AF,CR,LL,RW,SZ |
| 13907Y | TACROLIMUStacrolimus 500 microgram modified release capsule, 30 | 30 | $42.80 | LQ,SZ |
| 9664P | TACROLIMUStacrolimus 500 microgram modified release capsule, 30 | 30 | $37.52 | LQ,SZ |
| 9681M | TACROLIMUStacrolimus 500 microgram modified release capsule, 30 | 30 | $39.52 | LQ,SZ |
| 14070M | TACROLIMUStacrolimus 1 mg capsule, 100 | 100 | $116.19 | AF,CR,LL,RW,SZ |
| 6216E | TACROLIMUStacrolimus 1 mg capsule, 100 | 100 | $107.08 | AF,CR,LL,RW,SZ |
| 9560E | TACROLIMUStacrolimus 1 mg capsule, 100 | 100 | $102.96 | AF,CR,LL,RW,SZ |
| 13962W | TACROLIMUStacrolimus 1 mg modified release capsule, 60 | 60 | $69.71 | LQ,SZ |
| 9665Q | TACROLIMUStacrolimus 1 mg modified release capsule, 60 | 60 | $61.78 | LQ,SZ |
| 9682N | TACROLIMUStacrolimus 1 mg modified release capsule, 60 | 60 | $64.25 | LQ,SZ |
| 13906X | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $7.19 | AF,AP |
| 13960R | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $5.96 | AP |
| 1880Y | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $7.19 | AP |
| 13997Q | TAMOXIFENtamoxifen 20 mg tablet, 60 | 60 | $11.92 | AF,GX,OX,SZ |
| 14200J | TAMSULOSINtamsulosin hydrochloride 400 microgram modified release tablet, 30 | 30 | $54.30 | AF,BG,GQ,LS,SZ,TX,WG |
| 13818G | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13819H | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13822L | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13823M | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13824N | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13831Y | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13832B | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13833C | TEBENTAFUSPtebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial | 1 | $0.00 | WM |
| 13437F | TELMISARTANtelmisartan 40 mg tablet, 28 | 28 | $5.17 | AF,CR,RW,SZ,TX,WG |
| 13437F | TELMISARTANtelmisartan 40 mg tablet, 28 | 28 | $15.17 | BY |
| 13593K | TELMISARTANtelmisartan 80 mg tablet, 28 | 28 | $6.76 | AF,CR,RW,SZ,TX,WG |
| 13593K | TELMISARTANtelmisartan 80 mg tablet, 28 | 28 | $16.76 | BY |
| 13515H | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 10 mg tablet, 28 | 28 | $6.22 | AF,XT |
| 13483P | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 5 mg tablet, 28 | 28 | $5.60 | AF,XT |
| 13451Y | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 10 mg tablet, 28 | 28 | $9.07 | AF,XT |
| 13450X | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 5 mg tablet, 28 | 28 | $8.43 | AF,XT |
| 13546Y | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $5.29 | AF,RW,SZ,TX,WG |
| 13546Y | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $15.29 | BY |
| 13574K | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $6.76 | AF,RW,SZ,TX,WG |
| 13574K | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $16.76 | BY |
| 13607E | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $7.09 | AF,RW,SZ,TX,WG |
| 13607E | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $17.09 | BY |
| 2088X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $5.17 | AF,LN,TX,WG |
| 2088X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $10.24 | AS |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $5.17 | AF,LN,TX,WG |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $10.24 | AS |
| 10062N | TEMOZOLOMIDEtemozolomide 180 mg capsule, 5 | 5 | $112.53 | JX,TX |
| 8821G | TEMOZOLOMIDEtemozolomide 100 mg capsule, 5 | 5 | $54.37 | AL,JX,MK,TX |
| 9361Q | TEMOZOLOMIDEtemozolomide 140 mg capsule, 5 | 5 | $75.00 | AL,JX,MK,TX |
| 8820F | TEMOZOLOMIDEtemozolomide 20 mg capsule, 5 | 5 | $13.73 | AL,JX,TX |
| 8819E | TEMOZOLOMIDEtemozolomide 5 mg capsule, 5 | 5 | $6.74 | AL,JX,TX |
| 11114Y | TENOFOVIR ALAFENAMIDE + EMTRICITABINE + ELVITEGRAVIR + COBICISTATtenofovir alafenamide 10 mg + emtricitabine 200 mg + elvitegravir 150 mg + cobicistat 150 mg tablet, 30 | 30 | $930.16 | GI |
| 11142K | TENOFOVIR DISOPROXILtenofovir disoproxil phosphate 291 mg tablet, 30 | 30 | $40.96 | GQ |
| 11978K | TENOFOVIR DISOPROXILtenofovir disoproxil phosphate 291 mg tablet, 30 | 30 | $40.96 | GQ |
| 11155D | TENOFOVIR DISOPROXILtenofovir disoproxil maleate 300 mg tablet, 30 | 30 | $40.96 | AL |
| 11982P | TENOFOVIR DISOPROXILtenofovir disoproxil maleate 300 mg tablet, 30 | 30 | $40.96 | AL |
| 10310P | TENOFOVIR DISOPROXILtenofovir disoproxil fumarate 300 mg tablet, 30 | 30 | $58.80 | SZ,XT |
| 11992E | TENOFOVIR DISOPROXILtenofovir disoproxil fumarate 300 mg tablet, 30 | 30 | $58.80 | SZ,XT |
| 12506F | TENOFOVIR DISOPROXIL + EMTRICITABINEtenofovir disoproxil succinate 301 mg + emtricitabine 200 mg tablet, 30 | 30 | $22.00 | SZ |
| 11149T | TENOFOVIR DISOPROXIL + EMTRICITABINEtenofovir disoproxil maleate 300 mg + emtricitabine 200 mg tablet, 30 | 30 | $22.00 | AL |
| 10347N | TENOFOVIR DISOPROXIL + EMTRICITABINEtenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg tablet, 30 | 30 | $22.00 | HX,LR,XT,XW |
| 11732L | TENOFOVIR DISOPROXIL + EMTRICITABINE + EFAVIRENZtenofovir disoproxil maleate 300 mg + emtricitabine 200 mg + efavirenz 600 mg tablet, 30 | 30 | $141.38 | AL |
| 15231P | TENOFOVIR DISOPROXIL + EMTRICITABINE + EFAVIRENZtenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg + efavirenz 600 mg tablet, 30 | 30 | $141.38 | QY |
| 9160D | TERBINAFINEterbinafine hydrochloride 1% cream, 15 g | 1 | $15.91 | NP |
| 12267P | TERBUTALINEterbutaline sulfate 500 microgram/actuation powder for inhalation, 120 actuations | 1 | $9.79 | AP |
| 15188J | TERIPARATIDEteriparatide 250 microgram/mL injection, 2.4 mL cartridge | 1 | $168.80 | RA |
| 14482F | TERIPARATIDEteriparatide 250 microgram/mL injection, 2.4 mL pen device | 1 | $168.80 | FX,GQ |
| 14025E | TESTOSTERONEtestosterone 2% (23 mg/actuation) gel, 56 actuations | 1 | $74.45 | IX |
| 13924W | TESTOSTERONEtestosterone 1% (12.5 mg/actuation) gel, 2 x 60 actuations | 1 | $68.73 | HB |
| 14563L | TESTOSTERONEtestosterone 5% (50 mg/mL) cream, 50 mL | 1 | $98.74 | LX |
| 13983Y | TESTOSTERONEtestosterone 1% (50 mg/5 g) gel, 30 x 5 g sachets | 1 | $68.73 | HB |
| 14390J | TETRABENAZINEtetrabenazine 25 mg tablet, 112 | 112 | $202.59 | IL,RA |
| 2832C | TETRACOSACTIDEtetracosactide 1 mg/mL modified release injection, 1 mL ampoule | 1 | $60.04 | IX |
| 9667T | THALIDOMIDEthalidomide 100 mg capsule, 28 | 28 | $530.69 | BQ |
| 9684Q | THALIDOMIDEthalidomide 100 mg capsule, 28 | 28 | $550.69 | BQ |
| 6469L | THALIDOMIDEthalidomide 50 mg capsule, 28 | 28 | $275.35 | BQ |
| 9566L | THALIDOMIDEthalidomide 50 mg capsule, 28 | 28 | $265.35 | BQ |
| 13354W | THIAMINEthiamine hydrochloride 100 mg tablet, 100 | 100 | $6.35 | PP |
| 14182K | THIAMINEthiamine hydrochloride 100 mg tablet, 100 | 100 | $6.35 | PP |
| 13947C | TIAGABINEtiagabine 10 mg tablet, 50 | 50 | $51.31 | TB |
| 8222R | TIAGABINEtiagabine 10 mg tablet, 50 | 50 | $51.35 | TB |
| 13893F | TIAGABINEtiagabine 15 mg tablet, 50 | 50 | $73.81 | TB |
| 8223T | TIAGABINEtiagabine 15 mg tablet, 50 | 50 | $73.79 | TB |
| 13892E | TIAGABINEtiagabine 5 mg tablet, 50 | 50 | $25.67 | TB |
| 8221Q | TIAGABINEtiagabine 5 mg tablet, 50 | 50 | $26.90 | TB |
| 13524T | TICAGRELORticagrelor 90 mg tablet, 56 | 56 | $92.07 | AP,XE,XT |
| 15062R | TIMOLOLtimolol 0.5% eye drops, 2.5 mL | 1 | $12.57 | MF |
| 15048B | TIMOLOLtimolol 0.5% eye drops, 5 mL | 1 | $10.73 | MF |
| 14555C | TIOTROPIUMtiotropium 13 microgram powder for inhalation, 30 capsules | 30 | $28.57 | TB |
| 14361W | TIOTROPIUMtiotropium 18 microgram powder for inhalation, 30 capsules | 30 | $33.45 | BY |
| 14574C | TIOTROPIUMtiotropium 18 microgram powder for inhalation, 30 capsules | 30 | $28.57 | GQ |
| 14756P | TISLELIZUMABtislelizumab 100 mg/10 mL injection, 10 mL vial | 1 | $0.00 | IE |
| 14765D | TISLELIZUMABtislelizumab 100 mg/10 mL injection, 10 mL vial | 1 | $0.00 | IE |
| 13965B | TOBRAMYCINtobramycin 28 mg powder for inhalation, 224 capsules | 224 | $2359.88 | GO |
| 14006E | TOBRAMYCINtobramycin 300 mg/5 mL inhalation solution, 56 x 5 mL ampoules | 56 | $363.95 | GO,RA |
| 1356J | TOBRAMYCINtobramycin 80 mg/2 mL injection, 5 x 2 mL vials | 5 | $15.68 | AL |
| 8872Y | TOBRAMYCINtobramycin Injection 80 mg (base) in 2 mL (without preservative), 5 | 5 | $31.28 | PF |
| 13329M | TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial | 1 | $208.74 | RO |
| 13330N | TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial | 1 | $200.71 | RO |
| 13299Y | TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial | 1 | $399.39 | RO |
| 13323F | TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial | 1 | $415.37 | RO |
| 13304F | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $80.97 | RO |
| 13311N | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $84.21 | RO |
| 13315T | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $84.21 | RO |
| 13324G | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $80.97 | RO |
| 13690M | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $80.97 | RO |
| 13696W | TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial | 1 | $84.21 | RO |
| 14063E | TOPIRAMATEtopiramate 15 mg capsule, 60 | 60 | $13.77 | JC |
| 13905W | TOPIRAMATEtopiramate 25 mg capsule, 60 | 60 | $11.77 | JC |
| 13878K | TOPIRAMATEtopiramate 50 mg capsule, 60 | 60 | $17.99 | JC |
| 14008G | TOPIRAMATEtopiramate 100 mg tablet, 60 | 60 | $11.35 | AF,RA,RW,SZ,TX,WG |
| 14009H | TOPIRAMATEtopiramate 200 mg tablet, 60 | 60 | $17.42 | AF,RA,RW,SZ,TX,WG |
| 13969F | TOPIRAMATEtopiramate 25 mg tablet, 60 | 60 | $6.76 | AF,RA,RW,SZ,TX,WG |
| 13913G | TOPIRAMATEtopiramate 50 mg tablet, 60 | 60 | $8.12 | AF,RA,RW,SZ,TX,WG |
| 4617B | TOPOTECANtopotecan 4 mg injection, 5 vials | 5 | $0.00 | OC,SZ |
| 7260D | TOPOTECANtopotecan 4 mg injection, 5 vials | 5 | $0.00 | OC,SZ |
| 15125C | TORIPALIMABToripalimab 240 mg/6 mL injection, 6 mL vial | 1 | $0.00 | RZ |
| 15126D | TORIPALIMABToripalimab 240 mg/6 mL injection, 6 mL vial | 1 | $0.00 | RZ |
| 13340D | TRABECTEDINtrabectedin 1 mg injection, 1 vial | 1 | $0.00 | ZL |
| 13344H | TRABECTEDINtrabectedin 1 mg injection, 1 vial | 1 | $0.00 | ZL |
| 13346K | TRABECTEDINtrabectedin 1 mg injection, 1 vial | 1 | $0.00 | ZL |
| 13348M | TRABECTEDINtrabectedin 1 mg injection, 1 vial | 1 | $0.00 | ZL |
| 12008B | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $12.73 | AF,RW,SZ,TX,WG |
| 12008B | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $14.98 | CS |
| 12024W | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $12.73 | AF,RW,SZ,TX,WG |
| 12024W | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $14.98 | CS |
| 14742X | TRAMETINIBtrametinib 50 microgram/mL powder for oral liquid, 90 mL | 1 | $588.65 | NV |
| 14761X | TRAMETINIBtrametinib 50 microgram/mL powder for oral liquid, 90 mL | 1 | $588.65 | NV |
| 10385N | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1795.65 | NV |
| 10403M | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1795.65 | NV |
| 11821E | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1795.65 | NV |
| 14779W | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1787.33 | NV |
| 14780X | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1787.33 | NV |
| 15051E | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1795.65 | NV |
| 13429T | TRANDOLAPRILtrandolapril 1 mg capsule, 28 | 28 | $6.43 | AF,RW |
| 13429T | TRANDOLAPRILtrandolapril 1 mg capsule, 28 | 28 | $9.93 | GO |
| 13403K | TRANDOLAPRILtrandolapril 2 mg capsule, 28 | 28 | $7.24 | AF,RW |
| 13403K | TRANDOLAPRILtrandolapril 2 mg capsule, 28 | 28 | $10.74 | GO |
| 13467T | TRANDOLAPRILtrandolapril 4 mg capsule, 28 | 28 | $11.45 | AF,GO,RW |
| 13554J | TRANDOLAPRILtrandolapril 500 microgram capsule, 28 | 28 | $5.17 | RW |
| 13554J | TRANDOLAPRILtrandolapril 500 microgram capsule, 28 | 28 | $8.65 | GO |
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