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 |
|---|---|---|---|---|
| 15111H | APOMORPHINEApomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL cartridges | 5 | $412.63 | TD |
| 15118Q | APOMORPHINEApomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL cartridges | 5 | $419.68 | TD |
| 15121W | APOMORPHINEApomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL cartridges | 5 | $416.91 | TD |
| 15132K | APOMORPHINEApomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL cartridges | 5 | $414.85 | TD |
| 11672H | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL cartridges | 5 | $129.40 | IT |
| 11688E | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL cartridges | 5 | $131.40 | IT |
| 12133N | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL cartridges | 5 | $135.75 | IT |
| 14309D | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL cartridges | 5 | $133.25 | IT |
| 12142C | APOMORPHINEapomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL vials | 5 | $419.68 | IT |
| 14375N | APOMORPHINEapomorphine hydrochloride hemihydrate 100 mg/20 mL injection, 5 x 20 mL vials | 5 | $416.91 | IT |
| 11477C | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL pen devices | 5 | $129.40 | TD |
| 12137T | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL pen devices | 5 | $135.75 | TD |
| 14485J | APOMORPHINEapomorphine hydrochloride hemihydrate 30 mg/3 mL injection, 5 x 3 mL pen devices | 5 | $133.25 | TD |
| 12319J | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/10 mL injection, 5 x 10 mL syringes | 5 | $226.23 | TD |
| 14377Q | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/10 mL injection, 5 x 10 mL syringes | 5 | $224.84 | TD |
| 12306Q | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $171.02 | TD |
| 14407G | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $169.63 | TD |
| 5610G | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $167.49 | TD |
| 9640J | APOMORPHINEapomorphine hydrochloride hemihydrate 50 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $168.60 | TD |
| 10036F | ARACHIDONIC ACID AND DOCOSAHEXAENOIC ACID WITH CARBOHYDRATEarachidonic acid and docosahexaenoic acid with carbohydrate containing 200 mg arachidonic acid and 100 mg docosahexaenoic acid powder for oral liquid, 30 x 4 g sachets | 1 | $82.04 | VF |
| 10093F | ARGININE WITH CARBOHYDRATEarginine with carbohydrate containing 5 g arginine powder for oral liquid, 30 x 7.6 g sachets | 1 | $218.26 | VF |
| 5482M | ARGININE WITH CARBOHYDRATEarginine with carbohydrate containing 2 g arginine powder for oral liquid, 30 x 4 g sachets | 1 | $164.94 | VF |
| 9437Q | ARGININE WITH CARBOHYDRATEarginine with carbohydrate containing 500 mg arginine powder for oral liquid, 30 x 4 g sachets | 1 | $109.95 | VF |
| 10922W | ARMODAFINILarmodafinil 50 mg tablet, 30 | 30 | $47.51 | TB |
| 10691Q | ARSENICarsenic trioxide 10 mg/10 mL injection, 10 x 10 mL vials | 10 | $0.00 | FF,JU,OC |
| 10699D | ARSENICarsenic trioxide 10 mg/10 mL injection, 10 x 10 mL vials | 10 | $0.00 | FF,JU,OC |
| 4371C | ARSENICarsenic trioxide 10 mg/10 mL injection, 10 x 10 mL vials | 10 | $0.00 | FF,JU,OC |
| 7241D | ARSENICarsenic trioxide 10 mg/10 mL injection, 10 x 10 mL vials | 10 | $0.00 | FF,JU,OC |
| 13260X | ASCIMINIBasciminib 40 mg tablet, 60 | 60 | $6043.31 | NV |
| 10692R | ATAZANAVIR + COBICISTATatazanavir 300 mg + cobicistat 150 mg tablet, 30 | 30 | $352.90 | BQ |
| 13600T | ATENOLOLatenolol 50 mg/10 mL oral liquid, 300 mL | 1 | $39.59 | AE |
| 13540P | ATENOLOLatenolol 50 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RW,SZ,TY,WG |
| 13540P | ATENOLOLatenolol 50 mg tablet, 30 | 30 | $18.61 | IX |
| 11930X | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 11931Y | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 11940K | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 11957H | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12076N | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12078Q | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12097Q | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12098R | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12159Y | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 12174R | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 13170E | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 13173H | ATEZOLIZUMABatezolizumab 840 mg/14 mL injection, 14 mL vial | 1 | $0.00 | RO |
| 11277M | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11284X | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11297N | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11309F | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11792P | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11801D | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11802E | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11807K | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11926Q | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11927R | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11928T | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 11929W | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 12155R | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 12167J | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 12168K | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 12171N | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 13172G | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 13174J | ATEZOLIZUMABatezolizumab 1.2 g/20 mL injection, 20 mL vial | 1 | $0.00 | RO |
| 9092M | ATOMOXETINEatomoxetine 10 mg capsule, 28 | 28 | $33.30 | SZ,TX |
| 9093N | ATOMOXETINEatomoxetine 18 mg capsule, 28 | 28 | $33.30 | SZ,TX |
| 9094P | ATOMOXETINEatomoxetine 25 mg capsule, 28 | 28 | $33.30 | SZ,TX |
| 9095Q | ATOMOXETINEatomoxetine 40 mg capsule, 28 | 28 | $33.30 | SZ,TX |
| 9096R | ATOMOXETINEatomoxetine 60 mg capsule, 28 | 28 | $33.30 | SZ,TX |
| 13495G | ATORVASTATINatorvastatin 10 mg tablet, 30 | 30 | $5.17 | AF,AS,BG,CR,DZ,HX,RA,RF,TX,WG |
| 13529C | ATORVASTATINatorvastatin 20 mg tablet, 30 | 30 | $5.27 | AF,AS,BG,CR,DZ,HX,RA,RF,TX,WG |
| 13468W | ATORVASTATINatorvastatin 40 mg tablet, 30 | 30 | $6.17 | AF,AS,BG,CR,DZ,HX,RA,RF,TX,WG |
| 13374X | ATORVASTATINatorvastatin 80 mg tablet, 30 | 30 | $6.76 | AF,AS,BG,CR,DZ,HX,RA,RF,TX,WG |
| 11671G | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 11679Q | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 11685B | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 11695M | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 13122P | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 13123Q | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 13126W | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 13132E | AVELUMABavelumab 200 mg/10 mL injection, 10 mL vial | 1 | $0.00 | SG |
| 10540R | AXITINIBaxitinib 5 mg tablet, 28 | 28 | $2351.33 | PF |
| 10556N | AXITINIBaxitinib 5 mg tablet, 28 | 28 | $2351.33 | PF |
| 10539Q | AXITINIBaxitinib 1 mg tablet, 28 | 28 | $505.98 | PF |
| 10572K | AXITINIBaxitinib 1 mg tablet, 28 | 28 | $505.98 | PF |
| 13623B | AZACITIDINEazacitidine 200 mg tablet, 7 | 7 | $6690.91 | BQ |
| 13619T | AZACITIDINEazacitidine 300 mg tablet, 7 | 7 | $6681.89 | BQ |
| 13624C | AZACITIDINEazacitidine 300 mg tablet, 7 | 7 | $6665.23 | BQ |
| 12771E | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 12784W | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 13028Q | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 13033Y | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 13036D | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 13038F | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 13039G | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 13040H | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 13042K | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 13044M | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 6100C | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 6138C | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $15.22 | JO,JU,OC,RI,SZ,XN,YG |
| 9597D | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 9598E | AZACITIDINEazacitidine 100 mg injection, 1 vial | 1 | $14.63 | JO,JU,OC,RI,SZ,XN,YG |
| 5616N | AZITHROMYCINazithromycin 600 mg tablet, 8 | 8 | $55.38 | PF |
| 6221K | AZITHROMYCINazithromycin 600 mg tablet, 8 | 8 | $57.60 | PF |
| 11194E | BACLOFENbaclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule | 1 | $317.92 | BZ |
| 11195F | BACLOFENbaclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule | 1 | $305.69 | BZ |
| 5617P | BACLOFENbaclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule | 1 | $76.27 | DZ,NV |
| 6284R | BACLOFENbaclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule | 1 | $79.32 | DZ,NV |
| 13522Q | BACLOFENbaclofen 10 mg tablet, 100 | 100 | $11.33 | AF,NV,RW,TX |
| 13359D | BACLOFENbaclofen 25 mg tablet, 100 | 100 | $21.85 | AF,NV,RW,TX |
| 13484Q | BALSALAZIDEbalsalazide sodium 750 mg capsule, 280 | 280 | $149.93 | PK |
| 4654Y | BANDAGE COMPRESSIONbandage compression 8 cm x 2.6 m short stretch bandage, 1 | 1 | $14.14 | BV |
| 4598B | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $41.40 | SN |
| 4658E | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $62.70 | SN |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $13.07 | CC |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $29.12 | BV |
| 4657D | BANDAGE COMPRESSIONbandage compression 10 cm x 3.5 m high stretch bandage, 1 | 1 | $14.10 | MH |
| 4811F | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 5 cm x 1.3 m bandage, 1 | 1 | $5.76 | MM |
| 4812G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 7.5 cm x 1.3 m bandage, 1 | 1 | $7.19 | MM |
| 4813H | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 1.3 m bandage, 1 | 1 | $8.83 | MM |
| 4660G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 2 m bandage, 1 | 1 | $8.09 | MM |
| 4814J | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 15 cm x 1.3 m bandage, 1 | 1 | $11.92 | MM |
| 4719J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 6 cm x 2 m bandage, 1 | 1 | $6.72 | BV |
| 4662J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 10 cm x 2 m bandage, 1 | 1 | $13.65 | BV |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $10.70 | KE |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $13.42 | BV |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $7.24 | KE |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $8.57 | BV |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $9.33 | KE |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $10.85 | BV |
| 4799N | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking large size bandage, 1 | 1 | $15.81 | MH |
| 4797L | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking medium size bandage, 1 | 1 | $15.81 | MH |
| 4674B | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking small size bandage, 1 | 1 | $15.81 | MH |
| 4675C | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking XX/large size bandage, 1 | 1 | $15.82 | MH |
| 4816L | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking large D/E size bandage, 1 | 1 | $10.70 | MH |
| 4815K | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking medium C/D size bandage, 1 | 1 | $10.70 | MH |
| 4661H | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking small B/C size bandage, 1 | 1 | $10.70 | MH |
| 4669R | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $12.56 | MH |
| 4750B | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $46.67 | SN |
| 14540G | BECLOMETASONEbeclometasone dipropionate 50 microgram/actuation inhalation, 200 actuations | 1 | $9.53 | IL |
| 14541H | BECLOMETASONEbeclometasone dipropionate 100 microgram/actuation inhalation, 200 actuations | 1 | $17.32 | IL |
| 14514X | BECLOMETASONEbeclometasone dipropionate 100 microgram/actuation breath activated inhalation, 200 actuations | 1 | $20.43 | IL |
| 14376P | BECLOMETASONE + FORMOTEROLbeclometasone dipropionate 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $26.47 | EU,LR |
| 14538E | BECLOMETASONE + FORMOTEROLbeclometasone dipropionate 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $36.65 | EU,LR |
| 14310E | BECLOMETASONE + FORMOTEROL + GLYCOPYRRONIUMbeclometasone dipropionate 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation + glycopyrronium 10 microgram/actuation inhalation, 120 actuations | 1 | $64.36 | EU |
| 15243G | BECLOMETASONE + FORMOTEROL + GLYCOPYRRONIUMbeclometasone dipropionate 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation + glycopyrronium 10 microgram/actuation inhalation, 120 actuations | 1 | $64.36 | EU |
| 15232Q | BECLOMETASONE + FORMOTEROL + GLYCOPYRRONIUMbeclometasone dipropionate 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation + glycopyrronium 10 microgram/actuation inhalation, 120 actuations | 1 | $69.75 | EU |
| 10760H | BENDAMUSTINEbendamustine hydrochloride 100 mg injection, 1 vial | 1 | $0.00 | AF,DZ,SZ,YG |
| 10763L | BENDAMUSTINEbendamustine hydrochloride 100 mg injection, 1 vial | 1 | $0.00 | AF,DZ,SZ,YG |
| 15053G | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [4 mL ampoule], 1 pack | 1 | $49.58 | NG |
| 15058M | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [4 mL ampoule], 1 pack | 1 | $49.58 | NG |
| 15063T | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [4 mL ampoule], 1 pack | 1 | $49.58 | NG |
| 2647H | BENZYLPENICILLINbenzylpenicillin 3 g injection, 1 vial | 1 | $10.07 | SZ |
| 3399X | BENZYLPENICILLINbenzylpenicillin 3 g injection, 1 vial | 1 | $10.07 | SZ |
| 1775K | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.43 | SZ |
| 3398W | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.43 | SZ |
| 3486L | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.92 | SZ |
| 10800K | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $7.60 | AF |
| 10800K | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $5.15 | AL,NB |
| 10801L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.98 | AF |
| 10801L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.53 | AL,NB |
| 10802M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.86 | AF |
| 10802M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.41 | AL,NB |
| 10813D | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $7.19 | AF |
| 10813D | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.74 | AL,NB |
| 10824Q | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $8.83 | AF |
| 10824Q | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.38 | AL,NB |
| 10795E | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $8.83 | AF |
| 10795E | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.38 | AL,NB |
| 10816G | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.98 | AF |
| 10816G | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.53 | AL,NB |
| 10820L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $7.60 | AF |
| 10820L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $5.15 | AL,NB |
| 10821M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $7.19 | AF |
| 10821M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.74 | AL,NB |
| 10823P | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.86 | AF |
| 10823P | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.41 | AL,NB |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $7.76 | AL,LN |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $9.81 | AS |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $10.26 | AF |
| 10794D | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $6.48 | AS |
| 10794D | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.92 | LN |
| 10799J | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $7.71 | AS |
| 10799J | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.15 | LN |
| 10807T | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.86 | AS |
| 10807T | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.30 | LN |
| 10808W | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $6.07 | AS |
| 10808W | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.51 | LN |
| 10810Y | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.74 | AS |
| 10810Y | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.18 | LN |
| 12479T | BEVACIZUMABbevacizumab 100 mg/4 mL injection, 4 mL vial | 1 | $0.00 | AN,EW,SZ |
| 12508H | BEVACIZUMABbevacizumab 100 mg/4 mL injection, 4 mL vial | 1 | $0.00 | AN,EW,SZ |
| 13933H | BICARBONATEsodium bicarbonate 840 mg capsule, 100 | 100 | $10.65 | AS |
| 11649D | BICTEGRAVIR + EMTRICITABINE + TENOFOVIR ALAFENAMIDEbictegravir 50 mg + emtricitabine 200 mg + tenofovir alafenamide 25 mg tablet, 30 | 30 | $875.32 | GI |
| 14422C | BIMATOPROSTbimatoprost 0.03% eye drops, 30 x 0.4 mL ampoules | 1 | $19.03 | VE |
| 14315K | BIMATOPROSTbimatoprost 0.03% eye drops, 3 mL | 1 | $22.19 | AF,SZ,TY,VE,WG |
| 14351H | BIMATOPROST + TIMOLOLbimatoprost 0.03% + timolol 0.5% eye drops, 30 x 0.4 mL ampoules | 1 | $23.78 | VE |
| 14317M | BIMATOPROST + TIMOLOLbimatoprost 0.03% + timolol 0.5% eye drops, 3 mL | 1 | $26.05 | VE |
| 15119R | BIMEKIZUMABbimekizumab 320 mg/2 mL injection, 2 mL pen devices | 1 | $3337.03 | UC |
| 15131J | BIMEKIZUMABbimekizumab 320 mg/2 mL injection, 2 mL pen devices | 1 | $3337.03 | UC |
| 15110G | BIMEKIZUMABbimekizumab 160 mg/mL injection, 2 x 1 mL pen devices | 2 | $3337.03 | UC |
| 15116N | BIMEKIZUMABbimekizumab 160 mg/mL injection, 2 x 1 mL pen devices | 2 | $3337.03 | UC |
| 11948W | BINIMETINIBbinimetinib 15 mg tablet, 84 | 84 | $3603.71 | FB |
| 11961M | BINIMETINIBbinimetinib 15 mg tablet, 84 | 84 | $3603.71 | FB |
| 14446H | BISACODYLbisacodyl 5 mg enteric tablet, 200 | 200 | $8.90 | AE |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.28 | VZ |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.85 | PP |
| 1260H | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.28 | VZ |
| 1260H | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.85 | PP |
| 14447J | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.46 | VZ |
| 10580W | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $5.40 | PP |
| 1258F | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $5.40 | PP |
| 14305X | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $4.58 | PP |
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