Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
Previous Page |
Next Page | 4 of 15
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 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 | $989.39 | UC |
| 11322X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $989.39 | UC |
| 11323Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $989.39 | UC |
| 12027B | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $989.39 | UC |
| 10904X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $989.39 | UC |
| 10905Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $989.39 | UC |
| 10909E | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $989.39 | UC |
| 12063X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $989.39 | 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 | $32.04 | AS |
| 14658L | CHLORMETHINEchlormethine 0.016% (160 microgram/g) gel, 60 g | 1 | $1699.12 | XT |
| 13500M | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $5.17 | GH |
| 1585K | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $6.40 | GH |
| 13300B | CHORIOGONADOTROPIN ALFAchoriogonadotropin alfa 250 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $74.02 | SG |
| 14640M | CHORIOGONADOTROPIN ALFAchoriogonadotropin alfa 250 microgram/0.5 mL injection, 0.5 mL syringe | 1 | $127.32 | SG |
| 14348E | CICLESONIDEciclesonide 160 microgram/actuation inhalation, 120 actuations | 1 | $22.24 | EU |
| 14312G | CICLESONIDEciclesonide 80 microgram/actuation inhalation, 120 actuations | 1 | $13.30 | EU |
| 14001X | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $345.77 | 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 | $345.75 | NV |
| 13999T | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $41.98 | 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 | $42.46 | NV |
| 13911E | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.48 | NV,TX,WG |
| 5636P | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $93.45 | NV,TX,WG |
| 6354K | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $97.19 | NV,TX,WG |
| 8660T | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.46 | NV,TX,WG |
| 13883Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $24.93 | NV,TX,WG |
| 5634M | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $22.04 | NV,TX,WG |
| 6352H | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $23.04 | NV,TX,WG |
| 8658Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $26.16 | NV,TX,WG |
| 13910D | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.76 | NV,TX,WG |
| 5635N | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $45.87 | NV,TX,WG |
| 6353J | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $47.70 | NV,TX,WG |
| 8659R | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.78 | NV,TX,WG |
| 11887P | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $15.66 | AL,CR |
| 11891W | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $17.23 | AL,CR |
| 5621W | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $15.66 | AL,CR |
| 9625N | CINACALCETcinacalcet 30 mg tablet, 28 | 28 | $17.23 | AL,CR |
| 11886N | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $31.33 | AL,CR |
| 11889R | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $33.33 | AL,CR |
| 5622X | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $31.33 | AL,CR |
| 9626P | CINACALCETcinacalcet 60 mg tablet, 28 | 28 | $33.33 | AL,CR |
| 11885M | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $46.99 | AL,CR |
| 11888Q | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $48.99 | AL,CR |
| 5623Y | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $46.99 | AL,CR |
| 9627Q | CINACALCETcinacalcet 90 mg tablet, 28 | 28 | $48.99 | AL,CR |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $17.57 | NM |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $22.32 | NV |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $17.57 | NM |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $22.32 | 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 |
| 14313H | CITALOPRAMcitalopram 10 mg tablet, 28 | 28 | $5.17 | AF,RW,WG |
| 14490P | CITALOPRAMcitalopram 20 mg tablet, 28 | 28 | $5.17 | AF,RW,SZ,TX,TY,WG |
| 14490P | CITALOPRAMcitalopram 20 mg tablet, 28 | 28 | $18.32 | LU |
| 14518D | CITALOPRAMcitalopram 40 mg tablet, 28 | 28 | $5.21 | AF,RW,SZ,TX,WG |
| 14534Y | 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 | $13.10 | AE |
| 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 | $14.33 | 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 | $14.33 | AE |
| 5481L | CITRULLINE WITH CARBOHYDRATEcitrulline with carbohydrate containing 1 g citrulline powder for oral liquid, 30 x 4 g sachets | 1 | $109.95 | VF |
| 11604R | CLADRIBINEcladribine 10 mg tablet, 4 | 4 | $4563.75 | JG,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 | $6.76 | AF,PF,RW,TX,WG,XT |
| 11520H | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $6.77 | PB |
| 11559J | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $5.54 | PB |
| 1808E | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $6.22 | PB |
| 5339B | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $6.22 | PB |
| 1806C | CLONAZEPAMclonazepam 2 mg tablet, 100 | 100 | $11.95 | AF |
| 1805B | CLONAZEPAMclonazepam 500 microgram tablet, 100 | 100 | $9.23 | AF |
| 13578P | CLONIDINEclonidine hydrochloride 100 microgram tablet, 100 | 100 | $14.79 | GQ,IX,TX |
| 13548C | CLONIDINEclonidine hydrochloride 150 microgram tablet, 100 | 100 | $20.96 | IX |
| 15076L | CLOPIDOGRELclopidogrel 75 mg tablet, 30 | 30 | $15.08 | KQ |
| 15081R | CLOPIDOGRELclopidogrel 75 mg tablet, 30 | 30 | $28.38 | LM |
| 15085Y | CLOPIDOGRELclopidogrel 75 mg tablet, 30 | 30 | $25.75 | LM |
| 15086B | CLOPIDOGRELclopidogrel 75 mg tablet, 30 | 30 | $17.71 | KQ |
| 13365K | CLOPIDOGRELclopidogrel 75 mg tablet, 28 | 28 | $6.55 | RF,RW,WG |
| 13399F | CLOPIDOGRELclopidogrel 75 mg tablet, 28 | 28 | $6.55 | AF,AV,BG,CR,GQ,HX,WA |
| 15075K | CLOPIDOGRELclopidogrel 75 mg tablet, 28 | 28 | $22.35 | LM |
| 13427Q | CLOPIDOGREL + ASPIRINclopidogrel 75 mg + aspirin 100 mg tablet, 30 | 30 | $6.76 | AF,AV,TY,XT |
| 10981Y | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $237.53 | IS |
| 10982B | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $237.53 | IS |
| 10987G | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $237.53 | IS |
| 11007H | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $237.53 | IS |
| 11831Q | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $236.39 | IS |
| 12214W | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial | 1 | $237.53 | IS |
| 10988H | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $423.66 | IS |
| 11006G | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $423.66 | IS |
| 11015R | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $423.66 | IS |
| 11022D | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $423.66 | IS |
| 11857C | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $420.70 | IS |
| 12178Y | CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEXclostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial | 1 | $423.66 | IS |
| 10358E | CLOZAPINEclozapine 100 mg tablet, 100 | 100 | $108.20 | DU,GO,JU |
| 5629G | CLOZAPINEclozapine 100 mg tablet, 100 | 100 | $104.04 | DU,GO,JU |
| 6102E | CLOZAPINEclozapine 100 mg tablet, 100 | 100 | $108.20 | DU,GO,JU |
| 10288L | CLOZAPINEclozapine 200 mg tablet, 100 | 100 | $216.40 | DU,JU |
| 5627E | CLOZAPINEclozapine 200 mg tablet, 100 | 100 | $208.08 | DU,JU |
| 6418T | CLOZAPINEclozapine 200 mg tablet, 100 | 100 | $216.40 | DU,JU |
| 10289M | CLOZAPINEclozapine 25 mg tablet, 100 | 100 | $29.75 | DU,GO,JU |
| 5628F | CLOZAPINEclozapine 25 mg tablet, 100 | 100 | $27.75 | DU,GO,JU |
| 6101D | CLOZAPINEclozapine 25 mg tablet, 100 | 100 | $29.75 | DU,GO,JU |
| 10302F | CLOZAPINEclozapine 50 mg tablet, 100 | 100 | $57.71 | DU,JU |
| 5626D | CLOZAPINEclozapine 50 mg tablet, 100 | 100 | $55.49 | DU,JU |
| 6417R | CLOZAPINEclozapine 50 mg tablet, 100 | 100 | $57.71 | DU,JU |
| 12054K | CODEINEcodeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $14.19 | AS |
| 12065B | CODEINEcodeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $14.19 | AS |
| 14477Y | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 50 sachets | 1 | $36.42 | GO |
| 2967E | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 50 sachets | 1 | $37.17 | GO |
| 13862N | CORTISONEcortisone acetate 25 mg tablet, 60 | 60 | $14.92 | AS |
| 13946B | CORTISONEcortisone acetate 5 mg tablet, 50 | 50 | $9.79 | AS |
| 4327R | CYCLOPHOSPHAMIDEcyclophosphamide 500 mg injection, 1 vial | 1 | $0.00 | BX,RQ |
| 7226H | CYCLOPHOSPHAMIDEcyclophosphamide 500 mg injection, 1 vial | 1 | $0.00 | BX,RQ |
| 14022B | CYPROTERONEcyproterone acetate 100 mg tablet, 50 | 50 | $51.48 | GH |
| 14022B | CYPROTERONEcyproterone acetate 100 mg tablet, 50 | 50 | $50.27 | HX,RW |
| 13925X | CYPROTERONEcyproterone acetate 50 mg tablet, 20 | 20 | $14.74 | HX,RW |
| 1270W | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $33.16 | GH,HX,RW |
| 14023C | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $32.21 | GH,HX,RW |
| 4357H | CYTARABINEcytarabine 100 mg/5 mL injection, 5 x 5 mL vials | 5 | $0.00 | PF |
| 7227J | CYTARABINEcytarabine 100 mg/5 mL injection, 5 x 5 mL vials | 5 | $0.00 | PF |
| 13523R | DABIGATRANdabigatran etexilate 110 mg capsule, 60 | 60 | $31.94 | AF,CR,SZ,XT |
| 13523R | DABIGATRANdabigatran etexilate 110 mg capsule, 60 | 60 | $39.33 | BY |
| 13489Y | DABIGATRANdabigatran etexilate 150 mg capsule, 60 | 60 | $31.72 | AF,CR,SZ,XT |
| 13489Y | DABIGATRANdabigatran etexilate 150 mg capsule, 60 | 60 | $39.09 | BY |
| 9318K | DABIGATRANdabigatran etexilate 75 mg capsule, 10 | 10 | $11.60 | CR |
| 9322P | DABIGATRANdabigatran etexilate 75 mg capsule, 10 | 10 | $11.60 | CR |
| 9319L | DABIGATRANdabigatran etexilate 110 mg capsule, 10 | 10 | $7.37 | BY |
| 9323Q | DABIGATRANdabigatran etexilate 110 mg capsule, 10 | 10 | $7.37 | BY |
| 14752K | DABRAFENIBdabrafenib 10 mg dispersible tablet, 2 x 210 | 420 | $3341.47 | NV |
| 14753L | DABRAFENIBdabrafenib 10 mg dispersible tablet, 2 x 210 | 420 | $3341.47 | NV |
| 14773M | DABRAFENIBdabrafenib 10 mg dispersible tablet, 2 x 210 | 420 | $3341.47 | NV |
| 14755N | DABRAFENIBdabrafenib 50 mg capsule, 120 | 120 | $4740.52 | NV |
| 14760W | DABRAFENIBdabrafenib 50 mg capsule, 120 | 120 | $4740.52 | NV |
| 14778T | DABRAFENIBdabrafenib 50 mg capsule, 120 | 120 | $4740.52 | NV |
| 13844P | DAPAGLIFLOZINdapagliflozin 10 mg tablet, 28 | 28 | $41.62 | AP |
| 14054Q | DAPAGLIFLOZINdapagliflozin 10 mg tablet, 28 | 28 | $41.62 | AP |
| 15257B | DAPAGLIFLOZINdapagliflozin 10 mg tablet, 28 | 28 | $41.62 | AP |
| 13851B | DAPAGLIFLOZIN + METFORMINdapagliflozin 5 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $43.65 | AP |
| 13875G | DAPAGLIFLOZIN + METFORMINdapagliflozin 10 mg + metformin hydrochloride 1 g modified release tablet, 28 | 28 | $42.35 | AP |
| 14028H | DAPAGLIFLOZIN + METFORMINdapagliflozin 10 mg + metformin hydrochloride 500 mg modified release tablet, 28 | 28 | $41.57 | AP |
| 14645T | DAPAGLIFLOZIN + SITAGLIPTINDapagliflozin 10 mg + sitagliptin 100 mg tablet, 28 | 28 | $55.96 | AP |
| 12220E | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 12225K | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 12226L | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 12228N | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 12230Q | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 12231R | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15065X | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15066Y | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15072G | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15077M | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15093J | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 15094K | DARATUMUMABdaratumumab 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | JC |
| 5644C | DARBEPOETIN ALFAdarbepoetin alfa 80 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $670.41 | AN |
| 6438W | DARBEPOETIN ALFAdarbepoetin alfa 80 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $690.41 | AN |
| 5645D | DARBEPOETIN ALFAdarbepoetin alfa 20 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $52.82 | AN |
| 6488L | DARBEPOETIN ALFAdarbepoetin alfa 20 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $54.93 | AN |
| 5637Q | DARBEPOETIN ALFAdarbepoetin alfa 10 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $112.18 | AN |
| 6320P | DARBEPOETIN ALFAdarbepoetin alfa 10 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $116.67 | AN |
| 5638R | DARBEPOETIN ALFAdarbepoetin alfa 20 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $211.27 | AN |
| 6321Q | DARBEPOETIN ALFAdarbepoetin alfa 20 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $219.72 | AN |
| 5646E | DARBEPOETIN ALFAdarbepoetin alfa 40 microgram/0.4 mL injection, 0.4 mL pen device | 1 | $87.70 | AN |
| 6489M | DARBEPOETIN ALFAdarbepoetin alfa 40 microgram/0.4 mL injection, 0.4 mL pen device | 1 | $91.21 | AN |
| 5649H | DARBEPOETIN ALFAdarbepoetin alfa 100 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $206.39 | AN |
| 6492Q | DARBEPOETIN ALFAdarbepoetin alfa 100 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $211.39 | AN |
| 5651K | DARBEPOETIN ALFAdarbepoetin alfa 100 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $825.58 | AN |
| 6326Y | DARBEPOETIN ALFAdarbepoetin alfa 100 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $845.58 | AN |
| 5640W | DARBEPOETIN ALFAdarbepoetin alfa 40 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $350.83 | AN |
| 6323T | DARBEPOETIN ALFAdarbepoetin alfa 40 microgram/0.4 mL injection, 4 x 0.4 mL syringes | 4 | $364.86 | AN |
| 5650J | DARBEPOETIN ALFAdarbepoetin alfa 150 microgram/0.3 mL injection, 0.3 mL pen device | 1 | $307.52 | AN |
| 6493R | DARBEPOETIN ALFAdarbepoetin alfa 150 microgram/0.3 mL injection, 0.3 mL pen device | 1 | $312.52 | AN |
| 5643B | DARBEPOETIN ALFAdarbepoetin alfa 150 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $1230.09 | AN |
| 6365B | DARBEPOETIN ALFAdarbepoetin alfa 150 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $1250.09 | AN |
| 5641X | DARBEPOETIN ALFAdarbepoetin alfa 50 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $433.74 | AN |
| 6324W | DARBEPOETIN ALFAdarbepoetin alfa 50 microgram/0.5 mL injection, 4 x 0.5 mL syringes | 4 | $451.09 | AN |
| 5647F | DARBEPOETIN ALFAdarbepoetin alfa 60 microgram/0.3 mL injection, 0.3 mL pen device | 1 | $127.33 | AN |
| 6490N | DARBEPOETIN ALFAdarbepoetin alfa 60 microgram/0.3 mL injection, 0.3 mL pen device | 1 | $132.33 | AN |
| 5642Y | DARBEPOETIN ALFAdarbepoetin alfa 60 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $509.32 | AN |
| 6325X | DARBEPOETIN ALFAdarbepoetin alfa 60 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $529.32 | AN |
| 5648G | DARBEPOETIN ALFAdarbepoetin alfa 80 microgram/0.4 mL injection, 0.4 mL pen device | 1 | $167.61 | AN |
| 6491P | DARBEPOETIN ALFAdarbepoetin alfa 80 microgram/0.4 mL injection, 0.4 mL pen device | 1 | $172.61 | AN |
| 5639T | DARBEPOETIN ALFAdarbepoetin alfa 30 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $289.04 | AN |
| 6322R | DARBEPOETIN ALFAdarbepoetin alfa 30 microgram/0.3 mL injection, 4 x 0.3 mL syringes | 4 | $300.60 | AN |
| 12946J | DARUNAVIRdarunavir 600 mg tablet, 2 x 30 | 60 | $597.86 | JU |
| 10329P | DARUNAVIRdarunavir 600 mg tablet, 60 | 60 | $682.53 | JC |
| 10367P | DARUNAVIRdarunavir 800 mg tablet, 30 | 30 | $400.64 | JC |
| 12111K | DARUNAVIRdarunavir 800 mg tablet, 30 | 30 | $400.64 | JU |
| 10903W | DARUNAVIR + COBICISTATdarunavir 800 mg + cobicistat 150 mg tablet, 30 | 30 | $406.21 | JC |
| 11955F | DARUNAVIR + COBICISTAT + EMTRICITABINE + TENOFOVIR ALAFENAMIDEdarunavir 800 mg + cobicistat 150 mg + emtricitabine 200 mg + tenofovir alafenamide 10 mg tablet, 30 | 30 | $851.51 | JC |
| 14661P | DAUNORUBICIN + CYTARABINEdaunorubicin hydrochloride 44 mg + cytarabine 100 mg injection, 1 vial | 1 | $0.00 | JA |
| 14663R | DAUNORUBICIN + CYTARABINEdaunorubicin hydrochloride 44 mg + cytarabine 100 mg injection, 1 vial | 1 | $0.00 | JA |
| 14669C | DAUNORUBICIN + CYTARABINEdaunorubicin hydrochloride 44 mg + cytarabine 100 mg injection, 1 vial | 1 | $0.00 | JA |
| 14672F | DAUNORUBICIN + CYTARABINEdaunorubicin hydrochloride 44 mg + cytarabine 100 mg injection, 1 vial | 1 | $0.00 | JA |
| 11500G | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $29.02 | AF,CR,DZ,NM,SZ,TB,XT |
| 11510T | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $30.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 11496C | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $60.36 | AF,CR,DZ,NM,SZ,TB,XT |
| 11511W | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $60.36 | AF,DZ,NM,SZ,TB,XT |
| 11499F | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $14.51 | AF,CR,DZ,NM,SZ,TB,XT |
| 11235H | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $98.95 | CR,JU |
| 11236J | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $102.91 | CR,JU |
| 11241P | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $102.91 | CR,JU |
| 11247Y | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $98.95 | CR,JU |
| 11238L | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $21.40 | CR,JU |
| 11239M | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $20.58 | CR,JU |
| 11240N | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $20.58 | CR,JU |
| 11244T | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $21.40 | CR,JU |
| 11231D | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $59.68 | CR,JU |
| 11232E | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $62.07 | CR,JU |
| 11234G | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $59.68 | CR,JU |
| 11243R | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $62.07 | CR,JU |
Previous Page |
Next Page | 4 of 15
