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 |
|---|---|---|---|---|
| 11535D | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $29.02 | AF,CR,DZ,NM,SZ,TB,XT |
| 11546Q | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $30.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 11556F | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $29.02 | AF,CR,DZ,NM,SZ,TB,XT |
| 11557G | DEFERASIROXdeferasirox 180 mg tablet, 30 | 30 | $30.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 11511W | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $60.36 | CR |
| 11533B | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $58.04 | AF,CR,DZ,NM,SZ,TB,XT |
| 11536E | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $58.04 | AF,CR,DZ,NM,SZ,TB,XT |
| 11547R | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $60.36 | AF,CR,DZ,NM,SZ,TB,XT |
| 11555E | DEFERASIROXdeferasirox 360 mg tablet, 30 | 30 | $58.04 | AF,CR,DZ,NM,SZ,TB,XT |
| 11519G | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $14.51 | AF,CR,DZ,NM,SZ,TB,XT |
| 11534C | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $14.51 | AF,CR,DZ,NM,SZ,TB,XT |
| 11545P | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $15.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 11548T | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $15.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 11558H | DEFERASIROXdeferasirox 90 mg tablet, 30 | 30 | $15.18 | AF,CR,DZ,NM,SZ,TB,XT |
| 5654N | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $98.95 | CR,JU |
| 6499C | DEFERASIROXdeferasirox 125 mg dispersible tablet, 28 | 28 | $102.91 | CR,JU |
| 5655P | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $20.58 | CR,JU |
| 6500D | DEFERASIROXdeferasirox 250 mg dispersible tablet, 28 | 28 | $21.40 | CR,JU |
| 5656Q | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $59.68 | CR,JU |
| 9600G | DEFERASIROXdeferasirox 500 mg dispersible tablet, 28 | 28 | $62.07 | CR,JU |
| 11724C | DEFERIPRONEdeferiprone 1 g tablet, 50 | 50 | $391.90 | EU |
| 11747G | DEFERIPRONEdeferiprone 1 g tablet, 50 | 50 | $385.23 | EU |
| 5658T | DEFERIPRONEdeferiprone 100 mg/mL oral liquid, 250 mL | 1 | $192.62 | EU |
| 9638G | DEFERIPRONEdeferiprone 100 mg/mL oral liquid, 250 mL | 1 | $200.32 | EU |
| 5657R | DEFERIPRONEdeferiprone 500 mg tablet, 100 | 100 | $385.23 | EU |
| 6416Q | DEFERIPRONEdeferiprone 500 mg tablet, 100 | 100 | $398.56 | EU |
| 5662B | DESFERRIOXAMINEdesferrioxamine mesilate 500 mg injection, 10 vials | 10 | $138.88 | PF |
| 6113R | DESFERRIOXAMINEdesferrioxamine mesilate 500 mg injection, 10 vials | 10 | $139.88 | PF |
| 5661Y | DESFERRIOXAMINEdesferrioxamine mesilate 2 g injection, 1 vial | 1 | $43.58 | PF |
| 6270B | DESFERRIOXAMINEdesferrioxamine mesilate 2 g injection, 1 vial | 1 | $44.25 | PF |
| 15323L | DESMOPRESSINDesmopressin 120 microgram sublingual tablet, 30 | 30 | $39.47 | BZ |
| 12458Q | DESMOPRESSINdesmopressin acetate 10 microgram/actuation nasal spray, 50 actuations | 1 | $112.07 | DZ |
| 15282H | DESMOPRESSINdesmopressin acetate 10 microgram/actuation nasal spray, 50 actuations | 1 | $39.46 | DZ |
| 15312X | DESMOPRESSINDesmopressin 240 microgram sublingual tablet, 30 | 30 | $66.00 | BZ |
| 8711L | DESMOPRESSINdesmopressin acetate 10 microgram/actuation nasal spray, 60 actuations | 1 | $46.86 | FP |
| 13889B | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $34.86 | FP |
| 13945Y | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $35.67 | FP |
| 8662X | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $34.85 | FP |
| 14004C | DESMOPRESSINdesmopressin 120 microgram sublingual wafer, 30 | 30 | $39.47 | FP |
| 13890C | DESMOPRESSINdesmopressin 240 microgram sublingual wafer, 30 | 30 | $66.00 | FP |
| 14384C | DESVENLAFAXINEdesvenlafaxine 100 mg modified release tablet, 28 | 28 | $10.98 | GQ,TX |
| 14489N | DESVENLAFAXINEdesvenlafaxine 100 mg modified release tablet, 28 | 28 | $10.98 | AF,AL,BG,HX,RW,SZ,WG |
| 14545M | DESVENLAFAXINEdesvenlafaxine 100 mg modified release tablet, 28 | 28 | $15.48 | PF |
| 14383B | DESVENLAFAXINEdesvenlafaxine 50 mg modified release tablet, 28 | 28 | $9.40 | AF,AL,BG,HX,RW,SZ,WG |
| 14418W | DESVENLAFAXINEdesvenlafaxine 50 mg modified release tablet, 28 | 28 | $9.40 | GQ,TX |
| 14451N | DESVENLAFAXINEdesvenlafaxine 50 mg modified release tablet, 28 | 28 | $13.90 | PF |
| 14007F | DEXAMETHASONEdexamethasone 500 microgram tablet, 30 | 30 | $5.17 | AS |
| 14521G | DEXTRAN-70 + HYPROMELLOSEdextran-70 0.1% + hypromellose 0.3% eye drops, 15 mL | 1 | $6.22 | IQ |
| 14521G | DEXTRAN-70 + HYPROMELLOSEdextran-70 0.1% + hypromellose 0.3% eye drops, 15 mL | 1 | $10.22 | AQ |
| 1299J | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $5.17 | AL,RW,SZ,WG |
| 1299J | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $10.15 | NV |
| 5076E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $5.17 | AL,RW,SZ,WG |
| 5076E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $10.15 | NV |
| 10790X | DICLOXACILLINdicloxacillin 500 mg capsule, 24 | 24 | $10.56 | MQ,XT |
| 10790X | DICLOXACILLINdicloxacillin 500 mg capsule, 24 | 24 | $12.51 | AF |
| 3164M | DIGOXINdigoxin 50 microgram/mL oral liquid, 60 mL | 1 | $17.56 | AS |
| 14479C | DILTIAZEMdiltiazem hydrochloride 60 mg tablet, 90 | 90 | $12.32 | SW |
| 14479C | DILTIAZEMdiltiazem hydrochloride 60 mg tablet, 90 | 90 | $10.42 | AV |
| 14564M | DILTIAZEMdiltiazem hydrochloride 180 mg modified release capsule, 30 | 30 | $9.90 | SW |
| 14564M | DILTIAZEMdiltiazem hydrochloride 180 mg modified release capsule, 30 | 30 | $8.26 | AV,SZ |
| 14508N | DILTIAZEMdiltiazem hydrochloride 240 mg modified release capsule, 30 | 30 | $11.94 | SW |
| 14508N | DILTIAZEMdiltiazem hydrochloride 240 mg modified release capsule, 30 | 30 | $10.30 | AV,SZ |
| 14565N | DILTIAZEMdiltiazem hydrochloride 360 mg modified release capsule, 30 | 30 | $16.27 | SW |
| 14565N | DILTIAZEMdiltiazem hydrochloride 360 mg modified release capsule, 30 | 30 | $14.37 | AV,SZ |
| 2896K | DIMETHYL FUMARATEdimethyl fumarate 120 mg enteric capsule, 14 | 14 | $102.20 | BD,CR,SZ,XT |
| 2943X | DIMETHYL FUMARATEdimethyl fumarate 120 mg enteric capsule, 14 | 14 | $102.20 | BD,CR,SZ,XT |
| 3463G | DIPHTHERIA + TETANUS VACCINEdiphtheria 2 units + tetanus 20 units vaccine injection, 5 x 0.5 mL syringes | 5 | $84.99 | CS |
| 13280Y | DISOPYRAMIDEdisopyramide 100 mg capsule, 84 | 84 | $59.60 | OJ,YO |
| 10148D | DOCETAXELdocetaxel 80 mg/4 mL injection, 4 mL vial | 1 | $0.00 | OC |
| 10158P | DOCETAXELdocetaxel 80 mg/4 mL injection, 4 mL vial | 1 | $0.00 | OC |
| 10283F | DOLUTEGRAVIRdolutegravir 50 mg tablet, 30 | 30 | $620.66 | VI |
| 10345L | DOLUTEGRAVIR + ABACAVIR + LAMIVUDINEdolutegravir 50 mg + abacavir 600 mg + lamivudine 300 mg tablet, 30 | 30 | $715.61 | VI |
| 11843H | DOLUTEGRAVIR + LAMIVUDINEdolutegravir 50 mg + lamivudine 300 mg tablet, 30 | 30 | $671.16 | VI |
| 11540J | DOLUTEGRAVIR + RILPIVIRINEdolutegravir 50 mg + rilpivirine 25 mg tablet, 30 | 30 | $820.31 | VI |
| 5704F | DORNASE ALFAdornase alfa 2.5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules | 30 | $745.49 | RO |
| 6120D | DORNASE ALFAdornase alfa 2.5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules | 30 | $765.49 | RO |
| 14524K | DORZOLAMIDEdorzolamide 2% eye drops, 5 mL | 1 | $7.76 | AF,MF |
| 14386E | DORZOLAMIDE + TIMOLOLdorzolamide 2% + timolol 0.5% eye drops, 5 mL | 1 | $10.99 | AE,AF |
| 14386E | DORZOLAMIDE + TIMOLOLdorzolamide 2% + timolol 0.5% eye drops, 5 mL | 1 | $11.79 | MF |
| 14109N | DOSTARLIMABdostarlimab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | GK |
| 14122G | DOSTARLIMABdostarlimab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | GK |
| 14130Q | DOSTARLIMABdostarlimab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | GK |
| 14133W | DOSTARLIMABdostarlimab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | GK |
| 4361M | DOXORUBICINdoxorubicin hydrochloride 50 mg/25 mL injection, 25 mL vial | 1 | $0.00 | OC,PF |
| 7229L | DOXORUBICINdoxorubicin hydrochloride 50 mg/25 mL injection, 25 mL vial | 1 | $0.00 | OC,PF |
| 5705G | DOXORUBICIN HYDROCHLORIDE (AS PEGYLATED LIPOSOMAL)doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial | 1 | $138.42 | BX,RA |
| 6249X | DOXORUBICIN HYDROCHLORIDE (AS PEGYLATED LIPOSOMAL)doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial | 1 | $143.96 | BX,RA |
| 4364Q | DOXORUBICIN HYDROCHLORIDE (AS PEGYLATED LIPOSOMAL)doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BX,RA |
| 7230M | DOXORUBICIN HYDROCHLORIDE (AS PEGYLATED LIPOSOMAL)doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BX,RA |
| 10779H | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.92 | AF,RW,TX,WG |
| 10781K | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.92 | BG,HX |
| 14480D | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.30 | AF,RW,TX,WG |
| 14511R | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.30 | BG,HX |
| 2702F | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.92 | AF,RW,TX,WG |
| 2714W | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $4.33 | AF,RW,TX,WG |
| 9107H | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.92 | BG,HX |
| 9108J | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $4.33 | BG,HX |
| 14307B | DOXYCYCLINEdoxycycline 50 mg tablet, 25 | 25 | $5.34 | AF,RW,TX,WG |
| 14513W | DOXYCYCLINEdoxycycline 50 mg tablet, 25 | 25 | $5.34 | HX |
| 10777F | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $6.87 | YN |
| 10777F | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $5.46 | YT |
| 14443E | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $6.25 | YN |
| 14443E | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $4.84 | YT |
| 2703G | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $6.87 | YN |
| 2703G | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $5.46 | YT |
| 14484H | DOXYCYCLINEdoxycycline 50 mg modified release capsule, 25 | 25 | $10.34 | YN |
| 14484H | DOXYCYCLINEdoxycycline 50 mg modified release capsule, 25 | 25 | $7.92 | YT |
| 4681J | DRESSING ACTIVATED CHARCOAL MALODOROUS WOUNDdressing activated charcoal malodorous wound 10.5 cm x 10.5 cm dressing, 1 | 1 | $9.08 | KI |
| 4832H | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 1 | 1 | $9.83 | UM |
| 1905G | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 5 x 2 g | 5 | $51.93 | CC |
| 4682K | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g (40 cm) rope, 6 x 2 g | 1 | $62.62 | CT |
| 4684M | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 5 cm x 5 cm dressing, 1 | 1 | $4.09 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $8.10 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $7.58 | UM |
| 4688R | DRESSING FILMdressing film 15 cm x 20 cm dressing, 1 | 1 | $4.33 | MM |
| 4689T | DRESSING FILM ISLANDdressing film island 5 cm x 7 cm dressing, 1 | 1 | $1.34 | MM |
| 4690W | DRESSING FILM ISLANDdressing film island 9 cm x 10 cm dressing, 1 | 1 | $2.34 | MM |
| 4898T | DRESSING FILM ISLANDdressing film island 5 cm x 7.2 cm dressing, 5 | 1 | $14.44 | SN |
| 4899W | DRESSING FILM ISLANDdressing film island 8 cm x 10 cm dressing, 5 | 1 | $23.65 | SN |
| 2445Q | DRESSING GELLING FIBREdressing gelling fibre 15 cm x 15 cm dressing, 5 | 1 | $129.64 | SN |
| 4906F | DRESSING HYDROACTIVE SUPERFICIAL WOUND LIGHT EXUDATEdressing hydroactive superficial wound light exudate 10 cm x 10 cm dressing, 5 | 1 | $72.18 | SN |
| 4886E | DRESSING HYDROACTIVE SUPERFICIAL WOUND MODERATE EXUDATEdressing hydroactive superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $45.97 | SN |
| 4896Q | DRESSING HYDROCOLLOID CAVITY WOUNDdressing hydrocolloid cavity wound paste, 30 g | 1 | $13.23 | CC |
| 4897R | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $36.54 | CC |
| 4678F | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 7cm (butterfly shape) dressing, 1 | 1 | $9.83 | CT |
| 4920Y | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 20 cm x 20 cm dressing, 5 | 1 | $103.85 | CC |
| 4679G | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10cm (round) dressing, 1 | 1 | $10.65 | CT |
| 2803M | DRESSING HYDROFIBRE ALTERNATE TO ALGINATESdressing hydrofibre alternate to alginates 15 cm x 15 cm dressing, 5 | 1 | $96.70 | CC |
| 4894N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 25 g | 1 | $20.45 | SN |
| 4599C | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $11.64 | SN |
| 4914P | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $9.38 | JJ |
| 4913N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 3 x 30 g | 1 | $29.12 | CC |
| 4806Y | DRESSING HYDROGEL SHEETdressing hydrogel sheet 10 cm x 10 cm dressing, 5 | 1 | $23.64 | HR |
| 4911L | DRESSING HYDROGEL SHEETdressing hydrogel sheet 9.5 cm x 10.2 cm dressing, 5 | 1 | $37.36 | KI |
| 4862X | DRESSING NON ADHERENTdressing non adherent 10 cm x 10 cm dressing, 5 | 1 | $12.49 | SN |
| 4819P | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $7.41 | SN |
| 4860T | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $8.27 | SN |
| 4909J | DRESSING TULLE NON-ADHERENT PRIMARY WOUND CONTACT LAYER PARAFFINdressing tulle non-adherent primary wound contact layer paraffin 7.6 cm x 7.6 cm dressing, 1 | 1 | $1.30 | KI |
| 14875X | DROSPIRENONEdrospirenone 4 mg tablet [24] (&) inert substance tablet [4], 28 | 1 | $17.52 | GQ,HB |
| 14710F | DROSPIRENONE + ETHINYLESTRADIOLdrospirenone 3 mg + ethinylestradiol 20 microgram tablet [24] (&) inert substance tablet [4], 28 | 1 | $17.93 | XW |
| 14954C | DROSPIRENONE + ETHINYLESTRADIOLdrospirenone 3 mg + ethinylestradiol 20 microgram tablet [24] (&) inert substance tablet [4], 28 | 1 | $17.93 | GQ,HJ,SZ,XT |
| 14711G | DROSPIRENONE + ETHINYLESTRADIOLdrospirenone 3 mg + ethinylestradiol 30 microgram tablet [21] (&) inert substance tablet [7], 28 | 1 | $17.93 | GQ,HJ,SZ,XT,XW |
| 14712H | DULOXETINEduloxetine 60 mg enteric capsule, 28 | 28 | $6.76 | AL,BG,CR,HX,RW,SZ,TX,WG |
| 11911X | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 11915D | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13745K | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13766M | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13767N | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13775B | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13779F | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13780G | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 14889P | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 14925M | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 14932X | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 14942K | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15068C | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15091G | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15283J | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15292W | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15324M | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 15330W | DURVALUMABdurvalumab 500 mg/10 mL injection, 10 mL vial | 1 | $0.00 | AP |
| 13900N | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $18.82 | TX |
| 13900N | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $25.82 | GK |
| 14210X | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $18.82 | TX |
| 14210X | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $25.82 | GK |
| 13929D | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $20.36 | AF,GC,GQ,SZ,TN,WG |
| 13929D | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $23.86 | GK |
| 14184M | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $23.86 | GK |
| 12840T | ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial | 1 | $5358.60 | XI |
| 12877R | ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial | 1 | $5358.60 | XI |
| 12896R | ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial | 1 | $5363.60 | XI |
| 12899X | ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial | 1 | $5365.27 | XI |
| 14806G | EDARAVONEedaravone 30 mg/20 mL injection, 10 x 20 mL ampoules | 10 | $2220.00 | TB |
| 15334C | EDARAVONEedaravone 30 mg/20 mL injection, 10 x 20 mL ampoules | 10 | $2214.29 | TB |
| 14880E | EFLORNITHINEeflornithine 192 mg tablet, 100 | 100 | $11540.80 | NE |
| 14894X | EFLORNITHINEeflornithine 192 mg tablet, 100 | 100 | $11540.80 | NE |
| 14900F | EFLORNITHINEeflornithine 192 mg tablet, 100 | 100 | $11554.13 | NE |
| 14910R | EFLORNITHINEeflornithine 192 mg tablet, 100 | 100 | $11554.13 | NE |
| 12983H | ELOTUZUMABelotuzumab 400 mg injection, 1 vial | 1 | $0.00 | BQ |
| 12995Y | ELOTUZUMABelotuzumab 400 mg injection, 1 vial | 1 | $0.00 | BQ |
| 14115X | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1241.45 | NV |
| 14119D | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1241.45 | NV |
| 14120E | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1228.12 | NV |
| 14128N | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1228.12 | NV |
| 14136B | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1241.45 | NV |
| 14144K | ELTROMBOPAGeltrombopag 25 mg tablet, 28 | 28 | $1228.12 | NV |
| 14107L | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2469.57 | NV |
| 14112R | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2456.24 | NV |
| 14121F | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2456.24 | NV |
| 14127M | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2469.57 | NV |
| 14131R | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2456.24 | NV |
| 14143J | ELTROMBOPAGeltrombopag 50 mg tablet, 28 | 28 | $2469.57 | NV |
| 13845Q | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $44.41 | BY |
| 14018T | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $44.41 | BY |
| 15252R | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $44.41 | BY |
| 15253T | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $44.41 | BY |
| 13920P | EMPAGLIFLOZINempagliflozin 25 mg tablet, 30 | 30 | $44.63 | BY |
| 13904T | EMPAGLIFLOZIN + LINAGLIPTINempagliflozin 10 mg + linagliptin 5 mg tablet, 30 | 30 | $67.37 | BY |
| 13958P | EMPAGLIFLOZIN + LINAGLIPTINempagliflozin 25 mg + linagliptin 5 mg tablet, 30 | 30 | $67.37 | BY |
| 14029J | EMPAGLIFLOZIN + METFORMINempagliflozin 5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $44.93 | BY |
| 13852C | EMPAGLIFLOZIN + METFORMINempagliflozin 5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $46.36 | BY |
| 13903R | EMPAGLIFLOZIN + METFORMINempagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $44.93 | BY |
| 13987E | EMPAGLIFLOZIN + METFORMINempagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $46.36 | BY |
| 11104K | EMTRICITABINE + RILPIVIRINE + TENOFOVIR ALAFENAMIDEemtricitabine 200 mg + rilpivirine 25 mg + tenofovir alafenamide 25 mg tablet, 30 | 30 | $930.16 | GI |
| 11099E | EMTRICITABINE + TENOFOVIR ALAFENAMIDEemtricitabine 200 mg + tenofovir alafenamide 10 mg tablet, 30 | 30 | $685.06 | GI |
| 11113X | EMTRICITABINE + TENOFOVIR ALAFENAMIDEemtricitabine 200 mg + tenofovir alafenamide 25 mg tablet, 30 | 30 | $685.06 | GI |
| 13401H | ENALAPRILenalapril maleate 20 mg tablet, 30 | 30 | $6.38 | AL |
| 13369P | ENALAPRILenalapril maleate 5 mg tablet, 30 | 30 | $5.17 | AL,RW,SZ,TX,WG |
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