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 |
|---|---|---|---|---|
| 8753Q | MESALAZINEmesalazine 1 g/100 mL enema, 7 x 100 mL | 1 | $51.61 | FP |
| 8616L | MESALAZINEmesalazine 2 g/60 mL enema, 7 x 60 mL | 1 | $51.61 | FD |
| 8617M | MESALAZINEmesalazine 4 g/60 mL enema, 7 x 60 mL | 1 | $80.79 | FD |
| 8768L | MESALAZINEmesalazine 1 g/application foam, 14 applications | 1 | $59.74 | FD |
| 13460K | MESALAZINEmesalazine 1.5 g modified release granules, 60 sachets | 60 | $92.42 | FD |
| 13361F | MESALAZINEmesalazine 500 mg modified release granules, 100 sachets | 100 | $57.24 | FD |
| 8598M | MESALAZINEmesalazine 500 mg modified release granules, 100 sachets | 100 | $57.14 | FD |
| 13397D | MESALAZINEmesalazine 2 g modified release granules, 60 sachets | 60 | $120.72 | FP |
| 13576M | MESALAZINEmesalazine 1 g modified release tablet, 60 | 60 | $64.22 | FP |
| 3413P | MESALAZINEmesalazine 1 g modified release tablet, 60 | 60 | $64.12 | FP |
| 13487W | MESALAZINEmesalazine 1.2 g modified release tablet, 60 | 60 | $82.47 | NQ,TK |
| 9353G | MESALAZINEmesalazine 1.2 g modified release tablet, 60 | 60 | $82.37 | NQ,TK |
| 13423L | MESALAZINEmesalazine 250 mg enteric tablet, 100 | 100 | $33.95 | GO |
| 13362G | MESALAZINEmesalazine 500 mg enteric tablet, 100 | 100 | $57.24 | FD |
| 8731M | MESALAZINEmesalazine 500 mg enteric tablet, 100 | 100 | $57.14 | FD |
| 13396C | MESALAZINEmesalazine 500 mg modified release tablet, 100 | 100 | $57.24 | FP |
| 2214M | MESALAZINEmesalazine 500 mg modified release tablet, 100 | 100 | $57.14 | FP |
| 13395B | MESALAZINEmesalazine 1.6 g enteric tablet, 60 | 60 | $72.52 | EU |
| 13355X | MESALAZINEmesalazine 1 g modified release granules, 100 sachets | 100 | $98.00 | FP |
| 13398E | MESALAZINEmesalazine 1 g modified release granules, 100 sachets | 100 | $107.00 | FD |
| 13456F | MESALAZINEmesalazine 4 g modified release granules, 30 sachets | 30 | $120.72 | FP |
| 13518L | MESALAZINEmesalazine 3 g modified release granules, 30 sachets | 30 | $92.42 | FD |
| 13356Y | MESALAZINEmesalazine 1.2 g modified release tablet, 120 | 120 | $164.93 | RA |
| 13422K | MESALAZINEmesalazine 800 mg enteric tablet, 90 | 90 | $68.74 | EU |
| 13394Y | MESALAZINEmesalazine 1 g enteric tablet, 60 | 60 | $64.55 | FD |
| 14056T | METFORMINmetformin hydrochloride 1 g tablet, 90 | 90 | $6.61 | AF,BG,HQ,RW,SZ,TY,ZS |
| 14056T | METFORMINmetformin hydrochloride 1 g tablet, 90 | 90 | $11.50 | AL |
| 13847T | METFORMINmetformin hydrochloride 1 g modified release tablet, 60 | 60 | $6.61 | AF,CR,IB,RF,TX |
| 13847T | METFORMINmetformin hydrochloride 1 g modified release tablet, 60 | 60 | $11.95 | AL |
| 13976N | METFORMINmetformin hydrochloride 500 mg tablet, 100 | 100 | $5.54 | AF,BG,HQ,RF,SZ,TY,ZS |
| 13976N | METFORMINmetformin hydrochloride 500 mg tablet, 100 | 100 | $11.01 | AL |
| 13899M | METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 | 120 | $6.61 | CR,IB,RW,TX |
| 13899M | METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 | 120 | $11.95 | AL |
| 13952H | METFORMINmetformin hydrochloride 850 mg tablet, 60 | 60 | $5.54 | AF,BG,RF,SZ,TY,ZS |
| 13952H | METFORMINmetformin hydrochloride 850 mg tablet, 60 | 60 | $11.01 | AL |
| 14005D | METHENAMINE HIPPURATEmethenamine hippurate 1 g tablet, 100 | 100 | $20.61 | AS,IL |
| 13882P | METHOTREXATEmethotrexate 50 mg/2 mL injection, 5 x 2 mL vials | 5 | $29.73 | PF |
| 11275K | METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe | 1 | $20.51 | LM |
| 14091P | METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe | 1 | $20.51 | LM |
| 11283W | METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe | 1 | $20.51 | LM |
| 14089M | METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe | 1 | $20.51 | LM |
| 11268C | METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe | 1 | $20.51 | LM |
| 14102F | METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe | 1 | $20.51 | LM |
| 11288D | METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe | 1 | $20.51 | LM |
| 14097Y | METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe | 1 | $20.51 | LM |
| 11295L | METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe | 1 | $20.51 | LM |
| 14103G | METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe | 1 | $20.51 | LM |
| 10833E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $9.72 | LO |
| 10833E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $5.78 | XT |
| 10835G | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $10.03 | LO |
| 10835G | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $6.09 | XT |
| 10842P | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $11.57 | LO |
| 10842P | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $7.63 | XT |
| 10851D | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $9.84 | LO |
| 10851D | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $5.90 | XT |
| 10855H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $10.42 | LO |
| 10855H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $6.48 | XT |
| 10830B | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $6.89 | LO |
| 10838K | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $7.51 | LO |
| 10852E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $7.13 | LO |
| 10856J | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $8.28 | LO |
| 10834F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.84 | LO |
| 10834F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.90 | XT |
| 10836H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.42 | LO |
| 10836H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.48 | XT |
| 10839L | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.84 | LO |
| 10839L | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.90 | AS,XT |
| 10840M | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.42 | LO |
| 10840M | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.48 | AS,XT |
| 10843Q | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.72 | LO |
| 10843Q | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.78 | AS,XT |
| 10844R | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.03 | LO |
| 10844R | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.09 | AS,XT |
| 10845T | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.72 | LO |
| 10845T | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.78 | XT |
| 10846W | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $11.57 | LO |
| 10846W | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $7.63 | XT |
| 10848Y | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $11.57 | LO |
| 10848Y | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $7.63 | AS,XT |
| 10853F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.03 | LO |
| 10853F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.09 | XT |
| 13736Y | METHYLPREDNISOLONEmethylprednisolone (as sodium succinate) 40 mg powder for injection, 1 vial | 1 | $21.09 | LM |
| 11739W | METHYLPREDNISOLONEmethylprednisolone 40 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber vial | 1 | $6.84 | PF |
| 13420H | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 190 mg (controlled release), 30 | 30 | $30.77 | AF,AP,CR,RW |
| 13543T | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 47.5 mg (controlled release), 30 | 30 | $20.52 | AF,AP,CR,RW |
| 13544W | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 95 mg (controlled release), 30 | 30 | $25.07 | AF,AP,CR,RW |
| 13541Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 | 60 | $5.28 | AF,RW,SZ,TX,VO,ZS |
| 13541Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 | 60 | $18.43 | AP |
| 13598Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 | 100 | $5.02 | AF,RW,SZ,TX,VO,ZS |
| 13598Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 | 100 | $18.17 | AP |
| 3092R | MILK POWDER SYNTHETIC LOW CALCIUMmilk powder synthetic low calcium powder for oral liquid, 400 g | 1 | $44.47 | SB |
| 8630F | MILK PROTEIN AND FAT FORMULA WITH VITAMINS AND MINERALS CARBOHYDRATE FREEmilk protein and fat formula with vitamins and minerals carbohydrate free powder for oral liquid, 225 g | 1 | $37.53 | SB |
| 14041B | MINOXIDILminoxidil 10 mg tablet, 100 | 100 | $33.23 | PF |
| 8816B | MODAFINILmodafinil 100 mg tablet, 60 | 60 | $62.58 | AF,AL,GQ,RW,SZ,TX |
| 8816B | MODAFINILmodafinil 100 mg tablet, 60 | 60 | $67.98 | TB |
| 9386B | MODIFIED LONG CHAIN AMYLOPECTINmodified long chain amylopectin powder for oral liquid, 30 x 60 g sachets | 1 | $160.87 | VF |
| 10792B | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $7.75 | AL |
| 10792B | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.22 | AF,AS |
| 10809X | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $8.45 | AL |
| 10809X | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.92 | AF,AS |
| 10815F | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $8.06 | AL |
| 10815F | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.53 | AF,AS |
| 10818J | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $7.87 | AL |
| 10818J | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.34 | AF,AS |
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $9.60 | AL |
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $6.07 | AF,AS |
| 10804P | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $9.68 | AL |
| 10804P | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.15 | AF,EO |
| 10805Q | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $9.92 | AL |
| 10805Q | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.39 | AF,EO |
| 10819K | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $11.07 | AL |
| 10819K | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $7.54 | AF,EO |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $10.30 | AL |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.77 | AF,EO |
| 10791Y | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $7.75 | AL |
| 10791Y | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.22 | AF,AS,EO |
| 10793C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $7.87 | AL |
| 10793C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.34 | AF,AS,EO |
| 10812C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $9.60 | AL |
| 10812C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $6.07 | AF,AS,EO |
| 10814E | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $8.45 | AL |
| 10814E | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.92 | AF,AS,EO |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $8.06 | AL |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.53 | AF,AS,EO |
| 13750Q | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 100 mL | 100 | $67.26 | LM |
| 13761G | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 100 mL | 100 | $67.26 | LM |
| 13740E | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 300 mL | 300 | $103.64 | LM |
| 13756B | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 300 mL | 300 | $103.64 | LM |
| 13747M | MORPHINEmorphine sulfate 2 mg/mL oral solution, 100 mL | 100 | $48.03 | DZ |
| 13753W | MORPHINEmorphine sulfate 2 mg/mL oral solution, 100 mL | 100 | $48.03 | DZ |
| 13749P | MORPHINEmorphine sulfate 2 mg/mL oral solution, 500 mL | 500 | $114.81 | DZ |
| 13760F | MORPHINEmorphine sulfate 2 mg/mL oral solution, 500 mL | 500 | $114.81 | DZ |
| 14077X | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL | 20 | $55.22 | DZ |
| 14083F | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL | 20 | $55.22 | DZ |
| 13579Q | MOXONIDINEmoxonidine 200 microgram tablet, 30 | 30 | $7.75 | AL,GO,GQ,RF,SZ,TX |
| 13552G | MOXONIDINEmoxonidine 400 microgram tablet, 30 | 30 | $11.58 | AL,GO,GQ,RF,SZ,TX |
| 12931N | MYCOBACTERIUM BOVIS BCG DANISH STRAINMycobacterium bovis BCG Danish strain 30 mg injection, 4 vials | 1 | $479.78 | LM |
| 14037T | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 50 | 50 | $14.35 | AF |
| 1836P | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 50 | 50 | $14.47 | AF |
| 13884R | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $28.71 | CR,RO,SZ,TX |
| 8649F | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $28.94 | CR,RO,SZ,TX |
| 14071N | MYCOPHENOLATEmycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL | 1 | $275.86 | CR,RO |
| 14000W | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $28.68 | AF,CR,GQ,GX,RF,RO,SZ,XT |
| 8650G | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $28.91 | AF,CR,GQ,GX,RF,RO,SZ,XT |
| 13856G | MYCOPHENOLATEmycophenolate 180 mg enteric tablet, 120 | 120 | $96.66 | NV,XT |
| 13938N | MYCOPHENOLATEmycophenolate 360 mg enteric tablet, 120 | 120 | $193.49 | CR,NV,XT |
| 1674D | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $6.52 | IX |
| 5176K | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $6.52 | IX |
| 8298R | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.43 | AS |
| 9734H | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.43 | AS |
| 13568D | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $11.68 | AF,FK,GQ,SZ,TX |
| 9316H | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $12.83 | AF,FK,GQ,SZ,TX |
| 13441K | NEBIVOLOLnebivolol 10 mg tablet, 28 | 28 | $31.99 | AF,FK,GQ,SZ,TX |
| 13510C | NEBIVOLOLnebivolol 5 mg tablet, 28 | 28 | $28.57 | AF,FK,GQ,SZ,TX |
| 13550E | NICORANDILnicorandil 10 mg tablet, 60 | 1 | $10.99 | AF,TX |
| 13551F | NICORANDILnicorandil 20 mg tablet, 60 | 1 | $14.40 | AF,TX |
| 13502P | NIFEDIPINEnifedipine 30 mg modified release tablet, 30 | 30 | $9.20 | RW,TX |
| 13376B | NIFEDIPINEnifedipine 60 mg modified release tablet, 30 | 30 | $10.97 | RW,TX |
| 2732T | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.02 | AF,IL |
| 13873E | NORETHISTERONEnorethisterone 5 mg tablet, 30 | 30 | $24.52 | BN |
| 13932G | NORETHISTERONE ACETATE + ESTRADIOL (&) ESTRADIOLestradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone acetate 140 microgram/24 hours patch [4], 8 | 1 | $29.99 | SZ |
| 13981W | NORETHISTERONE ACETATE + ESTRADIOL (&) ESTRADIOLestradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone acetate 250 microgram/24 hours patch [4], 8 | 1 | $32.14 | SZ |
| 12642J | OFATUMUMABofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device | 1 | $2109.55 | NV |
| 5567B | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.24 | VE |
| 8383F | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.24 | VE |
| 9294E | OLANZAPINEolanzapine 210 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $157.16 | PB |
| 9295F | OLANZAPINEolanzapine 300 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $255.86 | PB |
| 11503K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 11522K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 12169L | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 12170M | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 12921C | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 12932P | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 13782J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 13783K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.63 | AP |
| 11528R | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 11539H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 12157W | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 12161C | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 12913P | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 12929L | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 13800H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 13807Q | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.63 | AP |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $6.43 | AF,BG,CR,MQ,RW,SZ,TX,TY |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $9.93 | AL |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $8.41 | AF,BG,CR,MQ,RW,SZ,TX,TY |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $10.86 | AL |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $9.18 | AF,CR,RW,SZ,TX |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $12.18 | AL |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $8.72 | AF,CR,RW,SZ,TX |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $11.72 | AL |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $6.20 | AF,CR,RW,SZ,TX |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $9.20 | AL |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.30 | AF,AL,RF,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.14 | AL,RF,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $13.76 | AF |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.55 | AL,RF,TX |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.81 | AF |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.70 | AL,RF,TX |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $15.37 | AF |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.08 | AL,RF,TX |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $15.75 | AF |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.61 | AF,CR,RW,SZ,TX,TY |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.61 | AL |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.21 | AF,CR,RW,SZ,TX,TY |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.46 | AL |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $8.98 | AF,CR,RW,SZ,TX,TY |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $11.24 | AL |
| 12281J | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.61 | AF,HX,TX |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.61 | FJ,FQ,SZ |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.76 | PB |
| 12272X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.61 | AF,RW,TX |
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