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 |
|---|---|---|---|---|
| 12635B | HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATEhigh fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate oral semi-solid, 36 x 100 g tubs | 1 | $196.56 | VF |
| 12789D | HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATEhigh fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons | 1 | $300.16 | QH |
| 12464B | HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATEhigh fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (3:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons | 1 | $179.81 | QH |
| 9446E | HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATEhigh fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio long chain fat to carbohydate plus protein) powder for oral liquid, 300 g | 1 | $36.23 | SB |
| 2652N | HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATEhigh fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (3:1 ratio long chain fat to carbohydrate plus protein) powder for oral liquid, 300 g | 1 | $34.66 | SB |
| 14354L | HYALURONATE SODIUMhyaluronate sodium 0.1% eye drops, 10 mL | 1 | $23.81 | AE |
| 14494W | HYALURONATE SODIUMhyaluronate sodium 0.2% eye drops, 10 mL | 1 | $23.81 | AE |
| 13409R | HYDROCHLOROTHIAZIDEhydrochlorothiazide 25 mg tablet, 100 | 100 | $10.61 | FF |
| 14476X | HYDROCORTISONEhydrocortisone 20 mg tablet, 60 | 60 | $23.10 | AL |
| 14476X | HYDROCORTISONEhydrocortisone 20 mg tablet, 60 | 60 | $26.10 | AF |
| 13863P | HYDROCORTISONEhydrocortisone 4 mg tablet, 50 | 50 | $16.92 | AL |
| 13863P | HYDROCORTISONEhydrocortisone 4 mg tablet, 50 | 50 | $19.92 | AF |
| 1501B | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $7.93 | PF |
| 1510L | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $6.29 | PF |
| 5118J | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $6.29 | PF |
| 1511M | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 250 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $10.41 | PF |
| 5119K | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 250 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $10.41 | PF |
| 12045Y | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $16.41 | MF |
| 12047C | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $16.41 | MF |
| 12032G | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.68 | MF |
| 12046B | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.68 | MF |
| 12010D | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $27.09 | MF |
| 12016K | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $27.09 | MF |
| 9487H | HYDROXYETHYL STARCH 130/0.4 + SODIUM CHLORIDEHYDROXYETHYL STARCH 130/0.4 I.V. infusion 30 g per 500 mL, 500 mL, 1 | 1 | $8.97 | PK |
| 14320Q | HYPROMELLOSEhypromellose 0.5% eye drops, 15 mL | 1 | $6.22 | AF |
| 14318N | HYPROMELLOSEhypromellose 0.3% w/w eye drops, 10 mL | 1 | $5.17 | PP |
| 14492R | HYPROMELLOSEhypromellose 0.3% w/v eye drops, 10 mL | 1 | $14.01 | CX |
| 3190X | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.33 | TX,WG |
| 3190X | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.84 | GO |
| 5123P | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.33 | TX,WG |
| 5123P | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.84 | GO |
| 12113M | IMIPRAMINEimipramine hydrochloride 25 mg tablet, 100 | 100 | $30.25 | QY |
| 14334K | INDACATEROLindacaterol 150 microgram powder for inhalation, 30 capsules | 30 | $48.37 | NV |
| 14368F | INDACATEROLindacaterol 300 microgram powder for inhalation, 30 capsules | 30 | $48.37 | NV |
| 14504J | INDACATEROL + GLYCOPYRRONIUMindacaterol 110 microgram + glycopyrronium 50 microgram powder for inhalation, 30 capsules | 30 | $77.16 | NV |
| 14399W | INDACATEROL + GLYCOPYRRONIUM + MOMETASONEindacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 136 microgram powder for inhalation, 30 capsules | 30 | $79.32 | NV |
| 14471P | INDACATEROL + GLYCOPYRRONIUM + MOMETASONEindacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 68 microgram powder for inhalation, 30 capsules | 30 | $62.70 | NV |
| 14332H | INDACATEROL + MOMETASONEindacaterol 125 microgram + mometasone furoate 62.5 microgram powder for inhalation, 30 capsules | 30 | $26.97 | NV |
| 14441C | INDACATEROL + MOMETASONEindacaterol 125 microgram + mometasone furoate 260 microgram powder for inhalation, 30 capsules | 30 | $48.61 | NV |
| 14333J | INDACATEROL + MOMETASONEindacaterol 125 microgram + mometasone furoate 127.5 microgram powder for inhalation, 30 capsules | 30 | $32.78 | NV |
| 13475F | INDAPAMIDEindapamide hemihydrate 1.5 mg modified release tablet, 90 | 90 | $7.91 | AF,TX |
| 13475F | INDAPAMIDEindapamide hemihydrate 1.5 mg modified release tablet, 90 | 90 | $14.18 | SE |
| 13378D | INDAPAMIDEindapamide hemihydrate 2.5 mg tablet, 90 | 90 | $6.76 | AF,RW |
| 2454E | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.79 | AF |
| 2454E | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $8.31 | AS |
| 5126T | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.79 | AF |
| 5126T | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $8.31 | AS |
| 2757D | INDOMETACINindometacin 100 mg suppository, 20 | 20 | $9.45 | AS |
| 5128X | INDOMETACINindometacin 100 mg suppository, 20 | 20 | $9.45 | AS |
| 12551N | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12554R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12560C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12567K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12575W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12577Y | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12584H | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12587L | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13048R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13049T | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13054C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13055D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13056E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13060J | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13061K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13062L | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13070X | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13075E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13076F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 13077G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.90 | EW |
| 12550M | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12552P | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12553Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12561D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12576X | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12585J | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12586K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 12597B | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13047Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13050W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13057F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13058G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13065P | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13066Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13067R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13069W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13072B | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13073C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13074D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13078H | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.68 | EW |
| 13651L | INSULIN ASPARTinsulin aspart 100 units/mL fast acting injection, 5 x 3 mL cartridges | 1 | $31.80 | NO |
| 8571D | INSULIN ASPARTinsulin aspart 100 units/mL injection, 1 x 10 mL vial | 1 | $18.54 | NO |
| 8435Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.80 | NO |
| 12254Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.80 | NF |
| 12238D | INSULIN ASPART + INSULIN ASPART PROTAMINEinsulin aspart 30 units/mL + insulin aspart protamine 70 units/mL injection, 5 x 3 mL pen devices | 1 | $31.80 | NF |
| 8609D | INSULIN ASPART + INSULIN ASPART PROTAMINEinsulin aspart 30 units/mL + insulin aspart protamine 70 units/mL injection, 5 x 3 mL cartridges | 1 | $31.80 | NO |
| 11426J | INSULIN DEGLUDEC + INSULIN ASPARTinsulin degludec 70 units/mL + insulin aspart 30 units/mL injection, 5 x 3 mL cartridges | 1 | $74.49 | NO |
| 12236B | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL pen devices | 1 | $69.53 | NF |
| 9040T | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL cartridges | 1 | $69.53 | NO |
| 11308E | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 3 x 1.5 mL pen devices | 1 | $49.48 | SW |
| 11302W | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 5 x 1.5 mL pen devices | 1 | $82.46 | SW |
| 11815W | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $35.78 | WA |
| 9039R | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $35.78 | GZ |
| 12268Q | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.81 | SW |
| 1921D | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.81 | AV |
| 1533Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.60 | LY,NO |
| 1761Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.51 | LY,NO |
| 12237C | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.80 | KP |
| 8084L | INSULIN LISPROinsulin lispro 100 units/mL injection, 1 x 10 mL vial | 1 | $18.54 | LY |
| 8212F | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.80 | LY |
| 11645X | INSULIN LISPROinsulin lispro 200 units/mL injection, 5 x 3 mL pen devices | 1 | $51.66 | LY |
| 12234X | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL pen devices | 1 | $31.80 | KP |
| 12261H | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 50 units/mL + insulin lispro protamine 50 units/mL injection, 5 x 3 mL pen devices | 1 | $31.80 | KP |
| 8390N | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL cartridges | 1 | $31.80 | LY |
| 8874C | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 50 units/mL + insulin lispro protamine 50 units/mL injection, 5 x 3 mL cartridges | 1 | $31.80 | LY |
| 1531N | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.60 | LY,NO |
| 1762R | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.51 | LY,NO |
| 1426C | INSULIN NEUTRAL HUMAN + INSULIN ISOPHANE HUMANinsulin neutral human 30 units/mL + insulin isophane human 70 units/mL injection, 10 mL vial | 1 | $15.60 | LY |
| 1763T | INSULIN NEUTRAL HUMAN + INSULIN ISOPHANE HUMANinsulin neutral human 30 units/mL + insulin isophane human 70 units/mL injection, 5 x 3 mL cartridges | 1 | $26.51 | LY |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.61 | BY |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.35 | BY |
| 8671J | IPRATROPIUMipratropium bromide monohydrate 21 microgram/actuation inhalation, 200 actuations | 1 | $13.03 | BY,LR |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $5.17 | AL,BG,RF,SZ,TX,WG |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $9.21 | AV,SW |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $6.22 | AL,BG,RF,SZ,TX,WG |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $10.26 | AV,SW |
| 13435D | IRBESARTANirbesartan 75 mg tablet, 30 | 30 | $5.17 | AL,BG,RF,SZ,TX,WG |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $5.17 | AL,RF,SZ,TX,WG |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.21 | AV,SW |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.33 | AL,RF,SZ,TX,WG |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $10.36 | AV,SW |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $6.67 | AL,RF,SZ,TX,WG |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $10.71 | AV,SW |
| 9436P | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 1 g isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $120.95 | VF |
| 9134R | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 50 mg isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $109.95 | VF |
| 13491C | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $4.99 | RW |
| 2588F | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $6.22 | RW |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $13.15 | IX |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $9.78 | IY |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $6.22 | AF,RF,TX,WG |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $9.60 | IX |
| 11621P | ISOTRETINOINisotretinoin 20 mg capsule, 30 | 30 | $15.78 | PB,RZ |
| 15270Q | IVABRADINEivabradine 5 mg tablet, 56 | 56 | $35.82 | SE,TX,WG |
| 15241E | IVABRADINEivabradine 7.5 mg tablet, 56 | 56 | $35.82 | SE,TX |
| 2868Y | IVERMECTINivermectin 3 mg tablet, 4 | 4 | $20.04 | MK |
| 13887X | LABETALOLlabetalol hydrochloride 100 mg tablet, 100 | 100 | $20.13 | AF |
| 13839J | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $51.58 | AF,CR,DZ,GQ,SZ,UC,XT |
| 13867W | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $51.58 | AF,CR,DZ,GQ,SZ,UC,XT |
| 13838H | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $77.27 | AF,CR,DZ,GQ,SZ,UC,XT |
| 14053P | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $77.27 | AF,CR,DZ,GQ,SZ,UC,XT |
| 13949E | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $103.03 | AF,CR,DZ,GQ,SZ,UC,XT |
| 13951G | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $103.03 | AF,CR,DZ,GQ,SZ,UC,XT |
| 10293R | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $7.36 | AF,CR,DZ,GQ,SZ,UC,XT |
| 12626M | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $7.36 | AF,CR,DZ,GQ,SZ,UC,XT |
| 14011K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $6.74 | AF,CR,DZ,GQ,SZ,UC,XT |
| 14049K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $6.74 | AF,CR,DZ,GQ,SZ,UC,XT |
| 11694L | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.37 | DZ,UC |
| 12628P | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.34 | DZ,UC |
| 14013M | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.36 | DZ,UC |
| 14048J | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.37 | DZ,UC |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $6.76 | AL,GQ,HX,RF,TY,WG,ZS |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $11.04 | AS |
| 15346Q | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $11.04 | AS |
| 15346Q | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $6.76 | GQ,HX |
| 14047H | LAMOTRIGINElamotrigine 5 mg tablet, 56 | 56 | $7.61 | AS |
| 15339H | LAMOTRIGINElamotrigine 5 mg tablet, 56 | 56 | $7.61 | AS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $7.52 | AL,GQ,HX,RF,TY,WG,ZS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $11.10 | AS |
| 15342L | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $11.10 | AS |
| 15342L | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $7.52 | GQ,HX |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $10.89 | AL,GQ,HX,RF,TY,WG,ZS |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $14.45 | AS |
| 15340J | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $14.45 | AS |
| 15340J | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $10.89 | GQ,HX |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $16.63 | AL,GQ,HX,RF,TY,WG,ZS |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $19.60 | AS |
| 15351Y | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $19.60 | AS |
| 15351Y | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $16.63 | GQ,HX |
| 14448K | LANSOPRAZOLElansoprazole 15 mg enteric capsule, 30 | 30 | $6.22 | AF |
| 12284M | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $6.76 | AF,RA,TX |
| 14302R | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $6.76 | AF,RA,TX |
| 14304W | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $5.53 | AF,RA,TX |
| 14340R | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $6.76 | AF,RA,TX |
| 14374M | LANSOPRAZOLElansoprazole 15 mg orally disintegrating tablet, 28 | 28 | $6.14 | AF,GQ,TX |
| 14374M | LANSOPRAZOLElansoprazole 15 mg orally disintegrating tablet, 28 | 28 | $10.94 | PF |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $6.76 | AF,GQ,TX |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $11.44 | PF |
| 14339Q | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $5.53 | AF,GQ,TX |
| 14339Q | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $10.21 | PF |
| 14342W | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $6.76 | AF,GQ,TX |
| 14342W | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $11.44 | PF |
| 14406F | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $6.76 | AF,GQ,TX |
| 14406F | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $11.44 | PF |
| 14060B | LANTHANUMlanthanum 500 mg chewable tablet, 2 x 45 | 90 | $186.69 | TK |
| 13986D | LANTHANUMlanthanum 750 mg chewable tablet, 6 x 15 | 90 | $281.92 | TK |
| 13874F | LANTHANUMlanthanum 1 g chewable tablet, 6 x 15 | 90 | $317.38 | TK |
| 11251E | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.97 | NV |
| 9148L | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.97 | NV |
| 14453Q | LATANOPROSTlatanoprost 0.005% eye drops, 2.5 mL | 1 | $6.76 | AF,AS,SZ,TX |
| 14350G | LATANOPROST + TIMOLOLlatanoprost 0.005% + timolol 0.5% eye drops, 2.5 mL | 1 | $10.61 | AF,AS,TX |
| 13940Q | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $13.37 | AF,HQ,RW,SW,SZ,TX,WG |
| 14068K | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $13.37 | AF,HQ,SW,SZ,TX,WG |
| 13998R | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $19.07 | AF,HQ,SW,SZ,TX,WG |
| 14069L | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $19.07 | AF,HQ,RW,SW,SZ,TX,WG |
| 10965D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2077.03 | EI |
| 13253M | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2077.03 | EI |
| 13283D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2077.03 | EI |
| 11638M | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2051.35 | EI |
| 13252L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2068.01 | EI |
| 13290L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2068.01 | EI |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $5.17 | AL,RW,TX,WG |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $8.65 | GO |
| 13412X | LERCANIDIPINElercanidipine hydrochloride 20 mg tablet, 28 | 28 | $6.22 | TX |
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