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 |
|---|---|---|---|---|
| 13465Q | ENALAPRILenalapril maleate 10 mg tablet, 30 | 30 | $6.08 | AL,RW,SZ,TX,WG |
| 13465Q | ENALAPRILenalapril maleate 10 mg tablet, 30 | 30 | $16.49 | AF |
| 13401H | ENALAPRILenalapril maleate 20 mg tablet, 30 | 30 | $6.38 | RW,SZ,TX,WG |
| 13401H | ENALAPRILenalapril maleate 20 mg tablet, 30 | 30 | $16.78 | AF |
| 13439H | ENALAPRIL + HYDROCHLOROTHIAZIDEenalapril maleate 20 mg + hydrochlorothiazide 6 mg tablet, 30 | 30 | $6.99 | SZ |
| 13439H | ENALAPRIL + HYDROCHLOROTHIAZIDEenalapril maleate 20 mg + hydrochlorothiazide 6 mg tablet, 30 | 30 | $13.95 | AF |
| 11937G | ENCORAFENIBencorafenib 50 mg capsule, 28 | 28 | $780.73 | FB |
| 11954E | ENCORAFENIBencorafenib 50 mg capsule, 28 | 28 | $780.73 | FB |
| 11938H | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1713.70 | FB |
| 11949X | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1713.70 | FB |
| 12814K | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1722.02 | FB |
| 12815L | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1722.02 | FB |
| 13634N | ENFORTUMAB VEDOTINenfortumab vedotin 20 mg injection, 1 vial | 1 | $0.00 | LL |
| 13648H | ENFORTUMAB VEDOTINenfortumab vedotin 20 mg injection, 1 vial | 1 | $0.00 | LL |
| 8510X | ENOXAPARIN SODIUMenoxaparin sodium 40 mg/0.4 mL injection, 10 x 0.4 mL syringes | 10 | $30.51 | AV,CR,JO,JU |
| 8639Q | ENOXAPARIN SODIUMenoxaparin sodium 40 mg/0.4 mL injection, 10 x 0.4 mL syringes | 10 | $30.51 | AV,CR,JO,JU |
| 8558K | ENOXAPARIN SODIUMenoxaparin sodium 20 mg/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $27.56 | AV,CR,JO,JU |
| 8716R | ENOXAPARIN SODIUMenoxaparin sodium 20 mg/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $27.56 | AV,CR,JO,JU |
| 5435C | ENOXAPARIN SODIUMenoxaparin sodium 100 mg/mL injection, 10 x 1 mL syringes | 10 | $71.84 | AV,CR,JO,JU |
| 8640R | ENOXAPARIN SODIUMenoxaparin sodium 60 mg/0.6 mL injection, 10 x 0.6 mL syringes | 10 | $51.02 | AV,CR,JO,JU |
| 5434B | ENOXAPARIN SODIUMenoxaparin sodium 80 mg/0.8 mL injection, 10 x 0.8 mL syringes | 10 | $54.16 | AV,CR,JO,JU |
| 14542J | ENTACAPONEentacapone 200 mg tablet, 100 | 100 | $85.36 | SZ |
| 8367J | ENTACAPONEentacapone 200 mg tablet, 100 | 100 | $85.34 | SZ |
| 10279B | ENTECAVIRentecavir 500 microgram tablet, 30 | 30 | $28.35 | AL,GQ,GX,LR,RA,SZ,WG |
| 10353X | ENTECAVIRentecavir 1 mg tablet, 30 | 30 | $44.86 | AL,GX,RA,SZ,WG |
| 4375G | EPIRUBICINepirubicin hydrochloride 200 mg/100 mL injection, 100 mL vial | 1 | $0.00 | OC |
| 7231N | EPIRUBICINepirubicin hydrochloride 200 mg/100 mL injection, 100 mL vial | 1 | $0.00 | OC |
| 13590G | EPLERENONEeplerenone 25 mg tablet, 30 | 30 | $43.09 | AF,GO,RW,TX |
| 13379E | EPLERENONEeplerenone 50 mg tablet, 30 | 30 | $43.09 | AF,GO,RW,TX |
| 5714R | EPOETIN ALFAepoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $87.99 | JC |
| 6251B | EPOETIN ALFAepoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $91.51 | JC |
| 5722E | EPOETIN ALFAepoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes | 6 | $620.72 | JC |
| 6207Q | EPOETIN ALFAepoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes | 6 | $640.72 | JC |
| 5719B | EPOETIN ALFAepoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $162.82 | JC |
| 6204M | EPOETIN ALFAepoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $169.33 | JC |
| 5713Q | EPOETIN ALFAepoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $1221.11 | JC |
| 6434P | EPOETIN ALFAepoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $1241.11 | JC |
| 5720C | EPOETIN ALFAepoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $210.10 | JC |
| 6205N | EPOETIN ALFAepoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $218.50 | JC |
| 5721D | EPOETIN ALFAepoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes | 6 | $267.57 | JC |
| 6206P | EPOETIN ALFAepoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes | 6 | $278.27 | JC |
| 5718Y | EPOETIN ALFAepoetin alfa 40 000 units/mL injection, 1 mL syringe | 1 | $395.06 | JC |
| 6339P | EPOETIN ALFAepoetin alfa 40 000 units/mL injection, 1 mL syringe | 1 | $410.86 | JC |
| 5715T | EPOETIN ALFAepoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $333.11 | JC |
| 6302Q | EPOETIN ALFAepoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $346.43 | JC |
| 5716W | EPOETIN ALFAepoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $395.42 | JC |
| 6303R | EPOETIN ALFAepoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $411.24 | JC |
| 5717X | EPOETIN ALFAepoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes | 6 | $512.86 | JC |
| 6305W | EPOETIN ALFAepoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes | 6 | $532.86 | JC |
| 5729M | EPOETIN BETAepoetin beta 10 000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $620.68 | RO |
| 6485H | EPOETIN BETAepoetin beta 10 000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $640.68 | RO |
| 5724G | EPOETIN BETAepoetin beta 2000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $162.80 | RO |
| 6480C | EPOETIN BETAepoetin beta 2000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $169.31 | RO |
| 5725H | EPOETIN BETAepoetin beta 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $210.09 | RO |
| 6481D | EPOETIN BETAepoetin beta 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $218.49 | RO |
| 5726J | EPOETIN BETAepoetin beta 4000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $267.55 | RO |
| 6482E | EPOETIN BETAepoetin beta 4000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $278.25 | RO |
| 5727K | EPOETIN BETAepoetin beta 5000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $333.09 | RO |
| 6483F | EPOETIN BETAepoetin beta 5000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $346.41 | RO |
| 5728L | EPOETIN BETAepoetin beta 6000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $395.39 | RO |
| 6484G | EPOETIN BETAepoetin beta 6000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $411.21 | RO |
| 9668W | EPOETIN LAMBDAepoetin lambda 1000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $83.60 | SZ |
| 9685R | EPOETIN LAMBDAepoetin lambda 1000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $86.94 | SZ |
| 9595B | EPOETIN LAMBDAepoetin lambda 10 000 units/mL injection, 6 x 1 mL syringes | 6 | $609.71 | SZ |
| 9596C | EPOETIN LAMBDAepoetin lambda 10 000 units/mL injection, 6 x 1 mL syringes | 6 | $589.71 | SZ |
| 9669X | EPOETIN LAMBDAepoetin lambda 2000 units/mL injection, 6 x 1 mL syringes | 6 | $154.67 | SZ |
| 9686T | EPOETIN LAMBDAepoetin lambda 2000 units/mL injection, 6 x 1 mL syringes | 6 | $160.86 | SZ |
| 9670Y | EPOETIN LAMBDAepoetin lambda 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $199.60 | SZ |
| 9687W | EPOETIN LAMBDAepoetin lambda 3000 units/0.3 mL injection, 6 x 0.3 mL syringes | 6 | $207.58 | SZ |
| 9587N | EPOETIN LAMBDAepoetin lambda 4000 units/0.4 mL injection, 6 x 0.4 mL syringes | 6 | $254.19 | SZ |
| 9688X | EPOETIN LAMBDAepoetin lambda 4000 units/0.4 mL injection, 6 x 0.4 mL syringes | 6 | $264.36 | SZ |
| 9588P | EPOETIN LAMBDAepoetin lambda 5000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $329.12 | SZ |
| 9589Q | EPOETIN LAMBDAepoetin lambda 5000 units/0.5 mL injection, 6 x 0.5 mL syringes | 6 | $316.46 | SZ |
| 9590R | EPOETIN LAMBDAepoetin lambda 6000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $390.69 | SZ |
| 9591T | EPOETIN LAMBDAepoetin lambda 6000 units/0.6 mL injection, 6 x 0.6 mL syringes | 6 | $375.66 | SZ |
| 9593X | EPOETIN LAMBDAepoetin lambda 8000 units/0.8 mL injection, 6 x 0.8 mL syringes | 6 | $506.71 | SZ |
| 9594Y | EPOETIN LAMBDAepoetin lambda 8000 units/0.8 mL injection, 6 x 0.8 mL syringes | 6 | $487.22 | SZ |
| 10117L | EPOPROSTENOLepoprostenol 1.5 mg injection, 1 vial | 1 | $59.33 | JC |
| 10129D | EPOPROSTENOLepoprostenol 1.5 mg injection, 1 vial | 1 | $60.66 | JC |
| 10111E | EPOPROSTENOLepoprostenol 500 microgram injection, 1 vial | 1 | $34.61 | JC |
| 10130E | EPOPROSTENOLepoprostenol 500 microgram injection, 1 vial | 1 | $33.28 | JC |
| 13861M | EPROSARTANeprosartan 600 mg tablet, 28 | 28 | $16.74 | GO |
| 13912F | EPROSARTANeprosartan 600 mg tablet, 28 | 28 | $16.74 | GO |
| 14337N | EPROSARTAN + HYDROCHLOROTHIAZIDEeprosartan 600 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $15.25 | GO |
| 10140Q | ERIBULINeribulin mesilate 1 mg/2 mL injection, 2 mL vial | 1 | $0.00 | EI,RZ |
| 10144X | ERIBULINeribulin mesilate 1 mg/2 mL injection, 2 mL vial | 1 | $0.00 | EI,RZ |
| 11199K | ERIBULINeribulin mesilate 1 mg/2 mL injection, 2 mL vial | 1 | $0.00 | EI,RZ |
| 11212D | ERIBULINeribulin mesilate 1 mg/2 mL injection, 2 mL vial | 1 | $0.00 | EI,RZ |
| 10780J | ERYTHROMYCINerythromycin 250 mg enteric capsule, 25 | 25 | $14.46 | YT |
| 14409J | ERYTHROMYCINerythromycin 250 mg enteric capsule, 25 | 25 | $13.23 | YT |
| 14546N | ESCITALOPRAMescitalopram 20 mg/mL oral liquid, 15 mL | 1 | $28.43 | LU |
| 14349F | ESCITALOPRAMescitalopram 10 mg tablet, 28 | 28 | $5.17 | AF,BG,HQ,HX,RW,TX,TY,WG,ZS |
| 14349F | ESCITALOPRAMescitalopram 10 mg tablet, 28 | 28 | $19.35 | LU |
| 14519E | ESCITALOPRAMescitalopram 10 mg tablet, 28 | 28 | $5.17 | AF,BG,HQ,HX,RW,TX,TY,WG |
| 14519E | ESCITALOPRAMescitalopram 10 mg tablet, 28 | 28 | $19.35 | LU |
| 14415Q | ESCITALOPRAMescitalopram 20 mg tablet, 28 | 28 | $5.17 | AF,BG,HQ,HX,RW,TX,TY,WG,ZS |
| 14415Q | ESCITALOPRAMescitalopram 20 mg tablet, 28 | 28 | $19.70 | LU |
| 14416R | ESCITALOPRAMescitalopram 20 mg tablet, 28 | 28 | $5.17 | AF,BG,HQ,HX,RW,TX,TY,WG |
| 14416R | ESCITALOPRAMescitalopram 20 mg tablet, 28 | 28 | $19.70 | LU |
| 14787G | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $299.16 | JC |
| 14811M | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $304.16 | JC |
| 14812N | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $315.95 | JC |
| 14816T | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $294.16 | JC |
| 14822D | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $294.16 | JC |
| 14836W | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 actuations | 1 | $313.42 | JC |
| 14794P | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $620.07 | JC |
| 14813P | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $588.32 | JC |
| 14814Q | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $598.32 | JC |
| 14815R | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $607.58 | JC |
| 14831N | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $593.32 | JC |
| 14837X | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations | 2 | $588.32 | JC |
| 14786F | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $901.74 | JC |
| 14798W | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $892.48 | JC |
| 14821C | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $882.48 | JC |
| 14823E | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $887.48 | JC |
| 14830M | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $914.23 | JC |
| 14835T | ESKETAMINEesketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations | 3 | $882.48 | JC |
| 12275C | ESOMEPRAZOLEesomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AL |
| 14303T | ESOMEPRAZOLEesomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AL |
| 14510Q | ESOMEPRAZOLEesomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AL |
| 14537D | ESOMEPRAZOLEesomeprazole 20 mg enteric capsule, 30 | 30 | $5.53 | AL |
| 12290W | ESOMEPRAZOLEesomeprazole 40 mg enteric capsule, 30 | 30 | $9.76 | AL |
| 14405E | ESOMEPRAZOLEesomeprazole 40 mg enteric capsule, 30 | 30 | $9.76 | AL |
| 14445G | ESOMEPRAZOLEesomeprazole 40 mg enteric capsule, 30 | 30 | $8.53 | AL |
| 12287Q | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 12287Q | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $13.76 | AP |
| 14308C | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 14308C | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $13.76 | AP |
| 14444F | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 14444F | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $13.76 | AP |
| 14481E | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 14481E | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $12.53 | AP |
| 12283L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $9.76 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 12283L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $16.76 | AP |
| 14373L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $9.76 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 14373L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $16.76 | AP |
| 14512T | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $8.53 | AF,BG,GQ,MQ,RA,RF,RW,TY,WG |
| 14512T | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $15.53 | AP |
| 9329B | ESSENTIAL AMINO ACIDS FORMULAessential amino acids formula powder for oral liquid, 2 x 200 g | 1 | $170.79 | SB |
| 2027Q | ESSENTIAL AMINO ACIDS FORMULA WITH MINERALS AND VITAMIN Cessential amino acids formula with minerals and vitamin C powder for oral liquid, 400 g | 1 | $102.95 | SB |
| 13759E | ESSENTIAL AMINO ACIDS FORMULA WITH VITAMINS AND MINERALSessential amino acids formula with vitamins and minerals powder for oral liquid, 30 x 12.5 g sachets | 1 | $195.57 | VF |
| 14741W | ESTRADIOLestradiol 0.06% (750 microgram/actuation) gel, 64 actuations | 1 | $25.21 | HB |
| 14642P | ESTRADIOLestradiol 0.1% (1 mg/g) gel, 28 x 500 mg sachets | 1 | $10.98 | OX |
| 13978Q | ESTRADIOLestradiol 10 microgram modified release pessary, 18 | 18 | $19.02 | AS,NO |
| 13931F | ESTRADIOLestradiol 2 mg tablet, 56 | 56 | $8.66 | XT |
| 14026F | ESTRADIOLestradiol 0.1% (1 mg/g) gel, 28 x 1 g sachets | 1 | $14.63 | OX |
| 13872D | ESTRADIOLestradiol valerate 1 mg tablet, 56 | 56 | $5.59 | GH |
| 13980T | ESTRADIOLestradiol valerate 2 mg tablet, 56 | 56 | $6.91 | GH |
| 14024D | ESTRADIOL (&) ESTRADIOL + DYDROGESTERONEestradiol 1 mg tablet [14] (&) estradiol 1 mg + dydrogesterone 10 mg tablet [14], 28 | 1 | $13.19 | XT |
| 13930E | ESTRADIOL (&) ESTRADIOL + DYDROGESTERONEestradiol 2 mg tablet [14] (&) estradiol 2 mg + dydrogesterone 10 mg tablet [14], 28 | 1 | $13.19 | XT |
| 13981W | ESTRADIOL (&) ESTRADIOL + NORETHISTERONE ACETATEestradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone acetate 250 microgram/24 hours patch [4], 8 | 1 | $32.29 | SZ |
| 13932G | ESTRADIOL (&) ESTRADIOL + NORETHISTERONE ACETATEestradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone acetate 140 microgram/24 hours patch [4], 8 | 1 | $33.95 | SZ |
| 14336M | ESTRADIOL + NORETHISTERONE ACETATEestradiol 50 microgram/24 hours + norethisterone acetate 250 microgram/24 hours patch, 8 | 1 | $23.73 | SZ |
| 13902Q | ESTRADIOL + NORETHISTERONE ACETATEestradiol 50 microgram/24 hours + norethisterone acetate 140 microgram/24 hours patch, 8 | 1 | $25.48 | SZ |
| 14059Y | ESTRIOLestriol 500 microgram pessary, 15 | 1 | $15.27 | AS |
| 13926Y | ESTRIOLestriol 0.1% (1 mg/g) cream, 15 g | 1 | $13.78 | AS |
| 11197H | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 13294Q | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $371.81 | PF |
| 13295R | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $386.68 | PF |
| 13693Q | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 1954W | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 3445H | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 3448L | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 8637N | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 8638P | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 8778B | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 8779C | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 9035M | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 9036N | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 9037P | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 9429G | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.78 | PF |
| 11703Y | ETHOSUXIMIDEethosuximide 250 mg capsule, 100 | 100 | $143.89 | IX |
| 14014N | ETHOSUXIMIDEethosuximide 250 mg/5 mL oral liquid, 200 mL | 1 | $63.57 | IX |
| 4428C | ETOPOSIDEetoposide phosphate 1.136 g (etoposide 1 g) injection, 1 vial | 1 | $0.00 | LM,SZ |
| 7237X | ETOPOSIDEetoposide phosphate 1.136 g (etoposide 1 g) injection, 1 vial | 1 | $0.00 | LM,SZ |
| 10301E | ETRAVIRINEetravirine 200 mg tablet, 60 | 60 | $405.11 | JC |
| 5738B | EVEROLIMUSeverolimus 250 microgram tablet, 60 | 60 | $151.93 | CR,NV |
| 6459Y | EVEROLIMUSeverolimus 250 microgram tablet, 60 | 60 | $158.01 | CR,NV |
| 5739C | EVEROLIMUSeverolimus 500 microgram tablet, 60 | 60 | $265.21 | CR,NV |
| 6460B | EVEROLIMUSeverolimus 500 microgram tablet, 60 | 60 | $275.82 | CR,NV |
| 14040Y | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $431.90 | CR,NV |
| 5740D | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $397.81 | CR,NV |
| 6461C | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $407.81 | CR,NV |
| 8842J | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $431.87 | CR,NV |
| 13941R | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $568.94 | CR,NV |
| 5737Y | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $530.42 | CR,NV |
| 9352F | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $571.11 | CR,NV |
| 9582H | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $540.42 | CR,NV |
| 10958R | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $214.47 | AN |
| 11484K | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $214.46 | AN |
| 11977J | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $214.47 | AN |
| 11985T | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $214.46 | AN |
| 13857H | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $40.30 | GQ,SZ,TX,WG |
| 13857H | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $43.03 | PF |
| 14036R | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $40.30 | GQ,SZ,TX,WG |
| 14036R | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $43.03 | PF |
| 13440J | EZETIMIBEezetimibe 10 mg tablet, 30 | 30 | $7.14 | AF,BG,CR,GQ,RW,SZ,TX,WG,XT |
| 13440J | EZETIMIBEezetimibe 10 mg tablet, 30 | 30 | $10.53 | AL |
| 13569E | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60 | 1 | $15.41 | AF,CR,SZ |
| 13569E | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60 | 1 | $18.38 | AL |
| 13480L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60 | 1 | $17.38 | AF,CR,SZ |
| 13480L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60 | 1 | $20.36 | AL |
| 13537L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60 | 1 | $17.07 | AF,CR,SZ |
| 13537L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60 | 1 | $20.16 | AL |
| 13629H | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60 | 1 | $14.02 | AF,SZ |
| 13629H | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60 | 1 | $16.89 | AL |
| 13539N | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 10 mg tablet, 30 | 30 | $11.03 | AF,GQ,XT |
| 13622Y | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 20 mg tablet, 30 | 30 | $13.79 | AF |
| 13622Y | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 20 mg tablet, 30 | 30 | $11.59 | GQ,XT |
| 13416D | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 40 mg tablet, 30 | 30 | $15.79 | AF |
| 13416D | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 40 mg tablet, 30 | 30 | $13.57 | GQ,XT |
| 13538M | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 80 mg tablet, 30 | 30 | $19.38 | AF |
| 13538M | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 80 mg tablet, 30 | 30 | $16.38 | GQ,XT |
| 13442L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 20 mg tablet, 30 | 30 | $9.46 | SZ,TX |
| 13385L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 10 mg tablet, 30 | 30 | $9.13 | CR,GQ,MQ,RW,SZ,TX,WG |
| 13385L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 10 mg tablet, 30 | 30 | $11.13 | AL |
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