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 |
|---|---|---|---|---|
| 14554B | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 100 mg + carbidopa 25 mg + entacapone 200 mg tablet, 100 | 100 | $64.28 | HX,SZ,TB,TX |
| 8798C | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 100 mg + carbidopa 25 mg + entacapone 200 mg tablet, 100 | 100 | $64.26 | HX,SZ,TB,TX |
| 9345W | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 125 mg + carbidopa 31.25 mg + entacapone 200 mg tablet, 100 | 100 | $66.70 | HX,SZ,TB,TX |
| 8799D | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 150 mg + carbidopa 37.5 mg + entacapone 200 mg tablet, 100 | 100 | $70.35 | HX,SZ,TB,TX |
| 9292C | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 200 mg + carbidopa 50 mg + entacapone 200 mg tablet, 100 | 100 | $75.94 | HX,SZ,TB,TX |
| 8797B | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 50 mg + carbidopa 12.5 mg + entacapone 200 mg tablet, 100 | 100 | $58.18 | HX,SZ,TB,TX |
| 9344T | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100 | 100 | $60.86 | HX,SZ,TB,TX |
| 13954K | LINAGLIPTINlinagliptin 5 mg tablet, 30 | 30 | $43.70 | BY |
| 13959Q | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $45.72 | BY |
| 14065G | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 850 mg tablet, 60 | 60 | $46.55 | BY |
| 13879L | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $47.03 | BY |
| 13966C | LIOTHYRONINEliothyronine sodium 20 microgram tablet, 100 | 100 | $46.75 | AS |
| 14352J | LIQUID PARAFFIN + GLYCEROL + TYLOXAPOL + POLOXAMER-188 + TROMETAMOL HYDROCHLORIDE + TROMETAMOL + CETALKONIUM CHLORIDEliquid paraffin + glycerol + tyloxapol + poloxamer-188 + trometamol hydrochloride + trometamol + cetalkonium chloride eye drops, 10 mL | 1 | $24.80 | CS |
| 13584Y | LISINOPRILlisinopril 10 mg tablet, 30 | 30 | $6.22 | AL,RW,SZ,TX,WG |
| 13584Y | LISINOPRILlisinopril 10 mg tablet, 30 | 30 | $11.06 | IX |
| 13402J | LISINOPRILlisinopril 20 mg tablet, 30 | 30 | $6.54 | AL,RW,SZ,TX,WG |
| 13402J | LISINOPRILlisinopril 20 mg tablet, 30 | 30 | $11.37 | IX |
| 13583X | LISINOPRILlisinopril 5 mg tablet, 30 | 30 | $5.18 | AL,RW,SZ,TX,WG |
| 13583X | LISINOPRILlisinopril 5 mg tablet, 30 | 30 | $10.00 | IX |
| 8290H | LITHIUM CARBONATElithium carbonate 450 mg modified release tablet, 100 | 100 | $36.29 | AS |
| 10889D | LOPERAMIDEloperamide hydrochloride 2 mg capsule, 12 | 12 | $2.47 | AS,CR |
| 15052F | LUMASIRANLumasiran 94.5 mg/0.5 mL injection, 0.5 mL vial | 1 | $98017.38 | WM |
| 15060P | LUMASIRANLumasiran 94.5 mg/0.5 mL injection, 0.5 mL vial | 1 | $98017.38 | WM |
| 14341T | MACROGOL-3350macrogol-3350 1 g/g powder for oral liquid, 510 g | 1 | $11.93 | KY |
| 14408H | MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.125 g + sodium chloride 350.7 mg + sodium bicarbonate 178.5 mg + potassium chloride 46.6 mg powder for oral liquid, 30 sachets | 1 | $8.73 | GX,OW,RF,RW,TX |
| 9327X | MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral liquid, 250 mL bottle | 1 | $20.25 | SB |
| 3128P | MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral oil, 500 mL | 1 | $53.01 | SB |
| 13849X | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 | 30 | $16.03 | PF |
| 13849X | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 | 30 | $9.33 | FZ |
| 13928C | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 | 100 | $32.06 | PF |
| 13928C | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 | 100 | $25.36 | FZ |
| 14067J | MEDROXYPROGESTERONEmedroxyprogesterone acetate 100 mg tablet, 100 | 100 | $76.53 | PF |
| 13881N | MEDROXYPROGESTERONEmedroxyprogesterone acetate 200 mg tablet, 60 | 60 | $87.29 | PF |
| 13961T | MEDROXYPROGESTERONEmedroxyprogesterone acetate 250 mg tablet, 60 | 60 | $89.94 | PF |
| 13956M | MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 | 56 | $12.52 | PF |
| 13956M | MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 | 56 | $7.94 | FZ |
| 1598D | MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 | 25 | $40.17 | LM |
| 1598D | MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 | 25 | $42.03 | AS |
| 12463Y | MESALAZINEmesalazine 1.6 g enteric tablet, 60 | 60 | $72.57 | EU |
| 13395B | MESALAZINEmesalazine 1.6 g enteric tablet, 60 | 60 | $72.60 | EU |
| 13355X | MESALAZINEmesalazine 1 g modified release granules, 100 sachets | 100 | $98.14 | FP |
| 13398E | MESALAZINEmesalazine 1 g modified release granules, 100 sachets | 100 | $107.15 | FD |
| 14843F | MESALAZINEmesalazine 1 g suppository, 30 | 30 | $90.64 | FD |
| 13456F | MESALAZINEmesalazine 4 g modified release granules, 30 sachets | 30 | $120.86 | FP |
| 13356Y | MESALAZINEmesalazine 1.2 g modified release tablet, 120 | 120 | $165.08 | RA |
| 14848L | MESALAZINEmesalazine 1 g/100 mL enema, 7 x 100 mL | 1 | $51.69 | FP |
| 8753Q | MESALAZINEmesalazine 1 g/100 mL enema, 7 x 100 mL | 1 | $51.68 | FP |
| 13518L | MESALAZINEmesalazine 3 g modified release granules, 30 sachets | 30 | $92.57 | FD |
| 11554D | MESALAZINEmesalazine 1 g enteric tablet, 60 | 60 | $64.60 | FD |
| 13394Y | MESALAZINEmesalazine 1 g enteric tablet, 60 | 60 | $64.63 | FD |
| 14838Y | MESALAZINEmesalazine 2 g/60 mL enema, 7 x 60 mL | 1 | $51.69 | FD |
| 8616L | MESALAZINEmesalazine 2 g/60 mL enema, 7 x 60 mL | 1 | $51.68 | FD |
| 14847K | MESALAZINEmesalazine 4 g/60 mL enema, 7 x 60 mL | 1 | $80.87 | FD |
| 8617M | MESALAZINEmesalazine 4 g/60 mL enema, 7 x 60 mL | 1 | $80.86 | FD |
| 14840C | MESALAZINEmesalazine 1 g/application foam, 14 applications | 1 | $59.83 | FD |
| 8768L | MESALAZINEmesalazine 1 g/application foam, 14 applications | 1 | $59.82 | FD |
| 13422K | MESALAZINEmesalazine 800 mg enteric tablet, 90 | 90 | $68.89 | EU |
| 13460K | MESALAZINEmesalazine 1.5 g modified release granules, 60 sachets | 60 | $92.57 | FD |
| 13361F | MESALAZINEmesalazine 500 mg modified release granules, 100 sachets | 100 | $57.31 | FD |
| 8598M | MESALAZINEmesalazine 500 mg modified release granules, 100 sachets | 100 | $57.29 | FD |
| 13397D | MESALAZINEmesalazine 2 g modified release granules, 60 sachets | 60 | $120.86 | FP |
| 14850N | MESALAZINEmesalazine 1 g suppository, 28 | 28 | $73.11 | FP |
| 13576M | MESALAZINEmesalazine 1 g modified release tablet, 60 | 60 | $64.29 | FP |
| 3413P | MESALAZINEmesalazine 1 g modified release tablet, 60 | 60 | $64.27 | FP |
| 13487W | MESALAZINEmesalazine 1.2 g modified release tablet, 60 | 60 | $82.54 | NQ,TK,TN |
| 9353G | MESALAZINEmesalazine 1.2 g modified release tablet, 60 | 60 | $82.52 | NQ,TK,TN |
| 13423L | MESALAZINEmesalazine 250 mg enteric tablet, 100 | 100 | $34.10 | GO |
| 13362G | MESALAZINEmesalazine 500 mg enteric tablet, 100 | 100 | $57.31 | FD |
| 8731M | MESALAZINEmesalazine 500 mg enteric tablet, 100 | 100 | $57.29 | FD |
| 13396C | MESALAZINEmesalazine 500 mg modified release tablet, 100 | 100 | $57.31 | FP |
| 2214M | MESALAZINEmesalazine 500 mg modified release tablet, 100 | 100 | $57.29 | FP |
| 14056T | METFORMINmetformin hydrochloride 1 g tablet, 90 | 90 | $6.76 | AF,BG,HQ,MQ,RW,SZ,TY,WG,ZS |
| 14056T | METFORMINmetformin hydrochloride 1 g tablet, 90 | 90 | $11.65 | AL |
| 13847T | METFORMINmetformin hydrochloride 1 g modified release tablet, 60 | 60 | $6.76 | AF,BG,CR,GQ,MQ,RF,SZ,TX,WG |
| 13847T | METFORMINmetformin hydrochloride 1 g modified release tablet, 60 | 60 | $12.10 | AL |
| 13976N | METFORMINmetformin hydrochloride 500 mg tablet, 100 | 100 | $5.69 | AF,BG,HQ,MQ,RF,SZ,TY,WG,ZS |
| 13976N | METFORMINmetformin hydrochloride 500 mg tablet, 100 | 100 | $11.16 | AL |
| 13899M | METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 | 120 | $6.76 | BG,CR,GQ,MQ,RW,SZ,TX,WG |
| 13899M | METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 | 120 | $12.10 | AL |
| 13952H | METFORMINmetformin hydrochloride 850 mg tablet, 60 | 60 | $5.69 | AF,BG,MQ,RF,SZ,TY,WG,ZS |
| 13952H | METFORMINmetformin hydrochloride 850 mg tablet, 60 | 60 | $11.16 | AL |
| 14005D | METHENAMINE HIPPURATEmethenamine hippurate 1 g tablet, 100 | 100 | $20.76 | AS,IL,RW,TX |
| 13882P | METHOTREXATEmethotrexate 50 mg/2 mL injection, 5 x 2 mL vials | 5 | $29.88 | PF |
| 11275K | METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe | 1 | $20.58 | LM |
| 14091P | METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe | 1 | $20.58 | LM |
| 11283W | METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe | 1 | $20.58 | LM |
| 14089M | METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe | 1 | $20.58 | LM |
| 11268C | METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe | 1 | $20.58 | LM |
| 14102F | METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe | 1 | $20.58 | LM |
| 11288D | METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe | 1 | $20.58 | LM |
| 14097Y | METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe | 1 | $20.58 | LM |
| 11295L | METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe | 1 | $20.58 | LM |
| 14103G | METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe | 1 | $20.58 | LM |
| 15070E | METHYLPHENIDATEmethylphenidate hydrochloride 30 mg modified release capsule, 100 | 100 | $560.32 | KQ |
| 14857Y | METHYLPHENIDATEmethylphenidate hydrochloride 18 mg modified release tablet, 60 | 60 | $223.03 | DZ |
| 14862F | METHYLPHENIDATEmethylphenidate hydrochloride 36 mg modified release tablet, 60 | 60 | $294.06 | DZ |
| 14871Q | METHYLPHENIDATEmethylphenidate hydrochloride 54 mg modified release tablet, 60 | 60 | $340.19 | DZ |
| 10833E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $9.75 | LO |
| 10833E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $5.81 | XT |
| 10835G | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $10.08 | LO |
| 10835G | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $6.14 | XT |
| 10842P | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $11.72 | LO |
| 10842P | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $7.78 | XT |
| 10851D | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $9.87 | LO |
| 10851D | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $5.93 | XT |
| 10855H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $10.49 | LO |
| 10855H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g | 1 | $6.55 | XT |
| 10830B | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $6.95 | LO |
| 10838K | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $7.61 | LO |
| 10852E | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $7.20 | LO |
| 10856J | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g | 1 | $8.43 | LO |
| 10834F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.87 | LO |
| 10834F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.93 | NB,XT |
| 10836H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.49 | LO |
| 10836H | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.55 | NB,XT |
| 10839L | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.87 | LO |
| 10839L | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.93 | AS,NB,XT |
| 10840M | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.49 | LO |
| 10840M | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.55 | AS,NB,XT |
| 10843Q | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.75 | LO |
| 10843Q | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.81 | AS,NB,XT |
| 10844R | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.08 | LO |
| 10844R | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.14 | AS,NB,XT |
| 10845T | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $9.75 | LO |
| 10845T | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $5.81 | NB,XT |
| 10846W | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $11.72 | LO |
| 10846W | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $7.78 | NB,XT |
| 10848Y | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $11.72 | LO |
| 10848Y | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $7.78 | AS,NB,XT |
| 10853F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $10.08 | LO |
| 10853F | METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g | 1 | $6.14 | NB,XT |
| 13420H | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 190 mg (controlled release), 30 | 30 | $30.92 | AF,AP,CR,RW |
| 13543T | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 47.5 mg (controlled release), 30 | 30 | $20.67 | AF,AP,CR,RW |
| 13544W | METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 95 mg (controlled release), 30 | 30 | $25.22 | AF,AP,CR,RW |
| 13541Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 | 60 | $5.43 | AF,RW,SZ,TX,WG,ZS |
| 13541Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 | 60 | $18.58 | AP |
| 13598Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 | 100 | $5.17 | AF,RW,SZ,TX,WG,ZS |
| 13598Q | METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 | 100 | $18.32 | AP |
| 14366D | MIANSERINmianserin hydrochloride 10 mg tablet, 50 | 50 | $10.26 | AF |
| 14505K | MIANSERINmianserin hydrochloride 20 mg tablet, 50 | 50 | $18.91 | AF |
| 14270C | MIDAZOLAMmidazolam 10 mg/mL oral liquid, 1 mL syringe | 1 | $135.43 | IX |
| 14299N | MIDAZOLAMmidazolam 10 mg/mL oral liquid, 1 mL syringe | 1 | $135.43 | IX |
| 14292F | MIDAZOLAMmidazolam 5 mg/0.5 mL oral liquid, 0.5 mL syringe | 1 | $135.43 | IX |
| 14293G | MIDAZOLAMmidazolam 5 mg/0.5 mL oral liquid, 0.5 mL syringe | 1 | $135.43 | IX |
| 14238J | MIDAZOLAMmidazolam 7.5 mg/0.75 mL oral liquid, 0.75 mL syringe | 1 | $135.43 | IX |
| 14291E | MIDAZOLAMmidazolam 7.5 mg/0.75 mL oral liquid, 0.75 mL syringe | 1 | $135.43 | IX |
| 3092R | MILK POWDER SYNTHETIC LOW CALCIUMmilk powder synthetic low calcium powder for oral liquid, 400 g | 1 | $44.51 | 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 | $37.54 | SB |
| 14483G | MINOCYCLINEminocycline 50 mg tablet, 60 | 60 | $11.61 | AF |
| 14483G | MINOCYCLINEminocycline 50 mg tablet, 60 | 60 | $14.84 | AS |
| 14041B | MINOXIDILminoxidil 10 mg tablet, 100 | 100 | $33.38 | PF |
| 14369G | MIRTAZAPINEmirtazapine 15 mg orally disintegrating tablet, 30 | 30 | $6.60 | RF |
| 14473R | MIRTAZAPINEmirtazapine 30 mg tablet, 30 | 30 | $6.22 | AF,BG,RF,SZ,TY,VO,WG |
| 14473R | MIRTAZAPINEmirtazapine 30 mg tablet, 30 | 30 | $12.23 | AL |
| 14370H | MIRTAZAPINEmirtazapine 30 mg orally disintegrating tablet, 30 | 30 | $7.16 | RF |
| 14561J | MIRTAZAPINEmirtazapine 45 mg tablet, 30 | 30 | $7.57 | AF,BG,RF,SZ,TY,WG |
| 14475W | MIRTAZAPINEmirtazapine 45 mg orally disintegrating tablet, 30 | 30 | $9.53 | RF |
| 14507M | MIRTAZAPINEmirtazapine 15 mg tablet, 30 | 30 | $5.40 | AF,BG,RF,SZ,TY,WG |
| 14560H | MOCLOBEMIDEmoclobemide 150 mg tablet, 60 | 60 | $9.06 | AF,SZ,WG,XT |
| 14560H | MOCLOBEMIDEmoclobemide 150 mg tablet, 60 | 60 | $11.09 | GO |
| 14442D | MOCLOBEMIDEmoclobemide 300 mg tablet, 60 | 60 | $13.47 | AF,SZ,WG,XT |
| 14442D | MOCLOBEMIDEmoclobemide 300 mg tablet, 60 | 60 | $15.50 | GO |
| 8816B | MODAFINILmodafinil 100 mg tablet, 60 | 60 | $62.72 | AL,GQ,RW,SZ,TX,WG |
| 8816B | MODAFINILmodafinil 100 mg tablet, 60 | 60 | $68.12 | TB |
| 9386B | MODIFIED LONG CHAIN AMYLOPECTINmodified long chain amylopectin powder for oral liquid, 30 x 60 g sachets | 1 | $160.94 | VF |
| 10792B | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $7.78 | AL |
| 10792B | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.25 | AF,AS |
| 10809X | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $8.52 | AL |
| 10809X | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.99 | AF,AS |
| 10815F | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $8.11 | AL |
| 10815F | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.58 | AF,AS |
| 10818J | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $7.90 | AL |
| 10818J | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $4.37 | AF,AS |
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $9.75 | AL |
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $6.22 | AF,AS |
| 10804P | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $10.71 | AL |
| 10804P | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.21 | AF,EO |
| 10805Q | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $10.96 | AL |
| 10805Q | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.46 | AF,EO |
| 10819K | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $12.19 | AL |
| 10819K | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $7.69 | AF,EO |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $11.37 | AL |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.87 | AF,EO |
| 10791Y | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $7.78 | AL |
| 10791Y | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.25 | AF,AS,EO |
| 10793C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $7.90 | AL |
| 10793C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.37 | AF,AS,EO |
| 10812C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $9.75 | AL |
| 10812C | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $6.22 | AF,AS,EO |
| 10814E | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $8.52 | AL |
| 10814E | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.99 | AF,AS,EO |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $8.11 | AL |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.58 | AF,AS,EO |
| 14526M | MONTELUKASTmontelukast 4 mg chewable tablet, 28 | 28 | $6.86 | AL,HQ,RF,SZ,TX,WG |
| 14553Y | MONTELUKASTmontelukast 5 mg chewable tablet, 28 | 28 | $6.76 | AL,HQ,RF,SZ,TX,WG |
| 12009C | MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 | 20 | $21.40 | RW |
| 12067D | MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 | 20 | $21.40 | RW |
| 13579Q | MOXONIDINEmoxonidine 200 microgram tablet, 30 | 30 | $7.00 | AL,GO,GQ,RF,SZ,TX,TY,WG |
| 13552G | MOXONIDINEmoxonidine 400 microgram tablet, 30 | 30 | $10.19 | AL,GO,GQ,RF,SZ,TX,WG |
| 12931N | MYCOBACTERIUM BOVIS BCG DANISH STRAINMycobacterium bovis BCG Danish strain 30 mg injection, 4 vials | 1 | $596.42 | LM |
| 13884R | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $21.66 | CR,SZ,TX |
| 13856G | MYCOPHENOLATEmycophenolate 180 mg enteric tablet, 120 | 120 | $96.81 | NV,XT |
| 13938N | MYCOPHENOLATEmycophenolate 360 mg enteric tablet, 120 | 120 | $193.64 | CR,NV,XT |
| 14071N | MYCOPHENOLATEmycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL | 1 | $276.00 | RO |
| 14000W | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $21.64 | AF,CR,GQ,SZ,XT |
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