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 |
|---|---|---|---|---|
| 13442L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 20 mg tablet, 30 | 30 | $9.46 | CR,MQ,RW,WG |
| 13442L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 20 mg tablet, 30 | 30 | $11.46 | AL |
| 13535J | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 40 mg tablet, 30 | 30 | $9.93 | CR,MQ,RW,SZ,TX,WG |
| 13535J | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 40 mg tablet, 30 | 30 | $12.93 | AL |
| 13595M | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 80 mg tablet, 30 | 30 | $10.59 | CR,MQ,RW,SZ,TX,WG |
| 13595M | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 80 mg tablet, 30 | 30 | $13.59 | AL |
| 15047Y | FAMOTIDINEfamotidine 20 mg tablet, 60 | 60 | $6.31 | RW |
| 15061Q | FAMOTIDINEfamotidine 40 mg tablet, 30 | 30 | $6.31 | RW |
| 13519M | FEBUXOSTATfebuxostat 80 mg tablet, 28 | 28 | $40.32 | FK |
| 13531E | FELODIPINEfelodipine 10 mg modified release tablet, 30 | 30 | $9.76 | IY,RW |
| 13531E | FELODIPINEfelodipine 10 mg modified release tablet, 30 | 30 | $13.51 | IX |
| 13377C | FELODIPINEfelodipine 2.5 mg modified release tablet, 30 | 30 | $5.80 | IY,XT |
| 13377C | FELODIPINEfelodipine 2.5 mg modified release tablet, 30 | 30 | $9.77 | IX |
| 13561R | FELODIPINEfelodipine 5 mg modified release tablet, 30 | 30 | $6.49 | IY,RW |
| 13561R | FELODIPINEfelodipine 5 mg modified release tablet, 30 | 30 | $10.37 | IX |
| 13469X | FENOFIBRATEfenofibrate 48 mg tablet, 60 | 60 | $6.76 | AL,GO,GQ,LR,RA,TX,TY,WG |
| 13587D | FENOFIBRATEfenofibrate 145 mg tablet, 30 | 30 | $8.81 | AL,BG,GO,GQ,LR,RA,SZ,TX,TY,WG,XT |
| 10697B | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 4 | 4 | $31.71 | TB |
| 10698C | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 28 | 28 | $214.91 | TB |
| 10737D | FENTANYLfentanyl 400 microgram orally disintegrating tablet, 28 | 28 | $135.72 | TB |
| 10713W | FENTANYLfentanyl 600 microgram orally disintegrating tablet, 28 | 28 | $135.72 | TB |
| 10738E | FENTANYLfentanyl 800 microgram orally disintegrating tablet, 28 | 28 | $135.72 | TB |
| 10684H | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 28 | 28 | $214.91 | TB |
| 10611L | FENTANYLfentanyl 800 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 10602B | FENTANYLfentanyl 100 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 10607G | FENTANYLfentanyl 200 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 10608H | FENTANYLfentanyl 400 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 10601Y | FENTANYLfentanyl 100 microgram sublingual tablet, 10 | 10 | $65.98 | FK |
| 10600X | FENTANYLfentanyl 200 microgram sublingual tablet, 10 | 10 | $65.98 | FK |
| 10610K | FENTANYLfentanyl 300 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 10613N | FENTANYLfentanyl 600 microgram sublingual tablet, 30 | 30 | $198.02 | FK |
| 12509J | FENTANYLfentanyl 100 microgram/hour patch, 5 | 5 | $30.92 | SZ,TX |
| 12541C | FENTANYLfentanyl 12 microgram/hour patch, 5 | 5 | $9.62 | SZ,TX |
| 10729Q | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 4 | 4 | $31.71 | TB |
| 12504D | FENTANYLfentanyl 25 microgram/hour patch, 5 | 5 | $11.58 | SZ,TX |
| 12477Q | FENTANYLfentanyl 50 microgram/hour patch, 5 | 5 | $19.20 | SZ,TX |
| 12474M | FENTANYLfentanyl 75 microgram/hour patch, 5 | 5 | $25.39 | SZ,TX |
| 5407N | FENTANYLfentanyl 200 microgram lozenge, 30 | 30 | $250.43 | TB |
| 5408P | FENTANYLfentanyl 400 microgram lozenge, 30 | 30 | $250.43 | TB |
| 5409Q | FENTANYLfentanyl 600 microgram lozenge, 30 | 30 | $181.83 | TB |
| 5410R | FENTANYLfentanyl 800 microgram lozenge, 30 | 30 | $181.83 | TB |
| 10104T | FERRIC CARBOXYMALTOSEiron (as ferric carboxymaltose) 500 mg/10 mL injection, 10 mL vial | 1 | $61.63 | CS |
| 11615H | FERRIC DERISOMALTOSEiron (as ferric derisomaltose) 500 mg/5 mL injection, 5 mL vial | 1 | $138.54 | FK |
| 4237B | FEXOFENADINEfexofenadine hydrochloride 60 mg tablet, 20 | 20 | $16.33 | VZ |
| 2747N | FILGRASTIMfilgrastim 300 microgram/0.5 mL injection, 5 x 0.5 mL syringes | 5 | $61.08 | SZ |
| 2758E | FILGRASTIMfilgrastim 300 microgram/0.5 mL injection, 5 x 0.5 mL syringes | 5 | $58.73 | SZ |
| 2733W | FILGRASTIMfilgrastim 480 microgram/0.5 mL injection, 5 x 0.5 mL syringes | 5 | $97.92 | SZ |
| 2783L | FILGRASTIMfilgrastim 480 microgram/0.5 mL injection, 5 x 0.5 mL syringes | 5 | $94.15 | SZ |
| 5829T | FILGRASTIMfilgrastim 120 microgram/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $123.84 | PF |
| 5830W | FILGRASTIMfilgrastim 120 microgram/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $128.79 | PF |
| 5742F | FILGRASTIMfilgrastim 300 microgram/0.5 mL injection, 10 x 0.5 mL syringes | 10 | $117.46 | PF |
| 6291D | FILGRASTIMfilgrastim 300 microgram/0.5 mL injection, 10 x 0.5 mL syringes | 10 | $122.16 | PF |
| 5744H | FILGRASTIMfilgrastim 480 microgram/0.5 mL injection, 10 x 0.5 mL syringes | 10 | $188.30 | PF |
| 6292E | FILGRASTIMfilgrastim 480 microgram/0.5 mL injection, 10 x 0.5 mL syringes | 10 | $195.83 | PF |
| 14191X | FINASTERIDEfinasteride 5 mg tablet, 28 | 28 | $80.94 | RZ |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $91.29 | CR,GN,OQ,SZ,TX |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $67.98 | AF,AL,GQ |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $86.73 | RW |
| 10788T | FLUCLOXACILLINflucloxacillin 500 mg capsule, 24 | 24 | $11.15 | AF,AL,MQ |
| 15144C | FLUDARABINEfludarabine phosphate 50 mg/2 mL injection, 2 mL vial | 1 | $0.00 | QY |
| 15145D | FLUDARABINEfludarabine phosphate 50 mg/2 mL injection, 2 mL vial | 1 | $0.00 | QY |
| 4393F | FLUDARABINEfludarabine phosphate 50 mg/2 mL injection, 5 x 2 mL vials | 5 | $0.00 | JO,SZ |
| 7233Q | FLUDARABINEfludarabine phosphate 50 mg/2 mL injection, 5 x 2 mL vials | 5 | $0.00 | JO,SZ |
| 1433K | FLUDROCORTISONEfludrocortisone acetate 100 microgram tablet, 100 | 100 | $13.30 | AS,DZ |
| 4394G | FLUOROURACILfluorouracil 1 g/20 mL injection, 20 mL vial | 1 | $0.00 | OC |
| 4431F | FLUOROURACILfluorouracil 1 g/20 mL injection, 20 mL vial | 1 | $0.00 | OC |
| 7234R | FLUOROURACILfluorouracil 1 g/20 mL injection, 20 mL vial | 1 | $0.00 | OC |
| 7239B | FLUOROURACILfluorouracil 1 g/20 mL injection, 20 mL vial | 1 | $0.00 | OC |
| 14548Q | FLUOXETINEfluoxetine 20 mg capsule, 28 | 28 | $6.22 | AF,BG,GQ,RF,SZ,TX,WG |
| 14717N | FLUOXETINEfluoxetine 20 mg tablet, 28 | 28 | $6.22 | AF |
| 14515Y | FLUTICASONE FUROATEfluticasone furoate 100 microgram/actuation powder for inhalation, 30 actuations | 1 | $18.45 | GK |
| 14380W | FLUTICASONE FUROATEfluticasone furoate 200 microgram/actuation powder for inhalation, 30 actuations | 1 | $31.88 | GK |
| 14382Y | FLUTICASONE FUROATE + UMECLIDINIUM + VILANTEROLfluticasone furoate 200 microgram/actuation + umeclidinium 62.5 microgram/actuation + vilanterol 25 microgram/actuation powder for inhalation, 30 actuations | 1 | $79.34 | GK |
| 14346C | FLUTICASONE FUROATE + UMECLIDINIUM + VILANTEROLfluticasone furoate 100 microgram/actuation + umeclidinium 62.5 microgram/actuation + vilanterol 25 microgram/actuation powder for inhalation, 30 actuations | 1 | $75.44 | GK |
| 14379T | FLUTICASONE FUROATE + VILANTEROLfluticasone furoate 100 microgram/actuation + vilanterol 25 microgram/actuation powder for inhalation, 30 actuations | 1 | $45.24 | GK |
| 14345B | FLUTICASONE FUROATE + VILANTEROLfluticasone furoate 200 microgram/actuation + vilanterol 25 microgram/actuation powder for inhalation, 30 actuations | 1 | $60.34 | GK |
| 14347D | FLUTICASONE PROPIONATEfluticasone propionate 125 microgram/actuation inhalation, 120 actuations | 1 | $15.78 | LR,TX |
| 14347D | FLUTICASONE PROPIONATEfluticasone propionate 125 microgram/actuation inhalation, 120 actuations | 1 | $18.78 | GK |
| 14487L | FLUTICASONE PROPIONATEfluticasone propionate 50 microgram/actuation inhalation, 120 actuations | 1 | $9.87 | TX |
| 14487L | FLUTICASONE PROPIONATEfluticasone propionate 50 microgram/actuation inhalation, 120 actuations | 1 | $13.87 | GK |
| 14412M | FLUTICASONE PROPIONATEfluticasone propionate 100 microgram/actuation powder for inhalation, 60 actuations | 1 | $8.32 | TX |
| 14412M | FLUTICASONE PROPIONATEfluticasone propionate 100 microgram/actuation powder for inhalation, 60 actuations | 1 | $12.32 | GK |
| 14381X | FLUTICASONE PROPIONATEfluticasone propionate 250 microgram/actuation powder for inhalation, 60 actuations | 1 | $15.78 | TX |
| 14381X | FLUTICASONE PROPIONATEfluticasone propionate 250 microgram/actuation powder for inhalation, 60 actuations | 1 | $19.78 | GK |
| 14411L | FLUTICASONE PROPIONATE + FORMOTEROLfluticasone propionate 50 microgram/actuation + formoterol fumarate dihydrate 5 microgram/actuation inhalation, 120 actuations | 1 | $28.28 | MF |
| 14343X | FLUTICASONE PROPIONATE + FORMOTEROLfluticasone propionate 125 microgram/actuation + formoterol fumarate dihydrate 5 microgram/actuation inhalation, 120 actuations | 1 | $28.85 | MF |
| 14344Y | FLUTICASONE PROPIONATE + FORMOTEROLfluticasone propionate 250 microgram/actuation + formoterol fumarate dihydrate 10 microgram/actuation inhalation, 120 actuations | 1 | $40.57 | MF |
| 14311F | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $41.87 | AF,LR,SZ,TX |
| 14311F | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $45.87 | GK |
| 14414P | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 50 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $32.93 | TX |
| 14414P | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 50 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $36.93 | GK |
| 14413N | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 100 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $32.93 | TX |
| 14413N | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 100 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $36.93 | GK |
| 14449L | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 250 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $31.57 | LR,OX,SZ,TX |
| 14449L | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 250 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $36.57 | GK |
| 14450M | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 500 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $41.87 | LR,OX,SZ,TX |
| 14450M | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 500 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $45.87 | GK |
| 14544L | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 125 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $31.57 | AF,LR,SZ,TX |
| 14544L | FLUTICASONE PROPIONATE + SALMETEROLfluticasone propionate 125 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations | 1 | $36.57 | GK |
| 14314J | FLUVOXAMINEfluvoxamine maleate 100 mg tablet, 30 | 30 | $11.03 | AF,RW,TX,WG |
| 14314J | FLUVOXAMINEfluvoxamine maleate 100 mg tablet, 30 | 30 | $14.53 | GO |
| 14488M | FLUVOXAMINEfluvoxamine maleate 50 mg tablet, 30 | 30 | $8.12 | AL,RW,TX,WG |
| 14488M | FLUVOXAMINEfluvoxamine maleate 50 mg tablet, 30 | 30 | $11.62 | GO |
| 10573L | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.60 | AF |
| 1437P | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.60 | AF |
| 10584C | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.56 | AF,PP |
| 2958Q | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.56 | AF,PP |
| 5890B | FOLINIC ACIDfolinic acid 50 mg/5 mL injection, 5 mL vial | 1 | $19.50 | PF |
| 8740B | FOLINIC ACIDfolinic acid 50 mg/5 mL injection, 5 mL vial | 1 | $22.01 | PF |
| 12769C | FOLLITROPIN ALFAfollitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge | 1 | $97.54 | TT |
| 12779N | FOLLITROPIN ALFAfollitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge | 1 | $89.88 | TT |
| 12800Q | FOLLITROPIN ALFAfollitropin alfa 450 units (33 microgram)/0.75 mL injection, 0.75 mL cartridge | 1 | $134.82 | TT |
| 12808D | FOLLITROPIN ALFAfollitropin alfa 450 units (33 microgram)/0.75 mL injection, 0.75 mL cartridge | 1 | $146.32 | TT |
| 12770D | FOLLITROPIN ALFAfollitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge | 1 | $335.48 | TT |
| 12778M | FOLLITROPIN ALFAfollitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge | 1 | $369.67 | TT |
| 10861P | FOLLITROPIN ALFAfollitropin alfa 75 units (5.5 microgram)/0.125 mL injection, 5 x 0.125 mL pen devices | 5 | $106.72 | FX |
| 10865W | FOLLITROPIN ALFAfollitropin alfa 75 units (5.5 microgram)/0.125 mL injection, 5 x 0.125 mL pen devices | 5 | $115.83 | FX |
| 10873G | FOLLITROPIN ALFAfollitropin alfa 150 units (11 microgram)/0.25 mL injection, 5 x 0.25 mL pen devices | 5 | $213.46 | FX |
| 10877L | FOLLITROPIN ALFAfollitropin alfa 150 units (11 microgram)/0.25 mL injection, 5 x 0.25 mL pen devices | 5 | $231.68 | FX |
| 10866X | FOLLITROPIN ALFAfollitropin alfa 300 units (22 microgram)/0.5 mL injection, 5 x 0.5 mL pen devices | 5 | $423.83 | FX |
| 10867Y | FOLLITROPIN ALFAfollitropin alfa 450 units (33 microgram)/0.75 mL injection, 5 x 0.75 mL pen devices | 5 | $629.07 | FX |
| 10872F | FOLLITROPIN ALFAfollitropin alfa 225 units (16.5 microgram)/0.375 mL injection, 5 x 0.375 mL pen devices | 5 | $320.18 | FX |
| 10876K | FOLLITROPIN ALFAfollitropin alfa 225 units (16.5 microgram)/0.375 mL injection, 5 x 0.375 mL pen devices | 5 | $342.19 | FX |
| 6431L | FOLLITROPIN ALFAfollitropin alfa 300 units (21.84 microgram)/0.48 mL injection, 0.48 mL pen device | 1 | $89.88 | SG |
| 8713N | FOLLITROPIN ALFAfollitropin alfa 300 units (21.84 microgram)/0.48 mL injection, 0.48 mL pen device | 1 | $97.54 | SG |
| 6432M | FOLLITROPIN ALFAfollitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device | 1 | $134.82 | SG |
| 8714P | FOLLITROPIN ALFAfollitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device | 1 | $146.32 | SG |
| 6433N | FOLLITROPIN ALFAfollitropin alfa 900 units (65.52 microgram)/1.44 mL injection, 1.44 mL pen device | 1 | $335.48 | SG |
| 8715Q | FOLLITROPIN ALFAfollitropin alfa 900 units (65.52 microgram)/1.44 mL injection, 1.44 mL pen device | 1 | $369.67 | SG |
| 11667C | FOLLITROPIN ALFA + LUTROPIN ALFAfollitropin alfa 900 units (65.52 microgram)/1.44 mL + lutropin alfa 450 units/1.44 mL injection, 1.44 mL pen device | 1 | $897.56 | SG |
| 6335K | FOLLITROPIN BETAfollitropin beta 300 units/0.36 mL injection, 0.36 mL cartridge | 1 | $95.04 | OQ |
| 8565T | FOLLITROPIN BETAfollitropin beta 300 units/0.36 mL injection, 0.36 mL cartridge | 1 | $103.13 | OQ |
| 6336L | FOLLITROPIN BETAfollitropin beta 600 units/0.72 mL injection, 0.72 mL cartridge | 1 | $185.45 | OQ |
| 8566W | FOLLITROPIN BETAfollitropin beta 600 units/0.72 mL injection, 0.72 mL cartridge | 1 | $201.27 | OQ |
| 6464F | FOLLITROPIN BETAfollitropin beta 900 units/1.08 mL injection, 1.08 mL cartridge | 1 | $273.09 | OQ |
| 8871X | FOLLITROPIN BETAfollitropin beta 900 units/1.08 mL injection, 1.08 mL cartridge | 1 | $299.23 | OQ |
| 11430N | FOLLITROPIN DELTAfollitropin delta 12 microgram/0.36 mL injection, 0.36 mL pen device | 1 | $87.39 | FP |
| 11431P | FOLLITROPIN DELTAfollitropin delta 36 microgram/1.08 mL injection, 1.08 mL pen device | 1 | $260.07 | FP |
| 11414R | FOLLITROPIN DELTAfollitropin delta 72 microgram/2.16 mL injection, 2.16 mL pen device | 1 | $514.16 | FP |
| 8775W | FONDAPARINUXfondaparinux sodium 2.5 mg/0.5 mL injection, 2 x 0.5 mL syringes | 2 | $30.20 | AS |
| 14419X | FORMOTEROLformoterol fumarate dihydrate 12 microgram powder for inhalation, 60 capsules | 60 | $19.45 | SZ |
| 14517C | FORMOTEROLformoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations | 1 | $18.95 | AP |
| 14547P | FORMOTEROLformoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 60 actuations | 1 | $13.43 | AP |
| 14876Y | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1263.43 | VE |
| 14886L | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1263.43 | VE |
| 14887M | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1275.92 | VE |
| 14888N | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1254.17 | VE |
| 14896B | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1275.92 | VE |
| 14914Y | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1244.17 | VE |
| 14915B | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1249.17 | VE |
| 14924L | FOSLEVODOPA + FOSCARBIDOPAfoslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials | 7 | $1244.17 | VE |
| 13504R | FUROSEMIDEfurosemide 10 mg/mL oral liquid, 30 mL | 1 | $30.20 | SW |
| 13501N | FUROSEMIDEfurosemide 20 mg tablet, 50 | 50 | $3.92 | AF,TY |
| 1810G | FUROSEMIDEfurosemide 20 mg tablet, 50 | 50 | $5.15 | AF,TY |
| 13473D | FUROSEMIDEfurosemide 20 mg tablet, 100 | 100 | $7.84 | AF,TX,WG |
| 13473D | FUROSEMIDEfurosemide 20 mg tablet, 100 | 100 | $8.90 | TY |
| 13472C | FUROSEMIDEfurosemide 40 mg tablet, 100 | 100 | $5.17 | AF,TX,WG,ZS |
| 13472C | FUROSEMIDEfurosemide 40 mg tablet, 100 | 100 | $6.21 | TY |
| 13474E | FUROSEMIDEfurosemide 500 mg tablet, 50 | 50 | $12.27 | RW |
| 10782L | FUSIDATEsodium fusidate 250 mg tablet, 36 | 36 | $92.18 | LO |
| 12478R | GALCANEZUMABgalcanezumab 120 mg/mL injection, 1 mL pen device | 1 | $514.53 | LY |
| 10328N | GANCICLOVIRganciclovir 500 mg injection, 5 vials | 5 | $120.73 | PB,XC |
| 5749N | GANCICLOVIRganciclovir 500 mg injection, 5 vials | 5 | $116.09 | PB,XC |
| 6136Y | GANCICLOVIRganciclovir 500 mg injection, 5 vials | 5 | $120.73 | PB,XC |
| 9583J | GANIRELIXganirelix 250 microgram/0.5 mL injection, 0.5 mL syringe | 1 | $19.27 | AF,GQ,RA,XT |
| 9584K | GANIRELIXganirelix 250 microgram/0.5 mL injection, 5 x 0.5 mL syringes | 5 | $96.36 | AF,GQ,RA,TT,XT |
| 15317E | GARADACIMABgaradacimab 200 mg/1.2 mL injection, 1.2 mL pen device | 1 | $30089.66 | VK |
| 4439P | GEMCITABINEgemcitabine 1 g/26.3 mL injection, 26.3 mL vial | 1 | $0.00 | PF |
| 7246J | GEMCITABINEgemcitabine 1 g/26.3 mL injection, 26.3 mL vial | 1 | $0.00 | PF |
| 13618R | GEMFIBROZILgemfibrozil 600 mg tablet, 60 | 60 | $12.36 | AF,RW |
| 12844B | GEMTUZUMAB OZOGAMICINgemtuzumab ozogamicin 5 mg injection, 1 vial | 1 | $0.00 | PF |
| 12861X | GEMTUZUMAB OZOGAMICINgemtuzumab ozogamicin 5 mg injection, 1 vial | 1 | $0.00 | PF |
| 12878T | GEMTUZUMAB OZOGAMICINgemtuzumab ozogamicin 5 mg injection, 1 vial | 1 | $0.00 | PF |
| 12904E | GEMTUZUMAB OZOGAMICINgemtuzumab ozogamicin 5 mg injection, 1 vial | 1 | $0.00 | PF |
| 15289Q | GIVOSIRANgivosiran 189 mg/mL injection, 1 mL vial | 1 | $81949.81 | WM |
| 13868X | GLIBENCLAMIDEglibenclamide 5 mg tablet, 100 | 100 | $6.22 | SW |
| 14740T | GLICLAZIDEgliclazide 30 mg modified release tablet, 100 | 100 | $7.74 | AL,CR,TX |
| 13922R | GLICLAZIDEgliclazide 60 mg modified release tablet, 60 | 60 | $6.67 | CR,GQ,SZ,XT |
| 13922R | GLICLAZIDEgliclazide 60 mg modified release tablet, 60 | 60 | $16.62 | SE |
| 13896J | GLICLAZIDEgliclazide 80 mg tablet, 100 | 100 | $7.59 | RW,TY |
| 13848W | GLIMEPIRIDEglimepiride 1 mg tablet, 30 | 30 | $5.17 | SZ,WG,XT |
| 13870B | GLIMEPIRIDEglimepiride 2 mg tablet, 30 | 30 | $5.17 | SZ,WG,XT |
| 14020X | GLIMEPIRIDEglimepiride 3 mg tablet, 30 | 30 | $5.36 | SZ,WG,XT |
| 14055R | GLIMEPIRIDEglimepiride 4 mg tablet, 30 | 30 | $5.90 | SZ,WG,XT |
| 14019W | GLIPIZIDEglipizide 5 mg tablet, 100 | 100 | $9.15 | AF,PF |
| 15227K | GLOFITAMABGlofitamab 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | RO |
| 15228L | GLOFITAMABGlofitamab 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | RO |
| 15249N | GLOFITAMABGlofitamab 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | RO |
| 15266L | GLOFITAMABGlofitamab 10 mg/10 mL injection, 10 mL vial | 1 | $0.00 | RO |
| 15250P | GLOFITAMABGlofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial | 1 | $0.00 | RO |
| 15269P | GLOFITAMABGlofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial | 1 | $0.00 | RO |
| 3107M | GLUCOSE AND KETONE INDICATOR URINEglucose and ketone indicator urine diagnostic strip, 50 | 1 | $6.35 | DX |
| 10596Q | GLYCEROLglycerol 1.4 g suppository, 12 | 1 | $5.72 | PP |
| 4246L | GLYCEROLglycerol 2.8 g suppository, 12 | 1 | $5.88 | PP |
| 10586E | GLYCEROLglycerol 700 mg suppository, 12 | 1 | $5.60 | PP |
| 13580R | GLYCERYL TRINITRATEglyceryl trinitrate 10 mg/24 hours patch, 30 | 30 | $23.73 | SZ |
| 13490B | GLYCERYL TRINITRATEglyceryl trinitrate 5 mg/24 hours patch, 30 | 30 | $18.68 | SZ |
| 14371J | GLYCERYL TRINITRATEglyceryl trinitrate 5 mg/24 hours patch, 30 | 30 | $18.68 | IL |
| 13549D | GLYCERYL TRINITRATEglyceryl trinitrate 400 microgram/actuation spray, 200 actuations | 1 | $15.09 | SW |
| 10195N | GLYCINE WITH CARBOHYDRATEglycine with carbohydrate containing 500 mg glycine powder for oral liquid, 30 x 4 g sachets | 1 | $116.06 | VF |
| 12175T | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACID FORMULA WITH VITAMINS, MINERALS, AND LOW IN TYROSINE AND PHENYLALANINEglycomacropeptide and essential amino acid formula with vitamins, minerals, and low in tyrosine and phenylalanine powder for oral liquid, 30 x 31 g sachets | 1 | $797.81 | QH |
| 11832R | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACID FORMULA WITH VITAMINS, MINERALS, AND LOW IN TYROSINE AND PHENYLALANINEglycomacropeptide and essential amino acid formula with vitamins, minerals, and low in tyrosine and phenylalanine powder for oral liquid, 30 x 35 g sachets | 1 | $973.32 | VF |
| 14820B | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 10 g of protein equivalent powder for oral liquid, 30 x 15 g sachets | 1 | $389.96 | QH |
| 13714T | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals powder for oral liquid, 30 x 40 g sachets | 1 | $579.62 | QH |
| 11279P | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 20 g of protein equivalent powder for oral liquid, 30 x 32 g sachets | 1 | $759.98 | QH |
| 11084J | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals powder for oral liquid, 60 x 20 g sachets | 1 | $261.86 | QH |
| 11290F | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 15 g of protein equivalent bar, 14 x 81 g | 1 | $346.44 | QH |
| 10332T | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 15 g of protein equivalent oral liquid, 30 x 250 mL cartons | 1 | $579.60 | QH |
| 10528D | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 15 g of protein equivalent oral liquid, 30 x 250 mL cartons | 1 | $739.62 | QH |
| 11640P | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals containing 15 g of protein equivalent oral liquid, 30 x 250 mL cartons | 1 | $579.60 | QH |
| 2644E | GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALSglycomacropeptide and essential amino acids with vitamins and minerals bar, 7 x 81 g | 1 | $135.75 | QH |
| 14650C | GLYCOMACROPEPTIDE FORMULA WITH AMINO ACIDS AND LOW PHENYLALANINEglycomacropeptide formula with amino acids and low phenylalanine powder for oral liquid, 30 x 12.5 g sachets | 1 | $261.86 | SB |
| 14644R | GLYCOMACROPEPTIDE FORMULA WITH AMINO ACIDS, VITAMINS, MINERALS, TRACE ELEMENTS, CARBOHYDRATE, FAT AND LOW PHENYLALANINEglycomacropeptide formula with amino acids, vitamins, minerals, trace elements, carbohydrate, fat and low phenylalanine powder for oral liquid, 30 x 33.4 g sachets | 1 | $519.21 | SB |
| 13257R | GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINEglycomacropeptide formula with docosahexaenoic acid and low phenylalanine oral liquid, 15 x 237 mL bottles | 1 | $246.98 | VF |
| 11844J | GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINEglycomacropeptide formula with docosahexaenoic acid and low phenylalanine oral liquid, 18 x 250 mL cartons | 1 | $149.61 | SB |
| 11071Q | GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINEglycomacropeptide formula with docosahexaenoic acid and low phenylalanine powder for oral liquid, 30 x 35 g sachets | 1 | $493.96 | VF |
| 14417T | GLYCOPYRRONIUMglycopyrronium 50 microgram powder for inhalation, 30 capsules | 30 | $48.37 | NV |
| 11382C | GOLIMUMABgolimumab 100 mg/mL injection, 1 mL pen device | 1 | $991.34 | JC |
| 5898K | GRANISETRONgranisetron 2 mg tablet, 1 | 1 | $8.29 | IX |
| 8728J | GRANISETRONgranisetron 2 mg tablet, 1 | 1 | $11.37 | IX |
| 12456N | 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 | $264.75 | QH |
| 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 |
| 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 |
| 10185C | 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 carbohydrate plus protein) oral liquid, 32 x 200 mL cartons | 1 | $186.29 | 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 |
| 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 |
| 15191M | HUMAN CHORIONIC GONADOTROPHINhuman chorionic gonadotrophin 5000 units injection [1 vial] (&) inert substance diluent [1 mL syringe], 1 pack | 1 | $109.03 | DZ |
| 2036E | HUMAN MENOPAUSAL GONADOTROPHINhuman menopausal gonadotrophin 600 units injection [1 vial] (&) inert substance diluent [1 mL syringe], 1 pack | 1 | $249.28 | FP |
| 2038G | HUMAN MENOPAUSAL GONADOTROPHINhuman menopausal gonadotrophin 1200 units injection [1 vial] (&) inert substance diluent [2 x 1 mL syringes], 1 pack | 1 | $489.39 | FP |
| 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 |
| 3470P | 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 |
| 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 |
| 12531M | HYDROMORPHONEhydromorphone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules | 5 | $10.55 | DZ,HW,JU,MF |
| 12493M | HYDROMORPHONEhydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules | 5 | $8.52 | DZ,HW,JU,MF |
| 12045Y | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $16.41 | MF |
| 12047C | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $16.41 | MF |
| 12497R | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $9.05 | MF |
| 12032G | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.68 | MF |
| 12046B | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.68 | MF |
| 12484C | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $11.32 | MF |
| 12010D | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $27.09 | MF |
| 12016K | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $27.09 | MF |
| 12515Q | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $19.73 | 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 |
| 5317W | HYOSCINE BUTYLBROMIDEhyoscine butylbromide 20 mg/mL injection, 5 x 1 mL ampoules | 5 | $7.88 | AE,DZ,VZ,XN |
| 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 |
| 14320Q | HYPROMELLOSEhypromellose 0.5% eye drops, 15 mL | 1 | $6.22 | AF |
| 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 |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.33 | TX,WG |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.84 | GO |
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