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 |
|---|---|---|---|---|
| 8649F | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $22.28 | CR,SZ,TX |
| 14071N | MYCOPHENOLATEmycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL | 1 | $276.00 | CR |
| 8650G | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $22.26 | AF,CR,GQ,SZ,XT |
| 1674D | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.18 | IX |
| 5176K | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.18 | IX |
| 8298R | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.58 | AS |
| 9734H | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.58 | AS |
| 13568D | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $10.47 | AF,FK,GQ,SZ,TX,WG |
| 9316H | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $11.70 | AF,FK,GQ,SZ,TX,WG |
| 13441K | NEBIVOLOLnebivolol 10 mg tablet, 28 | 28 | $28.52 | AF,CR,FK,GQ,SZ,TX,WG |
| 13510C | NEBIVOLOLnebivolol 5 mg tablet, 28 | 28 | $25.51 | AF,CR,FK,GQ,SZ,TX,WG |
| 13550E | NICORANDILnicorandil 10 mg tablet, 60 | 1 | $11.14 | AF,TX |
| 13551F | NICORANDILnicorandil 20 mg tablet, 60 | 1 | $14.55 | AF,TX |
| 13502P | NIFEDIPINEnifedipine 30 mg modified release tablet, 30 | 30 | $9.35 | TX |
| 13376B | NIFEDIPINEnifedipine 60 mg modified release tablet, 30 | 30 | $11.12 | TX |
| 2732T | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.17 | AF,IL |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $12.90 | AF,RF |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $20.49 | RW |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $12.90 | AF,RF |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $20.49 | RW |
| 13873E | NORETHISTERONEnorethisterone 5 mg tablet, 30 | 30 | $24.67 | BN |
| 12642J | OFATUMUMABofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device | 1 | $2109.64 | NV |
| 5567B | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 8383F | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 9294E | OLANZAPINEolanzapine 210 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $157.31 | PB |
| 9295F | OLANZAPINEolanzapine 300 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $256.01 | PB |
| 11503K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11522K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12169L | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12170M | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12921C | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12932P | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13782J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13783K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14181J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14216F | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14689D | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11528R | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 11539H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12157W | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12161C | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12913P | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12929L | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13800H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13807Q | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14208T | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14215E | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14687B | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $6.58 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $10.58 | AL |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $8.56 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $13.06 | AL |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $6.35 | AF,CR,RW,SZ,TY,WG |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $10.35 | AL |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $8.44 | AF,CR,RW,SZ,TY,WG |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $12.44 | AL |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $8.03 | AF,CR,RW,SZ,TY,WG |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $12.03 | AL |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.45 | AL,TX |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $12.45 | AF |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.29 | AL,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.29 | AF |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.70 | AL,TX |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.96 | AF |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.85 | AL,TX |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $16.85 | AF |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.23 | AL,TX |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $17.23 | AF |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.76 | AF,CR,RW,SZ,TX,TY,WG |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.76 | AL |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.36 | AF,CR,RW,SZ,TX,TY,WG |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $12.86 | AL |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $9.13 | AF,CR,RW,SZ,TX,TY,WG |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.63 | AL |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 12272X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | FJ,FQ,SZ |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $12.68 | PB |
| 14364B | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14533X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14558F | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | AF,RW,TX,WG |
| 14432N | OMEPRAZOLEomeprazole 10 mg enteric tablet, 30 | 30 | $6.22 | PB |
| 12281J | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14464G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14465H | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $5.53 | AF,CR,HX,SZ,TX,WG |
| 14559G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 3134Y | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $5.17 | AF,AS |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.17 | AF,TX,WG |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $6.01 | RW |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $9.09 | AS |
| 14033N | OXCARBAZEPINEoxcarbazepine 300 mg tablet, 100 | 100 | $74.85 | NV |
| 13935K | OXCARBAZEPINEoxcarbazepine 600 mg tablet, 100 | 100 | $125.09 | NV |
| 13936L | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.36 | NV |
| 8588B | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.68 | NV |
| 14562K | OXCARBAZEPINEoxcarbazepine 150 mg tablet, 100 | 100 | $45.68 | NV |
| 13957N | OXYBUTYNINoxybutynin hydrochloride 5 mg tablet, 100 | 100 | $11.30 | SW |
| 13984B | OXYBUTYNINoxybutynin 3.9 mg/24 hours patch, 8 | 1 | $28.79 | TT |
| 12031F | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 12074L | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 15087C | PALOVAROTENEpalovarotene 10 mg capsule, 28 | 28 | $99981.03 | IS |
| 12595X | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.65 | GO |
| 13407P | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.67 | GO |
| 13560Q | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.48 | GO |
| 8020D | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.47 | GO |
| 13470Y | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.77 | GO |
| 8021E | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.74 | GO |
| 13375Y | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.97 | GO |
| 5453B | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.96 | GO |
| 12282K | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14395P | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $22.35 | NQ |
| 14466J | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14500E | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14501F | PANTOPRAZOLEpantoprazole 20 mg enteric tablet, 30 | 30 | $5.17 | AF,BG,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 14501F | PANTOPRAZOLEpantoprazole 20 mg enteric tablet, 30 | 30 | $10.12 | NQ |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,VO,WG,ZS |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,VO,WG,ZS |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14362X | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,VO,WG,ZS |
| 14362X | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14394N | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $4.32 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,VO,WG,ZS |
| 14394N | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $9.27 | NQ |
| 8814X | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $6.22 | CR,GQ,RF,TX,XT |
| 5224Y | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.31 | BG,OW,QS,SI,SW,SZ,TX,XT |
| 8784H | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.31 | BG,OW,QS,SI,SW,SZ,TX,XT |
| 12022R | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $12.73 | AF,AL,AV,GQ,SZ,TX,TY |
| 12022R | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $16.57 | SW |
| 12066C | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $12.73 | AF,AL,AV,GQ,SZ,TX,TY |
| 12066C | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $16.57 | SW |
| 14353K | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $5.08 | IQ |
| 1754H | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $6.31 | IQ |
| 5523Q | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $6.31 | IQ |
| 14493T | PARAFFINparaffin 1 g/g eye ointment, 2 x 3.5 g | 1 | $9.84 | IQ |
| 14367E | PAROXETINEparoxetine 20 mg tablet, 30 | 30 | $6.22 | AF,BG,GQ,RW,SZ,TY,WG |
| 14367E | PAROXETINEparoxetine 20 mg tablet, 30 | 30 | $8.80 | AS |
| 13458H | PENICILLAMINEpenicillamine 125 mg tablet, 100 | 100 | $53.45 | AL |
| 13425N | PENICILLAMINEpenicillamine 250 mg tablet, 100 | 100 | $67.17 | AL |
| 10157N | PERAMPANELperampanel 2 mg tablet, 7 | 7 | $19.15 | EI |
| 11436X | PERAMPANELperampanel 2 mg tablet, 7 | 7 | $19.15 | EI |
| 14010J | PERAMPANELperampanel 6 mg tablet, 28 | 28 | $210.28 | EI |
| 14046G | PERAMPANELperampanel 6 mg tablet, 28 | 28 | $210.28 | EI |
| 13915J | PERAMPANELperampanel 8 mg tablet, 28 | 28 | $280.37 | EI |
| 13970G | PERAMPANELperampanel 8 mg tablet, 28 | 28 | $280.37 | EI |
| 13914H | PERAMPANELperampanel 10 mg tablet, 28 | 28 | $280.37 | EI |
| 13971H | PERAMPANELperampanel 10 mg tablet, 28 | 28 | $280.37 | EI |
| 13865R | PERAMPANELperampanel 12 mg tablet, 28 | 28 | $280.37 | EI |
| 14012L | PERAMPANELperampanel 12 mg tablet, 28 | 28 | $280.37 | EI |
| 13864Q | PERAMPANELperampanel 4 mg tablet, 28 | 28 | $140.17 | EI |
| 13948D | PERAMPANELperampanel 4 mg tablet, 28 | 28 | $140.17 | EI |
| 14424E | PERFLUOROHEXYLOCTANEperfluorohexyloctane 100% eye drops, 3 mL | 1 | $22.89 | AE |
| 13555K | PERINDOPRILperindopril arginine 10 mg tablet, 30 | 30 | $6.76 | TX,XT |
| 13555K | PERINDOPRILperindopril arginine 10 mg tablet, 30 | 30 | $16.51 | SE |
| 13494F | PERINDOPRILperindopril arginine 2.5 mg tablet, 30 | 30 | $5.17 | RX,SZ,TX,WG,XT |
| 13494F | PERINDOPRILperindopril arginine 2.5 mg tablet, 30 | 30 | $14.91 | SE |
| 13372T | PERINDOPRILperindopril erbumine 8 mg tablet, 30 | 30 | $6.76 | AF,AL,SZ,TX,WG |
| 13404L | PERINDOPRILperindopril erbumine 2 mg tablet, 30 | 30 | $5.17 | AF,AL,SZ,TX,WG |
| 13371R | PERINDOPRILperindopril erbumine 4 mg tablet, 30 | 30 | $5.86 | AF,AL,SZ,TX,WG |
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