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 |
|---|---|---|---|---|
| 4440Q | IDARUBICINidarubicin hydrochloride 5 mg/5 mL injection, 5 mL vial | 1 | $0.00 | PF |
| 7247K | IDARUBICINidarubicin hydrochloride 5 mg/5 mL injection, 5 mL vial | 1 | $0.00 | PF |
| 4448D | IFOSFAMIDEifosfamide 2 g injection, 1 vial | 1 | $0.00 | BX |
| 7248L | IFOSFAMIDEifosfamide 2 g injection, 1 vial | 1 | $0.00 | BX |
| 12113M | IMIPRAMINEimipramine hydrochloride 25 mg tablet, 100 | 100 | $30.25 | QY |
| 10994P | INCOBOTULINUMTOXINAincobotulinumtoxinA 100 units injection, 1 vial | 1 | $327.70 | EJ |
| 11005F | INCOBOTULINUMTOXINAincobotulinumtoxinA 100 units injection, 1 vial | 1 | $327.70 | EJ |
| 12087E | INCOBOTULINUMTOXINAincobotulinumtoxinA 100 units injection, 1 vial | 1 | $327.70 | EJ |
| 15307P | INCOBOTULINUMTOXINAincobotulinumtoxinA 100 units injection, 1 vial | 1 | $327.70 | EJ |
| 15319G | INCOBOTULINUMTOXINAincobotulinumtoxinA 100 units injection, 1 vial | 1 | $327.70 | EJ |
| 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 |
| 5377B | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.79 | AF |
| 5377B | 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 |
| 10057H | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,JC,OQ,PF |
| 10067W | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,JC,OQ,PF |
| 11396T | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11400B | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11423F | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11432Q | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11449N | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11450P | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11461F | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11483J | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,JC,OQ,PF |
| 11486M | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11488P | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11490R | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,JC,OQ,PF |
| 11514B | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11515C | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11595G | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 11605T | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11796W | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 13700C | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $193.61 | EW,FZ,OQ,PF |
| 13734W | INFLIXIMABinfliximab 100 mg injection, 1 vial | 1 | $186.16 | EW,FZ,OQ,PF |
| 11668D | INOTUZUMAB OZOGAMICINinotuzumab ozogamicin 1 mg injection, 1 vial | 1 | $0.00 | PF |
| 11673J | INOTUZUMAB OZOGAMICINinotuzumab ozogamicin 1 mg injection, 1 vial | 1 | $0.00 | PF |
| 11680R | INOTUZUMAB OZOGAMICINinotuzumab ozogamicin 1 mg injection, 1 vial | 1 | $0.00 | PF |
| 11696N | INOTUZUMAB OZOGAMICINinotuzumab ozogamicin 1 mg injection, 1 vial | 1 | $0.00 | PF |
| 13651L | INSULIN ASPARTinsulin aspart 100 units/mL fast acting 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 |
| 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 |
| 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 |
| 11815W | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $35.78 | WA |
| 11302W | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 5 x 1.5 mL pen devices | 1 | $82.46 | SW |
| 11308E | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 3 x 1.5 mL pen devices | 1 | $49.48 | SW |
| 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 |
| 11645X | INSULIN LISPROinsulin lispro 200 units/mL injection, 5 x 3 mL pen devices | 1 | $51.66 | LY |
| 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 |
| 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 |
| 5769P | INTERFERON GAMMA-1Binterferon gamma-1b 2 million units (100 microgram)/0.5 mL injection, 6 x 0.5 mL vials | 6 | $859.78 | LM |
| 6148N | INTERFERON GAMMA-1Binterferon gamma-1b 2 million units (100 microgram)/0.5 mL injection, 6 x 0.5 mL vials | 6 | $879.78 | LM |
| 15230N | IPILIMUMABipilimumab 50 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BQ |
| 15237Y | IPILIMUMABipilimumab 50 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BQ |
| 2638W | IPILIMUMABipilimumab 50 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BQ |
| 2641B | IPILIMUMABipilimumab 50 mg/10 mL injection, 10 mL vial | 1 | $0.00 | BQ |
| 8671J | IPRATROPIUMipratropium bromide monohydrate 21 microgram/actuation inhalation, 200 actuations | 1 | $13.03 | BY,LR |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.35 | BY |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.61 | BY |
| 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 |
| 4451G | IRINOTECANirinotecan hydrochloride trihydrate 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | BX,OC,YG |
| 7249M | IRINOTECANirinotecan hydrochloride trihydrate 100 mg/5 mL injection, 5 mL vial | 1 | $0.00 | BX,OC,YG |
| 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 |
| 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 |
| 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 |
| 10320E | LAMIVUDINElamivudine 10 mg/mL oral liquid, 240 mL | 1 | $58.22 | VI |
| 10315X | LAMIVUDINElamivudine 100 mg tablet, 28 | 28 | $26.62 | RW |
| 10315X | LAMIVUDINElamivudine 100 mg tablet, 28 | 28 | $25.44 | AF |
| 10348P | LAMIVUDINElamivudine 150 mg tablet, 60 | 60 | $46.26 | AL,VI |
| 10311Q | LAMIVUDINElamivudine 300 mg tablet, 30 | 30 | $46.26 | AF,AL,VI |
| 10284G | LAMIVUDINE + ZIDOVUDINElamivudine 150 mg + zidovudine 300 mg tablet, 60 | 60 | $81.07 | AL,VI |
| 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 |
| 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 |
| 14047H | 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 | $10.48 | AS |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $10.89 | AL,GQ,RF,TY,WG |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $13.86 | AS |
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