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 |
|---|---|---|---|---|
| 13589F | ROSUVASTATINrosuvastatin 40 mg tablet, 30 | 30 | $7.90 | AF,BG,CR,GQ,RA,RW,SZ,TY,WG |
| 13589F | ROSUVASTATINrosuvastatin 40 mg tablet, 30 | 30 | $12.84 | FK |
| 14359R | ROTIGOTINErotigotine 8 mg/24 hours patch, 28 | 28 | $102.61 | UC |
| 14327C | ROTIGOTINErotigotine 2 mg/24 hours patch, 28 | 28 | $60.99 | UC |
| 14326B | ROTIGOTINErotigotine 4 mg/24 hours patch, 28 | 28 | $81.32 | UC |
| 14431M | ROTIGOTINErotigotine 6 mg/24 hours patch, 28 | 28 | $92.28 | UC |
| 12001P | ROXITHROMYCINroxithromycin 150 mg tablet, 10 | 10 | $5.48 | RW,SZ,TX,TY,WG |
| 11993F | ROXITHROMYCINroxithromycin 300 mg tablet, 5 | 5 | $5.48 | RW,SZ,TX,TY,WG |
| 10614P | RUXOLITINIBruxolitinib 5 mg tablet, 56 | 56 | $2452.03 | NV |
| 10616R | RUXOLITINIBruxolitinib 5 mg tablet, 56 | 56 | $2452.03 | NV |
| 13570F | SACUBITRIL + VALSARTANsacubitril 24.3 mg + valsartan 25.7 mg tablet, 56 | 56 | $91.10 | CR,FY,NM,NV,TX |
| 13511D | SACUBITRIL + VALSARTANsacubitril 48.6 mg + valsartan 51.4 mg tablet, 56 | 56 | $91.10 | CR,FY,NM,NV,TX |
| 13445P | SACUBITRIL + VALSARTANsacubitril 97.2 mg + valsartan 102.8 mg tablet, 56 | 56 | $91.10 | CR,FY,NM,NV,TX |
| 14391K | SAFINAMIDEsafinamide 50 mg tablet, 30 | 30 | $52.20 | IX |
| 14528P | SAFINAMIDEsafinamide 100 mg tablet, 30 | 30 | $104.40 | IX |
| 2000G | SALBUTAMOLsalbutamol 2.5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules | 1 | $7.77 | LR |
| 2001H | SALBUTAMOLsalbutamol 5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules | 1 | $7.83 | LR |
| 8354Q | SALBUTAMOLsalbutamol 100 microgram/actuation breath activated inhalation, 200 actuations | 1 | $16.45 | IL |
| 1103C | SALBUTAMOLsalbutamol 2 mg/5 mL oral liquid, 150 mL | 1 | $9.32 | GK |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $8.75 | AF |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $11.29 | GK |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $8.29 | AL |
| 11130T | SALBUTAMOLsalbutamol 2.5 mg/2.5 mL inhalation solution, 20 x 2.5 mL ampoules | 1 | $6.52 | GK |
| 11095Y | SALBUTAMOLsalbutamol 5 mg/2.5 mL inhalation solution, 20 x 2.5 mL ampoules | 1 | $6.65 | GK |
| 14328D | SALMETEROLsalmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $19.45 | GK |
| 10086W | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 10087X | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 11691H | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 13923T | SAXAGLIPTINsaxagliptin 5 mg tablet, 28 | 28 | $40.95 | AP |
| 13895H | SAXAGLIPTINsaxagliptin 2.5 mg tablet, 28 | 28 | $40.95 | AP |
| 13855F | SAXAGLIPTIN + DAPAGLIFLOZINsaxagliptin 5 mg + dapagliflozin 10 mg tablet, 28 | 28 | $66.38 | AP |
| 14030K | SAXAGLIPTIN + METFORMINsaxagliptin 5 mg + metformin hydrochloride 500 mg modified release tablet, 28 | 28 | $41.75 | AP |
| 13876H | SAXAGLIPTIN + METFORMINsaxagliptin 5 mg + metformin hydrochloride 1 g modified release tablet, 28 | 28 | $42.54 | AP |
| 13880M | SAXAGLIPTIN + METFORMINsaxagliptin 2.5 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $43.76 | AP |
| 10890E | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $694.09 | NV |
| 10900Q | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $694.09 | NV |
| 12321L | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $689.09 | NV |
| 10894J | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1355.08 | NV |
| 10910F | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1355.08 | NV |
| 14154Y | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1355.08 | NV |
| 14430L | SELEGILINEselegiline hydrochloride 5 mg tablet, 100 | 100 | $42.77 | OX |
| 14703W | SELPERCATINIBselpercatinib 80 mg capsule, 56 | 56 | $4027.03 | LY |
| 14404D | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RW,SZ,TX,WG |
| 14404D | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $11.95 | UJ |
| 14506L | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RA,RW,SZ,TX,WG |
| 14506L | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $11.95 | UJ |
| 14400X | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RA,RW,SZ,TX,WG |
| 14400X | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $11.95 | UJ |
| 14403C | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RW,SZ,TX,WG |
| 14403C | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $11.95 | UJ |
| 14027G | SEVELAMERsevelamer carbonate 800 mg tablet, 180 | 180 | $179.24 | GQ,XT |
| 13934J | SEVELAMERsevelamer hydrochloride 800 mg tablet, 180 | 180 | $179.24 | GZ |
| 13528B | SIMVASTATINsimvastatin 10 mg tablet, 30 | 30 | $5.17 | AF,RW,SZ,TX,WG |
| 13373W | SIMVASTATINsimvastatin 20 mg tablet, 30 | 30 | $5.17 | AF,RW,SZ,TX,WG |
| 13373W | SIMVASTATINsimvastatin 20 mg tablet, 30 | 30 | $14.45 | AL,MQ |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $5.34 | AF,RW,SZ,TX,WG |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $14.58 | AL,MQ |
| 13559P | SIMVASTATINsimvastatin 5 mg tablet, 30 | 30 | $5.17 | AF,SZ |
| 13498K | SIMVASTATINsimvastatin 80 mg tablet, 30 | 30 | $6.22 | AF,RW,SZ,TX,WG |
| 13885T | SIROLIMUSsirolimus 1 mg/mL oral liquid, 60 mL | 1 | $513.49 | PF |
| 13860L | SIROLIMUSsirolimus 500 microgram tablet, 100 | 100 | $331.61 | PF |
| 14072P | SIROLIMUSsirolimus 1 mg tablet, 100 | 100 | $645.27 | PF |
| 13886W | SIROLIMUSsirolimus 2 mg tablet, 100 | 100 | $1252.09 | PF |
| 14021Y | SITAGLIPTINsitagliptin 25 mg tablet, 28 | 28 | $23.24 | AF,CR,GQ,RA,SZ,XT,XW |
| 14058X | SITAGLIPTINsitagliptin 50 mg tablet, 28 | 28 | $23.24 | AF,CR,GQ,RA,SZ,XT,XW |
| 13871C | SITAGLIPTINsitagliptin 100 mg tablet, 28 | 28 | $23.24 | AF,CR,GQ,RA,SZ,XT,XW |
| 14035Q | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 1 g tablet, 56 | 56 | $25.37 | AF,CR,RA,SZ,XT,XW |
| 13994M | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 500 mg tablet, 56 | 56 | $24.32 | AF,CR,RA,SZ,XT,XW |
| 14064F | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 850 mg tablet, 56 | 56 | $25.05 | AF,CR,RA,SZ,XT,XW |
| 13990H | SITAGLIPTIN + METFORMINsitagliptin 50 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $35.22 | SZ,XW |
| 14031L | SITAGLIPTIN + METFORMINsitagliptin 100 mg + metformin hydrochloride 1 g tablet: modified release, 28 | 28 | $34.16 | SZ,XW |
| 11049M | SODIUM CHLORIDE + POTASSIUM CHLORIDE + GLUCOSE + CITRIC ACIDsodium chloride 470 mg + potassium chloride 300 mg (potassium 4 mmol) + glucose monohydrate 3.56 g + sodium acid citrate 530 mg powder for oral liquid, 10 x 4.9 g sachets | 1 | $5.05 | XT |
| 11865L | SODIUM PHENYLBUTYRATEsodium phenylbutyrate 483 mg/g granules, 174 g | 1 | $517.67 | OH |
| 10226F | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 10242C | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 9380Q | SORAFENIBsorafenib 200 mg tablet, 60 | 60 | $2070.73 | BN |
| 14426G | SOY LECITHIN + TOCOPHEROL + VITAMIN Asoy lecithin 1% + tocopherol 0.002% + vitamin A palmitate 0.025% spray, 100 actuations | 1 | $9.37 | RB |
| 5545W | SOY LECITHIN + TOCOPHEROL + VITAMIN Asoy lecithin 1% + tocopherol 0.002% + vitamin A palmitate 0.025% spray, 100 actuations | 1 | $10.60 | RB |
| 9448G | SOY LECITHIN + TOCOPHEROL + VITAMIN Asoy lecithin 1% + tocopherol 0.002% + vitamin A palmitate 0.025% spray, 100 actuations | 1 | $10.60 | RB |
| 8577K | SOY PROTEIN AND FAT FORMULA WITH VITAMINS AND MINERALS CARBOHYDRATE FREEsoy protein and fat formula with vitamins and minerals carbohydrate free oral liquid, 384 mL can | 1 | $4.54 | AB |
| 14042C | SPIRONOLACTONEspironolactone 100 mg tablet, 100 | 100 | $17.27 | AF,AL,PF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $13.87 | PF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $10.87 | AF |
| 13503Q | SPIRONOLACTONEspironolactone 25 mg tablet, 100 | 100 | $6.22 | AL |
| 12103B | STIRIPENTOLstiripentol 250 mg capsule, 60 | 60 | $330.74 | EU |
| 12106E | STIRIPENTOLstiripentol 250 mg powder for oral liquid, 60 sachets | 60 | $330.74 | EU |
| 12107F | STIRIPENTOLstiripentol 500 mg capsule, 60 | 60 | $643.68 | EU |
| 12088F | STIRIPENTOLstiripentol 500 mg powder for oral liquid, 60 sachets | 60 | $643.68 | EU |
| 13985C | SUCROFERRIC OXYHYDROXIDEsucroferric oxyhydroxide 2.5 g (iron 500 mg) chewable tablet, 90 | 90 | $383.80 | VL |
| 13557M | SULFASALAZINEsulfasalazine 500 mg tablet, 100 | 100 | $20.91 | PF |
| 2093E | SULFASALAZINEsulfasalazine 500 mg tablet, 100 | 100 | $22.14 | PF |
| 13433B | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $22.90 | FZ |
| 13433B | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $24.90 | PF |
| 2096H | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $24.13 | FZ |
| 2096H | SULFASALAZINEsulfasalazine 500 mg enteric tablet, 100 | 100 | $26.13 | PF |
| 14016Q | SULTHIAMEsulthiame 200 mg tablet, 200 | 200 | $154.82 | FF |
| 13916K | SULTHIAMEsulthiame 50 mg tablet, 200 | 200 | $58.92 | FF |
| 8144P | SUMATRIPTANsumatriptan 50 mg tablet, 2 | 2 | $5.58 | AL,GQ,OW,TX |
| 13995N | TACROLIMUStacrolimus 2 mg capsule, 100 | 100 | $264.87 | SZ |
| 13908B | TACROLIMUStacrolimus 500 microgram capsule, 100 | 100 | $58.07 | AF,CR,LL,RW,SZ |
| 13907Y | TACROLIMUStacrolimus 500 microgram modified release capsule, 30 | 30 | $42.80 | LQ,SZ |
| 14070M | TACROLIMUStacrolimus 1 mg capsule, 100 | 100 | $116.19 | AF,CR,LL,RW,SZ |
| 13962W | TACROLIMUStacrolimus 1 mg modified release capsule, 60 | 60 | $69.71 | LQ,SZ |
| 13909C | TACROLIMUStacrolimus 5 mg capsule, 50 | 50 | $290.42 | CR,LL,RW,SZ |
| 14039X | TACROLIMUStacrolimus 5 mg modified release capsule, 30 | 30 | $422.36 | LQ,SZ |
| 13996P | TACROLIMUStacrolimus 3 mg modified release capsule, 50 | 50 | $371.50 | LQ,SZ |
| 14066H | TACROLIMUStacrolimus 750 microgram capsule, 100 | 100 | $110.69 | SZ |
| 13997Q | TAMOXIFENtamoxifen 20 mg tablet, 60 | 60 | $13.15 | AF,GX,OX,SZ |
| 13906X | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $7.80 | AF |
| 13906X | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $10.56 | AP |
| 13960R | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $9.33 | AP |
| 1880Y | TAMOXIFENtamoxifen 20 mg tablet, 30 | 30 | $10.56 | AP |
| 13437F | TELMISARTANtelmisartan 40 mg tablet, 28 | 28 | $5.17 | AF,CR,RW,SZ,TX,WG |
| 13437F | TELMISARTANtelmisartan 40 mg tablet, 28 | 28 | $15.17 | BY |
| 13593K | TELMISARTANtelmisartan 80 mg tablet, 28 | 28 | $6.76 | AF,CR,RW,SZ,TX,WG |
| 13593K | TELMISARTANtelmisartan 80 mg tablet, 28 | 28 | $16.76 | BY |
| 13515H | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 10 mg tablet, 28 | 28 | $6.22 | FI |
| 13515H | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 10 mg tablet, 28 | 28 | $11.71 | BY |
| 13483P | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 5 mg tablet, 28 | 28 | $5.60 | FI |
| 13483P | TELMISARTAN + AMLODIPINEtelmisartan 40 mg + amlodipine 5 mg tablet, 28 | 28 | $11.13 | BY |
| 13451Y | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 10 mg tablet, 28 | 28 | $9.07 | FI |
| 13451Y | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 10 mg tablet, 28 | 28 | $14.37 | BY |
| 13450X | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 5 mg tablet, 28 | 28 | $8.43 | FI |
| 13450X | TELMISARTAN + AMLODIPINEtelmisartan 80 mg + amlodipine 5 mg tablet, 28 | 28 | $13.73 | BY |
| 13546Y | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $5.29 | AF,RW,SZ,TX,WG |
| 13546Y | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $15.29 | BY |
| 13574K | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $6.76 | AF,RW,SZ,TX,WG |
| 13574K | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $16.76 | BY |
| 13607E | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $7.09 | AF,RW,SZ,TX,WG |
| 13607E | TELMISARTAN + HYDROCHLOROTHIAZIDEtelmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $17.09 | BY |
| 2088X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $5.17 | AF,LN,TX,WG |
| 2088X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $10.24 | AS |
| 10062N | TEMOZOLOMIDEtemozolomide 180 mg capsule, 5 | 5 | $112.53 | JX,TX |
| 8821G | TEMOZOLOMIDEtemozolomide 100 mg capsule, 5 | 5 | $67.37 | AL,JX,MK,TX |
| 9361Q | TEMOZOLOMIDEtemozolomide 140 mg capsule, 5 | 5 | $92.92 | AL,JX,MK,TX |
| 8820F | TEMOZOLOMIDEtemozolomide 20 mg capsule, 5 | 5 | $16.62 | AL,JX,TX |
| 8819E | TEMOZOLOMIDEtemozolomide 5 mg capsule, 5 | 5 | $6.74 | AL,JX,TX |
| 9160D | TERBINAFINEterbinafine hydrochloride 1% cream, 15 g | 1 | $15.91 | NP |
| 12267P | TERBUTALINEterbutaline sulfate 500 microgram/actuation powder for inhalation, 120 actuations | 1 | $9.79 | AP |
| 14482F | TERIPARATIDEteriparatide 250 microgram/mL injection, 2.4 mL pen device | 1 | $168.80 | FX,GQ |
| 14563L | TESTOSTERONEtestosterone 5% (50 mg/mL) cream, 50 mL | 1 | $98.74 | LX |
| 13924W | TESTOSTERONEtestosterone 1% (12.5 mg/actuation) gel, 2 x 60 actuations | 1 | $68.73 | HB |
| 14025E | TESTOSTERONEtestosterone 2% (23 mg/actuation) gel, 56 actuations | 1 | $74.45 | IX |
| 13983Y | TESTOSTERONEtestosterone 1% (50 mg/5 g) gel, 30 x 5 g sachets | 1 | $68.73 | HB |
| 14390J | TETRABENAZINEtetrabenazine 25 mg tablet, 112 | 112 | $227.97 | IL,RA |
| 2832C | TETRACOSACTIDEtetracosactide 1 mg/mL modified release injection, 1 mL ampoule | 1 | $60.04 | IX |
| 13354W | THIAMINEthiamine hydrochloride 100 mg tablet, 100 | 100 | $6.35 | PP |
| 13947C | TIAGABINEtiagabine 10 mg tablet, 50 | 50 | $51.31 | TB |
| 8222R | TIAGABINEtiagabine 10 mg tablet, 50 | 50 | $51.35 | TB |
| 13893F | TIAGABINEtiagabine 15 mg tablet, 50 | 50 | $73.81 | TB |
| 8223T | TIAGABINEtiagabine 15 mg tablet, 50 | 50 | $73.79 | TB |
| 13892E | TIAGABINEtiagabine 5 mg tablet, 50 | 50 | $25.67 | TB |
| 8221Q | TIAGABINEtiagabine 5 mg tablet, 50 | 50 | $26.90 | TB |
| 13524T | TICAGRELORticagrelor 90 mg tablet, 56 | 56 | $92.07 | AP,XE,XT |
| 14555C | TIOTROPIUMtiotropium 13 microgram powder for inhalation, 30 capsules | 30 | $28.57 | TB |
| 14361W | TIOTROPIUMtiotropium 18 microgram powder for inhalation, 30 capsules | 30 | $33.45 | BY |
| 14574C | TIOTROPIUMtiotropium 18 microgram powder for inhalation, 30 capsules | 30 | $28.57 | GQ |
| 14006E | TOBRAMYCINtobramycin 300 mg/5 mL inhalation solution, 56 x 5 mL ampoules | 56 | $363.95 | GO,JU,RA |
| 1356J | TOBRAMYCINtobramycin 80 mg/2 mL injection, 5 x 2 mL vials | 5 | $15.68 | AL |
| 8872Y | TOBRAMYCINtobramycin Injection 80 mg (base) in 2 mL (without preservative), 5 | 5 | $19.94 | PF |
| 13965B | TOBRAMYCINtobramycin 28 mg powder for inhalation, 224 capsules | 224 | $2359.88 | GO |
| 14063E | TOPIRAMATEtopiramate 15 mg capsule, 60 | 60 | $13.77 | JC |
| 13905W | TOPIRAMATEtopiramate 25 mg capsule, 60 | 60 | $11.77 | JC |
| 13878K | TOPIRAMATEtopiramate 50 mg capsule, 60 | 60 | $17.99 | JC |
| 14008G | TOPIRAMATEtopiramate 100 mg tablet, 60 | 60 | $12.91 | AF,RA,RW,SZ,TX,WG |
| 14009H | TOPIRAMATEtopiramate 200 mg tablet, 60 | 60 | $20.03 | AF,RA,RW,SZ,TX,WG |
| 13969F | TOPIRAMATEtopiramate 25 mg tablet, 60 | 60 | $6.76 | AF,RA,RW,SZ,TX,WG |
| 13913G | TOPIRAMATEtopiramate 50 mg tablet, 60 | 60 | $9.10 | AF,RA,RW,SZ,TX,WG |
| 13859K | TOREMIFENEtoremifene 60 mg tablet, 30 | 30 | $41.12 | OX |
| 12008B | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $12.73 | AF,RW,SZ,TX,WG |
| 12008B | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $14.98 | CS |
| 12024W | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $12.73 | AF,RW,SZ,TX,WG |
| 12024W | TRAMADOLtramadol hydrochloride 50 mg capsule, 20 | 20 | $14.98 | CS |
| 14742X | TRAMETINIBtrametinib 50 microgram/mL powder for oral liquid, 90 mL | 1 | $588.65 | NV |
| 14761X | TRAMETINIBtrametinib 50 microgram/mL powder for oral liquid, 90 mL | 1 | $588.65 | NV |
| 10385N | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1887.69 | NV |
| 10403M | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1887.69 | NV |
| 11821E | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1887.69 | NV |
| 14779W | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1879.37 | NV |
| 14780X | TRAMETINIBtrametinib 500 microgram tablet, 30 | 30 | $1879.37 | NV |
| 13429T | TRANDOLAPRILtrandolapril 1 mg capsule, 28 | 28 | $6.43 | AF,RW |
| 13429T | TRANDOLAPRILtrandolapril 1 mg capsule, 28 | 28 | $9.93 | GO |
| 13403K | TRANDOLAPRILtrandolapril 2 mg capsule, 28 | 28 | $7.24 | AF,RW |
| 13403K | TRANDOLAPRILtrandolapril 2 mg capsule, 28 | 28 | $10.74 | GO |
| 13467T | TRANDOLAPRILtrandolapril 4 mg capsule, 28 | 28 | $11.45 | AF,RW |
| 13467T | TRANDOLAPRILtrandolapril 4 mg capsule, 28 | 28 | $14.94 | GO |
| 13554J | TRANDOLAPRILtrandolapril 500 microgram capsule, 28 | 28 | $5.17 | AF,RW |
| 13554J | TRANDOLAPRILtrandolapril 500 microgram capsule, 28 | 28 | $8.65 | GO |
| 13594L | TRANDOLAPRIL + VERAPAMILtrandolapril 2 mg + verapamil hydrochloride 180 mg modified release tablet, 28 | 28 | $12.88 | GO |
| 13591H | TRANDOLAPRIL + VERAPAMILtrandolapril 4 mg + verapamil hydrochloride 240 mg modified release tablet, 28 | 28 | $18.95 | GO |
| 14401Y | TRANYLCYPROMINEtranylcypromine 10 mg tablet, 50 | 50 | $40.78 | GH |
| 14549R | TRAVOPROSTtravoprost 0.004% eye drops, 2.5 mL | 1 | $22.19 | NV |
| 14316L | TRAVOPROST + TIMOLOLtravoprost 0.004% + timolol 0.5% eye drops, 2.5 mL | 1 | $25.14 | NV |
| 2117K | TRIAMCINOLONEtriamcinolone acetonide 0.02% cream, 100 g | 1 | $7.86 | AS |
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