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 |
|---|---|---|---|---|
| 13529C | ATORVASTATINatorvastatin 20 mg tablet, 30 | 30 | $5.12 | AF,AS,BG,CR,HX,IB,RA,RF,VO |
| 10539Q | AXITINIBaxitinib 1 mg tablet, 28 | 28 | $530.97 | PF |
| 10572K | AXITINIBaxitinib 1 mg tablet, 28 | 28 | $530.97 | PF |
| 10540R | AXITINIBaxitinib 5 mg tablet, 28 | 28 | $2470.88 | PF |
| 10556N | AXITINIBaxitinib 5 mg tablet, 28 | 28 | $2470.88 | PF |
| 13623B | AZACITIDINEazacitidine 200 mg tablet, 7 | 7 | $6690.76 | CJ |
| 13619T | AZACITIDINEazacitidine 300 mg tablet, 7 | 7 | $6681.74 | CJ |
| 13624C | AZACITIDINEazacitidine 300 mg tablet, 7 | 7 | $6665.14 | CJ |
| 13522Q | BACLOFENbaclofen 10 mg tablet, 100 | 100 | $12.29 | AF,NV,RW,TX |
| 13359D | BACLOFENbaclofen 25 mg tablet, 100 | 100 | $24.12 | AF,NV,RW,TX |
| 13484Q | BALSALAZIDEbalsalazide sodium 750 mg capsule, 280 | 280 | $110.90 | PK |
| 13790T | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [5 mL vial], 1 pack | 1 | $50.31 | OJ |
| 13816E | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [5 mL vial], 1 pack | 1 | $50.31 | OJ |
| 2647H | BENZYLPENICILLINbenzylpenicillin 3 g injection, 1 vial | 1 | $10.04 | CS |
| 3399X | BENZYLPENICILLINbenzylpenicillin 3 g injection, 1 vial | 1 | $10.04 | CS |
| 1775K | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.40 | CS |
| 3398W | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.40 | CS |
| 10800K | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $7.53 | AF |
| 10800K | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $5.08 | AL |
| 10801L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.95 | AF |
| 10801L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.50 | AL |
| 10802M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.83 | AF |
| 10802M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.38 | AL |
| 10813D | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $7.14 | AF |
| 10813D | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $4.69 | AL |
| 10824Q | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $8.68 | AF |
| 10824Q | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% cream, 15 g | 1 | $6.23 | AL |
| 10795E | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $8.68 | AF |
| 10795E | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.23 | AL |
| 10816G | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.95 | AF |
| 10816G | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.50 | AL |
| 10820L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $7.53 | AF |
| 10820L | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $5.08 | AL |
| 10821M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $7.14 | AF |
| 10821M | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.69 | AL |
| 10823P | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $6.83 | AF |
| 10823P | BETAMETHASONE DIPROPIONATEbetamethasone (as dipropionate) 0.05% ointment, 15 g | 1 | $4.38 | AL |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $7.61 | AL,LN |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $9.66 | AS |
| 2812B | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.02% cream, 100 g | 1 | $10.11 | AF |
| 10794D | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $6.41 | AS |
| 10794D | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.85 | LN |
| 10799J | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $7.56 | AS |
| 10799J | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.00 | LN |
| 10807T | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.83 | AS |
| 10807T | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.27 | LN |
| 10808W | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $6.02 | AS |
| 10808W | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.46 | LN |
| 10810Y | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $5.71 | AS |
| 10810Y | BETAMETHASONE VALERATEbetamethasone (as valerate) 0.05% cream, 15 g | 1 | $3.15 | LN |
| 13933H | BICARBONATEsodium bicarbonate 840 mg capsule, 100 | 100 | $10.50 | AS |
| 11948W | BINIMETINIBbinimetinib 15 mg tablet, 84 | 84 | $3693.99 | FB |
| 11961M | BINIMETINIBbinimetinib 15 mg tablet, 84 | 84 | $3693.99 | FB |
| 1260H | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.18 | VZ |
| 1260H | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.75 | PP |
| 1258F | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $5.30 | PP |
| 13444N | BISOPROLOLbisoprolol fumarate 10 mg tablet, 28 | 28 | $7.85 | AF,GQ,LR,RW,SZ,TX,VO |
| 13444N | BISOPROLOLbisoprolol fumarate 10 mg tablet, 28 | 28 | $12.36 | AL |
| 13419G | BISOPROLOLbisoprolol fumarate 2.5 mg tablet, 28 | 28 | $6.61 | AF,GQ,LR,RW,SZ,TX,VO |
| 13419G | BISOPROLOLbisoprolol fumarate 2.5 mg tablet, 28 | 28 | $12.12 | AL |
| 13443M | BISOPROLOLbisoprolol fumarate 5 mg tablet, 28 | 28 | $6.74 | AF,GQ,LR,RW,SZ,TX,VO |
| 13443M | BISOPROLOLbisoprolol fumarate 5 mg tablet, 28 | 28 | $11.24 | AL |
| 11980M | BRIGATINIBbrigatinib 30 mg tablet, 28 | 28 | $1701.72 | TK |
| 13979R | BROMOCRIPTINEbromocriptine 2.5 mg tablet, 30 | 30 | $10.79 | SZ |
| 1443Y | BROMOCRIPTINEbromocriptine 2.5 mg tablet, 30 | 30 | $11.94 | SZ |
| 10024N | BUDESONIDE + FORMOTEROLbudesonide 50 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.06 | AP |
| 12100W | BUDESONIDE + FORMOTEROLbudesonide 50 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.06 | AP |
| 10015D | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 10015D | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 12042T | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 12042T | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 12089G | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $16.72 | XT |
| 12089G | BUDESONIDE + FORMOTEROLbudesonide 100 microgram/actuation + formoterol fumarate dihydrate 3 microgram/actuation inhalation, 120 actuations | 1 | $19.20 | AP |
| 10018G | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $26.03 | XT |
| 10018G | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $28.51 | AP |
| 12082X | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $26.03 | XT |
| 12082X | BUDESONIDE + FORMOTEROLbudesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation inhalation, 120 actuations | 1 | $28.51 | AP |
| 13258T | BUDESONIDE + FORMOTEROLbudesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations | 1 | $26.04 | EV,XT |
| 13258T | BUDESONIDE + FORMOTEROLbudesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations | 1 | $28.04 | AP |
| 13901P | CABERGOLINEcabergoline 500 microgram tablet, 8 | 8 | $55.94 | PF |
| 13520N | CALCIPOTRIOL + BETAMETHASONE DIPROPIONATEcalcipotriol 0.005% + betamethasone (as dipropionate) 0.05% foam, 60 g | 1 | $75.66 | LO |
| 13577N | CALCIPOTRIOL + BETAMETHASONE DIPROPIONATEcalcipotriol 0.005% + betamethasone (as dipropionate) 0.05% ointment, 30 g | 1 | $28.32 | LO,SZ |
| 2997R | CALCITONIN SALMONcalcitonin salmon 100 units/mL injection, 5 x 1 mL ampoules | 5 | $39.85 | EU |
| 13457G | CALCITRIOLcalcitriol 0.25 microgram capsule, 100 | 100 | $18.43 | AF,RW,TX,XT,ZS |
| 13457G | CALCITRIOLcalcitriol 0.25 microgram capsule, 100 | 100 | $20.72 | IX |
| 13547B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 240 | 240 | $10.98 | AE |
| 11726E | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.35 | PP |
| 13485R | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $9.20 | PP |
| 13565Y | CANDESARTANcandesartan cilexetil 16 mg tablet, 30 | 30 | $6.44 | AF,BG,IB,RF,SZ,TX,VO |
| 13565Y | CANDESARTANcandesartan cilexetil 16 mg tablet, 30 | 30 | $19.91 | LM |
| 13438G | CANDESARTANcandesartan cilexetil 32 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13438G | CANDESARTANcandesartan cilexetil 32 mg tablet, 30 | 30 | $18.22 | LM |
| 13592J | CANDESARTANcandesartan cilexetil 4 mg tablet, 30 | 30 | $5.02 | AF,BG,IB,RF,SZ,TX,VO |
| 13592J | CANDESARTANcandesartan cilexetil 4 mg tablet, 30 | 30 | $18.47 | LM |
| 13436E | CANDESARTANcandesartan cilexetil 8 mg tablet, 30 | 30 | $5.02 | AF,BG,IB,RF,SZ,TX,VO |
| 13436E | CANDESARTANcandesartan cilexetil 8 mg tablet, 30 | 30 | $18.47 | LM |
| 13391T | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 16 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13391T | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 16 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $19.70 | LM |
| 13452B | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.61 | AF,BG,IB,RF,SZ,TX,VO |
| 13452B | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $17.79 | LM |
| 13392W | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $7.15 | AF,BG,IB,RF,SZ,TX,VO |
| 13392W | CANDESARTAN + HYDROCHLOROTHIAZIDEcandesartan cilexetil 32 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $18.00 | LM |
| 14051M | CARBAMAZEPINEcarbamazepine 100 mg/5 mL oral liquid, 300 mL | 1 | $15.29 | NV |
| 2422L | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $7.52 | NM |
| 2422L | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $8.85 | NV |
| 5039F | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $7.52 | NM |
| 5039F | CARBAMAZEPINEcarbamazepine 100 mg tablet, 100 | 100 | $8.85 | NV |
| 1706T | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $11.02 | NM |
| 1706T | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $12.33 | NV |
| 1724R | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $11.02 | NM |
| 1724R | CARBAMAZEPINEcarbamazepine 200 mg tablet, 100 | 100 | $12.33 | NV |
| 14050L | CARBAMAZEPINEcarbamazepine 200 mg modified release tablet, 200 | 200 | $20.09 | NV |
| 13918M | CARBAMAZEPINEcarbamazepine 400 mg modified release tablet, 200 | 200 | $36.09 | NV |
| 1153Q | CARBIMAZOLEcarbimazole 5 mg tablet, 100 | 100 | $12.65 | GH,NB,TN |
| 13967D | CARBIMAZOLEcarbimazole 5 mg tablet, 100 | 100 | $11.50 | GH,NB,TN |
| 8369L | CARBOHYDRATE, FAT, VITAMINS, MINERALS AND TRACE ELEMENTScarbohydrate, fat, vitamins, minerals and trace elements powder for oral liquid, 400 g | 1 | $31.27 | SB |
| 10039J | CARBOHYDRATES, FAT, VITAMINS, MINERALS, TRACE ELEMENTS AND SUPPLEMENTED WITH ARACHIDONIC ACID AND DOCOSAHEXAENOIC ACIDcarbohydrates, fat, vitamins, minerals, trace elements and supplemented with arachidonic acid and docosahexaenoic acid providing 200 kilocalories powder for oral liquid, 30 x 43 g sachets | 1 | $105.99 | VF |
| 5502N | CARBOMER-974Pcarbomer-974P 0.3% eye gel, 30 x 500 mg ampoules | 1 | $6.97 | AQ |
| 8514D | CARBOMER-974Pcarbomer-974P 0.3% eye gel, 30 x 500 mg ampoules | 1 | $6.97 | AQ |
| 5504Q | CARBOMER-980carbomer-980 0.2% eye drops, 30 x 600 mg ampoules | 1 | $7.43 | UO |
| 8578L | CARBOMER-980carbomer-980 0.2% eye drops, 30 x 600 mg ampoules | 1 | $7.43 | UO |
| 2324H | CARMELLOSE SODIUMcarmellose sodium 1% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 5505R | CARMELLOSE SODIUMcarmellose sodium 1% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 2338C | CARMELLOSE SODIUMcarmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 5506T | CARMELLOSE SODIUMcarmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules | 1 | $6.10 | VE |
| 13418F | CARVEDILOLcarvedilol 12.5 mg tablet, 60 | 60 | $7.74 | AF,PB,RF,RW,SZ,TX,ZS |
| 13387N | CARVEDILOLcarvedilol 25 mg tablet, 60 | 60 | $9.09 | AF,PB,RF,RW,SZ,TX,ZS |
| 13417E | CARVEDILOLcarvedilol 6.25 mg tablet, 60 | 60 | $6.65 | AF,PB,RF,RW,SZ,TX,ZS |
| 11963P | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $5.02 | AF,TX |
| 11963P | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $9.74 | AS |
| 2655R | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $5.02 | AF,TX |
| 2655R | CEFALEXINcefalexin 250 mg capsule, 20 | 20 | $9.74 | AS |
| 10778G | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $5.02 | AF,BG,CR,GQ,SZ,TX,VO |
| 10778G | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $11.30 | AS |
| 11934D | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $5.02 | AF,BG,CR,GQ,SZ,TX,VO |
| 11934D | CEFALEXINcefalexin 500 mg capsule, 20 | 20 | $11.30 | AS |
| 1256D | CEFAZOLINcefazolin 500 mg injection, 5 vials | 5 | $6.00 | AE |
| 5477G | CEFAZOLINcefazolin 500 mg injection, 5 vials | 5 | $6.00 | AE |
| 1797N | CEFAZOLINcefazolin 1 g injection, 5 vials | 5 | $6.61 | AE |
| 1799Q | CEFAZOLINcefazolin 1 g injection, 5 vials | 5 | $6.61 | AE |
| 8315P | CEFEPIMEcefepime 1 g injection, 1 vial | 1 | $4.47 | OE,PK |
| 8316Q | CEFEPIMEcefepime 2 g injection, 1 vial | 1 | $4.76 | OE,PK |
| 12112L | CEFTRIAXONEceftriaxone 2 g injection, 10 vials | 10 | $36.87 | AF,AL |
| 12114N | CEFTRIAXONEceftriaxone 1 g injection, 10 vials | 10 | $36.66 | AF,AL |
| 1783W | CEFTRIAXONEceftriaxone 500 mg injection, 1 vial | 1 | $3.61 | AE |
| 13643C | CEFUROXIMEcefuroxime 125 mg/5 mL powder for oral liquid, 70 mL | 1 | $52.04 | RQ |
| 13653N | CEFUROXIMEcefuroxime 125 mg/5 mL powder for oral liquid, 70 mL | 1 | $52.04 | RQ |
| 10904X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 10905Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 10909E | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 12063X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes | 2 | $1003.39 | UC |
| 11319R | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 11322X | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 11323Y | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 12027B | CERTOLIZUMAB PEGOLcertolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices | 2 | $1003.39 | UC |
| 1163F | CHLORAMBUCILchlorambucil 2 mg tablet, 25 | 25 | $31.97 | AS |
| 13500M | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $5.10 | GH |
| 1585K | CHLORTALIDONEchlortalidone 25 mg tablet, 50 | 50 | $6.25 | GH |
| 13300B | CHORIOGONADOTROPIN ALFAchoriogonadotropin alfa 250 microgram/0.5 mL injection, 0.5 mL pen device | 1 | $52.79 | SG |
| 13999T | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $41.91 | NV |
| 8657P | CICLOSPORINciclosporin 10 mg capsule, 60 | 60 | $42.31 | NV |
| 13911E | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.41 | NM,NV,TX |
| 8660T | CICLOSPORINciclosporin 100 mg capsule, 30 | 30 | $105.31 | NM,NV,TX |
| 13883Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $24.86 | NM,NV,TX |
| 8658Q | CICLOSPORINciclosporin 25 mg capsule, 30 | 30 | $26.01 | NM,NV,TX |
| 13910D | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.69 | NM,NV,TX |
| 8659R | CICLOSPORINciclosporin 50 mg capsule, 30 | 30 | $51.63 | NM,NV,TX |
| 14001X | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $345.70 | NV |
| 8661W | CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL | 1 | $345.61 | NV |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $11.90 | NM |
| 1217C | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $14.08 | NV |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $11.90 | NM |
| 5564W | CIPROFLOXACINciprofloxacin 0.3% eye drops, 5 mL | 1 | $14.08 | NV |
| 2091C | CITRIC ACID + LAURYL SULFOACETATE SODIUM + SORBITOLsodium citrate dihydrate 450 mg/5 mL + lauryl sulfoacetate sodium 45 mg/5 mL + sorbitol 3.125 g/5 mL enema, 12 x 5 mL | 1 | $14.18 | AE |
| 5481L | CITRULLINE WITH CARBOHYDRATEcitrulline with carbohydrate containing 1 g citrulline powder for oral liquid, 30 x 4 g sachets | 1 | $109.88 | VF |
| 11604R | CLADRIBINEcladribine 10 mg tablet, 4 | 4 | $14642.44 | SG |
| 3138E | CLINDAMYCINclindamycin 150 mg capsule, 24 | 24 | $6.79 | AF,BZ,PF,RW,TX,XT |
| 1808E | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $6.07 | PB |
| 1806C | CLONAZEPAMclonazepam 2 mg tablet, 100 | 100 | $11.80 | AF |
| 1805B | CLONAZEPAMclonazepam 500 microgram tablet, 100 | 100 | $9.08 | AF |
| 11559J | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $5.47 | PB |
| 13578P | CLONIDINEclonidine hydrochloride 100 microgram tablet, 100 | 100 | $14.64 | GQ,IX,TX |
| 13548C | CLONIDINEclonidine hydrochloride 150 microgram tablet, 100 | 100 | $20.81 | IX |
| 13365K | CLOPIDOGRELclopidogrel 75 mg tablet, 28 | 28 | $6.40 | JB,RF,RW |
| 13399F | CLOPIDOGRELclopidogrel 75 mg tablet, 28 | 28 | $6.40 | AF,AV,BG,CR,GQ,HX,WA |
| 13427Q | CLOPIDOGREL + ASPIRINclopidogrel 75 mg + aspirin 100 mg tablet, 30 | 30 | $6.69 | AF,AV,GZ,TY,WA |
| 12054K | CODEINEcodeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $13.61 | AS |
| 12065B | CODEINEcodeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $13.61 | AS |
| 13347L | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 30 sachets | 30 | $61.16 | DZ |
| 13351Q | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 30 sachets | 30 | $61.16 | DZ |
| 2967E | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 50 sachets | 1 | $37.02 | GO |
| 9249T | COLESTYRAMINEcolestyramine 4 g powder for oral liquid, 50 sachets | 1 | $37.02 | GO |
| 13862N | CORTISONEcortisone acetate 25 mg tablet, 60 | 60 | $14.77 | AS |
| 13946B | CORTISONEcortisone acetate 5 mg tablet, 50 | 50 | $9.64 | AS |
| 14022B | CYPROTERONEcyproterone acetate 100 mg tablet, 50 | 50 | $51.33 | BN |
| 14022B | CYPROTERONEcyproterone acetate 100 mg tablet, 50 | 50 | $50.12 | CR,HX,RW |
| 13925X | CYPROTERONEcyproterone acetate 50 mg tablet, 20 | 20 | $14.59 | CR,HX,RW |
| 1270W | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $33.99 | BN |
| 1270W | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $33.01 | CR,HX,RW |
| 14023C | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $33.17 | BN |
| 14023C | CYPROTERONEcyproterone acetate 50 mg tablet, 50 | 50 | $32.14 | CR,HX,RW |
| 13489Y | DABIGATRANdabigatran etexilate 150 mg capsule, 60 | 60 | $41.96 | BY,SZ,XT |
| 13523R | DABIGATRANdabigatran etexilate 110 mg capsule, 60 | 60 | $42.24 | BY,SZ,XT |
| 9318K | DABIGATRANdabigatran etexilate 75 mg capsule, 10 | 10 | $13.42 | BY |
| 9322P | DABIGATRANdabigatran etexilate 75 mg capsule, 10 | 10 | $13.42 | BY |
| 9319L | DABIGATRANdabigatran etexilate 110 mg capsule, 10 | 10 | $8.97 | BY |
| 9323Q | DABIGATRANdabigatran etexilate 110 mg capsule, 10 | 10 | $8.97 | BY |
| 13844P | DAPAGLIFLOZINdapagliflozin 10 mg tablet, 28 | 28 | $44.90 | AP |
| 14054Q | DAPAGLIFLOZINdapagliflozin 10 mg tablet, 28 | 28 | $44.90 | AP |
| 13851B | DAPAGLIFLOZIN + METFORMINdapagliflozin 5 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $47.86 | AP |
| 13875G | DAPAGLIFLOZIN + METFORMINdapagliflozin 10 mg + metformin hydrochloride 1 g modified release tablet, 28 | 28 | $46.43 | AP |
| 14028H | DAPAGLIFLOZIN + METFORMINdapagliflozin 10 mg + metformin hydrochloride 500 mg modified release tablet, 28 | 28 | $45.66 | AP |
| 12458Q | DESMOPRESSINdesmopressin acetate 10 microgram/actuation nasal spray, 50 actuations | 1 | $111.93 | DZ |
| 8711L | DESMOPRESSINdesmopressin acetate 10 microgram/actuation nasal spray, 60 actuations | 1 | $46.71 | FP |
| 13889B | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $34.81 | FP |
| 13945Y | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $35.52 | FP |
| 8662X | DESMOPRESSINdesmopressin acetate 200 microgram tablet, 30 | 30 | $34.75 | FP |
| 14004C | DESMOPRESSINdesmopressin 120 microgram sublingual wafer, 30 | 30 | $39.32 | FP |
| 13890C | DESMOPRESSINdesmopressin 240 microgram sublingual wafer, 30 | 30 | $65.86 | FP |
| 14007F | DEXAMETHASONEdexamethasone 500 microgram tablet, 30 | 30 | $5.02 | AS |
| 5521N | DEXTRAN-70 + HYPROMELLOSEdextran-70 0.1% + hypromellose 0.3% eye drops, 28 x 0.4 mL ampoules | 1 | $7.23 | AQ |
| 8299T | DEXTRAN-70 + HYPROMELLOSEdextran-70 0.1% + hypromellose 0.3% eye drops, 28 x 0.4 mL ampoules | 1 | $7.23 | AQ |
| 1302M | DICLOFENACdiclofenac sodium 100 mg suppository, 20 | 20 | $10.52 | NV |
| 5079H | DICLOFENACdiclofenac sodium 100 mg suppository, 20 | 20 | $10.52 | NV |
| 1299J | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $5.02 | AL,RW,SZ,TX |
| 1299J | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $6.72 | NV |
| 5076E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $5.02 | AL,RW,SZ,TX |
| 5076E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $6.72 | NV |
| 10790X | DICLOXACILLINdicloxacillin 500 mg capsule, 24 | 24 | $10.41 | AL,MQ |
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