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 |
|---|---|---|---|---|
| 10790X | DICLOXACILLINdicloxacillin 500 mg capsule, 24 | 24 | $12.36 | AF |
| 3164M | DIGOXINdigoxin 50 microgram/mL oral liquid, 60 mL | 1 | $17.41 | AS |
| 2896K | DIMETHYL FUMARATEdimethyl fumarate 120 mg enteric capsule, 14 | 14 | $173.95 | BD,CR,LR,SZ,XT |
| 2943X | DIMETHYL FUMARATEdimethyl fumarate 120 mg enteric capsule, 14 | 14 | $173.95 | BD,CR,LR,SZ,XT |
| 13280Y | DISOPYRAMIDEdisopyramide 100 mg capsule, 84 | 84 | $59.36 | OJ |
| 10777F | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $6.80 | YN |
| 10777F | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $5.39 | YT |
| 2703G | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $6.80 | YN |
| 2703G | DOXYCYCLINEdoxycycline 100 mg modified release capsule, 7 | 7 | $5.39 | YT |
| 10779H | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.85 | AF,RW,TX |
| 10781K | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.85 | HX |
| 2702F | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.85 | AF,RW,TX |
| 2714W | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $4.23 | AF,RW,TX |
| 9107H | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $3.85 | HX |
| 9108J | DOXYCYCLINEdoxycycline 100 mg tablet, 7 | 7 | $4.23 | HX |
| 13900N | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $18.67 | TX |
| 13900N | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $25.67 | GK |
| 13929D | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $20.21 | GC |
| 13929D | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $23.71 | GK |
| 13845Q | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $50.09 | BY |
| 14018T | EMPAGLIFLOZINempagliflozin 10 mg tablet, 30 | 30 | $50.09 | BY |
| 13920P | EMPAGLIFLOZINempagliflozin 25 mg tablet, 30 | 30 | $50.33 | BY |
| 13904T | EMPAGLIFLOZIN + LINAGLIPTINempagliflozin 10 mg + linagliptin 5 mg tablet, 30 | 30 | $72.84 | BY |
| 13958P | EMPAGLIFLOZIN + LINAGLIPTINempagliflozin 25 mg + linagliptin 5 mg tablet, 30 | 30 | $72.84 | BY |
| 14029J | EMPAGLIFLOZIN + METFORMINempagliflozin 5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $51.93 | BY |
| 13852C | EMPAGLIFLOZIN + METFORMINempagliflozin 5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $53.51 | BY |
| 13903R | EMPAGLIFLOZIN + METFORMINempagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $51.93 | BY |
| 13987E | EMPAGLIFLOZIN + METFORMINempagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $53.51 | BY |
| 13465Q | ENALAPRILenalapril maleate 10 mg tablet, 30 | 30 | $5.93 | AL,GQ,RW,SZ,TX |
| 13465Q | ENALAPRILenalapril maleate 10 mg tablet, 30 | 30 | $16.34 | AF |
| 13401H | ENALAPRILenalapril maleate 20 mg tablet, 30 | 30 | $6.23 | AL,GQ,RW,SZ,TX |
| 13401H | ENALAPRILenalapril maleate 20 mg tablet, 30 | 30 | $16.63 | AF |
| 13369P | ENALAPRILenalapril maleate 5 mg tablet, 30 | 30 | $5.02 | AL,GQ,RW,SZ,TX |
| 13439H | ENALAPRIL + HYDROCHLOROTHIAZIDEenalapril maleate 20 mg + hydrochlorothiazide 6 mg tablet, 30 | 30 | $7.68 | AF,SZ |
| 11937G | ENCORAFENIBencorafenib 50 mg capsule, 28 | 28 | $780.70 | FB |
| 11954E | ENCORAFENIBencorafenib 50 mg capsule, 28 | 28 | $780.70 | FB |
| 11938H | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1756.58 | FB |
| 11949X | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1756.58 | FB |
| 12814K | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1764.88 | FB |
| 12815L | ENCORAFENIBencorafenib 75 mg capsule, 42 | 42 | $1764.88 | FB |
| 8510X | ENOXAPARIN SODIUMenoxaparin sodium 40 mg/0.4 mL injection, 10 x 0.4 mL syringes | 10 | $42.66 | AV,JU |
| 8639Q | ENOXAPARIN SODIUMenoxaparin sodium 40 mg/0.4 mL injection, 10 x 0.4 mL syringes | 10 | $42.66 | AV,JU |
| 5435C | ENOXAPARIN SODIUMenoxaparin sodium 100 mg/mL injection, 10 x 1 mL syringes | 10 | $103.22 | AV,JU |
| 8640R | ENOXAPARIN SODIUMenoxaparin sodium 60 mg/0.6 mL injection, 10 x 0.6 mL syringes | 10 | $73.16 | AV,JU |
| 5434B | ENOXAPARIN SODIUMenoxaparin sodium 80 mg/0.8 mL injection, 10 x 0.8 mL syringes | 10 | $77.79 | AV,JU |
| 8558K | ENOXAPARIN SODIUMenoxaparin sodium 20 mg/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $38.42 | AV,JU |
| 8716R | ENOXAPARIN SODIUMenoxaparin sodium 20 mg/0.2 mL injection, 10 x 0.2 mL syringes | 10 | $38.42 | AV,JU |
| 8367J | ENTACAPONEentacapone 200 mg tablet, 100 | 100 | $85.20 | SZ |
| 13590G | EPLERENONEeplerenone 25 mg tablet, 30 | 30 | $42.94 | AF,RW,TX,UJ |
| 13379E | EPLERENONEeplerenone 50 mg tablet, 30 | 30 | $42.94 | AF,RW,TX,UJ |
| 13861M | EPROSARTANeprosartan 600 mg tablet, 28 | 28 | $16.59 | GO |
| 13912F | EPROSARTANeprosartan 600 mg tablet, 28 | 28 | $16.59 | GO |
| 10780J | ERYTHROMYCINerythromycin 250 mg enteric capsule, 25 | 25 | $12.49 | YT |
| 12290W | ESOMEPRAZOLEesomeprazole 40 mg enteric capsule, 30 | 30 | $9.61 | AL |
| 12287Q | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $6.61 | AF,AL,BG,GQ,MQ,RA,RF,RW,TY,VO |
| 12287Q | ESOMEPRAZOLEesomeprazole 20 mg enteric tablet, 30 | 30 | $13.61 | AP |
| 12283L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $9.61 | AF,AL,BG,GQ,MQ,RA,RF,RW,TY,VO |
| 12283L | ESOMEPRAZOLEesomeprazole 40 mg enteric tablet, 30 | 30 | $16.61 | AP |
| 12275C | ESOMEPRAZOLEesomeprazole 20 mg enteric capsule, 30 | 30 | $6.61 | AL |
| 9329B | ESSENTIAL AMINO ACIDS FORMULAessential amino acids formula powder for oral liquid, 2 x 200 g | 1 | $170.74 | SB |
| 2027Q | ESSENTIAL AMINO ACIDS FORMULA WITH MINERALS AND VITAMIN Cessential amino acids formula with minerals and vitamin C powder for oral liquid, 400 g | 1 | $102.89 | SB |
| 13759E | ESSENTIAL AMINO ACIDS FORMULA WITH VITAMINS AND MINERALSessential amino acids formula with vitamins and minerals powder for oral liquid, 30 x 12.5 g sachets | 1 | $195.52 | VF |
| 13931F | ESTRADIOLestradiol 2 mg tablet, 56 | 56 | $8.51 | GO |
| 14026F | ESTRADIOLestradiol 0.1% (1 mg/g) gel, 28 x 1 g sachets | 1 | $14.48 | OX |
| 13872D | ESTRADIOLestradiol valerate 1 mg tablet, 56 | 56 | $5.44 | BN |
| 13980T | ESTRADIOLestradiol valerate 2 mg tablet, 56 | 56 | $6.76 | BN |
| 13978Q | ESTRADIOLestradiol 10 microgram modified release pessary, 18 | 18 | $18.87 | AS,NO |
| 13930E | ESTRADIOL (&) ESTRADIOL + DYDROGESTERONEestradiol 2 mg tablet [14] (&) estradiol 2 mg + dydrogesterone 10 mg tablet [14], 28 | 1 | $13.04 | GO |
| 14024D | ESTRADIOL (&) ESTRADIOL + DYDROGESTERONEestradiol 1 mg tablet [14] (&) estradiol 1 mg + dydrogesterone 10 mg tablet [14], 28 | 1 | $13.04 | GO |
| 13902Q | ESTRADIOL + NORETHISTERONE ACETATEestradiol 50 microgram/24 hours + norethisterone acetate 140 microgram/24 hours patch, 8 | 1 | $22.58 | SZ |
| 14059Y | ESTRIOLestriol 500 microgram pessary, 15 | 1 | $15.12 | AS |
| 13926Y | ESTRIOLestriol 0.1% (1 mg/g) cream, 15 g | 1 | $13.63 | AS |
| 11197H | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 11204Q | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 11207W | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 11223Q | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 13693Q | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 1954W | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 3445H | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 3448L | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 8637N | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 8638P | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 8778B | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 8779C | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 9035M | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 9036N | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 9037P | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 9429G | ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack | 1 | $418.63 | PF |
| 11703Y | ETHOSUXIMIDEethosuximide 250 mg capsule, 100 | 100 | $143.74 | IX |
| 13127X | ETHOSUXIMIDEethosuximide 250 mg capsule, 56 | 56 | $80.49 | IX |
| 14014N | ETHOSUXIMIDEethosuximide 250 mg/5 mL oral liquid, 200 mL | 1 | $63.43 | IX |
| 14040Y | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $431.82 | CR,NV |
| 8842J | EVEROLIMUSeverolimus 750 microgram tablet, 60 | 60 | $431.73 | CR,NV |
| 13941R | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $568.87 | CR,NV |
| 9352F | EVEROLIMUSeverolimus 1 mg tablet, 60 | 60 | $570.97 | CR,NV |
| 10958R | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $165.27 | AN |
| 11484K | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $165.21 | AN |
| 11977J | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $165.27 | AN |
| 11985T | EVOLOCUMABevolocumab 140 mg/mL injection, 1 mL pen device | 1 | $165.21 | AN |
| 13857H | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $47.74 | GQ,SZ,TX |
| 13857H | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $51.02 | PF |
| 14036R | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $47.74 | GQ,SZ,TX |
| 14036R | EXEMESTANEexemestane 25 mg tablet, 30 | 30 | $51.02 | PF |
| 13440J | EZETIMIBEezetimibe 10 mg tablet, 30 | 30 | $7.95 | AF,BG,CR,GQ,IB,RW,SZ,TX |
| 13440J | EZETIMIBEezetimibe 10 mg tablet, 30 | 30 | $10.11 | AL |
| 13480L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60 | 1 | $10.78 | AF,CR |
| 13480L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60 | 1 | $13.76 | AL |
| 13537L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60 | 1 | $11.92 | AF,CR |
| 13537L | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60 | 1 | $15.01 | AL |
| 13629H | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60 | 1 | $9.57 | AF |
| 13629H | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60 | 1 | $12.44 | AL |
| 13569E | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60 | 1 | $10.95 | AF,CR |
| 13569E | EZETIMIBE (&) ROSUVASTATINezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60 | 1 | $13.92 | AL |
| 13539N | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 10 mg tablet, 30 | 30 | $11.95 | AF |
| 13539N | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 10 mg tablet, 30 | 30 | $9.80 | GQ,XT |
| 13622Y | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 20 mg tablet, 30 | 30 | $12.52 | AF |
| 13622Y | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 20 mg tablet, 30 | 30 | $10.36 | GQ,XT |
| 13416D | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 40 mg tablet, 30 | 30 | $13.49 | AF |
| 13416D | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 40 mg tablet, 30 | 30 | $11.27 | GQ,XT |
| 13538M | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 80 mg tablet, 30 | 30 | $14.47 | AF |
| 13538M | EZETIMIBE + ATORVASTATINezetimibe 10 mg + atorvastatin 80 mg tablet, 30 | 30 | $12.26 | GQ,XT |
| 13385L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 10 mg tablet, 30 | 30 | $10.65 | AF,AL,CR,GQ,MQ,RW,SZ,TX |
| 13442L | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 20 mg tablet, 30 | 30 | $11.07 | AF,AL,CR,GQ,MQ,RW,SZ,TX |
| 13535J | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 40 mg tablet, 30 | 30 | $11.66 | AF,AL,CR,GQ,MQ,RW,SZ,TX |
| 13595M | EZETIMIBE + SIMVASTATINezetimibe 10 mg + simvastatin 80 mg tablet, 30 | 30 | $12.49 | AF,AL,CR,GQ,MQ,RW,SZ,TX |
| 13519M | FEBUXOSTATfebuxostat 80 mg tablet, 28 | 28 | $40.17 | FK |
| 13531E | FELODIPINEfelodipine 10 mg modified release tablet, 30 | 30 | $9.61 | AF,RW,TX |
| 13531E | FELODIPINEfelodipine 10 mg modified release tablet, 30 | 30 | $13.36 | GX |
| 13377C | FELODIPINEfelodipine 2.5 mg modified release tablet, 30 | 30 | $5.65 | AF,TX |
| 13377C | FELODIPINEfelodipine 2.5 mg modified release tablet, 30 | 30 | $9.62 | GX |
| 13561R | FELODIPINEfelodipine 5 mg modified release tablet, 30 | 30 | $6.34 | AF,RW,TX |
| 13561R | FELODIPINEfelodipine 5 mg modified release tablet, 30 | 30 | $10.22 | GX |
| 13587D | FENOFIBRATEfenofibrate 145 mg tablet, 30 | 30 | $11.43 | AL,BG,GO,IB,LR,RA,SZ,TX,XT |
| 13469X | FENOFIBRATEfenofibrate 48 mg tablet, 60 | 60 | $8.40 | AL,GO,LR,RA,TX |
| 10104T | FERRIC CARBOXYMALTOSEiron (as ferric carboxymaltose) 500 mg/10 mL injection, 10 mL vial | 1 | $145.68 | CS |
| 11615H | FERRIC DERISOMALTOSEiron (as ferric derisomaltose) 500 mg/5 mL injection, 5 mL vial | 1 | $138.44 | FK |
| 10788T | FLUCLOXACILLINflucloxacillin 500 mg capsule, 24 | 24 | $11.00 | AF,AL,MQ |
| 1433K | FLUDROCORTISONEfludrocortisone acetate 100 microgram tablet, 100 | 100 | $13.15 | AS,DZ |
| 13558N | FLUVASTATINfluvastatin 80 mg modified release tablet, 28 | 28 | $25.94 | NV |
| 1437P | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.45 | AF |
| 2958Q | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.41 | AF,PP |
| 8713N | FOLLITROPIN ALFAfollitropin alfa 300 units (21.84 microgram)/0.5 mL injection, 0.5 mL pen device | 1 | $97.44 | SG |
| 12778M | FOLLITROPIN ALFAfollitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge | 1 | $369.53 | TT |
| 8714P | FOLLITROPIN ALFAfollitropin alfa 450 units (32.76 microgram)/0.75 mL injection, 0.75 mL pen device | 1 | $146.22 | SG |
| 8715Q | FOLLITROPIN ALFAfollitropin alfa 900 units (65.52 microgram)/1.5 mL injection, 1.5 mL pen device | 1 | $369.53 | SG |
| 10876K | FOLLITROPIN ALFAfollitropin alfa 225 units (16.5 microgram)/0.375 mL injection, 5 x 0.375 mL pen devices | 5 | $342.09 | FX |
| 10865W | FOLLITROPIN ALFAfollitropin alfa 75 units (5.5 microgram)/0.125 mL injection, 5 x 0.125 mL pen devices | 5 | $115.73 | FX |
| 10877L | FOLLITROPIN ALFAfollitropin alfa 150 units (11 microgram)/0.25 mL injection, 5 x 0.25 mL pen devices | 5 | $231.59 | FX |
| 12769C | FOLLITROPIN ALFAfollitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge | 1 | $97.44 | TT |
| 12808D | FOLLITROPIN ALFAfollitropin alfa 450 units (33 microgram)/0.75 mL injection, 0.75 mL cartridge | 1 | $146.22 | TT |
| 8565T | FOLLITROPIN BETAfollitropin beta 300 units/0.36 mL injection, 0.36 mL cartridge | 1 | $103.04 | OQ,OV |
| 8566W | FOLLITROPIN BETAfollitropin beta 600 units/0.72 mL injection, 0.72 mL cartridge | 1 | $201.13 | OQ,OV |
| 8871X | FOLLITROPIN BETAfollitropin beta 900 units/1.08 mL injection, 1.08 mL cartridge | 1 | $299.08 | OQ,OV |
| 8775W | FONDAPARINUXfondaparinux sodium 2.5 mg/0.5 mL injection, 2 x 0.5 mL syringes | 2 | $30.12 | AS |
| 13504R | FUROSEMIDEfurosemide 10 mg/mL oral liquid, 30 mL | 1 | $18.33 | SW |
| 13501N | FUROSEMIDEfurosemide 20 mg tablet, 50 | 50 | $3.85 | TY |
| 1810G | FUROSEMIDEfurosemide 20 mg tablet, 50 | 50 | $5.00 | TY |
| 13473D | FUROSEMIDEfurosemide 20 mg tablet, 100 | 100 | $7.69 | TX |
| 13473D | FUROSEMIDEfurosemide 20 mg tablet, 100 | 100 | $8.75 | TY |
| 13472C | FUROSEMIDEfurosemide 40 mg tablet, 100 | 100 | $5.02 | AF,TX,VO,ZS |
| 13472C | FUROSEMIDEfurosemide 40 mg tablet, 100 | 100 | $6.06 | TY |
| 13474E | FUROSEMIDEfurosemide 500 mg tablet, 50 | 50 | $12.12 | RW |
| 10782L | FUSIDATEsodium fusidate 250 mg tablet, 36 | 36 | $92.03 | LO |
| 12478R | GALCANEZUMABgalcanezumab 120 mg/mL injection, 1 mL pen device | 1 | $514.38 | LY |
| 13618R | GEMFIBROZILgemfibrozil 600 mg tablet, 60 | 60 | $12.21 | AF,RW |
| 13868X | GLIBENCLAMIDEglibenclamide 5 mg tablet, 100 | 100 | $6.07 | SW |
| 13922R | GLICLAZIDEgliclazide 60 mg modified release tablet, 60 | 60 | $6.52 | CR,GQ,XT |
| 13922R | GLICLAZIDEgliclazide 60 mg modified release tablet, 60 | 60 | $13.27 | SE |
| 13896J | GLICLAZIDEgliclazide 80 mg tablet, 100 | 100 | $7.44 | AF,RW,TX,TY |
| 13848W | GLIMEPIRIDEglimepiride 1 mg tablet, 30 | 30 | $7.23 | SW |
| 13848W | GLIMEPIRIDEglimepiride 1 mg tablet, 30 | 30 | $5.02 | GX,SZ |
| 13870B | GLIMEPIRIDEglimepiride 2 mg tablet, 30 | 30 | $5.02 | GX,SZ |
| 14020X | GLIMEPIRIDEglimepiride 3 mg tablet, 30 | 30 | $5.21 | GX,SZ |
| 14055R | GLIMEPIRIDEglimepiride 4 mg tablet, 30 | 30 | $5.75 | GX,SZ |
| 14019W | GLIPIZIDEglipizide 5 mg tablet, 100 | 100 | $10.38 | AF,PF |
| 3107M | GLUCOSE AND KETONE INDICATOR URINEglucose and ketone indicator urine diagnostic strip, 50 | 1 | $6.20 | DX |
| 3104J | GLUCOSE INDICATOR URINEglucose indicator urine diagnostic strip, 50 | 1 | $5.99 | DX |
| 13580R | GLYCERYL TRINITRATEglyceryl trinitrate 10 mg/24 hours patch, 30 | 30 | $23.58 | SZ |
| 13490B | GLYCERYL TRINITRATEglyceryl trinitrate 5 mg/24 hours patch, 30 | 30 | $18.53 | SZ |
| 13549D | GLYCERYL TRINITRATEglyceryl trinitrate 400 microgram/actuation spray, 200 actuations | 1 | $14.23 | SW |
| 10195N | GLYCINE WITH CARBOHYDRATEglycine with carbohydrate containing 500 mg glycine powder for oral liquid, 30 x 4 g sachets | 1 | $122.09 | VF |
| 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 | $1022.45 | 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 | $837.70 | 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 | $91.83 | 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 | $392.88 | 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 | $739.55 | 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 | $392.88 | 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 | $261.80 | 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 | $346.40 | 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 | $519.14 | 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 | $392.89 | QH |
| 11287C | 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, 60 x 16 g sachets | 1 | $533.25 | QH |
| 11844J | GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINEglycomacropeptide formula with docosahexaenoic acid and low phenylalanine oral liquid, 18 x 250 mL cartons | 1 | $149.58 | 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 | $246.94 | VF |
| 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 | $493.89 | VF |
| 11245W | GLYCOMACROPEPTIDE FORMULA WITH DOCOSAHEXAENOIC ACID AND LOW PHENYLALANINEglycomacropeptide formula with docosahexaenoic acid and low phenylalanine powder for oral liquid, 30 x 27 g sachets | 1 | $373.95 | VF |
| 11382C | GOLIMUMABgolimumab 100 mg/mL injection, 1 mL pen device | 1 | $1095.69 | JC |
| 8728J | GRANISETRONgranisetron 2 mg tablet, 1 | 1 | $11.22 | IX |
| 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 | $40.68 | 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 | $40.68 | SB |
| 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 | $196.49 | VF |
| 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 | $225.32 | 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 | $255.27 | QH |
| 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 | $186.24 | SB |
| 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 | $153.48 | QH |
| 13409R | HYDROCHLOROTHIAZIDEhydrochlorothiazide 25 mg tablet, 100 | 100 | $10.46 | FF |
| 13863P | HYDROCORTISONEhydrocortisone 4 mg tablet, 50 | 50 | $16.77 | AL |
| 13863P | HYDROCORTISONEhydrocortisone 4 mg tablet, 50 | 50 | $19.77 | AF |
| 1502C | HYDROCORTISONE ACETATEhydrocortisone acetate 10% enema, 21.1 g | 1 | $17.10 | GO |
| 1501B | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $7.21 | PF |
| 1510L | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $5.67 | PF |
| 5118J | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $5.67 | PF |
| 1511M | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 250 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $9.53 | PF |
| 5119K | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 250 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $9.53 | PF |
| 12045Y | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $15.83 | MF |
| 12047C | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $15.83 | MF |
| 12032G | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.10 | MF |
| 12046B | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $18.10 | MF |
| 12010D | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $26.51 | MF |
| 12016K | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $26.51 | 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 | $11.46 | PK |
| 3190X | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.23 | NB,TX |
| 3190X | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.74 | GO |
| 5123P | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.23 | NB,TX |
| 5123P | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.74 | GO |
| 12113M | IMIPRAMINEimipramine hydrochloride 25 mg tablet, 100 | 100 | $29.67 | QY |
| 13475F | INDAPAMIDEindapamide hemihydrate 1.5 mg modified release tablet, 90 | 90 | $9.02 | AF,RW,TX |
| 13475F | INDAPAMIDEindapamide hemihydrate 1.5 mg modified release tablet, 90 | 90 | $16.74 | SE |
| 13378D | INDAPAMIDEindapamide hemihydrate 2.5 mg tablet, 90 | 90 | $6.76 | AF,RW |
| 2454E | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.64 | AF |
| 2454E | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $7.66 | AS |
| 5126T | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.64 | AF |
| 5126T | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $7.66 | AS |
| 2757D | INDOMETACINindometacin 100 mg suppository, 20 | 20 | $9.30 | AS |
| 5128X | INDOMETACINindometacin 100 mg suppository, 20 | 20 | $9.30 | AS |
| 12551N | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12554R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12560C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12567K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12575W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12577Y | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12584H | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12550M | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12552P | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12553Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12561D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12576X | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12585J | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
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