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 |
|---|---|---|---|---|
| 12587L | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13048R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13049T | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13054C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13055D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13056E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13060J | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13061K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13062L | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13070X | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13075E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13076F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 13077G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.76 | EW |
| 12586K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 12597B | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13047Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13050W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13057F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13058G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13065P | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13066Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13067R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13069W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13072B | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13073C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13074D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13078H | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.53 | EW |
| 13651L | INSULIN ASPARTinsulin aspart 100 units/mL fast acting injection, 5 x 3 mL cartridges | 1 | $31.74 | NO |
| 8571D | INSULIN ASPARTinsulin aspart 100 units/mL injection, 1 x 10 mL vial | 1 | $18.48 | NO |
| 8435Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.74 | NO |
| 12254Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.74 | NF |
| 8609D | INSULIN ASPART + INSULIN ASPART PROTAMINEinsulin aspart 30 units/mL + insulin aspart protamine 70 units/mL injection, 5 x 3 mL cartridges | 1 | $31.74 | 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 | $31.74 | NF |
| 11417X | INSULIN DEGLUDEC + INSULIN ASPARTinsulin degludec 70 units/mL + insulin aspart 30 units/mL injection, 5 x 3 mL pen devices | 1 | $74.43 | NO |
| 11426J | INSULIN DEGLUDEC + INSULIN ASPARTinsulin degludec 70 units/mL + insulin aspart 30 units/mL injection, 5 x 3 mL cartridges | 1 | $74.43 | NO |
| 9040T | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL cartridges | 1 | $69.48 | NO |
| 12236B | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL pen devices | 1 | $69.48 | NF |
| 9039R | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $35.72 | GZ |
| 11308E | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 3 x 1.5 mL pen devices | 1 | $49.42 | SW |
| 11302W | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 5 x 1.5 mL pen devices | 1 | $82.40 | SW |
| 11815W | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $35.72 | WA |
| 12268Q | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.75 | SW |
| 9224L | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 1 x 10 mL vial | 1 | $18.48 | SW |
| 1921D | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.75 | AV |
| 12262J | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 5 x 3 mL pen devices | 1 | $26.45 | NI |
| 1533Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.54 | LY,NO |
| 1761Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.45 | LY,NO |
| 8084L | INSULIN LISPROinsulin lispro 100 units/mL injection, 1 x 10 mL vial | 1 | $18.48 | LY |
| 8212F | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.74 | LY |
| 11645X | INSULIN LISPROinsulin lispro 200 units/mL injection, 5 x 3 mL pen devices | 1 | $51.61 | LY |
| 12237C | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.74 | KP |
| 12234X | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL pen devices | 1 | $31.74 | 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 | $31.74 | KP |
| 8390N | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL cartridges | 1 | $31.74 | LY |
| 8874C | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 50 units/mL + insulin lispro protamine 50 units/mL injection, 5 x 3 mL cartridges | 1 | $31.74 | LY |
| 1531N | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.54 | LY,NO |
| 1762R | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.45 | 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 | $15.54 | 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 | $26.45 | LY,NO |
| 12255B | INSULIN NEUTRAL HUMAN + INSULIN ISOPHANE HUMANinsulin neutral human 30 units/mL + insulin isophane human 70 units/mL injection, 5 x 3 mL pen devices | 1 | $26.45 | NI |
| 8671J | IPRATROPIUMipratropium bromide monohydrate 21 microgram/actuation inhalation, 200 actuations | 1 | $12.88 | BY |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.20 | AF,AL |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.42 | BY |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.46 | AF,AL |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.68 | BY |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $5.02 | AL,BG,GQ,IB,RF,SZ,TX,VO |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $8.12 | AV,SW |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $6.07 | AL,BG,GQ,IB,RF,SZ,TX,VO |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $9.19 | AV,SW |
| 13435D | IRBESARTANirbesartan 75 mg tablet, 30 | 30 | $5.02 | AL,BG,GQ,IB,RF,SZ,TX,VO |
| 13435D | IRBESARTANirbesartan 75 mg tablet, 30 | 30 | $8.12 | AV,SW |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $5.02 | AL,IB,RF,SZ,TX |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.12 | AV,SW |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.18 | AL,IB,RF,SZ,TX |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.30 | AV,SW |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $6.52 | AL,IB,RF,SZ,TX |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $9.64 | AV,SW |
| 9436P | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 1 g isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $120.88 | VF |
| 9134R | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 50 mg isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $109.88 | VF |
| 13491C | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $4.92 | RW |
| 2588F | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $6.07 | RW |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $13.00 | IX |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $9.63 | IY |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $6.07 | AF,RF,TX |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $9.45 | IX |
| 11621P | ISOTRETINOINisotretinoin 20 mg capsule, 30 | 30 | $17.70 | RO |
| 2868Y | IVERMECTINivermectin 3 mg tablet, 4 | 4 | $19.89 | MK |
| 13887X | LABETALOLlabetalol hydrochloride 100 mg tablet, 100 | 100 | $15.56 | AF |
| 13839J | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $90.72 | AF,CR,GQ,SZ,UC,XT |
| 13867W | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $90.72 | AF,CR,GQ,LR,SZ,UC,XT |
| 13838H | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $136.10 | AF,CR,GQ,SZ,UC,XT |
| 14053P | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $136.10 | AF,CR,GQ,LR,SZ,UC,XT |
| 13949E | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $181.55 | AF,CR,GQ,SZ,UC,XT |
| 13951G | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $181.55 | AF,CR,GQ,LR,SZ,UC,XT |
| 10293R | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $11.98 | AF,CR,GQ,SZ,UC,XT |
| 12626M | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $11.98 | AF,CR,GQ,SZ,UC,XT |
| 14011K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $11.40 | AF,CR,GQ,SZ,UC,XT |
| 14049K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $11.40 | AF,CR,GQ,SZ,UC,XT |
| 11694L | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.32 | UC |
| 12628P | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.19 | UC |
| 14013M | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.29 | UC |
| 14048J | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.35 | UC |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $12.13 | AL,GQ,HX,RF,TY,VO,ZS |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $15.58 | AS |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $18.81 | AL,GQ,HX,RF,TY,VO,ZS |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $22.27 | AS |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $6.61 | AL,GQ,HX,RF,TY,VO,ZS |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $10.89 | AS |
| 14047H | LAMOTRIGINElamotrigine 5 mg tablet, 56 | 56 | $8.63 | AS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $8.20 | AL,GQ,HX,RF,TY,VO,ZS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $11.64 | AS |
| 12284M | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $7.13 | AF,RA,TX,VO |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $7.13 | AF,GQ,TX |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $12.36 | PF |
| 14060B | LANTHANUMlanthanum 500 mg chewable tablet, 2 x 45 | 90 | $252.48 | TK |
| 13986D | LANTHANUMlanthanum 750 mg chewable tablet, 6 x 15 | 90 | $381.37 | TK |
| 13874F | LANTHANUMlanthanum 1 g chewable tablet, 6 x 15 | 90 | $427.74 | TK |
| 11251E | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.82 | NV |
| 9148L | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.82 | NV |
| 13940Q | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $15.08 | AF,AV,GX,HQ,RW,SW,SZ |
| 14068K | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $15.08 | AF,AV,GX,HQ,SW,SZ |
| 13998R | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $21.76 | AF,GX,HQ,SW,SZ |
| 14069L | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $21.76 | AF,GX,HQ,RW,SW,SZ |
| 10965D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.88 | EI |
| 13253M | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.88 | EI |
| 13283D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.88 | EI |
| 11638M | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2051.26 | EI |
| 13252L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2067.86 | EI |
| 13290L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2067.86 | EI |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $5.02 | AL,GX,JB,RW |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $8.50 | GO |
| 13412X | LERCANIDIPINElercanidipine hydrochloride 20 mg tablet, 28 | 28 | $6.07 | AL,GX,JB,RW,TX |
| 13412X | LERCANIDIPINElercanidipine hydrochloride 20 mg tablet, 28 | 28 | $9.57 | GO |
| 13507X | LERCANIDIPINE + ENALAPRILlercanidipine hydrochloride 10 mg + enalapril maleate 10 mg tablet, 28 | 28 | $7.29 | GO |
| 13477H | LERCANIDIPINE + ENALAPRILlercanidipine hydrochloride 10 mg + enalapril maleate 20 mg tablet, 28 | 28 | $8.07 | GO |
| 13939P | LETROZOLEletrozole 2.5 mg tablet, 30 | 30 | $15.40 | NV |
| 13939P | LETROZOLEletrozole 2.5 mg tablet, 30 | 30 | $12.76 | AF,CR,GX,HQ,SZ,ZS |
| 13993L | LEVETIRACETAMlevetiracetam 100 mg/mL oral liquid, 300 mL | 1 | $65.29 | AE,GQ,TX,UC,ZS |
| 13937M | LEVETIRACETAMlevetiracetam 1 g tablet, 60 | 60 | $29.03 | AF,AL,GQ,RW,SZ,TX,UC,VO,ZS |
| 13992K | LEVETIRACETAMlevetiracetam 250 mg tablet, 60 | 60 | $11.93 | AF,AL,GQ,RW,SZ,TX,UC,VO,ZS |
| 14034P | LEVETIRACETAMlevetiracetam 500 mg tablet, 60 | 60 | $18.34 | AF,AL,GQ,RW,SZ,TX,UC,VO,ZS |
| 11919H | LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL | 7 | $1473.68 | VE |
| 8970D | LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL | 7 | $1461.22 | VE |
| 8798C | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 100 mg + carbidopa 25 mg + entacapone 200 mg tablet, 100 | 100 | $75.95 | HX,SZ,TB,TX |
| 9345W | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 125 mg + carbidopa 31.25 mg + entacapone 200 mg tablet, 100 | 100 | $78.83 | HX,SZ,TB,TX |
| 8799D | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 150 mg + carbidopa 37.5 mg + entacapone 200 mg tablet, 100 | 100 | $83.15 | HX,SZ,TB,TX |
| 9292C | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 200 mg + carbidopa 50 mg + entacapone 200 mg tablet, 100 | 100 | $89.77 | HX,SZ,TB,TX |
| 8797B | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 50 mg + carbidopa 12.5 mg + entacapone 200 mg tablet, 100 | 100 | $68.74 | HX,SZ,TB,TX |
| 9344T | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100 | 100 | $71.90 | HX,SZ,TB,TX |
| 13954K | LINAGLIPTINlinagliptin 5 mg tablet, 30 | 30 | $48.40 | BY |
| 13959Q | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $52.45 | BY |
| 14065G | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 850 mg tablet, 60 | 60 | $53.57 | BY |
| 13879L | LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $54.03 | BY |
| 13966C | LIOTHYRONINEliothyronine sodium 20 microgram tablet, 100 | 100 | $46.60 | AS |
| 13584Y | LISINOPRILlisinopril 10 mg tablet, 30 | 30 | $6.07 | AL,RW,SZ,TX |
| 13584Y | LISINOPRILlisinopril 10 mg tablet, 30 | 30 | $10.91 | IX |
| 13402J | LISINOPRILlisinopril 20 mg tablet, 30 | 30 | $6.39 | AL,GQ,RW,SZ,TX |
| 13402J | LISINOPRILlisinopril 20 mg tablet, 30 | 30 | $11.22 | IX |
| 13583X | LISINOPRILlisinopril 5 mg tablet, 30 | 30 | $5.03 | AL,RW,SZ,TX |
| 13583X | LISINOPRILlisinopril 5 mg tablet, 30 | 30 | $9.85 | IX |
| 8290H | LITHIUM CARBONATElithium carbonate 450 mg modified release tablet, 100 | 100 | $36.14 | AS |
| 10889D | LOPERAMIDEloperamide hydrochloride 2 mg capsule, 12 | 12 | $2.41 | AS,CR |
| 9327X | MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral liquid, 250 mL bottle | 1 | $20.22 | SB |
| 3128P | MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral oil, 500 mL | 1 | $19.15 | SB |
| 13849X | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 | 30 | $15.88 | PF |
| 13849X | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 | 30 | $9.18 | FZ |
| 13928C | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 | 100 | $31.91 | PF |
| 13928C | MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 | 100 | $25.21 | FZ |
| 14067J | MEDROXYPROGESTERONEmedroxyprogesterone acetate 100 mg tablet, 100 | 100 | $76.39 | PF |
| 13881N | MEDROXYPROGESTERONEmedroxyprogesterone acetate 200 mg tablet, 60 | 60 | $87.15 | PF |
| 13961T | MEDROXYPROGESTERONEmedroxyprogesterone acetate 250 mg tablet, 60 | 60 | $89.80 | PF |
| 13956M | MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 | 56 | $12.37 | PF |
| 13956M | MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 | 56 | $7.79 | FZ |
| 14038W | MEDROXYPROGESTERONEmedroxyprogesterone acetate 500 mg tablet, 30 | 30 | $89.80 | PF |
| 1598D | MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 | 25 | $40.10 | LM |
| 1598D | MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 | 25 | $41.96 | AS |
| 11554D | MESALAZINEmesalazine 1 g enteric tablet, 60 | 60 | $64.46 | FD |
| 12463Y | MESALAZINEmesalazine 1.6 g enteric tablet, 60 | 60 | $72.43 | EU |
| 13356Y | MESALAZINEmesalazine 1.2 g modified release tablet, 120 | 120 | $164.93 | RA |
| 13355X | MESALAZINEmesalazine 1 g modified release granules, 100 sachets | 100 | $98.00 | FP |
| 13361F | MESALAZINEmesalazine 500 mg modified release granules, 100 sachets | 100 | $57.24 | FD |
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