Browse by Standard Packs

Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits

Item code Drug name
Form and Strength
Pack size Price Manufacturer
5304E BISACODYLbisacodyl 10 mg suppository, 12 1 $4.76 PP
5303D BISACODYLbisacodyl 10 mg suppository, 10 1 $5.95 VZ
5303D BISACODYLbisacodyl 10 mg suppository, 10 1 $5.52 PP
10953L BUPRENORPHINEbuprenorphine 15 microgram/hour patch, 2 2 $35.20 MF
10959T BUPRENORPHINEbuprenorphine 40 microgram/hour patch, 2 2 $69.18 MF
10948F BUPRENORPHINEbuprenorphine 10 microgram/hour patch, 2 2 $28.11 MF
10964C BUPRENORPHINEbuprenorphine 25 microgram/hour patch, 2 2 $49.02 MF
10957Q BUPRENORPHINEbuprenorphine 5 microgram/hour patch, 2 2 $16.49 MF
10949G BUPRENORPHINEbuprenorphine 30 microgram/hour patch, 2 2 $55.74 MF
10970J BUPRENORPHINEbuprenorphine 20 microgram/hour patch, 2 2 $42.30 MF
5339B CLONAZEPAMclonazepam 2.5 mg/mL oral liquid, 10 mL 1 $5.72 RO
5363G DICLOFENACdiclofenac sodium 100 mg suppository, 20 20 $10.18 NV
5361E DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 50 $3.44 AF,EA,ED,RW,SZ,TX
5361E DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 50 $5.16 NV
5407N FENTANYLFENTANYL Lozenge 200 micrograms (as citrate), 30 30 $282.60 TB
10608H FENTANYLfentanyl 400 microgram sublingual tablet, 30 30 $225.84 FK
10729Q FENTANYLfentanyl 100 microgram orally disintegrating tablet, 4 4 $31.22 TB
5409Q FENTANYLFENTANYL Lozenge 600 micrograms (as citrate), 30 30 $282.60 TB
5410R FENTANYLFENTANYL Lozenge 800 micrograms (as citrate), 30 30 $282.60 TB
10602B FENTANYLfentanyl 100 microgram sublingual tablet, 30 30 $225.84 FK
10738E FENTANYLfentanyl 800 microgram orally disintegrating tablet, 28 28 $210.71 TB
10607G FENTANYLfentanyl 200 microgram sublingual tablet, 30 30 $225.84 FK
10739F FENTANYLfentanyl 400 microgram orally disintegrating tablet, 4 4 $31.22 TB
10610K FENTANYLfentanyl 300 microgram sublingual tablet, 30 30 $225.84 FK
5408P FENTANYLFENTANYL Lozenge 400 micrograms (as citrate), 30 30 $282.60 TB
10613N FENTANYLfentanyl 600 microgram sublingual tablet, 30 30 $225.84 FK
10722H FENTANYLfentanyl 600 microgram orally disintegrating tablet, 4 4 $31.22 TB
10723J FENTANYLfentanyl 800 microgram orally disintegrating tablet, 4 4 $31.22 TB
5411T FENTANYLFENTANYL Lozenge 1200 micrograms (as citrate), 30 30 $282.60 TB
10713W FENTANYLfentanyl 600 microgram orally disintegrating tablet, 28 28 $210.71 TB
5412W FENTANYLFENTANYL Lozenge 1600 micrograms (as citrate), 30 30 $282.60 TB
10697B FENTANYLfentanyl 200 microgram orally disintegrating tablet, 4 4 $31.22 TB
10737D FENTANYLfentanyl 400 microgram orally disintegrating tablet, 28 28 $210.71 TB
10698C FENTANYLfentanyl 200 microgram orally disintegrating tablet, 28 28 $210.71 TB
10611L FENTANYLfentanyl 800 microgram sublingual tablet, 30 30 $225.84 FK
10684H FENTANYLfentanyl 100 microgram orally disintegrating tablet, 28 28 $210.71 TB
5317W HYOSCINE BUTYLBROMIDEhyoscine butylbromide 20 mg/mL injection, 5 x 1 mL ampoules 5 $15.36 VZ
5368M IBUPROFENibuprofen 400 mg tablet, 30 30 $3.60 GO
5378C INDOMETHACINindomethacin 100 mg suppository, 20 20 $8.96 AS
5377B INDOMETHACINindomethacin 25 mg capsule, 50 50 $4.77 AF
5377B INDOMETHACINindomethacin 25 mg capsule, 50 50 $6.79 AS
5426N MACROGOL-3350macrogol-3350 1 g/g powder for oral liquid, 510 g 1 $9.54 KY
2351R MACROGOL-3350macrogol-3350 1 g/g oral liquid: powder for, 30 x 17 g sachets 1 $9.54 ON
10127B MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.12 g/25 mL + sodium chloride 350.7 mg/25 mL + potassium chloride 46.6 mg/25 mL (0.63 mmol/25 mL potassium) + sodium bicarbonate 178.5 mg/25 mL oral liquid, 500 mL 1 $7.01 NE
5389P MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.12 g + sodium chloride 350.7 mg + potassium chloride 46.6 mg (0.63 mmol potassium) + sodium bicarbonate 178.5 mg solution, 30 sachets 1 $9.54 AE,EA,HM,NE,RF,RW,TX
5423K METHYLNALTREXONEmethylnaltrexone bromide 12 mg/0.6 mL injection, 0.6 mL vial 1 $36.66 LM
10762K METOCLOPRAMIDEmetoclopramide hydrochloride 10 mg/2 mL injection, 10 x 2 mL ampoules 10 $6.70 IA
5345H NAPROXENnaproxen 250 mg tablet, 50 50 $5.60 AF
5345H NAPROXENnaproxen 250 mg tablet, 50 50 $6.72 IX
5359C NITRAZEPAMnitrazepam 5 mg tablet, 25 25 $4.82 IA
5359C NITRAZEPAMnitrazepam 5 mg tablet, 25 25 $3.58 AF
5372R OXAZEPAMoxazepam 30 mg tablet, 25 25 $5.38 QA
5372R OXAZEPAMoxazepam 30 mg tablet, 25 25 $3.05 AF,RW,TX
5371Q OXAZEPAMoxazepam 15 mg tablet, 25 25 $6.05 QA
5371Q OXAZEPAMoxazepam 15 mg tablet, 25 25 $3.39 AF
5319Y PARACETAMOLparacetamol 500 mg suppository, 24 1 $18.73 GC
5343F PARACETAMOLparacetamol 665 mg modified release tablet, 96 96 $5.70 CR
5331N SORBITOL + CITRIC ACID + LAURYL SULFOACETATE SODIUMsorbitol 3.125 g/5 mL + citrate sodium dihydrate 450 mg/5 mL + lauryl sulfoacetate sodium 45 mg/5 mL enema, 12 x 5 mL 1 $11.10 AE
5375X TEMAZEPAMtemazepam 10 mg tablet, 25 25 $6.53 QA
5375X TEMAZEPAMtemazepam 10 mg tablet, 25 25 $3.05 AF,FM,TX