Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 5303D | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.07 | VZ |
| 5303D | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.64 | PP |
| 5304E | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $4.88 | PP |
| 10964C | BUPRENORPHINEbuprenorphine 25 microgram/hour patch, 2 | 2 | $41.66 | MF |
| 10953L | BUPRENORPHINEbuprenorphine 15 microgram/hour patch, 2 | 2 | $30.05 | MF,SZ |
| 10948F | BUPRENORPHINEbuprenorphine 10 microgram/hour patch, 2 | 2 | $24.10 | MF,SZ,TX |
| 10959T | BUPRENORPHINEbuprenorphine 40 microgram/hour patch, 2 | 2 | $58.92 | MF |
| 10949G | BUPRENORPHINEbuprenorphine 30 microgram/hour patch, 2 | 2 | $47.31 | MF |
| 10970J | BUPRENORPHINEbuprenorphine 20 microgram/hour patch, 2 | 2 | $36.02 | MF,SZ,TX |
| 10957Q | BUPRENORPHINEbuprenorphine 5 microgram/hour patch, 2 | 2 | $14.33 | MF,SZ,TX |
| 5331N | 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 | $11.27 | AE |
| 11520H | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $5.91 | RO |
| 5339B | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $5.89 | RO |
| 5361E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $3.61 | AF,EA,ED,RW,SZ,TX |
| 5361E | DICLOFENACdiclofenac sodium 25 mg enteric tablet, 50 | 50 | $5.33 | NV |
| 5363G | DICLOFENACdiclofenac sodium 100 mg suppository, 20 | 20 | $10.35 | NV |
| 5409Q | FENTANYLfentanyl 600 microgram lozenge, 30 | 30 | $287.53 | TB |
| 10697B | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 4 | 4 | $31.39 | TB |
| 10729Q | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 4 | 4 | $31.39 | TB |
| 10601Y | FENTANYLfentanyl 100 microgram sublingual tablet, 10 | 10 | $76.41 | FK |
| 10610K | FENTANYLfentanyl 300 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10600X | FENTANYLfentanyl 200 microgram sublingual tablet, 10 | 10 | $76.41 | FK |
| 10698C | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 28 | 28 | $214.60 | TB |
| 5407N | FENTANYLfentanyl 200 microgram lozenge, 30 | 30 | $287.53 | TB |
| 5412W | FENTANYLfentanyl 1600 microgram lozenge, 30 | 30 | $287.53 | TB |
| 10737D | FENTANYLfentanyl 400 microgram orally disintegrating tablet, 28 | 28 | $214.60 | TB |
| 10611L | FENTANYLfentanyl 800 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10739F | FENTANYLfentanyl 400 microgram orally disintegrating tablet, 4 | 4 | $31.39 | TB |
| 5410R | FENTANYLfentanyl 800 microgram lozenge, 30 | 30 | $287.53 | TB |
| 10613N | FENTANYLfentanyl 600 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10607G | FENTANYLfentanyl 200 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10608H | FENTANYLfentanyl 400 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10722H | FENTANYLfentanyl 600 microgram orally disintegrating tablet, 4 | 4 | $31.39 | TB |
| 10713W | FENTANYLfentanyl 600 microgram orally disintegrating tablet, 28 | 28 | $214.60 | TB |
| 10684H | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 28 | 28 | $214.60 | TB |
| 10723J | FENTANYLfentanyl 800 microgram orally disintegrating tablet, 4 | 4 | $31.39 | TB |
| 5411T | FENTANYLfentanyl 1200 microgram lozenge, 30 | 30 | $287.53 | TB |
| 5408P | FENTANYLfentanyl 400 microgram lozenge, 30 | 30 | $287.53 | TB |
| 10602B | FENTANYLfentanyl 100 microgram sublingual tablet, 30 | 30 | $229.95 | FK |
| 10738E | FENTANYLfentanyl 800 microgram orally disintegrating tablet, 28 | 28 | $214.60 | TB |
| 5317W | HYOSCINE BUTYLBROMIDEhyoscine butylbromide 20 mg/mL injection, 5 x 1 mL ampoules | 5 | $11.49 | VZ,XC |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $3.35 | TX |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.35 | GO |
| 5378C | INDOMETACINindometacin 100 mg suppository, 20 | 20 | $9.13 | AS |
| 5377B | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $4.94 | AF |
| 5377B | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $6.96 | AS |
| 5426N | MACROGOL-3350macrogol-3350 1 g/g powder for oral liquid, 510 g | 1 | $9.71 | KY |
| 5389P | MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.125 g + sodium chloride 350.7 mg + sodium bicarbonate 178.5 mg + potassium chloride 46.6 mg powder for oral liquid, 30 sachets | 1 | $9.71 | AE,EA,GO,GX,NE,RF,RW,TX |
| 10127B | MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.125 g/25 mL + sodium chloride 350.7 mg/25 mL + sodium bicarbonate 178.5 mg/25 mL + potassium chloride 46.6 mg/25 mL oral liquid, 500 mL | 1 | $7.18 | NE |
| 5423K | METHYLNALTREXONEmethylnaltrexone bromide 12 mg/0.6 mL injection, 0.6 mL vial | 1 | $33.69 | LM |
| 10762K | METOCLOPRAMIDEmetoclopramide hydrochloride 10 mg/2 mL injection, 10 x 2 mL ampoules | 10 | $6.78 | IL |
| 5345H | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $5.77 | AF |
| 5345H | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $6.89 | IX |
| 5359C | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $3.75 | AF |
| 5359C | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $4.99 | IL |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $3.22 | AF,RW,TX |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.55 | AS |
| 5371Q | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $3.56 | AF |
| 5371Q | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $6.22 | AS |
| 5319Y | PARACETAMOLparacetamol 500 mg suppository, 24 | 1 | $18.81 | GC |
| 5343F | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $5.87 | CR,TX |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $3.22 | AF,LN,TX |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $6.70 | AS |
