Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 10948F | BUPRENORPHINEbuprenorphine 10 microgram/hour patch, 2 | 2 | $20.75 | MF,SZ,TX |
| 10970J | BUPRENORPHINEbuprenorphine 20 microgram/hour patch, 2 | 2 | $30.86 | MF,SZ,TX |
| 10953L | BUPRENORPHINEbuprenorphine 15 microgram/hour patch, 2 | 2 | $25.80 | MF,SZ,TX |
| 10964C | BUPRENORPHINEbuprenorphine 25 microgram/hour patch, 2 | 2 | $35.63 | MF,SZ,TX |
| 10957Q | BUPRENORPHINEbuprenorphine 5 microgram/hour patch, 2 | 2 | $12.48 | MF,SZ,TX |
| 10949G | BUPRENORPHINEbuprenorphine 30 microgram/hour patch, 2 | 2 | $40.42 | MF,SZ,TX |
| 10959T | BUPRENORPHINEbuprenorphine 40 microgram/hour patch, 2 | 2 | $49.97 | 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 | $11.29 | AE |
| 11520H | CLONAZEPAMclonazepam 500 microgram tablet, 50 | 50 | $6.47 | PB |
| 5339B | CLONAZEPAMclonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL | 1 | $5.92 | PB |
| 10601Y | FENTANYLfentanyl 100 microgram sublingual tablet, 10 | 10 | $76.43 | FK |
| 10600X | FENTANYLfentanyl 200 microgram sublingual tablet, 10 | 10 | $76.43 | FK |
| 10697B | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 4 | 4 | $31.41 | TB |
| 10698C | FENTANYLfentanyl 200 microgram orally disintegrating tablet, 28 | 28 | $214.62 | TB |
| 10739F | FENTANYLfentanyl 400 microgram orally disintegrating tablet, 4 | 4 | $31.41 | TB |
| 10737D | FENTANYLfentanyl 400 microgram orally disintegrating tablet, 28 | 28 | $214.62 | TB |
| 10722H | FENTANYLfentanyl 600 microgram orally disintegrating tablet, 4 | 4 | $31.41 | TB |
| 10713W | FENTANYLfentanyl 600 microgram orally disintegrating tablet, 28 | 28 | $214.62 | TB |
| 12504D | FENTANYLfentanyl 25 microgram/hour patch, 5 | 5 | $10.87 | JC,SZ,TX |
| 12516R | FENTANYLfentanyl 25 microgram/hour patch, 5 | 5 | $10.87 | AF |
| 12521B | FENTANYLfentanyl 25 microgram/hour patch, 5 | 5 | $12.92 | ZP |
| 10610K | FENTANYLfentanyl 300 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 10723J | FENTANYLfentanyl 800 microgram orally disintegrating tablet, 4 | 4 | $31.41 | TB |
| 10738E | FENTANYLfentanyl 800 microgram orally disintegrating tablet, 28 | 28 | $214.62 | TB |
| 10684H | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 28 | 28 | $214.62 | TB |
| 5411T | FENTANYLfentanyl 1200 microgram lozenge, 30 | 30 | $287.55 | TB |
| 5412W | FENTANYLfentanyl 1600 microgram lozenge, 30 | 30 | $287.55 | TB |
| 12477Q | FENTANYLfentanyl 50 microgram/hour patch, 5 | 5 | $18.17 | JC,SZ,TX |
| 12513N | FENTANYLfentanyl 50 microgram/hour patch, 5 | 5 | $21.94 | ZP |
| 12546H | FENTANYLfentanyl 50 microgram/hour patch, 5 | 5 | $18.17 | AF |
| 12474M | FENTANYLfentanyl 75 microgram/hour patch, 5 | 5 | $24.09 | JC,SZ,TX |
| 12517T | FENTANYLfentanyl 75 microgram/hour patch, 5 | 5 | $29.27 | ZP |
| 12526G | FENTANYLfentanyl 75 microgram/hour patch, 5 | 5 | $24.09 | AF |
| 10613N | FENTANYLfentanyl 600 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 10611L | FENTANYLfentanyl 800 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 5407N | FENTANYLfentanyl 200 microgram lozenge, 30 | 30 | $287.55 | TB |
| 5408P | FENTANYLfentanyl 400 microgram lozenge, 30 | 30 | $287.55 | TB |
| 10729Q | FENTANYLfentanyl 100 microgram orally disintegrating tablet, 4 | 4 | $31.41 | TB |
| 12480W | FENTANYLfentanyl 100 microgram/hour patch, 5 | 5 | $35.79 | ZP |
| 12509J | FENTANYLfentanyl 100 microgram/hour patch, 5 | 5 | $29.37 | JC,SZ,TX |
| 12533P | FENTANYLfentanyl 100 microgram/hour patch, 5 | 5 | $29.37 | AF |
| 12491K | FENTANYLfentanyl 12 microgram/hour patch, 5 | 5 | $9.01 | AF |
| 12530L | FENTANYLfentanyl 12 microgram/hour patch, 5 | 5 | $10.62 | ZP |
| 12541C | FENTANYLfentanyl 12 microgram/hour patch, 5 | 5 | $9.01 | JC,SZ,TX |
| 5409Q | FENTANYLfentanyl 600 microgram lozenge, 30 | 30 | $287.55 | TB |
| 5410R | FENTANYLfentanyl 800 microgram lozenge, 30 | 30 | $287.55 | TB |
| 10602B | FENTANYLfentanyl 100 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 10607G | FENTANYLfentanyl 200 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 10608H | FENTANYLfentanyl 400 microgram sublingual tablet, 30 | 30 | $229.97 | FK |
| 12473L | HYDROMORPHONEhydromorphone hydrochloride 16 mg modified release tablet, 14 | 14 | $34.00 | JC |
| 12497R | HYDROMORPHONEhydromorphone hydrochloride 2 mg tablet, 20 | 20 | $8.75 | MF |
| 12543E | HYDROMORPHONEhydromorphone hydrochloride 32 mg modified release tablet, 14 | 14 | $61.36 | JC |
| 12484C | HYDROMORPHONEhydromorphone hydrochloride 4 mg tablet, 20 | 20 | $11.02 | MF |
| 12496Q | HYDROMORPHONEhydromorphone hydrochloride 4 mg modified release tablet, 14 | 14 | $17.57 | JC |
| 12535R | HYDROMORPHONEhydromorphone hydrochloride 64 mg modified release tablet, 14 | 14 | $108.40 | JC |
| 12515Q | HYDROMORPHONEhydromorphone hydrochloride 8 mg tablet, 20 | 20 | $19.43 | MF |
| 12482Y | HYDROMORPHONEhydromorphone hydrochloride 8 mg modified release tablet, 14 | 14 | $21.43 | JC |
| 12531M | HYDROMORPHONEhydromorphone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules | 5 | $16.60 | DZ,HW,JU,MF |
| 12493M | HYDROMORPHONEhydromorphone hydrochloride 2 mg/mL injection, 5 x 1 mL ampoules | 5 | $12.99 | DZ,HW,JU,MF |
| 5317W | HYOSCINE BUTYLBROMIDEhyoscine butylbromide 20 mg/mL injection, 5 x 1 mL ampoules | 5 | $7.78 | DZ,VZ,XN |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $4.13 | TX |
| 5368M | IBUPROFENibuprofen 400 mg tablet, 30 | 30 | $6.64 | GO |
| 5377B | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $5.49 | AF |
| 5377B | INDOMETACINindometacin 25 mg capsule, 50 | 50 | $7.51 | AS |
| 5426N | MACROGOL-3350macrogol-3350 1 g/g powder for oral liquid, 510 g | 1 | $9.73 | 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 | $9.73 | 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 | $7.20 | NE |
| 12481X | METHADONEmethadone hydrochloride 10 mg/mL injection, 5 x 1 mL ampoules | 5 | $37.18 | AS |
| 12520Y | METHADONEmethadone hydrochloride 10 mg tablet, 20 | 20 | $6.02 | AS |
| 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 | $6.79 | IL |
| 12507G | METOCLOPRAMIDEmetoclopramide hydrochloride 10 mg tablet, 25 | 25 | $3.77 | AF,RW,TX |
| 12507G | METOCLOPRAMIDEmetoclopramide hydrochloride 10 mg tablet, 25 | 25 | $7.32 | IL |
| 12502B | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL injection, 5 x 1 mL ampoules | 5 | $8.48 | JU |
| 12494N | MORPHINEmorphine hydrochloride trihydrate 20 mg/mL injection, 5 x 1 mL ampoules | 5 | $11.84 | JU |
| 12495P | MORPHINEmorphine sulfate pentahydrate 100 mg modified release granules, 28 sachets | 28 | $73.39 | MF |
| 12528J | MORPHINEmorphine sulfate pentahydrate 20 mg modified release granules, 28 sachets | 28 | $48.67 | MF |
| 12505E | MORPHINEmorphine sulfate pentahydrate 200 mg modified release granules, 28 sachets | 28 | $147.25 | MF |
| 12470H | MORPHINEmorphine hydrochloride trihydrate 50 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $18.29 | JU |
| 12537W | MORPHINEmorphine hydrochloride trihydrate 100 mg/5 mL injection, 5 x 5 mL ampoules | 5 | $29.04 | JU |
| 12488G | MORPHINEmorphine sulfate pentahydrate 30 mg modified release granules, 28 sachets | 28 | $50.29 | MF |
| 12536T | MORPHINEmorphine sulfate pentahydrate 60 mg modified release granules, 28 sachets | 28 | $57.64 | MF |
| 12547J | MORPHINEmorphine sulfate pentahydrate 10 mg modified release tablet, 28 | 28 | $11.65 | AF,MF,TX |
| 12483B | MORPHINEmorphine sulfate pentahydrate 100 mg modified release tablet, 28 | 28 | $60.16 | AF,MF,TX |
| 12476P | MORPHINEmorphine sulfate pentahydrate 15 mg modified release tablet, 28 | 28 | $15.29 | MF |
| 5391R | MORPHINEmorphine sulfate pentahydrate 200 mg modified release tablet, 28 | 28 | $107.26 | MF |
| 12500X | MORPHINEmorphine sulfate pentahydrate 30 mg modified release tablet, 28 | 28 | $25.43 | AF,MF,TX |
| 12492L | MORPHINEmorphine sulfate pentahydrate 5 mg modified release tablet, 28 | 28 | $9.53 | MF |
| 12544F | MORPHINEmorphine sulfate pentahydrate 60 mg modified release tablet, 28 | 28 | $43.01 | AF,MF,TX |
| 12472K | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 200 mL | 1 | $20.22 | MF |
| 12549L | MORPHINEmorphine hydrochloride trihydrate 5 mg/mL oral liquid, 200 mL | 1 | $18.19 | MF |
| 12501Y | MORPHINEmorphine sulfate pentahydrate 10 mg modified release capsule, 28 | 28 | $11.64 | YN |
| 12529K | MORPHINEmorphine sulfate pentahydrate 100 mg modified release capsule, 28 | 28 | $58.21 | YN |
| 12512M | MORPHINEmorphine sulfate pentahydrate 120 mg modified release capsule, 14 | 14 | $43.00 | MF |
| 12539Y | MORPHINEmorphine sulfate pentahydrate 20 mg modified release capsule, 28 | 28 | $15.97 | YN |
| 12490J | MORPHINEmorphine sulfate pentahydrate 30 mg modified release capsule, 14 | 14 | $15.28 | MF |
| 12489H | MORPHINEmorphine sulfate pentahydrate 50 mg modified release capsule, 28 | 28 | $31.88 | YN |
| 12487F | MORPHINEmorphine sulfate pentahydrate 60 mg modified release capsule, 14 | 14 | $25.41 | MF |
| 12514P | MORPHINEmorphine sulfate pentahydrate 90 mg modified release capsule, 14 | 14 | $30.24 | MF |
| 12499W | MORPHINEmorphine sulfate pentahydrate 10 mg/mL injection, 5 x 1 mL ampoules | 5 | $8.48 | DZ,PF |
| 12548K | MORPHINEmorphine sulfate pentahydrate 15 mg/mL injection, 5 x 1 mL ampoules | 5 | $9.88 | DZ,PF |
| 12503C | MORPHINEmorphine sulfate pentahydrate 30 mg/mL injection, 5 x 1 mL ampoules | 5 | $11.98 | DZ,PF |
| 5345H | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $6.91 | IX |
| 5359C | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $4.87 | AF,IL |
| 5371Q | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $4.87 | AS |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $4.87 | TX |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.71 | RW |
| 5372R | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $8.79 | AS |
| 12545G | OXYCODONEoxycodone hydrochloride 15 mg modified release tablet, 28 | 28 | $21.40 | MF |
| 12510K | OXYCODONEoxycodone hydrochloride 20 mg modified release tablet, 28 | 28 | $21.64 | MF,SZ |
| 12538X | OXYCODONEoxycodone hydrochloride 30 mg modified release tablet, 28 | 28 | $34.98 | MF |
| 12525F | OXYCODONEoxycodone hydrochloride 40 mg modified release tablet, 28 | 28 | $36.37 | MF,SZ |
| 12527H | OXYCODONEoxycodone hydrochloride 80 mg modified release tablet, 28 | 28 | $58.51 | MF,SZ |
| 12518W | OXYCODONEoxycodone hydrochloride 10 mg modified release tablet, 28 | 28 | $13.16 | MF,SZ |
| 12523D | OXYCODONE + NALOXONEoxycodone hydrochloride 10 mg + naloxone hydrochloride 5 mg modified release tablet, 28 | 28 | $20.89 | MF |
| 12486E | OXYCODONE + NALOXONEoxycodone hydrochloride 20 mg + naloxone hydrochloride 10 mg modified release tablet, 28 | 28 | $35.38 | MF |
| 12475N | OXYCODONE + NALOXONEoxycodone hydrochloride 40 mg + naloxone hydrochloride 20 mg modified release tablet, 28 | 28 | $60.90 | MF |
| 12522C | OXYCODONE + NALOXONEoxycodone hydrochloride 5 mg + naloxone hydrochloride 2.5 mg modified release tablet, 28 | 28 | $19.76 | MF |
| 12471J | OXYCODONE + NALOXONEoxycodone hydrochloride 2.5 mg + naloxone hydrochloride 1.25 mg modified release tablet, 28 | 28 | $12.02 | MF |
| 12540B | OXYCODONE + NALOXONEoxycodone hydrochloride 15 mg + naloxone hydrochloride 7.5 mg modified release tablet, 28 | 28 | $25.24 | MF |
| 12532N | OXYCODONE + NALOXONEoxycodone hydrochloride 30 mg + naloxone hydrochloride 15 mg modified release tablet, 28 | 28 | $41.53 | MF |
| 12511L | OXYCODONE + NALOXONEoxycodone hydrochloride 60 mg + naloxone hydrochloride 30 mg modified release tablet, 28 | 28 | $68.56 | MF |
| 12498T | OXYCODONE + NALOXONEoxycodone hydrochloride 80 mg + naloxone hydrochloride 40 mg modified release tablet, 28 | 28 | $83.93 | MF |
| 5343F | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $5.92 | CR,RF,TX |
| 12210P | PARACETAMOLparacetamol 500 mg suppository, 10 | 10 | $8.93 | GJ |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $4.87 | AF,LN,TX |
| 5375X | TEMAZEPAMtemazepam 10 mg tablet, 25 | 25 | $9.94 | AS |
