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