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