Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 4579B | ALPROSTADILalprostadil 10 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $33.06 | PF |
| 4580C | ALPROSTADILalprostadil 20 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $42.50 | PF |
| 4598B | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $39.32 | SN |
| 4658E | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $59.57 | SN |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $13.01 | CC |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $29.06 | BV |
| 4657D | BANDAGE COMPRESSIONbandage compression 10 cm x 3.5 m high stretch bandage, 1 | 1 | $14.04 | MH |
| 4654Y | BANDAGE COMPRESSIONbandage compression 8 cm x 2.6 m short stretch bandage, 1 | 1 | $14.08 | BV |
| 4813H | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 1.3 m bandage, 1 | 1 | $8.68 | MM |
| 4660G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 2 m bandage, 1 | 1 | $7.94 | MM |
| 4814J | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 15 cm x 1.3 m bandage, 1 | 1 | $11.77 | MM |
| 4811F | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 5 cm x 1.3 m bandage, 1 | 1 | $5.61 | MM |
| 4812G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 7.5 cm x 1.3 m bandage, 1 | 1 | $7.04 | MM |
| 4662J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 10 cm x 2 m bandage, 1 | 1 | $13.50 | BV |
| 4719J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 6 cm x 2 m bandage, 1 | 1 | $6.57 | BV |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $10.55 | KE |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $13.27 | BV |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $7.09 | KE |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $8.42 | BV |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $9.18 | KE |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $10.70 | BV |
| 4799N | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking large size bandage, 1 | 1 | $15.66 | MH |
| 4797L | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking medium size bandage, 1 | 1 | $15.66 | MH |
| 4674B | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking small size bandage, 1 | 1 | $15.66 | MH |
| 4675C | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking XX/large size bandage, 1 | 1 | $15.67 | MH |
| 4816L | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking large D/E size bandage, 1 | 1 | $10.55 | MH |
| 4815K | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking medium C/D size bandage, 1 | 1 | $10.55 | MH |
| 4661H | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking small B/C size bandage, 1 | 1 | $10.55 | MH |
| 4669R | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $12.41 | MH |
| 4750B | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $46.52 | SN |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.18 | VZ |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.75 | PP |
| 10580W | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $5.30 | PP |
| 4150K | BROMAZEPAMbromazepam 3 mg tablet, 30 | 30 | $12.34 | PB |
| 4151L | BROMAZEPAMbromazepam 6 mg tablet, 30 | 30 | $15.21 | PB |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $9.20 | PP |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $7.88 | CR |
| 11845K | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.35 | PP |
| 4681J | DRESSING ACTIVATED CHARCOAL MALODOROUS WOUNDdressing activated charcoal malodorous wound 10.5 cm x 10.5 cm dressing, 1 | 1 | $9.05 | KI |
| 4832H | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 1 | 1 | $9.80 | UM |
| 1905G | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 5 x 2 g | 5 | $51.78 | CC |
| 4682K | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g (40 cm) rope, 6 x 2 g | 1 | $62.47 | CT |
| 4684M | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 5 cm x 5 cm dressing, 1 | 1 | $4.06 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $8.07 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $7.55 | UM |
| 4688R | DRESSING FILMdressing film 15 cm x 20 cm dressing, 1 | 1 | $4.28 | MM |
| 4689T | DRESSING FILM ISLANDdressing film island 5 cm x 7 cm dressing, 1 | 1 | $1.31 | MM |
| 4690W | DRESSING FILM ISLANDdressing film island 9 cm x 10 cm dressing, 1 | 1 | $2.31 | MM |
| 4898T | DRESSING FILM ISLANDdressing film island 5 cm x 7.2 cm dressing, 5 | 1 | $14.05 | SN |
| 4899W | DRESSING FILM ISLANDdressing film island 8 cm x 10 cm dressing, 5 | 1 | $23.09 | SN |
| 2445Q | DRESSING GELLING FIBREdressing gelling fibre 15 cm x 15 cm dressing, 5 | 1 | $123.15 | SN |
| 4906F | DRESSING HYDROACTIVE SUPERFICIAL WOUND LIGHT EXUDATEdressing hydroactive superficial wound light exudate 10 cm x 10 cm dressing, 5 | 1 | $68.51 | SN |
| 4886E | DRESSING HYDROACTIVE SUPERFICIAL WOUND MODERATE EXUDATEdressing hydroactive superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $45.82 | SN |
| 4896Q | DRESSING HYDROCOLLOID CAVITY WOUNDdressing hydrocolloid cavity wound paste, 30 g | 1 | $13.20 | CC |
| 4897R | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $36.39 | CC |
| 4678F | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 7cm (butterfly shape) dressing, 1 | 1 | $9.77 | CT |
| 4920Y | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 20 cm x 20 cm dressing, 5 | 1 | $103.71 | CC |
| 4679G | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10cm (round) dressing, 1 | 1 | $10.59 | CT |
| 2803M | DRESSING HYDROFIBRE ALTERNATE TO ALGINATESdressing hydrofibre alternate to alginates 15 cm x 15 cm dressing, 5 | 1 | $96.56 | CC |
| 4894N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 25 g | 1 | $19.45 | SN |
| 4599C | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $11.20 | SN |
| 4914P | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $9.28 | JJ |
| 4913N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 3 x 30 g | 1 | $29.02 | CC |
| 4806Y | DRESSING HYDROGEL SHEETdressing hydrogel sheet 10 cm x 10 cm dressing, 5 | 1 | $23.49 | HR |
| 4911L | DRESSING HYDROGEL SHEETdressing hydrogel sheet 9.5 cm x 10.2 cm dressing, 5 | 1 | $37.21 | KI |
| 4862X | DRESSING NON ADHERENTdressing non adherent 10 cm x 10 cm dressing, 5 | 1 | $12.14 | SN |
| 4819P | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $7.16 | SN |
| 4860T | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $8.00 | SN |
| 4909J | DRESSING TULLE NON-ADHERENT PRIMARY WOUND CONTACT LAYER PARAFFINdressing tulle non-adherent primary wound contact layer paraffin 7.6 cm x 7.6 cm dressing, 1 | 1 | $1.27 | KI |
| 4237B | FEXOFENADINEfexofenadine hydrochloride 60 mg tablet, 20 | 20 | $16.23 | SW |
| 10573L | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.45 | AF |
| 10584C | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.41 | AF,PP |
| 10596Q | GLYCEROLglycerol 1.4 g suppository, 12 | 1 | $5.62 | PP |
| 4246L | GLYCEROLglycerol 2.8 g suppository, 12 | 1 | $5.78 | PP |
| 10586E | GLYCEROLglycerol 700 mg suppository, 12 | 1 | $5.50 | PP |
| 4572P | NICOTINEnicotine 14 mg/24 hours patch, 7 | 1 | $24.13 | AF |
| 4573Q | NICOTINEnicotine 21 mg/24 hours patch, 7 | 1 | $25.61 | AF |
| 4571N | NICOTINEnicotine 7 mg/24 hours patch, 7 | 1 | $22.55 | AF |
| 10585D | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.21 | AF,BG,OW,QS,SI,SW,SZ,TX,XT |
| 10598T | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $6.07 | CR,GQ |
| 11401C | PROTEIN FORMULA WITH ARGININE, VITAMIN C, E AND ZINCprotein formula with arginine, vitamin C, E and zinc oral liquid, 24 x 200 mL bottles | 1 | $99.25 | SB |
