Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 4580C | ALPROSTADILalprostadil 20 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $42.39 | PF |
| 4579B | ALPROSTADILalprostadil 10 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $32.95 | PF |
| 4598B | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $35.67 | SN |
| 4658E | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $54.08 | SN |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $12.95 | CC |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $28.99 | BV |
| 4654Y | BANDAGE COMPRESSIONbandage compression 8 cm x 2.6 m short stretch bandage, 1 | 1 | $14.02 | BV |
| 4657D | BANDAGE COMPRESSIONbandage compression 10 cm x 3.5 m high stretch bandage, 1 | 1 | $13.98 | MH |
| 4660G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 2 m bandage, 1 | 1 | $7.77 | MM |
| 4814J | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 15 cm x 1.3 m bandage, 1 | 1 | $11.60 | MM |
| 4811F | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 5 cm x 1.3 m bandage, 1 | 1 | $5.44 | MM |
| 4813H | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 1.3 m bandage, 1 | 1 | $8.51 | MM |
| 4812G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 7.5 cm x 1.3 m bandage, 1 | 1 | $6.87 | MM |
| 4719J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 6 cm x 2 m bandage, 1 | 1 | $6.40 | BV |
| 4662J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 10 cm x 2 m bandage, 1 | 1 | $13.33 | BV |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $9.01 | KE |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $10.53 | BV |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $10.38 | KE |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $13.10 | BV |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $6.92 | KE |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $8.25 | BV |
| 4797L | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking medium size bandage, 1 | 1 | $15.49 | MH |
| 4799N | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking large size bandage, 1 | 1 | $15.49 | MH |
| 4674B | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking small size bandage, 1 | 1 | $15.49 | MH |
| 4675C | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking XX/large size bandage, 1 | 1 | $15.50 | MH |
| 4661H | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking small B/C size bandage, 1 | 1 | $10.38 | MH |
| 4816L | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking large D/E size bandage, 1 | 1 | $10.38 | MH |
| 4815K | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking medium C/D size bandage, 1 | 1 | $10.38 | MH |
| 4669R | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $12.24 | MH |
| 4750B | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $41.18 | SN |
| 4670T | BANDAGE ZINC PASTEbandage zinc paste 10 cm x 9.1 m bandage, 1 | 1 | $11.86 | CC |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.07 | VZ |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.64 | PP |
| 10580W | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $4.88 | PP |
| 4150K | BROMAZEPAMbromazepam 3 mg tablet, 30 | 30 | $12.17 | PB |
| 4151L | BROMAZEPAMbromazepam 6 mg tablet, 30 | 30 | $15.04 | PB |
| 4142B | CALCIUMCALCIUM Tablet 600 mg (as carbonate), 120 | 120 | $7.71 | PP |
| 11845K | CALCIUMCALCIUM Tablet (chewable) 500 mg (as carbonate), 120 | 120 | $10.07 | PP |
| 4681J | DRESSING ACTIVATED CHARCOAL MALODOROUS WOUNDdressing activated charcoal malodorous wound 10.5 cm x 10.5 cm dressing, 1 | 1 | $9.02 | KI |
| 4682K | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g (40 cm) rope, 6 x 2 g | 1 | $62.30 | CT |
| 4832H | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 1 | 1 | $9.77 | UM |
| 1905G | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 5 x 2 g | 5 | $51.61 | CC |
| 4684M | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 5 cm x 5 cm dressing, 1 | 1 | $4.03 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $8.04 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $7.52 | UM |
| 4688R | DRESSING FILMdressing film 15 cm x 20 cm dressing, 1 | 1 | $4.22 | MM |
| 4898T | DRESSING FILM ISLANDdressing film island 5 cm x 7.2 cm dressing, 5 | 1 | $13.03 | SN |
| 4899W | DRESSING FILM ISLANDdressing film island 8 cm x 10 cm dressing, 5 | 1 | $21.39 | SN |
| 4689T | DRESSING FILM ISLANDdressing film island 5 cm x 7 cm dressing, 1 | 1 | $1.28 | MM |
| 4690W | DRESSING FILM ISLANDdressing film island 9 cm x 10 cm dressing, 1 | 1 | $2.28 | MM |
| 4906F | DRESSING HYDROACTIVE SUPERFICIAL WOUND LIGHT EXUDATEdressing hydroactive superficial wound light exudate 10 cm x 10 cm dressing, 5 | 1 | $62.09 | SN |
| 4886E | DRESSING HYDROACTIVE SUPERFICIAL WOUND MODERATE EXUDATEdressing hydroactive superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $44.40 | SN |
| 4896Q | DRESSING HYDROCOLLOID CAVITY WOUNDdressing hydrocolloid cavity wound paste, 30 g | 1 | $13.17 | CC |
| 4897R | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $36.22 | CC |
| 4679G | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10cm (round) dressing, 1 | 1 | $10.53 | CT |
| 4678F | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 7cm (butterfly shape) dressing, 1 | 1 | $9.71 | CT |
| 4920Y | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 20 cm x 20 cm dressing, 5 | 1 | $103.54 | CC |
| 2803M | DRESSING HYDROFIBRE ALTERNATE TO ALGINATESdressing hydrofibre alternate to alginates 15 cm x 15 cm dressing, 5 | 1 | $96.39 | CC |
| 2445Q | DRESSING HYDROFIBRE GELLING FIBREdressing hydrofibre gelling fibre 15 cm x 15 cm dressing, 5 | 1 | $108.54 | SN |
| 4913N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 3 x 30 g | 1 | $28.91 | CC |
| 4599C | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $10.21 | SN |
| 4914P | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $9.17 | JJ |
| 4894N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 25 g | 1 | $17.23 | SN |
| 4911L | DRESSING HYDROGEL SHEETdressing hydrogel sheet 9.5 cm x 10.2 cm dressing, 5 | 1 | $37.04 | KI |
| 4806Y | DRESSING HYDROGEL SHEETdressing hydrogel sheet 10 cm x 10 cm dressing, 5 | 1 | $23.32 | HR |
| 4862X | DRESSING NON ADHERENTdressing non adherent 10 cm x 10 cm dressing, 5 | 1 | $11.24 | SN |
| 4819P | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $6.62 | SN |
| 4860T | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $7.37 | SN |
| 4909J | DRESSING TULLE NON GAUZE PARAFFINdressing tulle non gauze paraffin 7.6 cm x 7.6 cm dressing, 1 | 1 | $1.24 | KI |
| 4237B | FEXOFENADINEfexofenadine hydrochloride 60 mg tablet, 20 | 20 | $16.12 | SW |
| 10573L | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.28 | AF |
| 10584C | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.17 | AF,PP |
| 10596Q | GLYCEROLglycerol 1.4 g suppository, 12 | 1 | $5.51 | PP |
| 10586E | GLYCEROLglycerol 700 mg suppository, 12 | 1 | $5.39 | PP |
| 4246L | GLYCEROLglycerol 2.8 g suppository, 12 | 1 | $5.67 | PP |
| 4573Q | NICOTINEnicotine 21 mg/24 hours patch, 7 | 1 | $30.47 | GC |
| 4573Q | NICOTINEnicotine 21 mg/24 hours patch, 7 | 1 | $25.44 | AF |
| 4572P | NICOTINEnicotine 14 mg/24 hours patch, 7 | 1 | $30.47 | GC |
| 4572P | NICOTINEnicotine 14 mg/24 hours patch, 7 | 1 | $23.96 | AF |
| 4571N | NICOTINEnicotine 7 mg/24 hours patch, 7 | 1 | $22.38 | AF |
| 10585D | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.08 | AF,EA,HX,OW,SI,SW,SZ,TX |
| 10598T | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $5.87 | CR,GQ |
| 10850C | PROTEIN FORMULA WITH ARGININE, VITAMIN C AND Eprotein formula with arginine, vitamin C and E powder for oral liquid, 14 x 9.2 g sachets | 1 | $38.54 | NT |
| 10841N | PROTEIN FORMULA WITH ARGININE, VITAMIN C, E AND ZINCprotein formula with arginine, vitamin C, E and zinc oral liquid, 27 x 237 mL cartons | 1 | $130.71 | NT |
| 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 | $99.08 | SB |
