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