Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
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| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 2666H | TRIMETHOPRIMtrimethoprim 300 mg tablet, 7 | 7 | $5.09 | MQ,WG |
| 2666H | TRIMETHOPRIMtrimethoprim 300 mg tablet, 7 | 7 | $9.07 | RW |
| 10784N | TRIMETHOPRIM + SULFAMETHOXAZOLEtrimethoprim 160 mg + sulfamethoxazole 800 mg tablet, 10 | 10 | $4.29 | AF,XO |
| 10784N | TRIMETHOPRIM + SULFAMETHOXAZOLEtrimethoprim 160 mg + sulfamethoxazole 800 mg tablet, 10 | 10 | $8.46 | RW |
| 9165J | TYROSINE WITH CARBOHYDRATEtyrosine with carbohydrate containing 1 g tyrosine powder for oral liquid, 30 x 4 g sachets | 1 | $109.92 | VF |
| 14389H | UMECLIDINIUMumeclidinium 62.5 microgram/actuation inhalation: powder for, 30 actuations | 1 | $50.73 | GK |
| 14358Q | UMECLIDINIUM + VILANTEROLumeclidinium 62.5 microgram/actuation + vilanterol 25 microgram/actuation powder for inhalation, 30 actuations | 1 | $81.15 | GK |
| 8448P | URSODEOXYCHOLIC ACIDursodeoxycholic acid 250 mg capsule, 100 | 100 | $109.55 | BZ,FD,GQ,TX |
| 11178H | USTEKINUMABustekinumab 45 mg/0.5 mL injection, 0.5 mL vial | 1 | $3886.05 | JC |
| 8133C | VALACICLOVIRvalaciclovir 500 mg tablet, 10 | 10 | $6.70 | AF,GX,RF,SZ,TY,WG |
| 8133C | VALACICLOVIRvalaciclovir 500 mg tablet, 10 | 10 | $9.40 | RW |
| 9135T | VALINE WITH CARBOHYDRATEvaline with carbohydrate containing 50 mg valine powder for oral liquid, 30 x 4 g sachets | 1 | $109.92 | VF |
| 9434M | VALINE WITH CARBOHYDRATEvaline with carbohydrate containing 1 g valine powder for oral liquid, 30 x 4 g sachets | 1 | $120.92 | VF |
| 13840K | VALPROATEvalproate sodium 100 mg tablet, 100 | 100 | $12.32 | SW |
| 2294R | VALPROATEvalproate sodium 100 mg tablet, 100 | 100 | $13.52 | SW |
| 14017R | VALPROATEvalproate sodium 200 mg enteric tablet, 100 | 100 | $5.50 | AF,RW,SZ,TX,WA |
| 14017R | VALPROATEvalproate sodium 200 mg enteric tablet, 100 | 100 | $6.23 | SW |
| 2289L | VALPROATEvalproate sodium 200 mg enteric tablet, 100 | 100 | $6.70 | AF,RW,SZ,TX,WA |
| 2289L | VALPROATEvalproate sodium 200 mg enteric tablet, 100 | 100 | $7.43 | SW |
| 13917L | VALPROATEvalproate sodium 500 mg enteric tablet, 100 | 100 | $9.23 | AF,RW,SZ,TX,WA |
| 13917L | VALPROATEvalproate sodium 500 mg enteric tablet, 100 | 100 | $9.92 | SW |
| 2290M | VALPROATEvalproate sodium 500 mg enteric tablet, 100 | 100 | $10.43 | AF,RW,SZ,TX,WA |
| 2290M | VALPROATEvalproate sodium 500 mg enteric tablet, 100 | 100 | $11.12 | SW |
| 13950F | VALPROATEvalproate sodium 200 mg/5 mL oral liquid, 300 mL | 1 | $15.61 | SW |
| 13973K | VALPROATEvalproate sodium 200 mg/5 mL oral liquid, 300 mL | 1 | $15.61 | SW |
| 2293Q | VALPROATEvalproate sodium 200 mg/5 mL oral liquid, 300 mL | 1 | $16.81 | SW |
| 2295T | VALPROATEvalproate sodium 200 mg/5 mL oral liquid, 300 mL | 1 | $16.81 | SW |
| 13566B | VALSARTANvalsartan 160 mg tablet, 28 | 28 | $9.27 | AF,NV |
| 13383J | VALSARTANvalsartan 320 mg tablet, 28 | 28 | $11.21 | AF,NV |
| 13414B | VALSARTANvalsartan 80 mg tablet, 28 | 28 | $7.75 | AF,NV |
| 13606D | VALSARTAN + HYDROCHLOROTHIAZIDEvalsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $10.65 | AF,NV |
| 13453C | VALSARTAN + HYDROCHLOROTHIAZIDEvalsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $11.75 | AF,NV |
| 13517K | VALSARTAN + HYDROCHLOROTHIAZIDEvalsartan 320 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $12.67 | AF,NV |
| 13455E | VALSARTAN + HYDROCHLOROTHIAZIDEvalsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 | 28 | $13.76 | AF,NV |
| 13393X | VALSARTAN + HYDROCHLOROTHIAZIDEvalsartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 | 28 | $9.07 | AF,NV |
| 3113W | VANCOMYCINvancomycin 125 mg capsule, 20 | 20 | $57.12 | AS,BZ |
| 3114X | VANCOMYCINvancomycin 250 mg capsule, 20 | 20 | $114.32 | AS,BZ |
| 2270L | VANCOMYCINvancomycin 1 g injection, 1 vial | 1 | $8.05 | AF |
| 3130R | VANCOMYCINvancomycin 500 mg injection, 1 vial | 1 | $6.70 | AF |
| 3131T | VANCOMYCINvancomycin 500 mg injection, 1 vial | 1 | $5.26 | AF |
| 3323X | VANCOMYCINvancomycin 500 mg injection, 1 vial | 1 | $6.70 | AF |
| 9129L | VARENICLINEvarenicline 1 mg tablet, 56 | 56 | $68.65 | AF,CR,PF,TX |
| 11076Y | VEMURAFENIBvemurafenib 240 mg tablet, 56 | 56 | $1670.71 | RO |
| 11081F | VEMURAFENIBvemurafenib 240 mg tablet, 56 | 56 | $1670.71 | RO |
| 12773G | VENETOCLAXvenetoclax 50 mg tablet, 7 | 7 | $235.95 | VE |
| 12999E | VENETOCLAXvenetoclax 10 mg tablet, 2 | 2 | $13.66 | VE |
| 14402B | VENLAFAXINEvenlafaxine 150 mg modified release capsule, 28 | 28 | $6.70 | AF,GQ,HX,RW,TX,WG |
| 14402B | VENLAFAXINEvenlafaxine 150 mg modified release capsule, 28 | 28 | $8.77 | UJ |
| 14472Q | VENLAFAXINEvenlafaxine 75 mg modified release capsule, 28 | 28 | $6.16 | AF,GQ,HX,RW,TX,WG |
| 14472Q | VENLAFAXINEvenlafaxine 75 mg modified release capsule, 28 | 28 | $8.31 | UJ |
| 13434C | VERAPAMILverapamil hydrochloride 180 mg modified release tablet, 30 | 30 | $7.74 | GT |
| 13434C | VERAPAMILverapamil hydrochloride 180 mg modified release tablet, 30 | 30 | $11.28 | GO |
| 13408Q | VERAPAMILverapamil hydrochloride 240 mg modified release tablet, 30 | 30 | $9.53 | GT |
| 13408Q | VERAPAMILverapamil hydrochloride 240 mg modified release tablet, 30 | 30 | $13.03 | GO |
| 13530D | VERAPAMILverapamil hydrochloride 80 mg tablet, 100 | 100 | $9.02 | AF |
| 13530D | VERAPAMILverapamil hydrochloride 80 mg tablet, 100 | 100 | $12.12 | GO |
| 13974L | VIGABATRINvigabatrin 500 mg powder for oral liquid, 60 sachets | 60 | $50.15 | SW |
| 13919N | VIGABATRINvigabatrin 500 mg tablet, 100 | 100 | $77.34 | SW |
| 13846R | VILDAGLIPTINvildagliptin 50 mg tablet, 60 | 60 | $39.53 | NV |
| 14032M | VILDAGLIPTIN + METFORMINvildagliptin 50 mg + metformin hydrochloride 1 g tablet, 60 | 60 | $40.92 | NV |
| 13877J | VILDAGLIPTIN + METFORMINvildagliptin 50 mg + metformin hydrochloride 500 mg tablet, 60 | 60 | $39.61 | NV |
| 13991J | VILDAGLIPTIN + METFORMINvildagliptin 50 mg + metformin hydrochloride 850 mg tablet, 60 | 60 | $40.46 | NV |
| 9009E | VINORELBINEvinorelbine 20 mg capsule, 1 | 1 | $51.19 | FB,XT |
| 9010F | VINORELBINEvinorelbine 30 mg capsule, 1 | 1 | $76.48 | FB,XT |
| 9328Y | VITAMINS, MINERALS AND TRACE ELEMENTS WITH CARBOHYDRATEvitamins, minerals and trace elements with carbohydrate powder for oral liquid, 200 g | 1 | $54.72 | SB |
| 13275Q | VOSORITIDEvosoritide 400 microgram injection [10 vials] (&) inert substance diluent [10 x 0.5 mL syringes], 1 pack | 10 | $9277.31 | IO |
| 13274P | VOSORITIDEvosoritide 560 microgram injection [10 vials] (&) inert substance diluent [10 x 0.7 mL syringes], 1 pack | 10 | $9277.31 | IO |
| 13270K | VOSORITIDEvosoritide 1.2 mg injection [10 vials] (&) inert substance diluent [10 x 0.6 mL syringes], 1 pack | 10 | $9277.31 | IO |
| 2870C | WHEY PROTEIN FORMULA SUPPLEMENTED WITH AMINO ACIDS, LONG CHAIN POLYUNSATURATED FATTY ACIDS, VITAMINS AND MINERALS, LOW IN PROTEIN, PHOSPHATE, POTASSIUM AND LACTOSEwhey protein formula supplemented with amino acids, long chain polyunsaturated fatty acids, vitamins and minerals, low in protein, phosphate, potassium and lactose powder for oral liquid, 6 x 400 g cans | 1 | $338.97 | VF |
| 8587Y | WHEY PROTEIN FORMULA SUPPLEMENTED WITH AMINO ACIDS, VITAMINS AND MINERALS, AND LOW IN PROTEIN, PHOSPHATE, POTASSIUM AND LACTOSEwhey protein formula supplemented with amino acids, vitamins and minerals, and low in protein, phosphate, potassium and lactose powder for oral liquid, 400 g | 1 | $54.11 | SB |
| 8266C | ZOLMITRIPTANzolmitriptan 2.5 mg tablet, 2 | 2 | $8.34 | RW,TX |
| 8266C | ZOLMITRIPTANzolmitriptan 2.5 mg tablet, 2 | 2 | $10.59 | AS |
| 13854E | ZONISAMIDEzonisamide 100 mg capsule, 56 | 56 | $32.61 | GH |
| 9390F | ZONISAMIDEzonisamide 100 mg capsule, 56 | 56 | $33.51 | GH |
| 13853D | ZONISAMIDEzonisamide 25 mg capsule, 56 | 56 | $13.59 | GH |
| 13988F | ZONISAMIDEzonisamide 50 mg capsule, 56 | 56 | $21.07 | GH |
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