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 |
|---|---|---|---|---|
| 13049T | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13054C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13055D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13056E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13060J | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13061K | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13062L | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13070X | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13075E | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13076F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13077G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL pen device | 1 | $284.84 | EW |
| 13050W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13057F | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13058G | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13065P | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13066Q | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13067R | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13069W | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13072B | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13073C | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13074D | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 13078H | INFLIXIMABinfliximab 120 mg/mL injection, 1 mL syringe | 1 | $375.62 | EW |
| 12254Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.77 | NF |
| 13651L | INSULIN ASPARTinsulin aspart 100 units/mL fast acting injection, 5 x 3 mL cartridges | 1 | $31.77 | NO |
| 8571D | INSULIN ASPARTinsulin aspart 100 units/mL injection, 1 x 10 mL vial | 1 | $18.52 | NO |
| 8435Y | INSULIN ASPARTinsulin aspart 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.77 | NO |
| 12238D | INSULIN ASPART + INSULIN ASPART PROTAMINEinsulin aspart 30 units/mL + insulin aspart protamine 70 units/mL injection, 5 x 3 mL pen devices | 1 | $31.77 | NF |
| 8609D | INSULIN ASPART + INSULIN ASPART PROTAMINEinsulin aspart 30 units/mL + insulin aspart protamine 70 units/mL injection, 5 x 3 mL cartridges | 1 | $31.77 | NO |
| 11417X | INSULIN DEGLUDEC + INSULIN ASPARTinsulin degludec 70 units/mL + insulin aspart 30 units/mL injection, 5 x 3 mL pen devices | 1 | $74.47 | NO |
| 11426J | INSULIN DEGLUDEC + INSULIN ASPARTinsulin degludec 70 units/mL + insulin aspart 30 units/mL injection, 5 x 3 mL cartridges | 1 | $74.47 | NO |
| 9040T | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL cartridges | 1 | $69.51 | NO |
| 12236B | INSULIN DETEMIRinsulin detemir 100 units/mL injection, 5 x 3 mL pen devices | 1 | $69.51 | NF |
| 11308E | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 3 x 1.5 mL pen devices | 1 | $49.46 | SW |
| 11302W | INSULIN GLARGINEinsulin glargine 300 units/mL injection, 5 x 1.5 mL pen devices | 1 | $82.44 | SW |
| 9039R | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $35.75 | GZ |
| 11815W | INSULIN GLARGINEinsulin glargine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $35.75 | WA |
| 12268Q | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.78 | SW |
| 9224L | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 1 x 10 mL vial | 1 | $18.52 | SW |
| 1921D | INSULIN GLULISINEinsulin glulisine 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.78 | AV |
| 12262J | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 5 x 3 mL pen devices | 1 | $26.48 | NI |
| 1533Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.58 | LY,NO |
| 1761Q | INSULIN ISOPHANE HUMANinsulin isophane human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.48 | LY,NO |
| 11645X | INSULIN LISPROinsulin lispro 200 units/mL injection, 5 x 3 mL pen devices | 1 | $51.64 | LY |
| 8084L | INSULIN LISPROinsulin lispro 100 units/mL injection, 1 x 10 mL vial | 1 | $18.52 | LY |
| 8212F | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL cartridges | 1 | $31.77 | LY |
| 12237C | INSULIN LISPROinsulin lispro 100 units/mL injection, 5 x 3 mL pen devices | 1 | $31.77 | KP |
| 12234X | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL pen devices | 1 | $31.77 | KP |
| 12261H | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 50 units/mL + insulin lispro protamine 50 units/mL injection, 5 x 3 mL pen devices | 1 | $31.77 | KP |
| 8390N | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 25 units/mL + insulin lispro protamine 75 units/mL injection, 5 x 3 mL cartridges | 1 | $31.77 | LY |
| 8874C | INSULIN LISPRO + INSULIN LISPRO PROTAMINEinsulin lispro 50 units/mL + insulin lispro protamine 50 units/mL injection, 5 x 3 mL cartridges | 1 | $31.77 | LY |
| 1531N | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 1 x 10 mL vial | 1 | $15.58 | LY,NO |
| 1762R | INSULIN NEUTRAL HUMANinsulin neutral human 100 units/mL injection, 5 x 3 mL cartridges | 1 | $26.48 | LY,NO |
| 1426C | INSULIN NEUTRAL HUMAN + INSULIN ISOPHANE HUMANinsulin neutral human 30 units/mL + insulin isophane human 70 units/mL injection, 10 mL vial | 1 | $15.58 | LY |
| 1763T | INSULIN NEUTRAL HUMAN + INSULIN ISOPHANE HUMANinsulin neutral human 30 units/mL + insulin isophane human 70 units/mL injection, 5 x 3 mL cartridges | 1 | $26.48 | LY |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.51 | BY |
| 1542E | IPRATROPIUMipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $9.29 | AF |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.77 | BY |
| 8238N | IPRATROPIUMipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules | 1 | $10.55 | AF |
| 8671J | IPRATROPIUMipratropium bromide monohydrate 21 microgram/actuation inhalation, 200 actuations | 1 | $12.97 | BY |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $5.11 | AL,BG,GQ,RF,SZ,TX,VO,WG |
| 13380F | IRBESARTANirbesartan 150 mg tablet, 30 | 30 | $8.61 | AV,SW |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $6.16 | AL,BG,GQ,IB,RF,SZ,TX,VO,WG |
| 13564X | IRBESARTANirbesartan 300 mg tablet, 30 | 30 | $9.66 | AV,SW |
| 13435D | IRBESARTANirbesartan 75 mg tablet, 30 | 30 | $5.11 | AL,BG,GQ,RF,SZ,TX,VO,WG |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $5.11 | AL,IB,RF,SZ,TX,WG |
| 13572H | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 150 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.61 | AV,SW |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.27 | AL,IB,RF,SZ,TX,WG |
| 13545X | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.77 | AV,SW |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $6.61 | AL,IB,RF,SZ,TX,WG |
| 13446Q | IRBESARTAN + HYDROCHLOROTHIAZIDEirbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $10.11 | AV,SW |
| 9436P | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 1 g isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $120.92 | VF |
| 9134R | ISOLEUCINE WITH CARBOHYDRATEisoleucine with carbohydrate containing 50 mg isoleucine powder for oral liquid, 30 x 4 g sachets | 1 | $109.92 | VF |
| 13491C | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $4.96 | RW |
| 2588F | ISOSORBIDE DINITRATEisosorbide dinitrate 5 mg sublingual tablet, 100 | 100 | $6.16 | RW |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $13.09 | IX |
| 13611J | ISOSORBIDE MONONITRATEisosorbide mononitrate 120 mg modified release tablet, 30 | 30 | $9.72 | IY |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $6.16 | AF,RF,TX,WG |
| 13461L | ISOSORBIDE MONONITRATEisosorbide mononitrate 60 mg modified release tablet, 30 | 30 | $9.54 | IX |
| 11621P | ISOTRETINOINisotretinoin 20 mg capsule, 30 | 30 | $17.79 | RO |
| 2868Y | IVERMECTINivermectin 3 mg tablet, 4 | 4 | $19.98 | MK |
| 13887X | LABETALOLlabetalol hydrochloride 100 mg tablet, 100 | 100 | $20.07 | AF |
| 11694L | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.35 | UC |
| 12628P | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.28 | UC |
| 14013M | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.33 | UC |
| 14048J | LACOSAMIDElacosamide 10 mg/mL oral liquid, 200 mL | 1 | $58.36 | UC |
| 13839J | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $74.72 | AF,CR,GQ,SZ,UC,XT |
| 13867W | LACOSAMIDElacosamide 100 mg tablet, 56 | 56 | $74.72 | AF,CR,GQ,LR,SZ,UC,XT |
| 13838H | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $112.11 | AF,CR,GQ,SZ,UC,XT |
| 14053P | LACOSAMIDElacosamide 150 mg tablet, 56 | 56 | $112.11 | AF,CR,GQ,LR,SZ,UC,XT |
| 13949E | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $149.52 | AF,CR,GQ,SZ,UC,XT |
| 13951G | LACOSAMIDElacosamide 200 mg tablet, 56 | 56 | $149.52 | AF,CR,GQ,LR,SZ,UC,XT |
| 10293R | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $10.10 | AF,CR,GQ,SZ,UC,XT |
| 12626M | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $10.10 | AF,CR,GQ,SZ,UC,XT |
| 14011K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $9.50 | AF,CR,GQ,SZ,UC,XT |
| 14049K | LACOSAMIDElacosamide 50 mg tablet, 14 | 14 | $9.50 | AF,CR,GQ,SZ,UC,XT |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $12.22 | AL,GQ,HX,RF,TY,VO,WG,ZS |
| 14052N | LAMOTRIGINElamotrigine 100 mg tablet, 56 | 56 | $15.67 | AS |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $18.90 | AL,GQ,HX,RF,TY,VO,WG,ZS |
| 13843N | LAMOTRIGINElamotrigine 200 mg tablet, 56 | 56 | $22.36 | AS |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $6.70 | AL,GQ,HX,RF,TY,VO,WG,ZS |
| 13842M | LAMOTRIGINElamotrigine 25 mg tablet, 56 | 56 | $10.98 | AS |
| 14047H | LAMOTRIGINElamotrigine 5 mg tablet, 56 | 56 | $8.72 | AS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $8.29 | AL,GQ,HX,RF,TY,VO,WG,ZS |
| 13975M | LAMOTRIGINElamotrigine 50 mg tablet, 56 | 56 | $11.73 | AS |
| 14448K | LANSOPRAZOLElansoprazole 15 mg enteric capsule, 30 | 30 | $6.16 | AF |
| 12284M | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $7.22 | AF,RA,TX,VO |
| 14302R | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $7.22 | AF,RA,TX,VO |
| 14304W | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $6.02 | AF,RA,TX,VO |
| 14340R | LANSOPRAZOLElansoprazole 30 mg enteric capsule, 28 | 28 | $7.22 | AF,RA,TX,VO |
| 14374M | LANSOPRAZOLElansoprazole 15 mg orally disintegrating tablet, 28 | 28 | $6.08 | AF,GQ,TX |
| 14374M | LANSOPRAZOLElansoprazole 15 mg orally disintegrating tablet, 28 | 28 | $10.88 | PF |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $7.22 | AF,GQ,TX |
| 12276D | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $12.45 | PF |
| 14339Q | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $6.02 | AF,GQ,TX |
| 14339Q | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $11.25 | PF |
| 14342W | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $7.22 | AF,GQ,TX |
| 14342W | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $12.45 | PF |
| 14406F | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $7.22 | AF,GQ,TX |
| 14406F | LANSOPRAZOLElansoprazole 30 mg orally disintegrating tablet, 28 | 28 | $12.45 | PF |
| 14060B | LANTHANUMlanthanum 500 mg chewable tablet, 2 x 45 | 90 | $252.57 | TK |
| 13986D | LANTHANUMlanthanum 750 mg chewable tablet, 6 x 15 | 90 | $381.45 | TK |
| 13874F | LANTHANUMlanthanum 1 g chewable tablet, 6 x 15 | 90 | $427.82 | TK |
| 11251E | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.91 | NV |
| 9148L | LAPATINIBlapatinib 250 mg tablet, 70 | 70 | $1100.91 | NV |
| 14453Q | LATANOPROSTlatanoprost 0.005% eye drops, 2.5 mL | 1 | $6.70 | AF,AS,SZ,TX,WG |
| 14350G | LATANOPROST + TIMOLOLlatanoprost 0.005% + timolol 0.5% eye drops, 2.5 mL | 1 | $10.55 | AF,AS,TX |
| 13940Q | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $15.17 | AF,GX,HQ,RW,SW,SZ,TX,WG |
| 14068K | LEFLUNOMIDEleflunomide 10 mg tablet, 30 | 30 | $15.17 | AF,GX,HQ,SW,SZ,TX,WG |
| 13998R | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $21.85 | AF,GX,HQ,SW,SZ,TX,WG |
| 14069L | LEFLUNOMIDEleflunomide 20 mg tablet, 30 | 30 | $21.85 | AF,GX,HQ,RW,SW,SZ,TX,WG |
| 10965D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.97 | EI |
| 13253M | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.97 | EI |
| 13283D | LENVATINIBlenvatinib 10 mg capsule, 30 | 30 | $2076.97 | EI |
| 11638M | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2051.31 | EI |
| 13252L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2067.95 | EI |
| 13290L | LENVATINIBlenvatinib 4 mg capsule, 30 | 30 | $2067.95 | EI |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $5.11 | AL,GX,RW,TX,WG |
| 13411W | LERCANIDIPINElercanidipine hydrochloride 10 mg tablet, 28 | 28 | $8.59 | GO |
| 13412X | LERCANIDIPINElercanidipine hydrochloride 20 mg tablet, 28 | 28 | $6.16 | AL,GX,RW,TX,WG |
| 13412X | LERCANIDIPINElercanidipine hydrochloride 20 mg tablet, 28 | 28 | $9.66 | GO |
| 13507X | LERCANIDIPINE + ENALAPRILlercanidipine hydrochloride 10 mg + enalapril maleate 10 mg tablet, 28 | 28 | $7.38 | GO |
| 13477H | LERCANIDIPINE + ENALAPRILlercanidipine hydrochloride 10 mg + enalapril maleate 20 mg tablet, 28 | 28 | $8.16 | GO |
| 13939P | LETROZOLEletrozole 2.5 mg tablet, 30 | 30 | $12.85 | AF,CR,GX,HQ,SZ,WG,XT,ZS |
| 13939P | LETROZOLEletrozole 2.5 mg tablet, 30 | 30 | $15.49 | NV |
| 13993L | LEVETIRACETAMlevetiracetam 100 mg/mL oral liquid, 300 mL | 1 | $67.77 | AE,GQ,TX,UC,ZS |
| 13937M | LEVETIRACETAMlevetiracetam 1 g tablet, 60 | 60 | $30.10 | AF,AL,GQ,MQ,RW,SZ,TX,UC,VO,WG,ZS |
| 13992K | LEVETIRACETAMlevetiracetam 250 mg tablet, 60 | 60 | $12.02 | AF,AL,GQ,MQ,RW,SZ,TX,UC,VO,WG,ZS |
| 14034P | LEVETIRACETAMlevetiracetam 500 mg tablet, 60 | 60 | $18.43 | AF,AL,GQ,RW,SZ,TX,UC,VO,WG,ZS |
| 14356N | LEVODOPA + BENSERAZIDElevodopa 50 mg + benserazide 12.5 mg dispersible tablet, 100 | 100 | $14.11 | RO |
| 14455T | LEVODOPA + BENSERAZIDElevodopa 100 mg + benserazide 25 mg tablet, 100 | 100 | $18.47 | RO |
| 14428J | LEVODOPA + BENSERAZIDElevodopa 200 mg + benserazide 50 mg tablet, 100 | 100 | $28.43 | RO |
| 14387F | LEVODOPA + BENSERAZIDElevodopa 100 mg + benserazide 25 mg capsule, 100 | 100 | $18.47 | RO |
| 14525L | LEVODOPA + BENSERAZIDElevodopa 100 mg + benserazide 25 mg modified release capsule, 100 | 100 | $22.03 | RO |
| 14551W | LEVODOPA + BENSERAZIDElevodopa 200 mg + benserazide 50 mg capsule, 100 | 100 | $28.43 | RO |
| 14388G | LEVODOPA + BENSERAZIDElevodopa 50 mg + benserazide 12.5 mg capsule, 100 | 100 | $14.11 | RO |
| 14552X | LEVODOPA + BENSERAZIDElevodopa 100 mg + benserazide 25 mg dispersible tablet, 100 | 100 | $24.21 | RO |
| 11919H | LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL | 7 | $1473.72 | VE |
| 8970D | LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL | 7 | $1461.24 | VE |
| 14427H | LEVODOPA + CARBIDOPAlevodopa 100 mg + carbidopa 25 mg tablet, 100 | 100 | $21.38 | AF,AL,RW,TX |
| 14322T | LEVODOPA + CARBIDOPAlevodopa 200 mg + carbidopa 50 mg modified release tablet, 100 | 100 | $58.55 | AL |
| 14454R | LEVODOPA + CARBIDOPAlevodopa 250 mg + carbidopa 25 mg tablet, 100 | 100 | $25.81 | AL,RW,TX |
| 14357P | LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 150 mg + carbidopa 37.5 mg + entacapone 200 mg tablet, 100 | 100 | $83.29 | HX,TX |
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