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 |
|---|---|---|---|---|
| 13760F | MORPHINEmorphine sulfate 2 mg/mL oral solution, 500 mL | 500 | $115.24 | DZ |
| 13761G | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 100 mL | 100 | $67.35 | LM |
| 13756B | MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 300 mL | 300 | $103.89 | LM |
| 14077X | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL | 20 | $55.24 | DZ |
| 14083F | MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL | 20 | $55.24 | DZ |
| 13579Q | MOXONIDINEmoxonidine 200 microgram tablet, 30 | 30 | $6.94 | AL,GO,GQ,RF,SZ,TX,WG |
| 13552G | MOXONIDINEmoxonidine 400 microgram tablet, 30 | 30 | $10.13 | AL,GO,GQ,RF,SZ,TX,WG |
| 12931N | MYCOBACTERIUM BOVIS BCG DANISH STRAINMycobacterium bovis BCG Danish strain 30 mg injection, 4 vials | 1 | $596.38 | LM |
| 13884R | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $28.74 | CR,SZ,TX |
| 8649F | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $29.00 | CR,SZ,TX |
| 13856G | MYCOPHENOLATEmycophenolate 180 mg enteric tablet, 120 | 120 | $96.75 | NV,XT |
| 13938N | MYCOPHENOLATEmycophenolate 360 mg enteric tablet, 120 | 120 | $193.58 | CR,NV,XT |
| 14071N | MYCOPHENOLATEmycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL | 1 | $275.94 | CR,RO |
| 14000W | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $28.70 | AF,CR,GQ,RF,SZ,XT |
| 8650G | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $28.97 | AF,CR,GQ,RF,SZ,XT |
| 1674D | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.12 | IX |
| 5176K | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.12 | IX |
| 8298R | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.52 | AS |
| 9734H | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.52 | AS |
| 13568D | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $10.44 | AF,FK,GQ,SZ,TX |
| 9316H | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $11.64 | AF,FK,GQ,SZ,TX |
| 13441K | NEBIVOLOLnebivolol 10 mg tablet, 28 | 28 | $28.46 | AF,FK,GQ,SZ,TX |
| 13510C | NEBIVOLOLnebivolol 5 mg tablet, 28 | 28 | $25.45 | AF,FK,GQ,SZ,TX |
| 13550E | NICORANDILnicorandil 10 mg tablet, 60 | 1 | $11.08 | AF,TX |
| 13551F | NICORANDILnicorandil 20 mg tablet, 60 | 1 | $14.49 | AF,TX |
| 13502P | NIFEDIPINEnifedipine 30 mg modified release tablet, 30 | 30 | $9.29 | TX |
| 13376B | NIFEDIPINEnifedipine 60 mg modified release tablet, 30 | 30 | $11.06 | TX |
| 2732T | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.11 | AF,IL |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $12.84 | AF,RF |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $20.43 | RW |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $12.84 | AF,RF |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $20.43 | RW |
| 13873E | NORETHISTERONEnorethisterone 5 mg tablet, 30 | 30 | $24.61 | BN |
| 12642J | OFATUMUMABofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device | 1 | $2109.60 | NV |
| 5567B | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.33 | VE |
| 8383F | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.33 | VE |
| 9294E | OLANZAPINEolanzapine 210 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $157.25 | PB |
| 9295F | OLANZAPINEolanzapine 300 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $255.95 | PB |
| 11503K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 11522K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 12169L | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 12170M | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 12921C | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 12932P | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 13782J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 13783K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 14181J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 14216F | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 14689D | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.72 | AP |
| 11528R | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 11539H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 12157W | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 12161C | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 12913P | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 12929L | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 13800H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 13807Q | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 14208T | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 14215E | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 14687B | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.72 | AP |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $6.52 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $10.52 | AL |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $8.50 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $12.50 | AL |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $7.97 | AF,CR,RW,SZ,TX,TY,WG |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $10.97 | AL |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $6.29 | AF,CR,RW,SZ,TX,TY,WG |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $10.29 | AL |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $8.38 | AF,CR,RW,SZ,TX,TY,WG |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $11.38 | AL |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.39 | AL,RF,TX |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.39 | AF |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.23 | AL,RF,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $13.85 | AF |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.64 | AL,RF,TX |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.90 | AF |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.79 | AL,RF,TX |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $15.46 | AF |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.17 | AL,RF,TX |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $15.84 | AF |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.70 | AF,CR,RW,SZ,TX,TY,WG |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.70 | AL |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.30 | AF,CR,RW,SZ,TX,TY,WG |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $12.30 | AL |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $9.07 | AF,CR,RW,SZ,TX,TY,WG |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.07 | AL |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | FJ,FQ,SZ |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.85 | PB |
| 12272X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | AF,RW,TX,WG |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.50 | FJ,FQ,SZ |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $12.65 | PB |
| 14364B | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | AF,RW,TX,WG |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | FJ,FQ,SZ |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.85 | PB |
| 14533X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | AF,RW,TX,WG |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.70 | FJ,FQ,SZ |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.85 | PB |
| 14558F | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.50 | AF,RW,TX,WG |
| 14432N | OMEPRAZOLEomeprazole 10 mg enteric tablet, 30 | 30 | $6.16 | PB |
| 12281J | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.70 | AF,CR,HX,RW,SZ,TX,WG |
| 14464G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.70 | AF,CR,HX,RW,SZ,TX,WG |
| 14465H | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $5.50 | AF,CR,HX,RW,SZ,TX,WG |
| 14559G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.70 | AF,CR,HX,RW,SZ,TX,WG |
| 3134Y | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $5.11 | AF,AS |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.11 | AF,TX,WG |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.95 | RW |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $9.03 | AS |
| 13936L | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.33 | NV |
| 8588B | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.62 | NV |
| 14562K | OXCARBAZEPINEoxcarbazepine 150 mg tablet, 100 | 100 | $45.62 | NV |
| 14033N | OXCARBAZEPINEoxcarbazepine 300 mg tablet, 100 | 100 | $74.79 | NV |
| 13935K | OXCARBAZEPINEoxcarbazepine 600 mg tablet, 100 | 100 | $125.03 | NV |
| 13957N | OXYBUTYNINoxybutynin hydrochloride 5 mg tablet, 100 | 100 | $6.59 | SW |
| 13984B | OXYBUTYNINoxybutynin 3.9 mg/24 hours patch, 8 | 1 | $21.22 | TT |
| 12031F | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $14.27 | BZ,MF |
| 12074L | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $14.27 | BZ,MF |
| 8461H | PAMIDRONATE DISODIUMpamidronate disodium 15 mg/5 mL injection, 5 mL vial | 1 | $16.05 | PF |
| 8462J | PAMIDRONATE DISODIUMpamidronate disodium 30 mg/10 mL injection, 10 mL vial | 1 | $32.11 | PF |
| 13560Q | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.47 | GO |
| 8020D | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.45 | GO |
| 13470Y | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.74 | GO |
| 8021E | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.68 | GO |
| 13375Y | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.95 | GO |
| 5453B | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.92 | GO |
| 12595X | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.59 | GO |
| 13407P | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.64 | GO |
| 12282K | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.52 | NQ |
| 14395P | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $22.32 | NQ |
| 14466J | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.52 | NQ |
| 14500E | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.52 | NQ |
| 14501F | PANTOPRAZOLEpantoprazole 20 mg enteric tablet, 30 | 30 | $5.11 | AF,BG,HQ,NQ,RA,RW,SZ,TW,TX,TY,VO,WG,ZS |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.49 | AF,BG,CR,HQ,NQ,RA,RW,SZ,TW,TX,TY,VO,WG,ZS |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.49 | AF,BG,CR,HQ,NQ,RA,RW,SZ,TW,TX,TY,VO,WG,ZS |
| 14362X | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.49 | AF,BG,CR,HQ,NQ,RA,RW,SZ,TW,TX,TY,VO,WG,ZS |
| 14394N | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $4.29 | AF,BG,CR,HQ,NQ,RA,RW,SZ,TW,TX,TY,VO,WG,ZS |
| 8814X | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $6.16 | CR,TX,XT |
| 5224Y | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.27 | BG,OW,QS,SI,SW,SZ,TX,XT |
| 8784H | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.27 | BG,OW,QS,SI,SW,SZ,TX,XT |
| 12022R | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $12.49 | AF,AL,AV,GQ,SZ,TX,TY |
| 12022R | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $15.79 | SW |
| 12066C | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $12.49 | AF,AL,AV,GQ,SZ,TX,TY |
| 12066C | PARACETAMOL + CODEINEparacetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20 | 20 | $15.79 | SW |
| 14353K | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $5.05 | IQ |
| 1754H | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $6.25 | IQ |
| 5523Q | PARAFFINparaffin 1 g/g eye ointment, 3.5 g | 1 | $6.25 | IQ |
| 14493T | PARAFFINparaffin 1 g/g eye ointment, 2 x 3.5 g | 1 | $9.78 | IQ |
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