Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 14183L | ALFUZOSINalfuzosin hydrochloride 10 mg modified release tablet, 30 | 30 | $66.64 | SW |
| 4579B | ALPROSTADILalprostadil 10 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $37.33 | PF |
| 4580C | ALPROSTADILalprostadil 20 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes | 2 | $48.10 | PF |
| 4598B | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $39.35 | SN |
| 4658E | BANDAGE COMPRESSIONbandage compression four layer bandage, 1 | 1 | $59.61 | SN |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $13.05 | CC |
| 4748X | BANDAGE COMPRESSIONbandage compression 10 cm x 3 m high stretch bandage, 1 | 1 | $29.10 | BV |
| 4657D | BANDAGE COMPRESSIONbandage compression 10 cm x 3.5 m high stretch bandage, 1 | 1 | $14.08 | MH |
| 4654Y | BANDAGE COMPRESSIONbandage compression 8 cm x 2.6 m short stretch bandage, 1 | 1 | $14.12 | BV |
| 4813H | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 1.3 m bandage, 1 | 1 | $8.77 | MM |
| 4660G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 10 cm x 2 m bandage, 1 | 1 | $8.03 | MM |
| 4814J | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 15 cm x 1.3 m bandage, 1 | 1 | $11.86 | MM |
| 4811F | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 5 cm x 1.3 m bandage, 1 | 1 | $5.70 | MM |
| 4812G | BANDAGE RETENTION COHESIVE HEAVYbandage retention cohesive heavy 7.5 cm x 1.3 m bandage, 1 | 1 | $7.13 | MM |
| 4662J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 10 cm x 2 m bandage, 1 | 1 | $13.59 | BV |
| 4719J | BANDAGE RETENTION COHESIVE LIGHTbandage retention cohesive light 6 cm x 2 m bandage, 1 | 1 | $6.66 | BV |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $10.64 | KE |
| 4729X | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 10 cm x 2.3 m bandage, 1 | 1 | $13.36 | BV |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $7.18 | KE |
| 4727T | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 5 cm x 2.3 m bandage, 1 | 1 | $8.51 | BV |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $9.27 | KE |
| 4728W | BANDAGE RETENTION COTTON CREPEbandage retention cotton crepe 7.5 cm x 2.3 m bandage, 1 | 1 | $10.79 | BV |
| 4799N | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking large size bandage, 1 | 1 | $15.75 | MH |
| 4797L | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking medium size bandage, 1 | 1 | $15.75 | MH |
| 4674B | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking small size bandage, 1 | 1 | $15.75 | MH |
| 4675C | BANDAGE TUBULAR LONG STOCKINGbandage tubular long stocking XX/large size bandage, 1 | 1 | $15.76 | MH |
| 4815K | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking medium C/D size bandage, 1 | 1 | $10.64 | MH |
| 4661H | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking small B/C size bandage, 1 | 1 | $10.64 | MH |
| 4816L | BANDAGE TUBULAR SHORT STOCKINGbandage tubular short stocking large D/E size bandage, 1 | 1 | $10.64 | MH |
| 4669R | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $12.50 | MH |
| 4750B | BANDAGE ZINC PASTEbandage zinc paste 7.5 cm x 6 m bandage, 1 | 1 | $46.61 | SN |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $6.24 | VZ |
| 10578R | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.81 | PP |
| 14567Q | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.44 | VZ |
| 14567Q | BISACODYLbisacodyl 10 mg suppository, 10 | 1 | $5.01 | PP |
| 10580W | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $5.36 | PP |
| 14572Y | BISACODYLbisacodyl 10 mg suppository, 12 | 1 | $4.56 | PP |
| 4150K | BROMAZEPAMbromazepam 3 mg tablet, 30 | 30 | $12.43 | PB |
| 4151L | BROMAZEPAMbromazepam 6 mg tablet, 30 | 30 | $15.30 | PB |
| 14174B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $9.29 | PP |
| 14174B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $7.97 | CR |
| 14175C | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $8.09 | PP |
| 14175C | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $6.77 | CR |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $9.29 | PP |
| 4142B | CALCIUMcalcium carbonate 1.5 g (calcium 600 mg) tablet, 120 | 120 | $7.97 | CR |
| 11845K | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.44 | PP |
| 14176D | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $10.44 | PP |
| 14217G | CALCIUMcalcium carbonate 1.25 g (calcium 500 mg) chewable tablet, 120 | 120 | $9.24 | PP |
| 4681J | DRESSING ACTIVATED CHARCOAL MALODOROUS WOUNDdressing activated charcoal malodorous wound 10.5 cm x 10.5 cm dressing, 1 | 1 | $9.07 | KI |
| 4832H | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 1 | 1 | $9.82 | UM |
| 1905G | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g rope, 5 x 2 g | 5 | $51.87 | CC |
| 4682K | DRESSING ALGINATE CAVITY WOUNDdressing alginate cavity wound 2 g (40 cm) rope, 6 x 2 g | 1 | $62.56 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $8.09 | CT |
| 4831G | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 10 cm x 10 cm dressing, 1 | 1 | $7.57 | UM |
| 4684M | DRESSING ALGINATE SUPERFICIAL WOUNDdressing alginate superficial wound 5 cm x 5 cm dressing, 1 | 1 | $4.08 | CT |
| 4688R | DRESSING FILMdressing film 15 cm x 20 cm dressing, 1 | 1 | $4.31 | MM |
| 4689T | DRESSING FILM ISLANDdressing film island 5 cm x 7 cm dressing, 1 | 1 | $1.33 | MM |
| 4690W | DRESSING FILM ISLANDdressing film island 9 cm x 10 cm dressing, 1 | 1 | $2.33 | MM |
| 4898T | DRESSING FILM ISLANDdressing film island 5 cm x 7.2 cm dressing, 5 | 1 | $14.14 | SN |
| 4899W | DRESSING FILM ISLANDdressing film island 8 cm x 10 cm dressing, 5 | 1 | $23.18 | SN |
| 2445Q | DRESSING GELLING FIBREdressing gelling fibre 15 cm x 15 cm dressing, 5 | 1 | $123.24 | SN |
| 4906F | DRESSING HYDROACTIVE SUPERFICIAL WOUND LIGHT EXUDATEdressing hydroactive superficial wound light exudate 10 cm x 10 cm dressing, 5 | 1 | $68.60 | SN |
| 4886E | DRESSING HYDROACTIVE SUPERFICIAL WOUND MODERATE EXUDATEdressing hydroactive superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $45.91 | SN |
| 4896Q | DRESSING HYDROCOLLOID CAVITY WOUNDdressing hydrocolloid cavity wound paste, 30 g | 1 | $13.22 | CC |
| 4679G | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10cm (round) dressing, 1 | 1 | $10.63 | CT |
| 4897R | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 10 cm x 10 cm dressing, 5 | 1 | $36.48 | CC |
| 4678F | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 7cm (butterfly shape) dressing, 1 | 1 | $9.81 | CT |
| 4920Y | DRESSING HYDROCOLLOID SUPERFICIAL WOUND MODERATE EXUDATEdressing hydrocolloid superficial wound moderate exudate 20 cm x 20 cm dressing, 5 | 1 | $103.79 | CC |
| 2803M | DRESSING HYDROFIBRE ALTERNATE TO ALGINATESdressing hydrofibre alternate to alginates 15 cm x 15 cm dressing, 5 | 1 | $96.64 | CC |
| 4894N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 25 g | 1 | $19.49 | SN |
| 4599C | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $11.26 | SN |
| 4914P | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 50 g | 1 | $9.34 | JJ |
| 4913N | DRESSING HYDROGEL AMORPHOUSdressing hydrogel amorphous gel, 3 x 30 g | 1 | $29.08 | CC |
| 4806Y | DRESSING HYDROGEL SHEETdressing hydrogel sheet 10 cm x 10 cm dressing, 5 | 1 | $23.58 | HR |
| 4911L | DRESSING HYDROGEL SHEETdressing hydrogel sheet 9.5 cm x 10.2 cm dressing, 5 | 1 | $37.30 | KI |
| 4862X | DRESSING NON ADHERENTdressing non adherent 10 cm x 10 cm dressing, 5 | 1 | $12.23 | SN |
| 4819P | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $7.25 | SN |
| 4860T | DRESSING NON ADHERENTdressing non adherent 5 cm x 5 cm dressing, 5 | 1 | $8.09 | SN |
| 4909J | DRESSING TULLE NON-ADHERENT PRIMARY WOUND CONTACT LAYER PARAFFINdressing tulle non-adherent primary wound contact layer paraffin 7.6 cm x 7.6 cm dressing, 1 | 1 | $1.29 | KI |
| 14210X | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $18.76 | TX |
| 14210X | DUTASTERIDEdutasteride 500 microgram capsule, 30 | 30 | $25.76 | GK |
| 14184M | DUTASTERIDE + TAMSULOSINdutasteride 500 microgram + tamsulosin hydrochloride 400 microgram modified release capsule, 30 | 30 | $23.80 | GK |
| 4237B | FEXOFENADINEfexofenadine hydrochloride 60 mg tablet, 20 | 20 | $16.29 | SW |
| 14191X | FINASTERIDEfinasteride 5 mg tablet, 28 | 28 | $80.88 | RZ |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $91.23 | CR,GN,OQ,SZ,TX |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $67.92 | AF,AL,GQ |
| 14199H | FINASTERIDEfinasteride 5 mg tablet, 30 | 30 | $86.67 | RW |
| 10573L | FOLIC ACIDfolic acid 5 mg tablet, 100 | 100 | $5.54 | AF |
| 10584C | FOLIC ACIDfolic acid 500 microgram tablet, 100 | 100 | $4.50 | AF,PP |
| 10596Q | GLYCEROLglycerol 1.4 g suppository, 12 | 1 | $5.68 | PP |
| 4246L | GLYCEROLglycerol 2.8 g suppository, 12 | 1 | $5.84 | PP |
| 10586E | GLYCEROLglycerol 700 mg suppository, 12 | 1 | $5.56 | PP |
| 4572P | NICOTINEnicotine 14 mg/24 hours patch, 7 | 1 | $24.22 | AF |
| 4573Q | NICOTINEnicotine 21 mg/24 hours patch, 7 | 1 | $25.70 | AF |
| 4571N | NICOTINEnicotine 7 mg/24 hours patch, 7 | 1 | $22.64 | AF |
| 10585D | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.27 | AF,BG,OW,QS,SI,SW,SZ,TX,XT |
| 10598T | PARACETAMOLparacetamol 665 mg modified release tablet, 96 | 96 | $6.16 | CR,GQ,HQ,XT |
| 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 | $99.33 | SB |
| 14197F | RISEDRONATErisedronate sodium 35 mg tablet, 4 | 4 | $22.82 | SZ,TX |
| 14198G | RISEDRONATErisedronate sodium 35 mg enteric tablet, 4 | 4 | $22.82 | TT |
| 14209W | RISEDRONATErisedronate sodium 5 mg tablet, 28 | 28 | $26.41 | TT |
| 14185N | SILODOSINsilodosin 4 mg capsule, 30 | 30 | $29.19 | YN |
| 14192Y | SILODOSINsilodosin 8 mg capsule, 30 | 30 | $33.94 | YN |
| 14200J | TAMSULOSINtamsulosin hydrochloride 400 microgram modified release tablet, 30 | 30 | $54.24 | AF,BG,IB,LS,SZ,TX |
| 14182K | THIAMINEthiamine hydrochloride 100 mg tablet, 100 | 100 | $6.29 | PP |
