| Image | NDC Number | Product Description | List Price | WAC Price | Others |
|
00051848888
|
ANDROGEL 1% PUMP, 2 PUMP TWINPACK
|
$674.09
|
$640.39
|
|
|
00051842530
|
ANDROGEL 1%, 2.5 G UNIT DOSE, 30'S
|
$655.86
|
$623.07
|
|
|
00051845030
|
ANDROGEL 1%, 5.0 G UNIT DOSE, 30'S
|
$674.09
|
$640.39
|
|
|
00051846231
|
ANDROGEL 1.62% 1.25GM UNIT DOSE
|
$655.84
|
$623.05
|
|
|
00051846230
|
ANDROGEL 1.62% 2.5GM UNIT DOSE
|
$674.07
|
$640.37
|
|
|
00051846233
|
ANDROGEL 1.62% PUMP
|
$653.75
|
$621.06
|
|
|
00032121201
|
CREON 12000USP DELAYED-RELEASE 100CAP
|
$351.60
|
$334.02
|
|
|
00032121207
|
CREON 12000USP DELAYED-RELEASE 250CAP
|
$878.98
|
$835.03
|
|
|
00032122401
|
CREON 24000USP DELAYED-RELEASE 100CAP
|
$696.93
|
$662.08
|
|
|
00032122407
|
CREON 24000USP DELAYED-RELEASE 250CAP
|
$1,714.27
|
$1,628.56
|
|
|
00032120370
|
CREON 3000USP DELAYED-RELEASE 70CAP
|
$104.00
|
$98.80
|
|
|
00032301613
|
CREON 36000USP DELAYED-RELEASE 100CAP
|
$1,058.20
|
$1,005.29
|
|
|
00032301628
|
CREON 36000USP DELAYED-RELEASE 250CAP
|
$2,645.20
|
$2,512.94
|
|
|
00032120601
|
CREON 6000 DELAYED-RELEASE CAPSULES 100S
|
$175.90
|
$167.10
|
|
|
00032120607
|
CREON 6000USP DELAYED-RELEASE 250CAP
|
$439.79
|
$417.80
|
|
|
00074621213
|
DEPAKOTE 125MG 100TAB
|
$186.95
|
$177.60
|
|
|
00074621413
|
DEPAKOTE 250MG 100TAB
|
$367.22
|
$348.86
|
|
|
00074621453
|
DEPAKOTE 250MG 500TAB
|
$1,836.11
|
$1,744.30
|
|
|
00074621513
|
DEPAKOTE 500MG 100TAB
|
$677.17
|
$643.31
|
|
|
00074621553
|
DEPAKOTE 500MG 500TAB
|
$3,385.84
|
$3,216.55
|
|
|
00074382613
|
DEPAKOTE ER 250MG 100TAB
|
$333.94
|
$317.24
|
|
|
00074382611
|
DEPAKOTE ER 250MG 10X10TAB
|
$335.44
|
$335.44
|
|
|
00074712613
|
DEPAKOTE ER 500MG 100TAB
|
$587.40
|
$558.03
|
|
|
00074712611
|
DEPAKOTE ER 500MG 10X10TAB
|
$588.90
|
$588.90
|
|
|
00074712653
|
DEPAKOTE ER 500MG 500TAB
|
$2,937.02
|
$2,790.17
|
|
|
00074611413
|
DEPAKOTE SPRINKLE CAPSULE, 125MG, 100
|
$178.23
|
$169.32
|
|
|
00074301207
|
DUOPA FILLED CASSETTE, 4.63/20 MG/ML
|
$1,412.88
|
$1,412.88
|
|
|
00074310932
|
GENGRAF, CAPSULES, 100MG, 30'S
|
$220.94
|
$209.89
|
|
|
00074310832
|
GENGRAF, CAPSULES, 25MG, 30'S
|
$55.31
|
$52.54
|
|
|
00074726950
|
GENGRAF, ORAL SOLUTION, 100 MG/ML
|
$416.13
|
$395.32
|
|
|
00074081702
|
HUMIRA 10MG/0.1ML PFS 2-PACK
|
$5,849.44
|
$5,556.97
|
|
|
00074006702
|
HUMIRA 1X80MG,0.8ML, 1X40MG,0.4ML PFS2PK
|
$8,774.19
|
$8,335.48
|
|
|
00074061602
|
HUMIRA 20MG/0.2ML PFS 2-PACK
|
$5,849.44
|
$5,556.97
|
|
|
00074937402
|
HUMIRA 20MG/0.4ML (2 SYRINGES)
|
$5,849.44
|
$5,556.97
|
|
|
00074433902
|
HUMIRA 40MG/0.8 ML (2 PENS)
|
$5,849.44
|
$5,556.97
|
|
|
00074379902
|
HUMIRA 40MG/0.8ML (2 SYRINGES)
|
$5,849.44
|
$5,556.97
|
|
|
00074254003
|
HUMIRA 80MG, 0.8ML PFS 3-PACK
|
$17,548.39
|
$16,670.97
|
|
|
00074012403
|
HUMIRA CROHN'S 80MG/0.8ML, 3 PENS
|
$17,548.39
|
$16,670.97
|
|
|
00074055402
|
HUMIRA PEN, 40MG/0.4ML, 2 PENS
|
$5,849.44
|
$5,556.97
|
|
|
00074024302
|
HUMIRA PFS, 40MG/0.4ML, 2 SYRINGES
|
$5,849.44
|
$5,556.97
|
|
|
00074153903
|
HUMIRA PSORIASIS; 1X80MG, 2X40MG (3PENS)
|
$11,698.91
|
$11,113.96
|
|
|
00074433906
|
HUMIRA, CROHN'S, 40MG/0.8 ML (6 PENS)
|
$17,548.39
|
$16,670.97
|
|
|
00074433907
|
HUMIRA, PSORIASIS, 40MG/0.8ML (4 PENS)
|
$11,698.91
|
$11,113.96
|
|
|
00074634702
|
HUMIRA, SINGLE DOSE SYRINGE, 10 MG/0.2ML
|
$5,849.44
|
$5,556.97
|
|
|
00074327813
|
K-TAB 10MEQ, 750MG, 100 FILMTAB TABLETS
|
$88.25
|
$83.84
|
|
|
00074327819
|
K-TAB, 10MEQ, 750, 1000 FILMTAB TABLETS
|
$838.39
|
$796.47
|
|
|
00074780413
|
K-TAB, FILMTABS 10 MEQ, 750 MG, 100'S
|
$88.25
|
$83.84
|
|
|
00074780419
|
K-TAB, FILMTABS 10 MEQ, 750 MG, 1000'S
|
$838.39
|
$796.47
|
|
|
00074302313
|
K-TAB, FILMTABS, 20MEQ, 1500MG, 100CT
|
$87.23
|
$82.87
|
|
|
00074302353
|
K-TAB, FILMTABS, 20MEQ, 1500MG, 500CT
|
$436.17
|
$414.36
|
|
|
00074305846
|
K-TAB, FILMTABS, 8MEQ, 600MG, 1000CT
|
$575.02
|
$546.27
|
|
|
00074305841
|
K-TAB, FILMTABS, 8MEQ, 600MG, 100CT
|
$57.50
|
$54.63
|
|
|
00074052260
|
KALETRA (100MG/25MG) 60 FILMCOATED TAB
|
$269.50
|
$256.03
|
|
|
00074679922
|
KALETRA (200MG/50MG) 120 FILMCOATED TAB
|
$1,078.04
|
$1,024.14
|
|
|
00074395646
|
KALETRA OS 80MG/20MG/ML 160ML
|
$539.02
|
$512.07
|
|
|
00074105305
|
LUPANETA 11.25 MG (3 MONTH) KIT
|
$4,189.84
|
$4,189.84
|
|
|
00074105205
|
LUPANETA, 3.75 MG (1 MONTH) KIT
|
$1,396.60
|
$1,396.60
|
|
|
00074347303
|
LUPRON 45MG 6MTH
|
$9,985.73
|
$9,985.73
|
|
|
00074244003
|
LUPRON DEPOT PED, 15 MG PDS KIT
|
$3,359.51
|
$3,359.51
|
|
|
00074377903
|
LUPRON DEPOT PED, 3MONTH, 11.25MG
|
$9,150.69
|
$9,150.69
|
|
|
00074969403
|
LUPRON DEPOT PED, 3MONTH, 30MG
|
$10,078.56
|
$10,078.56
|
|
|
00074210803
|
LUPRON DEPOT PED, 7.5 MG PDS KIT
|
$1,680.11
|
$1,680.11
|
|
|
00074366303
|
LUPRON DEPOT, 3 MONTH 11.25 MG PDS KIT
|
$4,189.84
|
$4,189.84
|
|
|
00074334603
|
LUPRON DEPOT, 3 MONTH 22.5 MG PDS KIT
|
$4,992.79
|
$4,992.79
|
|
|
00074364103
|
LUPRON DEPOT, 3.75 MG PDS KIT
|
$1,396.60
|
$1,396.60
|
|
|
00074368303
|
LUPRON DEPOT, 4 MONTH 30 MG PDS KIT
|
$6,657.06
|
$6,657.06
|
|
|
00074364203
|
LUPRON DEPOT, 7.5 MG PDS KIT
|
$1,664.27
|
$1,664.27
|
|
|
00074228203
|
LUPRON DEPOT-PED 11.25 MG PDS KIT
|
$3,050.22
|
$3,050.22
|
|
|
00074262580
|
MAVYRET 100MG/40MG 84 TAB BOTTLE
|
$13,200.00
|
$13,200.00
|
|
|
00074262528
|
MAVYRET 100MG/40MG, 84 TABS
|
$13,200.00
|
$13,200.00
|
|
|
00074308090
|
NIASPAN, TABLETS, 1000 MG, 90'S
|
$865.96
|
$822.66
|
|
|
00074327590
|
NIASPAN, TABLETS, 1000MG 90'S
|
$865.96
|
$822.66
|
|
|
00074307490
|
NIASPAN, TABLETS, 500 MG, 90'S
|
$489.62
|
$465.14
|
|
|
00074326590
|
NIASPAN, TABLETS, 500MG, 90'S
|
$489.62
|
$465.14
|
|
|
00074327490
|
NIASPAN, TABLETS, 750MG 90'S
|
$698.39
|
$663.47
|
|
|
00074438293
|
NIMBEX INJ NOVAPLUS 10MG/ML 20ML 1X10SDV
|
$3,126.28
|
$2,969.97
|
|
|
00074438081
|
NIMBEX INJ NOVAPLUS 2MG/ML 10ML 1X10 MDV
|
$289.52
|
$275.04
|
|
|
00074437836
|
NIMBEX INJ NOVAPLUS 2MG/ML 5ML 1X10 SDV
|
$165.03
|
$156.78
|
|
|
00074438291
|
NIMBEX INJ PREMIER 10MG/ML 20ML 1X10 SDV
|
$3,126.28
|
$2,969.97
|
|
|
00074438079
|
NIMBEX INJ PREMIER 2MG/ML 10ML 1X10 MDV
|
$289.52
|
$275.04
|
|
|
00074437824
|
NIMBEX INJ PREMIER 2MG/ML 5ML 1X10 SDV
|
$165.03
|
$156.78
|
|
|
00074438220
|
NIMBEX INJECTION 10MG/ML 20ML 1X10 SDV
|
$3,126.28
|
$2,969.97
|
|
|
00074438010
|
NIMBEX INJECTION 2MG/ML 10ML 1X10 MDV
|
$289.52
|
$275.04
|
|
|
00074437805
|
NIMBEX INJECTION 2MG/ML 5ML 1X10 SDV
|
$165.03
|
$156.78
|
|
|
00074333330
|
NORVIR 100MG, 30 FILMCOATED TAB
|
$270.71
|
$257.17
|
|
|
00074663330
|
NORVIR 100MG, 30 SOFT GELATIN CAP
|
$270.71
|
$257.17
|
|
|
00074194063
|
NORVIR 80MG/ML OS, 240ML
|
$1,516.00
|
$1,440.20
|
|
|
00074339930
|
NORVIR ORAL POWDER 100MG 30 PACKETS
|
$270.71
|
$257.17
|
|
|
00074101756
|
ORIAHNN 300MG
|
$907.39
|
$907.39
|
|
|
00074003828
|
ORILISSA 150MG TABS, 4X7 PACK
|
$907.39
|
$907.39
|
|
|
00074003956
|
ORILISSA 200MG TABS, 4X14 PACK
|
$907.39
|
$907.39
|
|
|
00074230630
|
RINVOQ 15MG 30 DAY BOTTLE
|
$4,916.67
|
$4,916.67
|
|
|
00074204202
|
SKYRIZI 75MG/0.83ML PFS X2 US/PR
|
$15,841.50
|
$15,841.50
|
|
|
00074104004
|
SURVANTA INTRATRACHEAL SUS 25MG/ML 4ML
|
$383.00
|
$383.00
|
|
|
00074104008
|
SURVANTA(8 ML)
|
$677.88
|
$677.88
|
|
|
00074662411
|
SYNTHROID, TABLETS, 100 MCG, 10 X 10'S
|
$129.82
|
$129.82
|
|
|
00074662419
|
SYNTHROID, TABLETS, 100 MCG, 1000'S
|
$1,366.88
|
$1,298.54
|
|
|
00074662490
|
SYNTHROID, TABLETS, 100 MCG, 90'S
|
$123.01
|
$116.86
|
|
|
00074929619
|
SYNTHROID, TABLETS, 112 MCG, 1000'S
|
$1,366.64
|
$1,298.31
|
|
|
00074929690
|
SYNTHROID, TABLETS, 112 MCG, 90'S
|
$123.02
|
$116.87
|
|
|
00074706811
|
SYNTHROID, TABLETS, 125 MCG, 10 X 10'S
|
$129.82
|
$129.82
|
|
|
00074706819
|
SYNTHROID, TABLETS, 125 MCG, 1000'S
|
$1,367.42
|
$1,299.05
|
|
|
00074706890
|
SYNTHROID, TABLETS, 125 MCG, 90'S
|
$123.09
|
$116.94
|
|
|
00074372719
|
SYNTHROID, TABLETS, 137 MCG, 1000'S
|
$1,367.35
|
$1,298.98
|
|
|
00074372790
|
SYNTHROID, TABLETS, 137 MCG, 90'S
|
$123.07
|
$116.92
|
|
|
00074706911
|
SYNTHROID, TABLETS, 150 MCG, 10 X 10'S
|
$129.82
|
$129.82
|
|
|
00074706919
|
SYNTHROID, TABLETS, 150 MCG, 1000'S
|
$1,367.48
|
$1,299.11
|
|
|
00074706990
|
SYNTHROID, TABLETS, 150 MCG, 90'S
|
$123.09
|
$116.94
|
|
|
00074707019
|
SYNTHROID, TABLETS, 175 MCG, 1000'S
|
$1,365.62
|
$1,297.34
|
|
|
00074707090
|
SYNTHROID, TABLETS, 175 MCG, 90'S
|
$122.91
|
$116.76
|
|
|
00074714811
|
SYNTHROID, TABLETS, 200 MCG, 10 X 10'S
|
$129.81
|
$129.81
|
|
|
00074714819
|
SYNTHROID, TABLETS, 200 MCG, 1000'S
|
$1,367.25
|
$1,298.89
|
|
|
00074714890
|
SYNTHROID, TABLETS, 200 MCG, 90'S
|
$123.07
|
$116.92
|
|
|
00074434119
|
SYNTHROID, TABLETS, 25 MCG, 1000'S
|
$1,367.42
|
$1,299.05
|
|
|
00074434190
|
SYNTHROID, TABLETS, 25 MCG, 90'S
|
$123.07
|
$116.92
|
|
|
00074714919
|
SYNTHROID, TABLETS, 300 MCG, 1000'S
|
$1,366.49
|
$1,298.17
|
|
|
00074714990
|
SYNTHROID, TABLETS, 300 MCG, 90'S
|
$122.98
|
$116.83
|
|
|
00074455211
|
SYNTHROID, TABLETS, 50 MCG, 10 X 10
|
$129.81
|
$129.81
|
|
|
00074455219
|
SYNTHROID, TABLETS, 50 MCG, 1000'S
|
$1,366.85
|
$1,298.51
|
|
|
00074455290
|
SYNTHROID, TABLETS, 50 MCG, 90'S
|
$123.02
|
$116.87
|
|
|
00074518211
|
SYNTHROID, TABLETS, 75 MCG, 10 X 10
|
$129.81
|
$129.81
|
|
|
00074518219
|
SYNTHROID, TABLETS, 75 MCG, 1000'S
|
$1,367.44
|
$1,299.07
|
|
|
00074518290
|
SYNTHROID, TABLETS, 75 MCG, 90'S
|
$123.06
|
$116.91
|
|
|
00074659419
|
SYNTHROID, TABLETS, 88 MCG, 1000'S
|
$1,367.22
|
$1,298.86
|
|
|
00074659490
|
SYNTHROID, TABLETS, 88 MCG, 90'S
|
$123.06
|
$116.91
|
|
|
00074328713
|
TARKA 2MG/180MG. 100TAB
|
$629.89
|
$598.40
|
|
|
00074328913
|
TARKA 2MG/240MG, 100TAB
|
$629.89
|
$598.40
|
|
|
00074329013
|
TARKA 4MG/240MG, 100TAB
|
$629.89
|
$598.40
|
|
|
00074318990
|
TRICOR, TABLETS, 145MG, 90CT BTL
|
$97.96
|
$93.06
|
|
|
00074317390
|
TRICOR, TABLETS, 48MG, 90CT BTL
|
$53.64
|
$50.96
|
|
|
00074316290
|
TRILIPIX DR CAP, 135MG 90'S
|
$854.79
|
$812.05
|
|
|
00074316190
|
TRILIPIX, DR CAP, 45MG 90'S
|
$284.92
|
$270.67
|
|
|
00074445651
|
ULTANE LIQUID, 250ML (NOVATION), 6'S
|
$197.89
|
$188.00
|
|
|
00074445604
|
ULTANE LIQUID, 250ML, 6'S
|
$197.89
|
$188.00
|
|
|
00074057634
|
VENCLEXTA 100MG BOTTLE 180 TABLETS
|
$18,440.21
|
$18,440.21
|
|
|
00074057622
|
VENCLEXTA 100MG BOTTLE, 120 TABLETS
|
$12,293.47
|
$12,293.47
|
|
|
00074057611
|
VENCLEXTA 100MG UNIT DOSE, 1 TABLET
|
$102.44
|
$102.44
|
|
|
00074056111
|
VENCLEXTA 10MG UNIT DOSE, 2 TABLETS
|
$20.49
|
$20.49
|
|
|
00074056114
|
VENCLEXTA 10MG WALLET, 2 TABLETS X 7
|
$143.42
|
$143.42
|
|
|
00074056611
|
VENCLEXTA 50MG UNIT DOSE, 1 TABLET
|
$51.22
|
$51.22
|
|
|
00074056607
|
VENCLEXTA 50MG WALLET, 1 TABLET X 7
|
$358.56
|
$358.56
|
|
|
00074057928
|
VENCLEXTA START PACK, 4X7 DAY WALLET
|
$2,653.34
|
$2,653.34
|
|
|
00074309328
|
VIEKIRA PAK 12.5/75/50/250MG TABS, 28DAY
|
$27,773.00
|
$27,773.00
|
|
|
00074165805
|
ZEMPLAR INJECTION 10MCG/2ML MDV
|
$3,030.00
|
$3,030.00
|
|
|
00074463701
|
ZEMPLAR INJECTION 2 MCG/ML, 1ML FLIP TOP
|
$606.00
|
$606.00
|
|
|
00074165801
|
ZEMPLAR INJECTION 5 MCG/ML, 1ML FLIP TOP
|
$1,515.00
|
$1,515.00
|
|
|
00074903630
|
ZEMPLAR, 1MCG 30 CAPSULES
|
$410.86
|
$390.32
|
|
|
00074903730
|
ZEMPLAR, 2MCG 30 CAPSULES
|
$821.71
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$780.62
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