NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
8-MOP 10 MG 00187065142 $29.7958/capsule
ABACAVIR-LAMIVUDINE 600-300MG 00093538256 $37.5733/tablet
ABACAVIR-LAMIVUDINE 600-300MG 66993048230 $39.0951/tablet
ABACAVIR-LAMIVUDINE-ZIDOVUDINE 150-300MG 68180028607 $23.4113/tablet
ABELCET 5 MG/ML 57665010141 $9.3425/ml
ABILIFY MAINTENA 300 MG 59148001870 $1360.5070/each Add
ABILIFY MAINTENA 300 MG 59148001871 $1360.4498/each
ABILIFY MAINTENA 300 MG 59148004580 $1360.4498/each
ABILIFY MAINTENA 400 MG 59148001970 $1813.9982/each Add
ABILIFY MAINTENA 400 MG 59148001971 $1813.9297/each
ABILIFY MAINTENA 400 MG 59148007280 $1813.9297/each
ABRAXANE 100 MG 68817013450 $1184.6694/each
ACTEMRA 162 MG/0.9 50242013801 $933.4308/ml
ACTEMRA 200MG/10ML 50242013601 $91.4333/ml
ACTEMRA 400MG/20ML 50242013701 $91.4328/ml
ACTEMRA 80 MG/4 ML 50242013501 $91.4328/ml
ACTHREL 100 MCG 55566030201 $795.3245/each
ACTIMMUNE 100MCG/0.5 42238011101 $7451.0194/ml
ACTIMMUNE 100MCG/0.5 42238011112 $7451.0194/ml
ACTIVASE 100 MG 50242008527 $8378.1318/each
ACTIVASE 50 MG 50242004413 $4189.0659/each
ADAGEN 250 UNIT/1 57665000101 $3356.5667/ml
ADCETRIS 50 MG 51144005001 $6391.2800/each
ADCIRCA 20 MG 66302046760 $55.8631/tablet Increase
ADEFOVIR DIPIVOXIL 10 MG 42794000308 $30.1317/tablet
ADEMPAS 0.5 MG 50419025001 $103.2512/tablet Increase
ADEMPAS 0.5 MG 50419025003 $103.2511/tablet Increase
ADEMPAS 0.5 MG 50419025091 $103.2512/tablet Increase
ADEMPAS 1 MG 50419025101 $103.2512/tablet Increase
ADEMPAS 1 MG 50419025103 $103.2511/tablet Increase
ADEMPAS 1 MG 50419025191 $103.2512/tablet Increase
ADEMPAS 1.5 MG 50419025201 $103.2512/tablet Increase
ADEMPAS 1.5 MG 50419025203 $103.2511/tablet Increase
ADEMPAS 1.5 MG 50419025291 $103.2512/tablet Increase
ADEMPAS 2 MG 50419025301 $103.2512/tablet Increase
ADEMPAS 2 MG 50419025303 $103.2511/tablet Increase
ADEMPAS 2 MG 50419025391 $103.2512/tablet Increase
ADEMPAS 2.5 MG 50419025401 $103.2512/tablet Increase
ADEMPAS 2.5 MG 50419025403 $103.2511/tablet Increase
ADEMPAS 2.5 MG 50419025491 $103.2512/tablet Increase
ADRENACLICK 0.3MG/0.3 52054080402 $232.7696/each
ADVATE 1000 (+/-) 00944292302 $1.0600/each
ADVATE 1000 (+/-) 00944305302 $1.0600/each
ADVATE 1500 (+/-) 00944305402 $1.0600/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ADVATE 2000 (+/-) 00944304510 $1.0600/each
ADVATE 250 (+/-) 00944305102 $1.0600/each
ADVATE 3000 (+/-) 00944296510 $1.0600/each
ADVATE 3000 (+/-) 00944304610 $1.0600/each
ADVATE 3000 (+/-) 00944304611 $1.0600/each
ADVATE 4000 (+/-) 00944294810 $1.0600/each
ADVATE 4000 (+/-) 00944304710 $1.0600/each
ADVATE 500 (+/-) 00944305202 $1.0600/each
ADVATE H 1000 (+/-) 00944294310 $1.0600/each
ADVATE L 250 (+/-) 00944294110 $1.0600/each
ADVATE M 500 (+/-) 00944294210 $1.0600/each
ADVATE SH 1500 (+/-) 00944294410 $1.0600/each
ADYNOVATE 1000 (+/-) 00944425602 $1.6080/each
ADYNOVATE 1000 (+/-) 00944462401 $1.6080/each
ADYNOVATE 1000 (+/-) 00944462402 $1.6080/each
ADYNOVATE 2000 (+/-) 00944425802 $1.6080/each
ADYNOVATE 2000 (+/-) 00944462501 $1.6080/each
ADYNOVATE 2000 (+/-) 00944462502 $1.6080/each
ADYNOVATE 250 (+/-) 00944425202 $1.6080/each
ADYNOVATE 250 (+/-) 00944462201 $1.6080/each
ADYNOVATE 250 (+/-) 00944462202 $1.6080/each
ADYNOVATE 500 (+/-) 00944425402 $1.6080/each
ADYNOVATE 500 (+/-) 00944462301 $1.6080/each
ADYNOVATE 500 (+/-) 00944462302 $1.6080/each
AFINITOR 10 MG 00078056751 $434.3667/tablet
AFINITOR 10 MG 00078056761 $434.3404/tablet
AFINITOR 2.5 MG 00078059451 $415.2712/tablet
AFINITOR 2.5 MG 00078059461 $415.2716/tablet
AFINITOR 5 MG 00078056651 $434.3667/tablet
AFINITOR 5 MG 00078056661 $434.3909/tablet
AFINITOR 7.5 MG 00078062051 $434.3667/tablet
AFINITOR 7.5 MG 00078062061 $434.3707/tablet
AFINITOR DISPERZ 2 MG 00078062651 $413.2004/tablet
AFINITOR DISPERZ 2 MG 00078062661 $413.2011/tablet
AFINITOR DISPERZ 3 MG 00078062751 $417.3396/tablet
AFINITOR DISPERZ 3 MG 00078062761 $417.3320/tablet
AFINITOR DISPERZ 5 MG 00078062851 $434.3667/tablet
AFINITOR DISPERZ 5 MG 00078062861 $434.3606/tablet
AFSTYLA 1000 (+/-) 69911047602 $1.2000/each
AFSTYLA 2000 (+/-) 69911047702 $1.2000/each
AFSTYLA 250 (+/-) 69911047402 $1.2000/each
AFSTYLA 3000 (+/-) 69911047802 $1.2000/each
AFSTYLA 500 (+/-) 69911047502 $1.2000/each
ALDURAZYME 2.9 MG/5ML 58468007001 $169.2760/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ALECENSA 150 MG 50242013001 $51.8779/capsule
ALIMTA 100 MG 00002764001 $638.7240/each
ALIMTA 500 MG 00002762301 $3193.6200/each
ALKERAN 2 MG 52609000105 $11.4336/tablet
ALKERAN 50 MG 52609300100 $1659.5310/each
ALPHANATE 1000 (400) 68516460302 $0.8680/each
ALPHANATE 1500 (600) 68516460402 $0.8680/each
ALPHANATE 2000 (800) 68516460902 $0.8680/each
ALPHANATE 2000 (800) 68516461002 $0.8680/each
ALPHANATE 250 (100) 68516460101 $0.8680/each
ALPHANATE 500 (200) 68516460201 $0.8680/each
ALPHANINE SD 1000 (+/-) 68516360202 $0.9000/each
ALPHANINE SD 1000 (+/-) 68516360502 $0.9000/each
ALPHANINE SD 1500 (+/-) 68516360302 $0.9000/each
ALPHANINE SD 1500 (+/-) 68516360602 $0.9000/each
ALPHANINE SD 500 (+/-) 68516360102 $0.9000/each
ALPHANINE SD 500 (+/-) 68516360402 $0.9000/each
ALPROLIX 1000 UNIT 64406092201 $2.4095/each
ALPROLIX 4000 UNIT 64406097701 $2.4095/each
ALPROLIX 2000 UNIT 64406093301 $2.4095/each
ALPROLIX 250 UNIT 64406096601 $2.4095/each
ALPROLIX 3000 UNIT 64406094401 $2.4095/each
ALPROLIX 500 UNIT 64406091101 $2.4095/each
AMBISOME 50 MG 00469305130 $192.7383/each
AMIFOSTINE 500 MG 47335058140 $456.4796/each
AMIFOSTINE 500 MG 47335058142 $456.4527/each
AMIFOSTINE 500 MG 55390030803 $505.0000/each
AMMONUL 10 %-10 % 00187001050 $922.3459/ml
AMMONUL 10 %-10 % 62592072050 $634.6006/ml
AMPYRA 10 MG 10144042760 $33.1856/tablet
ANCOBON 250 MG 00187355410 $77.6121/capsule
ANCOBON 500 MG 00187355510 $150.1807/capsule
ANZEMET 100 MG/5ML 00088120632 $11.8433/ml
ANZEMET 100 MG 00088120305 $96.4611/tablet
ANZEMET 100 MG 30698012105 $96.4611/tablet
ANZEMET 50 MG 00088120205 $72.7745/tablet
ANZEMET 50 MG 30698012005 $72.7745/tablet
APOKYN 10 MG/ML 15054021101 $334.9833/ml
APOKYN 10 MG/ML 15054021105 $334.9833/ml
APOKYN 10 MG/ML 27505000401 $334.9833/ml
APOKYN 10 MG/ML 27505000405 $334.9833/ml
APTIVUS 100 MG/ML 00597000201 $4.9777/ml
APTIVUS 250 MG 00597000302 $11.8226/capsule
ARALAST NP 1000 MG 00944281501 $0.5252/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ARALAST NP 500 MG 00944281401 $0.5252/each
ARANESP 100 MCG/ML 55513000501 $752.2480/ml
ARANESP 100 MCG/ML 55513000504 $752.2480/ml
ARANESP 100MCG/0.5 55513002501 $1504.4960/ml
ARANESP 100MCG/0.5 55513002504 $1504.4960/ml
ARANESP 10MCG/0.4 55513009801 $188.1125/ml
ARANESP 10MCG/0.4 55513009804 $188.1125/ml
ARANESP 150MCG/0.3 55513002701 $3761.2400/ml
ARANESP 150MCG/0.3 55513002704 $3761.2400/ml
ARANESP 200 MCG/ML 55513000601 $1504.4960/ml
ARANESP 200MCG/0.4 55513002801 $3761.2400/ml
ARANESP 25 MCG/ML 55513000201 $188.0620/ml
ARANESP 25 MCG/ML 55513000204 $188.0620/ml
ARANESP 25MCG/0.42 55513005701 $447.7667/ml
ARANESP 25MCG/0.42 55513005704 $447.7667/ml
ARANESP 300 MCG/ML 55513011001 $2256.7440/ml
ARANESP 300MCG/0.6 55513011101 $3761.2400/ml
ARANESP 40 MCG/0.4 55513002101 $752.3238/ml
ARANESP 40 MCG/0.4 55513002104 $752.3238/ml
ARANESP 40 MCG/ML 55513000301 $300.9295/ml
ARANESP 40 MCG/ML 55513000304 $300.9295/ml
ARANESP 500 MCG/ML 55513003201 $3761.2400/ml
ARANESP 60MCG/0.3 55513002301 $1504.5633/ml
ARANESP 60MCG/0.3 55513002304 $1504.5633/ml
ARANESP 60MCG/ML 55513000401 $451.3690/ml
ARANESP 60MCG/ML 55513000404 $451.3690/ml
ARCALYST 220 MG 61755000101 $5050.0000/each
ARISTADA 441 MG/1.6 65757040103 $686.1688/ml
ARISTADA 662 MG/2.4 65757040203 $685.9583/ml
ARISTADA 882 MG/3.2 65757040301 $685.5646/ml Add
ARISTADA 882 MG/3.2 65757040303 $685.5375/ml
ARRANON 250MG/50ML 00007440101 $14.8545/ml
ARRANON 250MG/50ML 00007440106 $14.8544/ml
ARRANON 250MG/50ML 00078068306 $14.8544/ml
ARRANON 250MG/50ML 00078068361 $14.8545/ml
ARZERRA 100 MG/5ML 00078066913 $105.1349/ml
ARZERRA 100 MG/5ML 00078066961 $105.1349/ml
ARZERRA 100 MG/5ML 00173082102 $102.0726/ml
ARZERRA 100 MG/5ML 00173082133 $102.0726/ml
ARZERRA 1000 MG/50 00078069061 $105.1353/ml
ARZERRA 1000 MG/50 00173082101 $102.0732/ml
ASTAGRAF XL 0.5 MG 00469064773 $2.0018/capsule
ASTAGRAF XL 1 MG 00469067773 $4.0036/capsule
ASTAGRAF XL 5 MG 00469068773 $20.0182/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ATGAM 50 MG/ML 00009722401 $280.2249/ml
ATGAM 50 MG/ML 00009722402 $280.2249/ml
ATRIPLA 600-200MG 15584010101 $80.5155/tablet
AUBAGIO 14 MG 58468021002 $211.9947/tablet
AUBAGIO 7 MG 58468021101 $211.9947/tablet
AUVI-Q 0.3MG/0.3 00024583302 $256.9945/each Delete
AVASTIN 25 MG/ML 50242006001 $183.1963/ml
AVASTIN 25 MG/ML 50242006101 $183.1963/ml
AVONEX 30 MCG 59627000103 $1469.8025/each
AVONEX 30 MCG 59627000104 $1469.8607/each
AVONEX 30 MCG 59627011103 $1469.8025/each
AVONEX 30MCG/.5ML 59627000205 $5879.2100/each
AVONEX 30MCG/.5ML 59627022205 $5879.2100/each
AVONEX PEN 30MCG/.5ML 59627000304 $5879.2100/each
AVONEX PEN 30MCG/.5ML 59627033304 $5879.2100/each
AVYCAZ 2.5 G 00456270001 $302.2545/each
AVYCAZ 2.5 G 00456270010 $302.2425/each
AZACITIDINE 100 MG 00591289749 $314.3928/each
AZACITIDINE 100 MG 00781325394 $314.3928/each
AZACITIDINE 100 MG 00781925394 $314.3928/each
AZACITIDINE 100 MG 43598030562 $499.0410/each
AZACITIDINE 100 MG 43598046562 $353.5000/each
AZACITIDINE 100 MG 67457025430 $314.3928/each
AZATHIOPRINE SODIUM 100 MG 00143956601 $252.5000/each
BANZEL 200 MG 62856058252 $9.1405/tablet
BANZEL 40 MG/ML 62856058446 $2.6501/ml
BANZEL 400 MG 62856058352 $18.2810/tablet
BARACLUDE 0.05 MG/ML 00003161412 $4.3591/ml
BCG (TICE STRAIN) 50 MG 00052060202 $146.6015/each
BEBULIN 700 (+/-) 64193044502 $0.5000/each
BELEODAQ 500 MG 68152010809 $1653.8346/each
BENDEKA 25 MG/ML 63459034804 $587.1736/ml
BENEFIX 1000 UNIT 58394063503 $1.2399/each
BENEFIX 2000 UNIT 58394063603 $1.2399/each
BENEFIX 250 UNIT 58394063303 $1.2399/each
BENEFIX 3000 UNIT 58394063703 $1.2399/each
BENEFIX 500 UNIT 58394063403 $1.2399/each
BENLYSTA 120 MG 49401010101 $496.7887/each
BENLYSTA 400 MG 49401010201 $1655.9253/each
BERINERT 500(10 ML) 63833082502 $2843.1500/each
BETASERON 0.3 MG 50419052309 $448.6420/each
BETASERON 0.3 MG 50419052401 $448.6420/each
BETASERON 0.3 MG 50419052435 $448.6355/each
BETHKIS 300 MG/4ML 10122082004 $25.5893/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
BETHKIS 300 MG/4ML 10122082028 $25.5882/ml
BETHKIS 300 MG/4ML 10122082056 $25.5882/ml
BICNU 100 MG 00015301260 $173.1241/each
BICNU 100 MG 23155026141 $3781.0360/each
BIVALIRUDIN 250 MG 00409830015 $535.5525/each
BIVALIRUDIN 250 MG 00409830025 $535.5737/each
BIVIGAM 10 % 59730650201 $13.0466/ml
BIVIGAM 10 % 59730650301 $13.0466/ml
BLINCYTO 35 MCG 55513016001 $3367.6430/each
BOSULIF 100 MG 00069013501 $101.1273/tablet
BOSULIF 500 MG 00069013601 $404.5090/tablet
BOTOX 100 UNIT 00023114501 $584.7900/each
BOTOX 200 UNIT 00023392102 $1169.5800/each
BOTOX COSMETIC 100 UNIT 00023923201 $584.7900/each
BUPHENYL 0.94 G/G 75987007009 $41.4706/gm
BUPHENYL 0.94 G/G 76325018864 $41.4706/gm Delete
BUPHENYL 500 MG 75987006008 $20.7353/tablet
BUPHENYL 500 MG 76325049603 $20.7353/tablet
BUSULFEX 60 MG/10ML 59148004790 $232.5684/ml
BUSULFEX 60 MG/10ML 59148004791 $232.5597/ml
BUSULFEX 60 MG/10ML 59148007090 $232.5684/ml
BUSULFEX 60 MG/10ML 59148007091 $232.5597/ml
CABOMETYX 20 MG 42388002426 $486.0625/tablet
CABOMETYX 40 MG 42388002526 $486.0625/tablet
CABOMETYX 60 MG 42388002326 $486.0625/tablet
CALCITRIOL 1 MCG/ML 00517013225 $5.0500/ml
CALCITRIOL 1 MCG/ML 17478083101 $6.8932/ml
CALCITRIOL 1 MCG/ML 17478093101 $6.8932/ml
CALCITRIOL 1 MCG/ML 63323073101 $6.0499/ml
CAMPTOSAR 300MG/15ML 00009752905 $12.6250/ml
CAPRELSA 100 MG 00310782030 $216.6652/tablet
CAPRELSA 300 MG 00310784030 $433.3301/tablet
CARBAGLU 200 MG 52276031205 $179.6346/tablet
CARBAGLU 200 MG 52276031260 $179.6339/tablet
CARBOPLATIN 150 MG 63323016721 $217.1500/each
CARIMUNE NF NANOFILTERED 12 G 44206041812 $1139.2800/each
CARIMUNE NF NANOFILTERED 6 G 44206041706 $569.6400/each
CARTICEL 12MM/0.4ML 58468102501 $33861.2600/each
CATHFLO ACTIVASE 2 MG 50242004163 $137.4307/each
CATHFLO ACTIVASE 2 MG 50242004164 $137.4307/each
CAYSTON 75 MG/ML 61958090101 $96.0967/ml
CELLCEPT 200 MG/ML 00004026129 $8.0984/ml
CELLCEPT 500 MG 00004029809 $100.0531/each
CEPROTIN 1000 UNIT 00944417510 $1.5150/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
CEPROTIN 1000 UNIT 00944417910 $1.5150/each
CEPROTIN 500 UNIT 00944417505 $1.5150/each
CEPROTIN 500 UNIT 00944417705 $1.5150/each
CERDELGA 84 MG 58468022001 $429.2500/capsule
CEREZYME 400 UNIT 58468466301 $1601.8600/each
CESAMET 1 MG 00037122150 $36.3931/capsule
CHENODAL 250 MG 45043087640 $477.7300/tablet
CHENODAL 250 MG 68974087640 $477.7300/tablet
CHOLBAM 250 MG 45043000202 $838.3000/capsule
CHOLBAM 50 MG 45043000102 $278.5917/capsule
CIMZIA 400 MG 50474070062 $3545.2515/each
CIMZIA 400MG/2ML 50474071079 $3545.2515/each
CIMZIA 400MG/2ML 50474071081 $3545.2515/each
CINQAIR 10 MG/ML 59310061031 $84.3350/ml
CINRYZE 500 (5 ML) 42227008105 $2705.2244/each
CISPLATIN 1 MG/ML 00703574711 $0.4070/ml
CISPLATIN 1 MG/ML 00703574811 $0.4070/ml
CISPLATIN 1 MG/ML 44567050901 $0.3787/ml
CISPLATIN 1 MG/ML 44567051001 $0.3030/ml
CISPLATIN 1 MG/ML 44567051101 $0.5050/ml
CISPLATIN 1 MG/ML 63323010351 $0.3646/ml
CISPLATIN 1 MG/ML 63323010364 $0.3646/ml
CISPLATIN 1 MG/ML 63323010365 $0.3646/ml
CISPLATIN 1 MG/ML 67457042410 $0.3434/ml
CISPLATIN 1 MG/ML 67457042551 $0.3434/ml
CISPLATIN 1 MG/ML 68001028324 $0.3535/ml
CISPLATIN 1 MG/ML 68001028327 $0.3535/ml
CISPLATIN 1 MG/ML 68001028332 $0.3535/ml
CISPLATIN 1 MG/ML 68001028333 $0.3535/ml
CLOLAR 20 MG/20ML 00024586001 $148.2049/ml
COAGADEX 250 (+/-) 64208775201 $7.8174/each
COAGADEX 250 (+/-) 64208775401 $7.8174/each
COAGADEX 500 (+/-) 64208775301 $7.8174/each
COAGADEX 500 (+/-) 64208775601 $7.8174/each
COMETRIQ 100 MG/DAY 42388001214 $255.2414/capsule
COMETRIQ 140 MG/DAY 42388001114 $127.6207/capsule
COMETRIQ 60 MG/DAY 42388001314 $170.1610/capsule
COMPLERA 200-25-300 61958110101 $84.4272/tablet
COPAXONE 20 MG/ML 68546031730 $221.9643/ml
COPAXONE 40 MG/ML 68546032506 $454.8547/ml
COPAXONE 40 MG/ML 68546032512 $454.8367/ml
CORIFACT 1000-1600 63833051802 $5.2900/each
CORTROSYN 0.25 MG 00548590000 $107.6458/each
COSENTYX (2 SYRINGES) 150 MG/ML 00078063998 $2052.6078/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
COSENTYX PEN 150 MG/ML 00078063968 $4105.2157/ml
COSENTYX PEN (2 PENS) 150 MG/ML 00078063941 $2052.6078/ml
COSENTYX SYRINGE 150 MG/ML 00078063997 $4105.2157/ml
COSMEGEN 0.5 MG 55292081155 $1240.9870/each
COSYNTROPIN 0.25 MG 00781344071 $81.0052/each
COSYNTROPIN 0.25 MG 00781344095 $81.0020/each
COSYNTROPIN 0.25 MG 67457022700 $89.0603/each
COSYNTROPIN 0.25 MG 67457022702 $89.0507/each
COSYNTROPIN 0.25 MG 67457025700 $81.0052/each
COSYNTROPIN 0.25 MG 67457025702 $81.0020/each
COTELLIC 20 MG 50242071701 $97.1806/tablet
CRESEMBA 372 MG 00469042099 $252.9343/each
CRIXIVAN 200 MG 00006057143 $1.2815/capsule
CRIXIVAN 400 MG 00006057362 $2.5630/capsule
CUBICIN 500 MG 67919001101 $449.9449/each
CUBICIN RF 500 MG 67919001201 $449.9449/each
CUBICIN RF 500 MG 67919001202 $449.9449/each
CUVITRU 1 G/5 ML 00944285001 $33.9360/ml
CUVITRU 1 G/5 ML 00944285002 $33.9373/ml
CUVITRU 2 G/10 ML 00944285003 $33.9360/ml
CUVITRU 2 G/10 ML 00944285004 $33.9373/ml
CUVITRU 4 G/20 ML 00944285005 $33.9360/ml
CUVITRU 4 G/20 ML 00944285006 $33.9373/ml
CUVITRU 8 G/40 ML 00944285007 $33.9360/ml
CUVITRU 8 G/40 ML 00944285008 $33.9373/ml
CUVPOSA 1 MG/5 ML 00259050116 $1.0666/ml
CYCLOPHOSPHAMIDE 1 G 00781324494 $665.8425/each
CYCLOPHOSPHAMIDE 1 G 10019093601 $577.0534/each
CYCLOPHOSPHAMIDE 1 G 10019093650 $577.0534/each
CYCLOPHOSPHAMIDE 1 G 10019093901 $574.9122/each
CYCLOPHOSPHAMIDE 1 G 10019093950 $574.9122/each
CYCLOPHOSPHAMIDE 1 G 10019094401 $574.9122/each
CYCLOPHOSPHAMIDE 1 G 10019094450 $574.9122/each
CYCLOPHOSPHAMIDE 1 G 10019095601 $739.8250/each
CYCLOPHOSPHAMIDE 1 G 10019095616 $739.8250/each
CYCLOPHOSPHAMIDE 2 G 00781325594 $1331.6850/each
CYCLOPHOSPHAMIDE 2 G 10019093701 $1154.1068/each
CYCLOPHOSPHAMIDE 2 G 10019093710 $1154.1068/each
CYCLOPHOSPHAMIDE 2 G 10019094201 $1149.8244/each
CYCLOPHOSPHAMIDE 2 G 10019094210 $1149.8244/each
CYCLOPHOSPHAMIDE 2 G 10019094501 $1149.8244/each
CYCLOPHOSPHAMIDE 2 G 10019094510 $1149.8244/each
CYCLOPHOSPHAMIDE 2 G 10019095701 $1479.6500/each
CYCLOPHOSPHAMIDE 2 G 10019095711 $1479.6500/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
CYCLOPHOSPHAMIDE 25 MG 00054038225 $7.5643/capsule
CYCLOPHOSPHAMIDE 50 MG 00054038325 $13.8824/capsule
CYCLOPHOSPHAMIDE 500 MG 00781323394 $332.9263/each
CYCLOPHOSPHAMIDE 500 MG 10019093501 $289.0620/each
CYCLOPHOSPHAMIDE 500 MG 10019093525 $289.0620/each
CYCLOPHOSPHAMIDE 500 MG 10019093801 $287.9914/each
CYCLOPHOSPHAMIDE 500 MG 10019093825 $287.9914/each
CYCLOPHOSPHAMIDE 500 MG 10019094301 $287.9914/each
CYCLOPHOSPHAMIDE 500 MG 10019094325 $287.9914/each
CYCLOPHOSPHAMIDE 500 MG 10019095501 $369.9125/each
CYCLOPHOSPHAMIDE 500 MG 10019095550 $369.9125/each
CYCLOSPORINE 100 MG 60505013400 $10.7245/capsule
CYCLOSPORINE 100 MG 68084092125 $9.4028/capsule
CYCLOSPORINE 100 MG 68084092195 $9.4032/capsule
CYCLOSPORINE 25 MG 60505013300 $2.6869/capsule
CYCLOSPORINE 25 MG 68084087925 $2.3876/capsule
CYCLOSPORINE 25 MG 68084087995 $2.0537/capsule
CYCLOSPORINE 250 MG/5ML 00574086610 $7.8994/ml
CYCLOSPORINE MODIFIED 50 MG 00093574165 $2.2203/capsule
CYCLOSPORINE MODIFIED 50 MG 00172731100 $2.3049/capsule
CYCLOSPORINE MODIFIED 50 MG 00172731146 $2.2203/capsule
CYRAMZA 100MG/10ML 00002766901 $108.2468/ml
CYRAMZA 500MG/50ML 00002767801 $108.2468/ml
CYSTADANE 1 G/1.7 ML 66621400001 $7.6207/gm Increase
CYSTAGON 150 MG 00378904501 $0.8242/capsule
CYSTAGON 150 MG 00378904505 $0.7830/capsule
CYSTAGON 50 MG 00378904001 $0.2828/capsule
CYSTAGON 50 MG 00378904005 $0.2687/capsule
CYSTARAN 0.44 % 54482002001 $87.6680/ml
CYTARABINE 100 MG/5ML 61703030538 $1.2625/ml
CYTARABINE 100 MG/5ML 67457045552 $0.9595/ml
CYTARABINE 20 MG/ML 61703030346 $0.5474/ml
CYTARABINE 20 MG/ML 61703030436 $0.6197/ml
CYTARABINE 20 MG/ML 67457045450 $0.4040/ml
CYTOGAM 50 MG/ML 44206053211 $25.9570/ml
DACARBAZINE 100 MG 63323012710 $9.5445/each
DACOGEN 50 MG 59148004670 $1728.1100/each
DACOGEN 50 MG 62856060001 $1728.1100/each
DAKLINZA 30 MG 00003021301 $757.5000/tablet
DAKLINZA 60 MG 00003021501 $757.5000/tablet
DAKLINZA 90 MG 00003001101 $757.5000/tablet
DALVANCE 500 MG 57970010001 $1504.9000/each
DAPTOMYCIN 500 MG 00703012501 $449.9045/each
DAPTOMYCIN 500 MG 63323087115 $424.2000/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
DARZALEX 100 MG/5ML 57894050205 $93.4452/ml
DARZALEX 400MG/20ML 57894050220 $93.4452/ml
DAUNORUBICIN HCL 20 MG 63323011908 $106.0500/each
DECITABINE 50 MG 00781313980 $1706.9000/each
DECITABINE 50 MG 43598034837 $1641.7045/each
DECITABINE 50 MG 43598042737 $1212.0000/each
DECITABINE 50 MG 47335036141 $1553.5315/each
DECITABINE 50 MG 55111055610 $1641.7045/each
DEFITELIO 80 MG/ML 68727080001 $333.3132/ml
DEFITELIO 80 MG/ML 68727080002 $333.3000/ml
DEPOCYT 50 MG/5 ML 57665033101 $581.3560/ml
DESCOVY 200MG-25MG 61958200201 $49.3701/tablet
DEXRAZOXANE 250 MG 67457020425 $277.0119/each
DEXRAZOXANE 250 MG 67457020725 $277.0026/each
DEXRAZOXANE 500 MG 67457020850 $553.9951/each
DEXRAZOXANE 500 MG 67457020950 $554.0154/each
DIBENZYLINE 10 MG 59212000101 $242.3798/capsule
DIBENZYLINE 10 MG 65197000101 $242.3798/capsule
DILUENT FOR EPOPROSTENOL 00703925809 $0.2376/ml
DILUENT FOR FLOLAN 00173051801 $0.2843/ml
DOCEFREZ 20 MG 47335028541 $271.4880/each
DOCEFREZ 80 MG 47335028641 $1086.0530/each
DOCETAXEL 160 MG/8ML 00955102208 $187.1656/ml Add
DOCETAXEL 160 MG/8ML 16729023165 $277.7500/ml
DOCETAXEL 160 MG/8ML 16729026765 $99.9900/ml
DOCETAXEL 160 MG/8ML 42367012129 $217.1500/ml
DOCETAXEL 160 MG/8ML 45963079056 $202.0000/ml
DOCETAXEL 160MG/16ML 00409020120 $83.2726/ml
DOCETAXEL 160MG/16ML 66758005003 $60.4485/ml
DOCETAXEL 160MG/16ML 66758095004 $60.4485/ml
DOCETAXEL 20 MG/2 ML 00069914111 $82.5978/ml
DOCETAXEL 20 MG/2 ML 00409020102 $84.0976/ml
DOCETAXEL 20 MG/2 ML 66758005001 $60.4485/ml
DOCETAXEL 20 MG/2 ML 66758095002 $60.4485/ml
DOCETAXEL 200MG/20ML 00069914411 $64.6400/ml
DOCETAXEL 20MG/ML(1) 00409036601 $99.9900/ml
DOCETAXEL 20MG/ML(1) 00703572001 $202.0000/ml
DOCETAXEL 20MG/ML(1) 00955102001 $374.3363/ml
DOCETAXEL 20MG/ML(1) 16714046501 $227.7853/ml
DOCETAXEL 20MG/ML(1) 16729023163 $277.7500/ml
DOCETAXEL 20MG/ML(1) 16729026763 $99.9900/ml
DOCETAXEL 20MG/ML(1) 42367012121 $217.1500/ml
DOCETAXEL 20MG/ML(1) 43598025811 $75.7500/ml
DOCETAXEL 20MG/ML(1) 45963073454 $202.0000/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
DOCETAXEL 20MG/ML(1) 63739093211 $260.5800/ml
DOCETAXEL 80 MG/4 ML 00409036701 $99.9900/ml
DOCETAXEL 80 MG/4 ML 00703573001 $202.0000/ml
DOCETAXEL 80 MG/4 ML 00955102104 $374.3312/ml
DOCETAXEL 80 MG/4 ML 16714050001 $227.7146/ml
DOCETAXEL 80 MG/4 ML 16729023164 $277.7500/ml
DOCETAXEL 80 MG/4 ML 16729026764 $99.9900/ml
DOCETAXEL 80 MG/4 ML 42367012125 $217.1500/ml
DOCETAXEL 80 MG/4 ML 43598025940 $75.7500/ml
DOCETAXEL 80 MG/4 ML 45963073452 $202.0000/ml
DOCETAXEL 80 MG/4 ML 63739097117 $260.2543/ml
DOCETAXEL 80 MG/8 ML 00069914211 $72.9914/ml
DOCETAXEL 80 MG/8 ML 00409020110 $84.1115/ml
DOCETAXEL 80 MG/8 ML 66758005002 $60.4485/ml
DOCETAXEL 80 MG/8 ML 66758095003 $60.4485/ml
DOXIL 2 MG/ML 59676096001 $108.8679/ml
DOXIL 2 MG/ML 59676096002 $108.8679/ml
DOXORUBICIN HCL 10 MG 67457047810 $53.1361/each
DOXORUBICIN HCL 50 MG 67457043650 $265.6603/each
DOXORUBICIN HCL LIPOSOME 2 MG/ML 47335004940 $97.8690/ml
DOXORUBICIN HCL LIPOSOME 2 MG/ML 47335005040 $97.8710/ml
DUOPA 4.63-20/ML 00074301207 $2.0386/ml
DYSPORT 300 UNIT 15054053006 $462.5800/each
DYSPORT 500 UNIT 15054050001 $770.6300/each
EDURANT 25 MG 59676027801 $30.1640/tablet
ELAPRASE 6 MG/3 ML 54092070001 $1015.1241/ml
ELELYSO 200 UNIT 00069010601 $787.2445/each
ELIGARD 22.5 MG 62935022305 $1368.6207/each
ELIGARD 30 MG 62935030230 $1824.8276/each
ELIGARD 30 MG 62935030330 $1826.8476/each
ELIGARD 45 MG 62935045245 $2737.2313/each Delete
ELIGARD 45 MG 62935045345 $2737.2313/each
ELIGARD 7.5 MG 62935075375 $456.2069/each
ELITEK 1.5 MG 00024515010 $776.4409/each
ELITEK 7.5 MG 00024515175 $3882.2784/each
ELOCTATE 1000 UNIT 64406080401 $1.6576/each
ELOCTATE 1500 UNIT 64406080501 $1.6576/each
ELOCTATE 2000 UNIT 64406080601 $1.6576/each
ELOCTATE 250 UNIT 64406080101 $1.6576/each
ELOCTATE 3000 UNIT 64406080701 $1.6576/each
ELOCTATE 500 UNIT 64406080201 $1.6576/each
ELOCTATE 750 UNIT 64406080301 $1.6576/each
EMCYT 140 MG 00013013202 $12.3540/capsule
EMPLICITI 300 MG 00003229111 $1793.7600/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
EMPLICITI 400 MG 00003452211 $2391.6800/each
EMTRIVA 10 MG/ML 61958060201 $0.7527/ml
EMTRIVA 200 MG 61958060101 $18.0628/capsule
ENBREL 25 MG 58406042534 $517.3422/each
ENBREL 25 MG 58406042541 $517.3422/each
ENBREL 25MG/0.5ML 58406045501 $1014.3965/ml
ENBREL 25MG/0.5ML 58406045504 $1014.3965/ml
ENBREL 50 MG/ML 58406043501 $1055.8004/ml
ENBREL 50 MG/ML 58406043504 $1055.8004/ml
ENBREL 50 MG/ML 58406044501 $1055.8004/ml
ENBREL 50 MG/ML 58406044504 $1055.8004/ml
ENOXAPARIN SODIUM 100 MG/ML 00548560500 $55.5500/ml
ENOXAPARIN SODIUM 100 MG/ML 00548563500 $55.5500/ml
ENOXAPARIN SODIUM 100 MG/ML 00703858021 $44.4400/ml
ENOXAPARIN SODIUM 100 MG/ML 00703858023 $20.0788/ml
ENOXAPARIN SODIUM 100 MG/ML 00781350005 $68.4125/ml
ENOXAPARIN SODIUM 100 MG/ML 00781350069 $44.4400/ml
ENOXAPARIN SODIUM 100 MG/ML 00955101010 $75.1703/ml
ENOXAPARIN SODIUM 100 MG/ML 62037086320 $55.5500/ml
ENOXAPARIN SODIUM 100 MG/ML 63323056884 $20.0788/ml
ENOXAPARIN SODIUM 100 MG/ML 63323056895 $10.1404/ml
ENOXAPARIN SODIUM 120MG/.8ML 00548560600 $83.3250/ml
ENOXAPARIN SODIUM 120MG/.8ML 00548563600 $83.3250/ml
ENOXAPARIN SODIUM 120MG/.8ML 00703861021 $66.6600/ml
ENOXAPARIN SODIUM 120MG/.8ML 00703861023 $30.1106/ml
ENOXAPARIN SODIUM 120MG/.8ML 00781361204 $102.6548/ml
ENOXAPARIN SODIUM 120MG/.8ML 00781361268 $66.6600/ml
ENOXAPARIN SODIUM 120MG/.8ML 00955101210 $112.7918/ml
ENOXAPARIN SODIUM 120MG/.8ML 62037086420 $83.3250/ml
ENOXAPARIN SODIUM 120MG/.8ML 63323056990 $30.1106/ml
ENOXAPARIN SODIUM 120MG/.8ML 63323056999 $15.2131/ml
ENOXAPARIN SODIUM 150 MG/ML 00548560700 $83.3250/ml
ENOXAPARIN SODIUM 150 MG/ML 00548563700 $83.3250/ml
ENOXAPARIN SODIUM 150 MG/ML 00703851021 $66.6600/ml
ENOXAPARIN SODIUM 150 MG/ML 00703851023 $30.1081/ml
ENOXAPARIN SODIUM 150 MG/ML 00781365505 $102.6605/ml
ENOXAPARIN SODIUM 150 MG/ML 00781365569 $66.6600/ml
ENOXAPARIN SODIUM 150 MG/ML 00955101510 $112.7928/ml
ENOXAPARIN SODIUM 150 MG/ML 62037086620 $83.3250/ml
ENOXAPARIN SODIUM 150 MG/ML 63323056984 $30.1081/ml
ENOXAPARIN SODIUM 150 MG/ML 63323056995 $15.2106/ml
ENOXAPARIN SODIUM 300MG/3ML 00781312293 $68.3366/ml
ENOXAPARIN SODIUM 300MG/3ML 00955101601 $75.0868/ml
ENOXAPARIN SODIUM 300MG/3ML 63323056586 $23.7081/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ENOXAPARIN SODIUM 300MG/3ML 63323056593 $11.9719/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00548560100 $55.5500/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00548563100 $55.5500/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00703853021 $44.4400/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00703853023 $20.0990/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00781313301 $68.3292/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00781313363 $44.4400/ml
ENOXAPARIN SODIUM 30MG/0.3ML 00955100310 $75.0868/ml
ENOXAPARIN SODIUM 30MG/0.3ML 62037083920 $55.5500/ml
ENOXAPARIN SODIUM 30MG/0.3ML 63323056883 $20.0990/ml
ENOXAPARIN SODIUM 30MG/0.3ML 63323056894 $10.1337/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00548560200 $55.5500/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00548563200 $55.5500/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00703854021 $44.4400/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00703854023 $20.0485/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00781322402 $68.3292/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00781322464 $44.4400/ml
ENOXAPARIN SODIUM 40MG/0.4ML 00955100410 $75.0809/ml
ENOXAPARIN SODIUM 40MG/0.4ML 62037084920 $55.5500/ml
ENOXAPARIN SODIUM 40MG/0.4ML 63323056887 $20.0485/ml
ENOXAPARIN SODIUM 40MG/0.4ML 63323056896 $10.1253/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00548560300 $55.5500/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00548563300 $55.5500/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00703856021 $44.4400/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00703856023 $20.0822/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00781335603 $68.4162/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00781335666 $44.4400/ml
ENOXAPARIN SODIUM 60MG/0.6ML 00955100610 $75.1709/ml
ENOXAPARIN SODIUM 60MG/0.6ML 62037086120 $55.5500/ml
ENOXAPARIN SODIUM 60MG/0.6ML 63323056888 $20.0822/ml
ENOXAPARIN SODIUM 60MG/0.6ML 63323056898 $10.1337/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00548560400 $55.5500/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00548563400 $55.5500/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00703868021 $44.4400/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00703868023 $20.0738/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00781342804 $68.4144/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00781342868 $52.0150/ml
ENOXAPARIN SODIUM 80MG/0.8ML 00955100810 $75.1718/ml
ENOXAPARIN SODIUM 80MG/0.8ML 62037086220 $55.5500/ml
ENOXAPARIN SODIUM 80MG/0.8ML 63323056890 $20.0738/ml
ENOXAPARIN SODIUM 80MG/0.8ML 63323056899 $10.1379/ml
ENTYVIO 300 MG 64764030020 $5264.3523/each
ENVARSUS XR 0.75 MG 68992307501 $3.6284/tablet
ENVARSUS XR 0.75 MG 68992307503 $3.6286/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ENVARSUS XR 1 MG 68992301001 $4.8379/tablet
ENVARSUS XR 1 MG 68992301003 $4.8379/tablet
ENVARSUS XR 4 MG 68992304001 $19.3516/tablet
ENVARSUS XR 4 MG 68992304003 $19.3516/tablet
EPCLUSA 400-100 MG 61958220101 $898.9000/tablet
EPINEPHRINE 0.3MG/0.3 54505010201 $199.5760/each
EPINEPHRINE 0.3MG/0.3 54505010202 $199.5810/each
EPIPEN 2-PAK 0.3MG/0.3 49502050002 $307.3480/each
EPIPEN JR 2-PAK 0.15MG/0.3 49502050102 $307.3480/each
EPIRUBICIN HCL 200 MG 61703034859 $2395.2554/each
EPIVIR 10 MG/ML 49702020548 $0.4666/ml
EPIVIR 150 MG 49702020318 $6.9983/tablet
EPIVIR 300 MG 49702020413 $13.9966/tablet
EPIVIR HBV 25 MG/5 ML 00173066300 $0.7533/ml
EPOGEN 10000/ML 55513014401 $161.1758/ml
EPOGEN 10000/ML 55513014410 $161.1708/ml
EPOGEN 2000/ML 55513012601 $32.2392/ml
EPOGEN 2000/ML 55513012610 $32.2342/ml
EPOGEN 20000/2ML 55513028301 $161.1708/ml
EPOGEN 20000/2ML 55513028310 $161.1708/ml
EPOGEN 20000/ML 55513047801 $322.3415/ml
EPOGEN 20000/ML 55513047810 $322.3415/ml
EPOGEN 3000/ML 55513026701 $48.3487/ml
EPOGEN 3000/ML 55513026710 $48.3487/ml
EPOGEN 4000/ML 55513014801 $64.4683/ml
EPOGEN 4000/ML 55513014810 $64.4683/ml
EPOPROSTENOL SODIUM 0.5 MG 00703198501 $16.3620/each
EPOPROSTENOL SODIUM 1.5 MG 00703199501 $39.5112/each
EPZICOM 600-300MG 49702020613 $43.4876/tablet
ERBITUX 100MG/50ML 66733094823 $11.3049/ml
ERBITUX 200MG/0.1L 66733095823 $11.3049/ml
ERIVEDGE 150 MG 50242014001 $369.8981/capsule
ERWINAZE 10000 UNIT 57902024901 $3837.4546/each
ERWINAZE 10000 UNIT 57902024905 $3837.4546/each
ESBRIET 267 MG 50242012101 $30.6367/capsule
ESBRIET 267 MG 64116012101 $30.6367/capsule
ETHYOL 500 MG 66220001703 $1005.4550/each
ETOPOPHOS 100 MG 00015340420 $142.3494/each
EVOMELA 50 MG 68152010900 $2531.4337/each
EVOTAZ 300-150 MG 00003364111 $50.9912/tablet
EXJADE 125 MG 00078046815 $33.4110/tablet
EXJADE 250 MG 00078046915 $66.8210/tablet
EXJADE 500 MG 00078047015 $133.6392/tablet
EXONDYS 51 100 MG/2ML 60923036302 $808.0000/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
EXONDYS 51 500MG/10ML 60923028410 $808.0000/ml
EXTAVIA 0.3 MG 00078056912 $374.2528/each
EXTAVIA 0.3 MG 00078056961 $374.2656/each
EXTAVIA 0.3 MG 00078056999 $374.2656/each
EYLEA 2MG/0.05ML 61755000502 $37370.0000/ml
FABRAZYME 35 MG 58468004001 $5719.6300/each Increase
FABRAZYME 5 MG 58468004101 $817.0900/each Increase
FARESTON 60 MG 42747032730 $40.0616/tablet
FARYDAK 10 MG 00078065006 $1234.4456/capsule
FARYDAK 15 MG 00078065106 $1234.4456/capsule
FARYDAK 20 MG 00078065206 $1234.4456/capsule
FASLODEX 250 MG/5ML 00310072010 $188.2074/ml
FEIBA NF 1750-3250 64193042502 $1.5120/each
FEIBA NF 400-650 64193042302 $1.5120/each
FEIBA NF 651-1200 64193042402 $1.5120/each
FERAHEME 510MG/17ML 59338077501 $41.7029/ml
FERAHEME 510MG/17ML 59338077510 $41.7029/ml
FERRIPROX 100 MG/ML 52609450207 $10.2447/ml
FERRIPROX 500 MG 52609000601 $51.2233/tablet
FIRAZYR 30 MG/3 ML 54092070202 $3178.3959/ml
FIRAZYR 30 MG/3 ML 54092070203 $3178.3948/ml
FIRMAGON 120 MG 55566840301 $769.7109/each
FIRMAGON 80 MG 55566830301 $493.3345/each
FLEBOGAMMA DIF 10 % 61953000501 $8.9108/ml Increase
FLEBOGAMMA DIF 10 % 61953000502 $8.9107/ml Increase
FLEBOGAMMA DIF 10 % 61953000503 $8.9108/ml Increase
FLEBOGAMMA DIF 10 % 61953000504 $8.9112/ml Increase
FLEBOGAMMA DIF 10 % 61953000505 $8.9111/ml Increase
FLEBOGAMMA DIF 10 % 61953000506 $8.9111/ml Increase
FLEBOGAMMA DIF 5 % 61953000400 $4.4556/ml Increase
FLEBOGAMMA DIF 5 % 61953000401 $4.4561/ml Increase
FLEBOGAMMA DIF 5 % 61953000402 $4.4555/ml Increase
FLEBOGAMMA DIF 5 % 61953000403 $4.4554/ml Increase
FLEBOGAMMA DIF 5 % 61953000404 $4.4554/ml Increase
FLEBOGAMMA DIF 5 % 61953000405 $4.4554/ml Increase
FLEBOGAMMA DIF 5 % 61953000406 $4.4560/ml Increase
FLEBOGAMMA DIF 5 % 61953000407 $4.4556/ml Increase
FLEBOGAMMA DIF 5 % 61953000408 $4.4556/ml Increase
FLEBOGAMMA DIF 5 % 61953000409 $4.4555/ml Increase
FLOLAN 0.5 MG 00173051700 $18.8769/each
FLOLAN 1.5 MG 00173051900 $45.5914/each
FLOXURIDINE 500 MG 63323014507 $120.1900/each
FLUCYTOSINE 250 MG 64980017901 $66.3118/capsule
FLUCYTOSINE 500 MG 64980018001 $128.3104/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
FLUOROURACIL 1 G/20 ML 16729027605 $1.2074/ml
FLUOROURACIL 1 G/20 ML 16729027667 $1.1590/ml
FLUOROURACIL 1 G/20 ML 63323011720 $0.3030/ml
FLUOROURACIL 1 G/20 ML 63323011728 $0.2803/ml
FLUOROURACIL 1 G/20 ML 68001026629 $1.1590/ml
FLUOROURACIL 1 G/20 ML 68001026631 $1.1590/ml
FLUTAMIDE 125 MG 00172496058 $3.5363/capsule
FLUTAMIDE 125 MG 00172496070 $3.5226/capsule
FLUTAMIDE 125 MG 00591246618 $1.5653/capsule
FLUTAMIDE 125 MG 49884075313 $1.5849/capsule
FOLOTYN 20MG/ML(1) 48818000101 $4548.4037/ml
FOLOTYN 40 MG/2 ML 48818000102 $4548.4037/ml
FORTEO 20MCG/DOSE 00002840001 $1147.9660/ml Increase
FRAGMIN 10000/ML 00069021701 $82.9074/ml
FRAGMIN 10000/ML 00069021702 $82.8958/ml
FRAGMIN 12500/0.5 00069022001 $207.2602/ml
FRAGMIN 12500/0.5 00069022002 $207.2540/ml
FRAGMIN 15000/0.6 00069022301 $207.2406/ml
FRAGMIN 15000/0.6 00069022302 $207.2419/ml
FRAGMIN 15000/0.6 62856015010 $179.0292/ml
FRAGMIN 18000/0.72 00069022801 $207.2569/ml
FRAGMIN 18000/0.72 00069022802 $207.2408/ml
FRAGMIN 2500/0.2ML 00069019501 $127.7701/ml
FRAGMIN 2500/0.2ML 00069019502 $127.7398/ml
FRAGMIN 25000/ML 00069023201 $187.5065/ml
FRAGMIN 5000/0.2ML 00069019601 $207.2686/ml
FRAGMIN 5000/0.2ML 00069019602 $207.2419/ml
FRAGMIN 7500/0.3ML 00069020601 $207.2546/ml
FRAGMIN 7500/0.3ML 00069020602 $207.2621/ml
FUSILEV 50 MG 68152010100 $230.2800/each
FUZEON 90 MG 00004038140 $57.4828/each
GABLOFEN 10000/20ML 45945015501 $11.6655/ml
GABLOFEN 10000/20ML 45945015502 $10.8575/ml
GABLOFEN 20K MCG/20 45945015601 $23.3310/ml
GABLOFEN 20K MCG/20 45945015602 $21.7150/ml
GABLOFEN 40000/20ML 45945015701 $46.7125/ml
GABLOFEN 40000/20ML 45945015702 $43.4300/ml
GABLOFEN 50 MCG/ML 45945015101 $80.8000/ml
GAMMAGARD LIQUID 10 % 00944270002 $13.1936/ml
GAMMAGARD LIQUID 10 % 00944270003 $13.1938/ml
GAMMAGARD LIQUID 10 % 00944270004 $13.1936/ml
GAMMAGARD LIQUID 10 % 00944270005 $13.1936/ml
GAMMAGARD LIQUID 10 % 00944270006 $13.1936/ml
GAMMAGARD LIQUID 10 % 00944270007 $13.1936/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
GAMMAGARD S-D 10 G 00944265804 $1703.8700/each
GAMMAGARD S-D 5 G 00944265603 $851.9350/each
GAMMAKED 1 G/10 ML 76125090001 $12.1806/ml
GAMMAKED 10 G/100ML 76125090010 $12.1805/ml
GAMMAKED 2.5G/25ML 76125090025 $12.1802/ml
GAMMAKED 20 G/200ML 76125090020 $12.1804/ml
GAMMAKED 5 G/50 ML 76125090050 $12.1804/ml
GAMMAPLEX 5 % 64208823402 $6.8150/ml
GAMMAPLEX 5 % 64208823403 $6.8150/ml
GAMMAPLEX 5 % 64208823404 $6.8150/ml
GAMMAPLEX 5 % 64208823406 $6.8150/ml
GAMMAPLEX 5 % 64208823407 $6.8150/ml
GAMMAPLEX 5 % 64208823408 $6.8150/ml
GAMUNEX-C 1 G/10 ML 13533080012 $10.6565/ml Increase
GAMUNEX-C 1 G/10 ML 13533080013 $10.6568/ml Increase
GAMUNEX-C 10 G/100ML 13533080071 $10.6567/ml Increase
GAMUNEX-C 10 G/100ML 13533080072 $10.6571/ml Increase
GAMUNEX-C 2.5G/25ML 13533080015 $10.6571/ml Increase
GAMUNEX-C 2.5G/25ML 13533080016 $10.6576/ml Increase
GAMUNEX-C 20 G/200ML 13533080024 $10.6567/ml Increase
GAMUNEX-C 20 G/200ML 13533080025 $10.6571/ml Increase
GAMUNEX-C 40 G/400ML 13533080040 $10.6567/ml Increase
GAMUNEX-C 40 G/400ML 13533080041 $10.6572/ml Increase
GAMUNEX-C 5 G/50 ML 13533080020 $10.6567/ml Increase
GAMUNEX-C 5 G/50 ML 13533080021 $10.6571/ml Increase
GATTEX 5 MG 68875010201 $33246.6750/each
GATTEX 5 MG 68875010301 $1274.7210/each
GAZYVA 1000 MG/40 50242007001 $141.3371/ml
GEMCITABINE HCL 1 G/26.3ML 00409018101 $1.7139/ml
GEMCITABINE HCL 1 G/26.3ML 00409018125 $1.7139/ml
GEMCITABINE HCL 1 G/26.3ML 45963062458 $1.7139/ml
GEMCITABINE HCL 2 G/52.6ML 00409018201 $1.9153/ml
GEMCITABINE HCL 2 G/52.6ML 00409018225 $1.7185/ml
GEMCITABINE HCL 2 G/52.6ML 45963063660 $1.7139/ml
GEMCITABINE HCL 200MG/5.26 00409018301 $1.7147/ml
GEMCITABINE HCL 200MG/5.26 00409018325 $1.7147/ml
GEMCITABINE HCL 200MG/5.26 45963062357 $1.7147/ml
GENGRAF 50 MG 00074054130 $3.5377/capsule
GENOTROPIN 0.2MG/0.25 00013264902 $22.9111/each
GENOTROPIN 0.4MG/0.25 00013265002 $45.8280/each
GENOTROPIN 0.6MG/0.25 00013265102 $68.7392/each
GENOTROPIN 0.8MG/0.25 00013265202 $91.6503/each
GENOTROPIN 1.2MG/0.25 00013265402 $137.4798/each
GENOTROPIN 1.4MG/0.25 00013265502 $160.3894/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
GENOTROPIN 1.6MG/0.25 00013265602 $183.2991/each
GENOTROPIN 1.8MG/0.25 00013265702 $206.2189/each
GENOTROPIN 12 MG/ML 00013264681 $1261.3183/each
GENOTROPIN 1MG/0.25ML 00013265302 $114.5686/each
GENOTROPIN 2MG/0.25ML 00013265802 $229.1286/each
GENOTROPIN 5 MG/ML 00013262681 $525.5333/each
GENVOYA 150-200-10 61958190101 $86.7812/tablet
GEODON FNL 20MG/1 00049392020 $38.2805/each
GEODON FNL 20MG/1 00049392083 $38.2800/each
GILENYA 0.5 MG 00078060715 $227.0231/capsule
GILENYA 0.5 MG 00078060751 $196.3177/capsule Delete
GILOTRIF 20 MG 00597014130 $254.2072/tablet
GILOTRIF 30 MG 00597013730 $254.2072/tablet
GILOTRIF 40 MG 00597013830 $254.2072/tablet
GLASSIA 1 G/50 ML 00944288401 $0.5252/each
GLATOPA 20 MG/ML 00781323434 $174.8620/ml
GLEOSTINE 10 MG 58181304005 $43.5573/capsule
GLEOSTINE 100 MG 58181304205 $435.5120/capsule
GLEOSTINE 40 MG 58181304105 $174.2250/capsule
GLEOSTINE 5 MG 58181304305 $26.3509/capsule
GLIADEL 7.7-192.3 24338005008 $3665.6056/each
GRANIX 300MCG/0.5 63459091011 $504.7172/ml
GRANIX 300MCG/0.5 63459091015 $504.7233/ml
GRANIX 300MCG/0.5 63459091017 $581.9216/ml
GRANIX 300MCG/0.5 63459091036 $581.9216/ml
GRANIX 480MCG/0.8 63459091211 $504.8611/ml
GRANIX 480MCG/0.8 63459091212 $504.8748/ml
GRANIX 480MCG/0.8 63459091215 $504.8548/ml
GRANIX 480MCG/0.8 63459091217 $579.1214/ml
GRANIX 480MCG/0.8 63459091236 $579.1214/ml
GRASTEK 2800 UNIT 00006422930 $8.9991/tablet
H.P. ACTHAR 80 UNIT/ML 63004871001 $6874.8680/ml
HARVONI 90MG-400MG 61958180101 $1136.2500/tablet
HELIXATE FS 1000 (+/-) 00053813302 $1.0000/each
HELIXATE FS 2000 (+/-) 00053813402 $1.0000/each
HELIXATE FS 250 (+/-) 00053813102 $1.0000/each
HELIXATE FS 3000 (+/-) 00053813502 $1.0000/each
HELIXATE FS 500 (+/-) 00053813202 $1.0000/each
HEMOFIL M 1501-2000 00944394602 $0.9400/each
HEMOFIL M 220-400 00944394002 $0.9400/each
HEMOFIL M 401-800 00944394202 $0.9400/each
HEMOFIL M 801-1500 00944394402 $0.9400/each
HEPAGAM B >312/ML(5) 53270005101 $141.2687/ml
HEPAGAM B >312/ML(5) 53270005401 $129.2800/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
HEPAGAM B >312/ML 53270005201 $161.3980/ml
HEPAGAM B >312/ML 53270005301 $147.7024/ml
HEPSERA 10 MG 61958050101 $41.6874/tablet
HERCEPTIN 440 MG 50242005656 $9.3235/mg
HERCEPTIN 440 MG 50242013468 $9.3231/mg
HETLIOZ 20 MG 43068022001 $415.7793/capsule
HEXALEN 50 MG 62856000110 $16.0590/capsule
HIZENTRA 1 G/5 ML 44206045101 $33.9360/ml
HIZENTRA 10 G/50 ML 44206045510 $33.9360/ml
HIZENTRA 2 G/10 ML 44206045202 $33.9360/ml
HIZENTRA 4 G/20 ML 44206045404 $33.9360/ml
HUMATE-P 1000-2400 63833061702 $0.9100/each
HUMATE-P 250-600 63833061502 $0.9100/each
HUMATE-P 500-1200 63833061602 $0.9100/each
HUMATROPE 12 MG 00002814801 $1275.0240/each
HUMATROPE 24 MG 00002814901 $2550.0480/each
HUMATROPE 5 MG 00002733511 $531.2600/each
HUMATROPE 5 MG 00002734901 $531.2600/each
HUMATROPE 6 MG 00002814701 $637.5120/each
HUMIRA 10MG/0.2ML 00074634702 $2069.0204/each Increase
HUMIRA 20MG/0.4ML 00074937402 $2069.0204/each Increase
HUMIRA 40MG/0.8ML 00074379902 $2069.0204/each Increase
HUMIRA PEDIATRIC CROHN'S 40MG/0.8ML 00074379903 $2069.0288/each
HUMIRA PEDIATRIC CROHN'S 40MG/0.8ML 00074379906 $2069.0271/each
HUMIRA PEN 40MG/0.8ML 00074433902 $2069.0204/each Increase
HUMIRA PEN CROHN-UC-HS STARTER 40MG/0.8ML 00074433906 $2069.0271/each
HUMIRA PEN PSORIASIS-UVEITIS 40MG/0.8ML 00074433907 $2069.0229/each
HYCAMTIN 0.25 MG 00007420511 $101.4979/capsule
HYCAMTIN 1 MG 00007420711 $405.9847/capsule Increase
HYPERHEP B S-D 110/0.5ML 13533063603 $178.6690/ml
HYPERHEP B S-D 220 UNIT/1 13533063601 $168.4579/ml
HYPERHEP B S-D 220 UNIT/1 13533063602 $168.4579/ml
HYPERHEP B S-D 220/ML (5) 13533063605 $161.6465/ml
HYPERRAB S-D 150 UNIT/1 13533061802 $333.4060/ml
HYPERRAB S-D 150 UNIT/1 13533061810 $304.3504/ml
HYPERRAB S-D 150 UNIT/1 13533061811 $304.3621/ml
HYPERRAB S-D 150 UNIT/1 13533061820 $333.4184/ml
HYPERRHO S-D 1500 UNIT 13533063102 $80.2849/each
HYPERRHO S-D 1500 UNIT 13533063110 $76.2752/each
HYPERRHO S-D 1500 UNIT 13533063120 $80.2898/each
HYPERRHO S-D 250 UNIT 13533066106 $29.2395/each
HYPERRHO S-D 250 UNIT 13533066160 $30.9363/each
HYQVIA 10 G/100ML 00944251202 $17.7952/ml
HYQVIA 2.5G/25ML 00944251002 $17.7952/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
HYQVIA 20 G/200ML 00944251302 $17.7952/ml
HYQVIA 30 G/300ML 00944251402 $17.7952/ml
HYQVIA 5 G/50 ML 00944251102 $17.7952/ml
IBANDRONATE SODIUM 3 MG/3 ML 62756021840 $141.7367/ml
IBRANCE 100 MG 00069018821 $497.4250/capsule
IBRANCE 125 MG 00069018921 $497.4250/capsule
IBRANCE 75 MG 00069018721 $497.4250/capsule
ICLUSIG 15 MG 76189053530 $557.5537/tablet
ICLUSIG 45 MG 76189053430 $557.5537/tablet
IDELVION 1000 (+/-) 69911086602 $3.7000/each
IDELVION 2000 (+/-) 69911086702 $3.7000/each
IDELVION 250 (+/-) 69911086402 $3.7000/each
IDELVION 500 (+/-) 69911086502 $3.7000/each
IFOSFAMIDE 1 G/20 ML 00703342711 $1.8554/ml
IFOSFAMIDE 1 G/20 ML 63323017420 $2.9315/ml
IFOSFAMIDE 1 G/20 ML 67457042920 $2.9290/ml
IFOSFAMIDE 1 G/20 ML 67457060920 $2.9290/ml
IFOSFAMIDE 3G/60ML 00703342911 $1.8103/ml
IFOSFAMIDE 3G/60ML 63323017460 $2.9315/ml
IFOSFAMIDE 3G/60ML 67457044360 $2.9290/ml
IFOSFAMIDE-MESNA 1G-1G 00703410048 $636.3000/each
IFOSFAMIDE-MESNA 1G-1G 00703410058 $1010.0000/each
IFOSFAMIDE-MESNA 3G-1G 00703410068 $945.3600/each
ILARIS 180 MG/1.2 00078058261 $16215.5601/each
ILUVIEN 0.19 MG 68611019002 $8888.0000/each
IMBRUVICA 140 MG 57962014009 $114.9442/capsule
IMBRUVICA 140 MG 57962014012 $114.9441/capsule
IMLYGIC 10EXP6/ML 55513007801 $44.4400/ml
IMLYGIC 10EXP8/ML 55513007901 $4444.0000/ml
IMOGAM RABIES-HT 150 UNIT/1 49281019020 $334.7544/ml
INCRELEX 10 MG/ML 15054104005 $848.9808/ml
INFED 100 MG/2ML 52544093102 $12.1478/ml
INFED 100 MG/2ML 52544093107 $12.1499/ml
INFLECTRA 100 MG 00069080901 $955.7428/each
INLYTA 1 MG 00069014501 $70.2943/tablet
INLYTA 5 MG 00069015111 $210.8828/tablet
INTELENCE 100 MG 59676057001 $9.1746/tablet
INTELENCE 200 MG 59676057101 $18.3492/tablet
INTELENCE 25 MG 59676057201 $2.2936/tablet
INTRON A 10MM UNIT 00085057102 $242.3899/each Delete
INTRON A 10MM UNIT 00085435001 $256.9440/each
INTRON A 10MM/ML 00085113301 $258.3391/ml
INTRON A 18MM UNIT 00085435101 $462.4992/each
INTRON A 50MM UNIT 00085435201 $1285.2250/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
INTRON A 6MMUNIT/ML 00085116801 $156.6351/ml
INVEGA SUSTENNA 117MG/0.75 50458056201 $1474.7077/ml
INVEGA SUSTENNA 156 MG/ML 50458056301 $1474.7717/ml
INVEGA SUSTENNA 234MG/1.5 50458056401 $1474.7347/ml
INVEGA SUSTENNA 39MG/0.25 50458056001 $1474.6000/ml
INVEGA SUSTENNA 78MG/0.5ML 50458056101 $1474.7010/ml
INVEGA TRINZA 273MG/.875 50458060601 $2528.0935/ml
INVEGA TRINZA 410/1.315 50458060701 $2523.2719/ml
INVEGA TRINZA 546MG/1.75 50458060801 $2528.1685/ml
INVEGA TRINZA 819/2.625 50458060901 $2528.1127/ml
INVIRASE 200 MG 00004024515 $4.1895/capsule
INVIRASE 500 MG 00004024451 $9.6330/tablet
IPRIVASK 15 MG 00187001110 $227.2500/each
IRESSA 250 MG 00310048230 $243.6120/tablet
IRINOTECAN HCL 500MG/25ML 61703034936 $5.8588/ml
ISENTRESS 100 MG 00006047761 $5.4190/tablet
ISENTRESS 100 MG 00006360301 $5.4191/each
ISENTRESS 100 MG 00006360360 $5.4190/each
ISENTRESS 25 MG 00006047361 $1.3549/tablet
ISENTRESS 400 MG 00006022761 $21.6739/tablet
ISTODAX 10 MG/2 ML 59572098301 $2956.4821/each
ISTODAX 10 MG/2 ML 59572098401 $3045.1803/each
IXEMPRA 15 MG 00015191012 $1135.0784/each
IXEMPRA 15 MG 70020191001 $1135.0784/each
IXEMPRA 45 MG 00015191113 $3405.2453/each
IXEMPRA 45 MG 70020191101 $3405.2453/each
IXINITY 1000 UNIT 53270027105 $1.4948/each
IXINITY 1000 UNIT 53270027106 $1.4948/each
IXINITY 1500 UNIT 53270027205 $1.4948/each
IXINITY 1500 UNIT 53270027206 $1.4948/each
IXINITY 500 UNIT 53270027005 $1.4948/each
JADENU 180 MG 00078065515 $66.8210/tablet
JADENU 360 MG 00078065615 $133.6392/tablet
JADENU 90 MG 00078065415 $33.4110/tablet
JAKAFI 10 MG 50881001060 $183.5507/tablet
JAKAFI 15 MG 50881001560 $183.5507/tablet
JAKAFI 20 MG 50881002060 $183.5507/tablet
JAKAFI 25 MG 50881002560 $183.5507/tablet
JAKAFI 5 MG 50881000560 $183.5507/tablet
JETREA 0.5 MG/0.2 24856000100 $19947.5000/ml
JEVTANA FDN10MG/ML 00024582411 $6558.1320/ml
JUXTAPID 10 MG 76431011001 $1103.3889/capsule
JUXTAPID 20 MG 76431012001 $1103.3889/capsule
JUXTAPID 30 MG 76431013001 $1103.3889/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
JUXTAPID 40 MG 76431014001 $1103.3889/capsule
JUXTAPID 5 MG 76431010501 $1103.3889/capsule
JUXTAPID 60 MG 76431016001 $1103.3889/capsule
KADCYLA 100 MG 50242008801 $2843.3217/each
KADCYLA 160 MG 50242008701 $4549.3127/each
KALBITOR 10MG/ML(1) 47783010101 $4250.2820/ml
KALETRA 100MG-25MG 00074052260 $3.8796/tablet
KALETRA 200MG-50MG 00074679922 $7.7594/tablet
KALETRA 400-100/5 00074395646 $2.9097/ml
KALYDECO 150 MG 51167020001 $430.9838/tablet
KALYDECO 150 MG 51167020002 $430.9838/tablet
KALYDECO 50 MG 51167030001 $430.9838/each
KALYDECO 75 MG 51167040001 $430.9838/each
KANUMA 20 MG/10ML 25682000701 $1010.0000/ml
KCENTRA 1000 UNIT 63833038702 $2.2321/each
KCENTRA 500 UNIT 63833038602 $2.2321/each
KEPIVANCE 6.25 MG 66658011201 $2148.7423/each
KEPIVANCE 6.25 MG 66658011203 $2148.6572/each
KEPIVANCE 6.25 MG 66658011206 $2148.6572/each
KEVEYIS 50 MG 51672417701 $137.8705/tablet
KEYTRUDA 100 MG/4ML 00006302601 $1122.7857/ml
KEYTRUDA 100 MG/4ML 00006302602 $1122.7412/ml
KEYTRUDA 50 MG 00006302901 $2212.3579/each
KEYTRUDA 50 MG 00006302902 $2212.2737/each
KINERET 100MG/0.67 66658023401 $196.0606/ml
KINERET 100MG/0.67 66658023407 $196.0563/ml
KINERET 100MG/0.67 66658023428 $196.0574/ml
KITABIS PAK 300 MG/5ML 24492085056 $16.2321/ml
KOATE-DVI 1000 (+/-) 76125066750 $0.7900/each
KOATE-DVI 1000 (+/-) 76125067250 $0.7900/each
KOATE-DVI 1000 (+/-) 76125067351 $0.7900/each
KOATE-DVI 250 (+/-) 76125025020 $0.7900/each
KOATE-DVI 500 (+/-) 76125066730 $0.7900/each
KOGENATE FS 1000 (+/-) 00026378555 $0.9700/each
KOGENATE FS 1000 (+/-) 00026379550 $0.9700/each
KOGENATE FS 2000 (+/-) 00026378665 $0.9700/each
KOGENATE FS 2000 (+/-) 00026379660 $0.9700/each
KOGENATE FS 250 (+/-) 00026378225 $0.9700/each
KOGENATE FS 250 (+/-) 00026379220 $0.9700/each
KOGENATE FS 3000 (+/-) 00026378775 $0.9700/each
KOGENATE FS 3000 (+/-) 00026379770 $0.9700/each
KOGENATE FS 500 (+/-) 00026378335 $0.9700/each
KOGENATE FS 500 (+/-) 00026379330 $0.9700/each
KORLYM 300 MG 76346007301 $398.9500/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
KORLYM 300 MG 76346007302 $398.9500/tablet
KOVALTRY 1000 (+/-) 00026382425 $1.1000/each
KOVALTRY 1000 (+/-) 00026482401 $1.1000/each
KOVALTRY 2000 (+/-) 00026382650 $1.1000/each
KOVALTRY 2000 (+/-) 00026482601 $1.1000/each
KOVALTRY 250 (+/-) 00026382125 $1.1000/each
KOVALTRY 250 (+/-) 00026482101 $1.1000/each
KOVALTRY 3000 (+/-) 00026382850 $1.1000/each
KOVALTRY 3000 (+/-) 00026482801 $1.1000/each
KOVALTRY 500 (+/-) 00026382225 $1.1000/each
KOVALTRY 500 (+/-) 00026482201 $1.1000/each
KUVAN 100 MG 68135030002 $33.6667/tablet
KUVAN 100 MG 68135030111 $33.6680/each
KUVAN 100 MG 68135030122 $33.6667/each
KUVAN 500 MG 68135048210 $168.3400/each
KUVAN 500 MG 68135048211 $168.3333/each
KYLEENA 17.5MCG/24 50419042401 $866.9133/each
KYNAMRO 200 MG/ML 58468019101 $7020.2171/ml
KYNAMRO 200 MG/ML 58468019102 $7020.2171/ml
KYPROLIS 30 MG 76075010201 $995.6075/each
KYPROLIS 60 MG 76075010101 $1991.2150/each
LAMIVUDINE 10 MG/ML 54838056670 $0.3499/ml
LAMIVUDINE 150 MG 00378516991 $1.9592/tablet
LAMIVUDINE 150 MG 31722075360 $5.8075/tablet
LAMIVUDINE 150 MG 60505325106 $3.7875/tablet
LAMIVUDINE 150 MG 65862055260 $2.2977/tablet
LAMIVUDINE 150 MG 68084057811 $6.8739/tablet
LAMIVUDINE 150 MG 68084057821 $7.5750/tablet
LAMIVUDINE 150 MG 68180060207 $5.7861/tablet
LAMIVUDINE 300 MG 00378517093 $3.9185/tablet
LAMIVUDINE 300 MG 31722075430 $11.6150/tablet
LAMIVUDINE 300 MG 60505325203 $7.5750/tablet
LAMIVUDINE 300 MG 65862055330 $4.5955/tablet
LAMIVUDINE 300 MG 68180060306 $11.5722/tablet
LARTRUVO 500MG/50ML 00002892601 $47.6720/ml
LEMTRADA 12MG/1.2ML 58468020001 $17038.4896/ml
LENVIMA 10 MG/DAY 62856071005 $435.6473/capsule
LENVIMA 10 MG/DAY 62856071030 $435.6467/capsule
LENVIMA 14 MG/DAY 62856071405 $217.8237/capsule
LENVIMA 14 MG/DAY 62856071430 $217.8233/capsule
LENVIMA 18 MG/DAY 62856071805 $162.0491/capsule
LENVIMA 18 MG/DAY 62856071830 $162.0489/capsule
LENVIMA 20 MG/DAY 62856072005 $243.0737/capsule
LENVIMA 20 MG/DAY 62856072030 $243.0733/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
LENVIMA 24 MG/DAY 62856072405 $162.0491/capsule
LENVIMA 24 MG/DAY 62856072430 $162.0489/capsule
LENVIMA 8 MG/DAY 62856070805 $217.8237/capsule
LENVIMA 8 MG/DAY 62856070830 $217.8233/capsule
LETAIRIS 10 MG 61958080201 $291.4611/tablet
LETAIRIS 10 MG 61958080202 $291.4611/tablet
LETAIRIS 10 MG 61958080203 $291.4597/tablet
LETAIRIS 10 MG 61958080205 $291.4597/tablet
LETAIRIS 5 MG 61958080101 $291.4611/tablet
LETAIRIS 5 MG 61958080102 $291.4611/tablet
LETAIRIS 5 MG 61958080103 $291.4597/tablet
LETAIRIS 5 MG 61958080105 $291.4597/tablet
LEUCOVORIN CALCIUM 10 MG 00054449705 $6.2931/tablet
LEUCOVORIN CALCIUM 10 MG 00054449710 $5.5946/tablet
LEUCOVORIN CALCIUM 100 MG 00703514001 $20.2000/each
LEUCOVORIN CALCIUM 100 MG 25021081430 $20.2000/each
LEUCOVORIN CALCIUM 100 MG 25021081467 $8.8880/each
LEUCOVORIN CALCIUM 100 MG 68001028528 $20.2008/each Add
LEUCOVORIN CALCIUM 100 MG 68001028536 $20.2000/each Add
LEUCOVORIN CALCIUM 15 MG 00054449810 $5.3480/tablet
LEUCOVORIN CALCIUM 200 MG 25021081530 $40.4000/each
LEUCOVORIN CALCIUM 200 MG 25021081567 $15.5540/each
LEUCOVORIN CALCIUM 200 MG 63323071050 $21.2706/each
LEUCOVORIN CALCIUM 200 MG 63323071059 $21.2706/each
LEUCOVORIN CALCIUM 200 MG 68001028529 $40.4016/each Add
LEUCOVORIN CALCIUM 200 MG 68001028537 $40.4000/each Add
LEUCOVORIN CALCIUM 350 MG 00143955201 $26.2600/each
LEUCOVORIN CALCIUM 350 MG 00703514501 $19.1395/each
LEUCOVORIN CALCIUM 350 MG 00703514591 $19.1395/each
LEUCOVORIN CALCIUM 350 MG 25021081630 $70.7000/each
LEUCOVORIN CALCIUM 350 MG 25021081667 $17.7760/each
LEUCOVORIN CALCIUM 350 MG 68001028638 $70.7000/each Add
LEUCOVORIN CALCIUM 350 MG 68001028639 $70.7028/each Add
LEUCOVORIN CALCIUM 50 MG 25021081310 $10.1000/each
LEUCOVORIN CALCIUM 50 MG 25021081366 $5.3328/each
LEUCOVORIN CALCIUM 50 MG 68001028522 $10.1004/each Add
LEUCOVORIN CALCIUM 50 MG 68001028540 $10.1000/each Add
LEUCOVORIN CALCIUM 500 MG 63323071100 $79.4971/each
LEUKERAN 2 MG 76388063525 $24.5709/tablet
LEUKERAN 2 MG 76388063550 $20.4757/tablet
LEUKINE 250 MCG 00024584301 $249.9916/each
LEUKINE 250 MCG 00024584305 $249.9811/each
LEVOLEUCOVORIN CALCIUM 10 MG/ML 00781320194 $46.0560/ml
LEVOLEUCOVORIN CALCIUM 10 MG/ML 67457060020 $41.4042/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
LEVOLEUCOVORIN CALCIUM 10 MG/ML 67457060130 $41.4043/ml
LEVOLEUCOVORIN CALCIUM 50 MG 00143955801 $184.2240/each
LEXIVA 50 MG/ML 49702020853 $0.7382/ml
LEXIVA 700 MG 49702020718 $18.0681/tablet
LILETTA 18.6MCG/24 00023585801 $631.2500/each
LILETTA 18.6MCG/24 52544003554 $631.2500/each
LINEZOLID 100 MG/5ML 00054031950 $4.5234/ml
LINEZOLID 100 MG/5ML 59762130801 $4.4171/ml
LINEZOLID 600MG/300 00409488201 $0.2104/ml
LINEZOLID 600MG/300 00703906031 $0.4151/ml
LINEZOLID 600MG/300 00703906033 $0.2104/ml
LINEZOLID 600MG/300 00781343346 $0.2192/ml
LINEZOLID 600MG/300 00781343395 $0.2104/ml
LINEZOLID 600MG/300 55150024251 $0.2070/ml
LINEZOLID 600MG/300 63323071313 $0.2626/ml
LIORESAL INTRATHECAL 2000MCG/ML 58281056102 $43.4300/ml
LIORESAL INTRATHECAL 2000MCG/ML 58281056301 $43.4300/ml
LIORESAL INTRATHECAL 2000MCG/ML 58281056302 $43.4300/ml
LIORESAL INTRATHECAL 50 MCG/ML 58281056201 $73.7300/ml
LIORESAL INTRATHECAL 500 MCG/ML 58281056001 $10.8575/ml
LIORESAL INTRATHECAL 500 MCG/ML 58281056002 $10.8575/ml
LIPODOX 2 MG/ML 47335008250 $96.8893/ml
LIPODOX 50 2 MG/ML 47335008350 $96.8913/ml
LOMUSTINE 100 MG 58181303205 $85.5874/capsule
LOMUSTINE 40 MG 58181303105 $44.8501/capsule
LONSURF 15-6.14 MG 64842102501 $144.0199/tablet
LONSURF 15-6.14 MG 64842102502 $144.0199/tablet
LONSURF 15-6.14 MG 64842102503 $144.0199/tablet
LONSURF 20-8.19 MG 64842102001 $192.0268/tablet
LONSURF 20-8.19 MG 64842102002 $192.0268/tablet
LONSURF 20-8.19 MG 64842102003 $192.0266/tablet
LOVENOX 100 MG/ML 00075062300 $83.6149/ml
LOVENOX 100 MG/ML 00075062301 $83.6149/ml
LOVENOX 100 MG/ML 00075802001 $83.6178/ml
LOVENOX 100 MG/ML 00075802010 $83.6149/ml
LOVENOX 120MG/.8ML 00075291201 $125.4635/ml
LOVENOX 120MG/.8ML 00075802201 $125.4680/ml
LOVENOX 120MG/.8ML 00075802210 $125.4635/ml
LOVENOX 150 MG/ML 00075291501 $125.4652/ml
LOVENOX 150 MG/ML 00075802501 $125.4705/ml
LOVENOX 150 MG/ML 00075802510 $125.4652/ml
LOVENOX 300MG/3ML 00075062603 $83.5203/ml
LOVENOX 300MG/3ML 00075803001 $83.5203/ml
LOVENOX 30MG/0.3ML 00075062430 $83.5203/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
LOVENOX 30MG/0.3ML 00075062431 $83.5203/ml
LOVENOX 30MG/0.3ML 00075801301 $83.5247/ml
LOVENOX 30MG/0.3ML 00075801310 $83.5203/ml
LOVENOX 40MG/0.4ML 00075062040 $83.5169/ml
LOVENOX 40MG/0.4ML 00075062041 $83.5169/ml
LOVENOX 40MG/0.4ML 00075801401 $83.5198/ml
LOVENOX 40MG/0.4ML 00075801410 $83.5169/ml
LOVENOX 60MG/0.6ML 00075062160 $83.6162/ml
LOVENOX 60MG/0.6ML 00075062161 $83.6162/ml
LOVENOX 60MG/0.6ML 00075801601 $83.6201/ml
LOVENOX 60MG/0.6ML 00075801610 $83.6162/ml
LOVENOX 80MG/0.8ML 00075062280 $83.6166/ml
LOVENOX 80MG/0.8ML 00075062281 $83.6166/ml
LOVENOX 80MG/0.8ML 00075801801 $83.6197/ml
LOVENOX 80MG/0.8ML 00075801810 $83.6166/ml
LUCENTIS 0.3MG/0.05 50242008201 $23634.0000/ml
LUCENTIS 0.5MG/0.05 50242008001 $39390.0000/ml
LUMIZYME 50 MG 58468016001 $761.5400/each
LUMIZYME 50 MG 58468016002 $761.5400/each
LUPANETA PACK 11.25-5 MG 00074105305 $3172.4504/each
LUPANETA PACK 3.75MG-5MG 00074105205 $1057.4700/each
LUPRON DEPOT 11.25 MG 00074366303 $3172.4504/each
LUPRON DEPOT 22.5 MG 00074334603 $3780.4199/each
LUPRON DEPOT 3.75 MG 00074364103 $1057.4700/each
LUPRON DEPOT 30 MG 00074368303 $5040.5767/each
LUPRON DEPOT 45 MG 00074347303 $7560.9711/each
LUPRON DEPOT 7.5 MG 00074364203 $1260.1467/each
LUPRON DEPOT-PED 11.25 MG 00074228203 $2309.5670/each
LUPRON DEPOT-PED 11.25 MG 00074377903 $6928.7010/each
LUPRON DEPOT-PED 15 MG 00074244003 $2543.7456/each
LUPRON DEPOT-PED 30 MG 00074969403 $7631.2570/each
LUPRON DEPOT-PED 7.5 MG 00074210803 $1272.1354/each
LYNPARZA 50 MG 00310065758 $27.0175/capsule
LYSODREN 500 MG 00015308060 $4.8475/tablet
MACUGEN 0.3 MG/90 68782000102 $11166.1111/ml
MAKENA 250 MG/ML 64011024301 $735.2295/ml
MAKENA 250 MG/ML 64011024702 $735.2295/ml
MARQIBO FNL 5MG/31 20536032201 $12388.5186/each
MATULANE 50 MG 54482005301 $67.6700/capsule
MEKINIST 0.5 MG 00078066615 $86.4627/tablet
MEKINIST 0.5 MG 00173084913 $86.4627/tablet
MEKINIST 2 MG 00078066815 $345.8499/tablet
MEKINIST 2 MG 00173084813 $345.8499/tablet
MELPHALAN HCL 50 MG 42023014901 $2020.0000/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
MELPHALAN HCL 50 MG 67457019501 $2531.4337/each
MELPHALAN HCL 50 MG 67457021501 $2531.4337/each
MELPHALAN HCL 50 MG 67457057901 $2531.4337/each
MESNA 100 MG/ML 00703480501 $3.0300/ml
MESNA 100 MG/ML 00703480503 $3.0300/ml
MESNA 100 MG/ML 10019095301 $3.3330/ml
MESNA 100 MG/ML 10019095302 $3.3330/ml
MESNA 100 MG/ML 10019095362 $3.3331/ml
MESNA 100 MG/ML 25021020110 $2.0200/ml
MESNA 100 MG/ML 25021020111 $2.0200/ml
MESNA 100 MG/ML 25021020166 $1.2120/ml
MESNA 100 MG/ML 25021020167 $1.2120/ml
MESNA 100 MG/ML 25021020168 $1.2726/ml
MESNA 100 MG/ML 25021020169 $1.2726/ml
MESNA 100 MG/ML 63323073310 $6.6963/ml
MESNA 100 MG/ML 63323073311 $6.6963/ml
MESNEX 100 MG/ML 00338130501 $3.3330/ml
MESNEX 100 MG/ML 00338130503 $3.3330/ml
MESNEX 400 MG 67108356509 $79.3769/tablet
METHOTREXATE 1 G 63323012250 $64.2360/each
METHOTREXATE 1 G 63323012259 $64.2360/each
METHOXSALEN 10 MG 45963032550 $67.4262/capsule
METHOXSALEN 10 MG 64380075216 $67.4262/capsule
METHOXSALEN 10 MG 68682006510 $67.4260/capsule
MIACALCIN 200/ML 00078014923 $1003.6219/ml Increase
MIACALCIN 200/ML 54766014923 $1153.1624/ml
MIACALCIN 200/ML 67457067502 $1153.1624/ml
MICRHOGAM ULTRA-FILTERED PLUS 250 UNIT 00562780600 $55.8631/each
MICRHOGAM ULTRA-FILTERED PLUS 250 UNIT 00562780601 $55.8631/each
MICRHOGAM ULTRA-FILTERED PLUS 250 UNIT 00562780605 $55.8631/each
MICRHOGAM ULTRA-FILTERED PLUS 250 UNIT 00562780625 $55.8631/each
MIRCERA 100MCG/0.3 00004040309 $606.0240/ml
MIRCERA 200MCG/0.3 00004040509 $1212.0480/ml
MIRCERA 50 MCG/0.3 00004040109 $303.0120/ml
MIRCERA 75 MCG/0.3 00004040209 $454.5180/ml
MIRENA 20MCG/24HR 50419042101 $866.9133/each
MIRENA 20MCG/24HR 50419042301 $866.9133/each
MODERIBA 200-400(7) 00074322456 $13.1744/tablet
MODERIBA 400-400(7) 00074323956 $13.8677/tablet
MODERIBA 600-400(7) 00074327156 $17.3348/tablet
MODERIBA 600-600(7) 00074328256 $20.8015/tablet
MONOCLATE-P 1000 (+/-) 00053763302 $0.8500/each
MONOCLATE-P 1000 (+/-) 00053764301 $0.8500/each
MONOCLATE-P 1500 (+/-) 00053763402 $0.8500/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
MONOCLATE-P 1500 (+/-) 00053764401 $0.8500/each
MONONINE 1000 (+/-) 00053623302 $1.0200/each
MONOVISC 88 MG/4 ML 59676082001 $298.3338/ml
MOZOBIL 24MG/1.2ML 00024586201 $6068.8964/ml
MUSTARGEN 10 MG 55292091151 $258.5171/each
MYCOPHENOLATE MOFETIL 200 MG/ML 67877023022 $6.8835/ml
MYCOPHENOLATE MOFETIL 500 MG 42023017204 $99.9900/each Add
MYLERAN 2 MG 76388071325 $23.6574/tablet
MYOBLOC 10000/2ML 10454071210 $569.6400/ml
MYOBLOC 2500/0.5ML 10454071010 $569.6400/ml
MYOBLOC 5000/ML 10454071110 $569.6400/ml
MYOZYME 50 MG 58468015001 $984.7500/each
NABI-HB >1560/5ML 59730420301 $129.9971/ml
NABI-HB >312/ML 59730420201 $148.4195/ml
NAGLAZYME 5 MG/5 ML 68135002001 $362.5900/ml
NATPARA 100 MCG 68875020502 $4197.8125/each
NATPARA 25MCG/DOSE 68875020202 $4197.8125/each
NATPARA 50MCG/DOSE 68875020302 $4197.8125/each
NATPARA 75MCG/DOSE 68875020402 $4197.8125/each
NEULASTA 6MG/0.6ML 55513019001 $9103.9717/ml
NEULASTA 6MG/0.6ML 55513019201 $9103.9717/ml
NEUMEGA 5 MG 58394000408 $445.1777/each
NEUMEGA 5 MG 58394010408 $445.1920/each
NEUPOGEN 300 MCG/ML 55513053001 $309.0196/ml
NEUPOGEN 300 MCG/ML 55513053010 $309.0196/ml
NEUPOGEN 300MCG/0.5 55513092401 $655.0860/ml
NEUPOGEN 300MCG/0.5 55513092410 $655.0860/ml
NEUPOGEN 300MCG/0.5 55513092491 $655.0860/ml
NEUPOGEN 480MCG/0.8 55513020901 $652.0181/ml
NEUPOGEN 480MCG/0.8 55513020910 $652.0181/ml
NEUPOGEN 480MCG/0.8 55513020991 $652.0181/ml
NEUPOGEN 480MCG/1.6 55513054601 $307.5450/ml
NEUPOGEN 480MCG/1.6 55513054610 $307.5450/ml
NEVIRAPINE 50 MG/5 ML 00054045058 $0.6369/ml
NEVIRAPINE ER 100 MG 00378695077 $6.4466/tablet
NEXAVAR 200 MG 50419048858 $127.2494/tablet
NEXPLANON 68 MG 00052027401 $779.2352/each Delete
NEXPLANON 68 MG 00052433001 $856.3790/each Increase
NILANDRON 150 MG 24987011114 $218.0344/tablet
NILANDRON 150 MG 59212011114 $218.0344/tablet
NILUTAMIDE 150 MG 62559017331 $155.7390/tablet
NINLARO 2.3 MG 63020007801 $3036.0600/capsule
NINLARO 2.3 MG 63020007802 $3036.0600/capsule
NINLARO 3 MG 63020007901 $3036.0600/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
NINLARO 3 MG 63020007902 $3036.0600/capsule
NINLARO 4 MG 63020008001 $3036.0600/capsule
NINLARO 4 MG 63020008002 $3036.0600/capsule
NIPENT 10 MG 00409080101 $2041.2605/each
NIPENT 10 MG 00409080109 $2010.6474/each
NORDITROPIN FLEXPRO 10MG/1.5ML 00169770521 $692.7253/ml
NORDITROPIN FLEXPRO 15MG/1.5ML 00169770821 $1039.0880/ml
NORDITROPIN FLEXPRO 30 MG/3 ML 00169770321 $1039.0880/ml
NORDITROPIN FLEXPRO 5 MG/1.5ML 00169770421 $346.3627/ml
NORTHERA 100 MG 67386082019 $21.9330/capsule
NORTHERA 200 MG 67386082119 $43.8660/capsule
NORTHERA 300 MG 67386082219 $65.7991/capsule
NORVIR 100 MG 00074333330 $8.6581/tablet
NORVIR 100 MG 00074663330 $8.6581/capsule
NORVIR 80 MG/ML 00074194063 $6.0608/ml
NOVOEIGHT 1000 (+/-) 00169781001 $1.1900/each
NOVOEIGHT 1500 (+/-) 00169781501 $1.1900/each
NOVOEIGHT 2000 (+/-) 00169782001 $1.1900/each
NOVOEIGHT 250 (+/-) 00169782501 $1.1900/each
NOVOEIGHT 3000 (+/-) 00169783001 $1.1900/each
NOVOEIGHT 500 (+/-) 00169785001 $1.1900/each
NOVOSEVEN RT 1 MG 00169720101 $1.4000/each
NOVOSEVEN RT 2 MG 00169720201 $1.4000/each
NOVOSEVEN RT 5 MG 00169720501 $1.4000/each
NOVOSEVEN RT 8 MG 00169720801 $1.4000/each
NPLATE 250 MCG 55513022101 $1606.3040/each
NPLATE 500 MCG 55513022201 $3212.6080/each
NUCALA 100 MG 00173088101 $2600.7500/each
NULOJIX 250 MG 00003037113 $943.8854/each
NUTROPIN AQ 10 MG/2 ML 50242004314 $534.4314/ml
NUTROPIN AQ 20 MG/2 ML 50242007301 $1068.8628/ml Delete
NUTROPIN AQ NUSPIN 10 MG/2 ML 50242007401 $534.4314/ml
NUTROPIN AQ NUSPIN 20 MG/2 ML 50242007601 $1068.8628/ml
NUTROPIN AQ NUSPIN 5 MG/2 ML 50242007501 $267.2157/ml
NUWIQ 1000 (+/-) 68982014301 $1.2000/each
NUWIQ 1000 (+/-) 68982014401 $1.2000/each
NUWIQ 2000 (+/-) 68982014501 $1.2000/each
NUWIQ 2000 (+/-) 68982014601 $1.2000/each
NUWIQ 250 (+/-) 68982013901 $1.2000/each
NUWIQ 250 (+/-) 68982014001 $1.2000/each
NUWIQ 500 (+/-) 68982014101 $1.2000/each
NUWIQ 500 (+/-) 68982014201 $1.2000/each
NYMALIZE 60 MG/20ML 24338020012 $3.5744/ml
NYMALIZE 60 MG/20ML 24338020016 $3.5769/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
NYMALIZE 60 MG/20ML 24338020020 $3.5747/ml
OBIZUR 500 (+/-) 00944500101 $3.6600/each
OBIZUR 500 (+/-) 00944500105 $3.6600/each
OBIZUR 500 (+/-) 00944500110 $3.6600/each
OCALIVA 10 MG 69516001030 $191.9000/tablet
OCALIVA 5 MG 69516000530 $191.9000/tablet
OCTAGAM 10 % 68982085001 $13.9804/ml
OCTAGAM 10 % 68982085002 $13.9804/ml
OCTAGAM 10 % 68982085003 $13.9804/ml
OCTAGAM 10 % 68982085004 $13.9804/ml
OCTAGAM 5 % 67467084301 $6.5196/ml
OCTAGAM 5 % 67467084302 $6.5196/ml
OCTAGAM 5 % 67467084303 $6.5196/ml
OCTAGAM 5 % 67467084304 $6.5196/ml
OCTAGAM 5 % 67467084305 $6.5196/ml
OCTAGAM 5 % 68209084301 $6.5196/ml
OCTAGAM 5 % 68209084302 $6.5196/ml
OCTAGAM 5 % 68209084303 $6.5196/ml
OCTAGAM 5 % 68209084304 $6.5196/ml
OCTAGAM 5 % 68982084001 $6.9902/ml
OCTAGAM 5 % 68982084002 $6.9902/ml
OCTAGAM 5 % 68982084003 $6.9902/ml
OCTAGAM 5 % 68982084004 $6.9902/ml
OCTAGAM 5 % 68982084005 $6.9902/ml
OCTAPLAS 45 TO 70MG 67467095201 $0.8560/ml
OCTAPLAS 45 TO 70MG 67467095202 $0.8560/ml
OCTAPLAS 45 TO 70MG 67467095203 $0.8560/ml
OCTAPLAS 45 TO 70MG 67467095204 $0.8560/ml
OCTAPLAS 45 TO 70MG 68209095201 $0.8560/ml
OCTAPLAS 45 TO 70MG 68209095202 $0.8560/ml
OCTAPLAS 45 TO 70MG 68209095203 $0.8560/ml
OCTAPLAS 45 TO 70MG 68209095204 $0.8560/ml
OCTREOTIDE ACETATE 100 MCG/ML 00781916771 $10.8676/ml
OCTREOTIDE ACETATE 100 MCG/ML 00781916795 $10.8676/ml
OCTREOTIDE ACETATE 100 MCG/ML 62756034944 $12.4988/ml
OCTREOTIDE ACETATE 100 MCG/ML 67457024500 $7.9793/ml
OCTREOTIDE ACETATE 100 MCG/ML 67457024501 $6.7731/ml
OCTREOTIDE ACETATE 50 MCG/ML 00703330101 $4.5452/ml
OCTREOTIDE ACETATE 50 MCG/ML 00703330104 $4.5450/ml
OCTREOTIDE ACETATE 50 MCG/ML 00781916671 $9.4026/ml
OCTREOTIDE ACETATE 50 MCG/ML 00781916695 $4.9288/ml
OCTREOTIDE ACETATE 50 MCG/ML 25021045101 $4.5450/ml
OCTREOTIDE ACETATE 50 MCG/ML 62756034844 $5.7065/ml
OCTREOTIDE ACETATE 50 MCG/ML 63323036501 $5.1106/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
OCTREOTIDE ACETATE 50 MCG/ML 63323036504 $2.3432/ml
OCTREOTIDE ACETATE 50 MCG/ML 67457023900 $4.0402/ml
OCTREOTIDE ACETATE 50 MCG/ML 67457023901 $3.9451/ml
OCTREOTIDE ACETATE 500 MCG/ML 00781916871 $50.4798/ml
OCTREOTIDE ACETATE 500 MCG/ML 00781916895 $50.4798/ml
OCTREOTIDE ACETATE 500 MCG/ML 62756035144 $58.0649/ml
OCTREOTIDE ACETATE 500 MCG/ML 67457024600 $40.0986/ml
OCTREOTIDE ACETATE 500 MCG/ML 67457024601 $33.8643/ml
ODEFSEY 200-25-25 61958210101 $78.9776/tablet
ODOMZO 200 MG 00078064515 $338.6867/capsule
OFEV 100 MG 00597014360 $145.4400/capsule
OFEV 150 MG 00597014560 $145.4400/capsule
OLYSIO 150 MG 59676022528 $797.9000/capsule
OMNITROPE 10MG/1.5ML 00781300407 $675.5957/ml
OMNITROPE 5 MG/1.5ML 00781300107 $337.7979/ml
OMNITROPE 5 MG/1.5ML 00781300126 $337.7979/ml
OMNITROPE 5.8 MG 00781400436 $299.9283/each
ONCASPAR 750/ML 00944381001 $2720.3683/ml
ONCASPAR 750/ML 54482030101 $2720.3683/ml
ONIVYDE 43 MG/10ML 69171039801 $163.6200/ml
OPDIVO 100MG/10ML 00003377412 $253.2615/ml
OPDIVO 40 MG/4 ML 00003377211 $253.2600/ml
OPSUMIT 10 MG 66215050115 $254.0150/tablet
OPSUMIT 10 MG 66215050130 $254.0150/tablet
ORALAIR 300 IR 59617001502 $12.1988/tablet
ORBACTIV 400 MG 65293001501 $976.3720/each
ORBACTIV 400 MG 65293001503 $976.3333/each
ORENCIA 125 MG/ML 00003218811 $911.9946/ml
ORENCIA 250 MG 00003218710 $940.4716/each
ORENCIA CLICKJECT 125 MG/ML 00003218851 $911.9946/ml
ORENITRAM ER 0.125 MG 66302030001 $4.9238/tablet
ORENITRAM ER 0.125 MG 66302030010 $4.9238/tablet
ORENITRAM ER 0.25 MG 66302030201 $9.8475/tablet
ORENITRAM ER 0.25 MG 66302030210 $9.8475/tablet
ORENITRAM ER 1 MG 66302031001 $39.3900/tablet
ORENITRAM ER 1 MG 66302031010 $39.3900/tablet
ORENITRAM ER 2.5 MG 66302032501 $98.4750/tablet
ORENITRAM ER 2.5 MG 66302032510 $98.4750/tablet
ORFADIN 10 MG 66658011060 $420.7840/capsule
ORFADIN 2 MG 66658010260 $84.1572/capsule
ORFADIN 20 MG 66658012060 $841.5680/capsule
ORFADIN 4 MG/ML 66658020490 $183.4564/ml
ORFADIN 5 MG 66658010560 $210.3917/capsule
ORKAMBI 100-125 MG 51167070002 $179.6635/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ORKAMBI 200-125MG 51167080901 $179.6635/tablet
ORTHOVISC 30 MG/2 ML 59676036001 $195.0562/ml
OTEZLA 10-20-30MG 59572063255 $47.4924/tablet
OTEZLA 30 MG 59572063106 $43.5347/tablet
OTREXUP 10MG/0.4ML 54436001002 $372.0735/ml
OTREXUP 10MG/0.4ML 54436001004 $372.0461/ml
OTREXUP 12.5MG/0.4 54436001204 $372.0461/ml
OTREXUP 15MG/0.4ML 54436001502 $372.0735/ml
OTREXUP 15MG/0.4ML 54436001504 $372.0461/ml
OTREXUP 17.5MG/0.4 54436001704 $372.0461/ml
OTREXUP 20MG/0.4ML 54436002002 $372.0735/ml
OTREXUP 20MG/0.4ML 54436002004 $372.0461/ml
OTREXUP 22.5MG/0.4 54436002204 $372.0461/ml
OTREXUP 25MG/0.4ML 54436002502 $372.0735/ml
OTREXUP 25MG/0.4ML 54436002504 $372.0461/ml
OTREXUP 7.5 MG/0.4 54436007504 $372.0461/ml
OXALIPLATIN 100 MG 45963061159 $202.0000/each
OXALIPLATIN 100 MG 47335017840 $535.3000/each
OXALIPLATIN 100 MG 63323017650 $1248.9660/each
OXALIPLATIN 100 MG 67457047610 $202.0000/each
OXALIPLATIN 50 MG 45963061153 $101.0000/each
OXALIPLATIN 50 MG 47335017640 $267.6500/each
OXALIPLATIN 50 MG 63323017530 $599.9400/each
OXSORALEN-ULTRA 10 MG 00187065042 $85.7666/capsule
OZURDEX 0.7 MG 00023334807 $1346.3300/each
PAMIDRONATE DISODIUM 30 MG 59923060110 $18.9779/each
PAMIDRONATE DISODIUM 60 MG/10ML 61703032518 $2.8320/ml
PAMIDRONATE DISODIUM 90 MG 59923060310 $56.9337/each
PARAGARD T 380-A 380 SQ MM 51285020401 $746.3900/each
PEGASYS 180MCG/0.5 00004035730 $1907.9102/ml
PEGASYS 180MCG/ML 00004035009 $953.9551/ml
PEGASYS PROCLICK 135MCG/0.5 00004036030 $1907.9102/ml
PEGASYS PROCLICK 180MCG/0.5 00004036530 $1907.9102/ml
PEGINTRON 120MCG/0.5 00085435501 $837.5122/each Delete
PEGINTRON 150MCG/0.5 00085435601 $879.4070/each Delete
PEGINTRON 50 MCG/0.5 00085435301 $759.6917/each
PEGINTRON REDIPEN 120MCG/0.5 00085129701 $837.5122/each
PEGINTRON REDIPEN 120MCG/0.5 00085129702 $837.5476/each Delete
PEGINTRON REDIPEN 150MCG/0.5 00085137001 $879.4070/each
PEGINTRON REDIPEN 50 MCG/0.5 00085132301 $759.6917/each
PEGINTRON REDIPEN 80MCG/0.5 00085131601 $797.5869/each Delete
PENTAM 300 300 MG 63323011310 $168.5589/each
PERJETA 420MG/14ML 50242014501 $321.2947/ml
PH 12 DILUENT FOR FLOLAN 00173085702 $0.2843/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
PHENOXYBENZAMINE HCL 10 MG 00054034925 $109.0709/capsule
PHENOXYBENZAMINE HCL 10 MG 66993006602 $108.9497/capsule
PLEGRIDY 125MCG/0.5 64406001501 $5879.2100/ml
PLEGRIDY 63-94 MCG 64406001601 $5879.2100/ml
PLEGRIDY PEN 125MCG/0.5 64406001101 $5879.2100/ml
PLEGRIDY PEN 63-94 MCG 64406001201 $5879.2100/ml
POMALYST 1 MG 59572050100 $646.8714/capsule
POMALYST 1 MG 59572050121 $646.8713/capsule
POMALYST 2 MG 59572050200 $646.8714/capsule
POMALYST 2 MG 59572050221 $646.8713/capsule
POMALYST 3 MG 59572050300 $646.8714/capsule
POMALYST 3 MG 59572050321 $646.8713/capsule
POMALYST 4 MG 59572050400 $646.8714/capsule
POMALYST 4 MG 59572050421 $646.8713/capsule
PORTRAZZA 800MG/50ML 00002771601 $80.8000/ml
PRALUENT PEN 150 MG/ML 00024590201 $565.6224/ml
PRALUENT PEN 150 MG/ML 00024590202 $565.6000/ml
PRALUENT PEN 75 MG/ML 00024590101 $565.6224/ml
PRALUENT PEN 75 MG/ML 00024590102 $565.6000/ml
PRALUENT SYRINGE 150 MG/ML 00024590401 $565.6224/ml
PRALUENT SYRINGE 150 MG/ML 00024590402 $565.6000/ml
PRALUENT SYRINGE 75 MG/ML 00024590301 $565.6224/ml
PRALUENT SYRINGE 75 MG/ML 00024590302 $565.6000/ml
PREZCOBIX 800-150 MG 59676057530 $52.2429/tablet
PREZISTA 100 MG/ML 59676056501 $3.8087/ml
PREZISTA 150 MG 59676056401 $5.7130/tablet
PREZISTA 600 MG 59676056201 $22.8521/tablet
PREZISTA 75 MG 59676056301 $2.8565/tablet
PREZISTA 800 MG 59676056630 $45.7042/tablet
PRIALT 100 MCG/ML 18860072010 $712.5247/ml
PRIALT 100 MCG/ML 18860072210 $712.5247/ml
PRIALT 25 MCG/ML 18860072310 $178.1312/ml
PRIVIGEN 10 % 44206043605 $13.3320/ml
PRIVIGEN 10 % 44206043710 $13.3320/ml
PRIVIGEN 10 % 44206043820 $13.3320/ml
PRIVIGEN 10 % 44206043940 $13.3320/ml
PROCRIT 10000/ML 59676031000 $236.3494/ml
PROCRIT 10000/ML 59676031001 $236.3400/ml
PROCRIT 10000/ML 59676031002 $236.3400/ml
PROCRIT 2000/ML 59676030200 $47.2699/ml
PROCRIT 2000/ML 59676030201 $47.2680/ml
PROCRIT 20000/2ML 59676031200 $236.3494/ml
PROCRIT 20000/2ML 59676031204 $236.3400/ml
PROCRIT 20000/ML 59676032000 $472.6987/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
PROCRIT 20000/ML 59676032004 $472.6800/ml
PROCRIT 3000/ML 59676030300 $70.9048/ml
PROCRIT 3000/ML 59676030301 $70.9020/ml
PROCRIT 4000/ML 59676030400 $94.5397/ml
PROCRIT 4000/ML 59676030401 $94.5360/ml
PROCRIT 40000/ML 59676034000 $945.3974/ml
PROCRIT 40000/ML 59676034001 $945.3600/ml
PROCYSBI 25 MG 49663000106 $76.9923/capsule
PROCYSBI 75 MG 49663000225 $76.9923/capsule
PROFILNINE 1000 (+/-) 68516320202 $0.8750/each
PROFILNINE 1000 (+/-) 68516320502 $0.8750/each
PROFILNINE 1500 (+/-) 68516320302 $0.8750/each
PROFILNINE 1500 (+/-) 68516320602 $0.8750/each
PROFILNINE 500 (+/-) 68516320101 $0.8750/each
PROFILNINE 500 (+/-) 68516320401 $0.8750/each
PROGRAF 5 MG/ML 00469301601 $174.9926/ml
PROLASTIN C 1000 MG 13533070002 $0.4848/each
PROLASTIN C 1000 MG 13533070101 $0.4848/each
PROLASTIN C 1000 MG 13533070310 $0.4848/each
PROLEUKIN 22MM UNIT 65483011607 $2922.9400/each
PROLIA 60 MG/ML 55513071001 $1037.4720/ml
PROMACTA 12.5 MG 00007464313 $123.6873/tablet
PROMACTA 12.5 MG 00078068415 $123.6873/tablet
PROMACTA 25 MG 00007464013 $115.7036/tablet
PROMACTA 25 MG 00078068515 $123.6873/tablet
PROMACTA 50 MG 00007464113 $215.2623/tablet
PROMACTA 50 MG 00078068615 $230.1154/tablet
PROMACTA 75 MG 00007464213 $322.8940/tablet
PROMACTA 75 MG 00078068715 $345.1736/tablet
PROVENGE 50 MM/250 30237890006 $173.2436/ml
PULMOZYME 1 MG/ML 50242010039 $41.3275/ml
PULMOZYME 1 MG/ML 50242010040 $41.3239/ml
PURIXAN 20 MG/ML 62484002001 $11.4694/ml
QUDEXY XR 100 MG 00245107415 $14.9884/capsule
QUDEXY XR 100 MG 00245107430 $14.9884/capsule
QUDEXY XR 150 MG 00245107515 $18.4357/capsule
QUDEXY XR 150 MG 00245107530 $18.4359/capsule
QUDEXY XR 200 MG 00245107315 $20.5030/capsule
QUDEXY XR 200 MG 00245107330 $20.5030/capsule
QUDEXY XR 25 MG 00245107115 $5.8075/capsule
QUDEXY XR 25 MG 00245107130 $5.8075/capsule
QUDEXY XR 50 MG 00245107215 $7.5649/capsule
QUDEXY XR 50 MG 00245107230 $7.5649/capsule
QUTENZA 8 % 10144092801 $798.0111/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
QUTENZA 8 % 10144092901 $1596.0121/each
RAGWITEK 12 UNIT 00006542030 $8.9991/tablet
RAGWITEK 12 UNIT 00006542054 $8.9991/tablet
RAPAMUNE 1 MG/ML 00008103004 $25.1756/ml
RAPAMUNE 1 MG/ML 00008103006 $25.1756/ml
RASUVO 10MG/0.2ML 59137051004 $565.6000/ml
RASUVO 12.5/0.25 59137051504 $452.4800/ml
RASUVO 15MG/0.3ML 59137052000 $377.0816/ml
RASUVO 15MG/0.3ML 59137052004 $377.0667/ml
RASUVO 17.5/0.35 59137052500 $323.2128/ml
RASUVO 17.5/0.35 59137052504 $323.2000/ml
RASUVO 20MG/0.4ML 59137053000 $282.8112/ml
RASUVO 20MG/0.4ML 59137053004 $282.8000/ml
RASUVO 22.5/0.45 59137053504 $251.3778/ml
RASUVO 25MG/0.5ML 59137054004 $226.2400/ml
RASUVO 27.5/0.55 59137054504 $205.6727/ml
RASUVO 30MG/0.6ML 59137055004 $188.5333/ml
RASUVO 7.5MG/0.15 59137050504 $754.1333/ml
RAVICTI 1.1GRAM/ML 75987005006 $152.9342/ml
RAVICTI 1.1GRAM/ML 76325010025 $152.9342/ml
REBETOL 40 MG/ML 00085131801 $1.9594/ml
REBIF 22MCG/.5ML 44087002203 $1057.7343/ml
REBIF 44MCG/.5ML 44087004403 $1057.7343/ml
REBIF 8.8-22(6) 44087882201 $1511.0490/ml
REBIF REBIDOSE 22MCG/.5ML 44087332201 $1057.7343/ml
REBIF REBIDOSE 44MCG/.5ML 44087334401 $1057.7343/ml
REBIF REBIDOSE 8.8-22(6) 44087018801 $1511.0490/ml
RECLAST 5 MG/100ML 00078043561 $10.9467/ml
RECOMBINATE 1000 (+/-) 00944284310 $1.0600/each
RECOMBINATE 1500 (+/-) 00944284410 $1.0600/each
RECOMBINATE 2000 (+/-) 00944284510 $1.0600/each
RECOMBINATE 250 (+/-) 00944284110 $1.0600/each
RECOMBINATE 500 (+/-) 00944284210 $1.0600/each
REMICADE 100 MG 57894003001 $1124.4027/each
REMODULIN 1 MG/ML 66302010101 $59.5395/ml
REMODULIN 10 MG/ML 66302011001 $595.3950/ml
REMODULIN 2.5 MG/ML 66302010201 $148.8488/ml
REMODULIN 5 MG/ML 66302010501 $297.6975/ml
REPATHA PUSHTRONEX 420 MG/3.5 55513077001 $339.0714/ml
REPATHA SURECLICK 140 MG/ML 55513076001 $547.7331/ml
REPATHA SURECLICK 140 MG/ML 55513076002 $547.7331/ml
REPATHA SYRINGE 140 MG/ML 55513075001 $547.7331/ml
RESCRIPTOR 100 MG 49702020924 $1.1564/tablet
RESCRIPTOR 200 MG 49702022517 $2.3128/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
RETROVIR 10 MG/ML 49702021301 $1.4742/ml
RETROVIR 10 MG/ML 49702021305 $1.4741/ml
REVATIO 10 MG/12.5 00069033801 $16.9171/ml
REVATIO 10 MG/ML 00069033621 $59.0613/ml
REVLIMID 10 MG 59572041000 $558.5099/capsule
REVLIMID 10 MG 59572041028 $558.5094/capsule
REVLIMID 15 MG 59572041500 $558.5099/capsule
REVLIMID 15 MG 59572041521 $558.5098/capsule
REVLIMID 2.5 MG 59572040200 $558.5099/capsule
REVLIMID 2.5 MG 59572040228 $558.5094/capsule
REVLIMID 20 MG 59572042000 $558.5099/capsule
REVLIMID 20 MG 59572042021 $558.5098/capsule
REVLIMID 25 MG 59572042500 $558.5099/capsule
REVLIMID 25 MG 59572042521 $558.5098/capsule
REVLIMID 5 MG 59572040500 $558.5099/capsule
REVLIMID 5 MG 59572040528 $558.5094/capsule
REYATAZ 150 MG 00003362412 $23.2372/capsule
REYATAZ 200 MG 00003363112 $23.2372/capsule
REYATAZ 300 MG 00003362212 $46.0351/capsule
REYATAZ 50 MG 00003363810 $7.1787/each
RHOGAM ULTRA-FILTERED PLUS 1500 UNIT 00562780500 $119.1800/each
RHOGAM ULTRA-FILTERED PLUS 1500 UNIT 00562780501 $119.1800/each
RHOGAM ULTRA-FILTERED PLUS 1500 UNIT 00562780505 $119.1800/each
RHOGAM ULTRA-FILTERED PLUS 1500 UNIT 00562780525 $119.1800/each
RHOPHYLAC 1500/2 ML 44206030001 $80.9919/ml
RHOPHYLAC 1500/2 ML 44206030010 $73.6290/ml
RIASTAP 900-1300MG 63833089151 $0.8800/each
RIBASPHERE 400 MG 66435010356 $27.0420/tablet
RIBASPHERE 600 MG 66435010456 $40.5630/tablet
RIBASPHERE RIBAPAK 200-400(7) 66435010856 $25.6901/tablet
RIBASPHERE RIBAPAK 200-400MG 66435010899 $25.6901/tablet
RIBASPHERE RIBAPAK 400-400 MG 66435010599 $27.0420/tablet
RIBASPHERE RIBAPAK 400-400(7) 66435010556 $27.0420/tablet
RIBASPHERE RIBAPAK 600-400 MG 66435010699 $33.8029/tablet
RIBASPHERE RIBAPAK 600-400(7) 66435010656 $33.8033/tablet
RIBASPHERE RIBAPAK 600-600 MG 66435010799 $40.5630/tablet
RIBASPHERE RIBAPAK 600-600(7) 66435010756 $40.5630/tablet
RISPERDAL CONSTA 12.5MG/2ML 50458030911 $200.5052/each
RISPERDAL CONSTA 25 MG/2 ML 50458030611 $400.9700/each
RISPERDAL CONSTA 37.5MG/2ML 50458030711 $601.4853/each
RISPERDAL CONSTA 50 MG/2 ML 50458030811 $801.9905/each
RITUXAN 10 MG/ML 50242005121 $81.1131/ml
RITUXAN 10 MG/ML 50242005306 $81.1131/ml
RIXUBIS 1000 UNIT 00944303002 $1.0800/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
RIXUBIS 2000 UNIT 00944303202 $1.0800/each
RIXUBIS 250 UNIT 00944302602 $1.0800/each
RIXUBIS 3000 UNIT 00944303402 $1.0800/each
RIXUBIS 500 UNIT 00944302802 $1.0800/each
RUCONEST 2100 UNIT 68012035001 $5765.3931/each
RUCONEST 2100 UNIT 68012035002 $5765.3931/each
SABRIL 500 MG 67386011101 $111.1809/tablet
SABRIL 500 MG 67386021165 $111.1808/each
SAIZEN 5 MG 44087100502 $541.2691/each
SAIZEN 8.8 MG/1.5 44087108001 $866.0245/each
SAIZEN 8.8 MG 44087108801 $866.0245/each
SAMSCA 15 MG 59148002050 $361.3861/tablet
SAMSCA 30 MG 59148002150 $374.8958/tablet
SANDIMMUNE 100 MG/ML 00078011022 $12.6458/ml
SANDIMMUNE 100 MG 00078024115 $13.0223/capsule
SANDIMMUNE 100 MG 00078024161 $13.0290/capsule
SANDIMMUNE 25 MG 00078024015 $3.2630/capsule
SANDIMMUNE 25 MG 00078024061 $3.2926/capsule
SANDIMMUNE 250 MG/5ML 00078010901 $10.1509/ml
SANDIMMUNE 250 MG/5ML 00078010961 $10.1525/ml
SANDOSTATIN 100 MCG/ML 00078018101 $27.1135/ml Increase
SANDOSTATIN 100 MCG/ML 00078018161 $27.1185/ml
SANDOSTATIN 50 MCG/ML 00078018001 $13.9774/ml
SANDOSTATIN 50 MCG/ML 00078018061 $13.9784/ml
SANDOSTATIN 500 MCG/ML 00078018201 $130.7728/ml
SANDOSTATIN 500 MCG/ML 00078018261 $130.7849/ml
SANDOSTATIN LAR 10 MG 00078034061 $2403.9616/each
SANDOSTATIN LAR 20 MG 00078034161 $3149.6143/each
SANDOSTATIN LAR 30 MG 00078034261 $4716.3061/each
SANDOSTATIN LAR DEPOT 10 MG 00078064661 $2725.4749/each
SANDOSTATIN LAR DEPOT 10 MG 00078064681 $2725.4749/each
SANDOSTATIN LAR DEPOT 20 MG 00078064761 $3570.8449/each
SANDOSTATIN LAR DEPOT 20 MG 00078064781 $3570.8449/each
SANDOSTATIN LAR DEPOT 30 MG 00078064861 $5347.0915/each
SANDOSTATIN LAR DEPOT 30 MG 00078064881 $5347.0915/each
SANDOSTATIN LAR DEPOT 30 MG 00078080461 $5347.0915/each Add
SANDOSTATIN LAR DEPOT 30 MG 00078082581 $5347.0915/each Add
SANTYL 250 UNIT/G 00064501030 $6.8949/gm
SANTYL 250 UNIT/G 00064501090 $6.5504/gm Delete
SANTYL 250 UNIT/G 50484001030 $6.8949/gm
SANTYL 250 UNIT/G 50484001090 $6.5504/gm
SELZENTRY 150 MG 49702022318 $21.8290/tablet
SELZENTRY 300 MG 49702022418 $21.8290/tablet
SENSIPAR 30 MG 55513007330 $25.1490/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
SENSIPAR 60 MG 55513007430 $50.2980/tablet
SENSIPAR 90 MG 55513007530 $75.4470/tablet
SEROSTIM 4 MG 44087000401 $290.5296/each
SEROSTIM 4 MG 44087000407 $290.5121/each
SEROSTIM 5 MG 44087000501 $363.1515/each
SEROSTIM 5 MG 44087000507 $363.1397/each
SEROSTIM 6 MG 44087000601 $435.7818/each
SEROSTIM 6 MG 44087000607 $435.7674/each
SIGNIFOR 0.3 MG/ML 00078063306 $201.4479/ml
SIGNIFOR 0.3 MG/ML 00078063320 $201.4465/ml
SIGNIFOR 0.3 MG/ML 00078063361 $201.4445/ml
SIGNIFOR 0.6 MG/ML 00078063406 $201.4479/ml
SIGNIFOR 0.6 MG/ML 00078063420 $201.4465/ml
SIGNIFOR 0.6 MG/ML 00078063461 $201.4445/ml
SIGNIFOR 0.9 MG/ML 00078063506 $201.4479/ml
SIGNIFOR 0.9 MG/ML 00078063520 $201.4465/ml
SIGNIFOR 0.9 MG/ML 00078063561 $201.4445/ml
SIGNIFOR LAR 20 MG 00078064161 $11312.0000/each
SIGNIFOR LAR 20 MG 00078064181 $11312.0000/each
SIGNIFOR LAR 40 MG 00078064261 $11312.0000/each
SIGNIFOR LAR 40 MG 00078064281 $11312.0000/each
SIGNIFOR LAR 60 MG 00078064361 $11312.0000/each
SIGNIFOR LAR 60 MG 00078064381 $11312.0000/each
SILDENAFIL CITRATE 10 MG/12.5 55150016613 $14.9480/ml
SIMPONI 100 MG/ML 57894007101 $4426.6987/ml
SIMPONI 100 MG/ML 57894007102 $4426.6987/ml
SIMPONI 50MG/0.5ML 57894007001 $7698.5836/ml
SIMPONI 50MG/0.5ML 57894007002 $7698.5836/ml
SIMPONI ARIA 50 MG/4 ML 57894035001 $383.2243/ml
SIMULECT 10 MG 00078039361 $2526.6261/each
SIMULECT 20 MG 00078033184 $3316.2037/each
SIRTURO 100 MG 59676070101 $161.1702/tablet
SIVEXTRO 200 MG 67919004001 $249.2175/each
SIVEXTRO 200 MG 67919004101 $312.8475/tablet
SIVEXTRO 200 MG 67919004102 $312.8475/tablet
SKYLA 14MCG/24HR 50419042201 $721.8470/each
SODIUM PHENYLACET-SOD BENZOATE 10 %-10 % 13811070550 $737.3000/ml
SODIUM PHENYLACET-SOD BENZOATE 10 %-10 % 68382039601 $707.8080/ml
SODIUM PHENYLBUTYRATE 0.94 G/G 42794008614 $18.1785/gm
SOLIRIS 300MG/30ML 25682000101 $215.9380/ml
SOMATULINE DEPOT 120MG/0.5 15054012001 $10922.1400/ml
SOMATULINE DEPOT 120MG/0.5 15054112003 $12715.9000/ml
SOMATULINE DEPOT 60MG/0.2ML 15054006001 $15836.8000/ml
SOMATULINE DEPOT 60MG/0.2ML 15054106003 $20230.3000/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
SOMATULINE DEPOT 90MG/0.3ML 15054009001 $14065.9333/ml
SOMATULINE DEPOT 90MG/0.3ML 15054109003 $17964.5333/ml
SOMAVERT 10 MG 00009517602 $173.0938/each
SOMAVERT 10 MG 00009716601 $173.0938/each
SOMAVERT 15 MG 00009517802 $259.6609/each
SOMAVERT 15 MG 00009716801 $259.6609/each
SOMAVERT 20 MG 00009518002 $346.1977/each
SOMAVERT 20 MG 00009718801 $346.1977/each
SOMAVERT 25 MG 00009519901 $432.7547/each
SOMAVERT 25 MG 00009520104 $432.7685/each
SOMAVERT 25 MG 00009719901 $432.7547/each
SOMAVERT 30 MG 00009520001 $519.2915/each
SOMAVERT 30 MG 00009537604 $519.3121/each
SOMAVERT 30 MG 00009720001 $519.2915/each
SOVALDI 400 MG 61958150101 $1010.0000/tablet
SPRYCEL 100 MG 00003085222 $380.4000/tablet
SPRYCEL 140 MG 00003085722 $380.4000/tablet
SPRYCEL 20 MG 00003052711 $105.5300/tablet
SPRYCEL 50 MG 00003052811 $211.0599/tablet
SPRYCEL 70 MG 00003052411 $211.0599/tablet
SPRYCEL 80 MG 00003085522 $380.4000/tablet
STELARA 130MG/26ML 57894005427 $62.1538/ml
STELARA 45MG/0.5ML 57894006003 $17857.2444/ml
STELARA 90 MG/ML 57894006103 $17857.2040/ml
STIVARGA 40 MG 50419017101 $166.4487/tablet
STIVARGA 40 MG 50419017103 $166.4486/tablet
STRENSIQ 18MG/.45ML 25682001001 $2828.1120/ml
STRENSIQ 18MG/.45ML 25682001012 $2828.0000/ml
STRENSIQ 28MG/0.7ML 25682001301 $2828.1120/ml
STRENSIQ 28MG/0.7ML 25682001312 $2828.0000/ml
STRENSIQ 40 MG/ML 25682001601 $2828.1120/ml
STRENSIQ 40 MG/ML 25682001612 $2828.0000/ml
STRENSIQ 80MG/0.8ML 25682001901 $7070.2800/ml
STRENSIQ 80MG/0.8ML 25682001912 $7070.0000/ml
STRIBILD 150-200 MG 61958120101 $97.3148/tablet
SUPPRELIN LA 50 MG 67979000201 $27175.9185/each
SUSTIVA 200 MG 00056047492 $10.3818/capsule
SUSTIVA 50 MG 00056047030 $2.5970/capsule
SUSTIVA 600 MG 00056051030 $31.1454/tablet
SUSTOL 10MG/0.4ML 47426010106 $1249.8750/ml
SUTENT 12.5 MG 00069055038 $153.7786/capsule
SUTENT 25 MG 00069077038 $307.5576/capsule
SUTENT 37.5 MG 00069083038 $461.3370/capsule
SUTENT 50 MG 00069098038 $535.4151/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
SYLATRON 200 MCG 00085434701 $1656.2384/each
SYLATRON 300 MCG 00085434801 $2484.3576/each
SYLATRON 600 MCG 00085434901 $4968.7152/each
SYLVANT 100 MG 57894042001 $866.5699/each
SYLVANT 400 MG 57894042101 $3466.2796/each
SYNAGIS 100 MG/ML 60574411301 $2801.4875/ml
SYNAGIS 50MG/0.5ML 60574411401 $2967.2184/ml
SYNAREL 2 MG/ML 00025016608 $273.2063/ml
SYNERCID 500 MG 61570026001 $409.7564/each
SYNERCID 500 MG 61570026010 $409.7408/each
SYNRIBO 3.5 MG 63459017714 $921.1200/each
SYNVISC 16MG/2ML 58468009001 $209.3966/ml
SYNVISC-ONE 48 MG/6 ML 58468009003 $209.3966/ml
SYPRINE 250 MG 00187212010 $214.7947/capsule
TABLOID 40 MG 76388088025 $25.5300/tablet
TAFINLAR 50 MG 00078068266 $52.5786/capsule
TAFINLAR 50 MG 00173084608 $52.5786/capsule
TAFINLAR 75 MG 00078068166 $78.8626/capsule
TAFINLAR 75 MG 00173084708 $78.8626/capsule
TAGRISSO 40 MG 00310134930 $455.0050/tablet
TAGRISSO 80 MG 00310135030 $455.0050/tablet
TALTZ AUTOINJECTOR 80 MG/ML 00002144501 $4513.8688/ml
TALTZ AUTOINJECTOR 80 MG/ML 00002144511 $4513.6900/ml
TALTZ AUTOINJECTOR (2 PACK) 80 MG/ML 00002144527 $4513.6900/ml
TALTZ AUTOINJECTOR (3 PACK) 80 MG/ML 00002144509 $4513.6900/ml
TALTZ SYRINGE 80 MG/ML 00002772401 $4513.8688/ml
TALTZ SYRINGE 80 MG/ML 00002772411 $4513.6900/ml
TALTZ SYRINGE (2 PACK) 80 MG/ML 00002772427 $4513.6900/ml
TALTZ SYRINGE (3 PACK) 80 MG/ML 00002772409 $4513.6900/ml
TARCEVA 100 MG 50242006301 $215.6707/tablet
TARCEVA 150 MG 50242006401 $243.9389/tablet
TARCEVA 25 MG 50242006201 $78.5208/tablet
TARGRETIN 1 % 00187552560 $490.8442/gm
TARGRETIN 1 % 62856060422 $327.2294/gm
TASIGNA 150 MG 00078059251 $95.0857/capsule
TASIGNA 150 MG 00078059287 $95.0863/capsule
TASIGNA 200 MG 00078052651 $95.0857/capsule
TASIGNA 200 MG 00078052687 $95.0863/capsule
TAXOTERE 20MG/ML(1) 00075800301 $581.3560/ml
TAXOTERE 80 MG/4 ML 00075800404 $581.3408/ml
TECENTRIQ 1200 MG/20 50242091701 $435.3100/ml
TECFIDERA 120 MG 64406000501 $106.3025/capsule
TECFIDERA 120-240 MG 64406000703 $106.3025/capsule
TECFIDERA 240 MG 64406000602 $106.3025/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
TECHNIVIE 12.5-75 MG 00074308228 $460.8305/tablet
TEMODAR 100 MG 00085138101 $838.8151/each
TENIPOSIDE 50 MG/5 ML 44567050701 $504.1819/ml
THALOMID 100 MG 59572021015 $280.1819/capsule
THALOMID 100 MG 59572021095 $280.1815/capsule
THALOMID 150 MG 59572021513 $299.5833/capsule
THALOMID 150 MG 59572021593 $299.5833/capsule
THALOMID 200 MG 59572022016 $318.9977/capsule
THALOMID 200 MG 59572022096 $318.9976/capsule
THALOMID 50 MG 59572020514 $172.6108/capsule
THALOMID 50 MG 59572020517 $189.8699/capsule
THALOMID 50 MG 59572020594 $172.6100/capsule
THALOMID 50 MG 59572020597 $189.8659/capsule
THERACYS 81 MG 49281088003 $172.3666/each
THIOTEPA 15 MG 00143956501 $1414.0000/each
THROMBATE III 500 (+/-) 13533060250 $3.9188/each
THROMBATE III 500 (+/-) 13533060320 $3.9188/each
THYMOGLOBULIN 25 MG 58468008001 $739.8856/each
THYROGEN 1.1 MG 58468003002 $1501.8144/each
THYROGEN 1.1 MG 58468184904 $1501.8144/each
TIVICAY 10 MG 49702022613 $9.5795/tablet
TIVICAY 25 MG 49702022713 $23.9491/tablet
TIVICAY 50 MG 49702022813 $47.8982/tablet
TOBI 300 MG/5ML 00078049461 $26.4681/ml
TOBI 300 MG/5ML 00078049471 $26.4685/ml
TOBI PODHALER 28 MG 00078063011 $39.9607/capsule Increase
TOBI PODHALER 28 MG 00078063019 $39.9607/capsule Increase
TOBI PODHALER 28 MG 00078063035 $39.9609/capsule
TOBI PODHALER 28 MG 00078063056 $39.9608/capsule
TOBRAMYCIN 300 MG/5ML 00093408563 $20.8095/ml
TOBRAMYCIN 300 MG/5ML 00781717156 $13.0001/ml
TOBRAMYCIN 300 MG/5ML 17478034038 $9.1080/ml Decrease
TOBRAMYCIN 300 MG/5ML 24492089999 $13.0001/ml
TOBRAMYCIN 300 MG/5ML 65162091446 $13.0027/ml
TOBRAMYCIN 300 MG/5ML 70644089999 $13.0001/ml
TOPIRAMATE ER 100 MG 00832107415 $10.1172/capsule
TOPIRAMATE ER 100 MG 00832107430 $10.1172/capsule
TOPIRAMATE ER 150 MG 00832107515 $12.4441/capsule
TOPIRAMATE ER 150 MG 00832107530 $12.4442/capsule
TOPIRAMATE ER 200 MG 00832107315 $13.8395/capsule
TOPIRAMATE ER 200 MG 00832107330 $13.8397/capsule
TOPIRAMATE ER 25 MG 00832107115 $3.9201/capsule
TOPIRAMATE ER 25 MG 00832107130 $3.9201/capsule
TOPIRAMATE ER 50 MG 00832107215 $5.1063/capsule
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
TOPIRAMATE ER 50 MG 00832107230 $5.1062/capsule
TOPOTECAN HCL 4 MG/4 ML 00409030201 $62.4862/ml
TOPOTECAN HCL 4 MG/4 ML 00409030225 $28.3356/ml
TOPOTECAN HCL 4 MG/4 ML 00703471401 $26.9872/ml
TOPOTECAN HCL 4 MG/4 ML 00703471471 $26.9872/ml
TOPOTECAN HCL 4 MG/4 ML 25021023604 $37.8750/ml
TORISEL FDN 30MG/3 00008117901 $1643.6033/ml
TRACLEER 125 MG 66215010203 $155.6915/tablet
TRACLEER 125 MG 66215010206 $155.6915/tablet
TRACLEER 62.5 MG 66215010103 $155.6915/tablet
TRACLEER 62.5 MG 66215010106 $155.6915/tablet
TREANDA 100 MG 63459039120 $2727.2020/each
TREANDA 180 MG/2ML 63459039602 $2145.5329/ml
TREANDA 25 MG 63459039008 $681.8106/each
TREANDA 45MG/0.5ML 63459039502 $2145.5430/ml
TRELSTAR 11.25 MG 52544015402 $2464.1172/each Decrease
TRELSTAR 11.25/2ML 52544018876 $2464.1172/each
TRELSTAR 22.5 MG 52544015602 $4928.2344/each Decrease
TRELSTAR 22.5MG/2ML 52544009276 $4928.2344/each
TRELSTAR 3.75 MG 52544015302 $821.3724/each Decrease
TRELSTAR 3.75MG/2ML 52544018976 $821.3724/each
TRETINOIN 10 MG 00555080802 $27.1624/capsule
TRETINOIN 10 MG 10370026801 $27.1624/capsule
TRETINOIN 10 MG 68084007511 $25.5203/capsule
TRETINOIN 10 MG 68084007521 $27.8026/capsule
TRETTEN 2500 UNIT 00169701301 $10.8200/each
TRETTEN 2500 UNIT 00169711311 $10.8200/each
TREXALL 10 MG 51285036801 $24.5592/tablet
TREXALL 15 MG 51285036901 $36.8394/tablet
TREXALL 5 MG 51285036601 $12.2796/tablet
TREXALL 7.5 MG 51285036701 $18.4194/tablet
TRISENOX 10 MG/10ML 63459060010 $62.6604/ml
TRIUMEQ 600-50-300 49702023113 $81.0586/tablet
TRIZIVIR 150-300MG 49702021718 $27.0966/tablet
TROKENDI XR 100 MG 17772010301 $19.3979/capsule
TROKENDI XR 100 MG 17772010315 $19.3977/capsule
TROKENDI XR 200 MG 17772010401 $26.5348/capsule
TROKENDI XR 200 MG 17772010415 $26.5351/capsule
TROKENDI XR 25 MG 17772010101 $7.5160/capsule
TROKENDI XR 25 MG 17772010115 $7.5161/capsule
TROKENDI XR 50 MG 17772010201 $9.7904/capsule
TROKENDI XR 50 MG 17772010215 $9.7903/capsule
TRUVADA 100-150 MG 61958070301 $49.3701/tablet
TRUVADA 133-200 MG 61958070401 $49.3701/tablet
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
TRUVADA 167-250 MG 61958070501 $49.3701/tablet
TRUVADA 200-300 MG 61958070101 $49.3701/tablet
TYBOST 150 MG 61958140101 $6.4781/tablet
TYKERB 250 MG 00078067119 $42.8109/tablet
TYKERB 250 MG 00173075200 $42.8109/tablet
TYSABRI 300MG/15ML 64406000801 $390.3313/ml
TYVASO 1.74MG/2.9 66302020603 $178.0560/ml
TYVASO INSTITUTIONAL START KIT 1.74MG/2.9 66302020604 $321.7198/ml
TYVASO REFILL KIT 1.74MG/2.9 66302020602 $178.1182/ml
TYVASO STARTER KIT 1.74MG/2.9 66302020601 $198.6416/ml
TYZEKA 600 MG 00078053815 $36.0587/tablet
UNITUXIN 3.5 MG/ML 66302001401 $1663.4700/ml
UPTRAVI 1000 MCG 66215061006 $244.4200/tablet
UPTRAVI 1200 MCG 66215061206 $244.4200/tablet
UPTRAVI 1400 MCG 66215061406 $244.4200/tablet
UPTRAVI 1600 MCG 66215061606 $244.4200/tablet
UPTRAVI 200 MCG 66215060206 $157.2233/tablet
UPTRAVI 200 MCG 66215060214 $157.1271/tablet
UPTRAVI 200-800MCG 66215062820 $109.9890/tablet
UPTRAVI 400 MCG 66215060406 $244.4200/tablet
UPTRAVI 600 MCG 66215060606 $244.4200/tablet
UPTRAVI 800 MCG 66215060806 $244.4200/tablet
VALCHLOR 0.016 % 66215001660 $53.2775/gm
VALSTAR 40 MG/ML 67979000101 $224.6190/ml
VANTAS 50 MG 67979050001 $3434.0000/each
VARIZIG 125 UNIT 53270012501 $689.3250/each
VARIZIG 125/1.2 ML 53270012601 $997.3750/ml
VARIZIG 125/1.2 ML 53270012602 $997.3750/ml
VARUBI 90 MG 69656010102 $267.6500/tablet
VECAMYL 2.5 MG 69413055840 $63.8320/tablet
VECTIBIX 100 MG/5ML 55513095401 $220.1497/ml
VECTIBIX 400MG/20ML 55513095601 $220.1497/ml
VELCADE 3.5 MG 63020004901 $1619.0300/each
VELETRI 0.5 MG 66215040301 $22.7856/each
VELETRI 1.5 MG 66215040201 $45.5712/each
VEMLIDY 25 MG 61958230101 $33.5916/tablet Add
VENCLEXTA 10 MG 00074056111 $8.0447/tablet
VENCLEXTA 10 MG 00074056114 $8.0461/tablet
VENCLEXTA 100 MG 00074057611 $80.4566/tablet
VENCLEXTA 100 MG 00074057622 $80.4616/tablet
VENCLEXTA 50 MG 00074056607 $40.2312/tablet
VENCLEXTA 50 MG 00074056611 $40.2283/tablet
VENCLEXTA STARTING PACK 10-50-100 00074057928 $49.6179/tablet
VENTAVIS 10 MCG/ML 66215030200 $118.8770/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
VENTAVIS 10 MCG/ML 66215030230 $118.8770/ml
VENTAVIS 20 MCG/ML 66215030300 $118.8770/ml
VENTAVIS 20 MCG/ML 66215030330 $118.8770/ml
VIDAZA 100 MG 59572010201 $591.0924/each
VIDEX FNL10MG/ML 00087663241 $0.5597/ml
VIDEX FNL10MG/ML 00087663341 $0.6109/ml
VIEKIRA PAK 12.5-75-50 00074309328 $250.4529/tablet
VIEKIRA XR 8.33-50 MG 00074006328 $333.9373/tablet
VIMIZIM 5 MG/5 ML 68135010001 $219.9780/ml
VINBLASTINE SULFATE 1 MG/ML 63323027810 $4.3501/ml
VIRACEPT 250 MG 63010001030 $3.5080/tablet
VIRACEPT 625 MG 63010002770 $8.7699/tablet
VIRAMUNE 50 MG/5 ML 00597004724 $0.6933/ml
VIRAMUNE XR 100 MG 00597012990 $7.9178/tablet
VIREAD 150 MG 61958040401 $31.1319/tablet
VIREAD 200 MG 61958040501 $31.1319/tablet
VIREAD 250 MG 61958040601 $31.1319/tablet
VIREAD 300 MG 61958040101 $33.5916/tablet
VIREAD 40MG/SCOOP 61958040301 $9.1582/gm
VISUDYNE 15 MG 00187560015 $1634.8870/each
VITEKTA 150 MG 61958130201 $40.5498/tablet
VITEKTA 85 MG 61958130101 $40.5498/tablet
VIVITROL 380MG 65757030001 $1322.0900/each
VONVENDI 1300 (+/-) 00944755201 $1.8600/each
VONVENDI 1300 (+/-) 00944755302 $1.8600/each
VONVENDI 650 (+/-) 00944755001 $1.8600/each
VONVENDI 650 (+/-) 00944755102 $1.8600/each
VOTRIENT 200 MG 00078067066 $84.3930/tablet
VOTRIENT 200 MG 00173080409 $84.3930/tablet
VPRIV 400 UNIT 54092070104 $1390.7700/each
WILATE 1K-1K UNIT 67467018202 $0.8236/each
WILATE 1K-1K UNIT 68982018202 $0.8236/each
WILATE 500-500 67467018201 $0.8236/each
WILATE 500-500 68982018201 $0.8236/each
WINRHO SDF 1500/1.3ML 53270330001 $302.0444/ml
WINRHO SDF 15000/13ML 53270300001 $303.9269/ml
WINRHO SDF 2500/2.2ML 53270350001 $299.3227/ml
WINRHO SDF 5000/4.4ML 53270310001 $299.3227/ml
XALKORI 200 MG 00069814120 $238.0051/capsule
XALKORI 250 MG 00069814020 $238.0051/capsule
XELJANZ 5 MG 00069100101 $58.3841/tablet
XELJANZ XR 11 MG 00069050130 $116.7681/tablet
XEOMIN 100 UNIT 00259161001 $486.8200/each Increase
XEOMIN 200 UNIT 00259162001 $973.6400/each Increase
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
XEOMIN 50 UNIT 00259160501 $255.5300/each Increase
XGEVA 120 MG/1.7 55513073001 $1208.9997/ml
XIAFLEX 0.9 MG 66887000301 $3680.8339/each
XOFIGO 1100KBQ/ML 50419020801 $22271.1464/each
XOLAIR 150 MG 50242004062 $992.9916/each
XTANDI 40 MG 00469012599 $78.8642/capsule
XYNTHA 1000 (+/-) 58394001401 $0.9949/each
XYNTHA 2000 (+/-) 58394001501 $0.9949/each
XYNTHA 250 (+/-) 58394001201 $0.9949/each
XYNTHA 3000 (+/-) 58394001603 $0.9949/each
XYNTHA 500 (+/-) 58394001301 $0.9949/each
XYNTHA SOLOFUSE 1000 (+/-) 58394002403 $0.9949/each
XYNTHA SOLOFUSE 2000 (+/-) 58394002503 $0.9949/each
XYNTHA SOLOFUSE 250 (+/-) 58394002203 $0.9949/each
XYNTHA SOLOFUSE 500 (+/-) 58394002303 $0.9949/each
XYREM 500 MG/ML 68727010001 $20.8340/ml
YERVOY 200MG/40ML 00003232822 $692.8943/ml
YERVOY 50 MG/10ML 00003232711 $692.8943/ml
YONDELIS 1 MG 59676061001 $2727.0000/each
ZALTRAP 100 MG/4ML 00024584001 $404.0000/ml
ZALTRAP 200 MG/8ML 00024584101 $404.0000/ml
ZANOSAR 1 G 00703463601 $352.7223/each
ZARXIO 300MCG/0.5 61314030401 $556.8332/ml
ZARXIO 300MCG/0.5 61314030410 $556.8332/ml
ZARXIO 480MCG/0.8 61314031201 $554.2122/ml
ZARXIO 480MCG/0.8 61314031210 $554.2122/ml
ZAVESCA 100 MG 66215020118 $300.9800/capsule
ZAVESCA 100 MG 66215020190 $300.9800/capsule
ZELAPAR 1.25 MG 00187045302 $68.5095/tablet
ZELBORAF 240 MG 50242009001 $45.6638/tablet
ZELBORAF 240 MG 50242009002 $45.6638/tablet
ZEMAIRA 1000 MG 00053720102 $0.5252/each
ZEPATIER 50MG-100MG 00006307401 $656.5260/tablet
ZEPATIER 50MG-100MG 00006307402 $656.5000/tablet
ZERIT 1 MG/ML 00003196801 $0.4323/ml
ZEVALIN 3.2MG/2ML 68152010303 $45919.4064/each
ZIAGEN 20 MG/ML 49702022248 $0.6180/ml
ZINBRYTA 150 MG/ML 00074003301 $6901.6633/ml
ZINECARD 250 MG 00013871762 $237.2288/each
ZINECARD 500 MG 00013872789 $474.4677/each
ZOLADEX 10.8MG 00310095130 $1668.0049/each
ZOLADEX 3.6 MG 00310095036 $556.0050/each
ZOLEDRONIC ACID 4 MG/100ML 25021082666 $0.6060/ml
ZOLEDRONIC ACID 4 MG/100ML 25021082667 $0.6060/ml
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ZOLEDRONIC ACID 4 MG/100ML 25021082682 $1.8180/ml
ZOLEDRONIC ACID 4 MG/5 ML 00143964201 $60.6000/ml
ZOLEDRONIC ACID 4 MG/5 ML 17478032705 $11.3625/ml
ZOLEDRONIC ACID 4 MG/5 ML 17478032745 $11.3625/ml
ZOLEDRONIC ACID 4 MG/5 ML 23155017031 $12.7260/ml
ZOLEDRONIC ACID 4 MG/5 ML 25021080166 $36.3600/ml
ZOLEDRONIC ACID 4 MG/5 ML 25021080167 $12.1200/ml
ZOLEDRONIC ACID 4 MG/5 ML 42023015101 $14.1400/ml
ZOLEDRONIC ACID 4 MG/5 ML 43598033011 $12.1200/ml
ZOLEDRONIC ACID 4 MG/5 ML 45963044055 $60.6000/ml
ZOLEDRONIC ACID 4 MG/5 ML 47335003540 $75.7500/ml
ZOLEDRONIC ACID 4 MG/5 ML 55111068507 $20.2000/ml
ZOLEDRONIC ACID 4 MG/5 ML 60505611000 $60.6000/ml
ZOLEDRONIC ACID 4 MG/5 ML 63323096198 $49.4900/ml
ZOLEDRONIC ACID 4 MG/5 ML 67457039054 $12.8997/ml
ZOLEDRONIC ACID 4 MG 47335096241 $378.7500/each
ZOLEDRONIC ACID 5 MG/100ML 23155018631 $3.0300/ml
ZOLEDRONIC ACID 5 MG/100ML 25021083082 $3.5350/ml
ZOLEDRONIC ACID 5 MG/100ML 42023016301 $2.0099/ml
ZOLEDRONIC ACID 5 MG/100ML 43598033111 $2.7775/ml
ZOLEDRONIC ACID 5 MG/100ML 55111068852 $3.0300/ml
ZOLINZA 100 MG 00006056840 $104.5877/capsule
ZOMACTON 10 MG 55566190101 $585.8000/each
ZOMACTON 5 MG 55566180101 $292.9000/each
ZOMETA 4 MG/100ML 00078059061 $9.3170/ml
ZOMETA 4 MG/5 ML 00078038725 $186.3410/ml
ZORBTIVE 8.8 MG 44087338807 $1116.6647/each
ZORTRESS 0.25 MG 00078041720 $7.8194/tablet
ZORTRESS 0.25 MG 00078041761 $7.8275/tablet
ZORTRESS 0.5 MG 00078041420 $15.6388/tablet
ZORTRESS 0.5 MG 00078041461 $15.6550/tablet
ZORTRESS 0.75 MG 00078041520 $23.4581/tablet
ZORTRESS 0.75 MG 00078041561 $23.4724/tablet
ZUPLENZ 4 MG 57881044401 $32.8600/each
ZUPLENZ 4 MG 57881044410 $32.8563/each
ZUPLENZ 8 MG 57881044801 $32.8600/each
ZUPLENZ 8 MG 57881044810 $32.8563/each
ZYDELIG 100 MG 61958170101 $160.8777/tablet
ZYDELIG 150 MG 61958170201 $160.8777/tablet
ZYKADIA 150 MG 00078064070 $96.7932/capsule
ZYPREXA RELPREVV 210 MG 00002763511 $595.5768/each
ZYPREXA RELPREVV 210 MG 00002765801 $595.6038/each
ZYPREXA RELPREVV 300 MG 00002763611 $850.8240/each
ZYPREXA RELPREVV 300 MG 00002765901 $850.8577/each
NAME OF DRUG Strength NDC
Price Effective
January 1, 2017
Add
Increase
Decrease
ZYPREXA RELPREVV 405 MG 00002763711 $1148.6124/each
ZYPREXA RELPREVV 405 MG 00002766001 $1148.6596/each
ZYTIGA 250 MG 57894015012 $72.6193/tablet
ZYVOX 100 MG/5ML 00009513601 $6.8578/ml
ZYVOX 200MG/0.1L 00009513701 $0.6060/ml
ZYVOX 200MG/0.1L 00009513704 $0.6060/ml
ZYVOX 600MG/300 00009499201 $0.2693/ml
ZYVOX 600MG/300 00009499202 $0.2693/ml
ZYVOX 600MG/300 00009514001 $0.2693/ml
ZYVOX 600MG/300 00009514004 $0.2693/ml
ZYVOX 600MG/300 00009780701 $0.2693/ml
ZYVOX 600MG/300 00009780702 $0.2693/ml
