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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
42 50838 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER TESTOSTERONE PRIMOTESTON 250MG AMP BQ 36.43 36.43 AMPG 4 AMP BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6808 ANDROGENS 2026-04-01 2028-03-31 IV 0 ANDROGENS
40 5083C TESTOSTERONE 250MG/ML INJ (RTM/PHA) TESTOSTERONE TESTOSTERONE 10X1ML BQ 140.81 14.08 INJECTION 0 AMP RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 6808 ANDROGENS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 5083C TESTOSTERONE 250MG/ML INJ (RTM) (BQ) TESTOSTERONE TESTOSTERONE 10X1ML BQ 157.34 15.7337 AMP 4 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 6808 ANDROGENS 2024-04-01 2026-03-31 IV 6 ANDROGENS
41 5083D SOSTENON 250MG/ML INJ (ASG) TESTOSTERONE (BQ) TESTOSTERONE SOSTENON 250MG PFS BQ 34.17 34.1693 PFS 4 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 6808 ANDROGENS 2024-04-01 2026-03-31 IM 6 ANDROGENS
41 51115 PROPYLTHIOURACIL 50MG TAB (MCP) PROPYLTHIOURACIL PROPYLTHIOURACIL 10X10 A 20.25 0.2025 TAB 270 BOX MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 683608 ANTI-THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 ANTI-THYROID AGENTS
40 51118 PROPYLTHIOURACIL 50MG TAB (HAL/COL) PROPYLTHIOURACIL PROPYLTHIOURACIL 100'S A 24.71 0.25 TABLET 270 TAB HAL HALEWOOD CHEMICALS LTD. COL COLLINS LTD 683608 ANTI-THYROID AGENTS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 51118 PROPYLTHIOURACIL 50MG TAB (HAL) (C) PROPYLTHIOURACIL PROPYLTHIOURACIL 100'S C 25.2 0.252 TAB 270 BOX HAL HALEWOOD CHEMICALS LTD. COL COLLINS LTD 683608 ANTI-THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 ANTI-THYROID AGENTS
42 5111A PROPYLTHIOURACIL 50MG TAB (HAL) PROPYLTHIOURACIL PROPYLTHIOURACIL 56'S A 14.76 0.26 TAB 270 BLIS HAL HALEWOOD CHEMICALS LTD. COL AVENTA BARBADOS 683608 ANTI-THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 ANTI-THYROID AGENTS
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP LATANOPROST|TIMOLOL XALACOM 2.5ML C 28.68 28.68 EYE DROP 0 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP LATANOPROST|TIMOLOL XALACOM 2.5ML C 37.89 37.89 EYE DROP 0 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-07-27 2024-03-31 Price Change OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-07-26
41 51311 XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL (C) LATANOPROST|TIMOLOL XALACOM 2.5ML C 34.58 34.5771 BOTT 1 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 51313 LOUTEN T 0.005% | 0.5% EYE DR (LPO/COL) LATANOP LATANOPROST|TIMOLOL LOUTEN T 2.5ML A 13.05 13.05 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 51313 LOUTEN T 0.005%|0.5% EYE DR (LPO) LATANO LATANOPROST|TIMOLOL LOUTEN T 2.5ML A 14.35 14.3528 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 51313 LOUTEN T 0.005%|0.5% EYE DR (LPO) LATANOPROST|TIMOLOL LATANOPROST|TIMOLOL LOUTEN T 2.5ML C 17.67 17.67 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 2028-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 51316 XALACOM 0.005% /0.5% EYE DR (PFI/SBI) LATANOP LATANOPROST|TIMOLOL XALACOM 2.5ML C 37.90 37.90 EYE DROP 0 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 Price Change OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-05-05
41 51316 XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL (C) LATANOPROST|TIMOLOL XALACOM 2.5ML C 34.58 34.5771 BOTT 1 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 5131BL LATANOPROST|TIMOLOL EYE DR (MTP) LATANOPROST|TIMOLOL LATANOPROST|TIMOLOL 2.5ML A 8.86 8.86 BOTT 1 BOTT MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 2028-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 5131L DUOTRAV 0.5% | 0.004% EYE DR (NVS/COL) TIMOLOL | TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.46 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI (C) TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.4568 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.46 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 2028-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS