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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 A531AH LOUTEN EMULSION 0.005% EYE DR (LPO) LATA LATANOPROST LOUTEN EMULSION 2.5ML C 16.31 16.31 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
41 A531AW BIMATOPROST 0.01% EYE DR (CIR) BIMATOPROST BIMATOPROST 2.5ML A 9.24 9.24 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524028 EENT PROSTAGLANDIN ANALOGS 2024-07-23 2025-01-16 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS 2024-07-23
41 A531AW BIMATOPROST 0.01% EYE DR (CIR) BIMATOPROST BIMATOPROST 2.5ML A 12.83 12.83 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524028 EENT PROSTAGLANDIN ANALOGS 2025-01-17 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS 2025-01-17
40 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS/COL) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.87 10.87 EYE DROP 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.87 10.8733 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.82 10.82 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
41 A531BF XALATAN 0.005% EYE DR (PFI) LATANOPROST LATANOPROST XALATAN 2.5ML A 8.86 8.8617 BOTT 2 BOTT PFI PFIZER CORPORATION COL COLLINS LIMITED B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS 2025-04-01
42 A531BF XALATAN 0.005% EYE DR (PFI) LATANOPROST LATANOPROST XALATAN 2.5ML A 8.51 8.51 BOTT 1 BOTT PFI PFIZER CORPORATION COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A531BH BITOD LS 0.01% EYE DR (SYP) BIMATOPROST BIMATOPROST BITOD LS 3ML A 8.54 8.54 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
40 A531H XALATAN 0.005% EYE DR (PFI/SBI) LATANOPROST LATANOPROST XALATAN 2.5ML A 11.66 11.66 EYE DROP 1 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 Price Change OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-05-03
41 A531H XALATAN 0.005% EYE DR (PFI) LATANOPROST LATANOPROST XALATAN 2.5ML A 8.86 8.8617 BOTT 1 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
40 A531J LUMIGAN 0.01% EYE DR (ALL/COL) BIMATOPROST BIMATOPROST LUMIGAN 2.5ML C 41.32 41.32 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A531J LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST (C) BIMATOPROST LUMIGAN 2.5ML C 41.32 41.3185 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A531J LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST BIMATOPROST LUMIGAN 2.5ML C 41.32 41.32 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
40 A531W SAFLUTAN 0.015MG/ML EYE DR (MSD/STO) TAFLUPROST TAFLUPROST SAFLUTAN 30X0.3ML B 36.43 36.43 EYE DROP 0 AMP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A573H ALENDRONATE 70MG TAB (CIP) (B) ALENDRONATE ALENDRONATE 40'S B 21.94 0.5484 TAB 5 BOX CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 9224 BONE RESORPTION INHIBITORS 2024-04-01 2026-03-31 ORAL 6 BONE RESORPTION INHIBITORS
42 A573K ALENDRONATE 70MG TAB (CIP) ALENDRONATE ALENDRONATE 4'S BQ 3.78 0.95 TAB 5 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 9224 BONE RESORPTION INHIBITORS 2026-04-01 2028-03-31 ORAL 0 BONE RESORPTION INHIBITORS
40 A573P ALENDRONATE 70MG TAB (APL/AHI) ALENDRONATE ALENDRONATE 4'S B 3.62 0.91 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 9224 BONE RESORPTION INHIBITORS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 A5916 DOXORUBICIN 50MG SOLN FOR INJ (EBA/COL) DOXORUBICIN DOXORUBICIN 50MG VIAL BQ 34.93 34.93 SOLUTION FOR 0 VIAL EBA EBEW ARZNEIMITTLE GES.MBH COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Price Change IV 0 ANTINEOPLASTICS 2022-01-18
40 A591AA DOXORUBICIN 50MG SOLN FOR INJ (DIL/AHI) DOXORUBICIN DOXORUBICIN 50MG VIAL BQ 25.91 25.91 SOLUTION FOR 0 VIAL DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS