NEDGROUP HOSPITAL AND SAVINGS PLAN

Transcription

1 NEDGROUP HOSPITAL AND SAVINGS PLAN A clinically relevant motivation is required when prescribing any product which does not appear on this list. Chronic application forms must accompany all first-time applications. All applications MUST include valid ICD10 codes. Risk Equalisation Fund criteria must be met. The formulary is subject to regular review. SCRIPTPHARM RISK MANAGEMENT reserves the right to update and change the formulary when new information becomes available or when new medicines are released. PLEASE TAKE NOTE OF THE FOLLOWING: Oxygen will only be considered for bronchiectasis and COPD in severe, advanced disease. For diabetic patients, the following limits apply. Please provide a motivation if a higher quantity is required. Lancets Glucose Monitoring Strips Needles Max 30 per month allowed Max 50 per month allowed Max 30 per month allowed Insulin syringes will only be considered on motivation. Pensets or penfills are recommended. Inteferons for Multiple Sclerosis will only be considered upon receipt of a clinically relevant motivation including history of therapy and expanded disability status scale report (EDSS) Treatment for hyperlipidaemia is subject to criteria for lipid-lowering therapy being met. Assessment required completed Risk Evaluation report as well as diagnostic and latest lipograms including LDL cholesterol levels. Major drug class Generic name Trade names and (nappi codes) Addison's disease E27.1 Corticosteroids Hydrocortisone 10mg Covocort 10mg Corticosteroids Fludrocortisone, 0.1mg Florinef 0.1mg For long term corticosteriod use Loop diuretics Furosemide 20mg Austell Furosemide 20mg Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Asthma J45 Apparatus Aerochamber Aerochamber adult Apparatus Aerochamber Aerochamber child Apparatus Aerochamber Aerochamber neonate Apparatus Aerochamber Glaxohaler Spacer Device Apparatus Aerochamber Huf Puf Kit Apparatus Aerochamber Zerostat Spacer Corticosteroids Prednisone 5mg Be-tabs prednisone Corticosteroids Prednisolone 5mg Aspelone Sympathomimetics Fenoterol 100mcg Berotec 100 HFA 200 dose Only for severe persistent asthma (motivation required from specialist) Only for severe persistent asthma (motivation required from specialist) Sympathomimetics Salbutamol sulphate 100mcg Asthavent 300dose ecohaler Limited to 3 inhalers per year if no inhaled steroid Sympathomimetics Salbutamol sulphate 2mg Venteze 2mg Sympathomimetics Salbutamol sulphate 4mg Venteze 4mg Sympathomimetics Salbutamol sulphate 2mg/5ml Venteze 2mg/5ml Sympathomimetics Salmeterol xinafoate 25mcg Serevent cfc free inhaler Only for moderate & severe persistent asthma Sympathomimetics Salmeterol xinafoate 25mcg Serevent 120 dose Only for moderate & severe persistent asthma Sympathomimetics Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose Only for moderate & severe persistent asthma Sympathomimetics Salmeterol xinafoate 25mcg Serevent 60 dose Only for moderate & severe persistent asthma Sympathomimetics Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Sereflo 25/50mcg 120 dose inh Only for moderate & severe persistent asthma Sympathomimetics Salmeterol fluticazone Foxair 25/125mcg 120 dose inh Sereflo 25/125mcg 120 dose inh Only for moderate & severe persistent asthma Sympathomimetics Salmeterol fluticazone Foxair 25/250mcg 120 dose inh Sereflo 25/250mcg 120 dose inh Only for moderate & severe persistent asthma Sympathomimetics Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters Only for moderate & severe persistent asthma Sympathomimetics Salmeterol 50ug/Fluticasone 250ug Foxair 50/250mcg 60 blisters Only for moderate & severe persistent asthma Sympathomimetics Salmeterol 50ug/Fluticasone 500ug Foxair 50/250mcg 60 blisters Only for moderate & severe persistent asthma Sympathomimetics Budesonide 160 / formoterol 4.5mcg Symbicord 60 dose Only for moderate & severe persistent asthma Sympathomimetics Budesonide 160 / formoterol 4.5mcg Symbicord 120 dose Vannair 160/4.5mcg Only for moderate & severe persistent asthma Sympathomimetics Budesonide 320 / formoterol 9mcg Symbicord 60 dose Only for moderate & severe persistent asthma Sympathomimetics Budesonide 80 / formoterol 4.5mcg Symbicord 120 dose Vannair 80/4.5mcg Only for moderate & severe persistent asthma Glucocorticoids Beclomethasone 100ug Beclate 100ug Only for moderate & severe persistent asthma Glucocorticoids Beclomethasone 200ug Beclate 200ug Only for moderate & severe persistent asthma Glucocorticoids Beclomethasone 50ug Beclate 50ug Only for moderate & severe persistent asthma Glucocorticoids Budesonide 100ug Budeflam 100ug 300 dose Only for moderate & severe persistent asthma Glucocorticoids Budesonide 200ug Budeflam 200 mg 300 dose Only for moderate & severe persistent asthma Glucocorticoids Budesonide 200ug Budeflam DP Inh cap Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 50mcg Flixotide 50 CFC free inhaler Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 50mcg Flixotide accuhaler 60 dose Glucocorticoids Fluticasone 100mcg Flixotide accuhaler 60 dose Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 125mcg Flixotide 125 CFC free inhaler Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 250mcg Flixotide 250 CFC free inhaler Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 250mcg Flixotide accuhaler 60 dose Only for moderate & severe persistent asthma Glucocorticoids Fluticasone 500mcg Flixotide accuhaler 60 dose Only for moderate & severe persistent asthma Glucocorticoids Budesonide 200ug Inflammide 200 novolizer complete Only for moderate & severe persistent asthma Glucocorticoids Budesonide 200ug Inflammide 200 novolizer refill Only for moderate & severe persistent asthma 1

2 Glucocorticoids Budesonide 400ug Inflammide 400 novolizer complete Only for moderate & severe persistent asthma Glucocorticoids Budesonide 400ug Inflammide novolizer refill Only for moderate & severe persistent asthma LABA Formoterol 12mcg Foratec hfa 120dose Only for moderate & severe persistent asthma Methylxanthine Theophylline 200mg Sandoz theophylline 200mg Theoplus 200mg Methylxanthine Theophylline 300mg Sandoz Theophylline 300mg Theoplus 300mg Inhaled anticholinergics Ipratropium bromide Ipvent 40mcg INH 300dose Bipolar depression F31 Anti-epileptic Valproic acid 150mg Convulex 150mg Anti-epileptic Valproic acid 300mg Convulex 300mg Anti-epileptic Valproic acid 500mg Convulex 500mg Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension Anti-epileptic Carbamazepine 200mg Degranol 200mg Therapy must be initiated by a Psychiatrist Anti-epileptic Sodium valproate Epilim 200mg/5ml liquid Therapy must be initiated by a Psychiatrist Anti-epileptic Sodium valproate Navalpro cr 200mg Epilizine cr 200mg Anti-epileptic Sodium valproate Navalpro cr 300mg Epilizine cr 300mg Anti-epileptic Sodium valproate Navalpro cr 500mg Epilizine cr 500mg Anti-epileptic Sodium valproate Epilim crushable 100mg Anti-epileptic Lamotrigine 25mg Dyna-Lamotrigine 25mg Therapy must be initiated by a Psychiatrist Anti-epileptic Lamotrigine 50mg Dyna-Lamotrigine 50mg Therapy must be initiated by a Psychiatrist Anti-epileptic Lamotrigine 100mg Dyna-Lamotrigine 100mg Therapy must be initiated by a Psychiatrist Anti-epileptic Lamotrigine 200mg Dyna-Lamotrigine 200mg Therapy must be initiated by a Psychiatrist Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg Quetoser 25mg Atypical antipsychotic Quetiapine 100mg Dopaquel 100mg Quetoser 100mg Atypical antipsychotic Quetiapine 200mg Dopaquel 200mg Quetoser 200mg Atypical antipsychotic Quetiapine 300mg Dopaquel 300mg Quetoser 300mg Benzamides Sulpiride 50mg Espiride Therapy must be initiated by a Psychiatrist Butyrephenones Haloperidol 1.5mg Sandoz haloperidol 1.5mg Therapy must be initiated by a Psychiatrist Butyrephenones Haloperidol 5mg Sandoz haloperidol 5mg Therapy must be initiated by a Psychiatrist Butyrephenones Haloperidol 0.5mg Serenace 0.5mg Therapy must be initiated by a Psychiatrist Lithium Lithium carbonate 250mg Camcolit 250mg Therapy must be initiated by a Psychiatrist Lithium Lithium carbonate 400mg Camcolit 400mg Therapy must be initiated by a Psychiatrist Lithium Lithium carbonate 450mg Quilonum Ret 450mcg tab Therapy must be initiated by a Psychiatrist MAOI Moclobemide 150mg Depnil Therapy must be initiated by a Psychiatrist MAOI Moclobemide 300mg Depnil Therapy must be initiated by a Psychiatrist Phenothiazines Chlorpromazine 25mg Largactil 25mg Therapy must be initiated by a Psychiatrist Phenothiazines Chlorpromazine 100mg Largactil 100mg Therapy must be initiated by a Psychiatrist Phenothiazines Chlorpromazine 50mg Largactil 50mg Therapy must be initiated by a Psychiatrist SSRI Fluoxetine 20mg Ranflocs 20mg Deprozan 20mg st line agent SSRI Citalopram 20mg Talomil 20mg Arrow Citalopram 20mg st line agent SSRI Paroxetine 20mg Serrapress 20mg Xet 20mg st line agent SSRI Sertraline 50mg Dyna-Sertraline 50mg Serdep 50mg SSRI Sertraline 100mg Dyna-Sertraline 100mg Serdep100mg SNRI Venlafaxine 37.5mg Odiven 37.5mg SNRI Venlafaxine Hcl 37.5mg Venlor XR SNRI Venlafaxine 75mg Venlor XR 75mg Venlafaxine Unicorn XR 75mg SNRI Venlafaxine 150mg Venlor XR 150mg Venlafaxine Unicorn XR 150mg SNRI Venlafaxine Hcl 150mg Illovex SR 150mg Tricyclic Dothiepin 25mg Thaden 25mg antidepressants Therapy must be initiated by a Psychiatrist Tricyclic antidepressants Dothiepin 75mg Thaden 75mg Therapy must be initiated by a Psychiatrist Tricyclic antidepressants Amitriptyline 10mg Trepiline 10mg Therapy must be initiated by a Psychiatrist Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg Therapy must be initiated by a Psychiatrist Anti-cholinergic Orphenadrine 50mg Disipal 50mg In combination with antipsychotic for drug-induced dyskinesias Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg In combination with antipsychotic for drug-induced dyskinesias Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg In combination with antipsychotic for drug-induced dyskinesias Bronchiectasis J47 Antibiotics Doxycycline 50mg Dumoxin Antibiotics Amoxycillin 500mg Moxypen Antibiotics Trimethoprim-sulfamethoxazole 80/400 Durobac 480mg Antibiotics Doxycycline HCl 100mg Doximal 100mg Corticosteroids Prednisone 5mg Be-tabs prednisone Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent dose Combinations Ipratropium brom. 20ug; salbutamol sulph. To salbutamol Combivent inhaler ug/met.dos. Sympathomimetics Formoterol fumerate Foratec HFA 120dose Sympathomimetics Fenoterol 100mcg Berotec 100 HFA 200 dose Sympathomimetics Salmeterol xinafoate 25mcg Serevent accuhaler 60 dose Sympathomimetics Salmeterol xinafoate 50mcg Serevent Inhaler 60 dose Serevent inhaler 120 dose Inhaled Beta 2-agonists, Salbutamol 100ug inhaler Asthavent 200dose Venteze CFC free 200dose Methylxanthine Theophylline 200mg Sandoz theophylline 200mg Theoplus 200mg Methylxanthine Theophylline 300mg Sandoz Theophylline 300mg Theoplus 300mg Cardiac failure I50 ACE inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE Inhibitors Ramipril 2.5mg Rampil 2.5mg ACE Inhibitors Ramipril 5mg Rampil 5mg ACE Inhibitors Ramipril 10mg Rampil10mg ACE Inhibitors Enalapril 10mg Alapren 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg

3 ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus ACE inhibitors Perindopril tertbutylamine salt 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 5mg Prexum 5mg ACE inhibitors Perindopril tertbutylamine salt 8mg Pearinda 8mg Vectoryl 8mg ACE inhibitor combinations Perindopril tertbutylamine salt 4mg; Indapamide 1.25mg Prexum Plus Vectoryl Plus ACE inhibitor combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus 5/1.25 mg ACE inhibitor combinations Perindopril 10mg/Indapamide 2.5mg Bioprexum 10/2.5mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg Aldosterone antagonist Spirinolactone 25 Spiractin 25mg Alpha + beta blocker Carvedilol 12.5mg Vediblok 12.5 mg Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg Alpha + beta blocker Carvedilol 25mg Vediblok 25mg Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin Beta-blockers Bisoprolol 5mg Bilocor 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Nitrates Isosorbide dinitrate 10mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Elantan 20mg Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg Thiazide diuretic Hydrochlorthiazide Hexazide Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg Lomanor 10mg Calcium channel blockers Amlodipine 5mg Amtas 5mg Lomanor 5mg Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Nifedipine SR 20mg Cipalat Retard 20mg Calcium channel blockers Nifedipine SR 30mg Fedaloc sr 30mg Angiotensin receptor blockers (ARBs) Losartan 50mg Losartan-Winthrop 50mg Angiotensin receptor blockers (ARBs) losartan 100mg Zartan 100mg ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/12.5mg Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Cipla- Indapamide 2.5mg If >120 required, documented evidence of hypokalaemia must be provided Cardiomyopathy I42 ACE Inhibitors Enalapril 10mg Alapren 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg ACE inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE inhbitor combinations Lisinopril 10mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 10/12.5mg ACE inhbitor combinations Lisinopril 20mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 20/12.5mg ACE inhibitors Ramipril 2.5mg Rampil 2.5mg ACE inhibitors Ramipril 5mg Rampil 5mg ACE inhibitors Ramipril 10mg Rampil10mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus ACE inhibitors Perindopril tertbutylamine salt 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE inhibitors Perindopril tertbutylamine salt 8mg Pearinda 8mg Vectoryl 8mg ACE inhibitor combinations Perindopril tertbutylamine salt 4mg; indapamide 1.25mg Prexum Plus Vectoryl Plus ACE inhibitor combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus 5/1.25 mg ACE inhibitor combinations Perindopril 10mg/Indapamide 2.5mg Bioprexum Plus 10/2.5mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg Angiotensin receptor blockers Losartan 100mg Zartan 100mg (ARBs) Motivation over ACE-inhibitor, including history of therapy, required ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/12.5mg Aldosterone antagonist Spirinolactone 25 Spiractin 25mg Alpha + beta blocker Carvedilol 12.5mg Vediblok 12.5 mg Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg Alpha + beta blocker Carvedilol 25mg Vediblok 25mg Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin

4 Beta-blockers Bisoprolol 5mg Bilocor 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Nitrates Isosorbide dinitrate 10mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Elantan 20mg Platelet aggregation Aspirin 81mg Ecotrin 81mg inhibitors Motivation required over normal aspirin If >120 required, documented evidence of hypokalaemia must be provided Thiazide diuretic Hydrochlorthiazide Hexazide Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Cipla- Indapamide 2.5mg Chronic renal disease N03 ACE Inhibitors Enalapril 10mg Alapren 10mg N05 ACE Inhibitors Enalapril 20mg Alapren 20mg N11 ACE Inhibitors Enalapril 5mg Alapren 5mg N18 ACE inhbitor combinations Enalapril / hydrochlorthiazide Enap co N19 ACE inhibitors Ramipril 2.5mg Rampil 2.5mg ACE inhibitors Ramipril 5mg Rampil 5mg ACE inhibitors Ramipril 10mg Rampil10mg ACE Inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE Inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE Inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE inhibitors Lisinopril 10mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 10/12.5mg ACE inhibitors Lisinopril 20mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 20/12.5mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus ACE Inhibitors Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE Inhibitors Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus ACE Inhibitors combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus 5/1.25 mg ACE Inhibitors combinations Perindopril 4mg/Indapamide 1.25mg Bioprexum Plus 10/2.5mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg Aldosterone antagonist Spironolactone 25mg Spiractin 25mg Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg Calciferol Calciferol 5 000u/ml Calciferol Oily solution 5000u/mL units day Calciferol Calciferol IU Lennon Strong Calciferol Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Diltiazem 60mg Zildem 60mg Calcium channel blockers - long acting Verapamil 240 SR Verahexal 240 sr Calcium channel blockers - long acting Nifedipine SR 20mg Nifedalat 20 sr tab Calcium channel blockers - long acting Nifedipine SR 30mg Fedaloc sr 30mg Calcium supplements Calcium carbonate 420mg Titralac Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide Motivation and Haemoglobin levels required- forward to Onecare Haematinics Erythropoietin Repotin 2000iu /Medscheme Motivation and Haemoglobin levels required- forward to Onecare Haematinics Erythropoietin Repotin 4000iu /Medscheme Motivation and Haemoglobin levels required- forward to Onecare Iron supplements Iron(III)-hydroxide sucrose complex Venofer /Medscheme Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Vitamins Folic acid 5mg Be-tabs folic 5mg If >120 required, documented evidence of hypokalaemia must be provided COPD J43 Corticosteroids Prednisone 5mg Be-tabs Prednisone 5mg J44 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent dose Sympathomimetics Salbutamol 200ug Asthavent dp Cybutol 200ug Sympathomimetics Salbutamol 400ug Cybutol 400ug Sympathomimetics Salbutamol 100ug inhaler Asthavent 200dose Venteze 100ug inhaler Sympathomimetics Salmeterol xinafoate 25mcg Serevent cfc free inhaler Sympathomimetics Salmeterol xinafoate 25mcg Serevent 120 dose Sympathomimetics Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose Sympathomimetics Salmeterol xinafoate 25mcg Serevent 60 dose Sympathomimetics Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Sereflo 25/50mcg 120 dose inh Sympathomimetics Salmeterol fluticazone Foxair 25/125mcg 120 dose inh Sereflo 25/125mcg 120 dose inh

5 Sympathomimetics Salmeterol fluticazone Foxair 25/250mcg 120 dose inh Sereflo 25/250mcg 120 dose inh Sympathomimetics Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters Sympathomimetics Salmeterol 50ug/Fluticasone 250ug Foxair 50/250mcg 60 blisters Sympathomimetics Salmeterol 50ug/Fluticasone 500ug Foxair 50/250mcg 60 blisters Combinations Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA Sympathomimetics Formoterol fumarate Foratec HFA 12mcg 120 dose Anticholinergics Tiotropium 18mcg Forvent handihaler Anticholinergics Tiotropium 18mcg Forvent 18mcg INH caps refill Glucocorticoids Beclomethasone dipropionate 100mcg Beclate 100mcg inhaler Glucocorticoids Beclomethasone dipropionate 200mcg Beclate 200mcg inhaler Glucocorticoids Budesonide 100ug Budeflam HFA 100mcg 300dose Glucocorticoids Budesonide 200ug Budeflam HFA 200mcg 300dose Glucocorticoids Budesonide 200ug Budeflam DP 200mcg inh caps Methylxanthine Theophylline 200mg Sandoz theophylline 200mg Theoplus 200mg Motivation, including history of therapy, required. FEV1<50 post bronchodilator Motivation, including history of therapy, required. FEV1<50 post bronchodilator For Stage ll & lll COPD only. Script from Pulmonologist or Specialist Physician For Stage ll & lll COPD only. Script from Pulmonologist or Specialist Physician For Stage ll & lll COPD only. Script from Pulmonologist or Specialist Physician For Stage ll & lll COPD only. Script from Pulmonologist or Specialist Physician For Stage ll & lll COPD only. Script from Pulmonologist or Specialist Physician Methylxanthine Theophylline 300mg Sandoz Theophylline 300mg Theoplus 300mg Motivation, including history of therapy, required. From Pulmonogist Combinations Ipratropium/salbutamol 0.5mg/2.5mg per 2.5ml Duolin Respules or Specialist Physician For long term oral corticosteroid treatment Coronary Artery Disease I20 Anticoagulant Warfarin 5mg cipla-warfarin I25 Beta blocker Propranolol 10mg Indoblok 10mg Beta blocker Propranolol 40mg Indoblok 40mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Bisbeta 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Bisbeta 10mg Alpha + beta blocker Carvedilol 12.5 Vediblok 12.5 mg Alpha + beta blocker Carvedilol 25mg Vediblok 25mg Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg Ciplavasc 10mg Calcium channel blockers Amlodipine 5mg Amtas 5mg Lomanor 5mg Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab Calcium channel blockers Nifedipine SR 30mg Fedaloc sr 30mg Calcium channel blockers Diltiazem 60mg Zildem 60mg Calcium channel blockers Diltiazem 90mg Zildem 90mg Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg Calcium channel blockers Felodipine 10mg Felodipine-hexal 10mg Calcium channel blockers Felodipine 5mg Felodipine-hexal 5mg Nitrates Glyceryl trintarate 0.5mg Angised Nitrates Isosorbide dinitrate 10mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Elantan 20mg Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg Platelet aggregation inhibitors Aspirin 100mg Ecotrin 81mg Platelet aggregation inhibitors Clopidogrel 75mg Pharma Dynamics Clopidogrel Fibrates Bezafibrate 400mg Dyna-Bezafibrate 400mg HMG-CoA reductase inhibitors (statins) Simvastatin 10mg Adco simvastatin 10mg Austell simvastatin 10mg HMG-CoA reductase inhibitors (statins) Simvastatin 20mg Adco simvastatin 20mg Austell simvastatin 20mg HMG-CoA reductase inhibitors (statins) Simvastatin 40mg Adco simvastatin 40mg Austell simvastatin 40mg Detailed clinical motivation required with stent types and dates and history of therapy From Cardiologist/Specialist Physician.Need to be loaded under Hyperlipidaemia From Cardiologist/Specialist Physician.Need to be loaded under Hyperlipidaemia From Cardiologist/Specialist Physician.Need to be loaded under Hyperlipidaemia From Cardiologist/Specialist Physician.Need to be loaded under Hyperlipidaemia Crohn's disease K50 5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin 500mg Motivation required - Treatment to be initiated by Specialist 5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin EN Motivation required - Treatment to be initiated by Specialist Antibiotics Metronidazole 200mg Acuzole 200mg Treatment to be initiated by Specialist Antibiotics Metronidazole 400mg Acuzole 400mg Treatment to be initiated by Specialist Antibiotics Ciprofloxacin 250mg Ciprol 250mg Treatment to be initiated by Specialist Antibiotics Ciprofloxacin 500mg Ciprol 500mg Treatment to be initiated by Specialist Antibiotics Ciprofloxacin 750mg Cifloc 750mg Treatment to be initiated by Specialist Corticosteroids Prednisolone 5mg Lenisolone 5mg Motivation required - Treatment to be initiated by Specialist Corticosteroids Prednisone 5mg Be-tabs prednisone Motivation required - Treatment to be initiated by Specialist Cytostatic Methotrexate 2.5 Methotrexate 2.5mg Treatment to be initiated by Specialist Immunosuppressive Azathioprine 50mg Azamun 50mg Treatment to be initiated by Specialist others Budesonide 2.3mg Entocord 2,3mg Enema Motivation required - Treatment to be initiated by Specialist 5

6 others Budesonide 3mg Entocord 3mg cap Motivation required - Treatment to be initiated by Specialist others Mesalazine [5-aminosalicylic acid.] rectal Asacol 500mg supp Motivation required - Treatment to be initiated by Specialist others Mesalazine [5-aminosalicylic acid.] rectal Asacol enema 2gm/50ml Motivation required - Treatment to be initiated by Specialist others Mesalazine [5-aminosalicylic acid.] tab Asacol 400mg tab Motivation required - Treatment to be initiated by Specialist others Mesalazine 500mg Pentasa 500mg tab Treatment to be initiated by Specialist others Olsalazine sod 250mg Dipentum 250mg cap Treatment to be initiated by Specialist Prenatal vitamins Folic Acid Be-Tabs Folic acid Treatment to be initiated by Specialist For long term oral corticosteroid treatment Diabetes insipidus E23.2 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml Treatment to be initiated by Specialist Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml Treatment to be initiated by Specialist Anti-Diuretics Desmopressin tab DDAVP 0.1mg Treatment to be initiated by Specialist Anti-Diuretics Desmopressin tab DDAVP 0.2mg Treatment to be initiated by Specialist Diabetes Mellitus 1 E10 Anti-hypoglycaemic agent Injection GlucaGen - Hypokit Diabetic consumables Lancets Accu-check pro lancets Diabetic consumables Lancets Accu-check softclix lancets Diabetic consumables Lancets Microlet lancets Diabetic consumables Needles Novofine needles Diabetic consumables Needles BD microfine needles Diabetic consumables Strips Accu-check advantage strip Diabetic consumables Strips Accutrend glucose strips Diabetic consumables Strips Ascensia elite ts (glucometer) Diabetic consumables Strips Ascensia entrust test strips Diabetic consumables Strips Ascensia glucodi esprit Diabetic consumables Strips Glucostix coastal Diabetic consumables Strips Glucostix high altitude Diabetic consumables Strips Haemo-Glucotest Diabetic consumables Strips Keto-Diastix 50's Diabetic consumables Strips Medisense optimum plus Diabetic consumables Strips Medisense precision plus electrodes Diabetic consumables Strips One touch ultra test strips Diabetic consumables Strips One touch horizon test strips Diabetic consumables Strips Homemed blood glucose strips Insulin Biphasic insulin Insu Actaphane HM(ge) 3.0ml Penset Insulin Biphasic insulin Insu Actraphane HM(ge) 10ml vial Insulin Fast acting insulin Insu Apidra 3.0ml cartridge Motivation required with treatment history Insulin Fast acting insulin Insu Apidra I optiset penset 3ml Motivation required with treatment history Insulin Fast acting insulin insu Apidra solostar disposable pens 3ml Motivation required with treatment history Insulin Fast acting insulin Insu Apidra 10ml vial Motivation required with treatment history Insulin Fast acting insulin Novorapid flexpen 3ml prefilled device penset Insulin Fast acting insulin Novorapid flexpen 3ml solution for inj penfill Insulin Fast acting insulin Novorapid vial 10ml Insulin Insulin Novomix 30 flexpen 3ml pf device Insulin Insulin Novomix 30 penfill 3ml pf device Insulin Insulin - rapid acting insulin Humalog 10ml vial Insulin Insulin - rapid acting Insulin humalog cartridge 3ml Insulin Insulin - rapid acting Insulin humalog pen 3ml disposable Insulin Insulin premixed biphasic Insulin humalog mix 25 10ml vial Insulin Insulin premixed biphasic Insulin humalog mix 25 cartridge 3 ml Insulin Insulin premixed biphasic Insulin humalog mix 25 disp pen 3 ml Insulin Insulin premixed biphasic Insulin humalog mix 50 cartridge 3ml Insulin Insulin glargine Lantus - 10ml vial Motivation required with treatment history Insulin Insulin glargine Lantus 5 x 3ml cartridge Motivation required with treatment history Insulin Insulin glargine Optisulin pen 100 IU/ml Motivation required with treatment history Insulin Insulin Detemir Levemir flexpen prefilled 3ml Motivation required with treatment history Insulin Insulin Detemir Levemir prefilled cartridge 3ml Motivation required with treatment history Insulin Insulin isophane - intermediate Humulin N vial 10ml Insulin Insulin isophane - intermediate Biosulin N 3ml cart Insulin Insulin isophane - intermediate Insulin humulin N pen 3ml disposable Insulin Insulin premixed biphasic Humulin 30/70 10ml vial Insulin Insulin premixed biphasic Biosulin 30/70 3ml cart Insulin Insulin premixed biphasic Humulin 30/70 disposable pens 3ml Insulin Insulin - short acting Humulin R 10ml vial Insulin Insulin - short acting Biosulin R 3ml cartridge Insulin Intermediate to long acting insulin Insu Protaphane flexpen 3ml pf device Insulin Intermediate to long acting insulin Insu Protaphane HM(ge) 10ml vial Platelet Aspirin 100mg Myoprin aggregation inhibitors Bayer Aspirin Cardio 100mg Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg Diabetes mellitus type 2 E11.9 Biguanides Metformin 850 mg Accord Metformin 850mg Diaphage 850mg Biguanides Metformin 500mg Accord Metformin 500mg Diaphage 500mg Biguanides Metformin 1000mg Bigsens 1000mg Mylan Metformin 1000mg

7 Biguanides Metformin 500mg Glucophage XR 500mg Biguanides Metformin 500mg Glucophage XR 500mg Biguanides Metformin 750mg Glucophage XR 750mg Biguanides Metformin 1000mg Glucophage XR 1000mg Sulphonylureas Glibenclamide 5mg Bio-glibenclamide Sulphonylureas Glimepiride 1mg Aspen Glimepiride 1mg Austell Glimepiride 1mg Sulphonylureas Glimepiride 2mg Aspen Glimepiride 2mg Austell Glimepiride 2mg Sulphonylureas Glimepiride 4mg Merck-glimepiride 4mg Austell Glimepiride 4mg Sulphonylureas Gliclazide 30mg MR Diaglucide 30mg MR Sulphonylureas Gliclazide 60mg MR Diaglucide 60mg MR Sulphonylureas Gliclazide 80mg Sandoz gliclazide 80mg Thiazolidinediones Pioglitazone Cipla pioglitazone 30mg Motivation required with treatment history Thiazolidinediones Pioglitazone Cipla pioglitazone 15mg Motivation required with treatment history Platelet aggregation Aspirin 100mg Myoprin inhibitors Bayer Aspirin Cardio 100mg Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg Dysrhythmia I47 Anti-arrhythmic Amiodarone 100mg Hexarone 100mg Treatment to be initiated by Specialist I48 Anti-arrhythmic Amiodarone 200mg Bio-Amiodarone 200mg Treatment to be initiated by Specialist Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin Beta-blockers Sotalol 160mg Sotahexal 160mg Treatment to be initiated by Specialist Beta-blockers Sotalol 80mg Sotahexal 80mg Treatment to be initiated by Specialist Beta-blockers Propranolol 10mg Indoblok 10mg Beta-blockers Propranolol 40mg Indoblok 40mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Alpha + beta blocker Carvedilol 12.5 Vediblok 12.5 mg Alpha + beta blocker Carvedilol 25mg Vediblok 25mg Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg Epilepsy G40 Anti-epileptic Valproic acid 150mg Convulex 150mg G41 Anti-epileptic Valproic acid 300mg Convulex 300mg Anti-epileptic Valproic acid 500mg Convulex 500mg Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension Anti-epileptic Phenytoin 100mg Epanutin 100mg Anti-epileptic Phenytoin 125mg/5mL susp Epanutin 125mg/5mL Anti-epileptic Sodium Valproate 100mg Epilim Crushable 100mg Anti-epileptic Sodium Valproate 200mg Navalpro 200 CR Epilizine cr 200mg Anti-epileptic Sodium Valproate 300mg Navalpro 300CR Epilizine cr 300mg Anti-epileptic Sodium Valproate 500mg Navalpro 500CR Epilizine cr 500mg Anti-epileptic Sodium Valproate 200mg/5ml Epilim sugar free Anti-epileptic Lamotrigine 25mg Dyna-Lamotrigine 25mg Anti-epileptic Lamotrigine 50mg Dyna-Lamotrigine 50mg Anti-epileptic Lamotrigine 100mg Dyna-Lamotrigine 100mg Anti-epileptic Lamotrigine 200mg Dyna-Lamotrigine 200mg Anti-epileptic Phenobarbitone 30mg Sedabarb 30mg Anti-epileptic Phenytoin 100mg Phenytoin sod Anti-epileptic Clonazepam Rivotril 0.5mg Anti-epileptic Clonazepam Rivotril 2.5mg/ml drops Anti-epileptic Clonazepam Rivotril 2mg Anti-epileptic Carbamazepine 100mg/ 5mL Tegretol susp 250mL Anti-epileptic Carbamazepine 200mg Degranol 200mg Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr Anti-epileptic Carbamazepine 400mg Sandoz carbamazepine cr Anti-epileptic Topiramate 25mg Epitoz 25mg Anti-epileptic Topiramate 50mg Epitoz 50mg Anti-epileptic Topiramate 100mg Epitoz 100mg Anti-epileptic Oxcarbazepine 300mg Trileptal 300mg Anti-epileptic Oxcarbazepine 600mg Trileptal 600mg Anti-epileptic Ethosuximide 250mg/5ml Zarontin 250mg/5ml syrup Prenatal vitamins Folic Acid Be-Tabs Folic acid Glaucoma 7

8 H40 Opthalmics -alpha-2-agonist Brimonidine tartrate Alphagan purite 5ml Carbonic anhydrase inhibitors Acetazolamide Azomid 250mg Carbonic anhydrase inhibitors Brinzolamide Azoptic eye suspension 1% Opthalmics -Beta-blockers Timolol 5mg/ml Glaucosan 0.5% Opthalmics -Beta-blockers Timolol 2.5mg/ml Timoptol 0.25% Opthalmics -Beta-blockers combination Dorzolamide 20mg; timolol 5mg/ml Cosopt 0.5% 5ml drp Opthalmics -Beta-blockers combination Brinzolamide 10mg; Timolol 5mg/ml Azarga 5ml Opthalmics -Beta-blockers combination Bimatopost 0.3mg; Timolol 5mg/ml Ganfort 3ml Opthalmics -carbonic anhydrase inhibitor Dorzolamide 20mg Trusopt solution Opthalmics-prostaglandin analogue Travoprost 40ug/ml Travatan eye drop solution Motivation, including history of therapy, required Opthalmics-prostaglandin analogue Lantanoprost/timolol Xalacom Opthalmics-prostaglandin analogue Lantanoprost 1ml/50mcg Ocuprost Motivation, including history of therapy, required Opthalmics-prostaglandin analogue Bimatropost 0.3mg/ml Lumigan 3ml Motivation, including history of therapy, required Ophthalmic - muscarinic agonists Pilocarpine 10mg/mL Isoptocarpine 1% - 15mL Ophthalmic - muscarinic agonists Pilocarpine 20mg/mL Isoptocarpine 2%- 15mL Ophthalmic - muscarinic agonists Pilocarpine 40mg/mL Isoptocarpine 4% - 15mL Haemophilia D66 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml Treatment to be initiated by Specialist Haematologist D67 Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml Treatment to be initiated by Specialist Haematologist Anti-diuretics Desmopressin DDAVP 0.2mg Treatment to be initiated by Specialist Haematologist Anti-diuretics Desmopressin DDAVP 0.1mg Treatment to be initiated by Specialist Haematologist Coagulants Tranexamic acid 500mg Cyklokapron Treatment to be initiated by Specialist Haematologist Coagulants Factor VIII 300u Haemosolvate Factor VIII Treatment to be initiated by Specialist Haematologist Coagulants Factor VIII 500u Haemosolvate Factor VIII Treatment to be initiated by Specialist Haematologist Coagulants Factor VIII 1000u Haemosolvate Factor VIII Treatment to be initiated by Specialist Haematologist Coagulants Factor IX 500u Haemosolvex Factor IX Treatment to be initiated by Specialist Haematologist Hyperlipidaemia Fibrates Bezafibrate 400mg Dyna-bezafibrate SR 400mg E78 HMG-CoA reductase inhibitors (statins) Simvastatin 10mg Adco simvastatin 10mg Austell simvastatin 10mg HMG-CoA reductase inhibitors (statins) Simvastatin 20mg Adco simvastatin 20mg Austell simvastatin 20mg HMG-CoA reductase inhibitors (statins) Simvastatin 40mg Adco simvastatin 40mg Austell simvastatin 40mg HMG-CoA reductase inhibitors (statins) Atorvastatin 10mg Aspavor 10mg Adco Atorvastatin 10mg Clinical motivation with treatment history must be submitted HMG-CoA reductase inhibitors (statins) Atorvastatin 20mg Aspavor 20mg Adco Atorvastatin 20mg Clinical motivation with treatment history must be submitted HMG-CoA reductase inhibitors (statins) Atorvastatin 40mg Astor 40mg Adco Atorvastatin 40mg Clinical motivation with treatment history must be submitted HMG-CoA reductase inhibitors (statins) Atorvastatin 80mg Lipogen 80mg Astor 80mg Clinical motivation with treatment history must be submitted Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg Hypertension ACE Inhibitors Captopril 25mg Merck-captopril 25mg I10 ACE Inhibitors Captopril 50mg Merck-captopril 50mg ACE Inhibitors combination Captopril/hydrochlorothiazide 50mg/25mg Captoretic 50/25mg ACE Inhibitors Enalapril 10mg Alapren 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg ACE Inhibitors combination Enalapril / hydrochlorthiazide Enap co ACE inhibitors Ramipril 2.5mg Rampil 2.5mg ACE inhibitors Ramipril 5mg Rampil 5mg ACE inhibitors Ramipril 10mg Rampil10mg ACE inhibitors Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE inhibitors Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus ACE Inhibitors combination Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus ACE Inhibitors combination Perindopril 4mg/Indapamide 1.25mg Prexum Plus 5/1.25 mg ACE Inhibitors combination Perindopril 10mg/Indapamide 2.5mg Bioprexum Plus 10/2.5mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg ACE inhibitor combinations Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg ACE inhibitor combinations Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg ACE inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE inhibitors Lisinopril 10mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 10/12.5mg ACE inhibitors Lisinopril 20mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 20/12.5mg ` Alpha + beta blocker Carvedilol 12.5mg Vediblok 12.5 mg Alpha + beta blocker Carvedilol 25mg Vediblok 25mg Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg Alpha receptor blockers Prazosin 1mg Pratsiol 1mg Motivation, including history of therapy, required Alpha receptor blockers Prazosin 2mg Pratsiol 2mg Motivation, including history of therapy, required Alpha receptor blockers Prazosin 5mg Pratsiol 5mg Motivation, including history of therapy, required Beta-blockers Propranolol 10mg Indoblok 10mg Beta-blockers Propranolol 40mg Indoblok 40mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Bisbeta 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Bisbeta 10mg Calcium channel blocker Amlodipine 10mg Gulf Amlodipine 10mg Lomanor 10mg Calcium channel blocker Amlodipine 5mg Amtas 5mg Lomanor 5mg Calcium channel blocker Diltiazem 60mg Zildem 60mg Calcium channel blocker Diltiazem 90mg Zildem 90mg Calcium channel blocker Diltiazem SR 180mg Zildem SR 180mg Calcium channel blocker Diltiazem SR 240mg Zildem SR 240mg

9 Calcium channel blocker Felodopine 5mg Hexal-felodopine 5mg Calcium channel blocker Felodopine 10mg Hexal-felodopine 10mg Calcium channel blockers - long acting Verapamil 240 SR Verahexal 240 sr Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers - long acting Nifedipine SR 20mg Nifedalat 20 sr tab Calcium channel blockers - long acting Nifedipine SR 30mg Fedaloc sr 30mg Central alpha-2 agonist Methyldopa 250 Hy-po-tone 250mg Aldosterone antagonist Spironolactone 25mg Spiractin 25mg Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Cipla- Indapamide 2.5mg Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg Diuretic - loop Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Diuretic-thiazide Hydrochlorthiazide /amiloride 25/2.5mg Amiloretic hs Diuretic-thiazide Hydrochlorthiazide /triamterene 25/50 Renezide Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide Diuretic-thiazide Hydrochlorthiazide/amiloride 50/5mg Spec -Co - Amiloride Diuretic-thiazide/K combination Hydrochlorthiazide 50mg / potassium 600mg Urirex K Direct vasodilator Hydralazine 10mg Hyperphen 10mg Direct vasodilator Hydralazine 50mg Hyperphen 50mg If >120 required, documented evidence of hypokalaemia must be provided Angiotensin receptor antagonists Losartan 50mg Losartan-Winthrop 50mg Motivation over ACE-inhibitor, including history of therapy, required Angiotensin receptor antagonists Losartan 100mg Zartan 100mg Motivation over ACE-inhibitor, including history of therapy, required ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/12.5mg Sympathetic nervous blockers Reserpine 0.25mg Reserpine 0.25mg Platelet aggregation inhibitors Aspirin Ecotrin 81mg Hypothyroidism E03 Thyroid preparation levothyroxine 100ug Euthyrox 100mcg tabb Eltroxin 100ug Thyroid preparation levothyroxine 50ug Euthyrox 50mcg tabb Eltroxin 50ug Thyroid preparation levothyroxine 25ug Euthyrox 25mcg tabb Thyroid preparation Liothyronine sodium 20mcg Tertroxin Multiple sclerosis G35 Anti-epileptic Carbamazepine 200mg Degranol 200mg Treatment to be initiated by Specialist Anticholinergics Oxybutinin 5mg Lenditro 5mg Treatment to be initiated by Specialist Analgesics Paracetamol 500mg Napamol Treatment to be initiated by Specialist Cytostatic Methotrexate 2.5mg Methotrexate 2.5mg Treatment to be initiated by Specialist Cytostatic Azathioprine 50mg Azamun 50mg Treatment to be initiated by Specialist Corticosteroids Prednisolone 5mg Lenisolone 5mg Treatment to be initiated by Specialist Corticosteroids Prednisone 5mg Be-tabs prednisone Treatment to be initiated by Specialist Immunosuppressants Cyclophosphamide Endoxan 50mg Treatment to be initiated by Specialist Muscle relaxants Baclofen 10 Teva-Baclofen 10mg Treatment to be initiated by Specialist NSAID'S Naproxen 250mg Napflam 250mg Treatment to be initiated by Specialist NSAID'S Naproxen 500mg Napflam 500mg Treatment to be initiated by Specialist NSAID'S Diclofenac sod. 25mg tab Panamor 25mg Treatment to be initiated by Specialist NSAID'S Diclofenac sod. 50mg tab Panamor 50mg Treatment to be initiated by Specialist NSAID'S Diclofenac sod. 100mg Panamor sr Treatment to be initiated by Specialist Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg Treatment to be initiated by Specialist SSRI Fluoxetine 20mg Deprozan Treatment to be initiated by Specialist Prenatal vitamins Folic Acid Be-Tabs Folic acid Immunostimulants inteferon beta-1a Rebif 44mcg/0.5ml To be reviewed from Specialised Drug Benefit - Specialist Physician/Neurologist must provide EDSS, relapsing-remitting history and number of relapses Immunostimulants inteferon beta-1a Rebif 22mcg/0.5ml To be reviewed from Specialised Drug Benefit - Specialist Physician/Neurologist must provide EDSS, relapsing-remitting history and number of relapses Parkinson's Requiring IV cortisone Treatment G20 Central muscarinic blockers Biperiden 2.5mg Lennon - Biperiden Treatment to be initiated by Specialist G21 Beta-blockers Propranolol 10mg Indoblok 10mg Treatment to be initiated by Specialist Beta-blockers Propranolol 40mg Indoblok 40mg Treatment to be initiated by Specialist dopamine agonists Ropinirole 0.25mg Resure 0.25mg Treatment to be initiated by Specialist dopamine agonists Ropinirole 0.5mg Resure 0.5mg Treatment to be initiated by Specialist Dopamine agonists Ropinirole 1mg Resure 1mg Treatment to be initiated by Specialist Dopamine agonists Ropinirole 2mg Resure 2mg Treatment to be initiated by Specialist Dopamine agonists Ropinirole 5mg Resure 5mg Treatment to be initiated by Specialist Dopamine agonists Amantadine 100mg Symadin Treatment to be initiated by Specialist Levodopa + dopamine decarboxylase Levodopa/carbidopa Teva Carbilevo 100/25mg Sinemet Treatment to be initiated by Specialist inhibitors 100/25mg 25mg/100mg Levodopa + dopamine decarboxylase inhibitors Levodopa/carbidopa 250/25mg Teva Carbilevo 250/25mg Sinemet 25mg/250mg Treatment to be initiated by Specialist Anti-cholinergic Orphenadrine 50mg Disipal 50mg Treatment to be initiated by Specialist Rheumatoid arthritis M05 Analgesics Paracetamol 500mg Napamol 500mg Treatment to be initiated by Specialist M06 5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin 500mg Treatment to be initiated by Specialist M08 5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin EN Treatment to be initiated by Specialist Corticosteroids Prednisolone 5mg Lenisolone 5mg Treatment to be initiated by Specialist Corticosteroids Prednisone 5mg Be-tabs prednisone Treatment to be initiated by Specialist Cytostatic Methotrexate 2.5 Methotrexate 2.5mg Treatment to be initiated by Specialist Cytostatics Cyclophosphamide 50mg Endoxan 50mg Motivation by Specialist Immunosuppressive Azathioprine 50mg Azamun 50mg Treatment to be initiated by Specialist Immunosuppressive Chloroquine 200mg Plasmoquine 200mg Treatment to be initiated by Specialist 9