Chronic Illness Benefit medicine list (formulary)

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2015

2 Chronic Illness Benefit 2015 Contents Page Explanation of terms 3 The Prescribed Minimum Benefits medicine list 4 Important information you need to know We may change the information contained in this document from time to time. We will communicate any changes to the way we pay medicines when we make these changes. The Chronic Illness Benefit (CIB) is managed by the University of KwaZulu-Natal Medical Scheme Rules. The use of the benefits and programmes linked with the Chronic Illness Benefit are subject to specific conditions and rules. Members must make sure that they know these rules and conditions. Any instructions or advice on medicines and the management of the member s condition are intended to add to, and not replace, the knowledge, expertise, skill and judgement of the member s doctor, pharmacist or other healthcare professional. University of KwaZulu-Natal Medical Scheme and Discovery Health (Pty) Ltd reserve the right to change the benefit at any time. Page 2 of 22 01/2015

3 Explanation of terms Benefit year A benefit year refers to the benefits a member is entitled to during a calendar year, that is to say 1 January to 31 December. This medicine list (formulary) and Chronic Drug Amounts are applicable for 2015 only. Chronic Drug Amount (CDA) The CDA is a monthly we pay up to for a medicine class. This applies to medicine that is not listed on the medicine list (formulary). The Chronic Drug Amount includes VAT and the dispensing fee. Prescribed Minimum s (PMB conditions) These are conditions which all medical schemes are required to cover by the Council for Medical Schemes for any setting according to clinical guidelines. Chronic Disease List (CDL) A defined list of chronic conditions we cover according to the Prescribed Minimum Benefits. Medicine class This describes medicines that have similar chemical structures or similar therapeutic effects. Active ingredient This is the main substance in a medicine that is responsible for the clinical action on a human body. Page 3 of 22 01/2015

4 Chronic Illness Benefit 2015 The Prescribed Minimum Benefits (PMB) medicine list Prescribed Minimum Addison s disease R105 Systemic corticosteroids: Mineralocorticoids Asthma R350 Adrenergics - Formoterol combinations R150 R395 Adrenergics: Long acting - Formoterol Adrenergics: Long acting - Salmeterol Fludrocortisone Florinef acetate 0.1mg Formoterol and Symbicord turbohaler 160/4.5mcg Budesonide 60 dose Symbicord turbohaler 320/9mcg 60dose Vannair 80/4.5mcg 120 dose Vannair 160/4.5mcg 120 dose Formoterol Foratec dp-caps 12mcg Foratec hfa 120dose 12mcg/1dose Salmeterol Serevent accuhaler 60 dose 50mcg Serevent CFC free 120 dose 25mcg R350 R30 R130 R205 Adrenergics: Salmeterol combinations Adrenergics: Short acting - Salbutamol Anti-asthmatics: Systemic xanthines Inhaled anti-cholinergics: Ipratropium bromide Salmeterol and Fluticasone Foxair accuhaler 50/100; 50/250; 50/ dose Sereflo hfa 25/50; 25/125; 25/ dose Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous ; 300mg Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose R345 Inhaled Beclomethasone Beceze 200 dose CFC free 100mcg Glucocorticoids Beclate 200 dose 100mcg; 200mcg Budesonide Budeflam dp-caps 200mcg Budeflam HFA 300dose 100mcg; 200mcg Inflammide novolizer complete 200 dose 200mcg Inflammide novolizer complete 100 dose 400mcg Inflammide novolizer refill 200 dose 200mcg Inflammide novolizer refill 100 dose 400mcg Pulmicort turbuhaler 200dose 100mcg; 200mcg R350 Surgical item Inhaler device Dp haler device R10 Systemic corticosteroids: Prednisone Paediatric Spacer Glaxohaler Prednisone Be-Tabs Prednisone Panafcort Trolic Page 4 of 22 01/2015

5 Bipolar mood disorder R330 R360 R395 R365 R100 R1 100 Anti-depressants: SSRIs Anti-epileptics: Carboxamide derivatives Anti-epileptics: Fatty acid derivatives Anti-epileptics: Other agents Butyrophenone derivatives Clozapine Citalopram Adco-Talomil Arrow Citalopram ; Bio Citalopram Cilate Escitalopram Accord Escitalopram 10mg; Escitalopram Be-Tabs 10mg; Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Prolax Ranflocs Rezak Zydus Fluoxetine Paroxetine Adco-Paroxetine Auro Paroxetine Serrapress Xet Sertraline Austell-Sertraline ; Dyna Sertraline ; Serdep ; Serlife Zolid Zylin Carbamazepine Degranol Sandoz Carbamazepine Sandoz Carbamazepine CR Zeptol ; 400mg Valproic acid Convulex 1 Convulex syrup Epilim crushable 2/5ml Epilim sugar-free syrup /5ml Epilizine CR ; 300mg; 500mg Navalpro CR ; 300mg; 500mg Vanapro 300mg; 500mg Lamotrigine Dyna-Lamotrigine 2; ; ; Epitec 2; ; ; Lamidus ; ; Sandoz Lamotrigine ; ; Haloperidol Gulf Haloperidol Sandoz Haloperidol 1.; Clozapine Aspen Clozapine 2; Cloment 2; R320 R605 R360 Lithium Olanzapine Phenothiazines with aliphatic side-chain Lithium Camcolit 2; 400mg Quilonum retard 4 Olanzapine Mylan Olanzapine Oleanz Olexar Prexolan odt Redilanz Chlorpromazine Largactil 2; Page 5 of 22 01/2015

6 Bipolar mood disorder R390 Quetiapine Quetiapine Dopaquel 2; ; ; 300mg Mylan Quetiapine 2; ; ; 300mg Psyquet 2; ; ; 300mg Quetoser 2; ; ; 300mg Serez 2; ; ; 300mg Sizonorm 2; ; ; 300mg R650 Flupenthixol Fluanxol 0.; 1mg Thioxanthene derivatives Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot R1 005 Other anti-psychotics Risperidone DRL-Risperidone 0.; 1mg; 2mg Perizal 0.; 1mg; 2mg; 3mg Risnia 0.; 1mg; 2mg; 3mg Rispacor 0.; 1mg; 2mg; 3mg Rispevon 3mg; Risponz 1mg; 2mg; 3mg; Schizorol 0. Zoxadon 0.; 1mg; 2mg Bronchiectasis R30 Adrenergics: Salbutamol Asthavent ecohaler 200 dose 100mcg Short acting - Salbutamol Venteze CFC free 200 dose 100mcg R205 Inhaled anti-cholinergics: Ipratropium bromide Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Cardiac failure R120 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. R115 ACE inhibitors: plain Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and diuretics Zydus Perindopril co 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap ; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; Page 6 of 22 01/2015

7 Cardiac failure R235 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 R115 Angiotensin II antagonists, Irbesartan and diuretics Isart co 150/12.; 300/12. Combinations Losartan and diuretics Austell Losartan co 50/12. R120 R85 R75 R25 Angiotensin II antagonists: plain Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Beta blocking agents: selective Cardiac glycosides: Digoxin Hytenza co Losaar Plus Losacar co Losartan co Unicorn Netrasol co 50/12. 50/12.; 100/2 50/12. 50/12.; 100/2 50/12.; 100/2 Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor Bilocor Bisohexal Bisoprolol Zydus Ziapro Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic Diuresix Furobe Mylan Furosemide R15 Low-ceiling diuretics: Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide R95 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R90 Potassium supplements Potassium chloride Plenish K 600mg Potassium Chloride Unicorn Sandoz K mg 600mg Ultipot 600mg Page 7 of 22 01/2015

8 Cardiac failure R180 Vasodilators in cardiac disease: Organic nitrates Glyceryl trinitrate Angised 0. Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR 60mg R80 Influenza vaccines Influenza, purified antigen Fluvax pre-filled syringe 0.5ml Influvac 0.5ml Mutagrip single dose 0.5ml R145 Pneumococcus vaccines Pneumococcus, purified Imovax pneumo 23 polysaccharides antigen Cardiomyopathy R120 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. Pharmapress co 20/12. R115 ACE inhibitors: plain Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn Lisoretic Zestoretic 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Zydus Perindopril co 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap ; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; R235 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 R115 Angiotensin II antagonists, Combinations Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 Irbesartan and diuretics Isart co 150/12.; 300/12. Losartan and diuretics Austell Losartan co 50/12. Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12.; 100/2 Netrasol co 50/12.; 100/2 Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Page 8 of 22 01/2015

9 Cardiomyopathy R120 Angiotensin II antagonists: plain Irbesartan Dynarb 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg R75 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R85 Arteriolar smooth muscle Hydralazine Hyperphen 10mg; agents: Hydrazinophthalazine Sandoz Hydralazine 2 derivatives R20 Aspirin Acetylsalicylic acid Aspirin 300mg Be-Tabs Aspirin (white) 300mg Gulf Aspirin 300mg R75 Beta blocking agents: Bisoprolol Adco-Bisocor selective Bilocor Bisohexal Bisoprolol Zydus Ziapro R25 Cardiac glycosides: Digoxin Lanoxin 0.062; 0.2 Digoxin Lanoxin paed syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic Diuresix Furobe Mylan Furosemide R15 Low-ceiling diuretics: Thiazides, plain Hydrochlorothiazide Hexazide 2 Ridaq 12. R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R95 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R90 Potassium supplements Potassium chloride Plenish K 600mg Potassium Chloride Unicorn 600mg Sandoz K mg Ultipot 600mg R180 Vasodilators in cardiac disease: Glyceryl trinitrate Angised 0. Organic nitrates Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR 60mg R80 Influenza vaccines Influenza, purified antigen Fluvax pre-filled syringe 0.5ml Influvac 0.5ml Mutagrip single dose 0.5ml R145 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 Page 9 of 22 01/2015

10 Chronic obstructive pulmonary disease (COPD) R165 R30 R130 R205 R713 R10 Adrenergics: Salbutamol combinations Adrenergics: Short acting - Salbutamol Anti-asthmatics: Systemic xanthines Inhaled anti-cholinergics: Ipratropium bromide Surgical item: Oxygen concentrator Systemic corticosteroids: Prednisone Salbutamol and Duolin hfa 200 dose Ipratropium bromide Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous ; 300mg Ipratropium bromide Atrovent HFA 200 dose 20mcg Oxygen R80 Influenza vaccines Influenza, purified antigen Ipvent HFA 200 dose Oxygen concentrator rental 40mcg/1dose Prednisone Be-Tabs Prednisone Panafcort Trolic Fluvax pre-filled syringe 0.5ml Influvac 0.5ml Mutagrip single dose 0.5ml Chronic renal disease R120 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and diuretics Zydus Perindopril co 4/1.2 R115 ACE inhibitors: Captopril Adco-Captomax 2; plain Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap ; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; R115 Angiotensin II antagonists, Combinations Irbesartan and diuretics Isart co 150/12.; 300/12. Losartan and diuretics Austell Losartan co 50/12. Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12.; 100/2 Netrasol co 50/12.; 100/2 Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Page 10 of 22 01/2015

11 Chronic renal disease R120 Angiotensin II antagonists: plain Coronary artery disease Irbesartan Dynarb 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Spec-Losartan Zartan R215 Calcium supplements Calcium carbonate B-cal Valsartan Diolo 80mg; 160mg R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R40 Iron in combination with folic Ferrous fumarate Pregamal acid R550 Iron trivalent, parenteral Iron, parenteral Cosmofer ampoule 2ml /1ml preparations preparations Rautevene ampoule 5ml /5ml Sucrofer /1ml Zypiron vial 5ml /1ml R4 000 Other anti-anaemic preparations Darbepoetin Alfa Aranesp pre-filled syringe 0.4ml 10mcg/0.4ml Aranesp pre-filled syringe 0.5ml Aranesp pre-filled syringe 0.3ml Aranesp pre-filled syringe 0.4ml Aranesp pre-filled syringe 0.5ml Aranesp pre-filled syringe 0.3ml 20mcg/0.5ml 30mcg/0.3ml 40mcg/0.4ml 50mcg/0.5ml 60mcg/0.3ml Erythropoietin Eprex pre-fill 2000U/0.5ml Methoxy polyethyleneglycol-epoetin beta Eprex pre-fill Recormon pre-filled syringe Recormon pre-filled syringe Recormon pre-filled syringe Repotin 1ml Repotin 1ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml 4000U/0.4ml 500U/0.3ml 2000U/0.3ml 4000U/0.3ml 2000IU 4000IU 30mcg/0.3ml 50mcg/0.3ml 75mcg/0.3ml 100mcg/0.3ml 120mcg/0.3ml 150mcg/0.3ml 200mcg/0.3ml 250mcg/0.3ml R375 Vitamin D and analogues Alfacalcidol One alpha 0.25mcg; 1mcg R20 Aspirin Acetylsalicylic acid Aspirin 300mg Be-Tabs Aspirin (white) 300mg Gulf Aspirin 300mg Page 11 of 22 01/2015

12 Coronary artery disease R190 R75 R285 R190 R180 Beta blocking agents: non-selective Beta blocking agents: selective Selective calcium channel blockers with direct cardiac effects Selective calcium channel blockers with mainly vascular effects Vasodilators in cardiac disease: Organic nitrates Propranolol Indoblok 10mg; Prodorol 10mg; Purbloka 10mg; Atenolol B-Block ; Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Amlodac Amtas Gulf Amlodipine Indo Amlodipine Lomanor Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Glyceryl trinitrate Angised 0. Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR 60mg Crohn s disease R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R710 Intestinal anti-inflammatories: Mesalazine Asacol 400mg; 500mg; 800mg Aminosalicylic acid and similar Pentasa 500mg; 1000mg agents Salofalk 1000mg Olsalazine Dipentum 2 R2 415 R625 R70 R10 Intestinal anti-inflammatories: Corticosteroids Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic corticosteroids: Prednisone Diabetes insipidus R1 700 Posterior pituitary hormones: Vasopressin and analogues Sulfasalazine Salazopyrin 500mg Budesonide Salazopyrin EN Entocord enema 500mg Azathioprine Azamun Azathioprine PCH Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Page 12 of 22 01/2015

13 Diabetes mellitus Type 1 Diabetes mellitus Type 2 R720 R280 Anti-diabetic agents: Insulins and analogues Blood glucose monitoring agents Insulin Glucose strips Actraphane hm(ge) vial 10ml Apidra solostar disposable pens 3ml Biosulin 30/70 cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 25 cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 50 cartridge 3ml; kwikpen 3ml Humulin 30/70 cartridge 3ml; kwikpen 3ml; vial 10ml Humulin n cartridge 3ml; kwikpen 3ml; vial 10ml Humulin r cartridge 3ml; vial 10ml Insuman comb 30/70 cartridge 3ml Novomix 30 flexpen 3ml Novorapid penfill 3ml Accu-check active mic strips Caresens II/pop test strip 29g Caresens n test strips 29g Freestyle optium glucose test strips Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 Surgical item Insulin pen device Biosulin pen device Lancets Lancets 50's Lancets blood collection needles loris Lancets glucoplus 66 x 44 x 78mm Lancets solus v2 Needles BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm BD microfine pen needle 30g 8mm Needle novofine R60 Anti-diabetic agents: Metformin Accord Metformin 500mg; 8 Biguanides Apex-Metformin 500mg Arrow Metformin 500mg; 8 Austell-Metformin 500mg; 8 Bigsens 500mg; 8; 1000mg Diaformin 500mg Diaformin forte 8 Diamin 500mg; 8 Diaphage 500mg; 8; 1000mg Gluconorm 500mg; 8 Mengen 500mg; 8; 1000mg Metchek 500mg; 8 Metforal 500mg; 8 Metformin Alkem 500mg; 8 Metored 500mg; 8; 1000mg Metphage 500mg; 8 Mylan Metformin 500mg; 8 Romidab 500mg; 8; 1000mg Sandoz Metformin 500mg Sandoz Metformin FCT 500mg; 8 Page 13 of 22 01/2015

14 Diabetes mellitus Type 2 R720 R105 R190 R280 Anti-diabetic agents: Insulins and analogues Anti-diabetic agents: Sulfonamides, urea derivatives Anti-diabetic agents: Thiazolidinediones Blood glucose monitoring agents Insulin Actraphane hm(ge) vial 10ml Apidra solostar disposable pens 3ml Biosulin 30/70 cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 25 cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 50 cartridge 3ml; kwikpen 3ml Humulin 30/70 cartridge 3ml; kwikpen 3ml; vial 10ml Humulin n cartridge 3ml; kwikpen 3ml; vial 10ml Humulin r cartridge 3ml; vial 10ml Insuman comb 30/70 cartridge 3ml Novomix 30 flexpen 3ml Novorapid penfill 3ml Glibenclamide Bio-Glibenclamide Diacare Glycomin Sandoz Glibenclamide Gliclazide Adco-Glucomed 80mg Arrow Gliclazide 80mg Austell-Gliclazide 80mg Diaglucide 80mg Diaran MR 30mg Dyna Gliclazide SR 30mg Glycron 80mg Glygard 80mg Sandoz Gliclazide 80mg Pioglitazone Accord Pioglitazone 1; 30mg; 4 Glucose strips Cipla-Pioglitazone Accu-check active mic strips Caresens II/pop test strip 29g Caresens n test strips 29g Freestyle optium glucose test strips Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 Surgical item Insulin pen device Biosulin pen device Lancets Lancets 50's Lancets blood collection needles loris Lancets glucoplus 66 x 44 x 78mm Lancets solus v2 Dysrhythmias R635 Anti-arrhythmics: class Ic 1; 30mg Needles BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm BD microfine pen needle 30g 8mm Needle novofine Flecainide Tambocor Tambocor CR ; Propafenone Rythmol 1; 300mg Page 14 of 22 01/2015

15 Dysrhythmias R400 Anti-arrhythmics: Amiodarone Arycor ; class III - Amiodarone Bio-Amiodarone Hexarone ; R75 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R20 Aspirin Acetylsalicylic acid Aspirin 300mg Be-Tabs Aspirin (white) 300mg Gulf Aspirin 300mg R190 Beta blocking agents: Propranolol Indoblok 10mg; non-selective Prodorol 10mg; Purbloka 10mg; R75 R25 Beta blocking agents: selective Cardiac glycosides: Digoxin R285 Selective calcium channel blockers with direct cardiac effects Epilepsy R270 Anti-epileptics: Benzodiazepine derivatives R360 Anti-epileptics: Carboxamide derivatives R395 R60 R365 R25 Anti-epileptics: Fatty acid derivatives Anti-epileptics: Hydantoin derivatives Anti-epileptics: Other agents Anti-epileptics: Barbiturates and derivatives Glaucoma R180 Anti-glaucoma agents: Carbonic anhydrase inhibitors R235 Anti-glaucoma agents: Prostaglandin analogues R255 Anti-glaucoma agents: Sympathomimetics Sotalol Sotahexal 80mg; 160mg Atenolol B-Block ; Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml Verapamil Vasomil ; 80mg Verahexal SR 2 Clonazepam Rivotril 0.; 2mg Carbamazepine Degranol Sandoz Carbamazepine Sandoz Carbamazepine CR ; 400mg Zeptol Valproic acid Convulex 1 Convulex syrup 2/5ml Epilim crushable Epilim sugar-free syrup /5ml Epilizine CR ; 300mg; 500mg Navalpro CR ; 300mg; 500mg Vanapro 300mg; 500mg Phenytoin Phenytoin sod Lamotrigine Dyna-Lamotrigine 2; ; ; Epitec 2; ; ; Lamidus ; ; Sandoz Lamotrigine ; ; Topiramate Adco-Topiramate 2; ; Epitoz 2; ; Sandoz Topiramate ; Phenobarbital Lethyl 30mg Sedabarb 30mg Dorzolamide Trusopt 5ml owi 2% Bimatoprost Lumigan 0.01% Latanoprost Ocuprost 3ml 50mcg/1ml Xalatan 2.5ml 50mcg/1ml Travoprost Travatan 2.5ml 0.004% Brimonidine Alphagan purite 5ml 1./1ml Page 15 of 22 01/2015

16 Glaucoma R85 Anti-glaucoma Beta blocking agents: Timolol R260 Anti-glaucoma Beta blocking agents: Timolol, combinations Haemophilia R5 Analgesics: Paracetamol R195 Anti-fibrinolytics: Amino acids Timolol Glaucosan 5ml 0.5% Timolol, combinations Azarga 5ml Combigan 5ml 2mg/ Cosopt 5ml 0.5% Duotrav 2.5ml Ganfort 3ml Xalacom 2.5ml Paracetamol Adco-Napamol 500mg Adco-Prolief 500mg Cetapon 500mg Painogesic 500mg Tranexamic acid Morwak 500mg Tranexamic Acid Medwich 500mg Tranic 500mg R Blood coagulation factors Coagulation factor IX Haemosolvex IX 500U R1 700 Posterior pituitary hormones: Vasopressin and analogues Coagulation factor VIII Haemosolvate VIII 300U; 500U; 1000U Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Hyperlipidaemia R255 Lipid modifying agents: Bezafibrate Dyna-Bezafibrate SR 400mg Fibrates Sandoz Bezafibrate 400mg R55 Lipid modifying agents: Atorvastatin Adco Atorvastatin 10mg; ; Statins Aspavor 10mg; ; ; 80mg Astor Dynator 10mg; ; ; 80mg Lipogen 80mg Vastor 10mg; ; ; 80mg Simvastatin Adco-Simvastatin 10mg; ; Austell-Simvastatin 10mg; ; Choleste Cipla-Simvastatin 10mg; ; Simvacor 10mg; ; Zysim 10mg; ; Hypertension R190 ACE inhibitors and calcium Perindopril and Coveram 5/; 10/; 5/10mg; 10/10mg channel blockers Amlodipine R120 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and diuretics Zydus Perindopril co 4/1.2 R115 ACE inhibitors: plain Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap ; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Page 16 of 22 01/2015

17 Hypertension R115 ACE inhibitors: Perindopril Acti-Prex plain Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; R235 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 R115 Angiotensin II antagonists, Irbesartan and diuretics Isart co 150/12.; 300/12. Combinations Losartan and diuretics Austell Losartan co 50/12. Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12.; 100/2 Netrasol co 50/12.; 100/2 Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 R120 Angiotensin II antagonists: Irbesartan Dynarb 1; 300mg plain Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg R140 Anti-adrenergic agents: Doxazosin Adco-Doxazosin 1mg; 2mg; Alpha-adrenoreceptor antagonists Cardugen 1mg; R130 Anti-adrenergic agents: Methyldopa Hypotone 2 Methyldopa Mylan Methyldopa 2 Sandoz Methyldopa 2 R25 Anti-adrenergic agents: Reserpine Reserpine 0.2 Rauwolfia alkaloids R85 Arteriolar smooth muscle Hydralazine Hyperphen 10mg; agents: Hydrazinophthalazine Sandoz Hydralazine 2 derivatives R190 Beta blocking agents: Propranolol Indoblok 10mg; non-selective Prodorol 10mg; Purbloka 10mg; R75 Beta blocking agents: Atenolol B-Block ; selective Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; R40 High-ceiling diuretics Furosemide Dino-Retic Diuresix Furobe Mylan Furosemide Page 17 of 22 01/2015

18 Hypertension R15 Low-ceiling diuretics: Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R95 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R90 Potassium supplements Potassium chloride Plenish K 600mg Potassium Chloride Unicorn 600mg Sandoz K mg Ultipot 600mg R285 Selective calcium channel Diltiazem Adco-Zildem 60mg blockers with direct cardiac Adco-Zildem SR 180mg; 2 effects Verapamil Vasomil ; 80mg Verahexal SR 2 R190 Selective calcium channel Amlodipine Amlodac blockers with mainly vascular Amtas effects Gulf Amlodipine Indo Amlodipine Lomanor Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Hypothyroidism R45 Thyroid hormones Levothyroxine sodium Euthyrox 25mcg; 50mcg; 100mcg Multiple sclerosis R70 Anti-depressants: Amitriptyline Gulf Amitriptyline 2 Tricyclics Sandoz Amitriptyline 2 Trepiline 10mg R Interferons Interferon beta-1a Avonex pre-filled syringe 0.5ml 30mcg/0.5ml Rebif 22 pre-filled syringe 0.5ml 44mcg/1ml Rebif 22 rebidose pre-filled pen 0.5ml 44mcg/1ml Rebif 44 pre-filled syringe 0.5ml 88mcg/1ml Rebif 44 rebidose pre-filled pen 0.5ml 88mcg/1ml Interferon beta-1b Betaferon pre-filled syringe 1ml u/1ml R1 090 Muscle relaxants: Baclofen Bio-Baclofen 10mg Other centrally acting agents Teva Baclofen 10mg R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic R245 Urinary Oxybutynin Lenditro anti-spasmodics Mylan Oxybutynin Parkinson's disease R315 Anti-cholinergic agents: Biperiden Akineton 2mg Tertiary amines Lennon-Biperiden 2mg R565 Dopamine agonists Pramipexole Oxpola 0.12; 0.2; 1mg Pramex 0.12; 0.2; 1mg Pramiola 0.12; 0.2 Ropinirole Accord Ropinirole 0.2; 0.; 1mg; 2mg; Requip 0.2; 0.; 1mg; 2mg; Page 18 of 22 01/2015

19 Parkinson's disease R645 Dopaminergic agents: Monoamine oxidase B inhibitors: Selegiline R280 R620 Dopaminergic agents: Adamantane derivatives Levodopa and decarboxylase inhibitor Rheumatoid arthritis R55 Anti-inflammatory agents: Acetic acid derivatives and related substances R90 R30 Anti-inflammatory agents: Oxicams Anti-inflammatory agents: Propionic acid derivatives Selegiline Parkilyne Amantadine Symadin Levodopa and Carbilev 25/; 25/2 decarboxylase inhibitor Sinemet 25/; 25/2 Teva Carbi-Levo 25/; 25/2 Diclofenac Adco-Diclofenac A-Lennon Diclofenac 2; Diclofenac Biotech 2 Mylan Diclofenac 2; Panamor AT Sandoz Diclofenac 2 Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 Meloxicam Adco-Meloxicam 7.; 1 Arrow Meloxicam 7. Flamaryx 7. Flexocam 7. Medoxicam 7. Zydus-Meloxicam 7. Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen Betaprofen FC 400mg Bren 400mg Ibu Ibucine ; 400mg Ibunate Ranfen 400mg Naproxen Be-Tabs Naproxen 2 Naproscript 2 R85 Anti-rheumatic agents: Chloroquine Plasmoquine Chloroquine R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R710 Intestinal anti-inflammatories: Sulfasalazine Salazopyrin 500mg Aminosalicylic acid and similar agents Salazopyrin EN 500mg R625 Other immuno- Azathioprine Azamun suppressive agents: Azathioprine Azathioprine PCH R70 Other immuno- Methotrexate Abitrexate 2. suppressive agents: Methotrexate Methotrexate 2. R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Schizophrenia R330 Anti-depressants: Citalopram Adco-Talomil SSRIs Arrow Citalopram ; Bio Citalopram Cilate Page 19 of 22 01/2015

20 Schizophrenia R330 Anti-depressants: SSRIs R360 R100 R1 100 R605 R360 R390 R650 Anti-epileptics: Carboxamide derivatives Butyrophenone derivatives Clozapine Olanzapine Phenothiazines with aliphatic side-chain Quetiapine Thioxanthene derivatives Escitalopram Accord Escitalopram 10mg; Escitalopram Be-Tabs Zytomil 10mg; 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Prolax Ranflocs Rezak Zydus Fluoxetine Paroxetine Adco-Paroxetine Auro Paroxetine Serrapress Xet Sertraline Austell-Sertraline ; Dyna Sertraline Serdep Serlife Zolid Zylin ; ; Carbamazepine Degranol Sandoz Carbamazepine Sandoz Carbamazepine CR Zeptol ; 400mg Haloperidol Gulf Haloperidol Sandoz Haloperidol 1.; Clozapine Aspen Clozapine 2; Cloment 2; Olanzapine Mylan Olanzapine Oleanz Olexar Prexolan odt Redilanz Chlorpromazine Largactil 2; Quetiapine Dopaquel 2; ; ; 300mg Mylan Quetiapine Psyquet Quetoser Serez Sizonorm 2; ; ; 300mg 2; ; ; 300mg 2; ; ; 300mg 2; ; ; 300mg 2; ; ; 300mg Flupenthixol Fluanxol 0.; 1mg Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot Page 20 of 22 01/2015

21 Schizophrenia R1 005 Other anti-psychotics Risperidone DRL-Risperidone 0.; 1mg; 2mg Perizal 0.; 1mg; 2mg; 3mg Systemic lupus erythematosus (SLE) R55 Anti-inflammatory agents: Acetic acid derivatives and related substances Page 21 of 22 01/2015 Risnia 0.; 1mg; 2mg; 3mg Rispacor 0.; 1mg; 2mg; 3mg Rispevon 3mg; Risponz 1mg; 2mg; 3mg; Schizorol 0. Zoxadon 0.; 1mg; 2mg Diclofenac Adco-Diclofenac A-Lennon Diclofenac 2; Diclofenac Biotech 2 Mylan Diclofenac 2; Panamor AT Sandoz Diclofenac 2 Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 R90 Anti-inflammatory agents: Meloxicam Adco-Meloxicam 7.; 1 Oxicams Arrow Meloxicam 7. Flamaryx 7. Flexocam 7. Medoxicam 7. Zydus-Meloxicam 7. Piroxicam Pyrocaps Roxifen R30 Anti-inflammatory agents: Ibuprofen Betaprofen Propionic acid derivatives Betaprofen FC 400mg Bren 400mg Ibu Ibucine ; 400mg Ibunate Ranfen 400mg Naproxen Be-Tabs Naproxen 2 Naproscript 2 R85 Anti-rheumatic agents: Chloroquine Plasmoquine Chloroquine R75 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R20 Aspirin Acetylsalicylic acid Aspirin 300mg Be-Tabs Aspirin (white) 300mg Gulf Aspirin 300mg R25 Emolients and protectives: Zinc products Zinc ointment bp Zinc products R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R625 Other immuno- Azathioprine Azamun suppressive agents: Azathioprine PCH Azathioprine R70 Other immuno- Methotrexate Abitrexate 2. suppressive agents: Methotrexate Methotrexate 2. R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic R25 Topical corticosteroids: Group III Betamethasone Repivate cream 0.1% Topivate cream 0.1% Vari-Betamethasone cream 0.1%

22 Ulcerative colitis R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R710 Intestinal anti-inflammatories: Mesalazine Asacol 400mg; 500mg; 800mg Aminosalicylic acid and similar Pentasa 500mg; 1000mg agents Salofalk 1000mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg R2 415 Intestinal anti-inflammatories: Budesonide Entocord enema Corticosteroids R625 Other immuno- Azathioprine Azamun suppressive agents: Azathioprine Azathioprine PCH R70 Other immuno- Methotrexate Abitrexate 2. suppressive agents: Methotrexate Methotrexate 2. R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Page 22 of 22 01/2015