Chronic Illness Benefit medicine list (formulary)

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2014

2 Chronic Illness Benefit 2014 Contents Page Explanation of terms 3 The Prescribed Minimum Benefits medicine list (for all plan types) 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 Remedi Medical Aid 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. Remedi Medical Aid Scheme and Discovery Health (Pty) Ltd reserve the right to change the benefit at any time. Page 2 of 23 01/2014

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 Amounts are applicable for 2014 only. Amount (CDA) The CDA is a monthly amount we pay up to for a medicine class. This applies to medicine that is not listed on the medicine list (formulary). The 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 23 01/2014

4 Chronic Illness Benefit 2014 The Prescribed Minimum Benefits (PMB) medicine list for the and Options. Prescribed Minimum Addison s disease R150 R150 Systemic corticosteroids: Hydrocortisone R105 R105 Systemic corticosteroids: Mineralocorticoids Asthma R325 R325 Adrenergics - Formoterol and budesonide R140 R140 Adrenergics: Long acting - Formoterol R280 R375 Adrenergics: Long acting - Salmeterol R325 R325 Adrenergics: Salmeterol and fluticasone R30 R30 Adrenergics: Short acting- Salbutamol R85 R125 Anti-asthmatics: Systemic xanthines R195 R195 Inhaled anti-cholinergics: Ipratropium bromide Hydrocortisone Covocort 10mg Fludrocortisone Florinef acetate 0.1mg Formoterol and Symbicord turbohaler 160/4.5mcg budesonide 60 dose Symbicord turbohaler 320/9mcg 60dose Formoterol Foratec dp-caps 12mcg Foratec hfa 120dose 12mcg/1dose Salmeterol Serevent accuhaler 60 dose 50mcg Serevent CFC free 120 dose 25mcg Salmeterol and Foxair accuhaler 50/100; 50/250; 50/500 fluticasone 60 dose Sereflo hfa 25/50; 25/125; 25/ dose Salbutamol Venteze CFC free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous ; 300mg Ipratropium bromide Atrovent HFA 200dose 20mcg Ipvent HFA 200 dose 40mcg/1dose R275 R330 Inhaled Glucocorticoids Beclometasone Beceze 200dose CFC free 100mcg 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 R350 Surgical item Inhaler device Dp haler device R10 R10 Systemic corticosteroids: Prednisone Paediatric Spacer Glaxohaler Prednisone Be-Tabs Prednisone Panafcort Trolic Page 4 of 23 01/2014

5 Bipolar mood disorder R115 R330 Anti-depressants: SSRIs R265 R345 Anti-epileptics: Carboxamide R365 R365 Anti-epileptics: Fatty acid R255 R375 Anti-epileptics: Other agents R95 R95 Anti-psychotics: Butyrophenone R685 R1 000 Anti-psychotics: Clozapine R305 R305 Anti-psychotics: Lithium Citalopram Adco-Talomil Arrow Citalopram ; Auro-Citalopram Austell-Citalopram Cilate Citalohexal Citalopram Actor Citalopram-Winthrop Mylan Citalopram Escitalopram Citraz 10mg; Escitalopram Be-Tabs 10mg; Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Ranflocs Rezak Zydus Fluoxetine Paroxetine Adco-Paroxetine Paroxetine Unicorn Serrapress Sertraline Austell-Sertraline 50mg; Serdep 50mg; Zylin 50mg Carbamazepine Degranol Sandoz Carbamazepine Sandoz Carbamazepine CR Zeptol ; 400mg Valproic acid Convulex 150mg Convulex syrup Epilim crushable 250mg/5ml Epilim sugar-free syrup /5ml Epilizine CR ; 300mg; 500mg Navalpro CR ; 300mg; 500mg Lamotrigine Dyna-Lamotrigine 2; 50mg; ; Lamidus 50mg; ; Sandoz Lamotrigine 50mg; ; Haloperidol Sandoz Haloperidol 1.; Clozapine Aspen Clozapine 2; Cloment 2; Lithium Camcolit 250mg; 400mg Quilonum retard 450mg Page 5 of 23 01/2014

6 Bipolar mood disorder R605 R605 Anti-psychotics: Olanzapine R345 R345 Anti-psychotics: Phenothiazines with aliphatic side-chain R550 R550 Anti-psychotics: Quetiapine Olanzapine Oleanz ; 10mg Olexar ; 10mg Redilanz ; 10mg Chlorpromazine Largactil 2; 50mg; Quetiapine Dopaquel 2; ; ; 300mg Mylan Quetiapine 2; ; ; 300mg Psyquet 2; ; ; 300mg Quetoser 2; ; ; 300mg Serez 2; ; ; 300mg R490 R620 Anti-psychotics: Flupenthixol Fluanxol 0.; 1mg Thioxanthene Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot R455 R990 Other anti-psychotics Risperidone DRL-Risperidone 0.; 1mg; 2mg Perizal 0.; 1mg; 2mg; 3mg Risnia 0.; 1mg; 2mg; 3mg Schizorol 0.; 1mg; 2mg Zoxadon 0.; 1mg; 2mg Bronchiectasis R30 R30 Adrenergics: Salbutamol Venteze CFC free 200 dose 100mcg Short acting - Salbutamol R195 R195 Inhaled anti-cholinergics: Ipratropium bromide Atrovent HFA 200dose 20mcg Ipratropium bromide Ipvent HFA 200 dose 40mcg/1dose R10 R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Cardiac failure R110 R115 ACE inhibitors and Enalapril and Enap co 20/12. Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co 10/12.; 20/12. Lisinopril co Unicorn 10/12.; 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. R75 R110 ACE inhibitors: plain Lisozide 20/12. Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; 10mg; Enalapril Unicorn 10mg; Enap ; 10mg; Hr-Enalapril ; 10mg; Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Page 6 of 23 01/2014

7 Cardiac failure R75 R110 ACE inhibitors: plain R200 R225 Alpha and Beta blocking agents R110 R115 Angiotensin II antagonists, Combinations: Losartan and R75 R115 Angiotensin II antagonists: plain R80 R80 Arteriolar smooth muscle agents: Hydrazinophthalazine R60 R75 Beta blocking agents: selective Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Ran-Perindopril Zydus Perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and Austell Losartan co 50/12. Ciplazar co 100/2 Hytenza co 50/12.; 100/2 Lohype Forte Plus 100/2 Losaar Plus 50/12.; 100/2 Losacar co Losartan co Unicorn Losartan co Unicorn Netrasol co 50/12. 50/ /2 50/12.; 100/2 Sartoc-co 100/2 Zartan co 100/2 Losartan Ciplazar Hytenza Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg Hydralazine Hyperphen 10mg; 50mg Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor ; 10mg Betacor ; 10mg Bilocor ; 10mg Bisohexal ; 10mg Bisoprolol Unicorn ; 10mg Ziapro ; 10mg Page 7 of 23 01/2014

8 Cardiac failure R25 R25 Cardiac glycosides: Digoxin Lanoxin 0.062; 0.2 Digoxin Lanoxin paed syrup 0.0/1ml R20 R40 High-ceiling Furosemide Beurises Dino-Retic Diuresix Mylan Furosemide R15 R15 Low-ceiling : Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 R20 Low-ceiling : Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R90 R90 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R85 R85 Potassium supplements Potassium chloride Plenish K 600mg Sandoz K mg R170 R170 Vasodilators in cardiac disease: Organic nitrates Glyceryl trinitrate Angised 0. Isosorbide dinitrate Sandoz Isosorbide dinitrate ; 10mg; 30mg Isosorbide mononitrate Elantan Elantan LA 50mg Monicor SR 60mg R70 R70 Influenza vaccines Influenza, purified antigen Fluarix pre-filled syringe 0.5ml Fluvax pre-filled syringe 0.5ml R135 R135 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 Enalapril and Enap co 20/12. Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. Cardiomyopathy R110 R115 ACE inhibitors and Hexal-Lisinopril co Lisinopril co Unicorn Lisinozide 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. R75 R110 ACE inhibitors: plain Lisoretic Lisozide 10/12.; 20/12. 20/12. Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; 10mg; Enalapril Unicorn 10mg; Enap ; 10mg; Hr-Enalapril ; 10mg; Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Page 8 of 23 01/2014

9 Cardiomyopathy R75 R110 ACE inhibitors: plain R200 R225 Alpha and Beta blocking agents R110 R115 Angiotensin II antagonists, Combinations: Losartan and R75 R115 Angiotensin II antagonists: plain R75 R75 Anti-thrombotic agents: Vitamin K antagonists R80 R80 Arteriolar smooth muscle agents: Hydrazinophthalazine Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Ran-Perindopril Zydus perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and Austell Losartan co 50/12. Ciplazar co 100/2 Hytenza co 50/12.; 100/2 Lohype Forte Plus 100/2 Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Sartoc co Zartan co 100/2 100/2 Losartan Ciplazar Hytenza Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg Warfarin Cipla-Warfarin 1mg; 3mg; Hydralazine Hyperphen 10mg; 50mg Sandoz Hydralazine 2 Page 9 of 23 01/2014

10 Cardiomyopathy R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Chronic obstructive pulmonary disease (COPD) R60 R75 Beta blocking agents: selective R25 R25 Cardiac glycosides: Digoxin Gulf Aspirin 300mg Bisoprolol Adco-Bisocor ; 10mg Betacor Bilocor Bisohexal Bisoprolol Unicorn Ziapro ; 10mg ; 10mg ; 10mg ; 10mg ; 10mg Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml R20 R40 High-ceiling Furosemide Beurises R15 R15 Low-ceiling : Thiazides, plain Dino-Retic Diuresix Mylan Furosemide Hydrochlorothiazide Hexazide 2 Ridaq 12. R20 R20 Low-ceiling : Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R90 R90 Potassium sparing Spironolactone Aldactone 2 agents Sandoz Spironolactone 2 Spiractin 2 R85 R85 Potassium supplements Potassium chloride Plenish K 600mg Sandoz K mg R170 R170 Vasodilators in cardiac Glyceryl trinitrate Angised 0. disease: Organic nitrates Isosorbide dinitrate Sandoz Isosorbide dinitrate ; 10mg; 30mg Isosorbide mononitrate Elantan Elantan LA 50mg Monicor SR 60mg R70 R70 Influenza vaccines Influenza, purified antigen Fluarix pre-filled syringe 0.5ml Fluvax pre-filled syringe 0.5ml R135 R135 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 R155 R155 Adrenergics: Salbutamol and Duolin hfa 200 dose Salbutamol and ipratropium bromide ipratropium bromide R30 R30 Adrenergics: Short acting - Salbutamol R85 R125 Anti-asthmatics: Systemic xanthines R195 R195 Inhaled anti-cholinergics: Ipratropium bromide Salbutamol Venteze CFC free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous ; 300mg Ipratropium bromide Atrovent HFA 200dose 20mcg Ipvent HFA 200 dose 40mcg/1dose Page 10 of 23 01/2014

11 Chronic obstructive pulmonary disease (COPD) R685 R685 Surgical item: Oxygen Oxygen concentrator rental Oxygen concentrator R10 R10 Systemic Prednisone Be-Tabs Prednisone corticosteroids: Panafcort Prednisone Trolic R70 R70 Influenza vaccines Influenza, purified antigen Fluarix pre-filled syringe 0.5ml Fluvax pre-filled syringe 0.5ml Enalapril and Enap co 20/12. Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co 10/12.; 20/12. Lisinopril co Unicorn 10/12.; 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. R75 R110 ACE inhibitors: Captopril Adco-Captomax 2; 50mg plain Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; 10mg; Enalapril Unicorn 10mg; Enap ; 10mg; Hr-Enalapril ; 10mg; Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Chronic renal disease R110 R115 ACE inhibitors and R110 R115 Angiotensin II antagonists, Combinations: Losartan and Pearinda Perindopril Unicorn Ran-Perindopril ; 8mg Zydus perindopril Quinapril Accumax 10mg; Losartan and Austell Losartan co 50/12. Ciplazar co 100/2 Hytenza co 50/12.; 100/2 Lohype Forte Plus 100/2 Losaar Plus 50/12.; 100/2 Page 11 of 23 01/2014

12 Chronic renal disease R110 R115 Angiotensin II Losartan and Losacar co 50/12. antagonists, Losartan co Unicorn 50/12. Combinations: Losartan and Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Sartoc co 100/2 Zartan co 100/2 R75 R115 Angiotensin II Losartan Ciplazar antagonists: plain Hytenza Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg R215 R215 Calcium supplements Calcium carbonate B-cal R5 R5 Folic acid and Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R65 R65 Iron in combination with Ferrous fumarate Pregamal folic acid R570 R570 Iron trivalent, parenteral Iron, parenteral Cosmofer ampoule 50mg/1ml preparations preparations Venofer /1ml R4 000 R4 000 Other anti-anaemic Darbepoetin Alfa Aranesp pre-filled syringe 0.4ml 10mcg/0.4ml preparations Aranesp pre-filled syringe 0.5ml 20mcg/0.5ml Aranesp pre-filled syringe 0.3ml 30mcg/0.3ml Aranesp pre-filled syringe 0.4ml 40mcg/0.4ml Aranesp pre-filled syringe 0.5ml 50mcg/0.5ml Aranesp pre-filled syringe 0.3ml 60mcg/0.3ml Erythropoietin Eprex pre-fill 2000U/0.5ml Eprex pre-fill 4000U/0.4ml Recormon pre-filled syringe 500U/0.3ml Recormon pre-filled syringe 2000U/0.3ml Recormon pre-filled syringe 4000U/0.3ml Repotin 1ml 2000IU Repotin 1ml 4000IU Methoxy Mircera pre-filled syringe 0.3ml 30mcg/0.3ml polyethylene-glycol- Mircera pre-filled syringe 0.3ml 50mcg/0.3ml epoetin beta Mircera pre-filled syringe 0.3ml 75mcg/0.3ml Mircera pre-filled syringe 0.3ml 100mcg/0.3ml Mircera pre-filled syringe 0.3ml 120mcg/0.3ml Mircera pre-filled syringe 0.3ml 150mcg/0.3ml Mircera pre-filled syringe 0.3ml 200mcg/0.3ml Mircera pre-filled syringe 0.3ml 250mcg/0.3ml R365 R365 Vitamin D and Alfacalcidol One alpha 0.25mcg; 1mcg analogues Coronary artery disease R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin 300mg R60 R170 Beta blocking agents: Propranolol Indoblok 10mg; non-selective Prodorol 10mg; Purbloka 10mg; Page 12 of 23 01/2014

13 Coronary artery disease R60 R75 Beta blocking agents: selective R180 R255 Selective calcium channel blockers with direct cardiac effects R130 R170 Selective calcium channel blockers with mainly vascular effects R170 R170 Vasodilators in cardiac disease: Organic nitrates Crohn s disease R5 R5 Folic acid and R680 R680 Intestinal antiinflammatories: Aminosalicylic acid and similar agents R2 285 R2 285 Intestinal antiinflammatories: Corticosteroids R590 R590 Other immunosuppressive agents: Azathioprine R65 R65 Other immunosuppressive agents: Methotrexate R10 R10 Systemic corticosteroids: Prednisone Atenolol B-Block 50mg; Bio-Atenolol 50mg; Gulf Atenolol 50mg; Sandoz Atenolol 50mg; Tenopress Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Almadin ; 10mg Amlodac Gulf Amlodipine Indo Amlodipine Lomanor ; 10mg ; 10mg Pharma Dynamics Amlodipine besylate ; 10mg Felodipine Felodipine-Hexal ; 10mg Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Glyceryl trinitrate Angised 0. Isosorbide dinitrate Sandoz Isosorbide dinitrate ; 10mg; 30mg Isosorbide mononitrate Elantan Elantan LA Monicor SR 50mg 60mg Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Mesalazine Asacol 400mg; 500mg; 800mg Pentasa Salofalk 500mg; 1000mg 1000mg Olsalazine Dipentum 250mg Sulfasalazine Salazopyrin 500mg Budesonide Salazopyrin EN Entocord enema 500mg Azathioprine Azamun 50mg Azathioprine PCH 50mg Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Page 13 of 23 01/2014

14 Diabetes insipidus R1 380 R1 600 Posterior pituitary hormones: Vasopressin and analogues Diabetes mellitus Type 1 R680 R720 Anti-diabetic agents: Insulins and analogues R200 R280 Blood glucose monitoring agents Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Insulin Glucose strips Actraphane hm(ge) - vial 10ml Apidra - solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog vial 10ml Humalog cartridge 3ml Humalog kwikpen - penset 3ml Humalog mix 25 kwikpen - penset 3ml Humalog mix 25 - cartridge 3ml; vial 10ml Humalog mix 50 - cartridge 3ml Humalog mix 50 - kwikpen 3ml Humulin 30/70 - cartridge 3ml; disposable pens 3ml; vial 10ml Humulin n - cartridge 3ml; disposable pen 3ml; vial 10ml Humulin r - cartridge 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml; penfill 3ml Novorapid - penfill 3ml Accu-chek active strips Caresens ii/pop test strip 29g Caresens n test strips 29g Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose test strips free style optium Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 R350 Surgical item Devices Biosulin pen device Lancets Lancets glucoplus 66 x 44 x 78mm Needles BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm Needle novofine Needle pen bd microfine 30g 8mm Diabetes mellitus Type 2 R60 R60 Anti-diabetic agents: Metformin Accord Metformin 500mg; 850mg Biguanides Arrow Metformin 500mg; 850mg Austell-Metformin 500mg; 850mg Bigsens 500mg; 850mg; 1000mg Diaformin 500mg Diaformin forte 850mg Diamin 500mg; 850mg Page 14 of 23 01/2014

15 Diabetes mellitus Type 2 R60 R60 Anti-diabetic agents: Biguanides R680 R720 Anti-diabetic agents: Insulins and analogues R100 R100 Anti-diabetic agents: Sulfonamides, urea R160 R180 Anti-diabetic agents: Thiazolidinediones R200 R280 Blood glucose monitoring agents Metformin Gluconorm 500mg; 850mg Mengen 500mg; 850mg; 1000mg Metchek 500mg; 850mg Metforal 500mg; 850mg Metored 500mg; 850mg; 1000mg Metphage 500mg; 850mg Mylan Metformin 500mg; 850mg Sandoz Metformin 500mg Sandoz Metformin FCT 500mg Insulin Actraphane hm(ge) - vial 10ml Apidra - solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog vial 10ml Humalog cartridge 3ml Humalog kwikpen - penset 3ml Humalog mix 25 kwikpen - penset 3ml Humalog mix 25 - cartridge 3ml; vial 10ml Humalog mix 50 - cartridge 3ml Humalog mix 50 kwikpen 3ml Humulin 30/70 - cartridge 3ml; disposable pens 3ml; vial 10ml Humulin n - cartridge 3ml; disposable pen 3ml; vial 10ml Humulin r - cartridge 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml; penfill 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 Cipla-Pioglitazone 1; 30mg Glucose strips Accu-chek active strips Caresens ii/pop test strip 29g Caresens n test strips 29g Glucocheck strips 50s Glucoplus Page 15 of 23 01/2014

16 Diabetes mellitus Type 2 R200 R280 Blood glucose monitoring agents Glucose strips Glucoplus provider strips Glucose test strips free style optium Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 R350 Surgical item Devices Biosulin pen device Lancets Lancets glucoplus 66 x 44 x 78mm Needles BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm Needle novofine Needle pen bd microfine 30g 8mm Dysrhythmias R530 R605 Anti-arrhythmics: Flecainide Tambocor class Ic Tambocor CR ; Propafenone Rythmol 150mg; 300mg R380 R380 Anti-arrhythmics: Amiodarone Arycor ; class III - Amiodarone Bio-Amiodarone Hexarone ; R75 R75 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; 3mg; Vitamin K antagonists R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin 300mg R60 R170 Beta blocking agents: Propranolol Indoblok 10mg; non-selective Prodorol 10mg; Purbloka 10mg; Sotalol Sotahexal 80mg; 160mg R60 R75 Beta blocking agents: Atenolol B-Block 50mg; selective Bio-Atenolol 50mg; Gulf Atenolol 50mg; Sandoz Atenolol 50mg; Tenopress R25 R25 Cardiac glycosides: Digoxin Lanoxin 0.062; 0.2 Digoxin Lanoxin paed syrup 0.0/1ml R180 R255 Selective calcium Verapamil Vasomil ; 80mg channel blockers with Verahexal SR 2 direct cardiac effects Epilepsy R170 R260 Anti-epileptics: Clonazepam Rivotril 0.; 2mg Benzodiazepine R265 R345 Anti-epileptics: Carbamazepine Degranol Carboxamide Sandoz Carbamazepine Sandoz Carbamazepine CR ; 400mg Zeptol R365 R365 Anti-epileptics: Valproic acid Convulex 150mg Fatty acid Convulex syrup 250mg/5ml Epilim crushable Epilim sugar-free syrup /5ml Epilizine CR ; 300mg; 500mg Navalpro CR ; 300mg; 500mg R60 R60 Anti-epileptics: Phenytoin Phenytoin sod Hydantoin R255 R375 Anti-epileptics: Lamotrigine Dyna-Lamotrigine 2; 50mg; ; Other agents Lamidus 50mg; ; Sandoz Lamotrigine 50mg; ; Topiramate Epitoz 2; 50mg; Sandoz Topiramate 50mg; Page 16 of 23 01/2014

17 Epilepsy R25 R25 Anti-epileptics: Barbiturates and Glaucoma R170 R170 Anti-glaucoma agents: Carbonic anhydrase inhibitors R225 R225 Anti-glaucoma agents: Prostaglandin analogues R245 R245 Anti-glaucoma agents: Sympathomimetics R85 R85 Anti-glaucoma Beta blocking agents: Timolol R240 R240 Anti-glaucoma Beta blocking agents: Timolol, combinations Haemophilia R5 R5 Analgesics: Paracetamol R195 R195 Anti-fibrinolytics: Amino acids R R Blood coagulation factors R1 380 R1 600 Posterior pituitary hormones: Vasopressin and analogues Hyperlipidaemia R245 R245 Lipid modifying agents: Fibrates R45 R55 Lipid modifying agents: Statins Phenobarbital Lethyl 30mg Sedabarb 30mg Dorzolamide Trusopt 5ml owi 2% Bimatoprost Lumigan 0.01% Latanoprost Ocuprost 3ml 50mcg/1ml Travoprost Travatan 2.5ml 0.004% Brimonidine Alphagan purite 5ml 1./1ml Timolol Glaucosan 5ml 0.5% Timolol, combinations Azarga 5ml Combigan 5ml 2mg/ Cosopt 5ml 0.5% Duotrav 2.5ml Ganfort 3ml Paracetamol Adco-Napamol 500mg Adco-Prolief 500mg Cetapon 500mg Painogesic 500mg Tranexamic acid Tranexamic acid medwich 500mg Tranic 500mg Coagulation factor IX Haemosolvex IX 500U Coagulation factor Haemosolvate VIII 300U; 500U; 1000U VIII Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Bezafibrate Dyna-Bezafibrate SR 400mg Sandoz Bezafibrate 400mg Atorvastatin Adco Atorvastatin 10mg; ; Aspavor 10mg; ; Atolip Dynator 10mg; ; 10mg; ; ; 80mg Hypertension R110 R115 ACE inhibitors and Lipogen 80mg Simvastatin Adco-Simvastatin Arrow Simvastatin Austell-Simvastatin 10mg; ; Biovac Simvastatin Choleste Cipla-Simvastatin 10mg; ; Redicor 10mg; ; Simvacor Simzor 10mg; ; Zysim 10mg; ; Enalapril and Enap co 20/12. Pharmapress co 20/12. Page 17 of 23 01/2014

18 Hypertension R110 R115 ACE inhibitors and R75 R110 ACE inhibitors: plain R200 R225 Alpha and Beta blocking agents R110 R115 Angiotensin II antagonists, Combinations: Losartan and R75 R115 Angiotensin II antagonists: plain Lisinopril and Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co 10/12.; 20/12. Lisinopril co Unicorn 10/12.; 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; 10mg; Enalapril Unicorn 10mg; Enap ; 10mg; Hr-Enalapril ; 10mg; Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Ran-Perindopril Zydus Perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and Austell Losartan co 50/12. Ciplazar co 100/2 Hytenza co 50/12.; 100/2 Lohype Forte Plus 100/2 Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Sartoc co 100/2 Zartan co 100/2 Losartan Ciplazar Hytenza Page 18 of 23 01/2014

19 Hypertension R75 R115 Angiotensin II antagonists: plain R130 R130 Anti-adrenergic agents: Alpha-adrenoreceptor antagonists R120 R120 Anti-adrenergic agents: Methyldopa Losartan Spec-Losartan Zartan Valsartan Diolo 80mg; 160mg Doxazosin Adco-Doxazosin 1mg; 2mg; Cardugen 1mg; Methyldopa Hypotone 250mg Mylan Methyldopa 250mg Sandoz Methyldopa 250mg R25 R25 Anti-adrenergic agents: Reserpine Reserpine 0.2 Rauwolfia alkaloids R80 R80 Arteriolar smooth muscle agents: Hydralazine Hyperphen 10mg; 50mg Hydrazinophthalazine Sandoz Hydralazine 2 R60 R170 Beta blocking agents: Propranolol Indoblok 10mg; non-selective Prodorol 10mg; Purbloka 10mg; R60 R75 Beta blocking agents: Atenolol B-Block 50mg; selective Bio-Atenolol 50mg; Gulf Atenolol 50mg; Sandoz Atenolol 50mg; Tenopress R20 R40 High-ceiling Furosemide Beurises Dino-Retic Diuresix Mylan Furosemide R15 R15 Low-ceiling : Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 R20 Low-ceiling : Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R90 R90 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R85 R85 Potassium supplements Potassium chloride Plenish K 600mg Sandoz K mg R180 R255 Selective calcium channel Diltiazem Adco-Zildem 60mg blockers with direct cardiac Adco-Zildem SR 180mg; 2 effects Verapamil Vasomil ; 80mg Verahexal SR 2 R130 R170 Selective calcium channel Amlodipine Almadin ; 10mg blockers with mainly vascular Amlodac effects Gulf Amlodipine ; 10mg Indo Amlodipine Lomanor ; 10mg Pharma Dynamics Amlodipine besylate ; 10mg Felodipine Felodipine-Hexal ; 10mg Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Hypothyroidism R45 R45 Thyroid hormones Levothyroxine Euthyrox 25mcg; 50mcg; 100mcg sodium Synthroid 50mcg; 88mcg; 100mcg; 112mcg Multiple sclerosis R65 R65 Anti-depressants: Amitriptyline Sandoz Amitriptyline 2 Tricyclics Trepiline 10mg Page 19 of 23 01/2014

20 Multiple sclerosis R 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 030 R1 030 Muscle relaxants: Baclofen Bio-Baclofen 10mg Other centrally acting agents Teva Baclofen 10mg R10 R10 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic R175 R230 Urinary Oxybutynin Lenditro anti-spasmodics Mylan Oxybutynin Parkinson's disease R305 R305 Anti-cholinergic agents: Biperiden Akineton 2mg Tertiary Amines Lennon-Biperiden 2mg R775 R775 Dopamine agonists Pramipexole Pexola 0.12; 0.2; 1mg Pramiola 0.12; 0.2 Ropinirole Requip 0.2; 0.; 1mg; 2mg; R610 R610 Dopaminergic agents: Selegiline Parkilyne Monoamine oxidase B inhibitors: Selegiline R280 R280 Dopaminergic agents: Adamantane Amantadine Symadin R570 R650 Levodopa and decarboxylase inhibitor Rheumatoid arthritis R45 R50 Anti-inflammatory agents: Acetic acid and related substances R75 R80 Anti-inflammatory agents: Oxicams R25 R25 Anti-inflammatory agents: Propionic acid Levodopa and Carbilev 25/; 25/250mg decarboxylase Sinemet 25/; 25/250mg inhibitor Teva Carbi-Levo 25/; 25/250mg Diclofenac Adco-Diclofenac 50mg A-Lennon Diclofenac 2; 50mg Diclofenac Biotech 2 Mylan Diclofenac 2; 50mg Panamor AT 50mg 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 Page 20 of 23 01/2014

21 Rheumatoid arthritis R25 R25 Anti-inflammatory agents: Naproxen Be-tabs Naproxen 250mg Propionic acid Naproscript 250mg R85 R85 Anti-rheumatic agents: Chloroquine Plasmoquine Chloroquine R5 R5 Folic acid and Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R680 R680 Intestinal anti- Sulfasalazine Salazopyrin 500mg inflammatories: Aminosalicylic acid and Salazopyrin EN 500mg similar agents R590 R590 Other immuno- Azathioprine Azamun 50mg suppressive agents: Azathioprine Azathioprine pch 50mg R65 R65 Other immunosuppressive agents: Methotrexate R10 R10 Systemic corticosteroids: Prednisone Schizophrenia R115 R330 Anti-depressants: SSRIs Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Adco-Talomil Arrow Citalopram ; Auro-Citalopram Austell-Citalopram Cilate Citalohexal Citalopram Actor Citalopram-Winthrop Mylan Citalopram Escitalopram Citraz 10mg; Escitalopram Be-Tabs 10mg; Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Ranflocs Rezak Zydus Fluoxetine Paroxetine Adco-Paroxetine Paroxetine Unicorn Serrapress Sertraline Austell-Sertraline 50mg; Serdep 50mg; Zylin 50mg Page 21 of 23 01/2014

22 Schizophrenia R265 R345 Anti-epileptics: Carboxamide Systemic lupus erythematosus (SLE) R95 R95 Anti-psychotics: Butyrophenone R685 R1 000 Anti-psychotics: Clozapine R605 R605 Anti-psychotics: Olanzapine R345 R345 Anti-psychotics: Phenothiazines with aliphatic side-chain R550 R550 Anti-psychotics: Quetiapine Carbamazepine Degranol Sandoz Carbamazepine Sandoz Carbamazepine CR ; 400mg Zeptol Haloperidol Sandoz Haloperidol 1.; Clozapine Aspen Clozapine 2; Cloment 2; Olanzapine Oleanz ; 10mg Olexar ; 10mg Redilanz ; 10mg Chlorpromazine Largactil 2; 50mg; Quetiapine Dopaquel 2; ; ; 300mg Mylan Quetiapine 2; ; ;300mg Psyquet 2; ; ;300mg Quetoser 2; ; ; 300mg Serez 2; ; ; 300mg R490 R620 Anti-psychotics: Flupenthixol Fluanxol 0.; 1mg Thioxanthene Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot R455 R990 Other anti-psychotics Risperidone DRL-Risperidone 0.; 1mg; 2mg Perizal 0.; 1mg; 2mg; 3mg Risnia 0.; 1mg; 2mg; 3mg R45 R50 Anti-inflammatory agents: Acetic acid and related substances R75 R80 Anti-inflammatory agents: Oxicams Schizorol Zoxadon 0.; 1mg; 2mg 0.; 1mg; 2mg Diclofenac Adco-Diclofenac 50mg A-Lennon Diclofenac Diclofenac Biotech Mylan Diclofenac Panamor AT Sandoz Diclofenac 2; 50mg 2 2; 50mg 50mg 2 Indomethacin Betacin 2 Gulf Indomethacin Methocaps 2 2 Meloxicam Adco-Meloxicam 7.; 1 Arrow Meloxicam Flamaryx Flexocam Medoxicam Zydus-Meloxicam Piroxicam Pyrocaps Roxifen Page 22 of 23 01/2014

23 Systemic lupus erythematosus (SLE) R25 R25 Anti-inflammatory Ibuprofen Betaprofen agents: Betaprofen FC 400mg Propionic acid Bren 400mg Ibu Ibucine ; 400mg Ibunate Ranfen 400mg Naproxen Be-Tabs Naproxen 250mg Naproscript 250mg R85 R85 Anti-rheumatic agents: Chloroquine Plasmoquine Chloroquine R75 R75 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; 3mg; Vitamin K antagonists R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin 300mg R25 R25 Emolients and Zinc products Zinc ointment bp protectives: Zinc products R5 R5 Folic acid and Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R590 R590 Other immunosuppressive Azathioprine Azamun 50mg agents: Azathioprine Azathioprine pch 50mg R65 R65 Other immunosuppressive agents: Methotrexate R10 R10 Systemic corticosteroids: Prednisone R25 R25 Topical corticosteroids: Group III Ulcerative colitis R5 R5 Folic acid and R680 R680 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents R2 285 R2 285 Intestinal anti-inflammatories: Corticosteroids R590 R590 Other immunosuppressive agents: Azathioprine R65 R65 Other immunosuppressive agents: Methotrexate R10 R10 Systemic corticosteroids: Prednisone Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Betamethasone Repivate cream 0.1% Topivate cream 0.1% Vari-Betamethasone cream 0.1% Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Mesalazine Asacol 400mg; 500mg; 800mg Pentasa 500mg; 1000mg Salofalk 1000mg Olsalazine Dipentum 250mg Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Budesonide Entocord enema Azathioprine Azamun 50mg Azathioprine pch 50mg Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Page 23 of 23 01/2014