Chronic Illness Benefit medicine list (formulary)

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2012

2 Discovery Health Chronic Illness Benefit 2012 Contents Page Explanation of terms 2 The Prescribed s medicine formulary (for all plan types) 3 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. The Chronic Illness Benefit (CIB) is governed by the Discovery Health Medical Scheme Rules. The utilisation of the benefits and programmes associated with the CIB are subject to specific s and rules. Members must ensure that they are familiar with these rules and s. Any instructions or advice on medicines and the management of the member s are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill and judgement of the member s doctor, pharmacist or other healthcare professional. Discovery Health reserves the right to change the benefit at any time. Page 2 of 23

3 Explanation of terms Benefit Year A benefit year refers to the benefits a member is entitled to during a calendar year, ie 1 January to 31 December. This medicine list (formulary) and s are applicable for 2012 only. (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 CDA includes VAT and the dispensing fee. Prescribed s (PMB s) These are s that the Council for Medical Schemes has determined for coverage by all medical schemes, in any setting, as per clinical guidelines. Chronic Disease List (CDL) A specified list of chronic s we cover according to the Prescribed Minimum Benefits. This describes medicines that have similar chemical structures or similar therapeutic effects. This is the main substance in a medicine that is responsible for the clinical action on a human body. Page 3 of 23

4 Chronic Illness Benefit 2012 The Prescribed minimum Benefits (PMB) medicine list (for all plan types) The PMB medicine list applies to all Discovery Health. The CDA ( ) does not apply to KeyCare. Prescribed Addison s disease R150 R150 Systemic corticosteroids: Hydrocortisone R105 R105 Systemic corticosteroids: Mineralocorticoids Asthma R135 R135 Adrenergics: Long acting - Formoterol R265 R355 Adrenergics: Long acting - Salmeterol R315 R315 Adrenergics: Salmeterol combinations R30 R30 Adrenergics: Short acting - Salbutamol R80 R115 Anti-asthmatics: Systemic Xanthines R180 R180 Inhaled anticholinergics: Ipratropium bromide R260 R310 Inhaled Glucocorticoids Hydrocortisone Covocort 10mg Fludrocortisone Florinef acetate 0.1mg Formoterol Foratec dp-caps 12mcg Foratec hfa 120dose 12mcg/1dose Salmeterol Serevent accuhaler 60 dose 50mcg Fluticasone/ Salmeterol Serevent CFC-free 120 dose 25mcg Foxair 25/50;25/125;25/ dose Foxair accuhaler 50/100;50/250;50/ dose Sereflo 25/50;25/125;25/ dose Salbutamol Asthavent 200 dose 100mcg Venteze cfc free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous 200mg;300mg Ipratropium bromide Atrovent HFA 200dose Ipvent HFA 200 dose 200mcg 40mcg/1dose Beclometasone 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 Pulmicort turbuhaler 200dose 200mcg Pulmicort turbuhaler 100dose 400mcg R350 R350 Surgical item Inhaler device Dp haler device R10 R10 Systemic corticosteroids: Prednisone Prednisone Be-Tabs Prednisone Panafcort Trolic Page 4 of 23

5 Bipolar mood disorder R115 R310 Antidepressants: SSRI's R260 R325 Antiepileptics: Carboxamide R460 R485 Antiepileptics: Fatty acid R315 R450 Antiepileptics: Other agents R90 R90 Antipsychotics: Butyrophenone R690 R980 Antipsychotics: Clozapine R315 R315 Antipsychotics: Lithium R630 R630 Antipsychotics: Olanzapine R455 R455 Antipsychotics: Phenothiazines with aliphatic side-chain R450 R610 Antipsychotics: Thioxanthene Citalopram Arrow Citalopram ; Auro-Citalopram Citalohexal Citalopram-Winthrop Depramil Escitalopram Aspen Escitalopram 10mg Citraz Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Ranflocs Rezak Zydus Fluoxetine Paroxetine Serrapress Sertraline Apex-Sertraline Austell-Sertraline ; Serdep Zylin Carbamazepine Sandoz Carbamazepine 200mg Sandoz Carbamazepine CR 400mg Valproic acid Convulex 1; 300mg;500mg Convulex syrup Epilim CR Epilim crushable 2/5ml 200mg; 300mg;500mg Epilim sugar-free syrup 200mg/5ml Lamotrigine Arrow Lamotrigine ; Dyna-Lamotrigine 2; ; ;200mg Lamidus ; ; 200mg Lamitor ; ; 200mg Haloperidol Sandoz Haloperidol 1.; Clozapine Cloment 2; Lithium Camcolit 2; 400mg Quilonum retard 4 Olanzapine Olexar ; 10mg Redilanz ; 10mg Chlorpromazine Largactil 2; ; Flupenthixol Fluanxol 0.; 1mg Fluanxol depot 1ml Fluanxol depot 2ml Page 5 of 23

6 Bipolar mood disorder Page 6 of 23 R445 R950 Other antipsychotics Risperidone Aspen Risperidone 4mg Bronchiectasis R30 R30 Adrenergics: Short acting - Salbutamol R180 R180 Inhaled anticholinergics: Ipratropium bromide R10 R10 Systemic corticosteroids: Prednisone Auropidone 0.; 1mg; 2mg; 3mg; 4mg DRL-Risperidone 0.; 1mg; 2mg; 3mg Perizal 0.; 1mg; 2mg; 3mg Rispacor 3mg; 4mg Risperidone Hexal 3mg Schizorol 0.; 1mg; 2mg Zoxadon 0.; 1mg; 2mg Salbutamol Asthavent 200 dose 100mcg Venteze cfc free 200 dose 100mcg Ipratropium bromide Atrovent HFA 200dose Ipvent HFA 200 dose 20mcg 40mcg/1dose Prednisone Be-Tabs Prednisone Panafcort Trolic Enalapril and Enap co 20/12. Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. Auro-Lisinopril co 10/12.; 20/12. Diace co 20/12. Hexal-Lisinopril co 10/12. Hexal-Lisinopril co 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. Zestozide 20/12. R70 R100 ACE inhibitors, plain Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; 10mg; Ciplatec ; Enap ; 10mg; Envas ; 10mg Hr-Enalapril 10mg; Pharmapess Cardiac failure R110 R110 ACE inhibitors and Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Perindopril Acti-Prex 4mg Cipla-Perindopril 8mg Ciplasyl 8mg Pearinda 4mg; 8mg Ran-Perindopril 4mg Quinapril Accumax 10mg; Quinagen

7 Cardiac failure R190 R220 Alpha and Beta blocking agents R110 R120 Angiotensin II antagonists, Combinations: Losartan and R70 R100 Angiotensin II antagonists: plain R80 R80 Arteriolar smooth muscle Hydrazinophthalazine R60 R110 Beta blocking selective R15 R15 Cardiac glycosides: Digoxin R20 R40 High-ceiling R25 R25 Low-ceiling : Thiazides, plain R20 R20 Low-ceiling : excluding Thiazides R85 R85 Potassium sparing agents R80 R80 Potassium supplements Carvedilol Aspen Carvedilol 6.2 Carvedilol-Hexal 6.2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and Lohype Forte Plus 100/2 Lohype Plus 50/12. Losaar Plus 50/12.; 100/2 Lozaan Co 50/12.; 100/2 Netrasol Co 50/12. Sartoc 50/12. Losartan Cipla-Losartan Spec-Losartan Zartan Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor ; 10mg Bilocor ; 10mg Bisohexal ; 10mg Bisoprolol hexal Bisoprolol Unicorn ; 10mg Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml Furosemide Beurises Dino-Retic Mylan Furosemide Hydrochloro- Hexazide 2 thiazide Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril 2. Merck-Indapamide 2. Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 Potassium Plenish K 600mg chloride Sandoz K mg Page 7 of 23

8 Cardiac failure R160 R175 Vasodilators in cardiac disease: Organic Nitrates Glyceryl trinitrate Isosorbide dinitrate Isosorbide mononitrate R65 R65 Influenza vaccines Influenza, inactivated, whole virus R130 R130 Pneumococcus vaccines Cardiomyopathy R110 R110 ACE inhibitors and Pneumococcus, purified polysaccharides antigen conjugated Enalapril and Angised Sandoz Isosorbide dinitrate Elantan Elantan LA Monicor SR Fluarix prefilled syringe 0.5ml X-flu prefilled 0,5ml syringe Imovax pneumo 23 Enap co Pharmapress co 0. ;10mg;30mg 60mg 20/12. 20/12. R70 R100 ACE inhibitors: plain Lisinopril and Adco-Zetomax co 10/12.; 20/12. Auro-Lisinopril co 10/12.; 20/12. Diace co 20/12. Hexal-Lisinopril co 10/12. Hexal-Lisinopril co 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. Zestozide 20/12. Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; 10mg; Ciplatec ; Enap ; 10mg; Envas ; 10mg Hr-Enalapril 10mg; Pharmapress Lisinopril Austell-Lisinopril 10mg; Sinopren 10mg; Perindopril Acti-Prex 4mg Cipla-Perindopril 8mg Ciplasyl 8mg Pearinda 4mg; 8mg Ran-Perindopril 4mg Quinapril Accumax 10mg; Quinagen Page 8 of 23

9 Cardiomyopathy R190 R220 Alpha and Beta blocking agents R110 R120 Angiotensin II antagonists, Combinations: Losartan and R70 R100 Angiotensin II antagonists: plain R10 R20 Aspirin Acetylsalicylic acid R60 R110 Beta blocking selective R15 R15 Cardiac glycosides: Digoxin Carvedilol Aspen Carvedilol 6.2 Carvedilol-Hexal Carvetrend Vediblok ; 12.; 2 6.2; 12.; 2 Losartan and Lohype Forte Plus 100/2 Lohype Plus 50/12. Losaar Plus 50/12.; 100/2 Lozaan Co 50/12.; 100/2 Netrasol Co 50/12. Sartoc 50/12. Losartan Cipla-Losartan Spec-Losartan Zartan Warfarin Cipla-Warfarin Hydralazine Hyperphen 10mg; Sandoz Hydralazine Aspirin Be-Tabs Aspirin (white) Gulf Aspirin 2 300mg 300mg 300mg Bisoprolol Adco-Bisocor ; 10mg Bilocor Bisohexal Bisoprolol hexal Bisoprolol Unicorn ; 10mg ; 10mg ; 10mg Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml R20 R40 High-ceiling R25 R25 Low-ceiling : Thiazides, plain R20 R20 Low-ceiling : excluding Thiazides R85 R85 Potassium sparing agents R80 R80 Potassium supplements Furosemide Beurises R70 R70 Antithrombotic Vitamin K antagonists R80 R80 Arteriolar smooth muscle Hydrazinophthalazine Hydrochlorothiazide Dino-Retic Mylan Furosemide Hexazide Ridaq Indapamide Cipla-Indapamide 2. Daptril 2. Merck-Indapamide 2. Spironolactone Aldactone 2 Potassium chloride Sandoz Spironolactone Spiractin Plenish K Sandoz K mg 600mg Page 9 of 23

10 Cardiomyopathy R160 R175 Vasodilators in cardiac disease: Organic Nitrates Chronic obstructive pulmonary disease (COPD) Chronic renal disease Glyceryl trinitrate Isosorbide dinitrate Isosorbide mononitrate R65 R65 Influenza vaccines Influenza, inactivated, whole virus R130 R130 Pneumococcus vaccines R30 R30 Adrenergics: Short acting - Salbutamol R80 R115 Anti-asthmatics: Systemic Xanthines R180 R180 Inhaled anticholinergics: Ipratropium bromide R800 R800 Surgical item: Oxygen concentrator R10 R10 Systemic corticosteroids: Prednisone Angised Sandoz Isosorbide dinitrate Elantan Elantan LA Monicor SR Fluarix prefilled syringe 0.5ml X-flu prefilled 0,5ml syringe 0. ;10mg; 30mg 60mg Pneumococcus, Imovax pneumo 23 purified polysaccharides antigen conjugated Salbutamol Asthavent 200 dose 100mcg Venteze cfc free 200 dose 100mcg Theophylline Sandoz Theophylline anhydrous 200mg;300mg Ipratropium bromide Oxygen R65 R65 Influenza vaccines Influenza, inactivated, whole virus R110 R110 ACE inhibitors and R70 R100 ACE inhibitors: plain Atrovent HFA 200dose Ipvent HFA 200 dose Oxygen concentrator 20mcg 40mcg/1dose Prednisone Be-Tabs Prednisone Enalapril and Lisinopril and Panafcort Trolic Fluarix prefilled syringe 0.5ml X-flu prefilled 0,5ml syringe Enap co 20/12. Pharmapress co 20/12. Adco-Zetomax co 10/12.; 20/12. Auro-Lisinopril co 10/12.; 20/12. Diace co 20/12. Hexal-Lisinopril co 10/12. Hexal-Lisinopril co 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. Zestozide 20/12. Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Page 10 of 23

11 Chronic renal disease R70 R100 ACE inhibitors: plain R110 R120 Angiotensin II antagonists, Combinations: Losartan and R70 R100 Angiotensin II antagonists: plain R230 R230 Calcium supplements R5 R5 Folic acid and R65 R65 Iron in combination with folic acid R4000 R4000 Other antianaemic preparations Enalapril Alapren ; 10mg; Ciplatec Enap Envas Hr-Enalapril ; ; 10mg; ; 10mg 10mg; Pharmapress Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Perindopril Acti-Prex 4mg Cipla-Perindopril 8mg Ciplasyl 8mg Pearinda 4mg; 8mg Ran-Perindopril 4mg Quinapril Accumax 10mg; Quinagen Losartan and Lohype Forte Plus 100/2 Lohype Plus 50/12. Losaar Plus 50/12.; 100/2 Lozaan Co 50/12.; 100/2 Netrasol Co 50/12. Sartoc 50/12. Losartan Cipla-Losartan Spec-Losartan Zartan Calcium Titralac carbonate Folic acid Aha Folic acid Ferrous fumarate Darbepoetin Alfa Be-Tabs Folic acid Folic acid Pregamal Aranesp prefilled syringe 0.4ml 10mcg/0.4ml Aranesp prefilled syringe 0.5ml 20mcg/0.5ml Aranesp prefilled syringe 0.3ml 30mcg/0.3ml Aranesp prefilled syringe 0.4ml 40mcg/0.4ml Aranesp prefilled syringe 0.5ml 50mcg/0.5ml Aranesp prefilled syringe 0.3ml 60mcg/0.3ml 0. Page 11 of 23

12 Chronic renal disease Coronary artery disease R4000 R4000 Other antianaemic preparations Darbepoetin Alfa Eprex prefill 2000IU/0.5ml Eprex prefill 4000IU/0.4ml Mircera prefilled syringe 0.3ml 50mcg/0.3ml Mircera prefilled syringe 0.3ml 75mcg/0.3ml Mircera prefilled syringe 0.3ml 100mcg/0.3ml Mircera prefilled syringe 0.3ml 150mcg/0.3ml Recormon 500IU/0.3ml Recormon 2000IU pre-filled syringe Recormon 4000IU/0.3ml Repotin 1ml 2000IU Repotin 1ml 4000IU R495 R495 Vitamin D and analogues Alfacalcidol One alpha 0.25mcg; 1mcg R10 R20 Aspirin Acetylsalicylic Aspirin 300mg acid Be-Tabs Aspirin (white) 300mg Gulf Aspirin 300mg R60 R170 Beta blocking Propranolol Indoblok 10mg; Prodorol 10mg; non-selective Purbloka 10mg; R60 R110 Beta blocking Atenolol B-Block ; Bio-Atenolol ; selective Sandoz Atenolol ; Tenopress R170 R260 Selective calcium Diltiazem Adco-Zildem 60mg channel blockers Adco-Zildem SR 180mg; 2 with direct cardiac Verapamil Vasomil ; 80mg effects Verahexal SR 2 R125 R165 Selective calcium channel blockers with mainly vascular effects R160 R175 Vasodilators in cardiac disease: Organic nitrates Amlodipine Almadin ; 10mg Auro-Amlodipine ; 10mg Corvadil ; 10mg Gulf Amlodipine ; 10mg Indo Amlodipine Keysal ; 10mg Klodip Lomanor ; 10mg Pharma dynamics amlodipine besylate ; 10mg Felodipine Felodipine-Hexal ; 10mg Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Glyceryl Angised 0. trinitrate Isosorbide Sandoz Isosorbide dinitrate ;10mg; 30mg dinitrate Isosorbide Elantan mononitrate Elantan LA Monicor SR 60mg Page 12 of 23

13 Crohn s disease R5 R5 Folic acid and R635 R900 Intestinal antiinflammatories: Aminosalicylic acid and similar agents R2120 R2120 Intestinal antiinflammatories: Corticosteroids R565 R565 Other immuno suppressive Azathioprine R45 R45 Other immuno suppressive Methotrexate R10 R10 Systemic corticosteroids: Prednisone Diabetes insipidus R1300 R1500 Posterior pituitary hormones: Vasopressin and analogues Diabetes mellitus Type 1 R680 R720 Anti-diabetic Insulins and analogues Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Mesalazine Asacol 400mg; 800mg Pentasa 500mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Budesonide Entocord enema Azathioprine Azamun Azathioprine pch Methotrexate Abitrexate (was Emthexate) 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Desmopressin Ddavp 0.1mg;0.2mg Insulin Ddavp nasal spray 5ml 0.1mg/1ml Actraphane hm(ge) - vial 10ml Apidra - cartridges 3ml; solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog cartridge 3ml Humalog kwikpen (was mirio pen) - penset 3ml Humalog mix 25 kwikpen (was mirio pen) - penset 3ml Humalog mix 25 - cartridge 3ml; vial 10ml Humalog mix 50 - cartridge 3ml Humulin 30/70 - cartridge 3ml; disposable pens 3ml; vial 10ml Humulin n - disposable pen 3ml; vial10ml Humulin r - vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml; penfill 3ml Novorapid - penfill 3ml Page 13 of 23

14 Diabetes mellitus Type 1 Diabetes mellitus Type 2 R200 R300 Blood glucose monitoring agents Glucose strips Accu-chek active strips (Not available on KeyCare Caresens ii test strips Caresens n test strips Caresens pop test strip Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose test strips onetouch select Optium h glucose test strips R350 R350 Surgical item Lancets Lancets glucoplus 66 x 44 x 78mm Needles Needle novofine Needle pen bd microfine 30g 8mm R55 R60 Anti-diabetic Metformin Accord Metformin 500mg;8 Biguanides Auro-Metformin 500mg;8;1000mg Austell-Metformin 500mg;8 Bigsens 1000mg Diamin 500mg;8 Gluconorm 500mg Metforal 500mg;8 Metored 500mg;8;1000mg Mylan Metformin 500mg;8 Sandoz Metformin 500mg Sandoz Metformin FCT 500mg R680 R720 Anti-diabetic Insulin Actraphane hm(ge) - vial 10ml Insulins and analogues Apidra - cartridges 3ml; solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml 29g 29g 29g Humalog cartridge 3ml Humalog kwikpen (was mirio pen) - penset 3ml Humalog mix 25 kwikpen (was mirio pen) - penset 3ml Humalog mix 25 - cartridge 3ml; vial 10ml Humalog mix 50 - cartridge 3ml Humulin 30/70 - cartridge 3ml; disposable pens 3ml; vial 10ml Humulin n - disposable pen 3ml; vial10ml Humulin r - vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml; penfill 3ml Novorapid - penfill 3ml Page 14 of 23

15 Diabetes mellitus Type 2 R100 R100 Anti-diabetic Sulfonamides, urea R145 R170 Anti-diabetic Thiazolidinediones R200 R300 Blood Glucose Monitoring Agents Glibenclamide Bio-Glibenclamide Diacare Glycomin Sandoz Glibenclamide Gliclazide Adco-Glucomed 80mg Arrow Gliclazide 80mg Austell-Gliclazide 80mg Diaglucide 80mg Diaglucide mr 30mg Glygard 80mg Sandoz Gliclazide 80mg Pioglitazone Cipla-Pioglitazone 1; 30mg Glucose strips Accu-chek active strips (Not available on KeyCare Caresens ii test strips 29g Caresens n test strips 29g Caresens pop test strip 29g Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose test strips onetouch select Optium h glucose test strips R350 R350 Surgical item Lancets Lancets glucoplus 66 x 44 x 78mm Dysrhythmias R500 R600 Anti-arrhythmics: class Ic R360 R360 Anti-arrhythmics: class III - Amiodarone R70 R70 Antithrombotic Vitamin K antagonists Needles R10 R20 Aspirin Acetylsalicylic acid Needle novofine Needle pen bd microfine 30g 8mm Flecainide Tambocor Propafenone Rythmol 1; 300mg Amiodarone Arycor ; 200mg Bio-Amiodarone 200mg Hexarone ; 200mg Warfarin Cipla-Warfarin Aspirin Be-Tabs Aspirin (white) Gulf Aspirin 300mg 300mg 300mg Page 15 of 23

16 Dysrhythmias R60 R170 Beta blocking non-selective R60 R110 Beta blocking selective R15 R15 Cardiac glycosides: Digoxin R170 R260 Selective calcium channel blockers with direct cardiac effects Epilepsy R165 R250 Antiepileptics: Benzodiazepine R260 R325 Antiepileptics: Carboxamide R460 R485 Antiepileptics: Fatty acid R60 R60 Antiepileptics: Hydantoin R315 R450 Antiepileptics: Other agents R25 R25 Antiepileptics: Barbiturates and Glaucoma R160 R160 Antiglaucoma Carbonic anhydrase inhibitors R210 R210 Antiglaucoma Prostaglandin analogues R235 R235 Antiglaucoma Sympathomimetics R75 R75 Antiglaucoma Beta blocking Timolol Propranolol Indoblok 10mg; Prodorol 10mg; Purbloka 10mg; Sotalol Sotahexal 80mg; 160mg Atenolol B-Block ; Bio-Atenolol ; Sandoz Atenolol ; Tenopress Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml Verapamil Vasomil ; 80mg Verahexal SR 2 Clonazepam Rivotril 0.; 2mg Carbamazepine Sandoz Carbamazepine 200mg Sandoz Carbamazepine CR 400mg Valproic acid Convulex 1; 300mg; 500mg Convulex syrup 2/5ml Epilim CR 200mg; 300mg; 500mg Epilim crushable Epilim sugar-free syrup 200mg/5ml Phenytoin Phenytoin sod Lamotrigine Arrow Lamotrigine ; Dyna-Lamotrigine 2; ; ; 200mg Lamidus ; ; 200mg Lamitor ; ; 200mg Phenobarbital Lethyl 30mg Dorzolamide Sedabarb Trusopt - 5ml owi 2% 30mg Bimatoprost Lumigan 3ml 0,03% Ocuprost 3ml 50mcg/1ml Brimonidine Alphagan purite - 5ml 1./1ml Timolol Glaucosan - 5ml 0.5% Page 16 of 23

17 Glaucoma R225 R235 Antiglaucoma Beta blocking Timolol, combinations Haemophilia R5 R5 Analgesics: Paracetamol R515 R515 Antifibrinolytics: Amino acids R32900 R32900 Blood coagulation factors R1300 R1500 Posterior pituitary hormones: Vasopressin and analogues Hyperlipidaemia R235 R235 Lipid modifying Fibrates R45 R110 Lipid modifying Statins Timolol, combinations Combigan - 5ml 2mg/ Cosopt - 5ml 0.5% Ganfort 3ml Paracetamol Adco-Napamol 500mg Adco-Prolief 500mg Tranexamic acid Tranexamic acid medwich 500mg Coagulation Haemosolvex IX 500IU factor IX, II, VII and X in combination Coagulation factor VIII Haemosolvate VIII 300IU; 500IU; 1000IU Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Bezafibrate Dyna-Bezafibrate SR 400mg Sandoz Bezafibrate 400mg Atorvastatin Atorvastatin Unicorn 10mg; ; Lipogen 10mg; ; ; 80mg Simvastatin Adco-Simvastatin 10mg; ; Aspen Simvastatin 10mg; ; Austell-Simvastatin 10mg; Biovac Simvastatin 10mg; ; Choleste ; Cipla-Simvastatin 10mg; ; 80mg Cipla-Simvastatin Michol 80mg Redicor 10mg; Redicor Simayla Simvastatin 10mg; ; Simvacor 10mg; Simvacor Simvotin 10mg; ; Simzor 10mg; Simzor Zysim 10mg; ; ; 80mg Page 17 of 23

18 Hypertension R110 R110 ACE inhibitors and Enalapril and Enap co 20/12. Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. Auro-Lisinopril co 10/12.; 20/12. Diace co 20/12. Hexal-Lisinopril co 10/12. Hexal-Lisinopril co 20/12. Lisinozide 10/12.; 20/12. Lisoretic 10/12.; 20/12. Lisozide 20/12. Zestozide 20/12. R70 R100 ACE inhibitors: plain Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; 10mg; Ciplatec ; Enap ; 10mg; Envas ; 10mg Hr-Enalapril 10mg; Pharmapress Lisinopril Austell-Lisinopril 10mg; Sinopren ; 10mg; Perindopril Acti-Prex 4mg Cipla-Perindopril 8mg Ciplasyl 8mg Pearinda 4mg; 8mg Ran-Perindopril 4mg Quinapril Accumax 10mg; Quinagen R190 R220 Alpha and Beta Carvedilol Aspen Carvedilol 6.2 blocking agents Carvedilol-Hexal 6.2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 R110 R120 Angiotensin II Losartan and Lohype Forte Plus 100/2 antagonists, Combinations: Lohype Plus 50/12. Losartan and Losaar Plus 50/12.; 100/2 Lozaan co 50/12.; 100/2 Netrasol co 50/12. Sartoc 50/12. Page 18 of 23

19 Hypertension R70 R100 Angiotensin II antagonists: Plain R125 R125 Antiadrenergic Alphaadrenoreceptor antagonists R120 R120 Antiadrenergic Methyldopa R25 R25 Antiadrenergic Rauwolfia alkaloids R80 R80 Arteriolar smooth muscle Hydrazinophthalazine R60 R170 Beta blocking non-selective R60 R170 Beta blocking selective R20 R40 High-ceiling R25 R25 Low-Ceiling Diuretics: Thiazides, plain R20 R20 Low-ceiling : excluding Thiazides R85 R85 Potassium sparing agents 80 R80 Potassium supplements R170 R260 Selective calcium channel blockers with direct cardiac effects R125 R165 Selective calcium channel blockers with mainly vascular effects Losartan Cipla-Losartan Spec-Losartan Zartan Doxazosin Adco-Doxazosin 4mg Cardugen 1mg; 4mg Methyldopa Hypotone 2 Mylan Methyldopa 2 Sandoz Methyldopa 2 Reserpine Reserpine 0.2 Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Propranolol Indoblok 10mg; Prodorol 10mg; Purbloka 10mg ; Atenolol B-Block ; Bio-Atenolol ; Sandoz Atenolol ; Tenopress Furosemide Beurises Dino-Retic Mylan Furosemide Hydrochloro- Hexazide 2 thiazide Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril Merck-Indapamide Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 Potassium Plenish K 600mg chloride Sandoz K mg Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Almadin ; 10mg Auro-Amlodipine ; 10mg Corvadil ; 10mg Gulf Amlodipine ; 10mg Indo Amlodipine Keysal ; 10mg Klodip Lomanor ; 10mg Pharma dynamics amlodipine besylate ; 10mg Page 19 of 23

20 Hypertension R125 R165 Selective calcium channel blockers with mainly vascular effects Hypothyroidism R50 R50 Thyroid hormones Levothyroxine sodium Felodipine Felodipine-Hexal ; 10mg Nifedipine Adco-Vascard SR Cipalat Retard Nifedalat SR Eltroxin 0.0; 0.1mg Euthyrox 0.02; 0.0; 0.1mg Multiple sclerosis R65 R65 Antidepressants: Amitriptyline Sandoz Amitriptyline 2 Tricyclics Trepiline 10mg R9800 R9800 Interferons Interferon beta-1a Avonex pre-filled syringe 30mcg Parkinson's disease Rheumatoid arthritis R960 R960 Muscle Relaxants: Other centrally acting agents R10 R10 Systemic corticosteroids: Prednisone R120 R160 Urinary antispasmodics Rebif 22 pre-filled syringe 0.5ml 44mcg/1ml Rebif 44 pre-filled syringe 0.5ml 88mcg/1ml Interferon beta-1b Betaferon pre-filled syringe 1ml u/1ml Baclofen Bio-Baclofen 10mg Teva Baclofen 10mg Prednisone Be-Tabs Prednisone Panafcort Trolic Oxybutynin Lenditro Mylan Oxybutynin R285 R285 Anticholinergic Biperiden Akineton 2mg Tertiary Amines R605 R660 Levodopa and Levodopa and Carbilev 25/; 25/2 decarboxylase decarboxylase Sinemet 25/; 25/2 inhibitor inhibitor Teva Carbi-Levo 25/; 25/2 R360 R635 Dopamine agonists Ropinirole Resure 0.2; 0.; 1mg; 2mg; R570 R570 Dopaminergic Monoamine oxidase B inhibitors - Selegiline R45 R50 Anti-inflammatory Acetic acid and related substances R50 R65 Anti-inflammatory Agents: Oxicams Selegiline Parkilyne Diclofenac Adco-Diclofenac A-Lennon Diclofenac Mylan Diclofenac Panamor AT 2; 2; Indomethacin Betacin 2 Gulf Indomethacin 2 Meloxicam Adco-Meloxicam 7. Flexocam 7. Piroxicam Pyrocaps Roxifen Page 20 of 23

21 Rheumatoid arthritis R25 R25 Anti-inflammatory Propionic acid R80 R80 Anti-rheumatic Chloroquine R5 R5 Folic acid and R635 R900 Intestinal antiinflammatories: Aminosalicylic acid and similar agents R565 R565 Other immunosuppressive Azathioprine R45 R45 Other immunosuppressive Methotrexate R10 R10 Systemic corticosteroids:predn isone Schizophrenia R115 R310 Anti-depressants: SSRI's Ibuprofen Betaprofen 200mg Ibunate 200mg Ranfen 400mg Chloroquine Plasmoquine 200mg Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Azathioprine Azamun Azathioprine pch Methotrexate Abitrexate (was Emthexate) 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Arrow Citalopram ; Auro-Citalopram Citalohexal Citalopram-Winthrop Depramil Escitalopram Aspen Escitalopram 10mg Citraz Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Ranflocs Rezak Zydus Fluoxetine Paroxetine Serrapress Sertraline Apex-Sertraline Austell Sertraline ; Serdep Zylin Page 21 of 23

22 Schizophrenia R260 R325 Antiepileptics: Carbamazepine Sandoz Carbamazepine 200mg Carboxamide Sandoz Carbamazepine CR 400mg R90 R90 Antipsychotics: Haloperidol Sandoz Haloperidol 1.; Butyrophenone R690 R690 Antipsychotics: Clozapine Clozapine Cloment 2; R455 R455 Antipsychotics: Chlorpromazine Largactil 2; ; Phenothiazines with aliphatic side-chain R450 R610 Antipsychotics: Flupenthixol Fluanxol 0.; 1mg Thioxanthene Fluanxol depot 1ml Fluanxol depot 2ml R445 R950 Other antipsychotics Risperidone Aspen Risperidone 4mg Auropidone 0.; 1mg; 2mg; 3mg; 4mg DRL-Risperidone 0,; 1mg; 2mg; 3mg Perizal 0,; 1mg; 2mg; 3mg Rispacor 3mg; 4mg Risperidone Hexal 3mg Schizorol 0.; 1mg; 2mg Zoxadon 0.; 1mg; 2mg Systemic lupus erythematosus R45 R50 Anti-inflammatory Acetic acid and related substances R50 R65 Anti-inflammatory Oxicams R25 R25 Anti-inflammatory Propionic acid R80 R80 Anti-rheumatic Chloroquine Diclofenac Adco-Diclofenac A-Lennon Diclofenac 2; Mylan Diclofenac 2; Panamor AT Indomethacin Betacin 2 Gulf Indomethacin 2 Meloxicam Adco-Meloxicam 7. Flexocam 7. Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Ibunate Ranfen 200mg 400mg Chloroquine Plasmoquine 200mg R70 R70 Antithrombotic Warfarin Cipla-Warfarin Vitamin K antagonists R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Be-Tabs Aspirin (white) 300mg R30 R30 Emolients and protectives: Zinc products Zinc products Gulf Aspirin Zinc ointment bp 300mg Page 22 of 23

23 Systemic lupus erythematosus R5 R5 Folic acid and R565 R565 Other immunosuppressive Azathioprine R45 R45 Other immunosuppressive Methotrexate R10 R10 Systemic corticosteroids: Prednisone R25 R30 Topical corticosteroids: Group III Ulcerative colitis R5 R5 Folic acid and R635 R900 Intestinal antiinflammatories: Aminosalicylic acid and similar agents R2120 R2120 Intestinal antiinflammatories: Corticosteroids R565 R565 Other Immunosuppressive Azathioprine Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Azathioprine Azamun Azathioprine pch Methotrexate Abitrexate (was Emthexate) 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Betamethasone Panafcort Trolic Topivate 0.1% cream Vari-Betamethasone 0.1% cream Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Mesalazine Asacol 400mg; 800mg Pentasa 500mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin 500mg Budesonide Salazopyrin EN Entocord enema 500mg Azathioprine Azamun Azathioprine pch R45 R45 Other immunosuppressive Methotrexate R10 R10 Systemic corticosteroids: Prednisone Methotrexate Abitrexate (was Emthexate) 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Page 23 of 23