For long term corticosteriod use

Transcription

1 NEDGROUP TRADITIONAL, COMPREHENSIVE AND PLATINUM PLANS A clinically relevant motivation is when prescribing any product which does not appear on this list. Chronic application forms must accompany all first-time applications. All applications MUST include valid ICD10 codes. Risk Equalisation Fund criteria must be met. The formulary is subject to regular review. SCRIPTPHARM RISK MANAGEMENT reserves the right to update and change the formulary when new information becomes available or when new medicines are released. PLEASE TAKE NOTE OF THE FOLLOWING: Oxygen will only be considered for bronchiectasis and COPD in severe, advanced disease. For diabetic patients, the following limits apply. Please provide a motivation if a higher quantity is. Lancets Max 30 per month allowed Glucose Monitoring Strip Max 50 per month allowed Needles Max 30 per month allowed syringes will only be considered on motivation. Pensets or penfills are recommended. Inteferons for Multiple Sclerosis will only be considered upon receipt of a clinically relevant motivation including history of therapy and expanded disability status scale report (EDSS) Treatment for hyperlipidaemia is subject to criteria for lipid-lowering therapy being met. Assessment completed Risk Evaluation report as well as diagnostic and latest lipograms including LDL cholesterol levels. Major drug class Generic name Trade names and (nappi codes) Addison's disease Corticosteroids Hydrocortisone 10mg Covocort 10mg E27.1 Corticosteroids Fludrocortisone, 0.1mg Florinef 0.1mg Corticosteroids Prednisone 5mg Be-tabs prednisone Potassium supplements Potassium chloride 600mg Plenish K 600mg Loop diuretics Loop diuretics Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Furosemide 20mg Furosemide 40mg Austell Furosemide 20mg Mylan Furosemide 40mg Sandoz Furosemide For long term corticosteriod use Asthma J45 Apparatus Aerochamber Aerochamber adult Apparatus Aerochamber Aerochamber child Apparatus Aerochamber Aerochamber neonate Apparatus Aerochamber Glaxohaler Spacer Device Apparatus Aerochamber Huf Puf Kit Apparatus Aerochamber Zerostat Spacer

2 Corticosteroids Prednisone 5mg Be-tabs prednisone Corticosteroids Prednisolone 15mg/5ml Aspelone Fenoterol 100mcg Salbutamol sulphate 100mcg Berotec 100 HFA 200 dose Asthavent 300dose ecohaler Salbutamol sulphate 2mg Venteze 2mg Salbutamol sulphate 4mg Venteze 4mg Venteze CFC Free 200 dose Only for severe persistent asthma (motivation from specialist) Only for severe persistent asthma (motivation from specialist) Limited to 3 inhalers per year if no inhaled steroid Salbutamol sulphate 2mg/5ml Venteze 2mg/5ml Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose Salmeterol xinafoate 25mcg Serevent 120 dose inhaler Salmeterol fluticazone Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Foxair 25/125mcg 120 dose inh Sereflo 25/50mcg Synchrobreather 120 dose inh Sereflo 25/125mcg Synchrobreather 120 dose inh Salmeterol fluticazone Foxair 25/250mcg 120 dose inh Sereflo 25/250mcg Synchobreather 120 dose inh Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters Salmeterol 50ug/Fluticasone 250ug Foxair 50/250mcg 60 blisters Salmeterol 50ug/Fluticasone 500ug Foxair 50/250mcg 60 blisters Budesonide 160 / formoterol 4.5mcg Symbicord 60 dose Budesonide 160 / formoterol 4.5mcg Symbicord 120 dose Vannair 160/4.5mcg Budesonide 320 / formoterol 9mcg Symbicord 60 dose Budesonide 80 / formoterol 4.5mcg Symbicord 120 dose Vannair 80/4.5mcg Beclomethasone 100ug Beclate 100ug Beclomethasone 200ug Beclate 200ug Beclomethasone 50ug Beclate 50ug Budesonide 100ug Budeflam 100ug 300 dose Budesonide 100ug Budeflam 200 mg 300 dose Budeflam DP Inh cap

3 Budesonide 200ug Pulmicort Turbohaler 200mcg 200D Budesonide 200ug Pulmicort Turbohaler 100mcg 200D Budesonide 400ug Pulmicort Turbohaler 400mcg 200D Fluticasone 50mcg Flixotide 50 CFC free 120 dose inhaler Fluticasone 125mcg Flixotide 125 CFC free 120 dose inhaler Fluticasone 250mcg Flixotide 250 CFC free 120 dose inhaler Fluticasone 50mcg Fluticasone 100mcg Fluticasone 250mcg Fluticasone 500mcg Ciclesonide 160mcg Ciclesonide 80mcg Flixotide 50 mcg accuhaler 60 dose Flixotide 100 mcg accuhaler 60 dose Flixotide 250 mcg accuhaler 60 dose Flixotide 500mcg accuhaler 60 dose Ciclovent 160mcg 60 dose Ciclovent 80mcg 60 dose LABA Formoterol 12mcg Foratec hfa 120dose Methylxanthine Theophylline 200mg Sandoz theophylline 200mg Theoplus 200mg Methylxanthine Leukotriene receptor antagonists Leukotriene receptor antagonists Leukotriene receptor antagonists Inhaled anticholinergics Combinations Theophylline 300mg Sandoz Theophylline 300mg Theoplus 300mg Montelukast 4mg Monte-Air 4mg Sintair 4mg Montelukast 5mg Monte-Air 5mg Sintair 5mg Montelukast 10mg Monte-Air 10mg Sintair 10mg Ipratropium bromide Ipratropium bromide 40mcg/ Fenoterol 100mcg Ipvent 40mcg INH 300dose Duovent HFA Pulmonologist motivation Pulmonologist motivation Pulmonologist motivation Bipolar depression F31 Anti-epileptic Valproic acid 150mg Convulex 150mg Anti-epileptic Valproic acid 300mg Convulex 300mg Anti-epileptic Valproic acid 500mg Convulex 500mg Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension Anti-epileptic Sodium valproate Epilim 200mg/5ml liquid Anti-epileptic Sodium valproate Epilizine cr 200mg Eprolep cr 200mg Anti-epileptic Sodium valproate Epilizine cr 300mg Eprolep cr 300mg Anti-epileptic Sodium valproate Epilizine cr 500mg Eprolep cr 500mg Anti-epileptic Sodium valproate Epilim crushable 100mg Anti-epileptic Carbamazepine 200mg Degranol 200mg

4 Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr Tegretol cr 200mg Anti-epileptic Carbamazepine 400mg Sandoz carbamazepine cr Tegretol cr 400mg Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS Anti-epileptic Lamotrigine 50mg Epitec 50mg TABS Lamidus 50mg Anti-epileptic Lamotrigine 100mg Epitec 100mg TABS Lamidus 100mg Anti-epileptic Lamotrigine 200mg Epitec 200mg TABS Lamidus 200mg Atypical antipsychotic Olanzapine 2.5mg Olawin 2.5mg Olexar 2.5mg Psych Motivation Atypical antipsychotic Olanzapine 5mg Olawin 5mg Olexar 5mg Psych Motivation Atypical antipsychotic Olanzapine 10mg Olawin 10mg Olexar 10mg Psych Motivation Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg Quetoser 25mg Atypical antipsychotic Quetiapine 100mg Dopaquel 100mg Quetoser 100mg Atypical antipsychotic Quetiapine 200mg Dopaquel 200mg Quetoser 200mg Atypical antipsychotic Quetiapine 300mg Dopaquel 300mg Quetoser 300mg Benzamides Sulpiride 50mg Espiride Psych Motivation Butyrephenones Haloperidol 1.5mg Sandoz haloperidol 1.5mg Butyrephenones Haloperidol 5mg Sandoz haloperidol 5mg Butyrephenones Haloperidol 0.5mg Serenace 0.5mg Lithium Lithium carbonate 250mg Camcolit 250mg Lithium Lithium carbonate 400mg Camcolit 400mg MAOI Moclobemide 150mg Depnil MAOI Moclobemide 300mg Depnil Phenothiazines Chlorpromazine 100mg Largactil 100mg Phenothiazines Chlorpromazine 25mg Largactil 25mg Phenothiazines Chlorpromazine 50mg Largactil 50mg SSRI Citalopram 20mg Talomil 20mg Cilate 20mg SSRI Escitalopram 10mg Lexamil 10MG Zytomil 10MG nd line agent SSRI Escitalopram 20mg Lexamil 20MG Zytomil 20MG nd line agent SSRI Fluoxetine 20mg Ranflocs 20mg Nuzak 20mg st line agent SSRI Paroxetine 20mg Serrapress 20mg Xet 20mg SSRI Sertraline 50mg Dyna-Sertraline 50mg Serlife 50mg SSRI Sertraline 100mg Dyna-Sertraline 100mg Serlife 100mg SNRI Venlafaxine Hcl 37.5mg Odiven 37.5mg SNRI Venlafaxine Hcl 37.5mg Venlor XR Venlafaxine Adco XR 37.5mg SNRI Venlafaxine Hcl 75mg Venlor XR 75mg Venlafaxine Adco XR 75mg SNRI Venlafaxine Hcl 150mg Venlor XR 150mg Venlafaxine Adco XR 150mg Other Other Mirtazapine 15mg Mirtazapine 30mg Mylan-Mirtazapine 15mg Mylan-Mirtazapine 30mg Tricyclic antidepressants Dothiepin 25mg Thaden 25mg Tricyclic antidepressants Dothiepin 75mg Thaden 75mg Miradep 15mg Miradep 30mg Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg Gulf Amitripryline Anti-cholinergic Orphenadrine 50mg Disipal 50mg Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg Prodorol 10mg In combination with antipsychotic for drug-induced dyskinesias In combination with antipsychotic for drug-induced dyskinesias 4

5 Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg Prodorol 40mg In combination with antipsychotic for drug-induced dyskinesias Other Antipsychotics Risperidone 0.5mg Zoxadon 0.5mg Risnia 0.5mg Psych Motivation Other Antipsychotics Risperidone 1mg Zoxadon 1mg Risnia 1mg Psych Motivation Other Antipsychotics Risperidone 2mg Zoxadon 2mg Risnia 2mg Psych Motivation Other Bupropion 150mg Wellbutrin XL 150mg Other Bupropion 300mg Wellbutrin XL 300mg Bronchiectasis J47 Antibiotics Amoxycillin 500mg Moxypen Antibiotics Doxycycline 100mg Doxycyl 100 mg Antibiotics Doxycycline 50mg Doxycyl 50mg Antibiotics Trimethoprimsulfamethoxazole 80/400 Durobac 480mg Purbac adult Antibiotics Oxytetracycline HCl 250mg Oxypan 250mg Corticosteroids Prednisone 5mg Be-tabs prednisone Inhaled anti cholinergics / Beta 2-agonist Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA Formoterol fumerate Foratec HFA 120dose Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose Salmeterol xinafoate 25mcg Serevent 120 dose inhaler Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent dose Inhaled Beta 2-agonists, Salbutamol 100ug inhaler Asthavent 200dose Venteze 100ug CFC inhaler Fenoterol 100mcg Berotec 100 HFA 200 dose Methylxanthine Theophylline 200mg Theoplus 200mg Sandoz theophylline 200mg Methylxanthine Theophylline 300mg Theoplus 300mg Sandoz Theophylline 300mg Cardiac failure I50 ACE Inhibitors Enalapril 10mg Alapren 10mg Enap 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg Enalapril / hydrochlorthiazide Enap co 20mg/ ACE Inhibitors Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE Inhibitors Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors Perindopril 10mg Prexum 10mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus Perindopril 4mg/Indapamide Prexum Plus 5/ mg mg Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg

6 Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg ACE Inhibitors Captopril Captohexal ACE Inhibitors Captopril 25mg Merck-captopril 25mg ACE Inhibitors Captopril 50mg Merck-captopril 50mg Captopril/hydrochlorthiazide Captoretic 50/25mg ACE Inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE Inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE Inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg ACE Ramipril 5mg Rampil 5mg ACE Ramipril 10mg Rampil10mg ACE Inhibitors Quinapril 5mg Quinagen 5mg ACE Quinapril 10mg Accumax 10mg ACE Quinapril 20mg Accumax 20mg ACE ACE Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ Hexal-lisinopril co 10/ Hexal-lisinopril co 20/ Alpha + beta blocker Carvedilol Carloc Carvetrend Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg Carvetrend 6.25mg Alpha + beta blocker Carvedilol 25mg Carloc 25mg Carvetrend 25mg Aldosterone antagonist Spironolactone 25 Spiractin Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin ` Beta-blockers Atenolol 50mg Tenopress 50mg Bio-atenolol 50mg Beta-blockers Atenolol 100mg Tenopress 100mg Bio-atenolol 100mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor Bilocor Co 2.5mg/6.25mg Bilocor Co 5mg/6.25mg Bilocor Co 10mg/6.25mg Atenolol 50mg/chlorthalidone Tenchlor-HS Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg Loop diuretics Torasemide 10mg Unat 10mg Motivation Loop diuretics Torasemide 2.5mg Unat 2.5mg Motivation 6

7 Loop diuretics Torasemide 5mg Unat 5mg Motivation Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Nitrates Furosemide 20mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Ismo 20mg Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg Organic Nitrates Ivabradine 5mg Coralan 5mg Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg Aspirin 81mg Ecotrin 81mg Aspirin 300mg Bayer Aspirin 300mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Potassium supplements Potassium chloride 600mg Plenish K 600mg Thiazide diuretic Hydrochlorthiazide Hexazide Diuretic-thiazide Hydrochlorthiazide/amiloride 50/5mg Spec -Co - Amiloride Amiloretic 50mg/5mg Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Cipla- Indapamide Cardiologist Prescription Cardiologist Prescription If >120, documented evidence of hypokalaemia must be provided Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg Ciplavasc 10mg Calcium channel blockers Amlodipine 5mg Amtas 5mg Lomanor 5mg Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab Cipalat Retard 20mg Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg Fedaloc sr 30mg Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg Fedaloc sr 60mg Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Losartan 50mg Ciplazar 50mg Zartan 50mg Losartan 100mg Ciplazar 100mg Zartan 100mg ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg Zartan Co 100mg/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ Zartan Co 50mg/25mg

8 Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg Diolo 80mg Valsartan 160mg Tareg 160mg Diolo 160mg ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ Diolo Co 80mg/ ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg Diolo Co 160mg/ Cardiomyopathy I42 ACE Inhibitors Enalapril 10mg Alapren 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg Enalapril / hydrochlorthiazide Enap co 20mg/ ACE Inhibitors Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE Inhibitors Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors Perindopril 10mg Prexum 10mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus Perindopril 4mg/Indapamide Prexum Plus 5/ mg mg Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg ACE Inhibitors Captopril Captohexal ACE Inhibitors Captopril 25mg Merck-captopril 25mg ACE Inhibitors Captopril 50mg Merck-captopril 50mg Captopril/hydrochlorthiazide Captoretic 50/25mg ACE Inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE Inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE Inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg ACE Ramipril 5mg Rampil 5mg ACE Ramipril 10mg Rampil10mg ACE Inhibitors Quinapril 5mg Quinagen 5mg ACE Quinapril 10mg Accumax 10mg Hexal-lisinopril co 10/ Hexal-lisinopril co 20/

9 ACE Quinapril 20mg Accumax 20mg ACE ACE Angiotensin receptor blockers (ARBs) Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ Losartan 50mg Ciplazar 50mg Zartan 50mg Angiotensin receptor blockers (ARBs) Losartan 100mg Ciplazar 100mg Zartan 100mg ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg Zartan Co 100mg/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ Zartan Co 50mg/25mg Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg Diolo 80mg Valsartan 160mg Tareg 160mg Diolo 160mg ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ Diolo Co 80mg/ ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg Diolo Co 160mg/ Alpha + beta blocker Carvedilol Carloc Carvetrend Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg Carvetrend 6.25mg Alpha + beta blocker Carvedilol 25mg Carloc 25mg Carvetrend 25mg Aldosterone antagonist Spironolactone 25 Spiractin Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin Beta-blockers Atenolol 50mg Tenopress 50mg Bio-atenolol 50mg Beta-blockers Atenolol 100mg Tenopress 100mg Bio-atenolol 100mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor Bilocor Co 2.5mg/6.25mg Bilocor Co 5mg/6.25mg Bilocor Co 10mg/6.25mg Atenolol 50mg/chlorthalidone Tenchlor-HS Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg

10 Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg Loop diuretics Torasemide 10mg Unat 10mg Motivation Loop diuretics Torasemide 2.5mg Unat 2.5mg Motivation Loop diuretics Torasemide 5mg Unat 5mg Motivation Loop diuretics Furosemide 40mg Mylan Furosemide 40mg Sandoz Furosemide Loop diuretics Furosemide 20mg Austell Furosemide 20mg Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Nitrates Isosorbide dinitrate 10mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Ismo 20mg Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg Cipla- Indapamide 2.5mg Aspirin 81mg Ecotrin 81mg Aspirin 300mg Bayer Aspirin 300mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Anticoagulant Warfarin 5mg cipla-warfarin Potassium supplements Potassium chloride 600mg Plenish K 600mg Thiazide diuretic Hydrochlorthiazide Hexazide Diuretic-thiazide Hydrochlorthiazide/amiloride 50/5mg Spec -Co - Amiloride Amiloretic 50mg/5mg If >120, documented evidence of hypokalaemia must be provided Chronic Renal Disease N03 ACE Inhibitors Enalapril 10mg Alapren 10mg N05 ACE Inhibitors Enalapril 20mg Alapren 20mg N11 ACE Inhibitors Enalapril 5mg Alapren 5mg N18 Enalapril / hydrochlorthiazide Enap co 20mg/ N19 ACE Inhibitors Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE Inhibitors Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors Perindopril 10mg Prexum 10mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus Perindopril 4mg/Indapamide Prexum Plus 5/ mg mg Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg

11 ACE Inhibitors Captopril Captohexal ACE Inhibitors Captopril 25mg Merck-captopril 25mg ACE Inhibitors Captopril 50mg Merck-captopril 50mg Captopril/hydrochlorthiazide Captoretic 50/25mg ACE Inhibitors Lisinopril 5mg Sinopren 5mg Zemax 5mg ACE Inhibitors Lisinopril 10mg Sinopren 10mg Austell Lisinopril 10mg ACE Inhibitors Lisinopril 20mg Sinopren 20mg Austell Lisinopril 20mg ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg ACE Ramipril 5mg Rampil 5mg ACE Ramipril 10mg Rampil10mg ACE Inhibitors Quinapril 5mg Quinagen 5mg ACE Quinapril 10mg Accumax 10mg ACE Quinapril 20mg Accumax 20mg ACE ACE Angiotensin receptor blockers (ARBs) Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ Hexal-lisinopril co 10/ Hexal-lisinopril co 20/ Losartan 50mg Ciplazar 50mg Zartan 50mg Angiotensin receptor blockers (ARBs) losartan 100mg Ciplazar 100mg Zartan 100mg ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg Zartan Co 100mg/25mg ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ Zartan Co 50mg/25mg Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg Diolo 80mg Valsartan 160mg Tareg 160mg Diolo 160mg ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ Diolo Co 80mg/ ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg Diolo Co 160mg/ Aldosterone antagonist Spironolactone 25mg Spiractin 25mg Beta-blockers Atenolol 50mg Tenopress 50mg Bio-atenolol 50mg Beta-blockers Atenolol 100mg Tenopress 100mg Bio-atenolol 100mg Atenolol 100mg/chlorthalidone 25mg Tenchlor 100mg/25mg

12 Atenolol 50mg/chlorthalidone Tenchlor hs 50mg/ Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg Prodorol 10mg Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg Prodorol 40mg Calcium channel blockers - long acting Verapamil 240 SR Verahexal 240 sr Ravamal SR 240mg Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab Cipalat Retard 20mg Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg Fedaloc sr 30mg Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg Fedaloc sr 60mg Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Diltiazem 60mg Zildem 60mg Calcium channel blockers Diltiazem 90mg Zildem 90mg Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg Calcium supplements Calcium carbonate 500mg Eno Tums Chew Calciferol Calciferol Minerals and vitamin D Calciferol 5 000u/ml Calciferol IU Alfacalcidol 0.25mcg Calciferol Oily solution 5000u/mL Lennon Strong Calciferol One alpha 0.25mcg cap Minerals and vitamin D Alfacalcidol 1mcg One alpha 1mcg cap Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide Ridaq 25mg Haematinics Erythropoietin Repotin 2000iu Haematinics Erythropoietin Repotin 4000iu Haematinics Erythropoietin Recormon numerous Iron supplements Iron supplements Iron supplements Iron(III)-hydroxide sucrose complex Iron polymaltose 50mg Ferrous-fumarate 200mg; folic acid 100ug Venofer Ferrimed Iron polymaltose 50mg capsule Pregamal Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Motivation and Haemoglobin levels - forward to Onecare/Medscheme Chelating Agents Calcium acetate anhydrous Phosphosorb 660mg Loop diuretics Loop diuretics Diuretic-thiazide Furosemide 40mg Furosemide 20mg Hydrochlorthiazide/amiloride 50/5mg Mylan Furosemide 40mg Austell Furosemide 20mg Sandoz Furosemide Potassium supplements Potassium chloride 600mg Plenish K 600mg Vitamins Folic acid 5 mg Be-tabs folic 5mg Spec -Co - Amiloride Amiloretic 50mg/5mg If >120, documented evidence of hypokalaemia must be provided 12

13 Chronic Obstructive Pulmonary disease J43 Corticosteroids Prednisone 5mg Be-tabs prednisone J44 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent dose Salbutamol 200ug Asthavent dp Fenoterol 100mcg Berotec 100 HFA 200 dose Salbutamol 200ug Cybutol 200ug Salbutamol 400ug Cybutol 400ug Salbutamol 100ug inhaler Asthavent 200dose Formoterol fumarate Foratec HFA 12mcg 120 dose Venteze cfc free 100ug inhaler Adrenergics Budesonide/Formoterol Symbicord 80/4.5mcg Vannair 80/4.5mcg Adrenergics Budesonide/Formoterol Symbicord 160/4.5mcg 60dose Adrenergics Budesonide/Formoterol Symbicord 160/4.5mcg 120dose Vannair 160/4.5mcg Adrenergics Budesonide/Formoterol Symbicord 320/9mcg Salmeterol fluticazone Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Foxair 25/125mcg 120 dose inh Sereflo 25/50mcg Synchrobreather 120 dose inh Sereflo 25/125mcg Synchrobreather 120 dose inh Salmeterol fluticazone Foxair 25/250mcg 120 dose inh Sereflo 25/250mcg Synchobreather 120 dose inh Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters Salmeterol 50ug/Fluticasone 250ug Salmeterol 50ug/Fluticasone 500ug Fluticasone 50mcg Foxair 50/250mcg 60 blisters Foxair 50/250mcg 60 blisters Flixotide 50 CFC free 120 dose inhaler Motivation, including history of therapy, Motivation, including history of therapy,. FEV1<50 post bronchodilator Fluticasone 125mcg Flixotide 125 CFC free 120 dose inhaler Fluticasone 250mcg Flixotide 250 CFC free 120 dose inhaler Fluticasone 50mcg Fluticasone 100mcg Fluticasone 250mcg Fluticasone 500mcg Ciclesonide 160mcg Ciclesonide 80mcg Flixotide 50 mcg accuhaler 60 dose Flixotide 100 mcg accuhaler 60 dose Flixotide 250 mcg accuhaler 60 dose Flixotide 500mcg accuhaler 60 dose Ciclovent 160mcg 60 dose Ciclovent 80mcg 60 dose Combinations Ipratropium brom. 20ug; salbutamol sulph. To salbutamol 100ug/met.dos. Duolin Respules For Stage ll & lll COPD only. Script from Pulmonologist or Physician 13

14 Anticholinergics Tiotropium 18mcg Forvent handihaler For Stage ll & lll COPD only. Script from Pulmonologist or Physician Anticholinergics Tiotropium 18mcg Forvent 18mcg INH caps refill For Stage ll & lll COPD only. Script from Pulmonologist or Physician Beclomethasone dipropionate 100mcg Beclate 100mcg inhaler For Stage ll & lll COPD only. Script from Pulmonologist or Physician Beclomethasone dipropionate 200mcg Budesonide 100ug Budesonide 200ug Budesonide 200ug Beclate 200mcg inhaler Budeflam HFA 100mcg 300dose Budeflam HFA 200mcg 300dose Budeflam DP 200mcg inh caps Budesonide 200ug Pulmicort Turbohaler 200mcg 200D Budesonide 200ug Pulmicort Turbohaler 100mcg 200D Budesonide 400ug Pulmicort Turbohaler 400mcg 200D Methylxanthine Theophylline 200mg Sandoz theophylline 200mg Theoplus 200mg Methylxanthine Theophylline 300mg Sandoz theophylline 300mg Potassium supplements Potassium chloride 600mg Plenish K 600mg Combinations Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA Theoplus 300mg For long term oral corticosteroid treatment Coronary Artery Disease I20 Anticoagulant Warfarin 5mg cipla-warfarin I25 Beta blocker Propranolol 10mg Indoblok 10mg Prodorol 10mg Beta blocker Propranolol 40mg Indoblok 40mg Prodorol 40mg Beta-blockers Atenolol 50mg Tenopress 50mg Bio-atenolol 50mg Beta-blockers Atenolol 100mg Tenopress 100mg Bio-atenolol 100mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Bisbeta 5mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Bisbeta 10mg Diuretic-thiazide Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Atenolol 50mg/chlorthalidone Hydrochlorthiazide/amiloride 50/5mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor 100mg/25mg Tenchlor hs 50mg/ Bilocor Co 2.5mg/6.25mg Bilocor Co 5mg/6.25mg Bilocor Co 10mg/6.25mg Spec -Co - Amiloride Amiloretic 50mg/5mg Alpha + beta blocker Carvedilol Carloc Carvetrend

15 Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg Carvetrend 6.25mg Alpha + beta blocker Carvedilol 25mg Carloc 25mg Carvetrend 25mg Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab Cipalat Retard 20mg Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg Fedaloc sr 30mg Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg Fedaloc sr 60mg Calcium channel blocker Amlodipine 5mg Amtas 5mg Lomanor 5mg Calcium channel blocker Amlodipine 10mg Gulf Amlodipine 10mg Lomanor 10mg Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Calcicard SR 240mg Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Diltiazem 60mg Zildem 60mg Calcium channel blockers Diltiazem 90mg Zildem 90mg Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg Calcium channel blockers Felodipine 10mg Felodipine-hexal 10mg Calcium channel blockers Felodipine 5mg Felodipine-hexal 5mg Nitrates Glyceryl trintarate 0.5mg Angised Nitrates Isosorbide mononitrate 60mg Monicor sr Nitrates Isosorbide dinitrate spray Dinospray 1.25mg/dose Nitrates Isosorbide dinitrate 10mg Isordil 10mg Nitrates Isosorbide dinitrate 30mg Isordil 30mg Nitrates Isosorbide dinitrate 5mg Isordil 5mg Nitrates Isosorbide mononitrate 20mg Ismo 20mg Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg Organic Nitrates Ivabradine 5mg Coralan 5mg Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg inhibitor inhibitor Aspirin 300mg Bayer Aspirin 300mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Aspirin 81mg Ecotrin 81mg Dipyridamole 100mg Plato 100mg Dipyridamole 25mg Plato 25mg Clopidogrel 75mg Plagrol Aspirin 100mg Bayer Aspirin Cardio 100mg Cardiologist Prescription Cardiologist Prescription Detailed clinical motivation with stent types and dates and history of therapy Fibrates Bezafibrate 400mg Dyna-Bezafibrate 400mg From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia 15

16 HMG-CoA reductase (statins) Simvastatin 10mg Adco simvastatin 10mg Austell simvastatin 10mg From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia HMG-CoA reductase (statins) Simvastatin 20mg Adco simvastatin 20mg Austell simvastatin 20mg From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia HMG-CoA reductase (statins) Simvastatin 40mg Adco simvastatin 40mg Austell simvastatin 40mg From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia Crohn's disease K50 Aminosalicylates Mesalazine 400mg tab Asacol 400mg Aminosalicylates Mesalazine 2g/50ml enema Asacol enema Aminosalicylates Mesalazine 500mg supps Asacol supps Aminosalicylates Mesalazine 500mg tab Pentasa 500mg Aminosalicylates Olsalazine 250mg Dipentum 250mg Aminosalicylates Sulphasalazine 500mg Salazopyrin 500mg Aminosalicylates Sulphasalazine 500mg Salazopyrin EN others Budesonide 2.3mg Entocord 2,3mg Enema others Budesonide 3mg Entocord 3mg cap Antibiotics Antibiotics Metronidazole 200mg Metronidazole 400mg Adco-metronidazole 200mg Adco-metronidazole 400mg Antibiotics Ciprofloxacin 250mg Ciprol Dynafloc Antibiotics Ciprofloxacin 500mg Ciprol Dynafloc Antibiotics Ciprofloxacin 750mg Cifloc 750mg Corticosteroids Prednisolone 5mg Lenisolone 5mg Capsoid Cytostatic Methotrexate 2.5 Methotrexate 2.5mg Corticosteroids Prednisone 5mg Be-tabs prednisone Immunosuppressive Azathioprine 50mg Azamun 50mg Prenatal vitamins Folic Acid Be-Tabs Folic acid Potassium supplements Potassium chloride 600mg Plenish K 600mg Motivation - Motivation - For long term oral corticosteroid treatment Diabetes insipidus E23.2 Anti-diuretics Desmopressin Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml DDAVP nasal spray 0.1mg/ml Anti-Diuretics Desmopressin tab DDAVP 0.1mg

17 Anti-Diuretics Desmopressin tab DDAVP 0.2mg Diabetes Mellitus 1 E10 Anti-hypoglycaemic agent Injection GlucaGen - Hypokit Diabetic consumables Lancets Accu-check pro lancets Diabetic consumables Lancets Accu-check softclix lancets Diabetic consumables Lancets Microlet lancets Diabetic consumables Needles Novofine needles Diabetic consumables Needles BD microfine needles Diabetic consumables Strips Accu-check advantage strip Diabetic consumables Strips Accutrend glucose strips Diabetic consumables Strips Ascensia elite ts (glucometer) Diabetic consumables Strips Ascensia entrust test strips Diabetic consumables Strips Ascensia glucodi esprit Diabetic consumables Strips Glucostix coastal Diabetic consumables Strips Glucostix high altitude Diabetic consumables Strips Haemo-Glucotest Diabetic consumables Strips Keto-Diastix 50's Diabetic consumables Strips Medisense optimum plus Diabetic consumables Diabetic consumables Diabetic consumables Diabetic consumables Strips Strips Strips Strips Biphasic insulin Biphasic insulin Fast acting insulin Fast acting insulin Fast acting insulin Medisense precision plus electrodes One touch ultra test strips One touch horizon test strips Homemed blood glucose strips Insu Actaphane HM(ge) 3.0ml Penset Insu Actraphane HM(ge) 10ml vial Insu Apidra 3.0ml cartridge Insu Apidra I optiset penset 3ml insu Apidra solostar disposable pens 3ml Fast acting insulin Insu Apidra 10ml vial Fast acting insulin Novorapid flexpen 3ml prefilled device penset Motivation with treatment history Motivation with treatment history Motivation with treatment history Motivation with treatment history Fast acting insulin Novorapid flexpen 3ml solution for inj. penfill Fast acting insulin Novorapid vial 10ml Novomix 30 flexpen 3ml pf device

18 Novomix 30 penfill 3ml pf device rapid acting - rapid acting insulin Humalog 10ml vial humalog cartridge 3ml rapid acting humalog pen 3ml disposable premixed biphasic humalog mix 25 10ml vial premixed biphasic humalog mix 25 cartridge 3 ml premixed biphasic humalog mix 25 disp pen 3 ml premixed biphasic humalog mix 50 cartridge 3ml glargine Optisulin Cartridge 100IU/ml Basaglar Cartridge 100IU/ml glargine Detemir Detemir isophane - intermediate isophane - intermediate Optisulin pen 100 IU/ml Levemir flexpen prefilled 3ml Levemir prefilled cartridge 3ml Basaglar Pen 100IU/ml Humulin N vial 10ml humulin N cartridge 3ml Biosulin N 3ml cart Motivation with treatment history Motivation with treatment history isophane - intermediate humulin N pen 3ml disposable premixed biphasic premixed biphasic Humulin 30/70 10ml vial Humulin 30/70 cartridge 3ml Biosulin 30/70 3ml cart premixed biphasic Humulin 30/70 disposable pens 3ml short acting Humulin R 10ml vial short acting Intermediate to long acting insulin Intermediate to long acting insulin humulin R 3ml cartridge Insu Protaphane flexpen 3ml pf device Insu Protaphane HM(ge) 10ml vial Biosulin R 3ml cartridge Aspirin 300mg Bayer Aspirin 300mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Aspirin 100mg Ecotrin 81mg Diabetes mellitus type 2 E11 Biguanides Metformin 850 mg Biguanides Metformin 500mg Accord Metformin 850mg Accord Metformin 500mg Diaphage 850mg Diaphage 500mg Biguanides Metformin 1000mg Bigsens 1000mg Mylan Metformin 1000mg Biguanides Metformin 500mg Glucophage XR 500mg

19 Biguanides Biguanides Metformin 750mg Metformin 1000mg Glucophage XR 750mg Glucophage XR 1000mg combinations Metformin/glibenclamide Glucovance 250/ combinations Metformin/glibenclamide Glucovance 500/ combinations Metformin/glibenclamide Glucovance 500/ Sulphonylureas Glibenclamide 5mg Bio-glibenclamide Sulphonylureas Glimepiride 1mg Mylan Glimepiride 1mg Sulphonur 1mg Sulphonylureas Glimepiride 2mg Mylan Glimepiride 2mg Sulphonur 2mg Sulphonylureas Glimepiride 4mg Austell Glimepiride 4mg Sulphonur 4mg Sulphonylureas Gliclazide 80mg Sandoz gliclazide 80mg Diaglucide 80mg Sulphonylureas Gliclazide 30mg MR Diaglucide 30mg MR Sulphonylureas Gliclazide 60mg MR Diaglucide 60mg MR Thiazolidinediones Pioglitazone Cipla pioglitazone 30mg Motivation with treatment history Thiazolidinediones Pioglitazone Cipla pioglitazone 15mg Aspirin 300mg Bayer Aspirin 300mg Acetylsalicylic Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Motivation with treatment history Acetylsalicylic Aspirin Ecotrin 81mg Dysrhythmia I47 Anti-arrhythmic Amiodarone 100mg Hexarone 100mg Arycor 100mg I48 Anti-arrhythmic Amiodarone 200mg Bio-amiodarone 200mg Anti-arrhythmic Propafenone 150mg Rhythmol 150mg Anti-arrhythmic Propafenone 300mg Rhythmol 300mg Anti-arrhythmic Disopyramide 100mg Rythmodan 100mg Anti-arrhythmic Disopyramide 250mg Rythmodan Retard 250mg Beta-blockers Sotalol 160mg Sotahexal 160mg Beta-blockers Sotalol 80mg Sotahexal 80mg Cardiac glycosides Digoxin Lanoxin mg Cardiac glycosides Digoxin Lanoxin 0.25mg Anticoagulant Warfarin 5mg cipla-warfarin Beta-blockers Propranolol 10mg Indoblok 10mg Prodorol 10mg Beta-blockers Propranolol 40mg Indoblok 40mg Prodorol 40mg Beta-blockers Bisoprolol 10mg Bilocor 10mg Beta-blockers Bisoprolol 5mg Bilocor 5mg Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Bilocor Co 2.5mg/6.25mg Bilocor Co 5mg/6.25mg Bilocor Co 10mg/6.25mg Beta-blockers Atenolol 50mg Tenopress 50mg Bio-atenolol 50mg Beta-blockers Atenolol 100mg Tenopress 100mg Bio-atenolol 100mg Alpha + beta blocker Carvedilol Carloc Carvetrend

20 Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg Carvetrend 6.25mg Alpha + beta blocker Carvedilol 25mg Carloc 25mg Carvetrend 25mg Atenolol 100mg/chlorthalidone 25mg Tenchlor 100mg/25mg Atenolol 50mg/chlorthalidone Tenchlor hs 50mg/ Calcium channel blockers Verapamil 240 SR Verahexal 240 sr Ravamil 240mg Calcium channel blockers Verapamil 40mg Vasomil 40mg Calcium channel blockers Verapamil 80mg Vasomil 80mg Calcium channel blockers Diltiazem 60mg Zildem 60mg Calcium channel blockers Diltiazem 90mg Zildem 90mg Calcium channel blockers Diltiazem SR 180 Zildem SR 180mg Calcium channel blockers Diltiazem SR 240 Zildem SR 240mg inhibitor inhibitor Aspirin 300mg Bayer Aspirin 300mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Aspirin 81mg Ecotrin 81mg Dipyridamole 100mg Plato 100mg Dipyridamole 25mg Plato 25mg Epilepsy G40 Anti-epileptic Valproic acid 150mg Convulex 150mg G41 Anti-epileptic Valproic acid 300mg Convulex 300mg Anti-epileptic Valproic acid 500mg Convulex 500mg Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension Anti-epileptic Sodium Valproate 100mg Epilim Crushable 100mg Anti-epileptic Sodium Valproate 200mg Epilizine cr 200mg Eprolep cr 200mg Anti-epileptic Sodium Valproate 300mg Epilizine cr 300mg Eprolep cr 300mg Anti-epileptic Sodium Valproate 500mg Epilizine cr 500mg Eprolep cr 500mg Anti-epileptic Sodium Valproate 200mg/5ml Epilim sugar free Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS Anti-epileptic Lamotrigine 50mg Epitec 50mg TABS Lamidus 50mg Anti-epileptic Lamotrigine 100mg Epitec 100mg TABS Lamidus 50mg Anti-epileptic Lamotrigine 200mg Epitec 200mg TABS Lamidus 50mg Anti-epileptic Phenobarbitone 30mg Sedabarb 30mg Anti-epileptic Phenytoin 100mg Phenytoin sod Anti-epileptic Phenytoin 125mg/5mL susp Epanutin 125mg/5mL Anti-epileptic Phenytoin sodium 50mg Epanutin Infatabs 50mg Anti-epileptic Clonazepam Rivotril 0.5mg Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation 20

21 Anti-epileptic Clonazepam Rivotril 2.5mg/ml drops Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Anti-epileptic Clonazepam Rivotril 2mg Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Anti-epileptic Carbamazepine 100mg/ 5mL Tegretol susp 250mL Anti-epileptic Carbamazepine 200mg Degranol 200mg Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr Tegretol cr 200mg Anti-epileptic Carbamazepine 400mg Sandoz carbamazepine cr Tegretol cr 400mg Anti-epileptic Gabapentin 100mg Epigab 100mg Neurexal 100mg Anti-epileptic Gabapentin 300mg Epigab 300mg Neurexal 300mg Anti-epileptic Gabapentin 400mg Epigab 400mg Neurexal 400mg Anti-epileptic Topiramate 15mg Topamax sc sprinkles 15mg Anti-epileptic Topiramate 25mg Epitoz 25mg Anti-epileptic Topiramate 50mg Epitoz 50mg Anti-epileptic Topiramate 100mg Epitoz 100mg Anti-epileptic Oxcarbazepine 300mg Trileptal 300mg Anti-epileptic Oxcarbazepine 600mg Trileptal 600mg Anti-epileptic Ethosuximide 250mg/5ml Zarontin 250mg/5ml syrup Prenatal vitamins Folic Acid Be-Tabs Folic acid Anti-epileptic Levetiracetam 250mg Epikepp 250mg Redilev 250mg Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. Motivation from neurologist, neurosurgeon or paediatric neurologist only. Anti-epileptic Levetiracetam 500mg Epikepp 500mg Redilev 500mg (Indicated for specific types of epilepsy and only for adults and children > 16yrs). Anti-epileptic Levetiracetam 750mg Epikepp 750mg Redilev 750mg Motivation from neurologist, neurosurgeon or paediatric neurologist only. 21

22 Glaucoma H40 Carbonic anhydrase Carbonic anhydrase Ophthalmics -alpha-2- agonist Acetazolamide Azomid 250mg Brinzolamide Azoptic eye suspension 1% Brimonidine tartrate Alphagan purite 5ml Ophthalmics -Beta-blockers Metipranolol 0.3% Beta-Opthiole 0.3% Ophthalmics -Beta-blockers Metipranolol 0.6% Beta-Opthiole 0.6% Ophthalmics -Beta-blockers Timolol 5mg/ml Glaucosan 0.5% Ophthalmics -Beta-blockers Timolol 2.5mg/ml Timoptol 0.25% 5ml drops Ophthalmics -Beta-blockers Bimatoprost 0.3mg/ml Lumigan 3ml Opthalmics -Beta-blockers Brinzolamide 10mg; Timolol combination 5mg/ml Azarga 5ml Opthalmics -Beta-blockers Bimatopost 0.3mg; Timolol combination 5mg/ml Ganfort 3ml Ophthalmics -Beta-blockers Dorzolamide 20mg; timolol 5mg/ml Cosopt 0.5% 5ml drp Ophthalmics Brimonidine tartrate 2mg; Combigan eye drops timolol 5mg/ml 5ml Ophthalmics - carbonic anhydrase inhibitor Ophthalmic - muscarinic agonists Ophthalmic - muscarinic agonists Ophthalmic - muscarinic agonists Ophthalmics-prostaglandin analogue Dorzolamide 20mg Trusopt solution Pilocarpine 10mg/mL Pilocarpine 20mg/mL Pilocarpine 40mg/mL Travoprost 40ug/ml Isoptocarpine 1% - 15mL Isoptocarpine 2%- 15mL Isoptocarpine 4% - 15mL Travatan eye drop solution Ophthalmics-prostaglandin analogue Lantanoprost/timolol Xalacom Co-Atana 2.5ml Opthalmics-prostaglandin analogue Lantanoprost 1ml/50mcg Xalatan Atana 50mcg/ml Ophthalmics Betaxolol 0.50% Betoptic 5ml Ophthalmics Betaxolol 0.25% Betoptic s 0.25% Motivation, including history of therapy, Haemophilia D66 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml Haematologist D67 Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml Anti-diuretics Desmopressin DDAVP 0.2mg Anti-diuretics Desmopressin DDAVP 0.1mg Coagulants Tranexamic acid 500mg Cyklokapron Haematologist Haematologist Haematologist Haematologist Coagulants Factor VIII 300u Haemosolvate Factor VIII Haematologist Coagulants Factor VIII 500u Haemosolvate Factor VIII Haematologist 22

23 Coagulants Factor VIII 1000u Haemosolvate Factor VIII Haematologist Coagulants Factor IX 500u Haemosolvex Factor IX Haematologist Analgesics Paracetamol 500mg Napamol 500mg Hyperlipidaemia E78 Fibrates Bezafibrate 400mg HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) Simvastatin 10mg Simvastatin 20mg Simvastatin 40mg Dyna-bezafibrate SR 400mg Adco simvastatin 10mg Adco simvastatin 20mg Adco simvastatin 40mg Austell simvastatin 10mg Austell simvastatin 20mg Austell simvastatin 40mg Atorvastatin 10mg Aspavor 10mg Adco Atorvastatin 10mg Atorvastatin 20mg Aspavor 20mg Adco Atorvastatin 20mg Atorvastatin 40mg Aspavor 40mg Adco Atorvastatin 40mg Atorvastatin 80mg Lipogen 80mg Astor 80mg Aspirin 100mg Myoprin Bayer Aspirin Cardio 100mg Aspirin 81mg Ecotrin 81mg Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Hypertension I10 ACE Inhibitors Captopril 25mg Merck-captopril 25mg ACE Inhibitors Captopril 50mg Merck-captopril 50mg ACE Inhibitors combination Captopril/hydrochlorothiazide 50mg/25mg Captoretic 50/25mg ACE Inhibitors Enalapril 10mg Alapren 10mg ACE Inhibitors Enalapril 20mg Alapren 20mg ACE Inhibitors Enalapril 5mg Alapren 5mg ACE Inhibitors combination Enalapril / hydrochlorthiazide Enap co ACE Ramipril 2.5mg Rampil 2.5mg ACE Ramipril 5mg Rampil 5mg ACE Ramipril 10mg Rampil10mg ACE Perindopril 4mg Prexum 4mg Vectoryl 4mg ACE Perindopril 8mg Pearinda 8mg Vectoryl 8mg ACE Inhibitors Perindopril 4mg Prexum 5mg ACE Perindopril 10mg Prexum 10mg ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus ACE Inhibitors combination Perindopril 4mg/Indapamide 1.25mg Prexum Plus Vectoryl Plus Perindopril 4mg/Indapamide Prexum Plus 5/ mg mg Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg