Chronic Illness Benefit medicine list (formulary) 2016

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2016 Who we are The Anglovaal Group Medical Scheme (referred to as the Scheme ), registration number This is a non-profit organisation, registered with the Council for Medical Schemes. Discovery Health (Pty) Ltd (referred to as the administrator ) is a separate company and an authorised financial services provider (registration number 1997/013480/07). We take care of the administration of your membership for the Scheme. 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 Anglovaal Group Medical Scheme rules. The use of the benefits and programmes linked with the Chronic Illness Benefit are subject to specific s and rules. Members must make sure that they know these rules and s. Any instructions or advice on medicines and the management of the member s are intended to add to, and not replace, the knowledge, expertise, skill and judgement of the member s doctor, pharmacist or other healthcare professional. Anglovaal Group Medical Scheme and Discovery Health (Pty) Ltd reserve the right to change the benefit at any time.

2 Explanation of terms Benefit year A benefit year refers to the benefits a member is entitled to during a calendar year, 1 January to 31 December. This medicine list (formulary) and Chronic Drug Amounts are applicable for 2016 only. Chronic Drug Amount (CDA) The CDA is a monthly we pay up to for a medicine class. This applies to medicine that is not listed on the medicine list (formulary). The Chronic Drug Amount includes VAT and the dispensing fee. Prescribed (PMB) s These are s which all medical schemes are required to cover by the Council for Medical Schemes according to clinical guidelines. Chronic Disease List (CDL) A defined list of chronic s we cover according to the Prescribed s. 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 2 of 20 01/2016

3 Chronic Illness Benefit 2016 The Prescribed s (PMB) medicine list Prescribed Addison s disease 170 Systemic corticosteroids: Hydrocortisone R110 Systemic corticosteroids: Mineralocorticoids Asthma R175 Adrenergics: Long acting - Formoterol R420 Adrenergics: Long acting - Salmeterol Bipolar mood disorder R35 Adrenergics: Short acting - Salbutamol Hydrocortisone Covocort 10mg Fludrocortisone Florinef acetate 0.1mg Formoterol Foratec HFA 120 dose 12mcg/1dose Salmeterol Serevent accuhaler 60 dose 50mcg Serevent CFC free 120 dose 25mcg Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg R135 Anti-asthmatics: Systemic xanthines Theophylline Sandoz Theophylline anhydrous 200mg; 300mg R415 Formoterol and Budesonide Formoterol and Symbicord turbohaler 160/4.5mcg; 320/9mcg Budesonide 60 dose Symbicord turbohaler 160/4.5mcg 120 dose Vannair 80/4.5mcg 120 dose Vannair 160/4.5mcg 120 dose R220 Inhaled anticholinergics: Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipratropium bromide Ipvent HFA 200 dose 40mcg/1dose R370 Inhaled Glucocorticoids Beclomethasone Beceze 200 dose CFC free 100mcg R415 Salmeterol and Fluticasone Salmeterol and Fluticasone Beclate 200 dose 100mcg; 200mcg Budesonide Budeflam dp-caps 200mcg Budeflam HFA 300 dose 100mcg; 200mcg Inflammide novolizer complete 200mcg 200 dose Inflammide novolizer complete 400mcg 100 dose Inflammide novolizer refill 200mcg 200 dose Inflammide novolizer refill 400mcg 100 dose Pulmicort turbuhaler 100mcg; 200mcg 200 dose Fluticasone Flixotide CFC free 120 actuations 125mcg Flixotide CFC free 120 dose R350 Surgical item Inhaler device Dp haler device R345 Systemic corticosteroids: Prednisone Anti-depressants: SSRIs 50mcg; 250mcg Foxair accuhaler 50/100; 50/250; 50/ dose Sereflo HFA 25/50; 25/125; 25/ dose Spacer Glaxohaler Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Adco-Talomil Arrow Citalopram Austell-Citalopram Bio Citalopram Cilate ; ; Page 3 of 20 01/2016

4 Bipolar mood disorder R345 Anti-depressants: SSRIs Escitalopram Accord Escitalopram 10mg; Escitalopram Be-Tabs 10mg; Escitalopram Winthrop 10mg; Zitolex 10mg; Zytomil 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Prolax Ranflocs Zydus Fluoxetine Paroxetine Adco-Paroxetine Auro Paroxetine Austell-Paroxetine Serrapress Sertraline Austell-Sertraline ; Dyna Sertraline ; Serdep ; Serlife Zolid R385 Anti-epileptics: Carboxamide derivatives Carbamazepine Degranol 200mg Sandoz Carbamazepine CR 200mg; 400mg Zeptol 200mg R460 Anti-epileptics: Fatty acid derivatives Valproic acid Convulex 1 Convulex syrup 2/5ml Epilim crushable Epilim sugar-free syrup 200mg/5ml Epilizine CR 200mg; 300mg; Eprolep CR 300mg; Navalpro CR 200mg; 300mg; Vanapro 300mg; R435 Anti-epileptics: Other agents Lamotrigine Dyna-Lamotrigine 2; ; ; 200mg Epitec 2; ; ; 200mg Lamidus ; ; 200mg Lamitor 2; ; ; 200mg R100 Butyrophenone derivatives Haloperidol Gulf Haloperidol Serenace 1. R1 185 Clozapine Clozapine Aspen Clozapine 2; Cloment 2; R330 Lithium Lithium Camcolit 2; 400mg Quilonum retard 4 R615 Olanzapine Olanzapine Lanazyp Mylan Olanzapine Oleanz Olexar Prexolan Prexolan odt Redilanz R385 Phenothiazines with aliphatic side-chain Chlorpromazine Largactil 2; R390 Quetiapine Quetiapine Dopaquel 2; ; 200mg; 300mg Mylan Quetiapine 2; ; 200mg; 300mg Psyquet 2; ; 200mg; 300mg Quetoser 2; ; 200mg; 300mg Serez 2; ; 200mg; 300mg Sizonorm 2; ; 200mg; 300mg Page 4 of 20 01/2016

5 Bipolar mood disorder R650 Thioxanthene derivatives Flupenthixol Fluanxol 0.; 1mg Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot R1 005 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg Bronchiectasis R35 Adrenergics: Short acting - Salbutamol R220 Inhaled anticholinergics: Ipratropium bromide Systemic corticosteroids: Prednisone Risnia Rispacor Rispevon Risponz Schizorol Zoxadon 200mg 0.; 1mg; 2mg; 3mg 0.; 1mg; 2mg; 3mg 3mg; 1mg; 2mg; 3mg; 0. 0.; 1mg; 2mg Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose Prednisone Be-Tabs Prednisone Panafcort Cardiac failure R125 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. R120 ACE inhibitors: Plain Trolic Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 20/12. 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn Prexum Plus Zydus Perindopril co 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril Mylan Captopril 2 2; Enalapril Alapren ; Enalapril Unicorn Enap Envas Hr-Enalapril 10mg; ; ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril Zydus Perindopril ; 8mg ; 8mg ; 8mg Quinapril Accumax 10mg; R250 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 Page 5 of 20 01/2016

6 Cardiac failure R120 Angiotensin II antagonists, Combinations R130 R90 R80 R25 Angiotensin II antagonists: Plain Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Beta blocking agents: Selective Cardiac glycosides: Digoxin Losartan and diuretics Austell Losartan co 50/12. Hytenza co Losaar Plus Losacar co Losartan co Unicorn Netrasol co 50/12. 50/12.; 100/2 50/ /2 50/12.; 100/2 Zartan co 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Irtanel Isart 1; 300mg 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant ; 80mg; 160mg Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor Bilocor Bislo Bisohexal Bisoprolol Zydus Retocar Ziapro Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic R20 Low-ceiling diuretics: Thiazides, plain Low-ceiling diuretics: excluding Thiazides Diuresix Furobe Mylan Furosemide Hydrochlorothiazide Hexazide 2 Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril Mylan Indapamide R105 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R95 Potassium supplements Potassium chloride Plenish K 600mg R180 Vasodilators in cardiac disease: Organic nitrates R85 Influenza vaccines Influenza, purified antigen R160 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Potassium Chloride Unicorn Sandoz K-600 Ultipot mg 600mg 600mg Glyceryl trinitrate Angised 0. Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled Imovax pneumo 23 60mg Page 6 of 20 01/2016

7 Cardiomyopathy R125 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. R120 ACE inhibitors: Plain Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 20/12. 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn Prexum Plus Zydus Perindopril co 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril Mylan Captopril 2 2; Enalapril Alapren ; Enalapril Unicorn Enap Envas Hr-Enalapril 10mg; ; ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril Zydus Perindopril ; 8mg ; 8mg ; 8mg Quinapril Accumax 10mg; R250 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 R120 R130 R80 Angiotensin II antagonists, Combinations Angiotensin II antagonists: Plain Anti-thrombotic agents: Vitamin K antagonists Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 Losartan and diuretics Austell Losartan co 50/12. Hytenza co Losaar Plus Losacar co Losartan co Unicorn Netrasol co 50/12. 50/12.; 100/2 50/ /2 50/12.; 100/2 Zartan co 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Irtanel Isart 1; 300mg 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant ; 80mg; 160mg Warfarin Cipla-Warfarin 1mg; Page 7 of 20 01/2016

8 Cardiomyopathy R90 Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Chronic obstructive pulmonary disease (COPD) Chronic renal disease Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 R20 Aspirin Acetylsalicylic acid Aspirin 300mg R80 R25 Beta blocking agents: Selective Cardiac glycosides: Digoxin Gulf Aspirin 300mg Bisoprolol Adco-Bisocor Bilocor Bislo Bisohexal Bisoprolol Zydus Retocar Ziapro Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic R20 Low-ceiling diuretics: Thiazides, plain Low-ceiling diuretics: excluding Thiazides Diuresix Furobe Mylan Furosemide Hydrochlorothiazide Hexazide 2 Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril Mylan Indapamide R105 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R95 Potassium supplements Potassium chloride Plenish K 600mg R180 Vasodilators in cardiac disease: Organic nitrates R85 Influenza vaccines Influenza, purified antigen Potassium Chloride Unicorn Sandoz K-600 Ultipot mg 600mg 600mg Glyceryl trinitrate Angised 0. Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled R160 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 R35 Adrenergics: Salbutamol Asthavent ecohaler 200 dose 100mcg Short acting - Salbutamol Venteze CFC free 200 dose 100mcg R135 R220 R175 R749 Anti-asthmatics: Systemic xanthines Inhaled anticholinergics: Ipratropium bromide Salbutamol and Ipratropium bromide Surgical item: Oxygen concentrator Systemic corticosteroids: Prednisone 60mg Theophylline Sandoz Theophylline anhydrous 200mg; 300mg Ipratropium bromide Atrovent HFA 200 dose 20mcg Salbutamol and Ipratropium bromide Oxygen R85 Influenza vaccines Influenza, purified antigen Ipvent HFA 200 dose Duolin HFA 200 dose Oxygen concentrator rental 40mcg/1dose Prednisone Be-Tabs Prednisone Panafcort Trolic Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled R125 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co 20/12. Page 8 of 20 01/2016

9 Chronic renal disease R125 ACE inhibitors and diuretics Lisinopril and diuretics Lisinopril co Unicorn 20/12. R120 R120 R130 ACE inhibitors: Plain Angiotensin II antagonists, Combinations Angiotensin II antagonists: Plain Lisoretic Lisozide Zestoretic 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn Prexum Plus Zydus Perindopril co 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril Mylan Captopril 2 2; Enalapril Alapren ; Enalapril Unicorn Enap Envas Hr-Enalapril 10mg; ; ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril Zydus Perindopril ; 8mg ; 8mg ; 8mg Quinapril Accumax 10mg; Losartan and diuretics Austell Losartan co 50/12. Hytenza co Losaar Plus Losacar co Losartan co Unicorn Netrasol co Zartan co 50/12. 50/12.; 100/2 50/ /2 50/12.; 100/2 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Irtanel Isart 1; 300mg 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan R215 Calcium supplements Calcium carbonate B-cal Valsartan Valant ; 80mg; 160mg R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid R40 Iron in combination with folic acid Ferrous fumarate Pregamal R560 Iron, parenteral preparations Iron, parenteral preparations Cosmofer ampoule 2ml Rautevene ampoule 5ml Sucrofer Zypiron vial 5ml 0. /1ml /5ml /1ml /1ml Page 9 of 20 01/2016

10 Chronic renal R4 000 Other anti-anaemic preparations Darbepoetin Alfa Aranesp pre-filled syringe 0.4ml 10mcg/0.4ml disease 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 polyethyleneglycol-epoetin Mircera pre-filled syringe 0.3ml 30mcg/0.3ml beta Mircera pre-filled syringe 0.3ml 50mcg/0.3ml 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 R385 Vitamin D and analogues Alfacalcidol One alpha 0.25mcg; 1mcg Coronary artery R20 Aspirin Acetylsalicylic acid Aspirin 300mg disease Gulf Aspirin 300mg R190 Beta blocking agents: Propranolol Indoblok 10mg; Non-selective Purbloka 10mg; R80 Beta blocking agents: Atenolol B-Block ; Selective Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; R285 Selective calcium channel blockers Diltiazem Adco-Zildem 60mg with direct cardiac effects Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 R200 Selective calcium channel blockers Amlodipine Amlodac with mainly vascular effects Amtas Calbloc Gulf Amlodipine Indo Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard R180 Vasodilators in cardiac disease: Glyceryl trinitrate Angised 0. Organic nitrates Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR 60mg Crohn s disease R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. Page 10 of 20 01/2016

11 Crohn s disease R795 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents R1 940 R665 R70 Intestinal anti-inflammatories: Corticosteroids Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic corticosteroids: Prednisone Diabetes insipidus R1 700 Posterior pituitary hormones: Vasopressin and analogues Diabetes mellitus Type 1 R720 Anti-diabetic agents: Insulins and analogues Mesalazine Asacol 400mg; ; 800mg Mezavant Pentasa Salofalk 1200mg ; 1000mg 1000mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin Budesonide Salazopyrin EN Entocord enema Azathioprine Azamun Azathioprine PCH Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Desmopressin Ddavp 0.1mg; 0.2mg Insulin Ddavp nasal spray 5ml 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 0.1mg/1ml Humalog - cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 25 - cartridge 3ml; kwikpen 3ml Humalog mix 25 - vial 10ml Humalog mix 50 - cartridge 3ml Humalog mix 50 - kwikpen 3ml Humulin 30/70 - cartridge 3ml; kwikpen 3ml; vial 10ml Humulin n - cartridge 3ml; kwikpen 3ml; vial 10ml Humulin r - cartridge 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml Novorapid - penfill 3ml R280 Blood glucose monitoring agents Glucose strips Accu-check active mic strips Caresens II/pop test strip 29g Caresens n test strips 29g Freestyle optium glucose test strips Glucocheck strips 50s Glucoplus R350 Surgical item Lancets Lancets 50's Needles Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) Lancets blood collection needles loris Lancets solus v2 BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm BD microfine pen needle 30g 8mm Droplet pen needle 12mm x 29g Droplet pen needle 10mm x 29g Droplet pen needle 8mm x 31g Page 11 of 20 01/2016

12 Diabetes mellitus Type 1 Diabetes mellitus Type 2 R350 Surgical item Needles Droplet pen needle 6mm x 31g R65 R720 R115 Anti-diabetic agents: Biguanides Anti-diabetic agents: Insulins and analogues Anti-diabetic agents: Sulfonamides, urea derivatives Syringes Droplet pen needle 6mm x 32g Needle novofine BD microfine 0.3ml insulin syringe 30g 8mm BD microfine 1ml insulin syringe 30g 8mm BD microfine 1ml insulin syringe 29g 12mm Needle accufine insulin pen 8 x 30g Syringe insulin 1.0ml with 27g needle Metformin Accord Metformin ; 8 Insulin Apex-Metformin Arrow Metformin Austell-Metformin Bigsens Diaformin Diaformin forte Diamin Diaphage Gluconorm Mengen Metchek Metforal Metformin Alkem Metored Metphage Mylan Metformin Romidab Sandoz Metformin Sandoz Metformin FCT Actraphane hm(ge) - vial 10ml ; 8 ; 8 ; 8; 1000mg 8 ; 8 ; 8; 1000mg ; 8 ; 8; 1000mg ; 8 ; 8 ; 8 ; 8; 1000mg Apidra - solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml ; 8 ; 8 ; 8; 1000mg ; 8 Humalog - cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 25 - kwikpen 3ml Humalog mix 25 - cartridge 3ml Humalog mix 25 - vial 10ml Humalog mix 50 - cartridge 3ml Humalog mix 50 - kwikpen 3ml Humulin 30/70 - cartridge 3ml; kwikpen 3ml; vial 10ml Humulin n - cartridge 3ml; kwikpen 3ml; vial 10ml Humulin r - cartridge 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Novomix 30 - flexpen 3ml Novorapid - penfill 3ml Glibenclamide Bio-Glibenclamide Diacare Glycomin Sandoz Glibenclamide Gliclazide Adco-Glucomed 80mg Austell-Gliclazide Diaglucide Diaglucide MR 80mg 80mg 60mg Page 12 of 20 01/2016

13 Diabetes mellitus Type 2 R115 R190 Anti-diabetic agents: Sulfonamides, urea derivatives Anti-diabetic agents: Thiazolidinediones Gliclazide Diaran MR 30mg Dyna Gliclazide SR Glycron Glygard Sandoz Gliclazide 30mg 80mg 80mg 80mg Pioglitazone Accord Pioglitazone 1; 30mg; 4 Cipla-Pioglitazone R280 Blood glucose monitoring agents Glucose strips Accu-check active mic strips Caresens II/pop test strip 29g Caresens n test strips 29g Freestyle optium glucose test strips Glucocheck strips 50s Glucoplus R350 Surgical item Lancets Lancets 50's Dysrhythmia R680 Anti-arrhythmics: class Ic R425 Anti-arrhythmics: class III - Amiodarone Needles Syringes Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) Lancets blood collection needles loris Lancets solus v2 BD microfine pen needle 32g 4mm BD microfine pen needle 31g 5mm BD microfine pen needle 30g 8mm Droplet pen needle 12mm x 29g Droplet pen needle 10mm x 29g Droplet pen needle 8mm x 31g Droplet pen needle 6mm x 31g Droplet pen needle 6mm x 32g Needle novofine BD microfine 0.3ml insulin syringe 30g 8mm BD microfine 1ml insulin syringe 30g 8mm BD microfine 1ml insulin syringe 29g 12mm Needle accufine insulin pen 8 x 30g Syringe insulin 1.0ml with 27g needle 1; 30mg Flecainide Tambocor Tambocor CR ; 200mg Propafenone Rythmol 1; 300mg Amiodarone Arycor ; 200mg Bio-Amiodarone Hexarone 200mg ; 200mg R80 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R20 Aspirin Acetylsalicylic acid Aspirin 300mg R190 R80 R25 R285 Beta blocking agents: Non-selective Beta blocking agents: Selective Cardiac glycosides: Digoxin Selective calcium channel blockers with direct cardiac effects Gulf Aspirin 300mg Propranolol Indoblok 10mg; Purbloka 10mg; Sotalol Sotahexal 80mg; 160mg Atenolol B-Block ; Bio-Atenolol Gulf Atenolol Sandoz Atenolol Tenopress Zetenol ; ; ; ; ; Digoxin Lanoxin 0.062; 0.2 Lanoxin paed syrup 0.0/1ml Verapamil Vasomil ; 80mg Verahexal SR 2 Page 13 of 20 01/2016

14 Epilepsy R285 Anti-epileptics: Benzodiazepine derivatives R385 Anti-epileptics: Carboxamide derivatives R460 R70 R435 R25 Anti-epileptics: Fatty acid derivatives Anti-epileptics: Hydantoin derivatives Anti-epileptics: Other agents Anti-epileptics: Barbiturates and derivatives Glaucoma R195 Anti-glaucoma agents: Carbonic anhydrase inhibitors R235 R270 R85 R270 Anti-glaucoma agents: Prostaglandin analogues Anti-glaucoma agents: Sympathomimetics Haemophilia R5 Analgesics: Paracetamol R195 Anti-glaucoma Beta blocking agents: Timolol Anti-glaucoma Beta blocking agents: Timolol, combinations Anti-fibrinolytics: Amino acids Clonazepam Rivotril 0.; 2mg Carbamazepine Degranol 200mg Sandoz Carbamazepine CR Zeptol 200mg; 400mg 200mg Valproic acid Convulex 1 Convulex syrup Epilim crushable Epilim sugar-free syrup Epilizine CR Eprolep CR Navalpro CR Vanapro 2/5ml 200mg/5ml 200mg; 300mg; 300mg; 200mg; 300mg; 300mg; Phenytoin Phenytoin sod Lamotrigine Dyna-Lamotrigine 2; ; ; 200mg Epitec Lamidus Lamitor 2; ; ; 200mg ; ; 200mg 2; ; ; 200mg Topiramate Epimate 200mg Epitoz 2; ; Phenobarbital Lethyl 30mg Sedabarb 30mg Dorzolamide Glaucopress 5ml 2% Trusopt 5ml owi 2% Bimatoprost Lumigan 0.01% Latanoprost Atana 2.5ml 50mcg/1ml Ocuprost 3ml Xalatan 2.5ml 50mcg/1ml 50mcg/1ml Travoprost Travatan 2.5ml 0.004% Brimonidine Alphagan purite 5ml 1./1ml Brimoct 5ml 2mg/1ml Timolol Glaucosan 5ml 0.5% Timolol, combinations Occumol 5ml 0.5% Azarga 5ml Combigan 5ml 2mg/ Cosopt 5ml 0.5% Duotrav 2.5ml Ganfort 3ml Xalacom 2.5ml Paracetamol Adco-Napamol Adco-Prolief Cetapon Painogesic Tranexamic acid Morwak Tranexamic Acid Medwich R Blood coagulation factors Coagulation factor IX Haemosolvex IX 500U R1 700 Posterior pituitary hormones: Vasopressin and analogues Hyperlipidaemia R260 Lipid modifying agents: Fibrates R55 Lipid modifying agents: Statins Tranic Coagulation factor VIII Haemosolvate VIII 300U; 500U; 1000U 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; ; ; 80mg Page 14 of 20 01/2016

15 Hyperlipidaemia R55 Lipid modifying agents: Statins Hypertension R190 ACE inhibitors and calcium channel blockers Atorvastatin Astor ; 80mg Atorvastatin Unicorn Dynator Lestavor Lipogen 10mg; ; 10mg; ; ; 80mg 80mg 80mg Simvastatin Adco-Simvastatin 10mg; ; Perindopril and Amlodipine Austell-Simvastatin Choleste Cipla-Simvastatin Simvacor Zysim Coveram 10mg; ; ; 10mg; ; 10mg; ; 10mg; ; 5/; 10/; 5/10mg; 10/10mg R125 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. R120 ACE inhibitors: Plain Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 20/12. 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn Prexum Plus Zydus Perindopril co 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril Mylan Captopril 2 2; Enalapril Alapren ; Enalapril Unicorn Enap Envas Hr-Enalapril 10mg; ; ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril Zydus Perindopril ; 8mg ; 8mg ; 8mg Quinapril Accumax 10mg; R250 Alpha and Beta blocking agents Carvedilol Carvedilol Unicorn 6.2; 12.; 2 R120 Angiotensin II antagonists, Combinations Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 Losartan and diuretics Austell Losartan co 50/12. Hytenza co Losaar Plus Losacar co Losartan co Unicorn Netrasol co Zartan co 50/12. 50/12.; 100/2 50/ /2 50/12.; 100/2 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Page 15 of 20 01/2016

16 Hypertension R130 Angiotensin II antagonists: Plain 0 R145 R25 R90 R190 R80 Anti-adrenergic agents: Alpha-adrenoreceptor antagonists Anti-adrenergic agents: Methyldopa Anti-adrenergic agents: Rauwolfia alkaloids Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Beta blocking agents: Non-selective Beta blocking agents: Selective Irbesartan Dynarb 1; 300mg Irtanel Isart 1; 300mg 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant ; 80mg; 160mg Doxazosin Cardugen 1mg; Methyldopa Hypotone 2 Mylan Methyldopa Sandoz Methyldopa 2 2 Reserpine Reserpine 0.2 Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Propranolol Indoblok 10mg; Purbloka 10mg; Atenolol B-Block ; Bio-Atenolol Gulf Atenolol Sandoz Atenolol Tenopress Zetenol ; ; ; ; ; R40 High-ceiling diuretics Furosemide Dino-Retic R20 Low-ceiling diuretics: Thiazides, plain Low-ceiling diuretics: excluding Thiazides Diuresix Furobe Mylan Furosemide Hydrochlorothiazide Hexazide 2 Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril Mylan Indapamide R105 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R95 Potassium supplements Potassium chloride Plenish K 600mg R285 R200 Selective calcium channel blockers with direct cardiac effects Selective calcium channel blockers with mainly vascular effects Potassium Chloride Unicorn Sandoz K-600 Ultipot mg 600mg 600mg Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Amlodac Amtas Calbloc Gulf Amlodipine Indo Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Page 16 of 20 01/2016

17 Hypertension R200 Selective calcium channel blockers with mainly vascular effects Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard Hypothyroidism R45 Thyroid hormones Levothyroxine sodium Euthyrox 25mcg; 50mcg; 100mcg Multiple sclerosis R75 Anti-depressants: Tricyclics R260 Drugs for urinary frequency and incontinence Amitriptyline Gulf Amitriptyline 2 Sandoz Amitriptyline Trepiline 2 10mg Oxybutynin Lenditro Mylan Oxybutynin 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 165 Muscle relaxants: Baclofen Bio-Baclofen 10mg Other centrally acting agents Teva Baclofen 10mg Systemic corticosteroids: Prednisone Parkinson's disease R340 Anti-cholinergic agents: Tertiary amines Rheumatoid arthritis Prednisone Be-Tabs Prednisone Panafcort Trolic Biperiden Akineton 2mg Lennon-Biperiden R630 Dopamine agonists Pramipexole Oxpola 0.12; 0.2; 1mg R690 R280 R620 R55 R95 Dopaminergic agents: Monoamine oxidase B inhibitors: Selegiline Dopaminergic agents: Adamantane derivatives Levodopa and decarboxylase inhibitor Anti-inflammatory agents: Acetic acid derivatives and related substances Anti-inflammatory agents: Oxicams Ropinirole Pramex Pramiola 2mg 0.12; 0.2; 1mg 0.12; 0.2 Accord Ropinirole 0.2; 0.; 1mg; 2mg; Requip 0.2; 0.; 1mg; 2mg; Selegiline Parkilyne Amantadine Symadin Levodopa and decarboxylase inhibitor Carbilev Sinemet Teva Carbi-Levo 25/; 25/2 25/; 25/2 25/; 25/2 Diclofenac Adco-Diclofenac A-Lennon Diclofenac Diclofenac Biotech Mylan Diclofenac Panamor AT 2; 2 2; Indomethacin Betacin 2 Gulf Indomethacin Methocaps 2 2 Meloxicam Adco-Meloxicam 7.; 1 Arrow Meloxicam Flamaryx Flexocam Medoxicam Zydus-Meloxicam Page 17 of 20 01/2016

18 Rheumatoid arthritis R95 R30 Anti-inflammatory agents: Oxicams Anti-inflammatory agents: Propionic acid derivatives Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Betaprofen FC Bren Ibu Ibucine Ibunate Ranfen 400mg 400mg 200mg 200mg; 400mg 200mg 400mg Naproxen Mylan Naproxen 2 Naproscript R90 Anti-rheumatic agents: Chloroquine Plasmoquine 200mg Chloroquine R5 Folic acid and derivatives Folic acid Aha Folic acid R795 R665 R70 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic corticosteroids: Prednisone Schizophrenia R345 Anti-depressants: SSRIs R385 R100 Anti-epileptics: Carboxamide derivatives Butyrophenone derivatives Be-Tabs Folic acid Folic acid 2 0. Sulfasalazine Salazopyrin Salazopyrin EN Azathioprine Azamun Azathioprine PCH Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Adco-Talomil Arrow Citalopram Austell-Citalopram Bio Citalopram Cilate ; ; Escitalopram Accord Escitalopram 10mg; Escitalopram Be-Tabs Escitalopram Winthrop Zitolex Zytomil 10mg; 10mg; 10mg; 10mg; Fluoxetine A-Lennon Fluoxetine Deprozan Fluoxetine Actor Prolax Ranflocs Zydus Fluoxetine Paroxetine Adco-Paroxetine Auro Paroxetine Austell-Paroxetine Serrapress Sertraline Austell-Sertraline ; Dyna Sertraline Serdep Serlife Zolid ; ; Carbamazepine Degranol 200mg Sandoz Carbamazepine CR Zeptol 200mg; 400mg 200mg Haloperidol Gulf Haloperidol Serenace 1. Page 18 of 20 01/2016

19 Schizophrenia R1 185 Clozapine Systemic lupus erythematosus (SLE) R615 R385 R390 R650 Olanzapine Phenothiazines with aliphatic side-chain Quetiapine Thioxanthene derivatives Clozapine Aspen Clozapine 2; Cloment 2; Olanzapine Lanazyp Mylan Olanzapine Oleanz Olexar Prexolan Prexolan odt Redilanz Chlorpromazine Largactil 2; Quetiapine Dopaquel 2; ; 200mg; 300mg Mylan Quetiapine Psyquet Quetoser Serez Sizonorm 2; ; 200mg; 300mg 2; ; 200mg; 300mg 2; ; 200mg; 300mg 2; ; 200mg; 300mg 2; ; 200mg; 300mg Flupenthixol Fluanxol 0.; 1mg Fluanxol depot 1ml Fluanxol depot 2ml Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot R1 005 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg R55 R95 R30 R90 Anti-inflammatory agents: Acetic acid derivatives and related substances Anti-inflammatory agents: Oxicams Anti-inflammatory agents: Propionic acid derivatives Anti-rheumatic agents: Chloroquine Risnia Rispacor Rispevon Risponz Schizorol Zoxadon 200mg 0.; 1mg; 2mg; 3mg 0.; 1mg; 2mg; 3mg 3mg; 1mg; 2mg; 3mg; 0. 0.; 1mg; 2mg Diclofenac Adco-Diclofenac A-Lennon Diclofenac Diclofenac Biotech Mylan Diclofenac Panamor AT 2; 2 2; Indomethacin Betacin 2 Gulf Indomethacin Methocaps 2 2 Meloxicam Adco-Meloxicam 7.; 1 Arrow Meloxicam Flamaryx Flexocam Medoxicam Zydus-Meloxicam Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Betaprofen FC Bren Ibu Ibucine Ibunate Ranfen 400mg 400mg 200mg 200mg; 400mg 200mg 400mg Naproxen Mylan naproxen 2 Naproscript 2 Chloroquine Plasmoquine 200mg Page 19 of 20 01/2016

20 Systemic lupus erythematosus (SLE) R80 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin R25 Emolients and protectives: Zinc products Zinc ointment bp Zinc products R5 Folic acid and derivatives Folic acid Aha Folic acid R665 R70 R25 Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic corticosteroids: Prednisone Topical corticosteroids: Group III Be-Tabs Folic acid Folic acid 300mg 0. Azathioprine Azamun Azathioprine PCH 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% Ulcerative colitis R5 Folic acid and derivatives Folic acid Aha Folic acid R795 R1 940 R665 R70 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents Intestinal anti-inflammatories: Corticosteroids Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic corticosteroids: Prednisone Be-Tabs Folic acid Folic acid 0. Mesalazine Asacol 400mg; ; 800mg Mezavant Pentasa Salofalk 1200mg ; 1000mg 1000mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin Budesonide Salazopyrin EN Entocord enema Azathioprine Azamun Azathioprine PCH Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Complaints process You may lodge a complaint or query with Anglovaal Group Medical Scheme directly on or address a complaint in writing directly to the Principal Officer. Should your complaint remain unresolved, you may lodge a formal dispute by following Anglovaal Group Medical Scheme s internal disputes process. Members, who wish to approach the Council for Medical Schemes for assistance, may do so in writing to: Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 or complaints@medicalschemes.com. Customer Care Centre: /website Page 20 of 20 01/2016