Chronic Illness Benefit medicine list (formulary) 2016

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2016 Who we are TFG Medical Aid Scheme (referred to as 'the Scheme"), registration number 1578, 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 who is registered as an authorised financial services provider (registration number 1997/013480/07), administers TFG Medical Aid Scheme. Contact us You can call us on or visit for more information.

2 Chronic Illness Benefit 2016 Contents Page Explanation of terms 3 The Prescribed Benefits medicine list (for all plan types) 4 Important information you need to know We may change the information contained in this document from time to time. We will communicate any changes to the way we pay medicines when we make these changes. The Chronic Illness Benefit (CIB) is managed by the TFG Medical Aid Scheme Rules. The use of the benefits and programmes linked with the Chronic Illness Benefit are subject to specific conditions and rules. Members must make sure that they know these rules and conditions. Any instructions or advice on medicines and the management of the member s condition are intended to add to, and not replace, the knowledge, expertise, skill and judgment of the member s doctor, pharmacist or other healthcare professional. TFG Medical Aid Scheme and Discovery Health (Pty) Ltd reserve the right to change the benefit at any time. Page 2 of 24 01/2016

3 Explanation of terms Benefit year A benefit year refers to the benefits a member is entitled to during a calendar year, that is to say 1 January to 31 December. This medicine list (formulary) and Chronic Drug Amounts are applicable for 2016 only. Chronic Drug Amount (CDA) The CDA is a monthly amount we pay up to for a medicine class. This applies to medicine that is not listed on the medicine list (formulary). The Chronic Drug Amount includes VAT and the dispensing fee. Prescribed s (PMB conditions) These are conditions which all medical schemes are required to cover by the Council for Medical Schemes for any setting according to clinical guidelines. Chronic Disease List (CDL) A defined list of chronic conditions we cover according to the Prescribed Benefits. Medicine class This describes medicines that have similar chemical structures or similar therapeutic effects. Active ingredient This is the main substance in a medicine that is responsible for the clinical action on a human body. Page 3 of 24 01/2016

4 Chronic Illness Benefit 2016 The Prescribed Benefits (PMB) medicine list (for all plan types) Prescribed Benefit condition Addison s disease Systemic corticosteroids: Hydrocortisone R110 R110 Systemic corticosteroids: Mineralocorticoids Asthma R175 R175 Adrenergics: Long acting - Formoterol R300 R420 Adrenergics: Long acting - Salmeterol Bipolar mood disorder R35 R35 Adrenergics: Short acting - Salbutamol R90 R135 Anti-asthmatics: Systemic xanthines R415 R415 Formoterol and Budesonide R220 R220 Inhaled anticholinergics: Ipratropium bromide 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 Theophylline Venteze CFC free 200 dose 100mcg Sandoz Theophylline anhydrous 200mg; 300mg 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 Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose R310 R370 Inhaled Glucocorticoids Beclomethasone Beceze 200 dose CFC free 100mcg 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 50mcg; 250mcg R415 R415 Salmeterol and Fluticasone Salmeterol and Fluticasone Foxair accuhaler 50/100; 50/250; 50/ dose Sereflo HFA 25/50; 25/125; 25/ dose R350 R350 Surgical item Inhaler device Dp haler device Spacer Glaxohaler R15 R15 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic R130 R345 Anti-depressants: Citalopram Adco-Talomil SSRIs Arrow Citalopram ; 40mg Page 4 of 24 01/2016

5 Benefit condition Bipolar mood disorder R130 R345 Anti-depressants: SSRIs R290 R385 Anti-epileptics: Carboxamide derivatives R460 R460 Anti-epileptics: Fatty acid derivatives R270 R435 Anti-epileptics: Other agents R100 R100 Anti-psychotics: Butyrophenone derivatives R705 R1 185 Anti-psychotics: Clozapine R330 R330 Anti-psychotics: Lithium R615 R615 Anti-psychotics: Olanzapine Citalopram Austell-Citalopram ; 40mg Bio Citalopram Cilate 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 Carbamazepine Degranol 200mg Sandoz Carbamazepine CR 200mg; 400mg Zeptol 200mg Valproic acid Convulex 1 Convulex syrup Epilim crushable 2/5ml Epilim sugar-free syrup 200mg/5ml Epilizine CR 200mg; 300mg; 500mg Eprolep CR 300mg; 500mg Navalpro CR 200mg; 300mg; 500mg Vanapro 300mg; 500mg Lamotrigine Dyna-Lamotrigine 2; ; ; 200mg Epitec 2; ; ; 200mg Lamidus ; ; 200mg Lamitor 2; ; ; 200mg Haloperidol Gulf Haloperidol Serenace 1. Clozapine Aspen Clozapine 2; Cloment 2; Lithium Camcolit 2; 400mg Quilonum retard 4 Olanzapine Lanazyp Mylan Olanzapine Page 5 of 24 01/2016

6 Bipolar mood disorder R615 R615 Anti-psychotics: Olanzapine R385 R385 Anti-psychotics: Phenothiazines with aliphatic side-chain R390 R390 Anti-psychotics: Quetiapine Olanzapine Oleanz Olexar Prexolan Prexolan odt Redilanz Chlorpromazine Largactil 2; 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 R515 R650 Anti-psychotics: Flupenthixol Fluanxol 0.; 1mg Thioxanthene derivatives Fluanxol depot 1ml Fluanxol depot 2ml 40mg Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot 200mg R550 R1 005 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg Risnia 0.; 1mg; 2mg; 3mg Rispacor 0.; 1mg; 2mg; 3mg Rispevon 3mg; Risponz 1mg; 2mg; 3mg; Schizorol 0. Zoxadon 0.; 1mg; 2mg Bronchiectasis R35 R35 Adrenergics: Salbutamol Asthavent ecohaler 200 dose 100mcg Short acting - Salbutamol Venteze CFC free 200 dose 100mcg R220 R220 Inhaled Ipratropium Atrovent HFA 200 dose 20mcg anticholinergics: bromide Ipratropium bromide Ipvent HFA 200 dose 40mcg/1dose R15 R15 Systemic corticosteroids: Prednisone Cardiac failure R115 R125 ACE inhibitors and diuretics R85 R120 ACE inhibitors: Prednisone Be-Tabs Prednisone Panafcort Trolic Enalapril and Enap co 20/12. diuretics Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. diuretics Hexal-Lisinopril co 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Lisozide 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and Bioprexum Plus 10/2. diuretics Perindopril co Unicorn 4/1.2 Prexum Plus 5/1.2 Zydus Perindopril co 4/1.2 Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap Enap 10mg; Envas Hr-Enalapril ; Page 6 of 24 01/2016

7 Cardiac failure R85 R120 ACE inhibitors: R225 R250 Alpha and Beta blocking agents R120 R120 Angiotensin II antagonists, Combinations R85 R130 Angiotensin II antagonists: Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and diuretics Austell Losartan co 50/12. Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Zartan co 50/12. Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Irtanel 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Page 7 of 24 01/2016

8 Cardiac failure R85 R130 Angiotensin II antagonists: R90 R90 Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives R70 R80 Beta blocking agents: Selective Cardiomyopathy R115 R125 ACE inhibitors and diuretics Valsartan Valant 40mg; 80mg; 160mg Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor Bilocor Bislo Bisohexal Bisoprolol Zydus Retocar Ziapro R25 R25 Cardiac glycosides: Digoxin Lanoxin 0.062; 0.2 Digoxin Lanoxin paed syrup 0.0/1ml R20 R40 High-ceiling diuretics Furosemide Dino-Retic 40mg Diuresix 40mg Furobe 40mg Mylan Furosemide 40mg R15 R15 Low-ceiling diuretics: Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R105 R105 Potassium sparing Spironolactone Aldactone 2 agents Sandoz Spironolactone 2 Spiractin 2 R95 R95 Potassium Potassium chloride Plenish K 600mg supplements Potassium Chloride Unicorn 600mg Sandoz K mg Ultipot 600mg R180 R180 Vasodilators in cardiac Glyceryl trinitrate Angised 0. disease: Isosorbide dinitrate Isordil 30mg Organic nitrates Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR 60mg R85 R85 Influenza vaccines Influenza, purified Influvac 0.5ml antigen Vaxigrip single dose 0.5ml pre-filled R160 R160 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 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. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Lisozide 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn 4/1.2 Prexum Plus 5/1.2 Zydus Perindopril co 4/1.2 R85 R120 ACE inhibitors: Captopril Adco-Captomax 2; Bio-Captopril 2 Page 8 of 24 01/2016

9 Cardiomyopathy R85 R120 ACE inhibitors: R225 R250 Alpha and Beta blocking agents R120 R120 Angiotensin II antagonists, Combinations R85 R130 Angiotensin II antagonists: Captopril Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap Enap 10mg; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and diuretics Austell Losartan co 50/12. Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Zartan co 50/12. Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 1; 300mg Irtanel 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Page 9 of 24 01/2016

10 TFG plan A Cardiomyopathy R85 R130 Angiotensin II antagonists: Chronic obstructive pulmonary disease (COPD) R80 R80 Anti-thrombotic agents: Vitamin K antagonists R90 R90 Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Losartan Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant 40mg; 80mg; 160mg Warfarin Cipla-Warfarin 1mg; Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin 300mg R70 R80 Beta blocking agents: Bisoprolol Adco-Bisocor Selective Bilocor Bislo Bisohexal Bisoprolol Zydus Retocar Ziapro R25 R25 Cardiac glycosides: Digoxin Lanoxin 0.062; 0.2 Digoxin Lanoxin paed syrup 0.0/1ml R20 R40 High-ceiling diuretics Furosemide Dino-Retic 40mg Diuresix 40mg Furobe 40mg Mylan Furosemide 40mg R15 R15 Low-ceiling diuretics: Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R105 R105 Potassium sparing Spironolactone Aldactone 2 agents Sandoz Spironolactone 2 Spiractin 2 R95 R95 Potassium Potassium chloride Plenish K 600mg supplements Potassium Chloride Unicorn 600mg Sandoz K mg Ultipot 600mg R180 R180 Vasodilators in Glyceryl trinitrate Angised 0. cardiac disease: Isosorbide dinitrate Isordil 30mg Organic nitrates Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA R85 R85 Isosorbide mononitrate Monicor SR 60mg Influenza vaccines Influenza, purified antigen Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled R160 R160 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Imovax pneumo 23 R35 R35 Adrenergics: Salbutamol Asthavent ecohaler 200 dose 100mcg Short acting - Venteze CFC free 200 dose 100mcg Salbutamol R90 R135 Anti-asthmatics: Theophylline Sandoz Theophylline anhydrous 200mg; 300mg Systemic xanthines Page 10 of 24 01/2016

11 Chronic obstructive pulmonary disease (COPD) Chronic renal disease R220 R220 Inhaled anticholinergics: Ipratropium bromide R175 R175 Salbutamol and Ipratropium bromide R749 R749 Surgical item: Oxygen concentrator R15 R15 Systemic corticosteroids: Prednisone Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose Salbutamol and Ipratropium bromide Oxygen Duolin HFA 200 dose Oxygen concentrator rental Prednisone Be-Tabs Prednisone Panafcort Trolic R85 R85 Influenza vaccines Influenza, purified antigen Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled R115 R125 ACE inhibitors and Enalapril and diuretics Enap co 20/12. diuretics Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Hexal-Lisinopril co 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Lisozide 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Perindopril co Unicorn 4/1.2 Prexum Plus 5/1.2 Zydus Perindopril co 4/1.2 R85 R120 ACE inhibitors: Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap Enap 10mg; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Page 11 of 24 01/2016

12 Chronic renal disease R85 R120 ACE inhibitors: Quinapril Accumax 10mg; R120 R120 Angiotensin II Losartan and diuretics Austell Losartan co 50/12. antagonists, Combinations Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Zartan co 50/12. Zartan co 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 R85 R130 Angiotensin II Irbesartan Dynarb 1; 300mg antagonists: Irtanel 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant 40mg; 80mg; 160mg R215 R215 Calcium supplements Calcium carbonate B-cal R5 R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R40 R40 Iron in combination with folic acid Ferrous fumarate Pregamal R560 R560 Iron, parenteral preparations R4 000 R4 000 Other anti-anaemic preparations Iron, parenteral Cosmofer ampoule 2ml /1ml preparations Rautevene ampoule 5ml /5ml Sucrofer /1ml Zypiron vial 5ml /1ml Darbepoetin Alfa Aranesp pre-filled syringe 0.4ml 10mcg/0.4ml 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 Page 12 of 24 01/2016

13 Chronic renal disease R4 000 R4 000 Other anti-anaemic Methoxy Mircera pre-filled syringe 0.3ml 30mcg/0.3ml preparations polyethylene-glycolepoetin Mircera pre-filled syringe 0.3ml 50mcg/0.3ml beta Mircera pre-filled syringe 0.3ml 75mcg/0.3ml Mircera pre-filled syringe 0.3ml 100mcg/0.3ml Mircera pre-filled syringe 0.3ml 120mcg/0.3ml Mircera pre-filled syringe 0.3ml 150mcg/0.3ml Mircera pre-filled syringe 0.3ml 200mcg/0.3ml Mircera pre-filled syringe 0.3ml 250mcg/0.3ml R385 R385 Vitamin D and analogues Alfacalcidol One alpha 0.25mcg; 1mcg Coronary artery R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg disease Gulf Aspirin 300mg R70 R190 Beta blocking agents: Propranolol Indoblok 10mg; 40mg Non-selective Purbloka 10mg; 40mg R70 R80 Beta blocking agents: Atenolol B-Block ; Selective Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; R210 R285 Selective calcium channel Diltiazem Adco-Zildem 60mg blockers with direct cardiac Adco-Zildem SR 180mg; 240mg effects Verapamil Vasomil 40mg; 80mg Verahexal SR 240mg R130 R200 Selective calcium channel Amlodipine Amlodac blockers with mainly vascular Amtas effects Calbloc Gulf Amlodipine Indo Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard R180 R180 Vasodilators in cardiac disease: Glyceryl trinitrate Angised 0. Organic nitrates Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide Elantan mononitrate Elantan LA Monicor SR 60mg Crohn s disease R5 R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R795 R795 Intestinal anti-inflammatories: Mesalazine Asacol 400mg; 500mg; 800mg Aminosalicylic acid and similar Mezavant 1200mg agents Pentasa 500mg; 1000mg Salofalk 1000mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg R1 940 R1 940 Intestinal anti-inflammatories: Budesonide Entocord enema Corticosteroids R665 R665 Other immuno- Azathioprine Azamun suppressive agents: Azathioprine Azathioprine PCH Page 13 of 24 01/2016

14 Crohn s disease R70 R70 Other immunosuppressive agents: Methotrexate R15 R15 Systemic corticosteroids: Prednisone Diabetes insipidus Diabetes mellitus Type 1 R1 450 R1 700 Posterior pituitary hormones: Vasopressin and analogues R680 R720 Anti-diabetic agents: Insulins and analogues R200 R280 Blood glucose monitoring agents Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Insulin Glucose strips Actraphane hm(ge) - vial 10ml Apidra - solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog - 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 Accu-check active mic strips Caresens II/pop test strip 29g Caresens n test strips 29g Freestyle optium glucose test strips Glucocheck strips 50s Glucoplus Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 R350 Surgical item Lancets Lancets 50's Lancets blood collection needles loris Lancets solus v2 Needles 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 Syringes 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 Page 14 of 24 01/2016

15 Diabetes mellitus Type 2 R65 R65 Anti-diabetic agents: Biguanides R680 R720 Anti-diabetic agents: Insulins and analogues R115 R115 Anti-diabetic agents: Sulfonamides, urea derivatives R175 R190 Anti-diabetic agents: Thiazolidinediones Metformin Accord Metformin 500mg; 8 Apex-Metformin 500mg Arrow Metformin 500mg; 8 Austell-Metformin 500mg; 8 Bigsens 500mg; 8; 1000mg Diaformin 500mg Diaformin forte 8 Diamin 500mg; 8 Diaphage 500mg; 8; 1000mg Gluconorm 500mg; 8 Mengen 500mg; 8; 1000mg Metchek 500mg; 8 Metforal 500mg; 8 Metformin Alkem 500mg; 8 Metored 500mg; 8; 1000mg Metphage 500mg; 8 Mylan Metformin 500mg; 8 Romidab 500mg; 8; 1000mg Sandoz Metformin 500mg Sandoz Metformin FCT 500mg; 8 Insulin Actraphane hm(ge) - vial 10ml Apidra - solostar disposable pens 3ml Biosulin cartridge 3ml Biosulin l cartridge 3ml Biosulin n cartridge 3ml Biosulin r cartridge 3ml Humalog - 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 80mg Diaglucide 80mg Diaglucide MR 60mg Diaran MR 30mg Dyna Gliclazide SR 30mg Glycron 80mg Glygard 80mg Sandoz Gliclazide 80mg Pioglitazone Accord Pioglitazone 1; 30mg; 4 Cipla-Pioglitazone 1; 30mg Page 15 of 24 01/2016

16 Diabetes mellitus Type 2 R200 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 Glucoplus provider strips Glucose blood test strips diamond Onetouch select glucose test strips On-call plus ez strips (all sizes) R350 R350 Surgical item Lancets Lancets 50's Lancets blood collection needles loris Lancets solus v2 Needles 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 Syringes 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 Dysrhythmias R595 R680 Anti-arrhythmics: Flecainide Tambocor class Ic Tambocor CR ; 200mg Propafenone Rythmol 1; 300mg R425 R425 Anti-arrhythmics: class III - Amiodarone Amiodarone Arycor ; 200mg Bio-Amiodarone Hexarone 200mg ; 200mg R80 R80 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg R70 R190 Beta blocking agents: Non-selective R70 R80 Beta blocking agents: Selective R25 R25 Cardiac glycosides: Digoxin R210 R285 Selective calcium channel blockers with direct cardiac effects Epilepsy R185 R285 Anti-epileptics: Benzodiazepine derivatives Gulf Aspirin 300mg Propranolol Indoblok 10mg; 40mg Purbloka 10mg; 40mg 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 40mg; 80mg Verahexal SR 240mg Clonazepam Rivotril 0.; 2mg Page 16 of 24 01/2016

17 Epilepsy R290 R385 Anti-epileptics: Carboxamide derivatives R460 R460 Anti-epileptics: Fatty acid derivatives R70 R70 Anti-epileptics: Hydantoin derivatives R270 R435 Anti-epileptics: Other agents R25 R25 Anti-epileptics: Barbiturates and derivatives Glaucoma R195 R195 Anti-glaucoma agents: Carbonic anhydrase inhibitors R235 R235 Anti-glaucoma agents: Prostaglandin analogues R270 R270 Anti-glaucoma agents: Sympathomimetics R85 R85 Anti-glaucoma Beta blocking agents: Timolol R270 R270 Anti-glaucoma Beta blocking agents: Timolol, combinations Haemophilia R5 R5 Analgesics: Paracetamol R195 R195 Anti-fibrinolytics: Amino acids Carbamazepine Degranol 200mg Sandoz Carbamazepine CR 200mg; 400mg Zeptol 200mg Valproic acid Convulex 1 Convulex syrup 2/5ml Epilim crushable Epilim sugar-free syrup 200mg/5ml Epilizine CR 200mg; 300mg; 500mg Eprolep CR 300mg; 500mg Navalpro CR 200mg; 300mg; 500mg Vanapro 300mg; 500mg Phenytoin Phenytoin sod Lamotrigine Dyna-Lamotrigine 2; ; ; 200mg Epitec 2; ; ; 200mg Lamidus ; ; 200mg Lamitor 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 50mcg/1ml Xalatan 2.5ml 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 500mg Adco-Prolief Cetapon Painogesic 500mg 500mg 500mg Tranexamic acid Morwak 500mg Tranexamic Acid Medwich R R Blood coagulation factors Coagulation factor IX Haemosolvex IX 500U R1 450 R1 700 Posterior pituitary hormones: Vasopressin and analogues Hyperlipidaemia R260 R260 Lipid modifying agents: Fibrates Tranic 500mg 500mg Coagulation factor Haemosolvate VIII 300U; 500U; 1000U VIII Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Bezafibrate Dyna-Bezafibrate SR 400mg Sandoz Bezafibrate 400mg Page 17 of 24 01/2016

18 Hyperlipidaemia R45 R55 Lipid modifying agents: Atorvastatin Adco Atorvastatin 10mg; ; 40mg Statins Aspavor 10mg; ; 40mg Aspavor 80mg Astor 40mg Astor 80mg Atorvastatin Unicorn 10mg; ; 40mg Dynator 10mg; ; 40mg Dynator 80mg Lestavor 80mg Lipogen 80mg Simvastatin Adco-Simvastatin 10mg; ; 40mg Austell-Simvastatin 10mg; ; 40mg Choleste ; 40mg Cipla-Simvastatin 10mg; ; 40mg Simvacor 10mg; ; 40mg Zysim 10mg; ; 40mg Hypertension R190 R190 ACE inhibitors and calcium Perindopril and Coveram 5/; 10/; 5/10mg; 10/10mg channel blockers Amlodipine R115 R125 ACE inhibitors and diuretics Enalapril and Enap co 20/12. diuretics Pharmapress co 20/12. Lisinopril and Adco-Zetomax co 10/12.; 20/12. diuretics Hexal-Lisinopril co 20/12. Lisinopril co Unicorn 20/12. Lisoretic 10/12.; 20/12. Lisozide 10/12.; 20/12. Zestoretic 10/12.; 20/12. Perindopril and Bioprexum Plus 10/2. diuretics Perindopril co Unicorn 4/1.2 Prexum Plus 5/1.2 Zydus Perindopril co 4/1.2 R85 R120 ACE inhibitors: Captopril Adco-Captomax 2; Bio-Captopril 2 Mylan Captopril 2; Enalapril Alapren ; Enalapril Unicorn 10mg; Enap Enap 10mg; Envas Hr-Enalapril ; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Acti-Prex Auro Perindopril Bindace Ciplasyl ; 8mg Pearinda ; 8mg Perindopril Unicorn Page 18 of 24 01/2016

19 Hypertension R85 R120 ACE inhibitors: R225 R250 Alpha and Beta blocking agents R120 R120 Angiotensin II antagonists, Combinations R85 R130 Angiotensin II antagonists: R150 R150 Anti-adrenergic agents: Alpha-adrenoreceptor antagonists R145 R145 Anti-adrenergic agents: Methyldopa R25 R25 Anti-adrenergic agents: Rauwolfia alkaloids R90 R90 Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Perindopril Prexum Ran-Perindopril Spec-Perindopril ; 8mg Zydus Perindopril Quinapril Accumax 10mg; Carvedilol Carvedilol Unicorn 6.2; 12.; 2 Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and Austell Losartan co 50/12. diuretics Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 100/2 Netrasol co 50/12.; 100/2 Zartan co 50/12. Zartan co 100/2 Valsartan and Dynaval co 80/12.; 160/12.; 160/2 diuretics Irbesartan Dynarb 1; 300mg Irtanel 1; 300mg Isart 1; 300mg Losartan Auro Losartan Austell Losartan Ciplazar Hytenza Losartan Unicorn Lozaan Spec-Losartan Zartan Valsartan Valant 40mg; 80mg; 160mg Doxazosin Cardugen 1mg; Methyldopa Hypotone 2 Mylan Methyldopa 2 Sandoz Methyldopa 2 Reserpine Reserpine 0.2 Hydralazine Hyperphen 10mg; Sandoz Hydralazine 2 Page 19 of 24 01/2016

20 Hypertension R70 R190 Beta blocking agents: Propranolol Indoblok 10mg; 40mg Non-selective Purbloka 10mg; 40mg R70 R80 Beta blocking agents: Atenolol B-Block ; Selective Bio-Atenolol ; Gulf Atenolol ; Sandoz Atenolol ; Tenopress ; Zetenol ; R20 R40 High-ceiling diuretics Furosemide Dino-Retic 40mg Diuresix 40mg Furobe 40mg Mylan Furosemide 40mg R15 R15 Low-ceiling diuretics: Hydrochlorothiazide Hexazide 2 Thiazides, plain Ridaq 12. R20 R20 Low-ceiling diuretics: Indapamide Cipla-Indapamide 2. excluding Thiazides Daptril 2. Mylan Indapamide 2. R105 R105 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone 2 Spiractin 2 R95 R95 Potassium supplements Potassium chloride Plenish K 600mg Potassium Chloride Unicorn 600mg Sandoz K mg Ultipot 600mg R210 R285 Selective calcium channel Diltiazem Adco-Zildem 60mg blockers with direct cardiac Adco-Zildem SR 180mg; 240mg effects Verapamil Vasomil 40mg; 80mg Verahexal SR 240mg R130 R200 Selective calcium channel Amlodipine Amlodac blockers with mainly vascular Amtas effects Calbloc Gulf Amlodipine Indo Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal 10mg Plendil 2.; Nifedipine Adco-Vascard SR Cipalat Retard Hypothyroidism R45 R45 Thyroid hormones Levothyroxine Euthyrox 25mcg; 50mcg; 100mcg sodium Multiple sclerosis R75 R75 Anti-depressants: Amitriptyline Gulf Amitriptyline 2 Tricyclics Sandoz Amitriptyline 2 Trepiline 10mg R200 R260 Drugs for urinary frequency Oxybutynin Lenditro and incontinence Mylan Oxybutynin R R Interferons Interferon beta-1a Avonex pre-filled syringe 0.5ml 30mcg/0.5ml Rebif 22 pre-filled syringe 0.5ml 44mcg/1ml Rebif 22 rebidose pre-filled pen 0.5ml 44mcg/1ml Page 20 of 24 01/2016

21 Multiple sclerosis R R Interferons Interferon beta-1a 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 R1 165 Muscle relaxants: Baclofen Bio-Baclofen 10mg Other centrally acting agents Teva Baclofen 10mg R15 R15 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Parkinson's R340 R340 Anti-cholinergic agents: Biperiden Akineton 2mg disease Tertiary amines Lennon-Biperiden 2mg R630 R630 Dopamine agonists Pramipexole Oxpola 0.12; 0.2; 1mg Pramex 0.12; 0.2; 1mg Pramiola 0.12; 0.2 Ropinirole Accord Ropinirole0.2; 0.; 1mg; 2mg; Requip 0.2; 0.; 1mg; 2mg; R690 R690 Dopaminergic agents: Selegiline Parkilyne Monoamine oxidase B inhibitors: Selegiline R280 R280 Dopaminergic agents: Adamantane derivatives Amantadine Symadin Rheumatoid arthritis R620 R620 Levodopa and decarboxylase inhibitor R55 R55 Anti-inflammatory agents: Acetic acid derivatives and related substances R55 R55 Anti-inflammatory agents: Acetic acid derivatives and related substances R75 R95 Anti-inflammatory agents: Oxicams R30 R30 Anti-inflammatory agents: Propionic acid derivatives R90 R90 Anti-rheumatic agents: Chloroquine Levodopa and Carbilev 25/; 25/2 decarboxylase Sinemet 25/; 25/2 inhibitor Teva Carbi-Levo 25/; 25/2 Diclofenac Adco-Diclofenac A-Lennon Diclofenac 2; Diclofenac Biotech 2 Mylan Diclofenac 2; Panamor AT Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 Meloxicam Adco-Meloxicam 7.; 1 Arrow Meloxicam 7. Flamaryx 7. Flexocam 7. Medoxicam 7. Zydus-Meloxicam 7. Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Betaprofen FC 400mg Bren 400mg Ibu 200mg Ibucine 200mg; 400mg Ibunate 200mg Ranfen 400mg Naproxen Mylan Naproxen 2 Naproscript 2 Chloroquine Plasmoquine 200mg Page 21 of 24 01/2016

22 Rheumatoid arthritis R90 R90 Anti-rheumatic agents: Chloroquine Plasmoquine 200mg Chloroquine R5 R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R795 R795 Intestinal antiinflammatories: Sulfasalazine Salazopyrin 500mg Aminosalicylic acid and similar agents Salazopyrin EN 500mg R665 R665 Other immunosuppressive agents: Azathioprine R70 R70 Other immunosuppressive agents: Methotrexate R15 R15 Systemic corticosteroids: Prednisone Schizophrenia R130 R345 Anti-depressants: SSRIs R290 R385 Anti-epileptics: Carboxamide derivatives Azathioprine Azamun Azathioprine PCH Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Adco-Talomil Arrow Citalopram ; 40mg Austell-Citalopram ; 40mg Bio Citalopram Cilate 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 Carbamazepine Degranol 200mg Sandoz Carbamazepine CR 200mg; 400mg Zeptol 200mg Page 22 of 24 01/2016

23 TFG plan B Schizophrenia R100 R100 Anti-psychotics: Butyrophenone derivatives R705 R1 185 Anti-psychotics: Clozapine R615 R615 Anti-psychotics: Olanzapine Systemic lupus erythematosus (SLE) R385 R385 Anti-psychotics: Phenothiazines with aliphatic side-chain R390 R390 Anti-psychotics: Quetiapine Haloperidol Gulf Haloperidol Serenace 1. 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 2; ; 200mg; 300mg Psyquet 2; ; 200mg; 300mg Quetoser 2; ; 200mg; 300mg Serez 2; ; 200mg; 300mg Sizonorm 2; ; 200mg; 300mg R515 R650 Anti-psychotics: Flupenthixol Fluanxol 0.; 1mg Thioxanthene derivatives Fluanxol depot 1ml Fluanxol depot 2ml 40mg Zuclopenthixol Clopixol 2mg; 10mg Clopixol depot 200mg R550 R1 005 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg Risnia 0.; 1mg; 2mg; 3mg Rispacor 0.; 1mg; 2mg; 3mg Rispevon 3mg; Risponz 1mg; 2mg; 3mg; Schizorol 0. Zoxadon 0.; 1mg; 2mg R55 R55 Anti-inflammatory agents: Diclofenac Adco-Diclofenac Acetic acid derivatives and A-Lennon Diclofenac 2; related substances Diclofenac Biotech 2 Mylan Diclofenac 2; Panamor AT Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 R75 R95 Anti-inflammatory agents: Meloxicam Adco-Meloxicam 7.; 1 Oxicams Arrow Meloxicam 7. Flamaryx 7. Flexocam 7. Medoxicam 7. Zydus-Meloxicam 7. Piroxicam Pyrocaps Roxifen R30 R30 Anti-inflammatory agents: Ibuprofen Betaprofen 200mg Propionic acid derivatives Betaprofen FC 400mg Bren 400mg Ibu 200mg Ibucine 200mg; 400mg Ibunate 200mg Ranfen 400mg Naproxen Mylan naproxen 2 Naproscript 2 R90 R90 Anti-rheumatic agents: Chloroquine Plasmoquine 200mg Chloroquine Page 23 of 24 01/2016

24 Systemic lupus erythematosus (SLE) R80 R80 Anti-thrombotic agents: Warfarin Cipla-Warfarin 1mg; Vitamin K antagonists R10 R20 Aspirin Acetylsalicylic acid Aspirin 300mg Gulf Aspirin 300mg R25 R25 Emolients and protectives: Zinc products Zinc ointment bp Zinc products R5 R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R665 R665 Other immuno-suppressive Azathioprine Azamun agents: Azathioprine Azathioprine PCH R70 R70 Other immuno-suppressive Methotrexate Abitrexate 2. agents: Methotrexate Methotrexate 2. R15 R15 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic R25 R25 Topical corticosteroids: Betamethasone Repivate cream 0.1% Group III Topivate cream 0.1% Vari-Betamethasone cream 0.1% Ulcerative colitis R5 R5 Folic acid and derivatives Folic acid Aha Folic acid Be-Tabs Folic acid Folic acid 0. R795 R795 Intestinal Mesalazine Asacol 400mg; 500mg; 800mg anti-inflammatories: Mezavant 1200mg Aminosalicylic acid and Pentasa 500mg; 1000mg similar agents Salofalk 1000mg Olsalazine Dipentum 2 Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg R1 940 R1 940 Intestinal Budesonide Entocord enema anti-inflammatories: Corticosteroids R665 R665 Other immuno-suppressive Azathioprine Azamun agents: Azathioprine Azathioprine PCH R70 R70 Other immuno-suppressive Methotrexate Abitrexate 2. agents: Methotrexate Methotrexate 2. R15 R15 Systemic corticosteroids: Prednisone Be-Tabs Prednisone Prednisone Panafcort Trolic Complaints process You may lodge a complaint or query with TFG Medical Aid Scheme directly on address a complaint in writing to the Principal Officer at the Scheme s registered address. Should your complaint remain unresolved, you may lodge a formal dispute by following the TFG Medical Aid Scheme internal disputes process. You may, as a last resort, approach the Council for Medical Schemes for assistance. Council for Medical Schemes Complaints Unit, Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 / / complaints@medicalschemes.com / Page 24 of 24 01/2016