Discovery Health PBR formulary and benchmark pricing

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1 Discovery Health PBR formulary and benchmark pricing Period: 2018 Q1 & Q2 Implementation date: 01 January 2018 Performance-based remuneration (PBR) is a voluntarily programme designed to provide additional remuneration to pharmacists for adhering to the Scheme s formulary. The PBR model aims to create additional funding through added prescription price efficiency and reduced remuneration for items that are not on the formulary. The inclusion of a broader set of products allows for a more affordable cross-funding mechanism. While prescriber preferences may from time to time compromise adherence to the formulary, this is adequately compensated for in the PBR model by lower compliance thresholds. Depending on the availability of preferentially priced generics, there may not always be a generic replacement item on the PBR formulary. PBR applies to Discovery Health Medical Scheme for claims paid from the Chronic Illness Benefit. We have enhanced what will be highlighted on pharmacy screens. Highlighted items on pharmacy screens will now include all preferred items both PBR and non-pbr related. Only PBR items attract additional dispensing fees subject to PBR rules. Although Non-PBR items do not attract additional remuneration, it represents other formulary items and Discovery Health preferred items. PBR Exclusions Claims listed below do not qualify for additional PBR dispensing fees and continue to be paid at the appropriate chosen standard network rates. These comprise claims: for KeyCare and Delta plans; for Non-SEP items such as unregistered medicine, schedule 0 medicines and surgical items; paid from HIV, oncology, acute and SMTB benefits. submitted by pharmacies without a signed non-exclusive designated service provider (DSP) contract submitted by courier pharmacies For out-of-stock products, pharmacists must please substitute with alternative formulary or benchmark items as most of these do not need to be re-authorised. Where necessary, however, please obtain authorisation for a replacement item by calling Add-A-Line on Adco abacavir 20mg/1mL SOL ABACAVIR Yes Yes Kavimun paed 60mg TAB ABACAVIR Yes Yes and Myoprin 100mg TAB ACETYLSALICYLIC ACID Yes Yes One alpha 0,25mcg CAP ALFACALCIDOL Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

2 and One alpha 1mcg CAP ALFACALCIDOL Yes Yes Symadin (was Flu-stop) 100mg CAP AMANTADINE Yes Yes Hexarone 100mg TAB AMIODARONE Yes Yes Arycor 100mg TAB AMIODARONE Yes Yes Bio-amiodarone 200mg TAB AMIODARONE Yes Yes Hexarone 200mg TAB AMIODARONE Yes Yes Arycor 200mg TAB AMIODARONE Yes Yes Trepiline 10mg TAB AMITRIPTYLINE Yes Yes Gulf amitriptyline 25mg TAB AMITRIPTYLINE Yes Yes Sandoz amitriptyline 25mg TAB AMITRIPTYLINE Yes Yes Gulf amlodipine 10mg TAB AMLODIPINE Yes Yes Amtas 10mg TAB AMLODIPINE Yes Yes Pharma dynamics amlodipine besylate 10mg TAB AMLODIPINE Yes Yes Lomanor 10mg TAB AMLODIPINE Yes Yes Calbloc 10mg TAB AMLODIPINE Yes Yes Pendine 10mg TAB AMLODIPINE Yes Yes Ciplavasc 10mg TAB AMLODIPINE Yes Yes Austell-amlodipine 10mg TAB AMLODIPINE Yes Yes Gulf amlodipine 5mg TAB AMLODIPINE Yes Yes Lomanor 5mg TAB AMLODIPINE Yes Yes Ciplavasc 5mg TAB AMLODIPINE Yes Yes Amtas 5mg TAB AMLODIPINE Yes Yes Pharma dynamics amlodipine besylate 5mg TAB AMLODIPINE Yes Yes Calbloc 5mg TAB AMLODIPINE Yes Yes Pendine 5mg TAB AMLODIPINE Yes Yes Austell-amlodipine 5mg TAB AMLODIPINE Yes Yes Tenopress 100mg TAB ATENOLOL Yes Yes B-block 100mg TAB ATENOLOL Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

3 and Zetenol 100mg TAB ATENOLOL Yes Yes Bio-atenolol 100mg TAB ATENOLOL Yes Yes Gulf atenolol 100mg TAB ATENOLOL Yes Yes Tenopress 50mg TAB ATENOLOL Yes Yes Zetenol 50mg TAB ATENOLOL Yes Yes Bio-atenolol 50mg TAB ATENOLOL Yes Yes Gulf atenolol 50mg TAB ATENOLOL Yes Yes Vastor 10mg TAB ATORVASTATIN Yes Yes Lipogen 10mg TAB ATORVASTATIN Yes Yes Lestavor 10mg TAB ATORVASTATIN Yes Yes Atorvastatin unicorn 10mg TAB ATORVASTATIN Yes Yes Atolip 10mg TAB ATORVASTATIN Yes Yes Aspavor 10mg TAB ATORVASTATIN Yes Yes Adco atorvastatin 10mg TAB ATORVASTATIN Yes Yes Lipogen 20mg TAB ATORVASTATIN Yes Yes Lestavor 20mg TAB ATORVASTATIN Yes Yes Atolip 20mg TAB ATORVASTATIN Yes Yes Vastor 20mg TAB ATORVASTATIN Yes Yes Atorvastatin unicorn 20mg TAB ATORVASTATIN Yes Yes Aspavor 20mg TAB ATORVASTATIN Yes Yes Adco atorvastatin 20mg TAB ATORVASTATIN Yes Yes Atolip 40mg TAB ATORVASTATIN Yes Yes Lipogen 40mg TAB ATORVASTATIN Yes Yes Lestavor 40mg TAB ATORVASTATIN Yes Yes Adco atorvastatin 40mg TAB ATORVASTATIN Yes Yes Vastor 40mg TAB ATORVASTATIN Yes Yes Atorvastatin unicorn 40mg TAB ATORVASTATIN Yes Yes Aspavor 40mg TAB ATORVASTATIN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

4 and Astor 40mg TAB ATORVASTATIN Yes Yes Dynator 40mg TAB ATORVASTATIN Yes Yes Lipogen 80mg TAB ATORVASTATIN Yes Yes Aspavor 80mg TAB ATORVASTATIN Yes Yes Lestavor 80mg TAB ATORVASTATIN Yes Yes Atolip 80mg TAB ATORVASTATIN Yes Yes Vastor 80mg TAB ATORVASTATIN Yes Yes Astor 80mg TAB ATORVASTATIN Yes Yes Dynator 80mg TAB ATORVASTATIN Yes Yes Azathioprine pch 50mg TAB AZATHIOPRINE Yes Yes Azamun 50mg TAB AZATHIOPRINE Yes Yes Teva baclofen 10mg TAB BACLOFEN Yes Yes Bio-baclofen (was Norton-baclofen) 10mg TAB BACLOFEN Yes Yes Beceze 100 cfc free 200dose 100mcg INH BECLOMETASONE Yes Yes Beclate 200dose 100mcg INH BECLOMETASONE Yes Yes Beclate 200dose 200mcg INH BECLOMETASONE Yes Yes Beclate aquanase 150dose 50mcg AQS BECLOMETASONE Yes Yes Clenil aqueous 200dose 50mcg AQS BECLOMETASONE Yes Yes Repivate 0,1% CRE BETAMETHASONE Yes Yes Vari-betamethasone 0,1% CRE BETAMETHASONE Yes Yes Topivate 0,1% CRE BETAMETHASONE Yes Yes Dyna-bezafibrate sr 400mg SRT BEZAFIBRATE Yes Yes Sandoz bezafibrate 400mg SRT BEZAFIBRATE Yes Yes Lumigan 0,01% OPD BIMATOPROST Yes Yes Akineton 2mg TAB BIPERIDEN Yes Yes Bisoprolol zydus 10mg TAB BISOPROLOL Yes Yes Bisoprolol unichem 10mg TAB BISOPROLOL Yes Yes Bisoprolol unicorn 10mg TAB BISOPROLOL Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

5 and Bislo 10mg TAB BISOPROLOL Yes Yes Betacor 10mg TAB BISOPROLOL Yes Yes Adco-bisocor 10mg TAB BISOPROLOL Yes Yes Ziapro 10mg TAB BISOPROLOL Yes Yes Retocar 10mg TAB BISOPROLOL Yes Yes Mylan bisoprolol 10mg TAB BISOPROLOL Yes Yes Bilocor 10mg TAB BISOPROLOL Yes Yes Bisoprolol zydus 5mg TAB BISOPROLOL Yes Yes Bisoprolol unichem 5mg TAB BISOPROLOL Yes Yes Bisoprolol unicorn 5mg TAB BISOPROLOL Yes Yes Bislo 5mg TAB BISOPROLOL Yes Yes Betacor 5mg TAB BISOPROLOL Yes Yes Adco-bisocor 5mg TAB BISOPROLOL Yes Yes Retocar 5mg TAB BISOPROLOL Yes Yes Ziapro 5mg TAB BISOPROLOL Yes Yes Mylan bisoprolol 5mg TAB BISOPROLOL Yes Yes Bilocor 5mg TAB BISOPROLOL Yes Yes Alphagan purite 5ml 1,5mg/1mL OPD BRIMONIDINE Yes Yes Brimoct 5ml 2mg/1mL OPD BRIMONIDINE Yes Yes Budeflam hfa 300dose 100mcg INH BUDESONIDE Yes Yes Pulmicort turbuhaler 200dose 100mcg TBH BUDESONIDE Yes Yes Budeflam hfa 300dose 200mcg INH BUDESONIDE Yes Yes Inflammide novolizer refill 200dose 200mcg REF BUDESONIDE Yes Yes Pulmicort turbuhaler 200dose 200mcg TBH BUDESONIDE Yes Yes Inflammide novolizer complete 200dose 200mcg TBH BUDESONIDE Yes Yes Inflammide novolizer refill 100dose 400mcg REF BUDESONIDE Yes Yes Inflammide novolizer complete 100dose 400mcg TBH BUDESONIDE Yes Yes Entocord ENE BUDESONIDE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

6 and Mylan captopril 25mg TAB CAPTOPRIL Yes Yes Bio-captopril 25mg TAB CAPTOPRIL Yes Yes Adco-captomax 25mg TAB CAPTOPRIL Yes Yes Mylan captopril 50mg TAB CAPTOPRIL Yes Yes Adco-captomax 50mg TAB CAPTOPRIL Yes Yes Tegretol cr 200mg SRT CARBAMAZEPINE Yes Yes Zeptol 200mg TAB CARBAMAZEPINE Yes Yes Degranol 200mg TAB CARBAMAZEPINE Yes Yes Tegretol cr 400mg SRT CARBAMAZEPINE Yes Yes Carloc 12,5mg TAB CARVEDILOL Yes Yes Carvetrend 12,5mg TAB CARVEDILOL Yes Yes Aspen carvedilol 12,5mg TAB CARVEDILOL Yes Yes Carvedilol unicorn 12,5mg TAB CARVEDILOL Yes Yes Vediblok 12,5mg TAB CARVEDILOL Yes Yes Carvetrend 25mg TAB CARVEDILOL Yes Yes Carloc 25mg TAB CARVEDILOL Yes Yes Aspen carvedilol 25mg TAB CARVEDILOL Yes Yes Carvedilol unicorn 25mg TAB CARVEDILOL Yes Yes Vediblok 25mg TAB CARVEDILOL Yes Yes Carloc 6,25mg TAB CARVEDILOL Yes Yes Carvetrend 6,25mg TAB CARVEDILOL Yes Yes Carvedilol unicorn 6,25mg TAB CARVEDILOL Yes Yes Aspen carvedilol 6,25mg TAB CARVEDILOL Yes Yes Vediblok 6,25mg TAB CARVEDILOL Yes Yes Coxleon 100mg CAP CELECOXIB No Yes Coxleon 200mg CAP CELECOXIB No Yes Plasmoquine 200mg CAP CHLOROQUINE Yes Yes Largactil 100mg TAB CHLORPROMAZINE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

7 and Largactil 25mg TAB CHLORPROMAZINE Yes Yes Ciclovent 60 dose 160mcg INH CICLESONIDE Yes Yes Ciclovent 60 dose 80mcg INH CICLESONIDE Yes Yes Adco-talomil 20mg TAB CITALOPRAM Yes Yes Cilate 20mg TAB CITALOPRAM Yes Yes Bio citalopram 20mg TAB CITALOPRAM Yes Yes Arrow citalopram 40mg TAB CITALOPRAM Yes Yes Clonam 0,5mg TAB CLONAZEPAM Yes Yes Rivotril 0,5mg TAB CLONAZEPAM Yes Yes Clonam 2mg TAB CLONAZEPAM Yes Yes Rivotril 2mg TAB CLONAZEPAM Yes Yes Plagrol 75mg TAB CLOPIDOGREL Yes Yes Clopidogrel 75 biotech 75mg TAB CLOPIDOGREL Yes Yes Closolve 75mg TAB CLOPIDOGREL Yes Yes Pharma dynamics clopidogrel 75mg TAB CLOPIDOGREL Yes Yes Aspen clozapine 100mg TAB CLOZAPINE Yes Yes Cloment 100mg TAB CLOZAPINE Yes Yes Aspen clozapine 25mg TAB CLOZAPINE Yes Yes Cloment 25mg TAB CLOZAPINE Yes Yes Haemosolvex ix 500u INJ COAGULATION FACTOR IX Yes Yes 1, , Haemosolvate viii 2x10ml 1000u INJ COAGULATION FACTOR VIII Yes Yes 3, , Haemosolvate viii 300u INJ COAGULATION FACTOR VIII Yes Yes 1, , Haemosolvate viii 10ml 500u INJ COAGULATION FACTOR VIII Yes Yes 1, , Aranesp prefilled syringe 0.4ml 10mcg/0,4mL INJ DARBEPOETIN ALFA Yes Yes Aranesp prefilled syringe 0.5ml 20mcg/0,5mL INJ DARBEPOETIN ALFA Yes Yes Aranesp prefilled syringe 0.3ml 30mcg/0,3mL INJ DARBEPOETIN ALFA Yes Yes Aranesp prefilled syringe 0.4ml 40mcg/0,4mL INJ DARBEPOETIN ALFA Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

8 and Aranesp prefilled syringe 0.5ml 50mcg/0,5mL INJ DARBEPOETIN ALFA Yes Yes Aranesp prefilled syringe 0.3ml 60mcg/0,3mL INJ DARBEPOETIN ALFA Yes Yes 1, , Ddavp 0,1mg TAB DESMOPRESSIN Yes Yes Ddavp nasal spray 5ml 0,1mg/1mL NSS DESMOPRESSIN Yes Yes Ddavp 0,2mg TAB DESMOPRESSIN Yes Yes Mylan diclofenac 25mg TAB DICLOFENAC Yes Yes Diclofenac biotech 25mg TAB DICLOFENAC Yes Yes A-lennon diclofenac 25mg TAB DICLOFENAC Yes Yes A-lennon diclofenac 50mg TAB DICLOFENAC Yes Yes Mylan diclofenac 50mg TAB DICLOFENAC Yes Yes Panamor at 50mg TAB DICLOFENAC Yes Yes Adco-diclofenac 50mg TAB DICLOFENAC Yes Yes Deladex 250mg CAP DIDANOSINE Yes Yes Videx ec 250mg CAP DIDANOSINE Yes Yes Videx ec 400mg CAP DIDANOSINE Yes Yes Deladex 400mg CAP DIDANOSINE Yes Yes Lanoxin paediatric/geriatric 0,05mg/1mL SYR DIGOXIN Yes Yes Lanoxin 0,0625mg TAB DIGOXIN Yes Yes Lanoxin 0,25mg TAB DIGOXIN Yes Yes Adco-zildem sr 180mg SRC DILTIAZEM Yes Yes Adco-zildem sr 240mg SRC DILTIAZEM Yes Yes Adco-zildem 60mg TAB DILTIAZEM Yes Yes Glaucopress 5ml 2% OPD DORZOLAMIDE Yes Yes Trusopt 5ml owi 2% OPD DORZOLAMIDE Yes Yes Cardugen (was merck-doxazosin) 1mg TAB DOXAZOSIN Yes Yes Cardugen (was merck-doxazosin) 4mg TAB DOXAZOSIN Yes Yes Adco-efavirenz 200mg CAP EFAVIRENZ Yes Yes Adco-efavirenz 50mg CAP EFAVIRENZ Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

9 Adco-efavirenz 600mg TAB EFAVIRENZ Yes Yes Elteno TAB EFAVIRENZ, TENOFOVIR DISOPROX Yes Yes Eflaten TAB EFAVIRENZ, TENOFOVIR DISOPROX Yes Yes Trivenz TAB EMTRICITABINE, TENOFOVIR DISOP Yes Yes and Enalapril biotech 10mg TAB ENALAPRIL Yes Yes Alapren 10mg TAB ENALAPRIL Yes Yes Enalapril unicorn 10mg TAB ENALAPRIL Yes Yes Envas 10mg TAB ENALAPRIL Yes Yes Alapren 20mg TAB ENALAPRIL Yes Yes Enalapril biotech 20mg TAB ENALAPRIL Yes Yes Enalapril unicorn 20mg TAB ENALAPRIL Yes Yes Hypace 5mg TAB ENALAPRIL Yes Yes Alapren 5mg TAB ENALAPRIL Yes Yes Enalapril biotech 5mg TAB ENALAPRIL Yes Yes Envas 5mg TAB ENALAPRIL Yes Yes Enap co 20mg/12.5mg 20mg;12,5mg TAB ENALAPRIL AND DIURETICS Yes Yes Pharmapress co 20mg/12.5mg TAB ENALAPRIL AND DIURETICS Yes Yes Repotin 1ml ampoule 2000iu INJ ERYTHROPOIETIN Yes Yes Eprex prefill 2000u/0,5mL INJ ERYTHROPOIETIN Yes Yes Recormon 2000 pre-filled syringe 2000unit/0,3mINJ ERYTHROPOIETIN Yes Yes Repotin 1ml ampoule 4000iu INJ ERYTHROPOIETIN Yes Yes Recormon 4000 iu/0.3ml prefilled syringe4000u/0,3ml INJ ERYTHROPOIETIN Yes Yes Eprex prefill 4000u/0,4mL INJ ERYTHROPOIETIN Yes Yes Recormon 500 iu/0.3ml prefilled syringe INJ ERYTHROPOIETIN Yes Yes Zitolex 10mg TAB ESCITALOPRAM No Yes Accord escitalopram 10mg TAB ESCITALOPRAM No Yes Zytomil 10mg TAB ESCITALOPRAM No Yes Zitolex 20mg TAB ESCITALOPRAM No Yes Discovery Health PBR formulary and benchmark pricing /10/28

10 and Accord escitalopram 20mg TAB ESCITALOPRAM No Yes Zytomil 20mg TAB ESCITALOPRAM No Yes Estro-pause 1mg TAB ESTRADIOL No Yes Estro-pause 2mg TAB ESTRADIOL No Yes Byetta disposable pen 60 doses 2.4ml 10mcg/1dose INJ EXENATIDE Yes Yes Byetta disposable pen 60 dose 1.2ml 5mcg/1dose INJ EXENATIDE Yes Yes Felodipine-hexal 10mg SRT FELODIPINE No Yes Plendil 2,5mg SRT FELODIPINE No Yes Plendil 5mg SRT FELODIPINE No Yes Felodipine-hexal 5mg SRT FELODIPINE No Yes Pregamal TAB FERROUS FUMARATE Yes Yes Tambocor 100mg TAB FLECAINIDE Yes Yes Tambocor cr 100mg SRC FLECAINIDE Yes Yes Tambocor cr 200mg SRC FLECAINIDE Yes Yes Florinef acetate 0,1mg TAB FLUDROCORTISONE Yes Yes Deprozan 20mg CAP FLUOXETINE Yes Yes Prolax 20mg CAP FLUOXETINE Yes Yes Fluoxetine actor 20mg CAP FLUOXETINE Yes Yes Ranflocs 20mg CAP FLUOXETINE Yes Yes Fluanxol 0,5mg TAB FLUPENTIXOL Yes Yes Fluanxol 1mg TAB FLUPENTIXOL Yes Yes Fluanxol depot 1ml 20mg INJ FLUPENTIXOL Yes Yes Fluanxol depot 2ml 40mg INJ FLUPENTIXOL Yes Yes Flixotide 125 cfc free 120 actuations 125mcg INH FLUTICASONE No Yes Flixotide cfc free 120dose 250mcg INH FLUTICASONE No Yes Flonase 120 dose 50mcg AQS FLUTICASONE Yes Yes Flomist 120dose 50mcg AQS FLUTICASONE Yes Yes Flixotide cfc free 120dose 50mcg INH FLUTICASONE No Yes Discovery Health PBR formulary and benchmark pricing /10/28

11 and Be-tabs folic acid 5mg TAB FOLIC ACID Yes Yes Foratec hfa 120dose 12mcg/1dose INH FORMOTEROL Yes Yes Symbicord turbohaler 60dose 160mcg/4.5mcg TBH FORMOTEROL AND BUDESONIDE Yes Yes Symbicord turboh 120dose 160mcg/4,5mcg TBH FORMOTEROL AND BUDESONIDE Yes Yes Symbicord 320/9mcg per inhalation 60dose TBH FORMOTEROL AND BUDESONIDE Yes Yes Vannair 160/4.5mcg per inhalation 120 dose INH FORMOTEROL AND BUDESONIDE Yes Yes Vannair 80/4.5mcg per inhalation 120 dose INH FORMOTEROL AND BUDESONIDE Yes Yes Dulera 100/5ug 120 dose INH FORMOTEROL AND MOMETASONE Yes Yes Dulera 200/5ug 120 dose INH FORMOTEROL AND MOMETASONE Yes Yes Mylan furosemide 40mg TAB FUROSEMIDE Yes Yes Furobe 40mg TAB FUROSEMIDE Yes Yes Dino-retic 40mg TAB FUROSEMIDE Yes Yes Diuresix 40mg TAB FUROSEMIDE Yes Yes Glycomin 5mg TAB GLIBENCLAMIDE Yes Yes Bio-glibenclamide 5mg TAB GLIBENCLAMIDE Yes Yes Diacare 5mg TAB GLIBENCLAMIDE Yes Yes Gliclazide unicorn mr 30mg SRT GLICLAZIDE Yes Yes Dyna gliclazide sr 30mg SRT GLICLAZIDE Yes Yes Diaran mr 30mg SRT GLICLAZIDE Yes Yes Diaglucide mr 60mg SRT GLICLAZIDE Yes Yes Sandoz gliclazide 80mg TAB GLICLAZIDE Yes Yes Austell-gliclazide 80mg TAB GLICLAZIDE Yes Yes Mylan gliclazide 80mg TAB GLICLAZIDE Yes Yes Diaglucide 80mg TAB GLICLAZIDE Yes Yes Adco-glucomed 80mg TAB GLICLAZIDE Yes Yes Glygard 80mg TAB GLICLAZIDE Yes Yes Glycron 80mg TAB GLICLAZIDE Yes Yes On-call plus ez strips STR GLUCOSE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

12 and Fora diamond blood glucose strip ZZZ GLUCOSE Yes Yes Test blood glucose strip clicks bionime gs550 ZZZ GLUCOSE Yes Yes Freestyle optium glucose test strips ZZZ GLUCOSE Yes Yes Caresens n glucose test strips 29g ZZZ GLUCOSE Yes Yes Glucose tests strips easymax ZZZ GLUCOSE Yes Yes Glucoplus STR GLUCOSE Yes Yes Glucocheck strips 50s ZZZ GLUCOSE Yes Yes Glucoplus provider strips STR GLUCOSE Yes Yes Onetouch select test strips ZZZ GLUCOSE Yes Yes Onetouch select plus test strip ZZZ GLUCOSE Yes Yes Accu-chek active strip ZZZ GLUCOSE Yes Yes Accu chek instant strip ZZZ GLUCOSE Yes Yes Angised 0,5mg SLT GLYCERYL TRINITRATE Yes Yes Seebri breezhaler (30 caps & inhaler) KIT GLYCOPYRRONIUM BROMIDE Yes Yes Engerix-b (new) monodose 1ml 20mcg VAC HEPATITIS B, PURIFIED ANTIGEN Yes Yes Heberbio hbv sgl dose 1ml adult 20mcg/1mL VAC HEPATITIS B, PURIFIED ANTIGEN Yes Yes Euvax b vial 1ml 20mcg/1mL VAC HEPATITIS B, PURIFIED ANTIGEN Yes Yes Hyperphen 10mg TAB HYDRALAZINE Yes Yes Sandoz hydralazine 25mg TAB HYDRALAZINE Yes Yes Hyperphen 50mg TAB HYDRALAZINE Yes Yes Ridaq 12,5mg TAB HYDROCHLOROTHIAZIDE Yes Yes Hexazide 25mg TAB HYDROCHLOROTHIAZIDE Yes Yes Covocort 10mg TAB HYDROCORTISONE Yes Yes Ibucine (was Ibumax) 200mg TAB IBUPROFEN Yes Yes Ibunate 200mg TAB IBUPROFEN Yes Yes Betaprofen 200mg TAB IBUPROFEN Yes Yes Ibucine (was Ibumax) 400mg TAB IBUPROFEN Yes Yes Betaprofen fc 400mg TAB IBUPROFEN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

13 and Bren 400mg TAB IBUPROFEN Yes Yes Ranfen 400mg TAB IBUPROFEN Yes Yes Onbrez breezhaler (30 caps & inhaler) KIT INDACATEROL Yes Yes Daptril 2,5mg TAB INDAPAMIDE Yes Yes Mylan indapamide 2,5mg TAB INDAPAMIDE Yes Yes Cipla-indapamide 2,5mg TAB INDAPAMIDE Yes Yes Methocaps 25mg CAP INDOMETACIN Yes Yes Gulf indomethacin 25mg CAP INDOMETACIN Yes Yes Betacin 25mg CAP INDOMETACIN Yes Yes Influvac 0.5ml VAC INFLUENZA, PURIFIED ANTIGEN Yes Yes Vaxigrip single dose 0.5ml pre-filled VAC INFLUENZA, PURIFIED ANTIGEN Yes Yes Biosulin r cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin r cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin r vial 10ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin n vial 10ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Biosulin l cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Biosulin n cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin n cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin n kwickpen 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Biosulin cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin 30/70 kwikpen 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Insuman comb 30/70 cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin 30/70 vial 10ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Humulin 30/70 cartridge 3ml 100u/1mL INJ INSULIN (HUMAN) Yes Yes Actraphane hm(ge) vial 10ml 100u/1mL INJ INSULIN (HUMAN) No Yes Novomix 30 flexpen 3ml 100u/1mL INJ INSULIN ASPART No Yes Levemir prefilled cartridge 3ml 100u/1mL INJ INSULIN DETEMIR No Yes Optisulin pen 3ml 100iu/1mL INJ INSULIN GLARGINE No Yes Discovery Health PBR formulary and benchmark pricing /10/28

14 and Optisulin cartridge 3ml 100u/1mL INJ INSULIN GLARGINE Yes Yes Basaglar cartridge 3ml 100u/1mL INJ INSULIN GLARGINE Yes Yes Basaglar pre-filled pen 3ml 100u/1mL INJ INSULIN GLARGINE No Yes Apidra cartridges 3ml 100iu/1mL INJ INSULIN GLULISINE Yes Yes Humalog vial 10ml 100u/1mL INJ INSULIN LISPRO Yes Yes Humalog cartridge 3ml 100u/1mL INJ INSULIN LISPRO Yes Yes Humalog mix 25 cartridge 3ml 100u/1mL INJ INSULIN LISPRO Yes Yes Humalog mix 25 vial 10ml 100u/1mL INJ INSULIN LISPRO Yes Yes Humalog mix 50 cartridge 3ml 100u/1mL INJ INSULIN LISPRO Yes Yes Humalog kwikpen 3ml INJ INSULIN LISPRO Yes Yes Humalog mix 50 kwikpen 3ml INJ INSULIN LISPRO No Yes Humalog mix 25 kwikpen 3ml INJ INSULIN LISPRO No Yes Rebif 22 rebidose pre-filled pen 0.5ml 22mcg/0,5mL INJ INTERFERON BETA-1A Yes Yes Rebif 22 pre-filled syringe 0.5ml 22mcg/0,5mL INJ INTERFERON BETA-1A Yes Yes Avonex prefilled syringe 0.5ml 30mcg/0,5mL INJ INTERFERON BETA-1A Yes Yes 2, , Rebif 44 rebidose pre-filled pen 0.5ml 44mcg/0,5mL INJ INTERFERON BETA-1A Yes Yes Rebif 44 pre-filled syringe 0.5ml 44mcg/0,5mL INJ INTERFERON BETA-1A Yes Yes Betaferon pre-filled syringe 1ml u/1mLINJ INTERFERON BETA-1B Yes Yes Atrovent HFA 200dose 20mcg INH IPRATROPIUM BROMIDE Yes Yes Ipvent HFA 200 dose 40mcg/1dose INH IPRATROPIUM BROMIDE Yes Yes Dynarb 150mg TAB IRBESARTAN No Yes Dynarb 300mg TAB IRBESARTAN No Yes Equifer ampoule 5ml 100mg/5mL INJ IRON, PARENTERAL PREPARATIONS Yes Yes Rautevene solution for injection ampoule100mg/5ml INJ IRON, PARENTERAL PREPARATIONS Yes Yes Sucrofer 5ml 20mg/1mL INJ IRON, PARENTERAL PREPARATIONS Yes Yes Zypiron 5ml vial 20mg/1mL INJ IRON, PARENTERAL PREPARATIONS Yes Yes Cosmofer ampoule 2ml 50mg/1mL INJ IRON, PARENTERAL PREPARATIONS Yes Yes Sandoz isosorbide dinitrate 10mg TAB ISOSORBIDE DINITRATE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

15 and Isordil 30mg TAB ISOSORBIDE DINITRATE Yes Yes Sandoz isosorbide dinitrate 5mg SLT ISOSORBIDE DINITRATE Yes Yes Elantan 20mg TAB ISOSORBIDE MONONITRATE Yes Yes Elantan la 50mg SRC ISOSORBIDE MONONITRATE Yes Yes Monicor sr 60mg SRT ISOSORBIDE MONONITRATE Yes Yes Adco-lamivudine 10mg/1mL SOL LAMIVUDINE Yes Yes Adco-lamivudine 150mg TAB LAMIVUDINE Yes Yes Girotec 100mg TAB LAMOTRIGINE Yes Yes Epitec 100mg TAB LAMOTRIGINE Yes Yes Dyna-lamotrigine 100mg TAB LAMOTRIGINE Yes Yes Lamitor 100mg TAB LAMOTRIGINE Yes Yes Girotec 200mg TAB LAMOTRIGINE Yes Yes Dyna-lamotrigine 200mg TAB LAMOTRIGINE Yes Yes Lamitor 200mg TAB LAMOTRIGINE Yes Yes Epitec 200mg TAB LAMOTRIGINE Yes Yes Dyna-lamotrigine 25mg TAB LAMOTRIGINE Yes Yes Epitec 25mg TAB LAMOTRIGINE Yes Yes Lamitor 25mg TAB LAMOTRIGINE Yes Yes Lamitor 50mg TAB LAMOTRIGINE Yes Yes Girotec 50mg TAB LAMOTRIGINE Yes Yes Lamidus 50mg TAB LAMOTRIGINE Yes Yes Epitec 50mg TAB LAMOTRIGINE Yes Yes Dyna-lamotrigine 50mg TAB LAMOTRIGINE Yes Yes Atana 2.5ml 50mcg/1mL OPD LATANOPROST Yes Yes Spersatan 2.5ml 50mcg/1mL OPD LATANOPROST Yes Yes Xalatan 2.5ml 50mcg/1mL OPD LATANOPROST Yes Yes Sinemet 25mg/250mg 25mg;250mg TAB LEVODOPA AND DECARBOXYLASE I Yes Yes Teva carbi-levo 25/100 TAB LEVODOPA AND DECARBOXYLASE I Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

16 and Sinemet 25mg/100mg TAB LEVODOPA AND DECARBOXYLASE I Yes Yes Teva carbi-levo 25/250 TAB LEVODOPA AND DECARBOXYLASE I Yes Yes Euthyrox 100mcg TAB LEVOTHYROXINE SODIUM Yes Yes Euthyrox 25mcg TAB LEVOTHYROXINE SODIUM Yes Yes Euthyrox 50mcg TAB LEVOTHYROXINE SODIUM Yes Yes Sinopren 10mg TAB LISINOPRIL Yes Yes Austell-lisinopril 10mg TAB LISINOPRIL Yes Yes Sinopren 20mg TAB LISINOPRIL Yes Yes Austell-lisinopril 20mg TAB LISINOPRIL Yes Yes Sinopren 5mg TAB LISINOPRIL Yes Yes Zestoretic 10mg/12.5mg 10mg;12,5mg TAB LISINOPRIL AND DIURETICS Yes Yes Zestoretic 20mg/12.5mg 20mg;12,5mg TAB LISINOPRIL AND DIURETICS Yes Yes Lisozide 10mg/12.5mg TAB LISINOPRIL AND DIURETICS Yes Yes Lisoretic 10/12.5 TAB LISINOPRIL AND DIURETICS Yes Yes Lisinopril co unicorn 10mg/12.5mg TAB LISINOPRIL AND DIURETICS Yes Yes Adco-zetomax co 10/12.5 TAB LISINOPRIL AND DIURETICS Yes Yes Lisozide 20mg/12.5mg TAB LISINOPRIL AND DIURETICS Yes Yes Lisinopril co unicorn 20mg/12.5mg TAB LISINOPRIL AND DIURETICS Yes Yes Lisoretic 20/12.5 TAB LISINOPRIL AND DIURETICS Yes Yes Adco-zetomax co 20/12.5 TAB LISINOPRIL AND DIURETICS Yes Yes Camcolit 250mg TAB LITHIUM Yes Yes Camcolit 400mg TAB LITHIUM Yes Yes Kaletra SYR LOPINAVIR AND RITONAVIR 2 Yes Yes Aluvia 200mg/50mg TAB LOPINAVIR AND RITONAVIR 2 Yes Yes Aluvia 100mg/25mg TAB LOPINAVIR AND RITONAVIR 2 Yes Yes Ciplazar 100mg TAB LOSARTAN No Yes Spec-losartan 100mg TAB LOSARTAN No Yes Losartan unicorn 100mg TAB LOSARTAN No Yes Discovery Health PBR formulary and benchmark pricing /10/28

17 and Zartan 100mg TAB LOSARTAN No Yes Losacar co 50mg/12,5mg TAB LOSARTAN AND DIURETICS Yes Yes Losaar plus 50mg/12.5mg TAB LOSARTAN AND DIURETICS Yes Yes Netrasol co 50/12.5mg TAB LOSARTAN AND DIURETICS Yes Yes Losartan co unicorn 50mg/12.5mg TAB LOSARTAN AND DIURETICS Yes Yes Hytenza co 50mg/12.5mg TAB LOSARTAN AND DIURETICS Yes Yes Zartan co 50mg/12.5mg TAB LOSARTAN AND DIURETICS Yes Yes Netrasol co 100/25mg TAB LOSARTAN AND DIURETICS Yes Yes Losaar plus 100mg/25mg TAB LOSARTAN AND DIURETICS Yes Yes Zartan co 100mg/25mg TAB LOSARTAN AND DIURETICS Yes Yes Losartan co unicorn 100mg/25mg TAB LOSARTAN AND DIURETICS Yes Yes Hexal-MPA 10mg TAB MEDROXYPROGESTERONE No Yes Hexal-MPA 5mg TAB MEDROXYPROGESTERONE No Yes Adco-meloxicam 15mg TAB MELOXICAM Yes Yes Medoxicam 7,5mg TAB MELOXICAM Yes Yes Flexocam 7,5mg TAB MELOXICAM Yes Yes Zydus-meloxicam 7,5mg TAB MELOXICAM Yes Yes Coxflam 7,5mg TAB MELOXICAM Yes Yes Pentasa 1000mg SUP MESALAZINE Yes Yes Salofalk 1000mg SAC MESALAZINE Yes Yes Mezavant 1200mg ERT MESALAZINE Yes Yes Asacol 400mg TAB MESALAZINE Yes Yes Pentasa 500mg TAB MESALAZINE Yes Yes Asacol 800mg TAB MESALAZINE Yes Yes Diaphage 1000mg TAB METFORMIN Yes Yes Bigsens 1000mg TAB METFORMIN Yes Yes Romidab 1000mg TAB METFORMIN Yes Yes Mylan metformin 1000mg TAB METFORMIN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

18 and Mengen 1000mg TAB METFORMIN Yes Yes Metored 1000mg TAB METFORMIN Yes Yes Sandoz metformin 500MG TAB METFORMIN Yes Yes Apex-metformin 500mg TAB METFORMIN Yes Yes Accord metformin 500mg TAB METFORMIN Yes Yes Metformin alkem 500mg TAB METFORMIN Yes Yes Metchek 500mg TAB METFORMIN Yes Yes Romidab 500mg TAB METFORMIN Yes Yes Bigsens 500mg TAB METFORMIN Yes Yes Mengen 500mg TAB METFORMIN Yes Yes Mylan metformin 500mg TAB METFORMIN Yes Yes Gluconorm 500mg TAB METFORMIN Yes Yes Diamin 500mg TAB METFORMIN Yes Yes Metphage 500mg TAB METFORMIN Yes Yes Diaphage 500mg TAB METFORMIN Yes Yes Diaformin 500mg TAB METFORMIN Yes Yes Austell-metformin 500mg TAB METFORMIN Yes Yes Sandoz metformin FCT 500mg TAB METFORMIN Yes Yes Metored 500mg TAB METFORMIN Yes Yes Arrow metformin 500mg TAB METFORMIN Yes Yes Metforal 500mg TAB METFORMIN Yes Yes Accord metformin 850mg TAB METFORMIN Yes Yes Metchek 850mg TAB METFORMIN Yes Yes Bigsens 850mg TAB METFORMIN Yes Yes Romidab 850mg TAB METFORMIN Yes Yes Metformin alkem 850mg TAB METFORMIN Yes Yes Diaphage 850mg TAB METFORMIN Yes Yes Mylan metformin 850mg TAB METFORMIN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

19 and Mengen 850mg TAB METFORMIN Yes Yes Diamin 850mg TAB METFORMIN Yes Yes Austell-metformin 850mg TAB METFORMIN Yes Yes Metphage 850mg TAB METFORMIN Yes Yes Gluconorm 850mg TAB METFORMIN Yes Yes Diaformin forte 850mg TAB METFORMIN Yes Yes Metored 850mg TAB METFORMIN Yes Yes Metforal 850mg TAB METFORMIN Yes Yes Sandoz metformin FCT 850mg TAB METFORMIN Yes Yes Arrow metformin 850mg TAB METFORMIN Yes Yes Abitrexate 2,5mg TAB METHOTREXATE Yes Yes Methotrexate 2,5mg TAB METHOTREXATE Yes Yes Mircera prefilled syringe 0.3ml 100mcg/0,3mLINJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 1, , Mircera prefilled syringe 0.3ml 120mcg/0,3mLINJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 2, , Mircera prefilled syringe 0.3ml 150mcg/0,3mLINJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 3, , Mircera prefilled syringe 0.3ml 200mcg/0,3mLINJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 3, , Mircera prefilled syringe 0.3ml 250mcg/0,3mLINJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 4, , Mircera prefilled syringe 0.3ml 30mcg/0,3mL INJ METHOXY POLYETHYLENE GLYCOL- Yes Yes Mircera prefilled syringe 0.3ml 50mcg/0,3mL INJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 1, , Mircera prefilled syringe 0.3ml 75mcg/0,3mL INJ METHOXY POLYETHYLENE GLYCOL- Yes Yes 1, , Mylan methyldopa 250mg TAB METHYLDOPA (LEVOROTATORY) Yes Yes Hypotone 250mg TAB METHYLDOPA (LEVOROTATORY) Yes Yes Asmanex twisthaler 30 dose 200mcg/1doseTBH MOMETASONE No Yes Asmanex twisthaler 60 dose 200mcg/1doseTBH MOMETASONE No Yes Asmanex twisthaler 30 dose 400mcg/1doseTBH MOMETASONE No Yes Asmanex twisthaler 60 dose 400mcg/1doseTBH MOMETASONE No Yes Lumont 10mg TAB MONTELUKAST Yes Yes Sintair 10mg TAB MONTELUKAST No Yes Discovery Health PBR formulary and benchmark pricing /10/28

20 and Monteflo 10mg TAB MONTELUKAST No Yes Topraz 10mg TAB MONTELUKAST No Yes Lumont 4mg CHU MONTELUKAST Yes Yes Sintair 4mg CHU MONTELUKAST No Yes Monteflo 4mg CHU MONTELUKAST No Yes Topraz 4mg CHU MONTELUKAST No Yes Lumont 5mg CHU MONTELUKAST Yes Yes Sintair 5mg CHU MONTELUKAST No Yes Monteflo 5mg CHU MONTELUKAST No Yes Topraz 5mg CHU MONTELUKAST No Yes Naproscript 250mg TAB NAPROXEN Yes Yes Mylan naproxen 250mg TAB NAPROXEN Yes Yes Adco-nevirapine 200mg TAB NEVIRAPINE Yes Yes Viropon 50mg/5mL SUS NEVIRAPINE Yes Yes Aspen nevirapine 50mg/5mL SUS NEVIRAPINE Yes Yes Viramune oral 50mg/5mL SUS NEVIRAPINE Yes Yes Cipalat retard 20mg TAB NIFEDIPINE Yes Yes Estro-pause n TAB NORETHISTERONE AND ESTROGEN No Yes Activelle TAB NORETHISTERONE AND ESTROGEN No Yes Olawin oradispersible 10mg MLT OLANZAPINE Yes Yes Prexolan odt 10mg MLT OLANZAPINE Yes Yes Olawin 10mg TAB OLANZAPINE Yes Yes Redilanz 10mg TAB OLANZAPINE Yes Yes Olexar 10mg TAB OLANZAPINE Yes Yes Zylena 10mg TAB OLANZAPINE Yes Yes Olawin oradispersible 5mg MLT OLANZAPINE Yes Yes Prexolan odt 5mg MLT OLANZAPINE Yes Yes Olawin 5mg TAB OLANZAPINE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

21 and Redilanz 5mg TAB OLANZAPINE Yes Yes Olexar 5mg TAB OLANZAPINE Yes Yes Zylena 5mg TAB OLANZAPINE Yes Yes Dipentum 250mg CAP OLSALAZINE Yes Yes Oxyrest 5mg TAB OXYBUTYNIN Yes Yes Mylan oxybutynin 5mg TAB OXYBUTYNIN Yes Yes Lenditro 5mg TAB OXYBUTYNIN Yes Yes Cetapon 500mg TAB PARACETAMOL Yes Yes Painogesic 500mg TAB PARACETAMOL Yes Yes Adco-napamol 500mg TAB PARACETAMOL Yes Yes Adco-prolief 500mg TAB PARACETAMOL Yes Yes Ran-perindopril 4mg TAB PERINDOPRIL Yes Yes Ciplasyl 4 4mg TAB PERINDOPRIL Yes Yes Pearinda 4mg TAB PERINDOPRIL No Yes Spec-perindopril 4mg TAB PERINDOPRIL No Yes Perindopril unicorn 4mg TAB PERINDOPRIL No Yes Prexum 5mg TAB PERINDOPRIL No Yes Spec-perindopril 8mg TAB PERINDOPRIL No Yes Perindopril unicorn 8mg TAB PERINDOPRIL No Yes Pearinda 8mg TAB PERINDOPRIL No Yes Ciplasyl 8 8mg TAB PERINDOPRIL No Yes Coveram 10/10 TAB PERINDOPRIL AND AMLODIPINE No Yes Coveram 10/5 TAB PERINDOPRIL AND AMLODIPINE No Yes Coveram 5/10 TAB PERINDOPRIL AND AMLODIPINE No Yes Coveram 5/5 TAB PERINDOPRIL AND AMLODIPINE No Yes Pearinda plus 4mg/1.25mg TAB PERINDOPRIL AND DIURETICS No Yes Ciplasyl plus 4mg/1.25mg TAB PERINDOPRIL AND DIURETICS No Yes Vectoryl plus 4mg/1.25mg TAB PERINDOPRIL AND DIURETICS No Yes Discovery Health PBR formulary and benchmark pricing /10/28

22 and Perindopril co unicorn 4mg/1.25mg TAB PERINDOPRIL AND DIURETICS No Yes Prexum plus 5mg/1.25mg TAB PERINDOPRIL AND DIURETICS No Yes Bioprexum plus 10mg/2.5mg TAB PERINDOPRIL AND DIURETICS No Yes Sedabarb 30mg TAB PHENOBARBITAL Yes Yes Lethyl 30mg TAB PHENOBARBITAL Yes Yes Phenytoin sod 100mg TAB PHENYTOIN Yes Yes Accord pioglitazone 15mg TAB PIOGLITAZONE Yes Yes Cipla-pioglitazone 15mg TAB PIOGLITAZONE Yes Yes Accord pioglitazone 30mg TAB PIOGLITAZONE Yes Yes Cipla-pioglitazone 30mg TAB PIOGLITAZONE Yes Yes Accord pioglitazone 45mg TAB PIOGLITAZONE Yes Yes Roxifen 20mg CAP PIROXICAM Yes Yes Pyrocaps 20mg CAP PIROXICAM Yes Yes Imovax pneumo 23 VAC PNEUMOCOCCUS, PURIFIED POLYS Yes Yes Ultipot 600mg TAB POTASSIUM CHLORIDE Yes Yes Plenish k 600mg TAB POTASSIUM CHLORIDE Yes Yes Sandoz k mg TAB POTASSIUM CHLORIDE Yes Yes Potassium chloride unicorn 600mg TAB POTASSIUM CHLORIDE Yes Yes Mylan pramipexole 0,125mg TAB PRAMIPEXOLE Yes Yes Pramex 0,125mg TAB PRAMIPEXOLE Yes Yes Oxpola 0,125mg TAB PRAMIPEXOLE Yes Yes Pramex 0,25mg TAB PRAMIPEXOLE Yes Yes Mylan pramipexole 0,25mg TAB PRAMIPEXOLE Yes Yes Oxpola 0,25mg TAB PRAMIPEXOLE Yes Yes Mylan pramipexole 1mg TAB PRAMIPEXOLE Yes Yes Pramex 1mg TAB PRAMIPEXOLE Yes Yes Oxpola 1mg TAB PRAMIPEXOLE Yes Yes Trolic 5mg TAB PREDNISONE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

23 and Panafcort 5mg TAB PREDNISONE Yes Yes Be-tabs prednisone 5mg TAB PREDNISONE Yes Yes Rythmol 150mg TAB PROPAFENONE Yes Yes Rythmol 300mg TAB PROPAFENONE Yes Yes Indoblok 10mg TAB PROPRANOLOL Yes Yes Inderal 10mg TAB PROPRANOLOL Yes Yes Indoblok 40mg TAB PROPRANOLOL Yes Yes Purbloka 40mg TAB PROPRANOLOL Yes Yes Mylan quetiapine 100mg TAB QUETIAPINE Yes Yes Spec quetiapine 100mg TAB QUETIAPINE Yes Yes Dopaquel 100mg TAB QUETIAPINE Yes Yes Psyquet 100mg TAB QUETIAPINE Yes Yes Quetiapine biotech 100mg TAB QUETIAPINE Yes Yes Serez 100mg TAB QUETIAPINE Yes Yes Quetoser 100mg TAB QUETIAPINE Yes Yes Mylan quetiapine 200mg TAB QUETIAPINE Yes Yes Serez 200mg TAB QUETIAPINE Yes Yes Dopaquel 200mg TAB QUETIAPINE Yes Yes Spec quetiapine 200mg TAB QUETIAPINE Yes Yes Quetiapine biotech 200mg TAB QUETIAPINE Yes Yes Psyquet 200mg TAB QUETIAPINE Yes Yes Quetoser 200mg TAB QUETIAPINE Yes Yes Mylan quetiapine 25mg TAB QUETIAPINE Yes Yes Spec quetiapine 25mg TAB QUETIAPINE Yes Yes Psyquet 25mg TAB QUETIAPINE Yes Yes Dopaquel 25mg TAB QUETIAPINE Yes Yes Serez 25mg TAB QUETIAPINE Yes Yes Quetiapine biotech 25mg TAB QUETIAPINE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

24 and Quetoser 25mg TAB QUETIAPINE Yes Yes Mylan quetiapine 300mg TAB QUETIAPINE Yes Yes Quetiapine biotech 300mg TAB QUETIAPINE Yes Yes Serez 300mg TAB QUETIAPINE Yes Yes Spec quetiapine 300mg TAB QUETIAPINE Yes Yes Dopaquel 300mg TAB QUETIAPINE Yes Yes Psyquet 300mg TAB QUETIAPINE Yes Yes Quetoser 300mg TAB QUETIAPINE Yes Yes Accumax 10mg TAB QUINAPRIL No Yes Accumax 20mg TAB QUINAPRIL No Yes Reserpine 0,25mg TAB RESERPINE Yes Yes Zoxadon 0,5mg TAB RISPERIDONE Yes Yes Risnia 0,5mg TAB RISPERIDONE Yes Yes Perizal 0,5mg TAB RISPERIDONE Yes Yes Rispacor 0,5mg TAB RISPERIDONE Yes Yes Zoxadon 1mg TAB RISPERIDONE Yes Yes Risnia 1mg TAB RISPERIDONE Yes Yes Perizal 1mg TAB RISPERIDONE Yes Yes Rispevon 1mg TAB RISPERIDONE Yes Yes Rispacor 1mg TAB RISPERIDONE Yes Yes Zoxadon 2mg TAB RISPERIDONE Yes Yes Risnia 2mg TAB RISPERIDONE Yes Yes Perizal 2mg TAB RISPERIDONE Yes Yes Rispevon 2mg TAB RISPERIDONE Yes Yes Rispacor 2mg TAB RISPERIDONE Yes Yes Zoxadon 3mg TAB RISPERIDONE Yes Yes Rispevon 3mg TAB RISPERIDONE Yes Yes Risnia 3mg TAB RISPERIDONE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

25 and Rispacor 3mg TAB RISPERIDONE Yes Yes Perizal 3mg TAB RISPERIDONE Yes Yes Zoxadon 4mg TAB RISPERIDONE Yes Yes Rispevon 4mg TAB RISPERIDONE Yes Yes Norvir 100mg CAP RITONAVIR Yes Yes Norvir 100mg TAB RITONAVIR Yes Yes Norvir 400mg/5mL SYR RITONAVIR Yes Yes Accord ropinirole 0,25mg TAB ROPINIROLE Yes Yes Requip 0,25mg TAB ROPINIROLE Yes Yes Accord ropinirole 0,5mg TAB ROPINIROLE Yes Yes Requip 0,5mg TAB ROPINIROLE Yes Yes Accord ropinirole 1mg TAB ROPINIROLE Yes Yes Requip 1mg TAB ROPINIROLE Yes Yes Accord ropinirole 2mg TAB ROPINIROLE Yes Yes Requip 2mg TAB ROPINIROLE Yes Yes Accord ropinirole 5mg TAB ROPINIROLE Yes Yes Requip 5mg TAB ROPINIROLE Yes Yes Venteze cfc free 200 dose 100mcg INH SALBUTAMOL Yes Yes Asthavent ecohaler 200dose 100mcg INH SALBUTAMOL Yes Yes Duolin hfa 200dose INH SALBUTAMOL AND IPATROPRIUM B Yes Yes Serevent cfc-free 120dose 25mcg INH SALMETEROL Yes Yes Serevent accuhaler 60dose 50mcg ACC SALMETEROL Yes Yes Foxair accuhaler 60 dose 50/100 ACC SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/125 hfa 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/125 hfa synchrobreathe 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/250 hfa synchrobreathe 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/250 hfa 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Foxair accuhaler 60 dose 50/250 ACC SALMETEROL AND FLUTICASONE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

26 and Foxair accuhaler 60 dose 50/500 ACC SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/50 hfa synchrobreathe 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Sereflo 25/50 hfa 120 dose INH SALMETEROL AND FLUTICASONE Yes Yes Onglyza 2,5mg TAB SAXAGLIPTIN Yes Yes Onglyza 5mg TAB SAXAGLIPTIN Yes Yes Dyna sertraline 100mg TAB SERTRALINE Yes Yes Serlife 100mg TAB SERTRALINE No Yes Serdep 100mg TAB SERTRALINE No Yes Dyna sertraline 50mg TAB SERTRALINE Yes Yes Serlife 50mg TAB SERTRALINE No Yes Serdep 50mg TAB SERTRALINE No Yes Austell-simvastatin 10mg TAB SIMVASTATIN Yes Yes Zysim 10mg TAB SIMVASTATIN Yes Yes Cipla-simvastatin 10mg TAB SIMVASTATIN Yes Yes Adco-simvastatin 10mg TAB SIMVASTATIN Yes Yes Aspen simvastatin 10mg TAB SIMVASTATIN Yes Yes Austell-simvastatin 20mg TAB SIMVASTATIN Yes Yes Zysim 20mg TAB SIMVASTATIN Yes Yes Cipla-simvastatin 20mg TAB SIMVASTATIN Yes Yes Adco-simvastatin 20mg TAB SIMVASTATIN Yes Yes Aspen simvastatin 20mg TAB SIMVASTATIN Yes Yes Choleste 20mg TAB SIMVASTATIN Yes Yes Cipla-simvastatin 40mg TAB SIMVASTATIN Yes Yes Adco-simvastatin 40mg TAB SIMVASTATIN Yes Yes Aspen simvastatin 40mg TAB SIMVASTATIN Yes Yes Choleste 40mg TAB SIMVASTATIN Yes Yes Austell-simvastatin 40mg TAB SIMVASTATIN Yes Yes Simvacor 40mg TAB SIMVASTATIN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

27 and Sotahexal 160mg TAB SOTALOL Yes Yes Sotahexal 80mg TAB SOTALOL Yes Yes Aldactone 25mg TAB SPIRONOLACTONE Yes Yes Sandoz spironolactone 25mg TAB SPIRONOLACTONE Yes Yes Spiractin 25mg TAB SPIRONOLACTONE Yes Yes Aspen stavudine 15mg CAP STAVUDINE Yes Yes Aspen stavudine 20mg CAP STAVUDINE Yes Yes Aspen stavudine 30mg CAP STAVUDINE Yes Yes Vari-stavudine 30mg CAP STAVUDINE Yes Yes Nevasta TAB STAVUDINE, LAMIVUDINE AND NEV Yes Yes Salazopyrin en 500mg ECT SULFASALAZINE Yes Yes Salazopyrin 500mg TAB SULFASALAZINE Yes Yes Adco tenofovir 300mg TAB TENOFOVIR DISOPROXIL Yes Yes Adco emtevir 200mg/300mg TAB TENOFOVIR DISOPROXIL AND EMTR Yes Yes Sandoz theophylline anhydrous 200mg SRT THEOPHYLLINE Yes Yes Sandoz theophylline anhydrous 300mg SRT THEOPHYLLINE Yes Yes Occumol 0,5% OPD TIMOLOL Yes Yes Glaucosan 5ml 0,5% OPD TIMOLOL Yes Yes Cosopt 5ml 0,5% OPD TIMOLOL, COMBINATIONS Yes Yes Combigan 2mg/5mg 5ml OPD TIMOLOL, COMBINATIONS Yes Yes Glaumide-co 5ml OPD TIMOLOL, COMBINATIONS Yes Yes Glauopt co 5ml OPD TIMOLOL, COMBINATIONS Yes Yes Ganfort 3ml OPD TIMOLOL, COMBINATIONS Yes Yes Co-atana 2.5ml OPD TIMOLOL, COMBINATIONS Yes Yes Xalacom 2.5ml OPD TIMOLOL, COMBINATIONS Yes Yes Duotrav 2.5ml OPD TIMOLOL, COMBINATIONS Yes Yes Azarga 5ml OPD TIMOLOL, COMBINATIONS Yes Yes Forvent (refill) 18mcg CPS TIOTROPIUM BROMIDE Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

28 and Epitoz 100mg TAB TOPIRAMATE Yes Yes Epitoz 25mg TAB TOPIRAMATE Yes Yes Epitoz 50mg TAB TOPIRAMATE Yes Yes Tranexamic acid medwich 500mg TAB TRANEXAMIC ACID Yes Yes Travatan 2,5ml 0,004% OPD TRAVOPROST Yes Yes Epilim crushable 100mg TAB VALPROIC ACID Yes Yes Convulex 150mg CAP VALPROIC ACID Yes Yes Eprolep cr mg SRT VALPROIC ACID Yes Yes Navalpro cr 200mg SRT VALPROIC ACID Yes Yes Epilizine cr 200mg SRT VALPROIC ACID Yes Yes Epilim sugar free 200mg/5mL SYR VALPROIC ACID Yes Yes Convulex 250mg/5mL SYR VALPROIC ACID Yes Yes Valeptic cr 300mg SRT VALPROIC ACID Yes Yes Eprolep cr mg SRT VALPROIC ACID Yes Yes Navalpro cr 300mg SRT VALPROIC ACID Yes Yes Epilizine cr 300mg SRT VALPROIC ACID Yes Yes Valeptic cr 500mg SRT VALPROIC ACID Yes Yes Eprolep cr mg SRT VALPROIC ACID Yes Yes Navalpro cr 500mg SRT VALPROIC ACID Yes Yes Epilizine cr 500mg SRT VALPROIC ACID Yes Yes Dynaval co 160mg/12.5mg TAB VALSARTAN AND DIURETICS No Yes Dynaval co 80mg/12.5mg TAB VALSARTAN AND DIURETICS No Yes Dynaval co 160mg/25mg TAB VALSARTAN AND DIURETICS No Yes Verahexal 240 sr 240mg SRT VERAPAMIL Yes Yes Vasomil 40mg TAB VERAPAMIL Yes Yes Vasomil 80mg TAB VERAPAMIL Yes Yes Cipla-warfarin 1mg TAB WARFARIN Yes Yes Cipla-warfarin 5mg TAB WARFARIN Yes Yes Discovery Health PBR formulary and benchmark pricing /10/28

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