Chronic Illness Benefit medicine list (formulary) 2018

Transcription

1 Chronic Illness Benefit medicine list (formulary) 2018 Who we are The Anglovaal Group Medical Scheme (referred to as the Scheme ), registration number 1571, is a nonprofit 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. Contact us You can call us on or visit for more information.

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 2018 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 25 04/2018

3 Chronic Illness Benefit 2018 The Prescribed s (PMB) medicine list Prescribed Addison s disease R175 Systemic Corticosteroids: Hydrocortisone R125 Systemic Corticosteroids: Mineralocorticoids Asthma R185 Adrenergics: Long acting - Formoterol R475 Adrenergics: Long acting - Salmeterol 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 R40 R270 R155 Adrenergics: Short acting Salbutamol Anti-asthmatics: Leukotriene receptor antagonists Anti-asthmatics: Systemic xanthines R415 Formoterol and Budesonide Formoterol and Budesonide R390 Formoterol and Mometasone Formoterol and Mometasone R245 Inhaled anticholinergics: Ipratropium bromide Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg Montelukast Lumont 4mg; Monteflo Sintair Topraz 4mg; 4mg; 4mg; Theophylline Sandoz Theophylline anhydrous 200mg; 300mg Symbicord turbohaler 60 dose Symbicord turbohaler 120 dose Vannair 120 dose Dulera 120 dose 160/4.5mcg; 320/9mcg 160/4.5mcg 80/4.5mcg; 160/4.5mcg 100/5mcg; 200/5mcg Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose R370 Inhaled Glucocorticoids Beclomethasone Beceze CFC free 200 dose 100mcg Beclate 200 dose 100mcg; 200mcg Budesonide Budeflam HFA 300 dose 100mcg; 200mcg Inflammide novolizer complete 200 dose Inflammide novolizer complete 100 dose Inflammide novolizer refill 200 dose 200mcg 400mcg 200mcg Inflammide novolizer refill 100 dose Pulmicort turbuhaler 200 dose 400mcg 100mcg; 200mcg Ciclesonide Ciclovent 60 dose 80mcg; 160mcg Fluticasone Flixotide CFC free 50mcg; 125mcg; 250mcg 120 dose Mometasone Asmanex twisthaler 30 dose 200mcg/1dose; 400mcg/1dose Asmanex twisthaler 60 dose 200mcg/1dose; 400mcg/1dose R100 Nasal Corticosteroids Beclomethasone Beclate aquanase 150 dose 50mcg Page 3 of 25 04/2018

4 Asthma R100 Nasal Corticosteroids Beclomethasone Clenil aqueous 200 dose 50mcg Fluticasone Flomist 120 dose 50mcg Flonase 120 dose 50mcg R390 Salmeterol and Fluticasone Salmeterol and Fluticasone Foxair accuhaler 50/100; 50/250; 50/ dose Sereflo HFA 120 dose 25/50; 25/125; 25/250 R350 Surgical item Inhaler device Dp haler device Sereflo HFA synchrobreathe 120 dose 25/50; 25/125; 25/250 Spacer Glaxohaler R15 Systemic Corticosteroids: Prednisone Prednisone Be-Tabs Prednisone Panafcort Trolic Bipolar mood disorder R160 Anti-depressants: SSRI s Citalopram Adco-Talomil Arrow Citalopram Bio Citalopram Cilate Escitalopram Accord Escitalopram 10mg; Zitolex 10mg; Zytomil 10mg; Fluoxetine Deprozan Fluoxetine Actor Prolax Ranflocs Sertraline Dyna Sertraline Serdep Serlife R385 Anti-epileptics: Carboxamide derivatives Carbamazepine Degranol 200mg Tegretol CR 200mg; 400mg Zeptol 200mg R490 Anti-epileptics: Fatty acid derivatives Valproic acid Convulex 150mg Convulex syrup 250mg/5ml Epilim crushable Epilim sugar-free syrup 200mg/5ml Epilizine CR 200mg; 300mg; 500mg Eprolep CR 200mg; 300mg; 500mg Navalpro CR 200mg; 300mg; 500mg Valeptic CR 300mg; 500mg R410 Anti-epileptics: Other agents Lamotrigine Dyna-Lamotrigine 2; ; 200mg Epitec 2; ; 200mg Girotec ; 200mg Lamidus 50mg Lamitor 2; ; 200mg R945 Anti-psychotics: Clozapine Clozapine Aspen Clozapine 2; Cloment 2; Page 4 of 25 04/2018

5 Bipolar mood disorder R345 R590 R400 R335 R650 Anti-psychotics: Lithium Anti-psychotics: Olanzapine Anti-psychotics: Phenothiazines with aliphatic side-chain Anti-psychotics: Quetiapine Anti-psychotics: Thioxanthene derivatives Lithium Camcolit 250mg; 400mg Olanzapine Olawin Olawin oradispersible Olexar Prexolan ODT Redilanz Zylena Chlorpromazine Largactil 2; Quetiapine Dopaquel 2; ; 200mg; 300mg Mylan Quetiapine Psyquet 2; ; 200mg; 300mg 2; ; 200mg; 300mg Quetiapine Biotech 2; ; 200mg; 300mg Quetoser Serez Spec Quetiapine 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 200mg R640 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg Bronchiectasis R40 Adrenergics: Short acting - Salbutamol R245 R15 Inhaled anticholinergics: Ipratropium bromide Systemic Corticosteroids: Prednisone Risnia Rispacor Rispevon Zoxadon 0.; 1mg; 2mg; 3mg 0.; 1mg; 2mg; 3mg 1mg; 2mg; 3mg; 4mg 0.; 1mg; 2mg; 3mg; 4mg 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. Trolic Pharmapress co 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Ciplasyl Plus Pearinda Plus 4/1.2 4/1.2 Page 5 of 25 04/2018

6 Cardiac failure R125 ACE inhibitors and diuretics Perindopril and diuretics Perindopril co Unicorn 4/1.2 R120 ACE inhibitors: Plain Prexum Plus 5/1.2 Vectoryl Plus 4/1.2 Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; Enalapril Biotech ; Enalapril Unicorn 10mg; Envas Hypace Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Ciplasyl 4mg; 8mg Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril 4mg; 8mg 4mg; 8mg 4mg 4mg; 8mg Quinapril Accumax 10mg; R260 Alpha and Beta blocking agents Carvedilol Aspen Carvedilol 6.2; 12.; 2 R120 R130 Angiotensin II antagonists: Combinations Angiotensin II antagonists: Plain Carloc Carvedilol Unicorn Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 6.2; 12.; 2 6.2; 12.; 2 Losartan and diuretics Hytenza co 50/12. Losaar Plus Losacar co Losartan co Unicorn Netrasol co Zartan co 50/12.; 100/2 50/12. 50/12.; 100/2 50/12.; 100/2 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 150mg; 300mg Losartan Ciplazar Losartan Unicorn R100 R85 Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Beta blocking agents: Selective Spec-Losartan Zartan Hydralazine Hyperphen 10mg; 50mg Sandoz Hydralazine 2 Bisoprolol Adco-Bisocor Betacor Bilocor Bislo Bisoprolol Unichem Bisoprolol Unicorn Page 6 of 25 04/2018

7 Cardiac failure R85 Beta blocking agents: Selective R25 Cardiac glycosides: Digoxin Bisoprolol Bisoprolol Zydus Mylan Bisoprolol Retocar Ziapro Digoxin Lanoxin 0.062; 0.2 Lanoxin paediatric/geriatric syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic R15 R25 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 R120 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R105 Potassium supplements Potassium chloride Plenish K 600mg R195 Vasodilators in cardiac disease: Organic nitrates 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 R90 Influenza vaccines Influenza, purified antigen Influvac 0.5ml R170 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen Vaxigrip single dose 0.5ml pre-filled Imovax pneumo 23 Cardiomyopathy R125 ACE inhibitors and diuretics Enalapril and diuretics Enap co 20/12. Pharmapress co 50mg 60mg 20/12. Lisinopril and diuretics Adco-Zetomax co 10/12.; 20/12. Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Ciplasyl Plus Pearinda Plus Perindopril co Unicorn Prexum Plus Vectoryl Plus 4/1.2 4/1.2 4/1.2 5/1.2 4/1.2 Page 7 of 25 04/2018

8 Cardiomyopathy R120 ACE inhibitors: Plain Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; Enalapril Biotech ; Enalapril Unicorn 10mg; Envas Hypace Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Ciplasyl 4mg; 8mg Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril 4mg; 8mg 4mg; 8mg 4mg 4mg; 8mg Quinapril Accumax 10mg; R260 Alpha and Beta blocking agents Carvedilol Aspen Carvedilol 6.2; 12.; 2 R120 R130 R85 R100 Angiotensin II antagonists: Combinations Angiotensin II antagonists: Plain Anti-thrombotic agents: Vitamin K antagonists Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Carloc Carvedilol Unicorn Carvetrend Vediblok 6.2; 12.; 2 6.2; 12.; 2 6.2; 12.; 2 6.2; 12.; 2 Losartan and diuretics Hytenza co 50/12. Losaar Plus Losacar co Losartan co Unicorn Netrasol co Zartan co 50/12.; 100/2 50/12. 50/12.; 100/2 50/12.; 100/2 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 150mg; 300mg Losartan Ciplazar Losartan Unicorn Spec-Losartan Zartan Warfarin Cipla-Warfarin 1mg; Hydralazine Hyperphen 10mg; 50mg Sandoz Hydralazine R35 Aspirin Acetylsalicylic acid Myoprin R85 Beta blocking agents: Selective 2 Bisoprolol Adco-Bisocor Betacor Bilocor Bislo Bisoprolol Unichem Bisoprolol Unicorn Page 8 of 25 04/2018

9 Cardiomyopathy R85 Beta blocking agents: Selective R25 Cardiac glycosides: Digoxin Bisoprolol Bisoprolol Zydus Mylan Bisoprolol Retocar Ziapro Digoxin Lanoxin 0.062; 0.2 Lanoxin paediatric/geriatric syrup 0.0/1ml R40 High-ceiling diuretics Furosemide Dino-Retic Diuresix Furobe Mylan Furosemide Chronic obstructive pulmonary disease (COPD) R15 R25 Low-ceiling diuretics: Thiazides, plain Low-ceiling diuretics: excluding Thiazides Hydrochlorothiazide Hexazide 2 Ridaq 12. Indapamide Cipla-Indapamide 2. Daptril Mylan Indapamide R120 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R105 Potassium supplements Potassium chloride Plenish K 600mg R195 Vasodilators in cardiac disease: Organic nitrates 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 R90 Influenza vaccines Influenza, purified antigen Influvac 0.5ml R170 Pneumococcus vaccines Pneumococcus, purified polysaccharides antigen R185 R40 Adrenergics: Long acting - Formoterol Adrenergics: Short acting - Salbutamol Vaxigrip single dose 0.5ml pre-filled Imovax pneumo 23 50mg 60mg Formoterol Foratec HFA 120 dose 12mcg/1dose Salbutamol Asthavent ecohaler 200 dose 100mcg Venteze CFC free 200 dose 100mcg R370 R155 Adrenergics: Ultra long acting - Indacaterol Anti-asthmatics: Systemic xanthines R415 Formoterol and Budesonide Formoterol and Budesonide Indacaterol Onbrez breezhaler 150mcg Theophylline Sandoz Theophylline anhydrous 200mg; 300mg Symbicord turbohaler 60 dose Symbicord turbohaler 120 dose 160/4.5mcg; 320/9mcg 160/4.5mcg Vannair 120 dose 80/4.5mcg; 160/4.5mcg Page 9 of 25 04/2018

10 Chronic obstructive pulmonary disease (COPD) Chronic renal disease R390 Formoterol and Mometasone Formoterol and Mometasone R430 R245 R470 R205 Inhaled anticholinergics: Glycopyrronium bromide Inhaled anticholinergics: Ipratropium bromide Inhaled anticholinergics: Tiotropium bromide Salbutamol and Ipratropium bromide Glycopyrronium bromide Dulera 120 dose Seebri breezhaler (30 caps & inhaler) 100/5mcg; 200/5mcg Ipratropium bromide Atrovent HFA 200 dose 20mcg Ipvent HFA 200 dose 40mcg/1dose Tiotropium bromide Forvent (refill) 18mcg Salbutamol and Ipratropium bromide R390 Salmeterol and Fluticasone Salmeterol and Fluticasone R793 R15 Surgical item: Oxygen concentrator Systemic Corticosteroids: Prednisone Oxygen Duolin HFA 200 dose Foxair accuhaler 50/100; 50/250; 50/ dose Sereflo HFA 120 dose 25/50; 25/125; 25/250 Sereflo HFA synchrobreathe 120 dose 25/50; 25/125; 25/250 Dummy NAPPI for oxygen Prednisone Be-Tabs Prednisone Panafcort Trolic R90 Influenza vaccines Influenza, purified antigen Influvac 0.5ml Vaxigrip single dose 0.5ml pre-filled 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. Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Ciplasyl Plus Pearinda Plus Perindopril co Unicorn Prexum Plus Vectoryl Plus 4/1.2 4/1.2 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; 50mg Bio-Captopril 2 Mylan Captopril 2; 50mg Enalapril Alapren ; Enalapril Biotech ; Enalapril Unicorn 10mg; Envas Hypace Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Ciplasyl 4mg; 8mg Page 10 of 25 04/2018

11 Chronic renal disease R120 ACE inhibitors: Plain Perindopril Pearinda 4mg; 8mg Perindopril Unicorn 4mg; 8mg Prexum Ran-Perindopril 4mg Spec-Perindopril 4mg; 8mg Quinapril Accumax 10mg; R120 Angiotensin II antagonists: Combinations Losartan and diuretics Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12.; 100/2 R130 Angiotensin II antagonists: Plain Netrasol co Zartan co 50/12.; 100/2 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Irbesartan Dynarb 150mg; 300mg Losartan Ciplazar Losartan Unicorn Spec-Losartan Page 11 of 25 04/2018 Zartan R215 Calcium supplements Calcium carbonate B-cal R5 Folic acid and derivatives Folic acid Be-Tabs Folic acid R240 Hepatitis B Vaccine Hepatitis B, purified antigen Folic acid Engerix-b (new) monodose 1ml Euvax b vial 1ml R45 Iron in combination with folic acid Ferrous fumarate Pregamal R525 Iron, parenteral preparations Iron, parenteral preparations Heberbio hbv sgl dose 1ml adult Cosmofer ampoule 2ml Equifer ampoule 5ml Rautevene ampoule 5ml Sucrofer 5ml Zypiron vial 5ml 0. 20mcg/1ml 20mcg/1ml 20mcg/1ml 50mg/1ml /5ml /5ml /1ml /1ml R3 670 Other anti-anaemic preparations Darbepoetin Alfa Aranesp pre-filled syringe 0.4ml 10mcg/0.4ml Aranesp pre-filled syringe 0.5ml Aranesp pre-filled syringe 0.3ml Aranesp pre-filled syringe 0.4ml Aranesp pre-filled syringe 0.5ml Aranesp pre-filled syringe 0.3ml 20mcg/0.5ml 30mcg/0.3ml 40mcg/0.4ml 50mcg/0.5ml 60mcg/0.3ml Erythropoietin Eprex pre-fill 2000U/0.5ml Methoxy polyethylene glycol-epoetin beta Eprex pre-fill Recormon pre-filled syringe Recormon pre-filled syringe Recormon pre-filled syringe Repotin ampoule 1ml Repotin ampoule 1ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml 4000U/0.4ml 500U/0.3ml 2000U/0.3ml 4000U/0.3ml 2000U 4000U 30mcg/0.3ml 50mcg/0.3ml

12 Chronic renal disease Coronary artery disease R3 670 Other anti-anaemic preparations Methoxy polyethylene glycol-epoetin beta Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml Mircera pre-filled syringe 0.3ml 75mcg/0.3ml 100mcg/0.3ml 120mcg/0.3ml 150mcg/0.3ml 200mcg/0.3ml 250mcg/0.3ml R400 Vitamin D and analogues Alfacalcidol One alpha 0.25mcg; 1mcg R220 Anti-thrombotic Agents: Clopidogrel Clopidogrel Clopidogrel 75 Biotech 7 Closolve Pharma Dynamics Clopidogrel 7 7 Plagrol R35 Aspirin Acetylsalicylic acid Myoprin R200 R85 R320 R130 R195 Beta blocking agents: Non-selective Beta blocking agents: Selective Selective calcium channel blockers with direct cardiac effects Selective calcium channel blockers with mainly vascular effects Vasodilators in cardiac disease: Organic nitrates 7 Propranolol Inderal 10mg Indoblok Purbloka 10mg; Atenolol B-Block Bio-Atenolol Gulf Atenolol Tenopress Zetenol Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Amtas Austell-Amlodipine Calbloc Ciplavasc Gulf Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal Plendil 2.; Nifedipine Cipalat Retard Glyceryl trinitrate Angised 0. Isosorbide dinitrate Isordil 30mg Sandoz Isosorbide dinitrate Isosorbide mononitrate Elantan Elantan LA Monicor SR Crohn s disease R5 Folic acid and derivatives Folic acid Be-Tabs Folic acid Folic acid 50mg 60mg 0. Page 12 of 25 04/2018

13 Crohn s disease R810 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents R1 940 R690 R250 R15 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 Mesalazine Asacol 400mg; 800mg Mezavant 1200mg Pentasa 500mg; 1000mg Salofalk 1000mg Olsalazine Dipentum 250mg Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Budesonide Entocord enema Azathioprine Azamun 50mg Azathioprine PCH 50mg Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Desmopressin Ddavp 0.1mg; 0.2mg Ddavp nasal spray 5ml 0.1mg/1ml Diabetes mellitus Type 1 ***Please note that an overall monthly limit applies to Insulins across the different Insulin classes*** The overall monthly limit is R720. R530 R720 R465 R555 Fast-acting Insulins Intermediate-acting or long-acting combined with fast-acting Insulins (Biphasic) Intermediate-acting Insulins Long-acting Insulins Insulin Glulisine Insulin Human Insulin Lispro Insulin Aspart Insulin Human Insulin Lispro Insulin Human Insulin Detemir Insulin Glargine Apidra - cartridge 3ml Biosulin r - cartridge 3ml Humulin r - cartridge 3ml; vial 10ml Humalog - cartridge 3ml; kwikpen 3ml; vial 10ml Novomix 30 - flexpen 3ml Actraphane hm(ge) - vial 10ml Biosulin cartridge 3ml Humulin 30/70 - cartridge 3ml; kwikpen 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Humalog mix 25 - cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 50 - cartridge 3ml; kwikpen 3ml Biosulin l - cartridge 3ml Biosulin n - cartridge 3ml Humulin n - cartridge 3ml; kwikpen 3ml; vial 10ml Levemir - prefilled cartridge 3ml Basaglar - cartridge 3ml; pre-filled pen 3ml Optisulin - cartridge 3ml; pen 3ml R35 Aspirin Acetylsalicylic acid Myoprin R280 Blood glucose monitoring agents Glucose strips Accu-chek active strips Accu chek instant strips Caresens n glucose test strips 29g Fora diamond blood glucose strips Page 13 of 25 04/2018

14 Diabetes mellitus Type 1 R280 Blood glucose monitoring agents Glucose strips Freestyle optium glucose test strips Glucocheck strips 50 s Glucoplus Glucoplus provider strips Glucose test strips easymax On-call plus ez strips Onetouch select plus test strips Onetouch select test strips Test blood glucose strip clicks bionime gs550 R350 Surgical item Lancets Lancets 50's Lancets blood collection needles loris Lancet fora collection needles sterile 3 Lancets solus v2 Lancets unilet sterile 28g Lancets unilet sterile 28g 4cm x 6cm x 7 On-call lancets glucose Needles 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 insulin pen bd microfine 30g 8mm Needle insulin pen bd microfine 31g 5mm Needle insulin pen bd microfine tw 32g 4mm Needle novofine Syringes Needle accufine insulin pen 8 x 30g Syringe insulin 1.0ml with 27g needle Syringe insulin bd microfine 0.3ml 30g 8mm demi Syringe insulin bd microfine 1ml 9g 12.7mm Syringe insulin bd microfine 1ml 30g 8mm Diabetes mellitus Type 2 R65 Biguanides Metformin Accord Metformin 500mg; 850mg Apex-Metformin 500mg Arrow Metformin 500mg; 850mg Austell-Metformin 500mg; 850mg Bigsens 500mg; 850mg; 1000mg Diaformin Diaformin forte Diamin Diaphage Gluconorm Mengen Metchek Metforal Metformin Alkem Metored 500mg 850mg 500mg; 850mg 500mg; 850mg; 1000mg 500mg; 850mg 500mg; 850mg; 1000mg 500mg; 850mg 500mg; 850mg 500mg; 850mg 500mg; 850mg; 1000mg Page 14 of 25 04/2018

15 Diabetes mellitus Type 2 R65 Biguanides Metformin Metphage 500mg; 850mg Mylan Metformin 500mg; 850mg; 1000mg Romidab 500mg; 850mg; 1000mg Sandoz Metformin 500mg Sandoz Metformin FCT 500mg; 850mg ***Please note that an overall monthly limit applies to Insulins across the different Insulin classes*** The overall monthly limit is R720. R530 Fast-acting Insulins Insulin Glulisine Insulin Human Apidra - cartridge 3ml Biosulin r - cartridge 3ml Humulin r - cartridge 3ml; vial 10ml R720 R465 R555 R675 R140 R215 Intermediate-acting or long-acting combined with fast-acting Insulins (Biphasic) Intermediate-acting Insulins Long-acting Insulins Other, excluding Insulins: Exanatide Sulfonamides, urea derivatives Thiazolidinediones Insulin Lispro Insulin Aspart Insulin Human Insulin Lispro Insulin Human Insulin Detemir Insulin Glargine Humalog - cartridge 3ml; kwikpen 3ml; vial 10ml Novomix 30 - flexpen 3ml Actraphane hm(ge) - vial 10ml Biosulin cartridge 3ml Humulin 30/70 - cartridge 3ml; kwikpen 3ml; vial 10ml Insuman comb 30/70 - cartridge 3ml Humalog mix 25 - cartridge 3ml; kwikpen 3ml; vial 10ml Humalog mix 50 - cartridge 3ml; kwikpen 3ml Biosulin l - cartridge 3ml Biosulin n - cartridge 3ml Humulin n - cartridge 3ml; kwikpen 3ml; vial 10ml Levemir - prefilled cartridge 3ml Basaglar - cartridge 3ml; pre-filled pen 3ml Optisulin - cartridge 3ml; pen 3ml Exanatide Byetta disposable pen 1.2ml 5mcg/1dose 60 dose Byetta disposable pen 2.4ml 60 dose 10mcg/1dose Glibenclamide Bio-Glibenclamide Diacare Glycomin Gliclazide Adco-Glucomed 80mg Austell-Gliclazide Diaglucide Diaglucide MR Diaran MR Dyna Gliclazide SR Gliclazide Unicorn MR Glycron Glygard Mylan Gliclazide Sandoz Gliclazide 80mg 80mg 60mg 30mg 30mg 30mg 80mg 80mg 80mg 80mg Pioglitazone Accord Pioglitazone 1; 30mg; 4 Cipla-Pioglitazone 1; 30mg Page 15 of 25 04/2018

16 Diabetes mellitus Type 2 R35 Aspirin Acetylsalicylic acid Myoprin R280 Blood glucose monitoring agents Glucose strips Accu-chek active strips Accu chek instant strips Caresens n glucose test strips 29g Fora diamond blood glucose strips Freestyle optium glucose test strips Glucocheck strips 50 s Glucoplus Glucoplus provider strips Glucose test strips easymax R215 Dipeptidyl peptidase inhibitors: Saxagliptin On-call plus ez strips Onetouch select plus test strips Onetouch select test strips Test blood glucose strip clicks bionime gs550 Saxagliptin Onglyza 2.; R350 Surgical item Lancets Lancets 50's Needles Syringes Lancets blood collection needles loris Lancet fora collection needles sterile 3 Lancets solus v2 Lancets unilet sterile 28g Lancets unilet sterile 28g 4cm x 6cm x 7 On-call lancets glucose 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 insulin pen bd microfine 30g 8mm Needle insulin pen bd microfine 31g 5mm Needle insulin pen bd microfine tw 32g 4mm Needle novofine Needle accufine insulin pen 8 x 30g Syringe insulin 1.0ml with 27g needle Syringe insulin bd microfine 0.3ml 30g 8mm demi Syringe insulin bd microfine 1ml 9g 12.7mm Syringe insulin bd microfine 1ml 30g 8mm Dysrhythmia R680 Anti-arrhythmics: class Ic R475 R85 Anti-arrhythmics: class III - Amiodarone Anti-thrombotic agents: Vitamin K antagonists Flecainide Tambocor Tambocor CR ; 200mg Propafenone Rythmol 150mg; 300mg Amiodarone Arycor ; 200mg Bio-Amiodarone 200mg Hexarone ; 200mg Warfarin Cipla-Warfarin 1mg; Page 16 of 25 04/2018

17 Dysrhythmia R35 Aspirin Acetylsalicylic acid Myoprin R200 R85 Beta blocking agents: Non-selective Beta blocking agents: Selective Propranolol Inderal 10mg Indoblok 10mg; Purbloka Sotalol Sotahexal 80mg; 160mg Atenolol B-Block Bio-Atenolol Gulf Atenolol Tenopress Zetenol R25 R320 Cardiac glycosides: Digoxin Selective calcium channel blockers with direct cardiac effects Epilepsy R285 Anti-epileptics: Benzodiazepine derivatives R385 R490 R85 R410 Anti-epileptics: Carboxamide derivatives Anti-epileptics: Fatty acid derivatives Anti-epileptics: Hydantoin derivatives Anti-epileptics: Other agents Digoxin Lanoxin 0.062; 0.2 Lanoxin paediatric/geriatric syrup 0.0/1ml Verapamil Vasomil ; 80mg Verahexal SR 2 Clonazepam Clonam 0.; 2mg Rivotril 0.; 2mg Carbamazepine Degranol 200mg Tegretol CR 200mg; 400mg Zeptol 200mg Valproic acid Convulex 150mg Convulex syrup 250mg/5ml Epilim crushable Epilim sugar-free syrup 200mg/5ml Epilizine CR 200mg; 300mg; 500mg Eprolep CR 200mg; 300mg; 500mg Navalpro CR 200mg; 300mg; 500mg Valeptic CR 300mg; 500mg Phenytoin Phenytoin sod Lamotrigine Dyna-Lamotrigine 2; ; 200mg Epitec 2; ; 200mg Girotec ; 200mg Lamidus 50mg Lamitor 2; ; 200mg Topiramate Epitoz 2; R30 Anti-epileptics: Barbiturates and derivatives Phenobarbital Lethyl 30mg Sedabarb R5 Folic acid and derivatives Folic acid Be-Tabs Folic acid Glaucoma R225 Anti-glaucoma agents: Carbonic anhydrase inhibitors R235 Anti-glaucoma agents: Prostaglandin analogues Folic acid 30mg 0. Dorzolamide Glaucopress 5ml 2% Trusopt 5ml owi 2% Bimatoprost Lumigan 0.01% Latanoprost Atana 2.5ml 50mcg/1ml Spersatan 2.5ml 50mcg/1ml Page 17 of 25 04/2018

18 Glaucoma R235 Anti-glaucoma agents: Prostaglandin analogues R270 R100 R295 Anti-glaucoma agents: Sympathomimetics Anti-glaucoma Beta blocking agents: Timolol Anti-glaucoma Beta blocking agents: Timolol, combinations Haemophilia R5 Analgesics: Paracetamol R220 Anti-fibrinolytics: Amino acids Latanoprost 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 Co-Atana 2.5ml Combigan 5ml 2mg/ Cosopt 5ml 0.5% Duotrav 2.5ml Ganfort 3ml Glaumide-co 5ml Glauopt co 5ml Xalacom 2.5ml Paracetamol Adco-Napamol 500mg Adco-Prolief Cetapon Painogesic 500mg 500mg 500mg Tranexamic acid Tranexamic Acid Medwich 500mg R Blood coagulation factors Coagulation factor IX Haemosolvex IX 500U R1 700 Posterior pituitary hormones: Vasopressin and analogues Hyperlipidaemia R290 Lipid modifying agents: Fibrates R55 Lipid modifying agents: Statins 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 Astor Atolip Atorvastatin Unicorn Dynator Lestavor Lipogen Vastor 10mg; ; ; 80mg ; 80mg 10mg; ; ; 80mg 10mg; ; ; 80mg 10mg; ; ; 80mg 10mg; ; ; 80mg 10mg; ; ; 80mg Simvastatin Adco-Simvastatin 10mg; ; Aspen Simvastatin Austell-Simvastatin Choleste Cipla-Simvastatin Simvacor Zysim 10mg; ; 10mg; ; ; 10mg; ; 10mg; Page 18 of 25 04/2018

19 Hypertension R200 ACE inhibitors and calcium channel blockers Perindopril and Amlodipine Coveram 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. Lisinopril co Unicorn Lisoretic Lisozide Zestoretic 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. 10/12.; 20/12. Perindopril and diuretics Bioprexum Plus 10/2. Ciplasyl Plus Pearinda Plus Perindopril co Unicorn Prexum Plus Vectoryl Plus 4/1.2 4/1.2 4/1.2 5/1.2 4/1.2 Captopril Adco-Captomax 2; 50mg Bio-Captopril Mylan Captopril 2 2; 50mg Enalapril Alapren ; Enalapril Biotech Enalapril Unicorn Envas Hypace ; 10mg; Lisinopril Austell-Lisinopril 10mg; Sinopren ; Perindopril Ciplasyl 4mg; 8mg Pearinda Perindopril Unicorn Prexum Ran-Perindopril Spec-Perindopril 4mg; 8mg 4mg; 8mg 4mg 4mg; 8mg Quinapril Accumax 10mg; R260 Alpha and Beta blocking agents Carvedilol Aspen Carvedilol 6.2; 12.; 2 Carloc Carvedilol Unicorn 6.2; 12.; 2 6.2; 12.; 2 R120 Angiotensin II antagonists: Combinations Carvetrend 6.2; 12.; 2 Vediblok 6.2; 12.; 2 Losartan and diuretics Hytenza co 50/12. Losaar Plus 50/12.; 100/2 Losacar co 50/12. Losartan co Unicorn 50/12.; 100/2 Netrasol co 50/12.; 100/2 Zartan co 50/12.; 100/2 Valsartan and diuretics Dynaval co 80/12.; 160/12.; 160/2 Page 19 of 25 04/2018

20 Hypertension R130 Angiotensin II antagonists: Plain R175 R170 Anti-adrenergic agents: Alpha-adrenoreceptor antagonists Anti-adrenergic agents: Methyldopa Irbesartan Dynarb 150mg; 300mg Losartan Ciplazar Losartan Unicorn Spec-Losartan Zartan Doxazosin Cardugen 1mg; 4mg Methyldopa Hypotone 250mg Mylan Methyldopa 250mg R30 R100 R200 R85 Anti-adrenergic agents: Rauwolfia alkaloids Arteriolar smooth muscle agents: Hydrazinophthalazine derivatives Beta blocking agents: Non-selective Beta blocking agents: Selective Reserpine Reserpine 0.2 Hydralazine Hyperphen 10mg; 50mg Sandoz Hydralazine 2 Propranolol Inderal 10mg Indoblok Purbloka 10mg; Atenolol B-Block Bio-Atenolol Gulf Atenolol Tenopress Zetenol R40 High-ceiling diuretics Furosemide Dino-Retic R15 R25 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 R120 Potassium sparing agents Spironolactone Aldactone 2 Sandoz Spironolactone Spiractin R105 Potassium supplements Potassium chloride Plenish K 600mg Potassium Chloride Unicorn mg R320 R130 Selective calcium channel blockers with direct cardiac effects Selective calcium channel blockers with mainly vascular effects Sandoz K mg Ultipot 600mg Diltiazem Adco-Zildem 60mg Adco-Zildem SR 180mg; 2 Verapamil Vasomil ; 80mg Verahexal SR 2 Amlodipine Amtas Austell-Amlodipine Calbloc Page 20 of 25 04/2018

21 Hypertension R130 Selective calcium channel blockers with mainly vascular effects Amlodipine Ciplavasc Gulf Amlodipine Lomanor Pendine Pharma Dynamics Amlodipine besylate Felodipine Felodipine-Hexal Plendil 2.; Nifedipine Cipalat Retard Hypothyroidism R45 Thyroid hormones Levothyroxine sodium Euthyrox 25mcg; 50mcg; 100mcg Multiple sclerosis R85 Anti-depressants: Parkinson's disease R265 Tricyclics Drugs for urinary frequency and incontinence Amitriptyline Gulf Amitriptyline 2 Sandoz Amitriptyline Trepiline 2 10mg Oxybutynin Lenditro Mylan Oxybutynin Oxyrest R Interferons Interferon beta-1a Avonex pre-filled syringe 0.5ml R1 250 R15 R380 Muscle relaxants: Other centrally acting agents Systemic Corticosteroids: Prednisone Anticholinergic agents: Tertiary amines Interferon beta-1b 30mcg/0.5ml Rebif 22 pre-filled syringe 0.5ml 22mcg/0.5ml Rebif 22 rebidose pre-filled pen 0.5ml 22mcg/0.5ml Rebif 44 pre-filled syringe 0.5ml 44mcg/0.5ml Rebif 44 rebidose pre-filled pen 0.5ml 44mcg/0.5ml Betaferon pre-filled syringe 1ml U/1ml Baclofen Bio-Baclofen 10mg Teva Baclofen 10mg Prednisone Be-Tabs Prednisone Panafcort Trolic Biperiden Akineton 2mg R725 Dopamine agonists Pramipexole Mylan Pramipexole 0.12; 0.2; 1mg Oxpola 0.12; 0.2; 1mg Pramex 0.12; 0.2; 1mg Ropinirole Accord Ropinirole 0.2; 0.; 1mg; 2mg; Requip 0.2; 0.; 1mg; 2mg; R280 Dopaminergic agents: Adamantane derivatives Amantadine Symadin R635 Levodopa and decarboxylase inhibitor Levodopa and decarboxylase inhibitor Sinemet Teva Carbi-Levo 25/; 25/250mg 25/; 25/250mg Rheumatoid arthritis R65 Anti-inflammatory agents: Acetic acid derivatives and related substances Diclofenac Adco-Diclofenac 50mg A-Lennon Diclofenac Diclofenac Biotech 2; 50mg 2 Page 21 of 25 04/2018

22 Rheumatoid arthritis R65 Anti-inflammatory agents: Acetic acid derivatives and related substances Diclofenac Mylan Diclofenac 2; 50mg Panamor AT 50mg Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 R335 Anti-inflammatory agents: Coxibs Celecoxib Coxleon ; 200mg R100 Anti-inflammatory agents: Oxicams Meloxicam Adco-Meloxicam 1 Coxflam 7. Flexocam 7. R30 R105 Anti-inflammatory agents: Propionic acid derivatives Anti-rheumatic agents: Chloroquine Medoxicam Zydus-Meloxicam Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Betaprofen FC Bren Ibucine Ibunate Ranfen 400mg 400mg 200mg; 400mg 200mg 400mg Naproxen Mylan Naproxen 250mg Naproscript 250mg Chloroquine Plasmoquine 200mg R5 Folic acid and derivatives Folic acid Be-Tabs Folic acid R810 R690 R250 R15 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic Corticosteroids: Prednisone Schizophrenia R160 Anti-depressants: SSRI s Folic acid 0. Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Azathioprine Azamun 50mg Azathioprine PCH 50mg Methotrexate Abitrexate 2. Methotrexate 2. Prednisone Be-Tabs Prednisone Panafcort Trolic Citalopram Adco-Talomil Arrow Citalopram Bio Citalopram Cilate Escitalopram Accord Escitalopram 10mg; Zitolex Zytomil 10mg; 10mg; Fluoxetine Deprozan Fluoxetine Actor Page 22 of 25 04/2018

23 Schizophrenia R160 Anti-depressants: SSRI s R385 R945 Anti-epileptics: Carboxamide derivatives Anti-psychotics: Clozapine Fluoxetine Prolax Ranflocs Sertraline Dyna Sertraline Serdep Serlife Carbamazepine Degranol 200mg Tegretol CR 200mg; 400mg Zeptol 200mg Clozapine Aspen Clozapine 2; Cloment 2; R590 R400 R335 R650 Anti-psychotics: Olanzapine Anti-psychotics: Phenothiazines with aliphatic side-chain Anti-psychotics: Quetiapine Anti-psychotics: Thioxanthene derivatives Olanzapine Olawin Olawin oradispersible Olexar Prexolan ODT Redilanz Zylena Chlorpromazine Largactil 2; Quetiapine Dopaquel 2; ; 200mg; 300mg Mylan Quetiapine Psyquet 2; ; 200mg; 300mg 2; ; 200mg; 300mg Quetiapine Biotech 2; ; 200mg; 300mg Quetoser Serez Spec Quetiapine 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 200mg R640 Other anti-psychotics Risperidone Perizal 0.; 1mg; 2mg; 3mg Risnia Rispacor Rispevon Zoxadon 0.; 1mg; 2mg; 3mg 0.; 1mg; 2mg; 3mg 1mg; 2mg; 3mg; 4mg 0.; 1mg; 2mg; 3mg; 4mg Systemic lupus erythematosus (SLE) R65 Anti-inflammatory agents: Acetic acid derivatives and related substances Diclofenac Adco-Diclofenac 50mg A-Lennon Diclofenac 2; 50mg Diclofenac Biotech 2 Mylan Diclofenac 2; 50mg Panamor AT 50mg Indomethacin Betacin 2 Gulf Indomethacin 2 Methocaps 2 Page 23 of 25 04/2018

24 Systemic lupus erythematosus (SLE) R335 R100 R30 R105 R85 Anti-inflammatory agents: Coxibs Anti-inflammatory agents: Oxicams Anti-inflammatory agents: Propionic acid derivatives Anti-rheumatic agents: Chloroquine Anti-thrombotic agents: Vitamin K antagonists Celecoxib Coxleon ; 200mg Meloxicam Adco-Meloxicam 1 Coxflam Flexocam Medoxicam Zydus-Meloxicam Piroxicam Pyrocaps Roxifen Ibuprofen Betaprofen 200mg Betaprofen FC Bren Ibucine Ibunate Ranfen 400mg 400mg 200mg; 400mg 200mg 400mg Naproxen Mylan Naproxen 250mg Naproscript 250mg Chloroquine Plasmoquine 200mg Warfarin Cipla-Warfarin 1mg; R35 Aspirin Acetylsalicylic acid Myoprin R25 Emolients and protectives: Zinc products Zinc products Zinc ointment bp R5 Folic acid and derivatives Folic acid Be-Tabs Folic acid R690 R250 R15 R25 Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic Corticosteroids: Prednisone Topical Corticosteroids: Group III Folic acid 0. Azathioprine Azamun 50mg Azathioprine PCH 50mg 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 Be-Tabs Folic acid R810 Intestinal anti-inflammatories: Aminosalicylic acid and similar agents Folic acid 0. Mesalazine Asacol 400mg; 800mg Mezavant 1200mg Pentasa 500mg; 1000mg Salofalk 1000mg Olsalazine Dipentum 250mg Sulfasalazine Salazopyrin 500mg Salazopyrin EN 500mg Page 24 of 25 04/2018

25 Ulcerative colitis R1 940 Intestinal anti-inflammatories: Corticosteroids Budesonide Entocord enema R690 R250 R15 Other immunosuppressive agents: Azathioprine Other immunosuppressive agents: Methotrexate Systemic Corticosteroids: Prednisone Azathioprine Azamun 50mg Azathioprine PCH 50mg 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 25 of 25 04/2018