YES = formulary NO = non-formulary NO BENEFIT = excluded. Beat4 Beat1 Beat 3 Pace2 Beat2 Pace1 Pace3 Pace4 B BECLOMETHASONE BECEZE 50MCG INHALER

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1 Benefits are subject to the following: Pre-authorisation Bestmed guidelines Bestmed protocols Mediscor Reference Price (MRP) This price represents the reasonable price in the market place for a particular group of generic equivalent medicines which is reviewed and updated regularly. MRP sets a maximum reimbursable price for a list of generically similar medicines with a cost lower than that of the original medicine. There may be instances where a generic alternative costs more than the set MRP. If you opt to use the original medicine and a generic alternative is available, or you use a medicine that costs more than the MRP, you will have to pay the difference between the price of the chosen medicine and that of MRP. This formulary is effective from 1 January This formulary is subject to change without notice. ONLY the following medicine classes will be considered for Beat1 and Beat2: Anticholinergic Methylxanthines Oral corticosteroids Sympathomimetics = formulary = non-formulary = excluded CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACTIVE INGREDIENT B BECLOMETHASONE BECEZE 50MCG INHALER DIPROPIONATE BECEZE 100MCG INHALER BECLATE 50MCG INHALER BECLATE 100MCG INHALER BECLATE 200MCG INHALER QVAR AUTOHALER 100MCG QVAR AUTOHALER 50MCG QVAR PRESS/BREATH 100MCG QVAR PRESS/BREATH 50MCG BETAMETHASONE SYRUP BETAID 0.6MG/5ML SYR STEROMIEN 0.6MG/5ML SYR 1

2 BUDESONIDE BUDESONIDE / FORMOTEROL BUDEFLAM DP 200MCG INH BUDEFLAM HFA 100MCG 300D BUDEFLAM HFA 200MCG 300D PULMICORT TURBU 100MCG PULMICORT TURBU 200MCG PULMICORT TURBU 400MCG INFLAMMIDE 100MCG INH 300 INFLAMMIDE 200MCG INH 300 INFLAMMIDE 200MCG VOLI INFLAMMIDE 400MCG VOLI INFLAMMIDE 50MCG INH 300D INFLAMMIDE COMP VO 200MCG INFLAMMIDE COMP VO 400MCG INFLAMMIDE REF VO 200MCG INFLAMMIDE REF VO 400MCG SYMBICORD INH 320/9MCG SYMBICORD INH 80/4.5MCG SYMBICORD TURBU 160/4.5 SYMBICORD TURBU 160/ VANNAIR 160/4.5MCG INH 2

3 VANNAIR 80/4.5MCG INH F FETEROL BEROTEC 100 HFA 200DOSE FETEROL / IPRATROPIUM DUOVENT HFA 200DOSE INH FLUTICASONE FLIXOTIDE 125 CFC FREE FLIXOTIDE 250 CFC FREE FLIXOTIDE 50MCG CFC FREE FLIXOTIDE ACUHALER 50MCG FLIXOTIDE ACUHALER 100MCG FLIXOTIDE ACUHALER 250MCG FLIXOTIDE ACUHALER 500MCG FORMOTEROL FUMARATE FORADIL INHALETS FORATEC DP INH CAP FORATEC HFA 120 DOSE INH OXIS TURBUHALER I IPRATROPIUM ALBUTEROL COMBIVENT INHALER DUOLIN HFA 200DOSE INH IPRATROPIUM BROMIDE ATROVENT 20 HFA 200 DOSE IPVENT-40MCG INH 300DOSE IPVENT 40 HFA INH P PREDNISONE BE-TABS PREDNISONE 5MG METICORTEN 5MG TAB PANAFCORT 5MG TAB TROLIC 5MG TAB S SALBUTAMOL ASTHAVENT 200D ECOHALER 3

4 ASTHAVENT 300D ECOHALER ASTHAVENT DP 200MCG CAPS VENTEZE CFC FREE 200D 100MCG VENTEZE INH COMP 200D VENTIMAX CFC FREE 100MCG 200D VENTOLIN INH 200D CFC FREE SALMETEROL XINAFOATE SEREVENT ACCUHALER SEREVENT CFC-FREE 120DOSE SEREVENT INHALER 120D SEREVENT INHALER 60D SALMETEROL / FLUTICASONE FOXAIR 25/ DOSE FOXAIR 25/ DOSE FOXAIR 25/ DOSE FOXAIR 50/500 ACCU 60 DOSE FOXAIR 50/250 ACCU 60 DOSE FOXAIR 50/100 ACCU 60 DOSE SEREFLO 25/125 GENTLE-HAL SEREFLO 25/250 GENTLE-HAL SEREFLO 25/50 GENTLE-HAL SERETIDE 25/ DOSE SERETIDE 25/ DOSE SERETIDE 25/ DOSE SERETIDE 50/100 ACCUHALER 4

5 SERETIDE 50/250 ACCUHALER SERETIDE 50/500 ACCUHALER T THEOPHYLLINE EUPHYLLIN RET 250MG NUELIN SA 250 SANDOZ THEOPHYLLINE 200 SANDOZ THEOPHYLLINE 300 THEOPLUS 200MG TAB THEOPLUS 300MG TAB DEVICES CYCLOHALER INHALATION DEV DP HALER DEVICE REVOLIZER UNI VACCINES FLUARIX PREFILLED SYRINGE FLUVAX 2009 PRE-FILLED IMOVAX PNEUMO 23 INFLUVAC 0.5ML MUTAGRIP SINGLE DOSE PNEUMOVAX VAC VAXIGRIP PREFIL S/DOSE 0. X-FLU PREFILLED SYR 0.5ML 5

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