YES = formulary NO = non-formulary NO BENEFIT = excluded

Transcription

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 Methylxanthine Oral corticosteroids Penicillin Sympathomimetics Tetracyclines BRONCHIECTASIS YES = formulary = non-formulary = excluded ACTIVE INGREDIENT A AMOXYCILLIN ADCO-AMOX 125MG SUSP ADCO-AMOX 250MG CAP YES ADCO-AMOX 250MG SUSP ADCO-AMOX 500MG CAP YES A-LENN AMOXYCILLIN 125 YES A-LENN AMOXYCILLIN 250M YES ALLMOX 250MG CAP YES ALLMOX 500MG CAP YES AMOCAS 250MG CAP YES AMOCILLIN 250MG CAP YES AMOCILLIN 125MG SUSP AMOCILLIN 500MG CAP YES AMOXICAP 250MG CAP YES AMOXICILLIN HEXAL 500MG YES AMOXIL 250MG CAP YES 1

2 AMOXIL 500MG CAP YES AMOXIL S 125MG SUSP AMOXIL SF 250MG SUSP AURO-AMOXYCILLIN 250MG CAP YES AURO-AMOXYCILLIN 500MG CAP YES AUSTELL-AMOXICILLIN 250MG YES AUSTELL-AMOXICILLIN 500MG YES BETAMOX 250MG CAP YES BETAMOX 500MG CAP YES BETAMOX S 125MG/5ML SUS BETAMOX SF 250MG/5ML SUS DYNA-AMOXYCIL 125MG/5ML IPCAMOX 250MG CAP YES MOXYMAX 125 SUSP MOXYMAX 250 SUSP MOXYPEN 125 SUSP MOXYPEN 250MG CAP YES MOXYPEN 250MG/5ML SUSP MOXYPEN 500MG CAP YES MYMOX 250MG CAP YES MYMOX 500MG CAP YES PROMOXIL 250MG CAP YES PROMOXIL 500MG CAP YES PROMOXIL S 125MG/5ML PROMOXIL SF 250MG/5ML RANMOXY 250MG CAP YES RANMOXY 500MG CAP YES RANMOXY SUSP 125MG RANMOXY SUSP 250MG SALTERMOX S 125MG/5ML SALTERMOX SF 250MG/5ML ZALOXY 125MG/5ML SUSP ZALOXY 250MG CAP YES 2

3 ZALOXY 250MG/5M SUSP ZALOXY 500MG CAP YES ZOXIL 250MG CAP YES ZOXIL 500MG CAP YES ZOXIL S 125MG/5ML SUS ZOXIL SF 250MG/5ML SUS AMOXICILLIN / CLAVULANIC ADCO-AMOCLAV 375 ADCO-AMOCLAV 625 ADCO-AMOCLAV BD 1000MG ADCO-AMOCLAV S ADCO-AMOCLAV SF AMOCLAN TAB AMOCLAN BID 1000MG TAB AMOCLAN FORTE TAB AMOCLAN S SUSP AMOCLAN SF SUSP APEX-CLAVUTIN 375MG TAB APEX-CLAVUTIN 625MG TAB APEX-CLAVUTIN SF AUGMAXCIL 375 AUGMAXCIL 625 AUGMAXCIL S AUGMAXCIL SF AUGMENTIN 375MG TAB AUGMENTIN 625MG TAB AUGMENTIN 1000MG BD TAB AUGMENTIN BD S SUSP AUGMENTIN BD SF SUSP AUGMENTIN S SUSP AUGMENTIN SF SUSP AUGMENTIN SR 1000MG AURO-AMOXICLAV 1000MG TAB AURO-AMOXICLAV 125/31.25MG 3

4 AURO-AMOXICLAV 250/62.5 MG AURO-AMOXICLAV 375MG TAB AURO-AMOXICLAV 625MG TAB AUSTELL-CO-AMOXICLAV 375MG AUSTELL-CO-AMOXICLAV 625MG BIO-AMOKSIKLAV 1000MG TAB BIO-AMOKSIKLAV 156 SUSP BIO-AMOKSIKLAV 312 SUSP BIO-AMOKSIKLAV 375 BIO-AMOKSIKLAV 625 TAB CLAMENTIN 1000MG TAB CLAMENTIN 375MG CLAMENTIN S CLAMENTIN SF CLAVUMOX 375MG CLAVUMOX S CLAVUMOX SF CURAM 1000GM BD TAB CURAM 625MG TAB CURAM BD SUSP FORCID SOLUTAB 875/125 MOXYCLAV 375MG MOXYCLAV S MOXYCLAV SF RANCLAV 1000MG TAB RANCLAV 375MG RANCLAV 625MG RANCLAV FORTE SUSPENSION RANCLAV SUSPENSION SANDOZ CO AMOCLAV S SANDOZ CO AMOCLAV SF SANDOZ CO AMOXYCLAV 375 SANDOZ CO-AMOXYCLAV BD 1 4

5 SANDOZ CO-AMOXYCLAV 625 SANDOZ CO-AMOXYCLAV BD AMPICILLIN AMPIPEN 250MG CAP BE-AMPICIL 125MG SUSP BE-AMPICIL 250MG CAP SANDOZ AMPICILLIN 250MG B BECLOMETHASONE BECLATE 50MCG INHALER BECLATE 100MCG INHALER BECLATE 200MCG INHALER BECEZE 50MCG INHALER BECEZE 100MCG INHALER BECOTIDE DISKHALER YES BECOTIDE ROTACAPS 100 YES BECOTIDE ROTACAPS 200 YES BECOTIDE ROTAHALER YES QVAR AUTOHALER 100MCG YES QVAR AUTOHALER 50MCG YES QVAR PRESS/BREATH 100MCG YES QVAR PRESS/BREATH 50MCG YES BETAMETHASONE BETAID 0.6MG/5ML SYR STEROMIEN 0.6MG/5ML SYR BUDESONIDE BUDEFLAM DP 200MCG INH CA 5

6 BUDEFLAM HFA 100MCG 300D BUDEFLAM HFA 200MCG 300D INFLAMMIDE 100MCG INH 300 INFLAMMIDE 200 MCG VOLI INFLAMMIDE 200MCG INH 300 INFLAMMIDE 400MCG VOLI INFLAMMIDE 50MCG INH 300D INFLAMMIDE COMP VOLIZER INFLAMMIDE REF VOLIZER PULMICORT TURBU 100MCG YES PULMICORT TURBU 200MCG YES PULMICORT TURBU 400MCG YES BUDESONIDE / FORMOTEROL SYMBICORD INH 320/9MCG YES SYMBICORD INH 80/4.5MCG YES SYMBICORD TURBU 160/4.5 YES SYMBICORD TURBU 160/ YES VANNAIR 160/4.5MCG INH YES VANNAIR 80/4.5MCG INH YES D DOXYCYLINE A-LENN DOXYCYCLINE HCL YES CYCLIDOX 100MG CAP YES 6

7 CYCLIDOX EC 100MG CAP YES CYCLIDOX EC 50MG CAP YES DOXITAB YES DOXYCYL 50MG CAP YES DOXYCYL 100MG CAP YES DUMOXIN 50MG CAP YES I IPRATROPIUM ATROVENT 20 HFA 200DOSE YES IPVENT-40MCG INH 300DOSE YES IPVENT 40 HFA INH YES IPRATROPIUM / SALBUTAMOL COMBIVENT INHALER YES DUOLIN HFA 200DOSE INH YES F FETEROL BEROTEC 100 HFA 200DOSE YES FETEROL / IPRATROPIUM DUOVENT HFA 200DOSE INH FLUTICASONE FLIXOTIDE 125 CFC FREE YES FLIXOTIDE 250 CFC FREE YES FLIXOTIDE 50MCG CFC FREE YES FLIXOTIDE ACUHALER 50MCG YES FLIXOTIDE ACUHALER 100MCG YES FLIXOTIDE ACUHALER 250MCG YES FLIXOTIDE ACUHALER 500MCG YES FORMOTEROL FORADIL INHALETS FORATEC DP INH CAP FORATEC HFA 120 DOSE INH OXIS TURBUHALER YES P PHEXYMETHYLPENICILLIN BETAPEN 125MG/5ML SYR BETAPEN 250MG TAB 7

8 PREDNISONE BE-TABS PREDNISONE 5MG TAB YES METICORTEN 5MG TAB YES PANAFCORT 5MG TAB YES TROLIC 5MG TAB YES S SALBUTAMOL ASTHAVENT 200D ECOHALER YES ASTHAVENT 300D ECOHALER YES ASTHAVENT DP 200MCG CAP ASTHAVENT INH 200D YES VENTEZE CFC FREE 200 DOSE YES VENTEZE INH COMP 200D YES VENTIMAX CFC FREE 100MCG YES VENTOLIN INH 200D CFC-FRE YES SALMETEROL SEREVENT ACCUHALER YES SEREVENT CFC-FREE 120DOSE YES SEREVENT INHALER 120 YES SALMETEROL / FLUTICASONE FOXAIR 25/ DOSE YES FOXAIR 25/ DOSE YES FOXAIR 25/ DOSE YES FOXAIR 50/100 ACCUHALER YES FOXAIR 50/250 ACCUHALER YES FOXAIR 50/500 ACCUHALER YES SEREFLO 25/125 YES SEREFLO 25/250 YES SEREFLO 25/50 YES SERETIDE 25/ DOSE YES 8

9 SERETIDE 25/ DOSE YES SERETIDE 25/ DOSE YES SERETIDE 50/100 ACCUHALER YES SERETIDE 50/250 ACCUHALER YES SERETIDE 50/500 ACCUHALER YES T THEOPHYLLINE EUPHYLLIN RET 250MG YES RSTAN-TED 200MG TAB YES NUELIN SA 250 YES SANDOZ THEOPHYLLINE 200 YES SANDOZ THEOPHYLLINE 300 YES THEOPLUS 200MG TAB YES THEOPLUS 300MG TAB YES DEVICES DP HALER DEVICE REVOLIZER UNI VACCINES FLUARIX PREFILLED SYRINGE YES FLUVAX 2009 PRE-FILLED YES IMOVAX PNEUMO 23 YES INFLUVAC 0.5ML YES MUTAGRIP SINGLE DOSE YES PNEUMOVAX VAC YES VAXIGRIP PREFIL S/DOSE YES X-FLU PREFILLED SYR 0.5ML YES 9