ICON Formulary - October 2018 Legend - ICON Protocols Essential (previously Standard), Core, Enhanced Core, Enhanced Enhanced

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1 ICON Formulary - October 2018 Legend - ICON Protocols Essential (previously Standard), Core, Enhanced Core, Enhanced Enhanced Class Medicine Name Nappi Strength Form Size Route Abiraterone Acetate ZYTIGA mg 120 ORAL Alemtuzumab Alemtuzumab Anastrozole STRADEXA mg 30 ORAL Anastrozole TEVA ANASTROZOLE mg 30 ORAL Anastrozole ACCORD ANASTROZOLE mg 30 ORAL Bendamustine RIBOMUSTIN mg 1 INJ Bendamustine RIBOMUSTIN mg 1 INJ Bevacizumab AVASTIN mg 1 INJ Bevacizumab AVASTIN mg 1 INJ Bicalutamide CALOXA mg 30 ORAL Bicalutamide SPEC-BICALUTAMIDE mg 30 ORAL Bicalutamide ACCORD BICALUTAMIDE mg 30 ORAL Bicalutamide TEVA BICALUTAMIDE mg 30 ORAL Bicalutamide ANANDROCA mg 30 ORAL Bicalutamide BICALOX mg 30 ORAL Bleomycin Bleolem IU 1 INJ Bortezomib VALTIB mg 1 INJ Bortezomib VELCADE mg 1 INJ Buserelin SUPREFACT 3 MONTH DEPOT mg 1 IMP Cabazitaxel CABITAS mg 1 INJ Capecitabine PECASET mg 60 ORAL Capecitabine CAPEXA mg 60 ORAL Capecitabine CAPECITABINE SPECPHARM mg 60 ORAL Capecitabine XELODA mg 60 ORAL Capecitabine PECASET mg 120 ORAL Capecitabine CAPEXA mg 120 ORAL Capecitabine CAPECITABINE SPECPHARM mg 120 ORAL Capecitabine XELODA mg 120 ORAL Carboplatin Accord Carboplatin mg 1 INJ Carboplatin Carbosin mg 1 INJ Carboplatin ASPEN CARBOPLATIN mg 1 INJ Carboplatin Accord Carboplatin mg 1 INJ Manufacturer JANSSEN PHARMACEUTICALS ASTELLAS PHARMA ASTELLAS PHARMA SPECPHARM (PTY) LTD ZYDUS CADILA PHARMAPLAN JANSSEN PHARMACEUTICALS SPECPHARM (PTY) LTD SPECPHARM (PTY) LTD

2 Carboplatin Carbosin mg 1 INJ Carboplatin ASPEN CARBOPLATIN mg 1 INJ Carboplatin Carbosin mg 1 INJ Cetuximab ERBITUX mg 1 INJ Chlorambucil LEUKERAN mg 25 ORAL Cisplatin CISACOR mg 1 INJ Cisplatin P&U CISPLATIN mg 1 INJ Cisplatin CISACOR mg 1 INJ Cisplatin P&U CISPLATIN mg 1 INJ Cyclophosphamide ENDOXAN mg 1 INJ Cyclophosphamide ENDOXAN mg 1 INJ Cyclophosphamide ENDOXAN mg 50 ORAL Cyproterone CIPLA-CYPROTERONE ACETATE mg 20 ORAL Cytarabine CYTOSAR mg 1 INJ Cytarabine LARACIT mg 1 INJ Dacarbazine DACIN mg 1 INJ Dactinomycin Dasatinib SPRYCEL mg 60 ORAL Dasatinib SPRYCEL mg 60 ORAL Dasatinib SPRYCEL mg 60 ORAL Dasatinib SPRYCEL mg 30 ORAL Daunorubicin DAUNOBLASTIN mg 1 INJ Docetaxel ERIOX mg 1 INJ Docetaxel KEY DOCETAXEL AND DILUENT mg 1 INJ Docetaxel DOCETAXEL ACCORD mg 1 INJ Docetaxel CIPLA-DOCETAXEL mg 1 INJ Docetaxel ERIOX mg 1 INJ Docetaxel KEY DOCETAXEL AND DILUENT mg 1 INJ Docetaxel DOCETAXEL ACCORD mg 1 INJ Docetaxel CIPLA-DOCETAXEL mg 1 INJ Docetaxel DOCETAXEL ACCORD mg 1 INJ Doxorubicin DOXORUBICIN RTU mg 1 INJ Doxorubicin RUBEXET mg 1 INJ Doxorubicin Cipla-Doxorubicin mg 1 INJ Doxorubicin DOXORUBICIN ACCORD mg 1 INJ Doxorubicin DOXORUBICIN RTU mg 1 INJ Doxorubicin RUBEXET mg 1 INJ Doxorubicin Cipla-Doxorubicin mg 1 INJ Doxorubicin DOXORUBICIN ACCORD mg 1 INJ Doxorubicin RUBEXET mg 1 INJ MERCK

3 Enzalutamide XTANDI mg 112 ORAL Epirubicin EPICORD mg 1 INJ Epirubicin Accord Epirubicin mg 1 INJ Epirubicin ASPEN EPIRUBICIN mg 1 INJ Epirubicin EPICORD mg 1 INJ Epirubicin Accord Epirubicin mg 1 INJ Epirubicin ASPEN EPIRUBICIN mg 1 INJ Epirubicin ASPEN EPIRUBICIN mg 1 INJ Eribulin HALAVEN mg 1 INJ Erlotinib TARCEVA mg 30 ORAL Erlotinib TARCEVA mg 30 ORAL Erlotinib TARCEVA mg 30 ORAL Etoposide EPOSIN mg 1 INJ Etoposide ASPEN ETOPOSIDE mg 1 INJ Etoposide oral Everolimus AFINITOR mg 30 ORAL Everolimus AFINITOR mg 30 ORAL Everolimus AFINITOR mg 30 ORAL Exemestane EXICAN mg 30 ORAL Exemestane EQUISIN mg 30 ORAL Exemestane ASPEN EXEMESTANE mg 30 ORAL Filgrastim FILGRASTIM TEVA MIU 5 INJ Filgrastim Neupogen Pref Syr MIU 5 INJ Fludarabine TEVA FLUDARABINE mg 1 INJ Fludarabine Fludara mg 5 INJ Fludarabine FLUDARA ORAL mg 20 ORAL Fluorouracil FLORACOR mg 1 INJ Fluorouracil FLURACEDYL mg 1 INJ Fluorouracil Fluracedyl mg 1 INJ Flutamide FLUTAPLEX mg 90 ORAL Fulvestrant FASLODEX mg 2 INJ Gemcitabine CYTIGEM mg 1 INJ Gemcitabine ACCORD GEMCITABINE mg 1 INJ Gemcitabine GEMCITABINE mg 1 INJ Gemcitabine ONCOGEM mg 1 INJ Gemcitabine CYTIGEM mg 1 INJ Gemcitabine ACCORD GEMCITABINE mg 1 INJ Gemcitabine GEMCITABINE mg 1 INJ Gemcitabine ONCOGEM mg 1 INJ Goserelin ZOLADEX DEPOT mg 1 INJ ASTELLAS PHARMA EQUITY PHARMACEUTICALS EQUITY PHARMACEUTICALS AMGEN ASTRAZENECA ASTRAZENECA

4 Goserelin ZOLADEX DEPOT mg 1 INJ Hydroxyurea HYDREA mg 100 ORAL Idarubicin ZAVEDOS mg 1 INJ Idarubicin ZAVEDOS mg 1 INJ Ifosfamide HOLOXAN mg 1 INJ Ifosfamide HOLOXAN mg 1 INJ Ifosfamide HOLOXAN mg 1 INJ Imatinib SUNMATIN mg 60 ORAL Imatinib MIVESTA mg 60 ORAL Imatinib IMAVEC mg 60 ORAL Imatinib IMATINIB ACCORD mg 60 ORAL Imatinib VATIVIO mg 120 ORAL Imatinib SUNMATIN mg 30 ORAL Imatinib MIVESTA mg 30 ORAL Imatinib IMAVEC mg 30 ORAL Imatinib IMATINIB ACCORD mg 30 ORAL Interferon alfa-2a Interferon alfa-2b Irinotecan IRINOTAS mg 1 INJ Irinotecan ACCORD IRINOTECAN mg 1 INJ Irinotecan CIPLA-IRINOTECAN mg 1 INJ Irinotecan IRINOTECAN mg 1 INJ Irinotecan IRINOTAS mg 1 INJ Irinotecan ACCORD IRINOTECAN mg 1 INJ Irinotecan CIPLA-IRINOTECAN mg 1 INJ Irinotecan IRINOTECAN mg 1 INJ Ketoconazole KETAZOL mg 10 ORAL Ketoconazole KETAZOL mg 30 ORAL Lanreotide SOMATULINE AUTOGEL mg 1 INJ Lanreotide SOMATULINE AUTOGEL mg 1 INJ Lanreotide SOMATULINE AUTOGEL mg 1 INJ Lapatinib TYKERB mg 70 ORAL Letrozole LARADEX mg 30 ORAL Letrozole CIPLA-LETROZOLE mg 30 ORAL Letrozole FEMZOLE mg 30 ORAL Letrozole ACCORD LETROZOLE mg 30 ORAL Leuprorelin LUCRIN DEPOT S/DOSE mg 1 INJ Leuprorelin LUCRIN VIAL mg 1 INJ Leuprorelin Hexal LEUPROLIDE HEXAL mg 1 IMP Leuprorelin with Atrigel ELIGARD mg 1 INJ ASTRAZENECA ADCOCK INGRAM CRITICAL CARE ABBVIE PTY LTD ABBVIE PTY LTD

5 Leuprorelin with Atrigel ELIGARD mg 1 INJ Leuprorelin with Atrigel ELIGARD mg 1 INJ Liposomal Doxorubicin DOXOLIP (10 ml) mg 1 INJ Liposomal Doxorubicin DOXOPEG mg 1 INJ Lomustine 10 Lomustine 40 Medroxyprogesterone PROVERA mg 100 ORAL Medroxyprogesterone PROVERA mg 100 ORAL Melphalan ALKERAN mg 1 INJ Melphalan ALKERAN mg 25 ORAL Methotrexate METHACOR mg 1 INJ Methotrexate ABITREXATE mg 1 INJ Methotrexate ABITREXATE VIAL 20ML mg 1 INJ Methotrexate ABITREXATE mg 1 INJ Methotrexate ABITREXATE mg 1 INJ Methotrexate ABITREXATE mg 100 ORAL Mitomycin MITOMYCIN-C mg 1 INJ Mitomycin MITOMYCIN-C mg 1 INJ Mitoxantrone MITOXANTRONE-HEXAL mg 1 INJ Nilotinib TASIGNA mg 112 ORAL Nilotinib TASIGNA mg 112 ORAL Octreotide SANDOSTATIN mg 5 INJ Octreotide SANDOSTATIN mg 5 INJ Octreotide SANDOSTATIN mg 1 INJ Octreotide SANDOSTATIN LAR PREFILL mg 1 INJ Octreotide SANDOSTATIN LAR PREFILL mg 1 INJ Octreotide SANDOSTATIN LAR PREF mg 1 INJ Oxaliplatin INTAS OXALIPLATIN mg 1 INJ Oxaliplatin OXALIPLATIN KEY mg 1 INJ Oxaliplatin OPLAXIN mg 1 INJ Oxaliplatin OXALIPLATIN PCH mg 1 INJ Oxaliplatin OXALIWIN RTU mg 1 INJ Oxaliplatin INTAS OXALIPLATIN mg 1 INJ Oxaliplatin OXALIPLATIN KEY mg 1 INJ Oxaliplatin OPLAXIN mg 1 INJ Oxaliplatin OXALIPLATIN PCH mg 1 INJ Oxaliplatin OXALIWIN RTU mg 1 INJ Paclitaxel ACCORD PACLITAXEL mg 1 INJ Paclitaxel PCH-PACLITAXEL mg 1 INJ Paclitaxel CIPLA-PACLITAXEL mg 1 INJ ZENTIVA SOUTH AFRICA PTY LTD ZENTIVA SOUTH AFRICA PTY LTD

6 Paclitaxel ACCORD PACLITAXEL mg 1 INJ Paclitaxel PCH-PACLITAXEL mg 1 INJ Paclitaxel CIPLA-PACLITAXEL mg 1 INJ Paclitaxel ACCORD PACLITAXEL mg 1 INJ Paclitaxel CIPLA-PACLITAXEL mg 1 INJ Paclitaxel PCH-PACLITAXEL mg 1 INJ Pazopanib VOTRIENT mg 30 ORAL Pazopanib VOTRIENT mg 30 ORAL Pemetrexed PEMETREXED ACCORD mg 1 INJ Rituximab MABTHERA mg 2 INJ Rituximab MABTHERA mg 1 INJ Sorafenib NEXAVAR mg 60 ORAL Streptozocin Sunitinib SUTENT mg 28 ORAL Sunitinib SUTENT mg 28 ORAL Sunitinib SUTENT mg 28 ORAL Tamoxifen KESSAR mg 30 ORAL Tamoxifen TAMOXIHEXAL mg 30 ORAL Tamoxifen TAMOPLEX mg 30 ORAL Tamoxifen NEOPHEDAN mg 30 ORAL Temozolomide TEMINTAS mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Temozolomide TEMINTAS mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Temozolomide TEMINTAS mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Temozolomide TEMINTAS mg 5 ORAL Temozolomide ACCORD TEMOZOLOMIDE mg 5 ORAL Temozolomide TEMODAL mg 5 ORAL Thalidomide THALIDOMIDE CELGENE mg 28 ORAL Topotecan HYCAMTIN mg 5 INJ Topotecan HYCAMTIN mg 10 ORAL Topotecan HYCAMTIN mg 10 ORAL Trastuzumab HERCEPTIN MULTIDOSE mg 1 INJ Trastuzumab HERCEPTIN SC mg 1 INJ BAYER PHARMA GLAXO SMITHKLINE

7 Vinblastine VINBLASTINE TEVA mg 1 INJ Vincristine P&U VINCRISTINE CSV mg 5 INJ Vincristine Accord Vincristine mg 1 INJ Vinorelbine VINORELBINE mg 1 INJ Vinorelbine NAVELBINE mg 10 INJ Vinorelbine VINORELBINE mg 1 INJ Vinorelbine NAVELBINE mg 10 INJ Vinorelbine NAVELBINE ORAL mg 1 ORAL Vinorelbine NAVELBINE ORAL mg 1 ORAL Zoledronic Acid ZOMEDRON mg 1 INJ Zoledronic Acid ZOBONE mg 1 INJ Zoledronic Acid ZOMABON mg 1 INJ ACTOR PHARMA

MABCAMPATH mg 3 INJ GENZYME BIOPHARMACEUTICALS. MABCAMPBATH mg 3 INJ GENZYME BIOPHARMACEUTICALS

MABCAMPATH mg 3 INJ GENZYME BIOPHARMACEUTICALS. MABCAMPBATH mg 3 INJ GENZYME BIOPHARMACEUTICALS ICON Formulary - November 2016 Class Medicine Name Nappi Strength Form Size Route Manufacturer Abiraterone Acetate ZYTIGA 250 720690001 250 mg 120 ORAL JANSSEN PHARMACEUTICALS Aldesleukin CHIRON IL-2 18