Restrictive Formulary. RESTRICTIVE PMB FORMULARY Effective 1 June 2010

Transcription

1 RESTRICTIVE PMB FORMULARY Effective 1 June 2010 Products included on this chronic medicines formulary will not attract a co-payment if authorised by Chronic Medicine Management (Medi-Serve) for a disease on the CDL and obtained from the Designated Service Provider. Reimbursement will however be subject to the Chronic Medicine Management clinical guidelines and protocols and the Medicine Price List (MPL). KEY to Chronic Medicine Management Reimbursement Criteria: Quantity/dosage and duration of authorisation may vary - depending on the requested drug. Accepted Treatment - will be authorised without requesting additional clinical information (unless specific concerns e.g. unusual dose requests). Clinical Review - will be authorised if the drug history or co-morbidity clearly indicates that use of the drug is indicated in the specific patient. Clinical Motivation - specific clinical information required before reimbursement is considered Specialist Script - will require a relevant specialist's prescription before reimbursement is considered Specialist Motivation - will require a relevant specialist motivation before reimbursement is considered Special Investigations (SI) - results of recent relevant tests required before reimbursement is considered Drug Name Active Ingredient Strength Drug Form Asthma Inhaled B2 agonists AIROMIR INHALER Salbutamol 100MCG INH Accepted treatment ASTHAVENT 200 DS Salbutamol 100MCG INH Accepted treatment ASTHAVENT 200 DS Salbutamol 100MCG INH Accepted treatment ASTHAVENT 300D ECOHALER CFC FREE Salbutamol 100MCG INH Accepted treatment VENTEZE COMPLETE Salbutamol 100MCG INH Accepted treatment VENTEZE CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment VENTOLIN INHALER 200 CFC FREE Salbutamol 100MCG INH Accepted treatment Long acting B2 agonists FORADIL DRY Formoterol 12MCG CPS Clinical Review FORATEC DP CAPS Formoterol 12MCG CAP Clinical Review FORATEC HFA 120DOSE Formoterol 12MCG INH Clinical Review Inhaled corticosteroids BECEZE INHALER COMPLETE Beclomethasone 100MCG INH Accepted treatment BECEZE INHALER COMPLETE Beclomethasone 50MCG INH Accepted treatment BECLATE INHALER Beclomethasone 100MCG INH Accepted treatment BECLATE INHALER Beclomethasone 200MCG INH Accepted treatment BECLATE INHALER Beclomethasone 50MCG INH Accepted treatment BECOTIDE 100 COMP Beclomethasone 100MCG INH Accepted treatment BECOTIDE 100 REFILL Beclomethasone 100MCG REF Accepted treatment BECOTIDE COMPLETE Beclomethasone 50MCG INH Accepted treatment BECOTIDE REFILL Beclomethasone 50MCG REF Accepted treatment BUDEFLAM CFC FREE 200MCG 300 DOSE INH Budesonide 200MCG INH Accepted treatment BUDEFLAM CFC FREE 300 DOSE INH Budesonide 100MCG INH Accepted treatment BUDEFLAM DP CAPS Budesonide 200MCG CAP Accepted treatment INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 100MCG INH Accepted treatment INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 200MCG INH Accepted treatment INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 50MCG INH Accepted treatment INFLAMMIDE INHALATION SYSTEM 300 DOSE Budesonide 100MCG KIT Accepted treatment INFLAMMIDE INHALATION SYSTEM 300 DOSE Budesonide 200MCG KIT Accepted treatment INFLAMMIDE 200 NOVOLIZE REFIL Budesonide 200MCG REF Accepted treatment INFLAMMIDE 200 NOVOLIZER COMPL Budesonide 200MCG INH Accepted treatment INFLAMMIDE NOVOLIZER COMPLETE 100DOSE Budesonide 400MCG INH Accepted treatment INFLAMMIDE NOVOLIZER REFILL 100DOSE Budesonide 400MCG REF Accepted treatment Chronic Medicine Management Reimbursement Criteria for formulary drugs /05/28

2 ROLAB-BECLOMETHASONE DIPROPIONATE AEROSO Beclomethasone 50MCG INH Accepted treatment ROLAB-BECLOMETHASONE DIPROPIONATE AEROSO Beclomethasone 50MCG REF Accepted treatment SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment SERETIDE 25/ DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment SERETIDE 50/100 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/100MCG INH Accepted treatment SERETIDE 50/250 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/250MCG INH Accepted treatment SERETIDE 50/500 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/500MCG INH Accepted treatment Oral Xanthines PULMOPHYLLIN SR 200 Theophylline 200MG SRT Clinical Review PULMOPHYLLIN SR 300 Theophylline 300MG SRT Clinical Review ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 200MG SRT Clinical Review ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 300MG SRT Clinical Review THEOPHEN Theophylline SYR Clinical Review Oral Corticosteroids ASPELONE Prednisolone 15MG/5ML LIQ Specialist script CAPSOID Prednisolone 5MG TAB Specialist script LENISOLONE Prednisolone 5MG TAB Specialist script PANAFCORT Prednisone 5MG TAB Specialist script PREDNISONE (BE-TABS) Prednisone 5mg TAB Specialist script PREDNISONE (FAMS) Prednisone 5MG TAB Specialist script PREFLAM Prednisolone 15MG/5ML SYR Specialist script PRELONE Prednisolone 15MG/5ML SYR Specialist script PULMISON ORAL SOLUTION Prednisone 5MG/1ML SYR Specialist script TROLIC Prednisone 5MG TAB Specialist script Addison's disease Oral Corticosteroids COVOCORT Hydrocortisone 10MG TAB Accepted treatment FLORINEF ACETATE Fludrocortisone 0.1MG TAB Accepted treatment Bipolar Mood Disorder Mood Stabilisers ARROW LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment ARROW LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment ARROW LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment ARROW LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment ASPEN LAMOTRIGINE 100MG Lamotrigine 100MG TAB Accepted treatment ASPEN LAMOTRIGINE 200MG Lamotrigine 200MG TAB Accepted treatment ASPEN LAMOTRIGINE 25MG Lamotrigine 25MG TAB Accepted treatment ASPEN LAMOTRIGINE 50MG Lamotrigine 50MG TAB Accepted treatment AUSTELL-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment AUSTELL-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment AUSTELL-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment AUSTELL-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment CAMCOLIT Lithium 250MG TAB Accepted treatment CAMCOLIT Lithium 400MG TAB Accepted treatment CONVULEX Valproic acid 150MG CAP Accepted treatment CONVULEX Valproic acid 250MG/5ML SYR Accepted treatment CONVULEX Valproic acid 300MG CAP Accepted treatment CONVULEX Valproic acid 500MG CAP Accepted treatment DEGRANOL Carbamazepine 200MG TAB Accepted treatment DYNA-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment DYNA-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment /05/28

3 DYNA-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment DYNA-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment EPILIM 200 EC Valproic acid 200MG ECT Accepted treatment EPILIM 500 EC Valproic acid 500MG ECT Accepted treatment EPILIM CR Valproic acid 200MG SRT Accepted treatment EPILIM CR Valproic acid 300MG SRT Accepted treatment EPILIM CR Valproic acid 500MG SRT Accepted treatment EPILIM CRUSHABLE Valproic acid 100MG TAB Accepted treatment EPILIM SUGAR FREE Valproic acid 200MG/5ML SYR Accepted treatment EPITEC 100MG Lamotrigine 100MG TAB Accepted treatment EPITEC 200MG Lamotrigine 200MG TAB Accepted treatment EPITEC 25MG Lamotrigine 25MG TAB Accepted treatment EPITEC 50MG Lamotrigine 50MG TAB Accepted treatment LAMEPTIL Lamotrigine 100MG TAB Accepted treatment LAMEPTIL Lamotrigine 200MG TAB Accepted treatment LAMEPTIL Lamotrigine 25MG TAB Accepted treatment LAMEPTIL Lamotrigine 50MG TAB Accepted treatment LAMICTIN Lamotrigine 100MG TAB Accepted treatment LAMICTIN Lamotrigine 200MG TAB Accepted treatment LAMICTIN Lamotrigine 25MG TAB Accepted treatment LAMICTIN Lamotrigine 50MG TAB Accepted treatment Lamictin 25 m starter pk-monotherapy Lamotrigine 25MG TAB Accepted treatment Lamictin 25 vp starter pk-add on Lamotrigine 25MG TAB Accepted treatment Lamictin 50 nvp starter pk-non valpr ao Lamotrigine 50MG TAB Accepted treatment LAMICTIN P100 Lamotrigine 100MG DSP Accepted treatment LAMICTIN P2 Lamotrigine 2MG DSP Accepted treatment LAMICTIN P200 Lamotrigine 200MG DSP Accepted treatment LAMICTIN P25 Lamotrigine 25MG DSP Accepted treatment LAMICTIN P5 Lamotrigine 5MG DSP Accepted treatment LAMICTIN P50 Lamotrigine 50MG DSP Accepted treatment LAMIDUS Lamotrigine 100MG TAB Accepted treatment LAMIDUS Lamotrigine 200MG TAB Accepted treatment LAMIDUS Lamotrigine 50MG TAB Accepted treatment LAMITOR Lamotrigine 100MG TAB Accepted treatment LAMITOR Lamotrigine 25MG TAB Accepted treatment LAMITOR Lamotrigine 50MG TAB Accepted treatment LAMITOR Lamotrigine 200MG TAB Accepted treatment LENTOLITH Lithium 400MG CAP Accepted treatment QUILONUM RETARD Lithium 450MG TAB Accepted treatment ROLAB-CARBAMAZEPINE Carbamazepine 200MG TAB Accepted treatment SANDOZ CARBAMAZEPINE CR200 Carbamazepine 200MG SRT Accepted treatment SANDOZ CARBAMAZIPINE CR400 Carbamazepine 400MG SRT Accepted treatment SANDOZ LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment SANDOZ LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment SANDOZ LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment SANDOZ LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment TEGRETOL S Carbamazepine 100MG/5ML SUS Accepted treatment Antipsychotic agents ASPEN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) ASPEN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) ASPEN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) ASPEN RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) ASPEN RISPERIDONE Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options) BIO-SULPIRIDE Sulpiride 200MG TAB Accepted treatment /05/28

4 CLOMENT Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options) CLOMENT Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options) CLOPIXOL DEPOT Zuclopenthixol 200MG/1ML INJS Accepted treatment CLOZAPINE-HEXAL Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options) CLOZAPINE-HEXAL Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options) DRL RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) DRL RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) DRL RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) DRL RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) EGLONYL FORTE Sulpiride 200MG TAB Accepted treatment FLUANXOL DEPOT 1ML Flupentixol 20MG/1ML INJS Accepted treatment FLUANXOL DEPOT 2ML Flupentixol 40MG/2ML INJS Accepted treatment LARGACTIL Chlorpromazine 100MG TAB Accepted treatment LARGACTIL Chlorpromazine 10MG TAB Accepted treatment LARGACTIL Chlorpromazine 25MG TAB Accepted treatment LARGACTIL Chlorpromazine 50MG TAB Accepted treatment LEPONEX Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options) LEPONEX Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options) MYLAN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) MYLAN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) MYLAN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) MODECATE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment MODECATE+SYRINGE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment PERIZAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) PERIZAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) PERIZAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) PERIZAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPACOR Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) RISPACOR Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPACOR Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPACOR Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPACOR Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL QUICKLET Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL QUICKLET Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL QUICKLET Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL QUICKLET Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERDAL QUICKLET Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERIDONE HEXAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERIDONE HEXAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERIDONE HEXAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERIDONE HEXAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERLET Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERLET Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPERLET Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPONZ Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) RISPONZ Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) RISPONZ Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options) RISPONZ Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options) ROLAB-HALOPERIDOL Haloperidol 1.5MG TAB Accepted treatment ROLAB-HALOPERIDOL Haloperidol 5MG TAB Accepted treatment /05/28

5 SERENACE Haloperidol 0.5MG CAP Accepted treatment SERENACE Haloperidol 1.5MG TAB Accepted treatment SERENACE Haloperidol 10MG TAB Accepted treatment SERENACE Haloperidol 5MG TAB Accepted treatment STELAZINE Trifluoperazine 1MG TAB Accepted treatment STELAZINE Trifluoperazine 5MG TAB Accepted treatment ZOXADON Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options) ZOXADON Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options) ZOXADON Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options) Antidepressants AURO-CITALOPRAM Citalopram 20MG TAB Accepted treatment AUSTELL-CITALOPRAM Citalopram 10MG TAB Accepted treatment AUSTELL-CITALOPRAM Citalopram 20MG TAB Accepted treatment AUSTELL-CITALOPRAM Citalopram 40MG TAB Accepted treatment A-LENNON FLUOXETINE Fluoxetine 20MG CAP Accepted treatment CILATE Citalopram 20MG TAB Accepted treatment CILIFT Citalopram 20MG TAB Accepted treatment CILORAM Citalopram 20MG TAB Accepted treatment CIPRAMIL Citalopram 20MG TAB Accepted treatment CITALOHEXAL Citalopram 20MG TAB Accepted treatment CITALOPRAM-WINTHROP Citalopram 20MG TAB Accepted treatment CITALOPRAM-WINTHROP Citalopram 40MG TAB Accepted treatment DEPRAMIL 20MG Citalopram 20MG TAB Accepted treatment DEPRAMIL Citalopram 40MG TAB Accepted treatment DEPROZAN Fluoxetine 20MG CAP Accepted treatment DRL CITALOPRAM Citalopram 20MG TAB Accepted treatment DRL CITALOPRAM Citalopram 40MG TAB Accepted treatment ETHIPRAMINE Imipramine 10MG TAB Accepted treatment ETHIPRAMINE Imipramine 25MG TAB Accepted treatment FLUTINOL Fluoxetine 20MG CAP Accepted treatment LILLY-FLUOXETINE Fluoxetine 20MG CAP Accepted treatment LORIEN Fluoxetine 20MG CAP Accepted treatment LORIEN 20MG Fluoxetine 20MG TAB Accepted treatment NORILINE Amitriptyline 10MG TAB Accepted treatment NORILINE Amitriptyline 25MG TAB Accepted treatment NUZAK Fluoxetine 20MG CAP Accepted treatment PROHEXAL Fluoxetine 20MG CAP Accepted treatment PROHEXAL 20T Fluoxetine 20MG DSP Accepted treatment PROHEXAL 40T Fluoxetine 40MG DSP Accepted treatment PROTHIADEN Dothiepin 25MG CAP Accepted treatment PROTHIADEN Dothiepin 75MG TAB Accepted treatment PROZAC Fluoxetine 20MG TAB Accepted treatment PROZAC LIQUID Fluoxetine 20MG/5ML SYR Accepted treatment PROZAC 20 Fluoxetine 20MG CAP Accepted treatment PROZAC 40 SI Fluoxetine 40MG CAP Accepted treatment RAN CITALOPRAM Citalopram 20MG TAB Accepted treatment RAN CITALOPRAM Citalopram 40MG TAB Accepted treatment RANFLOCS Fluoxetine 20MG CAP Accepted treatment REZAK Fluoxetine 20MG CAP Accepted treatment ROLAB-AMITRIPTYLINE HCL Amitriptyline 25MG TAB Accepted treatment ROLAB-DOTHIEPIN Dothiepin 25MG CAP Accepted treatment ROLAB-DOTHIEPIN Dothiepin 75MG TAB Accepted treatment ROLAB-FLUOXETINE Fluoxetine 20MG CAP Accepted treatment SANDOZ CITALOPRAM Citalopram 20MG TAB Accepted treatment /05/28

6 SANDOZ CITALOPRAM Citalopram 40MG TAB Accepted treatment SIMAYLA CITALOPRAM Citalopram 20MG TAB Accepted treatment TALOMIL Citalopram 20MG TAB Accepted treatment THADEN Dothiepin 25MG CAP Accepted treatment THADEN Dothiepin 75MG TAB Accepted treatment TOFRANIL Imipramine 10MG TAB Accepted treatment TOFRANIL Imipramine 25MG TAB Accepted treatment TREPILINE Amitriptyline 10MG TAB Accepted treatment TREPILINE Amitriptyline 25MG TAB Accepted treatment TRIZAC Fluoxetine 20MG CAP Accepted treatment TRYPTANOL Amitriptyline 25MG TAB Accepted treatment ZYDUS FLUOXETINE Fluoxetine 20MG CAP Accepted treatment Bronchiectasis Antibiotic therapy will be evaluated on an individual basis Chronic Obstructive Pulmonary Disease Inhaled B2 agonists AIROMIR INHALER Salbutamol 100MCG INH Accepted treatment ASTHAVENT 200 DS Salbutamol 100MCG INH Accepted treatment ASTHAVENT 300 DOSE Salbutamol 100MCG INH Accepted treatment ASTHAVENT 300D ECOHALER CFC FREE Salbutamol 100MCG INH Accepted treatment VENTEZE COMPLETE Salbutamol 100MCG INH Accepted treatment VENTEZE CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment VENTOLIN INHALER 200 CFC FREE Salbutamol 100MCG INH Accepted treatment Inhaled corticosteroids BECEZE INHALER COMPLETE Beclomethasone 100MCG INH Special Investigations (SI) BECEZE INHALER COMPLETE Beclomethasone 50MCG INH Special Investigations (SI) BECLATE INHALER Beclomethasone 100MCG INH Special Investigations (SI) BECLATE INHALER Beclomethasone 200MCG INH Special Investigations (SI) BECLATE INHALER Beclomethasone 50MCG INH Special Investigations (SI) BECOTIDE 100 COMP Beclomethasone 100MCG INH Special Investigations (SI) BECOTIDE 100 REFILL Beclomethasone 100MCG REF Special Investigations (SI) BECOTIDE COMPLETE Beclomethasone 50MCG INH Special Investigations (SI) BECOTIDE REFILL Beclomethasone 50MCG REF Special Investigations (SI) BUDEFLAM CFC FREE 200MCG 300 DOSE INH Budesonide 200MCG INH Special Investigations (SI) BUDEFLAM CFC FREE 300 DOSE INH Budesonide 100MCG INH Special Investigations (SI) BUDEFLAM DP CAPS Budesonide 200MCG CAP Special Investigations (SI) INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 100MCG INH Special Investigations (SI) INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 200MCG INH Special Investigations (SI) INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 50MCG INH Special Investigations (SI) INFLAMMIDE INHALATION SYSTEM 300 DOSE Budesonide 100MCG KIT Special Investigations (SI) INFLAMMIDE INHALATION SYSTEM 300 DOSE Budesonide 200MCG KIT Special Investigations (SI) INFLAMMIDE 200 NOVOLIZE REFIL Budesonide 200MCG REF Special Investigations (SI) INFLAMMIDE 200 NOVOLIZER COMPL Budesonide 200MCG INH Special Investigations (SI) INFLAMMIDE NOVOLIZER COMPLETE 100DOSE Budesonide 400MCG INH Special Investigations (SI) INFLAMMIDE NOVOLIZER REFILL 100DOSE Budesonide 400MCG REF Special Investigations (SI) ROLAB-BECLOMETHASONE DIPROPIONATE AEROSO Beclomethasone 50MCG INH Special Investigations (SI) ROLAB-BECLOMETHASONE DIPROPIONATE AEROSO Beclomethasone 50MCG REF Special Investigations (SI) SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Special Investigations (SI) SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Special Investigations (SI) SERETIDE 25/ DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Special Investigations (SI) SERETIDE 50/100 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/100MCG INH Special Investigations (SI) SERETIDE 50/250 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/250MCG INH Special Investigations (SI) /05/28

7 SERETIDE 50/500 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/500MCG INH Special Investigations (SI) Anticholinergic inhalers (short acting) ATROVENT 40 MAC COMPL 300 DOSE Ipratropium bromide 40MCG INH Accepted treatment IPVENT-40 Ipratropium bromide 40MCG INH Accepted treatment Oral Xanthines PULMOPHYLLIN SR 200 Theophylline 200MG SRT Accepted treatment PULMOPHYLLIN SR 300 Theophylline 300MG SRT Accepted treatment ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 200MG SRT Accepted treatment ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 300MG SRT Accepted treatment Oral Corticosteroids CAPSOID Prednisolone 5MG TAB Special Investigations (SI) LENISOLONE Prednisolone 5MG TAB Special Investigations (SI) PREDNISONE (BE-TABS) Prednisone 5mg TAB Special Investigations (SI) PREDNISONE (FAMS) Prednisone 5MG TAB Special Investigations (SI) TROLIC Prednisone 5MG TAB Special Investigations (SI) Cardiac failure/ Cardiomyopathy Anticoagulants WARFARIN Warfarin 5MG TAB Accepted treatment CIPLA WARFARIN 1MG Warfarin 1MG TAB Accepted treatment CIPLA-WARFARIN Warfarin 3MG TAB Accepted treatment CIPLA WARFARIN 5MG Warfarin 5MG TAB Accepted treatment Diuretics ADCO-RETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment ALDACTONE Spironolactone 25MG APP Accepted treatment AMILORETIC Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment AMILORETIC HS Hydrochlorothiazide and potassium-sparing agents 2.5MG/25MG TAB Accepted treatment AQUARID Furosemide 40MG CAP Accepted treatment BEURISES Furosemide 40MG TAB Accepted treatment BETARETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment CATEXAN Indapamide 2.5MG TAB Accepted treatment CIPLA-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment DAPAMAX Indapamide 2.5MG TAB Accepted treatment DAPTRIL Indapamide 2.5MG TAB Accepted treatment DINO-RETIC (bei) Furosemide 40MG TAB Accepted treatment DIURESIX Furosemide 40MG TAB Accepted treatment DYAZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment HEXARETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment HEXAZIDE Hydrochlorothiazide 25MG TAB Accepted treatment HYDRO-LESS Indapamide 2.5MG TAB Accepted treatment INDALIX Indapamide 2.5MG TAB Accepted treatment LASIX ORAL Furosemide 10MG/1ML SLN Clinical review LIXAMIDE Indapamide 2.5MG TAB Accepted treatment MYLAN FUROSEMIDE Furosemide 40MG TAB Accepted treatment MYLAN-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment MODURETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment MODURETIC HS Hydrochlorothiazide and potassium-sparing agents 2.5MG/25MG TAB Accepted treatment NATRILIX Indapamide 2.5MG TAB Accepted treatment RENEZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment RIDAQ Hydrochlorothiazide 25MG TAB Accepted treatment RIDAQ Hydrochlorothiazide 12.5MG TAB Accepted treatment ROLAB-AMILORIDE HCL/HYDROCHLOROTHIAZIDE Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment ROLAB-FUROSEMIDE Furosemide 40MG TAB Accepted treatment ROLAB-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment /05/28

8 ROLAB-SPIRONOLACTONE Spironolactone 25MG TAB Accepted treatment ROLAB-TRIAMTERENE/HYDROCHLOROTHIAZIDE Hydrochlorothiazide and potassium-sparing agents 50MG/25MG TAB Accepted treatment SPEC-CO-AMILORIDE Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment SPIRACTIN Spironolactone 25MG TAB Accepted treatment UREMIDE Furosemide 40MG TAB Accepted treatment URIREX-K Hydrochlorothiazide and potassium TAB Accepted treatment Potassium supplementation PLENISH K Potassium chloride 600MG TAB Accepted treatment SANDOZ K-600 Potassium chloride 600MG TAB Accepted treatment SLOW-K Potassium chloride 600MG TAB Accepted treatment ACE inhibitors ACCUMAX Quinapril 10MG TAB Accepted treatment ACCUMAX Quinapril 20MG TAB Accepted treatment ACCUPRIL Quinapril 10MG TAB Accepted treatment ACCUPRIL Quinapril 20MG TAB Accepted treatment ACETEN Captopril 12.5MG TAB Accepted treatment ACETEN Captopril 25MG TAB Accepted treatment ACETEN Captopril 50MG TAB Accepted treatment ADCO-CAPTOPRIL Captopril 25MG TAB Accepted treatment ADCO-CAPTOPRIL Captopril 50MG TAB Accepted treatment ADCO-ENALAPRIL 10MG Enalapril 10MG TAB Accepted treatment ADCO-ENALAPRIL 20MG Enalapril 20MG TAB Accepted treatment ADCO-ENALAPRIL 5MG Enalapril 5MG TAB Accepted treatment ALAPREN 10 Enalapril 10MG TAB Accepted treatment ALAPREN 20 Enalapril 20MG TAB Accepted treatment ALAPREN 5 Enalapril 5MG TAB Accepted treatment AUSTELL LISINOPRIL 2.5MG Lisinopril 2.5MG TAB Accepted treatment AUSTELL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment AUSTELL LISINOPRIL 20MG Lisinopril 20MG TAB Accepted treatment CAPACE Captopril 25MG TAB Accepted treatment CAPOTEN Captopril 25MG APP Accepted treatment CAPOTEN Captopril 50MG APP Accepted treatment CAPOTEN HS Captopril 12.5MG APP Accepted treatment CAPTOHEXAL Captopril 12.5MG TAB Accepted treatment CAPTOHEXAL Captopril 25MG TAB Accepted treatment CAPTOHEXAL Captopril 50MG TAB Accepted treatment CAPTOMAX Captopril 25MG TAB Accepted treatment CAPTOMAX Captopril 50MG TAB Accepted treatment CIPLATEC 10 Enalapril 10MG TAB Accepted treatment CIPLATEC 20MG Enalapril 20MG TAB Accepted treatment CIPLATEC 5 Enalapril 5MG TAB Accepted treatment ENAP 10MG Enalapril 10MG TAB Accepted treatment ENAP 20MG Enalapril 20MG TAB Accepted treatment ENAP 5MG Enalapril 5MG TAB Accepted treatment HEXAL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment HEXAL-LISINOPRIL Lisinopril 20MG TAB Accepted treatment HEXAL-LISINOPRIL Lisinopril 5MG TAB Accepted treatment HR-ENALAPRIL 10 Enalapril 10MG TAB Accepted treatment HR-ENALAPRIL 20 Enalapril 20MG TAB Accepted treatment HR-ENALAPRIL 5 Enalapril 5MG TAB Accepted treatment HYPACE Enalapril 5MG TAB Accepted treatment MYLAN CAPTOPRIL Captopril 25MG TAB Accepted treatment MYLAN-CAPTOPRIL Captopril 50MG TAB Accepted treatment PHARMAPRESS Enalapril 5MG TAB Accepted treatment /05/28

9 PHARMAPRESS Enalapril 10MG TAB Accepted treatment PHARMAPRESS Enalapril 20MG TAB Accepted treatment PRILOSIN 10MG Lisinopril 10MG TAB Accepted treatment PRILOSIN 5MG Lisinopril 5MG TAB Accepted treatment PRINIVIL Lisinopril 10MG TAB Accepted treatment PRINIVIL Lisinopril 20MG TAB Accepted treatment PRINIVIL Lisinopril 5MG TAB Accepted treatment QUINACE Quinapril 10MG TAB Accepted treatment QUINACE Quinapril 20MG TAB Accepted treatment QUINAGEN Quinapril 10MG TAB Accepted treatment QUINAGEN Quinapril 20MG TAB Accepted treatment QUINASPEN 10MG Quinapril 10MG TAB Accepted treatment QUINASPEN 20MG Quinapril 20MG TAB Accepted treatment RENITEC Enalapril 10MG TAB Accepted treatment RENITEC Enalapril 2.5MG TAB Accepted treatment RENITEC Enalapril 20MG TAB Accepted treatment RENITEC Enalapril 5MG TAB Accepted treatment RENOTENS 5 Lisinopril 5MG TAB Accepted treatment RENOTENS 10 Lisinopril 10MG TAB Accepted treatment RENOTENS 20 Lisinopril 20MG TAB Accepted treatment ROLAB-CAPTOPRIL Captopril 25MG TAB Accepted treatment ROLAB-CAPTOPRIL Captopril 50MG TAB Accepted treatment SIMAYLA LISINOPRIL Lisinopril 10MG TAB Accepted treatment SIMAYLA LISINOPRIL Lisinopril 20MG TAB Accepted treatment SIMAYLA LISINOPRIL Lisinopril 5MG TAB Accepted treatment SINOPREN 10 Lisinopril 10MG TAB Accepted treatment SINOPREN 20 Lisinopril 20MG TAB Accepted treatment SINOPREN 5 Lisinopril 5MG TAB Accepted treatment ZAPTO Captopril 25MG TAB Accepted treatment ZAPTO Captopril 50MG TAB Accepted treatment ZEMAX 10 Lisinopril 10MG TAB Accepted treatment ZEMAX 20 Lisinopril 20MG TAB Accepted treatment ZEMAX 5 Lisinopril 5MG TAB Accepted treatment ZEPROSIL 10MG Lisinopril 10MG TAB Accepted treatment ZEPROSIL 20MG Lisinopril 20MG TAB Accepted treatment ZEPROSIL 5MG Lisinopril 5MG TAB Accepted treatment ZESTRIL Lisinopril 10MG TAB Accepted treatment ZESTRIL Lisinopril 20MG TAB Accepted treatment ZESTRIL Lisinopril 5MG TAB Accepted treatment ZETOMAX (ZESTOMAX) 10MG Lisinopril 10MG TAB Accepted treatment ZETOMAX (ZESTOMAX) 20MG Lisinopril 20MG TAB Accepted treatment ZETOMAX (ZESTOMAX) 5MG Lisinopril 5MG TAB Accepted treatment ACE inhibitor and diuretic combinations CAPOZIDE Captopril and diuretics 50MG/25MG TAB Accepted treatment CAPTORETIC Captopril and diuretics 50MG/25MG TAB Accepted treatment CO-RENITEC Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment DIACE CO Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment ENAP-CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment HEXAL LISINOPRIL CO 10 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment HEXAL LISINOPRIL CO 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment LISINOZIDE Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment LISINOZIDE Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment LISORETIC 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment LISORETIC 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment /05/28

10 LISOZIDE 10MG/12.5MG Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment LISOZIDE 20MG/12.5MG Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment PHARMAPRESS CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment ZAPTO-CO Captopril and diuretics 50MG/25MG TAB Accepted treatment ZETOMAX CO 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment ZETOMAX CO 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment ZETOMAX CO 20/25 Lisinopril and diuretics 20MG/25MG TAB Accepted treatment ZESTORETIC Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment ZESTORETIC Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment ZESTOZIDE 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment Angiotensin Receptor Blockers COZAAR Losartan 50MG TAB Accepted treatment COZAAR Losartan 100MG TAB Accepted treatment CIPLA-LOSARTAN Losartan 100MG TAB Accepted treatment CIPLA-LOSARTAN Losartan 50MG TAB Accepted treatment LOS-ARB Losartan 50MG TAB Accepted treatment LEPITRIN Losartan 50MG TAB Accepted treatment LOSARTAN-WINTHROP Losartan 50MG TAB Accepted treatment ZARTAN Losartan 50MG TAB Accepted treatment ZARTAN Losartan 100MG TAB Accepted treatment Angiotensin Receptor Blockers and diuretic combinations COZAAR COMP Losartan and diuretics 50MG/12.5 MG TAB Accepted treatment FORTZAAR Losartan and diuretics 100MG/25MG TAB Accepted treatment Beta-blockers ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment B-BLOCK Atenolol 100MG TAB Accepted treatment B-BLOCK Atenolol 50MG TAB Accepted treatment BETACOR (NAMIBIA ONLY) Bisoprolol 10MG TAB Accepted treatment BETACOR (NAMIBIA ONLY) Bisoprolol 5MG TAB Accepted treatment BILOCOR 10 Bisoprolol 10MG TAB Accepted treatment BILOCOR 5 Bisoprolol 5MG TAB Accepted treatment BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment CONCOR Bisoprolol 10MG TAB Accepted treatment CONCOR Bisoprolol 5MG TAB Accepted treatment HEXA-BLOK Atenolol 100MG TAB Accepted treatment HEXA-BLOK Atenolol 50MG TAB Accepted treatment INDERAL Propranolol 10MG TAB Accepted treatment INDERAL Propranolol 40MG TAB Accepted treatment INDOBLOK 10 Propranolol 10MG TAB Accepted treatment INDOBLOK 40 Propranolol 40MG TAB Accepted treatment NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment PRODOROL Propranolol 10MG TAB Accepted treatment PRODOROL Propranolol 40MG TAB Accepted treatment /05/28

11 PURBLOKA Propranolol 10MG TAB Accepted treatment PURBLOKA Propranolol 40MG APP Accepted treatment ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment ROLAB-PROPRANOLOL HCL Propranolol 10MG TAB Accepted treatment ROLAB-PROPRANOLOL HCL Propranolol 40MG TAB Accepted treatment TEN-BLOKA Atenolol 100MG TAB Accepted treatment TEN-BLOKA Atenolol 50MG TAB Accepted treatment TENOPRESS Atenolol 100MG TAB Accepted treatment TENOPRESS Atenolol 25MG TAB Accepted treatment TENOPRESS Atenolol 50MG TAB Accepted treatment Alpha-beta blockers ASPEN CARVEDILOL Carvedilol 12.5MG TAB Accepted treatment ASPEN CARVEDILOL Carvedilol 25MG TAB Accepted treatment ASPEN CARVEDILOL Carvedilol 6.25MG TAB Accepted treatment CARLOC Carvedilol 25MG TAB Accepted treatment CARLOC 6.25 Carvedilol 6.25MG TAB Accepted treatment CARLOC 12.5 Carvedilol 12.5MG TAB Accepted treatment CARVEDILOL-HEXAL Carvedilol 12.5MG TAB Accepted treatment CARVEDILOL-HEXAL Carvedilol 25MG TAB Accepted treatment CARVEDILOL-HEXAL Carvedilol 6.25MG TAB Accepted treatment CARVETREND 12.5MG Carvedilol 12.5MG TAB Accepted treatment CARVETREND 25MG Carvedilol 25MG TAB Accepted treatment CARVETREND 6.25MG Carvedilol 6.25MG TAB Accepted treatment DILATREND Carvedilol 12.5MG TAB Accepted treatment DILATREND Carvedilol 25MG TAB Accepted treatment DILATREND Carvedilol 6.25MG TAB Accepted treatment VEDIBLOK Carvedilol 12.5MG TAB Accepted treatment VEDIBLOK Carvedilol 25MG TAB Accepted treatment VEDIBLOK Carvedilol 6.25MG TAB Accepted treatment Beta-blocker and diuretic combinations ADCO-LOTEN Atenolol and other diuretics 100MG/25MG TAB Accepted treatment ROLAB-ATENOLOL/CHLORTHALIDONE 100/25 Atenolol and other diuretics 100MG/25MG TAB Accepted treatment ROLAB-ATENOLOL/CHLORTHALIDONE 50/12.5 Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment TENCHLOR Atenolol and other diuretics 100MG/25MG TAB Accepted treatment TENCHLOR HS Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment Cardiac glycosides LANOXIN Digoxin 0.25MG TAB Accepted treatment LANOXIN PAED Digoxin 0.05MG/1ML SYR Accepted treatment LANOXIN PAED Digoxin 0.063MG TAB Accepted treatment PURGOXIN Digoxin 0.25MG TAB Accepted treatment Chronic Renal Disease For diuretics and antihypertensives, refer to "Hypertension" Calcium TITRALAC Calcium carbonate TAB Accepted treatment ENO TUMS Calcium carbonate 500MG CHU Accepted treatment ENO TUMS ASSORTED FRUIT FLAVOURS Calcium carbonate 500MG CHU Accepted treatment ENO TUMS ORANGE FLAVOUR ROLLPAC Calcium carbonate 500MG CHU Accepted treatment ENO TUMS PEPPERMINT FLAVOUR ROLLPAC Calcium carbonate 500MG CHU Accepted treatment Vitamin D CALCIFEROL Ergocalciferol 50000IU TAB Accepted treatment CALCIFEROL OILY 15ML Ergocalciferol 5000U/1ML APP Accepted treatment ONE ALPHA (014050) Alfacalcidol 0.25MCG CAP Accepted treatment /05/28

12 ONE ALPHA (014052) Alfacalcidol 1MCG CAP Accepted treatment ONE ALPHA DROPS 20ML Alfacalcidol DRP Accepted treatment ROCALTROL Calcitriol 0.25MCG CAP Accepted treatment Oral Iron and Folic Acid supplementation AHA FOLIC ACID Folic acid 5MG TAB Accepted treatment BODY BALANCE FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment FERROUS SULPHATE Ferrous sulfate 100MG TAB Accepted treatment FERROUS SULPHATE Ferrous sulfate 30MG TAB Accepted treatment FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment FERROUS SULPHATE CO Ferrous sulfate TAB Accepted treatment FOLIC ACID Folic acid.5mg TAB Accepted treatment FOLIC ACID Folic acid 5MG TAB Accepted treatment FOLIC ACID Folic acid 5MG TAB Accepted treatment FOLIFERR Ferrous sulphate 100MG TAB Accepted treatment GULF FERROUS SULPHATE COMPOUND Ferrous sulfate TAB Accepted treatment SYR FERRI PHOS CO Ferrous sulfate LIQ Accepted treatment Parenteral Iron Preparations COSMOFER AMPOULE 2ML Ferric oxide dextran complex 50MG/1ML INJ Clinical motivation COSMOFER AMPOULE 10ML Ferric oxide dextran complex 50MG/1ML INJ Clinical motivation FERRIMED 2ML Iron trivalent, parenteral preparations 50MG/1ML INJ Clinical motivation VENOFER 5X5ML AMP Saccharated iron oxide AMP Clinical motivation Erythropoietin ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 150MCG/.3ML INJ Specialist motivation ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 30MCG/.3ML INJ Specialist motivation ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 60MCG/.3ML INJ Specialist motivation ARANESP PREFILLED SYRINGE 0.4ML Darbepoetin alfa 10MCG/.4ML INJ Specialist motivation ARANESP PREFILLED SYRINGE 0.5ML Darbepoetin alfa 20MCG/.5ML INJ Specialist motivation ARANESP PREFILLED SYRINGE 0.6ML Darbepoetin alfa 300MCG/.6ML INJ Specialist motivation EPREX Erythropoietin 40000iu VIAL Specialist motivation EPREX 1ML Erythropoietin 10000U/1ML INJ Specialist motivation EPREX 1ML Erythropoietin 2000U/1ML INJ Specialist motivation EPREX 1ML Erythropoietin 4000U/1ML INJ Specialist motivation EPREX PREFILLED Erythropoietin 10000U/1ML INJ Specialist motivation EPREX PREFILLED Erythropoietin 2000U/.5ML INJ Specialist motivation EPREX PREFILLED Erythropoietin 4000U/.4ML INJ Specialist motivation EPREX PREFILLED Erythropoietin 40000U/1ML INJ Specialist motivation EPREX PREFILLED SYRINGE 0.6ML Erythropoietin 6000U/.6ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 100MCG/.3ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 150MCG/.3ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 200MCG/.3ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 250MCG/.3ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 50MCG/.3ML INJ Specialist motivation MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 75MCG/.3ML INJ Specialist motivation REPOTIN AMP 1ML Erythropoietin 2000U/1ML INJ Specialist motivation REPOTIN AMP 1ML Erythropoietin 4000U/1ML INJ Specialist motivation RECORMON 1000 Erythropoietin 1000U INJ Specialist motivation RECORMON Erythropoietin 10000iu INJ Specialist motivation RECORMON PRE-FILLED SYR Erythropoietin 10000IU INJ Specialist motivation RECORMON (5ML MULTIDOSE) Erythropoietin IU INJ Specialist motivation RECORMON 2000 Erythropoietin 2000U INJ Specialist motivation RECORMON Erythropoietin 20000IU INJ Specialist motivation RECORMON PRE-FILLED SYR Erythropoietin 30000IU INJ Specialist motivation RECORMON 4000 IU/0.3ML Erythropoietin 4000IU/0.3ML INJ Specialist motivation RECORMON 500 IU/0.3ML Erythropoietin 500IU/0.3ML INJ Specialist motivation /05/28

13 RECORMON 5000 Erythropoietin 5000U INJ Specialist motivation RECORMON (10ML MULTIDOSE) Erythropoietin 50000IU INJ Specialist motivation RECORMON 6000 PRE-FILLED SYR Erythropoietin 6000IU INJ Specialist motivation Coronary Artery Disease Aspirin ASPIRIN (WHITE) Acetylsalicylic acid 300MG TAB Accepted treatment ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment BAYER ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment BAYER ASPIRIN CARDIO Acetylsalicylic acid 100MG TAB Accepted treatment COMPRAL Acetylsalicylic acid 81MG TAB Accepted treatment DISPRIN CV Acetylsalicylic acid 100MG EEF Accepted treatment DISPRIN CV Acetylsalicylic acid 300MG EEF Accepted treatment DISPRIN REGULAR Acetylsalicylic acid 300MG EEF Accepted treatment ECOTRIN Acetylsalicylic acid 81MG ECT Accepted treatment GENPHARM CHILDREN ASPIRIN (ASPIRIN JUNIO Acetylsalicylic acid 60MG TAB Accepted treatment GULF ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment JUNIOR ASPIRIN (slt) Acetylsalicylic acid 97MG TAB Accepted treatment LO-ASPIRIN (CAPRIN) Acetylsalicylic acid 125MG TAB Accepted treatment MYOPRIN Acetylsalicylic acid 100MG EEF Accepted treatment Nitrates ANGISED Glyceryl trinitrate 0.5MG TAB Accepted treatment ANGI-SPRAY 20ML Isosorbide dinitrate 1.25MG/0.09ML INH Accepted treatment ANGITRATE Isosorbide mononitrate 20MG TAB Accepted treatment DINOSPRAY Isosorbide dinitrate 1.25MG/0.09ML UNIT Accepted treatment ELANTAN Isosorbide mononitrate 20MG TAB Accepted treatment ELANTAN LA Isosorbide mononitrate 50MG CAP Accepted treatment IMDUR Isosorbide mononitrate 60MG SRT Accepted treatment ISMO 20 Isosorbide mononitrate 20MG TAB Accepted treatment ISORDIL Isosorbide dinitrate 10MG TAB Accepted treatment ISORDIL Isosorbide dinitrate 30MG TAB Accepted treatment ISORDIL SUBLINGUAL Isosorbide dinitrate 5MG TAB Accepted treatment ISORDIL TEMBID Isosorbide dinitrate 40MG TAB Accepted treatment MONICOR SR Isosorbide mononitrate 60MG TAB Accepted treatment ROLAB-ISOSORBIDE DINITRATE Isosorbide dinitrate 10MG TAB Accepted treatment ROLAB-ISOSORBIDE DINITRATE Isosorbide dinitrate 30MG TAB Accepted treatment ROLAB-ISOSORBIDE DINITRATE SUBL Isosorbide dinitrate 5MG TAB Accepted treatment Beta-blockers ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment B-BLOCK Atenolol 100MG TAB Accepted treatment B-BLOCK Atenolol 50MG TAB Accepted treatment BETACOR (NAMIBIA ONLY) Bisoprolol 10MG TAB Accepted treatment BETACOR (NAMIBIA ONLY) Bisoprolol 5MG TAB Accepted treatment BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment CONCOR Bisoprolol 10MG TAB Accepted treatment /05/28

14 CONCOR Bisoprolol 5MG TAB Accepted treatment HEXA-BLOK Atenolol 100MG TAB Accepted treatment HEXA-BLOK Atenolol 50MG TAB Accepted treatment INDERAL Propranolol 10MG TAB Accepted treatment INDERAL Propranolol 40MG TAB Accepted treatment INDOBLOK 10 Propranolol 10MG TAB Accepted treatment INDOBLOK 40 Propranolol 40MG TAB Accepted treatment NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment PRODOROL Propranolol 10MG TAB Accepted treatment PRODOROL Propranolol 40MG TAB Accepted treatment PURBLOKA Propranolol 10MG TAB Accepted treatment PURBLOKA Propranolol 40MG APP Accepted treatment ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment ROLAB-PROPRANOLOL HCL Propranolol 10MG TAB Accepted treatment ROLAB-PROPRANOLOL HCL Propranolol 40MG TAB Accepted treatment TEN-BLOKA Atenolol 100MG TAB Accepted treatment TEN-BLOKA Atenolol 50MG TAB Accepted treatment TENOPRESS Atenolol 100MG TAB Accepted treatment TENOPRESS Atenolol 25MG TAB Accepted treatment TENOPRESS Atenolol 50MG TAB Accepted treatment Calcium channel antagonists ALMADIN Amlodipine 10MG TAB Accepted treatment ALMADIN Amlodipine 5MG TAB Accepted treatment AMLATE Amlodipine 10MG TAB Accepted treatment AMLATE Amlodipine 5MG TAB Accepted treatment AMLOC 10 Amlodipine 10MG TAB Accepted treatment AMLOC 5 Amlodipine 5MG TAB Accepted treatment AMLODAC Amlodipine 10MG TAB Accepted treatment AMLODAC Amlodipine 5MG TAB Accepted treatment AMLODIPINE-WINTHROP Amlodipine 10MG TAB Accepted treatment AMLODIPINE-WINTHROP Amlodipine 5MG TAB Accepted treatment AMLOSYN 10 Amlodipine 10MG TAB Accepted treatment AMLOSYN 5 Amlodipine 5MG TAB Accepted treatment AMTAS Amlodipine 10MG TAB Accepted treatment AMTAS Amlodipine 5MG TAB Accepted treatment AURO-AMLODIPINE Amlodipine 10MG TAB Accepted treatment AURO-AMLODIPINE Amlodipine 5MG TAB Accepted treatment AUSTELL-AMLODIPINE Amlodipine 10MG TAB Accepted treatment AUSTELL-AMLODIPINE Amlodipine 5MG TAB Accepted treatment CALBLOC Amlodipine 10MG TAB Accepted treatment CALBLOC Amlodipine 5MG TAB Accepted treatment CIPLAVASC Amlodipine 10MG TAB Accepted treatment CIPLAVASC Amlodipine 5MG TAB Accepted treatment CORVADIL Amlodipine 10MG TAB Accepted treatment CORVADIL Amlodipine 5MG TAB Accepted treatment CPL ALLIANCE AMLODIPINE Amlodipine 10MG TAB Accepted treatment CPL ALLIANCE AMLODIPINE Amlodipine 5MG TAB Accepted treatment CALCICARD SR Verapamil 240MG SRT Accepted treatment CIPALAT RETARD Nifedipine 20MG TAB Accepted treatment DILATAM Diltiazem 60MG TAB Accepted treatment FEDALOC SR Nifedipine 30MG TAB Accepted treatment FELODIPINE HEXAL Felodipine 5MG SRT Accepted treatment /05/28

15 FELODIPINE HEXAL Felodipine 10MG SRT Accepted treatment GULF AMLODIPINE Amlodipine 10MG TAB Accepted treatment GULF AMLODIPINE Amlodipine 5MG TAB Accepted treatment INDO AMLODIPINE Amlodipine 5MG TAB Accepted treatment ISOPTIN Verapamil 80MG TAB Accepted treatment ISOPTIN DRAGEES Verapamil 40MG TAB Accepted treatment ISOPTIN SR Verapamil 240MG SRT Accepted treatment KEYSAL Amlodipine 10MG TAB Accepted treatment KEYSAL Amlodipine 5MG TAB Accepted treatment KLODIP Amlodipine 5MG TAB Accepted treatment LOMANOR Amlodipine 5MG TAB Accepted treatment LOMANOR Amlodipine 10MG TAB Accepted treatment NIFEDALAT 20 SR Nifedipine 20MG SRT Accepted treatment NORVASC Amlodipine 10MG TAB Accepted treatment NORVASC Amlodipine 5MG TAB Accepted treatment PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 10MG TAB Accepted treatment PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 5MG TAB Accepted treatment RAVAMIL SR Verapamil 240MG SRT Accepted treatment ROLAB-DILTIAZEM HCL Diltiazem 60MG TAB Accepted treatment ROLAB-VERAPAMIL HCL Verapamil 120MG TAB Accepted treatment ROLAB-VERAPAMIL HCL Verapamil 40MG TAB Accepted treatment ROLAB-VERAPAMIL HCL Verapamil 80MG TAB Accepted treatment SANDOZ-AMLODIPINE Amlodipine 10MG TAB Accepted treatment SANDOZ-AMLODIPINE Amlodipine 5MG TAB Accepted treatment STAMLO Amlodipine 10MG TAB Accepted treatment STAMLO Amlodipine 5MG TAB Accepted treatment TILAZEM Diltiazem 60MG TAB Accepted treatment TILAZEM 180 CR Diltiazem 180MG SRC Accepted treatment TILAZEM 240 CR Diltiazem 240MG SRC Accepted treatment VASCARD SR Nifedipine 30MG CAP Accepted treatment VASOMIL Verapamil 40MG TAB Accepted treatment VASOMIL Verapamil 80MG TAB Accepted treatment VERAHEXAL 240 SR Verapamil 240MG SRT Accepted treatment ZILDEM Diltiazem 180MG SRC Accepted treatment ZILDEM Diltiazem 240MG SRC Accepted treatment ZILDEM 60 Diltiazem 60MG TAB Accepted treatment Crohn's Disease Aminosalicylic acid preparations SALAZOPYRIN Sulfasalazine 500MG TAB Accepted treatment SALAZOPYRIN E.N. Sulfasalazine 500MG ECT Accepted treatment Immunosuppressants AZAMUN Azathioprine 50MG TAB Accepted treatment AZAPRESS Azathioprine 50MG TAB Accepted treatment AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment Methotrexate ABITREXATE-20ML Methotrexate 500MG/20ML INJ Accepted treatment ABITREXATE-2ML Methotrexate 50MG INJ Accepted treatment EMTHEXATE RTU ML Methotrexate 25MG/1ML INJ Accepted treatment EMTHEXATE RTU ML Methotrexate 25MG/1ML INJ Accepted treatment METACHOR VIAL 2ML Methotrexate 25MG/1ML INJ Accepted treatment METHOTREXATE CSV 2ML (P&U) Methotrexate 50MG/2ML INJ Accepted treatment METHOTREXATE CSV 20ML (P&U) Methotrexate 500MG/20ML INJ Accepted treatment /05/28

16 METHOTREXATE Methotrexate 2.5MG TAB Accepted treatment Steroid preparations (oral) CAPSOID Prednisolone 5MG TAB Accepted treatment LENISOLONE Prednisolone 5MG TAB Accepted treatment PANAFCORT Prednisone 5MG TAB Accepted treatment PREDNISONE (BE-TABS) Prednisone 5mg TAB Accepted treatment PREDNISONE (FAMS) Prednisone 5MG TAB Accepted treatment TROLIC Prednisone 5MG TAB Accepted treatment Steroid preparations (enemas) ENTOCORD ENEMAS Budesonide 2.3MG ENE Accepted treatment Diabetes Mellitus Type 1 Insulin INSU ACTRAPH HMGE 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment INSU ACTRAPI HMGE 10ML VIALS Insulin (human) 100IU/1ML INJD Accepted treatment INSU ACTRAPI HMGE PENFILL 3ML Insulins, fast-acting 100IU/1ML INJD Accepted treatment INSU ACTRAPI HMGE PENSET 3ML Insulins, fast-acting 100IU/1ML INJD Accepted treatment INSU APIDRA CARTIDGES Insulin glulisine 100IU/1ML INJD Accepted treatment INSU APIDRA Insulin glulisine 100IU/1ML INJD Accepted treatment INSU APIDRA L OPTISET PENSET 3ML Insulin glulisine 100IU/1ML INJD Accepted treatment INSU APIDRA SOLOSTAR DISPOSABLE PENS 3ML Insulin glulisine 100U/1ML INJD Accepted treatment INSU BIOSULIN R CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment INSU BIOSULIN L CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment INSU BIOSULIN N CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment INSU BIOSULIN CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment INSU HUMALOG Insulin lispro 100IU/1ML INJD Accepted treatment INSU HUMALOG INJ 3.0ML CART Insulin lispro INJD Accepted treatment INSU HUMALOG MIX 25 10ML VIAL Insulin lispro 100IU/1ML INJD Accepted treatment INSU HUMALOG MIX 25 CART 3ML Insulin lispro INJD Accepted treatment INSU HUMALOG MIX 25 PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment INSU HUMALOG MIX 50 CART Insulin lispro 3ML INJD Accepted treatment INSU HUMALOG PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment INSU HUMULIN 30/70 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment INSU HUMULIN 30/70 3ML Insulin (human) INJD Accepted treatment INSU HUMULIN 30/70 PEN 3ML DISP Insulin (human) 100IU/1ML INJD Accepted treatment INSU HUMULIN N 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment INSU HUMULIN N 3.0ML CART 5 Insulin (human) INJD Accepted treatment INSU HUMULIN N PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment INSU HUMULIN R 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment INSU HUMULIN R 3.0ML CARTRIDGE Insulin (human) INJD Accepted treatment INSU HUMULIN R PEN 3ML DISP Insulin (human) 100IU/1ML INJD Accepted treatment INSU INSUMAN COMB 30/70 PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment INSU MIRIO PEN HUMALOG MIX 25 Insulin lispro INJD Accepted treatment INSU MIRIO PEN HUMALOG MIX 50 Insulin lispro INJD Accepted treatment INSU MIRIO PEN HUMALOG Insulin lispro INJD Accepted treatment INSU NOVORAPID 3ML SOLUTION FOR I Insulin aspart 100U INJD Accepted treatment INSU NOVORAPID FLEXPEN 3ML PENS Insulin aspart INJD Accepted treatment INSU NOVORAPID 10ML Insulin aspart 100IU/1ML INJ Accepted treatment INSU PROTAPH HMGE 10 ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment Applicances Diabetic strips, needles and lancets Accepted treatment Diabetes Mellitus Type 2 Biguanides /05/28