Oncology supportive medicine list formulary Disclaimer The Bankmed Special Care Oncology Programme is governed by the Bankmed Medical Scheme Rules. The use of the benefits and programmes associated with the Special Care Oncology Programme is subject to specific conditions and rules. Members must ensure that they are familiar with these rules and conditions. The scheme rules are available on www.bankmed.co.za The medicines listed in the oncology medicine list (formulary) apply across all health plans unless otherwise stated. Any instruction or advice we provide regarding medicines and the management of the member s condition is intended as a supplement to, and not a substitute for, the knowledge, expertise, skill and judgement of the member s doctor, pharmacist or other healthcare professional. Bankmed Medical Scheme reserves the right to change the benefit at any time. We will, however, communicate any changes to the way we pay medicines when we make these. The updated version of this document is available on our website at all times. Who we are Bankmed Medical Scheme (referred to as the Scheme ), registration number 1279. This is a non-profit 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). Discovery Health is responsible for the administration of Bankmed Medical Scheme.
Reflux 720812 Probitor 20mg CAP Omeprazole Reflux 838276 Cimetidine 100mg/2mL INJ Cimetidine 100mg/ml 2ml Reflux 703601 Pharma-q 200mg/2mL INJ Cimetidine cimetidine ampoule 2ml Reflux 886978 Bio-cimetidine 200mg TAB Cimetidine Reflux 854247 Cimlok 200mg TAB Cimetidine Reflux 811459 Adco-cimetidine 200mg TAB Cimetidine Reflux 797464 Secadine 200mg TAB Cimetidine Reflux 736260 Lenamet 400mg TAB Cimetidine Reflux 800252 Adco-cimetidine 400mg TAB Cimetidine Reflux 854255 Cimlok 400mg TAB Cimetidine Reflux 797472 Secadine 400mg TAB Cimetidine Reflux 887003 Bio-cimetidine 400mg TAB Cimetidine Reflux 712134 Austac 150mg TAB Ranitidine Reflux 700119 Cpl alliance 150mg TAB Ranitidine ranitidine Reflux 713553 Gulf ranitidine 150mg TAB Ranitidine Reflux 719669 Ranitidine 150mg TAB Ranitidine biotech Reflux 704786 R-loc 50mg/2mL INJ Ranitidine Reflux 700120 Cpl alliance 300mg TAB Ranitidine ranitidine Reflux 712135 Austac 300mg TAB Ranitidine Reflux 705360 Ranit 300mg TAB Ranitidine Reflux 841773 Histak 300mg TAB Ranitidine Reflux 713554 Gulf ranitidine 300mg TAB Ranitidine Reflux 704629 Nozer 20mg CAP Omeprazole Reflux 705466 Lokit 20mg CAP Omeprazole Reflux 703534 Sandoz 20mg CAP Omeprazole omeprazole Reflux 704668 Adco-roznal 30mg CAP Lansoprazole Reflux 708053 Lancap 30mg CAP Lansoprazole 721165 Grantryl 3mg/3ml INJ Granisetron Ampoule 3ml 721164 Grantryl 1mg/1ml INJ Granisetron Ampoule 1ml 716467 Emend combi Aprepitant pack (1 x 125mg cap & 2 x 80mg cap) 720786 Emistop 4mg/2ml INJ Granisetron ampoule 2ml 720788 Emistop 8mg/4ml INJ Granisetron ampoule 4ml 700712 Clomax 10mg TAB Metoclopramide 715875 Adco-contromet 10mg TAB Metoclopramide 783285 Setin 10mg TAB Metoclopramide 717891 Bio metoclopramide 10mg TAB Metoclopramide
856134 Metoclopramide amp st111 2ml 5mg/1mL INJ Metoclopramide 705973 Pharma-q 5mg/1mL INJ Metoclopramide metoclopramide ampoule 2ml 717049 Alepet ampoule 4mg/2mL INJ Ondansetron 2ml 705537 Mylan 4mg/2mL INJ Ondansetron ondansetron 710908 Danset ampoule 4mg/2mL INJ Ondansetron 2ml 716548 Vomiz ampoule 4mg/2mL INJ Ondansetron 2ml 718557 Ondansetron 4mg/2mL INJ Ondansetron fresenius ampoule 717050 Alepet ampoule 8mg/4mL INJ Ondansetron 4ml 705538 Mylan 8mg/4mL INJ Ondansetron ondansetron 710909 Danset ampoule 8mg/4mL INJ Ondansetron 4ml 718558 Ondansetron 8mg/4mL INJ Ondansetron fresenius ampoule 716801 Ciplaondansetron 4mg TAB Ondansetron 705944 Zofer 4mg TAB Ondansetron 707912 Mylan 4mg TAB Ondansetron ondansetron 711531 Vomiz 4mg TAB Ondansetron 716802 Ciplaondansetron 8mg TAB Ondansetron 705945 Zofer 8mg TAB Ondansetron 707913 Mylan 8mg TAB Ondansetron ondansetron 711532 Vomiz 8mg TAB Ondansetron 715706 Granitril vial 1ml 1mg/1mL INJ Granisetron 712891 Adcogranisetron ampoule 1ml 1mg/1mL INJ Granisetron 718524 Granisetron teva 1mg/1mL INJ Granisetron 1 718525 Granisetron teva 3mg/3mL INJ Granisetron 3 *** 708388 Onicit vial 5ml 50mcg/1mL INJ Palonosetron **** 705302 Emend ** 125mg CAP Aprepitant 705301 Emend ** 80mg CAP Aprepitant
799424 Nauzine 50mg TAB Cyclizine 809322 Covamet 50mg TAB Cyclizine 766526 Stemetil 25mg SUP Prochlorperazine 766461 Stemetil 1ml 12,5mg/1mL INJ Prochlorperazine 762849 Scripto-metic 5mg TAB Prochlorperazine 778362 Warfarin * 5mg TAB Warfarin 709906 Cipla Warfarin * 1mg TAB Warfarin 730599 Heparin sodium fresenius ampoule 1ml * 1000u/1mL INJ Heparin 782254 Heparin sodium 1000u/1mL INJ Heparin fresenius vial 5ml * 730602 Heparin sod 5000u/1mL INJ Heparin 1ml-fresenius * 701891 Amdocin 25mg CAP Indometacin 715944 Oxycontin 10mg SRT Oxycodone 715945 Oxycontin 20mg SRT Oxycodone 715943 Oxycontin 5mg SRT Oxycodone 704741 Arthrexin 100mg SUP Indometacin 814393 Methocaps 25mg CAP Indometacin 787833 Betacin 25mg CAP Indometacin 868213 Gulf 25mg CAP Indometacin indomethacin 786012 Mylan diclofenac 25mg TAB Diclofenac 719811 Sandoz diclofenac 25mg TAB Diclofenac 893390 A-lennon 25mg TAB Diclofenac diclofenac 718479 Diclofenac 25mg TAB Diclofenac biotech 893391 A-lennon 50mg TAB Diclofenac diclofenac 786020 Mylan diclofenac 50mg TAB Diclofenac 700316 Ibucine (was 200mg TAB Ibuprofen Ibumax) 868221 Ibunate 200mg TAB Ibuprofen 787426 Betaprofen 200mg TAB Ibuprofen 708536 Ibusor 200mg TAB Ibuprofen 708290 Bren 400mg TAB Ibuprofen
701975 Betaprofen fc 400mg TAB Ibuprofen 700318 Ibucine (was 400mg TAB Ibuprofen Ibumax) 701654 Ranfen 400mg TAB Ibuprofen 704587 Ibupain forte 460mg CAP Ibuprofen, combinations 704606 Gen-payne CAP Ibuprofen, combinations 705264 Dentopain forte CAP Ibuprofen, combinations 704791 Mybulen CAP Ibuprofen, combinations 719664 Ibupain forte blister pack CAP Ibuprofen, combinations 744573 Morphine hcl bp PDR Morphine - Allied 809721 Srm rhotard 100mg SRT Morphine 809691 Srm rhotard 10mg SRT Morphine 824267 Mylan morphine 15mg/1mL INJ Morphine 809705 Srm rhotard 30mg SRT Morphine 809713 Srm rhotard 60mg SRT Morphine 719382 Df 118 30mg TAB Dihydrocodeine 750565 Omnopon 1mlfresenius 20 20mg/1mL INJ Morphine, combinations 895156 Pharma-q 25mg/1mL INJ Pethidine pethidine ampoule 1ml 894958 Pharma-q 50mg/1mL INJ Pethidine pethidine ampoule 1ml 754463 Pethidine hcl 50mg/1mL INJ Pethidine 1ml-fresenius 783072 Temgesic 0,2mg TAB Buprenorphine sublingual 715949 Oxynorm 5mg CAP Oxycodone 715950 Oxynorm 10mg CAP Oxycodone 715951 Oxynorm 20mg CAP Oxycodone 704044 Dolotram 100mg INJ Tramadol 707365 Tramazac 100mg/2mL INJ Tramadol 708507 Tramaspen amp 100mg/2mL INJ Tramadol 2ml 705175 Domadol 50mg CAP Tramadol 705379 Dolotram 50mg CAP Tramadol 710250 Austell-tramadol 50mg CAP Tramadol
706475 Tramazac 50mg CAP Tramadol 704465 ogesic 500mg TAB Paracetam 704643 Cetapon 500mg TAB Paracetamol 757403 Adco-prolief 500mg TAB Paracetamol 745723 Adco-napamol 500mg TAB Paracetamol 805467 Antalgic 500mg TAB Paracetamol 892662 892662 Nucopain Nucopain TAB TAB Paracetamol, combinations combinations with psycholeptics with psycholeptics 809055 Adco-salterpyn TAB Paracetamol, combinations with psycholeptics Depression 724688 Ethipramine 25mg TAB Imipramine Depression 784230 Sandoz 25mg TAB Amitriptyline amitriptyline Depression 718746 Gulf 25mg TAB Amitriptyline amitriptyline Depression 718362 Venlafaxine 150mg SCR Venlafaxine unicorn xr Depression 718361 Venlafaxine 75mg SCR Venlafaxine unicorn xr Depression 716520 Fluoxetine actor 20mg CAP Fluoxetine Depression 703391 A-lennon 20mg CAP Fluoxetine fluoxetine Depression 700686 Ranflocs 20mg CAP Fluoxetine Depression 719658 Prolax 20mg CAP Fluoxetine Depression 894303 Deprozan 20mg CAP Fluoxetine Depression 715256 Efegen xr 150mg SRC Venlafaxine Depression 710972 Odiven 37,5mg TAB Venlafaxine Depression 715254 Efegen xr 75mg SRC Venlafaxine Depression 710973 Odiven 75mg TAB Venlafaxine Constipation 717972 Anlac 3300mg/5mL SYR Lactulose Constipation 708722 Aculax 3,3g/5mL SYR Lactulose Constipation 878707 Adco-liquilax 3300mg/5mL SYR Lactulose Constipation 797723 Lacson 3300mg/5mL SYR Lactulose Constipation 817309 Laxette 3300mg/5mL SYR Lactulose Diarrhoea 796697 Norimode 2mg TAB Loperamide Diarrhoea 791768 Adco-prodium 2mg TAB Loperamide Epilepsy 761079 Rivotril 0,5mg TAB Clonazepam Epilepsy 761087 Rivotril 2mg TAB Clonazepam Epilepsy 712493 Degranol 200mg TAB Carbamazepine Epilepsy 705597 Sandoz 200mg SRT Carbamazepine carbamazepine cr Epilepsy 705602 Sandoz 400mg SRT Carbamazepine carbamazepine cr Epilepsy 715962 Zeptol 200mg TAB Carbamazepine Epilepsy 715980 Convulex 150mg CAP Valproic acid Epilepsy 781541 Convulex 250mg/5mL SYR Valproic acid Epilepsy 821578 Epilim crushable 100mg TAB Valproic acid Epilepsy 780545 Epilim sugar 200mg/5mL SYR Valproic acid free Epilepsy 718274 Epilizine cr 200mg SRT Valproic acid
Epilepsy 718275 Epilizine cr 300mg SRT Valproic acid Epilepsy 718276 Epilizine cr 500mg SRT Valproic acid Epilepsy 718465 Navalpro cr 200mg SRT Valproic acid Epilepsy 718466 Navalpro cr 300mg SRT Valproic acid Epilepsy 718468 Navalpro cr 500mg SRT Valproic acid Epilepsy 720026 Vanapro 300mg SRT Valproic acid Epilepsy 720027 Vanapro 500mg SRT Valproic acid Epilepsy 754870 Phenytoin sod 100mg TAB Phenytoin Epilepsy 710389 Dynalamotrigine 100mg TAB Lamotrigine Epilepsy 710390 Dynalamotrigine 200mg TAB Lamotrigine Epilepsy 710387 Dynalamotrigine 25mg TAB Lamotrigine Epilepsy 710388 Dynalamotrigine 50mg TAB Lamotrigine Epilepsy 704381 Epitec 100mg TAB Lamotrigine Epilepsy 704382 Epitec 200mg TAB Lamotrigine Epilepsy 704379 Epitec 25mg TAB Lamotrigine Epilepsy 704380 Epitec 50mg TAB Lamotrigine Epilepsy 710887 Lamidus 100mg TAB Lamotrigine Epilepsy 710888 Lamidus 200mg TAB Lamotrigine Epilepsy 710885 Lamidus 50mg TAB Lamotrigine Epilepsy 710901 Epitoz 100mg TAB Topiramate Epilepsy 710899 Epitoz 25mg TAB Topiramate Epilepsy 710900 Epitoz 50mg TAB Topiramate Epilepsy 709287 Sandoz 200mg TAB Topiramate topiramate Epilepsy 709285 Sandoz 50mg TAB Topiramate topiramate Epilepsy 718858 Epimate 200mg TAB Topiramate Epilepsy 737844 Lethyl 30mg TAB Phenobarbital Epilepsy 814946 Sedabarb 30mg TAB Phenobarbital * We fund anticoagulation as listed on all Bankmed Plans on approved treatment plans, if certain clinical entry criteria are met. **Emend We fund Emend on all Bankmed plans if certain clinical entry criteria are met. (A single dose of a 5-HT3 antagonist, dexamethasone and an aprepitant with selected highly emetogenic agents only.) ***Granisetron (on approved treatment plans) We fund Granisetron on all Bankmed plans. This is how we will fund Granisetron on approved treatment plans: NAPPI code Product name Strength Frequency 718525 Granisetron teva 3ml 3mg/3ml 1 per 3 days ****Onicit We fund Onicit on all Bankmed plans. We fund Onicit where we have approved treatment. Because the registered recommendations state that repeat dosages within seven days are not recommended, we will fund one dose every seven days.
This is how we will fund Onicit on approved treatment plans: NAPPI code Product name Strength Frequency 708388 Onicit vial 5ml 50mcg/1ml 1 every 7 days *** Special approval required with quantity restrictions applied for the below NAPPI code Product name Strength Frequency 721165 Grantryl ampoule 3mg/3mL 1 every 7 days 3ml 787019 Kytril iv 3ml 1mg/1mL 1 every 7 days 716467 Emend combi pack (1 1 every 7 days x 125mg cap & 2 x 80mg cap) 718362 Venlafaxine unicorn 150mg Maximum of 30 tabs per Gen Grouper xr 718361 Venlafaxine unicorn xr 75mg Maximum of 30 tabs per Gen Grouper Other anti-emetic treatments not listed We will consider funding an alternate anti-emetic Zamanon on appeal if the patient experiences asthenia or any other side effect from their anti-emetic. Contact us Kindly contact 0800 226 5633 (0800 BANKMED) or e-mail us on oncology@bankmed.co.za Complaints process You may lodge a complaint or query with Bankmed Medical Scheme directly on 0800 BANKMED (0800 226 5633) or address a complaint in writing directly to the Principal Officer. Should your complaint remain unresolved, you may lodge a formal dispute by following Bankmed 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 via e-mail at complaints@medicalschemes.com. Customer Care Centre: 0861 123 267/website www.medicalschemes.com Bankmed Medical Scheme. Registration number: 1279. Administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07. An authorised financial services provider.