WitsMed: HIV Supportive Formulary 2017 Who we are WitsMed (referred to as the Scheme ), registration number 1282, is the medical scheme that you are a member of. 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). We take care of the administration of your membership for the Scheme. Contact us You can call us on 0860 44 44 50 or visit www.witsmed.co.za for more information. This document lists the Antiretroviral Drugs that are on the HIV ARV Formulary list of the HIVCare Programme for 2017.
HIVCare Programme 2017 Disclaimer The information contained in this document is subject to change. The HIVCare Programme is governed by WitsMed Rules, administered by Discovery Health (Pty) Ltd. The utilisation of the benefits and programmes associated with the HIVCare Programme is subject to specific conditions and rules. Members must ensure that they are familiar with these rules and conditions. Any instructions or advice on medicines and the management of the member s condition are 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. WitsMed reserves the right to change how we cover treatment on the programme at any time. WitsMed Network Option HIV Supportive Formulary Condition NAPPI_6 Product Name Strength Form Fungal 707685 Apex-fluconazole 200mg CAP Fungal 720045 Zydus fluconazole 200mg CAP Fungal 700202 Flucoric 200mg CAP Fungal 720827 Insep 200mg CAP Fungal 704910 Sandoz ketoconazole 200mg TAB Fungal 713557 Gulf fluconazole 200mg CAP Fungal 720661 Auro fluconazole 200mg CAP Fungal 701100 Candacide 100000u/1mL SUS Fungal 835056 Canstat oral SUS Fungal 835285 Nystacid SUS HIV - Related 718711 Azithromycin zydus 500mg TAB HIV - Related 705975 Zithrogen 500mg TAB HIV - Related 827282 Adco-acyclovir 200mg TAB HIV - Related 838225 Lovire 200mg DSP HIV - Related 704778 Acitab-200 dt 200mg DSP HIV - Related 719670 Acyclovir biotech 200mg TAB HIV - Related 838233 Lovire 400mg DSP HIV - Related 704779 Acitab-400 dt 400mg DSP HIV - Related 860581 Cyclivex 400mg TAB HIV - Related 717158 Apex-acyclovir 400mg TAB HIV - Related 717371 Aciclovir sandoz 400mg TAB
Condition NAPPI_6 Product Name Strength Form HIV - Related 791350 Benzathinepen 1,2mu-fresenius INJ HIV - Related 791369 Benzathinepen 2,4mu-fresenius INJ HIV - Related 714189 Triaphin vial 15ml 1g INJ HIV - Related 703474 Adco ceftriaxone powder for 1g INJ injection HIV - Related 702483 Rociject-powder for injection 1g INJ HIV - Related 717562 Gulf ceftriaxone powder for 1g INJ injection HIV - Related 714188 Triaphin vial 5ml 250mg INJ HIV - Related 700287 Cpl alliance ciprofloxacin 500mg TAB HIV - Related 713793 Biotech ciprofloxacin 500mg TAB HIV - Related 892147 Cifran 500 500mg TAB HIV - Related 703045 Ciprogen 500mg TAB HIV - Related 713362 Loxip 500mg TAB HIV - Related 704775 Ciprol 500mg TAB HIV - Related 720331 Flopro 500mg TAB HIV - Related 831913 Canex vag 1% VCR HIV - Related 846341 Fungispor (1 applicator) VCR HIV - Related 729752 Gyno pevaryl 150mg VAT HIV - Related 824682 Xeramel 250mg CAP HIV - Related 758388 Purmycin 250mg CAP HIV - Related 710310 Eryko 250mg TAB HIV - Related 780561 Adco-erythromycin 250mg CAP HIV - Related 702148 Amzole 400mg TAB HIV - Related 792136 Suprazole 400mg TAB HIV - Related 788708 Bemetrazole 400mg TAB HIV - Related 715866 Anaerobyl 400mg TAB HIV - Related 707242 Bio-metronidazole 400mg TAB HIV - Related 793167 Metazol 400mg TAB HIV - Related 884167 Nucotet 250mg CAP HIV - Related 703224 Pharmatet (yellow/orange) 250mg CAP HIV - Related 748196 Novocillin 10ml 300mg/1mL INJ HIV - Related 748218 Novocillin 20ml 300mg/1mL INJ HIV - Related 705031 Clarihexal 500mg TAB HIV - Related 779881 Co-trim SUS HIV - Related 705259 Ilvitrim SUS HIV - Related 816337 Xerazole SUS HIV - Related 894842 Doctrim SUS HIV - Related 758221 Purbac SUS
Condition NAPPI_6 Product Name Strength Form HIV - Related 704095 Ilvitrim TAB HIV - Related 867977 Nucotrim TAB HIV - Related 715609 Trixazole 480mg TAB HIV - Related 735698 Lagatrim 480mg TAB HIV - Related 789836 Trimethox TAB HIV - Related 782793 Sandoz co-trimoxazole TAB 800mg/160mg HIV - Related 758256 Purbac ds 960mg TAB HIV - Related 721778 Durobac 'ds' 960mg TAB HIV - Related 704464 Klarithran 500mg TAB HIV - Related 707256 Klarizon 500mg TAB HIV - Related 719921 Klaryvid 500mg TAB HIV - Related 720977 Klaribin 500mg TAB HIV - Related 705416 Mylan clarithromycin 500mg TAB Peripheral Neuropathy 784230 Sandoz amitriptyline 25mg TAB Peripheral Neuropathy 718746 Gulf amitriptyline 25mg TAB Peripheral Neuropathy 715962 Zeptol 200mg TAB Peripheral Neuropathy 713559 Pyridoxine 25mg TAB Peripheral Neuropathy 882996 Pyridoxine 25mg TAB Peripheral Neuropathy 855804 Be-tabs pyridoxine hcl 25mg TAB Peripheral Neuropathy 771996 Trepiline 25mg TAB 717460 Dapsone 100mg TAB 732966 Winthrop isoniazid 100mg TAB 709170 Ebsar 2-ds 300/150 TAB 710140 Rifinah 150mg/75mg TAB 758612 Pyrazide 500mg TAB 702502 Rifinah 150/150 150mg;150mg TAB 709171 Antib-4 TAB 760692 Rimactane 150mg CAP
Complaints process You may lodge a complaint or query with WitsMed directly on 0860 44 44 50 or address a complaint in writing directly to the Principal Officer. Should your complaint remain unresolved, you may lodge a formal dispute by following WitsMed 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 email complaints@medicalschemes.com. Customer Care Centre: 0861 123 267/website www.medicalschemes.com