For long term corticosteriod use

NEDGROUP TRADITIONAL, COMPREHENSIVE AND PLATINUM PLANS A clinically relevant motivation is when prescribing any product which does not appear on this list. Chronic application forms must accompany all first-time applications. All applications MUST include valid ICD10 codes. Risk Equalisation Fund criteria must be met. The formulary is subject to regular review. SCRIPTPHARM RISK MANAGEMENT reserves the right to update and change the formulary when new information becomes available or when new medicines are released. PLEASE TAKE NOTE OF THE FOLLOWING: Oxygen will only be considered for bronchiectasis and COPD in severe, advanced disease. For diabetic patients, the following limits apply. Please provide a motivation if a higher quantity is. Lancets Max 30 per month allowed Glucose Monitoring Strip Max 50 per month allowed Needles Max 30 per month allowed syringes will only be considered on motivation. Pensets or penfills are recommended. Inteferons for Multiple Sclerosis will only be considered upon receipt of a clinically relevant motivation including history of therapy and expanded disability status scale report (EDSS) Treatment for hyperlipidaemia is subject to criteria for lipid-lowering therapy being met. Assessment completed Risk Evaluation report as well as diagnostic and latest lipograms including LDL cholesterol levels. Major drug class Generic name Trade names and (nappi codes) Addison's disease Corticosteroids Hydrocortisone 10mg Covocort 10mg 716693 E27.1 Corticosteroids Fludrocortisone, 0.1mg Florinef 0.1mg 726540 Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Loop diuretics Loop diuretics Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Furosemide 20mg Furosemide 40mg Austell Furosemide 20mg Mylan Furosemide 40mg 707421 857769 Sandoz Furosemide 731668 For long term corticosteriod use Asthma J45 Apparatus Aerochamber Aerochamber adult 589209 Apparatus Aerochamber Aerochamber child 589217 Apparatus Aerochamber Aerochamber neonate 589225 Apparatus Aerochamber Glaxohaler Spacer Device 666720 Apparatus Aerochamber Huf Puf Kit 125137 Apparatus Aerochamber Zerostat Spacer 454299 1

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Corticosteroids Prednisolone 15mg/5ml Aspelone 714552 Fenoterol 100mcg Salbutamol sulphate 100mcg Berotec 100 HFA 200 dose Asthavent 300dose ecohaler 706544 Salbutamol sulphate 2mg Venteze 2mg 775398 Salbutamol sulphate 4mg Venteze 4mg 775401 700715 Venteze CFC Free 200 dose 711213 Only for severe persistent asthma (motivation from specialist) Only for severe persistent asthma (motivation from specialist) Limited to 3 inhalers per year if no inhaled steroid Salbutamol sulphate 2mg/5ml Venteze 2mg/5ml 775452 Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose 818496 Salmeterol xinafoate 25mcg Serevent 120 dose inhaler 787302 Salmeterol fluticazone Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Foxair 25/125mcg 120 dose inh 715752 715753 Sereflo 25/50mcg Synchrobreather 120 dose inh Sereflo 25/125mcg Synchrobreather 120 dose inh 721412 721413 Salmeterol fluticazone Foxair 25/250mcg 120 dose inh 715754 Sereflo 25/250mcg Synchobreather 120 dose inh 721414 Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters 715009 Salmeterol 50ug/Fluticasone 250ug Foxair 50/250mcg 60 blisters 715008 Salmeterol 50ug/Fluticasone 500ug Foxair 50/250mcg 60 blisters 715007 Budesonide 160 / formoterol 4.5mcg Symbicord 60 dose 700172 Budesonide 160 / formoterol 4.5mcg Symbicord 120 dose 700173 Vannair 160/4.5mcg 720219 Budesonide 320 / formoterol 9mcg Symbicord 60 dose 705984 Budesonide 80 / formoterol 4.5mcg Symbicord 120 dose 705986 Vannair 80/4.5mcg 720218 Beclomethasone 100ug Beclate 100ug 819638 Beclomethasone 200ug Beclate 200ug 820083 Beclomethasone 50ug Beclate 50ug 819611 Budesonide 100ug Budeflam 100ug 300 dose 897462 Budesonide 100ug Budeflam 200 mg 300 dose 897469 Budeflam DP Inh cap 704176 2

Budesonide 200ug Pulmicort Turbohaler 200mcg 200D 791423 Budesonide 200ug Pulmicort Turbohaler 100mcg 200D 791431 Budesonide 400ug Pulmicort Turbohaler 400mcg 200D 823791 Fluticasone 50mcg Flixotide 50 CFC free 120 dose inhaler 703275 Fluticasone 125mcg Flixotide 125 CFC free 120 dose inhaler 897752 Fluticasone 250mcg Flixotide 250 CFC free 120 dose inhaler 897759 Fluticasone 50mcg Fluticasone 100mcg Fluticasone 250mcg Fluticasone 500mcg Ciclesonide 160mcg Ciclesonide 80mcg Flixotide 50 mcg accuhaler 60 dose Flixotide 100 mcg accuhaler 60 dose Flixotide 250 mcg accuhaler 60 dose Flixotide 500mcg accuhaler 60 dose Ciclovent 160mcg 60 dose Ciclovent 80mcg 60 dose 808445 818453 818461 818488 721620 721621 LABA Formoterol 12mcg Foratec hfa 120dose 710307 Methylxanthine Theophylline 200mg Sandoz theophylline 200mg 788368 Theoplus 200mg 783005 Methylxanthine Leukotriene receptor antagonists Leukotriene receptor antagonists Leukotriene receptor antagonists Inhaled anticholinergics Combinations Theophylline 300mg Sandoz Theophylline 300mg 788376 Theoplus 300mg 783013 Montelukast 4mg Monte-Air 4mg 717468 Sintair 4mg 718604 Montelukast 5mg Monte-Air 5mg 717469 Sintair 5mg 718605 Montelukast 10mg Monte-Air 10mg 717470 Sintair 10mg 718606 Ipratropium bromide Ipratropium bromide 40mcg/ Fenoterol 100mcg Ipvent 40mcg INH 300dose 704681 Duovent HFA 707882 Pulmonologist motivation Pulmonologist motivation Pulmonologist motivation Bipolar depression F31 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980 Anti-epileptic Valproic acid 300mg Convulex 300mg 715999 Anti-epileptic Valproic acid 500mg Convulex 500mg 781568 Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension 781541 Anti-epileptic Sodium valproate Epilim 200mg/5ml liquid 780545 Anti-epileptic Sodium valproate Epilizine cr 200mg 718274 Eprolep cr 200mg 721460 Anti-epileptic Sodium valproate Epilizine cr 300mg 718275 Eprolep cr 300mg 720762 Anti-epileptic Sodium valproate Epilizine cr 500mg 718276 Eprolep cr 500mg 721055 Anti-epileptic Sodium valproate Epilim crushable 100mg 821578 Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493 3

Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr 705597 Tegretol cr 200mg 779652 Anti-epileptic Carbamazepine 400mg Sandoz carbamazepine cr 705602 Tegretol cr 400mg 779660 Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS 704379 Anti-epileptic Lamotrigine 50mg Epitec 50mg TABS 704380 Lamidus 50mg 710885 Anti-epileptic Lamotrigine 100mg Epitec 100mg TABS 704381 Lamidus 100mg 710887 Anti-epileptic Lamotrigine 200mg Epitec 200mg TABS 704382 Lamidus 200mg 710888 Atypical antipsychotic Olanzapine 2.5mg Olawin 2.5mg 721385 Olexar 2.5mg 715657 Psych Motivation Atypical antipsychotic Olanzapine 5mg Olawin 5mg 721388 Olexar 5mg 715658 Psych Motivation Atypical antipsychotic Olanzapine 10mg Olawin 10mg 721389 Olexar 10mg 715659 Psych Motivation Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg 716050 Quetoser 25mg 716635 Atypical antipsychotic Quetiapine 100mg Dopaquel 100mg 716051 Quetoser 100mg 716636 Atypical antipsychotic Quetiapine 200mg Dopaquel 200mg 716052 Quetoser 200mg 716637 Atypical antipsychotic Quetiapine 300mg Dopaquel 300mg 716053 Quetoser 300mg 716638 Benzamides Sulpiride 50mg Espiride 819654 Psych Motivation Butyrephenones Haloperidol 1.5mg Sandoz haloperidol 1.5mg 730335 Butyrephenones Haloperidol 5mg Sandoz haloperidol 5mg 730327 Butyrephenones Haloperidol 0.5mg Serenace 0.5mg 763411 Lithium Lithium carbonate 250mg Camcolit 250mg 712078 Lithium Lithium carbonate 400mg Camcolit 400mg 712086 MAOI Moclobemide 150mg Depnil 897213 MAOI Moclobemide 300mg Depnil 702008 Phenothiazines Chlorpromazine 100mg Largactil 100mg 735884 Phenothiazines Chlorpromazine 25mg Largactil 25mg 735868 Phenothiazines Chlorpromazine 50mg Largactil 50mg 735876 SSRI Citalopram 20mg Talomil 20mg 702769 Cilate 20mg 707888 SSRI Escitalopram 10mg Lexamil 10MG 710303 Zytomil 10MG 715402 2nd line agent SSRI Escitalopram 20mg Lexamil 20MG 710304 Zytomil 20MG 715403 2nd line agent SSRI Fluoxetine 20mg Ranflocs 20mg 700686 Nuzak 20mg 840653 1st line agent SSRI Paroxetine 20mg Serrapress 20mg 705122 Xet 20mg 705633 SSRI Sertraline 50mg Dyna-Sertraline 50mg 719972 Serlife 50mg 703132 SSRI Sertraline 100mg Dyna-Sertraline 100mg 719973 Serlife 100mg 703999 SNRI Venlafaxine Hcl 37.5mg Odiven 37.5mg 710972 SNRI Venlafaxine Hcl 37.5mg Venlor XR 37.5 706399 Venlafaxine Adco XR 37.5mg 719402 SNRI Venlafaxine Hcl 75mg Venlor XR 75mg 706402 Venlafaxine Adco XR 75mg 719403 SNRI Venlafaxine Hcl 150mg Venlor XR 150mg 706404 Venlafaxine Adco XR 150mg 719405 Other Other Mirtazapine 15mg Mirtazapine 30mg Mylan-Mirtazapine 15mg Mylan-Mirtazapine 30mg Tricyclic antidepressants Dothiepin 25mg Thaden 25mg 800198 Tricyclic antidepressants Dothiepin 75mg Thaden 75mg 800201 710802 Miradep 15mg 721209 710803 Miradep 30mg 721210 Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746 Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542 Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 In combination with antipsychotic for drug-induced dyskinesias In combination with antipsychotic for drug-induced dyskinesias 4

Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg 806560 Prodorol 40mg 787175 In combination with antipsychotic for drug-induced dyskinesias Other Antipsychotics Risperidone 0.5mg Zoxadon 0.5mg 711511 Risnia 0.5mg 717996 Psych Motivation Other Antipsychotics Risperidone 1mg Zoxadon 1mg 711512 Risnia 1mg 717997 Psych Motivation Other Antipsychotics Risperidone 2mg Zoxadon 2mg 711513 Risnia 2mg 717998 Psych Motivation Other Bupropion 150mg Wellbutrin XL 150mg 704070 Other Bupropion 300mg Wellbutrin XL 300mg 711009 Bronchiectasis J47 Antibiotics Amoxycillin 500mg Moxypen 744697 Antibiotics Doxycycline 100mg Doxycyl 100 mg 809667 Antibiotics Doxycycline 50mg Doxycyl 50mg 808407 Antibiotics Trimethoprimsulfamethoxazole 80/400 Durobac 480mg 721751 Purbac adult 758248 Antibiotics Oxytetracycline HCl 250mg Oxypan 250mg 751987 Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Inhaled anti cholinergics / Beta 2-agonist Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA 707882 Formoterol fumerate Foratec HFA 120dose 710307 Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose 818496 Salmeterol xinafoate 25mcg Serevent 120 dose inhaler 787302 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent-40 300dose 704681 Inhaled Beta 2-agonists, Salbutamol 100ug inhaler Asthavent 200dose 819603 Venteze 100ug CFC inhaler 711213 Fenoterol 100mcg Berotec 100 HFA 200 dose 706544 Methylxanthine Theophylline 200mg Theoplus 200mg 783005 Sandoz theophylline 200mg 788368 Methylxanthine Theophylline 300mg Theoplus 300mg 783013 Sandoz Theophylline 300mg 788376 Cardiac failure I50 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481 Enap 10mg 891279 ACE Inhibitors Enalapril 20mg Alapren 20mg 881503 ACE Inhibitors Enalapril 5mg Alapren 5mg 886835 Enalapril / hydrochlorthiazide Enap co 20mg/ 891287 ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297 ACE Inhibitors Perindopril 4mg Prexum 5mg 720387 ACE Inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925 ACE Inhibitors Perindopril 10mg Prexum 10mg 714646 ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus 721507 Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298 Perindopril 4mg/Indapamide Prexum Plus 5/12.5 1.25mg mg 720388 Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg 721508 Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg 719853 Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg 719854 5

Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg 719852 Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg 719855 ACE Inhibitors Captopril Captohexal 837628 ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619 ACE Inhibitors Captopril 50mg Merck-captopril 50mg 899429 Captopril/hydrochlorthiazide Captoretic 50/25mg 841137 ACE Inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646 ACE Inhibitors Lisinopril 10mg Sinopren 10mg 700692 Austell Lisinopril 10mg 712598 ACE Inhibitors Lisinopril 20mg Sinopren 20mg 700694 Austell Lisinopril 20mg 708189 ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg 705427 ACE Ramipril 5mg Rampil 5mg 705428 ACE Ramipril 10mg Rampil10mg 705429 ACE Inhibitors Quinapril 5mg Quinagen 5mg 708981 ACE Quinapril 10mg Accumax 10mg 708119 ACE Quinapril 20mg Accumax 20mg 708120 ACE ACE Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ 704597 Hexal-lisinopril co 10/ 704703 704598 Hexal-lisinopril co 20/ 704704 708116 708118 Alpha + beta blocker Carvedilol Carloc 700168 Carvetrend 704671 Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg 705459 Carvetrend 6.25mg 704670 Alpha + beta blocker Carvedilol 25mg Carloc 25mg 897117 Carvetrend 25mg 704672 Aldosterone antagonist Spironolactone 25 Spiractin 765910 Cardiac glycosides Digoxin Lanoxin 0.0625mg 735760 Cardiac glycosides Digoxin Lanoxin 0.25mg 735752 Anticoagulant Warfarin 5mg cipla-warfarin 712390 ` Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898 Beta-blockers Atenolol 100mg Tenopress 100mg 705873 Bio-atenolol 100mg 826901 Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372 Beta-blockers Bisoprolol 10mg Bilocor 10mg 704373 Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor 786217 718082 Bilocor Co 2.5mg/6.25mg 719200 718086 Bilocor Co 5mg/6.25mg 719201 Bilocor Co 10mg/6.25mg 719202 Atenolol 50mg/chlorthalidone Tenchlor-HS 807591 Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg 731714 Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg 731722 Loop diuretics Torasemide 10mg Unat 10mg 820385 Motivation Loop diuretics Torasemide 2.5mg Unat 2.5mg 820369 Motivation 6

Loop diuretics Torasemide 5mg Unat 5mg 820377 Motivation Loop diuretics Furosemide 40mg Mylan Furosemide 40mg 857769 Sandoz Furosemide 731668 Loop diuretics Furosemide 20mg Austell Furosemide 20mg 707421 Nitrates Furosemide 20mg Isordil 10mg 734381 Nitrates Isosorbide dinitrate 30mg Isordil 30mg 734403 Nitrates Isosorbide dinitrate 5mg Isordil 5mg 734411 Nitrates Isosorbide mononitrate 20mg Ismo 20mg 734055 Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg 734438 Organic Nitrates Ivabradine 5mg Coralan 5mg 710620 Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg 710621 Aspirin 81mg Ecotrin 81mg 823481 Aspirin 300mg Bayer Aspirin 300mg 706930 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Thiazide diuretic Hydrochlorthiazide Hexazide 890470 Diuretic-thiazide Hydrochlorthiazide/amiloride 50/5mg Spec -Co - Amiloride 706531 Amiloretic 50mg/5mg 702803 Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg 716962 Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg 703329 Cipla- Indapamide 710313 Cardiologist Prescription Cardiologist Prescription If >120, documented evidence of hypokalaemia must be provided Calcium channel blockers Amlodipine 10mg Gulf Amlodipine 10mg 712954 Ciplavasc 10mg 708152 Calcium channel blockers Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352 Calcium channel blockers Verapamil 240 SR Verahexal 240 sr 700071 Calcium channel blockers Verapamil 40mg Vasomil 40mg 774944 Calcium channel blockers Verapamil 80mg Vasomil 80mg 774952 Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab 829501 Cipalat Retard 20mg 864153 Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg 723283 Fedaloc sr 30mg 711682 Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg 723284 Fedaloc sr 60mg 711714 Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Losartan 50mg Ciplazar 50mg 716643 Zartan 50mg 709225 Losartan 100mg Ciplazar 100mg 716644 Zartan 100mg 709964 ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg 715857 Zartan Co 100mg/25mg 715857 ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ 715856 Zartan Co 50mg/25mg 715816 7

Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg 705060 Diolo 80mg 717034 Valsartan 160mg Tareg 160mg 704696 Diolo 160mg 717035 ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ 705068 Diolo Co 80mg/ 718607 ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg 715560 Diolo Co 160mg/ 718608 Cardiomyopathy I42 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481 ACE Inhibitors Enalapril 20mg Alapren 20mg 881503 ACE Inhibitors Enalapril 5mg Alapren 5mg 886835 Enalapril / hydrochlorthiazide Enap co 20mg/ 891287 ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297 ACE Inhibitors Perindopril 4mg Prexum 5mg 720387 ACE Inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925 ACE Inhibitors Perindopril 10mg Prexum 10mg 714646 ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus 721507 Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298 Perindopril 4mg/Indapamide Prexum Plus 5/12.5 1.25mg mg 720388 Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg 721508 Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg 719853 Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg 719854 Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg 719852 Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg 719855 ACE Inhibitors Captopril Captohexal 837628 ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619 ACE Inhibitors Captopril 50mg Merck-captopril 50mg 899429 Captopril/hydrochlorthiazide Captoretic 50/25mg 841137 ACE Inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646 ACE Inhibitors Lisinopril 10mg Sinopren 10mg 700692 Austell Lisinopril 10mg 712598 ACE Inhibitors Lisinopril 20mg Sinopren 20mg 700694 Austell Lisinopril 20mg 708189 ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg 705427 ACE Ramipril 5mg Rampil 5mg 705428 ACE Ramipril 10mg Rampil10mg 705429 ACE Inhibitors Quinapril 5mg Quinagen 5mg 708981 ACE Quinapril 10mg Accumax 10mg 708119 704597 Hexal-lisinopril co 10/ 704703 704598 Hexal-lisinopril co 20/ 704704 8

ACE Quinapril 20mg Accumax 20mg 708120 ACE ACE Angiotensin receptor blockers (ARBs) Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ 708116 708118 Losartan 50mg Ciplazar 50mg 716643 Zartan 50mg 709225 Angiotensin receptor blockers (ARBs) Losartan 100mg Ciplazar 100mg 716644 Zartan 100mg 709964 ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg 715857 Zartan Co 100mg/25mg 715857 ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ 715856 Zartan Co 50mg/25mg 715816 Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg 705060 Diolo 80mg 717034 Valsartan 160mg Tareg 160mg 704696 Diolo 160mg 717035 ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ 705068 Diolo Co 80mg/ 718607 ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg 715560 Diolo Co 160mg/ 718608 Alpha + beta blocker Carvedilol Carloc 700168 Carvetrend 704671 Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg 705459 Carvetrend 6.25mg 704670 Alpha + beta blocker Carvedilol 25mg Carloc 25mg 897117 Carvetrend 25mg 704672 Aldosterone antagonist Spironolactone 25 Spiractin 765910 Cardiac glycosides Digoxin Lanoxin 0.0625mg 735760 Cardiac glycosides Digoxin Lanoxin 0.25mg 735752 Anticoagulant Warfarin 5mg cipla-warfarin 712390 Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898 Beta-blockers Atenolol 100mg Tenopress 100mg 705873 Bio-atenolol 100mg 826901 Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372 Beta-blockers Bisoprolol 10mg Bilocor 10mg 704373 Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor 786217 718082 Bilocor Co 2.5mg/6.25mg 719200 718086 Bilocor Co 5mg/6.25mg 719201 Bilocor Co 10mg/6.25mg 719202 Atenolol 50mg/chlorthalidone Tenchlor-HS 807591 Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg 731714 9

Direct acting vasodilators Hydralazine 50mg Hyperphen 50mg 731722 Loop diuretics Torasemide 10mg Unat 10mg 820385 Motivation Loop diuretics Torasemide 2.5mg Unat 2.5mg 820369 Motivation Loop diuretics Torasemide 5mg Unat 5mg 820377 Motivation Loop diuretics Furosemide 40mg Mylan Furosemide 40mg 857769 Sandoz Furosemide 731668 Loop diuretics Furosemide 20mg Austell Furosemide 20mg 707421 Low ceiling diuretics Indapamide Dyna-Indapamide SR 1.5mg 716962 Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg Nitrates Isosorbide dinitrate 10mg Isordil 10mg 734381 Nitrates Isosorbide dinitrate 30mg Isordil 30mg 734403 Nitrates Isosorbide dinitrate 5mg Isordil 5mg 734411 Nitrates Isosorbide mononitrate 20mg Ismo 20mg 734055 Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg 734438 703329 Cipla- Indapamide 2.5mg 710313 Aspirin 81mg Ecotrin 81mg 823481 Aspirin 300mg Bayer Aspirin 300mg 706930 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Anticoagulant Warfarin 5mg cipla-warfarin 712390 Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Thiazide diuretic Hydrochlorthiazide Hexazide 890470 Diuretic-thiazide Hydrochlorthiazide/amiloride 50/5mg Spec -Co - Amiloride 706531 Amiloretic 50mg/5mg 702803 If >120, documented evidence of hypokalaemia must be provided Chronic Renal Disease N03 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481 N05 ACE Inhibitors Enalapril 20mg Alapren 20mg 881503 N11 ACE Inhibitors Enalapril 5mg Alapren 5mg 886835 N18 Enalapril / hydrochlorthiazide Enap co 20mg/ 891287 N19 ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297 ACE Inhibitors Perindopril 4mg Prexum 5mg 720387 ACE Inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925 ACE Inhibitors Perindopril 10mg Prexum 10mg 714646 ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus 721507 Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298 Perindopril 4mg/Indapamide Prexum Plus 5/1.25 1.25mg mg 720388 Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg 721508 Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg 719853 Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg 719854 Perindopril 5mg/Amlodipine 10mg Coveram 5/10mg 719852 Perindopril 5mg/Amlodipine 5mg Coveram 5/5mg 719855 10

ACE Inhibitors Captopril Captohexal 837628 ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619 ACE Inhibitors Captopril 50mg Merck-captopril 50mg 899429 Captopril/hydrochlorthiazide Captoretic 50/25mg 841137 ACE Inhibitors Lisinopril 5mg Sinopren 5mg 700691 Zemax 5mg 703646 ACE Inhibitors Lisinopril 10mg Sinopren 10mg 700692 Austell Lisinopril 10mg 712598 ACE Inhibitors Lisinopril 20mg Sinopren 20mg 700694 Austell Lisinopril 20mg 708189 ACE ACE Lisinopril 10mg/Hydrochlorothiazide Lisinopril 20mg/Hydrochlorothiazide Adco Zetomax-Co 10/ Adco Zetomax-Co 20/ ACE Ramipril 2.5mg Rampil 2.5mg 705427 ACE Ramipril 5mg Rampil 5mg 705428 ACE Ramipril 10mg Rampil10mg 705429 ACE Inhibitors Quinapril 5mg Quinagen 5mg 708981 ACE Quinapril 10mg Accumax 10mg 708119 ACE Quinapril 20mg Accumax 20mg 708120 ACE ACE Angiotensin receptor blockers (ARBs) Quinapril 10mg/hydrochlorthiazide Quinapril 20mg/hydrochlorthiazide Accumax Co 10/ Accumax Co 20/ 704597 Hexal-lisinopril co 10/ 704703 704598 Hexal-lisinopril co 20/ 704704 708116 708118 Losartan 50mg Ciplazar 50mg 716643 Zartan 50mg 709225 Angiotensin receptor blockers (ARBs) losartan 100mg Ciplazar 100mg 716644 Zartan 100mg 709964 ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg 715857 Zartan Co 100mg/25mg 715857 ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/ 715856 Zartan Co 50mg/25mg 715816 Angiotensin receptor blockers (ARBs) Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg 705060 Diolo 80mg 717034 Valsartan 160mg Tareg 160mg 704696 Diolo 160mg 717035 ARB combinations Valsartan 80mg/ hydrochlorothizide Co-Tareg 80mg/ 705068 Diolo Co 80mg/ 718607 ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg 715560 Diolo Co 160mg/ 718608 Aldosterone antagonist Spironolactone 25mg Spiractin 25mg 765910 Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898 Beta-blockers Atenolol 100mg Tenopress 100mg 705873 Bio-atenolol 100mg 826901 Atenolol 100mg/chlorthalidone 25mg Tenchlor 100mg/25mg 786217 11

Atenolol 50mg/chlorthalidone Tenchlor hs 50mg/ 807591 Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 Beta-receptor blockers Propranolol HCl 40mg Indoblok 40mg 806560 Prodorol 40mg 787175 Calcium channel blockers - long acting Verapamil 240 SR Verahexal 240 sr 700071 Ravamal SR 240mg 819573 Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab 829501 Cipalat Retard 20mg 864153 Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg 723283 Fedaloc sr 30mg 711682 Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg 723284 Fedaloc sr 60mg 711714 Calcium channel blockers Verapamil 40mg Vasomil 40mg 774944 Calcium channel blockers Verapamil 80mg Vasomil 80mg 774952 Calcium channel blockers Diltiazem 60mg Zildem 60mg 822213 Calcium channel blockers Diltiazem 90mg Zildem 90mg 824364 Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg 839183 Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg 839191 Calcium supplements Calcium carbonate 500mg Eno Tums Chew 703359 Calciferol Calciferol Minerals and vitamin D Calciferol 5 000u/ml Calciferol 50 000IU Alfacalcidol 0.25mcg Calciferol Oily solution 5000u/mL Lennon Strong Calciferol One alpha 0.25mcg cap 711853 711640 750654 Minerals and vitamin D Alfacalcidol 1mcg One alpha 1mcg cap 750662 Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide 890470 Ridaq 25mg 880949 Haematinics Erythropoietin Repotin 2000iu 839264 Haematinics Erythropoietin Repotin 4000iu 839272 Haematinics Erythropoietin Recormon numerous Iron supplements Iron supplements Iron supplements Iron(III)-hydroxide sucrose complex Iron polymaltose 50mg Ferrous-fumarate 200mg; folic acid 100ug Venofer 873276 Ferrimed Iron polymaltose 50mg capsule 725927 Pregamal 756571 Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Dialysis benefit - Medscheme or Onecare Motivation and Haemoglobin levels - forward to Onecare/Medscheme Chelating Agents Calcium acetate anhydrous Phosphosorb 660mg 718735 Loop diuretics Loop diuretics Diuretic-thiazide Furosemide 40mg Furosemide 20mg Hydrochlorthiazide/amiloride 50/5mg Mylan Furosemide 40mg Austell Furosemide 20mg 857769 Sandoz Furosemide 731668 707421 Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Vitamins Folic acid 5 mg Be-tabs folic 5mg 810967 Spec -Co - Amiloride 706531 Amiloretic 50mg/5mg 702803 If >120, documented evidence of hypokalaemia must be provided 12

Chronic Obstructive Pulmonary disease J43 Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 J44 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent-40 300dose 704681 Salbutamol 200ug Asthavent dp 878219 Fenoterol 100mcg Berotec 100 HFA 200 dose 706544 Salbutamol 200ug Cybutol 200ug 894397 Salbutamol 400ug Cybutol 400ug 894400 Salbutamol 100ug inhaler Asthavent 200dose 819603 Formoterol fumarate Foratec HFA 12mcg 120 dose 710307 Venteze cfc free 100ug inhaler 711213 Adrenergics Budesonide/Formoterol Symbicord 80/4.5mcg 705986 Vannair 80/4.5mcg 720218 Adrenergics Budesonide/Formoterol Symbicord 160/4.5mcg 60dose 700172 Adrenergics Budesonide/Formoterol Symbicord 160/4.5mcg 120dose 700172 Vannair 160/4.5mcg 720219 Adrenergics Budesonide/Formoterol Symbicord 320/9mcg 705984 Salmeterol fluticazone Salmeterol fluticazone Foxair 25/50mcg 120 dose inh Foxair 25/125mcg 120 dose inh 715752 715753 Sereflo 25/50mcg Synchrobreather 120 dose inh Sereflo 25/125mcg Synchrobreather 120 dose inh 721412 721413 Salmeterol fluticazone Foxair 25/250mcg 120 dose inh 715754 Sereflo 25/250mcg Synchobreather 120 dose inh 721414 Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters 715009 Salmeterol 50ug/Fluticasone 250ug Salmeterol 50ug/Fluticasone 500ug Fluticasone 50mcg Foxair 50/250mcg 60 blisters Foxair 50/250mcg 60 blisters Flixotide 50 CFC free 120 dose inhaler 715008 715007 703275 Motivation, including history of therapy, Motivation, including history of therapy,. FEV1<50 post bronchodilator Fluticasone 125mcg Flixotide 125 CFC free 120 dose inhaler 897752 Fluticasone 250mcg Flixotide 250 CFC free 120 dose inhaler 897759 Fluticasone 50mcg Fluticasone 100mcg Fluticasone 250mcg Fluticasone 500mcg Ciclesonide 160mcg Ciclesonide 80mcg Flixotide 50 mcg accuhaler 60 dose Flixotide 100 mcg accuhaler 60 dose Flixotide 250 mcg accuhaler 60 dose Flixotide 500mcg accuhaler 60 dose Ciclovent 160mcg 60 dose Ciclovent 80mcg 60 dose 808445 818453 818461 818488 721620 721621 Combinations Ipratropium brom. 20ug; salbutamol sulph. To salbutamol 100ug/met.dos. Duolin Respules 703983 For Stage ll & lll COPD only. Script from Pulmonologist or Physician 13

Anticholinergics Tiotropium 18mcg Forvent handihaler 714167 For Stage ll & lll COPD only. Script from Pulmonologist or Physician Anticholinergics Tiotropium 18mcg Forvent 18mcg INH caps refill 714152 For Stage ll & lll COPD only. Script from Pulmonologist or Physician Beclomethasone dipropionate 100mcg Beclate 100mcg inhaler 819638 For Stage ll & lll COPD only. Script from Pulmonologist or Physician Beclomethasone dipropionate 200mcg Budesonide 100ug Budesonide 200ug Budesonide 200ug Beclate 200mcg inhaler Budeflam HFA 100mcg 300dose Budeflam HFA 200mcg 300dose Budeflam DP 200mcg inh caps 820083 897462 897469 704176 Budesonide 200ug Pulmicort Turbohaler 200mcg 200D 791423 Budesonide 200ug Pulmicort Turbohaler 100mcg 200D 791431 Budesonide 400ug Pulmicort Turbohaler 400mcg 200D 823791 Methylxanthine Theophylline 200mg Sandoz theophylline 200mg 788368 Theoplus 200mg 783005 Methylxanthine Theophylline 300mg Sandoz theophylline 300mg Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Combinations Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA 707882 788376 Theoplus 300mg 783013 For long term oral corticosteroid treatment Coronary Artery Disease I20 Anticoagulant Warfarin 5mg cipla-warfarin 712390 I25 Beta blocker Propranolol 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 Beta blocker Propranolol 40mg Indoblok 40mg 806560 Prodorol 40mg 787175 Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898 Beta-blockers Atenolol 100mg Tenopress 100mg 705873 Bio-atenolol 100mg 826901 Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372 Bisbeta 5mg 720659 Beta-blockers Bisoprolol 10mg Bilocor 10mg 704373 Bisbeta 10mg 720660 Diuretic-thiazide Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Atenolol 100mg/chlorthalidone 25mg Atenolol 50mg/chlorthalidone Hydrochlorthiazide/amiloride 50/5mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg Tenchlor 100mg/25mg Tenchlor hs 50mg/ 718082 Bilocor Co 2.5mg/6.25mg 719200 718086 Bilocor Co 5mg/6.25mg 719201 786217 807591 Bilocor Co 10mg/6.25mg 719202 Spec -Co - Amiloride 706531 Amiloretic 50mg/5mg 702803 Alpha + beta blocker Carvedilol Carloc 700168 Carvetrend 704671 14

Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg 705459 Carvetrend 6.25mg 704670 Alpha + beta blocker Carvedilol 25mg Carloc 25mg 897117 Carvetrend 25mg 704672 Calcium channel blockers Nifedipine SR 20mg Nifedalat 20 sr tab 829501 Cipalat Retard 20mg 864153 Calcium channel blockers Nifedipine SR 30mg Cipalat XR 30mg 723283 Fedaloc sr 30mg 711682 Calcium channel blockers Nifedipine SR 60mg Cipalat XR 60mg 723284 Fedaloc sr 60mg 711714 Calcium channel blocker Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352 Calcium channel blocker Amlodipine 10mg Gulf Amlodipine 10mg 712954 Lomanor 10mg 708353 Calcium channel blockers Verapamil 240 SR Verahexal 240 sr 700071 Calcicard SR 240mg 813354 Calcium channel blockers Verapamil 40mg Vasomil 40mg 774944 Calcium channel blockers Verapamil 80mg Vasomil 80mg 774952 Calcium channel blockers Diltiazem 60mg Zildem 60mg 822213 Calcium channel blockers Diltiazem 90mg Zildem 90mg 824364 Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg 839183 Calcium channel blockers Diltiazem SR 240mg Zildem SR 240mg 839191 Calcium channel blockers Felodipine 10mg Felodipine-hexal 10mg 703902 Calcium channel blockers Felodipine 5mg Felodipine-hexal 5mg 703221 Nitrates Glyceryl trintarate 0.5mg Angised 703605 Nitrates Isosorbide mononitrate 60mg Monicor sr 710251 Nitrates Isosorbide dinitrate spray Dinospray 1.25mg/dose 701500 Nitrates Isosorbide dinitrate 10mg Isordil 10mg 734381 Nitrates Isosorbide dinitrate 30mg Isordil 30mg 734403 Nitrates Isosorbide dinitrate 5mg Isordil 5mg 734411 Nitrates Isosorbide mononitrate 20mg Ismo 20mg 734055 Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg 734438 Organic Nitrates Ivabradine 5mg Coralan 5mg 710620 Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg 710621 inhibitor inhibitor Aspirin 300mg Bayer Aspirin 300mg 706930 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Aspirin 81mg Ecotrin 81mg 823481 Dipyridamole 100mg Plato 100mg 720526 Dipyridamole 25mg Plato 25mg 755656 Clopidogrel 75mg Plagrol 711423 Aspirin 100mg Bayer Aspirin Cardio 100mg 862304 Cardiologist Prescription Cardiologist Prescription Detailed clinical motivation with stent types and dates and history of therapy Fibrates Bezafibrate 400mg Dyna-Bezafibrate 400mg 710122 From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia 15

HMG-CoA reductase (statins) Simvastatin 10mg Adco simvastatin 10mg 701276 Austell simvastatin 10mg 705464 From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia HMG-CoA reductase (statins) Simvastatin 20mg Adco simvastatin 20mg 701279 Austell simvastatin 20mg 705465 From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia HMG-CoA reductase (statins) Simvastatin 40mg Adco simvastatin 40mg 701281 Austell simvastatin 40mg 705467 From Cardiologist/ Physician.Need to be loaded under Hyperlipidaemia Crohn's disease K50 Aminosalicylates Mesalazine 400mg tab Asacol 400mg 783668 Aminosalicylates Mesalazine 2g/50ml enema Asacol enema 824127 Aminosalicylates Mesalazine 500mg supps Asacol supps 824135 Aminosalicylates Mesalazine 500mg tab Pentasa 500mg 890775 Aminosalicylates Olsalazine 250mg Dipentum 250mg 792519 Aminosalicylates Sulphasalazine 500mg Salazopyrin 500mg 762008 Aminosalicylates Sulphasalazine 500mg Salazopyrin EN 500 762016 others Budesonide 2.3mg Entocord 2,3mg Enema 824593 others Budesonide 3mg Entocord 3mg cap 838896 Antibiotics Antibiotics Metronidazole 200mg Metronidazole 400mg Adco-metronidazole 200mg Adco-metronidazole 400mg 742872 701076 Antibiotics Ciprofloxacin 250mg Ciprol 704777 Dynafloc 250 700516 Antibiotics Ciprofloxacin 500mg Ciprol 704775 Dynafloc 500 700518 Antibiotics Ciprofloxacin 750mg Cifloc 750mg 893963 Corticosteroids Prednisolone 5mg Lenisolone 5mg 800155 Capsoid 814407 Cytostatic Methotrexate 2.5 Methotrexate 2.5mg 742465 Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Immunosuppressive Azathioprine 50mg Azamun 50mg 701252 Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967 Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 Motivation - Motivation - For long term oral corticosteroid treatment Diabetes insipidus E23.2 Anti-diuretics Desmopressin Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml DDAVP nasal spray 0.1mg/ml 717746 837555 Anti-Diuretics Desmopressin tab DDAVP 0.1mg 837563 16

Anti-Diuretics Desmopressin tab DDAVP 0.2mg 703639 Diabetes Mellitus 1 E10 Anti-hypoglycaemic agent Injection GlucaGen - Hypokit 821365 Diabetic consumables Lancets Accu-check pro lancets 616091 Diabetic consumables Lancets Accu-check softclix lancets 616102 Diabetic consumables Lancets Microlet lancets 508771 Diabetic consumables Needles Novofine needles 458317 Diabetic consumables Needles BD microfine needles 463822 Diabetic consumables Strips Accu-check advantage strip 891500 Diabetic consumables Strips Accutrend glucose strips 831743 Diabetic consumables Strips Ascensia elite ts (glucometer) 811394 Diabetic consumables Strips Ascensia entrust test strips 701260 Diabetic consumables Strips Ascensia glucodi esprit 890752 Diabetic consumables Strips Glucostix coastal 831980 Diabetic consumables Strips Glucostix high altitude 831999 Diabetic consumables Strips Haemo-Glucotest 832014 Diabetic consumables Strips Keto-Diastix 50's 832203 Diabetic consumables Strips Medisense optimum plus 892998 Diabetic consumables Diabetic consumables Diabetic consumables Diabetic consumables Strips Strips Strips Strips Biphasic insulin Biphasic insulin Fast acting insulin Fast acting insulin Fast acting insulin Medisense precision plus electrodes One touch ultra test strips One touch horizon test strips Homemed blood glucose strips Insu Actaphane HM(ge) 3.0ml Penset Insu Actraphane HM(ge) 10ml vial Insu Apidra 3.0ml cartridge Insu Apidra I optiset penset 3ml insu Apidra solostar disposable pens 3ml 847887 702690 704130 460628 816213 733512 706039 710367 709861 Fast acting insulin Insu Apidra 10ml vial 706040 Fast acting insulin Novorapid flexpen 3ml prefilled device penset 897767 Motivation with treatment history Motivation with treatment history Motivation with treatment history Motivation with treatment history Fast acting insulin Novorapid flexpen 3ml solution for inj. penfill 897775 Fast acting insulin Novorapid vial 10ml 707927 Novomix 30 flexpen 3ml pf device 702086 17

Novomix 30 penfill 3ml pf device 702089 - rapid acting - rapid acting insulin Humalog 10ml vial humalog cartridge 3ml 819468 862355 - rapid acting humalog pen 3ml disposable 853445 premixed biphasic humalog mix 25 10ml vial 853437 premixed biphasic humalog mix 25 cartridge 3 ml 861782 premixed biphasic humalog mix 25 disp pen 3 ml 853461 premixed biphasic humalog mix 50 cartridge 3ml 705074 glargine Optisulin Cartridge 100IU/ml 723474 Basaglar Cartridge 100IU/ml 722456 glargine Detemir Detemir isophane - intermediate isophane - intermediate Optisulin pen 100 IU/ml Levemir flexpen prefilled 3ml Levemir prefilled cartridge 3ml 721502 Basaglar Pen 100IU/ml 722454 705312 705313 Humulin N vial 10ml 733458 humulin N cartridge 3ml 863556 Biosulin N 3ml cart 712768 Motivation with treatment history Motivation with treatment history isophane - intermediate humulin N pen 3ml disposable 853453 premixed biphasic premixed biphasic Humulin 30/70 10ml vial Humulin 30/70 cartridge 3ml 783811 863572 Biosulin 30/70 3ml cart 712770 premixed biphasic Humulin 30/70 disposable pens 3ml 704456 - short acting Humulin R 10ml vial 733431 - short acting Intermediate to long acting insulin Intermediate to long acting insulin humulin R 3ml cartridge Insu Protaphane flexpen 3ml pf device Insu Protaphane HM(ge) 10ml vial 863564 Biosulin R 3ml cartridge 712767 700183 733482 Aspirin 300mg Bayer Aspirin 300mg 706930 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Aspirin 100mg Ecotrin 81mg 823481 Diabetes mellitus type 2 E11 Biguanides Metformin 850 mg Biguanides Metformin 500mg Accord Metformin 850mg Accord Metformin 500mg 714426 Diaphage 850mg 719785 714427 Diaphage 500mg 719784 Biguanides Metformin 1000mg Bigsens 1000mg 709172 Mylan Metformin 1000mg 721443 Biguanides Metformin 500mg Glucophage XR 500mg 710196 18

Biguanides Biguanides Metformin 750mg Metformin 1000mg Glucophage XR 750mg Glucophage XR 1000mg 720925 720926 combinations Metformin/glibenclamide Glucovance 250/1.25 701109 combinations Metformin/glibenclamide Glucovance 500/2.5 701111 combinations Metformin/glibenclamide Glucovance 500/5 701112 Sulphonylureas Glibenclamide 5mg Bio-glibenclamide 827053 Sulphonylureas Glimepiride 1mg Mylan Glimepiride 1mg 709984 Sulphonur 1mg 710904 Sulphonylureas Glimepiride 2mg Mylan Glimepiride 2mg 709985 Sulphonur 2mg 710905 Sulphonylureas Glimepiride 4mg Austell Glimepiride 4mg 717078 Sulphonur 4mg 710906 Sulphonylureas Gliclazide 80mg Sandoz gliclazide 80mg 834866 Diaglucide 80mg 868906 Sulphonylureas Gliclazide 30mg MR Diaglucide 30mg MR 714582 Sulphonylureas Gliclazide 60mg MR Diaglucide 60mg MR 718247 Thiazolidinediones Pioglitazone Cipla pioglitazone 30mg 707981 Motivation with treatment history Thiazolidinediones Pioglitazone Cipla pioglitazone 15mg 707974 Aspirin 300mg Bayer Aspirin 300mg 706930 Acetylsalicylic Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Motivation with treatment history Acetylsalicylic Aspirin Ecotrin 81mg 823481 Dysrhythmia I47 Anti-arrhythmic Amiodarone 100mg Hexarone 100mg 863157 Arycor 100mg 703515 I48 Anti-arrhythmic Amiodarone 200mg Bio-amiodarone 200mg 707851 Anti-arrhythmic Propafenone 150mg Rhythmol 150mg 784869 Anti-arrhythmic Propafenone 300mg Rhythmol 300mg 784877 Anti-arrhythmic Disopyramide 100mg Rythmodan 100mg 761826 Anti-arrhythmic Disopyramide 250mg Rythmodan Retard 250mg 761842 Beta-blockers Sotalol 160mg Sotahexal 160mg 828009 Beta-blockers Sotalol 80mg Sotahexal 80mg 827991 Cardiac glycosides Digoxin Lanoxin 0.0625mg 735760 Cardiac glycosides Digoxin Lanoxin 0.25mg 735752 Anticoagulant Warfarin 5mg cipla-warfarin 712390 Beta-blockers Propranolol 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 Beta-blockers Propranolol 40mg Indoblok 40mg 806560 Prodorol 40mg 787175 Beta-blockers Bisoprolol 10mg Bilocor 10mg 704373 Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372 Bisoprolol 2.5mg/Hydrochlorothiazide 6.25mg Bisoprolol 5mg/Hydrochlorothiazide 6.25mg Bisoprolol 10mg/Hydrochlorothiazide 6.25mg Bisozyd Co 2.5mg/6.25mg Bisozyd Co 5mg/6.25mg 718082 Bilocor Co 2.5mg/6.25mg 719200 718086 Bilocor Co 5mg/6.25mg 719201 Bilocor Co 10mg/6.25mg 719202 Beta-blockers Atenolol 50mg Tenopress 50mg 705874 Bio-atenolol 50mg 826898 Beta-blockers Atenolol 100mg Tenopress 100mg 705873 Bio-atenolol 100mg 826901 Alpha + beta blocker Carvedilol Carloc 700168 Carvetrend 704671 19

Alpha + beta blocker Carvedilol 6.25mg Carloc 6.25mg 705459 Carvetrend 6.25mg 704670 Alpha + beta blocker Carvedilol 25mg Carloc 25mg 897117 Carvetrend 25mg 704672 Atenolol 100mg/chlorthalidone 25mg Tenchlor 100mg/25mg 786217 Atenolol 50mg/chlorthalidone Tenchlor hs 50mg/ 807591 Calcium channel blockers Verapamil 240 SR Verahexal 240 sr 700071 Ravamil 240mg 819573 Calcium channel blockers Verapamil 40mg Vasomil 40mg 774944 Calcium channel blockers Verapamil 80mg Vasomil 80mg 774952 Calcium channel blockers Diltiazem 60mg Zildem 60mg 822213 Calcium channel blockers Diltiazem 90mg Zildem 90mg 824364 Calcium channel blockers Diltiazem SR 180 Zildem SR 180mg 839183 Calcium channel blockers Diltiazem SR 240 Zildem SR 240mg 839191 inhibitor inhibitor Aspirin 300mg Bayer Aspirin 300mg 706930 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Aspirin 81mg Ecotrin 81mg 823481 Dipyridamole 100mg Plato 100mg 720526 Dipyridamole 25mg Plato 25mg 755656 Epilepsy G40 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980 G41 Anti-epileptic Valproic acid 300mg Convulex 300mg 715999 Anti-epileptic Valproic acid 500mg Convulex 500mg 781568 Anti-epileptic Valproic acid 250mg/ 5mL Convulex suspension 781541 Anti-epileptic Sodium Valproate 100mg Epilim Crushable 100mg 821578 Anti-epileptic Sodium Valproate 200mg Epilizine cr 200mg 718274 Eprolep cr 200mg 721460 Anti-epileptic Sodium Valproate 300mg Epilizine cr 300mg 718275 Eprolep cr 300mg 720762 Anti-epileptic Sodium Valproate 500mg Epilizine cr 500mg 718276 Eprolep cr 500mg 721055 Anti-epileptic Sodium Valproate 200mg/5ml Epilim sugar free 780545 Anti-epileptic Lamotrigine 25mg Epitec 25mg TABS 704379 Anti-epileptic Lamotrigine 50mg Epitec 50mg TABS 704380 Lamidus 50mg 710885 Anti-epileptic Lamotrigine 100mg Epitec 100mg TABS 704381 Lamidus 50mg 710885 Anti-epileptic Lamotrigine 200mg Epitec 200mg TABS 704382 Lamidus 50mg 710885 Anti-epileptic Phenobarbitone 30mg Sedabarb 30mg 814946 Anti-epileptic Phenytoin 100mg Phenytoin sod 754870 Anti-epileptic Phenytoin 125mg/5mL susp Epanutin 125mg/5mL 723533 Anti-epileptic Phenytoin sodium 50mg Epanutin Infatabs 50mg 723568 Anti-epileptic Clonazepam Rivotril 0.5mg 761079 Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation 20

Anti-epileptic Clonazepam Rivotril 2.5mg/ml drops 835129 Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Anti-epileptic Clonazepam Rivotril 2mg 761087 Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Anti-epileptic Carbamazepine 100mg/ 5mL Tegretol susp 250mL 769401 Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493 Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr 705597 Tegretol cr 200mg 779652 Anti-epileptic Carbamazepine 400mg Sandoz carbamazepine cr 705602 Tegretol cr 400mg 779660 Anti-epileptic Gabapentin 100mg Epigab 100mg 722865 Neurexal 100mg 708949 Anti-epileptic Gabapentin 300mg Epigab 300mg 722866 Neurexal 300mg 708994 Anti-epileptic Gabapentin 400mg Epigab 400mg 722867 Neurexal 400mg 708995 Anti-epileptic Topiramate 15mg Topamax sc sprinkles 15mg 878014 Anti-epileptic Topiramate 25mg Epitoz 25mg 710899 Anti-epileptic Topiramate 50mg Epitoz 50mg 710900 Anti-epileptic Topiramate 100mg Epitoz 100mg 719901 Anti-epileptic Oxcarbazepine 300mg Trileptal 300mg 892484 Anti-epileptic Oxcarbazepine 600mg Trileptal 600mg 892491 Anti-epileptic Ethosuximide 250mg/5ml Zarontin 250mg/5ml syrup 779105 Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967 Anti-epileptic Levetiracetam 250mg Epikepp 250mg 721701 Redilev 250mg 714662 Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. motivation Severe and uncontrolled epilepsy only, not responding to first-line agents. Motivation from neurologist, neurosurgeon or paediatric neurologist only. Anti-epileptic Levetiracetam 500mg Epikepp 500mg 721702 Redilev 500mg 714663 (Indicated for specific types of epilepsy and only for adults and children > 16yrs). Anti-epileptic Levetiracetam 750mg Epikepp 750mg 721703 Redilev 750mg 714664 Motivation from neurologist, neurosurgeon or paediatric neurologist only. 21

Glaucoma H40 Carbonic anhydrase Carbonic anhydrase Ophthalmics -alpha-2- agonist Acetazolamide Azomid 250mg 789771 Brinzolamide Azoptic eye suspension 1% 701523 Brimonidine tartrate Alphagan purite 5ml 709410 Ophthalmics -Beta-blockers Metipranolol 0.3% Beta-Opthiole 0.3% 816728 Ophthalmics -Beta-blockers Metipranolol 0.6% Beta-Opthiole 0.6% 816736 Ophthalmics -Beta-blockers Timolol 5mg/ml Glaucosan 0.5% 821624 Ophthalmics -Beta-blockers Timolol 2.5mg/ml Timoptol 0.25% 5ml drops 770833 Ophthalmics -Beta-blockers Bimatoprost 0.3mg/ml Lumigan 3ml 703666 Opthalmics -Beta-blockers Brinzolamide 10mg; Timolol combination 5mg/ml Azarga 5ml 717260 Opthalmics -Beta-blockers Bimatopost 0.3mg; Timolol combination 5mg/ml Ganfort 3ml 714110 Ophthalmics -Beta-blockers Dorzolamide 20mg; timolol 5mg/ml Cosopt 0.5% 5ml drp 860379 Ophthalmics Brimonidine tartrate 2mg; Combigan eye drops timolol 5mg/ml 5ml 709863 Ophthalmics - carbonic anhydrase inhibitor Ophthalmic - muscarinic agonists Ophthalmic - muscarinic agonists Ophthalmic - muscarinic agonists Ophthalmics-prostaglandin analogue Dorzolamide 20mg Trusopt solution 819832 Pilocarpine 10mg/mL Pilocarpine 20mg/mL Pilocarpine 40mg/mL Travoprost 40ug/ml Isoptocarpine 1% - 15mL Isoptocarpine 2%- 15mL Isoptocarpine 4% - 15mL Travatan eye drop solution 734284 734179 734195 702534 Ophthalmics-prostaglandin analogue Lantanoprost/timolol Xalacom 702983 Co-Atana 2.5ml 722712 Opthalmics-prostaglandin analogue Lantanoprost 1ml/50mcg Xalatan 833223 Atana 50mcg/ml 720971 Ophthalmics Betaxolol 0.50% Betoptic 5ml 708445 Ophthalmics Betaxolol 0.25% Betoptic s 0.25% 836052 Motivation, including history of therapy, Haemophilia D66 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml 717746 Haematologist D67 Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml 837555 Anti-diuretics Desmopressin DDAVP 0.2mg 703639 Anti-diuretics Desmopressin DDAVP 0.1mg 837563 Coagulants Tranexamic acid 500mg Cyklokapron 500 717134 Haematologist Haematologist Haematologist Haematologist Coagulants Factor VIII 300u Haemosolvate Factor VIII 841560 Haematologist Coagulants Factor VIII 500u Haemosolvate Factor VIII 800759 Haematologist 22

Coagulants Factor VIII 1000u Haemosolvate Factor VIII 813648 Haematologist Coagulants Factor IX 500u Haemosolvex Factor IX 800767 Haematologist Analgesics Paracetamol 500mg Napamol 500mg 745723 Hyperlipidaemia E78 Fibrates Bezafibrate 400mg HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) HMG-CoA reductase (statins) Simvastatin 10mg Simvastatin 20mg Simvastatin 40mg Dyna-bezafibrate SR 400mg Adco simvastatin 10mg Adco simvastatin 20mg Adco simvastatin 40mg 710122 701276 Austell simvastatin 10mg 705464 701279 Austell simvastatin 20mg 705465 701281 Austell simvastatin 40mg 705467 Atorvastatin 10mg Aspavor 10mg 708121 Adco Atorvastatin 10mg 718073 Atorvastatin 20mg Aspavor 20mg 708122 Adco Atorvastatin 20mg 718074 Atorvastatin 40mg Aspavor 40mg 710912 Adco Atorvastatin 40mg 718075 Atorvastatin 80mg Lipogen 80mg 714074 Astor 80mg 719189 Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304 Aspirin 81mg Ecotrin 81mg 823481 Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Clinical motivation with treatment history must be submitted Hypertension I10 ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619 ACE Inhibitors Captopril 50mg Merck-captopril 50mg 899429 ACE Inhibitors combination Captopril/hydrochlorothiazide 50mg/25mg Captoretic 50/25mg 841137 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481 ACE Inhibitors Enalapril 20mg Alapren 20mg 881503 ACE Inhibitors Enalapril 5mg Alapren 5mg 886835 ACE Inhibitors combination Enalapril / hydrochlorthiazide Enap co 891287 ACE Ramipril 2.5mg Rampil 2.5mg 705427 ACE Ramipril 5mg Rampil 5mg 705428 ACE Ramipril 10mg Rampil10mg 705429 ACE Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297 ACE Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925 ACE Inhibitors Perindopril 4mg Prexum 5mg 720387 ACE Perindopril 10mg Prexum 10mg 714646 ACE Inhibitors combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus 721507 ACE Inhibitors combination Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298 Perindopril 4mg/Indapamide Prexum Plus 5/1.25 1.25mg mg 720388 Perindopril 10mg/Indapamide Bioprexum 10/2.5mg 2.5mg 721508 Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg 719853 Perindopril 10mg/Amlodipine 5mg Coveram 10/5mg 719854 23