nedgroup traditional, traditional plus and platinum … · beta-receptor blockers propranolol hcl...

A clinically relevant motivation is required 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 required.

Lancets

Glucose Monitoring Strips

Needles

Insulin 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 required 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 For long term corticosteriod use

Platelet aggregation inhibitors Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304

Loop diuretics Furosemide 20mg Austell Furosemide 20mg 707421

Loop diuretics Furosemide 40mg Mylan Furosemide 40mg 857769 Sandoz Furosemide 731668

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

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783Only for severe persistent asthma (motivation required from

specialist)

Corticosteroids Prednisolone 15mg/5ml Aspelone 714552Only for severe persistent asthma (motivation required from

specialist)

Sympathomimetics Fenoterol 100mcg Berotec 100 HFA 200 dose 706544

Sympathomimetics Salbutamol sulphate 100mcg Asthavent 300dose ecohaler 700715 Venteze CFC Free 200 dose 711213 Limited to 3 inhalers per year if no inhaled steroid

Sympathomimetics Salbutamol sulphate 2mg Venteze 2mg 775398

Sympathomimetics Salbutamol sulphate 4mg Venteze 4mg 775401

Sympathomimetics Salbutamol sulphate 2mg/5ml Venteze 2mg/5ml 775452

Sympathomimetics Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose 818496 Only for moderate & severe persistent asthma

Sympathomimetics Salmeterol xinafoate 25mcg Serevent 120 dose inhaler 787302 Only for moderate & severe persistent asthma

Sympathomimetics Salmeterol fluticazone Foxair 25/50mcg 120 dose inh 715752 Sereflo 25/50mcg 120 dose inh 715189 Only for moderate & severe persistent asthma



Sympathomimetics Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters 715009 Only for moderate & severe persistent asthma



Sympathomimetics Budesonide 160 / formoterol 4.5mcg Symbicord 60 dose 700172 Only for moderate & severe persistent asthma

Sympathomimetics Budesonide 160 / formoterol 4.5mcg Symbicord 120 dose 700173 Vannair 160/4.5mcg 720219 Only for moderate & severe persistent asthma

Sympathomimetics Budesonide 320 / formoterol 9mcg Symbicord 60 dose 705984 Only for moderate & severe persistent asthma

Sympathomimetics Budesonide 80 / formoterol 4.5mcg Symbicord 120 dose 705986 Vannair 80/4.5mcg 720218 Only for moderate & severe persistent asthma

Glucocorticoids Beclomethasone 100ug Beclate 100ug 819638 Only for moderate & severe persistent asthma



Max 30 per month allowed



NEDGROUP TRADITIONAL, TRADITIONAL PLUS AND PLATINUM PLANS

1

Glucocorticoids Budesonide 100ug Budeflam 100ug 300 dose 897462 Only for moderate & severe persistent asthma

Glucocorticoids Budesonide 200ug Budeflam 200 mg 300 dose 897469 Budeflam DP Inh cap 704176 Only for moderate & severe persistent asthma

Glucocorticoids Fluticasone 50mcg Flixotide 50 CFC free 120 dose inhaler 703275 Only for moderate & severe persistent asthma



Glucocorticoids Fluticasone 50mcg Flixotide 50 mcg accuhaler 60 dose 808445 Only for moderate & severe persistent asthma

Glucocorticoids Fluticasone 100mcg Flixotide 100 mcg accuhaler 60 dose 818453


Glucocorticoids Fluticasone 500mcg Flixotide 500mcg accuhaler 60 dose 818488 Only for moderate & severe persistent asthma

Glucocorticoids Budesonide 200ug Inflammide 200 novolizer complete 704021 Only for moderate & severe persistent asthma

Glucocorticoids Budesonide 200ug Inflammide 200 novolizer refill 704020 Only for moderate & severe persistent asthma

Glucocorticoids Budesonide 400ug Inflammide 400 novolizer complete 707879 Inflammide novolizer refill 707881 Only for moderate & severe persistent asthma

Glucocorticoids Ciclesonide 160mcg Ciclovent 160mcg 60 dose 721620


LABA Formoterol 12mcg Foratec hfa 120dose 710307 Only for moderate & severe persistent asthma

Methylxanthine Theophylline 200mg Sandoz theophylline 200mg 788368 Theoplus 200mg 783005

Methylxanthine Theophylline 300mg Sandoz Theophylline 300mg 788376 Theoplus 300mg 783013

Leukotriene receptor antagonists Montelukast 4mg Monte-Air 4mg 717468 Sintair 4mg 718604 Pulmonologist motivation required



Inhaled anticholinergics Ipratropium bromide Ipvent 40mcg INH 300dose 704681

Combinations Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA 707882

Bipolar depression

F31 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980

Anti-epileptic Valproic acid 300mg Convulex 300mg 715999


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 Epilim crushable 100mg 821578

Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493

Anti-epileptic Carbamazepine 200mg Sandoz carbamazepine cr 705597 Tegretol cr 200mg 779652


Anti-epileptic Lamotrigine 25mg Dyna-Lamotrigine 25mg 710387




Atypical antipsychotic Olanzapine 2.5mg Olawin 2.5mg 721385 Olexar 2.5mg 715657 Psych Motivation required

Atypical antipsychotic Olanzapine 5mg Olawin 5mg 721388 Redilanz 5mg 715684 Psych Motivation required

Atypical antipsychotic Olanzapine 10mg Olawin 10mg 721389 Olexar 10mg 715659 Psych Motivation required

Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg 716050 Quetoser 25mg 716635




Benzamides Sulpiride 50mg Espiride 819654 Psych Motivation required

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



SSRI Citalopram 20mg Talomil 20mg 702769 Arrow Citalopram 20mg 713583

SSRI Escitalopram 10mg Zitolex 10mg 718743 2nd line agent

SSRI Escitalopram 10mg Zitolex 20mg 718744 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 Serdep 50mg 705420

SSRI Sertraline 100mg Dyna-Sertraline 100mg 719973 Serdep100mg 715935

SNRI Venlafaxine Hcl 37.5mg Odiven 37.5mg 7109722

SNRI Venlafaxine Hcl 37.5mg Venlor XR 37.5 706399

SNRI Venlafaxine Hcl 75mg Venlor XR 75mg 706402 Venlafaxine Unicorn XR 75mg 718361

SNRI Venlafaxine Hcl 150mg Venlor XR 150mg 706404 Venlafaxine Unicorn XR 150mg 718362

Other Mirtazapine 15mg Mylan-Mirtazapine 15mg 710802 Miradep 15mg 721209

Other Mirtazapine 30mg Mylan-Mirtazapine 30mg 710803 Miradep 30mg 721210

Tricyclic antidepressants Dothiepin 25mg Thaden 25mg 800198

Tricyclic antidepressants Dothiepin 75mg Thaden 75mg 800201

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746

Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542 In combination with antipsychotic for drug-induced dyskinesias

Beta-receptor blockers Propranolol HCl 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 In combination with antipsychotic for drug-induced dyskinesias

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 required

Other Antipsychotics Risperidone 1mg Zoxadon 1mg 711512 Risnia 1mg 717997 Psych Motivation required

Other Antipsychotics Risperidone 2mg Zoxadon 2mg 711513 Risnia 2mg 717998 Psych Motivation required

Other Bupropion 150mg Wellbutrin XL 150mg 704070 Therapy must be initiated by a Psychiatrist

Other Bupropion 300mg Wellbutrin XL 300mg 711009 Therapy must be initiated by a Psychiatrist

Bronchiectasis

J47 Antibiotics Amoxycillin 500mg Moxypen 744697

Antibiotics Doxycycline 100mg Doxycyl 100 mg 809667

Antibiotics Doxycycline 50mg Doxycyl 50mg 808407

Antibiotics Trimethoprim-sulfamethoxazole 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

Sympathomimetics Formoterol fumerate Foratec HFA 120dose 710307

Sympathomimetics Salmeterol xinafoate 50mcg Serevent accuhaler 60 dose 818496

Sympathomimetics 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


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 inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg 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 combination Perindopril 2,5mg/Indapamide 0.625mg Prexum 2.5 Plus 721507

ACE inhibitor combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298

ACE inhibitor combinations Perindopril 4mg/Indapamide 1.25mg Prexum Plus 5/12.5 mg 720388

ACE inhibitor combinations Perindopril 10mg/Indapamide 2.5mg Bioprexum 10/2.5mg 721508

ACE inhibitor combinations Perindopril 10mg/Amlodipine 10mg Coveram 10/10mg 719853




ACE Inhibitors Captopril 12.5mg Captohexal 12.5mg 837628

ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619


ACE inhibitor combinations 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 10mg/Hydrochlorothiazide 12.5mg Hexal-lisinopril co 10/12.5mg 704703


ACE inhibitors Ramipril 2.5mg Rampil 2.5mg 705427

ACE inhibitors Ramipril 5mg Rampil 5mg 705428

ACE inhibitors Ramipril 10mg Rampil10mg 705429

ACE Inhibitors Quinapril 5mg Quinagen 5mg 708981

ACE inhibitors Quinapril 10mg Accumax 10mg 7081193


ACE inhibitors Quinapril 10mg/hydrochlorthiazide 12.5mg Accumax Co 10/12.5mg 708116


Alpha + beta blocker Carvedilol 12.5 Vediblok 12.5 mg 710959

Alpha + beta blocker Carvedilol 25mg Vediblok 25mg 710960

Alpha + beta blocker Carvedilol 6.25mg Vediblok 6.25mg 710958

Aldosterone antagonist Spironolactone 25 Spiractin 765910

Cardiac glycosides Digoxin Lanoxin 0.0625mg 735760


Anticoagulant Warfarin 5mg cipla-warfarin 712390

` Beta-blockers Atenolol 50mg Bio-atenolol 50mg 826898 Sandoz Atenolol 50mg 787892

Beta-blockers Atenolol 100mg Bio-atenolol 100mg 826901 Sandoz Atenolol 100mg 787914

Beta-blockers Bisoprolol 5mg Bilocor 5mg 704372


Beta-blockers/diuretic Atenolol 100mg/chlorthalidone 25mg Tenchlor 786217

Beta-blockers/diuretic Atenolol 50mg/chlorthalidone 12.5mg Tenchlor-HS 807591

Direct acting vasodilators Hydralazine 10mg Hyperphen 10mg 731714


Loop diuretics Torasemide 10mg Unat 10mg 820385 Motivation required

Loop diuretics Torasemide 2.5mg Unat 2.5mg 820369 Motivation required




Nitrates Isosorbide dinitrate 10mg Isordil 10mg 734381



Nitrates Isosorbide mononitrate 20mg Elantan 20mg 793418

Nitrates Isosorbide dinitrate 40mg Isordil Tembid 40mg 734438

Organic Nitrates Ivabradine 5mg Coralan 5mg 710620 Cardiologist Prescription required

Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg 710621 Cardiologist Prescription required

Platelet aggregation inhibitors Aspirin 81mg Ecotrin 81mg 823481

Platelet aggregation inhibitors Aspirin 300mg Bayer Aspirin 300mg 706930


Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753If >120 required, documented evidence of hypokalaemia must

be provided

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

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 Nifedipine SR 20mg Nifedalat 20 sr tab 829501 Cipalat Retard 20mg 864153

Calcium channel blockers Nifedipine SR 30mg Fedaloc sr 30mg 711682

Angiotensin receptor blockers (ARBs) Losartan 50mg Losartan-Winthrop 50mg 709909Motivation over ACE-inhibitor, including history of therapy,

required

Angiotensin receptor blockers (ARBs) Losartan 100mg Zartan 100mg 709964Motivation over ACE-inhibitor, including history of therapy,

required

ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg 715857Motivation over ACE-inhibitor, including history of therapy,

required

ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/12.5mg 715856Motivation over ACE-inhibitor, including history of therapy,

required

Angiotensin receptor blockers (ARBs) Valsartan 80mg Tareg 80mg 705060 Diolo 80mg 717034Motivation over ACE-inhibitor, including history of therapy,

required


required

ARB combinations Valsartan 80mg/ hydrochlorothizide 12.5mg Co-Tareg 80mg/12.5mg 705068 Diolo Co 80mg/12.5mg 718607Motivation over ACE-inhibitor, including history of therapy,

required

ARB combinations Valsartan 160mg/ hydrochlorothizide 25mg Co-Zomevek 160mg/25mg 715560 Diolo Co 160mg/12.5mg 718608Motivation over ACE-inhibitor, including history of therapy,

required

Cardiomyopathy

I42 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481



ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg 891287

ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297






























required

Angiotensin receptor blockers (ARBs) losartan 100mg Zartan 100mg 709964Motivation over ACE-inhibitor, including history of therapy,

required


required


required


required


required


required


required




Aldosterone antagonist Spironolactone 25 Spiractin 765910








Beta-blockers/diuretic Atenolol 100mg/chlorthalidone 25mg Tenchlor 786217

Beta-blockers/diuretic Atenolol 50mg/chlorthalidone 12.5mg Tenchlor-HS 807591




Loop diuretics Torasemide 2.5mg Unat 2.5mg 820369 Motivation required





Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg 703329 Cipla- Indapamide 2.5mg 710313




Nitrates Isosorbide mononitrate 20mg Elantan 20mg 793418 5







be provided

Thiazide diuretic Hydrochlorthiazide Hexazide 890470


Chronic Renal Disease

N03 ACE Inhibitors Enalapril 10mg Alapren 10mg 881481



N18 ACE inhibitor combinations Enalapril / hydrochlorthiazide Enap co 20mg/12.5mg 891287

N19 ACE Inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297






























required

Angiotensin receptor blockers (ARBs) losartan 100mg Zartan 100mg 709964Motivation over ACE-inhibitor, including history of therapy,

required


required


required


required


required


required


required

Aldosterone antagonist Spironolactone 25mg Spiractin 25mg 765910


Beta-blockers Atenolol 100mg Bio-atenolol 100mg 826901

Beta-blockers/diuretic Atenolol 100mg/chlorthalidone 25mg Tenchlor 100mg/25mg 786217

Beta-blockers/diuretic Atenolol 50mg/chlorthalidone 12.5mg Tenchlor hs 50mg/12.5mg 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 30mg Fedaloc sr 30mg 711682



Calcium channel blockers Diltiazem 60mg Zildem 60mg 822213


Calcium channel blockers Diltiazem SR 180mg Zildem SR 180mg 839183


Calcium supplements Calcium carbonate 500mg Eno Tums Chew 830941

Calciferol Calciferol 5 000u/ml Calciferol Oily solution 5000u/mL 711853

Calciferol Calciferol 50 000IU Lennon Strong Calciferol 711640

Minerals and vitamin D Alfacalcidol 0.25mcg One alpha 0.25mcg cap 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 Dialysis benefit - Medscheme or Onecare

Haematinics Erythropoietin Repotin 4000iu 839272 Dialysis benefit - Medscheme or Onecare

Haematinics Erythropoietin Recormon numerous Dialysis benefit - Medscheme or Onecare

Iron supplements Iron(III)-hydroxide sucrose complex Venofer 873276 Dialysis benefit - Medscheme or Onecare

Iron supplements Iron polymaltose 50mg Ferrimed ® Iron polymaltose 50mg capsule 725927

Iron supplements Ferrous-fumarate 200mg; folic acid 100ug Pregamal 756571Motivation and Haemoglobin levels required - forward to

Onecare/Medscheme





be provided

Vitamins Folic acid 5 mg Be-tabs folic 5mg 810967

Chronic Obstructive

Pulmonary disease

J43 Corticosteroids Prednisone 5mg Be-tabs prednisone 788783

J44 Inhaled anti cholinergics Ipratropium bromide 40ug Ipvent-40 300dose 704681

Sympathomimetics Salbutamol 200ug Asthavent dp 878219


Sympathomimetics Salbutamol 200ug Cybutol 200ug 894397

Sympathomimetics Salbutamol 400ug Cybutol 400ug 894400

Sympathomimetics Salbutamol 100ug inhaler Asthavent 200dose 819603 Venteze cfc free 100ug inhaler 711213

Sympathomimetics Formoterol fumarate Foratec HFA 12mcg 120 dose 710307

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

Sympathomimetics Salmeterol fluticazone Foxair 25/50mcg 120 dose inh 715752 Sereflo 25/50mcg 120 dose inh 715189



Sympathomimetics Salmeterol 50ug/Fluticasone 100ug Foxair 50/100mcg 60 blisters 715009

Sympathomimetics Salmeterol 50ug/Fluticasone 250ug Foxair 50/250mcg 60 blisters 715008 Motivation, including history of therapy, required

Sympathomimetics Salmeterol 50ug/Fluticasone 500ug Foxair 50/250mcg 60 blisters 715007Motivation, including history of therapy, required. FEV1<50 post

bronchodilator

Glucocorticoids Fluticasone 50mcg Flixotide 50 CFC free 120 dose inhaler 703275






Glucocorticoids Fluticasone 500mcg Flixotide 500mcg accuhaler 60 dose 818488



CombinationsIpratropium brom. 20ug; salbutamol sulph. To

salbutamol 100ug/met.dos.Duolin Respules 703983

For Stage ll & lll COPD only. Script from Pulmonologist or

Specialist Physician

Anticholinergics Tiotropium 18mcg Forvent handihaler 714167For Stage ll & lll COPD only. Script from Pulmonologist or


Anticholinergics Tiotropium 18mcg Forvent 18mcg INH caps refill 714152For Stage ll & lll COPD only. Script from Pulmonologist or


Glucocorticoids Beclomethasone dipropionate 100mcg Beclate 100mcg inhaler 819638For Stage ll & lll COPD only. Script from Pulmonologist or


Glucocorticoids Beclomethasone dipropionate 200mcg Beclate 200mcg inhaler 820083

Glucocorticoids Budesonide 100ug Budeflam HFA 100mcg 300dose 897462 7

Glucocorticoids Budesonide 200ug Budeflam HFA 200mcg 300dose 897469

Glucocorticoids Budesonide 200ug Budeflam DP 200mcg inh caps 704176



Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 For long term oral corticosteroid treatment

Combinations Ipratropium bromide 40mcg/ Fenoterol 100mcg Duovent HFA 707882

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 Bisoprolol 5mg Bilocor 5mg 704372 Bisbeta 5mg 720659








Calcium channel blocker Nifedipine 30mg Fedaloc sr 30mg 711682

Calcium channel blocker Nifedipine 60mg 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 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 mononitrate 20mg Elantan 20mg 793418


Organic Nitrates Ivabradine 5mg Coralan 5mg 710620 Cardiologist Prescription required

Organic Nitrates Ivabradine 7.5mg Coralan 7.5mg 710621 Cardiologist Prescription required




Platelet aggregation inhibitor Dipyridamole 100mg Plato 100mg 720526


Platelet aggregation inhibitors Clopidogrel 75mg Plagrol 711423Detailed clinical motivation required with stent types and dates

and history of therapy

Platelet aggregation inhibitors Aspirin 100mg Bayer Aspirin Cardio 100mg 862304

Fibrates Bezafibrate 400mg Dyna-Bezafibrate 400mg 710122From Cardiologist/Specialist Physician .Need to be loaded under

Hyperlipidaemia

HMG-CoA reductase inhibitors (statins) Simvastatin 10mg Adco simvastatin 10mg 701276 Austell simvastatin 10mg 705464From Cardiologist/Specialist Physician .Need to be loaded under

Hyperlipidaemia


Hyperlipidaemia


Hyperlipidaemia

Crohn's disease

K50 Aminosalicylates Mesalazine 400mg tab Asacol 400mg 783668 Treatment to be initiated by Specialist

Aminosalicylates Mesalazine 2g/50ml enema Asacol enema 824127 Treatment to be initiated by Specialist

Aminosalicylates Mesalazine 500mg supps Asacol supps 824135 Treatment to be initiated by Specialist

Aminosalicylates Mesalazine 500mg tab Pentasa 500mg 890775 Treatment to be initiated by Specialist

Aminosalicylates Olsalazine 250mg Dipentum 250mg 792519 Treatment to be initiated by Specialist

Aminosalicylates Sulphasalazine 500mg Salazopyrin 500mg 762008 Treatment to be initiated by Specialist

Aminosalicylates Sulphasalazine 500mg Salazopyrin EN 500 762016 Treatment to be initiated by Specialist8

others Budesonide 2.3mg Entocord 2,3mg Enema 824593 Motivation required - Treatment to be initiated by Specialist

others Budesonide 3mg Entocord 3mg cap 838896 Motivation required - Treatment to be initiated by Specialist

Antibiotics Metronidazole 200mg Acuzole 200mg 792284 Adco-metronidazole 200mg 742872 Treatment to be initiated by Specialist


Antibiotics Ciprofloxacin 250mg Ciprol 704777 Dynafloc 250 700516 Treatment to be initiated by Specialist

Antibiotics Ciprofloxacin 500mg Ciprol 704775 Dynafloc 500 700518 Treatment to be initiated by Specialist

Antibiotics Ciprofloxacin 750mg Cifloc 750mg 893963 Treatment to be initiated by Specialist

Corticosteroids Prednisolone 5mg Lenisolone 5mg 800155 Capsoid 814407 Treatment to be initiated by Specialist

Cytostatic Methotrexate 2.5 Methotrexate 2.5mg 742465 Treatment to be initiated by Specialist

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Treatment to be initiated by Specialist

Immunosuppressive Azathioprine 50mg Azamun 50mg 701252 Treatment to be initiated by Specialist

Prenatal vitamins Folic Acid Be-Tabs Folic acid 810967

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 For long term oral corticosteroid treatment

Diabetes insipidus

E23.2 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml 717746 Treatment to be initiated by Specialist

Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml 837555 Treatment to be initiated by Specialist

Anti-Diuretics Desmopressin tab DDAVP 0.1mg 837563 Treatment to be initiated by Specialist

Anti-Diuretics Desmopressin tab DDAVP 0.2mg 703639 Treatment to be initiated by Specialist

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 Strips Medisense precision plus electrodes 847887

Diabetic consumables Strips One touch ultra test strips 702690

Diabetic consumables Strips One touch horizon test strips 704130

Diabetic consumables Strips Homemed blood glucose strips 460628

Insulin Biphasic insulin Insu Actaphane HM(ge) 3.0ml Penset 816213

Insulin Biphasic insulin Insu Actraphane HM(ge) 10ml vial 733512

Insulin Fast acting insulin Insu Apidra 3.0ml cartridge 706039 Motivation required with treatment history

Insulin Fast acting insulin Insu Apidra I optiset penset 3ml 710367 Motivation required with treatment history

Insulin Fast acting insulin insu Apidra solostar disposable pens 3ml 709861 Motivation required with treatment history

Insulin Fast acting insulin Insu Apidra 10ml vial 706040 Motivation required with treatment history

Insulin Fast acting insulinNovorapid flexpen 3ml prefilled device

penset897767

Insulin Fast acting insulinNovorapid flexpen 3ml solution for inj.

penfill 897775

Insulin Fast acting insulin Novorapid vial 10ml 707927

Insulin Insulin Novomix 30 flexpen 3ml pf device 702086

Insulin Insulin Novomix 30 penfill 3ml pf device 702089

Insulin Insulin - rapid acting insulin Humalog 10ml vial 819468

Insulin Insulin - rapid acting Insulin humalog cartridge 3ml 862355

Insulin Insulin - rapid acting Insulin humalog pen 3ml disposable 853445

Insulin Insulin premixed biphasic Insulin humalog mix 25 10ml vial 853437

Insulin Insulin premixed biphasic Insulin humalog mix 25 cartridge 3 ml 861782

Insulin Insulin premixed biphasic Insulin humalog mix 25 disp pen 3 ml 853461

Insulin Insulin premixed biphasic Insulin humalog mix 50 cartridge 3ml 705074

Insulin Insulin glargine Lantus 5 x 3ml cartridge 700308

Insulin Insulin glargine Optisulin pen 100 IU/ml 721502 9

Insulin Insulin Detemir Levemir flexpen prefilled 3ml 705312 Motivation required with treatment history

Insulin Insulin Detemir Levemir prefilled cartridge 3ml 705313 Motivation required with treatment history

Insulin Insulin isophane - intermediate Humulin – N vial 10ml 733458

Insulin Insulin isophane - intermediate Insulin humulin N cartridge 3ml 863556 Biosulin N 3ml cart 712768

Insulin Insulin isophane - intermediate Insulin humulin N pen 3ml disposable 853453

Insulin Insulin premixed biphasic Humulin 30/70 10ml vial 783811

Insulin Insulin premixed biphasic Humulin 30/70 cartridge 3ml 863572 Biosulin 30/70 3ml cart 712770

Insulin Insulin premixed biphasic Humulin 30/70 disposable pens 3ml 704456

Insulin Insulin - short acting Humulin – R 10ml vial 733431

Insulin Insulin - short acting Insulin humulin R 3ml cartridge 863564 Biosulin R 3ml cartridge 712767

Insulin Intermediate to long acting insulin Insu Protaphane flexpen 3ml pf device 700183

Insulin Intermediate to long acting insulin Insu Protaphane HM(ge) 10ml vial 733482




Diabetes mellitus type 2

E11 Biguanides Metformin 850 mg Accord Metformin 850mg 714426 Diaphage 850mg 719785

Biguanides Metformin 500mg Accord Metformin 500mg 714427 Diaphage 500mg 719784

Biguanides Metformin 1000mg Bigsens 1000mg 709172 Mylan Metformin 1000mg 721443

Biguanides Metformin 500mg Glucophage XR 500mg 710196



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 required with treatment history

Thiazolidinediones Pioglitazone Cipla pioglitazone 15mg 707974 Motivation required with treatment history


Acetylsalicylic Aspirin 100mg Myoprin 845590 Bayer Aspirin Cardio 100mg 862304

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 Propranolol 10mg Indoblok 10mg 806552 Prodorol 10mg 787167











Calcium channel blockers Verapamil 240 SR Verahexal 240 sr 700071 Ravamil 240mg 819573





10

Calcium channel blockers Diltiazem SR 180 Zildem SR 180mg 839183

Calcium channel blockers Diltiazem SR 240 Zildem SR 240mg 839191






Epilepsy

G40 Anti-epileptic Valproic acid 150mg Convulex 150mg 715980

G41 Anti-epileptic Valproic acid 300mg Convulex 300mg 715999


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 200mg/5ml Epilim sugar free 780545





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 761079Severe and uncontrolled epilepsy only, not responding to first-

line agents. Specialist motivation required

Anti-epileptic Clonazepam Rivotril 2.5mg/ml drops 835129Severe and uncontrolled epilepsy only, not responding to first-


Anti-epileptic Clonazepam Rivotril 2mg 761087 Severe and uncontrolled epilepsy only, not responding to first-


Anti-epileptic Carbamazepine 100mg/ 5mL Tegretol susp 250mL 769401

Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493



Anti-epileptic Gabapentin 100mg Epleptin 100mg 707622 Neurexal 100mg 708949



Anti-epileptic Topiramate 15mg Topamax sc sprinkles 15mg 878014Severe and uncontrolled epilepsy only, not responding to first-


Anti-epileptic Topiramate 25mg Epitoz 25mg 710899Severe and uncontrolled epilepsy only, not responding to first-






Anti-epileptic Oxcarbazepine 300mg Trileptal 300mg 892484Severe and uncontrolled epilepsy only, not responding to first-


Anti-epileptic Oxcarbazepine 600mg Trileptal 600mg 892491Severe and uncontrolled epilepsy only, not responding to first-


Anti-epileptic Ethosuximide 250mg/5ml Zarontin 250mg/5ml syrup 779105Severe and uncontrolled epilepsy only, not responding to first-



Anti-epileptic Levetiracetam 250mgEpikepp 250mg 721701

Redilev 250mg 714662Motivation from neurologist, neurosurgeon or paediatric

neurologist only.


Redilev 500mg 714663(Indicated for specific types of epilepsy and only for adults and

children > 16yrs).


Redilev 750mg 714664Motivation from neurologist, neurosurgeon or paediatric

neurologist only.

Glaucoma

H40 Carbonic anhydrase inhibitors Acetazolamide Azomid 250mg 789771

Carbonic anhydrase inhibitors Brinzolamide Azoptic eye suspension 1% 701523

Ophthalmics -alpha-2-agonist Brimonidine tartrate Alphagan purite 5ml 709410

Ophthalmics -Beta-blockers Metipranolol 0.3% Beta-Opthiole 0.3% 816728 11

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 combination Brinzolamide 10mg; Timolol 5mg/ml Azarga 5ml 717260

Opthalmics -Beta-blockers combination Bimatopost 0.3mg; Timolol 5mg/ml Ganfort 3ml 714110

Ophthalmics -Beta-blockers Dorzolamide 20mg; timolol 5mg/ml Cosopt 0.5% 5ml drp 860379

Ophthalmics Brimonidine tartrate 2mg; timolol 5mg/ml Combigan eye drops 5ml 709863

Ophthalmics - carbonic anhydrase

inhibitorDorzolamide 20mg Trusopt solution 819832

Ophthalmic - muscarinic agonists Pilocarpine 10mg/mL Isoptocarpine 1% - 15mL 734284

Ophthalmic - muscarinic agonists Pilocarpine 20mg/mL Isoptocarpine 2%- 15mL 734179

Ophthalmic - muscarinic agonists Pilocarpine 40mg/mL Isoptocarpine 4% - 15mL 734195

Ophthalmics-prostaglandin analogue Travoprost 40ug/ml Travatan eye drop solution 702534

Ophthalmics-prostaglandin analogue Lantanoprost/timolol Xalacom 702983

Ophthalmics-prostaglandin analogue Lantanoprost 1ml/50mcg Ocuprost 715961

Ophthalmics Betaxolol 0.50% Betoptic 5ml 708445

Ophthalmics Betaxolol 0.25% Betoptic s 0.25% 836052

Haemophilia

D66 Anti-diuretics Desmopressin DDAVP intranasal sol 0.1mg/ml 717746 Treatment to be initiated by Specialist Haematologist

D67 Anti-diuretics Desmopressin DDAVP nasal spray 0.1mg/ml 837555 Treatment to be initiated by Specialist Haematologist

Anti-diuretics Desmopressin DDAVP 0.2mg 703639 Treatment to be initiated by Specialist Haematologist

Anti-diuretics Desmopressin DDAVP 0.1mg 837563 Treatment to be initiated by Specialist Haematologist

Coagulants Tranexamic acid 500mg Cyklokapron 500 717134 Treatment to be initiated by Specialist Haematologist

Coagulants Factor VIII 300u Haemosolvate® Factor VIII 841560 Treatment to be initiated by Specialist Haematologist



Coagulants Factor IX 500u Haemosolvex® Factor IX 800767 Treatment to be initiated by Specialist Haematologist

Analgesics Paracetamol 500mg Napamol 500mg 745723

Hyperlipidaemia

E78 Fibrates Bezafibrate 400mg Dyna-bezafibrate SR 400mg 710122

HMG-CoA reductase inhibitors (statins) Simvastatin 10mg Adco simvastatin 10mg 701276 Austell simvastatin 10mg 705464



HMG-CoA reductase inhibitors (statins) Atorvastatin 10mg Aspavor 10mg 708121 Adco Atorvastatin 10mg 718073 Clinical motivation with treatment history must be submitted



HMG-CoA reductase inhibitors (statins) Atorvastatin 80mg Lipogen 80mg 714074 Astor 80mg 719189 Clinical motivation with treatment history must be submitted



Hypertension

I10 ACE Inhibitors Captopril 25mg Merck-captopril 25mg 852619


ACE Inhibitors combination Captopril/hydrochlorothiazide 50mg/25mg Captoretic 50/25mg 841137




ACE Inhibitors combination Enalapril / hydrochlorthiazide Enap co 891287




ACE inhibitors Perindopril 4mg Prexum 4mg 703541 Vectoryl 4mg 710297

ACE inhibitors Perindopril 8mg Pearinda 8mg 714528 Vectoryl 8mg 710925


ACE inhibitors Perindopril 10mg Prexum 10mg 714646


ACE Inhibitors combination Perindopril 4mg/Indapamide 1.25mg Prexum Plus 704929 Vectoryl Plus 710298












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 inhibitors Trandolapril 0,5mg Mavik 0.5mg 805033

ACE inhibitors Trandolapril 2mg Mavik 2mg 805068

ACE inhibitors Trandolapril 4mg Mavik 4mg 708279

Alpha + beta blocker Carvedilol 12.5mg Vediblok 12.5 mg 710959



Alpha receptor blockers Prazosin 1mg Pratsiol 1mg 782122 Motivation, including history of therapy, required



Alpha receptor blockers Doxazosin 1mg Cardugen (was merck-doxazosin) 701425 Motivation, including history of therapy, required

Alpha receptor blockers Doxazosin 4mg Cardugen (was merck-doxazosin) 701426 Motivation, including history of therapy, required

Alpha receptor blockers Doxazosin 4mg Carzin XL 4mg 714292











Calcium channel blocker Amlodipine 10mg Gulf Amlodipine 10mg 712954 Lomanor 10mg 708353

Calcium channel blocker Amlodipine 5mg Amtas 5mg 713971 Lomanor 5mg 708352

Calcium channel blocker Diltiazem 60mg Zildem 60mg 822213

Calcium channel blocker Diltiazem 90mg Zildem 90mg 824364

Calcium channel blocker Diltiazem SR 180mg Zildem SR 180mg 839183

Calcium channel blocker Diltiazem SR 240mg Zildem SR 240mg 839191

Calcium channel blocker Felodopine 5mg Hexal-felodopine 5mg 703221

Calcium channel blocker Felodopine 10mg Hexal-felodopine 10mg 703902

Calcium channel blockers - long acting Verapamil 240 SR Verahexal 240 sr 700071 Ravamil 240mg 819573



Calcium channel blockers - long acting Nifedipine SR 20mg Nifedalat 20 sr tab 829501 Cipalat Retard 20mg 864153

Calcium channel blockers - long acting Nifedipine SR 30mg Fedaloc sr 30mg 711682

Calcium channel blockers - long acting Nifedipine SR 60mg Fedaloc sr 60mg 711714

Central alpha-2 agonist Methyldopa 250 Hy-po-tone 250mg 732052

Aldosterone antagonist Spironolactone 25mg Spiractin 25mg 765910


Low ceiling diuretics Indapamide Mylan-Indapamide 2.5mg 703329 Cipla- Indapamide 2.5mg 710313

Diuretic - loop Furosemide 40mg Mylan Furosemide 40mg 857769 Sandoz Furosemide 731668

Diuretic - loop Furosemide 20mg Austell Furosemide 20mg 707421

Diuretic-thiazide Hydrochlorthiazide /amiloride 25/2.5mg Amiloretic hs 702811 13

Diuretic-thiazide Hydrochlorthiazide /triamterene 25/50 Renezide 780146

Diuretic-thiazide Hydrochlorothiazide 25mg Hexazide 890470 Ridaq 25mg 880949


Diuretic-thiazide/K combination Hydrochlorthiazide 50mg / potassium 600mg Urirex K 774057

Direct vasodilator Hydralazine 10mg Hyperphen 10mg 731714

Direct vasodilator Hydralazine 50mg Hyperphen 50mg 731722


be provided

Angiotensin receptor antagonists Losartan 50mg Losartan-Winthrop 50mg 709909 Hytenza 50mg 717024Motivation over ACE-inhibitor, including history of therapy,

required

Angiotensin receptor antagonists Losartan 100mg Zartan 100mg 709964 Hytenza 100mg 717042Motivation over ACE-inhibitor, including history of therapy,

required

ARB combinations Losartan 100mg/ hydrochlorothizide 25mg Losaar Plus 100/25mg 715857 Hytenza Co 50/12.5mg 716476

ARB combinations Losartan 50mg/ hydrochlorothizide 25mg Losaar Plus 50/12.5mg 715856 Hytenza Co 100/25mg 717084

Angiotensin receptor antagonists Valsartan 80mg Tareg 80mg 705060 Diolo 80mg 717034Motivation over ACE-inhibitor, including history of therapy,

required

Angiotensin receptor antagonists Valsartan 160mg Tareg 160mg 704696 Diolo 160mg 717035Motivation over ACE-inhibitor, including history of therapy,

required

Angiotensin receptor

antagonists/combinationValsartan/hydrochlorothiazide 80/12.5mg Co-Tareg 80mg/12.5mg 705068 Diolo Co 80mg/12.5mg 718607

Motivation over ACE-inhibitor, including history of therapy,

required


required

Sympathetic nervous blockers Reserpine 0.25mg Reserpine 0.25mg 760048



Hypothyroidism

E03 Thyroid preparation levothyroxine 100ug Euthyrox 100mcg tabb 713169 Eltroxin 100ug 722952

Thyroid preparation levothyroxine 50ug Euthyrox 50mcg tabb 713168 Eltroxin 50ug 722944

Thyroid preparation levothyroxine 25ug Euthyrox 25mcg tabb 713172

Thyroid preparation Liothyronine sodium 20mcg Tertroxin 769983

Multiple

sclerosis Analgesics Tramadol 50mg Austell-tramadol 710250 Domadol 705175 Treatment to be initiated by Specialist

G35 Analgesics Dextropropoxyphene /paracetamol Doloxene Co 720895 Treatment to be initiated by Specialist

Analgesics Paracetamol 500mg Napamol 745723 Painamol 500mg 799629 Treatment to be initiated by Specialist

Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493 Treatment to be initiated by Specialist

Anticholinergics Oxybutinin 5mg Lenditro 5mg 872253 Treatment to be initiated by Specialist


Corticosteroids Prednisolone 5mg Lenisolone 5 800155 Capsoid 814407 Treatment to be initiated by Specialist

Cytostatics Cyclophosphamide 50 mg Endoxan 50mg 723274 Treatment to be initiated by Specialist

Cytostatic Methotrexate 2.5mg Methotrexate 2.5mg 742465 Treatment to be initiated by Specialist


Muscle relaxants Baclofen Teva-Baclofen 10mg 712607 Treatment to be initiated by Specialist

NSAID'S Naproxen 250mg Nafasol EC 250mg 812625 Treatment to be initiated by Specialist

NSAID'S Naproxen 500mg Nafasol EC 500mg 812633 Treatment to be initiated by Specialist

NSAID'S Diclofenac sod. 100mg Panamor sr 827592 Treatment to be initiated by Specialist

NSAID'S Diclofenac sod. 25mg tab Panamor 25mg 752371 Treatment to be initiated by Specialist


SSRI Fluoxetine 20mg Deprozan 894303 Nuzak 840653 Treatment to be initiated by Specialist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746 Treatment to be initiated by Specialist


Immunostimulants inteferon beta-1A Rebif 44mcg/0.5ml 890887 To be reviewed from Specialised Drug Benefit

Immunostimulants inteferon beta-1A Rebif 22mcg/0.5ml 898891 To be reviewed from Specialised Drug Benefit

Parkinson's Disease

G20 Anti-cholinergic Orphenadrine 50mg Disipal 50mg 720542 Treatment to be initiated by Specialist

G21 Beta-blockers Propranolol 10mg Indoblok 10mg 806552 Prodorol 10mg 787167 Treatment to be initiated by Specialist

Beta-blockers Propranolol 40mg Indoblok 40mg 806560 Prodorol 40mg 787175 Treatment to be initiated by Specialist

Central muscarinic blockers Biperiden 2.5mg Lennon - Biperiden 713209 Treatment to be initiated by Specialist

COMT inhibitor Entacapone 200mg Comtan 200mg 868590 Treatment to be initiated by Specialist -motivation required

COMT inhibitor Tolcapone 100mg Tasmar 100mg 839108 Treatment to be initiated by Specialist -motivation required

Dopamine agonists Levodopa 200mg/benserazide 50mg Madopar 739928 Treatment to be initiated by Specialist

Dopamine agonists Levodopa 100mg/benserazide 25mg Madopar HBS 828483 Treatment to be initiated by Specialist

Dopamine agonists Bromocriptine 2.5mg Aspen bromocriptine 704593 Treatment to be initiated by Specialist

Dopamine agonists Pramipexole 0.125mg Pexola 0.125mg 898836 Treatment to be initiated by Specialist -motivation required

Dopamine agonists Pramipexole 0.25mg Pexola 0.25mg 898848 Treatment to be initiated by Specialist -motivation required

14

Dopamine agonists Pramipexole 1mg Pexola 1mg 898828 Treatment to be initiated by Specialist -motivation required

Dopamine agonists Amantadine 100mg Symadin 700500 Treatment to be initiated by Specialist

dopamine agonists Ropinirole 0.25mg Resure 0.25mg 715081 Treatment to be initiated by Specialist

dopamine agonists Ropinirole 0.5mg Resure 0.5mg 715082 Treatment to be initiated by Specialist

Dopamine agonists Ropinirole 1mg Resure 1mg 715083 Treatment to be initiated by Specialist



Levodopa + dopamine decarboxylase

inhibitorsLevodopa/carbidopa 100/25mg Teva Carbi-levo -100/25mg 710286 Sinemet 25mg/100mg 764078 Treatment to be initiated by Specialist

Levodopa + dopamine decarboxylase

inhibitorsLevodopa/carbidopa 250/25mg Teva Carbi-levo -250/25mg 710468 Sinemet 25mg/250mg 764086 Treatment to be initiated by Specialist

Rheumatoid arthritis

M05 Analgesics Dextropropoxyphene /paracetamol Doloxene Co 65mg 720895Motivation and relevant lab results required if prescribed

independently of other Anti-Rheumatic Agents

M06 Analgesics Paracetamol 500mg Napamol 500mg 745723 Painamol 500mg 752142Motivation and relevant lab results required if prescribed


M08 Analgesics Tramadol 50mg Austell-tramadol 710250 Domadol 705175Motivation and relevant lab results required if prescribed


Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493Motivation and relevant lab results required if prescribed


5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin 500mg 762008 Treatment to be initiated by Specialist

5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin EN 500 762016 Treatment to be initiated by Specialist

5 Aminosalycilic acid derivative Mesalazine 400mg Asacol 783668

5 Aminosalycilic acid derivative Mesalazine 500mg Pentasa 500mg 890775



Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753

Chelating agent D-Penicillamine Metalcaptase 300mg 742317 Motivation for Rheumatologist

Cytostatics Cyclophosphamide 50mg Endoxan 50mg 723274 Motivation by Specialist



Immunosuppressive Chloroquine 200mg Plasmoquine 200mg 794333 Treatment to be initiated by Specialist

NSAID'S Indomethacin 100mg Arthrexin 100mg supp. 704741Motivation and relevant lab results required if prescribed


NSAID'S Indomethacin 25mg Betacin 25mg 787833 Arthrexin 25mg 704725Motivation and relevant lab results required if prescribed


NSAID'S Ibuprofen 200mg Ranfen 200mg 824852Motivation and relevant lab results required if prescribed


NSAID'S Ibuprofen 400mg Ranfen 400mg 701654Motivation and relevant lab results required if prescribed


NSAID'S Ibuprofen 600mg Sandoz ibuprofen 600 mg 782807Motivation and relevant lab results required if prescribed


Selective COX II inhibitors Meloxicam 15mg Flexocam 15mg 704828 Arrow Meloxicam 15mg 711325Motivation and relevant lab results required if prescribed


Selective COX II inhibitors Meloxicam 7.5mg Flexocam 7.5mg 704829 Arrow Meloxicam 7.5mg 711324Motivation and relevant lab results required if prescribed


NSAID'S Piroxicam 20mg Roxifen 20mg 701072Motivation and relevant lab results required if prescribed


NSAID'S Naproxen 250mg Napflam 250mg 806447Motivation and relevant lab results required if prescribed


NSAID'S Naproxen 500mg Napflam 500mg 808474Motivation and relevant lab results required if prescribed


NSAID'S Diclofenac sod. 25mg tab Panamor 25mg 752371Motivation and relevant lab results required if prescribed


NSAID'S Diclofenac sod. 50mg tab Panamor 50mg 752398Motivation and relevant lab results required if prescribed


NSAID'S Diclofenac sod. 100mg Panamor sr 827592Motivation and relevant lab results required if prescribed


Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746 Treatment to be initiated by Specialist

Vitamins Folic acid 5mg Be-tabs folic 5mg 810967 Treatment to be initiated by Specialist15

Other musculo-skeletal agents Leflunomide 10mg Rheumalef 10mg 721609Motivation from specialist detailing clinical history especially use

of other formulary products

Other musculo-skeletal agents Leflunomide 20mg Rheumalef 20mg 721610Motivation from specialist detailing clinical history especially use

of other formulary products

Schizophrenia

F20 Anti-epileptic Carbamazepine 200mg Degranol 200mg 712493 Therapy must be initiated by a Psychiatrist

Anti-epileptic Carbamazepine 200mg cr Sandoz carbamazepine cr 200mg 705597 Tegretol cr 200mg 779652 Therapy must be initiated by a Psychiatrist

Anti-epileptic Carbamazepine 400mg cr Sandoz carbamazepine cr 400mg 705602 Tegretol cr 400mg 779660 Therapy must be initiated by a Psychiatrist

Anti-epileptic Lamotrigine 25mg Dyna-Lamotrigine 25mg 710387 Therapy must be initiated by a Psychiatrist




Phenothiazines Chlorpromazine 100mg Largactil 100mg 735884 Therapy must be initiated by a Psychiatrist



SSRI Fluoxetine 20mg Deprozan 894303 Nuzak 840653 Therapy must be initiated by a Psychiatrist - 1st line therapy

SSRI Citalopram 20mg Arrow Citalopram 713583 Talomil 702769 Therapy must be initiated by a Psychiatrist - 2nd line therapy

SSRI Paroxetine 20mg Serrapress 20mg 705122 Deparoc 20mg 704792 Therapy must be initiated by a Psychiatrist - 2nd line therapy

SSRI Escitalopram 10mg Mylan Escitalopram 10mg 714012 Zitolex 10mg 718743 Therapy must be initiated by a Psychiatrist - 2nd line therapy

SSRI Escitalopram 20mg Mylan Escitalopram 20mg 714013 Zitolex 20mg 718744 Therapy must be initiated by a Psychiatrist - 2nd line therapy

SSRI Sertraline 50mg Dyna-Sertraline 50mg 719972 Serdep 50mg 705420

SSRI Sertraline 100mg Dyna-Sertraline 100mg 719973 Serdep100mg 715935

Tricyclic antidepressants Dothiepin 25mg Thaden 25mg 800198 Therapy must be initiated by a Psychiatrist

Tricyclic antidepressants Dothiepin 75mg Thaden 75mg 800201 Therapy must be initiated by a Psychiatrist

Tricyclic antidepressants Amitriptyline 10mg Trepiline 10mg 772003 Therapy must be initiated by a Psychiatrist

Tricyclic antidepressants Amitriptyline 25mg Trepiline 25mg 771996 Gulf Amitripryline 718746 Therapy must be initiated by a Psychiatrist

Tricyclic antidepressants Imipramine HCI 10mg Ethipramine 10mg 724661 Therapy must be initiated by a Psychiatrist

Tricyclic antidepressants Imipramine HCI 25mg Ethipramine 25mg 724688 Therapy must be initiated by a Psychiatrist

MAOI Moclobemide 150mg Depnil 897213 Therapy must be initiated by a Psychiatrist

MAOI Moclobemide 300mg Depnil 702008 Therapy must be initiated by a Psychiatrist

Thioxanthines Zuclopenthixol decanoate 200mg/ml Clopixol Depot 200mg/ml 714852 Depot Preparations Only - 2nd Line

Thioxanthines Flupenthixol decanoate 20mg Fluanxol depot 1ml 20mg 726672 Depot Preparations Only - 2nd Line

Thioxanthines Flupenthixol decanoate 40mg Fluanxol depot 2ml 40mg 726680 Depot Preparations Only - 2nd Line

Thioxanthines Flupenthixol HCL 0.5mg Fluanxol 0.5mg 726656 Therapy must be initiated by a Psychiatrist

Thioxanthines Flupenthixol HCL 1mg Fluanxol 1mg 726664 Therapy must be initiated by a Psychiatrist

Butyrephenones Haloperidol 0.5mg Serenace 0.5mg 763411 Therapy must be initiated by a Psychiatrist

Butyrephenones Haloperidol 1.5mg Sandoz haloperidol 1.5mg 730335 Therapy must be initiated by a Psychiatrist

Butyrephenones Haloperidol 5mg Sandoz haloperidol 5mg 730327 Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Clozapine 100mg Aspen Clozapine 717082 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Clozapine 25mg Aspen Clozapine 717081 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Risperidone 1.mg Zoxadon 1mg 711512 Risnia 1mg 717997 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Risperidone 2mg Zoxadon 2mg 711513 Risnia 2mg 717998 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Olanzapine 2.5mgOlawin 2.5mg 721385

Olexar 2.5mg 715657 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Olanzapine 5mg Olawin 5mg 721388 Redilanz 5mg 715684 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Olanzapine 10mgOlawin 10mg 721389

Olexar 10mg 715659 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Quetiapine 25mg Dopaquel 25mg tabs 716050 Quetoser 25mg 716635 Motivation Required. Therapy must be initiated by a Psychiatrist




Atypical antipsychotic Amisulpride 50mg Solian 50mg 892309 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Amisulpride 200mg Solian 200mg 892310 Motivation Required. Therapy must be initiated by a Psychiatrist

Atypical antipsychotic Aripiprazole 10mg Abilify 10mg 705634 Motivation Required. Therapy must be initiated by a Psychiatrist



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Benzamides Sulpiride 50mg Espiride 819654 Therapy must be initiated by a Psychiatrist

Anti-cholinergic Biperiden 2.5mg Lennon - Biperiden 713209 Treatment to be initiated by Specialist

Anti-cholinergic Orphenadrine 50mg Disipal 50mg tabs 720542 Therapy must be initiated by a Psychiatrist

Systemic Lupus

Erythematosus

M32 Anti-protozoal agents Chloroquine phosphate Plasmoquine 200mg 794333 Treatment to be initiated by Specialist

L93 Anticoagulant Warfarin 5mg cipla-warfarin 712390 Treatment to be initiated by Specialist

Analgesics Paracetamol 500mg Napamol 500mg tab 745723 Painamol 500mg 752142 Treatment to be initiated by Specialist

Cytostatic Cyclophosphomide 50mg Endoxan 50mg 723274 Treatment to be initiated by Specialist


Immunosuppressants Azathioprine 50mg Azamun 50mg 701252 Treatment to be initiated by Specialist



NSAID'S Indomethacin 100mg Arthrexin 100mg supp. 704741 Treatment to be initiated by Specialist

NSAID'S Indomethacin 25mg Betacin 25mg 787833 Arthrexin 25mg 704725 Treatment to be initiated by Specialist

NSAID'S Aspirin 300mg Be-tabs aspirin 300mg 798533 Aspirin 704645 Treatment to be initiated by Specialist

NSAID'S Ibuprofen 200mg Ranfen 200mg 824852 Treatment to be initiated by Specialist

NSAID'S Ibuprofen 400mg Ranfen 400mg 701654 Treatment to be initiated by Specialist

NSAID'S Ibuprofen 600mg Sandoz ibuprofen 600 mg 782807 Treatment to be initiated by Specialist

Selective COX II inhibitors Meloxicam 15mg Flexocam 15mg 704828 Arrow Meloxicam 15mg 711325 Treatment to be initiated by Specialist

Selective COX II inhibitors Meloxicam 7.5mg Flexocam 7.5mg 704829 Arrow Meloxicam 7.5mg 711324 Treatment to be initiated by Specialist

NSAID'S Piroxicam 20mg Roxifen 20mg 701072 Treatment to be initiated by Specialist

NSAID'S Naproxen 250mg Napflam 250mg 806447 Treatment to be initiated by Specialist

NSAID'S Naproxen 500mg Napflam 500mg 808474 Treatment to be initiated by Specialist



NSAID'S Diclofenac sod. 100mg Panamor sr 827592 Treatment to be initiated by Specialist

Topical corticosteroids Betamethasone cream Topivate 0.1% cream 833037 Treatment to be initiated by Specialist

Topical corticosteroids Betamethasone lenovate Lenovate 0.1% ointment 800171 Treatment to be initiated by Specialist

Vitamins Folic acid 5mg Be-tabs folic acid 5mg 810967 Treatment to be initiated by Specialist

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 For long term oral corticosteriod use

Ulcerative colitis

K51 5 Aminosalycilic acid derivative Mesalazine enema Asacol 2g/50ml enema 824127 Treatment to be initiated by Specialist - motivation required

5 Aminosalycilic acid derivative Mesalazine 400mg Asacol 400mg 783668 Treatment to be initiated by Specialist - motivation required

5 Aminosalycilic acid derivative Mesalazine supp Asacol 500mg supp 824135 Treatment to be initiated by Specialist - motivation required

5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin 500mg 762008 Treatment to be initiated by Specialist - motivation required

5 Aminosalycilic acid derivative Sulphasalazine 500mg Salazopyrin EN 762016 Treatment to be initiated by Specialist - motivation required

Aminosalicylates Olsalazine 250mg Dipentum 250mg 792519 Treatment to be initiated by Specialist - motivation required

Aminosalicylates Mesalazine 500mg tab Pentasa 500mg 890775 Treatment to be initiated by Specialist - motivation required



Antibiotics Ciprofloxacin 250mg Ciprol 250mg 704777 Dynafloc 250 700516 Treatment to be initiated by Specialist

Antibiotics Ciprofloxacin 500mg Ciprol 500mg 704775 Dynafloc 500 700518 Treatment to be initiated by Specialist

Antibiotics Ciprofloxacin 750mg Cifloc 750mg 893963 Treatment to be initiated by Specialist

Corticosteroids Budesonide enema Entocord 2.3mg enema 824593 Treatment to be initiated by Specialist - motivation required

Corticosteroids Budesonide 3mg Entocord 3mg tab 838896 Treatment to be initiated by Specialist - motivation required

Corticosteroids Prednisolone 5mg Lenisolone 5mg 800155 Capsoid 814407 Treatment to be initiated by Specialist - motivation required

Corticosteroids Prednisone 5mg Be-tabs prednisone 788783 Treatment to be initiated by Specialist - motivation required

Immunosuppressive Azathioprine 50mg Azamun 50mg 701252 Treatment to be initiated by Specialist - motivation required

Cytostatic Methotrexate 2.5 Methotrexate 2.5mg 742465 Treatment to be initiated by Specialist - motivation required

Vitamins Folic acid 5mg Be-tabs folic acid 5mg 810967 Treatment to be initiated by Specialist

Potassium supplements Potassium chloride 600mg Plenish K 600mg 755753 For long term oral corticosteriod use

17

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