2018 Family Practitioner Guide - GEMS

2018 FamilyPractitioner Guide

Working towards a healthier you

2018 Family Practitioner Guidei

01 Introduction 1

02 Summary of Family Practitioner (FP) primary care benefits for Sapphire and Beryl 3

03 Family Practitioner tariffs and fees 5

04 Medicine 9

05 Ante-natal visits and the maternity benefit 11

06 Procedures performed in doctor’s rooms 12

07 Out-of-hospital specialist visits 13

08 Radiology 14

09 Pathology 15

10 Day-to-day benefits 16

11 Hospitalisation 18

12 Prescribed Minimum Benefits (PMBs) 18

13 HIV/AIDS registration 19

14 Circumcision 19

15 Disease management 20

16 Preventative care services 21

17 Documentation Based Care (DBC) Network 21

18 The referral management process for Sapphire and Beryl 22

19 Any other enquiries 22

20 Submitting claims 23

A Annexure A: GEMS Network Radiology Formulary 24

B Annexure B: GEMS Radiology Request Form 27

C Annexure C: GEMS Network Pathology Formulary 28

D Annexure D: GEMS Pathology Request Form 32

E Annexure E: GEMS Specialist Referral Form 33

F Annexure F: Sapphire and Beryl Re-order Form 34

G Annexure G: GEMS Sapphire and Beryl Network Chronic Medicine Formulary 35

H Annexure H: GEMS Sapphire and Beryl Network Acute Medicine Formulary 95

Table of Contents

Introduction

Thank you for being part of the GEMS Sapphire and Beryl Network. GEMS values the Family Practitioner’s role as the coordinator of care and believes the Family Practitioner (FP) has the best understanding of a patient’s health and treatment history, It is because of these reasons that GEMS is encouraging GEMS members to nominate a Network FP in 2018. GEMS continuously strives to provide its members with access to excellent, affordable healthcare and is therefore committed to the promotion of your services to improve access and promote the Family Practitioner as the coordinator of care.

GEMS offers two low cost options namely Sapphire and Beryl, aimed at employees who previously did not have access to healthcare cover. The contracted provider networks for Sapphire and Beryl are available on our website at www.gems.gov.za. Alternatively you may contact the GEMS Call Centre on 0860 436 777.

Summarised benefits offeredby Sapphire:• Primary care benefits through the GEMS Network of healthcare

providers (Family Practitioners, dentists, optometrists, pharmacies and specialists) subject to network formularies.

• Hospitalisation is at public hospitals, except for maternity, where Sapphire members have access to a network of private facilities.

• The maternity benefit is subject to Maternity Programme Protocols and includes two 2D ultrasound scans per pregnancy.

• Circumcision is limited to a global fee of R1 421 per beneficiary, which includes all post-operative care within a month of the procedure.

• In-hospital benefits are limited to R208 237 per family per annum subject to Prescribed Minimum Benefit (PMB) sub-limits.

• Preventative care investigations include the following and are subject to managed care principles and processes: Bone Density scan, Mammogram, Occult Blood Test, Pap Smear (including liquid based cytology), Prostate Specific Antigen, Glaucoma Screening, Serum Cholesterol, Serum Glucose, Thyrotropin (TSH) for Neonatal Hypothyroidism, Influenza-, HPV- and Pneumococcal vaccinations.

Summarised benefits offeredby Beryl:• Primary care benefits through the GEMS Network of healthcare

providers (Family Practitioners, dentists, optometrists, pharmacies and specialists) and subject to network formularies.

• The maternity benefit is subject to Maternity Programme Protocols and includes two 2D ultrasound scans per pregnancy.

• In-hospital benefits limited to R1 041 200 per family per annum subject to PMB sub-limits.

Preventative care investigations include the following investigations that may be performed annually per beneficiary: Bone Density scan, Mammogram, Occult Blood Test, Pap Smear (including liquid based cytology), Prostate Specific Antigen, Glaucoma Screening, Serum Cholesterol, Serum Glucose, Thyrotropin (TSH) for Neonatal Hypothyroidism, Influenza-, HPV- and Pneumococcal vaccinations.

• Circumcision is limited to a global fee of R1 421 per beneficiary which includes all post-operative care within a month of the procedure.

• Hospitalisation is at a network of private facilities as well as public hospitals. The hospital network list is available on our website at www.gems.gov.za. Alternatively you may contact the Gems Call Centre one 0860 436 777.

01

2018 Family Practitioner Guide 1

Sapphire and Beryl contribution rates for 2018:Sapphire Beryl

Salary Band Member Adult Child Salary Band Member Adult Child

R0 - R8 473 R 945 R 726 R 403 R0 - R8 473 R1 090 R 1055 R 605

R8 473.01 - R11 890 R 990 R 770 R 434 R8 473.01 - R11 890 R1 182 R1 139 R 668

R11 890.01 - R20 369 R 1 052 R 810 R 460 R11 890.01 - R20 369 R1 290 R1 253 R 717

R20 369.01 + R1 170 R 962 R 554 R20 369.01 + R1 547 R1 508 R 870

2018 Family Practitioner Guide2


Primary care benefits Sapphire Beryl

FP consultations • Reimbursed at the GEMS Network rate.• GEMS members are encouraged to nominate a GEMS network Family Practitioner (FP) who they

will visit for all their consultations in 2018.• If a GEMS member wishes to change their nominated FP, they can call the GEMS call

centre on 0860 00 4367. A FP can be changed every six (6) months.• Specific procedures can be charged in addition to the consultation. Certain of these procedures

are subject to authorisation.• Only listed tariff codes will be reimbursed. There will be no additional benefits for tariff codes that

are not listed in this guide.• Gastroscopy, Colonoscopy, Cataract surgery will require and be subject to pre-authorisation.

Sigmoidoscopy, Proctoscopy, Vasectomy, flexible Nasopharyngolaryngoscopy and ingrown toenail procedures performed in doctor’s rooms reimbursed at 200% of the GEMS Scheme Rate do not require pre-authorisation.

• Beneficiaries are allowed up to six (6) consultations per annum to their Network FP without necessitating pre-authorisation. After the sixth consultation pre-authorisation by the Network FP will be required by phoning the GEMS Provider Call Centre on 0860 436 777. Benefits above limit are subject to PMBs and managed care protocols.

Acute medicine • Subject to the GEMS Network acute medicine formulary.• The formulary will consist of a list of drugs marked as in-formulary and a list marked as out-of-formulary.• Any medicine not listed will not be covered.• The cost of acute medicine is included in the consultation fee for dispensing doctors.• For non-dispensing doctors, acute medicine is to be dispensed by Network pharmacies.

Chronic medicine • Subject to registration on the Chronic Medicine Management Programme and the GEMS Sapphire and Beryl chronic medicine formulary.

• Only on prescription by a Network FP or Specialist (provided that the specialist visit has been authorised as per the referral management process).

• All chronic medicine to be dispensed by a Designated Service Provider (DSP) Pharmacy who is part of the GEMS Pharmacy Network.

Specialist consultations • Specialist visits are only available through the State as the designated service provider.

• Private specialist benefits are only available for maternity cases subject to the referral management (Refer to the ante-natal benefit below).

• Limited to three consultations or R2 498 per beneficiary and five consultations or R3 747 per family per annum. (This includes the ante-natal benefit below).

• Only on referral from the Network FP and subject to authorisation and the GEMS Specialist Network.

Please refer to the Specialist Referral Request form included in this guide.

Summary of Family Practitioner (FP)Primary care benefits for Sapphire and Beryl

02


Primary care benefits Sapphire Beryl

Maternity benefit • Subject to registration on the Maternity Programme and the Maternity Programme Protocols.• Two 2D ultrasound scans per pregnancy.• All specialist referrals require the Network FP to obtain authorisation.


Pathology • Subject to PMBs and the GEMS pathology formulary.• Only on referral from a Network FP.• For tests not included in the formulary, please obtain authorisation.


Radiology • Subject to PMBs and the GEMS radiology formulary.• Only on referral from a Network FP.• For tests not included in the formulary, please obtain authorisation.


Preventative care investigations

• Bone Density scan, Mammogram, Occult Blood Test, Pap Smear (including liquid based cytology) Prostate Specific Antigen, Glaucoma Screening, Serum Cholesterol, Serum Glucose, Influenza-, HPV and Pneumococcal Vaccinations, Thyrotropin (TSH) for Neonatal Hypothyroidism, subject to managed care protocols and processes.

• Only on referral from a Network FP or on referral from a Specialist where the specialist visit was referred by the Network FP.

Rehabilitation Ten post-surgery physiotherapy consultation sessions to be used within 60 days after shoulder, hip or knee replacement surgery limited to R5 021 and subject to pre-authorisation.

Voluntary use of Out-of-Network providers

Limited to three visits per family per annum, and R 1 029 per event.

All ied health services, including: Physiotherapy,

• Benefits for allied health services are only available through the State healthcare sector as the DSP.

• Limited to R2 017 per beneficiary and R3 033 per family per annum.

• Sub-limit of R1 517 per family for Social Workers and Registered Counsellors.

Occupational Health and Audiology

• Only on referral from a Network FP and subject to authorisation.

The complete 2018 benefit schedule for Sapphire and Beryl can be viewed on the GEMS website at www.gems.gov.za.


Family Practitioner tariffs and fees

The following information appliesto both the Sapphire and Beryl options.Family Practitioners on the Sapphire and Beryl GEMS Network are paid according to a tiered performance based reimbursement model.

The level of reimbursement is determined quarterly and is based on the doctor’s GEMS score. The GEMS score is a combination of the following components:

• The doctor’s level of adherence to protocols as contained in this guide, for example obtaining pre-authorisation for specialist visits and adherence to formularies (in-room procedures, acute and chronic medicine formulary, radiology and pathology formulary).

• The doctor’s REPI2 score.

A performance report is distributed quarterly to keep Network FPs up-to-date with their latest GEMS and REPI2 categories as well as adherence performance. The quarterly practice performance report will highlight areas that may need change in order for a FP to obtain an improved level.

In 2018, GEMS is focusing on diabetes, hypertension and cardiac care. Network FPs will be profiled against quality measures relating to these conditions in their performance report. This profiling will not influence the FPs network practice score for 2018, but GEMS encourages the appropriate management of Sapphire and Beryl patients with these conditions.

The following requirements will determine the level of reimbursement:

• Adherence to protocols and formularies within certain criteria.

• REPI2 category 1 or 2 status.

• Adherence to protocols and formularies within certain criteria.

• REPI2 category 1 or 2 status.

• Guidance is required with adherence to formularies and protocols.

• REPI2 category 3 status.

Please take note that in order to sustain the Sapphire and Beryl options it is imperative to manage adherence to protocols and formularies. Non-adherence to protocols and formularies will result in termination of the Sapphire and Beryl Network contract.

03


Family Practitioner consultation feesGEMS SB FP Network Score Dispensing doctor tariff Non-dispensing doctor Tariff Authorisation Mandatory

Level 1 R 368.70 R 279.60

After 6th visit within networkLevel 2 R 354.30 R 279.60

Level 3 R 322.90 R 260.00

• Authorisation of additional visits will be subject to medical necessity and managed care protocols.• Doctors who do not adhere to the Scheme’s 2018 tariffs will no longer be able to participate in the network.

Family Practitioner tariff codesThe following tariff codes will be paid at the listed GEMS Network rates. Benefits will not be paid if the codes are not listed in this guide.

Members are entitled to six (6) FP consultations per annum. Authorisation of additional visits will be subject to medical necessity and managed care protocols.

GEMS tariff code GEMS tariff code description

0190 – 0192 Family Practitioner visit

Emergency consultations at casualty wards or emergency rooms

There are no benefits in respect of private hospital casualty/emergency room facilities unless the condition is an emergency medical condition as defined below:

“The sudden, and at the time unexpected, onsetof a life threatening health condition that requiresimmediate medical or surgical treatment,where failure to provide medical or surgicaltreatment would result in serious impairmentto bodily functions or serious dysfunctionof a bodily organ or part, or would placethe person’s life in serious jeopardy”.


Procedure codes that can be charged in addition toa consultation code


0300 Stitching of a wound

0301 Stitching of an additional wound

0307 Excision and repair

0255 Drainage of subcutaneous abscess and avulsion of nail

0259 Removal of foreign body superficial to deep fascia

0887 Limb cast (including cost of POP and material)

1725 Drainage of external thrombosed pile

Procedure codes that can be charged in addition to a consultation code but subject to authorisationFamily Practitioners need to obtain authorisation before charging for the following codes.


1186 Flow volume test: Inspiration/expiration

1188 Flow volume test: Inspiration/expiration/pre- and post- bronchodilator

1234 ECG bicycle

1235 ECG multistage treadmill

2713 Lumbar puncture

Note that these codes will only be allowed for the diagnosis and management of approved chronic conditions for registered chronic members as part of the chronic condition benefit, subject to PMB treatment guidelines. Payment will be subject to the doctor submitting the results for these tests. Rates are available on the Tariff file on the GEMS website www.gems.gov.za.


Codes which are included in the consultation feeThe tariff codes listed below are examples of commonly used codes that cannot be billed separately as they form part of the consultation fee:


0145 to 0149 Modifiers

0017 Injections by practitioner

Completion of chronic medicine forms by medical practitioners

0199

0202 Setting sterile tray

0205 Intravenous infusions (patient under 3 years)

0206 Intravenous infusions (patient over 3 years)

0222 Intralesional injection into areas of pathology e.g. Keloid: Single

0223 Intralesional injection into areas of pathology e.g. Keloids: Multiple

0233 Biopsy without suturing: First lesion

0234 Biopsy without suturing: Subsequent lesions

0235 Biopsy without suturing: Maximum for multiple additional lesions

0241 Treatment of benign skin lesion by chemo-cryotherapy: First Lesion

0242 Treatment of benign skin lesion by chemo-cryotherapy: Subsequent lesions (each)

0243 Treatment of benign skin lesion by chemo-cryotherapy: Maximum for mult iple additional lesions

0244 Repair nail bed

0245 Removal of benign lesion by curetting under local or general anaesthesia

0661 Aspiration of joint or intra-articular injection

0663 Multiple intra-articular injections for rheumatoid arthritis: First joint

GEMS tariff GEMS tariff code description code

0763 Muscle and tendon repair: Tendon or ligament injection

1063 Removal of foreign bodies from nose in rooms

1136 Nebulisation in rooms

1192 Peak Flow

1228 ECG: Without effort

1232 Electrocardiogram: Without effort

1233 Electrocardiogram: With and without effort

1996 Bladder catheterisation: Male (not at operation)

1997 Bladder catheterisation: Female (not at operation)

2442 Insertion of intra uterine contraceptive device (IUCD): Excluding cost of device

2565 Implantation hormone pellets

3275 Audiometry - tympanometry

3287 Spinal joint and ligament injection

4188 Urine dipstick, per stick (irrespective of the number of tests on stick)

*This list only refers to commonly used codes and is not exhaustive.


All medicine for Sapphire and Beryl is subject to the GEMS Network medicine formulary. Please refer to the formularies included in this guide or visit the GEMS website at www.gems.gov.za.

General:• Please ensure that all test results and motivations (where applicable) are included when submitting the Chronic Medicine

Application form.• Also ensure that the member/patient completes their relevant section and signs the form.

Prescriber Benefit for Sapphire and Beryl

Dispensing and Non- dispensing Network FPs

• All chronic medicine is subject to authorisation and registration of members on the Chronic Medicine Management Programme.

• Prescribed medicine is subject to the GEMS Network chronic formulary which is limited to PMB- CDL and DTP conditions.

• Chronic medicine can only be prescribed by GEMS Network FPs and Specialists, provided that the specialist visit has been authorised as per the specialist referral management process.

• All chronic medicine is dispensed by the Scheme’s Chronic DSP Courier or Network Pharmacy.• Chronic medicine obtained voluntarily from a pharmacy other than the Scheme’s Chronic DSP

Courier or Network Pharmacy, will incur a 30% member co-payment.

How to access the Chronic Medicine Application form

• The Chronic Medicine Application form can be accessed on the GEMS website at www.gems.gov.za or

• You can contact us on 0860 436 777 and a copy will be faxed or emailed to you.

Return completed application form

• Please fax the completed form to 0861 00 4367, or• Mail to: GEMS, Private bag X782, Cape Town, 8000, or• Email: [email protected]

Reimbursement for completing chronic applications

• As Sapphire and Beryl are the low contribution GEMS options, there is no additional tariff applicable for the completion of the Chronic Member Benefit Application form.

• The fee is included in the consultation fee.

Changes or updates • The Chronic Medicine Application form is completed only once.• Following registration on the Chronic Medicine Management Programme, all changes or

updates are done telephonically by calling 0860 436 777 or by faxing a prescription with the amendments to 0861 00 4367 or email: [email protected]

Chronic medicine

Medicine04


Acute medicine

Over the counter (OTC) medicine

Prescriber Benefit for Sapphire and Beryl

Dispensing Network FPs • Acute medicine is included in the consultation fee.• Doctors are requested to display the NAPPI codes for medicine dispensed which will be used for

analysis purposes. The consultation fee will be paid irrespective of medicine dispensed or not.• Acute pharmacy claims will not be covered where the scripting FP is contracted as a dispensing FP.• FPs contracted as dispensing FPs can, however, script chronic medicine as this is not included

in the fee structure.

Non-dispensing Network FPs • Subject to the GEMS Network acute formulary.• Prescribed acute medicine is obtainable from GEMS DSP Network pharmacies.• The network can be accessed on the GEMS website at www.gems.gov.za.• Acute medicine obtained voluntarily from a non-network pharmacy, will incur a non-

refundable 30% member co-payment.

Benefit for Sapphire and Beryl

• Acute medicine is included in the consultation fee.• Doctors are requested to display the NAPPI codes for medicine dispensed which will be used for analysis purposes. The

consultation fee will be paid irrespective of medicine dispensed or not.• Acute pharmacy claims will not be covered where the scripting FP is contracted as a dispensing FP.• FPs contracted as dispensing FPs can, however, script chronic medicine as this is not included in the fee structure.


Antenatal visits and the maternity benefit

The following benefits apply to both Sapphire and Beryl members per pregnancy, payable from risk for members who are registered on the Maternity Programme (members who are not registered on the Maternity Programme are limited to their day-to-day benefits as defined in the Scheme rules and subject to PMB legislation):

Benefit for Sapphire and Beryl

Ante-natal visits, scans and blood tests

The ante-natal benefit allows for six ante-natal consultations at the FP or midwife of which three may be gynaecologist visits. Gynaecologists form part of the GEMS Specialist Network and should your Gynaecologist form part of the Network they have agreed to charge at an agreed rate.

The schedule is as follows:

• Booking visit• One (1) visit every 4 weeks (24-36 weeks), i.e. 4 visits• One (1) visit at 38, 39 and 40 weeks gestation• Two (2) 2D ultrasound scans

The ultrasound scans must either be done by the doctor who will be responsible for the confinement or a radiologist or gynaecologist.

Blood tests included in this benefit:

• Three (3) Hb estimations• One (1) Blood group• One (1) VDRL (Syphilis)• Two (2) HIV of which one must be done in the third trimester

Specialist visits Please refer to the Specialist Referral Request form included in this guide.

All out-of-hospital specialist consultations must be referred by a GEMS Network FP and require the FP to obtain authorisation by contacting the GEMS Call Centre on 0860 436 777.

Hospital network • Beryl members have access to private hospitals, subject to pre-authorisation.• Sapphire members have access to private hospitals for maternity, subject to pre-authorisation.• All other admissions for Sapphire at public hospitals subject to PMBs.

FP services Subject to registration on the Maternity Programme and pre-authorisation

Pre-natal vitamins Available as per Maternity vitamin list. Prenatal vitamins will be funded up to a cut-off of R85 per month. Items must be prescribed by the FP or midwife. Subject to registration on the Maternity Programme.

Benefit for Sapphire only

Post discharge complications of a newborn

Hospitalisation in designated private hospitals for post discharge complications of a newborn limited to six (6) weeks.

05

Details Benefit for Sapphire and Beryl

Procedure Benefit Diagnostic procedures - Gastroscopy, Colonoscopy, Cataract surgery, Sigmoidoscopy, Proctoscopy, Vasectomy and flexible Nasopharyngolaryngoscopy including ingrown toenail procedures performed in doctor’s rooms.

Reimbursement Rate Reimbursed at 200% of the GEMS Scheme Rate for Network FPs. Gastroscopy, Colonoscopy and Cataract surgery require and is subject to pre-authorisation. Sigmoidoscopy, Proctoscopy, Vasectomy, flexible Nasopharyngolaryngoscopy and ingrown toenail procedures do not require pre-authorisation.

Authorisation Authorisation can be obtained by contacting the GEMS Call Centre on 0860 436 777 and following the prompts for the Sapphire and Beryl options.

Please note that authorisation is only required for Gastroscopy, Colonoscopy and Cataract surgery when performed in the doctor’s rooms

06Procedures performed in doctor’s rooms


Specialist benefits apply as follows:Sapphire• Benefits are subject to PMBs. Ante-natal visits are subject to Maternity Programme Protocols.• The State is the DSP for additional specialist visits.• All specialist visits which include all Allied Health services are subject to referral from a Network FP/DSP and obtaining authorisation.

The member may also obtain the authorisation before the specialist visit by contacting 0860 00 4367 and submitting the Specialist Referral form completed by the Network FP/DSP.

Beryl• Subject to authorisation and on referral from a Network FP/DSP.• Specialist visits which include all Allied Health services are limited to three visits per beneficiary and five per family per annum,

and further limited to R2 498 per beneficiary and R3 747 per family, subject to PMBs. Ante-natal visits are subject to Maternity Programme Protocols.

Authorising specialist visits• Family Practitioners can obtain authorisation for specialist visits by contacting the GEMS Call Centre on 0860 436 777 and

following the prompts to the Sapphire and Beryl options.

Please refer to the Specialist Referral form included in this guide.

07Out-of-hospital specialist visits


Out-of-hospital radiology Benefits for Sapphire and Beryl

Codes that apply • Out-of-hospital radiology is covered according to the GEMS radiology formulary. See Annexure A of this guide.

• All additional tests not listed in the formulary will require a pre-authorisation.• Please also refer to the Radiology Request form included in this guide.

Who can refer the member • Only scans and X-rays referred by the Network FP or a Specialist, subject to authorisation of the specialist visit, will qualify for payment

How to obtain authorisation • All additional investigations are subject to pre-authorisation as indicated in the radiology formulary.

• Authorisation is required for in and out-of-hospital specialised radiology scans additional to the hospital pre- authorisation and is subject to PMBs. This includes angiography, CT scans, MUGA/PET/MRI scans, and radio- isotope studies.

• Please contact the GEMS Call Centre on 0860 436 777 to obtain authorisation.

08Radiology


Out-of-hospital pathology Benefits for Sapphire and Beryl

Codes that apply • Out-of-hospital pathology is covered according to the GEMS pathology formulary Please refer to Annexure C of this guide.

• All additional tests not listed in the formulary will require pre-authorisation.Please also refer to the Pathology Request form included in this guide.

Who can refer the member • Members must be referred by the DSP FP or a Specialist, subject to authorisation of the specialist visit, in order for tests to qualify for payment.

How to obtain authorisation • Tests not included in the pathology formulary, are subject to pre-authorisation Please contact the GEMS Call Centre on 0860 436 777 to obtain authorisations.

• The authorisation number must be included in the Pathology Request form. Failure to do so will result in the laboratory being unable to perform the test.

09Pathology



Allied Health ServicesDetails Sapphire Beryl

Benefit includes:

• Chiropractors • Dieticians • Homeopaths • Podiatrists• Phytotherapists • Social Workers• Registered Counsellors• Orthoptists • Acupuncturists • Chinese Medicine Practitioners • Physiotherapists • Occupational Therapists• Audiologists

The state healthcare sector is the DSP for allied healthcare services for this option.

• In-hospital services limited to R2 075 per beneficiary and R3 122 per family per annum, subject to PMBs.

• Out-of-hospital services limited to R2 017 per beneficiary and R3 033 per family per annum, subject to PMBs.

• There is a sub-limit of R1 517 per family for Social Workers and Registered Counsellors.

Who can refer a member Subject to referral from a Network FP and the Network FP obtaining authorisation

How to obtain authorisation Authorisation is obtained by contacting the GEMS Call Centre on 0860 436 777.

10Day-to-day benefits


DentistryDetails Sapphire Beryl

Benefit includes:

Conservative dentistry • Two dental examinations which include preventative treatment consultations per beneficiary per annum at a GEMS Network provider only.

• Two events to complete fillings and extractions in multiple areas of the oral cavity per beneficiary per annum subject to PMBs (including conditions with pain and sepsis).

• Two intra-oral radiography events per beneficiary per annum subject to PMBs.

• One panoramic x-ray per beneficiary every three years.

• Emergency out-of-network visit limited to one event per beneficiary per annum.

• Dentures require pre-authorisation.• A list of approved services will apply.

• Two dental examination which includes preventative treatment consultations per beneficiary per annum at a GEMS Network provider only.

• Unlimited fillings at DSP.• One extraction or emergency root canal

per beneficiary per annum subject to PMBs.• Two Intra-oral radiography event per beneficiary

per annum subject to PMBs.• Two events related to pain and sepsis

per beneficiary per annum subject to PMBs.• One panoramic x-ray per beneficiary every

three years.• Emergency out-of-network visit limited to one

event per beneficiary per annum.• Dentures require pre-authorisation.• A list of approved services will apply.

Specialised dentistry • No benefit.• Subject to PMBs at State facilities.

• Benefit subject to pre-authorisation.• Limited to R3 434 per beneficiary per annum.• Benefit includes dentures and crowns.

Dental network The GEMS dental network for Sapphire and Beryl can be accessed on the GEMS website at www. gems.gov.za.

Authorisation for specialised dentistry

No specialised dentistry benefit. Authorisation for specialised dentistry can be obtained by contacting the GEMS Call Centre on 0860 436 777.


Details Sapphire Beryl

Benefit Annual limit of R208 237 per family, per annum subject to pre-authorisation and managed care protocols.

Annual limit of R1 041 200 per family, per annum subject to pre-authorisation and managed care protocols.

Which hospitals Access to public hospitals only, except for maternity, where a network of private hospitals can be accessed.

Public hospitals as well as a network of private hospitals.

Hospital network The GEMS hospital network for Sapphire and Beryl can be accessed on the GEMS website at www.gems.gov.za.

How to obtain pre-authorisation • Email: [email protected]• Fax: 0861 00 4367• Phone: 0860 436 777

Benefits for both Sapphire and Beryl are as per the GEMS PMB treatment protocols for each disease.

Registration for chronic diseases is compulsory.

All PMB services to be delivered by the GEMS designated provider networks for Sapphire and Beryl.

Hospitalisation11

12Prescribed Minimum Benefits (PMBs)


Details Benefits for Sapphire and Beryl

Benefit Benefits for both Sapphire and Beryl are subject to PMBs.

Reimbursement for completing the HIV/ AIDS Disease Management Programme registration form

Doctors will be reimbursed at the Scheme rate upon submission of the completed HIV/AIDS Disease Management Programme registration form and the successful registration of the beneficiary on the HIV/AIDS Disease Management Programme (DMP).

How to access the form The registration form can be accessed on the GEMS website at www.gems.gov.za.

Return the completed form • Fax (toll-free): 0800 436 7329• Email: [email protected]

Queries, clinical advice and script updates • Phone: 0860 436 736• Please call me: 083 843 6764

13HIV/AIDS registration

14Circumcision

Codes that apply• Network FPs will be reimbursed up

to the global fee upon submission of the claim.

• The GEMS tariff code 2133 or 2137 or 2139 or 9901 to be used for the procedure.

• Please include the correct and applicable ICD-10 code.

Benefit• Limited to a global fee of R1 421 which

includes all post-procedure care, consultations and medicine within a month of the procedure.

• The benefit is subject to pre- authorisation, managed care protocols and the use of a GEMS Network provider.

• Out-of-hospital only.

How to obtain authorisation

• Email: [email protected]• Fax: 0861 00 4367• Phone: 0860 436 777


Details Sapphire Beryl

Benefit includes:

• Oncology (chemotherapy and radiotherapy)

• Organ transplants and renal dialysis

• Mental health• Alcoholism and drug

dependency

• The State is the DSP.• Organ transplants are limited to PMBs and

a sub-limit of R19 960 per beneficiary per annum for corneal grafts.

• Oncology: Subject to the GEMS Oncology managed care protocols, annual hospital limit and a sub-limit of R208 236 per family per annum.

• Organ transplants are limited to PMBs and a sub-limit of R19 960 per beneficiary per annum for corneal grafts.

• Renal Dialysis: Subject to the annual hospital limit and a sub-limit of R208 236 per family per annum and PMBs.

• Mental health: Subject to annual hospital limit and combined in- and out-of-hospital sub-limit of R9 460 per family per annum and limited to PMBs.

• Alcoholism and drug dependency: The State healthcare sector is the DSP.

Authorisation of care • All benefits are subject to managed care protocols and the patient being registered on the relevant Disease Management Programme (DMP).

Registration on the Disease Management Programme (DMP)

Registration on the relevant DMP can be done by contacting the GEMS Call Centre at 0860 436 777

15Disease management


Details Benefits for Sapphire and Beryl

Benefit includes investigations for:

• Bone Density scan• Glaucoma Screening• Mammogram• Occult Blood Test• Pap smear (including liquid based cytology)• Prostate Specific Antigen• Serum Cholesterol• Serum Glucose• Thyrotropin (TSH) for Neonatal Hypothyroidism• Influenza vaccination• HPV vaccination• Pneumococcal vaccination

• Bone Density scan, Mammogram, Occult Blood Test, Pap Smear (including liquid based cytology) Prostate Specific Antigen, Glaucoma Screening, Serum Cholesterol, Serum Glucose investigations, Thyrotropin (TSH) for Neonatal Hypothyroidism, Influenza-, HPV- and Pneumococcal Vaccinations are according to managed care principles and processes.

• Only on referral of a Network FP or on referral from a Specialist where the specialist visit was authorised by a Network FP.

16

17

Preventative care and screening services

Documentation Based Care (DBC) Network

From 1 January 2018, GEMS will be implementing the Documentation Based Care (DBC) back and neck rehabilitation programme for chronic back and neck pain.

DBC is an evidence based physiotherapy and active rehabilitation programme that concentrates primarily on back and neck problems. DBC works on the concept of active muscle reconditioning, supported by scientific clinical studies which show that exercise reduces pain and can normalise function in many instances, thereby reducing the need for surgery. While conventional treatment often focuses on alleviating the symptoms, this solution aims to treat the underlying functional problem. Well documented results show

that patients who have chronic, recurrent, post traumatic or post-operative problems benefit from the DBC treatment.

The services provided by the DBC centres in accordance with the standards of professional conduct include, amongst others:

• Initial assessment of patients referred to the centre• Identifying patients for whom the treatment is contra-indicated

and referring such patients to the appropriate healthcare provider• Where the treatment is clinically indicated, the design of an

appropriate treatment programme in accordance with the DBC systems and its protocols


The referral management process for Sapphire and Beryl

Authorisation needs to be obtained by the Network FP before the event for the following benefit categories:• All specialist visits, including ante-natal visits at a gynaecologist.• Allied health visits• All additional FP consultations above the limit of six per beneficiary.• Certain special procedures that can be performed by the FP as indicated in this guide.• Radiology and pathology investigations not indicated on the GEMS pathology and radiology formularies in this guide.

For all GEMS Sapphire and Beryl queries (benefit and claims enquiries, pre-authorisation requests and chronic medicine authorisation requests) or other network related queries, please make use of our interactive voice recognition (IVR) call centre number on 0860 436 777 and follow the voice prompts.

Please contact the GEMS Call Centre on 0860 436 777 and follow the prompts to the Sapphire and Beryl options to obtain authorisation.

• Implementation of such a treatment programme in the inter-disciplinary environment and maintaining appropriate records as required by the DBC systems

• Providing the referring doctor with clinical feedback on services performed.

From 1 January 2018 GEMS members who suffer from chronic back and neck pain can be referred to the DBC facilities for functional restoration assessment and management. Identified members will have their claims paid from the overall annual limit with no financial impact on their day-to-day benefit or savings.

Should your GEMS patient require a referral to a DBC facility kindly send an e-mail to [email protected].

There are currently 12 DBC centres located across South Africa. The centres are found in Bellville, Centurion, Durban, Emalahleni, Kempton Park, Roodepoort, Pretoria East, Pretoria North, Sandton, Sasolburg and Secunda. Plans are in place to expand the network even further during the next two years. For an updated list of DBC facilities, please call the GEMS Call Centre on 0860 436 777.

We look forward to your support in making this programme a success.

18

19Any other enquiries


Scheme Name Routing Code

GEMS 875P

Should you have any queries, kindly contact the GEMS Call Centre on 0860 436 777.

Submit all paper claims and hospital claims to:

GEMS: Private Bag X782 Cape Town 8000

Other clearinghousesor hubs:

Please contact your relevant clearinghouses or hubs on the respective submission codes

Submit electronic claims usingthe following codes:

DHS Switch: QEDI - 875P | Mediswitch: GEMS0001

Firstnet or Gateway Communications mailboxes:

6004930008673 TUN Number A843

20Submitting claims


Annexure A: GEMS Network Radiology Formulary

MEDICAL PRACTITIONER RADIOLOGIST RADIOGRAPHY CODE DESCRIPTION

General

Non-chargable Non-chargable 39300 X-Ray films

Skull and Brain

3349 10100 39039 X-Ray of the skull

Facial and nasal bones

3353 11100 39043 X-Ray of the facial bones

3357 11120 39047 X-Ray of the nasal bones

Orbits and Paranasal sinuses

3353 12100 39043 X-ray orbits

3351 13100 39041 X-ray of the paranasal sinuses, single view

Non-chargable 13110 Non-chargable X-ray of the paranasal sinuses, two or more view

Mandible, teeth and maxilla

3355 14100 39045 X-ray of the mandible

3361 14130 39051 X-ray of the teeth single quadrant

3363 14140 39053 X-ray of the teeth more than one quadrant

3365 14150 39055 X-ray of the teeth full mouth

3361 15100 39059 X-ray tempero-mandibular joint, left

3361 15110 39059 X-ray tempero-mandibular joint, right

3359 16100 39049 X-ray of the mastoids, unilateral - Left

3359 16100 39049 X-ray of the mastoids, unilateral - Right

3359 16110 39049 X-ray of the mastoids, bilateral

Thorax

3445 30100 39107 X-ray of the chest, single view - PA

3445 30100 39107 X-ray of the chest, single view - Lateral

Non-chargable 30110 39107 X-ray of the chest two views, PA and lateral

3449 30150 39107 X-ray of the ribs

Abdomen and Pelvis

3477 40100 39125 X-ray of the abdomen

Non-chargable 40110 Non-chargable X-ray of the abdomen multiple views including chest

Non-chargable 40105 39125 X-ray of the abdomen supine and erect, or decubitus

Spine

3321 39017 Skeleton: Spinal column - Per region, e.g. cervical, sacral, lumbar coccygeal, one region thoracic

Non-chargable 50100 39025 X-ray of the spine scoliosis view AP only

3321 51110 39017 X-ray of the cervical spine, one or two views - AP

3321 51110 39017 X-ray of the cervical spine, one or two views - Lateral

*All codes not listed, require authorisation



3321 52100 39017 X-ray of the thoracic spine, one or two views - AP

3321 52100 39017 X-ray of the thoracic spine, one or two views - Lateral

3321 53110 39017 X-ray of the lumbar spine, one or two views - AP

3321 53110 39017 X-ray of the lumbar spine, one or two views - Lateral

3321 54100 39017 X-ray of the sacrum and coccyx

Non-chargable 54110 39027 X-ray of the sacro-iliac joints

Pelvis and Hips

3331 55100 39027 X-ray of the pelvis

6518 56100 39017 X-ray of the left hip

6518 56110 39017 X-ray of the right hip

Non-chargable 56120 Non-chargable X-ray pelvis and hips

Upper Limb

6509 61100 39003 X-ray of the left clavicle

6509 61105 39003 X-ray of the right clavicle

6510 61110 39003 X-ray of the left scapula

6510 61115 39003 X-ray of the right scapula

6508 61120 39003 X-ray of the left acromio-clavicular joint

6508 61125 39003 X-ray of the right acromio-clavicular joint

6507 61130 39003 X-ray of the left shoulder

6507 61135 39003 X-ray of the right shoulder

6506 62100 39003 X-ray of the left humerus

6506 62105 39003 X-ray of the right humerus

6505 63100 39003 X-ray of the left elbow

6505 63105 39003 X-ray of the right elbow

6504 64100 39003 X-ray of the left forearm

6504 64105 39003 X-ray of the right forearm

6500 65100 39003 X-ray of the left hand

6500 65105 39003 X-ray of the right hand

3305 65120 39001 X-ray of a finger

6501 65130 39003 X-ray of the left wrist

6501 65135 39003 X-ray of the right wrist

6503 65140 39003 X-ray of the left scaphoid

6503 65145 39003 X-ray of the right scaphoid

Lower Limb

6514 73100 39003 X-ray of the left lower leg

6514 73105 39003 X-ray of the right lower leg

6512 74100 39003 X-ray of the left ankle

6512 74105 39003 X-ray of the right ankle

6511 74120 39003 X-ray of the left foot

6511 74125 39003 X-ray of the right foot

6513 74130 39003 X-ray of the left calcaneus

6513 74135 39003 X-ray of the right calcaneus

6511 74140 39003 X-ray of both feet – standing – single view



3305 74145 39001 X-ray of a toe

6517 71100 39003 X-ray of the left femur

6517 71105 39003 X-ray of the right femur

6515 72100 39003 X-ray of the left knee one or two views - AP

6515 72100 39003 X-ray of the left knee one or two views - Lateral

6515 72105 39003 X-ray of the right knee one or two views - AP

6515 72105 39003 X-ray of the right knee one or two views - Lateral

Non-chargable 72120 39003 X-ray of the left knee including patella

Non-chargable 72125 39003 X-ray of the right knee including patella

6516 72140 39003 X-ray of left patella

6516 72145 39003 X-ray of right patella

Non-chargable 72150 39003 X-ray both knees standing – single view

6519 74150 39003 X-ray of the sesamoid bones one or both sides - Left

6519 74150 39003 X-ray of the sesamoid bones one or both sides - Right

Ultrasound abdomen and Pelvis

5102 61200 Non-chargable Ultrasound of the left shoulder joint

5102 61210 Non-chargable Ultrasound of the right shoulder joint

Non-chargable 41200 Non-chargable Ultrasound study of the upper abdomen

3627 40210 Non-chargable Ultrasound study of the whole abdomen including the pelvis

3618 43200 39147 Ultrasound study of the pelvis transabdominal

3615 43250 39145 Ultrasound study of the pregnant uterus, first trimester

Non-chargable 43270 39145 Ultrasound study of the pregnant uterus, third trimester, first visit

Non-chargable 43273 39145 Ultrasound study of the pregnant uterus, third trimester, follow-up visit

3615 43277 39145 Ultrasound study of the pregnant uterus, multiple gestation, second or

third trimester, first visit

3617 43260 39145 Routine obstetric ultrasound at 20 to 24 weeks to include detailed

anatomical assessment


GEMS Radiology Request FormSapphire • Beryl

Referring General Practitioner Details:Doctor’s Name: _____________________________________________________________________ Practice Number: nnnnnnnnnnnTel: nnnnnnnnnn Fax: nnnnnnnnnn Email: ___________________________________________________________

Signature: _____________________________

Patient Details:Patient date of birth: nnnnnnnn Gender: n M n FPatient Surname: ___________________________________________ Patient Name: ______________________________________________________Medical Scheme Name: _____________________________________________ Medical Scheme Option: ___________________________________Membership Number: nnnnnnnnnn Dependant Code: nn I certify that the above information is correct and give specific consent for selected test(s) to be done. I authorise the disclosure of these results to my doctor, medical aid administrators and/or insurance company. I

undertake to pay all outstanding monies not covered by medical aid. I fully understand the implication of the test and have received adequate pre-test counselling.

Patient Signature: _____________________________

Clinical Information:ICD-10 Codes: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please choose from the following investigations below. For certain tests, please specify the view and site.Skull and brain Ref price Pelvis and hips Ref price Lower limb cont. Ref price

Skull Pelvis Knee: right apFacial bones and nasal bones Hip: left Knee: right lateral

Facial bones Hip: right Knee including patella: leftNasal bones Pelvis and hips Knee including patella: right

Orbits and paranasal sinuses Upper limb Patella: leftOrbits Clavicle: left Patella: rightParanasal sinuses Clavicle: right Both knees standing: single viewParanasal sinuses: 2 views Scapula: left Sesamoid bones: left

Mandible, teeth and maxilla Scapula: right Sesamoid bones: rightMandible Acromio-clavicular joint: left UltrasoundTeeth: single quadrant Acromio-clavicular joint: right Ultrasound: left shoulder jointSpecify quadrants: Shoulder: left Ultrasound: right shoulder jointTeeth: more than one quadrant Shoulder: right Ultrasound study: upper abdomenSpecify quadrants: Humerus: left Ultrasound: abdomen and pelvisTeeth: full mouth Humerus: right Ultrasound: pelvis transabdominalTempero-mandibular joint: left Elbow: left Ultrasound: pregnant uterusTempero-mandibular joint: right Elbow: right

For tests not included on this form, please contact 0860 436 777 and request an authorisation number.Mastoids: left Forearm: left

Mastoids: right Forearm: rightMastoids: right and left Hand: left

Thorax Hand: right List additional test required:Chest: pa Finger: specifyChest: lateral Wrist: leftChest : pa and lateral Wrist: rightRibs Scaphoid: left

Abdomen Scaphoid: rightAbdomen Lower limbAbdomen: multiple views incl chest Lower leg: leftSpecify views: Lower leg: rightAbdomen: supine and erect or decubitus Ankle: left

Spine Ankle: right Authorisation number:Spine scoliosis view: ap only Foot: leftCervical spine: ap Foot: rightCervical spine: lateral Calcaneus: left Clinical informationThoracic spine: ap Calcaneus: rightThoracic spine: lateral Both feet standing: single viewLumbar spine: ap Toe: specifyLumbar spine: lateral Femur: leftSaccrum and coccyx Femur: rightSacro-iliac joints Knee: left ap

Knee: left lateral

Tel 0860 436 777 • Fax 0861 00 4367 • [email protected] • HIV Aids Helpline 0860 436 736• www.gems.gov.za

Annexure B: GEMS Radiology Request Form


Annexure C: GEMS Network Pathology Formulary

RPL DESCRIPTION SUBJECT TO AUTHORISATION

A. Chemistry

Cardia / Muscle

4152 CK-MB: Mass determination: Quantitative (Automated) No

4161 Troponin isoforms: Each No

Diabetes

4057 Glucose: Quantitative No

4064 HbA1C No

4221 Creatinine No

4261 Micro Albuminurea (Quantitative) No

Inflammation / Immune

3947 C-reactive protein No

Lipids

4027 Cholesterol total No

4026 LDL cholesterol No

4028 HDL cholesterol No

4147 Triglyceride No

4132 Creatinine Kinase (CK) No

Liver / Pancreas

3999 Albumin No

4001 Alkaline phosphatase No

4006 Amylase No

4009 Bilirubin: Total No

4010 Bilirubin: Conjugated No

4117 Protein: Total No

4130 Aspartate aminotransferase (AST) No

4131 Alanine aminotransferase (ALT) No

4133 Lactate dehidrogenase (LD) No

4134 Gamma glutamyl transferase (GGT) No

Renal / Electrolytes / Bone

4017 Calcium: Spectrophotometric No

4032 Creatinine No

4086 Lactate No

4094 Magnesium: Spectrophotometric No

4109 Phosphate No

4113 Potassium No

4114 Sodium No



4155 Uric acid No

4151 Urea No

Cerebrospinal fluid

B. Haematology

3709 Antiglobulin test (Coombs' or trypsinzied red cells) No

3716 Mean cell volume No

3743 Erythrocyte sedimentation rate No

3739 Erythrocyte Count No

3783 Leucocyte Differential Count No

3785 Leucocytes - Total Count No

3791 Packed Cell Volume: Haematocrit No

3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) No

3762 Haemoglobin estimation No

3764 Grouping: A B and O antigens No

3765 Grouping: Rh antigen No

3797 Platelet count No

3805 Prothrombin index No

3809 Reticulocyte count No

3865 Parasites in blood smear No

4071 Iron No

4144 Transferrin No

4491 Vitamin B12 No

4528 Ferritin No

4533 Folic acid No

C. Endocrine - Reproductive

4450 HCG: Monoclonal immunological: Qualitative No

4537 Prolactin No

Endocrine - Thyroid

4482 Free thyroxine (FT4) No

4507 Thyrotropin (TSH) No

Other Endocrine

4519 Prostate specific antigen No

D. Serology

Auto immune

3934 Auto antibodies by labelled antibodies: FOR ANF ONLY No

3939 Agglutination test per antigen No



4155 Uric acid No

4182 Quantitative protein estimation: Nephelometer or Turbidometeric method: FOR RHEUMATOID FACTOR ONLY

No

Hepatitis tests

4531 Hepatitis: Per antigen or antibody No

4531 Acute hepatitis A (IgM) No

4531 Chronic Hepatitis A (IgG) No

4531 Acute Hepatitis B (BsAG) No

4531 Hepatitis B: carrier/ immunity (BsAB) No

HIV tests

3816 T and B-cells EAC markers (limited to ONE marker only for CD4/8 counts) No

3932 Antibodies to human immunodeficiency virus (HIV): ELISA No

3974 Qualitative PCR (only for children < age 6 months) No

4429 Quantitative PCR (DNA/RNA) No

4614 HIV Rapid Test No

Infectious Diseases and Others

3946 IgM: Specific antibody titer: ELISA/EMIT: RUBELLA No

3948 IgG: Specific antibody titer: ELISA/EMIT: RUBELLA No

3949 Qualitative Kahn, VDRL or other flocculation No

3951 Quantatative Kahn, VDRL or other flocculation No

E. Cytology

4566 Vaginal or cervical smears, each No

F. Histology

4567 Histology per sample No

G. Miscellaneous

4352 Faecal occult blood test (FOB) No

H. Microbiology

MCHS

3909 Anaerobe culture: Limited procedure No

3901 Fungal culture No

3918 Mycoplasma culture: Comprehensive No

4401 Cell count No

4188 Urine dipstick, per stick (irrespective of the number of tests on stick) No

3928 Antimicrobic substances No

3893 Bacteriological culture: Miscellaneous No

3867 Miscellaneous (body fluids, urine, exudate, fungi, puss, scrapings, etc.) No

3922 Viable cell count No

3879 Campylobacter in stool: Fastidious culture No

3895 Bacteriological culture: Fastidious organisms No

3928 Antimicrobic substances No

3887 Antibiotic susceptibility test: Per organism No

3924 Biochemical identification of bacterium: Extended No

3869 Faeces (including parasites) No



3868 Fungus identification No

3881 Mycobacteria No

3901 Fungal culture No

3868 Fungus identification No

AFB flurochrome auramine (ZN) only

3885 Cytochemical stain No

3881 Antigen detection with monoclonal antibodies No

TB culture

0221 Mantoux-Tuberculin PPD test No

3881 Antigen detection with monoclonal antibodies No

4433 Bacteriological DNA identification (LCR) No

3916 Radiometric tuberculosis culture No


3895 Bacteriological culture: Fastidious organisms No

TB sensitivity

3887 Antibiotic susceptibility test: Per organism No

3974 Polymerase chain reaction Yes

Extrapulmonary TB

4139 Adenosine deaminase (CSF, Peritoneal or Pleural) No

Parasites

3869 Faeces (including parasites) No

3883 Concentration techniques for parasites No

3865 Parasites in blood smear No

Bilharzia micro

3980 Bilharzia Ag Serum/Urine No


3946 IgM: Specific antibody titer:ELISA/EMIT: Per Ag No

3883 Concentration techniques for parasites No


GEMS Pathology Clinical Request FormSapphire • Beryl

n Urgent

n RoutineReferring General Practitioner Details:Doctor’s Name: _____________________________________________________________________ Practice Number: nnnnnnnnnnnTel: nnnnnnnnnn Fax: nnnnnnnnnn Email: ___________________________________________________________

Signature: _____________________________

Copies to Doctors: _____________________________________________________________________________________________________Contact Person: ________________________________________________________________________________________________________Test Laboratory: ________________________________________________________________________________________________________

Patient Details (Patient to complete)

n Male n Female Date of birth: nnnnnnnnSurname: ___________________________________________________________First Name: ___________________________________________________________Medical Scheme Name: ________________________________________________Medical Scheme Option: ________________________________________________Membership number: nnnnnnnnnnnnDependent Code: nn

Person responsible for payment of account:ID Number: nnnnnnnnnnnnnSurname: _____________________________________________________________First name: ___________________________________________________________Tel: nnnnnnnnnnPostal Address: _________________________________________________________________________________________________________________________________________________________________________________________________

I certify that the above information is correct and give specific consent for selected test(s) to be done. I authorise the disclosure of these results to doctor, my medical aid administrators and/or insurance company. I fully understand the implication of the test and have received adequate pre-test counselling.

Patient SignatureICD 10 Codes: _____________________________________________________________________________________________________________________________

Clinical Information: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________________________________

Please note that the prices listed below, are reference prices only. GEMS has specific arrangements in place with various laboratories.Chemistry Ref price Endocrinology Ref price Inflammation/ immunology Ref priceRenal / electrolytes / bone Endocrine – thyroid Auto-immune

Creatinine TSH CRPCalcium (serum - no cuff) Free T4 ESRMagnesium Endocrine – reproductive Uric acidPhosphate (serum) b-HCG screen Rheumatoid factorSodium Prolactin (rest 15 minutes) ANF

Agglutination test per antigenPotassium Diabetes Infectious diseasesUrea Glucose fasting VDRL (Qualitative)Lactate Glucose random VDRL (Quantitative)

Liver / pancreas HBA1C Rubella immunity (IgG only)Albumin Creatinne Hepatitis tests: specifyTotal protein Microalbunurea (quanititative) Acute hepatitis A (IgM)ALP Antenatal screen Chronic hepatitis A (IgG)ALT Haemoglobin estimation Acute hepatitis B (Bs AG)AST Platelet count Hepatitis B (carrier/immunity : BsAB)Bilirubin (total, conjugated) - fee ± Blood group: A B and O antigen HIV testsGGT Coombs test HIV 1+2 Ab + P24 AgLactate dehydrogenase Grouping: Rh antigen HIV Ab - Rapid TestAmylase HEP B s Ag CD4 count

Cardiac / muscle HIV 1+2 Ab + P24 Ag The following HIV related tests require an authorisationTroponin VDRL HIV PCR viral loadCK-MB mass Rubella igg, IgM - fee ± HIV PCR qualitative (diagnostic only)

Lipids / CAD risk Tumour markers MicrobiologyCholesterol PSA Micro specimen type and site :HDL and LDL Haematology MCSTriglycerides (fasting) Grouping: A B and O antigens AFB fluorochrome auramine (ZN) onlyCreatinine kinase (ck) Grouping: Rh antigen Parasites

Histology Full blood count Bilharzia microscopyHistology per sample Platelet count TB tests

Clinical data (please supply): Haemoglobin estimation TB cultureReticulocyte count TB sensitivityESR Adenosine deaminase (CSF)

Specimen type: Iron Adenosine deaminase (Peritoneal)Transferrin Adenosine deaminase (Pleural)Ferritin Mantoux-Tuberculin PPD test

Cytology Folate (serum) The following TB related tests require an authorisation Cervical /vaginal smear Vit B12 TB PCR Testing

Specimen type: Coombs test For tests not mentioned on this request form, kindly contact 0860 436 777 for a pre-authorisation number.

Parasites in blood smear Other tests requested:

Coagulation Pre-authorisation number:INR/PIMiscellaneousFaecal occult blood test (FOB)

Tel 0860 436 777 • Fax 0861 00 4367 • [email protected] • HIV Aids Helpline 0860 436 736• www.gems.gov.za

Collection Date: ____________________________Collected by: _______________________________Collection Time: ____________________________

Annexure D: GEMS Pathology Request Form

Visit www.gems.gov.za to download this form.


Sapphire and BerylSpecialist Referral Form

All non-emergency and non-emergency out-of-hospital specialist referrals require an authorisation, obtainable from the GEMS Call Centre on 0860 436 777. Please ensure that this form accompanies the patient when consulting with the authorised specialist practitioner.

Authorisation Number:

Section 1: Patient Details

Surname: ______________________________________________________________________________________________________________

Full first name: __________________________________________________________________________________________________________

Date of birth: nnnnnnnn Age: nn ID No: nnnnnnnnnnnnn Gender: n M n F

Postal address: _________________________________________________________________________________________________________

____________________________________________________________________________________________ Code ______________________

Tel no (H): _______________________________________________ Tel no (W): _____________________________________________________

Cell phone: ______________________________________________ Scheme option: ________________________________________________

Member no: nnnnnnnnn Dependent code nn

Section 2: Referring Nominated Family Practitioner’s Details

Doctor’s name: __________________________________________________________________________________________________________

Practice no.: ____________________________________________________________________________________________________________

Tel no: ___________________________________________________ Email: ________________________________________________________

Section 3: Specialist Practitioner’s Details

Specialist name: _________________________________________________________________________________________________________

Consultation appointment date: nnnnnnnn

Section 4: Patient’s Clinical Details

Clinical diagnosis: _______________________________________________________________________________________________________

Reason for referral: ______________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

Date of onset: nnnnnnnn ICD 10 codes: ____________________________________________________________________

Current medication: ______________________________________________________________________________________________________

Special investigations and results: __________________________________________________________________________________________

Referring doctor’s signature: ______________________________________________________________________________________________

Specialist Practitioner’s please note: Sapphire and Beryl are low cost options subject to managed care protocols and formularies. The GEMS Sapphire & Beryl Medicine, Pathology and Radiology formularies are available on www.gems.gov.za. Pre-authorisation is needed for any further referrals, investigations or medicine not in the formulary. Kindly call 0860 436 777 for all pre-authorisations or for further queries.

Tel 0860 436 777 • Fax 0861 00 4367 • [email protected] • www.gems.gov.za

Annexure E: GEMS Specialist Referral Form



Sapphire and Beryl Re-order Form

Dear Doctor

To re-order a new pad please complete and fax to 0861 436 777 or scan and email to [email protected] and we will

post a new one to your practice.

Details of your practice

Name:

Practice No:

Tel No:

Postal address:

Code:

Tel 0860 436 777 • Fax 0861 00 4367 • [email protected] • HIV Aids Helpline 0860 436 736 • www.gems.gov.za

Annexure F: GEMS Sapphire and Beryl Re-order Form



Therapeutic Class Nappi Ingredients Product Name Strength Form Reimbursement criteria

Addison's disease

716693 Hydrocortisone COVOCORT 10MG TAB Accepted treatment

726540 Fludrocortisone FLORINEF ACETATE 0.1MG TAB Accepted treatment

Asthma

Inhaled B2 agonists 700715 Salbutamol ASTHAVENT 300D ECOHALER CFC FREE

INH Accepted treatment

878219 Salbutamol ASTHAVENT DP CPS Accepted treatment

849332 Salbutamol ASTHAVENT ECOHALER 200DOSE INH Accepted treatment

711213 Salbutamol VENTEZE CFC FREE 200 DOSE INH Accepted treatment

720723 Salbutamol VENTIMAX CFC FREE 200 DOSE 100MCG INH Accepted treatment

Long acting B2 agonists 704175 Formoterol FORATEC DP CAPS CPS Clinical review

710307 Formoterol FORATEC HFA 120DOSE INH Clinical review

Inhaled corticosteroids 827061 Beclomethasone BECEZE 50 200DOSE 50MCG INH Accepted treatment

827088 Beclomethasone BECEZE INHALER COMPLETE 100MCG INH Accepted treatment

820083 Beclomethasone BECLATE 200 200MCG INH Accepted treatment

819638 Beclomethasone BECLATE INHALER 100MCG INH Accepted treatment

819611 Beclomethasone BECLATE INHALER 50MCG INH Accepted treatment

897469 Budesonide BUDEFLAM CFC FREE 200MCG 300 DOSE INH

200MCG INH Accepted treatment

897462 Budesonide BUDEFLAM CFC FREE 300 DOSE INH 100MCG INH Accepted treatment

704176 Budesonide BUDEFLAM DP CAPS CAP Accepted treatment

707879 Budesonide INFLAMMIDE NOVOLIZER COMPLETE 100DOSE

400MCG INH Accepted treatment

707881 Budesonide INFLAMMIDE NOVOLIZER REFILL 100DOSE

400MCG REF Accepted treatment

791423 Budesonide PULMICORT 100 TURB (200 DOSE) 100MCG ATH Accepted treatment

KEY to Chronic Medicine Management Reimbursement Criteria:

• Quantity/dosage and duration of authorisation may vary - depending on the requested drug.• Accepted Treatment - will be authorised without requesting additional clinical information (unless specific concerns e.g. unusual

dose requests).• Clinical Review - will be authorised if the drug history or co-morbidity clearly indicates that use of the drug is indicated in the

specific patient.• Clinical Motivation - specific clinical information required before reimbursement is considered.• Specialist Script - will require a relevant specialist's prescription before reimbursement is considered.• Specialist Motivation - will require a relevant specialist motivation before reimbursement is considered.• Special Investigations (SI) - results of recent relevant tests required before reimbursement is considered.

Annexure G: GEMS Sapphire and Beryl Network Chronic Medicine Formulary



791431 Budesonide PULMICORT 200 TURB (200 DOSE) 200MCG ATH Accepted treatment

Oral xanthines 788368 Theophylline SANDOZ THEOPHYLLINE ANHYDROUS

200MG SRT Clinical review

788376 Theophylline SANDOZ THEOPHYLLINE ANHYDROUS 300

300MG SRT Clinical review

770388 Theophylline THEOPHEN SYR Clinical review

Oral corticosteroids 800155 Prednisolone LENISOLONE 5MG TAB Specialist script

814407 Prednisolone CAPSOID 5MG TAB Specialist script

752304 Prednisone PANAFCORT 5MG TAB Specialist script

788783 Prednisone BE-TABS PREDNISONE 5MG TAB Specialist script

Devices 577802 DP HALER DEVICE UNI Accepted treatment

Bipolar Mood Disorder

Mood stabilisers 712493 Carbamazepine DEGRANOL 200MG TAB Accepted treatment

712523 Carbamazepine SANDOZ CARBAMAZEPINE 200MG TAB Accepted treatment

705597 Carbamazepine SANDOZ CARBAMAZEPINE CR200 200MG SRT Accepted treatment

705602 Carbamazepine SANDOZ CARBAMAZIPINE CR400 400MG SRT Accepted treatment

779652 Carbamazepine TEGRETOL CR 200MG SRT Accepted treatment


769401 Carbamazepine TEGRETOL S 100MG/5ML SUS Accepted treatment

715962 Carbamazepine ZEPTOL 200MG TAB Accepted treatment

710389 Lamotrigine DYNA-LAMOTRIGINE 100MG TAB Accepted treatment




704381 Lamotrigine EPITEC 100MG 100MG TAB Accepted treatment




710887 Lamotrigine LAMIDUS 100MG TAB Accepted treatment



712217 Lamotrigine LAMITOR 200MG TAB Accepted treatment



712078 Lithium CAMCOLIT 250MG TAB Accepted treatment


758833 Lithium QUILONUM RETARD 450MG TAB Accepted treatment

715980 Valproic acid CONVULEX 150MG CAP Accepted treatment



781541 Valproic acid CONVULEX 50MG/ML SYR Accepted treatment

821578 Valproic acid EPILIM CRUSHABLE 100 MG TAB Accepted treatment

780545 Valproic acid EPILIM SUGAR FREE 200MG SYR Accepted treatment

721460 Valproic acid EPROLEP CR 200 200MG SRT Accepted treatment





718465 Valproic acid NAVALPRO CR 200MG SRT Accepted treatment



720026 Valproic acid VANAPRO 300MG SRT Accepted treatment


Antipsychotic agents 735884 Chlorpromazine LARGACTIL 100MG TAB Accepted treatment

735868 Chlorpromazine LARGACTIL 25MG TAB Accepted treatment


717082 Clozapine ASPEN CLOZAPINE 100MG TAB Accepted treatment

717081 Clozapine ASPEN CLOZAPINE 25MG TAB Accepted treatment

700178 Clozapine CLOMENT 100MG TAB Accepted treatment (clinical motivation

required for low cost option)



726672 Flupentixol FLUANXOL DEPOT 1ML 20MG INJ Accepted treatment

744328 Fluphenazine MODECATE PLUS SYRINGE 1ML 25MG/ML INJ Accepted treatment

719549 Haloperidol GULF HALOPERIDOL 5MG TAB Accepted treatment

730335 Haloperidol SANDOZ HALOPERIDOL 1.5 1.5MG TAB Accepted treatment

730327 Haloperidol SANDOZ HALOPERIDOL 5 5MG TAB Accepted treatment

763411 Haloperidol SERENACE 0.5MG CAP Accepted treatment

720527 Olanzapine LANAZYP 2.5MG TAB Accepted treatment (clinical motivation


720528 Olanzapine LANAZYP 5MG TAB Accepted treatment (clinical motivation


718997 Olanzapine MYLAN OLANZAPINE 10MG TAB Accepted treatment (clinical motivation


718995 Olanzapine MYLAN OLANZAPINE 2.5MG TAB Accepted treatment (clinical motivation




721389 Olanzapine OLAWIN 10MG TAB Accepted treatment (clinical motivation


721385 Olanzapine OLAWIN 2.5MG TAB Accepted treatment (clinical motivation






715659 Olanzapine OLEXAR 10MG TAB Accepted treatment (clinical motivation




720714 Olanzapine PREXOLAN 10MG TAB Accepted treatment (clinical motivation




715683 Olanzapine REDILANZ 2.5MG TAB Accepted treatment (clinical motivation


721653 Olanzapine ZYLENA 10MG TAB Accepted treatment (clinical motivation




716051 Quetiapine DOPAQUEL 100MG TAB Accepted treatment (clinical motivation








720980 Quetiapine KIZOFRIN 100MG TAB Accepted treatment (clinical motivation








716670 Quetiapine MYLAN QUETIAPINE 100MG TAB Accepted treatment (clinical motivation










718353 Quetiapine PSYQUET 100MG TAB Accepted treatment (clinical motivation






721745 Quetiapine QUETIAPINE BIOTECH 100MG TAB Accepted treatment (clinical motivation








716637 Quetiapine QUETOSER 200MG TAB Accepted treatment (clinical motivation




716652 Quetiapine SEREZ 100MG TAB Accepted treatment (clinical motivation








718704 Quetiapine SIZONORM 100MG TAB Accepted treatment (clinical motivation










720894 Quetiapine SPEC QUETIAPINE 100MG TAB Accepted treatment (clinical motivation










714686 Risperidone AUROPIDONE 0.5MG TAB Accepted treatment (clinical motivation


714690 Risperidone AUROPIDONE 4MG TAB Accepted treatment (clinical motivation


720334 Risperidone PERIDA 0.5MG TAB Accepted treatment (clinical motivation


712618 Risperidone PERIZAL 1MG TAB Accepted treatment (clinical motivation






717996 Risperidone RISNIA 0.5MG TAB Accepted treatment (clinical motivation


717997 Risperidone RISNIA 1MG TAB Accepted treatment (clinical motivation








714101 Risperidone RISPACOR 0.5MG TAB Accepted treatment (clinical motivation


713967 Risperidone RISPACOR 1MG TAB Accepted treatment (clinical motivation








823163 Risperidone RISPERDAL ORAL 1mg/ml SYR Accepted treatment (clinical motivation


718226 Risperidone RISPEVON 1MG TAB Accepted treatment (clinical motivation








711538 Risperidone RISPONZ 4MG TAB Accepted treatment (clinical motivation








715736 Risperidone SCHIZOROL 0.5MG TAB Accepted treatment (clinical motivation


711511 Risperidone ZOXADON 0.5MG TAB Accepted treatment (clinical motivation


711512 Risperidone ZOXADON 1MG TAB Accepted treatment (clinical motivation










705386 Sulpiride BIO-SULPIRIDE 200MG TAB Accepted treatment

766410 Trifluoperazine STELAZINE 1MG TAB Accepted treatment


786934 Zuclopenthixol CLOPIXOL ACUPHASE 50MG INJ Accepted treatment

714852 Zuclopenthixol CLOPIXOL DEPOT 200MG INJ Accepted treatment

Antidepressants 718746 Amitriptyline GULF AMITRIPTYLINE 25MG TAB Accepted treatment

784230 Amitriptyline SANDOZ AMITRIPTYLINE HCL 25MG TAB Accepted treatment

772003 Amitriptyline TREPILINE 10MG TAB Accepted treatment


713583 Citalopram ARROW CITALOPRAM 20MG TAB Accepted treatment


713356 Citalopram AURO-CITALOPRAM 20MG TAB Accepted treatment

707396 Citalopram AUSTELL-CITALOPRAM 10MG TAB Accepted treatment



717094 Citalopram BIO CITALOPRAM 20MG TAB Accepted treatment

707888 Citalopram CILATE 20MG TAB Accepted treatment

711988 Citalopram CILORAM 20MG TAB Accepted treatment

704331 Citalopram CITALOHEXAL 20MG TAB Accepted treatment

716521 Citalopram CITALOPRAM ACTOR 20MG TAB Accepted treatment

709407 Citalopram CITALOPRAM-WINTHROP 20MG TAB Accepted treatment

705252 Citalopram DEPRAMIL 40MG TAB Accepted treatment

713757 Citalopram DRL CITALOPRAM 40MG TAB Accepted treatment

717372 Citalopram GLENMARK CITALOPRAM 20MG TAB Accepted treatment

702769 Citalopram TALOMIL 20MG TAB Accepted treatment

703391 Fluoxetine A-LENNON FLUOXETINE 20MG CAP Accepted treatment

894303 Fluoxetine DEPROZAN 20MG CAP Accepted treatment

716520 Fluoxetine FLUOXETINE ACTOR 20MG CAP Accepted treatment

719658 Fluoxetine PROLAX 20MG CAP Accepted treatment

700686 Fluoxetine RANFLOCS 20MG CAP Accepted treatment

707426 Fluoxetine REZAK 20MG CAP Accepted treatment

705064 Fluoxetine ZYDUS FLUOXETINE 20MG CAP Accepted treatment

724661 Imipramine ETHIPRAMINE 10MG TAB Accepted treatment




Bronchiectasis

785229 Amoxicillin ADCO-AMOXYCILLIN 250MG CAP Accepted treatment

811440 Amoxicillin ADCO-AMOXYCILLIN 500MG CAP Accepted treatment

704443 Amoxicillin ALLMOX 250MG CAP Accepted treatment

704444 Amoxicillin ALLMOX 500MG CAP Accepted treatment

784656 Amoxicillin AMOCILLIN 250MG CAP Accepted treatment

704401 Amoxicillin AMOXICAP 250 250MG CAP Accepted treatment

714185 Amoxicillin AMYN 250MG CAP Accepted treatment

714184 Amoxicillin AMYN 500MG CAP Accepted treatment

713363 Amoxicillin AURO-AMOXYCILLIN 250MG CAP Accepted treatment

713364 Amoxicillin AURO-AMOXYCILLIN 500MG CAP Accepted treatment

707499 Amoxicillin AUSTELL-AMOXICILLIN 250MG CAP Accepted treatment

705637 Amoxicillin AUSTELL-AMOXICILLIN 500MG CAP Accepted treatment

788155 Amoxicillin BETAMOX 250 250MG CAP Accepted treatment

788546 Amoxicillin BETAMOX 500 500MG CAP Accepted treatment

815268 Amoxicillin IPCAMOX 250MG CAP Accepted treatment

806579 Amoxicillin MOXYMAX 250 250MG CAP Accepted treatment

806587 Amoxicillin MOXYMAX 500 500MG TAB Accepted treatment

744689 Amoxicillin MOXYPEN 250MG CAP Accepted treatment

744697 Amoxicillin MOXYPEN 500MG CAP Accepted treatment

705679 Amoxicillin MYMOX 250MG CAP Accepted treatment

705709 Amoxicillin MYMOX 500MG CAP Accepted treatment

808741 Amoxicillin PROMOXIL 250MG CAP Accepted treatment

808768 Amoxicillin PROMOXIL 500MG CAP Accepted treatment

824879 Amoxicillin RANMOXY 500 500MG CAP Accepted treatment

716122 Amoxicillin YOMAX 250MG CAP Accepted treatment

716123 Amoxicillin YOMAX 500MG CAP Accepted treatment

708398 Amoxicillin ZALOXY 250MG CAP Accepted treatment

708397 Amoxicillin ZALOXY 500MG CAP Accepted treatment

893402 Doxycycline A-LENNON DOXYCYCLINE HCL 100MG CAP Accepted treatment

716944 Doxycycline CYCLIDOX 100MG CAP Accepted treatment

809667 Doxycycline DOXYCYL 100MG CAP Accepted treatment

714192 Doxycycline DOXYTET 100MG CAP Accepted treatment

706948 Sulfamethoxazole and trimethoprim CASICOT 480MG TAB Accepted treatment

716731 Sulfamethoxazole and trimethoprim COZOLE 480MG TAB Accepted treatment

704095 Sulfamethoxazole and trimethoprim ILVITRIM 480MG TAB Accepted treatment

735698 Sulfamethoxazole and trimethoprim LAGATRIM 480MG TAB Accepted treatment

701754 Sulfamethoxazole and trimethoprim MICRO CO-TRIMOXAZOLE 480MG TAB Accepted treatment

867977 Sulfamethoxazole and trimethoprim NUCOTRIM 480MG TAB Accepted treatment

758248 Sulfamethoxazole and trimethoprim PURBAC ADULT 480MG TAB Accepted treatment

758256 Sulfamethoxazole and trimethoprim PURBAC DS 960MG TAB Accepted treatment

782793 Sulfamethoxazole and trimethoprim SANDOZ CO-TRIMOXAZOLE 960 960MG TAB Accepted treatment

789836 Sulfamethoxazole and trimethoprim TRIMETHOX 480MG TAB Accepted treatment



715609 Sulfamethoxazole and trimethoprim TRIXAZOLE 480MG TAB Accepted treatment

Chronic obstructive Pulmonary disease

Inhaled B2 agonists 849332 Salbutamol ASTHAVENT 300 DOSE INH Accepted treatment

700715 Salbutamol ASTHAVENT 300D ECOHALER CFC FREE

INH Accepted treatment

878219 Salbutamol ASTHAVENT DP CPS Accepted treatment

711213 Salbutamol VENTEZE CFC FREE 200 DOSE INH Accepted treatment

720723 Salbutamol VENTIMAX CFC FREE 200 DOSE 100MCG INH Accepted treatment

Inhaled corticosteroids 897469 Budesonide BUDEFLAM CFC FREE 200MCG 300 DOSE INH

200MCG INH Special investigations (SI)

897462 Budesonide BUDEFLAM CFC FREE 300 DOSE INH 100MCG INH Special investigations (SI)

704176 Budesonide BUDEFLAM DP CAPS CAP Special investigations (SI)

707879 Budesonide INFLAMMIDE NOVOLIZER COMPLETE 100DOSE

400MCG INH Special investigations (SI)

707881 Budesonide INFLAMMIDE NOVOLIZER REFILL 100DOSE

400MCG REF Special investigations (SI)

791423 Budesonide PULMICORT 100 TURB (200 DOSE) 100MCG ATH Special investigations (SI)

791431 Budesonide PULMICORT 200 TURB (200 DOSE) 200MCG ATH Special investigations (SI)

827061 Beclomethasone BECEZE 50 200DOSE 50MCG INH Special investigations (SI)

827088 Beclomethasone BECEZE INHALER COMPLETE 100MCG INH Special investigations (SI)

820083 Beclomethasone BECLATE 200 200MCG INH Special investigations (SI)

819638 Beclomethasone BECLATE INHALER 100MCG INH Special investigations (SI)

819611 Beclomethasone BECLATE INHALER 50MCG INH Special investigations (SI)

Anticholinergic inhalers 715574 Ipratropium bromide IPVENT HFA 200 DOSE 40MCG/1DOSE INH Accepted treatment

Oral xanthines 788368 Theophylline SANDOZ THEOPHYLLINE ANHYDROUS

200MG SRT Accepted treatment

788376 Theophylline SANDOZ THEOPHYLLINE ANHYDROUS 300

300MG SRT Accepted treatment

Oral corticosteroids 788783 Prednisone BE-TABS PREDNISONE 5MG TAB Special investigations (SI)

814407 Prednisolone CAPSOID 5MG TAB Special investigations (SI)

800155 Prednisolone LENISOLONE 5MG TAB Special investigations (SI)

752304 Prednisone PANAFCORT 5MG TAB Special investigations (SI)

Influenza vaccine 711345 Influenza inactivated whole virus FLUVAX PRE-FILLED SYRINGE 0.5ML VAC Accepted treatment

732826 Influenza inactivated whole virus INFLUVAC 0.5ML VAC Accepted treatment

813338 Influenza inactivated whole virus VAXIGRIP SINGLE DOSE VAC Accepted treatment

Devices 577802 DP HALER DEVICE UNI Accepted treatment

Cardiac failure/Cardiomyopathy

Anticoagulants 709906 Warfarin CIPLA WARFARIN 1MG 1MG TAB Accepted treatment

709905 Warfarin CIPLA WARFARIN 5MG 5MG TAB Accepted treatment



778362 Warfarin WARFARIN 5MG TAB Accepted treatment

Diuretics 821845 Furosemide BEURISES 40MG TAB Accepted treatment

716048 Furosemide DINO-RETIC 40MG TAB Accepted treatment

705967 Furosemide DIURESIX 40MG TAB Accepted treatment

857769 Furosemide MERCK FUROSEMIDE 40 MG TAB Accepted treatment

758272 Furosemide PURESIS 40MG TAB Accepted treatment

731668 Furosemide SANDOZ FUROSEMIDE 40 40MG TAB Accepted treatment

890470 Hydrochlorothiazide HEXAZIDE 25MG TAB Accepted treatment

710437 Hydrochlorothiazide RIDAQ 12.5MG 12.5MG TAB Accepted treatment

880949 Hydrochlorothiazide RIDAQ 25MG 25MG TAB Accepted treatment

774057 Hydrochlorothiazide and potassium URIREX-K TAB Accepted treatment

780618 Hydrochlorothiazide and potassium-sparing agents

ADCO-RETIC TAB Accepted treatment


AMILORETIC TAB Accepted treatment


BETARETIC TAB Accepted treatment


DEZRETIC 5MG/50MG 50MG/5MG TAB Accepted treatment


SPEC-CO-AMILORIDE 50MG/5MG TAB Accepted treatment

710313 Indapamide CIPLA-INDAPAMIDE 2.5MG TAB Accepted treatment

833045 Indapamide DAPTRIL 2.5MG TAB Accepted treatment

703329 Indapamide MERCK-INDAPAMIDE 2.5MG TAB Accepted treatment

701793 Spironolactone ALDACTONE 25MG TAB Accepted treatment

769665 Spironolactone SANDOZ SPIRONOLACTONE 25 25MG TAB Accepted treatment

765910 Spironolactone SPIRACTIN 25MG TAB Accepted treatment

Potassium supplementation

755753 Potassium chloride PLENISH K 600MG TAB Accepted treatment

719270 Potassium chloride POTASSIUM CHLORIDE UNICORN 600MG TAB Accepted treatment

702947 Potassium chloride SANDOZ K-600 600MG TAB Accepted treatment

764396 Potassium chloride SLOW-K 600MG TAB Accepted treatment

718911 Potassium chloride ULTIPOT 600MG SRT Accepted treatment

ACE inhibitors 852333 Captopril ACETEN 25MG TAB Accepted treatment

837628 Captopril CAPTOHEXAL 12.5MG TAB Accepted treatment

836451 Captopril CAPTOMAX 25MG TAB Accepted treatment


852619 Captopril MERCK CAPTOPRIL 25MG TAB Accepted treatment

899429 Captopril MERCK-CAPTOPRIL 50MG TAB Accepted treatment

886843 Enalapril ADCO-ENALAPRIL 10MG 10MG TAB Accepted treatment


881481 Enalapril ALAPREN 10 10MG TAB Accepted treatment



894324 Enalapril CIPLATEC 10 10MG TAB Accepted treatment

701729 Enalapril CIPLATEC 20MG 20MG TAB Accepted treatment




891279 Enalapril ENAP 10MG 10MG TAB Accepted treatment



712763 Enalapril ENVAS 10MG TAB Accepted treatment


867853 Enalapril HR-ENALAPRIL 10 10MG TAB Accepted treatment



868914 Enalapril PHARMAPRESS 10MG TAB Accepted treatment



715938 Lisinopril APEX-LISINOPRIL 20MG TAB Accepted treatment

712598 Lisinopril AUSTELL-LISINOPRIL 10MG TAB Accepted treatment


701392 Lisinopril HEXAL LISINOPRIL 10MG TAB Accepted treatment


714678 Lisinopril LIZRO (WAS AURO-LISINOPRIL) 10MG TAB Accepted treatment


714679 Lisinopril LIZRO(WAS AURO-LISINOPRIL) 20MG TAB Accepted treatment

716792 Lisinopril LYSIN 5MG TAB Accepted treatment

700692 Lisinopril SINOPREN 10 10MG TAB Accepted treatment



703645 Lisinopril ZEMAX 10MG TAB Accepted treatment


781703 Lisinopril ZESTRIL 10MG TAB Accepted treatment



862053 Lisinopril ZETOMAX (ZESTOMAX) 10MG TAB Accepted treatment



ACE inhibitors and diuretic combinations

787035 Enalapril and diuretics CO-RENITEC 20MG/12.5MG TAB Accepted treatment

891287 Enalapril and diuretics ENAP-CO 20MG/12.5MG TAB Accepted treatment

885019 Enalapril and diuretics PHARMAPRESS CO 10MG/12.5MG TAB Accepted treatment

704704 Lisinopril and diuretics HEXAL LISINOPRIL CO 20 20MG/12.5MG TAB Accepted treatment

716943 Lisinopril and diuretics LISINOPRIL CO UNICORN 10MG/12.5MG

10MG/12.5MG TAB Accepted treatment



704437 Lisinopril and diuretics LISORETIC 10/12,5 10MG/12.5MG TAB Accepted treatment


707292 Lisinopril and diuretics LISOZIDE 10MG/12.5MG 10MG/12.5MG TAB Accepted treatment




817848 Lisinopril and diuretics ZESTORETIC 10MG/12.5MG TAB Accepted treatment


704597 Lisinopril and diuretics ZETOMAX CO 10/12.5 10MG/12.5MG TAB Accepted treatment


Angiotensin receptor blockers

716495 Losartan AURO LOSARTAN 100MG TAB Accepted treatment


717068 Losartan AUSTELL LOSARTAN 50MG TAB Accepted treatment


716644 Losartan CIPLAZAR 100MG TAB Accepted treatment


717042 Losartan HYTENZA 100MG TAB Accepted treatment


718366 Losartan LOSARTAN UNICORN 100MG TAB Accepted treatment


720776 Losartan LOZAAN 100MG TAB Accepted treatment

721259 Losartan NORMOTEN 50MG TAB Accepted treatment


715871 Losartan RENICARD 50MG TAB Accepted treatment

713254 Losartan SPEC-LOSARTAN 100MG TAB Accepted treatment


709964 Losartan ZARTAN 100MG 100MG TAB Accepted treatment

Angiotensin receptor blockers and diuretic combinations

717070 Losartan and diuretics AUSTELL LOSARTAN CO 50MG/12.5MG


716476 Losartan and diuretics HYTENZA CO 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

715857 Losartan and diuretics LOSAAR PLUS 100MG/25MG 100MG/25MG TAB Accepted treatment

715856 Losartan and diuretics LOSAAR PLUS 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

716274 Losartan and diuretics LOSACAR CO 50MG/12,5MG 50MG/12.5MG TAB Accepted treatment

718368 Losartan and diuretics LOSARTAN CO UNICORN 100MG/25MG

100MG/25MG TAB Accepted treatment

718367 Losartan and diuretics LOSARTAN CO UNICORN 50MG/12.5MG


715849 Losartan and diuretics NETRASOL CO 100/25MG 100MG/25MG TAB Accepted treatment

715848 Losartan and diuretics NETRASOL CO 50/12.5MG 50MG/12.5MG TAB Accepted treatment

716217 Losartan and diuretics ZARTAN CO 100MG/25MG 100MG/25MG TAB Accepted treatment

716216 Losartan and diuretics ZARTAN CO 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

Beta blockers 704653 Atenolol B-BLOCK 50MG TAB Accepted treatment

704651 Atenolol B-BLOCK 100MG TAB Accepted treatment

826901 Atenolol BIO-ATENOLOL (WAS IVAX-ATENOLOL)

100MG TAB Accepted treatment

826898 Atenolol BIO-ATENOLOL (WAS NORTAN-ATENOLOL)


715626 Atenolol GULF ATENOLOL 100MG TAB Accepted treatment




787914 Atenolol SANDOZ ATENOLOL 100MG TAB Accepted treatment


705873 Atenolol TENOPRESS 100MG TAB Accepted treatment



719657 Atenolol ZETENOL 100MG TAB Accepted treatment


806552 Propranolol INDOBLOK 10MG TAB Accepted treatment

806560 Propranolol INDOBLOK 40 40MG TAB Accepted treatment

787167 Propranolol PRODOROL 10MG TAB Accepted treatment


758140 Propranolol PURBLOKA 10MG TAB Accepted treatment


Alpha-beta blockers 897117 Carvedilol CARLOC 25MG TAB Accepted treatment

700168 Carvedilol CARLOC 12.5 12.5MG TAB Accepted treatment

716743 Carvedilol CARVEDILOL UNICORN 12.5MG TAB Accepted treatment

716744 Carvedilol CARVEDILOL UNICORN 25MG TAB Accepted treatment

704671 Carvedilol CARVETREND 12.5MG 12.5MG TAB Accepted treatment

704672 Carvedilol CARVETREND 25MG 25MG TAB Accepted treatment

710959 Carvedilol VEDIBLOK 12.5MG TAB Accepted treatment

710960 Carvedilol VEDIBLOK 25MG TAB Accepted treatment

Beta-blocker and diuretic combinations

789615 Atenolol and other diuretics ROLAB-ATENOLOL/CHLORTHALIDONE 100/25


789607 Atenolol and other diuretics ROLAB-ATENOLOL/CHLORTHALIDONE 50/12.5


786217 Atenolol and other diuretics TENCHLOR 100MG TAB Accepted treatment

807591 Atenolol and other diuretics TENCHLOR HS 50MG TAB Accepted treatment

Cardiac glycosides 735744 Digoxin LANOXIN PAED 0.05MG/ML SYR Accepted treatment

735760 Digoxin LANOXIN PAED 0.0625MG TAB Accepted treatment

735752 Digoxin LANOXIN 0.25MG TAB Accepted treatment

758280 Digoxin PURGOXIN 0.25MG TAB Accepted treatment

Vaccines

Pneumococcal vaccine 836699 Pneumococcus purified polysaccharides antigen

IMOVAX PNEUMO 23 VAC Accepted treatment

Influenza vaccine 711345 Influenza inactivated whole virus FLUVAX PRE-FILLED SYRINGE 0.5ML VAC Accepted treatment

732826 Influenza inactivated whole virus INFLUVAC 0.5ML VAC Accepted treatment

813338 Influenza inactivated whole virus VAXIGRIP SINGLE DOSE VAC Accepted treatment

Chronic renal disease

For diuretics and antihypertensives refer to "Hypertension"

Calcium 828289 Calcium products > 300MG B-CAL CHU Accepted treatment

703359 Calcium carbonate ENO TUMS ASSORTED FRUIT FLAVOURS

500MG CHU Accepted treatment

703364 Calcium carbonate ENO TUMS ORANGE FLAVOUR ROLLPAC


703361 Calcium carbonate ENO TUMS PEPPERMINT FLAVOUR ROLLPAC




Vitamin D 750654 Alfacalcidol ONE ALPHA (014050) 0.25MCG CAP Accepted treatment

750662 Alfacalcidol ONE ALPHA (014052) 1MCG CAP Accepted treatment

380380 Alfacalcidol ONE ALPHA DROPS 20ML DRP Accepted treatment

761249 Calcitriol ROCALTROL 0.25MCG CAP Accepted treatment

711640 Ergocalciferol CALCIFEROL 50.000i.u. TAB Accepted treatment

711853 Ergocalciferol CALCIFEROL OILY 15ML 15ML DRP Accepted treatment

Oral iron and folic acid supplementation

713558 Ferrous sulfate BODY BALANCE FERROUS SULPHATE


721690 Ferrous sulfate FERROUS SULPHATE 75MG TAB Accepted treatment

710372 Ferrous sulfate FERROUS SULPHATE 75MG TAB Accepted treatment

710580 Ferrous sulphate EGOLI FERROUS SULPHATE 30MG TAB Accepted treatment

877832 Ferrous sulphate FERROUS SULPHATE 30MG TAB Accepted treatment

897329 Ferrous sulphate GULF FERROUS SULPHATE COMPOUND

TAB Accepted treatment

768596 Ferrous sulphate SYR FERRI PHOS CO MLS Accepted treatment

709874 Folic acid AHA FOLIC ACID 5MG TAB Accepted treatment

810967 Folic acid BE-TABS FOLIC ACID 5MG TAB Accepted treatment

871281 Folic acid FOLIC ACID .5MG TAB Accepted treatment

711922 Folic acid FOLIC ACID 5MG TAB Accepted treatment


721661 Folic acid FOLIK .5MG TAB Accepted treatment

Parenteral iron preparations

725943 Iron trivalent, parenteral preparations FERRIMED 2ML 50MG/ML INJ Special investigations (SI)

873276 Saccharated iron oxide VENOFER 5X5ML AMP AMP Special investigations (SI)

711596 Ferric oxide dextran complex COSMOFER AMPOULE 2ML INJ Special investigations (SI)

720231 Iron, parenteral preparations ZYPIRON 5ML VIAL 20MG/1ML INJ Special investigations (SI)

719989 Iron, parenteral preparations RAUTEVENE SOLUTION FOR INJECTION AMPOULE

100MG/5ML INJ Special investigations (SI)

720333 Iron, parenteral preparations SUCROFER 5ML 20MG/1ML INJ Special investigations (SI)

Erythropoetin 704632 Erythropoietin RECORMON 500 IU/0.3ML 500IU INJ Special investigations (SI)

704772 Erythropoietin RECORMON 2000 PRE-FILLED SYRINGE

2000IU INJ Special investigations (SI)

837318 Erythropoietin EPREX PREFILLED 2000U/.5ML INJ Special investigations (SI)

704631 Erythropoietin RECORMON 4000 IU/0.3ML 4000IU/.3ML INJ Special investigations (SI)

820741 Erythropoietin EPREX PREFILLED 4000U/.4ML INJ Special investigations (SI)

Coronary artery disease

Antiplatelet agents 712608 Acetylsalicylic acid ASPIRIN TEVA 80MG DSP Accepted treatment

704642 Acetylsalicylic acid SOLUSPIRIN (WAS ASPIRIN SOLUBLE)

300MG EFT Accepted treatment

704645 Acetylsalicylic acid ASPIRIN 300MG TAB Accepted treatment

719673 Acetylsalicylic acid DR DU TOITS PAIN EXPELLER 300MG TAB Accepted treatment

700909 Acetylsalicylic acid GULF ASPIRIN 300MG TAB Accepted treatment



798533 Acetylsalicylic acid ASPIRIN (WHITE) 300MG TAB Accepted treatment

Nitrates 703605 Glyceryl trinitrate ANGISED 0.5MG TAB Accepted treatment

784206 Isosorbide dinitrate SANDOZ ISOSORBIDE DINITRATE 10 10MG TAB Accepted treatment

784192 Isosorbide dinitrate SANDOZ ISOSORBIDE DINITRATE 5 5MG TAB Accepted treatment

793418 Isosorbide mononitrate ELANTAN 20MG TAB Accepted treatment






















Calcium channel antagonists

720693 Amlodipine ADCO NORPENE 5MG TAB Accepted treatment


708141 Amlodipine ALMADIN 5MG TAB Accepted treatment


708051 Amlodipine AMLODAC 10MG TAB Accepted treatment


704620 Amlodipine AMLOSYN 5 5MG TAB Accepted treatment

713972 Amlodipine AMTAS 10MG TAB Accepted treatment


714310 Amlodipine AURO-AMLODIPINE 5MG TAB Accepted treatment


708095 Amlodipine AUSTELL-AMLODIPINE 10MG TAB Accepted treatment


708040 Amlodipine CALBLOC 10MG TAB Accepted treatment


708150 Amlodipine CIPLAVASC 5MG TAB Accepted treatment




707980 Amlodipine CORVADIL 10MG TAB Accepted treatment


708191 Amlodipine CPL ALLIANCE AMLODIPINE 10MG TAB Accepted treatment

712954 Amlodipine GULF AMLODIPINE 10MG TAB Accepted treatment


708648 Amlodipine INDO AMLODIPINE 5MG TAB Accepted treatment

708162 Amlodipine KLODIP 5MG TAB Accepted treatment

708353 Amlodipine LOMANOR 10MG TAB Accepted treatment


710238 Amlodipine PHARMA DYNAMICS AMLODIPINE BESYLATE




839183 Diltiazem ZILDEM 180MG SRC Accepted treatment


822213 Diltiazem ZILDEM 60 MG TAB Accepted treatment

824364 Diltiazem ZILDEM 90 BD 90 MG TAB Accepted treatment

840963 Nifedipine ADCO-VASCARD SR 20MG TAB Accepted treatment

864153 Nifedipine CIPALAT RETARD 20MG TAB Accepted treatment

829501 Nifedipine NIFEDALAT 20 SR 20 MG SRT Accepted treatment

774944 Verapamil VASOMIL 40MG TAB Accepted treatment


700071 Verapamil VERAHEXAL 240 SR 240MG SRT Accepted treatment

Crohn's disease

Aminosalicylic acid preparations

762008 Sulfasalazine SALAZOPYRIN 500MG TAB Accepted treatment

762016 Sulfasalazine SALAZOPYRIN E.N. 500MG ECT Accepted treatment

Immunosuppressants 701252 Azathioprine AZAMUN 50MG TAB Accepted treatment

706108 Azathioprine AZAPRESS 50MG TAB Accepted treatment

712609 Azathioprine AZATHIOPRINE PCH 50MG TAB Accepted treatment

700777 Azathioprine ZAPRINE 50MG 50MG TAB Accepted treatment

Methotrexate 712504 Methotrexate EMTHEXATE 2.5MG TAB Accepted treatment

742465 Methotrexate METHOTREXATE 2.5MG TAB Accepted treatment

782548 Methotrexate ABITREXATE-2ML 50MG INJ Accepted treatment


Steroid preparations (oral) 800155 Prednisolone LENISOLONE 5MG TAB Accepted treatment

788783 Prednisone BE-TABS PREDNISONE 5MG TAB Accepted treatment

752304 Prednisone PANAFCORT 5MG TAB Accepted treatment

Steroid preparations (enemas)

824593 Budesonide ENTOCORD ENEMAS 2.3MG ENE Accepted treatment

Diabetes Mellitus Type 1

Insulin 704457 Insulin (human) HUMULIN R DISPOSABLE PEN 3ML 100IU/1ML INJ Accepted treatment

733512 Insulin (human) INSU ACTRAPH HMGE 10ML VIAL 100IU/1ML INJ Accepted treatment

712770 Insulin (human) INSU BIOSULIN 30-70 CARTRIDGE 3ML

100IU/1ML INJ Accepted treatment



712769 Insulin (human) INSU BIOSULIN L CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment

712768 Insulin (human) INSU BIOSULIN N CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment

712767 Insulin (human) INSU BIOSULIN R CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment

783811 Insulin (human) INSU HUMULIN 30/70 10ML VIAL 100IU/1ML INJ Accepted treatment

863572 Insulin (human) INSU HUMULIN 30/70 3ML 100IU/1ML INJ Accepted treatment

704456 Insulin (human) INSU HUMULIN 30/70 PEN 3ML DISP 100IU/1ML INJ Accepted treatment

733458 Insulin (human) INSU HUMULIN N 10ML VIAL 100IU/1ML INJ Accepted treatment

863556 Insulin (human) INSU HUMULIN N 3.0ML CART 5 100IU/1ML INJ Accepted treatment

853453 Insulin (human) INSU HUMULIN N PEN 3ML 100IU/1ML INJ Accepted treatment

733431 Insulin (human) INSU HUMULIN R 10ML VIAL 100IU/1ML INJ Accepted treatment

863564 Insulin (human) INSU HUMULIN R 3.0ML CARTRIDGE 100IU/1ML INJ Accepted treatment

710299 Insulin (human) INSU INSUMAN COMB 30/70 PEN 3ML


733482 Insulin (human) INSU PROTAPH HMGE 10 ML VIAL 100IU/1ML INJ Accepted treatment

707927 Insulin aspart INSU NOVORAPID 10ML 100IU/1ML INJ Accepted treatment

897775 Insulin aspart INSU NOVORAPID 3ML SOLUTION FOR I


706040 Insulin glulisine INSU APIDRA 100IU/1ML INJ Accepted treatment

709861 Insulin glulisine INSU APIDRA SOLOSTAR DISPOSABLE PENS 3ML


819468 Insulin lispro INSU HUMALOG 100IU/1ML INJ Accepted treatment

862355 Insulin lispro INSU HUMALOG INJ 3.0ML CART 100IU/1ML INJ Accepted treatment

706760 Insulin lispro INSU HUMALOG KWIKPEN (WAS MIRIO PEN)


853437 Insulin lispro INSU HUMALOG MIX 25 10ML 100IU/1ML INJ Accepted treatment

861782 Insulin lispro INSU HUMALOG MIX 25 CART 3ML 100IU/1ML INJ Accepted treatment

705074 Insulin lispro INSU HUMALOG MIX 50 CART 100IU/1ML INJ Accepted treatment

Appliances

Diabetic strips, needles, syringes and lancets

161552 Diagnostic agents payable by PBM - incl urine/blood glucose test strips

ACCU CHECK ACTIVE MIC STRIPS 8CM X 4.5CM

STR Clinical review


ACCU CHEK PERFORMA BLOOD GLUCOSE STRIPS

STR Clinical review



STR Clinical review


BLOODPLASMA CONTOUR PLUS STRIPS

ZZZ Clinical review



ZZZ Clinical review


BLOODPLASMA NOVICHECK STRIPS ZZZ Clinical review


CARESENS II/POP TEST STRIP 29G STR Clinical review


CARESENS N TEST STRIPS 29G ZZZ Clinical review


FREESTYLE OPTIUM NEO H GLUCOSE TEST STRI

ZZZ Clinical review


GLUCOCHECK STRIPS 50S STR Clinical review


GLUCOLAB AUTO CODING STRIPS 50 72 X 65MM

STR Clinical review




GLUCOPLUS PRO TEST STRIPS STR Clinical review


GLUCOPLUS TEST STRIPS STR Clinical review


GLUCOSE BLOOD TEST STRIPS DIAMOND

STR Clinical review


GLUCOSE CONTOUR TS STRIPS 25 STR Clinical review




GLUCOSE METER STRIPS SELF MONITORING

ZZZ Clinical review


GLUCOSE STRIPS LABSTIX OK MATCH 50

ZZZ Clinical review


GLUCOSE TEST STRIPS EASYMAX CLICKS

ZZZ Clinical review


GLUCOSE TEST STRIPS FREE STYLE OPTIUM

ZZZ Clinical review


GLUCOSE TEST STRIPS GLUCO LEADER

ZZZ Clinical review


GLUCOSE TEST STRIPS H FREE STYLE OPTIUM

ZZZ Clinical review


GLUCOSE TEST STRIPS OPTIMA ZZZ Clinical review


GLUCOSE TESTS STRIPS FREE STYLE 50'S

ZZZ Clinical review


LANCET BIONIME STERILE DISPOSABLE 39 X 1

ZZZ Clinical review


LANCETS EASYMAX ZZZ Clinical review


ON-CALL PLUS EZ STRIPS (ALL SIZES)

STR Clinical review


ONE TOUCH SELECT TEST STRIPS STR Clinical review


SYRINGE INSULIN 1ML WITH NEEDLE 27G

ZZZ Clinical review


TEST STRIPS ON CALL GLUCOSE TEST STRIPS

STR Clinical review


TEST STRIPS V2 SOLUS ZZZ Clinical review

620831 Non-therapeutic auxiliary products payable on chronic

1ML SYRINGE BD 300013 SUR Clinical review


ABBOTT THIN LANCETS 200 ZZZ Clinical review


BD MICROFINE 0.5ML INSULIN SYRINGE 29G 1

SNG Clinical review



SNG Clinical review


BD MICROFINE 1ML INSULIN SYRINGE 29G 12.

SNG Clinical review


BD MICROFINE 1ML INSULIN SYRINGE 30G 8MM

SNG Clinical review


BD MICROFINE PEN NEEDLE TW 32G 4MM

ZZZ Clinical review


BLOOD LANCETS GLUCOFLASH 50MM

ZZZ Clinical review




DROPLET PEN NEEDLE 31G 4mm NED Clinical review






DROPLET PEN NEEDLE 8MM X 31G NED Clinical review


INSULIN SYRINGE 29G 1ML SNG Clinical review


INSULIN SYRINGE BD MICROFINE DEMI NEEDLE

SNG Clinical review


INSULIN SYRINGE MICROFINE BLIST BD 1ML 3

SNG Clinical review


LANCET BLOOD STERILE ZZZ Clinical review


LANCET LORIS SAFETY 2.2MM DEPTH 21G X 1

ZZZ Clinical review


LANCET ON CALL PLUS RAPID DEVICE 5.5CM X

ZZZ Clinical review


LANCET THIN ABBOTT 50'S ZZZ Clinical review


LANCET TWIST TOP HEALTHHEASE 28G

SNG Clinical review


LANCETS ZZZ Clinical review


LANCETS BLOOD GLUCOSE ZZZ Clinical review


LANCETS BLOOD GLUCOSE TEST 21G X 2.4MM

ZZZ Clinical review


LANCETS CARELET ZZZ Clinical review


LANCETS COLLECTION NEEDLES FORA STERILE

NED Clinical review


LANCETS STERILE 30G ZZZ Clinical review


MICROFINE PEN NDL 30G 8MM NED Clinical review


MICROFINE PEN NEEDLE 29G 12.7MM

NED Clinical review


MICROLET LANCETS MULTICOLOURED

SUR Clinical review


NEEDLE BD PEN 29G X 12.7MM 12.7MM

ZZZ Clinical review


NEEDLE BD PEN 31G X 5MM ZZZ Clinical review


NEEDLE HYPODERMIC NOVOTWIST 30G X 8MM

ZZZ Clinical review



ZZZ Clinical review


NEEDLE PEN BD MICROFINE 31G 5M ZZZ Clinical review


NEEDLE UNILET EXELITE LL ZZZ Clinical review


ON-CALL LANCETS GLUCOSE STRIPS

ZZZ Clinical review




SYRIN DISP INSUL/NDL 0,5ML 29G TERUMO

SNG Clinical review


SYRINGE 0.5ML INSU 29X12.7 NDL SNG Clinical review


SYRINGE 01ML WITH 12.77MM INSULIN NDL

SNG Clinical review


SYRINGE INSU 1ML-100U 28G SNG Clinical review


SYRINGE INSULIN 0.5ML / 29G NEEDLE

SNG Clinical review


SYRINGE INSULIN TERUMO 1ML U100 27G NEE

SNG Clinical review


SYRINGES INSULIN MONOJECT & COMB 100U-29

SNG Clinical review



SNG Clinical review


TERUMO SYR INSU 1ML SNG Clinical review


TEST STRIPS ONETOUCH SELECT PLUS

ZZZ Clinical review


UNIFINE PENTIPS 31G X 8MM ZZZ Clinical review


YSPSOMED PEN INSULIN DELIVERY DEVICE

SNG Clinical review


UNISTIK 3 - EXTRA ZZZ Clinical review


LANCET LORIS SAFETY 1.8MM DEPTH 26G YELL

STR Clinical review

458317 Other non-therapeutic auxiliary products

NOVOFINE NEEDLES NED Clinical review


ONE TOUCH ULTRA SOFT LANCET ZZZ Clinical review


SYRINGE INSULIN NEEDLE 29G SNG Clinical review

678020 Other non-therapeutic auxiliary products,lancets,needles,syringes,admin

sets, et


ZZZ Clinical review


sets, et

'BD MICROFINE 1ML INSULIN SYRINGE 29G 12

ZZZ Clinical review


sets, et


ZZZ Clinical review


sets, et

BD MICROFINE PEN NEEDLE 30G 8MM

ZZZ Clinical review


sets, et

DROPLET PEN NEEDLE 4MM X 32G ZZZ Clinical review


sets, et

HUMAPEN LUXURA INSULIN DELIVERY DEVICE

SNG Clinical review


sets, et

INSULIN SYRINGE 8MM SNG Clinical review


sets, et

LANCETS SOLUS V2 ZZZ Clinical review




sets, et

MICROLET LANCETS ZZZ Clinical review


sets, et

NEEDLE BD PEN 31G 8MM 100 1350 SNG Clinical review


sets, et

NEEDLE INSUPEN 30G X 8MM ZZZ Clinical review


sets, et



sets, et



sets, et

SYRINGE INSULIN BD 0.3ML 8MM 30G

ZZZ Clinical review


sets, et


ZZZ Clinical review

438732 Other non-therapeutic auxilliary products, lancets, needles, syringes,

admin sets, etc.

GLUCO PLUS LANCETS ZZZ Clinical review


admin sets, etc.

GLUCOLAB GLUCOCHECK LANCETS ZZZ Clinical review


admin sets, etc.

LANCETS UNILET STERILE 28G 4CM X 6CM X 7

ZZZ Clinical review


admin sets, etc.

NEEDLE ACCUFINE INSULIN PEN 12 X29G

ZZZ Clinical review


admin sets, etc.

NEEDLE ACCUFINE INSULIN PEN 6 X 31G

ZZZ Clinical review


admin sets, etc.


ZZZ Clinical review


admin sets, etc.

STRIPS TESTING GLUCOLEADER YASEE

ZZZ Clinical review

Diabetes Mellitus Type 2

Biguanides 714427 Metformin ACCORD METFORMIN 500MG TAB Accepted treatment

715936 Metformin DIAFORMIN 500MG TAB Accepted treatment

714186 Metformin DIAMIN 500MG TAB Accepted treatment

719784 Metformin DIAPHAGE 500MG TAB Accepted treatment

714525 Metformin GLUCONORM 500MG TAB Accepted treatment

714680 Metformin MENGEN (WAS AURO-METFORMIN) 500MG TAB Accepted treatment

718231 Metformin METCHEK 500MG TAB Accepted treatment

718828 Metformin METFORMIN ALKEM 500MG TAB Accepted treatment

709246 Metformin METPHAGE 500MG TAB Accepted treatment

897957 Metformin MYLAN METFORMIN 500MG TAB Accepted treatment

707670 Metformin APEX-METFORMIN 500MG TAB Accepted treatment

707669 Metformin APEX-METFORMIN FORTE 850MG TAB Accepted treatment

708010 Metformin FORMINAL 850MG TAB Accepted treatment



714426 Metformin ACCORD METFORMIN 850MG TAB Accepted treatment

715937 Metformin DIAFORMIN FORTE 850MG TAB Accepted treatment




709339 Metformin INDO METFORMIN FC 850MG TAB Accepted treatment


897961 Metformin MERCK-METFORMIN 850MG TAB Accepted treatment


702363 Metformin METFORAL 850MG 850MG TAB Accepted treatment


711638 Metformin METORED 850MG TAB Accepted treatment


719293 Metformin SANDOZ-METFORMIN 850MG 850MG TAB Accepted treatment

815233 Metformin SANDOZ-METFORMIN FC 850MG 850MG TAB Accepted treatment

708281 Metformin BIGSENS 500MG TAB Accepted treatment


706673 Metformin ARROW METFORMIN 850MG TAB Accepted treatment

705758 Metformin AUSTELL-METFORMIN 850MG 850MG TAB Accepted treatment


Sulphonylureas 827053 Glibenclamide BIO-GLIBENCLAMIDE 5MG TAB Accepted treatment

729361 Glibenclamide GLYCOMIN 5MG TAB Accepted treatment

781258 Glibenclamide SANDOZ GLIBENCLAMIDE 5 5MG TAB Accepted treatment

709538 Gliclazide ARROW GLICLAZIDE 80MG TAB Accepted treatment

868906 Gliclazide DIAGLUCIDE 80MG TAB Accepted treatment

720665 Gliclazide DIAGLUMED 80MG TAB Accepted treatment

834599 Gliclazide GLUCOMED 80MG TAB Accepted treatment

838209 Gliclazide GLYCRON 80MG TAB Accepted treatment

700717 Gliclazide GLYGARD 80MG TAB Accepted treatment

834866 Gliclazide SANDOZ GLICLAZIDE 80 80MG TAB Accepted treatment

705760 Gliclazide AUSTELL-GLICLAZIDE 80MG TAB Accepted treatment

Thiazolidines 718148 Pioglitazone ACCORD PIOGLITAZONE 15MG TAB specialist motivation/SI

718150 Pioglitazone ACCORD PIOGLITAZONE 30MG TAB specialist motivation/SI

718151 Pioglitazone ACCORD PIOGLITAZONE 45MG TAB specialist motivation/SI

707974 Pioglitazone CIPLA PIOGLITAZONE 15 15MG TAB specialist motivation/SI

707981 Pioglitazone CIPLA PIOGLITAZONE 30 30MG TAB specialist motivation/SI

Insulin 704457 Insulin (human) HUMULIN R DISPOSABLE PEN 3ML 100IU/1ML INJ Accepted treatment

733512 Insulin (human) INSU ACTRAPH HMGE 10ML VIAL 100IU/1ML INJ Accepted treatment

712770 Insulin (human) INSU BIOSULIN 30-70 CARTRIDGE 3ML


712769 Insulin (human) INSU BIOSULIN L CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment



712768 Insulin (human) INSU BIOSULIN N CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment

712767 Insulin (human) INSU BIOSULIN R CARTRIDGE 3ML 100IU/1ML INJ Accepted treatment

783811 Insulin (human) INSU HUMULIN 30/70 10ML VIAL 100IU/1ML INJ Accepted treatment

863572 Insulin (human) INSU HUMULIN 30/70 3ML 100IU/1ML INJ Accepted treatment

704456 Insulin (human) INSU HUMULIN 30/70 PEN 3ML DISP 100IU/1ML INJ Accepted treatment

733458 Insulin (human) INSU HUMULIN N 10ML VIAL 100IU/1ML INJ Accepted treatment

863556 Insulin (human) INSU HUMULIN N 3.0ML CART 5 100IU/1ML INJ Accepted treatment

853453 Insulin (human) INSU HUMULIN N PEN 3ML 100IU/1ML INJ Accepted treatment

733431 Insulin (human) INSU HUMULIN R 10ML VIAL 100IU/1ML INJ Accepted treatment

863564 Insulin (human) INSU HUMULIN R 3.0ML CARTRIDGE 100IU/1ML INJ Accepted treatment

710299 Insulin (human) INSU INSUMAN COMB 30/70 PEN 3ML


733482 Insulin (human) INSU PROTAPH HMGE 10 ML VIAL 100IU/1ML INJ Accepted treatment

707927 Insulin aspart INSU NOVORAPID 10ML 100IU/1ML INJ Accepted treatment

897775 Insulin aspart INSU NOVORAPID 3ML SOLUTION FOR I


706040 Insulin glulisine INSU APIDRA 100IU/1ML INJ Accepted treatment

709861 Insulin glulisine INSU APIDRA SOLOSTAR DISPOSABLE PENS 3ML


819468 Insulin lispro INSU HUMALOG 100IU/1ML INJ Accepted treatment

862355 Insulin lispro INSU HUMALOG INJ 3.0ML CART 100IU/1ML INJ Accepted treatment

853437 Insulin lispro INSU HUMALOG MIX 25 10ML 100IU/1ML INJ Accepted treatment

861782 Insulin lispro INSU HUMALOG MIX 25 CART 3ML 100IU/1ML INJ Accepted treatment

705074 Insulin lispro INSU HUMALOG MIX 50 CART 100IU/1ML INJ Accepted treatment

706760 Insulin lispro INSU MIRIO PEN HUMALOG 100IU/1ML INJ Accepted treatment

Appliances

Diabetic strips, needles, syringes and lancets


ACCU CHECK ACTIVE MIC STRIPS 8CM X 4.5CM

STR Clinical review



STR Clinical review



STR Clinical review



ZZZ Clinical review


BLOODPLASMA NOVICHECK STRIPS ZZZ Clinical review


CARESENS II/POP TEST STRIP 29G STR Clinical review


CARESENS N TEST STRIPS 29G ZZZ Clinical review


FREESTYLE OPTIUM NEO H GLUCOSE TEST STRI

ZZZ Clinical review


GLUCOCHECK STRIPS 50S STR Clinical review


GLUCOLAB AUTO CODING STRIPS 50 72 X 65MM

STR Clinical review


GLUCOPLUS PRO TEST STRIPS STR Clinical review


GLUCOPLUS TEST STRIPS STR Clinical review




GLUCOSE BLOOD TEST STRIPS DIAMOND

STR Clinical review




GLUCOSE METER STRIPS SELF MONITORING

ZZZ Clinical review


GLUCOSE STRIPS LABSTIX OK MATCH 50

ZZZ Clinical review


GLUCOSE TEST STRIPS EASYMAX CLICKS

ZZZ Clinical review


GLUCOSE TEST STRIPS FREE STYLE OPTIUM

ZZZ Clinical review


GLUCOSE TEST STRIPS GLUCO LEADER

ZZZ Clinical review


GLUCOSE TEST STRIPS H FREE STYLE OPTIUM

ZZZ Clinical review


GLUCOSE TEST STRIPS OPTIMA ZZZ Clinical review


GLUCOSE TESTS STRIPS FREE STYLE 50'S

ZZZ Clinical review


LANCET BIONIME STERILE DISPOSABLE 39 X 1

ZZZ Clinical review


LANCETS EASYMAX ZZZ Clinical review


ON-CALL PLUS EZ STRIPS (ALL SIZES)

STR Clinical review


ONE TOUCH SELECT TEST STRIPS STR Clinical review


SYRINGE INSULIN 1ML WITH NEEDLE 27G

ZZZ Clinical review


TEST STRIPS ON CALL GLUCOSE TEST STRIPS

STR Clinical review


TEST STRIPS V2 SOLUS ZZZ Clinical review


1ML SYRINGE BD 300013 SUR Clinical review


ABBOTT THIN LANCETS 200 ZZZ Clinical review



SNG Clinical review



SNG Clinical review


BD MICROFINE 1ML INSULIN SYRINGE 29G 12.

SNG Clinical review



SNG Clinical review


BD MICROFINE PEN NEEDLE TW 32G 4MM

ZZZ Clinical review


BLOOD LANCETS GLUCOFLASH 50MM

ZZZ Clinical review










DROPLET PEN NEEDLE 8MM X 31G NED Clinical review


INSULIN SYRINGE 29G 1ML SNG Clinical review


INSULIN SYRINGE BD MICROFINE DEMI NEEDLE

SNG Clinical review


INSULIN SYRINGE MICROFINE BLIST BD 1ML 3

SNG Clinical review


LANCET BLOOD STERILE ZZZ Clinical review


LANCET LORIS SAFETY 2.2MM DEPTH 21G X 1

ZZZ Clinical review


LANCET ON CALL PLUS RAPID DEVICE 5.5CM X

ZZZ Clinical review


LANCET THIN ABBOTT 50'S ZZZ Clinical review


LANCET TWIST TOP HEALTHHEASE 28G

SNG Clinical review


LANCETS ZZZ Clinical review


LANCETS BLOOD GLUCOSE ZZZ Clinical review


LANCETS BLOOD GLUCOSE TEST 21G X 2.4MM

ZZZ Clinical review


LANCETS CARELET ZZZ Clinical review


LANCETS COLLECTION NEEDLES FORA STERILE

NED Clinical review


LANCETS STERILE 30G ZZZ Clinical review


MICROFINE PEN NDL 30G 8MM NED Clinical review


MICROFINE PEN NEEDLE 29G 12.7MM

NED Clinical review


MICROLET LANCETS MULTICOLOURED

SUR Clinical review


NEEDLE BD PEN 29G X 12.7MM 12.7MM

ZZZ Clinical review


NEEDLE BD PEN 31G X 5MM ZZZ Clinical review



ZZZ Clinical review



ZZZ Clinical review


NEEDLE PEN BD MICROFINE 31G 5M ZZZ Clinical review


NEEDLE UNILET EXELITE LL ZZZ Clinical review


ON-CALL LANCETS GLUCOSE STRIPS

ZZZ Clinical review


SYRIN DISP INSUL/NDL 0,5ML 29G TERUMO

SNG Clinical review


SYRINGE 0.5ML INSU 29X12.7 NDL SNG Clinical review


SYRINGE 01ML WITH 12.77MM INSULIN NDL

SNG Clinical review




SYRINGE INSU 1ML-100U 28G SNG Clinical review


SYRINGE INSULIN 0.5ML / 29G NEEDLE

SNG Clinical review


SYRINGE INSULIN TERUMO 1ML U100 27G NEE

SNG Clinical review



SNG Clinical review



SNG Clinical review


TERUMO SYR INSU 1ML SNG Clinical review


TEST STRIPS ONETOUCH SELECT PLUS

ZZZ Clinical review


UNIFINE PENTIPS 31G X 8MM ZZZ Clinical review


YSPSOMED PEN INSULIN DELIVERY DEVICE

SNG Clinical review


admin sets, etc.

UNISTIK 3 - EXTRA ZZZ Clinical review

157345 Non-therapeutic auxiliary products payable on chronic: lancets

LANCET LORIS SAFETY 1.8MM DEPTH 26G YELL

STR Clinical review


NOVOFINE NEEDLES NED Clinical review


ONE TOUCH ULTRA SOFT LANCET ZZZ Clinical review


SYRINGE INSULIN NEEDLE 29G SNG Clinical review


sets, et


ZZZ Clinical review


sets, et

'BD MICROFINE 1ML INSULIN SYRINGE 29G 12

ZZZ Clinical review


sets, et


ZZZ Clinical review


sets, et

BD MICROFINE PEN NEEDLE 30G 8MM

ZZZ Clinical review


sets, et

HUMAPEN LUXURA INSULIN DELIVERY DEVICE

SNG Clinical review


sets, et

INSULIN SYRINGE 8MM SNG Clinical review


sets, et

LANCETS SOLUS V2 ZZZ Clinical review


sets, et

MICROLET LANCETS ZZZ Clinical review


sets, et

NEEDLE BD PEN 31G 8MM 100 1350 SNG Clinical review


sets, et





sets, et



sets, et



sets, et


ZZZ Clinical review


sets, et


ZZZ Clinical review


admin sets, etc.

GLUCO PLUS LANCETS ZZZ Clinical review


admin sets, etc.

GLUCOLAB GLUCOCHECK LANCETS ZZZ Clinical review


admin sets, etc.

LANCETS UNILET STERILE 28G 4CM X 6CM X 7

ZZZ Clinical review


admin sets, etc.

NEEDLE ACCUFINE INSULIN PEN 12 X29G

ZZZ Clinical review


admin sets, etc.


ZZZ Clinical review


admin sets, etc.


ZZZ Clinical review


admin sets, etc.

STRIPS TESTING GLUCOLEADER YASEE

ZZZ Clinical review

Diabetes Insipidus

Desmopressin 703639 Desmopressin DDAVP TAB Special investigations

717746 Desmopressin DDAVP INTRANASAL SOLUTION 2.5ML NOD Special investigations

837555 Desmopressin DDAVP 5ML 0.1MG/ML NAS Special investigations

837563 Desmopressin DDAVP 0.1MG TAB Special investigations

722060 Desmopressin MINIRIN MELT 120MCG SLT Special investigations

722061 Desmopressin MINIRIN MELT 240MCG SLT Special investigations

Dysrythmias

Anticoagulants 709906 Warfarin CIPLA WARFARIN 1MG 1MG TAB Accepted treatment

709905 Warfarin CIPLA WARFARIN 5MG 5MG TAB Accepted treatment

778362 Warfarin WARFARIN 5MG TAB Accepted treatment

Antiplatelet agents 704645 Acetylsalicylic acid ASPIRIN 300MG TAB Accepted treatment






712608 Acetylsalicylic acid ASPIRIN TEVA 80MG DSP Accepted treatment
























828009 Sotalol SOTAHEXAL 160 MG TAB Accepted treatment

827991 Sotalol SOTAHEXAL 80 MG TAB Accepted treatment

Cardiac glycosides 735744 Digoxin LANOXIN PAED 0.05MG/ML SYR Accepted treatment

735760 Digoxin LANOXIN PAED 0.0625MG TAB Accepted treatment

735752 Digoxin LANOXIN 0.25MG TAB Accepted treatment

758280 Digoxin PURGOXIN 0.25MG TAB Accepted treatment









Anti-arrythymics 703515 Amiodarone ARYCOR 100MG TAB Accepted treatment

863157 Amiodarone HEXARONE 100MG 100MG TAB Accepted treatment

703513 Amiodarone ARYCOR 200MG TAB Accepted treatment

707851 Amiodarone BIO-AMIODARONE 200MG TAB Accepted treatment

863165 Amiodarone HEXARONE 200MG 200mg TAB Accepted treatment

Epilepsy



705597 Carbamazepine SANDOZ CARBAMAZEPINE CR200 SRT Accepted treatment

705602 Carbamazepine SANDOZ CARBAMAZEPINE CR400 SRT Accepted treatment


712493 Carbamazepine DEGRANOL 200MG TAB Accepted treatment





835129 Clonazepam RIVOTRIL 2.5MG DRP Accepted treatment

761079 Clonazepam RIVOTRIL 0.5MG TAB Accepted treatment

761087 Clonazepam RIVOTRIL 2MG TAB Accepted treatment

721545 Clonazepam CLONAM 0.5MG TAB Accepted treatment

721546 Clonazepam CLONAM 2MG TAB Accepted treatment

779105 Ethosuximide ZARONTIN SYR Accepted treatment















717226 Oxcarbazepine MYLAN OXCARBAZEPINE 300MG TAB Accepted treatment

717227 Oxcarbazepine MYLAN OXCARBAZEPINE 600MG TAB Accepted treatment

754803 Phenobarbital ADCO-PHENOBARB VITALET ELIXIR 100ML SYR Accepted treatment

737844 Phenobarbital LETHYL 30MG TAB Accepted treatment

814946 Phenobarbital SEDABARB 30MG TAB Accepted treatment

723525 Phenytoin EPANUTIN 100MG CAP Accepted treatment

723533 Phenytoin EPANUTIN FORTE 125/5ML SUS Accepted treatment

754870 Phenytoin PHENYTOIN SOD 100mg TAB Accepted treatment

















Glaucoma

Sympathomimetics 709410 Brimonidine ALPHAGAN PURITE 5ML 1.5MG/1ML OPD Clinical review

721293 Brimonidine BRIMOCT 5ML 2MG/1ML OPD Clinical review

Parasympathomimetics 734284 Pilocarpine ISOPTO CARPINE 15ML 1.00% OPD Accepted treatment

734179 Pilocarpine ISOPTO CARPINE 15ML 2.00% OPD Accepted treatment

734195 Pilocarpine ISOPTO CARPINE 15ML 4.00% OPD Accepted treatment

Carbonic anhydrase inhibitors

701523 Brinzolamide AZOPTIC EYE DROP OPD Clinical review

819832 Dorzolamide TRUSOPT 5ML 2% OPD Clinical review

720983 Dorzolamide GLAUCOPRESS 5ML 0.02 OPD Clinical review

Beta-blockers 770833 Timolol TIMOPTOL 5ML 0.25% OPD Accepted treatment

819816 Timolol TIMOPTOL-XE 0.25% 2.5ML 2.5ML DRP Accepted treatment

770841 Timolol TIMOPTOL 5ML 0.50% OPD Accepted treatment

819824 Timolol TIMOPTOL-XE 0.50 % 2.5ML 2.5ML DRP Accepted treatment

821624 Timolol GLAUCOSAN 0.5 % 5ML 5 MG/ML OPD Accepted treatment

720734 Timolol OCCUMOL 0.005 OPD Accepted treatment

Combination products 717260 Timolol, combinations AZARGA 5ML OPD Accepted treatment

709863 Timolol, combinations COMBIGAN 2MG/5MG 5ML OPD Accepted treatment

860379 Timolol, combinations COSOPT 5ML OPD Accepted treatment

708877 Timolol, combinations DUOTRAV 2.5ML OPD Accepted treatment

721902 Timolol, combinations GLAUMIDE-CO 10ML OPD Accepted treatment

721977 Timolol, combinations GLAUOPT CO 5ML 20MG/5MG OPD Accepted treatment

721977 Timolol, combinations GLAUOPT CO 5ML 20MG/5MG OPD Accepted treatment

Prostaglandin derivatives 833223 Latanoprost XALATAN 2.5ML 50MCG/ML OPD Clinical review

715961 Latanoprost OCUPROST 3ML 50MCG/ML OPD Clinical review

720971 Latanoprost ATANA 2.5ML 0.00005 OPD Clinical review

703666 Bimatoprost LUMIGAN 3ML OPD Clinical review

716754 Bimatoprost LUMIGAN 0.01% OPD Clinical review

702534 Travoprost TRAVATAN OPD Clinical review

720401 Tafluprost SAFLUTAN SINGLE DOSE CONTAINER 0.3ML

15MCG/1ML OPD Clinical review

Acetazolamide 789771 Acetazolamide AZOMID 250MG TAB Clinical review

Haemophilia

Tranexamic acid 714722 Tranexamic acid TRANEXAMIC ACID MEDWICH 500MG TAB Accepted treatment (intermittent use)

716276 Tranexamic acid TRANIC 500MG TAB Accepted treatment (intermittent use)

719414 Tranexamic acid MORWAK 500MG TAB Accepted treatment (intermittent use)

Desmopressin 703639 Desmopressin DDAVP TAB Accepted treatment (intermittent use)

717746 Desmopressin DDAVP INTRANASAL SOLUTION 2.5ML NOD Accepted treatment (intermittent use)

837555 Desmopressin DDAVP 5ML 0.1MG/ML NAS Accepted treatment (intermittent use)



837563 Desmopressin DDAVP 0.1MG TAB Accepted treatment (intermittent use)

722060 Desmopressin MINIRIN MELT 120MCG SLT Accepted treatment (intermittent use)

722061 Desmopressin MINIRIN MELT 240MCG SLT Accepted treatment (intermittent use)

Analgesics 792101 Paracetamol ACTAMOL 120MG/5ML SYR Accepted treatment

717725 Paracetamol ACTAMOL 500MG TAB Accepted treatment

704093 Paracetamol ACTAMOL RED (UN-BOXED) 120MG/5ML SYR Accepted treatment

894281 Paracetamol ADCO-PARACETAMOL 120MG/5ML SYR Accepted treatment

805467 Paracetamol ANTALGIC 500 500MG TAB Accepted treatment

713153 Paracetamol AUSTELL-PARACETAMOL 500MG TAB Accepted treatment

717187 Paracetamol BARRS PARACETAMOL 120MG/5ML SYR Accepted treatment

701634 Paracetamol DIS-CHEM PARACETAMOL 500MG TAB Accepted treatment

703820 Paracetamol FEVERPAIN 120MG/5ML SYR Accepted treatment

863742 Paracetamol FEVERPAIN (BOXED) 120MG/5ML SYR Accepted treatment

867950 Paracetamol GULF-PARACETAMOL 500MG TAB Accepted treatment

894212 Paracetamol JP PARACETAMOL 500MG TAB Accepted treatment

706192 Paracetamol MICROGESIC 120MG/5ML SYR Accepted treatment

745715 Paracetamol NAPAMOL 120MG/5ML SYR Accepted treatment

745723 Paracetamol NAPAMOL TABS 500MG TAB Accepted treatment

799629 Paracetamol PAINAMOL (GREEN) 500MG TAB Accepted treatment

752142 Paracetamol PAINAMOL WHITE 500MG TAB Accepted treatment

889772 Paracetamol PAINBLOK 120MG/5ML SYR Accepted treatment

704465 Paracetamol PAINOGESIC 500MG TAB Accepted treatment

704450 Paracetamol PAINOGESIC 120MG/5ML SYR Accepted treatment

704719 Paracetamol PARACET 500MG TAB Accepted treatment

707583 Paracetamol PARACETAMOL ELIXIR SAD (ALCOHOL FREE)

120MG/5ML SYR Accepted treatment

752878 Paracetamol PARAPANE 500MG TAB Accepted treatment

757403 Paracetamol PROLIEF 500MG TAB Accepted treatment

714707 Paracetamol PYNGESIC T 500MG TAB Accepted treatment

758558 Paracetamol PYRALEN 120MG/5ML SYR Accepted treatment

885863 Paracetamol VON PARACETAMOL 500MG TAB Accepted treatment

710211 Paracetamol ZYDUS-PARACETAMOL 500MG TAB Accepted treatment

787043 Paracetamol combinations payable by PBM

CODOROL TAB Accepted treatment


COGESIC 500MG/8MG TAB Accepted treatment


DINO-COD (BEI) TAB Accepted treatment


NAPACOD TAB Accepted treatment


PAINAMOL PLUS (BETACOD) TAB Accepted treatment


PAINCODEIN 500MG/8MG TAB Accepted treatment




ROCODIN TAB Accepted treatment


SPECTRAPAIN CAP Accepted treatment

Hyperlipidemia

Statins 718073 Atorvastatin ADCO ATORVASTATIN 10MG TAB Special investigations

718074 Atorvastatin ADCO ATORVASTATIN 20MG TAB Special investigations

718075 Atorvastatin ADCO ATORVASTATIN 40MG TAB Special investigations

710912 Atorvastatin ASPAVOR 40MG TAB Special investigations



719187 Atorvastatin ASTOR 40MG TAB Special investigations

714370 Atorvastatin ATOLIP 10MG TAB Special investigations



711621 Atorvastatin ATORVASTATIN UNICORN 10MG TAB Special investigations



718218 Atorvastatin DYNATOR 10MG TAB Special investigations



719366 Atorvastatin LESTAVOR 10MG TAB Special investigations



718934 Atorvastatin VASTOR 20MG TAB Special investigations



701276 Simvastatin ADCO-SIMVASTATIN 10MG TAB Special investigations



707089 Simvastatin ARROW SIMVASTATIN 10MG TAB Special investigations

706714 Simvastatin ASPEN SIMVASTATIN 10MG TAB Special investigations



705464 Simvastatin AUSTELL-SIMVASTATIN 10MG 10MG TAB Special investigations



709668 Simvastatin BIOVAC SIMVASTATIN 10MG TAB Special investigations

714705 Simvastatin CHOLESTE 20MG TAB Special investigations

714706 Simvastatin CHOLESTE 40MG TAB Special investigations

710511 Simvastatin CIPLA-SIMVASTATIN 40MG 40MG TAB Special investigations

708307 Simvastatin CIPLA-SIMVASTATIN 10MG TAB Special investigations

708308 Simvastatin CIPLA-SIMVASTATIN 20MG TAB Special investigations

710870 Simvastatin MICHOL 40MG TAB Special investigations



700519 Simvastatin SIMVACOR 10 10MG TAB Special investigations

700520 Simvastatin SIMVACOR 20 20MG TAB Special investigations

708463 Simvastatin SIMVACOR 40MG TAB Special investigations

710826 Simvastatin ZYSIM 10MG TAB Special investigations

710827 Simvastatin ZYSIM 20MG TAB Special investigations

Fibrates 708453 Bezafibrate BEZALIP 200MG TAB Special investigations

710122 Bezafibrate DYNA-BEZAFIBRATE SR SRT Special investigations

828300 Bezafibrate SANDOZ BEZAFIBRATE 400MG TAB Special investigations

Nicotinic acid 818518 Nicotinic acid BE-TABS NICOTINIC ACID 100MG CAP Special investigations

891322 Nicotinic acid NICOTINIC ACID TAB Special investigations

Hypertension

Centrally acting antiadrenergic agents

760048 Reserpine RESERPINE 0.25MG TAB Accepted treatment

764116 Methyldopa SANDOZ METHYLDOPA 250 250MG TAB Accepted treatment

732052 Methyldopa HYPOTONE 250MG TAB Accepted treatment

785962 Methyldopa MYLAN METHYLDOPA 250MG TAB Accepted treatment

Alpha-adrenergic blockers 701626 Doxazosin ADCO-DOXAZOSIN 1MG TAB Clinical review

701425 Doxazosin CARDUGEN WAS MERCK DOXAZOSIN

1MG TAB Clinical review

701631 Doxazosin ADCO-DOXAZASIN 4MG TAB Clinical review

701426 Doxazosin CARDUGEN WAS MERCK DOXAZOSIN

4MG TAB Clinical review

714292 Doxazosin CARZIN XL 4MG TAB Clinical review

Arterial vasodilators 731714 Hydralazine HYPERPHEN 10MG TAB Clinical review

761400 Hydralazine SANDOZ HYDRALAZINE HCL 25 25MG TAB Clinical review

731722 Hydralazine HYPERPHEN 50MG TAB Clinical review

761419 Hydralazine SANDOZ HYDRALAZINE HCL 50 50MG TAB Clinical review

Diuretics 821845 Furosemide BEURISES 40MG TAB Accepted treatment

716048 Furosemide DINO-RETIC 40MG TAB Accepted treatment

857769 Furosemide MERCK FUROSEMIDE 40MG TAB Accepted treatment

758272 Furosemide PURESIS 40MG TAB Accepted treatment

731668 Furosemide SANDOZ FUROSEMIDE 40 40MG TAB Accepted treatment

705967 Furosemide DIURESIX 40MG TAB Accepted treatment

710437 Hydrochlorothiazide RIDAQ 12.5MG 12.5MG TAB Accepted treatment

890470 Hydrochlorothiazide HEXAZIDE 25MG TAB Accepted treatment

880949 Hydrochlorothiazide RIDAQ 25MG 25MG TAB Accepted treatment

774057 Hydrochlorothiazide and potassium URIREX-K TAB Accepted treatment


ADCO-RETIC 50MG/5MG TAB Accepted treatment


AMILORETIC 50MG/5MG TAB Accepted treatment


BETARETIC 50MG/5MG TAB Accepted treatment


DEZRETIC 5MG/50MG 50MG/5MG TAB Accepted treatment


SPEC-CO-AMILORIDE 50MG/5MG TAB Accepted treatment



710313 Indapamide CIPLA-INDAPAMIDE 2.5MG TAB Accepted treatment

833045 Indapamide DAPTRIL 2.5MG TAB Accepted treatment

703329 Indapamide MERCK-INDAPAMIDE 2.5MG TAB Accepted treatment



765910 Spironolactone SPIRACTIN 25MG TAB Accepted treatment


















Beta-blocker and diuretic combinations

789615 Atenolol and other diuretics ROLAB-ATENOLOL/CHLORTHALIDONE 100/25


789607 Atenolol and other diuretics ROLAB-ATENOLOL/CHLORTHALIDONE 50/12.5


786217 Atenolol and other diuretics TENCHLOR 100MG TAB Accepted treatment

807591 Atenolol and other diuretics TENCHLOR HS 50MG TAB Accepted treatment








704620 Amlodipine AMLOSYN 5 5MG TAB Accepted treatment















708191 Amlodipine CPL ALLIANCE AMLODIPINE 10MG TAB Accepted treatment



708648 Amlodipine INDO AMLODIPINE 5MG TAB Accepted treatment

708162 Amlodipine KLODIP 5MG TAB Accepted treatment











840963 Nifedipine ADCO-VASCARD SR 20MG TAB Accepted treatment

864153 Nifedipine CIPALAT RETARD 20MG TAB Accepted treatment

829501 Nifedipine NIFEDALAT 20 SR 20 MG SRT Accepted treatment




ACE inhibitors 837628 Captopril CAPTOHEXAL 12.5MG TAB Accepted treatment


852619 Captopril MERCK CAPTOPRIL 25MG TAB Accepted treatment

852333 Captopril ACETEN 25MG TAB Accepted treatment


899429 Captopril MERCK-CAPTOPRIL 50MG TAB Accepted treatment










701729 Enalapril CIPLATEC 20MG 20MG TAB Accepted treatment
























715938 Lisinopril APEX-LISINOPRIL 20MG TAB Accepted treatment

714679 Lisinopril LIZRO(WAS AURO-LISINOPRIL) 20MG TAB Accepted treatment




716792 Lisinopril LYSIN 5MG TAB Accepted treatment



ACE inhibitors and diuretic combinations

787035 Enalapril and diuretics CO-RENITEC 20MG/12.5MG TAB Accepted treatment

891287 Enalapril and diuretics ENAP-CO 20MG/12.5MG TAB Accepted treatment

885019 Enalapril and diuretics PHARMAPRESS CO 20MG/12.5MG TAB Accepted treatment

704704 Lisinopril and diuretics HEXAL LISINOPRIL CO 20 20MG/12.5MG TAB Accepted treatment













Angiotensin receptor blockers













720776 Losartan LOZAAN 100MG TAB Accepted treatment



715871 Losartan RENICARD 50MG TAB Accepted treatment



709964 Losartan ZARTAN 100MG 100MG TAB Accepted treatment

Angiotensin receptor blockers and diuretic combinations

717070 Losartan and diuretics AUSTELL LOSARTAN CO 50MG/12.5MG


716476 Losartan and diuretics HYTENZA CO 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

715857 Losartan and diuretics LOSAAR PLUS 100MG/25MG 100MG/25MG TAB Accepted treatment

715856 Losartan and diuretics LOSAAR PLUS 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

716274 Losartan and diuretics LOSACAR CO 50MG/12,5MG 50MG/12.5MG TAB Accepted treatment

718368 Losartan and diuretics LOSARTAN CO UNICORN 100MG/25MG


718367 Losartan and diuretics LOSARTAN CO UNICORN 50MG/12.5MG


715849 Losartan and diuretics NETRASOL CO 100/25MG 100MG/25MG TAB Accepted treatment

715848 Losartan and diuretics NETRASOL CO 50/12.5MG 50MG/12.5MG TAB Accepted treatment

716217 Losartan and diuretics ZARTAN CO 100MG/25MG 100MG/25MG TAB Accepted treatment

` 716216 Losartan and diuretics ZARTAN CO 50MG/12.5MG 50MG/12.5MG TAB Accepted treatment

Hypothyroidism

722944 Levothyroxine sodium ELTROXIN 0.05MG TAB Accepted treatment

722952 Levothyroxine sodium ELTROXIN 0.1MG TAB Accepted treatment

713169 Levothyroxine sodium EUTHYROX 100MCG TAB Accepted treatment



Multiple sclerosis

Anticholinergics 722063 Oxybutynin OXYREST 5MG TAB Accepted treatment

701893 Oxybutynin MERCK OXYBUTYNIN CHLORIDE 5 TAB

872253 Oxybutynin LENDITRO TAB Accepted treatment

Immunosuppressants 712609 Azathioprine AZATHIOPRINE PCH 50MG TAB Accepted treatment


701252 Azathioprine AZAMUN 50MG TAB Accepted treatment





712504 Methotrexate EMTHEXATE 2.5MG TAB Accepted treatment



Muscle relaxants 722015 Baclofen ASPEN BACLOFEN 10MG TAB Accepted treatment

865567 Baclofen BIO-BACLOFEN (WAS NORTON-BACLOFEN)


712607 Baclofen TEVA BACLOFEN 10MG TAB Accepted treatment

Tricyclic antidepressants 718746 Amitriptyline GULF AMITRIPTYLINE 25MG TAB Accepted treatment






Carbamazepine 712493 Carbamazepine DEGRANOL 200MG TAB Accepted treatment



Analgesics 717725 Paracetamol ACTAMOL 500MG TAB Accepted treatment


















COGESIC TAB Accepted treatment















Non-steroidal anti-inflammatories

786594 Diclofenac ADCO-DICLOFENAC 25MG TAB Accepted treatment


893390 Diclofenac A-LENNON DICLOFENAC 25MG TAB Accepted treatment


718479 Diclofenac DICLOFENAC BIOTECH 25MG TAB Accepted treatment

841153 Diclofenac DICLOHEXAL 50MG TAB Accepted treatment

853240 Diclofenac DICLOHEXAL 25T 25MG TAB Accepted treatment

786012 Diclofenac MYLAN DICLOFENAC (ARCANAFENAC)


786020 Diclofenac MYLAN DICLOFENAC SOD (ARCANAFENAC)


752398 Diclofenac PANAMOR AT-50 50MG TAB Accepted treatment

827584 Diclofenac PANAMOR SR 75 MG TAB Accepted treatment

719838 Diclofenac SANDOZ DICLOFENAC SODIUM 50 50MG TAB Accepted treatment

719811 Diclofenac SANDOZ-DICLOFENAC SODIUM 25MG TAB Accepted treatment

793663 Diclofenac VELTEX CR 75MG SRC Accepted treatment

717155 Ibuprofen AUSTELL IBUPROFEN 200MG TAB Accepted treatment

721118 Ibuprofen AUSTIFEN 200MG TAB Accepted treatment

787426 Ibuprofen BETAPROFEN 200MG TAB Accepted treatment

701975 Ibuprofen BETAPROFEN 400 FC 400MG TAB Accepted treatment

708290 Ibuprofen BREN 400MG TAB Accepted treatment

895196 Ibuprofen Iboflam 200MG TAB Accepted treatment

705940 Ibuprofen IBU 200MG TAB Accepted treatment

700316 Ibuprofen IBUMAX 200MG TAB Accepted treatment


700315 Ibuprofen IBUMAX PAEDIATRIC 100MG/5ML SUS Accepted treatment

868221 Ibuprofen IBUNATE 200MG TAB Accepted treatment

708536 Ibuprofen IBUSOR 200MG TAB Accepted treatment

733741 Ibuprofen INZA 200MG TAB Accepted treatment

733768 Ibuprofen INZA 400MG 400MG TAB Accepted treatment

824852 Ibuprofen RANFEN 200MG TAB Accepted treatment

701654 Ibuprofen RANFEN 400 400MG TAB Accepted treatment

703966 Ibuprofen SANDOZ IBUPROFEN 200 200MG TAB Accepted treatment

701106 Indometacin ADCO-INDOMETHACIN 25MG CAP Accepted treatment

704725 Indometacin ARTHREXIN 25MG CAP Accepted treatment

787833 Indometacin BETACIN 25MG CAP Accepted treatment

868213 Indometacin GULF INDOMETHACIN 25MG CAP Accepted treatment

788996 Indometacin MEDIFLEX 25MG CAP Accepted treatment

814393 Indometacin METHOCAPS 25MG CAP Accepted treatment

704776 Indometacin SANDOZ INDOMETHACIN 25 25MG CAP Accepted treatment

799459 Naproxen BE-TABS NAPROXEN 250MG TAB Accepted treatment

715831 Naproxen BIO-NAPROXEN 250MG TAB Accepted treatment



810185 Naproxen MYLAN NAPROXEN (ARCANA-NAPROXEN)


806447 Naproxen NAPFLAM 250MG TAB Accepted treatment


805238 Naproxen NAPROSCRIPT 250MG TAB Accepted treatment

785253 Piroxicam ADCO-PIROXICAM 10MG CAP Accepted treatment


716517 Piroxicam PIROXICAM ACTOR DT 20MG DSP Accepted treatment

827428 Piroxicam PIXICAM 20MG DSP Accepted treatment

799432 Piroxicam PYROCAPS 20MG CAP Accepted treatment

701072 Piroxicam ROXIFEN 20MG CAP Accepted treatment

797030 Piroxicam XYCAM 20MG CAP Accepted treatment

797049 Piroxicam XYCAM DISPERS 20MG DSP Accepted treatment

Folic acid 709874 Folic acid AHA FOLIC ACID 5MG TAB Accepted treatment

810967 Folic acid BE-TABS FOLIC ACID 5MG TAB Accepted treatment


711922 Folic acid FOLIC ACID 5MG TAB Accepted treatment


721661 Folic acid FOLIK .5MG TAB Accepted treatment

720727 Folic acid GULF FOLIC ACID 5MG TAB Accepted treatment

Parkinson's disease

Levodopa combinations 828483 Levodopa and decarboxylase inhibitor MADOPAR HBS 25/100MG CAP Accepted treatment

794635 Levodopa and decarboxylase inhibitor SINEMET CR 50/200MG SRT Accepted treatment

824321 Levodopa and decarboxylase inhibitor CARBILEV 25/100 MG TAB Accepted treatment

764078 Levodopa and decarboxylase inhibitor SINEMET 25/100MG TAB Accepted treatment

824348 Levodopa and decarboxylase inhibitor CARBILEV 25/250 MG TAB Accepted treatment

764086 Levodopa and decarboxylase inhibitor SINEMET 25/250MG TAB Accepted treatment

739928 Levodopa and decarboxylase inhibitor MADOPAR 250MG TAB Accepted treatment

710286 Levodopa and decarboxylase inhibitor TEVA CARBI-LEVO 25/100 25MG/100MG TAB Accepted treatment

710468 Levodopa and decarboxylase inhibitor TEVA CARBI-LEVO 25/250 25MG/250MG TAB Accepted treatment

Dopamine agonists and other

700500 Amantadine SYMADIN (WAS FLUSTOP) CAP Accepted treatment

701491 Biperiden AKINETON 2MG TAB Accepted treatment

720542 Orphenadrine (chloride) DISIPAL 50MG TAB Accepted treatment

719569 Ropinirole ACCORD ROPINIROLE 0.25MG TAB Specialist motivation

700647 Ropinirole REQUIP 0.25MG 0.25MG TAB Specialist motivation

719570 Ropinirole ACCORD ROPINIROLE 0.50MG TAB Specialist motivation

700650 Ropinirole REQUIP 0.5MG 0.50MG TAB Specialist motivation

719571 Ropinirole ACCORD ROPINIROLE 1MG TAB Specialist motivation

700652 Ropinirole REQUIP 1MG 1MG TAB Specialist motivation







706712 Selegiline PARKILYNE TAB Accepted treatment

713210 Trihexyphenidyl BENZHEXOL 2MG TAB Accepted treatment

Rheumatoid arthritis

Disease modifying agents 747297 Chloroquine NIVAQUINE 200MG TAB Accepted treatment

794333 Chloroquine PLASMOQUINE 200MG CAP Accepted treatment

799149 Chloroquine DARAMAL SYR Accepted treatment

878790 Chloroquine MIRQUIN SYR Accepted treatment

782564 Methotrexate ABITREXATE-10ML 1G INJ Accepted treatment








700777 Azathioprine ZAPRINE 50MG TAB Accepted treatment

701252 Azathioprine AZAMUN TAB Accepted treatment


Alkylating agents 723274 Cyclophosphamide ENDOXAN 50MG TAB Specialist motivation








786020 Diclofenac MERCK DICLOFENAC SOD (ARCANAFENAC)














895196 Ibuprofen IBOFLAM 200MG TAB Accepted treatment




































Oral corticosteroids 800155 Prednisolone LENISOLONE 5MG TAB Accepted treatment

814407 Prednisolone CAPSOID 5MG TAB Accepted treatment



Schizophrenia

Antipsychotic agents 735884 Chlorpromazine LARGACTIL 100MG TAB Accepted treatment



717082 Clozapine ASPEN CLOZAPINE 100MG TAB Accepted treatment (clinical motivation


717081 Clozapine ASPEN CLOZAPINE 25MG TAB Accepted treatment (clinical motivation








726672 Flupentixol FLUANXOL DEPOT 1ML 20MG INJ Accepted treatment

744328 Fluphenazine MODECATE PLUS SYRINGE 1ML 25MG/ML INJ Accepted treatment

719549 Haloperidol GULF HALOPERIDOL 5MG TAB Accepted treatment

730335 Haloperidol SANDOZ HALOPERIDOL 1.5 1.5MG TAB Accepted treatment

730327 Haloperidol SANDOZ HALOPERIDOL 5 5MG TAB Accepted treatment

763411 Haloperidol SERENACE 0.5MG CAP Accepted treatment

704382 Lamotrigine EPITEC 200MG 200MG TAB Accepted treatment (clinical motivation


720527 Olanzapine LANAZYP 2.5MG TAB Accepted treatment (clinical motivation


720528 Olanzapine LANAZYP 5MG TAB Accepted treatment (clinical motivation




718995 Olanzapine MYLAN OLANZAPINE 2.5MG TAB Accepted treatment (clinical motivation






721385 Olanzapine OLAWIN 2.5MG TAB Accepted treatment (clinical motivation














715683 Olanzapine REDILANZ 2.5MG TAB Accepted treatment (clinical motivation














































714686 Risperidone AUROPIDONE 0.5MG TAB Accepted treatment (clinical motivation


714690 Risperidone AUROPIDONE 4MG TAB Accepted treatment (clinical motivation


720334 Risperidone PERIDA 0.5MG TAB Accepted treatment (clinical motivation








717996 Risperidone RISNIA 0.5MG TAB Accepted treatment (clinical motivation










714101 Risperidone RISPACOR 0.5MG TAB Accepted treatment (clinical motivation










823163 Risperidone RISPERDAL ORAL 1mg/ml SYR Accepted treatment (clinical motivation


















715736 Risperidone SCHIZOROL 0.5MG TAB Accepted treatment (clinical motivation










711511 Risperidone ZOXADON 0.5MG TAB Accepted treatment (clinical motivation




705386 Sulpiride BIO-SULPIRIDE 200MG TAB Accepted treatment



786934 Zuclopenthixol CLOPIXOL ACUPHASE 50MG INJ Accepted treatment

714852 Zuclopenthixol CLOPIXOL DEPOT 200MG INJ Accepted treatment

Antidepressants 772003 Amitriptyline TREPILINE 10MG TAB Accepted treatment

718746 Amitriptyline GULF AMITRIPTYLINE 25MG TAB Accepted treatment






























Mood stabilisers 705597 Carbamazepine SANDOZ CARBAMAZEPINE CR200 200MG SRT Accepted treatment
























758833 Lithium QUILONUM RETARD 450MG TAB Accepted treatment

















Systemic Lupus Erythematosus


















































Oral Corticosteroids 800155 Prednisolone LENISOLONE 5MG TAB Accepted treatment




Antiplatelet agents 704645 Acetylsalicylic acid ASPIRIN 300MG TAB Accepted treatment






712608 Acetylsalicylic acid ASPIRIN TEVA 80MG DSP Accepted treatment

Disease modifying agents 701252 Azathioprine AZAMUN 50MG TAB Accepted treatment


712609 Azathioprine AZATHIOPRINE PCH 50MG TAB Accepted treatment


782564 Methotrexate ABITREXATE-10ML 1G INJ Accepted treatment







Alkylating agents 723274 Cyclophosphamide ENDOXAN 50MG TAB Specialist motivation

Ulcerative colitis

Aminosalicylic acid preparations




700777 Azathioprine ZAPRINE 50MG TAB Accepted treatment

701252 Azathioprine AZAMUN TAB Accepted treatment


Oral corticosteroids 800155 Prednisolone LENISOLONE 5MG TAB Accepted treatment




818267 Prednisone TROLIC 5MG TAB Accepted treatment

Steroid preparations (enemas)

824593 Budesonide ENTOCORD ENEMAS 2.3MG ENE Accepted treatment

Menopause

756725 Conjugated estrogens PREMARIN 0.3MG TAB Accepted treatment





832448 Conjugated estrogens PREMARIN 42.5G .625MG/1G VCR Accepted treatment

750301 Estradiol OESTRADIOL 20MG IMP Accepted treatment

810290 Estradiol EVOREL 50 TTS 50MCG PAD Accepted treatment

706055 Estradiol ESTRADOT 100MCG PAD Accepted treatment


706052 Estradiol ESTRADOT 37.5MCG PAD Accepted treatment

824631 Estradiol CLIMARA 50 50MCG PAD Accepted treatment



893919 Estradiol ESTROFEM 1MG 1MG TAB Accepted treatment

822477 Estradiol ESTRO-PAUSE 1MG TAB Accepted treatment

757330 Estradiol PROGYNOVA 1MG TAB Accepted treatment

825883 Estradiol ESTROFEM 2MG TAB Accepted treatment



741817 Estradiol combinations MENOFLUSH TAB Accepted treatment

827452 Estriol SYNAPAUSE E3 2MG TAB Accepted treatment

718440 Medroxyprogesterone DEPO-PROVERA 1ML 150MG/1ML INJ Accepted treatment

780642 Medroxyprogesterone PETOGEN 1ML 150MG/1ML INJ Accepted treatment

706705 Medroxyprogesterone HEXAL-MPA 10MG TAB Accepted treatment


822493 Norethisterone and estrogen ESTRO-PAUSE N TAB Accepted treatment

704903 Norethisterone and estrogen NOVOFEM TAB Accepted treatment

825980 Norgestrel and estrogen POSTOVAL 28 TAB Accepted treatment

Polycystic ovarian syndrome (PCOS)

Contraceptives for systemic use

825964 Desogestrol and estrogen MARVELON 150/30 TAB Accepted treatment

826014 Gestodene and estrogen MINULETTE TAB Accepted treatment

720418 Levonorgestrel HY-AN 0.03MG TAB Accepted treatment

720419 levonorgestrel and ethinylestradiol ORALCON TAB Accepted treatment

720420 levonorgestrel and ethinylestradiol TRIGESTREL TAB Accepted treatment

721606 levonorgestrel and ethinylestradiol LEVETTE 0.15MG/0.03MG TAB Accepted treatment

826006 Levonorgestrol MICROVAL 28 0.3MG TAB Accepted treatment

825808 Levonorgestrol and estrogen BIPHASIL 28 TAB Accepted treatment

825956 Levonorgestrol and estrogen LOGYNON ED TAB Accepted treatment

826030 Levonorgestrol and estrogen NORDETTE TAB Accepted treatment

826049 Levonorgestrol and estrogen NORDIOL 28 TAB Accepted treatment

825832 Levonorgestrol and estrogen TRIPHASIL TAB Accepted treatment

720417 norgestrel and ethinylestradiol FAMYNOR TAB Accepted treatment

826138 Norgestrol and estrogen OVRAL TAB Accepted treatment

748552 Norithisterone NUR-ISTERATE 200MG/1ML INJ Accepted treatment

826073 Norithisterone and estrogen TRINOVUM TAB Accepted treatment



Biguanides 714427 Metformin ACCORD METFORMIN 500MG TAB Accepted treatment

715936 Metformin DIAFORMIN 500MG TAB Accepted treatment








897957 Metformin MYLAN METFORMIN 500MG TAB Accepted treatment

719643 Metformin ROMIDAB 500MG TAB Accepted treatment

707670 Metformin APEX-METFORMIN 500MG TAB Accepted treatment

707669 Metformin APEX-METFORMIN FORTE 850MG TAB Accepted treatment

708010 Metformin FORMINAL 850MG TAB Accepted treatment

714426 Metformin ACCORD METFORMIN 850MG TAB Accepted treatment

715937 Metformin DIAFORMIN FORTE 850MG TAB Accepted treatment






897961 Metformin MERCK-METFORMIN 850MG TAB Accepted treatment


702363 Metformin METFORAL 850MG 850MG TAB Accepted treatment


711638 Metformin METORED 850MG TAB Accepted treatment


719644 Metformin ROMIDAB 850MG TAB Accepted treatment

719293 Metformin SANDOZ-METFORMIN 850MG 850MG TAB Accepted treatment

815233 Metformin SANDOZ-METFORMIN FC 850MG 850MG TAB Accepted treatment



706673 Metformin ARROW METFORMIN 850MG TAB Accepted treatment

705758 Metformin AUSTELL-METFORMIN 850MG 850MG TAB Accepted treatment


Systemic hormones 756725 Conjugated estrogens PREMARIN 0.3MG TAB Accepted treatment



750301 Estradiol OESTRADIOL 20MG IMP Accepted treatment

810290 Estradiol EVOREL 50 TTS 50MCG PAD Accepted treatment



706052 Estradiol ESTRADOT 37.5MCG PAD Accepted treatment



824631 Estradiol CLIMARA 50 50MCG PAD Accepted treatment



893919 Estradiol ESTROFEM 1MG 1MG TAB Accepted treatment



825883 Estradiol ESTROFEM 2MG TAB Accepted treatment



741817 Estradiol combinations MENOFLUSH TAB Accepted treatment

827452 Estriol SYNAPAUSE E3 2MG TAB Accepted treatment





822493 Norethisterone and estrogen ESTRO-PAUSE N TAB Accepted treatment

704903 Norethisterone and estrogen NOVOFEM TAB Accepted treatment

825980 Norgestrel and estrogen POSTOVAL 28 TAB Accepted treatment

Anti-androgens 765910 Spironolactone SPIRACTIN 25MG TAB Accepted treatment



Endometriosis




748552 Norithisterone NUR-ISTERATE 200MG/1ML INJ Accepted treatment

825964 Desogestrol and estrogen MARVELON 150/30 TAB Accepted treatment

826014 Gestodene and estrogen MINULETTE TAB Accepted treatment

720418 Levonorgestrel HY-AN 0.03MG TAB Accepted treatment

720419 levonorgestrel and ethinylestradiol ORALCON TAB Accepted treatment

720420 levonorgestrel and ethinylestradiol TRIGESTREL TAB Accepted treatment

826006 Levonorgestrol MICROVAL 28 0.3MG TAB Accepted treatment

825808 Levonorgestrol and estrogen BIPHASIL 28 TAB Accepted treatment

825956 Levonorgestrol and estrogen LOGYNON ED TAB Accepted treatment

826030 Levonorgestrol and estrogen NORDETTE TAB Accepted treatment

826049 Levonorgestrol and estrogen NORDIOL 28 TAB Accepted treatment

825832 Levonorgestrol and estrogen TRIPHASIL TAB Accepted treatment

826138 Norgestrol and estrogen OVRAL TAB Accepted treatment

826073 Norithisterone and estrogen TRINOVUM TAB Accepted treatment












853240 Diclofenac DICLOHEXAL 25T 25MG TAB Accepted treatment















895196 Ibuprofen Iboflam 200MG TAB Accepted treatment




































Paraplegia

Muscle relaxants 722015 Baclofen ASPEN BACLOFEN 10MG TAB Accepted treatment

865567 Baclofen BIO-BACLOFEN (WAS NORTON-BACLOFEN)


712607 Baclofen TEVA BACLOFEN 10MG TAB Accepted treatment

Anticholinergics 722063 Oxybutynin OXYREST 5MG TAB Accepted treatment

701893 Oxybutynin MERCK OXYBUTYNIN CHLORIDE 5 TAB Accepted treatment

872253 Oxybutynin LENDITRO TAB Accepted treatment

Analgesics 792101 Paracetamol ACTAMOL 120MG/5ML SYR Accepted treatment

717725 Paracetamol ACTAMOL 500MG TAB Accepted treatment

704093 Paracetamol ACTAMOL RED (UN-BOXED) 120MG/5ML SYR Accepted treatment

894281 Paracetamol ADCO-PARACETAMOL 120MG/5ML SYR Accepted treatment


713153 Paracetamol AUSTELL-PARACETAMOL 500MG TAB Accepted treatment

717187 Paracetamol BARRS PARACETAMOL 120MG/5ML SYR Accepted treatment

701634 Paracetamol DIS-CHEM PARACETAMOL 500MG TAB Accepted treatment

703820 Paracetamol FEVERPAIN 120MG/5ML SYR Accepted treatment

863742 Paracetamol FEVERPAIN (BOXED) 120MG/5ML SYR Accepted treatment




745715 Paracetamol NAPAMOL 120MG/5ML SYR Accepted treatment



752142 Paracetamol PAINAMOL WHITE 500MG TAB Accepted treatment

889772 Paracetamol PAINBLOK 120MG/5ML SYR Accepted treatment


704450 Paracetamol PAINOGESIC 120MG/5ML SYR Accepted treatment



120MG/5ML SYR Accepted treatment












COGESIC TAB Accepted treatment






































































Antidepressants 772003 Amitriptyline TREPILINE 10MG TAB Accepted treatment

718746 Amitriptyline GULF AMITRIPTYLINE 25MG TAB Accepted treatment






























Anti-epileptics 705597 Carbamazepine SANDOZ CARBAMAZEPINE CR200 200MG SRT Accepted treatment








Laxatives 721522 Bisacodyl DULCOLAX ADULT 10MG SUP Accepted treatment

721530 Bisacodyl DULCOLAX PAED 5MG SUP Accepted treatment

715545 Bisacodyl FRESHEN BISOCODYL LAXATIVE TAB Accepted treatment

708008 Bisacodyl LAXADOR BISACODYL TAB Accepted treatment

702984 Senna glycosides BLACK FOREST SENNA TAB Accepted treatment

705231 Senna glycosides DIS-CHEM SENNA TAB Accepted treatment

707044 Senna glycosides PURITAN'S PRIDE SENNAGEN TAB Accepted treatment

708867 Senna glycosides SENNA-PIN TAB Accepted treatment

868078 Senna glycosides SOFLAX TAB Accepted treatment


Therapeutic Class Nappi Ingredients Product Name Strength Form ScheduleQuantities

and limitations

Formulary Status(In/

Out)

Alimentary tract and metabolism

Anti-fungals for local oral treatment

835056 NystatIn CANSTAT ORAL 20ML 100000U/1ML DRP 2 Max 2 Rx/annum

In

835285 NystatIn NYSTACID 100000U/1ML DRP 2 Max 2 Rx/annum

In

701100 NystatIn CANDACIDE 100000U/1ML DRP 2 Max 2 Rx/annum

In

728640 Gentian violet GENTIAN VIOLET 0.005 SLN 0 Max 20ml/Rx & 2 Rx/

annum

In

Apthous ulcers 835404 CholIne sal/cetalkonium chloride

TEEJEL 87MG/5G JEL 0 Max 5g/Rx & 2 Rx/annum

In

Peridontitis 731005 ChlorhexidIne mOuthwash

CORSODYL 0.002 MOW 0 Max 400ml/Rx & 2Rx/

annum

In

808377 ChlorhexidIne CORSODYL MInT 0.002 MOW 0 Max 400ml/Rx & 2Rx/

annum

In

705273 ChlorhexidIne mOuthwash

PAROEX MOutHRInSE 0.0012 MOW 0 Max 400ml/Rx & 2Rx/

annum

In

751049 HexidIne ORALDInE 15MG/15ML MOW 0 Max 400ml/Rx & 2Rx/

annum

In

Herpes stomatitis 826391 TetracaIne 1% oral DYNEXAN 0.01 OIn 1 Max 10g/Rx & 1Rx/

annum

In

Antacids 808555 Magnesium hydroxide MIST MAG HYDROX FAMS MLS 0 Max 200ml/Rx & 3Rx/

annum

In

839035 Magnesium silicate BE-TABS ANTACID SUS 0 Max 200ml/Rx & 3Rx/

annum

In

823031 CombInations MAGASIL (MIST MAG TRIS) SUS 0 Max 200ml/Rx & 3Rx/

annum

In

892654 CombInations MAGASIL SYR 0 Max 200ml/Rx & 3Rx/

annum

In

897400 Magnesium hydroxide MIST MAG HYDROXIDE 2500ML LIQ 0 Max 200ml/Rx & 3Rx/

annum

In

894838 CombInations MIST MAG TRISIL LIQ 0 Max 200ml/Rx & 3Rx/

annum

In

Products listed with a Formulary Status as "Out" will attract a 30% co-payment if claimed on acute benefit for the SAPPHIRE AND BERYL options. Items not listed will be rejected. In conjunction with this, other rules may apply.

Annexure H: GEMS Sapphire and Beryl Network Acute Medicine Formulary



and limitations


Out)

700460 AlumInium hydroxide ACIDEX SUSPENSION SUS 0 Max 200ml/Rx & 3Rx/

annum

In

702447 AlumInium hydroxide ALUM HYDROXIDE GEL SUS 0 Max 200ml/Rx & 3Rx/

annum

In

740551 OrdInary salt combInations

MAYOGEL SUS 0 Max 200ml/Rx & 3Rx/

annum

In

707899 Antacids with antispasmodics

BETACLOMIn GEL SUS 2 Max 200ml/Rx & 3Rx/

annum

In


SPASMOGEL SUS 2 Max 200ml/Rx & 3Rx/

annum

In


AMGEL SUS 2 Max 200ml/Rx & 3Rx/

annum

In


NEUTRAGEL D SUS 2 Max 200ml/Rx & 3Rx/

annum

In


ALUMAG D SUS 2 Max 200ml/Rx & 3Rx/

annum

In


DICYCLOMInE CO GEL SUS 2 Max 200ml/Rx & 3Rx/

annum

In


GELUMEN ANTACID SUS 2 Max 200ml/Rx & 3Rx/

annum

In


CO-GEL SUS 2 Max 200ml/Rx & 3Rx/

annum

Out

757675 Antacids, other combInations

PROPAN GEL S SUS 2 Max 200ml/Rx & 3Rx/

annum

In

740683 Antacids, other combInations

MEDIGEL SUS 2 Max 200ml/Rx & 3Rx/

annum

In

736252 CimetidIne LENAMET 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

832901 CimetidIne LENAMET OTC 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

854247 CimetidIne CIMLOK 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

797464 CimetidIne SECADInE 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

886978 CimetidIne BIO-CIMETIDInE 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

811459 CimetidIne ADCO-CIMETIDInE 200MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

736260 CimetidIne LENAMET 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

In



and limitations


Out)

854255 CimetidIne CIMLOK 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

797472 CimetidIne SECADInE 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

800252 CimetidIne ADCO-CIMETIDInE 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

887003 CimetidIne BIO-CIMETIDInE 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

806919 CimetidIne HEXAMET 400 400MG TAB 2 Max 20/Rx and 3 Rx/

annum

Out

841765 RanitidIne HISTAK 150 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

700119 RanitidIne CPL ALLIANCE RANITIDInE 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

713553 RanitidIne GULF RANITIDInE 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

705361 RanitidIne RANIT 150 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

867934 RanitidIne ULTAK 150MG 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

Out

717160 RanitidIne APEX-RANITIDInE 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

719669 RanitidIne RANITIDInE BIOTECH 150MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

700120 RanitidIne CPL ALLIANCE RANITIDInE 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

841773 RanitidIne HISTAK 300 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

705360 RanitidIne RANIT 300 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

In

713554 RanitidIne GULF RANITIDInE 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

Out

707309 RanitidIne SIMAYLA RANITIDInE 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

Out

841617 RanitidIne RANIHEXAL 300MG TAB 2 Max 20/Rx and 3 Rx/

annum

Out

Antispasmodics 701892 MebeverIne MYLAN MEBEVERInE HYDROCHLORIDE

135MG TAB 2 Max 30/Rx and 4 Rx/

annum

In

822019 MebeverIne BEVISPAS 135MG TAB 2 Max 30/Rx and 4 Rx/

annum

In



and limitations


Out)

825328 MebeverIne SANDOZ-MEBEVERInE 135MG TAB 2 Max 30/Rx and 4 Rx/

annum

In

731951 ButylscopolamIne HYOSPASMOL 10MG TAB 2 Max 20/Rx and 4 Rx/

annum

In

762725 ButylscopolamIne SCOPEX 10MG TAB 2 Max 20/Rx and 4 Rx/

annum

In

707213 ButylscopolamIne HYOSPASMOL 5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

In

825352 ButylscopolamIne A-LENNON HYOSCInE BUTYLBROMIDE 1ML

20MG/1ML InJ 2 Consumables In

715836 ButylscopolamIne FRESENIUS HYOSCInE BUTYLBROMIDE AMPOULE


762733 ButylscopolamIne SCOPEX 1ML 20MG/1ML InJ 2 Consumables Out

701514 ButylscopolamIne MICRO HYOSCInE BUTYLBROMIDE

20MG/1ML InJ 2 Consumables Out

Antiemetics 772135 CyclizIne TRIAZInE (PAEDIATRIC) 50MG SUP 2 Max 1 OP/Rx and 3 Rx/

annum

In

774618 CyclizIne VALOID PAED 50MG SUP 2 Max 1 OP/Rx and 3 Rx/

annum

Out

774626 CyclizIne VALOID 100MG SUP 2 Max 1 OP/Rx and 3 Rx/

annum

In

792845 CyclizIne MEDAZInE-S 12.5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

In

820571 CyclizIne NAUZInE S 12.5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

In

796700 CyclizIne TRIAZInE PAEDIATRIC (WAS NORIZInE)

12.5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

In

792225 CyclizIne ACULOID 12.5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

Out

808962 CyclizIne ADCO-CYCLIZInE 12.5MG/5ML SYR 2 Max 1 OP/Rx and 3 Rx/

annum

Out

772143 CyclizIne TRIAZInE 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

In

809322 CyclizIne COVAMET 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

In

792217 CyclizIne ACULOID 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

In

808954 CyclizIne ADCO-CYCLIZInE 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

In

799424 CyclizIne NAUZInE 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

In



and limitations


Out)

811513 CyclizIne EMITEX 50MG TAB 2 Max 1 OP/Rx and 3 Rx/

annum

Out

783064 Metoclopramide CONTROMET 5MG/5ML SYR 5 Max 1 OP/Rx and 3 Rx/

annum

In

715875 Metoclopramide CONTROMET 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

787817 Metoclopramide BETACLOPRAMIDE 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

700712 Metoclopramide CLOMAX 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

783285 Metoclopramide SETIn 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

717891 Metoclopramide BIO METOCLOPRAMIDE 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

714828 Metoclopramide CLOPAMON 10MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

Out

856134 Metoclopramide METOCLOPRAMIDE 2ML (ST111)


705973 Metoclopramide MICRO METOCLOPRAMIDE 5MG/1ML InJ 5 Consumables In

744182 ProchlorperazIne MITIL 5MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

762849 ProchlorperazIne SCRIPTO-METIC 5MG TAB 5 Max 1 OP/Rx and 3 Rx/

annum

In

723037 Sucrose/Phosphoric acid

EMETROL SYR 0 Max 1 OP/Rx and 3 Rx/

annum

In

784346 Invert sugar/Phosphoric acid

EMEX SYR 0 Max 1 OP/Rx and 3 Rx/

annum

In

Laxatives 721522 Bisacodyl DULCOLAX ADULT 10MG SUP 0 Max 1 OP/Rx and 2 Rx/

annum

In

721530 Bisacodyl DULCOLAX PAED 5MG SUP 0 Max 1 OP/Rx and 2 Rx/

annum

In

708008 Bisacodyl LAXADOR BISACODYL TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

715545 Bisacodyl FRESHEN BISOCODYL LAXATIVE

TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

868078 Senna glycosides SOFLAX TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

705231 Senna glycosides DIS-CHEM SENNA TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

707044 Senna glycosides PURITAN'S PRIDE SENNAGEN TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In



and limitations


Out)

702984 Senna glycosides BLACK FOREST SENNA TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

708867 Senna glycosides SENNA-PIn TAB 0 Max 1 OP/Rx and 2 Rx/

annum

In

763225 Senna glycosides SENOKOT TAB 0 Max 1 OP/Rx and 2 Rx/

annum

Out

710368 Senna glycosides LENNON SENNA TAB 0 Max 1 OP/Rx and 2 Rx/

annum

Out

710370 Senna glycosides LAXADOR SENNA TAB 0 Max 1 OP/Rx and 2 Rx/

annum

Out

797723 Lactulose LACSON SYR 0 Max 200ml/Rx and 2 Rx/

annum

In

708722 Lactulose ACULAX SYR 0 Max 200ml/Rx and 2 Rx/

annum

In

817309 Lactulose LAXETTE SYR 0 Max 200ml/Rx and 2 Rx/

annum

In

713232 Lactulose AGAROL LACTULOSE SYR 0 Max 200ml/Rx and 2 Rx/

annum

In

717972 Lactulose ANLAC SYR 0 Max 200ml/Rx and 2 Rx/

annum

In

721611 Lactulose DUPHALAC SYR 0 Max 200ml/Rx and 2 Rx/

annum

Out

878707 Lactulose ADCO-LIQUILAX SYR 0 Max 200ml/Rx and 2 Rx/

annum

Out

798940 Sorbitol SORBITOL 70% LIQ 0 Max 200ml/Rx and 2 Rx/

annum

In

726435 Sodium phosphate LENOLAX CHILD ENE 0 Max 1 OP/Rx and 2 Rx/

annum

In

726443 Sodium phosphate LENOLAX ADULT ENE 0 Max 1 OP/Rx and 2 Rx/

annum

In

835463 Glycerol GLYCERIn 12 SUP (ADULT) SUP 0 Max 1 OP/Rx and 2 Rx/

annum

In

835471 Glycerol GLYCERIn 12 SUP (PAED) SUP 0 Max 1 OP/Rx and 2 Rx/

annum

In

Anti-diarrhoeals 708976 Bismuth preparations BISKAPECT SUS 2 Max 100ml/Rx & 3 per

annum

In

713864 Bismuth preparations CHLOROPECT SUS 2 Max 100ml/Rx & 3 per

annum

In

723401 Bismuth preparations ENTERODYNE SUS 1 Max 100ml/Rx & 3 per

annum

In



and limitations


Out)

715468 Other IntestInal adsorbents

COLOPECT (WAS COLLODENE DIARRH

SUS 1 Max 100ml/Rx & 3 per

annum

In


ENTEROLYTE SUS 0 Max 100ml/Rx & 3 per

annum

In


GASTROPECT SUS 0 Max 100ml/Rx & 3 per

annum

In


BE-TABS BETAPECT SUS 0 Max 100ml/Rx & 3 per

annum

In


PECTIn-K SUS 0 Max 100ml/Rx & 3 per

annum

In


PECTIKON SUS 0 Max 100ml/Rx & 3 per

annum

In


KAOCREME SUS 0 Max 100ml/Rx & 3 per

annum

In


J.P.PECT SUS 0 Max 100ml/Rx & 3 per

annum

In

762873 Oral rehydration salt formulations

SCRIPTOLYTE SLN 0 Max 200ml/Rx & 3 per

annum

In

717711 Oral rehydration salt formulations

DARROW LIQ SYR 0 Max 200ml/Rx & 3 per

annum

In

738980 Diphenoxylate, atropIne sulphate

LOMOTIL TAB 2 Max 10/Rx & 3 per annum

In

811467 Loperamide ADCO-LOPERAMIDE 1MG/5ML SYR 2 Max 50ml/Rx & 3/annum

In

820563 Loperamide LOPERASTAT SYRUP 0.2MG/ML SYR 2 Max 50ml/Rx & 3/annum

In

810908 Loperamide GASTRON 0.2MG/ML SYR 2 Max 50ml/Rx & 3/annum

In

796697 Loperamide NORIMODE 2MG TAB 2 Max 10/Rx & 3/annum

In

810916 Loperamide GASTRON 2MG TAB 2 Max 10/Rx & 3 /annum

In

791768 Loperamide PRODIUM 2MG TAB 2 Max 10/Rx & 3 /annum

In

792071 Loperamide ADCO-LOPERAMIDE 2MG TAB 2 Max 10/Rx & 3 /annum

Out

707342 Loperamide CIPLA-LOPERAMIDE 2MG TAB 2 Max 10/Rx & 3 /annum

Out

Blood and blood-formIng organs

HaematInics 768596 Ferrous sulphate SYR FERRI PHOS CO MLS 0 Max 200mg/Rx& 3Rx/

annum

In

710372 Ferrous sulphate FERROUS SULPHATE 75MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

713558 Ferrous sulphate BODY BALANCE FERROUS SULPHATE

75MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In



and limitations


Out)

877832 Ferrous sulphate FERROUS SULPHATE 30MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

705532 Ferrous sulphate AHA FERROUS SULPHATE 30MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

710580 Ferrous sulphate EGOLI FERROUS SULPHATE 30MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

897329 Ferrous sulphate GULF FERROUS SULPHATE COMPOUND

TAB 0 Max 9 Rx/annum

(Pregnancy)

In

810967 Folic acid BE-TABS FOLIC ACID 5MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

709874 Folic acid AHA FOLIC ACID 5MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

711922 Folic acid FOLIC ACID 5MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

720727 Folic acid GULF FOLIC ACID 5MG TAB 0 Max 9 Rx/annum

(Pregnancy)

In

Cardiovascular

Vasodilators 703605 Glyceryl trInitrate ANGISED 0.5MG TAB 3 Max 1 OP/Rx & 2 Rx/

annum

In

784192 Isosorbide dInitrate SANDOZ ISOSORBIDE DInITRATE

5MG TAB 3 Max 1 OP/Rx & 2 Rx/

annum

In

734411 Isosorbide dInitrate ISORDIL SUBLInGUAL 5MG TAB 3 Max 1 OP/Rx & 2 Rx/

annum

In

Antihaemorrhoidals 704083 PramocaIne ANUGESIC OIn 1 Max 1 OP/Rx & 3 Rx /

annum

In

826375 Bismuth preparations, combInations

ANUSOL OIn 0 Max 1 OP/Rx & 3 Rx /

annum

In

704148 Bismuth preparations, combInations

ANUSOL SUP 0 Max 1 OP/Rx & 3 Rx /

annum

In

Beta-blockIng agents 758140 Propranolol PURBLOKA 10MG TAB 3 Max 20/Rx & 4 Rx/annum

In

806552 Propranolol InDOBLOK 10 10MG TAB 3 Max 20/Rx & 4 Rx/annum

In

787167 Propranolol PRODOROL 10MG TAB 3 Max 20/Rx & 4 Rx/annum

In

758167 Propranolol PURBLOKA 40MG TAB 3 Max 20/Rx & 4 Rx/annum

In

806560 Propranolol InDOBLOK 40 40MG TAB 3 Max 20/Rx & 4 Rx/annum

In

787175 Propranolol PRODOROL 40MG TAB 3 Max 20/Rx & 4 Rx/annum

In

Dermatogicals

Acne 807842 Benzoyl peroxide BENZAC GEL 0.05 JEL 0 Max 40g/Rx & 3 Rx/

annum

In



and limitations


Out)

TInea versicolor 763179 Selenium sulphide SELSUN 2.5% 0.025 SHA 0 Max 50ml/Rx & 2 Rx/

annum

In

Nappy rash 708211 ZInc and caster oil oIntment

ZInC AND CASTOR OIL BP OIn 0 Max 50g/Rx & 4 Rx/

annum

In

701429 ZInc and castor oil oIntment

ZInC AND CASTOR OIL OIn 0 Max 50g/Rx & 4 Rx/

annum

In

815616 Podophyllum resIn WARTEC SOLUTION SLN 2 Max 3ml/Rx & 1 Rx/

annum

In

Antifungals for topical use 784966 NystatIn CANSTAT 100000 U/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

797022 NystatIn NYSTACID 15G 100000 U/G OIn 1 Max 1 OP/Rx & 2 Rx/

annum

In

788554 Clotrimazole CANDASPOR 1% 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

793493 Clotrimazole NORMOSPOR 1% 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

826952 Clotrimazole A-POR 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

824011 Clotrimazole CANEX TOPICAL 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

816299 Clotrimazole XERASPOR-T 1% 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

846422 Clotrimazole FUNGISPOR TOPICAL 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

709885 Clotrimazole VARI-CLOTRIMAZOLE 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

878421 Clotrimazole CLOMADERM 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

808857 Clotrimazole CLOSCRIPT TOPICAL 10MG/1G CRM 1 Max 1 OP/Rx & 2 Rx/

annum

In

797006 Clotrimazole CANDIZOLE 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

Out

799505 Clotrimazole MICOMISAN 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

Out

839639 Clotrimazole TRIMAZE 10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

Out

705246 Clotrimazole DIS-CHEM CLOTRIMAZOLE TOPICAL CREAM

10MG/G CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

Antipruritics 800511 MepyramIne MEPYRIMAL CRE 1 Max 1 OP/Rx and 3 Rx/

annum

In



and limitations


Out)

701102 MepyramIne MEPYRADERM CRE 1 Max 1 OP/Rx & 2 Rx/

annum

In

897334 MepyramIne ALSAN (JP HIST CREAM) CRE 1 Max 1 OP/Rx and 3 Rx/

annum

Out

799211 TetracaIne AMETHOCAInE CRE 1 Max 1 OP/Rx and 3 Rx/

annum

In

703591 TetracaIne ANETHAInE CRE 1 Max 1 OP/Rx and 3 Rx/

annum

Out

731269 Other antipruritics HISTODOR CRE 1 Max 1 OP/Rx and 3 Rx/

annum

In

839027 Other antipruritics CALAMInE LOT LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

717243 Other antipruritics CALAMInE - ALCHEMIST LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

794120 Other antipruritics BIOHIST (GLASS/BOXED) LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

861758 Other antipruritics LInK LOT CALAMInE LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

735647 Other antipruritics LACTO CALAMInE LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

706615 Other antipruritics ARM CALAMInE LOT 0 Max 1 OP/Rx and 3 Rx/

annum

In

865311 Other antipruritics LOT CALAMInE LIQ 0 Max 1 OP/Rx and 3 Rx/

annum

In

739324 Other antipruritics LOT CALAMInE BP (bru) LIQ 0 Max 1 OP/Rx and 3 Rx/

annum

In

705561 Other antipruritics CALAMInE LOTION BP LOT 0 Max 1 OP/Rx and 3 Rx/

annum

Out

872490 Other antipruritics LOT CALAMInE BP MLS 0 Max 1 OP/Rx and 3 Rx/

annum

In

Antibiotics for topical use

MupirocIn 715837 MupirocIn SUPIROBAN OIn 4 Max 1 OP/Rx and 2 Rx/

annum

In

Chemotherapeutics for topical use

Sulphonamides 836664 Silver sulfadiazIne SILBECOR 10MG/G CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

791725 Silver sulfadiazIne BACTRAZInE 0.01 CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

Antivirals

Aciclovir 701035 Aciclovir LOVIRE 50MG/G CRE 1 Max 1 Rx/annum

In



and limitations


Out)

873551 Aciclovir ACITOP 50MG/G CRE 1 Max 1 Rx/annum

In

713942 Aciclovir BETA-VIRA 50MG/G CRE 1 Max 1 Rx/annum

In

824674 Aciclovir ADCO-ACYCLOVIR 50MG/G CRE 1 Max 1 Rx/annum

In

Corticosteroids topical 720011 Hydrocortisone DILUCORT 0.50% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

826642 Hydrocortisone MEZZODERM HYDROCORTISONE

0.50% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

720038 Hydrocortisone DILUCORT 0.50% OIn 2 Max 1 OP/Rx and 2 Rx/

annum

In

764353 Hydrocortisone SKInCALM 0.50% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

Out

810223 Hydrocortisone STOPITCH 20G 1% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

807834 Hydrocortisone BIOCORT 1% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

700445 Hydrocortisone VARI-HYDROCORTISONE CRE 2 Max 1 OP/Rx and 2 Rx/

annum

In

745448 Hydrocortisone MYLOCORT 1% OIn 2 Max 1 OP/Rx and 2 Rx/

annum

Out

745472 Hydrocortisone MYLOCORT 1% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

Out

754064 Betamethasone PERSIVATE 0.10% CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

800163 Betamethasone LENOVATE 0.10% CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

827290 Betamethasone ADCO-BETAMETHASONE CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

882934 Betamethasone REPIVATE CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

833037 Betamethasone TOPIVATE CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

701138 Betamethasone VARI BETAMETHASONE CRE 0.10% CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

878200 Betamethasone BECLATE 15G CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

708313 Betamethasone BETNOVATE 0.10% CRE 2 Max 1 OP/Rx and 2 Rx/

annum

Out

754072 Betamethasone PERSIVATE 0.10% OIn 4 Max 1 OP/Rx and 2 Rx/

annum

In



and limitations


Out)

800171 Betamethasone LENOVATE 0.10% OIn 4 Max 1 OP/Rx and 2 Rx/

annum

In

708348 Betamethasone BETNOVATE 0.10% OIn 2 Max 1 OP/Rx and 2 Rx/

annum

Out

716278 FluocInolone acetonide

CORTODERM 1.25MG/5G CRE 4 Max 1 OP/Rx and 2 Rx/

annum

In

716286 FluocInolone acetonide

CORTODERM 1.25MG/5G OIn 4 Max 1 OP/Rx and 2 Rx/

annum

In

Emollients 701399 EmulsifyIng oInt EMULSIFYInG OInTMENT OIn 0 Max 500g/Rx & 4 Rx/

annum

In

874779 EmulsifyIng oInt UNG EMULSIFICANS UNG 0 Max 500g/Rx & 4 Rx/

annum

In

868361 EmulsifyIng oInt EMULSIFYInG OInTMENT (ALPHEN)

OIn 0 Max 500g/Rx & 4 Rx/

annum

In

700190 EmulsifyIng oInt LInK EMULSIFYInG OInTMENT OIn 0 Max 500g/Rx & 4 Rx/

annum

In

702860 EmulsifyIng oInt FABUPHARM EMULSIFYIn UNG 0 Max 500g/Rx & 4 Rx/

annum

In

702863 EmulsifyIng oInt FABUPHARM EMULSIFYIn UNG 0 Max 500g/Rx & 4 Rx/

annum

In

868353 EmulsifyIng oInt EMULSIFYInG BASE (ALPHEN) OIn 0 Max 500g/Rx & 4 Rx/

annum

In

717965 EmulsifyIng oInt EMULSIFYInG BP BIOTECH OIn 0 Max 500g/Rx & 4 Rx/

annum

In

719181 EmulsifyIng oInt PHARMACHEM PHARMACEUTICALS EMULSIFYInG


annum

In

723797 Other emolients EPIZONE-E OIn 0 Max 500g/Rx & 4 Rx/

annum

In

723800 Other emolients EPIZONE-A CRE 0 Max 500g/Rx & 4 Rx/

annum

In

702852 Other emollients and protectives

CETOMACROGOL CREAM CRE 0 Max 500g/Rx & 4 Rx/

annum

In

802565 Aqueous cream AQUEOUS CR TEDRO CRE 0 Max 500g/Rx & 4 Rx/

annum

In

773700 Aqueous cream UNG EMULS AQUOSUM CRE 0 Max 500g/Rx & 4 Rx/

annum

In

700012 Aqueous cream AQUEOUS CREAM CRE 0 Max 500g/Rx & 4 Rx/

annum

In

884902 Aqueous cream AQUEOUS CREAM JAR CRE 0 Max 500g/Rx & 4 Rx/

annum

In



and limitations


Out)

717476 Aqueous cream EASIHEALTH AQUEOUS CRE 0 Max 500g/Rx & 4 Rx/

annum

In

718152 Aqueous cream ORIGInAL AQUEOUS CRE 0 Max 500g/Rx & 4 Rx/

annum

In

702843 Aqueous cream UNG EMULSIFICANS AQUOSUM CRE 0 Max 500g/Rx & 4 Rx/

annum

In

702850 Aqueous cream FABUPHARM AQUEOUS CR CRE 0 Max 500g/Rx & 4 Rx/

annum

In

700136 Aqueous cream LInK AQUEOUS CREAM CRM 0 Max 500g/Rx & 4 Rx/

annum

In

Antiseptics 821713 Povidone-iodIne SEPTADInE ANTISEP OIn 0 Max 1 OP/Rx and 2 Rx/

annum

In

717217 Povidone-iodIne BARRS POVIDONE-IODInE 10% OIn 0 Max 1 OP/Rx and 2 Rx/

annum

In

826634 Povidone-iodIne DERMADEX OIn 0 Max 1 OP/Rx and 2 Rx/

annum

In

755834 Povidone-iodIne PODInE OIn 0 Max 1 OP/Rx and 2 Rx/

annum

In

715022 Povidone-iodIne GERMADInE OIn 0 Max 1 OP/Rx and 2 Rx/

annum

In

788716 Povidone-iodIne DERMADInE OIn 0 Max 1 OP/Rx and 2 Rx/

annum

Out

707945 Povidone-iodIne BETADInE OInTMENT OIn 0 Max 1 OP/Rx and 2 Rx/

annum

Out

813060 Povidone-iodIne BETADInE FIRST AID CREAM CRE 0 Max 1 OP/Rx and 2 Rx/

annum

Out

871885 Povidone-iodIne BIOCREAM CRE 0 Max 1 OP/Rx and 2 Rx/

annum

Out

776300 QuInolIne derivatives VIODOR CRE 1 Max 1 OP/Rx and 2 Rx/

annum

In

839019 Cetrimide WOUND A SEPT CRE 0 Max 1 OP/Rx and 2 Rx/

annum

In

GenitourInary system and sex hormones

Gynecological ant-Infectives and antiseptics

831913 Clotrimazole CANEX VCR 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

839620 Clotrimazole GYNO TRIMAZE 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

878448 Clotrimazole GYNEZOL 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

846341 Clotrimazole FUNGISPOR 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In



and limitations


Out)

826960 Clotrimazole A-POR 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

711138 Clotrimazole InNOSPORE 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

831921 Clotrimazole CLOSCRIPT VAGInAL 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

705247 Clotrimazole DIS-CHEM CLOTRIMAZOLE 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

In

832596 Clotrimazole CANDIZOLE V 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out

831875 Clotrimazole CANALBA VAG 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out

832332 Clotrimazole COVOSPOR VAGInAL 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out

832499 Clotrimazole XERASPOR V 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out

832405 Clotrimazole MICOMISAN VAG 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out

831883 Clotrimazole CANDASPOR VAG 10MG/G VCR 1 Max 1 OP/Rx & 3 Rx/

annum

Out


826138 Norgestrol and estrogen

OVRAL TAB 3 Max 1OP/month

In

826049 Levonorgestrol and estrogen

NORDIOL 28 TAB 3 Max 1OP/month

In


NORDETTE TAB 3 Max 1OP/month

In

825964 Desogestrol and estrogen

MARVELON 150/30 TAB 3 Max 1OP/month

In


BIPHASIL 28 TAB 3 Max 1OP/month

In


LOGYNON ED TAB 3 Max 1OP/month

In


TRIPHASIL TAB 3 Max 1OP/month

In

826073 Norithisterone and estrogen

TRInOVUM TAB 3 Max 1OP/month

In

710109 Levonorgestrol ESCAPELLE 1.5MG TAB 3 Max 1OP/ Rx and 4 Rx/

annum

In

880612 Levonorgestrol NORLEVO .75MG TAB 3 Max 1OP/ Rx and 4 Rx/

annum

In

826006 Levonorgestrol MICROVAL 28 0.3MG TAB 3 Max 1OP/month

In

826014 Gestodene and estrogen

MInULETTE TAB 3 Max 1OP/month

In

748552 Norithisterone NUR-ISTERATE 200MG/1ML InJ 4 Max 1OP/ Rx and 4 Rx/

annum

In



and limitations


Out)


FEMODENE ED TAB 3 Max 1OP/month

Out


MELODENE TAB 3 Max 1OP/month

Out


MInESSE TAB 3 Max 1OP/month

Out


MIRELLE TAB 3 Max 1OP/month

Out


TRIODENE ED TAB 3 Max 1OP/month

Out

702542 Norgestimate and estrogen

CILEST .25MG/.35MG TAB 3 Max 1OP/month

Out

825972 Desogestrel and estrogen

MERCILON TAB 3 Max 1OP/month

Out

825999 Norethisterone MICRO-NOVUM .35MG TAB 3 Max 1OP/month

Out

Sex hormones (progesterons)

780642 Medroxyprogesterone PETOGEN 1ML 150MG/1ML InJ 4 Max 1OP/ Rx and 4 Rx/

annum

In

718440 Medroxyprogesterone DEPO-PROVERA 1ML 150MG/1ML InJ 4 Max 1OP/ Rx and 4 Rx/

annum

In

706704 Medroxyprogesterone HEXAL-MPA 5MG TAB 4 Max 20/Rx & 3 Rx /

annum

In

706705 Medroxyprogesterone HEXAL-MPA 10MG TAB 4 Max 20/Rx & 3 Rx /

annum

In

Urologicals (alkalInisers) 805130 AlkalInizers MIST POT CIT SIMPLEX SYR 0 Max 1 OP/Rx and 2 Rx

/annum

In

839760 AlkalInizers GENCIT SYR 0 Max 1 OP/Rx and 2 Rx

/annum

In

820059 AlkalInizers ADCO-SODASOL GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

816256 AlkalInizers ALKAFIZZ GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

712393 AlkalInizers BAO SODA GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

714534 AlkalInizers CITROCIT GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

712312 AlkalInizers MEDI SODA EFFERVESCENT GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

855227 AlkalInizers QUATRO-SODA GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

711378 AlkalInizers SMART SODA GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In

834823 AlkalInizers EFFERSOL GRA 0 Max 1 OP/Rx and 2 Rx

/annum

In



and limitations


Out)

Systemic hormonal preps

Corticosteroids for systemic use

899124 Betamethasone BETAMETHASONE MICRO 4MG/ML

4MG/ML InJ 4 Consumables In

826936 Betamethasone BETANOID 0.6MG/ML SYR 4 Max 3 Rx/annum

In

797596 Betamethasone STEROMIEN 0.6MG/ML SYR 4 Max 3 Rx/annum

In

788783 Prednisone BE-TABS PREDNISONE 5MG TAB 4 Max 3 Rx/annum

In

818267 Prednisone TROLIC 5MG TAB 4 Max 3 Rx/annum

In

752304 Prednisone PANAFCORT 5MG TAB 4 Max 3 Rx/annum

In

716381 Prednisolone ADCO PREDNISOLONE 15MG/5ML SYR 4 Max 3 Rx/annum

In

Anti-Infectives

Antibacterials

Macrolide 894443 AzithromycIn AZEE 250MG CAP 4 Max 4 Rx/annum

In

717496 AzithromycIn VARIMAX 500MG CAP 4 Max 4 Rx/annum

In

718711 AzithromycIn AZITHROMYCIn ZYDUS 500MG TAB 4 Max 4 Rx/annum

In

719156 AzithromycIn CIPLA AZITHROMYCIn 500MG TAB 4 Max 4 Rx/annum

In

717052 AzithromycIn AUSTELL AZITHROMYCIn 500MG TAB 4 Max 4 Rx/annum

In

717181 AzithromycIn ZEEMIDE 500MG TAB 4 Max 4 Rx/annum

In

715934 AzithromycIn APEX-AZITHROMYCIn 500MG TAB 4 Max 4 Rx/annum

In

707852 AzithromycIn SANDOZ AZITHROMYCIn 500MG TAB 4 Max 4 Rx/annum

In

705100 AzithromycIn ASPEN AZITHROMYCIn 500MG TAB 4 Max 4 Rx/annum

In

707552 AzithromycIn BInOZYT 500MG TAB 4 Max 4 Rx/annum

In

705975 AzithromycIn ZITHROGEN 500MG TAB 4 Max 4 Rx/annum

In

830720 AzithromycIn ZITHROMAX 200MG/5ML SUS 4 Max 4 Rx/annum

In

TetracyclInes 798401 DoxycyclIne DUMOXIn 50 50MG CAP 4 Max 4 Rx/annum

In

808407 DoxycyclIne DOXYCYL 50MG CAP 4 Max 4 Rx/annum

Out

714192 DoxycyclIne DOXYTET 100MG CAP 4 Max 4 Rx/annum

In

893402 DoxycyclIne A-LENNON DOXYCYCLInE HCL 100MG CAP 4 Max 4 Rx/annum

In

716944 DoxycyclIne CYCLIDOX 100MG CAP 4 Max 4 Rx/annum

In

809667 DoxycyclIne DOXYCYL 100MG CAP 4 Max 4 Rx/annum

In



and limitations


Out)

838691 DoxycyclIne DOXITAB 100MG TAB 4 Max 4 Rx/annum

Out

787434 OxytetracyclIne BE-OXYTET 250MG CAP 4 Max 4 Rx/annum

In

884167 OxytetracyclIne NUCOTET 250MG CAP 4 Max 4 Rx/annum

In

751987 OxytetracyclIne OXYPAN 250MG CAP 4 Max 4 Rx/annum

In

703224 OxytetracyclIne PHARMATET (YELLOW/ORANGE)

250MG CAP 4 Max 4 Rx/annum

In

812072 OxytetracyclIne TETRACEM 250MG CAP 4 Max 4 Rx/annum

In

895029 OxytetracyclIne OXY 250MG CAP 4 Max 4 Rx/annum

In

714151 Chloramphenicol CHLORCOL 125/5ML SUS 4 Max 4 Rx/annum

In

814385 Chloramphenicol CHLORPHEN 250MG CAP 4 Max 4 Rx/annum

In

714135 Chloramphenicol CHLORCOL 250MG CAP 4 Max 4 Rx/annum

Out

Beta-Lactams (PenicillIns)

ProcaIne penicillIn 748196 ProcaIne penicillIn BIO-CILLIn 10ML 300MG/1ML InJ 4 Consumables In

BenzylpenicillIn 748307 BenzylpenicillIn BIO-PEN 5.0 MU InJECTION 5MIU InJ 4 Consumables In

782203 BenzylpenicillIn BENZYLPENICILLIn 1MIU InJ 4 Consumables In

AmpicillIn 784583 AmpicillIn AMPIPEN 250MG CAP 4 Max 4 Rx/annum

In

783188 AmpicillIn BE-AMPICIL 250MG CAP 4 Max 4 Rx/annum

In

829307 AmpicillIn BE-AMPICIL 125MG/5ML SUS 4 Max 4 Rx/annum

In

AmoxicillIn 704443 AmoxicillIn ALLMOX 250MG CAP 4 Max 4 Rx/annum

In

784656 AmoxicillIn AMOCILLIn 250MG CAP 4 Max 4 Rx/annum

In

704401 AmoxicillIn AMOXICAP 250 250MG CAP 4 Max 4 Rx/annum

In

714185 AmoxicillIn AMYN 250MG CAP 4 Max 4 Rx/annum

In

713363 AmoxicillIn AURO-AMOXYCILLIn 250MG CAP 4 Max 4 Rx/annum

In

707499 AmoxicillIn AUSTELL-AMOXICILLIn 250MG CAP 4 Max 4 Rx/annum

In

788155 AmoxicillIn BETAMOX 250 250MG CAP 4 Max 4 Rx/annum

In

815268 AmoxicillIn IPCAMOX 250MG CAP 4 Max 4 Rx/annum

In

808741 AmoxicillIn PROMOXIL 250MG CAP 4 Max 4 Rx/annum

In

716122 AmoxicillIn YOMAX 250MG CAP 4 Max 4 Rx/annum

In

744689 AmoxicillIn MOXYPEN 250MG CAP 4 Max 4 Rx/annum

In



and limitations


Out)

806579 AmoxicillIn MOXYMAX 250 250MG CAP 4 Max 4 Rx/annum

In

785229 AmoxicillIn ADCO-AMOXYCILLIn 250MG CAP 4 Max 4 Rx/annum

In

708398 AmoxicillIn ZALOXY 250MG CAP 4 Max 4 Rx/annum

Out

705679 AmoxicillIn MYMOX 250MG CAP 4 Max 4 Rx/annum

Out

824860 AmoxicillIn RANMOXY 250 250MG CAP 4 Max 4 Rx/annum

Out

808539 AmoxicillIn ZOXIL 250MG CAP 4 Max 4 Rx/annum

Out

744697 AmoxicillIn MOXYPEN 500MG CAP 4 Max 4 Rx/annum

In

808768 AmoxicillIn PROMOXIL 500MG CAP 4 Max 4 Rx/annum

In

811440 AmoxicillIn ADCO-AMOXYCILLIn 500MG CAP 4 Max 4 Rx/annum

In

704444 AmoxicillIn ALLMOX 500MG CAP 4 Max 4 Rx/annum

In

714184 AmoxicillIn AMYN 500MG CAP 4 Max 4 Rx/annum

In

713364 AmoxicillIn AURO-AMOXYCILLIn 500MG CAP 4 Max 4 Rx/annum

In

705637 AmoxicillIn AUSTELL-AMOXICILLIn 500MG CAP 4 Max 4 Rx/annum

In

788546 AmoxicillIn BETAMOX 500 500MG CAP 4 Max 4 Rx/annum

In

824879 AmoxicillIn RANMOXY 500 500MG CAP 4 Max 4 Rx/annum

In

716123 AmoxicillIn YOMAX 500MG CAP 4 Max 4 Rx/annum

In

708397 AmoxicillIn ZALOXY 500MG CAP 4 Max 4 Rx/annum

In

705709 AmoxicillIn MYMOX 500MG CAP 4 Max 4 Rx/annum

In

806587 AmoxicillIn MOXYMAX 500 500MG CAP 4 Max 4 Rx/annum

In

808547 AmoxicillIn ZOXIL 500 500MG CAP 4 Max 4 Rx/annum

Out

829099 AmoxicillIn ADCO-AMOXYCILLIn 125MG/5ML SUS 4 Max 4 Rx/annum

In

829358 AmoxicillIn BETAMOX S 125MG/5ML SUS 4 Max 4 Rx/annum

In

830275 AmoxicillIn MOXYMAX S 125MG/5ML SUS 4 Max 4 Rx/annum

In

830291 AmoxicillIn MOXYPEN 125MG/5ML SUS 4 Max 4 Rx/annum

In

708396 AmoxicillIn ZALOXY 125MG/5ML SUS 4 Max 4 Rx/annum

In

714179 AmoxicillIn ALLMOX S 125MG/5ML SUS 4 Max 4 Rx/annum

In

714182 AmoxicillIn AMYN S 125MG/5ML SUS 4 Max 4 Rx/annum

In



and limitations


Out)

830488 AmoxicillIn PROMOXIL S 125MG/5ML SUS 4 Max 4 Rx/annum

In

701380 AmoxicillIn RANMOXY SUSPENSION 125MG/5ML

125MG/5ML SUS 4 Max 4 Rx/annum

In

830534 AmoxicillIn SALTERMOX S 125MG/5ML SUS 4 Max 4 Rx/annum

In

830739 AmoxicillIn ZOXIL S 125MG/5ML SUS 4 Max 4 Rx/annum

In

829102 AmoxicillIn ADCO-AMOXYCILLIn 250MG/5ML SUS 4 Max 4 Rx/annum

In

829366 AmoxicillIn BETAMOX SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

830283 AmoxicillIn MOXYMAX SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

830305 AmoxicillIn MOXYPEN 250MG/5ML SUS 4 Max 4 Rx/annum

In

708395 AmoxicillIn ZALOXY 250MG/5ML SUS 4 Max 4 Rx/annum

In

714183 AmoxicillIn AMYN SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

830496 AmoxicillIn PROMOXIL SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

701383 AmoxicillIn RANMOXY SUSPENSION 250MG/5ML


In

830542 AmoxicillIn SALTERMOX SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

830747 AmoxicillIn ZOXIL SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

714180 AmoxicillIn ALLMOX SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

AmpicillIn, combInations 797553 AmpicillIn, combInations

APEN 500 500MG CAP 4 Max 4 Rx/annum

In

829250 AmpicillIn, combInations

APEN S 125MG/5ML SUS 4 Max 4 Rx/annum

In

PhenoxymethylpenicillIn 751111 PhenoxymethylpenicillIn BETAPEN 125MG/5ML SUS 4 Max 4 Rx/annum

In

716611 PhenoxymethylpenicillIn ATHLONE PHENOXYMETHYLPENICILLIn


In

780081 PhenoxymethylpenicillIn BETAPEN 250MG TAB 4 Max 4 Rx/annum

In

CloxacillIn 809632 CloxacillIn CLOXIn 250MG CAP 4 Max 4 Rx/annum

In

809640 CloxacillIn CLOXIn 500MG CAP 4 Max 4 Rx/annum

In

FlucloxacillIn 781231 FlucloxacillIn SANDOZ FLUCLOXACILLIn 250 250MG CAP 4 Max 4 Rx/annum

In

710308 FlucloxacillIn FLUPEN 250MG CAP 4 Max 4 Rx/annum

In

AmoxicillIn and enzyme Inhibitor

705471 AmoxicillIn and enzyme Inhibitor

SANDOZ CO-AMOXYCLAV BD 457MG/5ML SUS 4 Max 4 Rx/annum

In


CURAM BD 457MG/5ML SUS 4 Max 4 Rx/annum

In


AUGMENTIn BD SF 457MG/5ML SUS 4 Max 4 Rx/annum

Out



and limitations


Out)


AUGMAXCIL S 156.25MG 156MG SUS 4 Max 4 Rx/annum

In


SANDOZ CO-AMOXYCLAV S 156MG SUS 4 Max 4 Rx/annum

In


AMOCLAN S 156MG SUS 4 Max 4 Rx/annum

In


BIO-AMOKSIKLAV S 156MG SUS 4 Max 4 Rx/annum

In


ADCO-AMOCLAV S 156MG SUS 4 Max 4 Rx/annum

In


CLAMENTIn S 156MG SUS 4 Max 4 Rx/annum

In


RANCLAV 156MG SUS 4 Max 4 Rx/annum

In


AUGMAXCIL SF 312.5MG 312MG SUS 4 Max 4 Rx/annum

In


SANDOZ CO-AMOXYCLAV SF 312MG SUS 4 Max 4 Rx/annum

In


AMOCLAN SF 312MG SUS 4 Max 4 Rx/annum

In


APEX-CLAVUTIn SF 312MG SUS 4 Max 4 Rx/annum

In


RANCLAV FORTE 312MG SUS 4 Max 4 Rx/annum

In


BIO-AMOKSIKLAV SF 312MG SUS 4 Max 4 Rx/annum

In


ADCO-AMOCLAV FORTE 312MG SUS 4 Max 4 Rx/annum

Out


CLAMENTIn SF 312MG SUS 4 Max 4 Rx/annum

Out


AUSTELL-CO-AMOXICLAV 375MG TAB 4 Max 4 Rx/annum

In


SANDOZ CO-AMOXYCLAV 375MG TAB 4 Max 4 Rx/annum

In


AUGMAXCIL 375MG 375MG TAB 4 Max 4 Rx/annum

In


ADCO-AMOCLAV 375MG 375MG TAB 4 Max 4 Rx/annum

In


AMOCLAN 375MG TAB 4 Max 4 Rx/annum

In


APEX-CLAVUTIn 375MG TAB 4 Max 4 Rx/annum

In


AURO-AMOXICLAV 375MG TAB 4 Max 4 Rx/annum

In


BInDOCLAV 375MG TAB 4 Max 4 Rx/annum

In


BIO-AMOKSIKLAV 375MG TAB 4 Max 4 Rx/annum

In


CLAMENTIn 375MG TAB 4 Max 4 Rx/annum

Out


RANCLAV 375 375MG TAB 4 Max 4 Rx/annum

Out


AUSTELL-CO-AMOXICLAV 625MG TAB 4 Max 4 Rx/annum

In



and limitations


Out)


SANDOZ CO-AMOXYCLAV 625MG


In


APEX-CLAVUTIn 625MG TAB 4 Max 4 Rx/annum

In


AUGMAXCIL 625MG 625MG TAB 4 Max 4 Rx/annum

In



In



In



In


ADCO-AMOCLAV 625MG 625MG TAB 4 Max 4 Rx/annum

Out


AMOCLAN FORTE 625MG TAB 4 Max 4 Rx/annum

Out


CURAM 625MG TAB 4 Max 4 Rx/annum

Out


RANCLAV 625 625MG TAB 4 Max 4 Rx/annum

Out



In


AUGMENTIn SR 1000MG TAB 4 Max 2 Rx/annum

In


FORCID SOLUTAB 1000MG TAB 4 Max 2 Rx/annum

Out


AMOCLAN BID 1000MG TAB 4 Max 2 Rx/annum

Out


ADCO-AMOCLAV BD 1000MG TAB 4 Max 2 Rx/annum

Out


AUGMENTIn 1000 BD 1000MG TAB 4 Max 2 Rx/annum

Out



Out


BETACLAV 1000MG TAB 4 Max 2 Rx/annum

Out



Out


CLAMENTIn 1000MG TAB 4 Max 2 Rx/annum

Out


CURAM 1000MG TAB 4 Max 2 Rx/annum

In


RANCLAV 1000MG TAB 4 Max 2 Rx/annum

Out


SANDOZ CO AMOXYCLAV 1000MG


Out

CombInations of penicillIns 797561 CombInations of penicillIns

MACROPEN 500MG CAP 4 Max 4 Rx/annum

In

830208 CombInations of penicillIns

MACROPEN S 250MG SUS 4 Max 4 Rx/annum

In

Other Beta-lactam antibacterials

CefalexIn 897880 CefalexIn CPL ALLIANCE CEPHALEXIn 250MG CAP 4 Max 2 Rx/annum

In

830909 CefalexIn RANCEPH 250MG CAP 4 Max 2 Rx/annum

In



and limitations


Out)

706326 CefalexIn BELEX 250 250MG CAP 4 Max 2 Rx/annum

In

837253 CefalexIn RANCEPH 500MG CAP 4 Max 2 Rx/annum

In

706327 CefalexIn BELEX 500 500MG CAP 4 Max 2 Rx/annum

In

897887 CefalexIn CPL ALLIANCE CEPHALEXIn 500MG CAP 4 Max 2 Rx/annum

In

714312 CefalexIn AURO-CEFALEXIn 500MG CAP 4 Max 2 Rx/annum

Out

Cefadroxil 821519 Cefadroxil DACEF 500 MG CAP 4 Max 2 Rx/annum

In

829781 Cefadroxil DACEF 250MG/5ML SUS 4 Max 2 Rx/annum

In

829803 Cefadroxil DACEF 500MG/5ML SUS 4 Max 2 Rx/annum

In

Cefuroxime 710077 Cefuroxime SANDOZ CEFUROXIME 125MG/5ML SUS 4 Max 2 Rx/annum

In

814091 Cefuroxime ZInNAT 125MG/5ML SUS 4 Max 2 Rx/annum

Out

713006 Cefuroxime ZEFURIME 250MG TAB 4 Max 2 Rx/annum

In

717799 Cefuroxime ALKOXIME 250MG TAB 4 Max 2 Rx/annum

In

718658 Cefuroxime POXIM 250MG TAB 4 Max 2 Rx/annum

In

717990 Cefuroxime ORCHID CEFUROXIME 250MG TAB 4 Max 2 Rx/annum

In

713531 Cefuroxime AUROXIME 250MG TAB 4 Max 2 Rx/annum

In

781339 Cefuroxime ZInNAT 250MG TAB 4 Max 2 Rx/annum

Out

703697 Cefuroxime ZEFROXE 250MG TAB 4 Max 2 Rx/annum

Out

707371 Cefuroxime CUROAX 250MG TAB 4 Max 2 Rx/annum

Out

700689 Cefuroxime CEROXIM 250 250MG TAB 4 Max 2 Rx/annum

Out

710530 Cefuroxime BETAROXIME T 250MG TAB 4 Max 2 Rx/annum

Out

704988 Cefuroxime CEFU-HEXAL 250 250MG TAB 4 Max 2 Rx/annum

Out

704982 Cefuroxime CEFASYN 250 250MG TAB 4 Max 2 Rx/annum

Out

715142 Cefuroxime ZInOXIME 250MG TAB 4 Max 2 Rx/annum

Out

703867 Cefuroxime SANDOZ CEFUROXIME 250MG TAB 4 Max 2 Rx/annum

Out

713007 Cefuroxime ZEFURIME 500MG TAB 4 Max 2 Rx/annum

In

717801 Cefuroxime ALKOXIME 500MG TAB 4 Max 2 Rx/annum

In

718659 Cefuroxime POXIM 500MG TAB 4 Max 2 Rx/annum

In



and limitations


Out)

717992 Cefuroxime ORCHID CEFUROXIME 500MG TAB 4 Max 2 Rx/annum

In

704983 Cefuroxime CEFASYN 500 500MG TAB 4 Max 2 Rx/annum

In

703868 Cefuroxime SANDOZ CEFUROXIME 500MG TAB 4 Max 2 Rx/annum

In

781347 Cefuroxime ZInNAT 500MG TAB 4 Max 2 Rx/annum

Out

703695 Cefuroxime ZEFROXE 500MG TAB 4 Max 2 Rx/annum

Out

707372 Cefuroxime CUROAX 500MG TAB 4 Max 2 Rx/annum

Out

700687 Cefuroxime CEROXIM 500 500MG TAB 4 Max 2 Rx/annum

Out

704990 Cefuroxime CEFU-HEXAL 500 500MG TAB 4 Max 2 Rx/annum

Out

710531 Cefuroxime BETAROXIME T 500MG TAB 4 Max 2 Rx/annum

Out

713532 Cefuroxime AUROXIME 500MG TAB 4 Max 2 Rx/annum

Out

715261 Cefuroxime ZInOXIME 500MG TAB 4 Max 2 Rx/annum

Out

Cefaclor 830658 Cefaclor VERCEF 187MG/5ML SUS 4 Max 2 Rx/annum

In

830666 Cefaclor VERCEF 375MG/5ML SUS 4 Max 2 Rx/annum

In

838217 Cefaclor VERCEF MR 375MG TAB 4 Max 2 Rx/annum

In

Ceftriaxone 714188 Ceftriaxone TRIAPHIn VIAL 5ML 250MG InJ 4 Max 1/Rx & 2 Rx/annum

In

893119 Ceftriaxone OFRAMAX STERILE POWDER VIAL

250MG InJ 4 Max 1/Rx & 2 Rx/annum

In

Cefixime 795771 Cefixime FIXIME 200MG TAB 4 Max 400mg/Rx & 2 Rx/

annum

In

715656 Cefixime FIXIME 400MG TAB 4 Max 1/Rx & 2 Rx/annum

In

Sulphonamides and trimethoprim

Sulfamethoxazole and trimethoprim

779881 Sulfamethoxazole and trimethoprim

CO-TRIM 240MG/5ML SUS 4 Max 4 Rx/annum

In


COZOLE SUSPENSION 240MG/5ML SUS 4 Max 4 Rx/annum

In


CASICOT SUSPENSION 240MG/5ML SUS 4 Max 4 Rx/annum

In


BENCOLE (COTRIVAN) 240MG/5ML SUS 4 Max 4 Rx/annum

In


DOCTRIM 240MG/5ML SUS 4 Max 4 Rx/annum

In


ILVITRIM 240MG/5ML SUS 4 Max 4 Rx/annum

In


PURBAC 240MG/5ML SUS 4 Max 4 Rx/annum

In



and limitations


Out)


XERAZOLE 240MG/5ML SUS 4 Max 4 Rx/annum

In


SANDOZ CO-TRIMOXAZOLE 960 960MG TAB 4 Max 4 Rx/annum

In


PURBAC DS 960MG TAB 4 Max 4 Rx/annum

In


DUROBAC DS 960MG TAB 4 Max 4 Rx/annum

Out

Macrolides and lIncosamides

ErythromycIn 758396 ErythromycIn PURMYCIn 125MG/5ML SUS 4 Max 4 Rx/annum

In

793329 ErythromycIn BETAMYCIn 125MG/5ML SUS 4 Max 4 Rx/annum

In

765678 ErythromycIn SPECTRASONE 125MG/5ML SUS 4 Max 4 Rx/annum

In

786608 ErythromycIn ADCO-ERYTHROMYCIn 125MG/5ML SUS 4 Max 4 Rx/annum

In

787108 ErythromycIn ERYMYCIn ESTOLATE P 125MG/5ML SUS 4 Max 4 Rx/annum

In

823570 ErythromycIn XERAMEL-S 125MG/5ML SUS 4 Max 4 Rx/annum

In

783277 ErythromycIn SPECTRASONE 250MG/5ML SUS 4 Max 4 Rx/annum

In

848409 ErythromycIn XERAMEL SF 250MG/5ML SUS 4 Max 4 Rx/annum

In

787086 ErythromycIn ERYMYCIn ESTOLATE PF 250MG/5ML SUS 4 Max 4 Rx/annum

Out

758418 ErythromycIn PURMYCIn 250MG/5ML SUS 4 Max 4 Rx/annum

Out

824682 ErythromycIn XERAMEL 250MG CAP 4 Max 4 Rx/annum

In

758388 ErythromycIn PURMYCIn 250MG CAP 4 Max 4 Rx/annum

In

765651 ErythromycIn SPECTRASONE 250MG CAP 4 Max 4 Rx/annum

In

780561 ErythromycIn ADCO-ERYTHROMYCIn 250MG CAP 4 Max 4 Rx/annum

In

710310 ErythromycIn ERYKO 250MG TAB 4 Max 4 Rx/annum

In

RoxithromycIn 704782 RoxithromycIn ROXXIBID 150MG TAB 4 Max 2 Rx/annum

In

899511 RoxithromycIn ROXITHROMYCIn HEXAL 150MG TAB 4 Max 2 Rx/annum

In

704614 RoxithromycIn THROSYN 150MG TAB 4 Max 2 Rx/annum

In

ClarithromycIn 704649 ClarithromycIn KLARITHRAN 125MG/5ML SUS 4 Max 2 Rx/annum

In

706758 ClarithromycIn CLARIHEXAL 125 P 125MG/5ML SUS 4 Max 2 Rx/annum

In

716627 ClarithromycIn CLAREN GRANULES 125MG/5ML SUS 4 Max 2 Rx/annum

In

707358 ClarithromycIn SIMAYLA CLARITHROMYCIn 250MG/5ML SUS 4 Max 2 Rx/annum

In



and limitations


Out)

704650 ClarithromycIn KLARITHRAN 250MG/5ML SUS 4 Max 2 Rx/annum

In

706759 ClarithromycIn CLARIHEXAL 250 P 250MG/5ML SUS 4 Max 2 Rx/annum

In

716628 ClarithromycIn CLAREN GRANULES 250MG/5ML SUS 4 Max 2 Rx/annum

In

704032 ClarithromycIn CLACEE 250MG 250MG TAB 4 Max 2 Rx/annum

In

707255 ClarithromycIn KLARIZON 250MG TAB 4 Max 2 Rx/annum

In

716675 ClarithromycIn KLARYVID 250MG TAB 4 Max 2 Rx/annum

In

720976 ClarithromycIn KLARIBIn 250MG TAB 4 Max 2 Rx/annum

In

719921 ClarithromycIn KLARYVID 500MG TAB 4 Max 2 Rx/annum

In

705031 ClarithromycIn CLARIHEXAL 500MG TAB 4 Max 2 Rx/annum

In

707256 ClarithromycIn KLARIZON 500MG TAB 4 Max 2 Rx/annum

In

704033 ClarithromycIn CLACEE 500MG 500MG TAB 4 Max 2 Rx/annum

In

704464 ClarithromycIn KLARITHRAN 500MG TAB 4 Max 2 Rx/annum

In

720977 ClarithromycIn KLARIBIn 500MG TAB 4 Max 2 Rx/annum

In

707662 ClarithromycIn APEX-CLARITHROMYCIn 500MG TAB 4 Max 2 Rx/annum

In

705416 ClarithromycIn MYLAN-CLARITHROMYCIn 500MG TAB 4 Max 2 Rx/annum

In

ClIndamycIn 849960 ClIndamycIn CLInDAHEXAL 150MG CAP 4 Max 2 Rx/annum

In

717347 ClIndamycIn DALACIn C 150MG CAP 4 Max 2 Rx/annum

Out

QuInolones

CiprofloxacIn 893240 CiprofloxacIn ADCO-CIPRIn 250MG TAB 4 Max 4 Rx/annum

In

713792 CiprofloxacIn BIOTECH CIPROFLOXACIn 250MG TAB 4 Max 4 Rx/annum

In

707886 CiprofloxacIn CILOFLOC 250MG TAB 4 Max 4 Rx/annum

In

700284 CiprofloxacIn CPL ALLIANCE CIPROFLOXACIn 250MG TAB 4 Max 4 Rx/annum

In

704353 CiprofloxacIn AUSTELL CIPROFLOXACIn 250MG


In

713361 CiprofloxacIn LOXIP 250MG TAB 4 Max 4 Rx/annum

In

703043 CiprofloxacIn CIPROGEN 250MG TAB 4 Max 4 Rx/annum

Out

701208 CiprofloxacIn ORPIC 250MG 250MG TAB 4 Max 4 Rx/annum

Out

704775 CiprofloxacIn CIPROL 500 500MG TAB 4 Max 4 Rx/annum

In

707887 CiprofloxacIn CILOFLOC 500MG TAB 4 Max 4 Rx/annum

In



and limitations


Out)

713793 CiprofloxacIn BIOTECH CIPROFLOXACIn 500MG TAB 4 Max 4 Rx/annum

In

892147 CiprofloxacIn CIFRAN 500MG 500MG TAB 4 Max 4 Rx/annum

In

703045 CiprofloxacIn CIPROGEN 500MG TAB 4 Max 4 Rx/annum

In

700287 CiprofloxacIn CPL ALLIANCE CIPROFLOXACIn 500MG TAB 4 Max 4 Rx/annum

In

713362 CiprofloxacIn LOXIP 500MG TAB 4 Max 4 Rx/annum

In

704460 CiprofloxacIn BIOCIP 500MG TAB 4 Max 4 Rx/annum

Out

893955 CiprofloxacIn CIFLOC 500 500MG TAB 4 Max 4 Rx/annum

Out

701780 CiprofloxacIn CIPRO-HEXAL 500 500MG TAB 4 Max 4 Rx/annum

Out

700518 CiprofloxacIn DYNAFLOC 500 500MG TAB 4 Max 4 Rx/annum

Out

716519 CiprofloxacIn CIPROFLOXACIn ACTOR 500MG TAB 4 Max 4 Rx/annum

Out

NorfloxacIn 702524 NorfloxacIn FLOXIn 400MG TAB 4 Max 4 Rx/annum

In

717382 NorfloxacIn UTIFLOXA 400MG TAB 4 Max 4 Rx/annum

In

Antimycotics

Fluconazole 707684 Fluconazole APEX-FLUCONAZOLE 150MG CAP 4 Max 2 Rx/annum

In

713556 Fluconazole GULF FLUCONAZOLE 150MG CAP 4 Max 2 Rx/annum

In

711530 Fluconazole MYCOREST 150MG CAP 4 Max 2 Rx/annum

In

704357 Fluconazole AUSTELL FLUCONAZOLE 150MG

150MG CAP 4 Max 2 Rx/annum

In

720826 Fluconazole InSEP 150MG CAP 4 Max 2 Rx/annum

In

700598 Fluconazole FLUZOL 150MG 150MG CAP 4 Max 2 Rx/annum

Out

718565 Fluconazole FLUCONAZOLE UNICORN 150MG CAP 4 Max 2 Rx/annum

Out

Antivirals

Aciclovir 838225 Aciclovir LOVIRE 200MG DSP 4 Max 1 Rx/annum

In

704778 Aciclovir ACITAB-200 DT 200MG DSP 4 Max 1 Rx/annum

Out

838233 Aciclovir LOVIRE 400MG DSP 4 Max 1 Rx/annum

In

704779 Aciclovir ACITAB-400 DT 400MG DSP 4 Max 1 Rx/annum

Out

827282 Aciclovir ADCO-ACYCLOVIR 200 MG TAB 4 Max 1 Rx/annum

In

824313 Aciclovir CYCLIVEX 200 MG TAB 4 Max 1 Rx/annum

Out

717370 Aciclovir ACICLOVIR SANDOZ 200 MG TAB 4 Max 1 Rx/annum

In



and limitations


Out)

717157 Aciclovir APEX-ACYCLOVIR 200 MG TAB 4 Max 1 Rx/annum

Out

860581 Aciclovir CYCLIVEX 400MG TAB 4 Max 1 Rx/annum

In

717158 Aciclovir APEX-ACYCLOVIR 400MG TAB 4 Max 1 Rx/annum

In

717371 Aciclovir ACICLOVIR SANDOZ 400MG TAB 4 Max 1 Rx/annum

In

Influenza vaccInes 711345 Influenza Inactivated whole virus

FLUVAX PRE-FILLED SYRInGE 0.5ML

VAC 2 Max 1 Rx/annum

In

732826 Influenza Inactivated whole virus

InFLUVAC 0.5ML VAC 2 Max 1 Rx/annum

Out

813338 Influenza Inactivated whole virus

VAXIGRIP SInGLE DOSE VAC 2 Max 1 Rx/annum

Out

Musculoskeletal system

Anti-Inflammatories 704725 IndometacIn ARTHREXIn 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

701106 IndometacIn ADCO-InDOMETHACIn 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

787833 IndometacIn BETACIn 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

868213 IndometacIn GULF InDOMETHACIn 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

814393 IndometacIn METHOCAPS 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

704776 IndometacIn SANDOZ InDOMETHACIn 25 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

788996 IndometacIn MEDIFLEX 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

726389 IndometacIn FLAMECID 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

701891 IndometacIn AMDOCIn 25MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

704741 IndometacIn ARTHREXIn 100MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In

899186 Diclofenac DICLOFENAC MICRO 3ML 75MG/3ML InJ 3 only Consumables In

893201 Diclofenac DIFENJECT 3ML 75MG/3ML InJ 3 only Consumables In

894050 Diclofenac BE-TABS DICLOFENAC 3ML 75MG/3ML InJ 3 only Consumables In

808601 Diclofenac ACU-DICLOFENAC 3ML 75MG/3ML InJ 3 only Consumables Out

701114 Diclofenac ADCO-DICLOFENAC 75MG/3ML InJ 3 only Consumables Out

704361 Diclofenac AUSTELL DICLOFENAC SODIUM 75MG/3ML InJ 3 only Consumables Out

780111 Diclofenac PANAMOR-75 3ML 75MG/3ML InJ 3 only Consumables Out

807605 Diclofenac PANAMOR SUPP-12.5 12.5MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In



and limitations


Out)

780855 Diclofenac VOLTAREN 12.5MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

Out

807613 Diclofenac PANAMOR SUPP-25 25MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In

780863 Diclofenac VOLTAREN 25MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

Out

807621 Diclofenac PANAMOR SUPP-100 100MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In

893398 Diclofenac A-LENNON DICLOFENAC 100MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In

845272 Diclofenac DICLOHEXAL 100MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

In

778214 Diclofenac VOLTAREN 100MG SUP 2 or 3 Max 1 OP/Rx & 2 Rx/

annum

Out

786594 Diclofenac ADCO-DICLOFENAC 25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

893390 Diclofenac A-LENNON DICLOFENAC 25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

853240 Diclofenac DICLOHEXAL 25T 25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In


25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

719811 Diclofenac SANDOZ-DICLOFENAC SODIUM 25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

718479 Diclofenac DICLOFENAC BIOTECH 25MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In



/annum

In

719838 Diclofenac SANDOZ DICLOFENAC SODIUM 50


/annum

In

752398 Diclofenac PANAMOR AT-50 50MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

788597 Diclofenac ADCO-DICLOFENAC 50MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

893391 Diclofenac A-LENNON DICLOFENAC 50MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

841153 Diclofenac DICLOHEXAL 50MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

705375 Meloxicam ADCO-MELOXICAM 7.5MG 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In



and limitations


Out)

711324 Meloxicam ARROW MELOXICAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

717091 Meloxicam FLAMARYX 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

704829 Meloxicam FLEXOCAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

701520 Meloxicam LOXIFLAM 7.5 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

705176 Meloxicam M-CAM 7.5MG 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

716168 Meloxicam MELOXICAM UNICORN 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

818615 Meloxicam MOBIC 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

705229 Meloxicam ZYDUS-MELOXICAM 7.5MG 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

718381 Meloxicam MEDOXICAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

707667 Meloxicam APEX-MELOXICAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

718306 Meloxicam GLENMARK MELOXICAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

899066 Meloxicam COXFLAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

707373 Meloxicam ARTHROCOX 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

705296 Meloxicam MELFLAM 7.5 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

704588 Meloxicam SANDOZ MELOXICAM 7.5MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

705230 Meloxicam ZYDUS-MELOXICAM 15MG 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

704828 Meloxicam FLEXOCAM 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

705376 Meloxicam ADCO-MELOXICAM 15MG 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

718382 Meloxicam MEDOXICAM 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

717092 Meloxicam FLAMARYX 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In



and limitations


Out)

711325 Meloxicam ARROW MELOXICAM 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

701522 Meloxicam LOXIFLAM 15 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

716169 Meloxicam MELOXICAM UNICORN 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

842052 Meloxicam MOBIC 15MG 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

705177 Meloxicam M-CAM 15MG 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

707668 Meloxicam APEX-MELOXICAM 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

718305 Meloxicam GLENMARK MELOXICAM 15MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

700315 Ibuprofen IBUMAX PAEDIATRIC 100MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

703966 Ibuprofen SANDOZ IBUPROFEN 200 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

787426 Ibuprofen BETAPROFEN 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

895196 Ibuprofen Iboflam 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

705940 Ibuprofen IBU 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

868221 Ibuprofen IBUNATE 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

824852 Ibuprofen RANFEN 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

733741 Ibuprofen InZA 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

700316 Ibuprofen IBUMAX 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

708536 Ibuprofen IBUSOR 200MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

701975 Ibuprofen BETAPROFEN 400 FC 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

708290 Ibuprofen BREN 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

733768 Ibuprofen InZA 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In



and limitations


Out)

701654 Ibuprofen RANFEN 400 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

700318 Ibuprofen IBUMAX 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

703974 Ibuprofen SANDOZ IBUPROFEN 400 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

780596 Ibuprofen ADCO-IBUPROFEN 400MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

806447 Naproxen NAPFLAM 250MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

799459 Naproxen BE-TABS NAPROXEN 250MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

715831 Naproxen BIO-NAPROXEN 250MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In



/annum

In

805238 Naproxen NAPROSCRIPT 250MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

808474 Naproxen NAPFLAM 500MG TAB 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

883102 Mefenamic acid ADCO-MEFENAMIC ACID 250MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

797707 Mefenamic acid FENAMIn 250MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

796433 Mefenamic acid PONAC 250MG CAP 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

875643 Mefenamic acid ADCO-MEFENAMIC SUS 50MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

In

797014 Mefenamic acid FENAMIn 50MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

793264 Mefenamic acid PONAC 50MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

756156 Mefenamic acid PONSTAN 50MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

810398 Mefenamic acid PONSTEL S 50MG/5ML SUS 2 or 3 Max Rx/7 days & 2 Rx

/annum

Out

Topical products for joInt and muscular paIn

883110 Preparations with salicylic acid derivatives

UNG METH SAL UNG Max 1 OP/Rx/annum

In


BE-TABS UNG METH SAL UNG Max 1 OP/Rx/annum

In



and limitations


Out)


METHYL SALICYLATE 10% OIn Max 1 OP/Rx/annum

In


SOLARUB OIn Max 1 OP/Rx/annum

In


METHYL SALICYLATE OIn Max 1 OP/Rx/annum

In

AntigOut preparations

ColchicIne 715271 ColchicIne COLCHICInE 0.5MG TAB 2 Max 20/Rx & 3 Rx /annum

In

Central Nervous System

Local Anaesthetics 898666 LignocaIne LIGNOCAInE HCL-FRESENIUS 20ML 1%


782300 LignocaIne PETERKAIEN 5ML 0.1MG/5ML InJ 4 Consumables In

898674 LignocaIne LIGNOCAInE HCL-FRESENIUS 20ML 2%


702061 LignocaIne LIGNOCAInE HCL FRESENIUS 5ML

0.5MG/5ML InJ 4 Consumables Out

702068 LignocaIne LIGNOCAInE HCL FRESENIUS 5ML


Analgesics

Narcotic analgesics 824267 MorphIne MYLAN-MORPHInE SULPH 15MG/1ML InJ 6 Consumables In

895157 MorphIne MORPHInE SULPHATE MICRO 10MG/1ML InJ 6 Consumables In

894951 MorphIne MORPHInE SULPHATE MICRO 15MG/1ML InJ 6 Consumables Out

Analgesics and antipyretics 704645 Acetylsalicylic acid ASPIRIn 300MG TAB 0 Max Rx/7 days & 3 Rx per annum

In

700909 Acetylsalicylic acid GULF ASPIRIn 300MG TAB 0 Max Rx/7 days & 3 Rx per annum

In

798533 Acetylsalicylic acid ASPIRIn (WHITE) 300MG TAB 0 Max Rx/7 days & 3 Rx per annum

In

704642 Acetylsalicylic acid SOLUSPIRIn (WAS ASPIRIn SOLUBLE)

300MG EEF 0 Max Rx/7 days & 3 Rx per annum

In

706930 Acetylsalicylic acid BAYER ASPIRIn 300MG TAB 0 Max Rx/7 days & 3 Rx per annum

Out

807206 Acetylsalicylic acid DISPRIn CV 300MG EEF 0 Max Rx/7 days & 3 Rx per annum

Out

720577 Acetylsalicylic acid DISPRIn REGULAR 300MG EEF 0 Max Rx/7 days & 3 Rx per annum

Out

719673 Acetylsalicylic acid DR DU TOITS PAIn EXPELLER 300MG TAB 0 Max Rx/7 days & 3 Rx per annum

Out

710250 Tramadol AUSTELL-TRAMADOL 50MG CAP 5 Max Rx/7 days & 3 Rx per annum

In

705175 Tramadol DOMADOL 50MG CAP 5 Max Rx/7 days & 3 Rx per annum

In



and limitations


Out)

705379 Tramadol DOLOTRAM 50MG CAP 5 Max Rx/7 days & 3 Rx per annum

In

706475 Tramadol TRAMAZAC 50MG CAP 5 Max Rx/7 days & 3 Rx per annum

In

717391 Tramadol TRAMASPEN 50MG CAP 5 Max Rx/7 days & 3 Rx per annum

Out

835102 Paracetamol PANADO InFANT DROPS 60MG/0.6ML DRP 0 Max 1 OP/Rx & 1 Rx/

annum

In

819697 Paracetamol EMPAPED 125MG SUP 2 Max 1 OP/Rx & 1 Rx/

annum

In

819700 Paracetamol EMPAPED 250 MG SUP 2 Max 1 OP/Rx & 1 Rx/

annum

In

703820 Paracetamol FEVERPAIn 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

863742 Paracetamol FEVERPAIn (BOXED) 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

889772 Paracetamol PAInBLOK 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

894281 Paracetamol ADCO-PARACETAMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

895199 Paracetamol GO-PAIn P 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

717187 Paracetamol BARRS PARACETAMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

792101 Paracetamol ACTAMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

704093 Paracetamol ACTAMOL RED (UN-BOXED) 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

745715 Paracetamol NAPAMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

704450 Paracetamol PAInOGESIC 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In


120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

758558 Paracetamol PYRALEN 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

789526 Paracetamol BRUNOMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In

783943 Paracetamol WInPAIn (BRUNEL) 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

In



and limitations


Out)

707562 Paracetamol PAInAMOL (GLASS BOTTLE) 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

Out

752118 Paracetamol PAInAMOL 120MG/5ML SYR 0 Max 200ml/Rx & 3 Rx per annum

Out

710211 Paracetamol ZYDUS-PARACETAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

714707 Paracetamol PYNGESIC T 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

867950 Paracetamol GULF PARACETAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

805467 Paracetamol ANTALGIC 500 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

745723 Paracetamol NAPAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

757403 Paracetamol PROLIEF 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

752878 Paracetamol PARAPANE 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

799629 Paracetamol PAInAMOL (GREEN) 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

894212 Paracetamol JP PARACETAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

885863 Paracetamol VON PARACETAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

717725 Paracetamol ACTAMOL 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

704465 Paracetamol PAInOGESIC 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

704719 Paracetamol PARACET 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

In

752142 Paracetamol PAInAMOL WHITE 500MG TAB 1 Max Rx/7 days & 3 Rx per annum

Out

833746 Paracetamol, combInations excl. psycholeptics

MEDIPYN S SUS 2 Max 100ml/Rx & 3 Rx per annum

In


SALTERPYN SYR 2 Max 100ml/Rx & 3 Rx per annum

In


GOLDGESIC SYR 2 Max 100ml/Rx & 3 Rx per annum

In


GO-PAIn SYR 2 Max 100ml/Rx & 3 Rx per annum

Out



and limitations


Out)


InFAPAIn SYR 2 Max 100ml/Rx & 3 Rx per annum

Out


InFAPAIn FORTE SYR 2 Max 100ml/Rx & 3 Rx per annum

Out


KID-EEZE SYR 2 Max 100ml/Rx & 3 Rx per annum

Out


PAInAGON SYR 2 Max 100ml/Rx & 3 Rx per annum

Out


TENSODOL TAB 2 Max Rx/7 days & 3 Rx per annum

In


CODOXOL TAB 2 Max Rx/7 days & 3 Rx per annum

In


KODAPON TAB 2 Max Rx/7 days & 3 Rx per annum

In


COPA-DOL TAB 2 Max Rx/7 days & 3 Rx per annum

In


PAXIDAL TAB 2 Max Rx/7 days & 3 Rx per annum

In


B-DOL TAB 2 Max Rx/7 days & 3 Rx per annum

In


DOXY CO TAB 2 Max Rx/7 days & 3 Rx per annum

Out


SUNCODIn TABLETS TAB 2 Max Rx/7 days & 3 Rx per annum

Out


ALPHA-DOL TAB 2 Max Rx/7 days & 3 Rx per annum

Out


ACURATE TAB 2 Max Rx/7 days & 3 Rx per annum

In


LENADOL TAB 2 Max Rx/7 days & 3 Rx per annum

Out


ABFLEX-4 TAB 2 Max Rx/7 days & 3 Rx per annum

Out

823538 Paracetamol, combInations with psycholeptics

GO-PAIn TAB 2 Max Rx/7 days & 3 Rx per annum

In


PYNMED TAB 2 Max Rx/7 days & 3 Rx per annum

In


NUCOPAIn TAB 2 Max Rx/7 days & 3 Rx per annum

In


SALTERPYN TAB 2 Max Rx/7 days & 3 Rx per annum

In



and limitations


Out)


ADCO-PAYNE TAB 2 Max Rx/7 days & 3 Rx per annum

Out


GOLDGESIC TAB 2 Max Rx/7 days & 3 Rx per annum

Out


PAInAGON TABS TAB 2 Max Rx/7 days & 3 Rx per annum

Out


SPECTRAPAIn FORTE TABS TAB 2 Max Rx/7 days & 3 Rx per annum

Out

745707 Paracetamol combInations payable by PBM

NAPACOD TAB 2 Max Rx/7 days & 3 Rx per annum

In


DOLOROL FORTE TAB 2 Max Rx/7 days & 3 Rx per annum

In


DInO-COD (BEI) TAB 2 Max Rx/7 days & 3 Rx per annum

In


PAInAMOL PLUS (BETACOD) TAB 2 Max Rx/7 days & 3 Rx per annum

In


PAInCODEIn TAB 2 Max Rx/7 days & 3 Rx per annum

In


ROCODIn TAB 2 Max Rx/7 days & 3 Rx per annum

In


COGESIC 500MG/8MG TAB 2 Max Rx/7 days & 3 Rx per annum

In


CODOROL TAB 2 Max Rx/7 days & 3 Rx per annum

In


PARACETACOD TAB 2 Max Rx/7 days & 3 Rx per annum

Out

Anxiolytics and hypnotics 702091 Midazolam MIDACUM 5MG/1ML SOLU FOR InJ


719621 Midazolam ACCORD MIDAZOLAM AMPOULE 3ML


711382 Midazolam ADCO-MIDAZOLAM AMPOULE 3ML


721123 Midazolam MICRO MIDAZOLAM 5MG/1ML InJ 5 Consumables Out

709134 Midazolam MIDAZOJECT AMPOULE 3ML 5MG/1ML InJ 5 Consumables Out

708062 Diazepam BETAPAM 5MG TAB 5 Max Rx/5 days every 120 days

In

721174 Diazepam DOVAL 5MG TAB 5 Max Rx/5 days every 120 days

In

753173 Diazepam PAX 5MG TAB 5 Max Rx/5 days every 120 days

Out

753181 Diazepam PAX 10MG TAB 5 Max Rx/5 days every 120 days

In



and limitations


Out)

703598 Diazepam MICRO DIAZEPAM 10MG/2ML InJ 5 Consumables Out

825212 Diazepam A-LENNON DIAZEPAM 2ML 5MG/1ML InJ 5 Consumables In

Antidepressants 772003 AmitriptylIne TREPILInE 10MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

771996 AmitriptylIne TREPILInE 25MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

784230 AmitriptylIne SANDOZ AMITRIPTYLInE HCL 25MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

718746 AmitriptylIne GULF AMITRIPTYLInE 25MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

707396 Citalopram AUSTELL-CITALOPRAM 10MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

709407 Citalopram CITALOPRAM-WInTHROP 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

704331 Citalopram CITALOHEXAL 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

713583 Citalopram ARROW CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

713356 Citalopram AURO-CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

717094 Citalopram BIO CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

707888 Citalopram CILATE 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

711988 Citalopram CILORAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

716521 Citalopram CITALOPRAM ACTOR 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In


annum

In

717372 Citalopram GLENMARK CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

702769 Citalopram TALOMIL 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

705417 Citalopram MERCK-CITALOPRAM 20 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

700157 Citalopram CILIFT 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

Out

704328 Citalopram DEPRAMIL 20MG 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

Out



and limitations


Out)

713445 Citalopram DRL CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

704590 Citalopram SANDOZ CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

Out

707304 Citalopram SIMAYLA CITALOPRAM 20MG TAB 5 Max 180/Rx & 12 Rx/

annum

Out

705252 Citalopram DEPRAMIL 40MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

713584 Citalopram ARROW CITALOPRAM 40MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

713757 Citalopram DRL CITALOPRAM 40MG TAB 5 Max 180/Rx & 12 Rx/

annum

In


annum

In

700686 FluoxetIne RANFLOCS 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

703391 FluoxetIne A-LENNON FLUOXETInE 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

705064 FluoxetIne ZYDUS FLUOXETInE 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

707426 FluoxetIne REZAK 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

894303 FluoxetIne DEPROZAN 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

716520 FluoxetIne FLUOXETInE ACTOR 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

719658 FluoxetIne PROLAX 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

In

821063 FluoxetIne LORIEN 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

Out

840653 FluoxetIne NUZAK 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

Out

879282 FluoxetIne PROHEXAL 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

Out

838713 FluoxetIne SANDOZ-FLUOXETInE 20MG CAP 5 Max 180/Rx & 12 Rx/

annum

Out

724661 ImipramIne ETHIPRAMInE 10MG TAB 5 Max 180/Rx & 12 Rx/

annum

In

724688 ImipramIne ETHIPRAMInE 25MG TAB 5 Max 180/Rx & 12 Rx/

annum

In



and limitations


Out)

Antiparasitics

Anti-malarial 876089 artemether and lumefantrIne

COARTEM 20mg/120mg TAB 4 Max 24 doses/script

& 1 Rx/annum

In

Anti-protozoal 772216 Metronidazole TRICHAZOLE 200MG TAB 4 Max 3 Rx/annum

In

792284 Metronidazole ACUZOLE 200MG TAB 4 Max 3 Rx/annum

In

742872 Metronidazole ADCO-METRONIDAZOLE 200MG TAB 4 Max 3 Rx/annum

In

821705 Metronidazole BEMETRAZOLE 200MG TAB 4 Max 3 Rx/annum

In

707241 Metronidazole BIO-METRONIDAZOLE 200MG TAB 4 Max 3 Rx/annum

In

784710 Metronidazole MEDAMET 200MG TAB 4 Max 3 Rx/annum

In

793159 Metronidazole METAZOL 200MG TAB 4 Max 3 Rx/annum

In

772224 Metronidazole TRICHAZOLE 400MG TAB 4 Max 3 Rx/annum

In

779822 Metronidazole METRAZOLE 400MG TAB 4 Max 3 Rx/annum

In

792292 Metronidazole ACUZOLE 400MG TAB 4 Max 3 Rx/annum

In

715866 Metronidazole ANAEROBYL 400MG TAB 4 Max 3 Rx/annum

In

788708 Metronidazole BEMETRAZOLE 400MG TAB 4 Max 3 Rx/annum

In

707242 Metronidazole BIO-METRONIDAZOLE 400MG TAB 4 Max 3 Rx/annum

In

793167 Metronidazole METAZOL 400MG TAB 4 Max 3 Rx/annum

In

783544 Metronidazole METROSTAT 400MG TAB 4 Max 3 Rx/annum

In

792136 Metronidazole SUPRAZOLE 400MG TAB 4 Max 3 Rx/annum

In

702148 Metronidazole AMZOLE 400MG TAB 4 Max 3 Rx/annum

In

701076 Metronidazole ADCO-METRONIDAZOLE 400MG TAB 4 Max 3 Rx/annum

In

717169 Praziquantel CYSTICIDE 500MG TAB 4 Max 1 OP & 2 Rx/annum

In

845698 Mebendazole WORMSTOP 100MG/5ML SUS 1 Max 1 OP & 2 Rx/annum

In

828297 Mebendazole CIPEX 100MG/5ML SUS 1 Max 1 OP & 2 Rx/annum

Out

703063 Mebendazole ADCO WORMEX 100MG TAB 1 Max 1 OP & 2 Rx/annum

In

845671 Mebendazole WORMSTOP 100MG TAB 1 Max 1 OP & 2 Rx/annum

In

810533 Mebendazole WORMGO 100MG TAB 1 Max 1 OP & 2 Rx/annum

In

878227 Mebendazole CIPEX 100MG TAB 1 Max 1 OP & 2 Rx/annum

Out



and limitations


Out)

704656 Mebendazole ADCO-WORMEX 500MG TAB 1 Max 1 OP & 2 Rx/annum

In

833894 Mebendazole D-WORM SD 500MG TAB 1 Max 1 OP & 2 Rx/annum

In

845701 Mebendazole WORMSTOP 500MG TAB 1 Max 1 OP & 2 Rx/annum

In

789720 Albendazole ZENTEL SYR 20MG/ML SYR 4 Max 1 OP & 2 Rx/annum

In

840262 Albendazole BENDEX 400MG TAB 4 Max 1 OP & 2 Rx/annum

In

707436 Albendazole WORMADOLE 400MG CHU 4 Max 1 OP & 2 Rx/annum

In

819689 PiperazIne PIPRInE ELIXIR 500 MG SYR 0 Max 1 OP & 2 Rx/annum

In

Scabicides 700205 Benzyl benzoate APP BENZYL BENZOATE LOT 0 Max 200ml/Rx & 2 Rx/

annum

In

707716 Benzyl benzoate APP BENZYL BENZ BPC LOT 0 Max 200ml/Rx & 2 Rx/

annum

In

702851 Benzyl benzoate FABUPHARM BENZYL BEN LOT 0 Max 200ml/Rx & 2 Rx/

annum

Out

718379 White soft paraffIn WHITE SOFT PARAFFIn UNG 0 Max 500g/Rx & 1 Rx/

annum

In

838136 White soft paraffIn PARAFF MOLLE ALB BP UNG 0 Max 500g/Rx & 1 Rx/

annum

In

716271 Sulphur oIntment SEKPHARMA SULPHUR FORMULATION


annum

In

701382 Sulphur oIntment ALPHA SULPHUR OInTMENT OIn 0 Max 250g/Rx & 4 Rx/

annum

In

773751 Sulphur oIntment UNG SULPHUR BP OIn 0 Max 250g/Rx & 4 Rx/

annum

In

Respiratory system

Nasal preparations 702618 OxymetazolIne DRInASAL (WAS MERCK-P-NASAL) 10ML

NOD 1 Max 1 OP/30 days & 3 Rx/

annum

In

732257 OxymetazolIne ILIADIn NOSE ADULT NOD 1 Max 1 OP/30 days & 3 Rx/

annum

In

732281 OxymetazolIne ILIADIn NOSE PAED NOD 1 Max 1 OP/30 days & 3 Rx/

annum

In

708510 OxymetazolIne ILIADIn NOD 1 Max 1 OP/30 days & 3 Rx/

annum

In

702620 OxymetazolIne DRInASAL METERED10M NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

721387 OxymetazolIne DRISTAN LONG LASTInG NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In



and limitations


Out)

721441 OxymetazolIne DRIXInE 0.05% 20ML NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

732303 OxymetazolIne ILIADIn SPRAY PLASTIC ADULT 20ML

NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

715296 OxymetazolIne NAZENE ADULT NASAL METERED SPRAY 20ML

NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

702940 OxymetazolIne SInUTAB NASAL SPRAY 10ML NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

746126 OxymetazolIne NAZENE SPRAY 20ML NAS 1 Max 1 OP/30 days & 3 Rx/

annum

In

783870 OxymetazolIne DRISTAN METER PUMP NAS 1 Max 1 OP/30 days & 3 Rx/

annum

Out

732265 OxymetazolIne ILIADIn METERED ADULT NAS 1 Max 1 OP/30 days & 3 Rx/

annum

Out

732338 OxymetazolIne ILIADIn METERED PAED NAS 1 Max 1 OP/30 days & 3 Rx/

annum

Out

700305 OxymetazolIne VICKS SInEX NAS 1 Max 1 OP/30 days & 3 Rx/

annum

Out

702939 Beclometasone CIPLANAZE MULTICARE AQS 2 Max 1 OP/Rx & 3 Rx/

annum

In

820709 Beclometasone BECLATE AQUANASE 150 DOSE AQS 2 Max 1 OP/Rx & 3 Rx/

annum

In

897937 Beclometasone CLENIL AQUEOUS 200DOSE AQS 2 Max 1 OP/Rx & 3 Rx/

annum

In

834882 Sodium Chloride SALEX NASAL SPRAY 30ML NAS 0 Max 1 OP/30 days & 4 Rx/

annum

In

796964 PseudoephedrIne ADCO-SUFEDRIn SYRUP SYR 6 Max 100ml/Rx and 3 Rx/

annum

In

799440 PseudoephedrIne DRILIX SYR 6 Max 100ml/Rx and 3 Rx/

annum

In

796972 PseudoephedrIne ADCO-SUFEDRIn TAB 6 Max 100ml/Rx and 3 Rx/

annum

In

794872 PseudoephedrIne SYMPTOFED TAB 6 Max 100ml/Rx and 3 Rx/

annum

In

PseudoephedrIne combInations

835544 PseudoephedrIne, combInations

MERCK FED (ARCANAFED SYRUP)

SYR 2 Max 100ml/Rx and 3 Rx/

annum

In

827355 PseudoephedrIne, combInations

FLUDACTIL CO LInCT SYR 2 Max 100ml/Rx and 3 Rx/

annum

In

794295 PseudoephedrIne/ triprolidIne

ACUGEST SYR 2 Max 100ml/Rx & 3 Rx/

annum

In



and limitations


Out)

814105 PhenylephrIne/ chlorpheniramIne/ phenylpropanolamIne

BETALIX DECONGESTANT ELIXIR

SYR 2 Max 100ml/Rx & 3 Rx/

annum

In

835536 PseudoephedrIne/ triprolidIne

MERCK FED (ARCANAFED) TAB 2 Max 20/Rx & 3 Rx/annum

In

Decongestant, antihistamInes comb.

822744 EphedrIne/ ChlorphenramIne/ paracetamol/ caffeIne

SInUEND TAB 2 Max 20/Rx & 3 Rx/annum

In

773875 MepyramIne/ phenylephrIne/ paracetamol

SInU FLU (WAS UNIVERSAL COLD AND FLU)

TAB 2 Max 20/Rx & 3 Rx/annum

In

760110 Other cold preparations

RESPInOL SYRUP SYR 2 Max 100ml/Rx & 3 Rx/

annum

In

807656 Paracetamol/ phenylpropanolamIne/ dextromethorphan

FLUSTAT SYR 2 Max 100ml/Rx & 3 Rx/

annum

In

807648 Paracetamol/ phenylpropanolamIne/ dextromethorphan

FLUSTAT TAB 2 Max 20/Rx & 3 Rx/annum

In


SInUCON TAB 2 Max 20/Rx & 3 Rx/annum

In


FLUTEX CAP 2 Max 20/Rx & 3 Rx/annum

In

726710 PhenylephrIne/ diphenhydramInemIne/ paracetamol/ caffeIne, vit C

FLUEND CAP 2 Max 20/Rx & 3 Rx/annum

In

806218 TriprolidIne/ pseudoephedrIne/ paracetamol

ADCO-FLUPAIn SYR 2 Max 100ml/Rx & 3 Rx/

annum

In


COLCLEER(COLD+FLU) TAB 2 Max 20/Rx & 3 Rx/annum

In


KIDDYFLU SYR 2 Max 100ml/Rx & 3 Rx/

annum

In


COLCLEER PAEDIATRIC SYRUP SYR 2 Max 100ml/Rx & 3 Rx/

annum

In


HISTACON CAP 2 Max 20/Rx & 3 Rx/annum

In


HISTAMED CO CAP 2 Max 20/Rx & 3 Rx/annum

In


DEQUA-FLU CAP 2 Max 20/Rx & 3 Rx/annum

In


DInEXOL COLD CAPS CAP 2 Max 20/Rx & 3 Rx/annum

In


FAMUCAPS CAP 2 Max 20/Rx & 3 Rx/annum

In


ANTIFLU TAB 2 Max 20/Rx & 3 Rx/annum

In

Antiseptic throat preparations

799688 Povidone-iodIne DERMADInE ORAL GARG MOW 0 Max 200ml/annum

In

819859 Povidone-iodIne SEPTADInE ORAL ANTISEPTIC MOW 0 Max 200ml/annum

In

890365 Povidone-iodIne STERIDInE MOutHWASH & GARGLE

MOW 0 Max 200ml/annum

In



and limitations


Out)

707937 Povidone-iodIne BETADInE MOutHWASH (ORAL) MOW 0 Max 200ml/annum

Out

886119 Myristyl-benzalkonium GLYCO-THYMOL MLS 0 Max 200ml/annum

In

751340 Various OROCAInE LOZ 1 Max 20/Rx & 4 Rx/annum

In

772674 Various TROCHAIn LOZ 1 Max 20/Rx & 4 Rx/annum

In

892670 Various IODISED THROAT LOZ 0 Max 20/Rx & 4 Rx/annum

In

Anti-asthmatics 802360 AmInophyllIne AMInOPHYLLIn 10ML 250MG/10ML InJ 4 Consumables In

832731 AmInophyllIne MYLAN AMInOPHYLLInE 10ML 250MG/10ML InJ 4 Consumables In

754315 AmInophyllIne PETERPHYLLIn 10ML 250MG/10ML InJ 4 Consumables Out

700715 Salbutamol ASTHAVENT 300D ECOHALER CFC FREE

100MCG InH 2 Max 1 OP/Rx & 4/annum

In

711213 Salbutamol VENTEZE CFC FREE 200 DOSE 100MCG InH 2 Max 1 OP/Rx & 4/annum

In

849332 Salbutamol ASTHAVENT ECOHALER 200DOSE

100MCG InH 2 Max 1 OP/Rx & 4/annum

In

720723 Salbutamol VENTIMAX CFC FREE 200 DOSE 100MCG InH 2 Max 1 OP/Rx & 4/annum

In

824186 Salbutamol ASTHAVENT 2MG/5ML SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

700920 Salbutamol VARI-SALBUTAMOL SYR 2MG/5ML SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

775452 Salbutamol VENTEZE 2MG/5ML SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

775398 Salbutamol VENTEZE 2MG TAB 2 Max 20 /Rx & 3 Rx/

annum

In

775401 Salbutamol VENTEZE 4MG TAB 2 Max 20 /Rx & 3 Rx/

annum

In

700238 TheophyllIne THEOPHEN CO UNBOXED SYR 1 Max 200ml/Rx & 3 Rx/

annum

In

701750 TheophyllIne ALCOPHYLLIn SYR 1 Max 200ml/Rx & 3 Rx/

annum

In

707283 TheophyllIne THEOPHEN CO ELIXIR SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

770388 CombInations of xanthInes

THEOPHEN SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

701742 TheophyllIne, combInations excl. psycholeptics

ALCOPHYLLEX SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

Cough preparations 887966 GuaifenesIn BRONCHOLIn EXPECT SYR 0 Max 200ml/Rx & 3 Rx/

annum

In

704178 GuaifenesIn BENYLIn WET COUGH LIQ 0 Max 200ml/Rx & 3 Rx/

annum

Out



and limitations


Out)

895150 GuaifenesIn BENYLIn WET COUGH MENTHOL

SYR 0 Max 200ml/Rx & 3 Rx/

annum

Out

738263 CombInations LInCTUS TUSSI InFANS SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

895032 CombInations AMCOUGH SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

705913 CombInations AMCOUGH (BOXED) SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

702172 CombInations PHENORANT SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

862312 CombInations FAMSTIM SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

703456 Expectorants FAMS MIST TUSSI InFANS SYR 0 Max 100ml/Rx & 3 Rx/

annum

In

898880 Expectorants MIST TUSSI InFANS MLS 0 Max 100ml/Rx & 3 Rx/

annum

In

755214 PholcodIne PHOLCOLInCT MLS 6 Max 100ml/Rx & 3 Rx/

annum

In

803081 Sod citrate/ diphenhydramIne/ ammonium Cl

CLEAR COUGH SYR 2 Max 100ml/Rx & 3 Rx/

annum

In

720291 Sod citrate/ diphenhydramIne/ ammonium Cl/Chloroform

DIPHENHYDRAMInE EXPECT SYR 2 Max 100ml/Rx & 3 Rx/

annum

In

853003 PhenylephrIne, combInations

BETAFED SYRUP SYR 2 Max 200ml/Rx & 3 Rx/

annum

In

AntihistamInes for systemic use

702145 ChlorpheniramIne ALLERGEX 2MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

702072 ChlorpheniramIne ALLERGEX 4MG TAB 2 Max 30/Rx & 3 Rx /annum

In

703162 ChlorpheniramIne RHInETON 4MG TAB 2 Max 30/Rx & 3 Rx /annum

In

710873 PromethazIne BRUNAZInE 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

757373 PromethazIne PROHIST 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

736244 PromethazIne LENAZInE ELIXIR 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

803065 PromethazIne RECEPTOZInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

803073 PromethazIne RECEPTOZInE 25MG TAB 2 Max 30/Rx & 3 Rx /annum

In

757527 PromethazIne PROMETHAZInE HCL 1ML 25MG/1ML InJ 5 Consumables In

757535 PromethazIne PROMETHAZInE HCL 2ML 50MG/2ML InJ 5 Consumables In



and limitations


Out)

708117 CetirizIne CETIRIZInE-HEXAL 10MG SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

707885 CetirizIne BETEK 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

712764 CetirizIne ZETOP 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

718452 CetirizIne TRANTRIn 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

720846 CetirizIne GULF CETIRIZInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

720664 CetirizIne ZInALLERG 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

720873 CetirizIne CETICIT 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

703314 CetirizIne TEXA 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

704188 CetirizIne ASPEN CETIRIZInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

703864 CetirizIne CETIRIZInE HEXAL 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

712890 CetirizIne ACUZYRT 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

703821 CetirizIne ALLERMInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

700001 CetirizIne UCB CETIRIZInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

703315 CetirizIne ALLECET 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

710672 CetirizIne TEXA SYRUP 10MG SYR 2 Max 200ml/Rx & 3 Rx /

annum

Out

703918 LoratadIne POLLENTYME S 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

705102 LoratadIne CLARInESE 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

704886 LoratadIne AP LORATADInE 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

701640 LoratadIne ALLERGEX NON DROWSY (WAS ADCO-LORAHIST)

5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

In

789291 LoratadIne CLARITYNE 5MG/5ML SYR 2 Max 200ml/Rx & 3 Rx /

annum

Out

704275 LoratadIne LORAHIST 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

713908 LoratadIne LORMEG 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

702518 LoratadIne LORANO 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

704773 LoratadIne ROHIST 10MG TAB 2 Max 30/Rx & 3 Rx /annum

In

705359 LoratadIne LORFAST 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out



and limitations


Out)

700092 LoratadIne LAURA 10 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

701361 LoratadIne POLLENTYME 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

702159 LoratadIne CLARInESE 10MG 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

899430 LoratadIne AP-LORATADInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

717051 LoratadIne APEX-LORATADInE 10MG TAB 2 Max 30/Rx & 3 Rx /annum

Out

Sensory organs

Opthalmologicals 713724 Chloramphenicol CHLORAMEX 3.5G EYO 4 Max 1 OP/Rx & 3 Rx/

annum

In

713759 Chloramphenicol CHLORCOL 3.5G EYO 4 Max 1 OP/Rx & 3 Rx/

annum

In

713872 Chloramphenicol CHLORNICOL 1% 3.5G EYO 4 Max 1 OP/Rx & 3 Rx/

annum

In

817201 Chloramphenicol CHLORPHEN 3.5G OInT EYO 4 Max 1 OP/Rx & 3 Rx/

annum

In

767360 Sulfacetamide SULPHACETAMIDE 3.5G EYO 1 Max 1 OP/Rx & 3 Rx/

annum

In

713880 Chloramphenicol MIn CHLORAMPHENICOL 0.5ML 5MG/1ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

702935 OfloxacIn OCTIn OPTHALMIC DROPS 5ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

839957 OfloxacIn EXOCIn 5ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

Out

708283 Betamethasone BETNESOL 3G EYO 4 Max 1 OP/Rx & 3 Rx/

annum

In

765821 Dexamethasone SPERSADEX 5ML 1MG/1ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

822698 Cromoglicic acid CROMOHEXAL EYE DROPS 20MG/1ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

894605 Cromoglicic acid STOP ALLERG 13.5ML 20MG/1ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

804630 Cromoglicic acid VIVIDRIn EYE DROPS 20MG/1ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

783641 Fusidic acid FUCITHALMIC 10MG/1G OPD 4 Max 1 OP/Rx & 3 Rx/

annum

In

728608 TetryzolIne, combInations

GEMInI 15ML OPD 2 Max 1 OP/Rx & 3 Rx/

annum

In


OCULERGE 15ML OPD 2 Max 1 OP/Rx & 3 Rx/

annum

In



and limitations


Out)


SPERSALLERG 10ML OPD 2 Max 1 OP/Rx & 3 Rx/

annum

Out

Otological 820717 Hydrocortisone and antiInfectives

OTOSPORIn EAR 4 Max 1 OP/Rx & 3 Rx/

annum

In

704127 Indifferent preparations

OTALGON EAR 0 Max 1 OP/Rx & 3 Rx/

annum

In


OTISED 15ML EAR 0 Max 1 OP/Rx & 3 Rx/

annum

In


OTOPHEN 10G EAR 0 Max 1 OP/Rx & 3 Rx/

annum

In

CombInation products 740462 Dexamethasone and antiInfectives

MAXITROL 3.5G EYO 4 Max 1 OP/Rx & 3 Rx/

annum

Out

789186 Dexamethasone and antiInfectives

TOBRADEX EYO 4 Max 1 OP/Rx & 3 Rx/

annum

Out


MAXITROL 5ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

Out


SPERSADEX COMP 5ML OPD 4 Max 1 OP/Rx & 3 Rx/

annum

Out


TOBRADEX OPD 4 Max 1 OP/Rx & 3 Rx/

annum

Out


SOFRADEX 8ML EED 4 Max 1 OP/Rx & 3 Rx/

annum

Out

Multi-VitamIns

Infant vitamIns 776181 Infant vitamIns VIDAYLIn SYR 0 Max 12 Rx/annum

In

835196 Infant vitamIns VIDAYLIn DRP 0 Max 12 Rx/annum

In

854581 Infant vitamIns VIDAYLIn PLUS IRON DRP 0 Max 12 Rx/annum

In

2018 Family Practitioner Guide142Working towards a healthier you

Contact detailsCall: 0860 436 777

HIV AIDS Helpline: 0860 436 736

Emergency Assistance: 0800 44 4367

Email: [email protected]

Post: GEMS, Private Bag X782,

Cape Town 8000

www.gems.gov.za

Encourage patients to download the GEMS Member App that will enable them to manage their benefits:

2018 Family Practitioner Guide - GEMS

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