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Sizwe Medical Fund: CDL Formulary - All Options
This formulary is a summary of treatment covered on the Chronic Disease List (CDL) Formulary.
Applications for approval on the Chronic Medication Benefit (Excluding HIV) can be faxed or e-mailed:
Fax: 011 353 0352 / 011 353 0076
Email: chronic@sizwe.co.za.
Pharmacists or doctors can register telephonically by calling 011 353 0030. Pharmacists or doctors can register telephonically by calling 011 353 0030.
Please contact the Wellcare Management Team at 0860 10 34 54 for all HIV/Aids queries. Applications for approval on the HIV Programme, can be faxed to 011 221 5235.
The 26 listed conditions below are covered in full in terms of the scheme rules if
services are rendered according to the scheme's benefits, careplans, policies and protocols.
These conditions are covered on all the options, but benefits will be more or less
restrictive depending on the option the member has chosen.
The dispensing pharmacy may select a different generic equivalent to assist members to avoid co-payments. Sizwe rates apply for generic equivalents.
Stepwise therapy will apply according to state algorithms and latest applicable funding
guidelines (First Line, Second Line etc).
Disclaimer: Policies and formularies are updated by the Clinical Review Committee on a regular basis to comply with the latest industry norms, legislation, efficacy and safety.
PLEASE NOTE: Claims will not be paid as a PMB without the correct and specific ICD10 codes on prescriptions and claims.
1. ADDISONS DISEASE
Drug Class Full Budget Affordable Primary Care Special
Requirements
Steroid therapy
H02AA02 Florinef Acetate Florinef Acetate Florinef Acetate REF Entry Criteria
H02AB07 Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
REF Entry Criteria
H02AB09 Covocort Covocort Covocort REF Entry Criteria
2. ASTHMA
Drug Class Full Budget Affordable Primary Care Special
Requirements
Selective Beta adrenoreceptor agonists
R03AC02 Asthavent, Venteze Asthavent, Venteze Asthavent, Venteze REF Entry Criteria
R03AC04 Berotec - - REF Entry Criteria
R03AC12 Serevent Serevent - REF Entry Criteria
R03AC13 Foratec, Oxis Foratec,Oxis Foratec REF Entry Criteria
Corticoid steroid inhalers
R03BA01 Beclate Beclate Beclate REF Entry Criteria
R03BA02 Budeflam, Inflammide Budeflam, Inflammide Budeflam, Inflammide REF Entry Criteria
R03BA05 Flixotide - - REF Entry Criteria
R03BA07 Asmanex Asmanex - REF Entry Criteria
R03BA08 Alvesco - - REF Entry Criteria
Adrenergics and combinations Inhalers
R03AK03 Duovent Duovent Duovent Step 3 & up -Stepwise
therapy
R03AK06 Foxair, Sereflo Foxair, Sereflo Foxair, Sereflo Step 3 & up -Stepwise
therapy
R03AK07 Symbicord - - Step 3 & up -Stepwise
therapy
Anticholinergics Inhalers
R03BB01 Ipvent Ipvent Ipvent Step 4 & up Stepwise
therapy
Xanthines
R03DA04 EuphyllinR, Norstan
Theophyllin, Nuelin,
Sandoz Theophylline,
Uniphyl,Theoplus
EuphyllinR, Norstan
Theophyllin, Nuelin, Sandoz
Theophylline, Uniphyl,Theoplus
EuphyllinR, Norstan
Theophyllin, Nuelin, Sandoz
Theophylline,
Uniphyl,Theoplus
Step 5,6 -Stepwise
therapy
Not approved as
Monotherapy
Leukotriene modifier (strictly according to policy)
R03DC03
Lumont, Min Air, Monte
Air, Topraz
Lumont, Min Air, Monte Air,
Topraz
Lumont, Min Air, Monte Air,
Topraz
Strictly according to
policy
3. BIPOLAR MOOD DISORDER
Drug Class Full Budget Affordable Primary Care Special Requirements
Moodstabilisers
N05AN01 Camcolit, Quilonum Camcolit, Quilonum Camcolit, Quilonum REF Entry Criteria
N03AA02 Lethyl Lethyl Lethyl REF Entry Criteria
N03AF01 Degranol; Sandoz
Carbamazepine; Tegretol
Syrup
Degranol; Sandoz
Carbamazepine; Tegretol Syrup
Degranol; Sandoz
Carbamazepine; Tegretol
Syrup
REF Entry Criteria
N03AG01 Convulex, Epilim Convulex, Epilim Convulex, Epilim REF Entry Criteria
N03AX09 Aspen Lamotrigine, Dyna
Lamotrigine, Epitec,
Lamidus, Lamitor, Sandoz
Lamotrigine
Aspen Lamotrigine, Dyna
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz Lamotrigine
Aspen Lamotrigine, Dyna
Lamotrigine, Epitec,
Lamidus, Lamitor, Sandoz
Lamotrigine
REF Entry Criteria
Antipsychotics: - Phenothiazines
N05AA01 Largactil Largactil Largactil REF Entry Criteria
N05AB02 Modecate Modecate Modecate REF Entry Criteria
N05AB06 Stelazine Stelazine Stelazine REF Entry Criteria
Butyrophenones
N05AD01 Sandoz Haloperidol Sandoz Haloperidol Sandoz Haloperidol REF Entry Criteria
N05AF01 Fluanxol Depot, Fluanxol
Tablets
Fluanxol Depot Fluanxol Depot REF Entry Criteria
N05AF05 Clopixol Clopixol Clopixol REF Entry Criteria
N05AH02 Aspen Clozapine Aspen Clozapine Aspen Clozapine REF Entry Criteria
N05AH03 Oleanz, Olexar,Redilanz Oleanz, Olexar,Redilanz Oleanz, Olexar,Redilanz REF Entry Criteria
N05AH04 Mylan Quetiapine,
Quetoser, Serez, Seroquel
xr,
Mylan Quetiapine, Quetoser,
Serez, Seroquel xr,
Mylan Quetiapine, Quetoser,
Serez, Seroquel xr,
REF Entry Criteria
N05AL05 Solian Solian - REF Entry Criteria
N05AX08 Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan
Risperidone, Zoxadon
Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan Risperidone,
Zoxadon
Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan Risperidone,
Zoxadon
REF Entry Criteria
Tricyclic antidepressants & Sulpiride
N05AL01
Bio Sulpiride, Espiride Bio Sulpiride, Espiride Bio Sulpiride, Espiride REF Entry Criteria
N06AA02 Ethipramine Ethipramine Ethipramine REF Entry Criteria
N06AA04 Edronax, Equinorm Equinorm 25mg Equinorm 25mg REF Entry Criteria
N06AA07 Emdalen - - REF Entry Criteria
N06AA10 Tydamine - - REF Entry Criteria
N06AA16 Thaden Thaden Thaden REF Entry Criteria
Selective Serotonin Re-uptake Inhibitors (SSIRs)
N06AB03 A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
REF Entry Criteria
N06AB04 Adco-Talomil, Arrow
Citalopram, Austell
citalopram, Bio citalopram,
Cilate, Cilift , Citalohexal,
Citalopram Winthrop,
Depramil, DRL
Citalopram, Simayla
Citalopram,Sandoz
Citalopram
Adco-Talomil, Austell
citalopram, Arrow Citalopram,
Bio citalopram, Cilate, Cilift ,
Citalohexal, Citalopram
Winthrop, Depramil, DRL
Citalopram, Simayla
Citalopram, Sandoz Citalopram
Adco-Talomil, Austell
citalopram, Arrow
Citalopram, Bio citalopram,
Cilate, Cilift , Citalohexal,
Citalopram Winthrop,
Depramil, DRL Citalopram,
Simayla Citalopram, Sandoz
Citalopram
REF Entry Criteria
N06AB05 Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Parax,Paroxetine unicorn,
Paxil,
Serrapress, Xet,
Paroxetine Unicorn
Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Paroxetine unicorn,
Parax,Paxil,
Serrapress, Xet, Paroxetine
Unicorn
Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Paroxetine unicorn, Paxil,
Parax,
Serrapress, Xet, Paroxetine
Unicorn
REF Entry Criteria
N06AB06 Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
REF Entry Criteria
N06AB08 Faverin, Fluvoxamine-
Hexal
- - REF Entry Criteria
N06AB10 Aspen Escitalopram,
Citraz, Lexamil, Mylan
Escitalopram, Zytomil
Aspen Escitalopram, Citraz,
Lexamil, Mylan Escitalopram,
Zytomil
- REF Entry Criteria
Mono-amine oxidase
N06AF04 Parnate Parnate Parnate
N06AG02 Depnil, Adco-
meclobemide
Depnil, Adco-meclobemide Depnil, Adco-meclobemide
Tetracyclics
N06AX03 Lantanon Lantanon Lantanon REF Entry Criteria
N06AX05 Aspen Trazodone, - - REF Entry Criteria
N06AX11 Adco-Mirteron, Aspen
Mitarzapine, Beron, Mylan
mirtazapine, Ramure,
Sandoz mirtazapine
- - REF Entry Criteria
Noadrenaline Re-uptake Inhibitors
N06AX12 Wellbutrin SR - - REF Entry Criteria
Serotonin & Noadrenaline Re-uptake Inhibitor
N06AX16 Efegen xr, Venlafaxine –
Adco, Odiven, Sandoz
venlafaxine xl, Venlor XR,
Venlafaxine-Unicon
- - REF Entry Criteria
N06AX21 Cymgen, Yelate - - REF Entry Criteria
Melatonergic Antidepressabt
N06AX22 Valdoxane - - REF Entry Criteria
4. BRONCHIECTASIS
Drug Class Full Budget Affordable Primary Care Special
Requirements
Selective Beta adrenoreceptor agonists
R03AC02 Asthavent, Venteze Asthavent, Venteze Asthavent, Venteze REF Entry Criteria
R03AC13 Foratec Foratec Foratec REF Entry Criteria
R03AC04 Berotec - - REF Entry Criteria
5. CARDIAC FAILURE & CARDIOMYOPATHY
Drug Class Full Budget Affordable Primary Care Special
Requirements
Potassium Chloride
A12BA51 Plenish K, Sandoz -K Plenish K, Sandoz -K Plenish K, Sandoz -K Not approved as
Monotherapy
Platelet aggregation inhibitors
B01AC06 Bayer Aspirin Cardio,
Myoprin, Lo-Aspirin,
Aspirirn Teva, Ecotrin
Bayer Aspirin Cardio, Myoprin,
Lo-Aspirin, Asprin Teva,
Ecotrin
Bayer Aspirin Cardio,
Myoprin, Lo-Aspirin, Aspirin
Teva, Ecotrin
REF Entry Criteria
Anticoagulants
B01A A03 Cipla-warfarin, Warfarin
5mg (Lennon)
Cipla-warfarin, Warfarin 5mg
(Lennon) Cipla-warfarin, Warfarin 5mg
(Lennon)
REF Entry Criteria
Digitalis
C01AA05 Lanoxin, Purgoxin Lanoxin, Purgoxin Lanoxin, Purgoxin REF Entry Criteria
Organic Nitrates
C01DA02 Angised Angised Angised REF Entry Criteria
C01DA08
Imdur, Sandoz-isosorbide
dinitrate, Isordil Tembid
Sandoz-isosorbide dinitrate,
Isordil Tembid
Sandoz-isosorbide dinitrate,
Isordil Tembid
REF Entry Criteria
C01DA14 Elantan, Monicor SR Elantan, Monicor SR Elantan, Monicor SR REF Entry Criteria
Antihypertensives
Diuretics
C03AA03 Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq REF Entry Criteria
C03AB03 Urirex K Urirex K Urirex K REF Entry Criteria
C03BA11
Adco-Dapamax, Cipla
indapamide, Dyna
indapamide sr, Mylan
Indapamide, Dapamax,
Hydroless, Sandoz-
indapamide, Daptril
Adco-Dapamax, Cipla
indapamide, Dyna indapamide
sr, Dapamax, Hydroless,
Sandoz-indapamide, Daptril,
Mylan Indapamide,
Adco-Dapamax, Cipla
indapamide, Dyna
indapamide sr, Dapamax,
Hydroless, Sandoz-
indapamide, Daptril, Mylan
Indapamide,
REF Entry Criteria
C03CA01
Austell Furosemide,
Beuresis, Lasix, Mylan-
Furosemide, Puresis, Sandoz-furosemide,
Furobe
Austell Furosemide, Beuresis,
Lasix, Mylan-Furosemide,
Puresis, Sandoz-furosemide,
Furobe
Austell Furosemide,
Beuresis, Lasix, Mylan-
Furosemide, Puresis, Sandoz-
furosemide, Furobe
REF Entry Criteria
C03CA02 Burinex - - REF Entry Criteria
C03CA04 Torahexal - - REF Entry Criteria
C03DA01 Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
REF Entry Criteria
C03DB01 Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
REF Entry Criteria
ACE Inhibitors with or without combinations
C09AA01 Adco Captomax, Bio-
Captopril, Captohexal,
Mylan Captopril, Sandoz
Captopril, Zapto
Adco Captomax, Bio-
Captopril, Captohexal, Mylan
Captopril, Sandoz Captopril,
Zapto
Adco Captomax, Bio-
Captopril, Captohexal, Mylan
Captopril, Sandoz Captopril,
Zapto
REF Entry Criteria
C09AA02 Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
Alapren, Ciplatec, Enap, Envas,
HR-Enalapril, Pharmapress
Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
REF Entry Criteria
Pharmapress Pharmapress
C09AA03 Adco Zetomax,Auro
Lisinopril, Austell
Lisinopril, Diace,Hexal-
lisinopril, Simayla
Lisinopril,Lysin, Sinopren,
Zemax
Adco Zetomax,, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril,Lysin,
Sinopren, Zemax
Adco Zetomax,, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril,Lysin,
Sinopren, Zemax
REF Entry Criteria
C09AA04 Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl, Coversyl
10mg, Pearinda, Prexum, Ran-
perindopril, Spec Perindopril,
Simayla Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
REF Entry Criteria
C09AA05 Austell-Ramipril; Ramipril
– Hexal; Ramiwin; Rampil;
Ran-ramipril; Retace;
Simayla Ramipril
Austell-Ramipril; Ramipril –
Hexal; Ramiwin; Rampil; Ran-
ramipril; Retace; Simayla
Ramipril
Austell-Ramipril; Ramipril –
Hexal; Ramiwin; Rampil; Ran-
ramipril; Retace; Simayla
Ramipril
REF Entry Criteria
C09AA06 Accumax; Quinaspen; Accumax; Quinaspen; Accumax; Quinaspen; REF Entry Criteria
C09AA10 Mavik Mavik Mavik REF Entry Criteria
C09BA01 Zapto-co Zapto-co Zapto-co REF Entry Criteria
C09BA02 Enap co; Pharmapress co Enap co; Pharmapress co Enap co; Pharmapress co REF Entry Criteria
C09BA03 Adco Zetomax, Diace co,
Hexal-lisinopril co,
Lisoretic, Lisozide,
Lisinopril , Co-Unicorm
Adco Zetomax, Diace co,
Hexal-lisinopril co, Lisoretic,
Lisozide, Lisinopril Co-
Unicorm
Adco Zetomax, Diace Co,
Hexal-lisinopril co, Lisoretic,
Lisozide, Lisinopril, Co-
Unicorm
REF Entry Criteria
C09BA04 Acesyl co, Prexum Plus,
Spec Perindopril plus,
Vectoryl Plus
Acesyl co, Prexum Plus, Spec
Perindopril plus, Vectoryl Plus
Acesyl co, Prexum Plus, Spec
Perindopril plus, Vectoryl
Plus
REF Entry Criteria
C09BA06 Accumax Co, Adco-
Quinaretic
Accumax Co, Adco-
Quinaretic
Accumax Co, Adco-
Quinaretic
REF Entry Criteria
Angiotensin Receptor Blockers (ARBs) & combinations
C09CA01 Cipla Losartan, Ciplazar,
Cozaar, Losaar plus,
Losartan Winthrop,
Netrasol co, Sartoc,
Zartan, Spec Losartan
Cipla Losartan, Ciplazar,
Cozaar, Lohype Plus, Losaar
plus, Losartan Winthrop,
Netrasol co, Sartoc, Zartan,
Spec Losartan,
Cipla Losartan, Ciplazar,
Cozaar, Lohype Plus, Losaar
plus, Losartan Winthrop,
Netrasol co, Sartoc, Zartan,
Spec Losartan
REF Entry Criteria
C09CA03 Migroben, Tareg,
Zomevek
- - REF Entry Criteria
C09CA04 Irbewin ,Dynarb - - REF Entry Criteria
C09CA07 Pritor - - REF Entry Criteria
C09DA01 Ciplazar, Ciplazar co,
Cozaar Comp, Fortzaar,
Lohype Forte Plus, Lozaan
co, Zartan co,Lozacar co,
Losaan co,Netrasol co
Ciplazar, Ciplazar co, Cozaar
Comp, Fortzaar, Lohype Forte
Plus, Lozaan co, Zartan
co,Lozacar co, Losaan
co,Netrasol co
Ciplazar, Ciplazar co, Cozaar
Comp, Fortzaar, Lohype
Forte Plus, Lozaan co, Zartan
co,Lozacar co, Losaan
co,Netrasol co
REF Entry Criteria
C09DA03 Co Tareg, Zomevak co - - REF Entry Criteria
C09DA04 Co Irbewin - - REF Entry Criteria
C09DA07 Co Pritor - - REF Entry Criteria
C09DB01 Exforge, Co exforge - - REF Entry Criteria
Beta Blockers
C07AB03
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
C07AA05 Prodorol; Purbloka; Prodorol; Purbloka Prodorol; Purbloka; REF Entry Criteria
C07AB04 Butobloc, Sectral - - REF Entry Criteria
C07AB07 Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
Adco-Bisocor, Betacor,Bilocor,
Bisohexal, Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol Unicorn
REF Entry Criteria
C07AB07 Bisoprolol
Hydrochlorothiazide
- - REF Entry Criteria
C07BB03 Tenchlor, Sandoz Co
Tenidone
Tenchlor, Sandoz Co Tenidone Tenchlor, Sandoz Co
Tenidone
REF Entry Criteria
Calcium Channel Blockers (CCBs)
C08CA01 Almadin, Amlate, Amloc,
Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics
Amlodipine Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn, Austell-
amlodipine, Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics Amlodipine
Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn, Austell-
amlodipine, Calbloc,
Ciplavasc, Klodip,Lomanor,
Norcard, Pharma Dynamics
Amlodipine Besylate,,
REF Entry Criteria
C08CA02 Felodipine Hexal, Fedaloc Felodipine Hexal,Fedaloc Felodipine Hexal, Fedaloc REF Entry Criteria
C08CA03 Dynacirc SRO - - REF Entry Criteria
C08CA05 Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
Adco-Vascard, Cipalat Retard,
Fedaloc, Macorel sr, Nifedalat
SR, Spec nifedipine SR
Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel sr,
Nifedalat SR, Spec nifedipine
SR
REF Entry Criteria
C08CA13 Zanidip - - REF Entry Criteria
C08DA01 Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
REF Entry Criteria
C08DB01 Adco-Zildem Adco-Zildem Adco-Zildem REF Entry Criteria
Alpha & Beta Receptor Blockers
C02CA01 Pratsiol - - REF Entry Criteria
C02CA04 Cardura XL, Adco-
Doxazosin, Cardugen,
Carzin
Adco-Doxazosin, Cardugen,
Carzin
Adco-Doxazosin, Cardugen,
Carzin
REF Entry Criteria
C07AG02 Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
REF Entry Criteria
Vasodilators
C02DB02 Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
REF Entry Criteria
Antiadrenergic agents, centrally acting
C02LB01 Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
Hypotone, Sandoz Methyldopa,
Mylan Methyldopa
Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
REF Entry Criteria
Sympathetic Nervous Blockers
C02AA02 Reserpine Reserpine Reserpine REF Entry Criteria
Antihypertensive Combinations with Statins
C10BX03 Caduet - - Motivation rqd
6. CHRONIC OBSTRUCTIVE AIRWAYS DISEASE
Drug Class Full Budget Affordable Primary Care Other Special
Requirements
Oral corticosteroids are no longer recommended for maintenance treatment of COPD-SPECIALIST REFERRAL REQUIRED.
R03AC02 Asthavent, Venteze Asthavent, Venteze Asthavent, Venteze Step 1 and up
R03AC04 Berotec - - Step 1 and up
R03AC12 Serevent Serevent - Step 2 and up
R03AC13 Foratec, Oxis Foratec,Oxis Foratec Step 2 and up
Anticholinergics
R03BB02 Atrovent, Ipvent Atrovent, Ipvent Atrovent, Ipvent Step 2 and up
R03BB04 Forvent Strictly according to policy Strictly according to policy Step 2 and up
Corticoid steroid inhalers
R03BA01 Beclate Beclate Beclate Step 2 and up
R03BA02 Budeflam, Inflammide Budeflam, Inflammide Budeflam, Inflammide Step 2 and up
R03BA05 Flixotide - - Step 2 and up
R03BA08 Alvesco - - Step 2 and up
Adrenergics and combinations for Obstructive Airways Disease
R03AK03 Duovent Duovent Duovent Step 2 and up
R03AK06 Foxair, Sereflo Foxair, Sereflo Foxair, Sereflo Step 2 and up
R03AK07 Symbicord - - Step 2 and up
Xanthines
R03DA04 EuphyllinR, Norstan
Theophyllin, Nuelin,
Sandoz Theophylline,
EuphyllinR, Norstan
Theophyllin, Nuelin, Sandoz
EuphyllinR, Norstan
Theophyllin, Nuelin, Sandoz
Theophylline,
Not approved as
Monotherapy
Uniphyl,Theoplus Theophylline,
Uniphyl,Theoplus
Uniphyl,Theoplus
7. CHRONIC RENAL FAILURE
Drug Class Full Budget Affordable Primary Care Other Special
Requirements
Vitamin D analogues and supplements
A11CC03 One Alpha One Alpha One Alpha REF Entry Criteria
A12AA B-Cal B-Cal B-Cal REF Entry Criteria
B03AB02 Venofer, Cosmofer Venofer, Cosmofer Venofer, Cosmofer REF Entry Criteria
Potassium Chloride
A12BA51 Plenish K, Sandoz -K Plenish K, Sandoz -K Plenish K, Sandoz -K
Haematopoietic Agents
B03XA01 Eprex; Recormon; Repotin Eprex; Recormon; Repotin Eprex; Recormon; Repotin REF Entry Criteria
Antihypertensives
Diuretics
C03AA03 Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq REF Entry Criteria
C03AB03 Urirex K Urirex K Urirex K REF Entry Criteria
C03BA11 Natrilix SR , Adco-
Dapamax, Cipla
indapamide, Dyna
indapamide sr, Hydroless,
Sandoz-indapamide
Adco-Dapamax, Cipla
indapamide, Dyna indapamide
sr, Hydroless, Sandoz-
indapamide
Adco-Dapamax, Cipla
indapamide, Dyna
indapamide sr, Hydroless,
Sandoz-indapamide
REF Entry Criteria
C03CA01 A lennon Furosemide,
Austell Furosemide,
Beuresis, Lasix, Lasix Soln,
Mylan-Furosemide, Puresis, Sandoz-furosemide,
Furobe
A lennon Furosemide, Austell
Furosemide, Beuresis, Lasix,
Lasix Soln, Mylan-Furosemide,
Puresis, Sandoz-furosemide,
Furobe
A lennon Furosemide,
Austell Furosemide,
Beuresis, Lasix, Lasix Soln,
Mylan-Furosemide, Puresis, Sandoz-furosemide, Furobe
C03CA02 Burinex - - REF Entry Criteria
C03CA04 Torahexal - - REF Entry Criteria
C03DA01 Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
REF Entry Criteria
C03DB01 Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
REF Entry Criteria
ACE Inhibitors and combinations
C09AA01 Adco Captomax, Bio-
Captopril, Captohexal,
Mylan Captopril, Sandoz
Captopril, Zapto,
Adco Captomax, Bio-
Captopril, Captohexal, Mylan
Captopril, Sandoz Captopril,
Zapto,
Adco Captomax, Bio-
Captopril, Captohexal,
Mylan Captopril, Sandoz
Captopril, Zapto,
REF Entry Criteria
C09AA02 Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
Pharmapress,
Alapren, Ciplatec, Enap, Envas,
HR-Enalapril, Pharmapress,
Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
Pharmapress,
REF Entry Criteria
C09AA03 Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril,
Sinopren, Zemax,
Zestozide
Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril, Sinopren,
Zemax, Zestozide
Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril,
Sinopren, Zemax,
Zestozide
REF Entry Criteria
C09AA04 Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl, Coversyl
10mg, Pearinda, Prexum, Ran-
perindopril, Spec Perindopril,
Simayla Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
REF Entry Criteria
C09AA05 Austell-Ramipril; Ramipril
– Hexal; Ramiwin; Rampil;
Ran-ramipril; Retace;
Simayla Ramipril
Austell-Ramipril; Ramipril –
Hexal; Ramiwin; Rampil; Ran-
ramipril; Retace; Simayla
Ramipril
Austell-Ramipril; Ramipril
– Hexal; Ramiwin; Rampil;
Ran-ramipril; Retace;
Simayla Ramipril
REF Entry Criteria
C09AA06 Accumax; Quinaspen; Accumax; Quinaspen; Accumax; Quinaspen; REF Entry Criteria
C09AA10 Mavik Mavik Mavik REF Entry Criteria
C09BA01 Zapto-co Zapto-co Zapto-co REF Entry Criteria
C09BA02 Enap co; Pharmapress co Enap co; Pharmapress co Enap co; Pharmapress co REF Entry Criteria
C09BA03 Adco Zetomax, Diace co,
Hexal-lisinopril co,
Lisoretic, Lisozide,
Lisinopril Co-Unicorm
Adco Zetomax, Diace co,
Hexal-lisinopril co, Lisoretic,
Lisozide, Lisinopril Co-
Unicorm
Adco Zetomax, Diace co,
Hexal-lisinopril co,
Lisoretic, Lisozide,
Lisinopril Co-Unicorm
REF Entry Criteria
C09BA04 Acesyl co, Prexum Plus,
Spec Perindopril plus,
Vectoryl Plus
Acesyl co, Prexum Plus, Spec
Perindopril plus, Vectoryl Plus
Acesyl co, Prexum Plus,
Spec Perindopril plus,
Vectoryl Plus
REF Entry Criteria
C09BA06 Accumax co, Adco-
Quinaretic
Accumax co, Adco-Quinaretic Accumax Co, Adco-
Quinaretic
REF Entry Criteria
Angiotensin Receptor Blockers & combinations
C09CA01 Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthprop,
Netrasol co, Sartoc,
Zartan,
Cipla Losartan, Cozaar, Lohype
Plus, Losaar plus, Losartan
Winthprop, Netrasol co,
Sartoc, Zartan,
Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthprop,
Netrasol co, Sartoc,
Zartan,
REF Entry Criteria
C09CA03 Co Tareg, Diovan, Co-
migroben, Co-zomevek,
Migroben, Sartoc, Tareg,
Zomevek
Co Tareg, Diovan, Sartoc,
Tareg,
Co Tareg, Diovan, Sartoc, Tareg,
REF Entry Criteria
C09CA04 Irbewin, Dynarb - - REF Entry Criteria
C09CA07 Pritor - - REF Entry Criteria
C09DA01 Ciplazar, Ciplazar co,
Cozaar Comp, Fortzaar,
Lohype Forte Plus, Lozaan
Ciplazar, Ciplazar co, Cozaar
Comp, Fortzaar, Lohype Forte
Plus, Lozaan co, Zartan co
Ciplazar, Ciplazar co,
Cozaar Comp, Fortzaar,
Lohype Forte Plus, Lozaan
REF Entry Criteria
co, Zartan co co, Zartan co
C09DA03 Co Tareg - - REF Entry Criteria
C09DA04 Co Irbewin - - REF Entry Criteria
C09DA07 Co Pritor - - REF Entry Criteria
C09DB01 Exforge, Co exforge - - REF Entry Criteria
Beta Blockers & combinations
C07AB03
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
C07AA05 Prodorol; Purbloka; Prodorol; Purbloka Prodorol; Purbloka; REF Entry Criteria
C07AB04 Butobloc, Sectral - - REF Entry Criteria
C07AB07 Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
Adco-Bisocor, Betacor,Bilocor,
Bisohexal, Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
REF Entry Criteria
C07AB57 Bisoprolol
Hydrochlorothiazide
- - REF Entry Criteria
C07BB03 Tenchlor, Sandoz Co
Tenidone
Tenchlor, Sandoz Co Tenidone Tenchlor, Sandoz Co
Tenidone
REF Entry Criteria
Calcium Channel Blockers (CCBs)
C08CA01 Almadin, Amlate, Amloc,
Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics
Amlodipine Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn, Austell-
amlodipine, Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics Amlodipine
Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics
Amlodipine Besylate,,
REF Entry Criteria
C08CA02 Felodipine Hexal, Fedaloc Felodipine Hexal,Fedaloc Felodipine Hexal, Fedaloc REF Entry Criteria
C08CA03 Dynacirc SRO - - REF Entry Criteria
C08CA05 Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
Adco-Vascard, Cipalat Retard,
Fedaloc, Macorel sr, Nifedalat
SR, Spec nifedipine SR
Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
REF Entry Criteria
C08CA13 Zanidip - - REF Entry Criteria
C08DA01 Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
REF Entry Criteria
C08DB01 Adco-Zildem Adco-Zildem Adco-Zildem REF Entry Criteria
Alpha & Beta Receptor Blockers
C02CA01 Pratsiol - - REF Entry Criteria
C02CA04 Cardura XL, Adco-
Doxazosin, Cardugen,
Carzin
Adco-Doxazosin, Cardugen,
Carzin
Adco-Doxazosin,
Cardugen, Carzin
REF Entry Criteria
C07AG02 Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
REF Entry Criteria
Vasodilators
C02DB02 Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
REF Entry Criteria
C02DC01 Loniten Loniten Loniten REF Entry Criteria
Centrally Acting Sympathetic NS Inhibitors
C02LB01 Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
Hypotone, Sandoz Methyldopa,
Mylan Methyldopa
Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
REF Entry Criteria
C02AA02 Reserpine Reserpine Reserpine REF Entry Criteria
C02LB01 Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
Hypotone, Sandoz Methyldopa,
Mylan Methyldopa
Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
REF Entry Criteria
Antihypertensive Combinations with Statins
C10BX03 Caduet - - Full Lipogram (Refer to
Hyperlipidaemia)
8. CORONARY ARTERY DISEASE
Drug Class Full Budget Affordable Primary Care Other Special
Requirements
Platelet aggregation inhibitors
B01AC06 Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
REF Entry Criteria
Organic Nitrates
C01DA02 Angised Angised Angised REF Entry Criteria
C01DA08 Imdur, Sandoz-isosorbide
dinitrate,
Sandoz-isosorbide dinitrate, Sandoz-isosorbide
dinitrate
REF Entry Criteria
C01DA14 Elantan, Monicor SR Elantan, Monicor SR Elantan, Monicor SR REF Entry Criteria
C01DA58 Isordil Tembid Isordil Tembid Isordil Tembid REF Entry Criteria
Antihypertensives
Beta Blockers
C07AB03
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Adco-Atenolol; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
C07AA05 Prodorol; Purbloka; Prodorol; Purbloka Prodorol; Purbloka; REF Entry Criteria
C07AB04 Butobloc, Sectral - - REF Entry Criteria
C07AB07 Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
Adco-Bisocor, Betacor,Bilocor,
Bisohexal, Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
REF Entry Criteria
C07AB07 Bisoprolol
Hydrochlorothiazide
- - REF Entry Criteria
C07BB03 Tenchlor, Sandoz Co
Tenidone
Tenchlor, Sandoz Co Tenidone Tenchlor, Sandoz Co
Tenidone
REF Entry Criteria
Alpha & Beta Blockers
C02CA01 Pratsiol - - REF Entry Criteria
C02CA04 Cardura XL, Adco-
Doxazosin, Cardugen,
Carzin
Adco-Doxazosin, Cardugen,
Carzin
Adco-Doxazosin,
Cardugen, Carzin
REF Entry Criteria
C07AG02 Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
REF Entry Criteria
Calcium Channel Blockers (CCBs)
C08CA01 Almadin, Amlate, Amloc,
Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics
Amlodipine Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn, Austell-
amlodipine, Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics Amlodipine
Besylate,
Almadin, Amlate, Amloc,
Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Klodip,Lomanor, Norcard,
Pharma Dynamics
Amlodipine Besylate,,
REF Entry Criteria
C08CA02 Felodipine Hexal, Fedaloc Felodipine Hexal,Fedaloc Felodipine Hexal, Fedaloc REF Entry Criteria
C08CA03 Dynacirc SRO - - REF Entry Criteria
C08CA05 Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
Adco-Vascard, Cipalat Retard,
Fedaloc, Macorel sr, Nifedalat
SR, Spec nifedipine SR
Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
REF Entry Criteria
C08CA13 Zanidip - - REF Entry Criteria
C08DA01 Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
REF Entry Criteria
C08DB01 Adco-Zildem Adco-Zildem Adco-Zildem REF Entry Criteria
9. CROHN’S DISEASE
Drug Class Full Budget Affordable Primary Care Special Requirements
Steroids
H02AB07 Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
REF Entry Criteria
A07EA06 Entocord Entocord Entocord REF Entry Criteria
5 - ASA Agents
A07EC01 Salazopyrin; Salazopyrin
EN,
Salazopyrin; Salazopyrin EN, Salazopyrin; Salazopyrin
EN,
REF Entry Criteria
A07EC01 Pentasa, Pentasa supp,
Dipentum, Asacol
Pentasa, Pentasa supp,
Dipentum, Asacol
Pentasa, Pentasa supp,
Dipentum, Asacol
REF Entry Criteria
Immunosuppressants
Folic Acid analogues
L01BA01 Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
REF Entry Criteria
Folic Acid Supplements
B03BB01 Betabs Folic Acid Betabs Folic Acid Betabs Folic Acid Only approved in
combination therapy
Other immunosuppressants
L04AX01 Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
REF Entry Criteria
Anti-TNF therapy and Biologics
Strictly according to policy Strictly according to policy Not Covered
10. DIABETES INSIPIDUS
Drug Class Full Budget Affordable Primary Care Special Requirements
Vasopressin Analogue
H01BA02 DDAVP DDAVP DDAVP REF Entry Criteria incl
Motivation
11. DIABETES MELLITIS Type 1
Drug Class Full Budget Affordable Primary Care Special Requirements
Insulins Fast Acting
A10AB01 Biosulin R; Humalog,
Humulin R, Novorapid
Biosulin R; Humalog, Humulin
R, Novorapid
Biosulin R; Humalog,
Humulin R, Novorapid
REF Entry Criteria
Analogues - Fast Acting
A10AB06 Apidra Apidra Apidra REF Entry Criteria
Insulins -Intermediate Acting
A10AC01 Biosulin N Biosulin N Biosulin N REF Entry Criteria
Insulins -Intermediate Acting combined with Fast Acting
A10AD01 Biosulin 30/70, Humulin
30/70 Humalog Mix 25,
Humalog Mix50
Actraphane, Novomix,
Insuman Comb
Biosulin 30/70, Humulin 30/70 Humalog Mix 25, Humalog
Mix50 Actraphane, Novomix,
Insuman Comb
Biosulin 30/70, Humulin
30/70 Humalog Mix 25,
Humalog Mix50
Actraphane, Novomix,
Insuman Comb
REF Entry Criteria
Insulins- long Acting
A10AE01 Biosulin L, Humulin N,
Protaphane
Biosulin L, Humulin N,
Protaphane
Biosulin L, Humulin N,
Protaphane
REF Entry Criteria
Analogues- long Acting
A10AE04 Lantus; Levemir Lantus; Levemir Lantus; Levemir Strictly according to
clinical criteria & protocol
(motivation rqd)
12. DIABETES MELLITIS Type 2
Drug Class Full Budget Affordable Primary Care Special Requirements
Biguanides
A10BA02 Accord Metformin;
Arrow-Metformin, Austell-
Metformin, Bigsens,
Forminal, Gluconorm,
Glucophage, Glucophage
XR, Metchek,Metforal,
Metored, Metphage, Mylan
Metformin, Sandoz-
metformin
Accord Metformin; Arrow-
Metformin, Austell-Metformin,
Bigsens, Forminal, Gluconorm,
Glucophage, Glucophage XR,
Metchek,Metforal, Metored,
Metphage, Mylan Metformin,
Sandoz-metformin
Accord Metformin;
Arrow-Metformin, Austell-
Metformin, Bigsens,
Forminal, Gluconorm,
Glucophage, Glucophage
XR, Metchek,Metforal,
Metored, Metphage, Mylan
Metformin, Sandoz-
metformin
REF Entry Criteria
Sulfonamides,urea derivatives
A10BB01 Bio-Glibenclamide,
Glycomin, Sandoz-
glibenclamide
Bio-Glibenclamide, Glycomin,
Sandoz-glibenclamide Bio-Glibenclamide,
Glycomin, Sandoz-
glibenclamide
REF Entry Criteria
A10BB02 Hypomide Hypomide Hypomide REF Entry Criteria
A10BB09 Adco Glucomed, Arrow
gliclazide, Austell
Adco Glucomed, Arrow
gliclazide, Austell Gliclazide,
Adco Glucomed, Arrow
gliclazide, Austell Gliclazide,
REF Entry Criteria
Gliclazide, Diaglucide,
Diaran, Dyna gliclazide sr,
Glycron, Glygard, Mylan
Gliclazide, Sandoz
Gliclazide
Diaglucide, Diaran, Dyna
gliclazide sr, Glycron, Glygard,
Mylan Gliclazide, Sandoz
Gliclazide
Diaglucide, Diaran, Dyna
gliclazide sr, Glycron,
Glygard, Mylan Gliclazide,
Sandoz Gliclazide
A10BB12 Aspen glimepiride, Euglim,
Glamaryl, Mylan
Glimepiride, Sandoz-
Glimepiride, ,Sulphonur
Aspen glimepiride, Euglim,
Glamaryl, Mylan Glimepiride,
Sandoz-Glimepiride, Sulphonur
Aspen glimepiride, Euglim,
Glamaryl, Mylan Glimepiride,
Sandoz-Glimepiride,
Sulphonur
REF Entry Criteria
Alpha glucosidase inhibitors
A10BFD01 Glucobay - - REF Entry Criteria
Thiazolidinediones
A10BG03 Cipla- Pioglitazone Cipla- Pioglitazone Cipla- Pioglitazone REF Entry Criteria
Combination :Sulfonamides and Biguanides
A10BA02 Glucovance - - REF Entry Criteria
Dipeptidyl peptidase-4 inhibitors
A10BH01
Januvia Januvia - Strictly on Motivation
A10BH02 Galvus Galvus - Strictly on Motivation
A10BH03 Onglyza Onglyza - Strictly on Motivation
Dipeptidyl peptidase-4 inhibitors combinations
A10BH01
Janumet Janumet - Strictly on Motivation
A10BH02 Galvus Met Galvus Met - Strictly on Motivation
GLP-1 AGONIST
A10BX04 Byetta - - Strictly on Motivation
A10BX07 Victoza - - Strictly on Motivation
Insulins Fast Acting
A10AB01 Biosulin R; Humalog,
Humulin R, Novorapid
Biosulin R; Humalog, Humulin
R, Novorapid
Biosulin R; Humalog,
Humulin R, Novorapid
REF Entry Criteria
Analogues - Fast Acting
A10AB06 Apidra Apidra Apidra REF Entry Criteria
Insulins -Intermediate Acting
A10AC01 Biosulin N Biosulin N Biosulin N REF Entry Criteria
Insulins -Intermediate Acting combined with Fast Acting
A10AD01 Biosulin 30/70, Humulin
30/70 Humalog Mix 25,
Biosulin 30/70, Humulin 30/70 Humalog Mix 25, Humalog
Biosulin 30/70, Humulin
30/70 Humalog Mix 25,
REF Entry Criteria
Humalog Mix50
Actraphane, Novomix,
Insuman Comb
Mix50 Actraphane, Novomix,
Insuman Comb Humalog Mix50 Actraphane,
Novomix, Insuman Comb
Insulins- long Acting
A10AE01 Biosulin L, Humulin N,
Protaphane
Biosulin L, Humulin N,
Protaphane
Biosulin L, Humulin N,
Protaphane
REF Entry Criteria
Analogues- long Acting
A10AE04 Lantus; Levemir Lantus; Levemir Lantus; Levemir Strictly on Motivation
13. DYSRHYTHMIAS
Drug Class Full Budget Affordable Primary Care Special
Requirements
Platelet Aggregation inhibitors
B01AC06 Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
REF Entry Criteria
Anticoagulants
B01A A03 Cipla-warfarin, Warfarin
5mg (Lennon)
Cipla-warfarin, Warfarin 5mg
(Lennon) Cipla-warfarin, Warfarin 5mg
(Lennon)
REF Entry Criteria
Digitalis
C01AA05 Lanoxin, Purgoxin Lanoxin, Purgoxin Lanoxin, Purgoxin REF Entry Criteria
Antiarrythmics
C01BA03 Rythmodan, Rythmol - - REF Entry Criteria
C01BD01 Arycor, Bio-Amiodarone,
Hexarone
Arycor, Bio-Amiodarone,
Hexarone
Arycor, Bio-Amiodarone,
Hexarone
REF Entry Criteria
Antihypertensives
Betablockers
C07AA05 Prodorol; Purbloka;
Sandoz-atenolol; Tenbloka;
Adco-atenolol, B-Block,
Bio-Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
C07AB04 Butobloc, Sectral - - REF Entry Criteria
C07AB07 Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
Adco-Bisocor, Betacor,Bilocor,
Bisohexal, Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol Unicorn
REF Entry Criteria
C07AG02 Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
REF Entry Criteria
Calcium Channel Blockers
C08DA01 Calcicard SR, Ravamil SR,
Vasomil, Verahexal
Calcicard SR, Ravamil SR,
Vasomil, Verahexal
Calcicard SR, Ravamil SR,
Vasomil, Verahexal
REF Entry Criteria
14. EPILEPSY
Drug Class Full Budget Affordable Primary Care Other Special
Requirements
Antiepeleptics
N03AA02 Lethyl Lethyl Lethyl REF Entry Criteria
N03AB02 Epanutin Caps, Epanutin
Syrup, Phenytoin Sodium
Epanutin Caps, Epanutin Syrup,
Phenytoin Sodium Epanutin Caps, Epanutin
Syrup, Phenytoin Sodium
REF Entry Criteria
N03AD01 Zarontin Zarontin Zarontin REF Entry Criteria
N03AE01 Rivotril Rivotril Rivotril REF Entry Criteria ,
Combination use only
N03AF01 Degranol, Sandoz-
Carbamazepine CR,
Sandoz-Carbamazepine,
CPL Carbamazepine
Tegretol CR, Tegretol
Syrup
Degranol, Sandoz-
Carbamazepine CR, Sandoz-
Carbamazepine, CPL
Carbamazepine Tegretol CR,
Tegretol Syrup
Degranol, Sandoz-
Carbamazepine CR, Sandoz-
Carbamazepine, CPL
Carbamazepine Tegretol CR,
Tegretol Syrup
REF Entry Criteria
N03AF02 Trileptal Trileptal Trileptal REF Entry Criteria
N03AG01 Convulex, Epilim CR,
Epilim Crushable, Epilim
Syrup
Convulex, Epilim CR, Epilim
Crushable, Epilim Syrup
Convulex, Epilim CR, Epilim
Crushable, Epilim Syrup
REF Entry Criteria
NO3AX09 Aspen lamotrigine, DYNA-
Lamotrigine, Epitec,
Lamidus, Lamitor, Sandoz-
Lamotrigine
Aspen lamotrigine, DYNA-
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz-Lamotrigine
Aspen lamotrigine, DYNA-
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz-Lamotrigine
REF Entry Criteria
NO3AX11 Epitoz, Sandoz
Topiramate,
Topalex,Toplep
Epitoz, Sandoz Topiramate,
Topalex,Toplep
Epitoz, Sandoz Topiramate,
Topalex,Toplep
REF Entry Criteria
NO3AX12 Epleptin, Neurexal, Ran
Gabapentin
Epleptin, Neurexal, Ran
Gabapentin
Epleptin, Neurexal, Ran
Gabapentin
REF Entry Criteria
NO3AX14 Redilev Redilev Redilev REF Entry Criteria
15. GLAUCOMA
Drug Class Full Budget Affordable Primary Care Special
Requirements
Beta Blockers
S01ED01 Glaucosan, Nyogel,
Timoptol, Timoptol XE
Glaucosan, Nyogel, Timoptol, Timoptol XE
Glaucosan, Nyogel,
Timoptol, Timoptol XE
REF Entry Criteria
S01ED01 Nyogel Nyogel Nyogel REF Entry Criteria
S01ED02 Betoptic S, Betoptic - - REF Entry Criteria
S01ED03 Betagan - - REF Entry Criteria
Parasympathomimetics
S01EB01 Isopto-carpine Isopto-carpine Isopto-carpine REF Entry Criteria
Sympathomimetics
S01EA05 Alphagan Alphagan Alphagan REF Entry Criteria
Carbonic anhydrase inhibitors
S01EC03 Trusopt Trusopt Trusopt REF Entry Criteria
S01EC04 Azoptic Azoptic Azoptic REF Entry Criteria
Prostaglandin analogues
S01EE01 Xalatan, Ocuprost Xalatan, Ocuprost Xalatan, Ocuprost REF Entry Criteria
S01EE03 Lumigan Lumigan Lumigan REF Entry Criteria
S01EE04 Travatan Travatan Travatan REF Entry Criteria
Beta Blocker Combinations
S01EE01 Xalacom Xalacom Xalacom REF Entry Criteria
S01ED51 Combigan Combigan Combigan REF Entry Criteria
S01ED51 Azarga Azarga Azarga REF Entry Criteria
S01EC03 Cosopt Cosopt Cosopt REF Entry Criteria
S01EE04 Duotrav Duotrav Duotrav REF Entry Criteria
16. HAEMOPHILIA
Drug Class Full Budget Affordable Primary Care Special
Requirements
Analgesics and Antipyretics
N02BE01 Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic,
Austell Paracetamol,
Napamol, Painamol, Betab
Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic, Austell
Paracetamol, Napamol,
Painamol, Betab
Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic,
Austell Paracetamol,
Napamol, Painamol, Betab
REF Entry Criteria
Paracetamol,Prolief,
Varipan
Paracetamol,Prolief, Varipan Paracetamol,Prolief, Varipan
Antifibrinolytics
B02AA02 Cyklokapron Cyklokapron Cyklokapron REF Entry Criteria
Blood Coagulation Factors
B02BD02 Haemosolvate Haemosolvate Haemosolvate REF Entry Criteria
17. HIV
Disease: Special Requirements
Registration with Wellcare at 0860 10 34 54 is required
Drug Class Full Budget Affordable Primary Care Special
Requirements
Analgesics and Antipyretics Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
J05AF01
Adco-Zidovudine, Aspen
Zidovudine, Auro-
Zidovudine, Cipla-
Zidovudine, Retrovir,
Dozra, Sonke-Zidovudine,
Zidomat,
Adco-Zidovudine, Aspen
Zidovudine, Auro-Zidovudine,
Cipla-Zidovudine, Retrovir,
Dozra, Sonke-Zidovudine,
Zidomat,
Adco-Zidovudine, Aspen
Zidovudine, Auro-
Zidovudine, Cipla-
Zidovudine, Retrovir, Dozra,
Sonke-Zidovudine, Zidomat,
J05AF02 Aspen Didanosine,
Deladex, Sonke-
Didanosine, Deladex,
Videx
Aspen Didanosine, Deladex,
Sonke-Didanosine, Deladex,
Videx
Aspen Didanosine, Deladex,
Sonke-Didanosine, Deladex,
Videx
J05AF04 Aspen Stavudine, Auro
Stavudine, Sonke-
Stavudine, Stavir, Vari-
Stavudine, Zerit,
Aspen Stavudine, Auro
Stavudine, Sonke-Stavudine,
Stavir, Vari-Stavudine, Zerit,
Aspen Stavudine, Auro
Stavudine, Sonke-Stavudine,
Stavir, Vari-Stavudine, Zerit,
J05AF05
Adco-lamivudine, Aspen
lamivudine, 3TC, Cipla-
lamivudine, Sonke-
lamivudine, Lazena,
Legram,
Adco-lamivudine, Aspen
lamivudine, 3TC, Cipla-
lamivudine, Sonke-lamivudine,
Lazena, Legram,
Adco-lamivudine, Aspen
lamivudine, 3TC, Cipla-
lamivudine, Sonke-
lamivudine, Lazena, Legram,
J05AF06 Adco-Abacavir, Auro-
Abacavir, Cipla-Abacavir,
Sonke-Abacavir, Kavimun
Adco-Abacavir, Auro-Abacavir,
Cipla-Abacavir, Sonke-Abacavir,
Kavimun
Adco-Abacavir, Auro-
Abacavir, Cipla-Abacavir,
Sonke-Abacavir, Kavimun
Subject to clinical
Criteria & protocols
J05AF07
Adco Tenofovir, Aspen
Tenofovir, Cipla-tenofovir,
Ricovir, Sonke- Tenofovir,
Tenofovir Winthrop,
Viread, Zefin
Adco Tenofovir, Aspen
Tenofovir, Cipla-tenofovir,
Ricovir, Sonke- Tenofovir,
Tenofovir Winthrop, Viread,
Zefin
Adco Tenofovir, Aspen
Tenofovir, Cipla-tenofovir,
Ricovir, Sonke- Tenofovir,
Tenofovir Winthrop, Viread,
Zefin
Subject to clinical
Criteria & protocols
Non-Nucleoside Reverse Transcriptase Inhibitors (NNTIs)
J05AG01
Adco-Nevirapine, Acriptaz,
Aspen Nevirapine, Cipla
Nevirapine, Auro-
Nevirapine, Sonke-
Nevirapine, Nevivir, Vari-
Nevirapine, Viramune,
Adco-Nevirapine, Acriptaz,
Aspen Nevirapine, Cipla
Nevirapine, Auro-Nevirapine,
Sonke-Nevirapine, Nevivir,
Vari-Nevirapine, Viramune,
Viropon
Adco-Nevirapine, Acriptaz,
Aspen Nevirapine, Cipla
Nevirapine, Auro-
Nevirapine, Sonke-
Nevirapine, Nevivir, Vari-
Nevirapine, Viramune,
Viropon Viropon
J05AG03
Adco-efavirenz, Arrow-
efavirenz, Auro-efavirenz,
Cipla-Efavirenz, Efavirenz
Winthrop, Efrin, Erige,
Hevaz, Sonke-Efavirenz,
Stocrin,
Adco-efavirenz, Arrow-
efavirenz, Auro-efavirenz,
Cipla-Efavirenz, Efavirenz
Winthrop, Efrin, Erige, Hevaz, Sonke-Efavirenz, Stocrin,
Adco-efavirenz, Arrow-
efavirenz, Auro-efavirenz,
Cipla-Efavirenz, Efavirenz
Winthrop, Efrin, Erige,
Hevaz, Sonke-Efavirenz,
Stocrin,
J05AG04
Intelence Intelence Intelence Subject to clinical
Criteria & protocols
Protease Inhibitors (PIs)
J05AE01
Invirase Invirase Invirase Subject to clinical
Criteria & protocols
J05AE02
Crixivan Crixivan Crixivan
J05AE03
Norvir, Norvir, Norvir,
J05AE08 Crixivan, Aspen atazanavir,
Atazor, Reyataz,
Crixivan, Aspen atazanavir,
Atazor, Reyataz,
Crixivan, Aspen atazanavir,
Atazor, Reyataz,
J05AE10 Prezista Prezista Prezista
Integrase Inhibitors
J05AX08 Isentress Isentress Isentress Subject to clinical
Criteria & protocols
Fixed Dose Combination Drugs
J05AR02 Kivexa, Dumiva Kivexa, Dumiva Kivexa, Dumiva Subject to clinical
Criteria & protocols
J05AF01
Adco
Lamivudine/zidovudine,
Aspen-lamzid, Auro-
Lamzido, Avocomb,
Cipla-Douvir, Combivir,
Combizil, Divuwin, Duovir,
Lodiz, Sonke-
Lamivudine/Zidovudine,
Zidolam, Zovilam,
Adco Lamivudine/zidovudine,
Aspen-lamzid, Auro-Lamzido, Avocomb, Cipla-Douvir,
Combivir, Combizil, Divuwin,
Duovir, Lodiz, Sonke-
Lamivudine/Zidovudine,
Zidolam, Zovilam,
Adco
Lamivudine/zidovudine,
Aspen-lamzid, Auro-
Lamzido, Avocomb, Cipla-
Douvir, Combivir, Combizil,
Divuwin, Duovir, Lodiz,
Sonke-
Lamivudine/Zidovudine,
Zidolam, Zovilam,
Subject to clinical
Criteria & protocols
J05AR03
Adco-emtevir, Didivir,
Tencitab, Temecit,
Tenemcom, Tenemine,
Truvada, Tyricten
Adco-emtevir, Didivir,
Tencitab, Temecit, Tenemcom,
Tenemine, Truvada, Tyricten
Adco-emtevir, Didivir,
Tencitab, Temecit,
Tenemcom, Tenemine,
Truvada, Tyricten
Subject to clinical
Criteria & protocols
J05AR04 Trizivar, Sonke-
Abaclamizid
Trizivar, Sonke-Abaclamizid Trizivar, Sonke-Abaclamizid Subject to clinical
Criteria & protocols
J05AF05 Triomune, Sonke-
Laminevstav
Triomune, Sonke-Laminevstav Triomune, Sonke-
Laminevstav
Subject to clinical
Criteria & protocols
J05AR01 Cipla Duovir & Efivarenz Cipla Duovir & Efivarenz co- Cipla Duovir & Efivarenz co- Subject to clinical
co-pack pack pack Criteria & protocols
J05AR06 Atripla, Atroiza, Odimune,
Tribuss, Citenvir, Trivenz
Atripla, Atroiza, Odimune,
Tribuss, Citenvir, Trivenz
Atripla, Atroiza, Odimune,
Tribuss, Citenvir, Trivenz
As Above
J05AR00 Tenarenz Tenarenz Tenarenz As Above
J05AR05 Triplavar Triplavar Triplavar As Above
J05AR10 Aluvia, Kaletra Aluvia, Kaletra Aluvia, Kaletra As Above
18. HYPERLIPIDAEMIA
Drug Class Full Budget Affordable Primary Care Special
Requirements
Platelet aggregation inhibitors
B01AC06 Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Gulf Aspirin,
Genpharma Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin, Gulf
Aspirin, Genpharma Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Gulf Aspirin,
Genpharma Aspirin, Aspirin
Teva, Ecotrin
REF Entry Criteria
Fibrates
C10AB02 Bezalip, Sandoz Bezalip,
Bezachole SR, Dyna
Bezafibrate
Bezalip, Sandoz Bezalip,
Bezachole SR, Dyna Bezafibrate
Bezalip, Sandoz Bezalip,
Bezachole SR, Dyna
Bezafibrate
REF Entry Criteria
Statins
C10AA01 Adco Simvastatin, Arrow
Simvastatin, Aspen
Simvastatin, Austell
Simvastatin, Biovac
Simvastatin, Choleste,
Cipla-Simvastatin, Michol,
Redicor, Simvacor,
Simvotin, Zysim
Adco Simvastatin, Arrow
Simvastatin, Aspen Simvastatin,
Austell Simvastatin, Biovac
Simvastatin, Choleste, Cipla-
Simvastatin, Michol, Redicor,
Simvacor, Simvotin, Zysim
Adco Simvastatin, Arrow
Simvastatin, Aspen
Simvastatin, Austell
Simvastatin, Biovac
Simvastatin, Choleste, Cipla-
Simvastatin, Michol, Redicor,
Simvacor, Simvotin, Zysim
REF Entry Criteria
C10AA02 Lovachol Lovachol Lovachol REF Entry Criteria
C10AA03 Aspen Pravastatin, Arrow
pravastatin, Colite, Pixeta,
Sandoz pravastatin
- - REF Entry Criteria
C10AA04 Lescol - - REF Entry Criteria
C10AA05 Adco Atorvastatin,
Aspavor, Atolip,
Atorvastatin Unicorn,
Atorvastatin Winthrop,
Dynator,Lipogen
- - REF Entry Criteria
C10AA07 Crestor - - REF Entry Criteria
Other lipid modifyingagents
C10AX09 Ezetrol - - REF Entry Criteria with
Motivation
HMG CoA Reductase inhibitors in combination
C10BA02 Inegy - - REF Entry Criteria
Motivation reqd
C10BX03 Caduet - - REF Entry Criteria
Motivation reqd
19. HYPERTENSION
Drug Class Full Budget Affordable Primary Care Special Requirements
Platelet aggregation inhibitors
B01AC06 Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio,
Disprin CV, Myoprin, Lo-
Aspirin, Aspirin Teva,
Ecotrin
REF Entry Criteria
Potassium Chloride
A12BA51 Plenish K, Sandoz -K Plenish K, Sandoz -K Plenish K, Sandoz -K
Diuretics
C03AA03 Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq Hexazide, Renezide, Ridaq REF Entry Criteria
C03AB03 Urirex K Urirex K Urirex K REF Entry Criteria
C03BA11 Natrilix SR , Adco-Dapamax,
Cipla indapamide, Dyna
indapamide sr, Hydroless,
Sandoz-indapamide
Adco-Dapamax, Cipla
indapamide, Dyna
indapamide sr, Hydroless,
Sandoz-indapamide
Adco-Dapamax, Cipla
indapamide, Dyna
indapamide sr, Hydroless,
Sandoz-indapamide
REF Entry Criteria
C03CA01 A lennon Furosemide, Austell
Furosemide, Beuresis, Lasix,
Lasix Soln, Mylan-Furosemide,
Puresis, Sandoz-furosemide,
Furobe
A lennon Furosemide,
Austell Furosemide,
Beuresis, Lasix, Lasix Soln,
Mylan-Furosemide, Puresis, Sandoz-furosemide,
Furobe
A lennon Furosemide,
Austell Furosemide,
Beuresis, Lasix, Lasix Soln,
Mylan-Furosemide, Puresis, Sandoz-furosemide, Furobe
REF Entry Criteria ,
C03CA02 Burinex - - REF Entry Criteria
C03CA04 Torahexal - - REF Entry Criteria
C03DA01 Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
Sandoz-spironolactone,
Spiractin,
REF Entry Criteria
C03DB01 Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
Adco-retic, Amiloretic,
Betaretic
REF Entry Criteria
ACE Inhibitors & combinations
C09AA01 Adco Captomax, Bio-
Captopril, Captohexal, Mylan
Captopril, Sandoz Captopril,
Zapto,
Adco Captomax, Bio-
Captopril, Captohexal,
Mylan Captopril, Sandoz
Captopril, Zapto,
Adco Captomax, Bio-
Captopril, Captohexal, Mylan
Captopril, Sandoz Captopril,
Zapto,
REF Entry Criteria
C09AA02 Alapren, Ciplatec, Enap, Envas,
HR-Enalapril, Pharmapress,
Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
Pharmapress,
Alapren, Ciplatec, Enap,
Envas, HR-Enalapril,
Pharmapress,
REF Entry Criteria
C09AA03 Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril, Sinopren,
Zemax, Zestozide
Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril,
Sinopren, Zemax,
Zestozide
Adco Zetomax, Austell
Lisinopril, Hexal-lisinopril,
Simayla Lisinopril, Sinopren,
Zemax, Zestozide
REF Entry Criteria
C09AA04 Acesyl, Bindace, Cipla-
perindopril, Ciplasyl, Coversyl
10mg, Pearinda, Prexum, Ran-
perindopril, Spec Perindopril,
Simayla Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
Acesyl, Bindace, Cipla-
perindopril, Ciplasyl,
Coversyl 10mg, Pearinda,
Prexum, Ran-perindopril,
Spec Perindopril, Simayla
Lisinopril,Vectoryl
REF Entry Criteria
C09AA05 Austell-Ramipril; Ramipril -
Hexal, Ramiwin, Rampil, Ran-
ramipril, Retace, Simayla
Ramipril
Austell-Ramipril; Ramipril -
Hexal, Ramiwin, Rampil,
Ran-ramipril; Retace;
Simayla Ramipril
Austell-Ramipril, Ramipril-
Hexal, Ramiwin,; Rampil,
Ran-ramipril, Retace, Simayla
Ramipril
REF Entry Criteria
C09AA06 Accumax, Quinaspen; Accumax, Quinaspen; Accumax, Quinaspen REF Entry Criteria
C09AA10 Mavik Mavik Mavik REF Entry Criteria
C09BA01 Zapto-co Zapto-co Zapto-co REF Entry Criteria
C09BA02 Enap co; Pharmapress co Enap co; Pharmapress co Enap co; Pharmapress co REF Entry Criteria
C09BA03 Adco Zetomax, Diace Co,
Hexal-lisinopril Co, Lisoretic,
Lisozide, Lisinopril Co-
Unicorm
Adco Zetomax, Diace Co,
Hexal-lisinopril Co,
Lisoretic, Lisozide,
Lisinopril Co-Unicorm
Adco Zetomax, Diace Co,
Hexal-lisinopril Co, Lisoretic,
Lisozide, Lisinopril Co-
Unicorm
REF Entry Criteria
C09BA04 Acesyl co, Prexum Plus, Spec
Perindopril plus, Vectoryl Plus
Acesyl co, Prexum Plus,
Spec Perindopril plus,
Vectoryl Plus
Acesyl co, Prexum Plus, Spec
Perindopril plus, Vectoryl
Plus
REF Entry Criteria
C09BA06 Accumax Co, Adco-
Quinaretic
Accumax Co, Adco-
Quinaretic
Accumax Co, Adco-
Quinaretic
REF Entry Criteria
Angiotensin Receptor Blockers & combinations
C09CA01 Cipla Losartan, Cozaar, Lohype
Plus, Losaar plus, Losartan
Winthprop, Netrasol co,
Sartoc, Zartan,
Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthprop,
Netrasol co, Sartoc,
Zartan,
Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthprop,
Netrasol co, Sartoc, Zartan,
REF Entry Criteria
C09CA03 Co Tareg, Diovan, Co-
migroben, Co-zomevek,
Migroben, Sartoc, Tareg,
Zomevek
Co Tareg, Diovan, Sartoc, Tareg,
Co Tareg, Diovan, Sartoc,
Tareg,
REF Entry Criteria
C09CA04 Irbewin, Dynarb - - REF Entry Criteria
C09CA07 Pritor - - REF Entry Criteria
C09DA01 Ciplazar, Ciplazar co, Cozaar
Comp, Fortzaar, Lohype Forte
Plus, Lozaan co, Zartan co
Ciplazar, Ciplazar co,
Cozaar Comp, Fortzaar,
Lohype Forte Plus, Lozaan
co, Zartan co
Ciplazar, Ciplazar co, Cozaar
Comp, Fortzaar, Lohype
Forte Plus, Lozaan co, Zartan
co
REF Entry Criteria
C09DA03 Co Tareg - - REF Entry Criteria
C09DA04 Co Irbewin - - REF Entry Criteria
C09DA07 Co Pritor - - REF Entry Criteria
C09DB01 Exforge, Co exforge - - REF Entry Criteria
C09CA01 Cipla Losartan, Cozaar, Lohype
Plus, Losaar plus, Losartan
Winthrop, Netrasol co, Sartoc,
Zartan,
Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthrop,
Netrasol co, Sartoc,
Zartan,
Cipla Losartan, Cozaar,
Lohype Plus, Losaar plus,
Losartan Winthrop, Netrasol
co, Sartoc, Zartan,
REF Entry Criteria
Beta Blockers & combinations
C07AA05 Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Prodorol; Purbloka;
Sandoz-atenolol; Tenbloka;
Adco-atenolol, B-Block,
Bio-Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
C07AB04 Butobloc, Sectral - - REF Entry Criteria
C07AB07 Adco-Bisocor, Betacor,Bilocor,
Bisohexal, Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol
Unicorn
Adco-Bisocor,
Betacor,Bilocor, Bisohexal,
Cardicor, Bisoprolol Unicorn
REF Entry Criteria
C07AB07 Bisoprolol Hydrochlorothiazide - - REF Entry Criteria
C07BB03 Tenchlor Tenchlor Tenchlor REF Entry Criteria
C07AA05 Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-Atenolol,
Hexablok
Prodorol; Purbloka;
Sandoz-atenolol; Tenbloka;
Adco-atenolol, B-Block,
Bio-Atenolol, Hexablok
Prodorol; Purbloka; Sandoz-
atenolol; Tenbloka; Adco-
atenolol, B-Block, Bio-
Atenolol, Hexablok
REF Entry Criteria
Calcium Channel Blockers (CCBs)
C08CA01 Almadin, Amitas, Amlate,
Amloc, Amlodac, Amlosyn,
Austell-amlodipine, Calbloc,
Ciplavasc, Lomanor, Pharma
Dynamics Amlodipine Besylate,
Almadin, Amitas, Amlate,
Amloc, Amlodac, Amlosyn,
Austell-amlodipine,
Calbloc, Ciplavasc,
Lomanor, Pharma
Dynamics Amlodipine
Besylate,
Almadin, Amitas, Amlate,
Amloc, Amlodac, Amlosyn,
Austell-amlodipine, Calbloc,
Ciplavasc, Lomanor, Pharma
Dynamics Amlodipine
Besylate,
REF Entry Criteria
C08CA02 Felodipine Hexal Felodipine Hexal Felodipine Hexal REF Entry Criteria
C08CA03 Dynacirc SRO - - REF Entry Criteria
C08CA05 Adco-Vascard, Cipalat Retard,
Fedaloc, Macorel sr, Nifedalat
SR, Spec nifedipine SR
Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel
sr, Nifedalat SR, Spec
nifedipine SR
Adco-Vascard, Cipalat
Retard, Fedaloc, Macorel sr,
Nifedalat SR, Spec nifedipine
SR
REF Entry Criteria
C08CA13 Zanidip - - REF Entry Criteria
C08DA01 Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
Calcicard SR, Ravamil SR,
Vasomil, Verahexal,
REF Entry Criteria
C08DB01 Adco-Zildem Adco-Zildem Adco-Zildem REF Entry Criteria
Alpha & Beta Blockers
C02CA01 Pratsiol - - REF Entry Criteria
C02CA04 Cardura XL, Adco-Doxazosin,
Cardugen, Carzin
Adco-Doxazosin,
Cardugen, Carzin
Adco-Doxazosin, Cardugen,
Carzin
REF Entry Criteria
C07AG02 Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
Aspen Carvedilol, Carloc,
Carvetrend, Vediblok,
REF Entry Criteria
Vasodilators
C02DB02 Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
Hyperphen, Sandoz
Hydralazine
REF Entry Criteria
C02DC01 Loniten Loniten Loniten REF Entry Criteria
Centrally Acting Sympathetic NS Inhibitors
C02LB01 Hypotone, Sandoz Methyldopa,
Mylan Methyldopa
Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
Hypotone, Sandoz
Methyldopa, Mylan
Methyldopa
REF Entry Criteria
C02AA02 Reserpine Reserpine Reserpine REF Entry Criteria
Antihypertensive Combinations with Statins
C10BX03 Caduet - - REF Entry Criteria , &
Motivation
20. HYPOTHYROIDISM
Drug Class Full Budget Affordable Primary Care Special
Requirements
Thyroid Replacement Hormones
H03AA01 Eltroxin, Euthyrox Eltroxin, Euthyrox Eltroxin, Euthyrox REF Entry Criteria
H03AA02 Tertroxin Tertroxin Tertroxin REF Entry Criteria
H03AA03 Diotroxin Diotroxin Diotroxin REF Entry Criteria
21. MULTIPLE SCLEROSIS
Drug Class Full Budget Affordable Primary Care Special
Requirements
Heterocyclic antidepressants
N06AA02 Ethipramine Ethipramine Ethipramine REF Entry Criteria
N06AA09 Trepiline, Sandoz Amytriptiline Trepiline, Sandoz
Amytriptiline
Trepiline, Sandoz
Amytriptiline
REF Entry Criteria
Anticonvulsants
N03AF01 Degranol, Sandoz-
Carbamazepine CR, Sandoz-
Carbamazepine, CPL
Carbamazepine Tegretol CR,
Tegretol Syrup
Degranol, Sandoz-
Carbamazepine CR,
Sandoz-Carbamazepine,
CPL Carbamazepine
Tegretol CR, Tegretol
Syrup
Degranol, Sandoz-
Carbamazepine CR, Sandoz-
Carbamazepine, CPL
Carbamazepine Tegretol CR,
Tegretol Syrup
REF Entry Criteria
Corticosteroids
H02AB04 Solumedrol Solumedrol Solumedrol REF Entry Criteria
H02AB07 Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
REF Entry Criteria
Immunosuppressants
Folic Acid analogues
L01BA01 Abitrexate , Methotrexate-
Lederle
Abitrexate , Methotrexate-
Lederle
Abitrexate , Methotrexate-
Lederle
REF Entry Criteria
Folic Acid analogues
B03BB01 Betabs Folic Acid Betabs Folic Acid Betabs Folic Acid REF Entry Criteria
L01AA01 Endoxan - - REF Entry Criteria
L04AX01 Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
REF Entry Criteria
Muscle Relaxants
M03BX01 Bio-Baclofen, Teva Baclofen Bio-Baclofen, Teva
Baclofen
Bio-Baclofen, Teva Baclofen REF Entry Criteria
Anticholinergics
G04BD04 Lenditro, Mylan Oxybutinin,
Urihexal
Lenditro, Mylan
Oxybutinin, Urihexal
Lenditro, Mylan Oxybutinin,
Urihexal
REF Entry Criteria
Immunostimulants
Motivation is required
Reimbursement - Strictly according to clinical criteria and protocol.
22. PARKINSONS DISEASE
Drug Class Full Budget Affordable Primary Care Special
Requirements
Dopaminergic agents
Carbidopa, and Levodopa derivatives
N04BA01 Carbilev, Sinemet CR, Sinemet,
Madopar, Teva Carbi-Levo
Carbilev, Sinemet CR,
Sinemet, Madopar, Teva
Carbi-Levo
Carbilev, Sinemet CR,
Sinemet, Madopar, Teva
Carbi-Levo
REF Entry Criteria
Anticholinergics
N04AA02 Akineton, Disipal Akineton, Disipal Akineton, Norflex, Disipal REF Entry Criteria
Adamantane derivatives
N04BB01 Symmetrel - - REF Entry Criteria
Monoamine oxidase B Inhibitors
N04BD01 Parkilyne Parkilyne Parkilyne REF Entry Criteria
Dopamine agonists
N04BC01 Aspen Bromocriptine Aspen Bromocriptine Aspen Bromocriptine REF Entry Criteria
N04BC04 Requip - - REF Entry Criteria
N04BC04 RequipXL - - Motivation reqd
N04BC05 Oxpola, Pramiola Oxpola, Pramiola Oxpola, Pramiola REF Entry Criteria
23. RHEUMATOID ARTHRITIS
Disease: Special Requirements Biological Alternatives: Reimbursement strictly according to the clinical criteria & reimbursement policy.
Drug Class Full Budget Affordable Primary Care Special
Requirements
Non Steroidal Anti-inflammatories
M01AB01 Arthrexin, Adco-Indomethacin,
Betacin, Flamecid, Methocaps
Arthrexin, Adco-
Indomethacin, Betacin,
Flamecid, Methocaps
Arthrexin, Adco-
Indomethacin, Betacin,
Flamecid, Methocaps
REF Entry Criteria
M01AB05 Fortfen SR , Adco-Diclofenac,
A-Lennon
Diclofenac,Diclohexal, Mylan
Diclofenac, Panamor, Panamor
SR, Sandoz Diclofenac Sodium,
Veltex
Fortfen SR , Adco-
Diclofenac, A-Lennon
Diclofenac,Diclohexal,
Mylan Diclofenac,
Panamor, Panamor SR,
Sandoz Diclofenac Sodium,
Veltex
Fortfen SR , Adco-
Diclofenac, A-Lennon
Diclofenac,Diclohexal, Mylan
Diclofenac, Panamor,
Panamor SR, Sandoz
Diclofenac Sodium, Veltex
REF Entry Criteria
M01AC01 Rheugesic, Xycam,Brexecam,
Pixicam, Pyrocaps
Rheugesic, Xycam,
Pixicam, Pyrocaps
Rheugesic, Xycam, Pixicam,
Pyrocaps
REF Entry Criteria
M01AE01 Adco-Ibuprofen, Betaprofen,
Iboflam, Inza, Ranfen, Sandoz
Adco-Ibuprofen,
Betaprofen, Iboflam, Inza,
Adco-Ibuprofen, Betaprofen,
Iboflam, Inza, Ranfen, Sandoz
REF Entry Criteria
Ibuprofen, Ranfen, Sandoz Ibuprofen, Ibuprofen,
M01AE02 Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan Naproxen,
Nafasol, Napflam
Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan
Naproxen, Nafasol,
Napflam
Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan Naproxen,
Nafasol, Napflam
REF Entry Criteria
M01AE03 Ketoflam Ketoflam Ketoflam REF Entry Criteria
M01AE06 Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-Cam,
Melflam, Meloxicam Unicorn,
Mobic, Zydus Meloxicam
Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-
Cam, Melflam, Meloxicam
Unicorn, Mobic, Zydus
Meloxicam
Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-Cam,
Melflam, Meloxicam Unicorn,
Mobic, Zydus Meloxicam
REF Entry Criteria
M01AH01 Celebrex - - Motivation rqd
M01AH05 Arcoxia Arcoxia Arcoxia Motivations rqd
Immunosuppressants
Folic Acid analogues
L01BA01 Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
Abitrexate , Methotrexate-
Lederle, Methotrexate
(Wyeth)
REF Entry Criteria
Folic Acid Supplements
B03BB01 Betabs Folic Acid Betabs Folic Acid Betabs Folic Acid REF Entry Criteria
Other Immunosuppressants
L04AX01 Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
REF Entry Criteria
A07EC01 Salazopyrin, Salazopyrin EN Salazopyrin, Salazopyrin
EN
Salazopyrin, Salazopyrin EN REF Entry Criteria
L04AA13
Arava Arava Arava Motivation Reqd
Chloroquine
P01BA01 Nivaquine, Plasmoquine Nivaquine, Plasmoquine Nivaquine, Plasmoquine, REF Entry Criteria
Oral Corticosteroids
H02AB07 Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Approval for 6months at
a time.
Paracetamol
N02BE01 Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic, Austell
Paracetamol, Napamol,
Painamol, Betab
Paracetamol,Prolief, Varipan
Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic,
Austell Paracetamol,
Napamol, Painamol, Betab
Paracetamol,Prolief,
Varipan
Panado, Feverpain,
Gencetamol, Adco
Paracetamol, Antalgic,
Austell Paracetamol,
Napamol, Painamol, Betab
Paracetamol,Prolief, Varipan
REF Entry Criteria
24. SCHIZOPHRENIA
Drug Class Full Budget Affordable Primary Care Special
Requirements
Antipsychotics - Phenothiazines
N05AA01 Largactil Largactil Largactil REF Entry Criteria
N05AB02 Modecate Modecate Modecate REF Entry Criteria
N05AB06 Stelazine Stelazine Stelazine REF Entry Criteria
Butyrophenones
N05AD01 Sandoz Haloperidol Sandoz Haloperidol Sandoz Haloperidol REF Entry Criteria
Atypical Antipsychotics
N05AF01 Fluanxol Depot, Fluanxol
Tablets
Fluanxol Depot Fluanxol Depot REF Entry Criteria
N05AF05 Clopixol Clopixol Clopixol REF Entry Criteria
N05AH02 Aspen Clozapine Aspen Clozapine Aspen Clozapine REF Entry Criteria
N05AH03 Oleanz, Olexar,Redilanz Oleanz, Olexar,Redilanz Oleanz, Olexar,Redilanz REF Entry Criteria
N05AH04 Mylan Quetiapine, Quetoser,
Serez, Seroquel xr
Mylan Quetiapine, Quetoser,
Serez, Seroquel xr
Mylan Quetiapine, Quetoser,
Serez, Seroquel xr
REF Entry Criteria
N05AL05 Solian Solian - REF Entry Criteria
N05AX08 Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan Risperidone,
Zoxadon
Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan Risperidone,
Zoxadon
Aspen risperidone, Drl
risperidone, Perizal, Risnia
Rispacor, Risperdal Drops,
Risperidone Hexal,
Risperlet, Risponz,
Schizorol,Mylan Risperidone,
Zoxadon
REF Entry Criteria
Mood stabilisers
N05AN01 Camcolit, Quilonum Camcolit, Quilonum Camcolit, Quilonum REF Entry Criteria
N03AF01 Degranol; Sandoz
Carbamazepine; Tegretol Syrup
Degranol; Sandoz
Carbamazepine; Tegretol
Syrup
Degranol; Sandoz
Carbamazepine; Tegretol
Syrup
REF Entry Criteria
N03AG01 Convulex, Epilim Convulex, Epilim Convulex, Epilim REF Entry Criteria
N03AX09 Aspen Lamotrigine, Dyna
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz Lamotrigine
Aspen Lamotrigine, Dyna
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz Lamotrigine
Aspen Lamotrigine, Dyna
Lamotrigine, Epitec, Lamidus,
Lamitor, Sandoz Lamotrigine
REF Entry Criteria
Tricyclic antidepressants & Sulpiride
N05AL01
Bio Sulpiride, Espiride Bio Sulpiride, Espiride Bio Sulpiride, Espiride REF Entry Criteria
N06AA02 Ethipramine Ethipramine Ethipramine REF Entry Criteria
N06AA04 Edronax, Equinorm Equinorm 25mg Equinorm 25mg REF Entry Criteria
N06AA07 Emdalen - - REF Entry Criteria
N06AA10 Tydamine - - REF Entry Criteria
N06AA16 Thaden Thaden Thaden REF Entry Criteria
Selective Serotonin Re-uptake Inhibitors (SSIRs)
N06AB03 A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
A-Lennon Fluoxetine,
Deprozan, Lorien, Nuzak,
Prohexal, Ranflocs, Rezak,
Sandoz fluoxetine, Trizac,
Zydus Fluoxetine
REF Entry Criteria
N06AB04 Adco-Talomil, Arrow
Citalopram, Austell citalopram,
Bio citalopram, Cilate, Cilift ,
Citalohexal, Citalopram
Winthrop, Depramil, DRL
Citalopram, Simayla
Citalopram,Sandoz Citalopram
Adco-Talomil, Austell
citalopram, Arrow
Citalopram, Bio citalopram,
Cilate, Cilift , Citalohexal,
Citalopram Winthrop,
Depramil, DRL Citalopram,
Simayla Citalopram, Sandoz
Citalopram
Adco-Talomil, Austell
citalopram, Arrow
Citalopram, Bio citalopram,
Cilate, Cilift , Citalohexal,
Citalopram Winthrop,
Depramil, DRL Citalopram,
Simayla Citalopram, Sandoz
Citalopram
REF Entry Criteria
N06AB05 Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Parax,Paroxetine unicorn,
Paxil,
Serrapress, Xet, Paroxetine
Unicorn
Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Paroxetine unicorn,
Parax,Paxil,
Serrapress, Xet, Paroxetine
Unicorn
Adco-Paroxetine, Austell-
paroxetine, Deparoc,
Paroxetine unicorn, Paxil,
Parax,
Serrapress, Xet, Paroxetine
Unicorn
REF Entry Criteria
N06AB06 Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
Arrow sertraline, Austell
sertraline, Serdep, Serlife,
Sertraline-winthrop, Zylin
REF Entry Criteria
N06AB08 Faverin, Fluvoxamine-Hexal - - REF Entry Criteria
N06AB10 Aspen Escitalopram, Citraz,
Lexamil, Mylan Escitalopram,
Zytomil
Aspen Escitalopram, Citraz,
Lexamil, Mylan Escitalopram,
Zytomil
- REF Entry Criteria
Mono-amine oxidase
N06AF04 Parnate Parnate Parnate
N06AG02 Depnil, Adco-meclobemide Depnil, Adco-meclobemide Depnil, Adco-meclobemide
Tetracyclics
N06AX03 Lantanon Lantanon Lantanon REF Entry Criteria
N06AX05 Aspen Trazodone, - - REF Entry Criteria
N06AX11 Adco-Mirteron, Aspen
Mitarzapine, Beron, Mylan
mirtazapine, Ramure, Sandoz
mirtazapine
- - REF Entry Criteria
Noadrenaline Re-uptake Inhibitors
N06AX12 Wellbutrin SR - - REF Entry Criteria
Serotonin & Noadrenaline Re-uptake Inhibitors
N06AX16 Efegen xr, Venlafaxine –Adco,
Odiven, Sandoz venlafaxine xl,
Venlor XR, Venlafaxine-Unicon
- - REF Entry Criteria
N06AX21 Cymgen, Yelate - - REF Entry Criteria
Melatonergic Antidepressants
N06AX22 Valdoxane - - REF Entry Criteria
25. SYSTEMIC LUPUS ERYTHEMATOSIS
Drug Class Full Budget Affordable Primary Care Special
Requirements
Non Steroidal Anti-inflammatories
M01AB01 Arthrexin, Adco-Indomethacin,
Betacin, Flamecid, Methocaps
Arthrexin, Adco-Indomethacin,
Betacin, Flamecid, Methocaps
Arthrexin, Adco-
Indomethacin, Betacin,
Flamecid, Methocaps
REF Entry Criteria
M01AB05 Fortfen SR , Adco-Diclofenac,
A-Lennon
Diclofenac,Diclohexal, Mylan
Diclofenac, Panamor, Panamor
SR, Sandoz Diclofenac Sodium,
Veltex
Fortfen SR , Adco-Diclofenac,
A-Lennon
Diclofenac,Diclohexal, Mylan
Diclofenac, Panamor, Panamor
SR, Sandoz Diclofenac Sodium,
Veltex
Fortfen SR , Adco-
Diclofenac, A-Lennon
Diclofenac,Diclohexal,
Mylan Diclofenac,
Panamor, Panamor SR,
Sandoz Diclofenac
Sodium, Veltex
REF Entry Criteria
M01AC01 Rheugesic, Xycam,Brexecam,
Pixicam, Pyrocaps
Rheugesic, Xycam, Pixicam,
Pyrocaps
Rheugesic, Xycam,
Pixicam, Pyrocaps
REF Entry Criteria
M01AE01 Adco-Ibuprofen, Betaprofen,
Iboflam, Inza, Ranfen, Sandoz
Ibuprofen,
Adco-Ibuprofen, Betaprofen,
Iboflam, Inza, Ranfen, Sandoz
Ibuprofen,
Adco-Ibuprofen,
Betaprofen, Iboflam,
Inza, Ranfen, Sandoz
Ibuprofen,
REF Entry Criteria
M01AE02 Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan Naproxen,
Nafasol, Napflam
Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan Naproxen,
Nafasol, Napflam
Adco-Naproxen, Aspen
Naproxen, Bio
Naproxen,Mylan
Naproxen, Nafasol,
Napflam
REF Entry Criteria
M01AE03 Ketoflam Ketoflam Ketoflam REF Entry Criteria
M01AE06 Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-Cam,
Melflam, Meloxicam Unicorn,
Mobic, Zydus Meloxicam
Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-Cam,
Melflam, Meloxicam Unicorn,
Mobic, Zydus Meloxicam
Adco Meloxicam, Arrow
Meloxicam, Coxflam,
Flexocam, Loxiflam, M-
Cam, Melflam,
Meloxicam Unicorn,
Mobic, Zydus Meloxicam
REF Entry Criteria
M01AH01 Celebrex - - Motivation reqd
M01AH05 Arcoxia Arcoxia Arcoxia Motivation reqd
Oral Corticosteroids
H02AB07 Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
Immunosuppressants
Folic Acid analogues
L01BA01 Abitrexate , Methotrexate-
Lederle
Abitrexate , Methotrexate-
Lederle
Abitrexate ,
Methotrexate-Lederle
REF Entry Criteria
Folic Acid Supplements
B03BB01 Betabs Folic Acid Betabs Folic Acid Betabs Folic Acid REF Entry Criteria
Chloroquine
P01BA01 Nivaquine, Plasmoquine Nivaquine, Plasmoquine, Nivaquine, Plasmoquine REF Entry Criteria
Platelet aggregation inhibitors
B01AC06 Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin, Gulf
Aspirin, Genpharma Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio, Disprin
CV, Myoprin, Lo-Aspirin, Gulf
Aspirin, Genpharma Aspirin,
Aspirin Teva, Ecotrin
Bayer Aspirin Cardio,
Disprin CV, Myoprin,
Lo-Aspirin, Gulf Aspirin,
Genpharma Aspirin,
Aspirin Teva, Ecotrin
REF Entry Criteria
26. ULCERATIVE COLITIS
Drug Class Full Budget Affordable Primary Care Special
Requirements
Steroids
A07EA06 Entocord Entocord Entocord REF Entry Criteria
H02AB07 Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone, Capsoid,
Pulmison, Panafcort,
Lenisolone
Be-tabs Prednisone,
Capsoid, Pulmison,
Panafcort, Lenisolone
A07EC01 Salazopyrin; Salazopyrin EN, Salazopyrin; Salazopyrin EN, Salazopyrin; Salazopyrin
EN,
REF Entry Criteria
A07EC01 Pentasa, Pentasa supp,
Dipentum, Asacol
Pentasa, Pentasa supp,
Dipentum, Asacol
Pentasa, Pentasa supp,
Dipentum, Asacol
Other immunosuppressants
L04AX01 Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
Azathioprine, Azapress,
Zaprine
REF Entry Criteria
Anti-TNF therapy and Biologics
Biologicals Biologicals Biologicals Strictly according to
clinical criteria & policy
Recommended