Prime Cure Dental Formulary 2024
PLEASE NOTE: Provider Trade Names are not listed on formulary, allowing for generic substitution, but applying Reference Pricing
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KEY TO QUANTITIES AND LIMITATIONS
- “Consumables – Clinic use only” means the medication may only be administrated by a DSP at the rooms. All injectables are consumables. Patients will not be able to collect from DSP pharmacies.
- “Max Rx/7 days & 3 Rx/annum” means a script filled to a maximum of 7 days medication supply and 3 prescriptions per year can be claimed.
- All items are to be dispensed by a contracted DSP pharmacy.
- Benefits for medicine are subject to Mediscor Reference Price (MRP). Should the cost of the item exceed the MRP, the patient will be liable for payment of the difference in cost. If this is the case, please inform the patient that it will be for his/her own personal account.
Prime Cure Dental Formulary 2024
| wdt_ID | wdt_created_by | wdt_created_at | wdt_last_edited_by | wdt_last_edited_at | Category | MIMS | Mims Description | Active Ingredient | Route of admin | Dosage Form | Acute | Quantities and Limitations |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANAESTHETICS | Local Anaesthetics | Local Anaesthetics | Lidocaine HCl Local Inj 2% | IJ | SOLN | A | Consumables |
| 2 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANAESTHETICS | Local Anaesthetics | Local Anaesthetics | Lidocaine Inj 2% w/ Epinephrine-1:80000 | IJ | SOLN | A | Consumables |
| 3 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Ibuprofen Susp 100 MG/5ML | OR | SUSP | A | Max 200ml/Rx & 3 Rx/annum |
| 4 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Mefanamic Acid Susp 50mg/5ml | OR | SUSP | A | Max 200ml/Rx & 3 Rx/annum |
| 5 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Mefenamic Acid Cap 250 MG | OR | CAPS | A | Max Rx/5 days & 3 Rx/annum |
| 6 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Elixir 120 MG/5ML | OR | ELIX | A | Max 200ml/Rx & 3 Rx/annum |
| 7 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Syrup 120 MG/5ML | OR | ELIX | A | Max 200ml/Rx & 3 Rx/annum |
| 8 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Tab 500 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
| 9 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Combinations | Combination Analgesics | Acetaminophen w/ Codeine Cap 500-8 MG | OR | CAPS | A | Max Rx/7 days & 3 Rx/annum |
| 10 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Combinations | Combination Analgesics | Paracetamol w/ Codeine Tab 500-10 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
| 11 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Combinations | Combination Analgesics | Paracetamol w/ Codeine Tab 500-8 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
| 12 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Combinations | Combination Analgesics | Paracetamol-Meprobamate-Caff-Cod Tab 320-150-32-8 MG | OR | TABS | A | Max Rx/5 days & 3 Rx/annum |
| 13 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANALGESICS | Combinations | Combination Analgesics | Paracetamol-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML | OR | SYRP | A | Max 100ml/Rx & 3 Rx/annum |
| 14 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | MUSCULO-SKELETAL AGENTS | Non-Steroidal Anti-Inflammatory Agents | COX Inhibitors | Diclofenac Sodium Tab Delayed Release 25 MG | OR | TBEC | A | Max Rx/7 days & 3 Rx/annum |
| 15 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | MUSCULO-SKELETAL AGENTS | Non-Steroidal Anti-Inflammatory Agents | COX Inhibitors | Diclofenac Sodium Tab Delayed Release 50 MG | OR | TBEC | A | Max Rx/7 days & 3 Rx/annum |
| 16 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | MUSCULO-SKELETAL AGENTS | Non-Steroidal Anti-Inflammatory Agents | COX Inhibitors | Ibuprofen Tab 200 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
| 17 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | MUSCULO-SKELETAL AGENTS | Non-Steroidal Anti-Inflammatory Agents | COX Inhibitors | Ibuprofen Tab 400 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
| 18 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Benzocaine Lozenge 10 MG | MT | LOZG | A | Max 20/Rx & 4 Rx/annum |
| 19 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Chlorhexidine Gluconate Soln 0.2% | MT | SOLN | A | Max 200ml/annum |
| 20 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Povidone-Iodine Mouthwash 1% | MT | SOLN | A | Max 200ml/annum |
| 21 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Tetracaine HCl Ointment 0.5% | MT | OINT | A | Max 1 op/annum |
| 22 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 23 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 24 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 25 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate Tab 250-125 MG | OR | TABS | A | Max 4 fills/annum |
| 26 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate Tab 500-125 MG | OR | TABS | A | Max 4 fills/annum |
| 27 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) For Susp 125 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 28 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) For Susp 250 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 29 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 30 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) Cap 500 MG | OR | CAPS | A | Max 4 fills/annum |
| 31 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Ampicillin-Cloxacillin Cap 250-250 MG | OR | CAPS | A | Max 4 fills/annum |
| 32 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Ampicillin-Cloxacillin For Susp 125-125 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
| 33 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Cloxacillin Sodium Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 34 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Cloxacillin Sodium Cap 500 MG | OR | CAPS | A | Max 4 fills/annum |
| 35 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Floxacillin Sodium Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 36 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin G Procaine Intramuscular Susp 300000 Unit/ML | IM | SUSP | A | Consumables - Clinic use only |
| 37 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin G Benzathine For Intramuscular Susp 2400000 Unit | IM | SUSR | A | Consumables - Clinic use only |
| 38 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin V Potassium For Soln 125 MG/5ML | OR | SOLR | A | Max 4 fills/annum |
| 39 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin V Potassium Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
| 40 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefotaxime Sodium For Inj 500 MG | IJ | SOLR | A | Consumables - Clinic use only |
| 41 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefoxitin Sodium For Inj 1 GM | IV | SOLR | A | Consumables - Clinic use only |
| 42 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Ceftriaxone Sodium For Inj 1 GM | IJ | SOLR | A | Consumables - Clinic use only |
| 43 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Ceftriaxone Sodium For IV Soln 2 GM | IV | SOLN | A | Consumables - Clinic use only |
| 44 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefuroxime Sodium For Inj 250 MG | IJ | SOLR | A | Consumables - Clinic use only |
| 45 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefuroxime Sodium For Inj 750 MG | IJ | SOLR | A | Consumables - Clinic use only |
| 46 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Beta-Lactams | Others | NONE LISTED | ||||
| 47 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 48 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Susp 125 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
| 49 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Susp 250 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
| 50 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Stearate Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
| 51 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Aminoglycosides | Aminoglycosides | Gentamicin Sulfate Inj 40 MG/ML | IJ | SOLN | A | Consumables - Clinic use only |
| 52 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Aminoglycosides | Aminoglycosides | Streptomycin Sulfate Inj 1000 MG/3ML | IJ | SOLN | A | Consumables - Clinic use only |
| 53 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Tetracyclines | Tetracyclines | Doxycycline Hyclate Cap 100 MG | OR | CAPS | A | Max 4 fills/annum |
| 54 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Tetracyclines | Tetracyclines | Oxytetracycline HCl Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 55 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Chloramphenicols | Chloramphenicols | Chloramphenicol Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
| 56 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Chloramphenicols | Chloramphenicols | Chloramphenicol Susp 125 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
| 57 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML | IV | SOLN | A | Consumables - Clinic use only |
| 58 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
| 59 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim Tab 400-80 MG | OR | TABS | A | Max 4 fills/annum |
| 60 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Quinolones | Quinolones | Ciprofloxacin HCl Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
| 61 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Quinolones | Quinolones | Ciprofloxacin HCl Tab 500 MG | OR | TABS | A | Max 4 fills/annum |
| 62 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Other anti-bacterial agents | Other anti-bacterial agents | Clindamycin HCl Cap 150 MG | OR | CAPS | A | Max 2 fills/annum |
| 63 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Anti-Fungal agents | Anti-Fungal agents | Nystatin Susp 100000 Unit/ML | MT | SUSP | A | Max 2 fills/annum |
| 64 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Susp 200 MG/5ML | OR | SUSP | A | Max 3 fills/annum |
| 65 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Tab 200 MG | OR | TABS | A | Max 3 fills/annum |
| 66 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Tab 400 MG | OR | TABS | A | Max 3 fills/annum |
| 67 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ANTI-MICROBIALS | Anti-viral agents | Other Anti-viral Agents | Acyclovir Cream 5% | EX | CREA | A | Max 1 Rx/annum |
| 68 | KirstyKF | 16/07/2025 06:58 AM | KirstyKF | 16/07/2025 06:58 AM | ENDOCRINE SYSTEM | Corticosteroids | Corticosteroids | Prednisone Tab 5 MG | OR | TABS | A | Max 3 fills/annum |
Disclaimer:
Please note that the formulary will be reviewed regularly by clinical and pharmaceutical advisors to ensure it complies with the latest industry norms for the treatment of dental conditions. Prime Cure reserves the right to change medication on the formulary when important information comes to light that requires us to do so, e.g. new findings regarding safety of medicine.