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.
wdt_ID | Category | MIMS | Mims Description | Active Ingredient | Route of admin | Dosage Form | Acute | Quantities and Limitations |
---|---|---|---|---|---|---|---|---|
1 | ANAESTHETICS | Local Anaesthetics | Local Anaesthetics | Lidocaine HCl Local Inj 2% | IJ | SOLN | A | Consumables |
2 | ANAESTHETICS | Local Anaesthetics | Local Anaesthetics | Lidocaine Inj 2% w/ Epinephrine-1:80000 | IJ | SOLN | A | Consumables |
3 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Ibuprofen Susp 100 MG/5ML | OR | SUSP | A | Max 200ml/Rx & 3 Rx/annum |
4 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Mefanamic Acid Susp 50mg/5ml | OR | SUSP | A | Max 200ml/Rx & 3 Rx/annum |
5 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Mefenamic Acid Cap 250 MG | OR | CAPS | A | Max Rx/5 days & 3 Rx/annum |
6 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Elixir 120 MG/5ML | OR | ELIX | A | Max 200ml/Rx & 3 Rx/annum |
7 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Syrup 120 MG/5ML | OR | ELIX | A | Max 200ml/Rx & 3 Rx/annum |
8 | ANALGESICS | Analgesics and Antipyretics | Analgesic and Antipyretics | Paracetamol Tab 500 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
9 | ANALGESICS | Combinations | Combination Analgesics | Acetaminophen w/ Codeine Cap 500-8 MG | OR | CAPS | A | Max Rx/7 days & 3 Rx/annum |
10 | ANALGESICS | Combinations | Combination Analgesics | Paracetamol w/ Codeine Tab 500-10 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
11 | ANALGESICS | Combinations | Combination Analgesics | Paracetamol w/ Codeine Tab 500-8 MG | OR | TABS | A | Max Rx/7 days & 3 Rx/annum |
12 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Chlorhexidine Gluconate Soln 0.2% | MT | SOLN | A | Max 200ml/annum |
20 | EAR, NOSE AND THROAT | Mouth and throat preparations | Mouth and Throat Preparations | Povidone-Iodine Mouthwash 1% | MT | SOLN | A | Max 200ml/annum |
21 | 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 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
23 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
24 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
25 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate Tab 250-125 MG | OR | TABS | A | Max 4 fills/annum |
26 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin & K Clavulanate Tab 500-125 MG | OR | TABS | A | Max 4 fills/annum |
27 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) For Susp 125 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
28 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) For Susp 250 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
29 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
30 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Amoxicillin (Trihydrate) Cap 500 MG | OR | CAPS | A | Max 4 fills/annum |
31 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Ampicillin-Cloxacillin Cap 250-250 MG | OR | CAPS | A | Max 4 fills/annum |
32 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Ampicillin-Cloxacillin For Susp 125-125 MG/5ML | OR | SUSR | A | Max 4 fills/annum |
33 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Cloxacillin Sodium Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
34 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Cloxacillin Sodium Cap 500 MG | OR | CAPS | A | Max 4 fills/annum |
35 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Floxacillin Sodium Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
36 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin G Procaine Intramuscular Susp 300000 Unit/ML | IM | SUSP | A | Consumables - Clinic use only |
37 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin G Benzathine For Intramuscular Susp 2400000 Unit | IM | SUSR | A | Consumables - Clinic use only |
38 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin V Potassium For Soln 125 MG/5ML | OR | SOLR | A | Max 4 fills/annum |
39 | ANTI-MICROBIALS | Beta-Lactams | Penicillins | Penicillin V Potassium Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
40 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefotaxime Sodium For Inj 500 MG | IJ | SOLR | A | Consumables - Clinic use only |
41 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefoxitin Sodium For Inj 1 GM | IV | SOLR | A | Consumables - Clinic use only |
42 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Ceftriaxone Sodium For Inj 1 GM | IJ | SOLR | A | Consumables - Clinic use only |
43 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Ceftriaxone Sodium For IV Soln 2 GM | IV | SOLN | A | Consumables - Clinic use only |
44 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefuroxime Sodium For Inj 250 MG | IJ | SOLR | A | Consumables - Clinic use only |
45 | ANTI-MICROBIALS | Beta-Lactams | Cephalosporins | Cefuroxime Sodium For Inj 750 MG | IJ | SOLR | A | Consumables - Clinic use only |
46 | ANTI-MICROBIALS | Beta-Lactams | Others | NONE LISTED | ||||
47 | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
48 | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Susp 125 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
49 | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Estolate Susp 250 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
50 | ANTI-MICROBIALS | Erythromycin and other Macrolides | Erythromycin and other Macrolides | Erythromycin Stearate Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
51 | ANTI-MICROBIALS | Aminoglycosides | Aminoglycosides | Gentamicin Sulfate Inj 40 MG/ML | IJ | SOLN | A | Consumables - Clinic use only |
52 | ANTI-MICROBIALS | Aminoglycosides | Aminoglycosides | Streptomycin Sulfate Inj 1000 MG/3ML | IJ | SOLN | A | Consumables - Clinic use only |
53 | ANTI-MICROBIALS | Tetracyclines | Tetracyclines | Doxycycline Hyclate Cap 100 MG | OR | CAPS | A | Max 4 fills/annum |
54 | ANTI-MICROBIALS | Tetracyclines | Tetracyclines | Oxytetracycline HCl Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
55 | ANTI-MICROBIALS | Chloramphenicols | Chloramphenicols | Chloramphenicol Cap 250 MG | OR | CAPS | A | Max 4 fills/annum |
56 | ANTI-MICROBIALS | Chloramphenicols | Chloramphenicols | Chloramphenicol Susp 125 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
57 | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML | IV | SOLN | A | Consumables - Clinic use only |
58 | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML | OR | SUSP | A | Max 4 fills/annum |
59 | ANTI-MICROBIALS | Sulphonamides and combinations | Sulphonamides and combinations | Sulfamethoxazole-Trimethoprim Tab 400-80 MG | OR | TABS | A | Max 4 fills/annum |
60 | ANTI-MICROBIALS | Quinolones | Quinolones | Ciprofloxacin HCl Tab 250 MG | OR | TABS | A | Max 4 fills/annum |
61 | ANTI-MICROBIALS | Quinolones | Quinolones | Ciprofloxacin HCl Tab 500 MG | OR | TABS | A | Max 4 fills/annum |
62 | ANTI-MICROBIALS | Other anti-bacterial agents | Other anti-bacterial agents | Clindamycin HCl Cap 150 MG | OR | CAPS | A | Max 2 fills/annum |
63 | ANTI-MICROBIALS | Anti-Fungal agents | Anti-Fungal agents | Nystatin Susp 100000 Unit/ML | MT | SUSP | A | Max 2 fills/annum |
64 | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Susp 200 MG/5ML | OR | SUSP | A | Max 3 fills/annum |
65 | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Tab 200 MG | OR | TABS | A | Max 3 fills/annum |
66 | ANTI-MICROBIALS | Anti-protozoal agents | Anti-protozoal agents | Metronidazole Tab 400 MG | OR | TABS | A | Max 3 fills/annum |
67 | ANTI-MICROBIALS | Anti-viral agents | Other Anti-viral Agents | Acyclovir Cream 5% | EX | CREA | A | Max 1 Rx/annum |
68 | 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.