Prime Cure Dental Formulary 2025

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

  1. “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.
  2. “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.
  3. All items are to be dispensed by a contracted DSP pharmacy.
  4. 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 wdt_created_by wdt_created_at wdt_last_edited_by wdt_last_edited_at MIMS MIMS Sub-category Mims Description Active Ingredient Route of admin Dosage Form Acute Quantities and Limitations
1 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANAESTHETICS Local Anaesthetics Local Anaesthetics Lidocaine HCl Local Inj 2% IJ SOLN A Consumables
2 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANAESTHETICS Local Anaesthetics Local Anaesthetics Lidocaine Inj 2% w/ Epinephrine-1:80000 IJ SOLN A Consumables
3 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Ibuprofen Susp 100 MG/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
4 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Mefanamic Acid Susp 50mg/5ml OR SUSP A Max 200ml/Rx & 3 Rx/annum
5 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Mefenamic Acid Cap 250 MG OR CAPS A Max Rx/5 days & 3 Rx/annum
6 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Elixir 120 MG/5ML OR ELIX A Max 200ml/Rx & 3 Rx/annum
7 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Syrup 120 MG/5ML OR ELIX A Max 200ml/Rx & 3 Rx/annum
8 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Tab 500 MG OR TABS A Max Rx/7 days & 3 Rx/annum
9 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Combinations Combination Analgesics Acetaminophen w/ Codeine Cap 500-8 MG OR CAPS A Max Rx/7 days & 3 Rx/annum
10 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-10 MG OR TABS A Max Rx/7 days & 3 Rx/annum
11 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANALGESICS Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-8 MG OR TABS A Max Rx/7 days & 3 Rx/annum
12 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML OR SUSR A Max 4 fills/annum
25 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 250-125 MG OR TABS A Max 4 fills/annum
26 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 500-125 MG OR TABS A Max 4 fills/annum
27 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin (Trihydrate) For Susp 125 MG/5ML OR SUSR A Max 4 fills/annum
28 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin (Trihydrate) For Susp 250 MG/5ML OR SUSR A Max 4 fills/annum
29 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin (Trihydrate) Cap 250 MG OR CAPS A Max 4 fills/annum
30 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Amoxicillin (Trihydrate) Cap 500 MG OR CAPS A Max 4 fills/annum
31 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Ampicillin-Cloxacillin Cap 250-250 MG OR CAPS A Max 4 fills/annum
32 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Ampicillin-Cloxacillin For Susp 125-125 MG/5ML OR SUSR A Max 4 fills/annum
33 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Cloxacillin Sodium Cap 250 MG OR CAPS A Max 4 fills/annum
34 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Cloxacillin Sodium Cap 500 MG OR CAPS A Max 4 fills/annum
35 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Floxacillin Sodium Cap 250 MG OR CAPS A Max 4 fills/annum
36 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Penicillin G Procaine Intramuscular Susp 300000 Unit/ML IM SUSP A Consumables - Clinic use only
37 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Penicillin G Benzathine For Intramuscular Susp 2400000 Unit IM SUSR A Consumables - Clinic use only
38 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Penicillin V Potassium For Soln 125 MG/5ML OR SOLR A Max 4 fills/annum
39 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Penicillins Penicillin V Potassium Tab 250 MG OR TABS A Max 4 fills/annum
40 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Cefotaxime Sodium For Inj 500 MG IJ SOLR A Consumables - Clinic use only
41 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Cefoxitin Sodium For Inj 1 GM IV SOLR A Consumables - Clinic use only
42 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Ceftriaxone Sodium For Inj 1 GM IJ SOLR A Consumables - Clinic use only
43 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Ceftriaxone Sodium For IV Soln 2 GM IV SOLN A Consumables - Clinic use only
44 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Cefuroxime Sodium For Inj 250 MG IJ SOLR A Consumables - Clinic use only
45 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Cephalosporins Cefuroxime Sodium For Inj 750 MG IJ SOLR A Consumables - Clinic use only
46 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Beta-Lactams Others NONE LISTED
47 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Aminoglycosides Aminoglycosides Gentamicin Sulfate Inj 40 MG/ML IJ SOLN A Consumables - Clinic use only
52 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Aminoglycosides Aminoglycosides Streptomycin Sulfate Inj 1000 MG/3ML IJ SOLN A Consumables - Clinic use only
53 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Tetracyclines Tetracyclines Doxycycline Hyclate Cap 100 MG OR CAPS A Max 4 fills/annum
54 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Tetracyclines Tetracyclines Oxytetracycline HCl Cap 250 MG OR CAPS A Max 4 fills/annum
55 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Chloramphenicols Chloramphenicols Chloramphenicol Cap 250 MG OR CAPS A Max 4 fills/annum
56 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Chloramphenicols Chloramphenicols Chloramphenicol Susp 125 MG/5ML OR SUSP A Max 4 fills/annum
57 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim Tab 400-80 MG OR TABS A Max 4 fills/annum
60 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Quinolones Quinolones Ciprofloxacin HCl Tab 250 MG OR TABS A Max 4 fills/annum
61 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Quinolones Quinolones Ciprofloxacin HCl Tab 500 MG OR TABS A Max 4 fills/annum
62 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 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 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Anti-Fungal agents Anti-Fungal agents Nystatin Susp 100000 Unit/ML MT SUSP A Max 2 fills/annum
64 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Anti-protozoal agents Anti-protozoal agents Metronidazole Susp 200 MG/5ML OR SUSP A Max 3 fills/annum
65 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 200 MG OR TABS A Max 3 fills/annum
66 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 400 MG OR TABS A Max 3 fills/annum
67 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ANTI-MICROBIALS Other Anti-viral Agents Other Anti-viral Agents Acyclovir Cream 5% EX CREA A Max 1 Rx/annum
68 KirstyKF 09/07/2025 11:09 AM KirstyKF 09/07/2025 11:09 AM ENDOCRINE SYSTEM Corticosteroids Corticosteroids Prednisone Tab 5 MG OR TABS A Max 3 fills/annum
MIMS MIMS Sub-category Mims Description Active Ingredient Route of admin Dosage Form

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.