Prime Cure HAART Formulary 2021 & 2022

PLEASE NOTE: Provider Trade Names are not listed on formulary, allowing for any generic substitution below or equal to Mediscor Reference Pricing (MRP).

Should you wish to export the formulary for your own offline use you are welcome to use the export buttons at the top of the table to export the full list in the format you prefer. If you only need a subset of the list please filter the table using the fields provided and then the export buttons will export only your chosen subset of data.

Abbreviations used:

HAART-Highly Active Antiretroviral Therapy; 
NRTI’S -Nucleotide Reverse Transcriptase,NNRTI’s /None Nucleotide Reverse Transcriptase;PI-Protease Inhibitor; Int Inh-Intergarse Inhibitor

KEY TO QUANTITIES AND LIMITATIONS

  1. “Therapeutic-ChroniLineTM” means the 1st months chronic medication (on formulary) can be obtained from the DSP (Designated Service Provider), there after registration with Mediscor ChroniLineTM is required.
  2. “Therapeutic-ChroniLineTM Pre-Auth” means the medication is approved subject to registration with Mediscor ChroniLineTM.
  3. “Consumables – Clinic use only” means the medication may only be administrated by a DSP at the rooms. Injectables are consumables. No scripting to patients to collect from DSP pharmacies.
  4. “HIV DMP” means Prime Cure’s HIV/AIDS Disease Management Programme.
  5. All items marked as either Chronic or PMB, to be supplied by a Registered DSP Chronic Medication Supplier (DSP Pharmacy, approved GP or contracted Courier Pharmacy).
  6. 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 the cost difference will be for his/her own personal account.
  7. Medication formulary contact details: Tel: 0861 665 665 OR Email: pcauth@mediscor.co.za or chronicdep@primecure.co.za or hivdmp@primecure.co.za
  8. Medication listed below will be approved as; chronic therapeutic treatment, post exposure prophylaxis and as pre-exposure prophylaxis subject to managed care protocols.

Prime Cure HAART Formulary

wdt_ID Nappi MIMS Description Active Ingredient Route of Admin Dosage Form Medicine Class Quantities and Limitations
1 715992 Eflaten Antiviral Combinations OR TABS Efavirenz, tenofovir disoproxil and lamivudine 30
2 718672 Trivenz Antiviral combination - OR TABS Emtricitabine, tenofovir disoproxil and efavirenz 30
3 717780 Tenarenz Antiviral Combination OR TAB Efavirenz, tenofovir disoproxil and lamivudine 30
4 718829 Nevasta Antiviral combination OR TABS Stavudine, lamivudine and nevirapine 60
5 717287 Tri-Nestalam 30 Antiviral combination OR TABS Stavudine, lamivudine and nevirapine 60
6 715992 Adco lamivudine & zidovudine 150mg/300mg Antiviral combination OR TABS Zidovudine and lamivudine 60
7 708708 Adco-lamivudine 10MG/1ML Antiviral Agent Oral SOL Lamivudine -NRTI's 240ml
8 707962 Adco-lamivudine 150mg Antiviral Agent OR TAB Lamivudine -NRTI's 60
9 715997 Adco emtevir 200mg/300mg Antiviral combination OR TABS Tenofovir disoproxil and emtricitabine 30
10 700924 Kaletra Antiviral combination OR Syringe Lopinavir and ritonavir 2 300mls
11 710028 Aluvia 200mg/50mg Antiviral combination OR TAB Lopinavir and ritonavir 2 120
12 715433 Aluvia100mg/25mg Antiviral combination OR TAB Lopinavir and ritonavir 2 120
13 704783 Videx EC 250mg Antiviral OR Capsule Didanosine-NRTI 30
14 704785 Videx EC 400mg Antiviral OR Capsule Didanosine-NRTI 30
15 715073 Deladex 250 Antiviral OR Capsule Didanosine-NRTI 30
16 715074 Deladex 400mg Antiviral OR Capsule Didanosine-NRTI 30
17 715585 Adco-efavirenz 50mg Antiviral OR Capsule Efavirenz-NNRTI's 90
18 712932 Adco-efavirenz 200mg Antiviral OR Capsule Efavirenz-NNRTI's 60
19 709545 Adco-efavirenz 600mg Antiviral OR Capsule Efavirenz-NNRTI's 30
20 704731 Aspen Nevirapine 50mg/5ml Antiviral OR SOL Nevirapine-NNRTI's 480mls
21 710604 Viropon 50mg/5ml Antiviral OR SOL Nevirapine-NNRTI's 480
22 707961 Adco-nevirapine 200mg Antiviral OR Tab Nevirapine-NNRTI's 60
23 720866 Adco-abacavir 20MG/1ml Antiviral OR SOL Abacavir-NRTI's 180
24 718160 Kavimun Paeds 60mg Antiviral or TAB Abacavir-NRTI's 60
25 701174 Aspen-Stavudine 30mg Antiviral OR Capsule Stavudine-NRTI's 60
26 709880 Vari-Stavudine 30mg Antiviral OR Capsule Stavudine-NRTI's 60
27 704885 Aspen Stavudine15mg Antiviral OR Capsule Stavudine-NRTI's 30
28 701172 Aspen Stavudine 20mg Antiviral OR Capsule Stavudine-NRTI's 60
29 715993 Adco-tenofovir 300mg Antiviral OR TAB Tenofovir disoproxil NRTI's 30
30 705452 Aspen Zidovudine 100mg Antiviral or Capsule Zidovudine NRTI's 60
31 717982 Zidomat 100mg Antiviral OR Tab Zidovudine-NRTI's 60
32 708709 Adco-Zidovudine 50mg/5ml Antiviral OR Syringe Zidovudine-NRTI's 480
33 705455 Aspen -Zidovudine 250mg Antiviral OR Capsules Zidvudine-NRTI'S 60
34 707960 Adco-Zidovudine 300mg Antiviral OR TAB Zidovudine -NRTI's 60
35 721595 Norvir 100m Antiviral OR TAB Norvir -PI 120
36 836095 Norvir 100mg Antiviral OR Capsule Norvir -PI 30
37 838527 Norvir 400mg/5ml Antiviral OR Syringe Norvir -PI 160mls
38 716209 Atazor 200mg Antiviral OR TAB Atazanavir -PI 60
39 716208 Atazor150mg Antiviral OR TAB Atazanavir -PI 60
40 718217 Atazor 300mg Antiviral OR TAB Atazanavir -PI 30
41 720029 Edurant25 mg Antiviral OR TAB Rilpivirine-NNRTI's 30
42 300141 Dolutegravir Antiviral OR TAB Dalumine-Int Inh 30
43 300087 Dolutegravir 50 Antiviral OR TAB Olegra-Int Inh 30
44 715303 Darunavir 300mg Antiviral OR TAB Prezista-PI 30
45 719710 Darunavir 150mg Antiviral OR TAB Prezista-PI 30
46 719709 Darunavir 75MG Antiviral or TAB Prezista-PI 30
47 715825 Isentress 400mg Antivireal or Tab Raltegravir-Int Inh 60
48 725090 Isentres 100mg Antiviral OR Tab chewable Raltegravir-Int Inh 60
49 720591 Isentress 25 mg Antiviral OR Tab chewable Raltegravir-Int Inh 60
Nappi MIMS Description Active Ingredient Route of Admin Dosage Form Medicine Class Quantities and Limitations

Disclaimer:
Please note that the formulary will be reviewed by the clinical and pharmaceutical advisors to ensure that it complies with the latest industry norms for the treatment of HIV. Kaelo Prime Cure reserves the right to change the medication on the formulary when important information comes to light that requires us to do so, for instance, new findings regarding safety of medicine. Any equivalent medication to the listed above will be funded.