Prime Cure HIV Formulary 2023

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

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Abbreviations used:

HAART – Highly Active Antiretroviral Therapy
NRTI’S – Nucleotide Reverse Transcriptase Inhibitors
NNRTI’s – Non-Nucleotide Reverse Transcriptase Inhibitors
PI – Protease Inhibitor
PEP – Post-Exposure Prophylaxis
PrEP – Pre-Exposure Prophylaxis
CHR – Chronic

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 HIVDMP is required.
  2. “Therapeutic-ChroniLineTM Pre-Auth” means the medication is approved subject to registration with HIV Disease Management Programme.
  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: hivdmp@primecure.co.za.

Prime Cure HIV Formulary 2023

wdt_ID Nappi Mims Description Active Ingredient Route of Admin Dosage Form Chronic /PEP Medicine Class Quantities and Limitations
1 7187330 Eflaten Antiviral combination OR Tab CHR Efavirenz 600mg, tenofovir disoproxil fumarate 300mg lamivudine 300mg. Therapeutic - Max 30 tabs every 30 days
2 718672 Trivenz Antiviral combination OR Tab CHR/PEP Efavirenz 600 mg, Emtricitabine 200 mg, Tenofovir disoproxil fumarate 300 mg Therapeutic - Max 30 tabs every 30 days
3 717780 Tenarenz Antiviral combination OR Tab CHR/PEP Efavirenz, tenofovir disoproxil and lamivudine Therapeutic - Max 30 tabs every 30 days
4 718829 Nevasta Antiviral combination OR Tab CHR Stavudine 30mg, lamivudine 150mg,nevirapine 200mg. Max 60 tabs per month
5 717287 Tri-Nestalam 30 Antiviral combination OR Tab CHR Stavudine 30mg, lamivudine 150mg,nevirapine 200mg. Max 60 tabs per month
6 715992 Adco lamivudine & zidovudine 150mg/300mg Antiviral combination OR Tab CHR/PEP Zidovudine and lamivudine Max 60 tabs per month
7 708708 Adco-lamivudine 10MG/1ML Antiviral Agent Oral SOL CHR Lamivudine -NRTI's Therapeutic
8 707962 Adco-lamivudine 150mg Antiviral Agent OR Tab CHR Lamivudine -NRTI's Max 60 tabs per month
9 715997 Adco emtevir 200mg/300mg Antiviral combination OR Tab CHR/PrEP Tenofovir disoproxil and emtricitabine Max 30 tabs per month
10 700924 Kaletra Antiviral combination OR Sol CHR Lopinavir and ritonavir 2 Max 480mls per 30 days
11 710028 Aluvia 200mg/50mg Antiviral combination OR Tab CHR/PEP Lopinavir and ritonavir 2 Max 120 tabs per month
12 715433 Aluvia100mg/25mg Antiviral combination OR Tab CHR Lopinavir and ritonavir 2 Max 120 tabs per month
13 704783 Videx EC 250mg Didanosine OR Capsule CHR Didanosine-NRTI Therapeutic - Max 30 tabs every 30 days
14 704785 Videx EC 400mg Didanosine OR Capsule CHR Didanosine-NRTI Therapeutic - Max 30 tabs every 30 days
15 715073 Deladex 250 Didanosine OR Capsule CHR Didanosine-NRTI Max 60 tabs per month
16 715074 Deladex 400mg Didanosine OR Capsule CHR Didanosine-NRTI Max 60 tabs per month
17 715585 Adco-efavirenz 50mg Efavirenz OR Capsule CHR Efavirenz-NNRTI's Therapeutic
18 712932 Adco-efavirenz 200mg Efavirenz OR Capsule CHR Efavirenz-NNRTI's Max 60 tabs per month
19 709545 Adco-efavirenz 600mg Efavirenz OR Capsule CHR Efavirenz-NNRTI's Max 30 tabs per month
20 704731 Aspen Nevirapine 50mg/5ml Nevirapine OR Sol CHR Nevirapine-NNRTI's Min 240 mls bottle
21 710604 Viropon 50mg/5ml Nevirapine OR Sol CHR Nevirapine-NNRTI's Min 240 mls bottle
22 707961 Adco-nevirapine 200mg Nevirapine OR Tab CHR Nevirapine-NNRTI's Max 60 tabs per month
23 720866 Adco-abacavir 20MG/1ml Ziagen OR Sol CHR Abacavir-NRTI's Min 240 mls bottle
24 718160 Kavimun Paeds 60mg Ziagen OR TAB CHR Abacavir-NRTI's Max 60 tabs per month
25 701174 Aspen-Stavudine 30mg Stavudine OR Capsule CHR Stavudine-NRTI's Max 60 tabs per month
26 709880 Vari-Stavudine 30mg Stavudine OR Capsule CHR Stavudine-NRTI's Max 60 tabs per month
27 704885 Aspen Stavudine15mg Stavudine OR Capsule CHR Stavudine-NRTI's Max 60 tabs per month
28 701172 Aspen Stavudine 20mg Stavudine OR Capsule CHR Stavudine-NRTI's Max 60 tabs per month
29 715993 Adco-tenofovir 300mg Tenofovir disoproxil OR Tab CHR Tenofovir disoproxil NRTI's Max 30 tabs per month
30 705452 Aspen Zidovudine 100mg Zidovudine or Capsule CHR Zidovudine NRTI's Max 60 tabs per month
31 717982 Zidomat 100mg Zidovudine OR Tab CHR Zidovudine-NRTI's Max 60 tabs per month
32 708709 Adco-Zidovudine 50mg/5ml Zidovudine OR Syringe CHR Zidovudine-NRTI's Min 200mls per bottle
33 705455 Aspen -Zidovudine 250mg Zidovudine OR Capsules CHR Zidovudine-NRTI'S Max 60 tabs per month
34 707960 Adco-Zidovudine 300mg Zidovudine OR Tab CHR Zidovudine -NRTI's Max 60 tabs per month
35 721595 Norvir 100m Ritonavir OR Tab CHR Norvir -PI Max 60 tabs per month
36 836095 Norvir 100mg Ritonavir OR Capsule CHR Norvir -PI Max 60 tabs per month
37 838527 Norvir 400mg/5ml Ritonavir OR Sol CHR Norvir -PI Min 90 mls per bottle
38 716209 Atazor 200mg Combination OR Tab CHR Atazanavir -PI Max 60 tabs per month
39 716208 Atazor150mg Combination OR Tab CHR Atazanavir -PI Max 60 tabs per month
40 718217 Atazor 300mg Combination OR Capsule CHR Atazanavir -PI Max 30 tabs per month
41 720029 Edurant25 mg Rilpivirine OR Tab CHR Rilpivirine-NNRTI's Max 30 tabs per month
42 3000426 Acriptega Combination OR Tab CHR Max 30 tabs per month
Nappi Mims Description Active Ingredient Route of Admin Dosage Form Chronic /PEP Medicine Class Quantities and Limitations

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 these conditions. Prime Cure reserves the right to change medication on the formulary when important information comes to light that requires us to do so – for instance, new findings regarding safety of medicine.