Prime Cure HIV Formulary 2024

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 HAART Formulary 2024

wdt_ID Single vs Combination Medicine Class Abbreviation Active Ingredient Dosage Route of admin Formulation Mims Description Nappi Indication Quantities and Limitations
1 Single drugs NRTI ddi Didanosine 250mg PO Capsule Videx EC 250mg 704783 C Therapeutic -Max 30 tabs every 30 days
2 Single drugs NRTI ddi Didanosine 400mg PO Capsule Videx EC 400mg 704785 C Therapeutic -Max 30 tabs every 30 days
3 Single drugs NRTI ddi Didanosine 250mg PO Capsule Deladex 250mg 715073 C Max 60 tabs per month
4 Single drugs NRTI ddi Didanosine 400mg PO Capsule Deladex 400mg 715074 C Max 60 tabs per month
5 Single drugs NRTI d4T Stavudine 30mg PO Capsule Aspen-Stavudine 30mg 701174 C Max 60 tabs per month
6 Single drugs NRTI d4T Stavudine 30mg PO Capsule Vari-Stavudine 30mg 709880 C Max 60 tabs per month
7 Single drugs NRTI d4T Stavudine 15mg PO Capsule Aspen Stavudine15mg 704885 C Max 60 tabs per month
8 Single drugs NRTI d4T Stavudine 20mg PO Capsule Aspen Stavudine 20mg 701172 C Max 60 tabs per month
9 Single drugs NRTI ABC Abacavir 20mg/ml PO SOL/Syringe Adco-abacavir 20MG/1ml 720866 C Min 240 mls bottle
10 Single drugs NRTI ABC Abacavir 60mg PO Tablet Kavimun Paeds 60mg 718160 C Max 60 tabs per month
11 Single drugs NRTI ABC Abacavir 300mg PO Tablet Hetacav 300mg 3001799 C Max 60 tabs per month
12 Single drugs NRTI AZT Zidovudine 100mg PO Capsule Aspen Zidovudine 100mg 705452 C Max 60 tabs per month
13 Single drugs NRTI AZT Zidovudine 100mg PO Tablet Zidomat 100mg 717982 C Max 60 tabs per month
14 Single drugs NRTI AZT Zidovudine 50mg/5ml PO Syringe Adco-Zidovudine 50mg/5ml 708709 C Min 200mls per bottle
15 Single drugs NRTI AZT Zidovudine 250mg PO Capsules Aspen -Zidovudine 250mg 705455 C Max 60 tabs per month
16 Single drugs NRTI AZT Zidovudine 300mg PO Tablet Adco-Zidovudine 300mg 707960 C Max 60 tabs per month
17 Single drugs NRTI TDF Tenofovir Disoproxil Fumarate 300mg PO Tablet Adco-tenofovir 300mg 715993 C Max 30 tabs per month
18 Single drugs NRTI 3TC Lamivudine 10mg/ml PO SOL Adco-lamivudine 10MG/1ML 708708 C Therapeutic
19 Single drugs NRTI 3TC Lamivudine 150mg PO Tablet Adco-lamivudine 150mg 707962 C Max 60 tabs per month
20 Single drugs NNRTI EFV Efavirenz 50mg PO Capsule Adco-efavirenz 50mg 715585 C Therapeutic
21 Single drugs NNRTI EFV Efavirenz 200mg PO Capsule Adco-efavirenz 200mg 712932 C Max 60 tabs per month
22 Single drugs NNRTI EFV Efavirenz 600mg PO Capsule Adco-efavirenz 600mg 709545 C Max 30 tabs per month
23 Single drugs NNRTI NVP Nevirapine 50mg/ml PO SOL/Syringe Aspen Nevirapine 50mg/5ml 704731 C Min 240 mls bottle
24 Single drugs NNRTI NVP Nevirapine 50mg/ml PO SOL Viropon 50mg/5ml 710604 C Min 240 mls bottle
25 Single drugs NNRTI NVP Nevirapine 200mg PO Tab Adco-nevirapine 200mg 707961 C Max 60 tabs per month
26 Single drugs NNRTI RPV Rilpivirine 25mg PO Tablet Edurant 25mg 720029 C Max 30 tabs per month
27 Single drugs PI LPV/r Lopinavir/ritonovir 200/50mg PO Tablet Aluvia 200mg/50mg 710028 C Max 120 tabs per month
28 Single drugs PI LPV/r Lopinavir/ritonovir 100/25mg PO Tablet Aluvia 100mg/25mg 715433 C Max 120 tabs per month
29 Single drugs PI LPV/r Lopinavir/ritonovir 80/20 mg/ml PO SOL Kaletra 700924 C Max 480mls per 30 days
30 Single drugs PI LPV/r Lopinavir/ritonovir 40/10mg PO Capsules (pellets) Lopimune oral pellets 40mg/10mg 3001450 C Max 120 tabs per month
31 Single drugs PI RTV Ritonavir 100mg PO Tablet Norvir 100mg 721595 C Max 60 tabs per month
32 Single drugs PI RTV Ritonavir 100mg PO Capsule Norvir 100mg 836095 C Max 60 tabs per month
33 Single drugs PI RTV Ritonavir 400mg/5ml PO Sol/Syringe Norvir 400mg/5ml 838527 C Min 90 mls per bottle
34 Single drugs PI RTV Ritonavir 100mg/packet PO Oral powder Norvir Oral Powder 100mg 3000740 C Max 30 sachets per month
35 Single drugs PI ATV Atazanavir 150mg PO Capsule Atazor150mg 716208 C Max 60 tabs per month
36 Single drugs PI ATV Atazanavir 200mg PO Capsule Atazor 200mg 716209 C Max 30 tabs per month
37 Single drugs PI ATV Atazanavir 300mg PO Capsule Atazor 300mg 718217 C Max 30 tabs per month
38 Single drugs InSTI RAL Raltegravir 400mg PO Tablet Isentress 400mg 715825 C Max 60 tabs per month
39 Single drugs InSTI DTG Dolutegravir 50mg PO Tablet Hetvir / Olegra / Dalimune / Stigra 3001470 C Max 30 tabs per month
40 Single drugs InSTI DTG Dolutegravir 10mg PO Dispersable tablet Odinsti dispersable 3006329 C Max 30 tabs per month
41 Fixed dose combinations FDC ABC/3TC Abacavir/Lamivudine 120/60mg PO Tablet Divudine 3002829 C Max 30 tabs per month
42 Fixed dose combinations FDC ABC/3TC Abacavir/Lamivudine 600/300mg PO Tablet Abacavir & Lamivudine 722096 C Max 30 tabs per month
43 Fixed dose combinations FDC ABC/3TC/DTG Abacavir/Lamivudine/Dolutegravir 60/30/5mg PO Tablet pALD C
44 Fixed dose combinations FDC ABC/3TC/DTG Abacavir/Lamivudine/Dolutegravir 600/300/50mg PO Tablet ALD C
45 Fixed dose combinations FDC ABC/3TC/LPV/r Abacavir/Lamivudine/Lopinavir/ritonavir 30/15/40/10mg PO Capsule C
46 Fixed dose combinations FDC TLD Tenofovir disoproxil fumarate/Lamivudine/Dolutegravir 300/300/50mg PO Tablet Acriptega 3000426 C Max 30 tabs per month
47 Fixed dose combinations FDC AZT/3TC Zidovudine/Lamivudine 300/150mg PO Tablet Adco lamivudine & zidovudine 150mg/300mg 715992 C Max 60 tabs per month
48 Fixed dose combinations FDC TDF/FTC Tenofovir disoproxil fumarate/Emtracitabine 300/200mg PO Tablet Adco emtevir 200mg/300mg 715997 C Max 30 tabs per month
49 Fixed dose combinations FDC TEE Tenofovir disoproxil fumarate/Emtracitabine/Efavirenz 300/200/600mg PO Tablet Trivenz 718672 C Therapeutic -Max 30 tabs every 30 days
50 Fixed dose combinations FDC ATV/RTV Atazanavir/ritonavir 300/100mg PO Tablet C
51 Fixed dose combinations FDC EFV/TDF/3TC Efavirenz/Tenofovir disoproxil fumarate/Lamivudine 600/300/300mg PO Tablet Eflaten 7187330 C Therapeutic -Max 30 tabs every 30 days
52 Fixed dose combinations FDC EFV/TDF/3TC Efavirenz/Tenofovir disoproxil fumarate/Lamivudine 600/300/300mg PO Tablet Tenarenz 717780 C Therapeutic -Max 30 tabs every 30 days
Single vs Combination Medicine Class Abbreviation Active Ingredient Mims Description Nappi

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.