Prime Cure Medicine Formulary 2021

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 for CDL (Chronic Disease List) conditions:
ADS – Addison’s Disease; AST – Asthma; BCE – Bronchiectasis; BMD – Bipolar Mood Disorder; CHF – Cardiac Heart Failure; CMY – Cardiomyopathy; COP – Chronic Obstructive Pulmonary Disease; CRD – Chronic Renal Disease; CSD – Crohn’s Disease; DBI – Diabetes Insipidus; DM1 – Diabetes Mellitus Type 1; DM2 – Diabetes Mellitus Type 2; DYS – Dysrhythmias; EPL – Epilepsy; GLC – Glaucoma; HAE – Haemophilia; HYL – Hyperlipidaemia; HYP – Hypertension; UC – Ulcerative Colitis;
CAD (IHD) – Coronary Artery Disease (Ischaemic Heart Disease) ; MSS – Multiple Sclerosis; PAR – Parkinson’s disease; RHA – Rheumatoid Arthritis; SCZ – Schizophrenia; SLE – Systemic Lupus Erythematosus; TDH – Hypothyroidism

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. “Therapeutic-ChroniLine 30 days/gastroscopy 90 days” means the medication is approved initially for 30 days with Mediscor ChroniLineTM and requires additional medical information for further approval.
  5. “Max Rx/5 days every 120 days” means a script filled to a maximum of 5 days medication supply every 120 days can be claimed.
  6. “HIV DMP” means Prime Cure’s HIV/AIDS Disease Management Programme.
  7. 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).
  8. All items marked as Acute may be supplied by the General Practitioner (provided the GP is registered with Prime Cure as a dispensing provider), alternatively dispensed by a contracted DSP pharmacy (where GP is non-dispensing only)
  9. 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.
  10. Medication formulary contact details: Tel: 0861 665 665 OR Email: pcauth@mediscor.co.za or chronicdep@primecure.co.za

Prime Cure Medicine Formulary

wdt_ID Category Sub-Category Description Active Ingredient Administer Dosage Form Acute Chronic CDL Conditions Quantities & Limitations
3 Central Nervous System Central nervous system stimulants Central Analeptics NONE LISTED
4 Central Nervous System Central nervous system stimulants Respiratory stimulants Naloxone HCl Inj 0.02 MG/ML INJ SOLN A Consumables - Clinic use only
5 Central Nervous System Central nervous system stimulants Respiratory stimulants Naloxone HCl Inj 0.4 MG/ML INJ SOLN A Consumables - Clinic use only
6 Central Nervous System Central nervous system stimulants Others NONE LISTED
8 Central Nervous System Sedative hypnotics Benzodiazepines Midazolam HCl Inj 5 MG/ML (Base Equivalent) INJ SOLN A Consumables - Clinic use only
9 Central Nervous System Sedative hypnotics Barbiturates Phenobarbitone Tab 30 MG OR TABS C EPL Therapeutic - ChroniLine
10 Central Nervous System Sedative hypnotics Others Zopiclone Tab 7.5 MG OR TABS A Max quantity 30 tabs every 90 days
12 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 0.25 MG OR TABS A Max Rx/5 days every 120 days
13 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 0.5 MG OR TABS A Max Rx/5 days every 120 days
14 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 1 MG OR TABS A Max Rx/5 days every 120 days
15 Central Nervous System Anxiolytics Benzodiazepines Bromazepam Tab 3 MG OR TABS A Max Rx/5 days every 120 days
16 Central Nervous System Anxiolytics Benzodiazepines Bromazepam Tab 6 MG OR TABS A Max Rx/5 days every 120 days
17 Central Nervous System Anxiolytics Benzodiazepines Diazepam Inj 5 MG/ML INJ SOLN A Consumables - Clinic use only
18 Central Nervous System Anxiolytics Benzodiazepines Diazepam Tab 5 MG OR TABS A Max Rx/5 days every 120 days
19 Central Nervous System Anxiolytics Benzodiazepines Diazepam Tab 10 MG OR TABS A Max Rx/5 days every 120 days
20 Central Nervous System Anxiolytics Benzodiazepines Lorazepam Inj 4 MG/ML INJ SOLN A Therapeutic - ChroniLine Pre-Auth
21 Central Nervous System Anxiolytics Benzodiazepines Lorazepam Tab 1 MG OR TABS A Max Rx/5 days every 120 days
22 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 10 MG OR TABS A Max Rx/5 days every 120 days
23 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 15 MG OR TABS A Max Rx/5 days every 120 days
24 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 30 MG OR TABS A Max Rx/5 days every 120 days
25 Central Nervous System Anxiolytics Others Hydroxyzine HCl IM Soln 50 MG/ML IM SOLN A Consumables - Clinic use only
26 Central Nervous System Anxiolytics Others Hydroxyzine HCl Syrup 10 MG/5ML OR SYRP A Max quantity 200ml per annum
28 Central Nervous System Anti-depressants Tricyclic Amitriptyline HCl Tab 10 MG OR TABS C MSS, SCZ Therapeutic - ChroniLine
29 Central Nervous System Anti-depressants Tricyclic Amitriptyline HCl Tab 25 MG OR TABS C MSS, SCZ Therapeutic - ChroniLine
30 Central Nervous System Anti-depressants Tricyclic Imipramine HCl Tab 10 MG OR TABS C MSS, SCZ Therapeutic - ChroniLine
31 Central Nervous System Anti-depressants Tricyclic Imipramine HCl Tab 25 MG OR TABS C MSS, SCZ Therapeutic - ChroniLine
32 Central Nervous System Anti-depressants Non-trycylic NONE
33 Central Nervous System Anti-depressants Mono-amine oxidase inhibitors NONE LISTED
34 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Citalopram Hydrobromide Tab 20 MG (Base Equiv) OR TABS C BMD, SCZ Therapeutic - ChroniLine
35 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Citalopram Hydrobromide Tab 40 MG (Base Equiv) OR TABS C BMD, SCZ Therapeutic - ChroniLine
36 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Fluoxetine HCl Cap 20 MG OR CAPS C BMD, SCZ Therapeutic - ChroniLine
37 Central Nervous System Anti-depressants Serotonin and noradrenaline re-uptake inhibitors (SNRIs) NONE LISTED
38 Central Nervous System Anti-depressants Noradrenaline (and dopamine) re-uptake inhibitors NONE LISTED
39 Central Nervous System Anti-depressants Tetracyclic NONE LISTED
40 Central Nervous System Anti-depressants Melatonergic specific NONE LISTED
41 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab 250 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
42 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab 400 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
43 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab CR 450 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
44 Central Nervous System Anti-depressants Others NONE LISTED
46 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 25 MG OR TABS C SCZ Therapeutic - ChroniLine Pre-Auth
47 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 50 MG OR TABS C SCZ Therapeutic - ChroniLine Pre-Auth
48 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 100 MG OR TABS C SCZ Therapeutic - ChroniLine Pre-Auth
49 Central Nervous System Anti-psychotics Phenothiazines Fluphenazine Decanoate Inj 25 MG/ML IM SOLN C SCZ Therapeutic - ChroniLine Pre-Auth
50 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Lactate Inj 5 MG/ML INJ SOLN A Therapeutic - ChroniLine Pre-Auth
51 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Lactate Inj 10 MG/ML INJ SOLN A Therapeutic - ChroniLine Pre-Auth
52 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Cap 0.5 MG OR CAPS C SCZ Therapeutic - ChroniLine Pre-Auth
53 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Tab 5 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
54 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Tab 10 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
55 Central Nervous System Anti-psychotics Atypical anti-Psychotics Clozapine Tab 25 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
56 Central Nervous System Anti-psychotics Atypical anti-Psychotics Clozapine Tab 100 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
57 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Orally Disintegrating Tab 5 MG TBDP TABS C BMD, SCZ Therapeutic - ChroniLine
58 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Orally Disintegrating Tab 10 MG TBDP TABS C BMD, SCZ Therapeutic - ChroniLine
59 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 2.5 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
60 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 5 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
61 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 10 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
62 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 25 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
63 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 100 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
64 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 200 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
65 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 300 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
66 Central Nervous System Anti-psychotics Atypical anti-Psychotics Risperidone Tab 0.5 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
67 Central Nervous System Anti-psychotics Atypical anti-Psychotics Risperidone Tab 1 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
68 Central Nervous System Anti-psychotics Others Flupentixol Decanoate IM Soln 20 MG/ML IM SOLN C BMD, SCZ Therapeutic - ChroniLine Pre-Auth
69 Central Nervous System Anti-psychotics Others Sulpiride Cap 50 MG OR CAPS C SCZ Therapeutic - ChroniLine Pre-Auth
70 Central Nervous System Anti-psychotics Others Zuclopenthixol Decanoate IM in Oil 200 MG/ML IM SOLN C BMD, SCZ Therapeutic - ChroniLine Pre-Auth
71 Central Nervous System Anti-psychotics Others Zuclopenthixol Dihydrochloride Tab 2 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
72 Central Nervous System Anti-psychotics Others Zuclopenthixol Dihydrochloride Tab 10 MG OR TABS C BMD, SCZ Therapeutic - ChroniLine
74 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Susp 100 MG/5ML OR SUSP C BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
75 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab 200 MG OR TABS C BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
76 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab SR 12HR 200 MG OR TB12 C BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
77 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab SR 12HR 400 MG OR TB12 C BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
78 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Conc for Inj 1 MG/ML INJ SOLN A Consumables - Clinic use only
79 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Tab 0.5 MG OR TABS C EPL Therapeutic - ChroniLine
80 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Tab 2 MG OR TABS C EPL Therapeutic - ChroniLine
81 Central Nervous System Anti-epileptics Anti-epileptics Ethosuximide 250mg/5ml syrup OR SYRP C EPL Therapeutic - ChroniLine
82 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 25 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
83 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 50 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
84 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 100 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
85 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 200 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
86 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab Chewable Dispersible 2 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
87 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab Chewable Dispersible 5 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
88 Central Nervous System Anti-epileptics Anti-epileptics Oxcarbazepine Tab 300 MG OR TABS C EPL Therapeutic - ChroniLine
89 Central Nervous System Anti-epileptics Anti-epileptics Oxcarbazepine Tab 600 MG OR TABS C EPL Therapeutic - ChroniLine
90 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Inj 50 MG/ML INJ SOLN A Consumables - Clinic use only
91 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Susp 125 MG/5ML OR SUSP C EPL Therapeutic - ChroniLine
92 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Prompt Tab 100 MG OR TABS C EPL Therapeutic - ChroniLine
93 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 25 MG OR TABS C EPL Therapeutic - ChroniLine
94 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 50 MG OR TABS C EPL Therapeutic - ChroniLine
95 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 100 MG OR TABS C EPL Therapeutic - ChroniLine
96 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 200 MG OR TABS C EPL Therapeutic - ChroniLine
97 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Sprinkle Cap 15 MG OR CAPS C EPL Therapeutic - ChroniLine
98 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium For IV Soln 400 MG IV SOLN A Consumables - Clinic use only
99 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Liqd 200 MG/5ML OR SOLN C BMD, EPL, SCZ Therapeutic - ChroniLine
100 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Syrup 250 MG/5ML (Base Equiv) OR SYRP C BMD, EPL, SCZ Therapeutic - ChroniLine
101 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab 100 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
102 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 200 MG OR TABS C BMD, EPL, SCZ Therapeutic - ChroniLine
103 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 300 MG OR TBCR C BMD, EPL, SCZ Therapeutic - ChroniLine
104 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 500 MG OR TBCR C BMD, EPL, SCZ Therapeutic - ChroniLine
105 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap 150 MG OR CAPS C BMD, EPL, SCZ Therapeutic - ChroniLine
106 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap 300 MG OR CAPS C BMD, EPL, SCZ Therapeutic - ChroniLine
107 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap Delayed Release 500 MG OR CAPS C BMD, EPL, SCZ Therapeutic - ChroniLine
109 Central Nervous System Anti-Parkinson agents Dopaminergics Amantadine HCl Cap 100 MG OR CAPS C PAR Therapeutic - ChroniLine Pre-Auth
110 Central Nervous System Anti-Parkinson agents Dopaminergics Carbidopa & Levodopa Tab 25-100 MG OR TABS C PAR Therapeutic - ChroniLine
111 Central Nervous System Anti-Parkinson agents Dopaminergics Carbidopa & Levodopa Tab 25-250 MG OR TABS C PAR Therapeutic - ChroniLine
112 Central Nervous System Anti-Parkinson agents Dopaminergics Pramipexole Dihydrochloride Tab 0.125 MG OR TABS C PAR Therapeutic - ChroniLine
113 Central Nervous System Anti-Parkinson agents Dopaminergics Pramipexole Dihydrochloride Tab 0.25 MG OR TABS C PAR Therapeutic - ChroniLine
114 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 0.25 MG OR TABS C PAR Therapeutic - ChroniLine Pre-Auth
115 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 0.5 MG OR TABS C PAR Therapeutic - ChroniLine Pre-Auth
116 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 1 MG OR TABS C PAR Therapeutic - ChroniLine Pre-Auth
117 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 2 MG OR TABS C PAR Therapeutic - ChroniLine Pre-Auth
118 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 5 MG OR TABS C PAR Therapeutic - ChroniLine Pre-Auth
119 Central Nervous System Anti-Parkinson agents Anti-cholinergics Biperiden Lactate Inj 5 MG/ML INJ SOLN A Consumables - Clinic use only
120 Central Nervous System Anti-Parkinson agents Anti-cholinergics Biperiden HCl Tab 2 MG OR TABS C PAR Therapeutic - ChroniLine
121 Central Nervous System Anti-Parkinson agents Anti-cholinergics Orphenadrine HCl Tab 50 MG OR TABS C PAR Therapeutic - ChroniLine
122 Central Nervous System Anti-Parkinson agents Anti-cholinergics Trihexyphenidyl HCl Tab 2 MG OR TABS C PAR Therapeutic - ChroniLine
124 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Buclizine-Pyridoxine Tab 25-50 MG OR TABS A Max 30/Rx & 3 Rx/annum (Gender)
125 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Cyclizine HCl Syrup 12.5 MG/5ML OR SYRP A Max 1 package/Rx & 3 Rx/annum
126 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Cyclizine HCl Tab 50 MG OR TABS A Max 1 package/Rx & 3 Rx/annum
127 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Cyclizine HCl Supp 50 MG RE SUPP A Max 1 package/Rx & 3 Rx/annum
128 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Fructose-Dextrose-Phosphoric Acid Oral Soln OR SOLN A Max 200ml/Rx & 3 Rx/annum
129 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Inj 5 MG/ML INJ SOLN A Consumables - Clinic use only
130 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Syrup 5 MG/5ML OR SYRP A Max 1 package/Rx & 3 Rx/annum
131 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Tab 10 MG OR TABS A Max 30/Rx & 3 Rx/annum
132 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Phosphorated Carbohydrate Syrup OR SYRP A Max 200ml/Rx & 3 Rx/annum
133 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Prochlorperazine Inj 12.5 MG/ML IM SOLN A Consumables - Clinic use only
134 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Prochlorperazine Maleate Tab 5 MG OR TABS A Max 30/Rx & 3 Rx/annum
136 Central Nervous System Anti-migraine agents Anti-migraine agents Clonidine HCl Tab 0.025 MG OR TABS A Max 3 Rx/annum
137 Central Nervous System Anti-migraine agents Anti-migraine agents Clonidine HCl (Migraine) Oral Drops 25 MCG/0.5ML OR SOLN A Max 1 package/Rx & 3 Rx/annum
139 Central Nervous System Alzheimer's disease Alzheimer's disease NONE LISTED
142 Anaesthetics General anaesthetics General anaesthetics NONE LISTED
144 Anaesthetics Local Anaesthetics Local Anaesthetics Bupivacaine HCl Inj 0.5% INJ SOLN A Consumables - Clinic use only
145 Anaesthetics Local Anaesthetics Local Anaesthetics Lidocaine HCl Local Inj 2% INJ SOLN A Consumables - Clinic use only
146 Anaesthetics Local Anaesthetics Local Anaesthetics Lidocaine Inj 2% w/ Epinephrine-1:80000 INJ SOLN A Consumables - Clinic use only
147 Anaesthetics Surface anaesthetics Surface anaesthetics Tetracaine HCl Cream 1% EX CREA A Max 1 Rx/annum
149 Anaesthetics Muscle relaxants Muscle relaxants NONE LISTED
152 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Inj 10 MG/ML INJ SOLN A Consumables - Clinic use only
153 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Inj 15 MG/ML INJ SOLN A Consumables - Clinic use only
154 Analgesics Narcotic Analgesics Narcotic Analgesics Codeine Phosphate Tab 30 MG OR TABS A Therapeutic - ChroniLine Pre-Auth
155 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Tab CR 10 MG OR TABS A Therapeutic - ChroniLine Pre-Auth
156 Analgesics Narcotic Analgesics Narcotic Analgesics Oxycodone HCl Cap 5 MG OR TABS A Therapeutic - ChroniLine Pre-Auth
157 Analgesics Narcotic Analgesics Narcotic Analgesics Pethidine HCl Inj 25 MG/ML INJ SOLN A Consumables - Clinic use only
158 Analgesics Narcotic Analgesics Narcotic Analgesics Pethidine HCl Inj 50 MG/ML INJ SOLN A Consumables - Clinic use only
160 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Tab 300 MG OR TABS C CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
161 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Tab 300 MG OR TABS A Max Rx/5 days & 3 Rx/annum
162 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Dispersible Tab 300 MG OR TABS C CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
163 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Dispersible Tab 300 MG OR TABS A Max Rx/5 days & 3 Rx/annum
164 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Ibuprofen Susp 100 MG/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
165 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Mefanamic Acid Susp 50mg/5ml OR SUSP A Max 200ml/Rx & 3 Rx/annum
166 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Mefenamic Acid Cap 250 MG OR CAPS A Max Rx/5 days & 3 Rx/annum
167 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Elixir 120 MG/5ML OR ELIX A Max 200ml/Rx & 3 Rx/annum
168 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Elixir 120 MG/5ML OR ELIX C HAE Therapeutic - ChroniLine
169 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Syrup 120 MG/5ML OR ELIX A Max 200ml/Rx & 3 Rx/annum
170 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Syrup 120 MG/5ML OR ELIX C HAE Therapeutic - ChroniLine
171 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Tab 500 MG OR TABS A Max Rx/5 days & 3 Rx/annum
172 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Tab 500 MG OR TABS C HAE, MSS, RHA, SLE Therapeutic - ChroniLine
174 Analgesics Combinations Combination Analgesics Acetaminophen w/ Codeine Cap 500-8 MG OR CAPS A Max Rx/5 days & 3 Rx/annum
175 Analgesics Combinations Combination Analgesics Acetaminophen w/ Codeine Cap 500-8 MG OR CAPS C HAE, MSS, SLE Therapeutic - ChroniLine
176 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-10 MG OR TABS A Max Rx/5 days & 3 Rx/annum
177 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-10 MG OR TABS C HAE, MSS, SLE Therapeutic - ChroniLine
178 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-8 MG OR TABS A Max Rx/5 days & 3 Rx/annum
179 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-8 MG OR TABS C HAE, MSS, SLE Therapeutic - ChroniLine
180 Analgesics Combinations Combination Analgesics Paracetamol-Meprobamate-Caff-Cod Tab 320-150-32-8 MG OR TABS A Max Rx/5 days & 3 Rx/annum
181 Analgesics Combinations Combination Analgesics Paracetamol-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML OR SYRP A Max 100ml/Rx & 3 Rx/annum
183 Analgesics Others Other Analgesics Tramadol HCl Cap 50 MG OR CAPS C HAE, MSS Therapeutic - ChroniLine Pre-Auth
186 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium IM Inj Soln 25 MG/ML IM SOLN A Consumables - Clinic use only
187 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium Tab Delayed Release 25 MG OR TBEC A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
188 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium Tab Delayed Release 50 MG OR TBEC A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
189 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Ibuprofen Tab 200 MG OR TABS A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
190 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Ibuprofen Tab 400 MG OR TABS A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
191 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Indomethacin Cap 25 MG OR CAPS A C RHA, SLE Therapeutic - ChroniLine
192 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Naproxen Tab 250 MG OR TABS A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
193 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Naproxen Tab 500 MG OR TABS A C RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
194 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Piroxicam Cap 20 MG OR CAPS A C RHA, SLE Therapeutic - ChroniLine
195 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Selective COX2 inhibitors Meloxicam Tab 7.5 MG OR TABS C RHA, SLE Therapeutic - ChroniLine Pre-Auth
196 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Selective COX2 inhibitors Meloxicam Tab 15 MG OR TABS C RHA, SLE Therapeutic - ChroniLine Pre-Auth
197 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Specific cyclo-oxygenase-2 inhibitor (COXIB) NONE LISTED
199 Musculo-Skeletal Agents Anti-gout Anti-gout Allopurinol Tab 100 MG OR TABS Max 6 Rx/annum - Prophylactic
200 Musculo-Skeletal Agents Anti-gout Anti-gout Allopurinol Tab 300 MG OR TABS Max 6 Rx/annum - Prophylactic
201 Musculo-Skeletal Agents Anti-gout Anti-gout Colchicine Tab 0.5 MG OR TABS A Max 12/Rx & 3 Rx/annum
202 Musculo-Skeletal Agents Anti-gout Anti-gout Colchicine Tab 1 MG OR TABS A Max 12/Rx & 3 Rx/annum
204 Musculo-Skeletal Agents Topical agents Topical agents Diclofenac Diethylammonium Gel 1.3% EX GEL A Max 1 package/annum
205 Musculo-Skeletal Agents Topical agents Topical agents Ibuprofen Gel 5% EX GEL A Max 1 package/annum
206 Musculo-Skeletal Agents Topical agents Topical agents Liniments and rubs - ointment EX GEL A Max 50g package/annum
207 Musculo-Skeletal Agents Topical agents Topical agents Zinc Oxide Oint 15% EX OINT C SLE Therapeutic - ChroniLine
209 Musculo-Skeletal Agents Gold Gold NONE
211 Musculo-Skeletal Agents Centrally acting muscle relaxants Centrally acting muscle relaxants Baclofen Tab 10 MG OR TABS C MSS Therapeutic - ChroniLine Pre-Auth
212 Musculo-Skeletal Agents Centrally acting muscle relaxants Centrally acting muscle relaxants Orphenadrine Citrate Tab 100 MG OR TABS A Max Rx/5 days & 3 Rx/annum
214 Musculo-Skeletal Agents Others Others Sulfasalazine Tab Delayed Release 500 MG OR TBEC C RHA, SLE, CSD, UC Therapeutic - ChroniLine Pre-Auth
216 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Bisphosphonates NONE LISTED
217 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Selective oestrogen receptor modulators NONE LISTED
218 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Calcitonin NONE LISTED
219 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Alfacalcidol Cap 0.25 MCG OR CAPS C CRD Therapeutic - ChroniLine Pre-Auth
220 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Alfacalcidol Cap 1 MCG OR CAPS C CRD Therapeutic - ChroniLine Pre-Auth
221 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Ergocalciferol Tab 50000 Unit OR CAPS C CRD Therapeutic - ChroniLine Pre-Auth
222 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Dual action bone agents NONE LISTED
225 Autonomic Sympathomimetics Sympathomimetics Epinephrine HCl Inj 1 MG/ML INJ SOLN A Consumables - Clinic use only
227 Autonomic Sympatholytics Sympatholytics NONE LISTED
229 Autonomic Cholinergics Cholinergics NONE LISTED
231 Autonomic Anti-cholinergics Anti-cholinergics Atropine Sulfate Inj 0.5 MG/ML INJ SOLN A Consumables - Clinic use only
232 Autonomic Anti-cholinergics Anti-cholinergics Atropine Sulfate Inj 1 MG/ML INJ SOLN A Consumables - Clinic use only
233 Autonomic Anti-cholinergics Anti-cholinergics Oxybutynin Chloride Tab 5 MG OR TABS C MSS Therapeutic - ChroniLine
235 Autonomic Others Others NONE
238 Autocoids Anti-Histamines Anti-Histamines Chlorpheniramine Maleate Syrup 2 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
239 Autocoids Anti-Histamines Anti-Histamines Chlorpheniramine Maleate Tab 4 MG OR TABS A Max 30/Rx & 3 Rx/annum
240 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Inj 25 MG/ML INJ SOLN A Consumables - Clinic use only
241 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Syrup 5 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
242 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Tab 10 MG OR TABS A Max Rx/5 days & 3 Rx/annum
243 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Tab 25 MG OR TABS A Max Rx/5 days & 3 Rx/annum
244 Autocoids Anti-Histamines Anti-Histamines Diphenhydramine-Pyrilamine Cream 1-1% EX CREA A Max 1 package/Rx & 3 Rx/annum
245 Autocoids Anti-Histamines Anti-Histamines Pyrilamine Maleate Cream 2% EX CREA A Max Rx/5 days & 3 Rx/annum
247 Autocoids Serotonin antagonists Serotonin antagonists NONE LISTED
249 Autocoids NK1 antagonists NK1 antagonists NONE LISTED
252 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Elixir 0.05 MG/ML OR SYRP C CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
253 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Tab 0.25 MG OR TABS C CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
254 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Tab 62.5 MCG (0.0625 MG) OR TABS C CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
255 Cardio-Vascular Agents Positive inotropic agents Others NONE LISTED
257 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Amiodarone HCl Tab 100 MG OR TABS C DYS Therapeutic - ChroniLine Pre-Auth
258 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Amiodarone HCl Tab 200 MG OR TABS C DYS Therapeutic - ChroniLine Pre-Auth
259 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Lidocaine HCl IV Inj 10 MG/ML INJ SOLN A Consumables - Clinic use only
260 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Lidocaine HCl IV Inj 20 MG/ML INJ SOLN A Consumables - Clinic use only
262 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Central acting sympathetic nervous system inhibitors Methyldopa Tab 250 MG OR TABS C HYP Therapeutic - ChroniLine (4th Line and Pregnancy)
263 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha-receptor blockers Doxazosin Mesylate Tab 1 MG OR TABS C HYP Therapeutic - ChroniLine
264 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha-receptor blockers Doxazosin Mesylate Tab 4 MG OR TABS C HYP Therapeutic - ChroniLine
265 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol & Chlorthalidone Tab 50-12.5 MG OR TABS C CHF, CMY, CRD, HYP Therapeutic - ChroniLine
266 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol & Chlorthalidone Tab 100-25 MG OR TABS C CHF, CMY, CRD, HYP Therapeutic - ChroniLine
267 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol Tab 50 MG OR TABS C CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
268 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol Tab 100 MG OR TABS C CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
269 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Propranolol HCl Tab 10 MG OR TABS C CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
270 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Propranolol HCl Tab 40 MG OR TABS C CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
271 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha- and beta-receptor blockers Carvedilol Tab 12.5 MG OR TABS C CAD, CHF, CMY, CRD, HYP Therapeutic - ChroniLine
272 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha- and beta-receptor blockers Carvedilol Tab 25 MG OR TABS C CAD, CHF, CMY, CRD, HYP Therapeutic - ChroniLine
273 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Sympathetic nervous blockers Reserpine Tab 0.25 MG OR TABS C HYP Therapeutic - ChroniLine
274 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 10 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
275 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 25 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
276 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 50 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
277 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers Amlodipine Besylate Tab 5 MG OR TABS C CAD, CRD, HYP Therapeutic - ChroniLine
278 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers Amlodipine Besylate Tab 10 MG OR TABS C CAD, CRD, HYP Therapeutic - ChroniLine
279 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers REFER TO 7.4.1 Calcium channel blockers
280 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Captopril Tab 25 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
281 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Captopril Tab 50 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
282 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate & Hydrochlorothiazide Tab 20-12.5 MG OR TABS C CHF,CMY,CRD,HYP Therapeutic - ChroniLine
283 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 5 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
284 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 10 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
285 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 20 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
286 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril & Hydrochlorothiazide Tab 10-12.5 MG OR TABS C CHF,CMY,CRD,HYP Therapeutic - ChroniLine
287 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril & Hydrochlorothiazide Tab 20-12.5 MG OR TABS C CHF,CMY,CRD,HYP Therapeutic - ChroniLine
288 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 5 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
289 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 10 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
290 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 20 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
291 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium Tab 50 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
292 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium Tab 100 MG OR TABS C CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
293 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium & Hydrochlorothiazide Tab 50-12.5 MG OR TABS C CHF,CMY,CRD,HYP Therapeutic - ChroniLine
294 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium & Hydrochlorothiazide Tab 100-25 MG OR TABS C CHF,CMY,CRD,HYP Therapeutic - ChroniLine
295 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Others NONE LISTED
297 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Diltiazem HCl Tab 60 MG OR TABS C CAD, CRD, HYP Therapeutic - ChroniLine
298 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap 5 MG OR CAPS A Max Rx/60 days only
299 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap 10 MG OR CAPS A Max Rx/60 days only
300 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap CR 20 MG OR CPCR C CAD, CRD, HYP Therapeutic - ChroniLine
301 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Tab SR 12HR 20 MG OR TB12 C CAD, CRD, HYP Therapeutic - ChroniLine
302 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Tab SR 24HR 30 MG OR TB24 C CAD, CRD, HYP Therapeutic - ChroniLine
303 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl IV Soln 2.5 MG/ML IV SOLN A Consumables - Clinic use only
304 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab 40 MG OR TABS C DYS, CAD,CRD, HYP Therapeutic - ChroniLine
305 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab 80 MG OR TABS C DYS, CAD,CRD, HYP Therapeutic - ChroniLine
306 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab CR 240 MG OR TBCR C DYS, CAD,CRD, HYP Therapeutic - ChroniLine
307 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers REFER TO 7.3.7 Calcium channel blockers
308 Cardio-Vascular Agents Anti-anginal agents Beta-receptor blockers REFER TO 7.3.3 Beta-receptor blockers
309 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate SL Tab 5 MG SL TABS C CAD, CHF, CMY Therapeutic - ChroniLine
310 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate Tab 10 MG OR TABS C CAD, CHF, CMY Therapeutic - ChroniLine
311 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate Tab 30 MG OR TABS C CAD, CHF, CMY Therapeutic - ChroniLine
312 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Cap CR 50 MG OR CPCR C CAD, CHF, CMY Therapeutic - ChroniLine
313 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Tab 20 MG OR TABS C CAD, CHF, CMY Therapeutic - ChroniLine
314 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Tab SR 24HR 60 MG OR TB24 C CAD, CHF, CMY Therapeutic - ChroniLine
315 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Nitroglycerin SL Tab 0.5 MG SL TABS C CAD, CHF, CMY Therapeutic - ChroniLine
316 Cardio-Vascular Agents Anti-anginal agents Others NONE LISTED
318 Cardio-Vascular Agents Other vasodilators After-load reducers NONE LISTED
319 Cardio-Vascular Agents Other vasodilators Peripheral vasodilators NONE LISTED
321 Cardio-Vascular Agents Vasoconstrictors Vasoconstrictors NONE LISTED
323 Cardio-Vascular Agents Hipolipidaemic agents Fibrates Bezafibrate Tab CR 400 MG OR TBCR C HYL Therapeutic - ChroniLine
324 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 10 MG (Base Equivalent) OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
325 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 20 MG (Base Equivalent) OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
326 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 40 MG (Base Equivalent) OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
327 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 10 MG OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
328 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 20 MG OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
329 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 40 MG OR TABS C HYL Therapeutic - ChroniLine Pre-Auth
330 Cardio-Vascular Agents Hipolipidaemic agents Cholesterol absorption inhibitors NONE LISTED
331 Cardio-Vascular Agents Hipolipidaemic agents Others NONE LISTED
333 Cardio-Vascular Agents Plasma expanders Plasma expanders NONE LISTED
336 Blood and Haemopoeitic Haemostatics Haemostatics Tranexamic Acid Tab 500 MG OR TABS A Max 20/Rx & 2 Rx/annum
337 Blood and Haemopoeitic Haemostatics Haemostatics Tranexamic Acid Tab 500 MG OR TABS C HAE Therapeutic - ChroniLine
339 Blood and Haemopoeitic Anticoagulants Anticoagulants Warfarin Sodium Tab 5 MG OR TABS C CHF, CMY, DYS, CAD Therapeutic - ChroniLine
341 Blood and Haemopoeitic Fibrinolytics Fibrinolytics NONE LISTED
343 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Dispersible Tab 81 MG OR TBDP C CHF, CMY, DYS, CAD, HYL, DM1, DM2 Therapeutic - ChroniLine
344 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Tab Delayed Release 81 MG OR TBEC C CHF, CMY, DYS, CAD, HYL, DM1, DM3 Therapeutic - ChroniLine
345 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Tab 100 MG OR TABS C CHF, CMY, DYS, CAD, HYL, DM1, DM4 Therapeutic - ChroniLine
346 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Dispersible Tab 300 MG OR TBDP C CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
348 Blood and Haemopoeitic Sclerosing agents Sclerosing agents NONE LISTED
350 Blood and Haemopoeitic Haematinics Haematinics Erythropoietin and Erythropoiesis Stimulating Agents (ESA) INJ SOLN CRD Limited to Hospital Risk options only
353 Blood and Haemopoeitic Haematinics Haematinics Ferrous Fumarate-Folic Acid Tab 200-0.1 MG OR TABS A Max 9 Rx/annum (Gender)
354 Blood and Haemopoeitic Haematinics Haematinics Ferrous Lactate Drops 25 MG/ML OR SOLN C CRD Therapeutic - ChroniLine
355 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate Tab 30 MG OR TABS C CRD Therapeutic - ChroniLine
356 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate Tab 75 MG OR TABS C CRD Therapeutic - ChroniLine
357 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate-Copper-Manganese Tab 170-2.5-2.5 MG OR TABS C CRD Therapeutic - ChroniLine
359 Blood and Haemopoeitic Haemoglobin-based oxygen carrier Haemoglobin-based oxygen carrier NONE LISTED
361 Blood and Haemopoeitic Others Others NONE LISTED
363 Alcoholism Alcoholism Alcoholism NONE LISTED
366 Respiratory System Coughs and colds Antitussives and expectorants Aminophylline-Diphenhyd-Ammon Cl-Sod Citrate Syrup OR SYRP A Max 200ml/Rx & 3 Rx/annum
367 Respiratory System Coughs and colds Antitussives and expectorants Diphenhyd-Cod-Amm Cl-Sod Cit Syrup 12.5-10-125-50 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
368 Respiratory System Coughs and colds Antitussives and expectorants Diphenhyd-Cod-Amm Cl-Sod Cit Syrup 7-2.5-68.5-28 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
369 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine w/ Codeine-Ammon Cl Syr 12-7.5-100 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
370 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14.07-137-57 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
371 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14.1-135-55 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
372 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14-136-56 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
373 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate-Men Syr 12.5-125-50-1MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
374 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate-Men Syr 14-137-57-1 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
375 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-Ammonium Chloride Syrup 12.5-125 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
376 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-Pholcodine-GG Syr 15-8-100 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
377 Respiratory System Coughs and colds Antitussives and expectorants DPH-AmCl-Sod Citrate-Men Syr 28.1-273.9-113.7-2.5 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
378 Respiratory System Coughs and colds Antitussives and expectorants Ephedrine w/ DM-Ammonium Cl Syrup 7.5-15-125 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
379 Respiratory System Coughs and colds Antitussives and expectorants Ephedrine-Promethazine-Codeine Syrup 7.2-3.6-9 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
380 Respiratory System Coughs and colds Antitussives and expectorants Guaifenesin Syrup 100 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
381 Respiratory System Coughs and colds Antitussives and expectorants Ipecac-Squill Syrup OR SYRP A Max 200ml/Rx & 3 Rx/annum
382 Respiratory System Coughs and colds Antitussives and expectorants Metaproterenol-Bromhexine Syrup 5-4 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
383 Respiratory System Coughs and colds Antitussives and expectorants Pholcodine Syrup 4.052 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
384 Respiratory System Coughs and colds Antitussives and expectorants Pseudoephedrine-Triprolidine w/ COD Syrup 30-1.25-10 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
385 Respiratory System Coughs and colds Antitussives and expectorants Pseudoephed-Triprolidine-DM Syrup 30-1.25-10 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
386 Respiratory System Coughs and colds Antitussives and expectorants Pseudoeph-Triprolidine w/ COD-GG Syr 20-1.25-7.5-100 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
387 Respiratory System Coughs and colds Antitussives and expectorants Pseudoeph-Triprolidine w/ COD-GG Syrup 12-0.6-3-50 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
388 Respiratory System Coughs and colds Antitussives and expectorants Theophylline-Etofylline-Diphenhyd-Ammon Cl-Sod Cit Syrup OR SYRP A Max 200ml/Rx & 3 Rx/annum
389 Respiratory System Coughs and colds Antitussives and expectorants Theophylline-Etofylline-Diphenylpyraline-Ammon Cl Syrup OR SYRP A Max 200ml/Rx & 3 Rx/annum
390 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG OR TABS A Max 20/Rx & 3 Rx/annum
391 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE w/ APAP-Caffeine Cap 2-5-200-30 MG OR CAPS A Max 20/Rx & 3 Rx/annum
392 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE w/ APAP-Caffeine Syrup 2-2.5-75-7.5 MG/5ML OR SYRP A From 1 year Max 100ml/Rx & 3 Rx/annum
393 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE-APAP-Caff-Vit C Cap 2-5-300-30-75 MG OR CAPS A Max 20/Rx & 3 Rx/annum
394 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE-APAP-Salicylamide-Vit C Cap 2-2-100-75-50 MG OR CAPS A Max 20/Rx & 3 Rx/annum
395 Respiratory System Coughs and colds Decongestant, analgesic combinations Diphenhydramine-Phenyleph-APAP-Vit C Cap 10-5-400-50 MG OR CAPS A Max 20/Rx & 3 Rx/annum
396 Respiratory System Coughs and colds Decongestant, analgesic combinations DM-Phenylpropanolamine-APAP Syrup 15-25-500 MG/20ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
397 Respiratory System Coughs and colds Decongestant, analgesic combinations PE-CPM-APAP-Atropine-Caff-Vit C Cap 5-2-300-0.125-30-75 MG OR CAPS A Max 20/Rx & 3 Rx/annum
398 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenyleph-Chlorphen-DM w/APAP Syrup 2.5-0.5-2-120 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
399 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenylpropanolamine w/ Acetaminophen Cap 18-325 MG OR CAPS A Max 24/Rx & 3 Rx/annum
400 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenylprop-Phenyltolox w/ Cod-APAP Tab 25-22-15-300 MG OR TABS A Max 20/Rx & 3 Rx/annum
401 Respiratory System Coughs and colds Decongestant, analgesic combinations Pyrilamine-Phenylephrine-Acetaminophen Tab 5-5-500 MG OR TABS A Max 20/Rx & 3 Rx/annum
402 Respiratory System Coughs and colds Decongestant, analgesic combinations Triprolidine-Pseudoephedrine-APAP Syrup 0.625-15-125 MG/5ML OR SYRP A From 6 months Max 100ml/Rx & 3 Rx/annum
403 Respiratory System Coughs and colds Decongestants Pseudoephedrine HCl Syrup 30 MG/5ML OR SYRP A Max 100ml/Rx & 3 Rx/annum
404 Respiratory System Coughs and colds Decongestants Pseudoephedrine HCl Tab 60 MG OR TABS A Max 20/Rx & 3 Rx/annum
405 Respiratory System Coughs and colds Decongestants Triprolidine & Pseudoephedrine Syrup 1.25-30 MG/5ML OR SYRP A Max 100ml/Rx & 3 Rx/annum
406 Respiratory System Coughs and colds Decongestants Triprolidine & Pseudoephedrine Tab 1.25-30 MG OR TABS A Max 20/Rx & 3 Rx/annum
408 Respiratory System Bronchodilators Sympathomimetics Formoterol Fumarate Inhal Aerosol 12 UG/ACT IN AERP C AST, BCE, COP Therapeutic - ChroniLine
409 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Cap For Inhal 200 MCG IN CAPS C AST, BCE, COP Therapeutic - ChroniLine
410 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Inhal Aero 108 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
411 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Syrup 2 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
412 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Tab 2 MG OR TABS A Max 30/Rx & 3 Rx/annum
413 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Tab 4 MG OR TABS A Max 30/Rx & 3 Rx/annum
414 Respiratory System Bronchodilators Methylxanthines and combinations Aminophylline Dihydrate Inj 25 MG/ML INJ SOLN A Consumables - Clinic use only
415 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Syrup 80 MG/15ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
416 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Syrup 80 MG/15ML OR SYRP C AST, BCE, COP Therapeutic - ChroniLine
417 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Tab SR 12HR 200 MG OR TB12 C AST, BCE, COP Therapeutic - ChroniLine
418 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Tab SR 12HR 300 MG OR TB12 C AST, BCE, COP Therapeutic - ChroniLine
419 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline-Etofylline Elixir 80-10 MG/15ML OR ELIX A Max 200ml/Rx & 3 Rx/annum
420 Respiratory System Bronchodilators Anticholinergics Ipratropium Bromide Inhal Aerosol 40 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
421 Respiratory System Bronchodilators Combinations Ipratropium-Albuterol Aerosol 18-103 MCG/ACT (20-120MCG/ACT) IN AERO C AST, BCE, COP Therapeutic - ChroniLine
423 Respiratory System Mucolytics Mucolytics Carbocysteine Cap 375 MG OR CAPS A Max 30/Rx & 3 Rx/annum
424 Respiratory System Mucolytics Mucolytics Carbocysteine Syrup 250 MG/5ML OR SYRP A Max 200ml/Rx & 3 Rx/annum
426 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 42 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
427 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 84 UG/AC IN AERO C AST, BCE, COP Therapeutic - ChroniLine
428 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 200 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
429 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhaler Aerosol 100 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
430 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhaler Aerosol 200 UG/ACT IN AERO C AST, BCE, COP Therapeutic - ChroniLine
431 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhal Aero Powd 100 MCG/INH (Breath Activated) IN AERO C AST, BCE, COP Therapeutic - ChroniLine
432 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhal Aero Powd 200 MCG/INH (Breath Activated) IN AERO C AST, BCE, COP Therapeutic - ChroniLine
433 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort Turbu 160/4.5 60 dose IN AERO C AST, BCE, COP Therapeutic - ChroniLine
434 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort turbu 160/4.5 120 dose IN AERO C AST, BCE, COP Therapeutic - ChroniLine
435 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort Inh 320/9MCG 60 dose IN AERO C AST, BCE, COP Therapeutic - ChroniLine
436 Respiratory System Anti-asthmatics Anti-asthmatics Foxair (InhalerAero Powd) IN AERO C AST,COP Therapeutic- Chroniline
437 Respiratory System Leukotriene receptor antagonist Leukotriene receptor antagonist NONE LISTED
438 Respiratory System Chromones Chromones NONE
439 Respiratory System Other anti-asthmatics Other anti-asthmatics NONE LISTED
441 Respiratory System Surfactants Surfactants NONE LISTED
443 Respiratory System Others Others NONE LISTED
445 Ear Nose and Throat Topical nasal preparations Antimicrobial and combinations NONE LISTED
446 Ear Nose and Throat Topical nasal preparations Glucocorticosteroids Beclomethasone Dipropionate Nasal Soln 0.05% NA SOLN A Max 1/Rx & 4 Rx/annum
447 Ear Nose and Throat Topical nasal preparations Chromones NONE
448 Ear Nose and Throat Topical nasal preparations Decongestants Phenylephrine HCl Nasal Soln 0.25% NA SOLN A Max 1 package every 30 days & 3 Rx/annum
449 Ear Nose and Throat Topical nasal preparations Phenylephrine HCl Nasal Soln 1% NA SOLN A Max 1 package every 30 days & 3 Rx/annum
450 Ear Nose and Throat Topical nasal preparations Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML NA SOLN A Max 1 package every 30 days & 3 Rx/annum
451 Ear Nose and Throat Topical nasal preparations Antihistamines NONE LISTED
452 Ear Nose and Throat Topical nasal preparations Mucolytics NONE
453 Ear Nose and Throat Topical nasal preparations Others Saline Nasal Spray 0.9% NA SOLN A Max 1 package every 30 days & 3 Rx/annum
455 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine Otic Soln 5% OT SOLN A Max 1 package every 30 days & 3 Rx/annum
456 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine-Benzocaine Otic Soln 5-1% OT SOLN A Max 1 package every 30 days & 3 Rx/annum
457 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine-Benzocaine-Ephedrine-Pot Oxyquinolone Otic Soln OT SOLN A Max 1 package every 30 days & 3 Rx/annum
458 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine-Procaine-Pot Oxyquinoline Otic Soln 5-1-0.1% OT SOLN A Max 1 package every 30 days & 3 Rx/annum
459 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Neomycin-Sodium Propionate Otic Soln 3-50 MG/ML OT SOLN A Max 1 package every 30 days & 3 Rx/annum
461 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
462 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Menthol Lozenge 1 MG MT LOZG A Max 20/Rx & 4 Rx/annum
463 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Povidone-Iodine Mouthwash 1% MT SOLN A Max 200ml/annum
464 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Tetracaine HCl Ointment 0.5% MT OINT A Max 1 package/annum
467 Gastro-Intestinal Tract Digestants Digestants NONE LISTED
469 Gastro-Intestinal Tract Appetite suppressants Appetite suppressants NONE LISTED
471 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Inj 20 MG/ML INJ SOLN A Consumables - Clinic use only
472 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Syr 5 MG/5ML OR SYRP A Max 100ml/Rx & 3 Rx/annum
473 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Tab 10 MG OR TABS A Max 20/Rx & 4 Rx/annum
474 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Mebeverine HCl Tab 135 MG OR TABS A Max 30/Rx & 4 Rx/annum
475 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics PB-Hyoscy-Atropine-Scopolamine Tab 15-0.104-0.02-0.006 MG OR TABS A Max 30/Rx & 4 Rx/annum
477 Gastro-Intestinal Tract Acid reducers Antacids Aluminum Hydroxide-Mag Oxide Susp 282-120 MG/15ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
478 Gastro-Intestinal Tract Acid reducers Antacids Cal & Mag Carb-Mag Trisilicate Susp 250-250-500 MG/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
479 Gastro-Intestinal Tract Acid reducers Antacids Mag Carb-Mag Trisilicate-Sod Bicarb Susp 250-250-250 MG/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
480 Gastro-Intestinal Tract Acid reducers Antacids Mag Carb-Mag Trisilicate-Sod Bicarb Susp 500-500-500 MG/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
481 Gastro-Intestinal Tract Acid reducers Antacids and combinations Al & Mg Oxides-Dicycl-Methylcell-Simeth Susp OR SUSP A Max 200ml/Rx & 3 Rx/annum
482 Gastro-Intestinal Tract Acid reducers Antacids and combinations Al Hyd-Mag Oxide-Dicyclomine-Dimeth Susp 400-200-5-50MG/10ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
483 Gastro-Intestinal Tract Acid reducers Antacids and combinations Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
484 Gastro-Intestinal Tract Acid reducers Antacids and combinations Alum Oxide-Mag Oxide-Dicyclomine Gel 200-200-5 MG/10ML OR GEL A Max 200ml/Rx & 3 Rx/annum
485 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Cimetidine Tab 200 MG OR TABS C Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
486 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Cimetidine Tab 400 MG OR TABS C Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
487 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Ranitidine HCl Tab 150 MG OR TABS C Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
488 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Ranitidine HCl Tab 300 MG OR TABS C Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
489 Gastro-Intestinal Tract Acid reducers Proton pump inhibitors NONE LISTED
490 Gastro-Intestinal Tract Acid reducers Cytoprotective agents NONE LISTED
491 Gastro-Intestinal Tract Acid reducers Other acid reducers NONE
493 Gastro-Intestinal Tract Motility enhancers Motility enhancers REFER TO 1.8 Anti-Vertigo and anti-emetic agents
495 Gastro-Intestinal Tract Laxatives Laxatives Bisacodyl Tab Delayed Release 5 MG OR TBEC A Max 30/Rx & 2 Rx/annum
496 Gastro-Intestinal Tract Laxatives Laxatives Lactulose Solution 10 G/15ML OR SOLN A Max 200ml/Rx & 2 Rx/annum
497 Gastro-Intestinal Tract Laxatives Laxatives Sennosides Tab 7.5 MG OR TABS A Max 30/Rx & 2 Rx/annum
498 Gastro-Intestinal Tract Laxatives Laxatives Sodium Phosphates - Enema RE ENEM A Max 1 package/Rx & 2 Rx/annum
500 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Susp 1-0.05 GM/5ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
501 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Liquid 3-0.15 GM/15ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
502 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Susp 6-0.45 GM/30ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
503 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin w/ Electrolytes Susp 6-0.12 GM/30ML OR SUSP A Max 200ml/Rx & 3 Rx/annum
504 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Loperamide HCl Syrup 1 MG/5ML OR SYRP A Max 50ml/Rx & 3 Rx/annum
505 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Loperamide HCl Tab 2 MG OR TABS A Max 20/Rx & 3 Rx/annum
507 Gastro-Intestinal Tract Liver, gall bladder and bile Liver, gall bladder and bile NONE LISTED
509 Gastro-Intestinal Tract Suppositories and anal ointments Suppositories and anal ointments Hemorrhoidal Anesthetic Compound - Supp RE SUPP A Max 1 package/Rx & 3 Rx/annum
510 Gastro-Intestinal Tract Suppositories and anal ointments Suppositories and anal ointments Pramoxine HCl Rectal Oint 1% RE OINT A Max 1 package/Rx & 3 Rx/annum
512 Gastro-Intestinal Tract Others Others Budesonide Enema Kit 0.02 MG/ML RE KIT C CSD, UC Therapeutic - ChroniLine Pre-Auth
513 Gastro-Intestinal Tract Others Others Mesalamine Suppos 500 MG RE SUPP C CSD, UC Therapeutic - ChroniLine Pre-Auth
514 Gastro-Intestinal Tract Others Others Mesalamine Suppos 1000 MG RE SUPP C CSD, UC Therapeutic - ChroniLine Pre-Auth
515 Gastro-Intestinal Tract Others Others Mesalamine Enema 2 GM RE ENEM C CSD, UC Therapeutic - ChroniLine Pre-Auth
516 Gastro-Intestinal Tract Others Others Mesalamine Tab CR 500 MG OR TBCR C CSD, UC Therapeutic - ChroniLine Pre-Auth
517 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 400 MG OR TBEC C CSD, UC Therapeutic - ChroniLine Pre-Auth
518 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 800 MG OR TBEC C CSD, UC Therapeutic - ChroniLine Pre-Auth
519 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 1.2 GM OR TBEC C CSD, UC Therapeutic - ChroniLine Pre-Auth
520 Gastro-Intestinal Tract Others Others Olsalazine Sodium Cap 250 MG OR CAPS C CSD, UC Therapeutic - ChroniLine Pre-Auth
521 Gastro-Intestinal Tract Others Others Sulfasalazine Tab 500 MG OR TABS C CSD, RHA, UC Therapeutic - ChroniLine Pre-Auth
523 Antihelmintics Antihelmintics Antihelmintics Albendazole Susp 100 MG/5ML OR SUSP A Max 1 package/Rx & 2 Rx/annum
524 Antihelmintics Antihelmintics Antihelmintics Mebendazole Susp 20 MG/ML OR SUSP A Max 1 package/Rx & 2 Rx/annum
525 Antihelmintics Antihelmintics Antihelmintics Mebendazole Tab 100 MG OR TABS A Max 1 package/Rx & 2 Rx/annum
526 Antihelmintics Antihelmintics Antihelmintics Praziquantel Tab 600 MG OR TABS A Max 1 package/Rx & 2 Rx/annum
529 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Iodoquinol-Chlorobutanol-Benzocaine Cream 30-10-10 MG/GM EX CREA A Max 1 package/Rx & 2 Rx/annum
530 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Nitrofurazone Oint 0.2% EX OINT A Max 1 package/Rx & 2 Rx/annum
531 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Povidone-Iodine Oint 10% EX OINT A Max 1 package/Rx & 2 Rx/annum
532 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Silver Sulfadiazine Cream 1% EX CREA A Max 1 package/Rx & 2 Rx/annum
533 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Sulfanilamide-Mercurochrome-Peru Balsam-Cod Liver Oil Oint EX OINT A Max 1 package/Rx & 2 Rx/annum
535 Dermatologicals Anti-parasitics Anti-parasitics Benzyl Benzoate Emulsion 25% EX EMUL A Max 200ml/Rx & 2 Rx/annum
536 Dermatologicals Anti-parasitics Anti-parasitics Sulfiram Bar 5% EX BAR A Max 2 bars/Rx & 2 Rx/annum
538 Dermatologicals Fungicides Fungicides Clotrimazole Cream 1% EX CREA A Max 1 package/Rx & 2 Rx/annum
540 Dermatologicals Cortico-steroids Cortico-steroids (topical) Betamethasone Valerate Cream 0.1% EX CREA A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
541 Dermatologicals Cortico-steroids Cortico-steroids (topical) Betamethasone Valerate Oint 0.1% EX OINT A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
542 Dermatologicals Cortico-steroids Cortico-steroids (topical) Fluocinolone Acetonide Cream 0.025% EX CREA A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
543 Dermatologicals Cortico-steroids Cortico-steroids (topical) Fluocinolone Acetonide Oint 0.025% EX OINT A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
544 Dermatologicals Cortico-steroids Cortico-steroids (topical) Hydrocortisone Acetate Cream 1% EX CREA A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
545 Dermatologicals Cortico-steroids Cortico-steroids (topical) Hydrocortisone Cream 1% EX CREA A C SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
546 Dermatologicals Cortico-steroids Cortico-steroids with anti-infective agents Iodoquinol-Chlorobutanol-HC Cream 3-1-0.25% EX CREA A Max 1 package/Rx & 2 Rx/annum
547 Dermatologicals Cortico-steroids Cortico-steroids with anti-infective agents Neomycin-HC Ace Cream 1% EX CREA A Max 1 package/Rx & 2 Rx/annum
549 Dermatologicals Psoriasis Psoriasis Coal Tar Cream 1% EX CREA C Therapeutic - ChroniLine
550 Dermatologicals Psoriasis Psoriasis Coal Tar Liquid EX LIQD C Therapeutic - ChroniLine
551 Dermatologicals Psoriasis Psoriasis Coal Tar Shampoo 5% EX SHAM C Therapeutic - ChroniLine
553 Dermatologicals Acne Acne NONE LISTED
555 Dermatologicals Melanin inhibitors and stimulants Melanin inhibitors and stimulants NONE
557 Dermatologicals Emollients and protectives Emollients and protectives Calamine Phenolated Lotion EX LOTN A Max 100ml/Rx & 3 Rx/annum
559 Dermatologicals Others Others Diphenhydramine-Calamine-Phenol Lotion 1-15-0.4% EX LOTN A Max 100ml/Rx & 3 Rx/annum
562 Ophthalmics Anti-infectives Anti-infectives Chloramphenicol Ophth Oint 1% OP OINT A Max 1 package/Rx & 3 Rx/annum
563 Ophthalmics Anti-infectives Anti-infectives Sulfacetamide Sodium Ophth Oint 10% OP OINT A Max 1 package/Rx & 3 Rx/annum
564 Ophthalmics Anti-infectives Antivirals NONE LISTED
566 Ophthalmics Corticoids Corticoids NONE LISTED
568 Ophthalmics Combinations (Anti-infectives with corticoids) Combinations (Anti-infectives with corticoids) NONE LISTED
570 Ophthalmics Decongestants Decongestants Oxymetazoline HCl Ophth Soln 0.025% OP SOLN A Max 1 package/Rx & 3 Rx/annum
571 Ophthalmics Decongestants Decongestants Phenylephrine-Boric Acid Ophth Soln 1.25-20 MG/ML OP SOLN A Max 1 package/Rx & 3 Rx/annum
573 Ophthalmics Mydriatics Mydriatics Atropine Sulfate Ophth Soln 1% OP SOLN A Max 1 package/Rx & 3 Rx/annum
575 Ophthalmics Glaucoma Glaucoma Bimatoprost Ophth Soln 0.01% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
576 Ophthalmics Glaucoma Glaucoma Bimatoprost-Timolol Maleate Ophth Soln 0.03-0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
577 Ophthalmics Glaucoma Glaucoma Brimonidine Tartrate Ophth Soln 0.2% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
578 Ophthalmics Glaucoma Glaucoma Brimonidine Tartrate-Timolol Maleate Ophth Soln 0.2-0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
579 Ophthalmics Glaucoma Glaucoma Brinzolamide-Timolol Ophth Susp 1-0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
580 Ophthalmics Glaucoma Glaucoma Dorzolamide HCl Ophth Soln 2% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
581 Ophthalmics Glaucoma Glaucoma Dorzolamide HCl-Timolol Maleate Ophth Soln 22.3-6.8 MG/ML OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
582 Ophthalmics Glaucoma Glaucoma Latanoprost Ophth Soln 0.005% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
583 Ophthalmics Glaucoma Glaucoma Latanoprost-Timolol Maleate Ophth Soln 0.005-0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
584 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 1% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
585 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 2% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
586 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 4% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
587 Ophthalmics Glaucoma Glaucoma Timolol Maleate Ophth Soln 0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
588 Ophthalmics Glaucoma Glaucoma Travoprost Ophth Soln 0.004% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
589 Ophthalmics Glaucoma Glaucoma Travoprost-Timolol Maleate Ophth Soln 0.004-0.5% OP SOLN C GLC Therapeutic - ChroniLine Pre-Auth
591 Ophthalmics Others Others Cromolyn Sodium Ophth Soln 2% OP SOLN A Max 1 package/Rx & 3 Rx/annum
594 Urinary System Diuretics Diuretics Amiloride & Hydrochlorothiazide Tab 5-50 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
595 Urinary System Diuretics Diuretics Furosemide Inj 10 MG/ML INJ SOLN A Consumables - Clinic use only
596 Urinary System Diuretics Diuretics Furosemide Tab 40 MG OR TABS C CHF, CMY, CRD, HYP Therapeutic - ChroniLine
597 Urinary System Diuretics Diuretics Hydrochlorothiazide Tab 12,5 MG OR TABS C CHF, CMY, CRD, HYP Therapeutic - ChroniLine
598 Urinary System Diuretics Diuretics Hydrochlorothiazide Tab 25 MG OR TABS C CHF, CMY, CRD, HYP Therapeutic - ChroniLine
599 Urinary System Diuretics Diuretics Hydrochlorothiazide-Potassium Chloride Tab 50-300 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
600 Urinary System Diuretics Diuretics Indapamide Tab 2.5 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
601 Urinary System Diuretics Diuretics Spironolactone Tab 25 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
602 Urinary System Diuretics Diuretics Triamterene & Hydrochlorothiazide Tab 50-25 MG OR TABS C CHF, CMY, HYP Therapeutic - ChroniLine
604 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Nasal Solution 0.01% (Refridgerated) NA SOLN C DBI, HAE Therapeutic - ChroniLine Pre-Auth
605 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Tab 0.1 MG OR TABS C DBI, HAE Therapeutic - ChroniLine Pre-Auth
606 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Tab 0.2 MG OR TABS C DBI, HAE Therapeutic - ChroniLine Pre-Auth
608 Urinary System Urinary alkalinizers Urinary alkalinizers Potassium Citrate & Citric Acid Soln 20-4% OR SOLN A Max 200ml/Rx & 3 Rx/annum
609 Urinary System Urinary alkalinizers Urinary alkalinizers Potassium Citrate & Citric Acid Soln 45-21 MG/15ML OR SOLN A Max 200ml/Rx & 3 Rx/annum
611 Urinary System Urinary antiseptics Urinary antiseptics NONE LISTED
613 Urinary System Others Others NONE LISTED
616 Genital System Contraceptives Contraceptives NONE LISTED
618 Genital System Vaginal Preparations Vaginal Preparations Aminacrine-Iodoquinol-Boric Acd-Cetylpyridinium Vag Gel VA GEL A Max 1 package/Rx & 3 Rx/annum
619 Genital System Vaginal Preparations Vaginal Preparations Clotrimazole Vaginal Cream 1% VA CREA A Max 1 package/Rx & 3 Rx/annum
621 Genital System Oxytocics Oxytocics Ergonovine Maleate Inj 0.5 MG/ML INJ SOLN A Consumables - Clinic use only
623 Genital System Uterine antispasmodics Uterine antispasmodics NONE LISTED
625 Genital System Sexual dysfunction Others NONE
626 Genital System Sexual dysfunction Erectile dysfunction NONE LISTED
629 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML OR SUSR A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
630 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML OR SUSR A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
631 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML OR SUSR A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
632 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 250-125 MG OR TABS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
633 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 500-125 MG OR TABS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
634 Antimicrobials Beta-Lactams Penicillins Amoxicillin Cap 250 MG OR CAPS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
635 Antimicrobials Beta-Lactams Penicillins Amoxicillin Cap 500 MG OR CAPS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
636 Antimicrobials Beta-Lactams Penicillins Amoxicillin For Susp 125 MG/5ML OR SUSR A C BCE Max 4 fills/annum
637 Antimicrobials Beta-Lactams Penicillins Amoxicillin For Susp 250 MG/5ML OR SUSR A C BCE Max 4 fills/annum
638 Antimicrobials Beta-Lactams Penicillins Amoxicillin-Floxacillin Cap 250-250 MG OR CAPS A Max 4 fills/annum
639 Antimicrobials Beta-Lactams Penicillins Amoxicillin-Floxacillin For Susp 125-125 MG/5ML OR SUSR A Max 4 fills/annum
640 Antimicrobials Beta-Lactams Penicillins Ampicillin Cap 250 MG OR CAPS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
641 Antimicrobials Beta-Lactams Penicillins Ampicillin For Susp 125 MG/5ML OR SUSR A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
642 Antimicrobials Beta-Lactams Penicillins Ampicillin-Cloxacillin Cap 250-250 MG OR CAPS A Max 4 fills/annum
643 Antimicrobials Beta-Lactams Penicillins Ampicillin-Cloxacillin For Susp 125-125 MG/5ML OR SUSR A Max 4 fills/annum
644 Antimicrobials Beta-Lactams Penicillins Cloxacillin Sodium Cap 250 MG OR CAPS A Max 4 fills/annum
645 Antimicrobials Beta-Lactams Penicillins Cloxacillin Sodium Cap 500 MG OR CAPS A Max 4 fills/annum
646 Antimicrobials Beta-Lactams Penicillins Floxacillin Sodium Cap 250 MG OR CAPS A Max 4 fills/annum
647 Antimicrobials Beta-Lactams Penicillins Penicillin G Benzathine For Intramuscular Susp 1200000 Unit IM SUSR A Consumables - Clinic use only
648 Antimicrobials Beta-Lactams Penicillins Penicillin G Benzathine For Intramuscular Susp 2400000 Unit IM SUSR A Consumables - Clinic use only
649 Antimicrobials Beta-Lactams Penicillins Penicillin G Procaine Intramuscular Susp 300000 Unit/ML IM SUSP A Consumables - Clinic use only
650 Antimicrobials Beta-Lactams Penicillins Penicillin G Sodium For Inj 1000000 Unit IM SUSR A Consumables - Clinic use only
651 Antimicrobials Beta-Lactams Penicillins Penicillin G Sodium For Inj 5000000 Unit IM SUSR A Consumables - Clinic use only
652 Antimicrobials Beta-Lactams Penicillins Penicillin V Potassium For Soln 125 MG/5ML OR SUSR A Max 4 fills/annum
653 Antimicrobials Beta-Lactams Penicillins Penicillin V Potassium Tab 250 MG OR TABS A Max 4 fills/annum
654 Antimicrobials Beta-Lactams Cephalosporins
655 Antimicrobials Beta-Lactams 1st generation Cefazolin Sodium For Inj 1 GM INJ SOLR A Consumables - Clinic use only
656 Antimicrobials Beta-Lactams 1st generation Cephalexin Cap 250 MG OR CAPS A Max 4 fills/annum
657 Antimicrobials Beta-Lactams 1st generation Cephalexin Cap 500 MG OR CAPS A Max 4 fills/annum
658 Antimicrobials Beta-Lactams 1st generation Cephalexin For Susp 125 MG/5ML OR SUSR A Max 4 fills/annum
659 Antimicrobials Beta-Lactams 1st generation Cephalexin For Susp 250 MG/5ML OR SUSR A Max 4 fills/annum
660 Antimicrobials Beta-Lactams 2nd generation Cefoxitin Sodium For Inj 1 G IV SOLR A Consumables - Clinic use only
661 Antimicrobials Beta-Lactams 2nd generation Cefuroxime Sodium For Inj 250 MG INJ SOLR A Consumables - Clinic use only
662 Antimicrobials Beta-Lactams 2nd generation Cefuroxime Sodium For Inj 750 MG INJ SOLR A Consumables - Clinic use only
663 Antimicrobials Beta-Lactams 3rd generation Cefotaxime Sodium For Inj 500 MG INJ SOLR A Consumables - Clinic use only
664 Antimicrobials Beta-Lactams 3rd generation Ceftriaxone Sodium For Inj 1 G INJ SOLR A Consumables - Clinic use only
665 Antimicrobials Others Others NONE LISTED
667 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Cap 250 MG OR CAPS A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
668 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Susp 125 MG/5ML OR SUSP A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
669 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Susp 250 MG/5ML OR SUSP A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
670 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Stearate Tab 250 MG OR SUSP A C BCE Max 4 fills/annum / Therapeutic - ChroniLine
672 Antimicrobials Aminoglycosides Aminoglycosides Gentamicin Sulfate Inj 40 MG/ML INJ SOLN A Consumables - Clinic use only
673 Antimicrobials Aminoglycosides Aminoglycosides Streptomycin Sulfate Inj 1000 MG/3ML INJ SOLN A Consumables - Clinic use only
675 Antimicrobials Tetracyclines Tetracyclines Doxycycline Hyclate Cap 100 MG OR CAPS A BCE Max 4 fills/annum / Therapeutic - ChroniLine
676 Antimicrobials Tetracyclines Tetracyclines Oxytetracycline HCl Cap 250 MG OR CAPS A Max 4 fills/annum
678 Antimicrobials Chloramphenicols Chloramphenicols Chloramphenicol Cap 250 MG OR CAPS A Max 4 fills/annum
679 Antimicrobials Chloramphenicols Chloramphenicols Chloramphenicol Susp 125 MG/5ML OR SUSP A Max 4 fills/annum
681 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML IV SOLN A Consumables - Clinic use only
682 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML OR SUSP A Max 4 fills/annum / Therapeutic - ChroniLine
683 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim Tab 400-80 MG OR TABS A Max 4 fills/annum / Therapeutic - ChroniLine
685 Antimicrobials Quinolones Quinolones Ciprofloxacin HCl Tab 250 MG OR TABS A BCE, CSD Max 4 fills/annum
686 Antimicrobials Quinolones Quinolones Ciprofloxacin HCl Tab 500 MG OR TABS A BCE, CSD Max 4 fills/annum
688 Antimicrobials Mycobacteria Tuberculostatics Ethambutol HCl Tab 400mg OR TABS CDL Therapeutic - ChroniLine Pre-Auth
689 Antimicrobials Mycobacteria Tuberculostatics Isoniazid Tab 100mg OR TABS CDL Therapeutic - ChroniLine Pre-Auth
690 Antimicrobials Mycobacteria Tuberculostatics Isoniazid Tab 200mg OR TABS CDL Therapeutic - ChroniLine Pre-Auth
691 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab 100-150 MG OR TABS CDL Therapeutic - ChroniLine Pre-Auth
692 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab 150-300 MG OR TABS CDL Therapeutic - ChroniLine Pre-Auth
693 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab Disp 60-30 MG OR TBDP CDL Therapeutic - ChroniLine Pre-Auth
694 Antimicrobials Mycobacteria Tuberculostatics Isoniazid-Rifampin-Ethamb-Pyrazinamide Tab 75-150-275-400 MG OR TABS CDL Therapeutic - ChroniLine Pre-Auth
695 Antimicrobials Mycobacteria Anti-leprotics Dapsone Tab 100 MG OR TABS CDL Therapeutic - ChroniLine Pre-Auth
697 Antimicrobials Other anti-bacterial agents Other anti-bacterial agents Clindamycin HCl Cap 150 MG OR CAPS A Max 2 fills/annum
699 Antimicrobials Anti-fungal agents Anti-fungal agents Fluconazole Cap 150 MG OR CAPS A Max 2 fills/annum / Therapeutic - ChroniLine
700 Antimicrobials Anti-fungal agents Anti-fungal agents Nystatin Susp 100000 Unit/ML MT SUSP A Max 2 fills/annum
702 Antimicrobials Anti-protozoal agents Anti-protozoal agents Chloroquine Sulfate Cap 200 MG OR CAPS C RHA, SLE Therapeutic - ChroniLine
703 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Susp 200 MG/5ML OR SUSP A Max 3 fills/annum
704 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 200 MG OR TABS A C CSD Max 3 fills/annum / Therapeutic - ChroniLine
705 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 400 MG OR TABS A C CSD Max 3 fills/annum / Therapeutic - ChroniLine
707 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Cream 5% EX CREA A Max 1 Rx/annum
708 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab 200 MG OR TABS A Max 1 Rx/annum
709 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab 400 MG OR TABS A Max 1 Rx/annum
710 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab Disp 200 MG OR TBDP A Max 1 Rx/annum
711 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab Disp 400 MG OR TBDP A Max 1 Rx/annum
712 Antimicrobials Anti-retroviral agents Anti-retroviral agents According to HIV Disease Management Programme (DMP)
715 Endocrine System Anti-diabetic agents Insulins
716 Endocrine System Anti-diabetic agents Rapid acting Insulins Insulin Lispro (Human) Inj 100 Unit/ML (10ml vial) SC SOLN C DM1, DM2 Therapeutic - ChroniLine
717 Endocrine System Anti-diabetic agents Insulin Aspart Inj 100 Unit/ML (10ml vial) SC SOLN C DM1, DM2 Therapeutic - ChroniLine
718 Endocrine System Anti-diabetic agents Insulin Glulisine Subcutaneous Inj 100 Unit/ML (10ml vial) SC SOLN C DM1, DM2 Therapeutic - ChroniLine
719 Endocrine System Anti-diabetic agents Short acting Insulins Insulin Regular (Human) Inj 100 Unit/ML SC SOLN C DM1, DM2 Therapeutic - ChroniLine
720 Endocrine System Anti-diabetic agents Intermediate acting Insulins Insulin Isophane (Human) Inj 100 Unit/ML SC SUSP C DM1, DM2 Therapeutic - ChroniLine
721 Endocrine System Anti-diabetic agents Biphasic Insulins Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (75-25) SC SUSP C DM1, DM2 Therapeutic - ChroniLine
722 Endocrine System Anti-diabetic agents Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (50-50) SC SUSP C DM1, DM2 Therapeutic - ChroniLine
723 Endocrine System Anti-diabetic agents Insulin Aspart Prot & Aspart (Human) Inj 100 Unit/ML (70-30) SC SUSP C DM1, DM2 Therapeutic - ChroniLine
724 Endocrine System Anti-diabetic agents Insulin Isophane & Regular (Human) Inj 100 Unit/ML (70-30) SC SUSP C DM1, DM2 Therapeutic - ChroniLine
725 Endocrine System Anti-diabetic agents Oral anti-diabetic agents Gliclazide Tab 80 MG OR TABS C DM2 Therapeutic - ChroniLine
726 Endocrine System Anti-diabetic agents Gliclazide Tab SR 24HR 30 MG OR TABS C DM2 Therapeutic - ChroniLine
727 Endocrine System Anti-diabetic agents Gliclazide Tab SR 24HR 60 MG OR TABS C DM2 Therapeutic - ChroniLine
728 Endocrine System Anti-diabetic agents Metformin HCl Tab 500 MG OR TABS C DM2 Therapeutic - ChroniLine
729 Endocrine System Anti-diabetic agents Metformin HCl Tab 850 MG OR TABS C DM2 Therapeutic - ChroniLine
730 Endocrine System Anti-diabetic agents Metformin HCl Tab 1000 MG OR TABS C DM2 Therapeutic - ChroniLine
731 Endocrine System Anti-diabetic agents GLP-1 agonists NONE LISTED
733 Endocrine System Anti-hypoglycaemic agents Anti-hypoglycaemic agents Glucagon For Inj Kit 1 MG INJ KIT CDL Therapeutic - ChroniLine Pre-Auth
735 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 100 UG OR TABS C TDH Therapeutic - ChroniLine
736 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 50 UG OR TABS C TDH Therapeutic - ChroniLine
737 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 25 UG OR TABS C TDH Therapeutic - ChroniLine
739 Endocrine System Parathyroid and calcitonin Parathyroid and calcitonin NONE LISTED
741 Endocrine System Corticosteroids Corticosteroids Betamethasone Sodium Phosphate Inj 4 MG/ML INJ SOLN A Consumables - Clinic use only
742 Endocrine System Corticosteroids Corticosteroids Betamethasone Syrup 0.6 MG/5ML OR SYRP A Max 3 fills/annum
743 Endocrine System Corticosteroids Corticosteroids Dexamethasone Sodium Phosphate Inj 4 MG/ML INJ SOLN A Consumables - Clinic use only
744 Endocrine System Corticosteroids Corticosteroids Fludrocortisone Acetate Tab 0.1 MG OR TABS C ADS Therapeutic - ChroniLine Pre-Auth
745 Endocrine System Corticosteroids Corticosteroids Hydrocortisone Sodium Succinate For Inj 100 MG INJ SOLN A Consumables - Clinic use only
746 Endocrine System Corticosteroids Corticosteroids Hydrocortisone Tab 10 MG OR TABS C ADS Therapeutic - ChroniLine Pre-Auth
747 Endocrine System Corticosteroids Corticosteroids Prednisolone Syrup 15 MG/5ML OR SYRP A Max 3 fills/annum
748 Endocrine System Corticosteroids Corticosteroids Prednisolone Tab 5 MG OR TABS A Max 3 fills/annum
749 Endocrine System Corticosteroids Corticosteroids Prednisolone Tab 5 MG OR TABS C ADS, AST, BCE, COP, CSD, UC, RHA, SLE Therapeutic - ChroniLine
750 Endocrine System Corticosteroids Corticosteroids Prednisone Tab 5 MG OR TABS A Max 3 fills/annum
751 Endocrine System Corticosteroids Corticosteroids Prednisone Tab 5 MG OR TABS C ADS, AST, BCE, COP, CSD, UC, RHA, SLE Therapeutic - ChroniLine
753 Endocrine System Sex hormones Androgens and anabolic steroids NONE LISTED
754 Endocrine System Sex hormones Oestrogens Estradiol Valerate Tab 1 MG OR TABS C Therapeutic - ChroniLine Pre-Auth
755 Endocrine System Sex hormones Oestrogens Estradiol Valerate Tab 2 MG OR TABS C Therapeutic - ChroniLine Pre-Auth
756 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 0.3 MG OR TABS C Therapeutic - ChroniLine Pre-Auth
757 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 0.625 MG OR TABS C Therapeutic - ChroniLine Pre-Auth
758 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 1.25 MG OR TABS C Therapeutic - ChroniLine Pre-Auth
759 Endocrine System Sex hormones Progestogens Medroxyprogesterone Acetate Tab 5 MG OR TABS A C Max 15/Rx & 2 fills per annum / Therapeutic - ChroniLine Pre-Auth
760 Endocrine System Sex hormones Progestogens Medroxyprogesterone Acetate Tab 10 MG OR TABS A C Max 15/Rx & 2 fills per annum / Therapeutic - ChroniLine Pre-Auth
761 Endocrine System Sex hormones Combinations Estradiol Val 1 MG & Estradiol-Norethin Tab 1-1 MG OR TABS C HRT Therapeutic - ChroniLine Pre-Auth
762 Endocrine System Sex hormones Combinations Estradiol Val 2 MG & Estradiol-Norethin Tab 2-1 MG OR TABS C HRT Therapeutic - ChroniLine Pre-Auth
763 Endocrine System Sex hormones Other NONE LISTED
765 Endocrine System Tropic hormones Tropic hormones NONE LISTED
767 Endocrine System Hormone inhibitors Hormone inhibitors NONE LISTED
770 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamins Niacin Tab CR 500 MG OR TABS C HYL Therapeutic - ChroniLine
771 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamins Pyridoxine HCl Tab 25 MG OR TABS CDL (Only whilst on Isoniazid) Therapeutic - ChroniLine Pre-Auth
772 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamin combinations NONE LISTED
773 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Gluconate Chew Tab 300 MG OR CHEW C CRD, SLE Therapeutic - ChroniLine
774 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Gluconate Tab 300 MG (Elemental Ca) OR TABS C CRD, SLE Therapeutic - ChroniLine
775 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Carbonate Chew Tab 1250 MG OR CHEW C CRD, SLE Therapeutic - ChroniLine
776 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Folic Acid Tab 5 MG OR TABS A Max 9 Rx/annum (Gender)
777 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Folic Acid Tab 5 MG OR TABS C CRD, CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine
778 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Pregi Forte Capsules (nappi code 715465) OR CAPS A Max 9 Rx/annum (Gender)
779 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Calcipreg Tablets (nappi code 704600) OR TABS A Max 9 Rx/annum (Gender)
780 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Preg-Natal Capsules (nappi code 701693) OR CAPS A Max 9 Rx/annum (Gender)
782 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium Carbonate-Vitamin D Chew Tab 1250 MG-200 Unit OR CHEW C CRD, SLE Therapeutic - ChroniLine
783 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium Carbonate-Vitamin D Tab 1250 MG-400 Unit OR TABS C CRD, SLE Therapeutic - ChroniLine
784 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium-Magnesium w/ Vitamin D Chew Tab 500MG-125MG-250 Unit OR CHEW C CRD, SLE Therapeutic - ChroniLine
785 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium-Magnesium w/ Vitamin D Tab 500 MG-125 MG-250 Unit OR TABS C CRD, SLE Therapeutic - ChroniLine
787 Vitamins Tonics Minerals and Electrolytes Tonics Tonics NONE LISTED
789 Vitamins Tonics Minerals and Electrolytes Minerals and electrolytes Minerals and electrolytes Magnesium Sulfate Inj 50% INJ SOLN A Consumables - Clinic use only
791 Amino-acids Amino-acids Amino-acids NONE LISTED
793 Special foods Special foods Special foods NONE LISTED
795 Cytostatics Cytostatics Cytostatics Methotrexate Tab 2.5 MG OR TABS C CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine Pre-Auth
797 Immunological Immunosuppressants Immunosuppressants Azathioprine Tab 50 MG OR TABS C CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine Pre-Auth
798 Immunological Immunostimulants Immunostimulants NONE LISTED
800 Chelating agents ION exchange preparations Chelating agents, ion exchange preparations Chelating agents, ion exchange preparations NONE LISTED
803 Biologicals Biologicals Flu Vaccination High risk members only, as per 2019 flu vaccination policy
804 Biologicals Biologicals Other Biologicals NONE LISTED
806 Diagnostics and Devices Diagnostics and Devices Insulin syringes and needles Insulin Pen Needle - MISC Therapeutic - ChroniLine Pre-Auth
807 Diagnostics and Devices Diagnostics and Devices Glucometers GlucoCheck Classic Blood Glucose Monitoring Unit - KIT Therapeutic - ChroniLine Pre-Auth
808 Diagnostics and Devices Diagnostics and Devices Glucometer test strips GlucoCheck Test Strips 50’s - TEST Therapeutic - ChroniLine Pre-Auth
809 Diagnostics and Devices Diagnostics and Devices Glucocheck Lancets GlucoCheck Lancets 50’s - MISC Therapeutic - ChroniLine Pre-Auth
810 Diagnostics and Devices Diagnostics and Devices Inhaler Devices Drug Application Product - Misc - DEVI Therapeutic - ChroniLine Pre-Auth
Category Sub-Category Description Active Ingredient Administer Dosage Form Acute Chronic CDL Conditions Quantities & 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.