Prime Cure Medicine Formulary 2022

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 2022

wdt_ID Category Sub-Category Description Active Ingredient Administer Dosage Form Acute Chronic OTC CDL Conditions Quantities & Limitations
1 Central Nervous System Central nervous system stimulants Central Analeptics NONE LISTED
2 Central Nervous System Central nervous system stimulants Respiratory stimulants Naloxone HCl Inj 0.02 MG/ML INJ SOLN A No Consumables - Clinic use only
3 Central Nervous System Central nervous system stimulants Respiratory stimulants Naloxone HCl Inj 0.4 MG/ML INJ SOLN A No Consumables - Clinic use only
4 Central Nervous System Central nervous system stimulants Others NONE LISTED
5 Central Nervous System Sedative hypnotics Benzodiazepines Midazolam HCl Inj 5 MG/ML (Base Equivalent) INJ SOLN A No Consumables - Clinic use only
6 Central Nervous System Sedative hypnotics Barbiturates Phenobarbitone Tab 30 MG OR TABS C No EPL Therapeutic - ChroniLine
7 Central Nervous System Sedative hypnotics Others Zopiclone Tab 7.5 MG OR TABS A No Max quantity 30 tabs every 90 days
8 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 0.25 MG OR TABS A No Max Rx/5 days every 120 days
9 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 0.5 MG OR TABS A No Max Rx/5 days every 120 days
10 Central Nervous System Anxiolytics Benzodiazepines Alprazolam Tab 1 MG OR TABS A No Max Rx/5 days every 120 days
11 Central Nervous System Anxiolytics Benzodiazepines Bromazepam Tab 3 MG OR TABS A No Max Rx/5 days every 120 days
12 Central Nervous System Anxiolytics Benzodiazepines Bromazepam Tab 6 MG OR TABS A No Max Rx/5 days every 120 days
13 Central Nervous System Anxiolytics Benzodiazepines Diazepam Inj 5 MG/ML INJ SOLN A No Consumables - Clinic use only
14 Central Nervous System Anxiolytics Benzodiazepines Diazepam Tab 5 MG OR TABS A No Max Rx/5 days every 120 days
15 Central Nervous System Anxiolytics Benzodiazepines Diazepam Tab 10 MG OR TABS A No Max Rx/5 days every 120 days
16 Central Nervous System Anxiolytics Benzodiazepines Lorazepam Inj 4 MG/ML INJ SOLN A No Therapeutic - ChroniLine Pre-Auth
17 Central Nervous System Anxiolytics Benzodiazepines Lorazepam Tab 1 MG OR TABS A No Max Rx/5 days every 120 days
18 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 10 MG OR TABS A No Max Rx/5 days every 120 days
19 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 15 MG OR TABS A No Max Rx/5 days every 120 days
20 Central Nervous System Anxiolytics Benzodiazepines Oxazepam Tab 30 MG OR TABS A No Max Rx/5 days every 120 days
21 Central Nervous System Anxiolytics Others Hydroxyzine HCl IM Soln 50 MG/ML IM SOLN A No Consumables - Clinic use only
22 Central Nervous System Anxiolytics Others Hydroxyzine HCl Syrup 10 MG/5ML OR SYRP A No Max quantity 200ml per annum
23 Central Nervous System Anti-depressants Tricyclic Amitriptyline HCl Tab 10 MG OR TABS C No MSS, SCZ Therapeutic - ChroniLine
24 Central Nervous System Anti-depressants Tricyclic Amitriptyline HCl Tab 25 MG OR TABS C No MSS, SCZ Therapeutic - ChroniLine
25 Central Nervous System Anti-depressants Tricyclic Imipramine HCl Tab 10 MG OR TABS C No MSS, SCZ Therapeutic - ChroniLine
26 Central Nervous System Anti-depressants Tricyclic Imipramine HCl Tab 25 MG OR TABS C No MSS, SCZ Therapeutic - ChroniLine
27 Central Nervous System Anti-depressants Non-trycylic NONE
28 Central Nervous System Anti-depressants Mono-amine oxidase inhibitors NONE LISTED
29 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Citalopram Hydrobromide Tab 20 MG (Base Equiv) OR TABS C No BMD, SCZ Therapeutic - ChroniLine
30 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Citalopram Hydrobromide Tab 40 MG (Base Equiv) OR TABS C No BMD, SCZ Therapeutic - ChroniLine
31 Central Nervous System Anti-depressants Selective serotonin re-uptake inhibitors (SSRIs) Fluoxetine HCl Cap 20 MG OR CAPS C No BMD, SCZ Therapeutic - ChroniLine
32 Central Nervous System Anti-depressants Serotonin and noradrenaline re-uptake inhibitors (SNRIs) NONE LISTED
33 Central Nervous System Anti-depressants Noradrenaline (and dopamine) re-uptake inhibitors NONE LISTED
34 Central Nervous System Anti-depressants Tetracyclic NONE LISTED
35 Central Nervous System Anti-depressants Melatonergic specific NONE LISTED
36 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab 250 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
37 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab 400 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
38 Central Nervous System Anti-depressants Lithium Lithium Carbonate Tab CR 450 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
39 Central Nervous System Anti-depressants Others NONE LISTED
40 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 25 MG OR TABS C No SCZ Therapeutic - ChroniLine Pre-Auth
41 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 50 MG OR TABS C No SCZ Therapeutic - ChroniLine Pre-Auth
42 Central Nervous System Anti-psychotics Phenothiazines Chlorpromazine HCl Tab 100 MG OR TABS C No SCZ Therapeutic - ChroniLine Pre-Auth
43 Central Nervous System Anti-psychotics Phenothiazines Fluphenazine Decanoate Inj 25 MG/ML IM SOLN C No SCZ Therapeutic - ChroniLine Pre-Auth
44 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Lactate Inj 5 MG/ML INJ SOLN A No Therapeutic - ChroniLine Pre-Auth
45 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Lactate Inj 10 MG/ML INJ SOLN A No Therapeutic - ChroniLine Pre-Auth
46 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Cap 0.5 MG OR CAPS C No SCZ Therapeutic - ChroniLine Pre-Auth
47 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Tab 5 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
48 Central Nervous System Anti-psychotics Butyrophenones Haloperidol Tab 10 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
49 Central Nervous System Anti-psychotics Atypical anti-Psychotics Clozapine Tab 25 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
50 Central Nervous System Anti-psychotics Atypical anti-Psychotics Clozapine Tab 100 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
51 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Orally Disintegrating Tab 5 MG TBDP TABS C No BMD, SCZ Therapeutic - ChroniLine
52 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Orally Disintegrating Tab 10 MG TBDP TABS C No BMD, SCZ Therapeutic - ChroniLine
53 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 2.5 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
54 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 5 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
55 Central Nervous System Anti-psychotics Atypical anti-Psychotics Olanzapine Tab 10 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
56 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 25 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
57 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 100 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
58 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 200 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
59 Central Nervous System Anti-psychotics Atypical anti-Psychotics Quetiapine Fumarate Tab 300 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
60 Central Nervous System Anti-psychotics Atypical anti-Psychotics Risperidone Tab 0.5 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
61 Central Nervous System Anti-psychotics Atypical anti-Psychotics Risperidone Tab 1 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
62 Central Nervous System Anti-psychotics Others Flupentixol Decanoate IM Soln 20 MG/ML IM SOLN C No BMD, SCZ Therapeutic - ChroniLine Pre-Auth
63 Central Nervous System Anti-psychotics Others Sulpiride Cap 50 MG OR CAPS C No SCZ Therapeutic - ChroniLine Pre-Auth
64 Central Nervous System Anti-psychotics Others Zuclopenthixol Decanoate IM in Oil 200 MG/ML IM SOLN C No BMD, SCZ Therapeutic - ChroniLine Pre-Auth
65 Central Nervous System Anti-psychotics Others Zuclopenthixol Dihydrochloride Tab 2 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
66 Central Nervous System Anti-psychotics Others Zuclopenthixol Dihydrochloride Tab 10 MG OR TABS C No BMD, SCZ Therapeutic - ChroniLine
67 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Susp 100 MG/5ML OR SUSP C No BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
68 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab 200 MG OR TABS C No BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
69 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab SR 12HR 200 MG OR TB12 C No BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
70 Central Nervous System Anti-epileptics Anti-epileptics Carbamazepine Tab SR 12HR 400 MG OR TB12 C No BMD, EPL, MSS, SCZ Therapeutic - ChroniLine
71 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Conc for Inj 1 MG/ML INJ SOLN A No Consumables - Clinic use only
72 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Tab 0.5 MG OR TABS C No EPL Therapeutic - ChroniLine
73 Central Nervous System Anti-epileptics Anti-epileptics Clonazepam Tab 2 MG OR TABS C No EPL Therapeutic - ChroniLine
74 Central Nervous System Anti-epileptics Anti-epileptics Ethosuximide 250mg/5ml syrup OR SYRP C No EPL Therapeutic - ChroniLine
75 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 25 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
76 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 50 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
77 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 100 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
78 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab 200 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
79 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab Chewable Dispersible 2 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
80 Central Nervous System Anti-epileptics Anti-epileptics Lamotrigine Tab Chewable Dispersible 5 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
81 Central Nervous System Anti-epileptics Anti-epileptics Oxcarbazepine Tab 300 MG OR TABS C No EPL Therapeutic - ChroniLine
82 Central Nervous System Anti-epileptics Anti-epileptics Oxcarbazepine Tab 600 MG OR TABS C No EPL Therapeutic - ChroniLine
83 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Inj 50 MG/ML INJ SOLN A No Consumables - Clinic use only
84 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Susp 125 MG/5ML OR SUSP C No EPL Therapeutic - ChroniLine
85 Central Nervous System Anti-epileptics Anti-epileptics Phenytoin Sodium Prompt Tab 100 MG OR TABS C No EPL Therapeutic - ChroniLine
86 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 25 MG OR TABS C No EPL Therapeutic - ChroniLine
87 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 50 MG OR TABS C No EPL Therapeutic - ChroniLine
88 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 100 MG OR TABS C No EPL Therapeutic - ChroniLine
89 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Tab 200 MG OR TABS C No EPL Therapeutic - ChroniLine
90 Central Nervous System Anti-epileptics Anti-epileptics Topiramate Sprinkle Cap 15 MG OR CAPS C No EPL Therapeutic - ChroniLine
91 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium For IV Soln 400 MG IV SOLN A No Consumables - Clinic use only
92 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Liqd 200 MG/5ML OR SOLN C No BMD, EPL, SCZ Therapeutic - ChroniLine
93 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Syrup 250 MG/5ML (Base Equiv) OR SYRP C No BMD, EPL, SCZ Therapeutic - ChroniLine
94 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab 100 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
95 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 200 MG OR TABS C No BMD, EPL, SCZ Therapeutic - ChroniLine
96 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 300 MG OR TBCR C No BMD, EPL, SCZ Therapeutic - ChroniLine
97 Central Nervous System Anti-epileptics Anti-epileptics Valproate Sodium Tab CR 500 MG OR TBCR C No BMD, EPL, SCZ Therapeutic - ChroniLine
98 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap 150 MG OR CAPS C No BMD, EPL, SCZ Therapeutic - ChroniLine
99 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap 300 MG OR CAPS C No BMD, EPL, SCZ Therapeutic - ChroniLine
100 Central Nervous System Anti-epileptics Anti-epileptics Valproic Acid Cap Delayed Release 500 MG OR CAPS C No BMD, EPL, SCZ Therapeutic - ChroniLine
101 Central Nervous System Anti-Parkinson agents Dopaminergics Amantadine HCl Cap 100 MG OR CAPS C No PAR Therapeutic - ChroniLine Pre-Auth
102 Central Nervous System Anti-Parkinson agents Dopaminergics Carbidopa & Levodopa Tab 25-100 MG OR TABS C No PAR Therapeutic - ChroniLine
103 Central Nervous System Anti-Parkinson agents Dopaminergics Carbidopa & Levodopa Tab 25-250 MG OR TABS C No PAR Therapeutic - ChroniLine
104 Central Nervous System Anti-Parkinson agents Dopaminergics Pramipexole Dihydrochloride Tab 0.125 MG OR TABS C No PAR Therapeutic - ChroniLine
105 Central Nervous System Anti-Parkinson agents Dopaminergics Pramipexole Dihydrochloride Tab 0.25 MG OR TABS C No PAR Therapeutic - ChroniLine
106 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 0.25 MG OR TABS C No PAR Therapeutic - ChroniLine Pre-Auth
107 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 0.5 MG OR TABS C No PAR Therapeutic - ChroniLine Pre-Auth
108 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 1 MG OR TABS C No PAR Therapeutic - ChroniLine Pre-Auth
109 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 2 MG OR TABS C No PAR Therapeutic - ChroniLine Pre-Auth
110 Central Nervous System Anti-Parkinson agents Dopaminergics Ropinirole Hydrochloride Tab 5 MG OR TABS C No PAR Therapeutic - ChroniLine Pre-Auth
111 Central Nervous System Anti-Parkinson agents Anti-cholinergics Biperiden Lactate Inj 5 MG/ML INJ SOLN A No Consumables - Clinic use only
112 Central Nervous System Anti-Parkinson agents Anti-cholinergics Biperiden HCl Tab 2 MG OR TABS C No PAR Therapeutic - ChroniLine
113 Central Nervous System Anti-Parkinson agents Anti-cholinergics Orphenadrine HCl Tab 50 MG OR TABS C No PAR Therapeutic - ChroniLine
114 Central Nervous System Anti-Parkinson agents Anti-cholinergics Trihexyphenidyl HCl Tab 2 MG OR TABS C No PAR Therapeutic - ChroniLine
115 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Buclizine-Pyridoxine Tab 25-50 MG OR TABS A No Max 30/Rx & 3 Rx/annum (Gender)
116 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 No Max 1 package/Rx & 3 Rx/annum
117 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Cyclizine HCl Tab 50 MG OR TABS A No Max 1 package/Rx & 3 Rx/annum
118 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Cyclizine HCl Supp 50 MG RE SUPP A No Max 1 package/Rx & 3 Rx/annum
119 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Fructose-Dextrose-Phosphoric Acid Oral Soln OR SOLN A No Max 200ml/Rx & 3 Rx/annum
120 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Inj 5 MG/ML INJ SOLN A No Consumables - Clinic use only
121 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Syrup 5 MG/5ML OR SYRP A No Max 1 package/Rx & 3 Rx/annum
122 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Metoclopramide HCl Tab 10 MG OR TABS A No Max 30/Rx & 3 Rx/annum
123 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Phosphorated Carbohydrate Syrup OR SYRP A No Max 200ml/Rx & 3 Rx/annum
124 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Prochlorperazine Inj 12.5 MG/ML IM SOLN A No Consumables - Clinic use only
125 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Prochlorperazine Maleate Tab 5 MG OR TABS A No Max 30/Rx & 3 Rx/annum
126 Central Nervous System Anti-vertigo and anti-emetic agents Anti-vertigo and anti-emetic agents Dicyclomine-doxylamine Pyridoxine Tab 10-10-50 MG OR TABS A Yes 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 100 MG PR SUPP A Yes Max 1 package/Rx & 3 Rx/annum
128 Central Nervous System Anti-migraine agents Anti-migraine agents Clonidine HCl Tab 0.025 MG OR TABS A Yes Max 3 Rx/annum
129 Central Nervous System Anti-migraine agents Anti-migraine agents Clonidine HCl (Migraine) Oral Drops 25 MCG/0.5ML OR SOLN A Yes Max 1 package/Rx & 3 Rx/annum
130 Central Nervous System Alzheimer's disease Alzheimer's disease NONE LISTED
131 Anaesthetics General anaesthetics General anaesthetics NONE LISTED
132 Anaesthetics Local Anaesthetics Local Anaesthetics Bupivacaine HCl Inj 0.5% INJ SOLN A No Consumables - Clinic use only
133 Anaesthetics Local Anaesthetics Local Anaesthetics Lidocaine HCl Local Inj 2% INJ SOLN A No Consumables - Clinic use only
134 Anaesthetics Local Anaesthetics Local Anaesthetics Lidocaine Inj 2% w/ Epinephrine-1:80000 INJ SOLN A No Consumables - Clinic use only
135 Anaesthetics Surface anaesthetics Surface anaesthetics Tetracaine HCl Cream 1% EX CREA A Yes Max 1 Rx/annum
136 Anaesthetics Muscle relaxants Muscle relaxants NONE LISTED
137 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Inj 10 MG/ML INJ SOLN A No Consumables - Clinic use only
138 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Inj 15 MG/ML INJ SOLN A No Consumables - Clinic use only
139 Analgesics Narcotic Analgesics Narcotic Analgesics Codeine Phosphate Tab 30 MG OR TABS A No Therapeutic - ChroniLine Pre-Auth
140 Analgesics Narcotic Analgesics Narcotic Analgesics Morphine Sulfate Tab CR 10 MG OR TABS A No Therapeutic - ChroniLine Pre-Auth
141 Analgesics Narcotic Analgesics Narcotic Analgesics Oxycodone HCl Cap 5 MG OR TABS A No Therapeutic - ChroniLine Pre-Auth
142 Analgesics Narcotic Analgesics Narcotic Analgesics Pethidine HCl Inj 25 MG/ML INJ SOLN A No Consumables - Clinic use only
143 Analgesics Narcotic Analgesics Narcotic Analgesics Pethidine HCl Inj 50 MG/ML INJ SOLN A No Consumables - Clinic use only
144 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Tab 300 MG OR TABS C No CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
145 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Tab 300 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
146 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Dispersible Tab 300 MG OR TABS C Yes CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
147 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Aspirin Dispersible Tab 300 MG OR TABS A No Max Rx/5 days & 3 Rx/annum
148 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Ibuprofen Susp 100 MG/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
149 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Mefanamic Acid Susp 50mg/5ml OR SUSP A No Max 200ml/Rx & 3 Rx/annum
150 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Mefenamic Acid Cap 250 MG OR CAPS A No Max Rx/5 days & 3 Rx/annum
151 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Elixir 120 MG/5ML OR ELIX A Yes Max 200ml/Rx & 3 Rx/annum
152 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Elixir 120 MG/5ML OR ELIX C Yes HAE Therapeutic - ChroniLine
153 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Syrup 120 MG/5ML OR ELIX A Yes Max 200ml/Rx & 3 Rx/annum
154 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Syrup 120 MG/5ML OR ELIX C Yes HAE Therapeutic - ChroniLine
155 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Tab 500 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
156 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Tab 500 MG OR TABS C Yes HAE, MSS, RHA, SLE Therapeutic - ChroniLine
157 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol Susp 120 MG/5ML OR SYRP A C Yes Max 200ml/Rx & 3 Rx/annum
158 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol 125MG SUPP PR SUPP A C Yes Max 1 package/Rx & 3 Rx/annum
159 Analgesics Analgesic and Antipyretics Analgesic and Antipyretics Paracetamol 250MG SUPP PR SUPP A C Yes Max 1 package/Rx & 3 Rx/annum
160 Analgesics Combinations Combination Analgesics Acetaminophen w/ Codeine Cap 500-8 MG OR CAPS A No Max Rx/5 days & 3 Rx/annum
161 Analgesics Combinations Combination Analgesics Acetaminophen w/ Codeine Cap 500-8 MG OR CAPS C No HAE, MSS, SLE Therapeutic - ChroniLine
162 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-10 MG OR TABS A No Max Rx/5 days & 3 Rx/annum
163 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-10 MG OR TABS C No HAE, MSS, SLE Therapeutic - ChroniLine
164 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-8 MG OR TABS A No Max Rx/5 days & 3 Rx/annum
165 Analgesics Combinations Combination Analgesics Paracetamol w/ Codeine Tab 500-8 MG OR TABS C No HAE, MSS, SLE Therapeutic - ChroniLine
166 Analgesics Combinations Combination Analgesics Paracetamol-Meprobamate-Caff-Cod Tab 320-150-32-8 MG OR TABS A No Max Rx/5 days & 3 Rx/annum
167 Analgesics Combinations Combination Analgesics Paracetamol-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML OR SYRP A No Max 100ml/Rx & 3 Rx/annum
168 Analgesics Combinations Combination Analgesics Paracetamol-Doxylamine-Caffeine-Codeine Tab 450-5-30-10 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
169 Analgesics Combinations Combination Analgesics Paracetamol-Doxylamine-Caffeine-Codeine Tab 450-5-45-10 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
170 Analgesics Combinations Combination Analgesics *Already included in Acute Paracetamol-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML molecule (above) OR SYRP A Yes Max 100ml/Rx & 3 Rx/annum
171 Analgesics Combinations Combination Analgesics Ibuprofen-Paracetamol-Codeine CAP 200-250-10MG OR CAPS A Yes Max Rx/5 days & 3 Rx/annum
172 Analgesics Combinations Combination Analgesics Ibuprofen-Paracetamol SUSP 100-125MG/5ML OR SYRP A Yes Max 100ml/Rx & 3 Rx/annum
173 Analgesics Combinations Combination Analgesics Ibuprofen-Paracetamol-Codeine TAB 200-350-10MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
174 Analgesics Combinations Combination Analgesics Ibuprofen-Paracetamol CAPS 200-250MG OR CAPS A Yes Max Rx/5 days & 3 Rx/annum
175 Analgesics Combinations Combination Analgesics *Included in Ibuprofen-Paracetamol-Codeine CAP 200-250-10MG (above) OR CAPS A Yes Max Rx/5 days & 3 Rx/annum
176 Analgesics Others Other Analgesics Tramadol HCl Cap 50 MG OR CAPS C No HAE, MSS Therapeutic - ChroniLine Pre-Auth
177 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium IM Inj Soln 25 MG/ML IM SOLN A No Consumables - Clinic use only
178 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium Tab Delayed Release 25 MG OR TBEC A C No RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
179 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Diclofenac Sodium Tab Delayed Release 50 MG OR TBEC A C No RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
180 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Ibuprofen Tab 200 MG OR TABS A C Yes RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
181 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Ibuprofen Tab 400 MG OR TABS A C Yes RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
182 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Indomethacin Cap 25 MG OR CAPS A C No RHA, SLE Therapeutic - ChroniLine
183 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Naproxen Tab 250 MG OR TABS A C No RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
184 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Naproxen Tab 500 MG OR TABS A C No RHA, SLE Max Rx/5 days & 2 Rx/annum / Therapeutic - ChroniLine
185 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents COX inhibitors Piroxicam Cap 20 MG OR CAPS A C No RHA, SLE Therapeutic - ChroniLine
186 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Selective COX2 inhibitors Meloxicam Tab 7.5 MG OR TABS C No RHA, SLE Therapeutic - ChroniLine Pre-Auth
187 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Selective COX2 inhibitors Meloxicam Tab 15 MG OR TABS C No RHA, SLE Therapeutic - ChroniLine Pre-Auth
188 Musculo-Skeletal Agents Non-steroidal anti-inflammatory agents Specific cyclo-oxygenase-2 inhibitor (COXIB) NONE LISTED
189 Musculo-Skeletal Agents Anti-gout Anti-gout Allopurinol Tab 100 MG OR TABS No Max 6 Rx/annum - Prophylactic
190 Musculo-Skeletal Agents Anti-gout Anti-gout Allopurinol Tab 300 MG OR TABS No Max 6 Rx/annum - Prophylactic
191 Musculo-Skeletal Agents Anti-gout Anti-gout Colchicine Tab 0.5 MG OR TABS A No Max 12/Rx & 3 Rx/annum
192 Musculo-Skeletal Agents Anti-gout Anti-gout Colchicine Tab 1 MG OR TABS A No Max 12/Rx & 3 Rx/annum
193 Musculo-Skeletal Agents Topical agents Topical agents Diclofenac Diethylammonium Gel 1.3% EX GEL A Yes Max 1 package/annum
194 Musculo-Skeletal Agents Topical agents Topical agents Ibuprofen Gel 5% EX GEL A Yes Max 1 package/annum
195 Musculo-Skeletal Agents Topical agents Topical agents Liniments and rubs - ointment EX GEL A Yes Max 50g package/annum
196 Musculo-Skeletal Agents Topical agents Topical agents Fusidic Acid Cream 2% EX GEL A Yes Max 50g package/annum
197 Musculo-Skeletal Agents Topical agents Topical agents Mupirocin Oint 2% EX GEL A Yes Max 50g package/annum
198 Musculo-Skeletal Agents Topical agents Topical agents Diethylamine Salicylate-B Aescin Gel 50-10MG/GM EX GEL A Yes Max 1 package/annum
199 Musculo-Skeletal Agents Topical agents Topical agents Zinc Oxide Oint 15% EX OINT C No SLE Therapeutic - ChroniLine
200 Musculo-Skeletal Agents Gold Gold NONE
201 Musculo-Skeletal Agents Centrally acting muscle relaxants Centrally acting muscle relaxants Baclofen Tab 10 MG OR TABS C No MSS Therapeutic - ChroniLine Pre-Auth
202 Musculo-Skeletal Agents Centrally acting muscle relaxants Centrally acting muscle relaxants Orphenadrine Citrate Tab 100 MG OR TABS A No Max Rx/5 days & 3 Rx/annum
203 Musculo-Skeletal Agents Others Others Sulfasalazine Tab Delayed Release 500 MG OR TBEC C No RHA, SLE, CSD, UC Therapeutic - ChroniLine Pre-Auth
204 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Bisphosphonates NONE LISTED
205 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Selective oestrogen receptor modulators NONE LISTED
206 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Calcitonin NONE LISTED
207 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Alfacalcidol Cap 0.25 MCG OR CAPS C No CRD Therapeutic - ChroniLine Pre-Auth
208 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Alfacalcidol Cap 1 MCG OR CAPS C No CRD Therapeutic - ChroniLine Pre-Auth
209 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Minerals and vitamin D Ergocalciferol Tab 50000 Unit OR CAPS C No CRD Therapeutic - ChroniLine Pre-Auth
210 Musculo-Skeletal Agents Osteoporosis (and other metabolic bone disorders) Dual action bone agents NONE LISTED
211 Autonomic Sympathomimetics Sympathomimetics Epinephrine HCl Inj 1 MG/ML INJ SOLN A No Consumables - Clinic use only
212 Autonomic Sympatholytics Sympatholytics NONE LISTED
213 Autonomic Cholinergics Cholinergics NONE LISTED
214 Autonomic Anti-cholinergics Anti-cholinergics Atropine Sulfate Inj 0.5 MG/ML INJ SOLN A No Consumables - Clinic use only
215 Autonomic Anti-cholinergics Anti-cholinergics Atropine Sulfate Inj 1 MG/ML INJ SOLN A No Consumables - Clinic use only
216 Autonomic Anti-cholinergics Anti-cholinergics Oxybutynin Chloride Tab 5 MG OR TABS C No MSS Therapeutic - ChroniLine
217 Autonomic Others Others NONE
218 Autocoids Anti-Histamines Anti-Histamines Chlorpheniramine Maleate Syrup 2 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
219 Autocoids Anti-Histamines Anti-Histamines Chlorpheniramine Maleate Tab 4 MG OR TABS A Yes Max 30/Rx & 3 Rx/annum
220 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Inj 25 MG/ML INJ SOLN A No Consumables - Clinic use only
221 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Syrup 5 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
222 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Tab 10 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
223 Autocoids Anti-Histamines Anti-Histamines Promethazine HCl Tab 25 MG OR TABS A Yes Max Rx/5 days & 3 Rx/annum
224 Autocoids Anti-Histamines Anti-Histamines Diphenhydramine-Pyrilamine Cream 1-1% EX CREA A Yes Max 1 package/Rx & 3 Rx/annum
225 Autocoids Anti-Histamines Anti-Histamines Pyrilamine Maleate Cream 2% EX CREA A Yes Max Rx/5 days & 3 Rx/annum
226 Autocoids Serotonin antagonists Serotonin antagonists NONE LISTED
227 Autocoids NK1 antagonists NK1 antagonists NONE LISTED
228 Autocoids Anti-Histamines Anti-Histamines Desloratadine SYR 0.5MG/ML OR SYRP Max 200ml/Rx & 3 Rx/annum
229 Autocoids Anti-Histamines Anti-Histamines Loratadine SYR 5MG/5ML OR SYRP Max 200ml/Rx & 3 Rx/annum
230 Autocoids Anti-Histamines Anti-Histamines Loratadine TAB 10MG OR TABS Max Rx/5 days & 3 Rx/annum
231 Autocoids Anti-Histamines Anti-Histamines CetirizineHCL ORAL Solution1MG/ML(5MG/5ML) OR SYRP Yes Max 200ml/Rx & 3 Rx/annum
232 Autocoids Anti-Histamines Anti-Histamines Cetirizine HCL TAB 10MG OR TABS Max Rx/5 days & 3 Rx/annum
233 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Elixir 0.05 MG/ML OR SYRP C No CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
234 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Tab 0.25 MG OR TABS C No CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
235 Cardio-Vascular Agents Positive inotropic agents Cardiac glycosides Digoxin Tab 62.5 MCG (0.0625 MG) OR TABS C No CHF, CMY, DYS Therapeutic - ChroniLine Pre-Auth
236 Cardio-Vascular Agents Positive inotropic agents Others NONE LISTED
237 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Amiodarone HCl Tab 100 MG OR TABS C No DYS Therapeutic - ChroniLine Pre-Auth
238 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Amiodarone HCl Tab 200 MG OR TABS C No DYS Therapeutic - ChroniLine Pre-Auth
239 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Lidocaine HCl IV Inj 10 MG/ML INJ SOLN A No Consumables - Clinic use only
240 Cardio-Vascular Agents Anti-arrhythmics Anti-arrhythmics Lidocaine HCl IV Inj 20 MG/ML INJ SOLN A No Consumables - Clinic use only
241 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 No HYP Therapeutic - ChroniLine (4th Line and Pregnancy)
242 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha-receptor blockers Doxazosin Mesylate Tab 1 MG OR TABS C No HYP Therapeutic - ChroniLine
243 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha-receptor blockers Doxazosin Mesylate Tab 4 MG OR TABS C No HYP Therapeutic - ChroniLine
244 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 No CHF, CMY, CRD, HYP Therapeutic - ChroniLine
245 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol & Chlorthalidone Tab 100-25 MG OR TABS C No CHF, CMY, CRD, HYP Therapeutic - ChroniLine
246 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol Tab 50 MG OR TABS C No CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
247 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Atenolol Tab 100 MG OR TABS C No CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
248 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Propranolol HCl Tab 10 MG OR TABS C No CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
249 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Beta-receptor blockers Propranolol HCl Tab 40 MG OR TABS C No CAD, CHF,CMY,CRD,DYS,HYP Therapeutic - ChroniLine
250 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 No CAD, CHF, CMY, CRD, HYP Therapeutic - ChroniLine
251 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Alpha- and beta-receptor blockers Carvedilol Tab 25 MG OR TABS C No CAD, CHF, CMY, CRD, HYP Therapeutic - ChroniLine
252 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Sympathetic nervous blockers Reserpine Tab 0.25 MG OR TABS C No HYP Therapeutic - ChroniLine
253 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 10 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
254 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 25 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
255 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Direct acting vasodilators Hydralazine HCl Tab 50 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
256 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers Amlodipine Besylate Tab 5 MG OR TABS C No CAD, CRD, HYP Therapeutic - ChroniLine
257 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers Amlodipine Besylate Tab 10 MG OR TABS C No CAD, CRD, HYP Therapeutic - ChroniLine
258 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Calcium channel blockers REFER TO 7.4.1 Calcium channel blockers No
259 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Captopril Tab 25 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
260 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Captopril Tab 50 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
261 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 No CHF,CMY,CRD,HYP Therapeutic - ChroniLine
262 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 5 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
263 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 10 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
264 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Enalapril Maleate Tab 20 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
265 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril & Hydrochlorothiazide Tab 10-12.5 MG OR TABS C No CHF,CMY,CRD,HYP Therapeutic - ChroniLine
266 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril & Hydrochlorothiazide Tab 20-12.5 MG OR TABS C No CHF,CMY,CRD,HYP Therapeutic - ChroniLine
267 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 5 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
268 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 10 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
269 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) ACE inhibitors Lisinopril Tab 20 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
270 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium Tab 50 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
271 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Angiotensin receptor antagonists Losartan Potassium Tab 100 MG OR TABS C No CAD,CHF,CMY,CRD,HYP Therapeutic - ChroniLine
272 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 No CHF,CMY,CRD,HYP Therapeutic - ChroniLine
273 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 No CHF,CMY,CRD,HYP Therapeutic - ChroniLine
274 Cardio-Vascular Agents Anti-hypertensives (single agents and combinations including diuretic combinations) Others NONE LISTED
275 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Diltiazem HCl Tab 60 MG OR TABS C No CAD, CRD, HYP Therapeutic - ChroniLine
276 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap 5 MG OR CAPS A No Max Rx/60 days only
277 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap 10 MG OR CAPS A No Max Rx/60 days only
278 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Cap CR 20 MG OR CPCR C No CAD, CRD, HYP Therapeutic - ChroniLine
279 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Tab SR 12HR 20 MG OR TB12 C No CAD, CRD, HYP Therapeutic - ChroniLine
280 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Nifedipine Tab SR 24HR 30 MG OR TB24 C No CAD, CRD, HYP Therapeutic - ChroniLine
281 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl IV Soln 2.5 MG/ML IV SOLN A No Consumables - Clinic use only
282 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab 40 MG OR TABS C No DYS, CAD,CRD, HYP Therapeutic - ChroniLine
283 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab 80 MG OR TABS C No DYS, CAD,CRD, HYP Therapeutic - ChroniLine
284 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers Verapamil HCl Tab CR 240 MG OR TBCR C No DYS, CAD,CRD, HYP Therapeutic - ChroniLine
285 Cardio-Vascular Agents Anti-anginal agents Calcium channel blockers REFER TO 7.3.7 Calcium channel blockers No
286 Cardio-Vascular Agents Anti-anginal agents Beta-receptor blockers REFER TO 7.3.3 Beta-receptor blockers No
287 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate SL Tab 5 MG SL TABS C No CAD, CHF, CMY Therapeutic - ChroniLine
288 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate Tab 10 MG OR TABS C No CAD, CHF, CMY Therapeutic - ChroniLine
289 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Dinitrate Tab 30 MG OR TABS C No CAD, CHF, CMY Therapeutic - ChroniLine
290 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Cap CR 50 MG OR CPCR C No CAD, CHF, CMY Therapeutic - ChroniLine
291 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Tab 20 MG OR TABS C No CAD, CHF, CMY Therapeutic - ChroniLine
292 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Isosorbide Mononitrate Tab SR 24HR 60 MG OR TB24 C No CAD, CHF, CMY Therapeutic - ChroniLine
293 Cardio-Vascular Agents Anti-anginal agents Organic nitrates Nitroglycerin SL Tab 0.5 MG SL TABS C No CAD, CHF, CMY Therapeutic - ChroniLine
294 Cardio-Vascular Agents Anti-anginal agents Others NONE LISTED
295 Cardio-Vascular Agents Other vasodilators After-load reducers NONE LISTED
296 Cardio-Vascular Agents Other vasodilators Peripheral vasodilators NONE LISTED
297 Cardio-Vascular Agents Vasoconstrictors Vasoconstrictors NONE LISTED
298 Cardio-Vascular Agents Hipolipidaemic agents Fibrates Bezafibrate Tab CR 400 MG OR TBCR C No HYL Therapeutic - ChroniLine
299 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 10 MG (Base Equivalent) OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
300 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 20 MG (Base Equivalent) OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
301 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Atorvastatin Calcium Tab 40 MG (Base Equivalent) OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
302 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 10 MG OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
303 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 20 MG OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
304 Cardio-Vascular Agents Hipolipidaemic agents HMG-CoA reductase inhibitors (Statins) Simvastatin Tab 40 MG OR TABS C No HYL Therapeutic - ChroniLine Pre-Auth
305 Cardio-Vascular Agents Hipolipidaemic agents Cholesterol absorption inhibitors NONE LISTED
306 Cardio-Vascular Agents Hipolipidaemic agents Others NONE LISTED
307 Cardio-Vascular Agents Plasma expanders Plasma expanders NONE LISTED
308 Blood and Haemopoeitic Haemostatics Haemostatics Tranexamic Acid Tab 500 MG OR TABS A No Max 20/Rx & 2 Rx/annum
309 Blood and Haemopoeitic Haemostatics Haemostatics Tranexamic Acid Tab 500 MG OR TABS C No HAE Therapeutic - ChroniLine
310 Blood and Haemopoeitic Anticoagulants Anticoagulants Warfarin Sodium Tab 5 MG OR TABS C No CHF, CMY, DYS, CAD Therapeutic - ChroniLine
311 Blood and Haemopoeitic Fibrinolytics Fibrinolytics NONE LISTED
312 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Dispersible Tab 81 MG OR TBDP C No CHF, CMY, DYS, CAD, HYL, DM1, DM2 Therapeutic - ChroniLine
313 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Tab Delayed Release 81 MG OR TBEC C No CHF, CMY, DYS, CAD, HYL, DM1, DM3 Therapeutic - ChroniLine
314 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Tab 100 MG OR TABS C No CHF, CMY, DYS, CAD, HYL, DM1, DM4 Therapeutic - ChroniLine
315 Blood and Haemopoeitic Platelet aggregation inhibitors Platelet aggregation inhibitors Aspirin Dispersible Tab 300 MG OR TBDP C No CHF, CMY, DYS, CAD, HYL, DM1, DM2, SLE, RHA Therapeutic - ChroniLine
316 Blood and Haemopoeitic Sclerosing agents Sclerosing agents NONE LISTED
317 Blood and Haemopoeitic Haematinics Haematinics Erythropoietin and Erythropoiesis Stimulating Agents (ESA) INJ SOLN No CRD Limited to Hospital Risk options only
318 Blood and Haemopoeitic Haematinics Haematinics Erythropoietin and Erythropoiesis Stimulating Agents (ESA) INJ SOLN No CRD Therapeutic - ChroniLine Pre-Auth
319 Blood and Haemopoeitic Haematinics Haematinics Erythropoietin and Erythropoiesis Stimulating Agents (ESA) INJ SOLN No CRD Reserved for Iron Therapy Failure
320 Blood and Haemopoeitic Haematinics Haematinics Iron Polymaltose-Folic Acid CAP 50-0.15 MG OR CAPS YES Max 9 Rx/annum (Gender)
321 Blood and Haemopoeitic Haematinics Haematinics Ferrous Fumarate-Folic Acid Tab 200-0.1 MG OR TABS A No Max 9 Rx/annum (Gender)
322 Blood and Haemopoeitic Haematinics Haematinics Ferrous Lactate Drops 25 MG/ML OR SOLN C No CRD Therapeutic - ChroniLine
323 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate Tab 30 MG OR TABS C No CRD Therapeutic - ChroniLine
324 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate Tab 75 MG OR TABS C No CRD Therapeutic - ChroniLine
325 Blood and Haemopoeitic Haematinics Haematinics Ferrous Sulfate-Copper-Manganese Tab 170-2.5-2.5 MG OR TABS C No CRD Therapeutic - ChroniLine
326 Blood and Haemopoeitic Haemoglobin-based oxygen carrier Haemoglobin-based oxygen carrier NONE LISTED
327 Blood and Haemopoeitic Others Others NONE LISTED
328 Alcoholism Alcoholism Alcoholism NONE LISTED
329 Respiratory System Coughs and colds Antitussives and expectorants Aminophylline-Diphenhyd-Ammon Cl-Sod Citrate Syrup OR SYRP A No Max 200ml/Rx & 3 Rx/annum
330 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 No Max 200ml/Rx & 3 Rx/annum
331 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 No Max 200ml/Rx & 3 Rx/annum
332 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine w/ Codeine-Ammon Cl Syr 12-7.5-100 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
333 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14.07-137-57 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
334 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14.1-135-55 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
335 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate Syrup 14-136-56 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
336 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate-Men Syr 12.5-125-50-1MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
337 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-AmCl-Sod Citrate-Men Syr 14-137-57-1 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
338 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-Ammonium Chloride Syrup 12.5-125 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
339 Respiratory System Coughs and colds Antitussives and expectorants Diphenhydramine-Pholcodine-GG Syr 15-8-100 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
340 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 No Max 200ml/Rx & 3 Rx/annum
341 Respiratory System Coughs and colds Antitussives and expectorants Ephedrine w/ DM-Ammonium Cl Syrup 7.5-15-125 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
342 Respiratory System Coughs and colds Antitussives and expectorants Ephedrine-Promethazine-Codeine Syrup 7.2-3.6-9 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
343 Respiratory System Coughs and colds Antitussives and expectorants Guaifenesin Syrup 100 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
344 Respiratory System Coughs and colds Antitussives and expectorants Ipecac-Squill Syrup OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
345 Respiratory System Coughs and colds Antitussives and expectorants Metaproterenol-Bromhexine Syrup 5-4 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
346 Respiratory System Coughs and colds Antitussives and expectorants Pholcodine Syrup 4.052 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
347 Respiratory System Coughs and colds Antitussives and expectorants Pseudoephedrine-Triprolidine w/ COD Syrup 30-1.25-10 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
348 Respiratory System Coughs and colds Antitussives and expectorants Pseudoephed-Triprolidine-DM Syrup 30-1.25-10 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
349 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 No Max 200ml/Rx & 3 Rx/annum
350 Respiratory System Coughs and colds Antitussives and expectorants Pseudoeph-Triprolidine w/ COD-GG Syrup 12-0.6-3-50 MG/5ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
351 Respiratory System Coughs and colds Antitussives and expectorants Theophylline-Etofylline-Diphenhyd-Ammon Cl-Sod Cit Syrup OR SYRP A No Max 200ml/Rx & 3 Rx/annum
352 Respiratory System Coughs and colds Antitussives and expectorants Theophylline-Etofylline-Diphenylpyraline-Ammon Cl Syrup OR SYRP A No Max 200ml/Rx & 3 Rx/annum
353 Respiratory System Coughs and colds Antitussives and expectorants Dextromethorphan-Amcl Syrp 15-90MG/5ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
354 Respiratory System Coughs and colds Antitussives and expectorants Terbutaline-Ammon CL-Sodium Citrate Syrup 1.25-60-25 MG/5ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
355 Respiratory System Coughs and colds Antitussives and expectorants Etofylline-Diphenhyd-Ammon CL Syrup 105.5-42.2-410.5MG/15ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
356 Respiratory System Coughs and colds Antitussives and expectorants Salbutamol-Bromhexine Syrup 2.41-4MG/5ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
357 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG OR TABS A No Max 20/Rx & 3 Rx/annum
358 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE w/ APAP-Caffeine Cap 2-5-200-30 MG OR CAPS A No Max 20/Rx & 3 Rx/annum
359 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 YES From 1 year Max 100ml/Rx & 3 Rx/annum
360 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE-APAP-Caff-Vit C Cap 2-5-300-30-75 MG OR CAPS A No Max 20/Rx & 3 Rx/annum
361 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-PE-APAP-Salicylamide-Vit C Cap 2-2-100-75-50 MG OR CAPS A No Max 20/Rx & 3 Rx/annum
362 Respiratory System Coughs and colds Decongestant, analgesic combinations Diphenhydramine-Phenyleph-APAP-Vit C Cap 10-5-400-50 MG OR CAPS A No Max 20/Rx & 3 Rx/annum
363 Respiratory System Coughs and colds Decongestant, analgesic combinations DM-Phenylpropanolamine-APAP Syrup 15-25-500 MG/20ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
364 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 No Max 20/Rx & 3 Rx/annum
365 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 No Max 200ml/Rx & 3 Rx/annum
366 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenylpropanolamine w/ Acetaminophen Cap 18-325 MG OR CAPS A No Max 24/Rx & 3 Rx/annum
367 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenylprop-Phenyltolox w/ Cod-APAP Tab 25-22-15-300 MG OR TABS A No Max 20/Rx & 3 Rx/annum
368 Respiratory System Coughs and colds Decongestant, analgesic combinations Pyrilamine-Phenylephrine-Acetaminophen Tab 5-5-500 MG OR TABS A No Max 20/Rx & 3 Rx/annum
369 Respiratory System Coughs and colds Decongestant, analgesic combinations Triprolidine-Pseudoephedrine-APAP Syrup 0.625-15-125 MG/5ML OR SYRP A No From 6 months Max 100ml/Rx & 3 Rx/annum
370 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-Pseudoephedrine W/APAP Syrup 2-5-120MG/5ML OR SYRP A YES Max 100ml/Rx & 3 Rx/annum
371 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-Phenyltolox-PE-Apap-Caff Cap 2-12.5-5-5-20 OR CAPS
372 Respiratory System Coughs and colds Decongestant, analgesic combinations Phenylephrine-APAP-Caffeine CAP 5-300-25MG OR CAPS A YES Max 20/Rx & 3 Rx/annum
373 Respiratory System Coughs and colds Decongestant, analgesic combinations Pseudoephedrine-Ibuprofen TAB 30-200MG OR TABS A YES Max 20/Rx & 3 Rx/annum
374 Respiratory System Coughs and colds Decongestant, analgesic combinations Diphenhydramine-PSE W/APAP Syrup 25-45-1000MG/20ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
375 Respiratory System Coughs and colds Decongestant, analgesic combinations Pseudoeph-Promethazine-Cod-APAP Syrup 25-25-5-120MG/5ML OR SYRP A YES Max 100ml/Rx & 3 Rx/annum
376 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorpheniramine-Phenylephrine-ASA EFFER TAB 2-7.8-325MG OR TABS A YES Max 10/Rx & 3 Rx/annum
377 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorphen-Pseudoeph-ASA VIT C EFFER TAB 4-50-600-330MG OR TABS A YES Max 12/Rx & 3 Rx/annum
378 Respiratory System Coughs and colds Decongestant, analgesic combinations Chlorpheniramine-Pseudoephedrine-Vit C Syrup 2-25-50MG/5ML OR SYRP A YES Max 100ml/Rx & 3 Rx/annum
379 Respiratory System Coughs and colds Decongestant, analgesic combinations Paracetamol-Caffeine-Vit C Packet 800-50-10MG OR SCAH A YES Max 8/Rx & 3 Rx/annum
380 Respiratory System Coughs and colds Decongestants Pseudoephedrine HCl Syrup 30 MG/5ML OR SYRP A No Max 100ml/Rx & 3 Rx/annum
381 Respiratory System Coughs and colds Decongestants Pseudoephedrine HCl Tab 60 MG OR TABS A No Max 20/Rx & 3 Rx/annum
382 Respiratory System Coughs and colds Decongestants Pseudoephedrine w/Acetaminophen liquid 15-160 MG/ OR SYRP No
383 Respiratory System Coughs and colds Decongestants Triprolidine & Pseudoephedrine Syrup 1.25-30 MG/5ML OR SYRP A No Max 100ml/Rx & 3 Rx/annum
384 Respiratory System Coughs and colds Decongestants Triprolidine & Pseudoephedrine Tab 1.25-30 MG OR TABS A No Max 20/Rx & 3 Rx/annum
385 Respiratory System Coughs and colds Decongestants Tripolidine-Pseudoephedrine-Vit C Syrup 1.25-25-75MG/5ML SYRP A YES Max 100ml/Rx & 3 Rx/annum
386 Respiratory System Coughs and colds Decongestants Tripolidine-Pseudoephedrine W/APAP TAB 2.5-60-500MG TABS A YES Max 1 package/Rx & 3 Rx/annum
387 Respiratory System Coughs and colds Decongestants Loratadine&Pseudoephedrine TAB ER 12HR 5-20MG TABS A YES Max 1 package/Rx & 3 Rx/annum
388 Respiratory System Coughs and colds Decongestants Chlorpheniramine&Phenylephrine Syr 1.25-2.5MG/5ML SYRP A YES Max 100ml/Rx & 3 Rx/annum
389 Respiratory System Bronchodilators Sympathomimetics Formoterol Fumarate Inhal Aerosol 12 UG/ACT IN AERP C No AST, BCE, COP Therapeutic - ChroniLine
390 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Cap For Inhal 200 MCG IN CAPS C No AST, BCE, COP Therapeutic - ChroniLine
391 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Inhal Aero 108 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
392 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Syrup 2 MG/5ML OR SYRP A Yes Max 200ml/Rx & 3 Rx/annum
393 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Tab 2 MG OR TABS A Yes Max 30/Rx & 3 Rx/annum
394 Respiratory System Bronchodilators Sympathomimetics Salbutamol (Albuterol) Sulfate Tab 4 MG OR TABS A Yes Max 30/Rx & 3 Rx/annum
395 Respiratory System Bronchodilators Methylxanthines and combinations Aminophylline Dihydrate Inj 25 MG/ML INJ SOLN A No Consumables - Clinic use only
396 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Syrup 80 MG/15ML OR SYRP A No Max 200ml/Rx & 3 Rx/annum
397 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Syrup 80 MG/15ML OR SYRP C No AST, BCE, COP Therapeutic - ChroniLine
398 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Tab SR 12HR 200 MG OR TB12 C No AST, BCE, COP Therapeutic - ChroniLine
399 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline Tab SR 12HR 300 MG OR TB12 C No AST, BCE, COP Therapeutic - ChroniLine
400 Respiratory System Bronchodilators Methylxanthines and combinations Theophylline-Etofylline Elixir 80-10 MG/15ML OR ELIX A No Max 200ml/Rx & 3 Rx/annum
401 Respiratory System Bronchodilators Anticholinergics Ipratropium Bromide Inhal Aerosol 40 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
402 Respiratory System Bronchodilators Combinations Ipratropium-Albuterol Aerosol 18-103 MCG/ACT (20-120MCG/ACT) IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
403 Respiratory System Mucolytics Mucolytics Acetylcysteine EFF 200MG TABS YES Max 1 package/Rx & 3 Rx/annum
404 Respiratory System Mucolytics Mucolytics Carbocysteine Cap 375 MG OR CAPS A YES Max 30/Rx & 3 Rx/annum
405 Respiratory System Mucolytics Mucolytics Carbocysteine Syrup 250 MG/5ML OR SYRP A YES Max 200ml/Rx & 3 Rx/annum
406 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 42 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
407 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 84 UG/AC IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
408 Respiratory System Anti-asthmatics Anti-asthmatics Beclomethasone Dipropionate Inhal Aero 200 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
409 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhaler Aerosol 100 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
410 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhaler Aerosol 200 UG/ACT IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
411 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhal Aero Powd 100 MCG/INH (Breath Activated) IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
412 Respiratory System Anti-asthmatics Anti-asthmatics Budesonide Inhal Aero Powd 200 MCG/INH (Breath Activated) IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
413 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort Turbu 160/4.5 60 dose IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
414 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort turbu 160/4.5 120 dose IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
415 Respiratory System Anti-asthmatics Anti-asthmatics Symbicort Inh 320/9MCG 60 dose IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
416 Respiratory System Anti-asthmatics Anti-asthmatics Albuterol Sulfate Inh Aero 108 MCG/ACT (90MCG BA IN AERO C No AST, BCE, COP Therapeutic - ChroniLine
417 Respiratory System Anti-asthmatics Anti-asthmatics Ketotifen Fumarate Syr 0.2MG/ML OR SYRP C No AST, BCE, COP Therapeutic - ChroniLine
418 Respiratory System Leukotriene receptor antagonist Leukotriene receptor antagonist NONE LISTED
419 Respiratory System Chromones Chromones NONE
420 Respiratory System Other anti-asthmatics Other anti-asthmatics NONE LISTED
421 Respiratory System Surfactants Surfactants NONE LISTED
422 Respiratory System Others Others NONE LISTED
423 Ear Nose and Throat Topical nasal preparations Antimicrobial and combinations NONE LISTED
424 Ear Nose and Throat Topical nasal preparations Glucocorticosteroids Beclomethasone Dipropionate Nasal Soln 0.05% NA SOLN A Yes Max 1/Rx & 4 Rx/annum
425 Ear Nose and Throat Topical nasal preparations Chromones NONE
426 Ear Nose and Throat Topical nasal preparations Decongestants Phenylephrine HCl Nasal Soln 0.25% NA SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
427 Ear Nose and Throat Topical nasal preparations Decongestants Phenylephrine HCl Nasal Soln 1% NA SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
428 Ear Nose and Throat Topical nasal preparations Decongestants Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML NA SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
429 Ear Nose and Throat Topical nasal preparations Antihistamines NONE LISTED
430 Ear Nose and Throat Topical nasal preparations Mucolytics NONE
431 Ear Nose and Throat Topical nasal preparations Decongestants Oxymetazoline-Zinc Sulfate Nasal SOLN 0.5-0.02MG/ML SPRY A YES Max 1 package every 30 days & 3 Rx/annum
432 Ear Nose and Throat Topical nasal preparations Decongestants Xylometazoline Hcl Nasal SOLN 0.1% SPRY A YES Max 1 package every 30 days & 3 Rx/annum
433 Ear Nose and Throat Topical nasal preparations Others Saline Nasal Spray 0.9% NA SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
434 Ear Nose and Throat Topical nasal preparations Others Saline Nasal Aerosol SOLN 0.9% NA SPRY A YES Max 1/Rx & 4 Rx/annum
435 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine Otic Soln 5% OT SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
436 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine-Benzocaine Otic Soln 5-1% OT SOLN A Yes Max 1 package every 30 days & 3 Rx/annum
437 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Antipyrine-Benzocaine-Ephedrine-Pot Oxyquinolone Otic Soln OT SOLN A No Max 1 package every 30 days & 3 Rx/annum
438 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 No Max 1 package every 30 days & 3 Rx/annum
439 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Benzocaine-Antipyrine-Chlorobutanol Otic SOLN 1-5-1% OT SOLN YES Max 1 package every 30 days & 3 Rx/annum
440 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Neomycin-Sodium Propionate Otic Soln 3-50 MG/ML OT SOLN A No Max 1 package every 30 days & 3 Rx/annum
441 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Acetic Acid Otic Soln 1% OT SOLN A No Max 1 package every 30 days & 3 Rx/annum
442 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Acetic Acid Otic Soln 2% OT SOLN A No Max 1 package every 30 days & 3 Rx/annum
443 Ear Nose and Throat Ear drops and ointments Ear drops and ointments Docusate Sodium Otic SOLN 0.5% OT SOLN YES Max 1 package every 30 days & 3 Rx/annum
444 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Benzocaine Lozenge 10 MG MT LOZG A No Max 20/Rx & 4 Rx/annum
445 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Menthol Lozenge 1 MG MT LOZG A No Max 20/Rx & 4 Rx/annum
446 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Povidone-Iodine Mouthwash 1% MT SOLN A No Max 200ml/annum
447 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Benzydamine HCL SOLN 0.15% MT SOLN YES Max 1/Rx & 3 Rx/annum
448 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Benzydamine HCL AEROSOL 0.15% MT SPRY YES Max 1/Rx & 3 Rx/annum
449 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Chlorhexidine Gluconate Soln 0.2% MT SOLN YES Max 1/Rx & 3 Rx/annum
450 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Cetylpyridinium-Benzocaine Lozenge 0.5-10MG MT LOZG YES Max 1/Rx & 3 Rx/annum
451 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations *Throat Lozenges MT LOZG YES Max 1/Rx & 3 Rx/annum
452 Ear Nose and Throat Mouth and throat preparations Mouth and throat preparations Tetracaine HCl Ointment 0.5% MT OINT A No Max 1 package/annum
453 Gastro-Intestinal Tract Digestants Digestants NONE LISTED
454 Gastro-Intestinal Tract Appetite suppressants Appetite suppressants NONE LISTED
455 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Inj 20 MG/ML INJ SOLN A No Consumables - Clinic use only
456 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Syr 5 MG/5ML OR SYRP A Yes Max 100ml/Rx & 3 Rx/annum
457 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Scopolamine N-Butylbromide Tab 10 MG OR TABS A Yes Max 20/Rx & 4 Rx/annum
458 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics Mebeverine HCl Tab 135 MG OR TABS A Yes Max 30/Rx & 4 Rx/annum
459 Gastro-Intestinal Tract Anti-Spasmodics Anti-Spasmodics PB-Hyoscy-Atropine-Scopolamine Tab 15-0.104-0.02-0.006 MG OR TABS A No Max 30/Rx & 4 Rx/annum
460 Gastro-Intestinal Tract Acid reducers Antacids Aluminum Hydroxide-Mag Oxide Susp 282-120 MG/15ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
461 Gastro-Intestinal Tract Acid reducers Antacids Cal & Mag Carb-Mag Trisilicate Susp 250-250-500 MG/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
462 Gastro-Intestinal Tract Acid reducers Antacids Mag Carb-Mag Trisilicate-Sod Bicarb Susp 250-250-250 MG/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
463 Gastro-Intestinal Tract Acid reducers Antacids Mag Carb-Mag Trisilicate-Sod Bicarb Susp 500-500-500 MG/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
464 Gastro-Intestinal Tract Acid reducers Antacids Aluminum Hydroxide Gel SUSP 300MG/5ML OR SUSP Yes Max 200ml/Rx & 3 Rx/annum
465 Gastro-Intestinal Tract Acid reducers Antacids and combinations Al & Mg Oxides-Dicycl-Methylcell-Simeth Susp OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
466 Gastro-Intestinal Tract Acid reducers Antacids and combinations Al Hyd-Mag Oxide-Dicyclomine-Dimeth Susp 400-200-5-50MG/10ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
467 Gastro-Intestinal Tract Acid reducers Antacids and combinations Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
468 Gastro-Intestinal Tract Acid reducers Antacids and combinations Alum Oxide-Mag Oxide-Dicyclomine Gel 200-200-5 MG/10ML OR GEL A Yes Max 200ml/Rx & 3 Rx/annum
469 Gastro-Intestinal Tract Acid reducers Antacids and combinations Sodium Alginate-Sodium Bicarbonate SUSP 1000-267MG/10ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
470 Gastro-Intestinal Tract Acid reducers Antacids and combinations *Included in Sodium Alginate-Sodium Bicarbonate SUSP (above) OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
471 Gastro-Intestinal Tract Acid reducers Antacids and combinations Alum&Mag Hydroxide-Simethicone SUSP 225-200-25MG/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
472 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Cimetidine Tab 200 MG OR TABS C No Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
473 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Cimetidine Tab 400 MG OR TABS C No Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
474 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Ranitidine HCl Tab 150 MG OR TABS C No Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
475 Gastro-Intestinal Tract Acid reducers Histamine-2 receptor antagonists Ranitidine HCl Tab 300 MG OR TABS C No Therapeutic - ChroniLine - 30 days / Gastroscopy - 90 days
476 Gastro-Intestinal Tract Acid reducers Proton pump inhibitors NONE LISTED
477 Gastro-Intestinal Tract Acid reducers Cytoprotective agents NONE LISTED
478 Gastro-Intestinal Tract Acid reducers Other acid reducers NONE
479 Gastro-Intestinal Tract Proton pump inhibitors Proton pump inhibitors Lansoprazole Cap Delayed Release 15mg OR CAPS Yes 3 Rx/annum
480 Gastro-Intestinal Tract Motility enhancers Motility enhancers REFER TO 1.8 Anti-Vertigo and anti-emetic agents No
481 Gastro-Intestinal Tract Laxatives Laxatives Bisacodyl Tab Delayed Release 5 MG OR TBEC A No Max 30/Rx & 2 Rx/annum
482 Gastro-Intestinal Tract Laxatives Laxatives Lactulose Solution 10 G/15ML OR SOLN A Yes Max 200ml/Rx & 2 Rx/annum
483 Gastro-Intestinal Tract Laxatives Laxatives Sennosides Tab 7.5 MG OR TABS A Yes Max 30/Rx & 2 Rx/annum
484 Gastro-Intestinal Tract Laxatives Laxatives Sodium Phosphates - Enema RE ENEM A Yes Max 1 package/Rx & 2 Rx/annum
485 Gastro-Intestinal Tract Laxatives Laxatives Bisacodyl suppos 10 MG RE SUPP Yes Max 1 package/Rx & 2 Rx/annum
486 Gastro-Intestinal Tract Laxatives Laxatives Glycerin SUPPOS RE SUPP Yes Max 1 package/Rx & 2 Rx/annum
487 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Susp 1-0.05 GM/5ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
488 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Liquid 3-0.15 GM/15ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
489 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin Susp 6-0.45 GM/30ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
490 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin w/ Electrolytes Susp 6-0.12 GM/30ML OR SUSP A Yes Max 200ml/Rx & 3 Rx/annum
491 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Loperamide HCl Syrup 1 MG/5ML OR SYRP A Yes Max 50ml/Rx & 3 Rx/annum
492 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Loperamide HCl Tab 2 MG OR TABS A Yes Max 20/Rx & 3 Rx/annum
493 Gastro-Intestinal Tract Liver, gall bladder and bile Liver, gall bladder and bile NONE LISTED
494 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Kaolin-Pectin-Chlorodyne W/Electrolytes SUSP OR SUSP A Yes Max 1 package/Rx & 3 Rx/annum
495 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Gelatin Tannate CAP 500MG OR CAPS A Yes Max 1 package/Rx & 3 Rx/annum
496 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals Gelatin Tannate PACKET 250MG OR SACHET A Yes Max 1 package/Rx & 3 Rx/annum
497 Gastro-Intestinal Tract Antidiarrhoeals Antidiarrhoeals *Banana Flakes Pack OR SACHET A Yes Max 1 package/Rx & 3 Rx/annum
498 Gastro-Intestinal Tract Suppositories and anal ointments Suppositories and anal ointments Hemorrhoidal Anesthetic Compound - Supp RE SUPP A Yes Max 1 package/Rx & 3 Rx/annum
499 Gastro-Intestinal Tract Suppositories and anal ointments Suppositories and anal ointments Pramoxine HCl Rectal Oint 1% RE OINT A No Max 1 package/Rx & 3 Rx/annum
500 Gastro-Intestinal Tract Others Others Budesonide Enema Kit 0.02 MG/ML RE KIT C No CSD, UC Therapeutic - ChroniLine Pre-Auth
501 Gastro-Intestinal Tract Others Others Mesalamine Suppos 500 MG RE SUPP C No CSD, UC Therapeutic - ChroniLine Pre-Auth
502 Gastro-Intestinal Tract Others Others Mesalamine Suppos 1000 MG RE SUPP C No CSD, UC Therapeutic - ChroniLine Pre-Auth
503 Gastro-Intestinal Tract Others Others Mesalamine Enema 2 GM RE ENEM C No CSD, UC Therapeutic - ChroniLine Pre-Auth
504 Gastro-Intestinal Tract Others Others Mesalamine Tab CR 500 MG OR TBCR C No CSD, UC Therapeutic - ChroniLine Pre-Auth
505 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 400 MG OR TBEC C No CSD, UC Therapeutic - ChroniLine Pre-Auth
506 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 800 MG OR TBEC C No CSD, UC Therapeutic - ChroniLine Pre-Auth
507 Gastro-Intestinal Tract Others Others Mesalamine Tab Delayed Release 1.2 GM OR TBEC C No CSD, UC Therapeutic - ChroniLine Pre-Auth
508 Gastro-Intestinal Tract Others Others Olsalazine Sodium Cap 250 MG OR CAPS C No CSD, UC Therapeutic - ChroniLine Pre-Auth
509 Gastro-Intestinal Tract Others Others Sulfasalazine Tab 500 MG OR TABS C No CSD, RHA, UC Therapeutic - ChroniLine Pre-Auth
510 Gastro-Intestinal Tract Others Others *Lactobacillus-PACKET** OR SACH A No Max 1 package/Rx & 3 Rx/annum
511 Gastro-Intestinal Tract Others Others *Probiotic Product-CAP* OR CAPS A No Max 30/Rx & 3 Rx/annum
512 Gastro-Intestinal Tract Others Others *Probiotic Product-CHEW TAB* OR CHEW A No Max 30/Rx & 3 Rx/annum
513 Gastro-Intestinal Tract Others Others *Probiotic Product-LIQUID* OR SOLN A No Max 1 package/Rx & 3 Rx/annum
514 Gastro-Intestinal Tract Others Others Saccharomyces Boulardii CAP 250MG OR CAPS A No Max 1 package/Rx & 3 Rx/annum
515 Gastro-Intestinal Tract Others Others *Lactobacillus CAP** OR CAPS A No Max 30/Rx & 3 Rx/annum
516 Gastro-Intestinal Tract Others Others *Lactobacillus Reuteri CHEW TAB** OR C HEW A No Max 30/Rx & 3 Rx/annum
517 Gastro-Intestinal Tract Others Others *Lactobacillus-LIQUID** OR SOLN A No Max 1 package/Rx & 3 Rx/annum
518 Antihelmintics Antihelmintics Antihelmintics Albendazole Susp 100 MG/5ML OR SUSP A No Max 1 package/Rx & 2 Rx/annum
519 Antihelmintics Antihelmintics Antihelmintics Mebendazole Susp 20 MG/ML OR SUSP A Yes Max 1 package/Rx & 2 Rx/annum
520 Antihelmintics Antihelmintics Antihelmintics Mebendazole Tab 100 MG OR TABS A Yes Max 1 package/Rx & 2 Rx/annum
521 Antihelmintics Antihelmintics Antihelmintics Praziquantel Tab 600 MG OR TABS A No Max 1 package/Rx & 2 Rx/annum
522 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Mupirocin Calcium CREAM 2% EX CREA A Yes Max 1 package/Rx & 2 Rx/annum
523 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Povidone-Iodine CREAM 5% EX CREA A Yes Max 1 package/Rx & 2 Rx/annum
524 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Iodoquinol-Chlorobutanol-Benzocaine Cream 30-10-10 MG/GM EX CREA A Yes Max 1 package/Rx & 2 Rx/annum
525 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Nitrofurazone Oint 0.2% EX OINT A Yes Max 1 package/Rx & 2 Rx/annum
526 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Povidone-Iodine Oint 10% EX OINT A Yes Max 1 package/Rx & 2 Rx/annum
527 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Mupirocin Calcium OINTMENT 2% EX OINT A Yes Max 1 package/Rx & 2 Rx/annum
528 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Silver Sulfadiazine Cream 1% EX CREA A Yes Max 1 package/Rx & 2 Rx/annum
529 Dermatologicals Anti-bacterial antiseptic agents Anti-bacterial antiseptic agents Sulfanilamide-Mercurochrome-Peru Balsam-Cod Liver Oil Oint EX OINT A No Max 1 package/Rx & 2 Rx/annum
530 Dermatologicals Anti-parasitics Anti-parasitics Benzyl Benzoate Emulsion 25% EX EMUL A Yes Max 200ml/Rx & 2 Rx/annum
531 Dermatologicals Anti-parasitics Anti-parasitics Sulfiram Bar 5% EX BAR A Yes Max 2 bars/Rx & 2 Rx/annum
532 Dermatologicals Fungicides Fungicides Clotrimazole Cream 1% EX CREA A Yes Max 1 package/Rx & 2 Rx/annum
533 Dermatologicals Fungicides Fungicides Terbinafine HCL CREAM 1% CREA A Yes Max 1 package/Rx & 2 Rx/annum
534 Dermatologicals Fungicides Fungicides Nystatin OINT OINT A Yes Max 1 package/Rx & 2 Rx/annum
535 Dermatologicals Cortico-steroids Cortico-steroids (topical) Betamethasone Valerate Cream 0.1% EX CREA A C No SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
536 Dermatologicals Cortico-steroids Cortico-steroids (topical) Betamethasone Valerate Oint 0.1% EX OINT A C No SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
537 Dermatologicals Cortico-steroids Cortico-steroids (topical) Fluocinolone Acetonide Cream 0.025% EX CREA A C No SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
538 Dermatologicals Cortico-steroids Cortico-steroids (topical) Fluocinolone Acetonide Oint 0.025% EX OINT A C No SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
539 Dermatologicals Cortico-steroids Cortico-steroids (topical) Hydrocortisone Acetate Cream 1% EX CREA A C Yes SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
540 Dermatologicals Cortico-steroids Cortico-steroids (topical) Hydrocortisone Cream 1% EX CREA A C Yes SLE Max 1 package/Rx & 2 Rx/annum / Therapeutic - ChroniLine
541 Dermatologicals Cortico-steroids Cortico-steroids with anti-infective agents Iodoquinol-Chlorobutanol-HC Cream 3-1-0.25% EX CREA A No Max 1 package/Rx & 2 Rx/annum
542 Dermatologicals Cortico-steroids Cortico-steroids with anti-infective agents Neomycin-HC Ace Cream 1% EX CREA A No Max 1 package/Rx & 2 Rx/annum
543 Dermatologicals Psoriasis Psoriasis Coal Tar Cream 1% EX CREA C No Therapeutic - ChroniLine
544 Dermatologicals Psoriasis Psoriasis Coal Tar Liquid EX LIQD C No Therapeutic - ChroniLine
545 Dermatologicals Psoriasis Psoriasis Coal Tar Shampoo 5% EX SHAM C No Therapeutic - ChroniLine
546 Dermatologicals Acne Acne NONE LISTED
547 Dermatologicals Melanin inhibitors and stimulants Melanin inhibitors and stimulants NONE
548 Dermatologicals Emollients and protectives Emollients and protectives Calamine Phenolated Lotion EX LOTN A Yes Max 100ml/Rx & 3 Rx/annum
549 Dermatologicals Others Others Diphenhydramine-Calamine-Phenol Lotion 1-15-0.4% EX LOTN A No Max 100ml/Rx & 3 Rx/annum
550 Ophthalmics Anti-infectives Anti-infectives Chloramphenicol Ophth Oint 1% OP OINT A No Max 1 package/Rx & 3 Rx/annum
551 Ophthalmics Anti-infectives Anti-infectives Sulfacetamide Sodium Ophth Oint 10% OP OINT A Yes Max 1 package/Rx & 3 Rx/annum
552 Ophthalmics Anti-infectives Antivirals NONE LISTED
553 Ophthalmics Corticoids Corticoids NONE LISTED
554 Ophthalmics Combinations (Anti-infectives with corticoids) Combinations (Anti-infectives with corticoids) NONE LISTED
555 Ophthalmics Decongestants Decongestants Oxymetazoline HCl Ophth Soln 0.025% OP SOLN A Yes Max 1 package/Rx & 3 Rx/annum
556 Ophthalmics Decongestants Decongestants Phenylephrine-Boric Acid Ophth Soln 1.25-20 MG/ML OP SOLN A Yes Max 1 package/Rx & 3 Rx/annum
557 Ophthalmics Mydriatics Mydriatics Atropine Sulfate Ophth Soln 1% OP SOLN A No Max 1 package/Rx & 3 Rx/annum
558 Ophthalmics Glaucoma Glaucoma Bimatoprost Ophth Soln 0.01% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
559 Ophthalmics Glaucoma Glaucoma Bimatoprost-Timolol Maleate Ophth Soln 0.03-0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
560 Ophthalmics Glaucoma Glaucoma Brimonidine Tartrate Ophth Soln 0.2% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
561 Ophthalmics Glaucoma Glaucoma Brimonidine Tartrate-Timolol Maleate Ophth Soln 0.2-0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
562 Ophthalmics Glaucoma Glaucoma Brinzolamide-Timolol Ophth Susp 1-0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
563 Ophthalmics Glaucoma Glaucoma Dorzolamide HCl Ophth Soln 2% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
564 Ophthalmics Glaucoma Glaucoma Dorzolamide HCl-Timolol Maleate Ophth Soln 22.3-6.8 MG/ML OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
565 Ophthalmics Glaucoma Glaucoma Latanoprost Ophth Soln 0.005% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
566 Ophthalmics Glaucoma Glaucoma Latanoprost-Timolol Maleate Ophth Soln 0.005-0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
567 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 1% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
568 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 2% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
569 Ophthalmics Glaucoma Glaucoma Pilocarpine HCl Ophth Soln 4% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
570 Ophthalmics Glaucoma Glaucoma Timolol Maleate Ophth Soln 0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
571 Ophthalmics Glaucoma Glaucoma Travoprost Ophth Soln 0.004% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
572 Ophthalmics Glaucoma Glaucoma Travoprost-Timolol Maleate Ophth Soln 0.004-0.5% OP SOLN C No GLC Therapeutic - ChroniLine Pre-Auth
573 Ophthalmics Others Others Cromolyn Sodium Ophth Soln 2% OP SOLN A Yes Max 1 package/Rx & 3 Rx/annum
574 Urinary System Diuretics Diuretics Amiloride & Hydrochlorothiazide Tab 5-50 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
575 Urinary System Diuretics Diuretics Furosemide Inj 10 MG/ML INJ SOLN A No Consumables - Clinic use only
576 Urinary System Diuretics Diuretics Furosemide Tab 40 MG OR TABS C No CHF, CMY, CRD, HYP Therapeutic - ChroniLine
577 Urinary System Diuretics Diuretics Hydrochlorothiazide Tab 12,5 MG OR TABS C No CHF, CMY, CRD, HYP Therapeutic - ChroniLine
578 Urinary System Diuretics Diuretics Hydrochlorothiazide Tab 25 MG OR TABS C No CHF, CMY, CRD, HYP Therapeutic - ChroniLine
579 Urinary System Diuretics Diuretics Hydrochlorothiazide-Potassium Chloride Tab 50-300 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
580 Urinary System Diuretics Diuretics Indapamide Tab 2.5 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
581 Urinary System Diuretics Diuretics Spironolactone Tab 25 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
582 Urinary System Diuretics Diuretics Triamterene & Hydrochlorothiazide Tab 50-25 MG OR TABS C No CHF, CMY, HYP Therapeutic - ChroniLine
583 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Nasal Solution 0.01% (Refridgerated) NA SOLN C No DBI, HAE Therapeutic - ChroniLine Pre-Auth
584 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Tab 0.1 MG OR TABS C No DBI, HAE Therapeutic - ChroniLine Pre-Auth
585 Urinary System Anti-diuretics Anti-diuretics Desmopressin Acetate Tab 0.2 MG OR TABS C No DBI, HAE Therapeutic - ChroniLine Pre-Auth
586 Urinary System Urinary alkalinizers Urinary alkalinizers Potassium Citrate & Citric Acid Soln 20-4% OR SOLN A Yes Max 200ml/Rx & 3 Rx/annum
587 Urinary System Urinary alkalinizers Urinary alkalinizers Sod Bicarb-Sod Citrate-Citric Acid Tartatic ACD EFF GRAN OR GRAN A Yes Max 1 package/Rx & 3 Rx/annum
588 Urinary System Urinary antiseptics Urinary antiseptics NONE LISTED
589 Urinary System Others Others NONE LISTED
590 Genital System Contraceptives Contraceptives NONE LISTED
591 Urinary System Others Others Flavoxate HCL TAB 200mg OR TABS A Yes Max 1 package/Rx & 3 Rx/annum
592 Genital System Vaginal Preparations Vaginal Preparations Aminacrine-Iodoquinol-Boric Acd-Cetylpyridinium Vag Gel VA GEL A No Max 1 package/Rx & 3 Rx/annum
593 Genital System Vaginal Preparations Vaginal Preparations Clotrimazole Vaginal Cream 1% VA CREA A Yes Max 1 package/Rx & 3 Rx/annum
594 Genital System Oxytocics Oxytocics Ergonovine Maleate Inj 0.5 MG/ML INJ SOLN A No Consumables - Clinic use only
595 Genital System Uterine antispasmodics Uterine antispasmodics NONE LISTED
596 Genital System Sexual dysfunction Others NONE
597 Genital System Sexual dysfunction Erectile dysfunction NONE LISTED
598 Genital System Ántispasmodics Ántispasmodics *Already included in Scopolamine N-Butylbromide TABS No Max 1 package/Rx & 2 Rx/annum
599 Genital System Ántispasmodics Ántispasmodics *Already included in Scopolamine N-Butylbromide TABS No Max 1 package/Rx & 2 Rx/annum
600 Genital System Ántispasmodics Ántispasmodics *Already included in Mebeverine HCL TAB TABS No Max 1 package/Rx & 2 Rx/annum
601 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML OR SUSR A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
602 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML OR SUSR A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
603 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML OR SUSR A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
604 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 250-125 MG OR TABS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
605 Antimicrobials Beta-Lactams Penicillins Amoxicillin & K Clavulanate Tab 500-125 MG OR TABS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
606 Antimicrobials Beta-Lactams Penicillins Amoxicillin Cap 250 MG OR CAPS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
607 Antimicrobials Beta-Lactams Penicillins Amoxicillin Cap 500 MG OR CAPS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
608 Antimicrobials Beta-Lactams Penicillins Amoxicillin For Susp 125 MG/5ML OR SUSR A C No BCE Max 4 fills/annum
609 Antimicrobials Beta-Lactams Penicillins Amoxicillin For Susp 250 MG/5ML OR SUSR A C No BCE Max 4 fills/annum
610 Antimicrobials Beta-Lactams Penicillins Amoxicillin-Floxacillin Cap 250-250 MG OR CAPS A No Max 4 fills/annum
611 Antimicrobials Beta-Lactams Penicillins Amoxicillin-Floxacillin For Susp 125-125 MG/5ML OR SUSR A No Max 4 fills/annum
612 Antimicrobials Beta-Lactams Penicillins Ampicillin Cap 250 MG OR CAPS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
613 Antimicrobials Beta-Lactams Penicillins Ampicillin For Susp 125 MG/5ML OR SUSR A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
614 Antimicrobials Beta-Lactams Penicillins Ampicillin-Cloxacillin Cap 250-250 MG OR CAPS A No Max 4 fills/annum
615 Antimicrobials Beta-Lactams Penicillins Ampicillin-Cloxacillin For Susp 125-125 MG/5ML OR SUSR A No Max 4 fills/annum
616 Antimicrobials Beta-Lactams Penicillins Cloxacillin Sodium Cap 250 MG OR CAPS A No Max 4 fills/annum
617 Antimicrobials Beta-Lactams Penicillins Cloxacillin Sodium Cap 500 MG OR CAPS A No Max 4 fills/annum
618 Antimicrobials Beta-Lactams Penicillins Floxacillin Sodium Cap 250 MG OR CAPS A No Max 4 fills/annum
619 Antimicrobials Beta-Lactams Penicillins Penicillin G Benzathine For Intramuscular Susp 1200000 Unit IM SUSR A No Consumables - Clinic use only
620 Antimicrobials Beta-Lactams Penicillins Penicillin G Benzathine For Intramuscular Susp 2400000 Unit IM SUSR A No Consumables - Clinic use only
621 Antimicrobials Beta-Lactams Penicillins Penicillin G Procaine Intramuscular Susp 300000 Unit/ML IM SUSP A No Consumables - Clinic use only
622 Antimicrobials Beta-Lactams Penicillins Penicillin G Sodium For Inj 1000000 Unit IM SUSR A No Consumables - Clinic use only
623 Antimicrobials Beta-Lactams Penicillins Penicillin G Sodium For Inj 5000000 Unit IM SUSR A No Consumables - Clinic use only
624 Antimicrobials Beta-Lactams Penicillins Penicillin V Potassium For Soln 125 MG/5ML OR SUSR A No Max 4 fills/annum
625 Antimicrobials Beta-Lactams Penicillins Penicillin V Potassium Tab 250 MG OR TABS A No Max 4 fills/annum
626 Antimicrobials Beta-Lactams Cephalosporins No
627 Antimicrobials Beta-Lactams 1st generation Cefazolin Sodium For Inj 1 GM INJ SOLR A No Consumables - Clinic use only
628 Antimicrobials Beta-Lactams 1st generation Cephalexin Cap 250 MG OR CAPS A No Max 4 fills/annum
629 Antimicrobials Beta-Lactams 1st generation Cephalexin Cap 500 MG OR CAPS A No Max 4 fills/annum
630 Antimicrobials Beta-Lactams 1st generation Cephalexin For Susp 125 MG/5ML OR SUSR A No Max 4 fills/annum
631 Antimicrobials Beta-Lactams 1st generation Cephalexin For Susp 250 MG/5ML OR SUSR A No Max 4 fills/annum
632 Antimicrobials Beta-Lactams 2nd generation Cefoxitin Sodium For Inj 1 G IV SOLR A No Consumables - Clinic use only
633 Antimicrobials Beta-Lactams 2nd generation Cefuroxime Sodium For Inj 250 MG INJ SOLR A No Consumables - Clinic use only
634 Antimicrobials Beta-Lactams 2nd generation Cefuroxime Sodium For Inj 750 MG INJ SOLR A No Consumables - Clinic use only
635 Antimicrobials Beta-Lactams 3rd generation Cefotaxime Sodium For Inj 500 MG INJ SOLR A No Consumables - Clinic use only
636 Antimicrobials Beta-Lactams 3rd generation Ceftriaxone Sodium For Inj 1 G INJ SOLR A No Consumables - Clinic use only
637 Antimicrobials Others Others NONE LISTED
638 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Cap 250 MG OR CAPS A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
639 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Susp 125 MG/5ML OR SUSP A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
640 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Estolate Susp 250 MG/5ML OR SUSP A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
641 Antimicrobials Erythromycin and other macrolides Erythromycin and other macrolides Erythromycin Stearate Tab 250 MG OR SUSP A C No BCE Max 4 fills/annum / Therapeutic - ChroniLine
642 Antimicrobials Aminoglycosides Aminoglycosides Gentamicin Sulfate Inj 40 MG/ML INJ SOLN A No Consumables - Clinic use only
643 Antimicrobials Aminoglycosides Aminoglycosides Streptomycin Sulfate Inj 1000 MG/3ML INJ SOLN A No Consumables - Clinic use only
644 Antimicrobials Tetracyclines Tetracyclines Doxycycline Hyclate Cap 100 MG OR CAPS A No BCE Max 4 fills/annum / Therapeutic - ChroniLine
645 Antimicrobials Tetracyclines Tetracyclines Oxytetracycline HCl Cap 250 MG OR CAPS A No Max 4 fills/annum
646 Antimicrobials Chloramphenicols Chloramphenicols Chloramphenicol Cap 250 MG OR CAPS A No Max 4 fills/annum
647 Antimicrobials Chloramphenicols Chloramphenicols Chloramphenicol Susp 125 MG/5ML OR SUSP A No Max 4 fills/annum
648 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML IV SOLN A No Consumables - Clinic use only
649 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML OR SUSP A No Max 4 fills/annum / Therapeutic - ChroniLine
650 Antimicrobials Sulphonamides and combinations Sulphonamides and combinations Sulfamethoxazole-Trimethoprim Tab 400-80 MG OR TABS A No Max 4 fills/annum / Therapeutic - ChroniLine
651 Antimicrobials Quinolones Quinolones Ciprofloxacin HCl Tab 250 MG OR TABS A No BCE, CSD Max 4 fills/annum
652 Antimicrobials Quinolones Quinolones Ciprofloxacin HCl Tab 500 MG OR TABS A No BCE, CSD Max 4 fills/annum
653 Antimicrobials Mycobacteria Tuberculostatics Ethambutol HCl Tab 400mg OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
654 Antimicrobials Mycobacteria Tuberculostatics Isoniazid Tab 100mg OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
655 Antimicrobials Mycobacteria Tuberculostatics Isoniazid Tab 200mg OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
656 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab 100-150 MG OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
657 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab 150-300 MG OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
658 Antimicrobials Mycobacteria Tuberculostatics Isoniazid & Rifampin Tab Disp 60-30 MG OR TBDP No CDL Therapeutic - ChroniLine Pre-Auth
659 Antimicrobials Mycobacteria Tuberculostatics Isoniazid-Rifampin-Ethamb-Pyrazinamide Tab 75-150-275-400 MG OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
660 Antimicrobials Mycobacteria Anti-leprotics Dapsone Tab 100 MG OR TABS No CDL Therapeutic - ChroniLine Pre-Auth
661 Antimicrobials Other anti-bacterial agents Other anti-bacterial agents Clindamycin HCl Cap 150 MG OR CAPS A No Max 2 fills/annum
662 Antimicrobials Anti-fungal agents Anti-fungal agents Fluconazole Cap 150 MG OR CAPS A No Max 2 fills/annum / Therapeutic - ChroniLine
663 Antimicrobials Anti-fungal agents Anti-fungal agents Nystatin Susp 100000 Unit/ML MT SUSP A Yes Max 2 fills/annum
664 Antimicrobials Anti-protozoal agents Anti-protozoal agents Chloroquine Sulfate Cap 200 MG OR CAPS C No RHA, SLE Therapeutic - ChroniLine
665 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Susp 200 MG/5ML OR SUSP A No Max 3 fills/annum
666 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 200 MG OR TABS A C No CSD Max 3 fills/annum / Therapeutic - ChroniLine
667 Antimicrobials Anti-protozoal agents Anti-protozoal agents Metronidazole Tab 400 MG OR TABS A C No CSD Max 3 fills/annum / Therapeutic - ChroniLine
668 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Cream 5% EX CREA A Yes Max 1 Rx/annum
669 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab 200 MG OR TABS A No Max 1 Rx/annum
670 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab 400 MG OR TABS A No Max 1 Rx/annum
671 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab Disp 200 MG OR TBDP A No Max 1 Rx/annum
672 Antimicrobials Anti-viral agents Anti-viral agents Acyclovir Tab Disp 400 MG OR TBDP A No Max 1 Rx/annum
673 Antimicrobials Anti-viral agents Anti-viral agents Penciclovir Cream 1% EX CREA YES Max 2 Rx/annum
674 Antimicrobials Anti-retroviral agents Anti-retroviral agents According to HIV Disease Management Programme (DMP) No
675 Endocrine System Anti-diabetic agents Insulins No
676 Endocrine System Anti-diabetic agents Rapid acting Insulins Insulin Lispro (Human) Inj 100 Unit/ML (10ml vial) SC SOLN C No DM1, DM2 Therapeutic - ChroniLine
677 Endocrine System Anti-diabetic agents Insulin Aspart Inj 100 Unit/ML (10ml vial) SC SOLN C No DM1, DM2 Therapeutic - ChroniLine
678 Endocrine System Anti-diabetic agents Insulin Glulisine Subcutaneous Inj 100 Unit/ML (10ml vial) SC SOLN C No DM1, DM2 Therapeutic - ChroniLine
679 Endocrine System Anti-diabetic agents Short acting Insulins Insulin Regular (Human) Inj 100 Unit/ML SC SOLN C No DM1, DM2 Therapeutic - ChroniLine
680 Endocrine System Anti-diabetic agents Intermediate acting Insulins Insulin Isophane (Human) Inj 100 Unit/ML SC SUSP C No DM1, DM2 Therapeutic - ChroniLine
681 Endocrine System Anti-diabetic agents Biphasic Insulins Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (75-25) SC SUSP C No DM1, DM2 Therapeutic - ChroniLine
682 Endocrine System Anti-diabetic agents Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (50-50) SC SUSP C No DM1, DM2 Therapeutic - ChroniLine
683 Endocrine System Anti-diabetic agents Insulin Aspart Prot & Aspart (Human) Inj 100 Unit/ML (70-30) SC SUSP C No DM1, DM2 Therapeutic - ChroniLine
684 Endocrine System Anti-diabetic agents Insulin Isophane & Regular (Human) Inj 100 Unit/ML (70-30) SC SUSP C No DM1, DM2 Therapeutic - ChroniLine
685 Endocrine System Anti-diabetic agents Oral anti-diabetic agents Gliclazide Tab 80 MG OR TABS C No DM2 Therapeutic - ChroniLine
686 Endocrine System Anti-diabetic agents Gliclazide Tab SR 24HR 30 MG OR TABS C No DM2 Therapeutic - ChroniLine
687 Endocrine System Anti-diabetic agents Gliclazide Tab SR 24HR 60 MG OR TABS C No DM2 Therapeutic - ChroniLine
688 Endocrine System Anti-diabetic agents Metformin HCl Tab 500 MG OR TABS C No DM2 Therapeutic - ChroniLine
689 Endocrine System Anti-diabetic agents Metformin HCl Tab 850 MG OR TABS C No DM2 Therapeutic - ChroniLine
690 Endocrine System Anti-diabetic agents Metformin HCl Tab 1000 MG OR TABS C No DM2 Therapeutic - ChroniLine
691 Endocrine System Anti-diabetic agents GLP-1 agonists NONE LISTED
692 Endocrine System Anti-hypoglycaemic agents Anti-hypoglycaemic agents Glucagon For Inj Kit 1 MG INJ KIT No CDL Therapeutic - ChroniLine Pre-Auth
693 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 100 UG OR TABS C No TDH Therapeutic - ChroniLine
694 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 50 UG OR TABS C No TDH Therapeutic - ChroniLine
695 Endocrine System Thyroid Thyroid Levothyroxine Sodium Tab 25 UG OR TABS C No TDH Therapeutic - ChroniLine
696 Endocrine System Parathyroid and calcitonin Parathyroid and calcitonin NONE LISTED
697 Endocrine System Corticosteroids Corticosteroids Betamethasone Sodium Phosphate Inj 4 MG/ML INJ SOLN A No Consumables - Clinic use only
698 Endocrine System Corticosteroids Corticosteroids Betamethasone Syrup 0.6 MG/5ML OR SYRP A No Max 3 fills/annum
699 Endocrine System Corticosteroids Corticosteroids Dexamethasone Sodium Phosphate Inj 4 MG/ML INJ SOLN A No Consumables - Clinic use only
700 Endocrine System Corticosteroids Corticosteroids Fludrocortisone Acetate Tab 0.1 MG OR TABS C No ADS Therapeutic - ChroniLine Pre-Auth
701 Endocrine System Corticosteroids Corticosteroids Hydrocortisone Sodium Succinate For Inj 100 MG INJ SOLN A No Consumables - Clinic use only
702 Endocrine System Corticosteroids Corticosteroids Hydrocortisone Tab 10 MG OR TABS C No ADS Therapeutic - ChroniLine Pre-Auth
703 Endocrine System Corticosteroids Corticosteroids Prednisolone Syrup 15 MG/5ML OR SYRP A No Max 3 fills/annum
704 Endocrine System Corticosteroids Corticosteroids Prednisolone Tab 5 MG OR TABS A No Max 3 fills/annum
705 Endocrine System Corticosteroids Corticosteroids Prednisolone Tab 5 MG OR TABS C No ADS, AST, BCE, COP, CSD, UC, RHA, SLE Therapeutic - ChroniLine
706 Endocrine System Corticosteroids Corticosteroids Prednisone Tab 5 MG OR TABS A No Max 3 fills/annum
707 Endocrine System Corticosteroids Corticosteroids Prednisone Tab 5 MG OR TABS C No ADS, AST, BCE, COP, CSD, UC, RHA, SLE Therapeutic - ChroniLine
708 Endocrine System Sex hormones Androgens and anabolic steroids NONE LISTED
709 Endocrine System Sex hormones Oestrogens Estradiol Valerate Tab 1 MG OR TABS C No Therapeutic - ChroniLine Pre-Auth
710 Endocrine System Sex hormones Oestrogens Estradiol Valerate Tab 2 MG OR TABS C No Therapeutic - ChroniLine Pre-Auth
711 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 0.3 MG OR TABS C No Therapeutic - ChroniLine Pre-Auth
712 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 0.625 MG OR TABS C No Therapeutic - ChroniLine Pre-Auth
713 Endocrine System Sex hormones Oestrogens Estrogens, Conjugated Tab 1.25 MG OR TABS C No Therapeutic - ChroniLine Pre-Auth
714 Endocrine System Sex hormones Progestogens Medroxyprogesterone Acetate Tab 5 MG OR TABS A C No Max 15/Rx & 2 fills per annum / Therapeutic - ChroniLine Pre-Auth
715 Endocrine System Sex hormones Progestogens Medroxyprogesterone Acetate Tab 10 MG OR TABS A C No Max 15/Rx & 2 fills per annum / Therapeutic - ChroniLine Pre-Auth
716 Endocrine System Sex hormones Combinations Estradiol Val 1 MG & Estradiol-Norethin Tab 1-1 MG OR TABS C No HRT Therapeutic - ChroniLine Pre-Auth
717 Endocrine System Sex hormones Combinations Estradiol Val 2 MG & Estradiol-Norethin Tab 2-1 MG OR TABS C No HRT Therapeutic - ChroniLine Pre-Auth
718 Endocrine System Sex hormones Other NONE LISTED
719 Endocrine System Tropic hormones Tropic hormones NONE LISTED
720 Endocrine System Hormone inhibitors Hormone inhibitors NONE LISTED
721 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamins Niacin Tab CR 500 MG OR TABS C No HYL Therapeutic - ChroniLine
722 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamins Pyridoxine HCl Tab 25 MG OR TABS No CDL (Only whilst on Isoniazid) Therapeutic - ChroniLine Pre-Auth
723 Vitamins Tonics Minerals and Electrolytes Vitamins Vitamin combinations NONE LISTED
724 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Gluconate Chew Tab 300 MG OR CHEW C No CRD, SLE Therapeutic - ChroniLine
725 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Gluconate Tab 300 MG (Elemental Ca) OR TABS C No CRD, SLE Therapeutic - ChroniLine
726 Vitamins Tonics Minerals and Electrolytes Vitamins Calcium Calcium Carbonate Chew Tab 1250 MG OR CHEW C No CRD, SLE Therapeutic - ChroniLine
727 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Folic Acid Tab 5 MG OR TABS A Yes Max 9 Rx/annum (Gender)
728 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Folic Acid Tab 5 MG OR TABS C No CRD, CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine
729 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Pregi Forte Capsules (nappi code 715465) OR CAPS A Yes Max 9 Rx/annum (Gender)
730 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Calcipreg Tablets (nappi code 704600) OR TABS A Yes Max 9 Rx/annum (Gender)
731 Vitamins Tonics Minerals and Electrolytes Vitamins Prenatal vitamins Preg-Natal Capsules (nappi code 701693) OR CAPS A Yes Max 9 Rx/annum (Gender)
732 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium Carbonate-Vitamin D Chew Tab 1250 MG-200 Unit OR CHEW C No CRD, SLE Therapeutic - ChroniLine
733 Vitamins Tonics Minerals and Electrolytes Vitamins with minerals Vitamins with minerals Calcium Carbonate-Vitamin D Tab 1250 MG-400 Unit OR TABS C No CRD, SLE Therapeutic - ChroniLine
734 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 No CRD, SLE Therapeutic - ChroniLine
735 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 No CRD, SLE Therapeutic - ChroniLine
736 Vitamins Tonics Minerals and Electrolytes Tonics Tonics NONE LISTED
737 Vitamins Tonics Minerals and Electrolytes Minerals and electrolytes Minerals and electrolytes Magnesium Sulfate Inj 50% INJ SOLN A No Consumables - Clinic use only
738 Amino-acids Amino-acids Amino-acids NONE LISTED
739 Special foods Special foods Special foods NONE LISTED
740 Vitamins Tonics Minerals and Electrolytes Minerals and electrolytes Minerals and electrolytes *Oral Electrolyte - PACKET** OR SACH A YES Max 3 fills/annum
741 Oils & Waxes Oils & Waxes Oils & Waxes Eucalyptus Oil OIL YES Max 3 fills/annum
742 Cytostatics Cytostatics Cytostatics Methotrexate Tab 2.5 MG OR TABS C No CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine Pre-Auth
743 Immunological Immunosuppressants Immunosuppressants Azathioprine Tab 50 MG OR TABS C No CSD, MSS, RHA, SLE, UC Therapeutic - ChroniLine Pre-Auth
744 Immunological Immunostimulants Immunostimulants NONE LISTED
745 Chelating agents ION exchange preparations Chelating agents, ion exchange preparations Chelating agents, ion exchange preparations NONE LISTED
746 Biologicals Biologicals Flu Vaccination High risk members only, as per 2019 flu vaccination policy No
747 Biologicals Biologicals Other Biologicals NONE LISTED
748 Diagnostics and Devices Diagnostics and Devices Insulin syringes and needles Insulin Pen Needle - MISC No Therapeutic - ChroniLine Pre-Auth
749 Diagnostics and Devices Diagnostics and Devices Glucometers GlucoCheck Classic Blood Glucose Monitoring Unit - KIT No Therapeutic - ChroniLine Pre-Auth
750 Diagnostics and Devices Diagnostics and Devices Glucometer test strips GlucoCheck Test Strips 50’s - TEST No Therapeutic - ChroniLine Pre-Auth
751 Diagnostics and Devices Diagnostics and Devices Glucocheck Lancets GlucoCheck Lancets 50’s - MISC No Therapeutic - ChroniLine Pre-Auth
752 Diagnostics and Devices Diagnostics and Devices Inhaler Devices Drug Application Product - Misc - DEVI No Therapeutic - ChroniLine Pre-Auth
Category Sub-Category Description Active Ingredient Administer Dosage Form Acute Chronic OTC 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.