28
ITEM NO. DRUG DESCRIPTION GENERIC NAME UNIT PRICE ($) PK UNIT TAC018 ACTAL NA POLYHYDROXYALUMINIUM 1.50 TAB TAI010 AIR-X CHEWABLE 80mg SIMETHICONE 1.00 TAB TAX010 AXID 150mg NIZATIDINE 150mg 7.00 TAB MBA008 BABCON 20mg/mL DIMETHYLPOLYSILOXANE 20mg 0.50 ML TBU020 BUWECON 0.125mg HYOSCINE/SCOPOLAMINE 0.700 TAB TCY040 CYTOTEC 200mcg MISOPROSTOL 200mcg 9.00 TAB TDE040 DENOL COLLOIDAL BISMUTH SUBCITRATE 6.00 TAB TDE080 DEXILANT DEXLANSOPRAZOLE 16.50 CAP TDE081 DEXILANT DEXLANSOPRAZOLE 25.00 CAP TGA010 GAVISCON ALGINIC ACID, AL HYDROXIDE... 4.10 TAB MGA010 GAVISCON ADVANCE SODIUM ALGINATE AND POTASSIUM 1.00 ML MGE016 GELUMAG SUSPENSION ALUMINIUM HYDROXIDE GEL 0.00 ML TGE010 GELUSIL MG TRISILICATE, AL HYDROXIDE 0.60 TAB TLO041 LOSEC CAP 20mg (GE) OMEPRAZOLE 20mg 10.00 CAP TLO042 LOSEC MUPS 10mg OMEPRAZOLE 10mg 17.50 TAB TLO040 LOSEC MUPS 20mg OMEPRAZOLE 20mg 21.20 TAB TMA010 MAALOX PLUS AL & MG HYDROXIDE, 0.70 TAB MMA010 MAALOX SUSPENSION AL HYDROXIDE, DIMETHICONE 0.17 ML TMI036 MILID 200mg PROGLUMIDE 200mg 2.00 TAB TMU010 MUCAINE (GE) ALUMINA, MGCO3, OXETHAZINE 0.60 TAB MMU010 MUCAINE SUSPENSION OXETHAZAINE, AL HYDROXIDE... 0.18 ML TMY020 MYLANTA (GE) AL & MG HYDROXIDE, 0.60 TAB MMY020 MYLANTA SUSPENSION AL HYDROXIDE, MG HYDROXIDE... 0.22 ML TNE050 NEXIUM 20mg ESOMEPRAZOLE 20mg 22.90 TAB TNE052 NEXIUM 40mg ESOMEPRAZOLE 40mg 32.60 TAB MNE010 NEXIUM GRANULES 10mg ESOMEPRAZOLE 22.70 SACH TPA044 PANTOLOC 20mg PANTOPRAZOLE SODIUM 20mg 15.50 TAB TPA045 [PANTOPRAZOLE] PANTOPRAZOLE 10.60 TAB TPA046 PANTOLOC 40mg PANTOPRAZOLE SODIUM 40mg 22.90 TAB TPA047 PANTALOC 40mg (GE) - [PANTOPRAZOLE] PANTOPRAZOLE 15.50 TAB TPA055 GLUCOPHAGE RABEPRAZOLE SODIUM 10mg 8.30 TAB TPA056 PARIET 20mg RABEPRAZOLE SODIUM 20mg 11.00 TAB CPA094 PEPCIDINE 20mg FAMOTIDINE 6.00 TAB TPE040 PEPCIDINE 20mg (GE) FAMOTIDINE 2.40 TAB CPA098 PEPCIDINE 40mg FAMOTIDINE 10.00 TAB TPY008 PYLORID 400mg RANITIDINE BISMUTH CITRATE 15.00 TAB MSU020 SACHETS SUCRALFATE 5.00 SACH TTA010 TAGAMET 200mg (GE) CIMETIDINE 200mg 2.00 TAB TTA012 TAGAMET 400mg (GE) CIMETIDINE 400mg 4.00 TAB TTA020 TAKEPRON 30mg LANSOPRAZOLE 30mg 22.00 CAP TTA021 TAKEPRON OD 30mg LANSOPRAZOLE 30mg 25.10 TAB CPA109 TAKEPRON OD 15mg LANSOPRAZOLE 15mg 9.00 TAB TUL010 ULSANIC 500 mg SUCRALFATE 500mg 2.00 TAB TUL012 ULSANIC 500mg (GE) SUCRALFATE 500mg 1.40 TAB MUL010 ULSANIC GRANULES 1g SUCRALFATE 1g 3.70 SACH IZA010 ZANTAC [ranitidine] RANTIDINE 46.40 AMP TZA030 ZANTAC 150 mg RANITIDINE HCL 150mg 7.60 TAB TZA032 ZANTAC 300 mg RANITIDINE HCL 300mg 17.80 TAB TZA034 [RANITIDINE] RANITIDINE HCL 150mg 4.50 TAB CPA041 ZANTAC SYRUP RANITIDINE HCL 0.85 ML TAS010 ASACOL 400mg MESALAZINE 400mg 5.90 TAB PAS010 ASACOL SUPP 500mg MESALAZINE 20.00 SUPP TCE052 CEREKINON 100mg TRIMEBUTINE MALEATE 2.00 TAB TCH010 CHARCOAL 300mg CHARCOAL 300mg 0.60 TAB TCH012 CHARCOAL 200mg CHARCOAL 200mg 0.800 TAB TDI102 DIPENTUM 250mg OLSALAZINE SODIUM 250mg 4.50 TAB TDI106 DISFLATYL 40mg DIMETHICONE/SILICON DIOXIDE 1.90 TAB TEU020 ENTOCORT 3mg BUDESONIDE 3mg 27.40 CAP PEN010 ENTOCORT ENEMA BUDESONIDE 200.00 TUB TGA008 GASTEEL ALUMINIUM HYDROXIDE 1.50 TAB MGA004 GASCON DROP 20mg/mL DIMETHYLPOLYSILOXANE 2.00 ML TMA022 MAGESTO PRECIPITATED CA CARBONATE 0.60 TAB CPA097 MOTILIUM 10mg DOMPERIDONE 4.00 TAB TMO040 MOTILIUM 10mg (GE) DOMPERIDONE 1.70 TAB PMO010 MOTILIUM SUPP 10mg (GE) DOMPERIDONE 6.00 SUPP PMO012 MOTILIUM SUPP 30mg (GE) DOMPERIDONE 9.50 SUPP MMO010 MOTILIUM SYRUP 1mg/mL DOMPERIDONE 1mg 1.80 ML TMY030 MYLICON (GASTEEL) DIMETHICONE 40mg 1.00 TAB TPE030 PENTASA 500mg MESALAZINE 500mg 7.80 TAB PPE010 PENTASA SUPP 1g MESALAZINE 26.00 SUPP MPE016 (60's/BOX) MESALAZINE 2g 37.00 SACH MPE017 PENTASA SCAHET 1g MESALAZINE 1g 18.50 SACH TPR060 PREPULSID 5mg CISAPRIDE 5mg 3.00 TAB TPR062 PREPULSID 10mg CISAPRIDE 10mg 5.30 TAB TSA030 SALOFALK 250mg MESALAZINE 250mg 13.00 TAB TSA032 SALOFALK 500mg MESALAZINE 500mg 15.00 CAP PSA010 SALOFALK SUPP 250mg MESALAZINE, 5-AMINOSAL. ACID 55.00 SUPP ANTACIDS & ANTIULCERANTS DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014] Disclaimer: Please note that this list is not exhaustive and contains certain drugs that may not be covered under the Cathay Pacific Medical Scheme, e.g. drugs use for psychological conditions, drugs use for management of fertility and contraception. Should you prescribe item that is not included here or have any queries, please call the CPA Provider Hotline at 2851-3870 or email [email protected] . GIT REGULATORS,ANTIFLATULENTS & ANTI-INFLAMMATORIS Page 1 of 28

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

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Page 1: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

TAC018 ACTAL NA POLYHYDROXYALUMINIUM

MONOCA

1.50 TAB

TAI010 AIR-X CHEWABLE 80mg SIMETHICONE 1.00 TAB

TAX010 AXID 150mg NIZATIDINE 150mg 7.00 TAB

MBA008 BABCON 20mg/mL DIMETHYLPOLYSILOXANE 20mg 0.50 ML

TBU020 BUWECON 0.125mg HYOSCINE/SCOPOLAMINE 0.700 TAB

TCY040 CYTOTEC 200mcg MISOPROSTOL 200mcg 9.00 TAB

TDE040 DENOL COLLOIDAL BISMUTH SUBCITRATE 6.00 TAB

TDE080 DEXILANT

[DEXLANSOPRAZOLE] MR

DEXLANSOPRAZOLE 16.50 CAP

TDE081 DEXILANT

[DEXLANSOPRAZOLE] MR

DEXLANSOPRAZOLE 25.00 CAP

TGA010 GAVISCON ALGINIC ACID, AL HYDROXIDE... 4.10 TAB

MGA010 GAVISCON ADVANCE SODIUM ALGINATE AND POTASSIUM

BICARBONATE

1.00 ML

MGE016 GELUMAG SUSPENSION ALUMINIUM HYDROXIDE GEL 0.00 ML

TGE010 GELUSIL MG TRISILICATE, AL HYDROXIDE 0.60 TAB

TLO041 LOSEC CAP 20mg (GE) OMEPRAZOLE 20mg 10.00 CAP

TLO042 LOSEC MUPS 10mg OMEPRAZOLE 10mg 17.50 TAB

TLO040 LOSEC MUPS 20mg OMEPRAZOLE 20mg 21.20 TAB

TMA010 MAALOX PLUS AL & MG HYDROXIDE,

SIMETHICONE

0.70 TAB

MMA010 MAALOX SUSPENSION

(GE)

AL HYDROXIDE, DIMETHICONE 0.17 ML

TMI036 MILID 200mg PROGLUMIDE 200mg 2.00 TAB

TMU010 MUCAINE (GE) ALUMINA, MGCO3, OXETHAZINE 0.60 TAB

MMU010 MUCAINE SUSPENSION

(GE)

OXETHAZAINE, AL HYDROXIDE... 0.18 ML

TMY020 MYLANTA (GE) AL & MG HYDROXIDE,

DIMETHICONE

0.60 TAB

MMY020 MYLANTA SUSPENSION

(GE)

AL HYDROXIDE, MG HYDROXIDE... 0.22 ML

TNE050 NEXIUM 20mg ESOMEPRAZOLE 20mg 22.90 TAB

TNE052 NEXIUM 40mg ESOMEPRAZOLE 40mg 32.60 TAB

MNE010 NEXIUM GRANULES 10mg ESOMEPRAZOLE 22.70 SACH

TPA044 PANTOLOC 20mg PANTOPRAZOLE SODIUM 20mg 15.50 TAB

TPA045

PANTALOC 20mg (GE) -

[PANTOPRAZOLE] PANTOPRAZOLE 10.60 TAB

TPA046 PANTOLOC 40mg PANTOPRAZOLE SODIUM 40mg 22.90 TAB

TPA047

PANTALOC 40mg (GE) -

[PANTOPRAZOLE] PANTOPRAZOLE 15.50

TAB

TPA055 GLUCOPHAGE RABEPRAZOLE SODIUM 10mg 8.30 TAB

TPA056 PARIET 20mg RABEPRAZOLE SODIUM 20mg 11.00 TAB

CPA094 PEPCIDINE 20mg FAMOTIDINE 6.00 TAB

TPE040 PEPCIDINE 20mg (GE) FAMOTIDINE 2.40 TAB

CPA098 PEPCIDINE 40mg FAMOTIDINE 10.00 TAB

TPY008 PYLORID 400mg RANITIDINE BISMUTH CITRATE

400mg

15.00 TAB

MSU020

SUCRATE GEL 1G/5mL

SACHETS SUCRALFATE 5.00 SACH

TTA010 TAGAMET 200mg (GE) CIMETIDINE 200mg 2.00 TAB

TTA012 TAGAMET 400mg (GE) CIMETIDINE 400mg 4.00 TAB

TTA020 TAKEPRON 30mg LANSOPRAZOLE 30mg 22.00 CAP

TTA021 TAKEPRON OD 30mg LANSOPRAZOLE 30mg 25.10 TAB

CPA109 TAKEPRON OD 15mg LANSOPRAZOLE 15mg 9.00 TAB

TUL010 ULSANIC 500 mg SUCRALFATE 500mg 2.00 TAB

TUL012 ULSANIC 500mg (GE) SUCRALFATE 500mg 1.40 TAB

MUL010 ULSANIC GRANULES 1g SUCRALFATE 1g 3.70 SACH

IZA010 ZANTAC [ranitidine]

25mg/mL INJ

RANTIDINE 46.40 AMP

TZA030 ZANTAC 150 mg RANITIDINE HCL 150mg 7.60 TAB

TZA032 ZANTAC 300 mg RANITIDINE HCL 300mg 17.80 TAB

TZA034

ZANTAC 150mg (GE)-

[RANITIDINE] RANITIDINE HCL 150mg 4.50 TAB

CPA041 ZANTAC SYRUP RANITIDINE HCL 0.85 ML

TAS010 ASACOL 400mg MESALAZINE 400mg 5.90 TAB

PAS010 ASACOL SUPP 500mg MESALAZINE 20.00 SUPP

TCE052 CEREKINON 100mg TRIMEBUTINE MALEATE 2.00 TAB

TCH010 CHARCOAL 300mg CHARCOAL 300mg 0.60 TAB

TCH012 CHARCOAL 200mg CHARCOAL 200mg 0.800 TAB

TDI102 DIPENTUM 250mg OLSALAZINE SODIUM 250mg 4.50 TAB

TDI106 DISFLATYL 40mg DIMETHICONE/SILICON DIOXIDE 1.90 TAB

TEU020 ENTOCORT 3mg BUDESONIDE 3mg 27.40 CAP

PEN010 ENTOCORT ENEMA

2mg/100mL

BUDESONIDE 200.00 TUB

TGA008 GASTEEL

DIMETHYLPOLYSILOXANE,

ALUMINIUM HYDROXIDE 1.50 TAB

MGA004 GASCON DROP 20mg/mL

300mL

DIMETHYLPOLYSILOXANE 2.00 ML

TMA022 MAGESTO PRECIPITATED CA CARBONATE

200mg/MYLASE 37.5mg/NA

0.60 TAB

CPA097 MOTILIUM 10mg DOMPERIDONE 4.00 TAB

TMO040 MOTILIUM 10mg (GE) DOMPERIDONE 1.70 TAB

PMO010 MOTILIUM SUPP 10mg (GE) DOMPERIDONE 6.00 SUPP

PMO012 MOTILIUM SUPP 30mg (GE) DOMPERIDONE 9.50 SUPP

MMO010 MOTILIUM SYRUP 1mg/mL DOMPERIDONE 1mg 1.80 ML

TMY030 MYLICON (GASTEEL) DIMETHICONE 40mg 1.00 TAB

TPE030 PENTASA 500mg MESALAZINE 500mg 7.80 TAB

PPE010 PENTASA SUPP 1g MESALAZINE 26.00 SUPP

MPE016

PENTASA SACHET 2g

(60's/BOX) MESALAZINE 2g 37.00 SACH

MPE017 PENTASA SCAHET 1g MESALAZINE 1g 18.50 SACH

TPR060 PREPULSID 5mg CISAPRIDE 5mg 3.00 TAB

TPR062 PREPULSID 10mg CISAPRIDE 10mg 5.30 TAB

TSA030 SALOFALK 250mg MESALAZINE 250mg 13.00 TAB

TSA032 SALOFALK 500mg MESALAZINE 500mg 15.00 CAP

PSA010 SALOFALK SUPP 250mg MESALAZINE, 5-AMINOSAL. ACID 55.00 SUPP

ANTACIDS & ANTIULCERANTS

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

Disclaimer: Please note that this list is not exhaustive and contains certain drugs that may not be covered under the Cathay Pacific

Medical Scheme, e.g. drugs use for psychological conditions, drugs use for management of fertility and contraception. Should you

prescribe item that is not included here or have any queries, please call the CPA Provider Hotline at 2851-3870 or email

[email protected] .

GIT REGULATORS,ANTIFLATULENTS & ANTI-INFLAMMATORIS

Page 1 of 28

Page 2: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

PSA012 SALOFALK SUPP 500mg MESALAZINE, 5-AMINOSAL. ACID 80.00 SUPP

MSA008

SALOFALK GRANULES

500mg MESALAZINE 500mg 13.00 SACH

MSA010 SALOFALK GRANULES 1G MESALAZINE 1G 26.60 SACH

TST036 STROCAIN

POLYMIGEL 244mg, OXETHAZAINE

5mg 0.95 TAB

TBU010 BUSCOPAN 10mg (GE) HYOSCINE-N-BUTYLBROMIDE 10mg 0.80 TAB

IBU010 BUSCOPAN INJ 20mg/mL HYOSCINE BUTYLBROMIDE 38.00 AMP

IBU012 BUSCOPAN INJ 20mg/mL

10mL

HYOSCINE BUTYLBROMIDE 20.00 ML

MBU010 BUSCOPAN LIQUID

1mg/mL (GE)

HYOSCINE-N-BUTYLBROMIDE 0.40 ML

TDA040 DARICON 5mg OXYPHENCYCLIMINE HCL 5mg 1.10 TAB

MDO010 DONNATAL SYRUP PHENOBARBITONE, HYOSCYAMINE.. 0.27 ML

TDU020 DUSPATALIN 135 mg MEBEVERINE HCL 135mg 5.00 TAB

TDU021 DUSPATALIN RETARD

200mg

MEBEVERINE HCL 200mg 6.80 CAP

THO010 HOLOPON 1mg (GE) SCOPOLAMINE METHYLBROMIDE

1mg

1.10 TAB

MIN010 INFACOL SUSPENSION

(GE)

DIMETHICONE 0.26 ML

MIN012 INFACOL WIND DROPS DIMETHICONE 2.30 ML

TLE016 LEVSIN SL 125mcg HYOSCYAMINE SULFATE 125mcg 2.70 TAB

TLI010 LIBRAX (GE) CHLORDIAZEPOXIDE, CLIDINIUM 1.50 TAB

TLI020 LIBRIUM 5mg (GE) CHLORDIAZEPOXIDE 1.00 TAB

TPR084 PROBANTHINE 15mg (GE) PROPANTHELINE BROMIDE 15mg 0.60 TAB

TSP012 SPASMOMEN 40mg OTILONIUM BROMIDE 4.40 TAB

TSP010 SPASMONAL 60mg (GE) ALVERINE CITRATE 2.20 TAB

CPA096 SPASMONAL CAP 60MG ALVERINE CITRATE 4.00 CAP

TUR020 URISPAS 100mg FLAVOXATE HCL 100mg 1.50 TAB

TUR022 URISPAS 200mg FLAVOXATE HCL 200mg 2.70 TAB

TZE007 ZELMAC 6mg TEGASEROD 6mg 8.00 TAB

TAN020 ANTIDIA 200mg NIFUROXAZIDE 200mg 0.80 CAP

TER020 ERCEFURYL 200mg (GE) NIFUROXAZIDE 200mg 0.65 CAP

MHI010

HIDRASEC 10mg SACHET

(INFANTS) RACECADOTRIL 4.00 SACH

MHI012

HIDRASEC 30mg SACHET

(CHILDREN) RACECADOTRIL 6.00 SACH

TIM028 IMODIUM 2mg LOPERAMIDE HCL 2mg 7.00 CAP

TIM030 IMODIUM 2mg (G.E.) LOPERAMIDE HCL 2mg 1.90 TAB

MIM012 IMODIUM DROPS 2mg/mL

(GE)

LOPERAMIDE HCL 1.00 ML

MIM010 IMODIUM SYRUP 2mg/5mL

(GE)

LOPERAMIDE HCL 1.00 ML

MKA010 KAOPECTATE (GE) LIGHT KAOLIN, PECTIN 0.18 ML

TLO010 LOMOTIL DIPHENOXYLATE HCL, ATROPINE 1.00 TAB

TLO011 LOMOTIL (GE) DIPHENOXYLATE HCL, ATROPINE 0.70 TAB

MLO010 LOMOTIL SYRUP

2.5mg/5mL (GE)

DIPHENOXYLATE, ATROPINE 0.28 ML

MSM010 SMECTA 3g DIOCTAHEDRAL SMECTITE 4.40 SACH

MAG008 AGAROL SUSPENSION LIQUID PARAFFIN 0.20 ML

MAG010 AGAROL SUSPENSION

(GE)

LIQUID PARAFFIN 0.17 ML

MAG015 AGIOCUR GRANULES 250g PLANTAGO SEED, ISPAGHULA

HUSKS

130.00 BOT

MAG020 AGIOLAX 100g PLANTAGO SEED, SENNA PODS... 0.60 g

PBA012 BANDI-ENEMA ADULT GLYCERIN, MG SULFATE, NACL 3.00 TUB

PBA010 BANDI-ENEMA PAED GLYCERIN, MG SULFATE, NACL 2.50 TUB

MBI008 BISACODYL IN

POLYETHYLENE LIQUID

BISACODYL, POLYETHYLENE

GLYCOL

0.25 ML

TDO006 DOCUSATE SODIUM 100mg DOCUSATE Na 1.80 CAP

TDU010 DULCOLAX 5mg (GE) BISACODYL 5mg 0.80 TAB

PDU010 DULCOLAX SUPP 10mg

(GE)

BISACODYL 4.60 SUPP

MDU010 DUPHALAC SYRUP

10g/15mL

LACTULOSE 0.45 ML

PFL020 FLEET ENEMA NA BIPHOSPHATE, NA PHOSPHATE 25.00 BOT

PFL010 FLEET ENEMA

(CHILDREN)

NA BIPHOSPHATE, NA PHOSPHATE 26.00 BOT

MFL006 FLEET PHOSPHO-SODA MONOBASIC Na

PHOSPHATE/DIBASIC

0.80 ML

MF0010 FORLAX MACROGOL 4000 4.70 SACH

MFY010 FYBOGEL ISPAGHULA HUSK 4.00 SACH

PGL010 GLYCERINE SUPP

(ADULT) (GE)

GLYCERIN 6.00 SUPP

PGL012 GLYCERINE SUPP (PAED)

(GE)

GLYCERIN 4.20 SUPP

MKL020 KLEAN-PREP POLYETHYLENE

GLYCOL,KCL,NA2CO3

27.00 SACH

MME010 METAMUCIL POWDER

100g

PSYLLIUM HYDROPHILIC

MUCILLOID

0.40 g

MME012 METAMUCIL POWDER

336g

PSYLLIUM HYDROPHILIC

MUCILLOID

0.45 g

MME013 METAMUCIL POWDER

504g

PSYLLIUM HYDROPHILIC

MUCILLOID

0.60 g

MME015 METAMUCIL POWDER

528g (ORANGE)

PSYLLIUM HYDROPHILIC

MUCILLOID

0.55 g

MME014 METAMUCIL POWDER 6g PSYLLIUM HYDROPHILIC

MUCILLOID

4.00 SACH

PMI010 MICROLAX ENEMA NA CITRATE+LAURYL

SULFOACETATE

10.50 BOT

MMU040 MUCOFALK ORANGE 5g ISPAGHULA HUSK 5g 5.70 SACH

MNA010 NATURLAX POWDER 368g PSYLLIUM HYDROPHILIC

MUCILLOID

0.40 g

MNO010 NORMACOL STERCULIA 62% 9.20 SACH

MNO020 NORMACOL PLUS STERCULIA 62%, FRANGULA 8% 9.20 SACH

MPA020 PARAFFIN LIQUID (GE) PARAFFIN LIQUID 0.30 ML

MPE005 PEGLYTE POWDER POLYETHYLENE GLYCOL,

ELECTROLYTES

45.00 SACH

MPH040 PHOSPHATE SOLUTION

45mL

SODIUM PHOSPHATE 0.40 ML

MPI006 PICOLAX ORAL SOLUTION

NA PICOSULFATE 10mg,MG OXIDE

3.5g//CITRIC ACID 12g 56.00 SACH

MPI008 PICOLAX POWDER 10mg SODIUM PICOSULFATE 40.00 SACH

TSE030 SENOKOT SENNOSIDES B 7.5mg 0.70 TAB

PSA008 SALOFALK ENEMAS

4G/60mL

MESALAZINE, 5-AMINOSAL. ACID 280.00 PC

TCO054 COMBIZYM

PANCREATIN, ENZYME

CONCENTRATE 2.10 TAB

TCR010 CREON PANCREATIN/AMYLASE/LIPASE/PRO

T

4.70 CAP

TEN030 ENZYPLEX AMYLASE,PROTEASE,LIPASE... 1.30 TAB

TPA040 PANKREOFLAT PANCREATIN, SIMETHICONE 2.20 TAB

TBI008 BILSAN CHOLINE, DEHYDROCHOLIC ACID,

INOSITOL…

1.90 TAB

CHOLAGOGUES, CHOLELITHOLYTICS & HEPATIC PROTECTORS

DIGESTIVES

ANTIDIARRHEALS

LAXATIVES, PURGATIVES

ANTISPASMODICS

Page 2 of 28

Page 3: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TCH020 CHENOFALK 250mg CHENODEOXYCHOLIC ACID 250mg 11.60 CAP

TLE006 LEGALON 35mg SILYMARIN 35mg 3.30 TAB

TLE008 LEGALON 70mg SILYMARIN 70mg 4.40 TAB

CPA088 LEGALON 140mg SILYMARIN 140mg 5.00 TAB

TUR028 URSOFALK 250mg URSODEOXYCHOLIC ACID 16.00 CAP

TUR029

URSOFALK 250mg (GE)-

[URSODEOXYCHOLIC] URSODEOXYCHOLIC ACID 10.50 CAP

TUR030 URSOLVAN 200mg URSODEOXYCHOLIC ACID 200mg 6.00 TAB

IAD012 ADRENALINE INJ 1:10,000

10mL

ADRENALINE 70.00 AMP

TCO070 CORDARONE 200 mg AMIODARONE HCL 200mg 8.80 TAB

ICO015 CORDARONE INJ

150mg/3mL (GE)

AMIODARONE HCL 150mg 85.00 AMP

IDI010 DIGOXIN INJ 0.5mg/2mL DIGOXIN 120.00 AMP

TKI010 KINIDIN DURULE 200mg QUINIDINE BISULFATE 200mg 3.80 TAB

TLA040 LANITOP 0.1mg METILDIGOXIN 0.1mg 1.50 TAB

TLA050 LANOXIN PG 0.0625mg DIGOXIN 0.0625mg 1.20 TAB

TLA052 LANOXIN 0.25mg DIGOXIN 0.25mg 1.70 TAB

TMU035 MULTAQ FILM-COATED

400 mg

DRONEDARONE HC1 17.50 TAB

TNO060 NORPACE 100mg DISOPYRAMIDE PHOSPHATE 100mg 4.40 CAP

TNO070 NORPACE RETARD 150mg DISOPYRAMIDE PHOSPHATE 150mg 5.00 TAB

TRY010 RYTMONORM 150mg PROPAFENONE HCL 150mg 11.00 TAB

TRY012

RYTMONORM

<propafenone> 150mg [APO- PROPAFENONE 11.000 TAB

TSL020 SLOW K 600mg POTASSIUM CHLORIDE 600mg 1.50 TAB

TSL030 SLOW K 600mg (GE) POTASSIUM CHLORIDE 600mg 0.90 TAB

TTA022 TAMBOCOR 100mg FLECAINIDE ACETATE 100mg 17.00 TAB

IXY030 XYLOCARD INJ 100mg/5mL LIDOCAINE HCl 150.00 AMP

TCO069 CORALAN 5mg IVABRADINE 11.00 TAB

TEL010 ELANTAN 20mg ISOSORBIDE MONONITRATE 20mg 7.00 TAB

TIM010 IMDUR 60mg ISOSORBIDE-5-MONONITRATE 60mg 7.10 TAB

TIS008 ISO MACK RETARD 40mg ISOSORBIDE DINITRATE 40mg 2.50 TAB

SIS010 ISOMACK SPRAY ISOSORBIDE DINITRATE 130.00 BOT

TIS040 ISORDIL 10mg ISOSORBIDE DINITRATE 10mg 1.00 TAB

TIS050 ISORDIL SUBLINGUAL 5mg ISOSORBIDE DINITRATE 1.20 TAB

TIS060 ISORDIL TEMBIDS 40mg

(GE)

ISOSORBIDE DINITRATE 40mg 2.00 TAB

CPA150 LOMAKLINE 5 mg AMLODIPINE BESILATE 7.00 TAB

CPA151 LOMAKLINE 10 mg AMLODIPINE BESILATE 7.00 TAB

ANI020 NITRODERM TTS-10 50mg NITROGLYCERIN 30.00 PC

TNI030 NITRODISC 5mg NITROGLYCERIN 14.30 DISC

SNI010 NITROLINGUAL SPRAY

0.4mg

NITROGLYCERIN 0.4mg 220.00 PC

TNI040 NITROSTAT 500mcg

(ANGISED)

GLYCERYL TRINITRATE 500mcg 1.90 TAB

TPE070 PERSANTIN 25mg (GE) DIPYRIDAMOLE 25mg 0.80 TAB

TPE073 PERSANTIN 75mg DIPYRIDAMOLE 75mg 2.70 TAB

TPE072 PERSANTIN 75mg (GE) DIPYRIDAMOLE 75mg 2.00 TAB

TPE074 PERSANTIN PLUS DIPYRIDAMOLE/ACETYSALICYLIC

ACID

3.50 CAP

TVA030 VASTAREL 20mg TRIMETAZIDINE DIHCL 20mg 5.30 TAB

TVA032 VASTAREL MR TRIMETAZIDINE

DIHYDROCHLORIDE 35mg

9.00 TAB

TIS042 ISORDIL 10mg (GE) ISOSORBIDE DINITRATE 10mg 0.60 TAB

TCO101 COZAAR <Losartan> 50mg

(GE)

LOSARTAN 50mg 7.50 TAB

TCO111 COZAAR 100mg (GE)-[LOSARTAN]LOSARTAN 100mg 8.50 TAB

TCO112 COZAAR [Losartan] 100mg [LOSACOR] LOSARTAN 1.26 TAB

THY023 HYZAAR (GE) LOSARTAN,

HYDROCHLOROTHIAZIDE

8.50 TAB

THY024 HYZAAR [LOSACOR HCT

50 mg-12.5mg]

HYDROCHLOROTHIAZIDE ,

LOSARTAN POTASSIUM

9.90 TAB

TMI007 MICARDIS PLUS 80mg TELMISARTAN/HYDROCHLOROTHIA

ZIDE 12.5mg

16.00 TAB

TOL029 OLMETEC 40mg OLMESARTAN MEDOXOMIL 40mg 13.70 TAB

TOL030 OLMETEC 20mg OLMESARTAN MEDOXOMIL 11.70 TAB

TOL031 OLMETEC 10mg OLMESARTAN 9.00 TAB

TOL032

OLMETEC PLUS

20mg/12.5mg

OLMESARTAN,

HYDROCHLOROTHIAZIDE 11.00 TAB

TAC008 ACCUPRIL 10mg QUINAPRIL HCL 10mg 7.00 TAB

TAC007 ACCUPRIL 20mg QUINAPRIL HCL 20mg 10.00 TAB

TAC006 ACCUPRIL 5mg QUINAPRIL HCL 5mg 4.60 TAB

TAC012 ACERTIL 2mg PERINDOPRIL 2mg 3.80 TAB

TAC010 ACERTIL 4mg PERINDOPRIL 4mg 6.70 TAB

CPA081 ACERTIL PLUS FILM-

COATED 5mg

PERINDOPRIL ARGININE 4.50 TAB

TAC011 ACERTIL AR 5mg PERINDOPRIL ARGININE 7.50 TAB

TAL018 ALDOMET 125mg (GE) METHYLDOPA 125mg 1.10 TAB

TAL020 ALDOMET 250mg (GE) METHYLDOPA 250mg 1.60 TAB

TAP010 APRESOLINE 10mg HYDRALAZINE HCL 10mg 1.50 TAB

TAP012 APRESOLINE 25mg HYDRALAZINE HCL 25mg 2.00 TAB

TAP020 APRESOLINE 50mg (GE) HYDRALAZINE HCL 50mg 2.00 TAB

TAP040 APROVEL 150mg IRBESARTAN 150mg 8.50 TAB

TAP042 APROVEL 300mg IRBESARTAN 300mg 14.00 TAB

TBL023 BLOPRESS Plus16mg CANDESARTAN CILEXETIL 16mg 16.00 TAB

TBL021 BLOPRESS Plus 8mg CANDESARTAN CILEXETIL 8mg 9.60 TAB

TBL022 BLOPRESS 16mg CANDESARTAN CILEXETIL 16mg 16.00 TAB

TBL020 BLOPRESS 8mg CANDESARTAN CILEXETIL 8mg 9.60 TAB

TCA050 CAPOTEN 12.5mg CAPTOPRIL 12.5mg 2.60 TAB

TCA052 CAPOTEN 25mg (GE) CAPTOPRIL 25mg 2.00 TAB

TCA056 CAPOTEN 50mg CAPTOPRIL 50mg 7.70 TAB

TCA054 CAPOTEN 50mg (GE) CAPTOPRIL 50mg 3.50 TAB

TCA060 CARDURA 1mg DOXAZOSIN MESYLATE 1mg 6.40 TAB

TCA062 CARDURA 2mg DOXAZOSIN MESYLATE 2mg 10.30 TAB

TCA064 CARDURA XL 4mg DOXAZOSIN MESYLATE 4mg 8.90 TAB

ANGIOTENSIN II ANTAGONIST

ANTI-ANGINAL DRUGS

CARDIAC DRUGS

ANTIHYPERTENSIVE DRUGS

Page 3 of 28

Page 4: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TCA066 CARDURA XL 8mg DOXAZOSIN MESYLATE 8mg 11.80 TAB

ICA030 CATAPRES INJ 150mcg/mL CLONIDINE HCL 50.00 AMP

TAP043 CO-APROVEL

150mg/12.5mg

IRBESARTAN

150mg/HYDROCHLOROTHIAZIDE

8.50 TAB

TAP044 CO-APROVEL

300mg/12.5mg

IRBESARTAN

300mg/HYDROCHLOROTHIAZIDE

14.00 TAB

CPA125 CO-APROVEL 300/25 mg tab 300mg/25mg IRBESARTAN 300mg /

HCTZ 25mg

14.00 TAB

TCO015 CO-DIOVAN 160mg/12.5mg VALSARTAN

160mg/HYDROCHLOROTHIAZIDE

15.00 TAB

TCO016 CO-DIOVAN 80mg/12.5mg (GE)-[VALSARTAN + HCT]VALSARTAN, HYDROCHLOROTHIAZIDE 7.00 TAB

TCO017 CO-DIOVAN 160mg/12.5mg (GE)-[VALSARTAN + HCT]VALSARTAN, HYDROCHLOROTHIAZIDE 10.00 TAB

TCO013 CO-DIOVAN 80mg/12.5mg VALSARTAN

80mg/HYDROCHLOROTHIAZIDE

10.70 TAB

TRE018 CO-RENITEC ENALAPRIL

20mg/HYDROCHLOROTHIAZIDE

8.50 TAB

TCO110 COZAAR 100mg LOSARTAN POTASSIUM 100mg 10.00 TAB

TCO100 COZAAR 50mg LOSARTAN POTASSIUM 50mg 9.90 TAB

TDI050 DIBENYLINE 10mg PHENOXYBENZAMINE 10mg 8.00 CAP

TDI101 DIOVAN 160mg VALSARTAN 160mg 15.00 TAB

TDI103 DIOVAN 80mg (GE)-[VALSARTAN]VALSARTAN 6.50 TAB

TDI104 DIOVAN 160mg (GE)-[VALSARTAN]VALSARTAN 9.50 TAB

TDI100 DIOVAN 80mg VALSARTAN 80mg 10.70 CAP

TDI099 DIOVAN 320mg VALSARTAN 20.00 TAB

TDY020 DYNACIRC 2.5mg ISRADIPINE 2.5mg 3.50 TAB

THY020 HYZAAR LOSARTAN

50mg/HYDROCHLOROTHIAZIDE

9.90 TAB

THY022 HYZAAR FORTE LOSARTAN

100mg/HYDROCHLOROTHIAZIDE 25

11.50 TAB

THY021 HYZAAR PLUS LOSARTAN,

HYDROCHLOROTHIAZIDE

10.00 TAB

TIN060 INHIBACE 2.5mg CLIAZAPRIL 2.5mg 4.40 TAB

TMI005 MICARDIS 40mg TELMISARTAN 40mg 10.60 TAB

TMI006 MICARDIS 80mg TELMISARTAN 80mg 16.80 TAB

TMI004 MICARDIS PLUS

40mg/12.5mg

TELMISARTAN

40mg/HYDROCHLOROTHIAZIDE

10.00 TAB

TMI050 MINIPRESS 1mg (GE) PRAZOSIN HCL 1mg 1.50 TAB

TMI052 MINIPRESS 2mg (GE) PRAZOSIN HCL 2mg 2.00 TAB

TMI054 MINIPRESS 5mg PRAZOSIN HCL 5mg 8.60 TAB

TMI053 MINIPRESS 5mg (GE) PRAZOSIN HCL 5mg 5.00 TAB

TMO030 MONOPRIL 10mg FOSINOPRIL SODIUM 10mg 4.50 TAB

TNA020 NATRILIX 2.5mg (GE) INDAPAMIDE 2.5mg 2.00 TAB

TNA021 NATRILIX SR 1.5mg INDAPAMIDE 1.5mg 5.20 TAB

TNI026 NIFTEN ATENOLOL 50mg/NIFEDIPINE SR

20mg

11.90 CAP

TPR026 PREDONIUM PERINDOPRIL 2mg/INDAPAMIDE

0.625mg

5.00 TAB

TPR082 PRINIVIL 5mg LISINOPRIL 5mg 3.50 TAB

TRA005 RASILEZ 150mg ALISKIREN 150mg 16.00 TAB

TRA006 RASILEZ 300mg ALISKIREN 300mg 20.00 TAB

TRA007 RASILEZ HCT ALISKIREN 150mg, HCT 12.5mg 16.000 TAB

TRA008 RASILEZ HCT ALISKIREN 300mg, HCT 12.5mg 20.000 TAB

TRE020 RENITEC 10mg ENALAPRIL MALEATE 10mg 5.30 TAB

TRE021 RENITEC 10mg (GE) ENALAPRIL MALEATE 10mg 3.20 TAB

TRE026 RENITEC 2.5mg ENALAPRIL MALEATE 2.5mg 3.00 TAB

TRE022 RENITEC 20mg ENALAPRIL MALEATE 20mg 7.00 TAB

TRE023 RENITEC 20mg (GE) ENALAPRIL MALEATE 20mg 4.20 TAB

TRE024 RENITEC 5mg ENALAPRIL MALEATE 5mg 3.70 TAB

TRE025 RENITEC 5mg (GE) ENALAPRIL MALEATE 5mg 2.10 TAB

TTA025 TANATRIL 10mg IMIDAPRIL 10mg 4.00 TAB

TTA060 TARKA VERAPAMIL,TRANDOLAPRIL 7.20 CAP

TTE030 TENORET 50mg ATENOLOL 50mg/CHLORTHALIDONE

12.5mg

7.50 TAB

TTE040 TENORETIC ATENOLOL

100mg/CHLORTHALIDONE 25mg

10.90 TAB

TTE042 TENORETIC (GE) ATENOLOL

100mg/CHLORTHALIDONE 25mg

5.00 TAB

TTE080 TEVETEN 600mg EPROSARTAN 600mg 15.00 TAB

TTR010 TRANDATE 100mg LABETALOL HCL 100mg 7.00 TAB

TTR068 TRITACE 2.5mg RAMIPRIL 2.5mg 2.40 TAB

TTR070 TRITACE 5mg RAMIPRIL 5mg 3.50 TAB

TZE010 ZESTORETIC LISINOPRIL

20mg/HYDROCHLOROTHIAZIDE

11.30 TAB

TZE020 ZESTRIL 10mg LISINOPRIL DIHYDRATE 10mg 7.20 TAB

TZE021 ZESTRIL 10mg (GE) LISINOPRIL DIHYDRATE 10mg 3.50 TAB

TZE022 ZESTRIL 20mg LISINOPRIL DIHYDRATE 20mg 9.90 TAB

TZE023 ZESTRIL 20mg (GE) LISINOPRIL DIHYDRATE 20mg 5.00 TAB

TZE024 ZESTRIL 5mg LISINOPRIL DIHYDRATE 5mg 4.30 TAB

TZE025 ZESTRIL 5mg (GE) LISINOPRIL DIHYDRATE 5mg 2.00 TAB

DAZ006 AZARGA EYE DROPS BRINZOLAMIDE 10mg,TIMOLOL 5mg 230 BOT

DTA004 TAFLOTAN EYE DROPS

2.5mL

TAFLUPROST 250 BOT

DGA008 GANFORT EYE DROPS BIMATOPROST,TIMOLOL 320.00 BOT

TBE028 BETALOC 100mg METOPROLOL 100mg 6.20 TAB

TBE033 BETALOC 50mg METOPROLOL TARTRATE 50mg 3.70 TAB

TBE032 BETALOC 50mg (GE) METOPROLOL TARTRATE 50mg 1.50 TAB

TBE030 BETALOC 100mg (GE) METOPROLOL TARTRATE 100mg 2.90 TAB

TBE040 BETALOC DURULE 200mg METOPROLOL TARTRATE 200mg 5.50 TAB

TBE046 BETALOC ZOK 25mg METOPROLOL SUCCINATE 25mg 3.80 TAB

TBE048 BETALOC ZOK 50mg METOPROLOL SUCCINATE 50mg 3.70 TAB

TBE049 BETALOC ZOK 50mg (GE) METOPROLOL SUCCINATE 50mg 2.00 TAB

TBE050 BETALOC ZOK 100mg METOPROLOL SUCCINATE 100mg 5.90 TAB

TBE052 BETALOC ZOK 200mg METOPROLOL SUCCINATE 200mg 12.50 TAB

TBE034 BETALOC COMP 100mg METOPROLOL

100mg/HYDROCHLORTHIAZIDE

12.5mg

5.40 TAB

IBE012 BETALOC INJ 1mg/Ml METOPROLOL SUCCINATE 401.30 AMP

TBL010 BLOCADREN 10mg TIMOLOL MALEATE 10mg 3.50 TAB

TCO062 CONCOR 2.5mg BISOPROLOL FUMARATE 2.5mg 3.50 TAB

TCO060 CONCOR 5mg BISOPROLOL FUMARATE 5mg 4.00 TAB

ANTIGLAUCOMA PREPARATION

BETA-BLOCKERS

Page 4 of 28

Page 5: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TCO080 CORGARD 80mg NADOLOL 80mg 5.00 TAB

TDI075 DILATREND 6.25mg CARVEDILOL 6.25mg 4.00 TAB

TDI076 DILATREND 12.5mg CARVEDILOL 12.5mg 5.10 TAB

TDI077 DILATREND 25mg CARVEDILOL 25mg 5.60 TAB

TIN020 INDERAL 10mg (GE) PROPRANOLOL HCL 10mg 1.00 TAB

CPA148 INDERAL TABLET 10mg PROPRANOLOL HYDROCHLORIDE 1.50 TAB

CPA124 INDERAL 20mg (GE) PROPRANOLOL HCL 20mg 1.30 TAB

TIN022 INDERAL 40mg (GE) PROPRANOLOL HCL 40mg 1.50 TAB

TIN030 INDERAL LA 80mg PROPRANOLOL HCL 80mg 4.50 CAP

TIN032 INDERAL LA 160 mg PROPRANOLOL HCL 160mg 6.70 CAP

IIN010 INDERAL INJ 1mg/mL PROPRANOLOL HCL 80.00 AMP

TLO013 LOGIMAX FELODIPINE 5mg,METOPROLOL 50mg 21.50 TAB

TLO006 LODOZ 2.5mg/6.25mg BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZID

3.30 TAB

TLO007 LODOZ 5mg/6.25mg BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZID

3.30 TAB

TSE010 SECTRAL 100mg ACEBUTOLOL HCL 100mg 2.35 CAP

TSE012 SECTRAL 200mg ACEBUTOLOL HCL 200mg 4.16 CAP

TSE018 SELECTOL 200mg CELIPROLOL HCL 200mg 6.00 TAB

TSO020 SOTACOR 80mg SOTALOL HCL 80mg 5.00 TAB

TSO022

SOTACOR 80mg (GE)-

[SOTALOL] SOTALOL 2.50 TAB

TTE055 TENORMIN 25mg (GE) ATENOLOL 25mg 2.00 TAB

TTE052 TENORMIN 50mg ATENOLOL 50mg 3.00 TAB

TTE054 TENORMIN 50mg (GE) ATENOLOL 50mg 2.00 TAB

TTE050 TENORMIN 100mg ATENOLOL 100mg 4.00 TAB

TTE056 TENORMIN 100mg (GE) ATENOLOL 100mg 2.80 TAB

TAC013 ACERYCAL 5mg/5mg PERINDOPRIL 5mg, AMLODIPINE 5mg 9 TAB

TAC014 ACERYCAL 5mg/10mg PERINDOPRIL 5mg, AMLODIPINE

10mg

12.5 TAB

TAC016 ACERYCAL 10mg/10mg PERINDOPRIL, AMLODIPINE 14.3 TAB

TAC017 ACERYCAL 10mg/5mg PERINDOPRIL, AMLODIPINE 12.5 TAB

TAD012 ADALAT 5mg (GE) NIFEDIPINE 5mg 2.00 CAP

TAD010 ADALAT 10mg (GE) NIFEDIPINE 10mg 3.00 CAP

TAD020 ADALAT GITS 30mg NIFEDIPINE 30mg 10.80 TAB

TAD021 ADALAT GITS 30mg (GE) NIFEDIPINE 30mg 5.50 TAB

TAD022 ADALAT GITS 60mg NIFEDIPINE 60mg 15.90 TAB

TAD028 ADALAT RETARD TAB

20MG

NIFEDIPINE MODIFIED RELEASE 10.00 TAB

TAD030 ADALAT RETARD 20mg

(GE)

NIFEDIPINE 20mg 4.30 TAB

TAZ010 AZOREN 20mg/5mg

OLMESARTAN 20mg, AMLODIPINE

5mg 9.90 TAB

TAZ012 AZOREN 40mg/5mg

OLMESARTAN 40mg, AMLODIPINE

5mg 12.30 TAB

TBA010 BAYPRESS 10mg NITRENDIPINE 10mg 8.80 TAB

TBA020 BAYPRESS 20mg NITRENDIPINE 20mg 11.00 TAB

TEX022 EXFORGE 5mg/160mg AMLODIPINE BESYLATE

VALSARTANA

17.00 TAB

TEX020 EXFORGE 5mg/80mg AMLODIPINE BESYLATE

VALSARTANA

14.00 TAB

TEX023

EXFORGE HCT

5mg/160mg/12.5mg

AMLODIPINE 5mg, VALSARTAN

160mg, HYDROCHLOROTHIAZIDE 17.00 TAB

TEX024 EXFORGE 10mg/160mg AMLODIPINE BESYLATE

VALSARTANA

20.00 TAB

TEX025

EXFORGE HCT

10mg/160mg/12.5mg

AMLODIPINE 10mg, VALSARTAN

160mg, HYDROCHLOROTHIAZIDE 20.00 TAB

TEX026

EXFORGE HCT

10mg/160mg/25mg

AMLODIPINE 10mg, VALSARTAN

160mg, HYDROCHLOROTHIAZIDE 20.00 TAB

TEX027 EXFORGE HCT

10mg/320mg/25mg

AMLODIPINE 10mg, VALSARTAN

320mg, HYDROCHLOROTHIAZIDE

21.7 TAB

CPA085 EXFORGE

HCT(5mg/160mg/12.5mg)

AMLODIPINE, VALSARTANA,

HYDROCHLOROTHIAZIDE

17.60 TAB

THE018 HERBESSER 30mg DILTIAZEM 2.50 TAB

THE020 HERBESSER 30mg (GE) DILTIAZEM HCL 30mg 1.50 TAB

THE022 HERBESSER 60mg (GE) DILTIAZEM HCL 60mg 3.00 TAB

THE024 HERBESSER 60mg DILTIAZEM HCL 60mg 3.20 TAB

THE034 HERBESSER SR 90mg DILTIAZEM HCL 90mg 5.00 TAB

THE030 HERBESSER SR 120mg (GE) DILTIAZEM HCL 120mg 5.50 TAB

THE032 HERBESSER SR 180mg DILTIAZEM HCL 180mg 7.00 TAB

THE033 HERBESSER R 100mg DILTIAZEM HCL 100mg 4.50 TAB

CPA077 HERBESSER SR 200mg DILTIAZEM HCL 200mg 11.00 TAB

IHE050 HERBESSER INJ 50mg DILTIAZEM 90.00 AMP

TIS018 ISOPTIN 40mg VERAPAMIL HCL 40mg 3.60 TAB

TIS020 ISOPTIN 40mg (GE) VERAPAMIL HCL 40mg 2.50 TAB

TIS022 ISOPTIN 80mg (GE) VERAPAMIL HCL 80mg 4.00 TAB

TIS030 ISOPTIN SR 240mg VERAPAMIL HCL 240mg 12.30 TAB

IIS010 ISOPTIN INJ 5mg/2mL VERAPAMIL HCL 90.00 AMP

TLA018 LACIPIL 2mg LACIDIPINE 2mg 5.10 TAB

TLA020 LACIPIL 4mg LACIDIPINE 4mg 7.70 TAB

TNO080 NORVASC 5mg AMLODIPINE BESYLATE 5mg 6.50 TAB

TNO081 NORVASC 5mg [ACTAPIN] AMLODIPINE BESYLATE 5mg 4.00 TAB

TNO082 NORVASC 10mg AMLODIPINE BESYLATE 10mg 11.70 TAB

TNO083 NORVASC 10mg [ACTAPIN] AMLODIPINE BESYLATE 10mg 7.50 TAB

TPL022 PLENDIL 2.5mg FELODIPINE 2.5mg 4.40 TAB

TPL024 PLENDIL 5mg FELODIPINE 5mg 6.80 TAB

TPL025 PLENDIL 5mg (GE) FELODIPINE 4.00 TAB

TPL020 PLENDIL 10mg FELODIPINE 10mg 12.40 TAB

TTW010 TWYNSTA 40mg/5mg TELMISARTAN 40mg, AMLODIPINE

5mg

11.00 TAB

TTW012 TWYNSTA 40mg/10mg TELMISARTAN 40mg, AMLODIPINE

10mg

12.00 TAB

TTW014 TWYNSTA 80mg/5mg TELMISARTAN 80mg, AMLODIPINE

5mg

17.00 TAB

TTW016 TWYNSTA 80mg/10mg TELMISARTAN 80mg, AMLODIPINE

10mg

18.00 TAB

TZA025 ZANIDIP 10mg LERCANIDIPINE HCl 10mg 7.20 TAB

DIURET

ICSTAL012 ALDACTONE 100mg SPIRONOLACTONE 25mg 13.00 TAB

TAL010 ALDACTONE 25mg SPIRONOLACTONE 100mg 5.80 TAB

TAL008 ALDACTONE 25mg (GE) SPIRONOLACTONE 25mg 3.70 TAB

TAM018 AMILORIDE 5mg AMILORIDE 5mg 0.70 TAB

CALCIUM ANTAGONISTS

Page 5 of 28

Page 6: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TDI030 DIAMOX 250mg (GE) ACETAZOLAMIDE 250mg 2.50 TAB

IDI006 DIAMOX INJ 500mg (GE) ACETAZOLAMIDE 480.00 TAB

TDY008 DYAZIDE TRIAMTERENE

50mg/HYDROCHLOROTHIAZIDE 25mg

2.00 AMP

TDY010 DYAZIDE (GE) TRIAMTERENE

50mg/HYDROCHLOROTHIAZIDE 25mg

1.40 TAB

TEN020 ENDURON 5mg METHYCLOTHIAZIDE 5mg 2.00 TAB

TFR010 FRUMIL FRUSEMIDE 40mg/AMILORIDE 5mg 3.60 TAB

THY006 HYDROCHLOROTHIAZIDE

25mg

HYDROCHLOROTHIAZIDE 25mg 0.30 TAB

THY008 HYDROCHLOROTHIAZIDE

50mg

HYDROCHLOROTHIAZIDE 50mg 0.50 TAB

TLA078 LASIX 40mg FRUSEMIDE 40mg 3.00 TAB

TLA080 LASIX 40mg (GE) FRUSEMIDE 40mg 1.60 TAB

ILA012 LASIX INJ 20mg/2mL FRUSEMIDE 42.00 TAB

TLA090 LASIX SPECIAL TAB 500mg FRUSEMIDE 500mg 23.00 AMP

TMI028 MIDAMOR 5mg AMILORIDE 5mg 1.70 TAB

TMO008 MODURETIC AMILORIDE

5mg/HYDROCHLOROTHIAZIDE 50mg

2.20 TAB

TMO010 MODURETIC (GE) AMILORIDE

5mg/HYDROCHLOROTHIAZIDE 50mg

1.40 TAB

TNA030 NAVISPARE CYCLOPENTHIAZIDE

0.25mg/AMILORIDE 2.5mg

3.30 TAB

TZA050 ZAROXOLYN 5mg METOLZAONE 8.40 TAB

CPA076 ZAROXOLYN METOLAZONE 4.95 TAB

TMI059 MINIRIN 0.1mg DESMOPRESSION 13.50 TAB

TMI060 MINIRIN 0.2mg DESMOPRESSION 20.00 TAB

TMI061 MINIRIN MELT 60mcg DESMOPRESSIN ORAL

LYOPHILISATES 60mcg

12.18 TAB

TMI062 MINIRIN MELT 120mcg DESMOPRESSIN ACETATE 120mcg 30.00 TAB

DMI010 MINIRIN DDAVP NASAL

SPRAY 0.01%

DESMOPRESSION ACETATE 540.00 BOT

IAT006 ATP INJ 20mg/2mL ATP 25.00 AMP

TDO062 DOXIUM 500mg CA DOBESILATE 6.30 CAP

TDU030 DUXARIL AOLMITRINE 30mg,RAUBASINE 10mg 8.90 TAB

TME040 MERISLON 6mg BETAHISTINE MESILATE 6mg 1.20 TAB

TSE056 SERMION 10mg NICERGOLINE 10mg 12.50 TAB

CPA101 SERMION 30mg NICERGOLINE 30mg 33.00 TAB

CPA078 STUGERON 25mg (JASSEN) CINNARIZINE 2.70 TAB

TST040 STUGERON 25mg (GE) CINNARIZINE 25mg 1.20 TAB

MIGRAI

NETCA010 CAFERGOT ERGOTAMINE TARTRATE

1mg/CAFFEINE 100mg

7.00 TAB

TDI120 DIXARIT 0.025mg CLONIDINE HCL 0.025mg 2.80 TAB

TGR006 GRAVERGOL ERGOTAMINE,DIMENHYDRINATE,C

AFFEINE

1.65 CAP

TIM018 IMIGRAN 50mg SUMATRIPTAN SUCCINATE 50mg 96.00 TAB

IIM010 IMIGRAN INJ 6mg/0.5mL

(REFILL)

SUMATRIPTAN SUCCINATE 440.00 AMP

TMI030 MIGRIL ERGOTAMINE,CYCLIZINE,CAFFEINE 5.50 TAB

TSA040 SANDOMIGRAN 0.5mg PIZOTIFEN 0.5mg 3.20 TAB

TSI010 SIBELIUM 5mg (GE) FLUNARIZINE 5mg 3.00 CAP

TZO024 ZOMIG 2.5mg ZOLMITRIPTAN 2.5mg 102.40 TAB

TZO025 ZOMIG RAPIMELT 2.5mg ZOLMITRIPTAN 2.5mg 89.00 TAB

TTR020 TRANSAMIN 250mg TRANEXAMIC ACID 250mg 2.30 CAP

TTR022 TRANSAMIN 500mg TRANEXAMIC ACID 500mg 3.00 TAB

ITR020 TRANSAMIN 5% IV INJ

(250mg/5mL)

TRANEXAMIC ACID 80.00 AMP

ITR010 TRANSAMIN 10% IM INJ

(250mg/2.5mL)

TRANEXAMIC ACID 110.00 AMP

TRE050 REVOLADE 25mg ELTROMBOPAG OLAMINE 400.00 TAB

TVI060 VITAMIN K-3 10mg VITAMIN K-3 10mg 1.10 TAB

TAG010 AGGRENOX DIPYRIDAMOLE,ASPIRIN 6.90 CAP

TBR024 BRILINTA 90mg TICAGRELOR 25.00 TAB

TCA070 CARTIA 100mg ASPIRIN 100mg 1.70 TAB

ICL010 CLEXANE 40mg/0.4mL ENOXAPARIN 40mg 100.00 AMP

ICL012 CLEXANE 60mg/0.6mL ENOXAPARIN 60mg 120.00 AMP

ICL013 CLEXANE 80mg/0.8mL ENOXAPARIN 80mg 150.00 AMP

TCO067 CO-PLAVIX CLOPIDOGREL, ASPIRIN 20.00 TAB

TCO094 COUMADIN 2mg WARFARIN 2mg 1.50 TAB

TEL015 ELIQUIS 5mg APIXABAN 17.00 TAB

IFR010 FRAGMIN INJ 5,000 IU/2mL DALTEPARIN Na 94.00 AMP

IFR019 FRAXIPRARINE 2850 AXa

iu/0.3mL

NADROPARIN Ca 160.00 AMP

IFR020 FRAXIPARINE 3,800 AXa

IU/0.4mL INJ

NADROPARIN Ca 156.00 AMP

IIN018 INNOHEP 20,000 IU/mL

2X0.5mL

TINZAPARIN 190.00 AMP

TXA014 XARELTO 10mg RIVAROXABAN 38.00 TAB

TXA015 XARELTO 20mg RIVAROXABAN 20mg 40.00 TAB

TPR005 PRADAXA 75mg DABIGATRAN 75mg 20.00 CAP

TPR006 PRADAXA 110mg DABIGATRAN 20.00 CAP

TPR007 PRADAXA 150mg DABIGATRAN 150mg 20.00 CAP

TPL014 PLAVIX 75mg CLOPIDOGREL 75mg 20.00 CAP

TPL015 PLAVIX 75mg (GE) CLOPIDOGREL 14.00 TAB

TPL028 PLETAAL 50mg CILOSTAZOL 50mg 6.80 TAB

TTI010 TICLID 250mg TICLOPIDINE 250mg 19.50 TAB

TWA010 WARFARIN 1mg WARFARIN 1mg 1.10 TAB

TWA012 WARFARIN 3mg WARFARIN 3mg 1.60 TAB

TWA014 WARFARIN 5mg WARFARIN 5mg 2.00 TAB

CAN028 ANUSOL OINTMENT 25g BISMUTH SUBGALLATE 2.50 g

CAN030 ANUSOL OINTMENT (GE)

30g

BISMUTH SUBGALLATE 1.00 g

PAN010 ANUSOL SUPP BALSAM PERU, BISMUTH OXIDE... 4.60 SUPP

CAN040 ANUSOL-HC OINTMENT

(GE) 15g

HYDROCORTISONE, ZINC SULFATE 2.00 g

PAN018 ANUSOL-HC SUPP BISMUTH OXIDE, ZINC OXIDE.... 6.00 SUPP

PAN020 ANUSOL-HC SUPP (GE) BISMUTH OXIDE, ZINC OXIDE.... 6.00 SUPP

ANTIDIURETICS

HAEMORRHOIDAL, PHLEBITIS & VARICOSE PREPARATIONS

PERIPHERAL VASODILATORS & CEREBRAL ACTIVATORS

ANTICOAGULANTS, ANTITHROMBOTICS & FIBRINOLYTICS

HAEMOSTATICS

Page 6 of 28

Page 7: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TDA010 DAFLON 500mg DIOSMIN 450mg, HESPERIDIN 50mg 6.00 TAB

CFA010 FAKTU OINTMENT 20g POLICRESULEN, CINCHOCAINE HCL 4.30 g

PFA010 FAKTU SUPP POLICRESULEN, CINCHOCAINE HCL 6.00 SUPP

CHI031 HIRUDOID CREAM 5g (GE) MUCOPOLYSACCHARIDE

POLYSULFATE

2.30 g

CHI030 HIRUDOID CREAM 14g MUCOPOLYSACCHARIDE

POLYSULFATE

3.80 g

CHI040 HIRUDOID CREAM 40g MUCOPOLYSACCHARIDE

POLYSULFATE

2.80 g

CHI032 HIRUDOID FORTE CREAM

14g

MUCOPOLYSACCHARIDE

POLYSULFATE

4.64 g

IPH020 PHENOL IN ALMOND OIL

INJ 250mg/5mL

PHENOL 100.00 VIA

CPH013 PHENOL 5% IN ALMOND

OIL

PHENOL 3.40 ML

CPR008 PREMARIN VAGINAL

CREAM 14g

CONJUGATED ESTROGENS 84.00 TUB

CPR014 PROCTOSEDYL

OINTMENT 15g

HYDROCORTISONE, CINCHOCAINE... 3.40 g

PRO010 PROCTOSEDYL SUPP HYDROCORTISONE,CINCHOCAINE

HCL

4.60 SUPP

TRE027 REPARIL 20mg AESCIN 1.75 TAB

ISO072 SODIUM TETRADECYL

SULPHATE (FIBRO-VEIN)

SODIUM TETRADECYL SULPHATE 400.00 AMP

ITR040 TROMBOVAR 3% INJ SODIUM TETRADECYL SULFATE 60.00 VIA

CUL010 ULTRAPROCT OINTMENT

10g

FLUOCORTOLONE, CINCHOCAINE 9.00 g

CUL012 ULTRAPROCT-N CREAM

10g

FLUOCORTOLONE PIVALATE 8.60 g

PUL010 ULTRAPROCT SUPP FLUOCORTOLONE, CINCHOCAINE

HCL

9.20 SUPP

TVE020 VENORUTON 300mg TRIHYDROXYETHYLRUTOSIDE

300mg

6.00 CAP

CXY030 XYLOPROCT OINTMENT

20g

LIDOCAINE, HYDROCORTISONE 3.20 g

PXY010 XYLOPROCT SUPP LIDOCAINE, HYDROCORTISONE 5.80 SUPP

CZI020 ZINC OXIDE OINTMENT ZINE OXIDE 15% 0.80 g

CPA112 ARANESP 20 mcg/0.5 mL DARBEPOETIN α 500 AMP

CPA113 ARANESP 40 mcg/0.4 Ml DARBEPOETIN α 880 AMP

CPA114 ARANESP 100 mcg/0.5 mL DARBEPOETIN α 1700 AMP

IAR001 ARANESP [darbepoetin]

40mcg/0.4ml PRE-FILLED

DARBEPOETIN 1314 SYR

ILE010 LEUCOMAX INJ 150mcg MOLGRAMOSTIM 680.00 VIA

ILE012 LEUCOMAX INJ 300mcg MOLGRAMOSTIM 1280.00 VIA

INE005 NEULASTIM 6 mg/0.6 mL PEGFILGRASTIM 14520.00 AMP

INE006

NEUPOGEN 300mcg/0.5mL

PRE-FILLED FILGRASTIM 1300.00 AMP

IRE010 RECORMON INJ 5,000IU ERYTHROPOIETIN 760.00 VIA

IAD005

ADENOSCAN INJ

30mg/10mL ADENOSINE 210 AMP

CPA156 EDARBI 40 mg AZILSARTAN MEDOXOMIL 7.30 TAB

CPA149 EDARBI 80mg AZILSARTAN MEDOXOMIL 8.50 TAB

TEF020 EFFIENT 10mg PRASUGREL 10mg 28.00 TAB

CPA045 EIQUINON 10mg UBIDECARENONE (COENZYME Q10) 2.30 TAB

TGU010 GUTRON 2.5mg MIDRODINE HYDROCHOLORIDE 3.00 TAB

TIM019 IMIGRAN 50mg (GE) SUMATRIPTAN SUCCINATE 50mg 50.00 TAB

TIN080 INSPRA 25mg EPLERENONE 25mg 32.10 TAB

TIN082 INSPRA 50mg EPLERENONE 50mg 51.00 TAB

TPR017 PRAXILENE 100mg NAFTIDROFURYL 100mg 3.70 TAB

TTR030 TRENTAL 400mg PENTOXIFYLLINE 400mg 6.40 TAB

IAD010 ADRENALINE INJ 1:1,000

IM (GE)

ADRENALINE 70.00 AMP

CPA074 ALVESCO METERED-DOSE

INHALER

CICLESONIDE 238.00 PC

CPA144 ALVESCO MDI 160

mcg/actuation

CICLESONIDE 375.00 PC

IAM020 AMINOPHYLLINE INJ

250mg/10mL IV

AMINOPHYLLINE 50.00 AMP

IAM010 AMINOPHYLLINE INJ

250mg/2mL IM

AMINOPHYLLINE 32.00 AMP

SAT018 ATROVENT INHALER

20mcg/puff (200 Doses)

IPRATROPIUM BROMIDE

ANHYDROUS

220.00 PC

SAT010 ATROVENT NEB

SOLUTION 0.25mg/mL

IPRATROPIUM BROMIDE

ANHYDROUS

150.00 BOT

TBA004 BAMBEC 10mg BAMBUTEROL HYDROCHLORIDE 3.50 TAB

MBA010 BAMBEC SYR.1mg/1ml BAMBUTEROL HYDROCHLORIDE 0.60 ML

SBE006 BECLAZONE INHALER

100mcg

BECLOMETHASONE DIPROPIONATE 255.00 PC

SBE010 BECLOFORTE INHALER

250mcg/puff (200 Doses)

BECLOMETHASONE DIPROPIONATE 360.00 PC

SBE011

BECLOFORTE INHALER

250mcg/puff (GE) BECLOMETHASONE DIPROPIONATE 120.00 PC

SBE020 BECODISK 100mcg x 8

Doses

BECLOMETHASONE DIPROPIONATE 18.00 DISC

SBE022 BECODISK 200mcg x 8

Doses

BECLOMETHASONE DIPROPIONATE 30.00 DISC

SBE060 BECOTIDE DISKHALER BECODISK DISKHALER 55.00 PC

SBE070 BECOTIDE INHALER

50mcg/puff (200 Doses)

BECLOMETHASONE DIPROPIONATE 110.00 PC

SBE071 BECOTIDE INHALER

50mcg/puff (GE)

BECLOMETHASONE DIPROPIONATE 70.00 PC

TBE020 BEROTEC 2.5mg FENOTEROL HBr 2.5mg 1.00 TAB

SBE080 BEROTEC INHALER

0.2mg/puff 300 puffs

FENOTEROL HBr 120.00 PC

TBR010 BRICANYL 2.5mg TERBUTALINE SULFATE 2.5mg 1.00 TAB

TBR012 BRICANYL 2.5mg (GE) TERBUTALINE SULFATE 2.5mg 1.20 TAB

TBR020 BRICANYL DURULE 5mg TERBUTALINE SULFATE 5mg 2.60 TAB

TBR022 BRICANYL DURULE 7.5mg TERBUTALINE SULFATE 7.5mg 4.20 TAB

MBR010 BRICANYL SYRUP

1.5mg/5mL (GE)

TERBUTALINE SULFATE 0.17 ML

IBR010 BRICANYL INJ 0.5mg/mL TERBUTALINE SULFATE 77.30 AMP

SBR010 BRICANYL INHALER

250mcg/puff (400 Doses)

TERBUTALINE SULPHATE 132.00 PC

SBR020 BRICANYL NEB SOLUTION

10mg/mL 50mL/BOT

TERBUTALINE SULFATE 160.00 BOT

SBR026 BRICANYL SPACER

INHALER 250mcg/puff 400

TERBUTALINE SULFATE 130.00 PC

SBR030 BRICANYL TURBUHALER

0.5mg/dose (200 Doses)

TERBUTALINE SULFATE 258.00 PC

SBR024 BRINCANYL RESPULE

0.5mg/2mL

TERBUTALINE SULFATE 9.00 AMP

SCO020 COMBIVENT INHALER IPRATROPIUM, SALBUTAMOL 200.00 PC

TDA070 DAXAS 500mcg ROFLUMILAST 20.500 TAB

SCO010 COMBIVENT

NEB.SOLU.2.5ml/vial

IPRATROPIUM Br

ANHYDROUS/SALBU

12.00 VIA

CPA137 COMBIVENT NEBULE IPRATROPIUM BR ANHYDROUS

0.5mg, SALBUTAMOL 2.5mg

9.00 NEB

MDI020 DIPROPHYLLINE

100mg/5mL

DIPROPHYLLINE 0.17 ML

IEP002 EPIPEN AUTO-INJECTOR

1:1000

ADRENALINE 1500.00 AMP

SFL024 FLIXOTIDE ACCUHALER

50mcg

FLUTICASONE PROPIONATE 400.00 PC

SFL026 FLIXOTIDE INHALER

25mcg/puff ( 60 DOSE)

FLUTICASONE PROPIONATE 50.00 PC

ANTIASTHMATIC PREPARATIONS

OTHER CARDIOVASCULAR DRUGS

HAEMATOPOIETIC AGENTS

Page 7 of 28

Page 8: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

SFL028 FLIXOTIDE INHALER

50mcg/puff (60 Doses)

FLUTICASONE PROPIONATE 105.00 PC

SFL029 FLIXOTIDE INHALER

50mcg/puff (120 Doses)

FLUTICASONE PROPIONATE 322.00 PC

SFL030 FLIXOTIDE INHALER

125mcg/puff (60 Doses)

FLUTICASONE PROPIONATE 340.00 PC

SFL032 FLIXOTIDE INHALER

250mcg/puff (120 Doses)

FLUTICASONE PROPIONATE 605.00 PC

SFL033 FLIXOTIDE INHALER

250mcg/puff (60 Doses)

FLUTICASONE PROPIONATE 336.00 PC

SFL025 FLIXOTIDE ACCUHALER

250mcg

FLUTICASONE PROPIONATE 442.00 PC

CPA138 FLIXOTIDE NEBULES 0.5

mg/2 mL

FLUTICASONE PROPIONATE 25.00 NEB

SIN010 INTAL INHALER 1mg/puff

(200 Doses)

SODIUM CROMOGLYCATE 204.00 PC

SIN012 INTAL INHALER 5mg/puff

(112 Doses)

SODIUM CROMOGLYCATE 170.00 PC

SIN030 INTAL NEB SOLUTION

20mg/2mL

SODIUM CROMOGLYCATE 3.00 AMP

SIN040 INTAL SPINCAP 20mg SODIUM CROMOGLYCATE 3.00 CAP

TNU010 NUELIN SR 200mg ANHYDROUS THEOPHYLLINE 200mg 1.30 TAB

TNU012 NUELIN SR 300mg ANHYDROUS THEOPHYLLINE 300mg 1.60 TAB

MNU010 NUELIN SYRUP 80mg/15mL

60mL

THEOPHYLLINE 0.22 ML

CPA145 ONBREZ BREEZHALER 150

mcg INHALATION POWD

CAP

INDACATEROL MALEATE 384.00 PC

CPA146 ONBREZ BREEZHALER 300

mcg INHALATION POWD

CAP

INDACATEROL MALEATE 637.00 PC

SOX010 OXIS TURBUHALER

4.5mcg/dose (60 Doses)

FORMOTEROL FUMARATE 4.5mcg 173.00 PC

SOX011 OXIS TURBUHALER

9mcg/dose (60 Doses)

FORMOTEROL FUMARATE 9 mcg 318.00 PC

SPU012 PULMICORT INHALER

50mcg/puff (200 Doses)

BUDESONIDE 140.00 PC

SPU010 PULMICORT INHALER

200mcg/puff (100 Doses)

BUDESONIDE 210.00 PC

SPU011

PULMICORT INHALER

200mcg/puff (120 Dose) BUDESONIDE 295.00 PC

SPU040 PULMICORT SPACE

INHALER 200mcg/puff (100

BUDESONIDE 210.00 PC

SPU042 PULMICORT SPACE

INHALER 50mcg/puff (200

BUDESONIDE 140.00 PC

SPU060 PULMICORT

TURBUHALER 100mcg/dose

BUDESONIDE 472.00 PC

SPU062 PULMICORT

TURBUHALER 200mcg/dose

BUDESONIDE 795.00 PC

SPU064 PULMICORT

TURBUHALER 400mcg/dose

BUDESONIDE 1210.00 PC

SPU030 PULMICORT RESPULE

0.5mg/2mL

BUDESONIDE 58.30 AMP

SRE010 RESPOLIN AUTO-HALER

100mcg/puff (400 Doses)

SALBUTAMOL SULFATE 260.00 PC

SSE020 SERETIDE INHALER

25mcg/125mcg

SALMETEROL, FLUTICASONE 595.00 PC

SSE009 SERETIDE INHALER

25mcg/50mcg

SALMETEROL, FLUTICASONE 360.00 PC

SSE022 SERETIDE INHALER

25mcg/250mcg

SALMETEROL, FLUTICASONE 825.00 PC

SSE006 SERETIDE ACCUHALER

50mcg/100mcg (60 Doses)

SALMETEROL, FLUTICASONE 462.00 PC

SSE007 SERETIDE ACCUHALER

50mcg/500mcg (60 Doses)

SALMETEROL, FLUTICASONE 905.00 PC

SSE008 SERETIDE ACCUHALER

50mcg/250mcg (60 Doses)

SALMETEROL, FLUTICASONE 755.00 PC

CPA079 SERETIDE ACCUHALER

500mcg

SALMETEROL, FLUTICASONE 820.00 PC

SSE012 SEREVENT INHALER

25mcg/puff (120 Doses)

SALMETEROL XINAFOATE 455.00 PC

SSE010 SEREVENT INHALER

25mcg/puff (60 Doses)

SALMETEROL XINAFOATE 275.00 PC

SSE016 SEREVENT ACCUHALER

50mcg/dose (60 Doses)

SALMETEROL XINAFOATE 629.00 PC

TSI058 SINGULAIR 4mg ZINCAPS 14.30 TAB

TSI060 SINGULAIR 5mg MONTELUKAST SODIUM 5mg 14.30 TAB

TSI062 SINGULAIR 10mg MONTELUKAST SODIUM 10mg 14.30 TAB

MSI020 SINGULAIR ORAL

GRANULES 4mg

MONTELUKAST SODIUM 4mg 14.30 SACH

TSL012 SLO-BID 50mg THEOPHYLLINE 50mg 0.80 CAP

TSL010 SLO-BID 100mg THEOPHYLLINE 100mg 0.70 CAP

TSL011 SLO-BID 200mg THEOPHYLLINE 200mg 0.50 CAP

TSL014 SLO-THEO 50mg ANHYDROUS THEOPHYLLINE 50mg 0.70 CAP

TSL016 SLO-THEO 100mg ANHYDROUS THEOPHYLLINE 100mg 0.90 CAP

SSP020 SPIRIVA 18mcg CAPSULES

FOR INHALATION

TIOTROPIUM 18 mcg 19.00 CAP

CPA089 SPIRIVA RESPIMAT

SOLUTION FOR

TIOTROPIUM BR 600.00 PC

CPA087 SPIRIVA TURBUHALER

18mcg

TIOTROPIUM 18 mcg 400.00 PC

SSY010 SYMBICORT

TURBUHALER 160/4.5mcg

BUDESONIDE/FORMOTEROL

FUMARATE

416.00 PC

SSY012

SYMBICORT

TURBUHALER

320/9mcg/dose (60 doses)

BUDESONIDE 320mcg,FORMOTEROL

FUMARATE DIHYDRATE 9mcg 705

PC

SSY008 SYMBICORT

TURBUHALER

BUDESONIDE/FORMOTEROL

FUMARATE

285.00 PC

TTE006 TEDRAL SA THEOPHYLLINE, EPHEDRINE... 1.10 TAB

TTH010 THEODUR 200mg ANHYDROUS THEOPHYLLINE 200mg 1.20 TAB

TTH012 THEODUR 300mg ANHYDROUS THEOPHYLLINE 300mg 1.50 TAB

STI010 TILADE STANDARD

INHALER 2mg/puff, 112

NEDOCROMIL Na 230.00 PES

CPA147 VANNAIR 160/4.5 mcg MDI BUDESONIDE, FORMOTEROL

FUMARATE DIHYDRATE

820.00 PC

SVE010 VENTIDE INHALER (200

Doses)

SALBUTAMOL, BECLOMETHASONE 200.00 PC

SVE020 VENTODISK 200mcg x 8

Doses

SALBUTAMOL SULPHATE 16.00 DISC

SVE022 VENTODISK 400mcg x 8

Doses

SALBUTAMOL SULPHATE 20.00 DISC

TVE030 VENTOLIN 2mg (GE) SALBUTAMOL 2mg 0.80 TAB

TVE032 VENTOLIN 4mg (GE) SALBUTAMOL 4mg 1.30 TAB

MVE012 VENTOLIN EXPECTORANT

(G.E)

SALBUTAMOL SULPHATE 0.17 ML

MVE010 VENTOLIN SYRUP

2mg/5mL (GE)

SALBUTAMOL SULPHATE 0.19 ML

IVE010 VENTOLIN INJ 0.5mg/mL SALBUTAMOL SULPHATE 30.00 AMP

SVE050 VENTOLIN INHALER

100mcg/puff (200 Doses)

SALBUTAMOL SULPHATE 115.00 PC

SVE052 VENTOLIN INHALER

100mcg/puff (GE)

SALBUTAMOL SULPHATE 56.00 PC

SVE030 VENTOLIN ACCUHALER

200mcg

SALBUTAMOL SULPHATE 215.00 PC

SVE040 VENTOLIN DISKHALER SALBUTAMOL SULPHATE 58.00 PC

SVE060 VENTOLIN NEBULE

2.5mg/2.5mL

SALBUTAMOL SULPHATE 6.70 AMP

SVE070 VENTOLIN RESP

SOLUTION 5mg/mL

SALBUTAMOL SULPHATE 137.00 BOT

TVO010 VOLMAX 4mg SALBUTAMOL SULPHATE 4mg 2.70 TAB

TVO011 VOLMAX {Salbutamol} 4mg

(GE)

SALBUTAMOL SULPHATE 4mg 2.70 TAB

TVO012 VOLMAX 8mg SALBUTAMOL SULPHATE 8mg 4.50 TAB

AVO012 VOLUMATIC SOFT

(GLAXO)

171.00 PC

TZA018 ZADITEN 1mg KETOTIFEN HYDROGEN FUMARATE

1mg

5.00 TAB

TZA020 ZADITEN 1mg (GE) KETOTIFEN 1mg 2.60 TAB

MZA020 ZADITEN SYRUP 1mg/5mL KETOTIFEN HYDROGEN FUMATATE 1.50 ML

MZA030 ZANTAC 150mg/10mL RANITIDINE HCL 2.20 ML

DIN010 INHALANT 30mL/BOT (GE) MENTHOL, EUCALYPTUSE 0.33 ML

Page 8 of 28

Page 9: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

MME005 MEPTIN SYRUP 5mcg/mL PROCATEROL HYDROCHLORIDE 0.79 ML

TAC020 ACTIFED (GE) TRIPROLIDINE, PSEUDOEPHEDRINE 2.00 TAB

MAC008 ACTIFED COMPOUND

LINCTUS

CODEINE PSEUDOEPHEDRINE

TRIPROLIDINE

60.00 BOT

MAC010 ACTIFED CO SYRUP (GE) CODEINE, PSEUDOEPHEDRINE.... 0.40 ML

MAC012 ACTIFED CO SYRUP (1/2

STRENGTH)

CODEINE, PSEUDOEPHEDRINE.... 0.17 ML

MAC014 ACTIFED CO "UNI-FEDRA

COMPOUND" SYRUP

TRIPROLIDINE, CODEINE,

PSEUDOEPHEDRINE

0.32 ML

MAC020 ACTIFED SYRUP (GE) TRIPROLIDINE, PSEUDOEPHEDRINE 0.30 ML

MBE020 BENADRYL

EXPECTORANT (GE)

DIPHENHYDRAMINE, AMMONIUM

CL..

0.20 ML

TBI020 BISOLVON 8mg (GE) BROMHEXINE 8mg 0.85 TAB

MBI020 BISOLVON SYRUP

4mg/5mL (GE)

BROMHEXINE HCL 0.17 ML

MBI022 BISOLVON SYRUP

8mg/5mL (GE)

BROMHEXINE HCL 0.17 ML

MBI010 BISOLVON CO ELIXIR (GE) BROMHEXINE,CODEINE 0.17 ML

TCP010 C.P.P. CHLORPHENIRAMINE,PHENYLEHRI

NE

0.50 TAB

MCH010 CHRISTOLIN SYRUP EPHEDRINE/AMMONIUM

CHLORDIE/PO

0.17 ML

TCL010 CLARINASE LORATADINE, PSEUDOEPHEDRINE 5.50 TAB

TCL012 CLARINASE EXTENDED

RELEASE

LORATADINE, PSEUDOEPHEDRINE 10.20 TAB

MCO010 COCILLANA CO MIXTURE

(GE)

COCILLANA, SENEGA, EUPHORBIA… 0.18 ML

MCO012 COCILLANA CO MIXTURE

WITH CODEINE

COCILLANA, CONDEINE, SENEGA,

EUPHORBIA…

0.42 ML

CPA104 CODAPANE FORTE PARACETAMOL, CODEINE

PHOSPHATE

8.00 TAB

CPA157 CO-CODAMOL PARACETAMOL, CODEINE

PHOSPHATE

2.00 TAB

MCO020 CODEINE LINCTUS

12.5mg/5mL (1/2

CODEINE PHOSPHATE 0.23 ML

MCO022 CODEINE LINCTUS

25mg/5mL (FULL

CODEINE PHOSPHATE 0.32 ML

TCO010 CODEINE PHOSPHATE

15mg

CODEINE PHOSPHATE 15mg 1.00 TAB

TCO012 CODEINE PHOSPHATE

30mg

CODEINE PHOSPHATE 30mg 1.50 TAB

TCO014 CODIPRONT CODEINE, PHENYLTOLOXAMINE 5.50 CAP

TCO020 CODOPLEX CODEINE, CHLORPHENIRAMINE... 1.80 TAB

TCO022 CODOPLEX JUNIOR CODEINE, CHLORPHENIRAMINE... 0.50 TAB

MCO030 CODOPLEX SYRUP CODEINE, CHLORPHENIRAMINE... 0.30 ML

TCO030 COFREL BENPROPERINE 20mg 2.10 TAB

MCO060 COSYR DEXTROMETHORPHAN/CHLORPHEN

IRAM

0.17 ML

TDA026 DANZEN 5mg SERRAPEPTASE 1.20 TAB

MDE010 DEC SYRUP CODEINE,EPHEDRINE,DEXCHLORPH

ENIRAMINE

0.40 ML

MDE050 DEXTROCILLA SYRUP DEXTROMETHORPHAN,COCILLANA

0.22 ML

MDE060 DEXTROMETHORPHAN

15mg/5mL SYRUP

DEXTROMETHORPHAN 0.22 ML

CPA099 DURO-TUSS FORT PHOLCODINE 0.50 ML

MEX008 EXPECT STIM MIXTURE

(120mL)

AMMONIUM CO3, IPECAUANHA

TINCT

0.17 ML

MEX010 EXPECT STIM MIXTURE

(3600mL)

AMMONIUM CO3, IPECAUAUHA

TINCT

0.25 ML

MFL020 FLUIMUCIL 100mg ACETYLCYSTEINE 2.00 SACH

MFL022 FLUIMUCIL 200mg ACETYLCYSTEINE 2.50 SACH

MFL021 FLUIMUCIL A 100mg ACETYLCYSTEINE 2.60 SACH

MFL023 FLUIMUCIL A 200mg ACETYLCYSTEINE 3.20 SACH

CPA090 FLUIMUCIL A

EFFERVESCENT 600mg

ACETYLCYSTEINE 4.00 TAB

TFL050 FLU-OFF PARACETAMOL,

CHLORPHENIRAMINE…

1.20 CAP

TFL040 FLUCOR DAY

PARACETAMOL,

PSEUDOEPHEDRINE, 2.000 CAP

MGE010 GEE'S LINCTUS (GE) OPIUM TINCT, SQUIL LIQ EXTRACT 0.18 ML

TGE008 GELOMYRTOL FORTE MYRTOL 300mg 3.70 TAB

MGL010 GLYCERYL

GUAIACOLATE 100mg

GLYCERYL GUAIACOLATE 100mG 0.17 ML

MGU010 GUAIFENESIN 100mg/5mL GUAIFENESIN 100mg 0.17 ML

TLO012 LOGICIN FLU STRENGTH PARACETAMOL, PSEUDOEPHEDRINE 1.85 TAB

CPA111 LOGICIN RAPID RELIEF

LOZ

LIGNOCAINE HCI, BENZYDAMINE

HCI, DICHLOROBENZYL ALCOHOL

1.2 mg

1.50 TAB

MME020 METHORSEDYL SYRUP DEXTROMETHORPHAN,PROMETHAZ

INE

0.25 ML

IME005 METHON-S (50'S/BOX)

CHLORPHENIRAMINE,DEXTROMETHOR

PHAN,GUAIPHENESIN,METHOXPHENAM 35.00 AMP

TMU020 MUCODYNE 375mg (GE) CARBOCISTEINE 1.50 TAB

TMU030 MUCOSOLVAN 30mg (GE) AMBROXOL HCL 30mg 1.20 TAB

CPA039 MUCOSOLVAN 30mg AMBROXOL HCL 30mg 1.50 TAB

MMU024 MUCOSPECT SYRUP

100mg/5mL

CARBOCYSTEINE 0.23 ML

MMU026 MUCOSPECT SYRUP

250mg/5mL

CARBOCYSTEINE 0.27 ML

TPA019 PANADOL EXTEND 665mg ACETAMINOPHEN 1.00 TAB

TPA034 PANADOL COLD & FLU ACETAMINOPHEN/PHENYLEPHRINE 2.00 TAB

MPH012 PHENEXPECT SYRUP DIPHENHYDRAMINE/AMMON CL/NA

CI

0.17 ML

MPH020 PHENSEDYL SYRUP (GE) PROMEHTAZINE,CODEINE,EPHEDRI

NE

0.40 ML

TPH026 PHENSEDYL TAB (GE) PROMETHAZINE,CODEINE,EPHEDRI

NE

2.00 TAB

MPH030 PHOLCODINE SYRUP

5mg/5mL

PHOLCODINE 0.20 ML

MPI010 PIRITON EXPECTORANT

(GE)

CHLORPHENIRAMINE, AMMONIUM

CL

0.17 ML

MPR030 PRODEX COUGH SYRUP DEXTROMETHORPHAN HBR/

EPHEDRINE HCL/PROMETHAZINE

HCL

0.20 ML

MRH008 RHINATHIOL INFANT

SYRUP

CARBOCISTEINE 0.24 ML

TRO050 ROMILAR 15mg

(DEXTROMETHORPHAN)

DEXTROMETHORPHAN 15mg 1.10 TAB

TRO052 ROMILAR 25mg

(DEXTROMETHORPHAN)

DEXTROMETHORPHAN 25mg 1.50 TAB

TSU010 SUDAFED 60mg (GE) PSEUDOEPHEDRINE 60mg 2.00 TAB

MSU010 SUDAFED SYRUP

30mg/5mL (GE)

PSEUDOEPHEDRINE HCL 0.30 ML

MCO052 CORYAID SYRUP (1/2

STRENGTH) (GE)

CHLORPEHNIRAMINE,CODEINE,EPH

ED

0.18 ML

MCO050 CORYAID SYRUP (GE) CHLORPEHNIRAMINE,CODEINE,EPH

ED

0.18 ML

TCO090 CORYZAC (GE) CAFFEINE,CHLORPHENIRAMINE,PPA 0.60 CAP

MDI010 DIMETAPP ELIXIR (GE) BROMPHENIRAMINE,PPA,PHENYLEP

HR

0.18 ML

MMU050 MUCOFLUX D,L-trans-1 methyl-4-cyclohex-1,2-2n-6-ol

80mg, 60% sucrose syrup

1.00 ML

TNE020 NEOZEP PARACETAMOL,PPA,SALICYLAMIDE.

.

1.20 TAB

MRH010 RHINOPRONT SYRUP PPA, CARBINOXAMINE 0.40 ML

MTI010 TIXYLIX SYRUP (GE) PPA, PHOLCODINE, PROMETHAZINE 0.19 ML

TCO008 CODAEWON DIHYDROCODEINE, GUAIFENESIN,

CHLORPHENIRAMINE,

1.20 TAB

SAF012 AFRIN (PAED) NOSE

DROPS/SPRAY 0.025%

OXYMETAZOLINE HCL 45.00 BOT

COUGH & COLD REMEDIES

DECONGESTANTS & OTHER NASAL PREPARATIONSPage 9 of 28

Page 10: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

SAF010 AFRIN (ADULT) NASAL

SPRAY 0.05% 15mL/BOT

OXYMETAZOLINE HCL 60.00 BOT

CPA059 AVAMYS NASAL SPRAY FLUTICASONE FUROATE 120.00 PC

SAV010 AVAMYS NASAL SPRAY

27.5mcg 120 Doses

FLUTICASONE FUROATE 200.00 PC

SBE050 BECONASE NASAL SPRAY

50mcg

BECLOMETHASONE DIPROPIONATE 92.00 BOT

SBE040 BECONASE AQUEOUS

NASAL SPRAY 50mcg

BECLOMETHASONE DIPROPIONATE 175.00 BOT

DCR020 CROMOLYN NASAL

SOLUTION 2%

SODIUM CROMOGLYCATE 90.00 BOT

TDR010 DRIXORAL (GE) DEXBROMPHENIRAMINE,

PSEUDOEPHEDRINE

2.00 TAB

DEP010 EPHEDRINE NASAL

DROPS 0.5% 15mL/BOT

EPHEDRINE 0.5% 0.36 ML

DEP012 EPHEDRINE NASAL

DROPS 1% 15 mL/BOT

EPHEDRINE 1% 0.45 ML

SFL010 FLIXONASE AQUEOUS

NASAL SPRAY

FLUTICASONE PROPIONATE 128.00 BOT

CPA105 MAR PLUS NASAL SPRAY

(140 SPRAYS) 10 mg/1 mL x

DEXPANTHENOAL 10MG,

SEAWATER 250 mg.

30.00 PC

SNA006 NASACORT AQ NASAL

SPRAY

TRIAMICINOLONE ACETONIDE

55mcg

255.00 BOT

SNA010 NASONEX NASAL SPRAY

0.05% 140 Doses

MOMETASONE FUROATE 168.00 BOT

SNA012 NASONEX NASAL SPRAY

0.05% 60 Doses

MOMETASONE FUROATE 135.00 BOT

CNI006 NISITA OINTMENT 20g Na Iodide, Na Bromide, Na Cl.. 2.00 g

SNI004 NISITA NASAL SPRAY Na IODIDE, Na BROMIDE, NaCl 120.00 BOT

CPA103 OMNARIS NASAL SPRAY

50MCG

CICLESONIDE 315.00 PC

SOT010 OTRIVIN CHILDREN

NASAL DROPS

XYLOMETAZOLINE HCL 0.05% 38.00 BOT

SOT030 OTRIVIN ADULTS NASAL

DROPS

XYLOMETAZOLINE HCL 0.1% 60 BOT

SRH010 RHINOCORT NASAL

SPRAY 50mcg (GE)

BUDESONIDE 100.00 BOT

SRH008 RHINOCORT AQUA NASAL

SPRAY 50mcg

BUDESONIDE 145.00 BOT

SRH009 RHINOCORT AQUA NASAL

SPRAY 64mcg

BUDESONIDE 147.90 BOT

SRH012 RHINOCORT

TURBUHALER 100mcg/dose

BUDESONIDE 421.80 PC

SST010 STERIMAR MICROSPRAY

50ml

PHYSIOLOGICAL SEA WATER 60.00 BOT

SRY010 RYNACROM M NASAL

SPRAY 2%

SODIUM CROMOGLYCATE 70.00 BOT

DSI020 SINOMARIN ADULTS

125mL

SEA WATER SOLUTION 83.00 BOT

DSI022 SINOMARIN

CHILDREN/ENFANTS

HYPERTONIC SEA WATER 64.00 BOT

CVI010 VIBROCIL GEL 12g DIMETHINDENE, PHENYLEPHRINE 3.75 g

DXY010 XYLOMA NASAL DROPS

0.1%

XYLOMETAZOLINE HCl 23.00 BOT

TBR030 BROTASE 20mg BROMELAIN 0.800 TAB

TNE040 NEUZYM 30mg LYSOZYME HCL 30mg 1.00 TAB

TNE042 NEUZYM 30mg (GE) LYSOZYME HCL 30mg 0.70 TAB

TNE044 NEUZYM 60mg (GE) LYSOZYME HCL 60mg 0.60 TAB

TPA042 PAPASE PROLASE 10,000U 0.70 TAB

TPA043 PAPASE (GE) PROLASE 10,000U 0.80 TAB

TAS050 ASTRIX 100mg ASPIRIN 1.85 TAB

TAS034 ASPILETS ASPIRIN 80mg 0.50 TAB

TAS030 ASPIRIN 300mg (GE) ASPIRIN 300mg 0.60 TAB

TAS032 ASPIRIN 75mg (GE) ASPIRIN 75mg 0.50 TAB

TAS033 ASPIRIN 80mg (GE) ASPIRIN 80mg 0.70 TAB

TAS040 ASPIRIN SOLUBLE 300mg

(GE)

ASPIRIN SOLUBLE 300mg 0.60 TAB

TBE061 BEXTRA 20mg VALDECOXIB 20mg 10.00 TAB

MCA010 CALPOL SUSPENSION

120mg/5mL

PARACETAMOL 0.25 ML

TDF010 DF 118 30mg DIHYDROCODEINE TARTRATE 30mg 5.50 TAB

TDI108 DISPRIN 300mg ASPIRIN 300mg 1.70 TAB

TDO020 DOLOBID 250mg DIFLUNISAL 250mg 3.20 CAP

TDO030 DOLOGESIC (GE) DEXTROPROPOXYPHENE,PARACET

AMOL

1.20 TAB

TDO040 DOLOXENE 32mg DEXTROPROPOXYPHENE 2.00 CAP

TDO038 DOLOXENE 32mg (GE) DEXTROPROPOXYPHENE 1.00 CAP

TDO050 DOLOXENE CO (GE) DEXTROPROPOXYPHENE,ASA,CAFF

EIN

2.00 CAP

PEP012 EPIZON CHILD RECTOCAP PARACETAMOL,PROPYPHENAZONE

5.00 SUPP

PEP010 EPIZON INFANT

RECTOCAP

PARACETAMOL,PROPYPHENAZONE

4.80 SUPP

IFE020 FENTANYL INJ 0.05mg/2mL FENTANYL 92.00 AMP

IMO012 MORPHINE INJ 10mg/mL MORPHINE 50.00 AMP

IMO030 MORPHINE INJ 15mg/mL MORPHINE 50.00 AMP

MMO008 MORPHINE SYRUP

10mg/5mL

MORPHINE 0.67 ML

TOX012 OXYNORM [OXYCODONE]

5mg

OXYCODONE 5mg 26.00 CAP

TOX013 OXYNORM [OXYCODONE]

10mg

OXYCODONE 10mg 33.00 CAP

TOX006 OXYCONTIN 5mg OXYCODONE HYDROCHLORIDE 43.00 TAB

TOX008 OXYCONTIN 10mg OXYCODONE HYDROCHLORIDE 54.00 TAB

CPA043 PANADEINE PARACETAMOL, CODEINE 1.60 TAB

TPA020 PANADEINE (GE) PARACETAMOL, CODEINE (500/8mg) 2.00 TAB

TPA028 PANADOL 250mg (GE) PARACETAMOL 250mg 0.30 TAB

TPA018 PANADOL 500mg PARACETAMOL 500mg 2.00 TAB

TPA030 PANADOL 500mg (GE) PARACETAMOL 500mg 0.60 TAB

TPA052 PARCOTEN TAB CODEINE PARACETAMOL 3.00 TAB

PPA010 PANADOL SUPP 125mg

(GE)

PARACETAMOL 2.80 SUPP

PPA012 PANADOL SUPP 250mg

(GE)

PARACETAMOL 2.90 SUPP

MPA014 PANADOL SUSPENSION

250mg/5mL (GE)

PARACETAMOL 0.22 ML

MPA010 PANADOL SYRUP

120mg/5mL (GE)

PARACETAMOL 0.17 ML

MPA012 PANADOL SYRUP

250mg/5mL (GE)

PARACETAMOL 0.20 ML

IPE020 PETHIDINE INJ 100mg/2mL PETHIDINE 60.00 AMP

IPE022 PETHIDINE INJ 50mg/mL PETHIDINE 50.00 AMP

TPH030 PHYSEPTONE 5mg METHADONE HCL 5mg 10.00 TAB

TPO018 PONSTAN 250mg MEFENAMIC ACID 250mg 1.30 CAP

TPO020 PONSTAN 250mg (GE) MEFENAMIC ACID 250mg 1.05 CAP

TPO022 PONSTAN 500mg MEFENAMIC ACID 500mg 1.60 CAP

TPO024 PONSTAN 500mg (GE) MEFENAMIC ACID 500mg 1.30 TAB

TTE028 TEMGESIC 0.2mg BUPRENORPHINE HCL 0.2mg 6.20 TAB

ITE008 TEMGESIC INJ 0.3mg/mL BUPRENORPHINE HCL 50.00 AMP

ANO003 NORSPAN

[BUPRENORPHINE]

TRANSDERMAL PATCH 5

BUPRENORPHINE 820.00 BOX

ANTI-INFLAMMATORY ENZYMES

ANALGESICS & ANTIPYRETICS

Page 10 of 28

Page 11: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ANO004 NORSPAN

[BUPRENORPHINE]

TRANSDERMAL PATCH 10

BUPRENORPHINE 1320.00 BOX

TTR006 TRAMAL 50mg TRAMADOL HCL 50mg 5.00 CAP

TTR007

TRAMAL <TRAMADOL>

50mg [MABRON] TRAMADOL 2.70 CAP

ITR006 TRAMAL INJ 50mg TRAMADOL 40.00 AMP

ITR007

TRAMAL <TRAMADOL>

INJ 100mg/2mL TRAMADOL 40.00 AMP

TTR008 TRAMAL RETARD 100mg TRAMADOL HCL 100mg 9.20 TAB

TUL030 ULTRACET TRAMADOL

37.5mg/ACETAMINOPHEN 325mg

5.30 TAB

TAF010 AFLOXAN 150mg PROGLUMETACIN 150mg 2.50 CAP

TAR044 ARCOXIA 120mg ETORICOXIB 120mg 11.80 TAB

TAR040 ARCOXIA 60mg ETORICOXIB 60mg 10.50 TAB

TAR042 ARCOXIA 90mg ETORICOXIB 90mg 10.40 TAB

CPA086 ARCOXIA 30mg ETORICOXIB 30mg 8.50 TAB

TAR025 ARTRODAR 50mg DIACEREIN 10.00 CAP

TAR020 ARTHROTEC DICLOFENAC NA, MISOPROSTOL 6.30 TAB

TAS020 ASCRIPTIN A/D AL & MG HYDROXIDE, ASPIRIN 0.50 TAB

TBE060 BEXTRA 10mg VALDECOXIB 10mg 10.00 TAB

TBE062 BEXTRA 40mg VALDECOXIB 40mg 17.00 TAB

TBR120 BRUFEN 200mg (GE) IBUPROFEN 200mg 0.85 TAB

TBR122 BRUFEN 400mg IBUPROFEN 1.700 TAB

TCA080 CATAFLAM 25mg DICLOFENAC POTASSIUM 25mg 3.50 TAB

TCA082 CATAFLAM 50mg DICLOFENAC POTASSIUM 50mg 5.80 TAB

TCE034 CELEBREX 100mg CELECOXIB 100mg 8.00 CAP

TCE036 CELEBREX 200mg CELECOXIB 200mg 9.20 CAP

CPA046 CELEBREX 400mg CELECOXIB 400mg 15.00 CAP

CPA054 CLINORIL 200mg SULINDAC 200mg 4.00 TAB

TCU010 CUPRIMINE 250mg PENICILLAMINE 250mg 6.50 TAB

IDY010 DYNASTAT INJ 40mg PARECOXIB 40 mg 340.00 VIA

TEC010 ECOTRIN 650mg ASPIRIN 650mg 1.00 TAB

IEN020 ENBREL 25mg ETANERCEPT 25mg 1586.00 AMP

TFE010 FELDENE 10mg (GE) PIROXICAM 10mg 3.50 CAP

IFE010 FELDENE INJ PIROXICAM 35.00 AMP

TIN040 INDOCID 25mg (GE) INDOMETHACIN 25mg 1.00 CAP

TLO008 LODINE 200mg ETODOLAC 200mg 6.25 CAP

TME048 MESULID 100mg NIMESULIDE 100mg 3.00 TAB

TMO005 MOBIC 15mg MELOXICAM 10mg 10.00 TAB

TMO004 MOBIC 7.5mg MELOXICAM 7.5mg 7.00 TAB

AMO010 MOHRUS PATCH KETOPROFEN 84.00 BOX

IMY010 MYOCRISIN INJ 20mg NA AUROTHIOMALATE 60.00 AMP

TNA010 NAPROSYN 250mg (GE) NAPROXEN 250mg 2.30 TAB

TNI024 NIDOL 100mg NIMESULIDE 100mg 2.80 TAB

MBR020 BRUFEN SUSPENSION

100MG/5ML 90ml

IBUPROFEN 65.00 BOT

MNU020 NUROFEN SYRUP

100mg/5mL 60mL (GE)

IBUPROFEN 0.50 ML

TOR020 ORUVAIL 100mg KETOPROFEN 100mg 3.30 CAP

TOR030 ORUVAIL 200mg KETOPROFEN 200mg 5.50 CAP

TPL010 PLAQUENIL 200mg HYDROXYCHLOROQUINE 200mg 14.00 TAB

MPO020 PONSTAN SUSPENSION

50mg/5mL (GE)

MEFENAMIC ACID 0.17 ML

MPO022

PONSTAN SUSPENSION

250mg/5mL MEFENAMIC ACID 0.17 ML

TRE010 RELIFEX 500mg NABUMETONE 500mg 8.00 TAB

TRI008 RIDAURA 3mg AURANOFIN 3mg 14.00 TAB

TSA020 SALAZOPYRIN EN 500mg SULFASALAZINE 500mg 4.10 TAB

CPA110 SIMPONI 50mg/0.5 mL GOLIMUMAB 12000.00 UNIT

TSY010 SYNFLEX 275mg NAPROXEN SODIUM 275mg 2.50 TAB

TTI020 TILCOTIL 20mg (GE) TENOXICAM 20mg 2.50 TAB

TVI028 VIOXX 25mg ROFECOXIB 25mg 6.50 TAB

TVI029 VIOXX 50mg ROFECOXIB 50mg 9.50 TAB

TVO020 VOLTAREN 25mg (GE) DICLOFENAC SODIUM 25mg 2.00 TAB

TVO022 VOLTAREN 50mg DICLOFENAC SODIUM 50mg 7.00 TAB

TVO021 VOLTAREN 50mg (GE) DICLOFENAC SODIUM 50mg 4.00 TAB

IVO010 VOLTAREN INJ 75mg (GE) DICLOFENAC SODIUM 58.00 AMP

TVO028 VOLTAREN SR 100mg DICLOFENAC SODIUM 100mg 10.00 TAB

TVO031 VOLTAREN SR 100mg CAP

(GE)

DICLOFENAC SODIUM 100mg 4.50 CAP

TVO030 VOLTAREN SR 100mg TAB

(GE)

DICLOFENAC SODIUM 100mg 5.00 TAB

TVO032 VOLTAREN SR 75mg DICLOFENAC SODIUM 75mg 7.40 TAB

TVO034 VOLTAREN SR 75mg (GE) DICLOFENAC SODIUM 75mg 4.50 TAB

PVO010 VOLTAREN SUPP 100mg

(GE)

DICLOFENAC SODIUM 14.00 SUPP

PVO004 VOLTAREN SUPP 12.5mg DICLOFENAC SODIUM 5.40 SUPP

PVO006 VOLTAREN SUPP 25mg DICLOFENAC SODIUM 7.90 SUPP

AVO005 VOLTAREN PATCH 15mg

5's

DICLOFENAC SODIUM 55.00 BOX

AVO006 VOLTAREN PATCH LARGE

30mg 7's

DICLOFENAC SODIUM 101.50 BOX

GOUT

PREPARTBE010 BENEMID 500mg (GE) PROBENECID 500mg 3.80 TAB

TCO040 COLCHICINE 0.5mg (GE) COLCHICINE 0.5mg 1.00 TAB

TFE004 FEBURIC 80mg FEBUXOSTAT 80mg 20.30 TAB

TZY010 ZYLORIC 100mg (GE) ALLOPURINOL 100mg 1.00 TAB

TZY012 ZYLORIC 300mg (GE) ALLOPURINOL 300mg 2.80 TAB

TZY014 ZYLORIC 300mg ALLOPURINOL 300mg 7.00 TAB

TAT020 ATIVAN 0.5mg LORAZEPAM 0.5mg 2.00 TAB

TAT022 ATIVAN 1mg LORAZEPAM 1mg 3.00 TAB

TLE032 LEXOTAN 1.5mg BROMAZEPAM 1.5mg 3.00 TAB

TLE030 LEXOTAN 1.5mg (GE) BROMAZEPAM 1.5mg 3.00 TAB

MINOR TRANQUILLISERS

ANTIRHEUMATICS, ANTIINFLAMMATORY ANALGESICS

Page 11 of 28

Page 12: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TLE034 LEXOTAN 3mg BROMAZEPAM 5.00 TAB

TVA010 VALIUM 2mg (GE) DIAZEPAM 2mg 1.50 TAB

TVA012 VALIUM 5mg (GE) DIAZEPAM 5mg 2.00 TAB

IVA010 VALIUM INJ 10mg/2mL DIAZEPAM 60.00 AMP

PVA012 VALIUM RECTAL TUBE

5mg (GE)

DIAZEPAM 80.00 TUB

PVA010 VALIUM RECTAL TUBE

10mg (GE)

DIAZEPAM 100.00 TUB

TLA060 LARGACTIL 25mg CHLORPROMAZINE 25mg 1.70 TAB

TLA061 LARGACTIL 25mg (GE) CHLORPROMAZINE 25mg 1.20 TAB

TST008 STELAZINE 2mg (GE) TRIFLUOPERAZINE 2mg 1.50 TAB

TST010 STELAZINE 5mg (GE) TRIFLUOPERAZINE 5mg 2.00 TAB

TDO070 DORMICUM 7.5mg MIDAZOLAM 7.5mg 4.50 TAB

TDO080 DORMICUM 15mg MIDAZOLAM 15mg 8.00 TAB

IDO010 DORMICUM INJ 5mg/mL MIDAZOLAM 55.00 AMP

IDO011 DORMICUM INJ 5mg/5mL MIDAZOLAM 55.00 AMP

IDO012 DORMICUM INJ 15mg/3ml MIDAZOLAM 90.00 AMP

IGA010 GARDENAL INJ 200mg/mL

(PHENOBARBITONE)

PHENOBARBITONE 30.00 AMP

THA010 HALCION 0.25mg TRIAZOLAM 0.25mg 5.40 TAB

THE010 HEMINEVRIN 300mg CLOMETHIAZOLE 300mg 4.30 CAP

TLO034 LORAMET 1mg LORMETAZEPAM 1mg 5.50 TAB

TMO020 MOGADON 5mg (GE) NITRAZEPAM 5mg 4.10 TAB

IPA010 PARALDEHYDE INJ PARALDEHYDE 50.00 AMP

TRO040 ROHYPNOL 2mg (GE) FLUNITRAZEPAM 2mg 8.00 TAB

TST030 STILNOX 10mg ZOLPIDEM 10mg 4.30 TAB

TST031 STILNOX 10mg (GE) ZOLPIDEM TARTRATE 10mg 3.10 TAB

TDI070 DILANTIN 100mg PHENYTOIN SODIUM 100mg 4.40 CAP

TDI072 DILANTIN 30mg PHENYTOIN SODIUM 30mg 4.40 CAP

TEP010 EPILIM 200mg SODIUM VALPROATE 200mg 3.50 TAB

TEP030 EPILIM CHRONO 200mg SODIUM VALPROATE 250mg 3.50 TAB

TEP028 EPILIM CHRONO 300mg SODIUM VALPROATE 300mg 4.40 TAB

TEP020 EPILIM CHRONO 500mg SODIUM VALPROATE 500mg 7.00 TAB

MEP010 EPILIM SF LIQUID

200mg/5mL 300mL

SODIUM VALPROATE 1.10 ML

TKE028 KEPPRA 250mg LEVETIRACETAM 11.60 TAB

TKE030 KEPPRA 500mg LEVETIRACETAM 21.30 TAB

TKE032 KEPPRA 1000mg LEVETIRACETAM 48.00 TAB

CPA050 KEPPRA SYRUP 100mg/ml LEVETIRACETAM 100mg 4.10 ML

CPA132

LAMICTAL DISPERSIBLE 5

mg LAMOTRIGINE 5mg 3.80 TAB

TLA024 LAMICTAL 50mg LAMOTRIGINE 50mg 11.80 TAB

TLA026 LAMICTAL 100mg LAMOTRIGINE 100mg 19.40 TAB

TLY008 LYRICA 25mg PREGABALIN 25mg 13.20 CAP

TLY009 LYRICA 50mg PREGABALIN 50mg 13.50 CAP

TLY010 LYRICA 75mg PREGABALIN 75mg 13.60 CAP

TLY011 LYRICA 150mg PREGABALIN 150mg 21.90 TAB

TNE034 NEURONTIN 100mg GABAPENTIN 100mg 8.80 CAP

TNE035

NEURONTIN 100mg (GE)-

[GABAPENTIN] GABAPENTIN 100mg 5.00 CAP

TNE036 NEURONTIN 300mg GABAPENTIN 300mg 10.50 CAP

TNE037 NEURONTIN 300mg (GE) GABAPENTIN 300mg 7.00 CAP

TPH020 PHENOBARBITONE 15mg PHENOBARBITONE SODIUM 15mg 1.00 TAB

TPH022 PHENOBARBITONE 30mg PHENOBARBITONE SODIUM 30mg 1.50 TAB

MPH014 PHENOBARBITONE SYRUP

15mg/5mL

PHENOBARBITONE 0.30 ML

TRI050 RIVOTRIL 0.5mg CLONAZEPAM 0.5mg 2.00 TAB

TTE010 TEGRETOL 200mg (GE) CARBAMAZEPINE 200mg 2.00 TAB

TTE020 TEGRETOL CR 200mg CARBAMAZEPINE 200mg 5.50 TAB

MTE020 TEGRETOL SYRUP 2%

250mL

CARBAMAZEPINE 0.56 ML

CPA073 TEGRETOL CR 400MG CARBAMAZEPINE 8.00 TAB

CPA056 TOPAMAX 50mg TOPIRAMATE 19.00 TAB

TTO030 TOPAMAX 25mg TOPIRAMATE 12.60 TAB

TTO032 TOPAMAX 100mg TOPIRAMATE 100mg 33.50 TAB

TTR036 TRILEPTAL 300mg OXCARBAZEPINE 300mg 5.60 TAB

CPA129

VIMPAT FILM-COATED

TAB 50 mg LACOSAMIDE 50mg 19.00 TAB

CPA130

VIMPAT FILM-COATED

TAB 100 mg LACOSAMIDE 100mg 35.00 TAB

CPA131

VIMPAT FILM-COATED

TAB 150 mg LACOSAMIDE 150mg 52.00 TAB

TAR004 ARCALION 200 SULBUTIAMINE 200mg 4.20 TAB

TME062 METHYCOBAL 500mcg MECOBALAMIN 500mcg 5.00 TAB

TME054 METHYCOBAL 500mg MECOBALAMIN 500mg 3.40 TAB

TNO030 NOOTROPIL 400mg (GE) PIRACETAM 400mg 2.00 CAP

TNO032 NOOTROPIL 800mg PIRACETAM 800mg 8.20 TAB

TNO033 NOOTROPIL 800mg (GE)

[VICK-TROPIL]

PIRACETAM 2.50 CAP

CPA100 PIRACETAM (GE) 1200mg PIRACETAM 4.00 CAP

TAV010 AVOMINE 25mg PROMETHAZINE THEOCLATE 25mg 0.80 TAB

TGR012 GRAVOL 50mg DIMENHYDRINATE 50mg 1.00 TAB

TGR010 GRAVOL 50mg (GE) DIMENHYDRINATE 50mg 1.00 TAB

MGR010 GRAVOL SYRUP 15mg/5mL

(GE)

DIMENHYDRINATE 0.40 ML

IGR010 GRAVOL INJ 50mg/mL DIMENHYDRINATE 25.00 ML

IGR011 GRAVOL

<DIMENHYDRINATE> INJ

50mg/mL10mL

DIMENHYDRINATE 28.00 ML

PGR010 GRAVOL SUPP (PAED)

50mg (GE)

DIMENHYDRINATE 5.60 SUPP

IKY010 KYTRIL [GRANISETRON]

1mg/mL INJ

GRANISETRON 121.00 AMP

TMA034 MARZINE 50mg CYCLIZINE HCL 50mg 4.40 TAB

MAJOR TRANQUILLISERS

NOOTROPICS & NEUROTONICS

HYPNOTICS & SEDATIVES

ANTICONVULSANTS

ANTIEMETICS & ANTIVERTIGO DRUGS

Page 12 of 28

Page 13: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TMA048 MAXOLON 5mg METOCLOPRAMIDE 5mg 1.00 TAB

TMA050 MAXOLON 10mg (GE) METOCLOPRAMIDE 10mg 1.00 TAB

MMA020 MAXOLON SYRUP

5mg/5mL (GE)

METOCLOPRAMIDE 0.23 ML

IMA020 MAXOLON INJ 10mg/2mL METOCLOPRAMIDE 30.00 AMP

TNA026 NAVIDOXINE MECLIZINE HCL, PYRIDOXINE HCL 1.50 TAB

TNA036 NAVOBAN 5mg TROPISETRON 5mg 270.00 TAB

INA010 NAVOBAN INJ 5mg/5mL TROPISETRON 350.00 AMP

TST020 STEMETIL 5mg (GE) PROCHLORPERAZINE 5mg 0.50 TAB

IST010 STEMETIL INJ 12.5mg/mL PROCHLORPERAZINE 25.00 AMP

TZO017 ZOFRAN 4mg ONDANSETRON HCL DIHYDRATE

4mg

52.00 TAB

TZO018 ZOFRAN 8mg ONDANSETRON HCL DIHYDRATE

8mg

214.00 TAB

IZO004 ZOFRAN [ondansetron] 4mg

INJECTION

ONDANSETRON 192.50 AMP

IZO006 ZOFRAN [ondansetron] 8mg

INJECTION

ONDANSETRON 140.00 AMP

TAR006 ARICEPT 5mg DONEPEZIL 5mg 29.00 TAB

TEB010 EBIXA 10mg MEMANTINE HCL 10mg 15.80 TAB

TAM010 AMANTADINE SULFATE

100mg

AMANTADINE SULFATE 100mg 5.00 TAB

TAR010 ARTANE 2mg (GE) TRIHEXYPHENIDYL HCL 2mg 1.50 TAB

TAZ004 AZILECT 1mg RASAGILINE 37.00 TAB

TCO055 COMTAN 200mg ENTACAPONE 14.50 TAB

ICO008 COGENTIN INJ 2mg/2mL BENZTROPINE MESYLATE 75.00 AMP

TJU012 JUMEX SELEGILINE HCL 5mg 13.20 TAB

TJU010 JUMEX 5mg (GE) SELEGILINE HCL 5mg 6.00 TAB

TLE017 LEVOMED 100/25mg LEVODOPA 100mg 2.20 TAB

TMA020 MADOPAR 250mg LEVODOPA, BENSERAZIDE 8.20 TAB

TMA018 MADOPAR DISPERSIBLE

125mg

LEVODOPA, BENSERAZIDE 5.90 TAB

TMA019 MADOPAR HBS 125mg LEVODOPA, BENSERAZIDE 5.70 CAP

ANE060 NEUPRO PATCH 2mg ROTIGOTINE 47.00 PC

ANE062 NEUPRO PATCH 4mg ROTIGOTINE 51.00 PC

ANE064 NEUPRO PATCH 6mg ROTIGOTINE 58.50 PC

ANE066 NEUPRO PATCH 8mg ROTIGOTINE 73.50 PC

TPA060 PARLODEL 2.5mg (GE) BROMOCRIPTINE MESYLATE 2.5mg 6.00 TAB

TRE028 REQUIP 0.25mg AMORPHOUS AESCIN 6.80 TAB

TRE029 REQUIP 1mg ROPINIROLE 12.50 TAB

TRE030 REQUIP 2mg ROPINIROLE 14.30 TAB

TRE032 REQUIP PD 2mg ROPINIROLE 2mg 21.70 TAB

TRE033 REQUIP PD 4mg ROPINIROLE 4 mg 38.00 TAB

TSI032 SINEMET 25/100 CARBIDOPA. LEVODOPA (25/100mg) 5.20 TAB

TSI030 SINEMET 25/250 CARBIDOPA, LEVODOPA (25/250mg) 8.90 TAB

TSI034 SINEMET CR 50/200 CARBIDOPA, LEVODOPA (50/200mg) 7.40 TAB

TME044 MESTINON 10mg PYRIDOSTIGMINE BROMIDE 10mg 2.60 TAB

TME046 MESTINON 60mg PYRIDOSTIGMINE BROMIDE 60mg 11.00 TAB

TNO040 NORGESIC (GE) ORPHENADRINE, PARACETAMOL 1.10 TAB

TME045

PYRIDOSTIGMINE> 10mg

[JM-PYRIDOSTIGMINE] PYRIDOSTIGMINE 2.30 TAB

ITE010 TENSILON INJ 10mg/mL EDROPHONIUM CHLORIDE 50.00 AMP

TRI032 RILUTEK 50mg RILUZOLE 50mg 100.00 TAB

TUB010 UBRETID 5mg DISTIGMINE BROMIDE 5mg 7.90 TAB

TBA002 BACLOFEN 10mg BACLOFEN 10mg 2.50 TAB

TCA069 CARISOPRODOL 125mg 0.60 TAB

TLI024 LIORESAL 10mg (GE) BACOLFEN 10mg 2.00 TAB

TMY018 MYDOCALM 50mg TOLPERISONE HYDROCHLORIDE

50mg

1.60 TAB

TQU010 QUININE BISULPHATE 300

mg

QUININE BISULPHATE 300mg 2.50 TAB

TQU020 QUININE SULPHATE 200mg QUININIE SULPHATE 200mg 2.70 TAB

TRO020 ROBAXIN 500mg METHOCARBAMOL 500mg 3.00 TAB

TAN013 ANDRIOL TESTOCAP 40mg TESTOSTERONE UNDECANOATE 12.00 CAP

CAN018 ANDROGEL 50mg TESTOSTERONE 25.00 TAB

TDA020 DANOCRINE 200mg DANAZOL 200mg 13.00 CAP

TDA022 DANOCRINE 200mg (GE) DANAZOL 200mg 10.00 CAP

INE004 NEBIDO 25% 1000mg/4mL INJTESTOSTERONE UNDECANOATE 1700.00 AMP

TPR140 PROVIRON 25mg MESTEROLONE 25mg 12.00 TAB

ISU010 SUSTANON INJ 250mg/mL TESTOSTERONE PROPIONATE 30mg,

DECABIATE 100mg

205.00 AMP

ITE012 TESTOSTERONE IMPLANT

100mg

TESTOSTERONE 250.00 AMP

ITE020 TESTOVIRON INJ 250mg TESTOSTERONE 270.00 VIA

TAC024 ACTIVELLE 28's ESTRADIOL, NORETHISTERONE 5.00 TAB

TAN014 ANDROCUR 50mg CYPROTERONE ACETATE 29.00 TAB

TAN016 ANGELIQ 28's ESTRADIOL 1mg, DROSPIRENONE

2mg

15.00 TAB

TCL024 CLIMEN 28's ESTRADIOL VALERATE 3.00 TAB

PCY010 CYCLOGEST PESSARY

200mg

PROGESTERONE 20.00 PES

PCY012 CYCLOGEST PESSARY

400mg

PROGESTERONE 38.00 PES

TCY030 CYCLO-PROGYNOVA 2mg

21's

OESTRADIOL

VALERATE,NORGESTREL

5.30 TAB

TDI074 DILENA 21's ESTRADIOL,

MEDROXYPROGESTERONE

5.00 TAB

CPA127 DEPO PROVERA

150MG/ML SUSP., 1ML/

MEDROXYPROGESTERONE

ACETATE

190.00 AMP

TDO056 DOSTINEX 0.5mg CABERGOLINE 132.00 TAB

TDU018 DUPHASTON 10mg DYDROGESTERONE 10mg 11.00 TAB

TES020 ESTRACOMB TTS 50 ESTRADIOL, NORETHISTERONE 245.00 BOX

TES030 ESTRADERM TTS 25 6'S 17 BETA-ESTRADIOL 2mg 170.00 BOX

TES032 ESTRADERM TTS 50 17 BETA-ESTRADIOL 4mg 160.00 BOX

TES034 ESTRADERM TTS 100 (6

PCs)

17 BETA-ESTRADIOL 8mg 200.00 BOX

CES010 ESTREVA GEL 0.1% 50g NATURAL ESTRADIOL 0.1% 2.70 g

MUSCLE RELAXANTS

ANDROGENS & RELATED SYNTHETIC DRUGS

NEURODEGENERATIVE DISEASE DRUGS

ANTIPARKINSONIAN DRUGS

OESTROGEN & PROGESTERONES & RELATED SYNTHETIC DRUGS

NEUROMUSCULAR DISORDER DRUGS

Page 13 of 28

Page 14: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TES040 ESTROFEM 28's OESTRADIOL 2mg 2.60 TAB

TFE012 FEMARA 2.5mg LETROZOLE 61.00 TAB

TFE013 FEMOSTON 2/10 28'S OESTRADIOL + 155.00 PK

CPA091 KLIOGEST ESTRADIOL, NORETHISTERONE 4.50 TAB

TLI050 LIVIAL 2.5mg 30's TIBOLONE 2.5mg 14.50 TAB

TLU010 LUTENYL 5mg NOMEGESTROL ACETATE 5mg 6.00 TAB

CPA064 NORCOLUT 5mg NORETHISTERONE 2.70 TAB

TNO085 NOVOFEM

ESTRADIOL 1mg,NORETHISTERONE

ACETATE 1mg 4.00 TAB

IOE012 OESTRADIOL IMPLANT

50mg

OESTRADIOL 320.00 AMP

IOF010 OESTRADIOL IMPLANT

100mg

OESTRADIOL 520.00 AMP

COE010 OESTROGEL 0.06% 80g NATURAL 17B-ESTRADIOL 0.06% 1.80 g

TOV008 OVESTIN 1mg 30's ESTRIOL 1mg 3.80 TAB

TPR030 PREMARIN 0.3mg CONJUGATED OESTROGENS 0.3mg 3.40 TAB

TPR032 PREMARIN 0.625mg CONJUGATED OESTROGENS 0.625mg 4.80 TAB

TPR034 PREMARIN 1.25mg CONJUGATED OESTROGENS 1.25mg 3.50 TAB

TPR036 PREMELLE 0.625mg/2.5mg

28's

MEDROXYPROGESTERONE,

OESTROGEN

5.70 TAB

TPR038 PREMELLE CYCLE 28's MEDROXYPROGESTERONE,

OESTROGEN

3.30 TAB

TPR040 PREMPAK 0.625mg 31's MEDROGESTONE, OESTROGENS 2.74 TAB

TPR050 PREMPAK-C 0.625mg 40's NORGESTREL, OESTROGENS 4.00 TAB

TPR052 PREMPAK-C 1.25mg 40's NORGESTREL, OESTROGENS 4.00 TAB

TPR080 PRIMOLUT-N 5mg (GE) NORETHISTERONE 5mg 2.90 TAB

IPR038 PROGESTERONE INJ 50mg PROGESTERONE 50.00 AMP

IPR040 PROGESTERONE INJ 50mg

+ESTRADIOL BENZOATE

PROGESTERONE/ESTRADIOL 110.00 AMP

TPR094 PROGYNOVA 2mg 28's ESTRADIOL VALERATE 2mg 2.70 TAB

IPR054 PROLUTON DEPOT INJ

250mg

HYDROXYPROGESTERONE 130.00 AMP

TPR130 PROVERA 5mg MEDROXYPROGESTERONE

ACETATE

3.90 TAB

TPR132 PROVERA 10mg MEDROXYPROGESTERONE

ACETATE

5.70 TAB

TST022 STILBOESTROL 1mg DIETHYLSTILBOESTROL 0.20 TAB

TST024 STILBOESTROL 5mg DIETHYLSTILBOESTROL 0.30 TAB

TTR060 TRISEQUENS 28's ESTRADIOL, NORETHISTERONE 4.80 TAB

TUT010 UTROGESTAN 100mg PROGESTERONE MICRONISED 100mg 5.00 TAB

CPA153 VAGIFEM VAGINAL TAB

10mcg

ESTRADIOL 18.00 TAB

PVA020 VAGIFEM VAGINAL TAB

25mcg

ESTRADIOL 22.00 TAB

PVA021 VAGIFEM VAGINAL TAB

10mcg 18'S

ESTRADIOL 16.00 PES

CPA093 COLIFOAM ENEMA HYDROCORTISONE 500.00 PC

TCO084 CORTONE 25mg CORTISONE ACETATE 25mg 2.80 TAB

TCO095 CORTEF 20mg HYDROCORTISONE 20mg 3.90 TAB

TDE020 DECADRON 0.5mg (GE) DEXAMETHASONE 0.5mg 1.20 TAB

TDE070 DEXAMETHASONE 4mg DEXAMETHASONE 4mg 2.00 TAB

IDE010 DEPO-MEDROL INJ 40

mg/mL

METHYLPREDNISOLONE ACETATE 145.00 VIA

IDE030 DEPO-

MEDROL+LIDOCAINE INJ

METHYLPREDNISOLONE,

LIDOCAINE

155.00 VIA

IDE038 DEXAMETHASONE INJ

4mg/mL

DEXAMETHASONE SODIUM

PHOSPHATE

25.00 AMP

IDE040 DEXAMETHASONE INJ

50mg/10mL

DEXAMETHASONE SODIUM

PHOSPHATE

25.00 ML

CPA155 DEXAMETHASONE-

HOSPIRA INJ 8 mg/2 mL

DEXAMETHASONE NA PHOSPHATE 70.00 AMP

IDI020 DIPROSPAN INJ 1mL BETAMETHASONE DIPROPIONATE... 90.00 AMP

TFL020 FLORINEF 0.1mg FLUDROCORTISONE ACETATE 0.1mg 2.70 TAB

IHY010 HYDROCORTISONE INJ

100mg/2mL

HYDROCORTISONE 125.00 VIA

THY005 HYDROCORTISONE 20mg HYDROCORTISONE 20mg 2.00 TAB

IKE020 KENACORT-A IA/ID INJ

10mg/mL 5mL

TRIAMCINOLONE ACETONIDE 37.00 ML

IKE010 KENACORT-A IM INJ 40

mg/mL

TRIAMCINOLONE ACETONIDE 150.00 AMP

IKE011 KENACORT-A IM INJ 40

mg/mL (GE)

TRIAMCINOLONE ACETONIDE 70.00 AMP

IKE021 KENACORT-A

{Triamicinolone} IA/ID INJ

TRIAMICINOLONE ACETONIDE 57 ML

TME010 MEDROL 4mg METHYLPREDNISOLONE 4mg 2.75 TAB

TPR018 PREDNISOLONE 1mg PREDNISOLONE 1mg 0.50 TAB

TPR020 PREDNISOLONE 5mg (GE) PREDNISOLONE 5mg 1.20 TAB

DPR014

PREDNISOLONE 0.5%

MINIMS (20'S/BOX) PREDNISOLONE 26.50 PC

MPR010 PREDNISOLONE

SUSPENSION 10mg/5mL

PREDNISOLONE 0.28 ML

IPR010 PREDNISOLONE INJ

25mg/mL 20mL

PREDNISOLONE 25.00 ML

CPA108 REDIPRED (RASPBERRY

FLAVOUR) 5 mg/1 mL x 30

PREDNISOLONE NA 90.00 BOT

MRE020 REDIPRED ORAL LIQUID

5mg/ml

PREDNISOLONE 100.00 BOT

ISO080 SOLU-MEDROL 500mg METHYLPREDNISOLONE NA

SUCCINATE

520.00 VIA

CAC020 ACTHAR GEL 40 UNITS ADRENOCORTICOTROPIC HORMONE 330.00 VIA

ICO020 CORTROSYN DEPOT INJ

1mg/mL

TETRACOSACTIDE HEXAACETATE 330.00 VIA

IDE006 DECAPEPTYL CR INJ TRIPTORELIN 1350.00 VIA

IDE005 DECAPEPTYL INJ 0.1mg TRIPTORELIN 150.00 VIA

IDI016 DIPHERELINE PR INJ

3.75mg

TRIPTORELIN 1740.00 VIA

IEN012 ENANTONE INJ 11.25mg LEUPRORELIN ACETATE 5240.00 VIA

IEN010 ENANTONE INJ 3.75mg LEUPRORELIN ACETATE 2050.00 VIA

IGO012 GONAL-F 150IU/mL FOLLITROPIN ALFA 700.00 VIA

IGO010 GONAL-F 1050IU/1.75mL FOLLITROPIN ALFA 3200.00 VIA

AMI010 MIRENA LEVONORGESTREL 2555.00 SET

AMO020 Mona Lisa CU 375 IUD 375 220.00 PIE

IPR036 PROFASI INJ 10,000IU HUMAN CHORIONIC

GONADOTROPHIN

280.00 AMP

IPR034 PROFASI INJ 5,000 IU HUMAN CHORIONIC

GONADOTROPHIN

150.00 AMP

SSU010 SUPRECUR NASAL SPRAY BUSERELIN ACETATE 690.00 BOT

SSY020 SYNAREL NASAL SPRAY

2mg/mL

NAFARELIN ACETATE 2100.00 BOT

IZO010 ZOLADEX DEPOT INJ

3.6mg

GOSERELIN ACETATE 3.6mg 2500.00 AMP

IZO012 ZOLADEX LA DEPOT INJ

10.8mg

GOSERELIN ACETATE 10.8mg 6040.00 AMP

IZO030 ZOMACTON

[SOMATROPIN] 4MG

SOMATROPIN 1000.00 AMP

IPR015 PREGNYL INJ 5,000iu/mL HUMAN CHORIONIC

GONADOTROPHIN

165.00 AMP

CEPHA

LOSPORTCE008 CECLOR 250mg (GE) CEFACLOR MONOPHYDRATE 4.30 CAP

CORTICOSTEROID HORMONES

TROPHIC HORMONES & RELATED SYNTHETIC DRUGS

Page 14 of 28

Page 15: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TCE009 CECLOR 500mg (GE)-

[CEFALOR PLUS]

CEFACLOR 7.50 CAP

TCE010 CECLOR MR 375mg CEFACLOR MONOHYDRATE 375mg 13.00 TAB

MCE012 CECLOR SUSPENSION

125mg/5mL (GE)

CEFACLOR MONOHYDRATE 1.20 ML

MCE010 CECLOR SUSPENSION

125mg/5mL 60mL

CEFACLOR MONOHYDRATE 1.10 ML

TCE020 CEDAX 200mg CEFTIBUTEN DIHYDRATE 200mg 25.50 CAP

MCE020 CEDAX SUSPENSION

180mg/5mL 30mL

CEFTIBUTEN DIHYDRATE 4.50 ML

ICE010 CEFOBID INJ 1g CEFOPERAZONE SODIUM 440.00 VIA

TCL040 CLOXACILLIN CLOXACILLIN SODIUM 250mg 2.50 CAP

TDU019 DURACEF 250mg CEFADROXIL MONOHYDRATE 250mg 3.50 CAP

CPA047 CEFADROXIL 500mg (GE) CEFADROXIL 500mg 4.00 CAP

TKE010 KEFLEX 250mg (GE) CEPHALEXIN MONOHYDRATE

262.5mg

3.00 CAP

TKE020 KEFLEX 500mg (GE) CEPHALEXIN MONOHYDRATE 575mg 5.00 CAP

MKE010 KEFLEX SUSPENSION 125

mg/5mL 60mL

CEPHALEXIN 0.90 ML

MKE012 KEFLEX SUSPENSION

125mg/5mL 60mL (GE)

CEPHALEXIN 0.70 ML

CPA084 MAXIPIME IM/IV 1g CEFEPIME HCI 350.00 VIA

IRO013 ROCEPHIN IM 500g (GE) LIGNOCAINE CEFTRIAXONE 150.00 AMP

IRO014 ROCEPHIN INJ 250mg CEFTRIAXONE DISODIUM 120.00 VIA

IRO015 ROCEPHIN INJ 250mg (GE) CEFTRIAXONE DISODIUM 105.00 VIA

IRO012 ROCEPHIN INJ 500mg CEFTRIAXONE DISODIUM 185.00 VIA

IRO010 ROCEPHIN INJ 1g CEFTRIAXONE DISODIUM 380.00 VIA

IRO011 ROCEPHIN INJ 1g (GE) CEFTRIAXONE DISODIUM 330.00 VIA

TVE010 VELOSEF 250mg CEPHRADINE 250mg 5.90 CAP

IZI010 ZINACEF 250mg INJ CEPHRADINE NA 150.00 AMP

TZI010 ZINNAT 125mg CEFUROXIME AXETIL 125mg 9.80 TAB

TZI012 ZINNAT 250mg CEFUROXIME AXETIL 250mg 18.00 TAB

TZI014 ZINNAT 500mg CEFUROXIME AXETIL 500mg 59.00 TAB

MZI006 ZINNAT 125mg/5mL

SUSPENSION

CEFUROXIME AXETIL 2.10 ML

MACRO

LIDESTER010 ERYTHROMYCIN 250mg ERYTHROMYCIN 250mg 1.50 TAB

MER010 ERYTHROMYCIN

GRANULES 200mg/5mL

ERYTHROMYCIN ETHYLSUCCINATE 0.50 ML

MER020 ERYTHROMYCIN

SUSPENSION 125mg/5mL

ERYTHROMYCIN 0.33 ML

TKL010 KLACID 250mg CLARITHROMYCIN 250mg 12.20 TAB

TKL013 KLACID 250mg (GE) CLARITHROMYCIN 250mg 6.00 TAB

TKL011 KLACID 500mg CLARITHROMYCIN 500mg 25.00 TAB

TKL012 KLACID MR 500mg CLARITHROMYCIN 250mg 22.60 TAB

MKL010 KLACID SUSPENSION

125mg/5mL 60mL

CLARITHROMYCIN 1.70 ML

MKL012 KLACID SUSPENSION

125mg (GE) SACHET

CLARITHROMYCIN 6.50 SACH

TRU010 RULID 150mg ROXITHROMYCIN 150mg 13.70 TAB

TZI020 ZITHROMAX 250mg AZITHROMYCIN DIHYDRATE 250mg 22.50 TAB

TZI021 ZITHROMAX 250mg (GE) AZITHROMYCIN 14.00 TAB

MZI010 ZITHROMAX SUSPENSION

200MG/5ML 15ML

AZITHROMYCIN DIHYDRATE 6.20 ML

IDE042 DEXAMETHASONE

8mg/2mL INJ

DEXAMETHASONE 65.00 VIA

IDO020 DOXORUBICIN-EBEWE INJ

50MG/25ML

DOXORUBICIN 983.40 VIA

IEL001 ELOXATIN

[OXALIPLATINE] 50mg INJ

OXALIPLATINE 2750.00 VIA

IEL002 ELOXATIN

[OXALIPLATINE] 100mg

OXALIPLATINE 5200.00 VIA

IEN030 ENDOXAN INJ 1G CYCLOPHOSPHAMIDE 567.60 VIA

IPA020 PARAPLATIN INJ

150mg/15mL

CARBOPLATIN 1080.00 VIA

TPU010 PURI-NETHOL 50mg 6-MERCAPTOPURINE 50mg 70.00 TAB

ITA010 TAXOTERE CONC FOR INF

20mg/0.5ml

DOCETAXEL 2664.000 VIA

ITA012 TAXOTERE CONC FOR

INF. 80mg/2ml

DOCETAXEL 9526.000 VIA

TXE005 XELODA [capecitabine]

150mg

CAPECITABINE 11.00 TAB

TXE006 XELODA [capecitabine]

500mg

CAPECITABINE 37.00 TAB

TCA075 CASODEX [bicalutamide]

150mg

BICALUTAMIDE 283.00 TAB

TFL060 FLUTAMIDE 250mg(G.E) FLUTAMIDE 11.50 TAB

IHE060 HERCEPTIN 150mg TRASTUZUMAB 8976.00 VIA

IHE062 HERCEPTIN 440mg TRASTUZUMAB 25740.00 VIA

TJA002 JAKAVI [ruxolitinib] 5mg RUXOLITINIB 357.00 TAB

TJA003 JAKAVI [ruxolitinib] 20mg RUXOLITINIB 895.00 TAB

TSP030 SPRYCEL[dasatinib] 50mg DASATINIB 435.00 TAB

TXA013 XALKORI 250mg 60's CRIZOTNIB 250mg 1166.00 CAP

PENICIL

LINSTAM020 AMOXIL 250mg (GE) AMOXYCILLIN 250mg 2.20 CAP

TAM022 AMOXIL 500mg (GE) AMOXYCILLIN 500mg 3.50 CAP

MAM010 AMOXIL SYRUP

125mg/5mL (GE)

AMOXYCILLIN TRIHYDRATE 0.42 ML

MAM012 AMOXIL SYRUP

125mg/5mL 60mL- NEO

CHEM

AMOXYCILLIN 0.49 ML

TAM030 AMPICILLIN 250mg AMPICILLIN 250mg 1.50 CAP

TAM032 AMPICILLIN 500mg AMPICILLIN 500mg 2.00 CAP

MAM020 AMPICILLIN SYRUP

125mg/5mL (GE)

AMPICILLIN 0.25 ML

IAM030 AMPICILLIN INJ 500mg AMPICILLIN 45.00 VIA

TAM040 AMPICLOX 500mg (GE) AMPICILLIN, CLOXACILLIN 4.00 CAP

MAM030 AMPICLOX SYRUP

250mg/5mL (GE)

AMPICILLIN, CLOXACILLIN 0.50 ML

TAU010 AUGMENTIN 375mg AMOXYCILLIN, CLAVULANATE K 8.00 TAB

TAU011 AUGMENTIN 375mg (GE)-

[AMOXYCILLIN,

CLAVULANIC ACID]

AMOXYCILLIN, CLAVULANATE K

6.000

TAB

CPA126 AUGMENTIN 625mg AMPICILLIN, CLOXACILLIN 8.00 TAB

TAU012 AUGMENTIN 1g AMOXYCILLIN, CLAVULANIC ACID 11.00 TAB

TAU014 AUGMENTIN 1g (GE) AMOXYCILLIN CLAVULANIC ACID 8.00 TAB

TARGETED CANCER THERAPY

HORMONAL CHEMOTHERAPY

CYTOTOXIC CHEMOTHERAPY

Page 15 of 28

Page 16: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

MAU010 AUGMENTIN SYRUP

156mg/5mL (60mL)

AMOXYCILLIN, CLAVULANATE K 1.05 ML

MAU020 AUGMENTIN BD SYRUP

457mg/5mL, 35mL

AMOXYCILLIN, CLAVULANIC ACID 2.90 ML

MAU011

AUGMENTIN SYRUP

156.25mg/5mL 100mL (GE)- AMOXYCILLIN, CLAVULANIC ACID 1.00 ML

CPA133

CURAM 156.25mg/5 mL

ORAL SUSP, 60mL x 1's AMOXYCILLIN, CLAVULANATE K 30.00 BOT

CPA134

CURAM 312.5mg/5 mL

ORAL SUSP, 60mL x 1's AMOXYCILLIN, CLAVULANATE K 50.00 BOT

CPA135

CURAM 457mg/5 mL ORAL

SUSP, 35mL x 1's AMOXYCILLIN, CLAVULANATE K 70.00 BOT

CPA142 CURAM 375 mg

AMOXYCILLIN, CLAVULANATE

POTASSIUM 6.00 TAB

CPA143 CURAM 1,000 mg

AMOXYCILLIN, CLAVULANATE

POTASSIUM 11.00 TAB

MFL012 FLUCLOXACILLIN ELIXIR

125mg/5mL

FLUCLOXACILLIN 0.50 ML

TOR010 ORBENIN 250mg (GE) CLOXACILLIN 2.50 CAP

MOR010 ORBENIN SYRUP

125mg/5mL 100mL (GE)

CLOXACILLIN 0.45 ML

IPE010 PENADUR LA INJ 1.2MU

4mL

BENZATHINE PENICILLIN G 110.00 VIA

TPE020 PENGLOBE 400mg BACAMPICILLIN 400mg 4.00 TAB

IPE016 PENICILLIN G INJ 600mg BENZYLPENICILLIN SODIUM 35.00 VIA

IPE017 PENICILLIN G INJ 1M IU BENZYLPENICILLIN SODIUM 60.00 VIA

MPE010 PENICILLIN V

SUSPENSION 125mg/5mL

PHENOXYMETHYLPENICILLIN 0.25 ML

TPE010 PEN-V K 250 mg (GE) PHENOXYMETHYLPENICILLIN 250mg 1.00 TAB

IPR030 PROCAINE PENICILLIN G

INJ

PROCAINE PENICILLIN 40.00 VIA

QUINOL

ONESTAV008 AVELOX 400mg MOXIFLOXACIN HCl 400mg 45.00 TAB

TCI010 CIPROXIN 250mg CIPROFLOXACIN 250mg 11.60 TAB

TCI008 CIPROXIN 250mg (GE) CIPROFLOXACIN 250mg 7.70 TAB

TCI009 CIPROXIN 500mg (GE) CIPROFLOXACIN 500mg 11.27 CAP

TCR006 CRAVIT 100mg LEVOFLOXACIN 100mg 8.10 TAB

TCR007 CRAVIT 250mg LEVOFLOXACIN 250mg 16.00 TAB

TCR008 CRAVIT 500mg LEVOFLOXACIN 500mg 29.00 TAB

DCR011

CRAVIT EYE DROPS (GE)-

[LEVOFLOXACIN] LEVOFLOXACIN 40.00 BOT

TLE020 LEXINOR 100mg NORFLOXACIN 100mg 4.50 TAB

TLE021 LEXINOR 400mg TAB NORFLOXACIN 400mg 15.00 TAB

TTA030 TARIVID 100mg OFLOXACIN 100mg 6.00 TAB

TTA036 TARIVID 100mg (GE) OFLOXACIN 100mg 4.20 TAB

TTA032 TARIVID 200mg OFLOXACIN 200mg 11.00 TAB

TTA034 TARIVID 200mg (GE) OFLOXACIN 200mg 8.60 TAB

TUR026 UROTRACTIN PIPEMIDIC ACID 400mg 8.50 CAP

TWI012 WINTOMYLON 500mg NALIDIXIC ACID 500mg 3.10 TAB

TWI010 WINTOMYLON 500mg (GE) NALIDIXIC ACID 500mg 2.50 TAB

TMI072 MINOCIN 50mg MINOCYCLINE HCL 50mg 5.00 CAP

TMI074 MINOCIN 50mg (GE) MINOCYCLINE HCL 50mg 3.50 CAP

TMI070 MINOCIN 100mg MINOCYCLINE HCL 100mg 10.00 CAP

TMI080 MINOCIN MR 100mg MINOCYCLINE HCL 100mg 13.00 CAP

TMI076 MINOCIN 100mg (GE) MINOCYCLINE HCL 100mg 6.00 CAP

TOX010 OXY-TETRACYCLINE 250

mg

OXYTETRACYCLINE HCL 250mg 0.70 CAP

TTE060 TETRACYCLINE 250 mg TETRACYCLINE 250mg 0.90 CAP

TTE070 TETRALYSAL 300 CAP TETRALYSAL 300 CAP 10.00 CAP

TVI018 VIBRAMYCIN 50mg DOXYCYCLINE HYCLATE 50mg 4.00 TAB

TVI020 VIBRAMYCIN 100mg (GE) DOXYCYCLINE HYCLATE 100mg 3.00 TAB

CPA139 VIBRAMYCIN FILM-

COATED TAB 100 mg

DOXYCYXLINE 9.00 TAB

CPA063 CLOZOLE PESSARY 500MG CLOTRIMAZOLE 5.00 TAB

TDI058 DIFLUCAN 50mg FLUCONAZOLE 50mg 85.00 TAB

TDI059 DIFLUCAN 50mg (GE) FLUCONAZOLE 50mg 40.00 CAP

TDI060 DIFLUCAN 150mg FLUCONAZOLE 150mg 180.00 CAP

TDI062 DIFLUCAN 150mg (GE) FLUCONAZOLE 150mg 105.00 CAP

MDI006 DIFLUCAN SUSPENSION

50mg/5mL

FLUCONAZOLE 16.50 ML

TGR030 GRISEOSTATIN 330mg GRISEOFULVIN ULTRAMICROSIZE 4.30 TAB

TGR020 GRISOVIN 125mg GRISEOFULVIN 125mg 1.20 TAB

TGR021 GRISOVIN 125mg (GE) GRISEOFULVIN 125mg 1.20 TAB

TGR022 GRISOVIN 500mg GRISEOFULVIN 500mg 3.00 TAB

TGR023 GRISOVIN 500mg (GE) GRISEOFULVIN 500mg 2.80 TAB

TLA030 LAMISIL 250mg TERBINAFINE 250mg 21.00 TAB

TLA031 LAMISIL 250mg (GE) TERBINAFINE 250mg 14.00 TAB

TMY016 MYCOSTATIN 500,000U

(GE)

NYSTATIN 500,000U 1.30 TAB

MMY010 MYCOSTATIN DROPS

100,000 unit/mL (GE)

NYSTATIN 4.00 ML

TNI060 NIZORAL 200mg KETOCONAZOLE 200mg 26.00 TAB

TNI062 NIZORAL 200mg (GE) KETOCONAZOLE 200mg 7.00 TAB

TSE040 SEPTRIN (GE) TRIMETHOPRIM,

SULFAMETHOXAZOLE

1.50 TAB

MSE010 SEPTRIN SUSPENSION (GE) TRIMETHOPRIM,

SULFAMETHOXAZOLE

0.27 ML

TSP020 SPORANOX 100mg ITRACONAZOLE 100mg 28.00 CAP

TSP022 SPORANOX 100mg (GE) ITRACONAZOLE 100mg 17.00 CAP

IAR003 ARANESP [darbepoetin]

100mcg/0.5ml PRE-FILLED

DARBEPOETIN 100mcg 1892.00 SYR

TDA018 DALACIN C 150mg CLINDAMYCIN 150mg 7.60 CAP

TDA019 DALACIN C 300mg CLINDAMYCIN 300mg 10.50 CAP

TDA034 DAPSONE 100mg DAPSONE 100mg 1.50 TAB

TFL010 FLAGYL 200mg (GE) METRONIDAZOLE 200mg 1.70 TAB

CPA 079 FLAGYL 200mg

(BRANDED)

METRONIDAZOLE 200mg 3.00 TAB

MFL010 FLAGYL-S SUSPENSION

200mg/5mL 100mL

METRONIDAZOLE 1.80 ML

TFL011 FLAGYL 250mg(G.E) METRONIDAZOLE 2.50 TAB

TFL012 FLAGYL 400mg METRONIDAZOLE 7.00 TAB

TFU010 FURADANTIN 50mg (GE) NITROFURANTOIN 50mg 1.30 TAB

IGE010 GENTAMYCIN INJ

80mg/mL + LIDOCAINE 1%

GENTAMICIN, LIDOCAINE 70.00 VIA

IIN080 INVANZ INJ 1g ERTAPENEM 1g 525.00 VIA

ILI020 LINCOCIN INJ 3g/10mL LINCOMYCIN 100.00 VIA

TETRACYCLINES

ANTIFUNGALS

OTHER ANTIBIOTICS

Page 16 of 28

Page 17: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TLO030 LORABID 200mg LORACARBEF 200mg 32.00 CAP

MMO006 MONUROL 3g FOSFOMYCIN TROMETAMOL 82.50 SACH

IST020 STREPTOMYCIN INJ 1g STREPTOMYCIN 40.00 VIA

CPA 081 TRIMETHOPRIM HCI TRIMETHOPRIM HCI 1.50 ML

ITR030 TROBICIN INJ 2g SPECTINOMYCIN HCL 205.00 VIA

IGE008 GENTAMYCIN INJ

80mg/2mL

GENTAMICIN 50.00 AMP

CPA057 UNASYN 375mg AMPICILLIN SODIUM / SULBACTAM

SODIUM

8.60 TAB

CPA100 ZYVOX 600mg LINZOLID 540.00 TAB

TZY060 ZYVOX [linezolid] 600mg LINEZOLID 517.00 TAB

TIS010 ISONIAZID 100mg (GE) ISONIAZID 100mg 0.50 TAB

TIS012 ISONIAZID 50mg (GE) ISONIAZID 50mg 0.40 TAB

MRI010 MPR050 100mg/5mL RIFAMPICIN 2.00 ML

TMY010 MYAMBUTOL 100mg ETHAMBUTOL 100mg 2.20 TAB

TMY012 MYAMBUTOL 400mg ETHAMBUTOL 400mg 4.80 TAB

TMY013 MYAMBUTOL 400mg (GE) ETHAMBUTOL 400mg 4.40 TAB

TPY010 PYRAMIDE 500mg (GE) PYRAZINAMIDE 500mg 2.00 TAB

TRI010 RIFADIN 150mg (GE) RIFAMPICIN 150mg 4.50 CAP

TRI012 RIFADIN 300mg (GE) RIFAMPICIN 300mg 7.00 CAP

TRI030 RIFADIN 450mg (GE) RIFAMPICIN 450mg 10.00 TAB

TRI014 RIFATER RIFAMPICIN/INH/PYRAZINAMIDE 7.50 TAB

TRI018 RIFINAH 150mg RIFAMPICIN,ISONIAZID 150/100mg 8.60 TAB

TRI020 RIFINAH 300mg RIFAMPICIN,ISONIAZID 300/150mg 19.00 TAB

TFA020 FASIGYN 500mg (GE) TINIDAZOLE 500mg 12.00 TAB

TBI010 BILTRICIDE 600mg PRAZIQUANTEL 600mg 160.00 TAB

TCO050 COMBANTRIN 125mg PYRANTEL PAMOATE 125mg 6.00 TAB

TCO051 COMBANTRIN 125mg (GE) PYRANTEL PAMOATE 125mg 3.00 TAB

MCO040 COMBANTRIN

SUSPENSION 125mg/5mL

PYRANTEL PAMOATE 2.00 ML

MCO042 COMBANTRIN

SUSPENSION 250mg/5mL

PYRANTEL PAMOATE 5.50 ML

TDE030 DECARIS 50mg LEVAMISOLE 50mg 10.00 TAB

TVE040 VERMOX 100mg MEBENDAZOLE 100mg 6.50 TAB

TVE041 VERMOX 100mg (GE) MEBENDAZOLE 100mg 4.50 TAB

CPA080 VERMOX 500mg

(BRANDED)

MEBENDAZOLE 100mg 48.00 TAB

MVE020 VERMOX SUSPENSION

100mg/5mL 30mL

MEBENDAZOLE 3.00 ML

MAC005 ACICLOVIR SUSPENSION

100mg/5mL

ACICLOVIR 0.25 ML

CAL030 ALDARA CREAM 5% IMIQUIMOD 5% CREAM 720.00 BOX

TBA007 BARACLUDE 0.5mg ENTECAVIR 90.00 TAB

TCO066 COPEGUS (RIBAVIRIN)

200mg

RIBAVIRIN 200mg 0.00 TAB

TFA010 FAMVIR 125mg FAMCICLOVIR 125mg 35.00 TAB

TFA012 FAMVIR 250mg FAMCICLOVIR 250mg 38.00 TAB

TFA013

FAMVIR 250mg (GE)-

[FAMCICLOVIR] FAMCICLOVIR 30.00 TAB

THE016 HEPSERA 10mg ADEFOVIR DIPIVOXIL 10mg 75.00 TAB

IPE006 PEG-INTRON REDIPEN INJ

80mcg

RECOMBINANT ALPHA-2B

INTERFERON

1700.00 PEN

IPE004 PEGASYS INJ INTERFERON ALPHA-2A 1680.00 SYR

IPE005 PEGASYS INJ 180mcg/0.5mL ITERFERON ALPHA-2A 1750.00 SYR

IPE007 PEG-INTRON INJ 120mcg

(C.U.)

ALPHA-2B INTERFERON 450.00 VIA

IPE008 PEG-INTRON REDIPEN INJ

100mcg

ALPHA-2B INTERFERON 1700.00 PEN

SRE006 RELENZA INHALER ZANAMIVIR 320.00 BOX

TSE005 SEBIVO 600mg TELBIVUDINE 600mg 56.50 TAB

TTA023 TAMIFLU 75mg OSELTAMIVIR PHOSPHATE 75mg 32.00 CAP

MTA010 TAMIFLU SUSPENSION

12mg/mL x 62mL

OSELTAMIVIR 5.00 ML

TVA020 VALTREX 500mg VALACICLOVIR 500mg 22.00 TAB

TVI027 VIREAD 300mg TENOFOVIR DISOPROXIL

FUMARATE

110.00 TAB

TZE004 ZEFFIX 100mg LAMIVUDINE 100mg 35.00 TAB

TZO030 ZOVIRAX 200mg ACYCLOVIR 200mg 27.60 TAB

TZO031 ZOVIRAX 200mg (GE) ACYCLOVIR 200mg 7.00 TAB

TZO032 ZOVIRAX 400mg ACYCLOVIR 400mg 16.40 TAB

TZO033 ZOVIRAX 400mg (GE) ACYCLOVIR 400mg 10.00 TAB

TZO034 ZOVIRAX 800mg ACYCLOVIR 800mg 20.50 TAB

TZO035 ZOVIRAX 800mg (GE) ACYCLOVIR 800mg 13.00 TAB

MZO010 ZOVIRAX SUSPENSION

200mg/5mL 125mL

ACYCLOVIR 5.40 ML

TAR030 ARIMIDEX 1mg ANASTROZOLE 82.00 TAB

TCA072 CASODEX BICALUTAMIDE 151.00 TAB

CEF022 EFUDIX CREAM 5% 20g 5-FLUORO-URACIL 12.50 g

CEF020 EFUDIX OINTMENT 5% 20g 5-FLUORO-URACIL 12.50 g

TEN010 ENDOXAN 50mg CYCLOPHOSPHAMIDE 50mg 13.50 TAB

IFL010 FLUORO-URACIL INJ

250mg/5mL

5-FLUOROURACIL 80.00 VIA

THY004 HYDREA 500mg HYDROXYUREA 500mg 11.80 CAP

IIN020 INTRON-A INJ 3MIU +

RIBARIVARIN 200mg TAB

INTERFERON ALPHA-2b 580.00 VIA

TME050 METHOTREXATE 2.5mg METHOTREXATE 2.5mg 8.80 TAB

IME007 METHOTREXATE 10mg INJ METHOTREXATE 10mg 40.00 AMP

IME009 METHOTREXATE 25mg/mL INJMETHOTREXATE 160.00 VIA

IMI005 MITOMYCIN-C 2mg MITOMYCIN 130.00 AMP

TNO010 NOLVADEX 10mg (GE) TAMOXIFEN CITRATE 10mg 3.50 TAB

TNO020 NOLVADEX-D 20mg TAMOXIFEN CITRATE 20mg 28.10 TAB

TNO022 NOLVADEX-D 20mg (GE) TAMOXIFEN CITRATE 20mg 6.50 TAB

IRO016 ROFERON-A INJ 3MIU INTERFERON ALPHA 2A 500.00 VIA

TLA070 LARIAM 250mg (GE) MEFLOQUINE 250mg 41.00 TAB

TMA025 MALARONE ATOVAQUONE, PROGUANIL HCL 73.50 TAB

ANTIMALARIALS

ANTINEOPLASTICS

ANTIAMOEBICS

ANTHELMINTICS

ANTIVIRALS

ANTITUBERCULOUS AGENTS

Page 17 of 28

Page 18: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TNI050 NIVAQUIN 200mg (GE) CHLOROQUINE PHOSPHATE 200mg 1.00 TAB

PAL010 ALBOTHYL VAGINAL

SUPP 90mg

POLICRESULEN 14.50 PES

PBE010 BETADINE PESSARY

200mg

POVIDONE IODINE 5.00 PES

PCA010 CANESTEN PESSARY

100mg 6'S

CLOTRIMAZOLE 17.00 PES

PCA011 CANESTEN VAGINAL TAB

500MG

CLOTRIMAZOLE 120.00 PES

PCA012 CANESTEN PESSARY 500

mg 1's (GE)

CLOTRIMAZOLE 43.00 PES

CPA154 CANESTEN PESSARY 500

mg

CLOTRIMAZOLE 85.00 PES

PCO010 COLPOSEPTINE PESSARY PROMESTRIENE, CHLORQUINALDOL 7.00 PES

CDI006 DIENOESTROL CREAM

0.01% 78g

DIENOESTROL 0.01% 1.92 g

PGI010 GINETRIS PESSARY CHLORAMPHENICOL/MYRALACT//C

LOP

7.80 PES

PGY020 GYNE-LOTREMIN

PESSARY 100mg

CHLORAMPHENICOL/MYRALACT//C

LOP

11.00 PES

PGY016 GYNO-PEVARYL PESSARY

150mg

ECONAZOLE NITRATE 40.00 PES

PGY010 GYNO-TRAVOGEN

PESSARY 300mg

ISOCONAZOLE NITRATE 35.00 PES

PGY030 GYNO-TROSYD PESSARY TIOCONAZOLE 36.00 PES

PGY008 GYNOFLOR VAGINAL TAB

VIABLE LACTOBACILLUS

ACIDOPHILUS ,ESTRIOL 17.00 PES

CPA116 GYNOFLOR VAGINAL CAP

VIABLE LACTOBACILLUS

ACIDOPHILUS ,ESTRIOL 8.00 CAP

CPA140

GYNOPHILUS VAG CAP

341 341 mg

LACTOBACILLUS CASEI V.

RHAMNOSUS DODERLEIN (LCR35) 8.60 CAP

PMY010 MYCOSTATIN PESSARY

100,000U (GE)

NYSTATIN 3.20 PES

CPR010 PREMARIN VAGINAL

CREAM 42.5g

CONJUGATED ESTROGENS 6.00 g

CPA117 PREMARIN VAGINAL

CREAM 0.625 mg/1 g x 14 g

CONJUGATED ESTROGENS 70.00 TUB

PTA010 TALSUTIN PESSARY TETRACYCLINE, AMPHOTERICIN B 4.50 PES

PZA010

ZALAIN VAGINAL OVULE

300mg SERTACONAZOLE 75.00 PES

MCI010 CITRAVESCENT

GRANULES

SODIUM BICARBONATE, CITRIC

ACID…

2.50 PK

TUR024 UROCIT-K POTASSIUM CITRATE 6.50 TAB

MMI010 MIST POTASSIUM

CITRATE

POTASSIUM CITRATE 0.40 ML

TAV009 AVODART 0.5mg DUTASTERIDE 14.70 CAP

THA032 HARNAL D 0.2mg TAMSULOSIN HCl 15.00 TAB

TCE050 CETIPRIN NOVUM 200mg EMEPRONIUM CARRAGEENATE

200mg

4.10 TAB

CPA044 DETRUSITOL 1mg TOLTERODINE I-TARTRATE 1mg 9.10 TAB

TDE044 DETRUSITOL 2mg TOLTERODINE I-TARTRATE 2mg 10.60 TAB

TDI110 DITROPAN 5mg (GE) OXYBUTYNIN CHLORIDE 5mg 2.00 TAB

THA030 HARNAL OCAS 0.4mg TAMSULOSIN HYDROCHLORIDE 13.50 TAB

THY010 HYTRIN 1mg TERAZOSIN HCL 1mg 5.10 TAB

THY012 HYTRIN 2mg TERAZOSIN HCL 2mg 8.30 TAB

THY013 HYTRIN 5mg TERAZOSIN HCL 5mg 23.00 TAB

TPR110 PROSCAR 5mg FINASTERIDE 5mg 15.00 TAB

TPR112 PROSCAR 5mg (GE) FINASTERIDE 5mg 10.00 TAB

TPY020 PYRIDIUM 100mg PHENAZOPYRIDINE HCL 100mg 1.20 TAB

TPY022 PYRIDIUM 100mg (GE) PHENAZOPYRIDINE HCL 100mg 1.00 TAB

TXA016 XATRAL SR 5mg ALFUZOSIN HCL 5mg 6.00 TAB

TXA018 XATRAL XL 10mg ALFUZOSIN HCL 10mg 8.00 TAB

TVE060 VESICARE 5mg SOLIFENACIN SUCCINATE 5mg 10.50 TAB

INSULIN

IAC010 ACTRAPID HM 100IU/mL

(10mL)

INSULIN 355.00 VIA

IAC020 ACTRAPID HM PENFILL

100IU/mL (3mL)

INSULIN 105.00 AMP

IAC030 ACTRAPID-MC 100IU/mL

(10mL)

INSULIN 310.00 VIA

IAP010 APIDRA SOLOSTAR

100IU/mL

INSULIN HUMAN SHORT 140.00 AMP

IHU006 HUMALOG MIX 25 100U/mL KWIPENINSULIN LISPRO 25% ,INSULIN LISPRO PROTAMINE 75%195.00 AMP

IHU007

HUMALOG 100U/mL x

10mL INSULIN LISPRO 500.00 VIA

IHU008 HUMALOG 100IU/mL

PENFILL 5x3mL

INSULIN 180.00 AMP

IHU010 HUMULIN 70/30 100IU/mL

(10mL)

INSULIN (SOLUBLE + ISOPHANE) 260.00 VIA

IHU020 HUMULIN 70/30 PENFILL

100IU/mL (3mL)

INSULIN (SOLUBLE + ISOPHANE) 85.00 AMP

IHU030 HUMULIN L 100IU/mL

(10mL)

LENTE INSULIN 260.00 VIA

IHU040 HUMULIN N 100IU/mL

(10mL)

360.00 VIA

IHU042 HUMULIN N PENFILL

100IU/ML (3mL)

ISOPHANE INSULIN 85.00 AMP

IHU050 HUMULIN R 100IU/mL

(10mL)

INSULIN 260.00 VIA

ILA020 LANTUS 100IU/mL 3mL INSULIN 144.00 AMP

ILA022 LANTUS 100IU/mL 10mL INSULIN GLARGINE 180.00 VIA

ILA021 LANTUS OPTISET

100IU/mL 3mL

INSULIN GLARGINE 144.00 AMP

CPA082 LANTUS SOLOSTAR PRE-

FILLED PEN

INSULIN GLARGINE 160.00 PC

ILE020 LEVEMIR FLEXPEN

100U/mL

INSULIN DETEMIR 198.00 AMP

IMI013 MIXTARD HM PENFILL

10/90 100IU/mL 5x3mL

INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP

IMI012 MIXTARD HM PENFILL

20/80 100IU/mL 5x3mL

INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP

IMI010 MIXTARD HM PENFILL

30/70 100IU/mL 5x3mL

INSULIN (SOLUBLE + ISOPHANE) 105.00 AMP

IMI014 MIXTARD HM PENFILL

50/50 100IU/mL 5X3mL

INSULIN (SOLUBLE + ISOPHANE) 80.00 AMP

IMI020 MIXTARD-HM 100IU/mL

(10mL)

INSULIN (SOLUBLE + ISOPHANE) 355.00 VIA

IMO010 MONOTARD-HM 100IU/mL

(10mL)

INSULIN ZINC SUSPENSION 260.00 VIA

IMO020 MONOTARD-MC 100IU/mL

(10mL)

INSULIN ZN SUSPENSION(PORCINE) 310.00 VIA

INO010 NOVOMIX 30 FLEXPEN

100U/mL

INSULIN ASPART 205.00 AMP

INO020 NOVORAPID PENFILL

100u/mL 3mL

INSULIN ASPART 205.00 AMP

INO021

NOVORAPID FLEXPEN

100U/mL (3mL) INSULIN ASPART 205.00 AMP

TNO050 NORMIX 200mg RIFAXIMIN 40.00 TAB

IPR060 PROTAPHANE HM

PENFILL 100IU/mL (3mL)

INSULIN ISOPHANE 105.00 AMP

IPR062 PROTAPHANE-HM

100IU/mL (10mL)

INSULIN ISOPHANE 355.00 VIA

IPR064 PROTAPHANE-MC

100IU/mL (10mL)

INSULIN 270.00 VIA

IUL010 ULTRATARD HM 100IU/mL

(10mL)

INSULIN CRYSTALLINE SUSPENSION 260.00 VIA

APE050 PEN ULTRA 3mL 460.00 PC

URINARY ANTISEPTICS

DRUGS FOR BLADDER & PROSTATE DISORDERS

OTHER DRUGS ACTING ON GENITO-URINARY SYSTEM

ORAL ANTIDIABETIC AGENTS

PREPARATIONS FOR VAGINAL CONDITIONS

Page 18 of 28

Page 19: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TAC028 ACTOS 30mg PIOGLITAZONE 30mg 33.00 TAB

TAC029 ACTOSMET 15mg/850 28'S

PIOGLITAZONE HCl 15MG,

METFORMIN HCl 850MG 19.00 TAB

TAC031 ACTOS 15mg PIOGLITAZONE 19.40 TAB

TAV001 AVANDAMET 1mg/500mg ROSIGLITAZONE 1mg, METFORMIN

500mg

5.00 TAB

TAV002 AVANDAMET 2mg/500mg ROSIGLITAZONE 2mg, METFORMIN

500mg

8.60 TAB

TAV003 AVANDAMET 4mg/500mg ROSIGLITAZONE 4mg, METFORMIN

500mg

14.20 TAB

TAV011 AVANDAMET 4mg/1000mg

ROSIGLITAZONE MELEATE

4mg,METFORMIN 1000mg 14.20 TAB

CPA102 AMARYL 1mg GLIMEPIRIDE 1mg 2.50 TAB

TAM014 AMARYL 2mg GLIMEPIRIDE 2mg 5.00 TAB

TAM016 AMARYL 4mg GLIMEPIRIDE 4mg 8.00 TAB

TAV004 AVANDIA 2mg ROSIGLITAZONE MALEATE 2mg 9.30 TAB

TAV006 AVANDIA 4mg ROSIGLITAZONE MALEATE 4mg 17.60 TAB

TAV007 AVANDIA 8mg ROSIGLITAZONE MALEATE 8mg 31.00 TAB

TDA030 DAONIL 5mg (GE) GLIBENCLAMIDE 5mg 1.50 TAB

TDI010 DIABINESE 250mg (GE) CHLORPROPAMIDE 250mg 1.50 TAB

TDI018 DIAMICRON MR 30mg GLICLAZIDE MR 30mg 4.80 TAB

TDI019

DIAMICRON MR 30mg

(GE)-[GLICLAZIDE] GLICLAZIDE 3.20 TAB

TDI017

DIAMICRON MR 60mg 30'S

[GLICLAZIDE] GLICLAZIDE 9.60 TAB

TDI020 DIAMICRON 80mg (GE) GLICLAZIDE 80mg 2.70 TAB

TGA002 GALVUS MET 50mg/850mg VILDAGLIPTIN 50mg, METFORMIN 850mg 7.60 TAB

TGA003 GALVUS MET 50mg/500mg

VILDAGLIPTIN 50mg, METFORMIN

500mg 7.60 TAB

TGA004 GALVUS MET 50mg/1000mg VILDAGLIPTIN 50mg, METFORMIN 1000mg 7.60 TAB

TGA005 GALVUS 50mg VILDAGLIPTIN 7.10 TAB

TGL012 GLUCOBAY 50mg ACARBOSE 50mg 3.40 TAB

TGL010 GLUCOBAY 100mg ACARBOSE 100mg 3.50 TAB

TGL020 GLUCOPHAGE 250mg (GE) METFORMIN HCL 250mg 0.50 TAB

TGL022 GLUCOPHAGE 500mg METFORMIN HCL 500mg 1.00 TAB

TGL023 GLUCOPHAGE XR 500mg METFORMIN 500mg 2.50 TAB

TGL025 GLUCOPHAGE XR 750mg METFORMIN 3.65 TAB

TGL024 GLUCOPHAGE 850mg METFORMIN HCL 850mg 2.50 TAB

TGL030 GLUCOTROL XL 5mg GLIPIZIDE 5mg 4.20 TAB

TGL040 GLUCOVANCE

500mg/2.5mg

METFORMIN, GLIBENCLAMIDE 2.00 TAB

TGL041 GLUCOVANCE 500mg/5mg METFORMIN HCL; GLIBENCLAMIDE 2.00 TAB

TJA020 JANUVIA 100mg SITAGLIPTIN 100mg 17.50 TAB

TJA022 JANUMET 50mg/500mg SITAGLIPTIN 50mg, METFORMIN

500mg

8.75 TAB

TJA023 JANUMET 50mg/1000mg

SITAGLIPTIN PHOSPHATE 50mg,

METFORMIN 1000mg 8.75 TAB

TME020 MELBIN 250mg METFORMIN HCL 250mg 2.40 TAB

TMI040 MINIDIAB 5mg GLIPIZIDE 5mg 4.00 TAB

TN0090 NOVONORM 0.5mg REPAGLINIDE 0.5mg 3.40 TAB

TN0092 NOVONORM 1mg REPAGLINIDE 1mg 4.20 TAB

TNO094 NOVONORM 2mg REPAGLINIDE 2 mg 5.50 TAB

TON040 ONGLYZA 5mg SAXAGLIPTIN 12.000 TAB

CPA118 ONGLYZA FILM-COATED

TAB

SAXAGLIPTIN HCI 13.00 TAB

TRA010 RASTINON 500mg (GE) TOLBUTAMIDE 500mg 1.00 TAB

IBY010 BYETTA 5mcg/20 microlitre EXENATIDE 2400.00 BOX

IBY012 BYETTA 10mcg/20 microlitre EXENATIDE 2400.00 BOX

IVI004 VICTOZA 6mg/mL PRE-FILLED PENLIRAGLUTIDE 1445.00 SYR

TTR004 TRAJENTA 5mg LINAGLIPTIN 15.00 TAB

TEL020 ELTROXIN 100mcg THYROXINE SODIUM 100mcg 1.00 TAB

TTH030 THYROXINE 50mcg THYROXINE 50mcg 0.60 TAB

TTH032 THYROXINE 100mcg THYROXINE 100mcg 1.20 TAB

MLU010 LUGOL'S IODINE

SOLUTION

IODINE 0.60 ML

TNE010 NEO-MERCARZOLE 5mg

(GE)

CARBIMAZOLE 5mg 1.00 TAB

TNE012 NEO-MERCAZOL 5mg CARBIMAZOLE 5mg 0.85 TAB

TPR100 PROPYLTHIOURACIL 50mg PROPYLTHIOURACIL 50mg 1.20 TAB

TPR102 PROPYLTHIOURACIL

200mg

PROPYLTHIOURACIL 200MG 2.20 TAB

TTA026 TAPAZOLE 5mg METHIMAZOLE 5mg 5.00 TAB

TAT030 ATROMID-S 500mg CLOFIBRATE 500mg 3.00 CAP

TBE070 BEZALIP 200mg BEZAFIBRATE 200mg 5.00 TAB

TBE072 BEZALIP RETARD 400mg BEZAFIBRATE 400mg 11.60 TAB

TCA067 CADUET 5mg/10mg AMLODIPINE 5mg, ATORVASTATIN

10mg

15.80 TAB

TCA068 CADUET 10mg/10mg AMLODIPINE 10mg, ATORVASTATIN

10mg

18.70 TAB

TCA073 CADUET 5mg/20mg

AMLODIPINE 5mg, ATORVASTATIN

20mg 24.50 TAB

TCA074 CADUET 10mg/20mg

AMLODIPINE 10mg, ATORVASTATIN

20mg 26.20 TAB

TCR028 CRESTOR 5mg ROSUVASTATIN 5mg 12.90 TAB

TCR030 CRESTOR 10mg ROSUVASTATIN 10mg 16.50 TAB

TCR032 CRESTOR 20mg ROSUVASTATIN 20mg 22.40 TAB

TDU014 DUOLIP 250mg THEOFIBRATE 250mg 2.50 CAP

TDU016 DUOLIP 500mg THEOFIBRATE 500mg 4.80 CAP

TEZ010 EZETROL 10mg EZETIMIBE 10mg 16.50 TAB

TLE010 LESCOL 20mg FLUVASTATIN SODIUM 20mg 4.00 TAB

TLE012 LESCOL 40mg FLUVASTATIN SODIUM 40mg 7.00 TAB

TLE014 LESCOL XL 80mg FLUVASTATIN SODIUM 80mg 7.60 TAB

TLI027

LIPANTHYL 300mg (GE) -

[FENOFIBRATE] FENOFIBRATE 300mg 8.00 CAP

TLI028 LIPANTHYL 100mg FENOFIBRATE 100mg 3.00 TAB

TLI029 LIPANTHYL 200mg FENOFIBRATE 200mg 15.30 TAB

TLI030 LIPANTHYL 300mg FENOFIBRATE 300mg 12.10 TAB

TLI040 LIPITOR 10mg ATORVASTATIN 10mg 11.80 TAB

TLI041 LIPITOR 10mg [ATACOR] ATORVASTATIN CALCIUM 7.20 TAB

ANTITHYROIDS

ANTIDIABETIC AGENTS

THYROID PREPARATIONS

ANTIHYPERLIPIDAEMIC AGENTS

Page 19 of 28

Page 20: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TLI042 LIPITOR 20mg ATORVASTATIN 20mg 17.40 TAB

TLI043 LIPITOR 20mg [ATACOR] ATORVASTATIN CALCIUM 11.00 TAB

TLI044 LIPITOR 40mg ATORVASTATIN 40mg 28.90 TAB

TLI045 LIPITOR 80mg ATORVASTATIN 80mg 47.00 TAB

TLI046 LIPOBAY 0.2mg CERIVASTATIN SODIUM 0.2mg 12.50 TAB

TLI051 LIPITOR 10mg [LIPISTAD

10] 30'S

ATORVASTATIN 7.20 TAB

TLI052 LIPITOR 20mg [LIPISTAD

20] 30'S

ATORVASTATIN 11.00 TAB

TLO020 LOPID 300mg (GE) GEMFIBROZIL 300mg 3.15 CAP

TLO021 LOPID 600mg GEMFIBROZIL 600mg 8.00 CAP

TLO022 LOPID 600mg (GE) GEMFIBROZIL 600mg 4.40 TAB

TLO024 LOPID 900mg GEMFIBROZIL 900mg 9.50 TAB

TME060 MEVACOR 20mg LOVASTATIN 20mg 11.30 TAB

TME061 MEVACOR 20mg (GE) LOVASTATIN 20mg 7.00 TAB

TNI004 NIASPAN 375mg NICOTINIC ACID 375mg 7.45 TAB

TNI005 NIASPAN 500mg NICOTINIC ACID 500mg 9.00 TAB

TNI006 NIASPAN 1000mg NICOTINIC ACID 1000mg 17.10 TAB

TNI010 NICOBID 250mg NIACIN 5.50 CAP

TOL010 OLBETAM 250mg ACIPIMOX 250mg 9.50 CAP

TPR010 PRAVACHOL 10mg PRAVASTATIN SODIUM 10mg 10.00 TAB

TPR012 PRAVACHOL 20mg PRAVASTATIN SODIUM 20mg 16.00 TAB

TPR014 PRAVACHOL 40mg PRAVASTATIN SODIUM 40mg 18.00 TAB

MQU010 QUESTRAN GRANULES 9g CHOLESTYRAMINE RESIN 12.00 SACH

TTR028 TREDAPTIVE 1G/20mg ER NIACIN, LAROPIPRANT 9.40 TAB

CPA068 TREDAPTIVE LAROPIPRANT

NICOTINIC ACID

20.00 TAB

TVY021 VYTORIN 10mg/10mg EZETIMIBE / SIMVASTATIN 14.30 TAB

TVY022 VYTORIN 10mg/20mg EZETIMIBE / SIMVASTATIN 17.60 TAB

TVY024 VYTORIN 10mg/40mg EZETIMIBE, SIMVASTATIN 26.80 TAB

TZO010 ZOCOR 10mg SIMVASTATIN 10mg 7.80 TAB

TZO011 ZOCOR 10mg (GE) SIMVASTATIN 10mg 6.30 TAB

TZO012 ZOCOR 20mg SIMVASTATIN 20mg 8.80 TAB

TZO013 ZOCOR 20mg (GE) SIMVASTATIN 20mg 7.10 TAB

TZO014 ZOCOR 40mg SIMVASTATIN 40mg 16.50 TAB

TZO015 ZOCOR 40mg (GE) SIMVASTATIN 40mg 11.50 TAB

TZO016 ZOCOR 80mg SIMVASTATIN 80mg 18.00 TAB

TAC023

ACTONEL 150mg ONCE-A-

MONTH RISEDRONATE SODIUM 150mg 300.00 TAB

TAC026 ACTONEL 5mg RISEDRONATE SODIUM 5mg 13.50 TAB

TAC027 ACTONEL 35mg RISEDRONATE SODIUM 35mg 75.00 TAB

TEV010 EVISTA 60mg RALOXIFENE HCL 60mg 16.90 TAB

TFO020 FOSAMAX 10mg ALENDRONATE SODIUM 10mg 16.00 TAB

TFO022 FOSAMAX 70mg ALENDRONATE SODIUM 70mg 81.00 TAB

TFO023 FOSAMAX 70mg (GE) ALENDRONATE SODIUM 70mg 60.00 TAB

TFO024 FOSAMAX PLUS ALENDRONATE, COLECALCIFEROL 81.00 TAB

TFO025 FOSAMAX PLUS 5,600IU ALENDRONATE 70mg,

COLECALCIFEROL 5600IU

81.000 TAB

IGL010 GLUCAGON INJ 1mg/1mL LYOPHILISED GLUCAGON HCL 620.00 AMP

TON010 ONE-ALPHA 0.25mcg ALFACALCIDOL 0.25mcg 3.20 CAP

TON012 ONE-ALPHA 1mcg ALFACALCIDOL 1mcg 8.00 CAP

TOS030 OSTAC 520mg CLODRONIC ACID 75.00 TAB

TRO030 ROCALTROL 0.25mcg CALCITRIOL 0.25mcg 8.00 CAP

TRO032 ROCALTROL 0.5mcg CALCITRIOL 0.5mcg 13.00 CAP

CSI020 SILKIS OINTMENT 30g CALCITRIOL 3mcg/g 6.90 g

MGE020 GES 45 KCL, NACL, NA2CO3, GLUCOSE 3.00 SACH

MOR005 ORAL REHYDRATION

SALTS

KCL, NACL, NA CITRATE 2.80 SACH

IMA006 MAGNESIUM SULPHATE

49.3% INJ

MAGNESIUM SULPHATE 70.00 AMP

MPO030 POTASSIUM CHLORIDE

10%

POTASSIUM CHLORIDE 10% 0.50 ML

TPO050

POTASSIUM CHLORIDE

500mg POTASSIUM CHLORIDE 0.80 TAB

DAZ030 AZYTER 15mg/g EYE

DROPS

AZITHROMYCIN 60.000 BOX

DCE010 CEBEMYXINE EYE

OINTMENT 5g

NEOMYCIN, POLYMYXIN B 22.00 TUB

CCH010 CHLORAMPHENICOL

OINTMENT 2%

CHLORAMPHENICOL 2% 0.67 g

DCH010 CHLORAMPHENICOL EYE

DROPS (GE)

CHLORAMPHENICOL 0.5% 12.50 BOT

DCH020 CHLORAMPHENICOL EYE

OINTMENT 1%

CHLORAMPHENICOL 1% 12.00 TUB

DCH022 CHLORAMPHENICOL

OPTICOPS EYE OINTMENT

CHLORAMPHENICOL 1% 2.50 CAP

DCI010 CILOXAN EYE DROPS 0.3% CIPROFLOXACIN HCl 63.00 BOT

DCR010 CRAVIT OPHTHALMIC

SOLUTION

LEVOFLOXACIN 50.00 BOT

DCU010 CUSIVIRAL EYE

OINTMENT

ACYCLOVIR 3% 175.00 TUB

DFU010 FUCITHALMIC EYE DROPS FUSIDIC ACID 1% 78.50 TUB

DFL010 FLAREX EYE DROPS FLUOROMETHOLONE 62.00 BOT

CGA012 GARAMYCIN CREAM 0.3%

15g (GE)

GENTAMICIN SULFATE 0.3% 2.60 g

DGA010 GARAMYCIN EYE DROPS

(GE)

GENTAMICIN SULFATE 0.3% 44.00 BOT

DGA012 GARAMYCIN EYE

OINTMENT

GENTAMICIN SULFATE 0.3% 42.00 TUB

DMU010 MURO 128 5% EYE

OINTMENT

SODIUM CHLORIDE HYPERTONICITY 54.00 TUB

DNE010 NEOSPORIN EYE DROPS POLYMYXINB,NEOMYCIN,GRAMICI

DIN

32.00 BOT

DNE012 NEOSPORIN EYE DROPS

(GE)

POLYMYXIN B SULPHATE 5000 U 38.00 BOT

DNE020 NEOSPORIN EYE

OINTMENT

POLYMYXINB,NEOMYCIN,BACITRA

CIN

50.00 TUB

DNE030 NEVANAC EYE DROPS NEPAFENAC 82.00 BOT

DOK010 OKACIN EYE DROPS LOMEFLOXACIN 0.3% 58.00 BOT

DPH020 PHYSIODOSE EYE &

NASAL DROP 5ml

SODIUM CHLORIDE 5.00 AMP

DPO010 POLYFAX EYE OINTMENT POLYMYXIN B, BACITRACIN 54.00 TUB

DSU010 SULPHACETAMIDE EYE

DROPS 10% (GE)

SULFACETAMIDE SODIUM 10% 15.00 BOT

EYE ANTI-INFECTIVES & ANTISEPTICS

OTHER AGENTS AFFECTING METABOLISM

ELECTROLYTES AND MINERALS

Page 20 of 28

Page 21: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

DSY010 SYSTANE EYE DROPS

15mL

BORIC ACID, CALCIUM CHLORIDE 70.00 BOT

DSY012

SYSTANE EYE DROPS SDU

(28's) BORIC ACID, CALCIUM

CHLORIDE,HYDROXPROPYL GUAR

115.00 BOX

DSY013

SYSTANE ULTRA EYE

DROPS 10mL POLYETHYLENE

GLYCOL,PROPYLENE GLYCOL

62.00 BOT

DTA010 TARIVID EYE DROPS OFLOXACIN 50.00 BOT

DTA012 TARIVID EYE DROPS (GE) OFLOXACIN 28.00 BOT

DTA020 TARIVID EYE OINTMENT OFLOXACIN 3mg/g 60.00 TUB

DTE020 TERRAMYCIN EYE

OINTMENT

OXYTETRACYCLINE, POLYMYXIN B 38.00 TUB

DTO010 TOBREX EYE DROPS TOBRAMYCIN 0.3% 68.00 BOT

DTO011

TOBREX EYE DROPS (GE) -

[TOBRAMYCIN] TOBRAMYCIN 52.00 BOT

DTO012 TOBREX EYE OINTMENT TOBRAMYCIN 0.3% 83.00 BOT

DTR004 TRIHERPINE EYE

OINTMENT 2.5g

TRIFLUOROTHYMIDINE 1% 135.00 TUB

DVI008 VIGAMOX EYE DROPS MOXIFLOXACIN HYDROCHLORIDE

5.4

110.00 BOT

DZO010 ZOVIRAX EYE OINTMENT ACYCLOVIR 3% 355.00 TUB

ITO010 TOBRAMYCIN 40mg/ml TOBRAMYCIN 30.00 VIA

DEF010 EFEMOLINE EYE DROPS FLUOROMETHOLONE 0.1%... 60.00 BOT

DFM010 FML EYE DROPS 0.02%

(GE)

FLUOROMETHOLONE 0.02% 46.00 BOT

DFM012 FML EYE DROPS 0.1% FLUOROMETHOLONE 0.1% 64.00 BOT

DHY006 HYDROCORTISONE EYE

OINTMENT 1%

HYDROCORTISONE 1% 22.00 TUB

DAL019 ALREX EYE DROPS 0.2% LOTEPREDNOL 85.00 BOT

DLO010 LOTEMAX EYE DROPS LOTEPREDNOL ETABONATE 126.00 BOT

DMA014 MAXIDEX EYE DROPS DEXAMETHASONE 0.1% 60.00 BOT

DPR010 PRED FORTE EYE DROPS

1%

PRENISOLONE ACETATE 1% 54.00 BOT

DPR012 PRED-MILD EYE DROPS PRENISOLONE ACETATE 0.12% 49.00 BOT

DSP048 SPERSADEX 0.1% EYE

DROPS

DEXAMETHASONE NA PHOSPHATE 54.00 BOT

DUL008 ULTRACORTENOL EYE

DROPS

PREDNISOLONE 43.00 BOT

DUL010 ULTRACORTENOL EYE

OINT

PREDNISOLONE ACETATE 5mg/mL 63.00 TUB

DVE010 VEXOL 1% EYE DROPS RIMEXOLONE 1% 133.00 BOT

DFM013 FML EYE DROPS 0.1% (GE) FLUOROMETHOLONE 0.1% 52.00 BOT

DBL010 BLEPHAMIDE EYE DROPS SULFACETAMIDE, PREDNISOLONE.. 39.00 BOT

DCO016 CORTIPHENOL-H EYE

OINTMET

HYDROCORTISONE 1%/CHLORAMPH

1%

68.50 TUB

DCO020 CORTISON-KEMICETINE

EYE OINTMENT

CHLORAMPHENICOL,HYDROCORTIS

ONE

32.00 TUB

DDE020 DEXAMETHASONE 0.1% +

CHLORAMPHENICOL 0.5%

DEXAMETHASONE,

CHLORAMPHENICOL

7.00 BOT

DFM020 FML-NEO EYE DROPS FLUOROMETHOLONE, NEOMYCIN 50.00 BOT

DGA020 GARASONE EYE DROPS GENTAMICIN, BETAMETHASONE 55.00 BOT

DGA030 GARASONE EYE

OINTMENT

GENTAMICIN, BETAMETHASONE 42.00 TUB

DMA010 MAXITROL EYE DROPS DEXAMETHASONE, NEOMYCIN... 65.00 BOT

DMA012 MAXITROL EYE

OINTMENT

DEXAMETHASONE, NEOMYCIN... 72.00 BOT

DSP050 SPERSADEX COMP EYE

DROP

DEXAMETHASONE,

CHLORAMPHENICOL

52.00 BOT

DSP010 SPERSADEXOLINE EYE

DROPS

DEXAMETHASONE,

CHLORAMPHENICOL

45.00 BOT

DSP012 SPERSADEXOLINE EYE

DROPS (GE)

DEXAMETHASONE,

CHLORAMPHENICOL

34.50 BOT

DTO022 TOBRADEX EYE DROPS TOBRAMYCIN, DEXAMETHASONE 73.00 BOT

DTO020 TOBRADEX EYE

OINTMENT

TOBRAMYCIN, DEXAMETHASONE 76.00 TUB

DOT020 OTOZAMBON EAR DROPS LIGNOCAINE NEOMYCIN

POLYMYXIN B

45.00 BOT

DAT010 ATROPINE EYE DROPS 1% ATROPINE SULFATE 1% 75.00 BOT

DAT012 ATROPINE EYE

OINTMENT

ATROPINE SULFATE 1% 60.00 TUB

DCY010 CYCLOPENTOLATE EYE

DROPS 0.5%

CYCLOPENTOLATE HCL 0.5% 45.00 BOT

DCY011 CYCLOPENTOLATE EYE

DROPS 0.5% MINIM

CYCLOPENTOLATE HCL 0.5% 21.00 PC

DCY012 CYCLOPENTOLATE EYE

DROPS 1% MINIM

CYCLOPENTOLATE HCL 1% 20.00 PC

DHO010

HOMATRPINE 2% EYE

DROPS HOMATRPINE 100.00 BOT

DMY010 MYDFRIN EYE DROPS

2.5%

PHENYLEPHRINE HCL 2.5% 36.00 BOT

DMY020 MYDRIACYL EYE DROPS

1%

TROPICAMIDE 1% 134.00 BOT

DMY030 MYDRIN-P EYE DROPS TROPICAMIDE,PHENYLEPHERINE

HCL

94.00 BOT

DNY010 NYOLOL EYE DROPS 0.5% TIMOLOL MALEATE 0.5% 53.00 BOT

DPH010 PHENYLEPHERINE

MINIMS 10% EYE DROPS

PHENYLEPHERINE 10% 24.00 PC

DTR006 TROPICAMIDE 0.5%

MINIMS

TROPICAMIDE 0.5% 21.00 PC

MIOTIC

DRUGSIMI004 MIOCHOL-E 20mg INJ ACETYLCHOLINE CI 200.00 AMP

DAC030 ACULAR 0.5% EYE DROPS KETOROLAC TROMETHAMINE 72.00 BOT

DAL018 ALCAINE EYE DROPS PROPARACAINE HCL 0.5% 52.00 BOT

DAL010 ALOMIDE EYE DROPS LODOXAMIDE 0.1% 105.00 BOT

DAL004 ALBALON EYE DROPS NAPHAZOLINE 75.00 BOT

DAL020 ALPHAGAN EYE DROPS BRIMONIDINE TARTRATE 207.50 BOT

DAL022 ALPHAGAN-P 0.15% EYE

DROPS

BRIMONIDINE TARTRATE 0.15% 230.00 BOT

DAM010 AMETHOCAINE EYE

DROPS 1% MINIMS

TETRACAINE 26.50 PC

DAZ010 AZOPT 1% EYE

SUSPENSION

BRINZOLAMIDE 1% 180.00 BOT

DBE020 BETOPIC-S EYE DROPS BETAXOLOL 0.25% 94.00 BOT

DBE010 BETOPTIC EYE DROPS BETAXOLOL 0.5% 105.00 BOT

DBI010 BION TEARS EYE DROPS

0.45mL

DEXTRAN 70%, HYDROXYPROPYL

MET

108.00 BOX

DBL006 BLEPHAGEL POLOXAMER 188/PEG-75/SODIUM BO 131.00 BOX

DCA010 CATALIN EYE DROPS PIRENOXINE Na 70.00 BOT

DCO006 COBAMIN EYE SOLN

0.2mg/mL

CYANOCOBALAMIN 60.00 BOT

DCO009 COMBIGAN EYE DROPS

BRIMONIDINE TARTRATE

2mg,TIMOLOL 5mg 235.00 BOT

DCO015 CORNEREGEL EYE GEL

DEXPANTHENOL 50mg, CETRIMIDE

0.1mg, WATER FOR INJ. 945.79mg 51.50 TUB

DCO030 COSOPT EYE DROPS DORZOLAMIDE/TIMOLOL MALEATE 280.00 BOT

DCY004 CYCLOGYL 1% EYE

DROPS

CYCLOPENTOLATE 1% 50.00 BOT

DDU006 DUOTRAV EYE DROPS TRAVOPROST,TIMOLOL 340.00 BOT

DDU010 DURATEARS EYE

OINTMENT

WHITE PETROLATUM, LIQ LANOLIN 55.00 TUB

DEM010 EMADINE EYE DROPS

0.05%

EMEDASTINE DIFUMARATE 0.05% 75.00 BOT

DHI010 HIALID 0.1% EYE DROPS

5mL

SODIUM HYALURONATE 0.1% 83.00 BOT

MYDRIATIC DRUGS

EYE CORTICOSTEROIDS

EYE ANTISEPTICS WITH CORTICOSTEROIDS

OTHER EYE PREPARATIONS

EAR ANTI-INFECTIVES & ANTISEPTICS

Page 21 of 28

Page 22: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

DHY010 HYPOTEARS EYE DROPS POLYVINYL ALCOHOL 1% 67.50 BOT

DHY011 HYPOTEARS EYE GEL VIT A PALMITATE/POLYACRYLIC AC 60.00 TUB

DHY012 HYPOTEARS PLUS EYE

DROPS

POLYVINYL ALCOHOL 1% 62.00 BOT

DHY014 HYPOTEARS PLUS SDU

EYE DROPS 0.4mL

POLYVINYL ALCOHOL 1% 3.50 PC

DHY020 HYPROMELLOSE EYE

DROPS 0.3%

HYPROMELLOSE 0.3% 15.00 BOT

DIO010 IOPIDINE EYE DROPS 0.5% APRACLONIDINE HCl 115.00 BOT

DIS012 ISOPTO CARPINE EYE

DROPS 1%

PILOCARPINE NITRATE 1% 56.00 BOT

DIS011 ISOPTO CARPINE EYE

DROPS 2%

PILOCARPINE NITRATE 2% 60.00 BOT

DIS010 ISOPTO CARPINE EYE

DROPS 4%

PILOCARPINE NITRATE 4% 88.00 BOT

DKA010 KARY UNI EYE DROPS

0.05mg/mL

PIRENOXINE 45.00 BOT

DLA010 LARMABAK EYE DROPS SODIUM CHLORIDE 0.9% 95.00 BOT

DLU010 LUMIGAN EYE DROPS BIMATOPROST 390.00 BOT

DNA008 NAAXIA EYE DROPS N-ACETYL ASPARTYLGLUTAMIC

ACID

35.00 BOT

DNA010 NAPHCON-A EYE DROPS

15mL

NAPHAZOLINE HCL, PHENIRAMINE 54.00 BOT

DNA011 NAPHCON-A EYE DROPS

15mL(GE)-

NAPHAZOLINE HCL 0.025%,

PHENIRAMINE MALEATE 0.3%

39.00 BOT

DNA012 NAPHCON-A EYE DROPS

3mL

NAPHAZOLINE HCL, PHENIRAMINE 36.00 BOT

DNO010 NOVESIN EYE DROPS OXYBUPROCAINE HCL 0.4% 42.00 BOT

DOC010 OCULOSAN EYE DROPS ZINC SULFATE, NAPHAZOLINE 60.00 BOT

DOC020 OCUSAN EYE DROPS

0.35ML(20's/BOX)

SODIUM HYALURONATE 0.15% 50.00 BOX

DOP010 OPTICROM EYE DROPS

(GE)

SODIUM CROMOGLYCATE 2% 55.00 BOT

DOP012 OPTICROM 4% EYE DROPS

(GE)

SODIUM CROMOGLYCATE 60.00 BOT

DOP020 OPTIZOLINE EYE DROPS TETRAHYDROZOLINE HCL 0.05% 32.00 BOT

DOP021 OPTIZOLINE EYE DROPS

(GE)

TETRAHYDROZOLINE HCL 0.05% 32.00 BOT

DPA008 PATADAY EYE DROPS

0.2%

OLOPATADINE 0.2% HCL 115.00 BOT

DPA010 PATANOL EYE DROPS

0.1%

OLOPATADINE 112.00 BOT

DPR013 PROPINE EYE DROPS DIPIVEFRIN HCL 0.1% 85.00 BOT

DPR020 PROTAGENT EYE DROPS POLYVINYL PYRROLIDONE 20mg/mL 38.00 BOT

DQU010 QUINAX EYE DROPS AZAPENTACENE POLYSULFONATE

Na

135.00 BOT

DRE010 REFRESH PLUS EYE

DROPS (30pcs)

CARBOXYMETHCELLULOSE NA

(PRESE

115.00 BOX

DRE040 RELESTAT 0.05% EYE

DROPS

EPINASTINE 78.50 BOT

DSI010 SICCAPROTECT EYE

DROPS

DEXPANTHENOL 29.00 BOT

DNO005 SODIUM CHLORIDE EYE

DROPS 0.9%

SODIUM CHLORIDE 20.00 BOT

DSO020 SOLCOSERYL EYE GEL HEMODIALYSATE 20% 79.00 TUB

DSP040 SPERSACARPINE EYE

DROPS 1%

PILOCARPINE HCL 1% 40.00 BOT

DSP044 SPERSACARPINE EYE

DROPS 4%

PILOCARPINE HCL 4% 40.00 BOT

DSP020 SPERSALLERG EYE DROPS ANTAZOLINE, TETRAHYDROZOLINE 45.00 BOT

DSP022 SPERSALLERG SDU EYE

DROPS

ANTAZOLINE, TETRAHYDROZOLINE 70.00 BOX

DSP042 SPERSCARPINE EYE

DROPS 2%

PILOCARPINE HCL 2% 40.00 BOT

DTI010 TIMOPTOL EYE DROPS

0.25%

TIMOLOL MALEATE 0.25% 70.00 BOT

DTI012 TIMOPTOL EYE DROPS

0.5%

TIMOLOL MALEATE 0.5% 85.00 BOT

DTI013 TIMOPTOL EYE DROPS

0.5% (GE)

TIMOLOL MALEATE 0.5% 58.00 BOT

DTI014 TIMOPTOL-XE EYE DROPS

0.5%

TIMOLOL MALEATE 0.5% 85.00 BOT

DTR003 TRAVATAN EYE DROPS TRAVOPROST 365.00 BOT

DTR010 TRUSPOT 2% EYE DROPS DORZOLAMIDE HCL 180.00 BOT

DVI010 VISCOTEARS EYE GEL POLYACRYLIC ACID 0.02% 80.00 TUB

DVI020 VITREOLENT EYE DROPS NA IODIDE 0.3%, K IODIDE 0.3% 60.00 BOT

DVD010 VOLTAREN EYE DROPS DICLOFENAC SODIUM 0.1% 85.50 BOT

DXA006 XALACOM EYE DROPS LATANOPROST 50mcg,TIMOLOL 5mg 400.00 BOT

DXA010 XALATAN EYE DROPS LATANOPROST 0.005% 385.00 BOT

DZA012 ZADITEN (SDU) EYE

DROPS 10's

KETOTIFEN 58.00 BOX

DZA012. ZADITEN (SDU) EYE

DROPS 20's

KETOTIFEN 0.025% 90.00 BOX

DZA010 ZADITEN EYE DROPS KETOTIFEN 0.025% 100.00 BOT

DAP010 APLOSYN EAR DROPS NEOMYCIN, POLYMYXIN,

FLUOCINOLONE

20.00 BOT

DCH034 CHLORAMPHENICOL EAR

DROPS 5%

CHLORAMPHENICOL 5% 1.00 ML

DCH032 CHLORAMPHENICOL EAR

DROP 10% 15mL/BOT

CHLORAMPHENICOL 10% 1.30 ML

DCO018 CORTISON KEMICETINE

EAR DROPS

CHLORAMPHENICOL,

HYDROCORTISONE

49.50 BOT

DDE010 DECADRON & NEOMYCIN

EYE/EAR DROPS

DEXAMETHASONE, NEOMYCIN 20.00 BOT

DKE010 KENACOMB EAR DROPS TRIAMCINOLONE, NEOMYCIN... 55.00 BOT

DOT010 OTOSPORIN EAR DROPS POLYMYXIN B, HYDROCORTISONE... 105.00 BOT

DOT012 OTOSPORIN EAR DROPS

(GE)

POLYMYXIN B, HYDROCORTISONE... 22.00 BOT

DSO010 SOFRADEX EAR/EYE

DROPS (GE)

DEXAMETHASONE, FRAMYCETIN... 61.00 BOT

DTA006 TARIVID EAR DROPS OFLOXACIN 3mg/mL 57.00 BOT

DTR008 TROPEX EAR DROPS 10mL PHENAZONE 5%, GLYCEROL 75.00 BOT

CAC002 A-CERUMEN EAR DROPS

2ml

TEA-COCOYL HYDROLYZED

COLLAGEN, COCO-BETAINE,

14.00 AMP

DOL010 OLIVE OIL EAR DROPS

15mL/BOT

OLIVE OIL 0.60 ML

DWA012 WAX-EZE EAR DROPS

10mL

DOCUSATE SODIUM 0.5% 448.00 BOT

DWA010 WAXSOL EAR DROPS DOCUSATE SODIUM 0.5% 66.00 BOT

TCE049 CEPACOL CETYLPYRIDINIUM CL 0.07% 1.20 TAB

CCO040 CORSODYL CHLORHEXIDINE GLUCONATE 0.2% 0.26 ML

CDA040 DAKTARIN ORAL GEL MICONAZOLE 4.50 g

TDE050 DEQUADIN LOZENGES DEQUALINIUM CHLORIDE 0.25mg 0.60 TAB

TDE051

DEQUADIN LOZENGES

(GE)-[DEQUALINUM] DEQUALINUM CHLORIDE 0.25mg 0.60 TAB

TDI054 DIFFLAM LOZENGES BENZYDAMINE, CETYLPYRIDINIUM 2.80 TAB

ADI020 DIFFLAM SOLUTION

120mL

BENZYDAMINE HCL SOLUTION 0.30 ML

ADI022 DIFFLAM-C SOLUTION BENZYDAMINE HCL, CHLORHEXIDINE 0.60 ML

CEU034 EUROCORT PASTE 5g TRIAMCINOLONE

ACETONIDE/LIGNOC

5.50 g

AGL022 GLYCERINE THYMOL

GARGLE (GE) "BLUE"

GLYCERIN THYMOL GARGLE 0.22 ML

AGL020 GLYCERINE THYMOL

GARGLE (GE) "RED"

GLYCERIN THYMOL GARGLE 0.13 ML

CKE030 KENALOG IN ORABASE 5g

(GE)

TRIAMCINOLONE ACETONIDE 0.1% 8.00 g

CKE032 ORACORT E 5g (GE) LIGNOCAINE, TRIAMCINOLONE 8.80 g

COR010 ORAGESIC GEL 5g TRIAMCINOLONE, CHLORHEXIDINE,

LIGNOCAINE

6.50 g

EAR ANTI-INFECTIVES, ANTISEPTICS WITH OR WITHOUT CORTICOSTEROIDS

OTHER EAR PREPARATIONS

MOUTH / THROAT PREPARATION

Page 22 of 28

Page 23: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

COR020 ORAMEDY PASTE 5g TRIAMCINOLONE ACETONIDE 7.50 g

CTR034 TRI-GEL 5g TRIAMCINOLONE, LIGNOCAINE 5.00 g

TTY010 TYROCAINE LOZENGES TYROTHRICIN, BENZOCAINE 0.52 TAB

CAC010 AUREOMYCIN OINTMENT

3% 15g

CHLORTETRACYCLINE HCL OINT 3% 7.00 g

CBA008 BACTROBAN NASAL

OINTMENT 3g

MUPIROCIN 68.00 g

CPA119 BACTROBAN OINTMENT

15g

MUPIROCIN 83.00 TUB

CBA010 BACTROBAN OINTMENT

15g

MUPIROCIN 5.50 g

CBA012 BACTROBAN OINTMENT

15g (GE)

MUPIROCIN 2% 4.50 g

CBU010 BURNOL CREAM 25g AMINACRIEN HCL, CETRIMIDE 1.00 g

CCH008 CHLORAMPHENICOL

CREAM 2%

CHLORAMPHENICOL 2% 0.67 g

CEL005 ELIDEL CREAM 1% 15g PIMECROLIMUS 1% 21.50 g

CFL008 FLAMAZINE CREAM 25g

(GE)

SILVER SULFADIAZINE 3.47 g

CFL010 FLAMAZINE CREAM 80g

(GE)

SILVER SULFADIAZINE 3.00 g

CFU030 FUCIDIN CREAM 15g FUSIDIC ACID 4.90 g

CFU020 FUCIDIN OINTMENT 5g FUSIDIC ACID 7.60 g

CGA011 GARAMYCIN CREAM 0.1%

450g (GE)

GENTAMICIN SULFATE 0.1% 2.90 g

CGA010 GARAMYCIN SKIN CREAM

0.1% 15g (GE)

GENTAMICIN SULFATE 0.1% 2.70 g

CNE010 NEBACETIN SPRAY

150mL/BOT

NEOMYCIN SULFATE, BACITRACIN 110.00 BOT

CNE030 NEOMYCIN CREAM 0.5%

(G.E.)

NEOMYCIN SULFATE 0.5% 0.90 g

CNO010 NORITATE CREAM 1% 30g METRONIDAZOLE 1% 4.00 g

CPR028 PROTOPIC OINTMENT

0.03% 30g

TACROLIMUS 17.30 g

CPR030 PROTOPIC OINTMENT

0.1% 30g

TACROLIMUS 19.60 g

CRO010 ROZEX GEL 15g METRONIDAZOLE 0.75% 6.30 g

CSU010 SULPHADIAZINE CREAM

5%

SULPHADIAZINE 5% 0.80 g

CTE010 TETRACYCLINE

OINTMENT

TETRACYCLINE 0.80 g

CBE070 BETNOVATE-C CREAM 15g BETAMETHASONE 0.1%,

CLIOQUINOL

3.13 g

CBE090 BETNOVATE-N CREAM

(GE)

BETAMETHASONE, NEOMYCIN 2.90 g

CBE080 BETNOVATE-N CREAM

15g

BETAMETHASONE, NEOMYCIN 0.5% 4.40 g

CPA040 DAKTACORT CREAM 15g MICONAZOLE 2%,

HYDROCORTISONE

5.63 g

CDA020 DAKTACORT CREAM 15g

(GE)

MICONAZOLE 2%,

HYDROCORTISONE

2.50 g

CDI016 DIPROGENTA CREAM 15g BETAMETHASONE DIPROPIONATE

.05

7.00 g

CDI018 DIPROGENTA CREAM 450g BETAMETHASONE DIP, GENTAMICIN 6.00 g

CDI022 DIPROGENTA OINTMENT

15g

BETAMETHASONE DIP, GENTAMICIN 6.70 g

CDI024 DIPROGENTA OINTMENT

450g

BETAMETHASONE DIP, GENTAMICIN 6.00 g

CDI030 DIPROSALIC LOTION

10mL/BOT

BETAMETHASONE DIP, SAL. ACID 75.70 BOT

CDI040 DIPROSALIC OINTMENT

15g

BETAMETHASONE DIP, SAL. ACID 7.60 g

CDI042 DIPROSALIC OINTMENT

450g (GE)

BETAMETHASONE DIP, SAL. ACID 4.68 g

CDI056 DIPROSONE OINTMENT

0.05% (GE)

BETAMETHASONE DIPROPIONATE

0.05%

1.90 g

CPA115 DERMAID 0.5 % x 15 g HYDROCORTISONE 30.00 TUBE

CFU010 FUCICORT CREAM 15g FUSIDIC ACID 2%, BETAMETHASONE 5.20 g

CFU040 FUCIDIN H CREAM 2% FUSIDIC ACID, HYDROCORTISONE 5.20 g

CHY032 HYDROCORTISONE 1% +

MICONAZOLE 2%

HYDROCORTISONE 1%,

MICONAZOLE 2%

1.20 g

CHY042 HYDROCORTISONE 1% +

NEOMYCIN 1% LOTION

HYDROCORTISONE1%, NEOMYCIN

1%

1.20 ML

CHY040 HYDROCORTISONE-

NEOMYCIN CREAM (GE)

HYDROCORTISONE1%,NEOMYCIN

0.5%

1.20 g

CHY050 HYDROCORTISONE-

VIOFORM CREAM (GE)

HYDROCORTISONE1%,

CLIOQUINOL3%

1.20 g

CKE010 KENACOMB CREAM (GE) TRIAMCINOLONE, NEOMYCIN... 4.20 g

CKE011 KENACOMB CREAM 5g TRIAMCINOLONE, NEOMYCIN... 6.00 g

CNE042 NERISONE C CREAM

10g/15g

DIFLUCORTOLONE,

CHLORQUINALDOL

7.10 g

CPE020 PEVISONE CREAM 15g ECONAZOLE1%,

TRIAMCINOLONE0.1%

14.00 g

CSI006 SICORTEN CREAM 10g HALOMETASONE MONOHYDRATE

0.05%

6.00 g

CSY016 SYNALAR-C CREAM 15g FLUOCINOLONE, CLIOQUINOL 2.67 g

CSY018 SYNALAR-C OINTMENT

15g

FLUOCINOLONE, CLIOQUINOL 2.40 g

CSY030 SYNALAR-N CREAM (GE) FLUOCINOLONE 0.025%,NEOMYCIN 1.65 g

CTR010 TRAVOCORT CREAM 10g ISOCONAZOLE, DIFLUCORTOLONE 6.50 g

CTR032 TRIDERM CREAM 100g BETAMETHASONE, CLOTRIMAZOLE.. 6.00 g

CTR033 TRIDERM CREAM 450g

(GE)

BETAMETHASONE, CLOTRIMAZOLE.. 4.00 g

CTR030 TRIDERM CREAM 5g BETAMETHASONE, CLOTRIMAZOLE.. 6.00 g

CTT010 TTY CREAM

(CTcycline/Hydrocortisone/Tra

CTcycline/Hydrocortisone/Trav 3.34 g

CPA123 ZARICORT 15 g HYDROCORTISONE 1%, MICONAZLE

NITRATE 2% 2%

37.00 TUB

CAD008 ADVANTAN CREAM 0.1%

10g

METHYLPREDNISOLONE

ACEPONATE 0

8.00 g

CAD010 ADVANTAN OINTMENT

0.1% 10g

METHYLPREDNISOLONE

ACEPONATE 0

7.00 g

CAD011 ADVANTAN OINTMENT

0.1% 15g

METHYLPREDNISOLONE

ACEPONATE 0

7.50 g

CAQ005 AQUANIL HC LOTION HYDROCORTISONE 1.40 g

CAR010 ARISTOCORT CREAM

0.02%

TRIAMCINOLONE ACETONIDE 2.00 g

CPA058 BEPROSONE OINTMENT BETAMETHASONE DIPROPINATE 1.00 g

CBE042 BETNOVATE CREAM (GE) BETAMETHASONE VALERATE 0.1% 1.65 g

CBE040 BETNOVATE CREAM 15g BETAMETHASONE VALERATE 0.1% 3.90 g

CBE052 BETNOVATE OINTMENT

(GE)

BETAMETHASONE VALERATE 0.1% 1.65 g

CBE050 BETNOVATE OINTMENT

15g

BETAMETHASONE VALERATE 0.1% 3.90 g

CBE060 BETNOVATE SCALP

LOTION 30mL

BETAMETHASONE VALERATE 0.1% 4.80 ML

CBE064 BETNOVATE SCALP

LOTION 450mL (GE)-

BETAMETHASONE SCALP

APPLICATION 0.1%

0.80 ML

CCL010 CLOBETASOL 0.02% & SAL

ACID 7.5% OINTMENT

CLOBETASOL/SAL ACID 2.00 g

CCL016 CLOBEX SHAMPOO 0.05% CLOBETASOL PROPIONATE 0.05% 3.50 ML

CCU010 CUTIVATE CREAM 15g FLUTICASONE PROPIONATE 0.05% 6.10 g

CDE020 DERMOVATE CREAM (GE) CLOBETASOL PROPIONATE 0.05% 1.80 g

CDE022 DERMOVATE CREAM 25g CLOBETASOL PROPIONATE 0.05% 3.80 g

CDE030 DERMOVATE OINTMENT

(GE)

CLOBETASOL PROPIONATE 0.05% 1.80 g

CDE032 DERMOVATE OINTMENT

25g

CLOBETASOL PROPIONATE 0.05% 3.80 g

CDE040 DERMOVATE SCALP

APPLICATION 30mL

CLOBETASOL PROPIONATE 0.05% 4.90 ML

CDI012 DIPROCEL CREAM BETAMETHASONE DIPROPIONATE 3.80 g

CDI014 DIPROCEL OINTMENT BETAMETHASONE DIPROPIONATE 4.40 g

TOPICAL ANTI-INFECTIVES

TOPICAL ANTI-INFECTIVES WITH CORTICOSTEROIDS

TOPICAL CORTICOSTEROIDS

Page 23 of 28

Page 24: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

CDI048 DIPROSONE CREAM

0.0125% 1/4 STRENGTH

BETAMETHASONE DIPROPIONATE 1.34 g

CDI050 DIPROSONE CREAM

0.025% 1/2 STRENGTH (GE)

BETAMETHASONE DIPROPIONATE 2.00 g

CDI052 DIPROSONE CREAM 0.05%

(FULL STRENGTH)

BETAMETHASONE DIPROPIONATE 2.40 g

CDI054 DIPROSONE CREAM 0.05%

(GE)

BETAMETHASONE DIPROPIONATE

0.05%

1.90 g

CDI060 DIPROSONE OINTMENT BETAMETHASONE DIPROPIONATE 2.40 g

CEF010 EFCORTELEN LOTION 1%

30mL/BOT (GE)

DEXAMETHASONE 1% 60.00 BOT

CEL038 ELOMET CREAM 15g MOMETASONE FUROATE 5.60 g

CEL040 ELOMET OINTMENT 15g MOMETASONE FUROATE 6.00 g

CEL042 ELOMET SCALP LOTION

0.1%

MOMETASONE FUROATE 0.1% 4.80 ML

CEU010 EUMOVATE CREAM 25g CLOBETASONE BUTYRATE 4.40 g

CEU030 EURAX-HC CREAM 15g

(GE)

CROTAMITON 2.20 g

CHY020 HYDROCORTISONE

CREAM 0.5% (GE)

HYDROCORTISONE 0.5% 1.00 g

CHY022 HYDROCORTISONE

CREAM 1% (GE)

HYDROCORTISONE 1% 1.20 g

CHY024 HYDROCORTISONE

CREAM 1% 15g (GE)

HYDROCORTISONE 1% 1.20 g

CHY030 HYDROCORTISONE

OINTMENT 1% (GE)

HYDROCORTISONE 1% 1.20 g

CKE020 KENACORT-A CREAM

0.1% 15g

TRIAMCINOLONE ACETONIDE 0.1% 3.33 g

CLA006 LACTICARE-HC LOTION

1%

HYDROCORTISONE,LACTIC ACID/Na 1.20 ML

CME020 METOSYN CREAM 0.05%

15g

FLUOCINONIDE 0.05% 3.10 g

CME040 NERISONE CREAM 0.1%

15g

DIFLUCORTOLONE VALERATE 0.1% 4.80 g

CNE046 NERISONE FATTY

OINTMENT 0.1% 10g

DIFLUCORTOLONE VALERATE 0.1% 7.10 g

CNE044 NERISONE OINTMENT

0.1% 10g

DIFLUCORTOLONE VALERATE 0.1% 5.50 g

CPE010 PERDERM CREAM 0.05% ALCLOMETASONE DIPROPION 0.05% 3.70 g

PPR010 PREDENEMA PREDNISOLONE 70.00 BOT

PPR020 PREDFOAM PREDNISOLONE 430.00 BOX

CQU006 QUADRIDERM CREAM 15g BETAMETHASONE/GENTAMICIN/TO

LNA

7.50 g

CSY008 SYNALAR CREAM 0.005%

(GE)

FLUOCINOLONE ACETONIDE 0.005% 1.65 g

CSY010 SYNALAR CREAM 0.025%

(GE)

FLUOCINOLONE ACETONIDE 0.025% 1.70 g

CSY040 SYNALAR GEL 30g FLUOCINOLONE ACETONIDE 0.025% 2.60 g

CSY020 SYNALAR OINTMENT 15g FLUOCINOLONE ACETONIDE 0.025% 4.50 g

CSY022 SYNALAR OINTMENT 450g

(GE)

FLUOCINOLONE ACETONIDE 0.025% 2.00 g

CAC012 ACNE AID CREAM 40g SULPHUR 2.5%, RESORCINOL 1.25% 2.20 g

CAC013 ACNE AID LIQUID SULFONATED OIL 0.46 ML

CAC014 ACNEDERM OINTMENT

25g

SULFUR 2.5%, ICHTHAMMOL 1% 2.00 g

CAK010 AKNE-MYCIN SOLUTION

25 mL/BOT (GE)

ERYTHROMYCIN SOLUTION 2% 89.00 BOT

CBR010 BREVOXYL CREAM 4%

40g

BENZOYL PEROXIDE 4% 2.80 g

CDA075 DALACIN T GEL 1% 15g

(GE)

CLINDAMYCIN PHOSPHATE 1% 6.00 g

CDA070 DALACIN T SOLU.1% ( G.

E.)

CLINDAMYCIN PHOSPHATE 1% 90.00 BOT

CDA074 DALACIN-T GEL 1% CLINDAMYCIN PHOSPHATE 1% 160.00 BOT

CDA076

DALACIN T GEL 1% 25g

[G.E]-[CLINDAMYCIN] CLINDAMYCIN 1% GEL 4.00 g

CDA072 DALACIN-T LOTION 1% CLINDAMYCIN PHOSPHATE 1% 160.00 BOT

TDI040 DIANE 21's CYPROTERONE,

ETHINYLESTRADIOL

7.90 TAB

CDI009 DIFFERIN CREAM 30g ADAPALENE O.1% 4.40 g

CDI011 DIFFERIN GEL 30g ADAPALENE O.1% 4.40 g

CDI008 DIFFERIN GEL 15g (GE) ADAPALENE 0.1% 3.00 g

CDU003 DUAC GEL CLINDAMYCIN 1%, BENZOYL

PEROXIDE 5%

14.64 g

CEP010 EPIDUO GEL 15g ADAPALENE, BENZOYL PEROXIDE 16.50 g

CER010 ERYLIK GEL 30g ERYTHROMYCIN,TRETINOIN 2.50 g

CIS010 ISOTREX 0.05% CREAM ISOTRETINOIN 0.05% 5.80 g

CIS011 ISOTREX 0.05% GEL ISOTRETINOIN 0.05% 8.10 g

CIS012 ISOTREX 0.1% CREAM ISOTRETINOIN 0.1% 7.00 g

CNE020 NEO-MEDROL ACNE

LOTION 30mL/BOT

METHYLPREDNISOLONE,

NEOMYCIN

140.00 BOT

COX012 OXY-5 (GE) BENZOYL PEROXIDE 5% 1.30 g

COX010 PANOXYL GEL 10% BENZOYL PEROXIDE 10% 2.00 g

CPA012 PANOXYL GEL 2.5% 40g BENZOYL PEROXIDE 2.5% 2.00 g

CRE020 RETIN-A CREAM 0.025%

25g (GE)

TRETINOIN 0.025% 7.70 g

CRE010 RETIN-A CREAM 0.01% 25g

(GE)

TRETINOIN 0.01% 7.70 g

CRE022 RETIN-A CREAM 0.05% 25g

(GE)

TRETINOIN 0.05% 7.70 g

CRE023

RETIN-A <Tretinoin>

CREAM 0.05% 500g [ACTA] TRETINOIN 2.20 g

CRE024 RETIN-A CREAM 0.1% 25g

(GE)

TRETINOIN 0.1% 9.20 g

CRE025

RETIN-A <Tretinoin>

CREAM 0.1% 500g [ACTA] TRETINOIN 1.50 g

CRE021 RETIN-A 0.025% GEL 15g TRETINOIN 0.025% 16.70 g

CRE026 RETIN-A 0.01% GEL 15g TRETINOIN 0.01% 18.00 g

TRO010 ROACCUTANE 10mg ISOTRETINOIN 10mg 31.80 CAP

TRO013 ROACCUTANE 10mg (GE) ISOTRETINOIN 10mg 16.00 CAP

TRO012 ROACCUTANE 20mg ISOTRETINOIN 20mg 40.00 CAP

TRO014 ROACCUTANE 20mg (GE) ISOTRETINOIN 20mg 32.00 CAP

CSK010 SKINOREN 20% 30g MCIRONIZED AZELAIC ACID 20% 6.50 g

CAL010 ALCOHOL, BURNING ALCOHOL, BURNING 0.30 ML

CBE028 BETADINE CREAM 15g POVIDONE-IODINE 3.00 g

CBE030 BETADINE SOLUTION POVIDONE-IODINE 0.35 ML

CCA050 CASTELLANI'S PAINT CASTELLANI'S PAINT 0.40 ML

CCH030

CHLORHEXIDINE

COMPOUND CREAM CHLORHEXIDINE 0.500 g

CCI022 CIDEX SOLUTION (28

DAYS)

ACTIVATED GLUTARALDHYDE 0.10 ML

CCI020 CIDEZYME LIQ. 0.23 ML

CDR010 DRAPOLENE 55g BENZALKONIUM CL, CETRIMIDE 1.58 g

CET010 ETHER 450mL ETHER 0.275 ML

CEU040 EUSOL 3600mL CHLORINATED LIME 0.14 ML

CHI020 HIBITANE 0.5% IN 70%

ALCOHOL

CHLORHEXIDINE GLUCONATE 0.40 ML

CHI018 HIBITANE 5%

CONCENTRATE

CHLORHEXIDINE GLUCONATE 0.20 ML

CHI022 HIBITANE SOLUTION IN

AQ.

CHLORHEXIDINE ACETATE 0.05%w/v 0.15 ML

CHY060 HYDROGEN PEROXIDE 6%

(20 volume)

HYDROGEN PEROXIDE 6% 1.00 ML

CIO010 IODINE TINTURE IODINE TINCTURE 0.28 ML

ACNE TREATMENT PREPARATIONS

ANTISEPTICS & DISINFECTANTS

Page 24 of 28

Page 25: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

CLY010 LYSOL 5000mL 0.13 ML

CME010 MERCUOCHROME

SOLUTION 2.5%

MERCUOCHROME 2.5% 0.50 ML

CNA010 NASEPTIN CREAM 15g

(GE)

CHLORHEXIDINE 1.00 g

AOP010 OPSITE SPRAY 115.00 BOT

CPH010 PHENOL SOL 5% PHENOL 80% 0.30 ML

CKM010 POTASSIUM

PERMANGANATE SOLN

POTASSIUM PERMANGANATE 1% 0.30 ML

CKM012

POTASSIUM

PERMANGANATE SOLN POTASSIUM PERMANGANATE 4% 0.50 ML

CSA024 SAVLON CREAM 30g CHLORHEXIDINE, CETRIMIDE 0.70 g

CPA106 SAVLON CONC SOLUTION

(GE)

CHLORHEXIDINE, CETRIMIDE 0.16 ML

CSU008 SULPHACETAMIDE 20% IN

ALCOHOL 50%

SULPHACETAMIDE 20% 0.39 ML

AUN010 UNISEPT 25mL (HIBITANE) CHLORHEXIDINE 7.00 PK

CVI020 VIOFORM CREAM (GE) CLIOQUINOL 3% 0.70 g

CZI010 ZINC & CASTOR OIL

CREAM (GE)

ZINE OXIDE, CASTOR OIL 0.80 g

CAL040

A-LICES SCALP HYGIENE

SHAMPOO MALATHION 1% 2.40 ML

CAC008 ACETIC ACID 5%

SOLUTION

ACETIC ACID 2% 0.16 ML

CBA020 BATRAFEN NAIL

LACQUER

CICLOPIROX 310.00 BOX

CBE010 BENZYL BENZOATE

APPLICATION 25% 450mL

BENZYL BENZOATE 25% 0.30 ML

CCA038 CANESTEN CREAM 1% CLOTRIMAZOLE 90.00 TUB

CCA040 CANESTEN CREAM

15g/20g/500g (GE)

CLOTRIMAZOLE 2.00 g

CPA121 CANESTEN CREAM 1% 20g CLOTRIMAZOLE 60.00 TUB

CDA030 DAKTARIN CREAM 15g

(GE)

MCIONAZOLE NITRATE 2% 1.50 g

CEX010 EXODERIL CREAM 1% 15g NAFTIFINE HCL 2.40 g

CGA004 GAMMA BENZENE

HEXACHLORIDE 1%

GAMMA BENZENE HEXACHLORIDE

1%

0.60 ML

CGE010 GENTIAN VIOLET (GE) GENTIAN VIOLET 0.17 ML

CLA010 LAMISIL CREAM TERBINAFINE 1% 5.70 g

CLA011 LAMISIL CREAM (GE) TERBINAFINE 3.40 g

CLA012 LAMISIL SPRAY 1% 30mL TERBINAFINE 1% 125.00 BOT

CLI010 LINDANE LOTION 1%

60mL/BOT

GAMMA BENZENE HEXACHLORIDE

1%

80.00 BOT

CLI012 LINDANE SHAMPOO 1%

60mL/BOT

GAMMA BENZENE HEXACHLORIDE

1%

0.80 ML

CLO020 LOCERYL 5% NAIL

LACQUER 2.5mL

AMOROLFINE 5% 385.00 BOT

CLO022 LOCERYL 0.25% CREAM

20g

AMOROLFINE 0.25% 4.20 g

CLO012 LOTREMIN SOLUTION 1%

10mL/BOT

CLOTRIMAZOLE 1% 70.00 BOT

CMY010 MYCOSPOR CREAM 1%

15g

BIFONAZOLE 1% 6.70 g

CMY020 MYCOSTATIN CREAM 15g NYSTATIN 100,000u/g 3.00 g

CNI010 NIZORAL CREAM 2% 15g KETOCONAZOLE 2% 10.00 g

CNI020

NIZORAL SHAMPOO

100mL/BOT KETOCONAZOLE 2% 2.20 ML

CNI020 NIZORAL SHAMPOO

60mL/BOT

KETOCONAZOLE 2% 180.00 BOT

CQU008 QUELLADA HEADLICE

TREATMENT LIQUID

PERMETHRIN 10mg/mL 2.50 ML

CQU010 QUELLADA SCABIES

LOTION 50mg/mL

PERMETHRIN 2.20 ML

CSO018 SODIUM THIOSULPHATE

10%

SODIUM THIOSULPHATE 10% 0.50 ML

CSO020 SODIUM THIOSULPHATE

SOLUTION 20%

SODIUM THIOSULPHATE 20% 0.80 ML

CCO030 CORN PAD SALICYLIC ACID 40% 18.00 BOX

CTA020 TARSUM SHAMPOO 120mL COAL TAR, SALICYLIC ACID 0.54 ML

CTI010 TINEAFAX POWDER (GE)

55g/BOT

UNDECENOIC ACID 2% 50.00 BOT

CTR020 TRAVOGEN CREAM 20 g ISOCONAZOLE NITRATE 1% 3.70 g

CTR040 TROSYD CREAM 1% 30g TIOCONAZOLE 4.00 g

CTR042 TROSYD NAIL SOLUTION TIOCONAZOLE 308.00 BOT

CWH010 WHITFIELD OINTMENT

(GE)

BENZOIC ACID 5%, SAL. ACID 3% 0.67 g

CWH020 WHITFIELD'S SOLUTION

(GE)

BENZOIC ACID 5%, SAL. ACID 3% 2.50 ML

CPA120 ZALAIN CREAM 2% 20g SERTACONAZOLE NITRATE 60.00 TUB

CNI022 ZORINAX SHAMPOO

120mL/BOT

KETOCONAZOLE 2% 120.00 BOT

CNI024 ZORINAX SHAMPOO

30mL/BOT

KETOCONAZOLE 2% 30.00 BOT

CCO004 COAL TAR 10% OINTMENT COAL TAR 10% 0.90 g

CCO005 COAL TAR PASTE 5% COAL TAR 5% 0.80 g

CCO006 COCOIS OINTMENT COAL TAR SOL.12%, SULPHUR 4% 3.20 g

CDA008 DAIVONEX CREAM 30g CALCIOTRIOL 9.00 g

CDA010 DAIVONEX OINTMENT 30g CALCIOTRIOL 9.00 g

CDA012 DAIVONEX SCALP LOTION

30mL

CALCIOTRIOL 7.50 ML

CDA006 DAIVOBET OINTMENT 15g CALCIPOTRIOL, BETAMETHASONE 10.60 g

CDI070 DITHRANOL 1% IN

LASSA'S PASTE

DITHRANOL 1% 1.00 g

CEG010 EGOPSORYL TA SULFUR 0.5%, PHENOL 0.5%, TAR 1.30 g

CEL050 ELOSALIC OINTMENT 15g MOMETASONE, SALICYLIC ACID 5.70 g

CMI004 MICANOL 1% CREAM 50g DITHRANOL 1% 2.50 g

TNE013 NEOTIGASON 10mg ACITRETIN 10mg 19.00 CAP

TNE014 NEOTIGASON 25mg ACITRETIN 25mg 42.00 CAP

CSA033 SAL. ACID OINTMENT 3% SALICYLIC ACID 3% 1.00 g

CST016 STIEPROX LIQUID 1.5% CICLOPIROX 1.30 ML

CSE010 SELSUN SUSPENSION

120mL/BOT

SELENIUM SULFIDE 1% 100.00 BOT

CXA010 XAMIOL GEL 15g CALCIPOTRIOL, BETAMETHASONE 175.00 BOT

CAC030 ACTOVEGIN 5% CREAM

20g

HEMODERIVATIVE 2mg/g 2.00 g

CAL020 ALUMINIUM CHLORIDE

SOLUTION 20%

ALUMINIUM CHLORIDE SOLN 20% 2.00 ML

CCL020 CLOTRIMAZOLE+SYNALA

R+NEOMYCIN CREAM

CLOTRIMAZOLE

/FLUCINOLONE/NEOM

1.00 g

CPA048 DILTIAZEM Cream 200.00 TUB

CTR037 TRILUMA CREAM 15g FLUOCINOLONE,HYDROQUINONE,T

RETINOIN

37.80 g

CTR038 TRILUMA CREAM 30g FLUOCINOLONE,HYDROQUINONE,T

RETINOIN

34.00 g

CZI040 ZINDACLIN 1% GEL CLINDAMYCIN, ZINC ACETARE 5.00 g

CST020 STOXIL 0.5% 5g IDOXURUDINE 11.00 g

CVI012 VIRU-MERZ GEL 10g TROMANTADINE HCL 1% 6.50 g

CZO008 ZOVIRAX COLD SORE

CREAM 5% 5g (GE)

ACYCLOVIR 5% 8.00 g

CZO010 ZOVIRAX COLD SORE

CREAM 5% 4g (GE)

ACYCLOVIR 5% 8.00 g

FUNGICIDES & ANTIPARASITES

PSORIASIS, SEBORRHEA & ICHTHYOSIS

TOPICAL ANTIVIRALS

OTHER DERMOLOGICALS

Page 25 of 28

Page 26: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

CZO012 ZOVIRAX CREAM 5% 10g ACYCLOVIR 5% 169.00 tube

CCO020 COLLOMACK SOLUTION

10mL

SALICYLIC ACID 2G, LACTIC ACID 4.00 ML

CDU008 DUOFILM GEL SALICYLIC ACID 27% 7.40 g

CDU012 DUOFILM SOLUTION 14mL

(GE)

SALICYLIC ACID, LACTIC ACID 4.10 ML

CDU010 DUOFILM SOLUTION 15mL SALICYLIC ACID, LACTIC ACID 6.80 ML

CPO010 PODOPHYLLIN IN SPIRIT

25% 30mL (GE)

TINCT BENZ CO, PODOPHYLLIN 4.50 ML

CPO020 PODOPHYLLIN 5%, SAL.

ACID 5% IN COLLODION

TINCT BENZ CO, PODOPHYLLIN 2.18 ML

CPO050 POSALFILIN OINTMENT

10g

PODOPHYLLUM, SALICYLIC ACID 11.00 g

CSA004 SALICYLIC ACID 1%

OINTMENT

SALICYLIC ACID 1% 0.33 g

CSA006 SALICYLIC ACID 2% IN

SULPHUR 2% CREAM

SALICYLIC ACID 2%/SULPHUR 2% 1.20 g

CSA008 SALICYLIC ACID 5% IN AQ

CREAM

SALICYLIC ACID 5% 0.33 g

CSA009 SALICYLIC ACID 10% IN

AQ CREAM

SALICYLIC ACID 10% 0.60 g

CSA010 SALICYCLIC ACID IN AQ

CREAM 20%

SALICYLIC ACID 20% 0.60 g

CSA018 SALICYCLIC ACID PAINT

15% IN COLLODION

SALICYLIC ACID 15% 1.40 ML

CSA020 SALICYCLIC ACID PAINT

15% (GE)

SALICYLIC ACID 15% 0.83 ML

CSA023 SALICYLIC ACID 20% IN

COLLODIO

SALICYLIC ACID 20% 2.00 ML

CSA032 SAL. ACID OINTMENT 6% SALICYLIC ACID 6% 1.00 g

CSA034 SALICYLIC ACID 4% &

UREA 20% CREAM

SALICYLIC ACID 4%, UREA 20% 1.00 g

CSA035 SALICYLIC ACID 3% IN

ALCOHOL

SALICYLIC ACID 3% 0.19 ML

CTR026 TRICHLOROACETIC ACID

10%

TRICHLOROACAETIC ACID 10% 5.00 ML

CTR027 TRICHLOROACETIC ACID

50%

TRICHLOROACAETIC ACID 50% 6.00 ML

CTR028 TRICHLOROACETIC ACID

90%

TRICHLOROACAETIC ACID 90% 6.00 ML

CVE010 VERRUMAL SOLUTION

13mL/BOT

FLUOROURACIL 0.5%,SAL. ACID10% 80.00 BOT

CWA008 WARTEC 0.15% CREAM 5g PODOPHYLLOTOXIN 0.15% 109.00 g

CWA010 WARTEC TOPICAL

SOLUTION 0.5%

PODOPHYLLOTOXIN 0.5% 475.00 BOT

CAN022 ANTHISAN CREAM 2% 15g MEPYRAMINE 45.00 TUB

CCA010 CALAMINE CREAM (GE) CALAMINE 20% 0.90 g

CCA020 CALAMINE LOTION (GE) CALAMINE 15% 0.40 ML

CCA024 CALAMNE-DPH 1%

CREAM

CALAMINE, DIPHENHYDRAMINE 0.80 g

CCA026 CALAMINE + DPH 0.2%

LOTION

CALAMINE, DIPHENHYDRAMINE 0.17 ML

CCA028 CALAMINE + 0.25%

MENTHOL

CALAMINE,MENTHOL 0.25% 0.17 ML

CCA029 CALAMINE + 5%

SULPHATE LOTION

CALAMINE,SULPHUR 5% 0.30 ML

CEU018 EURAX CREAM 15g (GE) CROTAMITON 1.50 g

CEU020 EURAX CREAM 450g (GE) CROTAMITON CREAM 10% 1.10 g

CHY031 HYDROCORTISONE 1% IN

CALAMINE LOTION

HYDROCORTISONE 1%/CALAMINE 0.60 ML

CST010 STEREX SHAMPOO

114mL/BOT

COAL TAR, SAL.ACID, SULPHUR 70.00 BOT

CUR010 UREA CREAM 10% UREA 10% 1.50 g

TZY024 ZYRTEC-D CETIRIZINE 5mg, PSEUDOEPHEDRINE

120mg

7.50 TAB

CAN020 ANTHISAN CREAM (GE) MEPYRAIMINE MALEATE CREAM 0.84 g

CAN010 ANALGESIC BALM (GE) METHYL SALICYLATE 0.60 g

CBE012 BENGAY 28g METHYL SALICYLATE 30%,

MENTHOL

0.60 g

CBE013 BENGAY 30g (GE) {BAGES

CREAM}

METHYL

SALICYLATE,MENTHOL,CAMPHOR

0.50 g

CBO010 BONJELA 15g CHOLINE SALICYLATE 8.7% 1.90 g

CDI010 DIFFLAM CREAM 30g BENZYDAMINE 1.83 g

CDI019 DIPROGENTA CREAM 450g

(GE)

BETAMETHASONE DIPROPIONATE

0.05%,GENTAMICIN SULFATE 0.1%

1.80 g

CPA141 DUROGESIC D-TRANS

DERMAL PATCH 25 mcg/hr

FENTANYL BASE 340.00 PATCH

CFE010 FELDENE GEL 25g PIROXICAM 0.5% 2.50 g

CIN010 INDOMET GEL 20g INDOMETHACIN 1% 1.25 g

CRU010 RUBESAL CREAM 25g DIETHYLAMINE

SALICYLATE/CAMPHO

0.62 g

CSO040 SOLCOSERYL JELLY 20g METHYL PARAHYDROXYBENZOATE 3.50 g

CSO042 SOLCOSERYL OINTMENT

20g

METHYL PARAHYDROXYBENZOATE 2.40 g

CPA122 OLFEN GEL 1 % x 20 g DICLOFENAC NA 46.00 TUB

CVO006 VOLTAREN EMULGEL 1% DICLOFENAC 65.00 TUB

CVO010 VOLTAREN EMULGEL 20g

(GE)

DICLOFENAC NA 2.30 g

CPA042 VOLTAREN GEL 1% 20g DICLOFENAC NA 2.20 g

DCO014 COCAINE 10% SOLUTION COCAINE 15.00 ML

DCO010 COCAINE 10% WITH

ADRENALINE 1:1000

COCAINE 17.00 ML

DCO012 COCAINE 5% SOLUTION COCAINE 10.00 ML

CEL003 ELA-MAX CREAM 4% LIDOCAINE 4% 15.00 g

CEM010 EMLA CREAM 5% 5g LIDOCAINE 25mg,PRILOCAINE 25mg 30.50 g

CIN018 INSTILLAGEL 11mL LIDOCAINE HYDROCHLOREDE

215.7mg,CHLORHEXIDINE

55.00 TUB

CEM011

EMLA CREAM 5% 5g (GE) -

[LIDOCAINE + LIDOCAINE 25mg,PRILOCAINE 25mg 17.00 g

ILI008 LIGNOCAINE INJ 1% 5mL LIGNOCAINE HCL 30.00 AMP

ILI010 LIGNOCAINE INJ 2% 5mL LIGNOCAINE HCL 62.00 AMP

IMA009 MARCAINE INJ 0.5% 10mL BUPIVACAINE HCL 214.00 VIA

IMA010 MARCAINE INJ 0.5% 20mL BUPIVACAINE HCL 260.00 VIA

IXY004 XYLESTESIN- A 1.8mL LIDOCAINE HCL 20mg/EPINEPHRINE

HCL 0.015mg

4.00 AMP

IXY018 XYLOCAINE 1% +

ADRENALINE INJ 20mL

LIDOCAINE, ADRENALINE 15.00 ML

IXY020 XYLOCAINE 2% +

ADRENALINE INJ 20mL

LIDOCAINE, ADRENALINE 15.00 ML

IXY006 XYLOCAINE INJ 1% 5mL LIDOCAINE HCL 26.00 AMP

IXY007 XYLOCAINE INJ 2% 5mL

(50'S)

LIDOCAINE HCL 29.40 AMP

IXY008 XYLOCAINE INJ 1% 20mL LIDOCAINE HCL 10.00 ML

IXY010 XYLOCAINE INJ 2% 20mL LIDOCAINE HCL 10.00 ML

CXY010 XYLOCAINE JELLY 2% 30g LIDOCAINE HCl 2% 7.10 g

CXY020 XYLOCAINE OINTMENT

5% 35g

LIDOCAINE HCl 5% 3.40 g

CXY040 XYLOCAINE SPRAY 10%

80g/BOT

LIDOCAINE 10% 489.00 BOT

TAC030 ACCOLATE 20mg ZAFIRLUKAST 20mg 8.20 TAB

TAE010 AERIUS 5mg DESLORATADINE 5mg 5.20 TAB

TAT010 ATARAX 10mg HYDROXYZINE 10mg 1.80 TAB

ANTIHISTAMINES & ANTIALLERGICS

KERATOLYTICS

TOPICAL ANTIHISTAMINES / ANTIPRURITICS

ANAESTHETICS - LOCAL & GENERAL

TOPICAL ANALGESICS & ANTIINFLAMMATORIES

Page 26 of 28

Page 27: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

TAT012 ATARAX 25mg HYDROXYZINE 25mg 2.80 TAB

MAT010 ATARAX SYRUP 0.2%

200mL

HYDROXYZINE HCL 0.70 ML

MBE010 BENADRYL ELIXIR

25mg/5mL (GE)

DIPHENHYDRAMINE HCL 0.17 ML

IBE010 BENADRYL INJ

500mg/10mL

DIPHENHYDRAMINE HCL 200.00 VIA

TCE042 CELESTAMINE DEXCHLORPHENIRAMINE,

BETAMETHA

2.20 TAB

TCE040 CELESTAMINE (GE) DEXCHLORPHENIRAMINE,

BETAMETHA

1.50 TAB

MCE030 CELESTAMINE SYRUP

(GE)

DEXCHLORPHENIRAMINE

MALEATE..

0.19 ML

TCL020 CLARITYNE 10mg LORATADINE 10mg 6.00 TAB

TCL022 CLARITYNE 10mg (GE) LORATADINE 10mg 3.80 TAB

MCL010 CLARITYNE SYRUP

1mg/mL (GE)

LORATADINE 0.50 ML

CPA053 CLARITYNE SYRUP

1mg/mL

LORATADINE 1.00 ML

ICO010 CORAMINE INJ NIKETHAMINE 50.00 AMP

CDI013 DIPHENHYDRAMINE 2%

CREAM 450g

DIPHENHYDRAMINE 2% 0.70 g

TDI080 DIMETANE 4mg (GE) BROMPHENIRAMINE MALEATE 4mg 1.00 TAB

TEM010 EMEND [APREPITANT]

TRIPACK

APREPITANT 1030.00 BOX

THI010 HISMANAL ASTEMIZOLE 6.00 TAB

TIN010 INCIDAL 50 mg MEBHYDROLIN NAPADISYLATE 2.00 TAB

TKE050 KESTINE 10mg EBASTINE 10mg 5.00 TAB

TPE060 PERIACTIN 4mg (GE)-

[CYPROHEPTADINE]

CYPROHEPTADINE 4mg 0.18 TAB

TPH010 PHENERGAN 10mg (GE) PROMETHAZINE HCL 10mg 1.10 TAB

TPH012 PHENERGAN 25mg (GE) PROMETHAZINE HCL 25mg 1.10 TAB

MPH010 PHENERGAN ELIXIR

5mg/5mL (GE)

PROMETHAZINE HCL 5MG 0.19 ML

IPH010 PHENERGAN INJ 25mg/mL PROMETHAZINE HCL 25.00 AMP

TPI010 PIRITON 2mg (GE) CHLORPHENIRAMINE MALEATE 2mg 0.40 TAB

TPI012 PIRITON 4mg (GE) CHLORPHENIRAMINE MALEATE 4mg 0.53 TAB

TPI014 PIRITON SR 12mg (GE) CHLORPHENIRAMINE MALEATE

12mg

1.20 CAP

MPI020 PIRITON SYRUP 2.5mg/5mL

(GE)

CHLORPHENIRAMINE MALEATE 0.17 ML

MPI025 PIRITON SYRUP 2mg/5mL

(GE)

CHLORPHENIRAMINE MALEATE 0.17 ML

MPI030 PIRITON FORTE SYRUP

4mg/5mL (GE)

CHLORPHENIRAMINE MALEATE 0.19 ML

IPI010 PIRITON INJ 10mg/mL (GE) CHLORPHENIRAMINE MALEATE 25.00 ML

TPL030 PLOKON TAB PIRINHYDRINATE 3mg 1.30 TAB

TPO010 POLARAMINE 2mg (GE) DEXCHLORPHENIRAMINE MALEATE 0.70 TAB

CPA065 POLARAMINE 6mg DEXCHLORPHENIRAMINE 2.50 TAB

TPO012 POLARAMINE SA 6mg (GE) DEXCHLORPHENIRAMINE MALEATE 1.10 TAB

MPO008 POLARAMINE

EXPECTORANT

DEXCHLORPHENIRAMINE

GUAIPHENESIN PSEUDOEPHEDRINE

50.00 BOT

MPO010 POLARAMINE SYRUP

2mg/5mL (GE)

DEXCHLORPHENIRAMINE MALEATE 0.17 ML

TSE020 SEMPREX 8mg ACRIVASTINE 8mg 2.40 CAP

TTE025 TELDANE (GE) TERFENADINE 60mg 2.00 TAB

MTE010 TELDANE SUSPENSION

30mg/5mL 120mL

TERFENADINE 0.80 ML

TTE026 TELFAST 60mg FEXOFENADINE HCL 60mg 2.50 TAB

TTE024 TELFAST 120mg FEXOFENADINE HCL 120mg 5.50 TAB

TTE027 TELFAST 180mg FEXOFENADINE HCL 180mg 7.50 TAB

TTE029 TELFAST-D FEXOFENADINE

HCL/PSEUDOEPHEDRI

4.20 TAB

MVA010 VALLERGEN FORTE

30mg/5mL 100mL

TRIMEPRAZINE TARTRATE 1.00 ML

MXY010 XYZAL ORAL DROPS

5mg/ml

LEVOCETIRIZINE 284.00 BOT

TXY010 XYZAL 5mg LEVOCETIRIZINE 5mg 6.30 TAB

CPA052 XYZAL DROPS 20 ml LEVOCETIRIZINE 105.00 BOT

TZA010 ZADINE 1mg AZATADINE MALEATE 1mg 2.50 TAB

MZA010 ZADINE SYRUP 0.5mg/5mL

100mL

AZATADINE MALEATE 0.38 ML

TZY020 ZYRTEC 10mg CETIRIZINE HCL 10mg 4.00 TAB

TZY022 ZYRTEC 10mg (GE) CETIRIZINE HCL 10mg 2.40 TAB

MZY010 ZYRTEC ORAL

SOL.1mg/1ml

CETIRIZINE HCL 1.08 ML

MZY008 ZYRTEC ORAL DROPS 1%

(10mL)

CETIRIZINE HCL 8.60 ML

MZY012 ZYRTEC SYRUP 1mg/mL

60mL (GE)

CETIRIZINE HCL 0.60 ML

TBP010 B.P.P. PPA,BROMPHENIRAMINE,PHENYLEP

HR

1.00 TAB

TDI090 DIME-TIME BROMPHENIRAMINE,PPA,PHENYLEP

HE

2.50 TAB

CPA152 BENLYSTA POWDER FOR

CONCENTRATE FOR

SOLUTION FOR INFUSION

BELIMUMAB 14000.00 INJ

TCE046 CELLCEPT 250mg MYCOPHENOLATE MOFETIL 250mg 22.00 CAP

TCE048 CELLCEPT CAP 500mg MYCOPHENOLATE MOFETIL 500mg 41.00 CAP

VGA010 GAMMA GLOBULIN 5mL IMMUNE GLOBULIN IV (HUMAN) 210.00 VIA

IHU009 HUMIRA 40mg/0.8mL ADALIMUMAB 6052.00 SYR

TIM048 IMURAN 25mg AZATHIOPRINE 25mg 16.50 TAB

TIM050 IMURAN 50mg AZATHIOPRINE 50mg 21.60 TAB

TIM051

IMURAN 50mg [APO-

AZATHIOPRINE] AZATHIOPRINE 18.00 TAB

TPR091 PROGRAF 1mg TACROLIMUS 1mg 45.00 TAB

TPR092 PROGRAF 5mg TACROLIMUS 5mg 184.00 CAP

IRE040 REBIF 44mcg RECOMBINANT HUMAN

INTERFERON

870.00 AMP

DRE050 RESTASIS 0.05% EYE

DROPS

CYCLOSPORINE 0.05% 30.00 PC

TSA034 SANDIMMUN NEORAL

100mg

CYCLOSPORIN A 100mg 70.00 TAB

TSA036 SANDIMMUN NEORAL

25mg

CYCLOSPORIN A 25mg 18.50 TAB

IST004 STELARA INJ 45mg USTEKINUMAB 37000.00 VIA

TAR002 ARAVA 10mg LEFLUNOMIDE 20.00 TAB

ISO010 SODIUM BICARBONATE

8.4% 100mL

SODIUM BICARBONATE 90.00 BOT

ISO060 SODIUM CHLORIDE 0.9%

INJ 10mL

SODIUM CHLORIDE 0.9% 2.90 VIA

ISO061 SODIUM CHLORIDE 0.9%

INJ 20mL

SODIUM CHLORIDE 8.00 AMP

TBO010 BONVIVA 150mg IBANDRONIC ACID 150mg 320 TAB

IBO006

BONVIVA INJ 3mg/3mL (1

SYRING/BOX) IBANDRONIC ACID 150mg 1650.00 SYR

IPR052 PROLIA 60mg/Ml DENOSUMAB 4000.00 SYR

MPR050 PROTOS 2g STRONTIUM RANELATE 15.20 SACH

DISEASE-MODIFYING ANIT-RHEUMATIC DRUGS (DMARDs)

IMMUNOLOGICALS & IMMUNOSUPPRESSANTS

INTRAVENOUS & OTHER STERILE SOLUTIONS

AGENT AFFECTING BONE METABOLISM

Page 27 of 28

Page 28: DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

ITEM

NO.

DRUG DESCRIPTION GENERIC NAME UNIT PRICE

($)

PK UNIT

DRUG FORMULARY (MAY 2014) [EFFECTIVE ON MAY 2014]

CPA128 FORTEO PRE-FILLED PEN

250 mcg/mL, 2.4 mL x 1's

TERIPARATIDE 6000.00 PEN

CBE025 BETACAINE GEL 30g LIDOCAINE 5% 11.00 g

IMI002 MIACALCIC INJ 100 IU/mL SYNTHETIC SALMON CALCITONIN 180.00 AMP

IMI003 MIACALCIC INJ 50 IU/mL SYNTHETIC SALMON CALCITONIN 150.00 AMP

IXY019 XYLOCAINE 2% +

ADRENALINE 1:80,000

LIDOCAINE, ADRENALINE 4.00 AMP

IAT010 ATROPINE INJ 0.6mg/mL

(GE)

ATROPINE SULFATE 30.00 AMP

IDE050 DEXTROSE INJ 5% 500mL DEXTROSE 77.00 BOT

IDE060 DEXTROSE INJ 50% 20mL DEXTROSE 6.50 AMP

IGE020 GELOFUSINE 4% 500mL SUCCINYLATED GELATIN 100.00 BOT

CPA092 TORADOL 30MG/ML/AMP KETOROLAC TROMETAMOL 200 AMP

TRE014 RENAGEL 800mg SEVELAMER HCL 12.50 TAB

DBS008 BSS SOLUTION 15mL

SODIUM CHLORIDE/POTASSIUM

CHLO 111.00 BOT

TS0004 SODIUM BICARBONATE SODIUM BICARBONATE 1.10 TAB

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

MISCELLANEOUS

ANAESTHETICS - LOCAL & GENERAL

INTRAVENOUS & OTHER STERILE SOLUTIONS

Page 28 of 28