Upload
others
View
10
Download
0
Embed Size (px)
Citation preview
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Asthma
Inhaled B2 agonists
707882 DUOVENT HFA 200DOSE aminophylline 50MCG/20MCG INH
706544 BEROTEC HFA 200 DOSE Fenoterol 100MCG INH
849332 ASTHAVENT 300 DOSE Salbutamol 100MCG INH Accepted treatment
700715 ASTHAVENT 300D ECOHALER CFC FREE Salbutamol 100MCG INH Accepted treatment
878219 ASTHAVENT DP Salbutamol 200MCG CPS Accepted treatment
711213 VENTEZE CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment
720723 VENTIMAX CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment
703371 VENTOLIN INHALER 200 CFC FREE Salbutamol 100MCG INH Accepted treatment
824623 COMBIVENT MDI Salbutamol and other drugs for obstructive airway diseases 20MCG/100MCG INH
718698 DUOLIN HFA 200DOSE Salbutamol and other drugs for obstructive airway diseases INH
720748 BRICANYL 100 DOSE Terbutaline .5MG/1DOSE TBH
791415 BRICANYL TURBOHALER Terbutaline 0.5MG INH
Long acting B2 agonists
820911 FORADIL DRY Formoterol 12MCG CPS Clinical Review
704175 FORATEC DP CAPS Formoterol 12MCG CAP Clinical Review
710307 FORATEC HFA 120DOSE Formoterol 12MCG INH Clinical Review
840246 OXIS TURBUHALER Formoterol 9MCG INH Clinical Review
818496 SEREVENT ACCUHALER Salmeterol 50MCG INH
708289 SEREVENT CFC-FREE 120DOSE Salmeterol 25MCG INH
787302 SEREVENT INHAL(120) Salmeterol 25MCG INH
791695 SEREVENT INHAL(60) Salmeterol 25MCG INH
722933 DULERA 200/5UG 120 DOSE Formoterol and mometasone 200MCG/50MCG INH Accepted treatment
722934 DULERA 100/5UG 120 DOSE Formoterol and mometasone 100MCG/5MCG INH Accepted treatment
Inhaled corticosteroids
827061 BECEZE 50 200DOSE Beclomethasone 50MCG INH Accepted treatment
Specialist Script - will require a relevant specialist's prescription before reimbursement is considered
Specialist Motivation - will require a relevant specialist motivation before reimbursement is considered
POLMED COMPREHENSIVE PMB FORMULARYJanuary 2018
Depending on the specific Scheme option, products included on this chronic medication formulary will not attract a co-payment if authorised by Chronic Medicine Management for a disease on the Chronic Disease List (CDL) and obtained from the Designated
Service Provider (where applicable). Reimbursement will however be subject to the Chronic Medicine Management clinical guidelines and protocols and the POLMED Generic Reference Price List.
Please Note:
Special Investigations (SI) - results of recent relevant tests required before reimbursement is considered
* : these agents are only available on more comprehensive options
KEY to Chronic Medicine Management Reimbursement Criteria for use of preferred formulary drugs:
Quantity/dosage and duration of authorisation may vary - depending on the requested drug.
Accepted Treatment - will be authorised without requesting additional clinical information (unless specific concerns e.g. unusual dose requests).
Clinical Review - will be authorised if the drug history or co-morbidity clearly indicates that use of the drug is indicated in the specific patient.
Clinical Motivation - specific clinical information required before reimbursement is considered
Page 1 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
827088 BECEZE INHALER COMPLETE Beclomethasone 100MCG INH Accepted treatment
819638 BECLATE INHALER Beclomethasone 100MCG INH Accepted treatment
820083 BECLATE INHALER Beclomethasone 200MCG INH Accepted treatment
819611 BECLATE INHALER Beclomethasone 50MCG INH Accepted treatment
897469 BUDEFLAM CFC FREE 200MCG 300 DOSE INH Budesonide 200MCG INH Accepted treatment
897462 BUDEFLAM CFC FREE 300 DOSE INH Budesonide 100MCG INH Accepted treatment
704176 BUDEFLAM DP CAPS Budesonide 200MCG CAP Accepted treatment
704020 INFLAMMIDE 200 NOVOLIZE REFIL Budesonide 200MCG REF Accepted treatment
704021 INFLAMMIDE 200 NOVOLIZER COMPL Budesonide 200MCG INH Accepted treatment
839329 INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 100MCG INH Accepted treatment
839337 INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 200MCG INH Accepted treatment
707879 INFLAMMIDE NOVOLIZER COMPLETE 100DOSE Budesonide 400MCG INH Accepted treatment
707881 INFLAMMIDE NOVOLIZER REFILL 100DOSE Budesonide 400MCG REF Accepted treatment
791423 PULMICORT 100 TURB (200 DOSE) Budesonide 100MCG ATH Accepted treatment
791431 PULMICORT 200 TURB (200 DOSE) Budesonide 200MCG ATH Accepted treatment
823791 PULMICORT TURB (100 DOSE) Budesonide 400MCG ATH Accepted treatment
705269 ALVESCO 160MCG 120 DOSE Ciclesonide 160MCG INH Accepted treatment
705267 ALVESCO 160MCG 60 DOSE Ciclesonide 160MCG INH Accepted treatment
705265 ALVESCO 80MCG 60 DOSE Ciclesonide 80MCG INH Accepted treatment
720735 CICLOVENT 120 DOSE Ciclesonide 160MCG INH Accepted treatment
720711 CICLOVENT 120 DOSES Ciclesonide 80MCG INH Accepted treatment
721620 CICLOVENT 60 DOSE Ciclesonide 160MCG INH Accepted treatment
721621 CICLOVENT 60 DOSE Ciclesonide 80MCG INH Accepted treatment
703275 FLIXOTIDE 50 CFC FREE 120 ACT Fluticasone 50MCG INH Accepted treatment
818453 FLIXOTIDE ACCUHALER Fluticasone 100MCG CAP Accepted treatment
818461 FLIXOTIDE ACCUHALER Fluticasone 250MCG CAP Accepted treatment
818488 FLIXOTIDE ACCUHALER Fluticasone 500MCG CAP Accepted treatment
818445 FLIXOTIDE ACCUHALER Fluticasone 50MCG CAP Accepted treatment
897752 FLIXOTIDE CFC FREE (120 ACT) Fluticasone 125MCG INH Accepted treatment
897759 FLIXOTIDE CFC FREE (120 ACT) Fluticasone 250MCG INH Accepted treatment
720219 VANNAIR 160/4.5MCG PER INHALATION 120 DO formoterol and budesonide 4.5MCG/160MCG INH Accepted treatment
720218 VANNAIR 80/4.5MCG PER INHALATION 120 DOS formoterol and budesonide 4.5MCG/80MCG INH Accepted treatment
700173 SYMBICORD TURBO 120 DOSE Formoterol/Budesonide 4.5MCG/160MCG INH Accepted treatment
700172 SYMBICORD TURBO 60 DOSE Formoterol/Budesonide 4.5MCG/160MCG INH Accepted treatment
705984 SYMBICORD 320/9MCG PER INHALATION Formutoterol and other anti- asthmatics 9MCG/320MCG INH Accepted treatment
705986 SYMBICORD 80/4.5MCG PER INHALATION Formutoterol and other anti- asthmatics 4.5MCG/80MCG INH Accepted treatment
717571 ASMANEX TWISTHALER 30 DOSE Mometasone 200MCG/1DOSE TBH Accepted treatment
717581 ASMANEX TWISTHALER 30 DOSE Mometasone 400MCG/1DOSE TBH Accepted treatment
717572 ASMANEX TWISTHALER 60 DOSE Mometasone 200MCG/1DOSE TBH Accepted treatment
717582 ASMANEX TWISTHALER 60 DOSE Mometasone 400MCG/1DOSE TBH Accepted treatment
715753 FOXAIR 25/125 120DOSE Salmeterol and other anti-asthmatics 25MCG/125MCG INH Accepted treatment
715754 FOXAIR 25/250 120DOSE Salmeterol and other anti-asthmatics 25MCG/250MCG INH Accepted treatment
715752 FOXAIR 25/50 120 DOSE Salmeterol and other anti-asthmatics 25MCG/50MCG INH Accepted treatment
715009 FOXAIR 50/100 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715008 FOXAIR 50/250 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715007 FOXAIR 50/500 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715190 SEREFLO 25/125 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
721413 SEREFLO 25/125 HFA SYNCHROBREATHE 120 DO Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
715191 SEREFLO 25/250 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
721414 SEREFLO 25/250 HFA SYNCHROBREATHE 120 DO Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
715189 SEREFLO 25/50 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
721412 SEREFLO 25/50 HFA SYNCHROBREATHE 120 DOS Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
894990 SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
Page 2 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
895006 SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
894989 SERETIDE 25/50 120 DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
874493 SERETIDE 50/100 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/100MCG INH Accepted treatment
874507 SERETIDE 50/250 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/250MCG INH Accepted treatment
874515 SERETIDE 50/500 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/500MCG INH Accepted treatment
723303 RELVAR ELLIPTA 184/22UG 30 DOSE vilanterol and fluticasone furoate 184MCG/22MCG INH Accepted treatment
723300 RELVAR ELLIPTA 92/22UG 30 DOSE vilanterol and fluticasone furoate 92MCG/22MCG INH Accepted treatment
Oral Xanthines
725005 EUPHYLLIN RETARD Theophylline 250MG SRT Clinical Review
748498 NUELIN Theophylline 125MG TAB Clinical Review
748528 NUELIN LIQUID Theophylline 25MG/5ML SYR Clinical Review
748501 NUELIN SA 250 Theophylline 250MG TAB Clinical Review
788368 ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 200MG SRT Clinical Review
788376 ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 300MG SRT Clinical Review
770388 THEOPHEN Theophylline SYR Clinical Review
783005 THEOPLUS Theophylline 200MG SRT Clinical Review
783013 THEOPLUS Theophylline 300MG SRT Clinical Review
785105 UNIPHYL Theophylline 400MG SRT Clinical Review
816159 UNIPHYL Theophylline 600MG SRT Clinical Review
Oral Corticosteroids
716381 ADCO PREDNISOLONE Prednisolone 15MG/5ML LIQ Specialist script
714552 ASPELONE Prednisolone 15MG/5ML LIQ Specialist script
814407 CAPSOID Prednisolone 5MG TAB Specialist script
800155 LENISOLONE Prednisolone 5MG TAB Specialist script
700170 PREFLAM Prednisolone 15MG/5ML SYR Specialist script
703720 PRELONE Prednisolone 5MG TAB Specialist script
805149 PRELONE Prednisolone 15MG/5ML SYR Specialist script
742759 METICORTEN Prednisone 50MG TAB Specialist script
742732 METICORTEN Prednisone 5MG TAB Specialist script
752304 PANAFCORT Prednisone 5MG TAB Specialist script
788783 PREDNISONE (BE-TABS) Prednisone 5MG TAB Specialist script
703603 PULMISON ORAL SOLUTION Prednisone 5MG/1ML SYR Specialist script
836826 PULMISON TABS Prednisone 20MG TAB Specialist script
818267 TROLIC Prednisone 5MG TAB Specialist script
Addison's disease
Oral Corticosteroids
716693 COVOCORT Hydrocortisone 10MG TAB Accepted treatment
726540 FLORINEF ACETATE Fludrocortisone 0.1MG TAB Accepted treatment
Bipolar Mood Disorder
Mood Stabilizers
712493 DEGRANOL Carbamazepine 200MG TAB Accepted treatment
712523 ROLAB-CARBAMAZEPINE Carbamazepine 200MG TAB Accepted treatment
705597 SANDOZ CARBAMAZEPINE CR200 Carbamazepine 200MG SRT Accepted treatment
705602 SANDOZ CARBAMAZIPINE CR400 Carbamazepine 400MG SRT Accepted treatment
769398 TEGRETOL Carbamazepine 200MG TAB Accepted treatment
779652 TEGRETOL CR Carbamazepine 200MG SRT Accepted treatment
779660 TEGRETOL CR Carbamazepine 400MG SRT Accepted treatment
769401 TEGRETOL S Carbamazepine 100MG/5ML SUS Accepted treatment
715962 ZEPTOL Carbamazepine 200MG TAB Accepted treatment
705441 ASPEN LAMOTRIGINE 100MG Lamotrigine 100MG TAB Accepted treatment
705436 ASPEN LAMOTRIGINE 25MG Lamotrigine 25MG TAB Accepted treatment
Page 3 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
705440 ASPEN LAMOTRIGINE 50MG Lamotrigine 50MG TAB Accepted treatment
707789 AUSTELL-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
707790 AUSTELL-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
707787 AUSTELL-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
707788 AUSTELL-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
710389 DYNA-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
710390 DYNA-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
710387 DYNA-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
710388 DYNA-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
704381 EPITEC 100MG Lamotrigine 100MG TAB Accepted treatment
704382 EPITEC 200MG Lamotrigine 200MG TAB Accepted treatment
704379 EPITEC 25MG Lamotrigine 25MG TAB Accepted treatment
704380 EPITEC 50MG Lamotrigine 50MG TAB Accepted treatment
722725 GIROTEC Lamotrigine 50MG TAB Accepted treatment
722726 GIROTEC Lamotrigine 100MG TAB Accepted treatment
722727 GIROTEC Lamotrigine 200MG TAB Accepted treatment
805521 LAMICTIN Lamotrigine 100MG TAB Accepted treatment
819034 LAMICTIN Lamotrigine 200MG TAB Accepted treatment
805505 LAMICTIN Lamotrigine 25MG TAB Accepted treatment
805513 LAMICTIN Lamotrigine 50MG TAB Accepted treatment
813907 LAMICTIN P100 Lamotrigine 100MG DSP Accepted treatment
704533 LAMICTIN P2 Lamotrigine 2MG DSP Accepted treatment
891716 LAMICTIN P200 Lamotrigine 200MG DSP Accepted treatment
813893 LAMICTIN P25 Lamotrigine 25MG DSP Accepted treatment
813885 LAMICTIN P5 Lamotrigine 5MG DSP Accepted treatment
891708 LAMICTIN P50 Lamotrigine 50MG DSP Accepted treatment
710887 LAMIDUS Lamotrigine 100MG TAB Accepted treatment
710888 LAMIDUS Lamotrigine 200MG TAB Accepted treatment
710885 LAMIDUS Lamotrigine 50MG TAB Accepted treatment
704488 LAMITOR Lamotrigine 100MG TAB Accepted treatment
704486 LAMITOR Lamotrigine 25MG TAB Accepted treatment
704487 LAMITOR Lamotrigine 50MG TAB Accepted treatment
712217 LAMITOR Lamotrigine 200MG TAB Accepted treatment
705248 SANDOZ LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
705249 SANDOZ LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
705251 SANDOZ LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
705250 SANDOZ LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
712078 CAMCOLIT Lithium 250MG TAB Accepted treatment
712086 CAMCOLIT Lithium 400MG TAB Accepted treatment
758833 QUILONUM RETARD Lithium 450MG TAB Accepted treatment
715980 CONVULEX Valproic acid 150MG CAP Accepted treatment
781541 CONVULEX Valproic acid 250MG/5ML SYR Accepted treatment
715999 CONVULEX Valproic acid 300MG CAP Accepted treatment
781568 CONVULEX Valproic acid 500MG CAP Accepted treatment
818666 EPILIM CR Valproic acid 200MG SRT Accepted treatment
818674 EPILIM CR Valproic acid 300MG SRT Accepted treatment
818682 EPILIM CR Valproic acid 500MG SRT Accepted treatment
821578 EPILIM CRUSHABLE Valproic acid 100MG TAB Accepted treatment
780545 EPILIM SUGAR FREE Valproic acid 200MG/5ML SYR Accepted treatment
718274 EPILIZINE CR Valproic acid 200MG SRT Accepted treatment
718275 EPILIZINE CR Valproic acid 300MG SRT Accepted treatment
718276 EPILIZINE CR Valproic acid 500MG SRT Accepted treatment
721460 EPROLEP CR 200 Valproic acid 200MG SRT Accepted treatment
Page 4 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
720762 EPROLEP CR 300 Valproic acid 300MG SRT Accepted treatment
721055 EPROLEP CR 500 Valproic acid 500MG SRT Accepted treatment
718465 NAVALPRO CR Valproic acid 200MG SRT Accepted treatment
718466 NAVALPRO CR Valproic acid 300MG SRT Accepted treatment
718468 NAVALPRO CR Valproic acid 500MG SRT Accepted treatment
720026 VANAPRO Valproic acid 300MG SRT Accepted treatment
720027 VANAPRO Valproic acid 500MG SRT Accepted treatment
Antipsychotic agents
892310 SOLIAN Amisulpride 200MG TAB
892309 SOLIAN Amisulpride 50MG TAB
705634 ABILIFY 10MG Aripiprazole 10MG TAB
705635 ABILIFY 15MG Aripiprazole 15MG TAB
712192 ABILIFY 5MG Aripiprazole 5MG TAB
735884 LARGACTIL Chlorpromazine 100MG TAB Accepted treatment
735868 LARGACTIL Chlorpromazine 25MG TAB Accepted treatment
735876 LARGACTIL Chlorpromazine 50MG TAB Accepted treatment
717082 ASPEN CLOZAPINE Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
717081 ASPEN CLOZAPINE Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
700178 CLOMENT Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
700176 CLOMENT Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
736716 LEPONEX Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
736708 LEPONEX Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
726656 FLUANXOL Flupentixol .5MG TAB Accepted treatment
726664 FLUANXOL Flupentixol 1MG TAB Accepted treatment
726672 FLUANXOL DEPOT 1ML Flupentixol 20MG/1ML INJS Accepted treatment
726680 FLUANXOL DEPOT 2ML Flupentixol INJ Accepted treatment
744301 MODECATE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment
744328 MODECATE+SYRINGE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment
719549 GULF HALOPERIDOL Haloperidol 5MG TAB Accepted treatment
730335 ROLAB-HALOPERIDOL Haloperidol 1.5MG TAB Accepted treatment
730327 ROLAB-HALOPERIDOL Haloperidol 5MG TAB Accepted treatment
763411 SERENACE Haloperidol 0.5MG CAP Accepted treatment
763535 SERENACE Haloperidol 10MG TAB Accepted treatment
763454 SERENACE Haloperidol 5MG TAB Accepted treatment
720687 ADCO OLANZAPINE Olanzapine 2.5MG TAB Accepted treatment
720691 ADCO OLANZAPINE Olanzapine 5MG TAB Accepted treatment
720692 ADCO OLANZAPINE Olanzapine 10MG TAB Accepted treatment
720529 LANAZYP Olanzapine 10MG TAB Accepted treatment
720527 LANAZYP Olanzapine 2.5MG TAB Accepted treatment
720528 LANAZYP Olanzapine 5MG TAB Accepted treatment
718997 MYLAN OLANZAPINE Olanzapine 10MG TAB Accepted treatment
718995 MYLAN OLANZAPINE Olanzapine 2.5MG TAB Accepted treatment
718996 MYLAN OLANZAPINE Olanzapine 5MG TAB Accepted treatment
721389 OLAWIN Olanzapine 10MG TAB Accepted treatment
721385 OLAWIN Olanzapine 2.5MG TAB Accepted treatment
721388 OLAWIN Olanzapine 5MG TAB Accepted treatment
721390 OLAWIN ORADISPERSIBLE Olanzapine 10MG MLT Accepted treatment
721386 OLAWIN ORADISPERSIBLE Olanzapine 5MG MLT Accepted treatment
715996 OLEANZ Olanzapine 10MG TAB Accepted treatment
715994 OLEANZ Olanzapine 2.5MG TAB Accepted treatment
715995 OLEANZ Olanzapine 5MG TAB Accepted treatment
715968 OLEANZ RAPITAB Olanzapine 10MG MLT Accepted treatment
715967 OLEANZ RAPITAB Olanzapine 5MG MLT Accepted treatment
Page 5 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
715659 OLEXAR Olanzapine 10MG TAB Accepted treatment
715657 OLEXAR Olanzapine 2.5MG TAB Accepted treatment
715658 OLEXAR Olanzapine 5MG TAB Accepted treatment
720714 PREXOLAN Olanzapine 10MG TAB Accepted treatment
720712 PREXOLAN Olanzapine 2.5MG TAB Accepted treatment
720713 PREXOLAN Olanzapine 5MG TAB Accepted treatment
719807 PREXOLAN ODT Olanzapine 10MG MLT Accepted treatment
719806 PREXOLAN ODT Olanzapine 5MG MLT Accepted treatment
715685 REDILANZ Olanzapine 10MG TAB Accepted treatment
715683 REDILANZ Olanzapine 2.5MG TAB Accepted treatment
715684 REDILANZ Olanzapine 5MG TAB Accepted treatment
721653 ZYLENA Olanzapine 10MG TAB Accepted treatment
721652 ZYLENA Olanzapine 5MG TAB Accepted treatment
827517 ZYPREXA Olanzapine 10MG TAB Accepted treatment
864188 ZYPREXA Olanzapine 2.5MG TAB Accepted treatment
827509 ZYPREXA Olanzapine 5MG TAB Specialist motivation
715666 INVEGA Paliperidone 3MG SRT Specialist motivation
715667 INVEGA Paliperidone 6MG SRT Specialist motivation
715668 INVEGA Paliperidone 9MG SRT Specialist motivation
718469 XEPLION PREFILLED SYRINGE 0.5ML Paliperidone 50MG/.5ML INJ Specialist motivation
718470 XEPLION PREFILLED SYRINGE 0.75ML Paliperidone 75MG/.75ML INJ Specialist motivation
718472 XEPLION PREFILLED SYRINGE 1.5ML Paliperidone 150MG/1.5ML INJ Specialist motivation
718471 XEPLION PREFILLED SYRINGE 1ML Paliperidone 100MG/1ML INJ Specialist motivation
751073 ORAP Pimozide 1MG TAB Specialist motivation
751081 ORAP Pimozide 4MG TAB Specialist motivation
716051 DOPAQUEL Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716052 DOPAQUEL Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716050 DOPAQUEL Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716053 DOPAQUEL Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
720981 KIZOFRIN Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
720979 KIZOFRIN Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
720980 KIZOFRIN Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
720982 KIZOFRIN Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716670 MYLAN QUETIAPINE Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716671 MYLAN QUETIAPINE Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716668 MYLAN QUETIAPINE Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716672 MYLAN QUETIAPINE Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
718353 PSYQUET Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
718354 PSYQUET Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
718352 PSYQUET Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
718355 PSYQUET Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
721745 QUETIAPINE BIOTECH Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
721746 QUETIAPINE BIOTECH Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
721744 QUETIAPINE BIOTECH Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
721747 QUETIAPINE BIOTECH Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716636 QUETOSER Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716637 QUETOSER Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716635 QUETOSER Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716638 QUETOSER Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716652 SEREZ Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716653 SEREZ Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716651 SEREZ Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716654 SEREZ Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
Page 6 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
850535 SEROQUEL Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
850543 SEROQUEL Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
850527 SEROQUEL Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
703344 SEROQUEL Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
713747 SEROQUEL XR Quetiapine 50MG SRT Accepted treatment (clinical motivation for low-cost options)
717404 SEROQUEL XR Quetiapine 150MG SRT Accepted treatment (clinical motivation for low-cost options)
713748 SEROQUEL XR Quetiapine 200MG SRT Accepted treatment (clinical motivation for low-cost options)
713749 SEROQUEL XR Quetiapine 300MG SRT Accepted treatment (clinical motivation for low-cost options)
713750 SEROQUEL XR Quetiapine 400MG SRT Accepted treatment (clinical motivation for low-cost options)
718704 SIZONORM Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
718705 SIZONORM Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
718674 SIZONORM Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
718706 SIZONORM Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
720894 SPEC QUETIAPINE Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
721710 SPEC QUETIAPINE Quetiapine 150MG TAB Accepted treatment (clinical motivation for low-cost options)
720896 SPEC QUETIAPINE Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
720893 SPEC QUETIAPINE Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
720897 SPEC QUETIAPINE Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716647 TRUVALIN Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716648 TRUVALIN Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716646 TRUVALIN Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716649 TRUVALIN Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
711471 ASPEN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
711472 ASPEN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711473 ASPEN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
711474 ASPEN RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711475 ASPEN RISPERIDONE Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
716500 AUROPERDAL Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
716501 AUROPERDAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
716502 AUROPERDAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
716503 AUROPERDAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
716504 AUROPERDAL Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
714686 AUROPIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
714687 AUROPIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
714688 AUROPIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
714689 AUROPIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
714690 AUROPIDONE Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
712212 DRL RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712211 DRL RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712210 DRL RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
712209 DRL RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
712191 MYLAN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712190 MYLAN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712189 MYLAN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
720334 PERIDA Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
720335 PERIDA Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712617 PERIZAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712618 PERIZAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712619 PERIZAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
712621 PERIZAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
717996 RISNIA Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
717997 RISNIA Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
717998 RISNIA Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
Page 7 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
717999 RISNIA Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
714101 RISPACOR Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
713967 RISPACOR Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
713966 RISPACOR Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
713965 RISPACOR Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
713964 RISPACOR Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
891523 RISPERDAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
828432 RISPERDAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
801860 RISPERDAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
801879 RISPERDAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
705474 RISPERDAL CONSTA Risperidone 25MG VIAL Specialist motivation
705475 RISPERDAL CONSTA Risperidone 37.5MG VIAL Specialist motivation
705476 RISPERDAL CONSTA Risperidone 50MG VIAL Specialist motivation
710790 RISPERIDONE HEXAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
710791 RISPERIDONE HEXAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
710793 RISPERIDONE HEXAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711419 RISPERLET Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
711420 RISPERLET Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711421 RISPERLET Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
718226 RISPEVON Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
718227 RISPEVON Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
718228 RISPEVON Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
718229 RISPEVON Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
723314 RISPIDE Risperidone .5MG TAB Accepted treatment
723315 RISPIDE Risperidone 1MG TAB Accepted treatment
723316 RISPIDE Risperidone 2MG TAB Accepted treatment
711537 RISPONZ Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711534 RISPONZ Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
711536 RISPONZ Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711538 RISPONZ Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
715736 SCHIZOROL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
715737 SCHIZOROL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
715738 SCHIZOROL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
721750 ZOXADON Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
721752 ZOXADON Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
711511 ZOXADON Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
711512 ZOXADON Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711513 ZOXADON Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
705386 BIO-SULPIRIDE Sulpiride 200MG TAB Accepted treatment
766410 STELAZINE Trifluoperazine 1MG TAB Accepted treatment
766437 STELAZINE Trifluoperazine 5MG TAB Accepted treatment
703465 GEODON Ziprasidone 20MG CAP
703468 GEODON Ziprasidone 40MG CAP
703475 GEODON Ziprasidone 60MG CAP
703476 GEODON Ziprasidone 80MG CAP
789798 CLOPIXOL Zuclopenthixol 10MG TAB Accepted treatment
796751 CLOPIXOL Zuclopenthixol 2MG TAB Accepted treatment
714852 CLOPIXOL DEPOT Zuclopenthixol 200MG/1ML INJS Accepted treatment
Antidepressants
718746 GULF AMITRIPTYLINE Amitriptyline 25MG TAB Accepted treatment
784230 ROLAB-AMITRIPTYLINE HCL Amitriptyline 25MG TAB Accepted treatment
772003 TREPILINE Amitriptyline 10MG TAB Accepted treatment
771996 TREPILINE Amitriptyline 25MG TAB Accepted treatment
Page 8 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
772860 TRYPTANOL Amitriptyline 25MG TAB Accepted treatment
713583 ARROW CITALOPRAM Citalopram 20MG TAB Accepted treatment
713584 ARROW CITALOPRAM Citalopram 40MG TAB Accepted treatment
713356 AURO-CITALOPRAM Citalopram 20MG TAB Accepted treatment
707396 AUSTELL-CITALOPRAM Citalopram 10MG TAB Accepted treatment
707398 AUSTELL-CITALOPRAM Citalopram 20MG TAB Accepted treatment
707397 AUSTELL-CITALOPRAM Citalopram 40MG TAB Accepted treatment
717094 BIO CITALOPRAM Citalopram 20MG TAB Accepted treatment
707888 CILATE Citalopram 20MG TAB Accepted treatment
700157 CILIFT Citalopram 20MG TAB Accepted treatment
711988 CILORAM Citalopram 20MG TAB Accepted treatment
810622 CIPRAMIL Citalopram 20MG TAB Accepted treatment
704331 CITALOHEXAL Citalopram 20MG TAB Accepted treatment
716521 CITALOPRAM ACTOR Citalopram 20MG TAB Accepted treatment
709407 CITALOPRAM-WINTHROP Citalopram 20MG TAB Accepted treatment
704328 DEPRAMIL 20MG Citalopram 20MG TAB Accepted treatment
705252 DEPRAMIL Citalopram 40MG TAB Accepted treatment
713445 DRL CITALOPRAM Citalopram 20MG TAB Accepted treatment
713757 DRL CITALOPRAM Citalopram 40MG TAB Accepted treatment
717372 GLENMARK CITALOPRAM Citalopram 20MG TAB Accepted treatment
705417 MERCK-CITALOPRAM 20 Citalopram 20MG TAB Accepted treatment
704590 SANDOZ CITALOPRAM Citalopram 20MG TAB Accepted treatment
707304 SIMAYLA CITALOPRAM Citalopram 20MG TAB Accepted treatment
702769 TALOMIL Citalopram 20MG TAB Accepted treatment
816515 SANDOZ DOTHIEPIN HCL Dosulepin 75MG TAB Accepted treatment
757888 PROTHIADEN Dosulepin 25MG CAP Accepted treatment
800198 THADEN Dosulepin 25MG CAP Accepted treatment
800201 THADEN Dosulepin 75MG TAB Accepted treatment
703391 A-LENNON FLUOXETINE Fluoxetine 20MG CAP Accepted treatment
894303 DEPROZAN Fluoxetine 20MG CAP Accepted treatment
716520 FLUOXETINE ACTOR Fluoxetine 20MG CAP Accepted treatment
820016 LILLY-FLUOXETINE Fluoxetine 20MG CAP Accepted treatment
821063 LORIEN Fluoxetine 20MG CAP Accepted treatment
700877 LORIEN 20MG Fluoxetine 20MG TAB Accepted treatment
840653 NUZAK Fluoxetine 20MG CAP Accepted treatment
879282 PROHEXAL Fluoxetine 20MG CAP Accepted treatment
894243 PROHEXAL 20T Fluoxetine 20MG DSP Accepted treatment
894249 PROHEXAL 40T Fluoxetine 40MG DSP Accepted treatment
719658 PROLAX Fluoxetine 20MG CAP Accepted treatment
822981 PROZAC Fluoxetine 20MG TAB Accepted treatment
757969 PROZAC 20 Fluoxetine 20MG CAP Accepted treatment
700686 RANFLOCS Fluoxetine 20MG CAP Accepted treatment
707426 REZAK Fluoxetine 20MG CAP Accepted treatment
838713 ROLAB-FLUOXETINE Fluoxetine 20MG CAP Accepted treatment
705064 ZYDUS FLUOXETINE Fluoxetine 20MG CAP Accepted treatment
724661 ETHIPRAMINE Imipramine 10MG TAB Accepted treatment
724688 ETHIPRAMINE Imipramine 25MG TAB Accepted treatment
771120 TOFRANIL Imipramine 10MG TAB Accepted treatment
771139 TOFRANIL Imipramine 25MG TAB Accepted treatment
735795 LANTANON Mianserin 10MG TAB
735817 LANTANON Mianserin 30MG TAB
704904 ADCO-PAROXETINE Paroxetine 20MG TAB
791571 AROPAX Paroxetine 20MG TAB
Page 9 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
703219 AROPAX 30 Paroxetine 30MG TAB
704647 AROPAX CR Paroxetine 12.5MG SRT
704646 AROPAX CR Paroxetine 25MG SRT
718058 AURO PAROXETINE Paroxetine 20MG TAB
707399 AUSTELL-PAROXETINE Paroxetine 20MG TAB
707400 AUSTELL-PAROXETINE Paroxetine 30MG TAB
704792 DEPAROC Paroxetine 20MG TAB
705186 PARAX 20 Paroxetine 20MG TAB
716745 PAROXETINE UNICORN Paroxetine 20MG TAB
704794 PAXIL 20 Paroxetine 20MG TAB
705122 SERRAPRESS 20 Paroxetine 20MG TAB
717561 TEXINE Paroxetine 20MG TAB
705633 XET 20MG Paroxetine 20MG TAB
711911 ZYDUS-PAROXETINE Paroxetine 20MG TAB
Bronchiectasis
Antibiotic therapy will be evaluated on an individual basis
Chronic Obstructive Pulmonary Disease
Inhaled B2 agonists
849332 ASTHAVENT 300 DOSE Salbutamol 100MCG INH Accepted treatment
700715 ASTHAVENT 300D ECOHALER CFC FREE Salbutamol 100MCG INH Accepted treatment
878219 ASTHAVENT DP Salbutamol 200MCG CPS
706544 BEROTEC HFA 200 DOSE Fenoterol 100MCG INH
791415 BRICANYL TURBOHALER Terbutaline 0.5MG INH
720748 BRICANYL 100 DOSE Terbutaline .5MG/1DOSE TBH
824623 COMBIVENT MDI Salbutamol and other drugs for obstructive airway diseases 20MCG/100MCG INH
718698 DUOLIN HFA 200DOSE Salbutamol and other drugs for obstructive airway diseases INH
707882 DUOVENT HFA 200DOSE Fenoterol and ipratropium bromide 50MCG/20MCG INH
711213 VENTEZE CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment
720723 VENTIMAX CFC FREE 200 DOSE Salbutamol 100MCG INH Accepted treatment
703371 VENTOLIN INHALER 200 CFC FREE Salbutamol 100MCG INH Accepted treatment
Long acting B2 agonists
820911 FORADIL DRY Formoterol 12MCG CPS
704175 FORATEC DP CAPS Formoterol 12MCG CAP
710307 FORATEC HFA 120DOSE Formoterol 12MCG INH
717402 ONBREZ BREEZHALER (30 CAPS & INHALER) Indacaterol KIT
840246 OXIS TURBUHALER Formoterol 9MCG INH
818496 SEREVENT ACCUHALER Salmeterol 50MCG INH
708289 SEREVENT CFC-FREE 120DOSE Salmeterol 25MCG INH
787302 SEREVENT INHAL(120) Salmeterol 25MCG INH
791695 SEREVENT INHAL(60) Salmeterol 25MCG INH
722933 DULERA 200/5UG 120 DOSE Formoterol and mometasone 200MCG/50MCG INH
722934 DULERA 100/5UG 120 DOSE Formoterol and mometasone 100MCG/5MCG INH
Inhaled corticosteroids
827061 BECEZE 50 200DOSE Beclomethasone 50MCG INH Accepted treatment
827088 BECEZE INHALER COMPLETE Beclomethasone 100MCG INH Accepted treatment
819638 BECLATE INHALER Beclomethasone 100MCG INH Accepted treatment
820083 BECLATE INHALER Beclomethasone 200MCG INH Accepted treatment
819611 BECLATE INHALER Beclomethasone 50MCG INH Accepted treatment
897469 BUDEFLAM CFC FREE 200MCG 300 DOSE INH Budesonide 200MCG INH Accepted treatment
897462 BUDEFLAM CFC FREE 300 DOSE INH Budesonide 100MCG INH Accepted treatment
704176 BUDEFLAM DP CAPS Budesonide 200MCG CAP Accepted treatment
Page 10 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
704020 INFLAMMIDE 200 NOVOLIZE REFIL Budesonide 200MCG REF Accepted treatment
704021 INFLAMMIDE 200 NOVOLIZER COMPL Budesonide 200MCG INH Accepted treatment
839329 INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 100MCG INH Accepted treatment
839337 INFLAMMIDE AEROSOL COMPLETE (MAC) Budesonide 200MCG INH Accepted treatment
707879 INFLAMMIDE NOVOLIZER COMPLETE 100DOSE Budesonide 400MCG INH Accepted treatment
707881 INFLAMMIDE NOVOLIZER REFILL 100DOSE Budesonide 400MCG REF Accepted treatment
791423 PULMICORT 100 TURB (200 DOSE) Budesonide 100MCG ATH Accepted treatment
791431 PULMICORT 200 TURB (200 DOSE) Budesonide 200MCG ATH Accepted treatment
823791 PULMICORT TURB (100 DOSE) Budesonide 400MCG ATH Accepted treatment
705269 ALVESCO 160MCG 120 DOSE Ciclesonide 160MCG INH Accepted treatment
705267 ALVESCO 160MCG 60 DOSE Ciclesonide 160MCG INH Accepted treatment
705265 ALVESCO 80MCG 60 DOSE Ciclesonide 80MCG INH Accepted treatment
720735 CICLOVENT 120 DOSE Ciclesonide 160MCG INH Accepted treatment
720711 CICLOVENT 120 DOSES Ciclesonide 80MCG INH Accepted treatment
721620 CICLOVENT 60 DOSE Ciclesonide 160MCG INH Accepted treatment
721621 CICLOVENT 60 DOSE Ciclesonide 80MCG INH Accepted treatment
703275 FLIXOTIDE 50 CFC FREE 120 ACT Fluticasone 50MCG INH Accepted treatment
818453 FLIXOTIDE ACCUHALER Fluticasone 100MCG CAP Accepted treatment
818461 FLIXOTIDE ACCUHALER Fluticasone 250MCG CAP Accepted treatment
818488 FLIXOTIDE ACCUHALER Fluticasone 500MCG CAP Accepted treatment
818445 FLIXOTIDE ACCUHALER Fluticasone 50MCG CAP Accepted treatment
897752 FLIXOTIDE CFC FREE (120 ACT) Fluticasone 125MCG INH Accepted treatment
897759 FLIXOTIDE CFC FREE (120 ACT) Fluticasone 250MCG INH Accepted treatment
720219 VANNAIR 160/4.5MCG PER INHALATION 120 DO formoterol and budesonide 4.5MCG/160MCG INH Accepted treatment
720218 VANNAIR 80/4.5MCG PER INHALATION 120 DOS formoterol and budesonide 4.5MCG/80MCG INH Accepted treatment
700173 SYMBICORD TURBO 120 DOSE Formoterol/Budesonide 4.5MCG/160MCG INH Accepted treatment
700172 SYMBICORD TURBO 60 DOSE Formoterol/Budesonide 4.5MCG/160MCG INH Accepted treatment
705984 SYMBICORD 320/9MCG PER INHALATION Formutoterol and other anti- asthmatics 9MCG/320MCG INH Accepted treatment
705986 SYMBICORD 80/4.5MCG PER INHALATION Formutoterol and other anti- asthmatics 4.5MCG/80MCG INH Accepted treatment
717571 ASMANEX TWISTHALER 30 DOSE Mometasone 200MCG/1DOSE TBH Accepted treatment
717581 ASMANEX TWISTHALER 30 DOSE Mometasone 400MCG/1DOSE TBH Accepted treatment
717572 ASMANEX TWISTHALER 60 DOSE Mometasone 200MCG/1DOSE TBH Accepted treatment
717582 ASMANEX TWISTHALER 60 DOSE Mometasone 400MCG/1DOSE TBH Accepted treatment
715753 FOXAIR 25/125 120DOSE Salmeterol and other anti-asthmatics 25MCG/125MCG INH Accepted treatment
715754 FOXAIR 25/250 120DOSE Salmeterol and other anti-asthmatics 25MCG/250MCG INH Accepted treatment
715752 FOXAIR 25/50 120 DOSE Salmeterol and other anti-asthmatics 25MCG/50MCG INH Accepted treatment
715009 FOXAIR 50/100 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715008 FOXAIR 50/250 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715007 FOXAIR 50/500 ACCUHALER Salmeterol/Fluticasone combinations INH Accepted treatment
715190 SEREFLO 25/125 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
721413 SEREFLO 25/125 HFA SYNCHROBREATHE 120 DO Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
715191 SEREFLO 25/250 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
721414 SEREFLO 25/250 HFA SYNCHROBREATHE 120 DO Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
715189 SEREFLO 25/50 HFA 120 DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
721412 SEREFLO 25/50 HFA SYNCHROBREATHE 120 DOS Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
894990 SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/125MCG INH Accepted treatment
895006 SERETIDE 120 DOSE Salmeterol/Fluticasone combinations 25MCG/250MCG INH Accepted treatment
894989 SERETIDE 25/50 120 DOSE Salmeterol/Fluticasone combinations 25MCG/50MCG INH Accepted treatment
874493 SERETIDE 50/100 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/100MCG INH Accepted treatment
874507 SERETIDE 50/250 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/250MCG INH Accepted treatment
874515 SERETIDE 50/500 ACCUHALER Salmeterol/Fluticasone combinations 50MCG/500MCG INH Accepted treatment
723300 RELVAR ELLIPTA 92/22UG 30 DOSE vilanterol and fluticasone furoate 92MCG/22MCG INH Accepted treatment
Page 11 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Anticholinergic inhalers (short acting)
706543 ATROVENT HFA 200 DOSE Ipratropium bromide 20MCG INH Accepted treatment
715574 IPVENT HFA 200 DOSE Ipratropium bromide 40MCG/1DOSE INH Accepted treatment
Oral Xanthines
725005 EUPHYLLIN RETARD Theophylline 250MG SRT
748498 NUELIN Theophylline 125MG TAB
748501 NUELIN SA 250 Theophylline 250MG TAB
788368 ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 200MG SRT Accepted treatment
788376 ROLAB-THEOPHYLLINE ANHYDROUS Theophylline 300MG SRT Accepted treatment
783005 THEOPLUS Theophylline 200MG SRT
783013 THEOPLUS Theophylline 300MG SRT
785105 UNIPHYL Theophylline 400MG SRT
816159 UNIPHYL Theophylline 600MG SRT
Oral Corticosteroids
814407 CAPSOID Prednisolone 5MG TAB Special Investigations (SI)
800155 LENISOLONE Prednisolone 5MG TAB Special Investigations (SI)
742759 METICORTEN Prednisone 50MG TAB
742732 METICORTEN Prednisone 5MG TAB
752304 PANAFCORT Prednisone 5MG TAB
788783 PREDNISONE (BE-TABS) Prednisone 5MG TAB Special Investigations (SI)
703720 PRELONE Prednisolone 5MG TAB
836826 PULMISON TABS Prednisone 20MG TAB
818267 TROLIC Prednisone 5MG TAB Special Investigations (SI)
Cardiac failure/ Cardiomyopathy
Anticoagulants
778362 WARFARIN Warfarin 5MG TAB Accepted treatment
709906 CIPLA WARFARIN 1MG Warfarin 1MG TAB Accepted treatment
712390 CIPLA-WARFARIN Warfarin 3MG TAB Accepted treatment
709905 CIPLA WARFARIN 5MG Warfarin 5MG TAB Accepted treatment
Diuretics
780618 ADCO-RETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
701807 ALDACTONE Spironolactone 100MG TAB
701793 ALDACTONE Spironolactone 25MG APP Accepted treatment
702803 AMILORETIC Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
702811 AMILORETIC HS Hydrochlorothiazide and potassium-sparing agents 2.5MG/25MG TAB Accepted treatment
807796 ARELIX Piretanide 3MG TAB
807818 ARELIX Piretanide 6MG TAB
707423 AUSTELL-FUROSEMIDE Furosemide 40MG TAB Accepted treatment
707421 AUSTELL-FUROSEMIDE Furosemide 20MG TAB Accepted treatment
808695 BETARETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
821845 BEURISES Furosemide 40MG TAB Accepted treatment
711152 BURINEX Bumetanide 1MG TAB
710313 CIPLA-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
819417 DAPAMAX Indapamide 2.5MG TAB Accepted treatment
833045 DAPTRIL Indapamide 2.5MG TAB Accepted treatment
719984 DEZRETIC 5MG/50MG Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
716048 DINO-RETIC Furosemide 40MG TAB Accepted treatment
705967 DIURESIX Furosemide 40MG TAB Accepted treatment
721824 DYAZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment
716962 DYNA INDAPAMIDE SR Indapamide 1.5MG SRT
890470 HEXAZIDE Hydrochlorothiazide 25MG TAB Accepted treatment
822825 HYDRO-LESS Indapamide 2.5MG TAB Accepted treatment
Page 12 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
735930 LASIX Furosemide 20MG TAB
735949 LASIX Furosemide 40MG TAB
735957 LASIX Furosemide 500MG TAB
839515 LASIX ORAL Furosemide 10MG/1ML SLN Clinical review
857769 MYLAN FUROSEMIDE Furosemide 40MG TAB Accepted treatment
703329 MYLAN-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
744379 MODURETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
830836 NATRILIX SR Indapamide 1.5MG SRT
758272 PURESIS Furosemide 40MG TAB
780146 RENEZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment
880949 RIDAQ Hydrochlorothiazide 25MG TAB Accepted treatment
710437 RIDAQ Hydrochlorothiazide 12.5MG TAB Accepted treatment
731668 ROLAB-FUROSEMIDE Furosemide 40MG TAB Accepted treatment
831026 ROLAB-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
769665 ROLAB-SPIRONOLACTONE Spironolactone 25MG TAB Accepted treatment
706531 SPEC-CO-AMILORIDE Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
898937 SPIRACTIN Spironolactone 100MG TAB
765910 SPIRACTIN Spironolactone 25MG TAB Accepted treatment
707191 TORAHEXAL Torasemide 10MG TAB
707189 TORAHEXAL Torasemide 2.5MG TAB
707190 TORAHEXAL Torasemide 5MG TAB
820369 UNAT Torasemide 2.5MG TAB
820377 UNAT Torasemide 5MG TAB
820385 UNAT Torasemide 10MG TAB
774057 URIREX-K Hydrochlorothiazide and potassium TAB Accepted treatment
Potassium supplementation
755753 PLENISH K Potassium chloride 600MG TAB Accepted treatment
719270 POTASSIUM CHLORIDE UNICORN Potassium chloride 600MG TAB Accepted treatment
702947 SANDOZ K-600 Potassium chloride 600MG TAB Accepted treatment
764396 SLOW-K Potassium chloride 600MG TAB Accepted treatment
718911 ULTIPOT Potassium chloride 600MG TAB Accepted treatment
768227 SWISS-KAL SR Potassium chloride SRT
ACE inhibitors
794058 CIBACE Benazepril 10MG TAB
852333 BIO-CAPTOPRIL Captopril 25MG TAB Accepted treatment
795267 CAPACE Captopril 25MG TAB Accepted treatment
712361 CAPOTEN Captopril 50MG TAB Accepted treatment
837628 CAPTOHEXAL Captopril 12.5MG TAB Accepted treatment
837636 CAPTOHEXAL Captopril 25MG TAB Accepted treatment
837644 CAPTOHEXAL Captopril 50MG TAB Accepted treatment
836451 CAPTOMAX Captopril 25MG TAB Accepted treatment
836478 CAPTOMAX Captopril 50MG TAB Accepted treatment
852619 MYLAN CAPTOPRIL Captopril 25MG TAB Accepted treatment
899429 MYLAN-CAPTOPRIL Captopril 50MG TAB Accepted treatment
850896 ROLAB-CAPTOPRIL Captopril 25MG TAB Accepted treatment
850918 ROLAB-CAPTOPRIL Captopril 50MG TAB Accepted treatment
839779 ZAPTO Captopril 25MG TAB Accepted treatment
839787 ZAPTO Captopril 50MG TAB Accepted treatment
792756 INHIBACE Cilazapril 5MG TAB
886843 ADCO-ENALAPRIL 10MG Enalapril 10MG TAB Accepted treatment
886851 ADCO-ENALAPRIL 20MG Enalapril 20MG TAB Accepted treatment
881481 ALAPREN 10 Enalapril 10MG TAB Accepted treatment
Page 13 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
881503 ALAPREN 20 Enalapril 20MG TAB Accepted treatment
881473 ALAPREN 5 Enalapril 5MG TAB Accepted treatment
721626 AUSTELL ENALAPRIL Enalapril 10MG TAB Accepted treatment
721627 AUSTELL ENALAPRIL Enalapril 20MG TAB Accepted treatment
721625 AUSTELL ENALAPRIL Enalapril 5MG TAB Accepted treatment
894324 CIPLATEC 10 Enalapril 10MG TAB Accepted treatment
701729 CIPLATEC 20MG Enalapril 20MG TAB Accepted treatment
894316 CIPLATEC 5 Enalapril 5MG TAB Accepted treatment
723156 ENALAPRIL BIOTECH Enalapril 5MG TAB Accepted treatment
723157 ENALAPRIL BIOTECH Enalapril 10MG TAB Accepted treatment
723159 ENALAPRIL BIOTECH Enalapril 20MG TAB Accepted treatment
891279 ENAP 10MG Enalapril 10MG TAB Accepted treatment
891280 ENAP 20MG Enalapril 20MG TAB Accepted treatment
891272 ENAP 5MG Enalapril 5MG TAB Accepted treatment
712763 ENVAS Enalapril 10MG TAB Accepted treatment
712762 ENVAS Enalapril 5MG TAB Accepted treatment
867853 HR-ENALAPRIL 10 Enalapril 10MG TAB Accepted treatment
867861 HR-ENALAPRIL 20 Enalapril 20MG TAB Accepted treatment
867845 HR-ENALAPRIL 5 Enalapril 5MG TAB Accepted treatment
862622 HYPACE Enalapril 5MG TAB Accepted treatment
862622 HYPACE Enalapril 5MG TAB Accepted treatment
868914 PHARMAPRESS Enalapril 10MG TAB Accepted treatment
868922 PHARMAPRESS Enalapril 20MG TAB Accepted treatment
708109 PHARMAPRESS Enalapril 5MG TAB Accepted treatment
759783 RENITEC Enalapril 10MG TAB Accepted treatment
810355 RENITEC Enalapril 2.5MG TAB Accepted treatment
759767 RENITEC Enalapril 20MG TAB Accepted treatment
759759 RENITEC Enalapril 5MG TAB Accepted treatment
791962 MONOPRIL Fosinopril 20MG TAB Accepted treatment
791962 MONOPRIL Fosinopril 20MG TAB
705450 MYLAN-FOSINOPRIL 10 Fosinopril 10MG TAB
705453 MYLAN-FOSINOPRIL 20 Fosinopril 20MG TAB
715938 APEX-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
714678 AURO-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
714679 AURO-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
714677 AURO-LISINOPRIL Lisinopril 5MG TAB Accepted treatment
704354 AUSTELL LISINOPRIL 2.5MG Lisinopril 2.5MG TAB Accepted treatment
708189 AUSTELL LISINOPRIL 20MG Lisinopril 20MG TAB Accepted treatment
712598 AUSTELL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
701392 HEXAL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
701394 HEXAL-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
701387 HEXAL-LISINOPRIL Lisinopril 5MG TAB Accepted treatment
716794 LYSIN Lisinopril 10MG TAB Accepted treatment
716792 LYSIN Lisinopril 5MG TAB Accepted treatment
707311 SIMAYLA LISINOPRIL Lisinopril 10MG TAB Accepted treatment
707312 SIMAYLA LISINOPRIL Lisinopril 20MG TAB Accepted treatment
700692 SINOPREN 10 Lisinopril 10MG TAB Accepted treatment
700694 SINOPREN 20 Lisinopril 20MG TAB Accepted treatment
700691 SINOPREN 5 Lisinopril 5MG TAB Accepted treatment
703645 ZEMAX 10 Lisinopril 10MG TAB Accepted treatment
705318 ZEMAX 20 Lisinopril 20MG TAB Accepted treatment
703646 ZEMAX 5 Lisinopril 5MG TAB Accepted treatment
781703 ZESTRIL Lisinopril 10MG TAB Accepted treatment
Page 14 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
781711 ZESTRIL Lisinopril 20MG TAB Accepted treatment
781681 ZESTRIL Lisinopril 5MG TAB Accepted treatment
862053 ZETOMAX (ZESTOMAX) 10MG Lisinopril 10MG TAB Accepted treatment
862061 ZETOMAX (ZESTOMAX) 20MG Lisinopril 20MG TAB Accepted treatment
862045 ZETOMAX (ZESTOMAX) 5MG Lisinopril 5MG TAB Accepted treatment
890229 PERDIX 15MG Moexipril 15MG TAB
890222 PERDIX 7.5MG Moexipril 7.5MG TAB
715649 ACESYL Perindopril 4MG TAB
714869 ACTI-PREX (GLENMARK PERINDOPRIL) Perindopril 4MG TAB
716505 AURO PERINDOPRIL Perindopril 4MG TAB
716506 AURO PERINDOPRIL Perindopril 8MG TAB
717293 BINDACE Perindopril 4MG TAB
717294 BINDACE Perindopril 8MG TAB
710302 CIPLA-PERINDOPRIL Perindopril 4MG TAB
710510 CIPLA-PERINDOPRIL Perindopril 8MG TAB
715786 CIPLASYL Perindopril 4MG TAB
715795 CIPLASYL Perindopril 8MG TAB
785121 COVERSYL Perindopril 4MG TAB
705915 COVERSYL Perindopril 10MG TAB
714527 PEARINDA Perindopril 4MG TAB
714528 PEARINDA Perindopril 8MG TAB
717783 PERINDOPRIL UNICORN Perindopril 4MG TAB
717784 PERINDOPRIL UNICORN Perindopril 8MG TAB
721339 PERISTAR Perindopril 4MG TAB
721340 PERISTAR Perindopril 8MG TAB
703541 PREXUM Perindopril 4MG TAB
720387 PREXUM Perindopril 5MG TAB
714646 PREXUM Perindopril 10MG TAB
710611 RAN-PERINDOPRIL Perindopril 4MG TAB
712615 SPEC-PERINDOPRIL Perindopril 4MG TAB
712616 SPEC-PERINDOPRIL Perindopril 8MG TAB
710297 VECTORYL Perindopril 4MG TAB
710925 VECTORYL Perindopril 8MG TAB
716680 ZYDUS PERINDOPRIL Perindopril 4MG TAB
708119 ACCUMAX Quinapril 10MG TAB Accepted treatment
708120 ACCUMAX Quinapril 20MG TAB Accepted treatment
783293 ACCUPRIL Quinapril 5MG TAB
783307 ACCUPRIL Quinapril 10MG TAB Accepted treatment
783315 ACCUPRIL Quinapril 20MG TAB Accepted treatment
853186 ACCUPRIL Quinapril 40MG TAB
708981 QUINAGEN Quinapril 5MG TAB
708982 QUINAGEN Quinapril 10MG TAB Accepted treatment
708983 QUINAGEN Quinapril 20MG TAB Accepted treatment
708985 QUINAGEN Quinapril 40MG TAB
705457 QUINASPEN 10MG Quinapril 10MG TAB Accepted treatment
705447 QUINASPEN 20MG Quinapril 20MG TAB Accepted treatment
715957 APEX-RAMIPRIL Ramipril 10MG CAP
715954 APEX-RAMIPRIL Ramipril 2.5MG CAP
715955 APEX-RAMIPRIL Ramipril 5MG CAP
705752 AUSTELL-RAMIPRIL 1.25MG Ramipril 1.25MG CAP
705755 AUSTELL-RAMIPRIL 10MG Ramipril 10MG CAP
705753 AUSTELL-RAMIPRIL 2.5MG Ramipril 2.5MG CAP
705754 AUSTELL-RAMIPRIL 5MG Ramipril 5MG CAP
Page 15 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
704374 RAMIPRIL HEXAL Ramipril 2.5MG TAB
704375 RAMIPRIL HEXAL Ramipril 5MG TAB
704023 RAMIWIN Ramipril 2.5MG CAP
704025 RAMIWIN Ramipril 5MG CAP
705426 RAMPIL 1.25MG Ramipril 1.25MG CAP
705429 RAMPIL 10MG Ramipril 10MG CAP
705427 RAMPIL 2.5MG Ramipril 2.5MG CAP
705428 RAMPIL 5MG Ramipril 5MG CAP
704975 RAN RAMIPRIL Ramipril 10MG CAP
707383 RETACE Ramipril 2.5MG TAB
707385 RETACE Ramipril 5MG TAB
707869 SIMAYLA RAMIPRIL Ramipril 10MG CAP
841579 TRITACE Ramipril 1.25MG TAB
841587 TRITACE Ramipril 2.5MG TAB
841595 TRITACE Ramipril 5MG TAB
782602 TRITACE Ramipril 10MG CAP
805068 MAVIK (PREVIOUSLY GOPTEN) Trandolapril 2MG CAP
805033 MAVIK (PREVIOUSLY GOPTEN) Trandolapril 0.5MG CAP
ACE inhibitor and diuretic combinations
708116 ACCUMAX CO Quinapril and diuretics 10MG/12.5MG TAB
708118 ACCUMAX CO Quinapril and diuretics 20MG/12.5MG TAB
795755 ACCURETIC Quinapril and diuretics 10MG/12.5MG TAB
805297 ACCURETIC Quinapril and diuretics 20MG/12.5MG TAB
715651 ACESYL CO Perindopril and diuretics 1.25MG/4MG TAB
706235 ADCO-QUINARETIC 10/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
706236 ADCO-QUINARETIC 20/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
717795 ARIPREL PLUS 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
716120 AURO-LISINOPRIL CO Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
716121 AURO-LISINOPRIL CO Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
718056 AURO QUINAPRIL CO 10MG/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
718057 AURO QUINAPRIL CO 20MG/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
721508 BIOPREXUM PLUS 10MG/2.5MG Perindopril and diuretics 10MG/2.5MG TAB
719873 BIQURETIC 10MG/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
719874 BIQURETIC 20MG/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
787035 CO-RENITEC Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
877549 COVERSYL PLUS Perindopril and diuretics 4MG/1.25MG TAB
720389 COVERSYL PLUS 5MG/1.25MG Perindopril and diuretics 5MG/1.25MG TAB
710978 DIACE CO Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
891287 ENAP-CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
815055 INHIBACE PLUS Cilazapril and diuretics 5MG/12.5MG TAB
704703 HEXAL LISINOPRIL CO 10 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704704 HEXAL LISINOPRIL CO 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
716943 LISINOPRIL CO UNICORN 10MG/12.5MG Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
716945 LISINOPRIL CO UNICORN 20MG/12.5MG Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
711989 LISINOZIDE Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
711990 LISINOZIDE Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704437 LISORETIC 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704438 LISORETIC 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
707292 LISOZIDE 10MG/12.5MG Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
707291 LISOZIDE 20MG/12.5MG Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
714952 PEARINDA PLUS Perindopril and diuretics 1.25MG/4MG TAB
717782 PERINDOPRIL CO UNICORN 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
721519 BIOCOVERSYL PLUS 10MG/2.5MG Perindopril and diuretics 10MG/2.5MG TAB
Page 16 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
885019 PHARMAPRESS CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
704929 PREXUM PLUS Perindopril and diuretics 4MG/1.25MG TAB
720388 PREXUM PLUS 5MG/1.25MG Perindopril and diuretics 5MG/1.25MG TAB
707550 QUINAZIDE 10/12.5 Quinapril and diuretics 10MG/12.5MG TAB
707551 QUINAZIDE 20/12.5 Quinapril and diuretics 20MG/12.5MG TAB
713763 SPEC-PERINDOPRIL PLUS Perindopril and diuretics 1.25MG/4MG TAB
718093 TRITACE PLUS 10MG/12.5MG Ramipril and diuretics 10MG/12.5MG TAB
718094 TRITACE PLUS 5MG/12.5MG Ramipril and diuretics 5MG/12.5MG TAB
718092 TRITACE PLUS 5MG/25MG Ramipril and diuretics 5MG/25MG TAB
710298 VECTORYL PLUS Perindopril and diuretics 1.25MG/4MG TAB
839795 ZAPTO-CO Captopril and diuretics 50MG/25MG TAB Accepted treatment
704597 ZETOMAX CO 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704598 ZETOMAX CO 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
817848 ZESTORETIC Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
797685 ZESTORETIC Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
708260 ZESTOZIDE 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
717095 ZYDUS PERINDOPRIL CO 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
Angiotensin Receptor Blockers
720582 ANTOSART Irbesartan 150MG TAB
720583 ANTOSART Irbesartan 300MG TAB
718667 ADCO IRBESARTAN Irbesartan 150MG TAB
718668 ADCO IRBESARTAN Irbesartan 300MG TAB
837814 APROVEL Irbesartan 150MG TAB
837822 APROVEL Irbesartan 300MG TAB
856118 ATACAND Candesartan 16MG TAB
856096 ATACAND Candesartan 8MG TAB
723123 ATERWIN Candesartan 8MG TAB Accepted treatment
723124 ATERWIN Candesartan 16MG TAB Accepted treatment
898635 ATACAND PLUS Candesartan and diuretics 16MG/12.5MG TAB
721629 ABECARD Candesartan 8MG TAB
721630 ABECARD Candesartan 16MG TAB
716495 AURO LOSARTAN Losartan 100MG TAB Accepted treatment
716494 AURO LOSARTAN Losartan 50MG TAB Accepted treatment
717069 AUSTELL LOSARTAN Losartan 100MG TAB Accepted treatment
717068 AUSTELL LOSARTAN Losartan 50MG TAB Accepted treatment
719453 CANDEPRES PLUS 16MG/12.5MG Candesartan and diuretics 16MG/12.5MG TAB
720319 CANDAGEN Candesartan 16MG TAB
720318 CANDAGEN Candesartan 8MG TAB
716644 CIPLAZAR Losartan 100MG TAB Accepted treatment
716643 CIPLAZAR Losartan 50MG TAB Accepted treatment
709845 CIPLA-LOSARTAN Losartan 100MG TAB Accepted treatment
709844 CIPLA-LOSARTAN Losartan 50MG TAB Accepted treatment
818739 COZAAR Losartan 50MG TAB Accepted treatment
710079 COZAAR Losartan 100MG TAB Accepted treatment
717035 DIOLO Valsartan 160MG TAB
717034 DIOLO Valsartan 80MG TAB
700710 DIOVAN 160 Valsartan 160MG TAB
700000 DIOVAN 80 Valsartan 80MG TAB
717793 DYNARB Irbesartan 150MG TAB
717794 DYNARB Irbesartan 300MG TAB
712385 IRBEWIN Irbesartan 150MG TAB
712384 IRBEWIN Irbesartan 300MG TAB
Page 17 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
718506 IRTANEL Irbesartan 150MG TAB
718507 IRTANEL Irbesartan 300MG TAB
719162 ISART Irbesartan 150MG TAB
719163 ISART Irbesartan 300MG TAB
709924 LOS-ARB Losartan 50MG TAB Accepted treatment
720776 LOZAAN Losartan 100MG TAB Accepted treatment
720775 LOZAAN Losartan 50MG TAB Accepted treatment
718366 LOSARTAN UNICORN Losartan 100MG TAB Accepted treatment
718365 LOSARTAN UNICORN Losartan 50MG TAB Accepted treatment
709909 LOSARTAN-WINTHROP Losartan 50MG TAB Accepted treatment
860387 MICARDIS Telmisartan 40MG TAB
860395 MICARDIS Telmisartan 80MG TAB
721133 MYCARBIS (NAMIBIA ONLY) Telmisartan 40MG TAB
721134 MYCARBIS (NAMIBIA ONLY) Telmisartan 80MG TAB
721678 TESAR Telmisartan 40MG TAB
721679 TESAR Telmisartan 80MG TAB
715569 MIGROBEN Valsartan 160MG TAB
715568 MIGROBEN Valsartan 80MG TAB
720439 MIZART Telmisartan 40MG TAB
720440 MIZART Telmisartan 80MG TAB
719210 MYLACAND Candesartan 16MG TAB
719209 MYLACAND Candesartan 8MG TAB
719506 MYLACAND PLUS 16MG/12.5MG Candesartan and diuretics 16MG/12.5MG TAB
721259 NORMOTEN Losartan 50MG TAB Accepted treatment
721260 NORMOTEN Losartan 100MG TAB Accepted treatment
714249 PRITOR Telmisartan 40MG TAB
714250 PRITOR Telmisartan 80MG TAB
717296 RASOL Losartan 100MG TAB Accepted treatment
717295 RASOL Losartan 50MG TAB Accepted treatment
715871 RENICARD Losartan 50MG TAB Accepted treatment
713254 SPEC-LOSARTAN Losartan 100MG TAB Accepted treatment
713255 SPEC-LOSARTAN Losartan 50MG TAB Accepted treatment
704696 TAREG Valsartan 160MG TAB
705060 TAREG Valsartan 80MG TAB
720592 TELGEN Telmisartan 40MG TAB
720593 TELGEN Telmisartan 80MG TAB
719851 VALANT Valsartan 160MG TAB
719849 VALANT Valsartan 40MG TAB
719850 VALANT Valsartan 80MG TAB
718364 VALSARTAN UNICORN Valsartan 160MG TAB
718363 VALSARTAN UNICORN Valsartan 80MG TAB
709225 ZARTAN Losartan 50MG TAB Accepted treatment
709964 ZARTAN Losartan 100MG TAB Accepted treatment
715556 ZOMEVEK Valsartan 160MG TAB
715555 ZOMEVEK Valsartan 80MG TAB
Angiotensin Receptor Blockers and diuretic combinations
891353 COAPROVEL Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
712386 CO-IRBEWIN Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
718571 ISART CO 150MG/12.5MG Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
898597 COAPROVEL Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
712387 CO-IRBEWIN Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
718573 ISART CO 300MG/12.5MG Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
Page 18 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
720930 CO-IRBEWIN 300MG/25MG Irbesartan and diuretics 300MG/25MG TAB Accepted treatment
723331 COZAAR COMP 100MG/12.5MG Losartan and diuretics 100MG/12.5MG TAB Accepted treatment
716613 CIPLAZAR CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
887096 FORTZAAR Losartan and diuretics 100MG/25MG TAB Accepted treatment
717084 HYTENZA CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716059 LOHYPE FORTE PLUS 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
715857 LOSAAR PLUS 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
718368 LOSARTAN CO UNICORN 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
715739 LOZAAN CO 100/25 Losartan and diuretics 100MG/25MG TAB Accepted treatment
715849 NETRASOL CO 100/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716515 SARTOC 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716217 ZARTAN CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
717070 AUSTELL LOSARTAN CO 50MG/12.5MG Losartan and diuretics 50MG/12.5 MG TAB Accepted treatment
828181 COZAAR COMP Losartan and diuretics 50MG/12.5 MG TAB Accepted treatment
716612 CIPLAZAR CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716476 HYTENZA CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716058 LOHYPE PLUS 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715856 LOSAAR PLUS 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716274 LOSACAR CO 50MG/12,5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
718367 LOSARTAN CO UNICORN 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715740 LOZAAN CO 50/12.5 Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
722549 MEDI-LOSARCO (NAMIBIA ONLY) 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715848 NETRASOL CO 50/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715064 SARTOC 50/12.5 Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716216 ZARTAN CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
714251 CO-PRITOR 40/12.5 MG Telmisartan + Hydrochlorothiazide 40MG/12.5MG TAB Accepted treatment
714252 CO-PRITOR 80/12.5MG Telmisartan + Hydrochlorothiazide 80MG/12.5MG TAB Accepted treatment
716791 CO-MICARDIS 80MG/25MG Telmisartan + Hydrochlorothiazide 80MG/25MG TAB Accepted treatment
894614 CO-MICARDIS 40/12.5MG Telmisartan + Hydrochlorothiazide 40MG/12.5MG TAB Accepted treatment
894621 CO-MICARDIS 80/12.5MG Telmisartan + Hydrochlorothiazide 80MG/12.5MG TAB Accepted treatment
715672 CO-TAREG 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
718608 DIOLO CO 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
719205 DYNAVAL CO 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
891894 CO-DIOVAN Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
719206 DYNAVAL CO 160MG/25MG Valsartan and diuretics 160MG/25MG TAB Accepted treatment
706051 CO-DIOVAN PLUS Valsartan and diuretics 160MG/25MG TAB Accepted treatment
715673 CO-TAREG PLUS Valsartan and diuretics 160MG/25MG TAB Accepted treatment
705068 CO-TAREG 80MG/12.5MG Valsartan and diuretics 80MG TAB Accepted treatment
718607 DIOLO CO 80MG/12.5MG Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
719204 DYNAVAL CO 80MG/12.5MG Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
839884 CO-DIOVAN Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
715571 CO-MIGROBEN 160MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715572 CO-MIGROBEN 160MG/25MG Valsartan and diuretics TAB Accepted treatment
715570 CO-MIGROBEN 80MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715559 CO-ZOMEVEK 160MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715558 CO-ZOMEVEK 80MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715560 CO-ZOMEVEK160MG/25MG Valsartan and diuretics TAB Accepted treatment
Beta-blockers
786586 ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment
786578 ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment
703914 ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment
703913 ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment
Page 19 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
721438 MYLAN BISOPROLOL Bisoprolol 10MG TAB Accepted treatment
721437 MYLAN BISOPROLOL Bisoprolol 5MG TAB Accepted treatment
704651 B-BLOCK Atenolol 100MG TAB Accepted treatment
704653 B-BLOCK Atenolol 50MG TAB Accepted treatment
706179 BETACOR Bisoprolol 10MG TAB Accepted treatment
706178 BETACOR Bisoprolol 5MG TAB Accepted treatment
704373 BILOCOR 10 Bisoprolol 10MG TAB Accepted treatment
704372 BILOCOR 5 Bisoprolol 5MG TAB Accepted treatment
719154 BISLO Bisoprolol 5MG TAB Accepted treatment
719155 BISLO Bisoprolol 10MG TAB Accepted treatment
720660 BISBETA Bisoprolol 10MG TAB Accepted treatment
720659 BISBETA Bisoprolol 5MG TAB Accepted treatment
704133 BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment
704132 BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment
707393 BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment
707391 BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment
716166 BISOPROLOL UNICORN Bisoprolol 10MG TAB Accepted treatment
716167 BISOPROLOL UNICORN Bisoprolol 5MG TAB Accepted treatment
720043 BISOPROLOL ZYDUS Bisoprolol 10MG TAB Accepted treatment
720044 BISOPROLOL ZYDUS Bisoprolol 5MG TAB Accepted treatment
704441 CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment
704439 CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment
704440 CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment
818437 CONCOR Bisoprolol 10MG TAB Accepted treatment
818429 CONCOR Bisoprolol 5MG TAB Accepted treatment
720821 RETOCAR Bisoprolol 10MG TAB Accepted treatment
720820 RETOCAR Bisoprolol 5MG TAB Accepted treatment
722055 BISOPROLOL UNICHEM Bisoprolol 5MG TAB Accepted treatment
722056 BISOPROLOL UNICHEM Bisoprolol 10MG TAB Accepted treatment
715626 GULF ATENOLOL Atenolol 100MG TAB Accepted treatment
715625 GULF ATENOLOL Atenolol 50MG TAB Accepted treatment
806897 HEXA-BLOK Atenolol 100MG TAB Accepted treatment
806889 HEXA-BLOK Atenolol 50MG TAB Accepted treatment
732567 INDERAL Propranolol 10MG TAB Accepted treatment
732575 INDERAL Propranolol 40MG TAB Accepted treatment
732648 INDERAL LA Propranolol 80MG CAP
806552 INDOBLOK 10 Propranolol 10MG TAB Accepted treatment
806560 INDOBLOK 40 Propranolol 40MG TAB Accepted treatment
716483 LOVISPES Nebivolol 5MG TAB
700558 NEBILET 5MG Nebivolol 5MG TAB
826901 NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment
826898 NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment
787167 PRODOROL Propranolol 10MG TAB Accepted treatment
787175 PRODOROL Propranolol 40MG TAB Accepted treatment
758140 PURBLOKA Propranolol 10MG TAB Accepted treatment
758167 PURBLOKA Propranolol 40MG APP Accepted treatment
787914 ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment
787892 ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment
828009 SOTAHEXAL Sotalol 160MG TAB
827991 SOTAHEXAL Sotalol 80MG TAB
786195 TEN-BLOKA Atenolol 100MG TAB Accepted treatment
786187 TEN-BLOKA Atenolol 50MG TAB Accepted treatment
705873 TENOPRESS Atenolol 100MG TAB Accepted treatment
Page 20 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
705872 TENOPRESS Atenolol 25MG TAB Accepted treatment
705874 TENOPRESS Atenolol 50MG TAB Accepted treatment
797693 TENORMIN Atenolol 25MG TAB
769576 TENORMIN Atenolol 100MG TAB Accepted treatment
769584 TENORMIN Atenolol 50MG TAB Accepted treatment
719657 ZETENOL Atenolol 100MG TAB Accepted treatment
719656 ZETENOL Atenolol 50MG TAB Accepted treatment
715276 ZIAPRO Bisoprolol 10MG TAB Accepted treatment
715274 ZIAPRO Bisoprolol 5MG TAB Accepted treatment
Alpha-beta blockers
710339 ASPEN CARVEDILOL Carvedilol 12.5MG TAB Accepted treatment
710340 ASPEN CARVEDILOL Carvedilol 25MG TAB Accepted treatment
710338 ASPEN CARVEDILOL Carvedilol 6.25MG TAB Accepted treatment
897117 CARLOC Carvedilol 25MG TAB Accepted treatment
705459 CARLOC 6.25 Carvedilol 6.25MG TAB Accepted treatment
700168 CARLOC 12.5 Carvedilol 12.5MG TAB Accepted treatment
705770 CARVEDILOL-HEXAL Carvedilol 12.5MG TAB Accepted treatment
705767 CARVEDILOL-HEXAL Carvedilol 25MG TAB Accepted treatment
705749 CARVEDILOL-HEXAL Carvedilol 6.25MG TAB Accepted treatment
716743 CARVEDILOL UNICORN Carvedilol 12.5MG TAB Accepted treatment
716744 CARVEDILOL UNICORN Carvedilol 25MG TAB Accepted treatment
716742 CARVEDILOL UNICORN Carvedilol 6.25MG TAB Accepted treatment
704671 CARVETREND 12.5MG Carvedilol 12.5MG TAB Accepted treatment
704672 CARVETREND 25MG Carvedilol 25MG TAB Accepted treatment
704670 CARVETREND 6.25MG Carvedilol 6.25MG TAB Accepted treatment
836354 DILATREND Carvedilol 12.5MG TAB Accepted treatment
788856 DILATREND Carvedilol 25MG TAB Accepted treatment
833428 DILATREND Carvedilol 6.25MG TAB Accepted treatment
710959 VEDIBLOK Carvedilol 12.5MG TAB Accepted treatment
710960 VEDIBLOK Carvedilol 25MG TAB Accepted treatment
710958 VEDIBLOK Carvedilol 6.25MG TAB Accepted treatment
Beta-blocker and diuretic combinations
719202 BILOCOR CO 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
719200 BILOCOR CO 2.5MG/6.25MG Bisoprolol and thiazides 2.5MG/6.25MG TAB
719201 BILOCOR CO 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
718087 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 10MG Bisoprolol and thiazides 10MG/6.25MG TAB
718082 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 2.5MG Bisoprolol and thiazides 2.5MG/6.25MG TAB
718086 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 5MG Bisoprolol and thiazides 5MG/6.25MG TAB
789615 ROLAB-ATENOLOL/CHLORTHALIDONE 100/25 Atenolol and other diuretics 100MG/25MG TAB Accepted treatment
789607 ROLAB-ATENOLOL/CHLORTHALIDONE 50/12.5 Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment
786217 TENCHLOR Atenolol and other diuretics 100MG/25MG TAB Accepted treatment
807591 TENCHLOR HS Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment
852929 ZIAK Bisoprolol and thiazides 10MG/6.25MG TAB
840300 ZIAK Bisoprolol and thiazides 2.5MG/6.25MG TAB
840319 ZIAK Bisoprolol and thiazides 5MG/6.25MG TAB
721589 BISOPROLOL CO UNICORN 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
721588 BISOPROLOL CO UNICORN 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
717988 ZIRINAK CO 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
717986 ZIRINAK CO 2.5MG/6.25MG Bisoprolol and thiazides 2.5MG/6.25MG TAB
717987 ZIRINAK CO 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
720033 ZIABETA 10/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
720031 ZIABETA 2.5/6.25MG Bisoprolol and thiazides 6.25MG/2.5MG TAB
720032 ZIABETA 5/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
Page 21 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Cardiac glycosides
735752 LANOXIN Digoxin 0.25MG TAB Accepted treatment
735744 LANOXIN PAED Digoxin 0.05MG/1ML SYR Accepted treatment
735760 LANOXIN PAED Digoxin 0.063MG TAB Accepted treatment
758280 PURGOXIN Digoxin 0.25MG TAB Accepted treatment
Chronic Renal Disease
For diuretics and antihypertensives, refer to "Hypertension"
Calcium
828289 B-CAL Calcium products > 300MG CHU Accepted treatment
703359 ENO TUMS ASSORTED FRUIT FLAVOURS Calcium carbonate 500MG CHU Accepted treatment
703364 ENO TUMS ORANGE FLAVOUR ROLLPAC Calcium carbonate 500MG CHU Accepted treatment
703361 ENO TUMS PEPPERMINT FLAVOUR ROLLPAC Calcium carbonate 500MG CHU Accepted treatment
718735 PHOSPHOSORB 660 Calcium acetate anhydrous 660MG TAB Accepted treatment
Vitamin D
711640 CALCIFEROL Ergocalciferol 50000IU TAB Accepted treatment
711853 CALCIFEROL OILY 15ML Ergocalciferol 5000U/1ML APP Accepted treatment
750654 ONE ALPHA (014050) Alfacalcidol 0.25MCG CAP Accepted treatment
750662 ONE ALPHA (014052) Alfacalcidol 1MCG CAP Accepted treatment
380380 ONE ALPHA DROPS 20ML Alfacalcidol DRP Accepted treatment
761249 ROCALTROL Calcitriol 0.25MCG CAP Accepted treatment
Oral Iron and Folic Acid supplementation
756571 PREGAMAL Ferrous fumarate and folic acid 200MG/100MCG TAB
705532 AHA FERROUS SULPHATE Ferrous sulfate 30MG TAB Accepted treatment
713558 BODY BALANCE FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment
710580 EGOLI FERROUS SULPHATE Ferrous sulfate 30MG TAB Accepted treatment
723814 FERROUS SULPHATE Ferrous sulfate 100MG TAB Accepted treatment
877832 FERROUS SULPHATE Ferrous sulfate 30MG TAB Accepted treatment
723552 FERROUS SULPHATE Ferrous sulfate 30MG TAB Accepted treatment
723553 FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment
721690 FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment
710372 FERROUS SULPHATE Ferrous sulfate 75MG TAB Accepted treatment
897329 GULF FERROUS SULPHATE COMPOUND Ferrous sulfate TAB Accepted treatment
768596 SYR FERRI PHOS CO Ferrous sulfate LIQ Accepted treatment
705531 AHA FOLIC ACID Folic acid 0.5MG TAB Accepted treatment
709874 AHA FOLIC ACID Folic acid 5MG TAB Accepted treatment
721366 FOLIC ACID Folic acid 0.5MG TAB Accepted treatment
871281 FOLIC ACID Folic acid .5MG TAB Accepted treatment
711922 FOLIC ACID Folic acid 5MG TAB Accepted treatment
721661 FOLIK Folic acid .5MG TAB Accepted treatment
720727 GULF FOLIC ACID Folic acid 5MG TAB Accepted treatment
727024 FOLIGLOBIN Iron vitamin B12 and folic acid TAB
Parenteral Iron Preparations
711596 COSMOFER AMPOULE 2ML Ferric oxide dextran complex 50MG/1ML INJ Clinical motivation
713080 COSMOFER AMPOULE 10ML Iron, parenteral preparations 50MG/1ML INJ Clinical motivation
722191 MONOFER VIAL 1ML Iron, parenteral preparations 100MG/1ML INJ Clinical motivation
722193 MONOFER VIAL 10ML Iron, parenteral preparations 1000MG/10ML INJ Clinical motivation
722192 MONOFER VIAL 5ML Iron, parenteral preparations 500MG/5ML INJ Clinical motivation
725943 FERRIMED 2ML Iron, parenteral preparations 50MG/1ML INJ Clinical motivation
720333 SUCROFER 5ML Iron, parenteral preparations 20MG/1ML INJ Clinical motivation
873276 VENOFER 5X5ML AMP Iron, parenteral preparations AMP Clinical motivation
720231 ZYPIRON 5ML VIAL Iron, parenteral preparations 20MG/1ML INJ Clinical motivation
717447 EQUIFER AMPOULE 5ML Iron, parenteral preparations 100MG/5ML INJ Clinical motivation
Page 22 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
719989 RAUTEVENE SOLUTION FOR INJECTION AMPOULE Iron, parenteral preparations 100MG/5ML INJ Clinical motivation
720107 FERINJECT VIAL 10ML SOLUTION FOR INJECTI Iron, parenteral preparations 50MG/1ML INJ Clinical motivation
721475 ENCIFER (NAMIBIA ONLY) 5ML AMPOULE Iron, parenteral preparations 100MG/5ML INJ Clinical motivation
Erythropoietin
714021 ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 150MCG/.3ML INJ Specialist motivation
714019 ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 30MCG/.3ML INJ Specialist motivation
714020 ARANESP PREFILLED SYRINGE 0.3ML Darbepoetin alfa 60MCG/.3ML INJ Specialist motivation
714017 ARANESP PREFILLED SYRINGE 0.4ML Darbepoetin alfa 10MCG/.4ML INJ Specialist motivation
714018 ARANESP PREFILLED SYRINGE 0.5ML Darbepoetin alfa 20MCG/.5ML INJ Specialist motivation
714022 ARANESP PREFILLED SYRINGE 0.6ML Darbepoetin alfa 300MCG/.6ML INJ Specialist motivation
715971 ARANESP PREFILLED SYRINGE 0.4ML darbepoetin alfa 40MCG/.4ML INJ Specialist motivation
715974 ARANESP PREFILLED SYRINGE 0.4ML darbepoetin alfa 80MCG/.4ML INJ Specialist motivation
715975 ARANESP PREFILLED SYRINGE 0.5ML darbepoetin alfa 100MCG/.5ML INJ Specialist motivation
715973 ARANESP PREFILLED SYRINGE 0.5ML darbepoetin alfa 50MCG/.5ML INJ Specialist motivation
839876 EPREX PREFILLED Erythropoietin 10000U/1ML INJ Specialist motivation
837318 EPREX PREFILLED Erythropoietin 2000U/.5ML INJ Specialist motivation
820741 EPREX PREFILLED Erythropoietin 4000U/.4ML INJ Specialist motivation
705487 EPREX PREFILLED Erythropoietin 40000U/1ML INJ Specialist motivation
712391 EPREX PREFILLED SYRINGE 0.6ML Erythropoietin 6000U/.6ML INJ Specialist motivation
712564 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 100MCG/.3ML INJ Specialist motivation
712565 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 150MCG/.3ML INJ Specialist motivation
712567 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 200MCG/.3ML INJ Specialist motivation
712568 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 250MCG/.3ML INJ Specialist motivation
712562 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 50MCG/.3ML INJ Specialist motivation
712563 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 75MCG/.3ML INJ Specialist motivation
717045 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 120MCG/.3ML INJ Specialist motivation
717044 MIRCERA PREFILLED SYRINGE 0.3ML Methoxy polyethylene glycol-epoetin beta 30MCG/.3ML INJ Specialist motivation
717046 MIRCERA PREFILLED SYRINGE 0.6ML Methoxy polyethylene glycol-epoetin beta 360MCG/.6ML INJ Specialist motivation
839264 REPOTIN AMP 1ML Erythropoietin 2000U/1ML INJ Specialist motivation
839272 REPOTIN AMP 1ML Erythropoietin 4000U/1ML INJ Specialist motivation
705261 RECORMON 10000 PRE-FILLED SYR Erythropoietin 10000IU INJ Specialist motivation
705751 RECORMON 30000 PRE-FILLED SYR Erythropoietin 30000IU INJ Specialist motivation
704631 RECORMON 4000 IU/0.3ML Erythropoietin 4000IU/0.3ML INJ Specialist motivation
704632 RECORMON 500 IU/0.3ML Erythropoietin 500IU/0.3ML INJ Specialist motivation
704630 RECORMON 6000 PRE-FILLED SYR Erythropoietin 6000IU INJ Specialist motivation
Coronary Artery Disease
Aspirin
704645 ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
798533 ASPIRIN (WHITE) Acetylsalicylic acid 300MG TAB Accepted treatment
706930 BAYER ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
862304 BAYER ASPIRIN CARDIO Acetylsalicylic acid 100MG TAB Accepted treatment
847283 DISPRIN CV Acetylsalicylic acid 100MG EEF Accepted treatment
807206 DISPRIN CV Acetylsalicylic acid 300MG EEF Accepted treatment
720577 DISPRIN REGULAR Acetylsalicylic acid 300MG EEF Accepted treatment
719673 DR DU TOITS PAIN EXPELLER Acetylsalicylic acid 300MG TAB Accepted treatment
823481 ECOTRIN Acetylsalicylic acid 81MG ECT Accepted treatment
700909 GULF ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
815160 LO-ASPIRIN (CAPRIN) Acetylsalicylic acid 125MG TAB Accepted treatment
721258 MYOPRIN Acetylsalicylic acid 100MG TAB Accepted treatment
845590 MYOPRIN Acetylsalicylic acid 100MG EEF Accepted treatment
712608 PCH ACETYLSALICYLIC ACID CARDIO Acetylsalicylic acid 80MG DSP Accepted treatment
722806 SOLUSPRIN CV Acetylsalicylic acid 100MG DSP Accepted treatment
Page 23 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Nitrates
703605 ANGISED Glyceryl trinitrate 0.5MG TAB Accepted treatment
793418 ELANTAN Isosorbide mononitrate 20MG TAB Accepted treatment
860115 ELANTAN LA Isosorbide mononitrate 50MG CAP Accepted treatment
821500 IMDUR Isosorbide mononitrate 60MG SRT Accepted treatment
734055 ISMO 20 Isosorbide mononitrate 20MG TAB Accepted treatment
734381 ISORDIL Isosorbide dinitrate 10MG TAB Accepted treatment
734403 ISORDIL Isosorbide dinitrate 30MG TAB Accepted treatment
734411 ISORDIL SUBLINGUAL Isosorbide dinitrate 5MG TAB Accepted treatment
734438 ISORDIL TEMBID Isosorbide dinitrate 40MG TAB Accepted treatment
710251 MONICOR SR Isosorbide mononitrate 60MG TAB Accepted treatment
784206 ROLAB-ISOSORBIDE DINITRATE Isosorbide dinitrate 10MG TAB Accepted treatment
784214 ROLAB-ISOSORBIDE DINITRATE Isosorbide dinitrate 30MG TAB Accepted treatment
784192 ROLAB-ISOSORBIDE DINITRATE SUBL Isosorbide dinitrate 5MG TAB Accepted treatment
Beta-blockers
786586 ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment
786578 ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment
703914 ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment
703913 ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment
721438 MYLAN BISOPROLOL Bisoprolol 10MG TAB Accepted treatment
721437 MYLAN BISOPROLOL Bisoprolol 5MG TAB Accepted treatment
721589 BISOPROLOL CO UNICORN 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB Accepted treatment
721588 BISOPROLOL CO UNICORN 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB Accepted treatment
704651 B-BLOCK Atenolol 100MG TAB Accepted treatment
704653 B-BLOCK Atenolol 50MG TAB Accepted treatment
706179 BETACOR Bisoprolol 10MG TAB Accepted treatment
706178 BETACOR Bisoprolol 5MG TAB Accepted treatment
704373 BILOCOR 10 Bisoprolol 10MG TAB Accepted treatment
704372 BILOCOR 5 Bisoprolol 5MG TAB Accepted treatment
719154 BISLO Bisoprolol 5MG TAB Accepted treatment
719155 BISLO Bisoprolol 10MG TAB Accepted treatment
720660 BISBETA Bisoprolol 10MG TAB Accepted treatment
720659 BISBETA Bisoprolol 5MG TAB Accepted treatment
704133 BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment
704132 BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment
707393 BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment
707391 BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment
716166 BISOPROLOL UNICORN Bisoprolol 10MG TAB Accepted treatment
716167 BISOPROLOL UNICORN Bisoprolol 5MG TAB Accepted treatment
720043 BISOPROLOL ZYDUS Bisoprolol 10MG TAB Accepted treatment
720044 BISOPROLOL ZYDUS Bisoprolol 5MG TAB Accepted treatment
704441 CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment
704439 CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment
704440 CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment
818437 CONCOR Bisoprolol 10MG TAB Accepted treatment
818429 CONCOR Bisoprolol 5MG TAB Accepted treatment
720821 RETOCAR Bisoprolol 10MG TAB Accepted treatment
720820 RETOCAR Bisoprolol 5MG TAB Accepted treatment
722055 BISOPROLOL UNICHEM Bisoprolol 5MG TAB Accepted treatment
722056 BISOPROLOL UNICHEM Bisoprolol 10MG TAB Accepted treatment
715626 GULF ATENOLOL Atenolol 100MG TAB Accepted treatment
715625 GULF ATENOLOL Atenolol 50MG TAB Accepted treatment
806897 HEXA-BLOK Atenolol 100MG TAB Accepted treatment
Page 24 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
806889 HEXA-BLOK Atenolol 50MG TAB Accepted treatment
732567 INDERAL Propranolol 10MG TAB Accepted treatment
732575 INDERAL Propranolol 40MG TAB Accepted treatment
732648 INDERAL LA Propranolol 80MG CAP
806552 INDOBLOK 10 Propranolol 10MG TAB Accepted treatment
806560 INDOBLOK 40 Propranolol 40MG TAB Accepted treatment
716483 LOVISPES Nebivolol 5MG TAB
700558 NEBILET 5MG Nebivolol 5MG TAB
826901 NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment
826898 NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment
787167 PRODOROL Propranolol 10MG TAB Accepted treatment
787175 PRODOROL Propranolol 40MG TAB Accepted treatment
758140 PURBLOKA Propranolol 10MG TAB Accepted treatment
758167 PURBLOKA Propranolol 40MG APP Accepted treatment
787914 ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment
787892 ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment
786195 TEN-BLOKA Atenolol 100MG TAB Accepted treatment
786187 TEN-BLOKA Atenolol 50MG TAB Accepted treatment
705873 TENOPRESS Atenolol 100MG TAB Accepted treatment
705872 TENOPRESS Atenolol 25MG TAB Accepted treatment
705874 TENOPRESS Atenolol 50MG TAB Accepted treatment
797693 TENORMIN Atenolol 25MG TAB
769576 TENORMIN Atenolol 100MG TAB Accepted treatment
769584 TENORMIN Atenolol 50MG TAB Accepted treatment
719657 ZETENOL Atenolol 100MG TAB Accepted treatment
719656 ZETENOL Atenolol 50MG TAB Accepted treatment
715276 ZIAPRO Bisoprolol 10MG TAB Accepted treatment
715274 ZIAPRO Bisoprolol 5MG TAB Accepted treatment
Alpha-Beta blockers
710339 ASPEN CARVEDILOL Carvedilol 12.5MG TAB
710340 ASPEN CARVEDILOL Carvedilol 25MG TAB
710338 ASPEN CARVEDILOL Carvedilol 6.25MG TAB
897117 CARLOC Carvedilol 25MG TAB
705459 CARLOC 6.25 Carvedilol 6.25MG TAB
700168 CARLOC 12.5 Carvedilol 12.5MG TAB
705770 CARVEDILOL-HEXAL Carvedilol 12.5MG TAB
705767 CARVEDILOL-HEXAL Carvedilol 25MG TAB
705749 CARVEDILOL-HEXAL Carvedilol 6.25MG TAB
716743 CARVEDILOL UNICORN Carvedilol 12.5MG TAB
716744 CARVEDILOL UNICORN Carvedilol 25MG TAB
716742 CARVEDILOL UNICORN Carvedilol 6.25MG TAB
704671 CARVETREND 12.5MG Carvedilol 12.5MG TAB
704672 CARVETREND 25MG Carvedilol 25MG TAB
704670 CARVETREND 6.25MG Carvedilol 6.25MG TAB
836354 DILATREND Carvedilol 12.5MG TAB
788856 DILATREND Carvedilol 25MG APP
833428 DILATREND Carvedilol 6.25MG TAB
710959 VEDIBLOK Carvedilol 12.5MG TAB
710960 VEDIBLOK Carvedilol 25MG TAB
710958 VEDIBLOK Carvedilol 6.25MG TAB
Calcium channel antagonists
720694 ADCO NORPENE Amlodipine 10MG TAB Accepted treatment
720693 ADCO NORPENE Amlodipine 5MG TAB Accepted treatment
Page 25 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
708142 ALMADIN Amlodipine 10MG TAB Accepted treatment
708141 ALMADIN Amlodipine 5MG TAB Accepted treatment
707278 AMLATE Amlodipine 10MG TAB Accepted treatment
707277 AMLATE Amlodipine 5MG TAB Accepted treatment
703917 AMLOC 10 Amlodipine 10MG TAB Accepted treatment
703916 AMLOC 5 Amlodipine 5MG TAB Accepted treatment
708051 AMLODAC Amlodipine 10MG TAB Accepted treatment
708050 AMLODAC Amlodipine 5MG TAB Accepted treatment
704621 AMLOSYN 10 Amlodipine 10MG TAB Accepted treatment
704620 AMLOSYN 5 Amlodipine 5MG TAB Accepted treatment
713972 AMTAS Amlodipine 10MG TAB Accepted treatment
713971 AMTAS Amlodipine 5MG TAB Accepted treatment
714311 AURO-AMLODIPINE Amlodipine 10MG TAB Accepted treatment
714310 AURO-AMLODIPINE Amlodipine 5MG TAB Accepted treatment
708095 AUSTELL-AMLODIPINE Amlodipine 10MG TAB Accepted treatment
708094 AUSTELL-AMLODIPINE Amlodipine 5MG TAB Accepted treatment
708040 CALBLOC Amlodipine 10MG TAB Accepted treatment
708039 CALBLOC Amlodipine 5MG TAB Accepted treatment
708152 CIPLAVASC Amlodipine 10MG TAB Accepted treatment
708150 CIPLAVASC Amlodipine 5MG TAB Accepted treatment
707980 CORVADIL Amlodipine 10MG TAB Accepted treatment
707979 CORVADIL Amlodipine 5MG TAB Accepted treatment
708191 CPL ALLIANCE AMLODIPINE Amlodipine 10MG TAB Accepted treatment
708190 CPL ALLIANCE AMLODIPINE Amlodipine 5MG TAB Accepted treatment
712954 GULF AMLODIPINE Amlodipine 10MG TAB Accepted treatment
712953 GULF AMLODIPINE Amlodipine 5MG TAB Accepted treatment
708648 INDO AMLODIPINE Amlodipine 5MG TAB Accepted treatment
712216 KEYSAL Amlodipine 10MG TAB Accepted treatment
712215 KEYSAL Amlodipine 5MG TAB Accepted treatment
708162 KLODIP Amlodipine 5MG TAB Accepted treatment
708352 LOMANOR Amlodipine 5MG TAB Accepted treatment
708353 LOMANOR Amlodipine 10MG TAB Accepted treatment
799122 NORVASC Amlodipine 10MG TAB Accepted treatment
791245 NORVASC Amlodipine 5MG TAB Accepted treatment
710238 PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 10MG TAB Accepted treatment
710236 PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 5MG TAB Accepted treatment
713491 STAMLO Amlodipine 10MG TAB Accepted treatment
713490 STAMLO Amlodipine 5MG TAB Accepted treatment
813125 TILAZEM 180 CR Diltiazem 180MG SRC Accepted treatment
813133 TILAZEM 240 CR Diltiazem 240MG SRC Accepted treatment
839183 ZILDEM Diltiazem 180MG SRC Accepted treatment
839191 ZILDEM Diltiazem 240MG SRC Accepted treatment
822213 ZILDEM 60 Diltiazem 60MG TAB Accepted treatment
824364 ZILDEM 90 BD Diltiazem 90MG TAB
703902 FELODIPINE HEXAL Felodipine 10MG SRT Accepted treatment
703221 FELODIPINE HEXAL Felodipine 5MG SRT Accepted treatment
813982 PLENDIL Felodipine 10MG SRT
805548 PLENDIL Felodipine 5MG SRT
821896 PLENDIL Felodipine 2.5MG SRT
793124 ADALAT XL Nifedipine 30MG SRT Accepted treatment
840963 ADCO-VASCARD SR Nifedipine 20MG SRC Accepted treatment
718083 BIO NIFEDIPINE XL Nifedipine 30MG SRT Accepted treatment
864153 CIPALAT RETARD Nifedipine 20MG TAB Accepted treatment
Page 26 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
723283 CIPALAT XR Nifedipine 30MG SRT Accepted treatment
711682 FEDALOC SR Nifedipine 30MG TAB Accepted treatment
719449 GITSALAT Nifedipine 30MG TAB Accepted treatment
715000 MACOREL SR Nifedipine 30MG SRT Accepted treatment
829501 NIFEDALAT 20 SR Nifedipine 20MG SRT Accepted treatment
715002 SPEC NIFEDIPINE SR Nifedipine 30MG SRT Accepted treatment
861545 VASCARD SR Nifedipine 30MG CAP Accepted treatment
813354 CALCICARD SR Verapamil 240MG SRT Accepted treatment
734071 ISOPTIN DRAGEES Verapamil 40MG TAB Accepted treatment
734373 ISOPTIN SR Verapamil 240MG SRT Accepted treatment
819573 RAVAMIL SR Verapamil 240MG SRT Accepted treatment
774944 VASOMIL Verapamil 40MG TAB Accepted treatment
774952 VASOMIL Verapamil 80MG TAB Accepted treatment
700071 VERAHEXAL 240 SR Verapamil 240MG SRT Accepted treatment
Crohn's Disease
Aminosalicylic acid preparations
783668 ASACOL Mesalazine 400MG TAB
709076 ASACOL Mesalazine 800MG TAB
792519 DIPENTUM Olsalazine 250MG CAP
720355 MEZAVANT Mesalazine 1200MG ERT
890775 PENTASA Mesalazine 500MG TAB
762008 SALAZOPYRIN Sulfasalazine 500MG TAB Accepted treatment
762016 SALAZOPYRIN E.N. Sulfasalazine 500MG ECT Accepted treatment
716333 SALOFALK Mesalazine 1000MG SAC
Immunosuppressants
701252 AZAMUN Azathioprine 50MG TAB Accepted treatment
706108 AZAPRESS Azathioprine 50MG TAB Accepted treatment
712609 AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment
732524 IMURAN Azathioprine 50MG TAB
700777 ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment
Methotrexate
782556 ABITREXATE-20ML Methotrexate 500MG/20ML INJ Accepted treatment
782548 ABITREXATE-2ML Methotrexate 50MG INJ Accepted treatment
712504 EMTHEXATE Methotrexate 2.5MG TAB Accepted treatment
825557 EMTHEXATE RTU 500-20 20ML Methotrexate 25MG/1ML INJ Accepted treatment
711328 METACHOR VIAL 2ML Methotrexate 25MG/1ML INJ Accepted treatment
840815 METHOTREXATE CSV 2ML (P&U) Methotrexate 50MG/2ML INJ Accepted treatment
840807 METHOTREXATE CSV 20ML (P&U) Methotrexate 500MG/20ML INJ Accepted treatment
742465 METHOTREXATE Methotrexate 2.5MG TAB Accepted treatment
Steroid preparations (oral)
814407 CAPSOID Prednisolone 5MG TAB Accepted treatment
716693 COVOCORT Hydrocortisone 10MG TAB
800155 LENISOLONE Prednisolone 5MG TAB Accepted treatment
741124 MEDROL Methylprednisone 16MG TAB
741116 MEDROL Methylprednisone 4MG TAB
742759 METICORTEN Prednisone 50MG TAB
742732 METICORTEN Prednisone 5MG TAB
752304 PANAFCORT Prednisone 5MG TAB Accepted treatment
788783 PREDNISONE (BE-TABS) Prednisone 5mg TAB Accepted treatment
703720 PRELONE Prednisolone 5MG TAB
836826 PULMISON TABS Prednisone 20MG TAB
818267 TROLIC Prednisone 5MG TAB Accepted treatment
Page 27 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Steroid preparations (enemas)
824593 ENTOCORD ENEMAS Budesonide 2.3MG ENE Accepted treatment
Diabetes Mellitus Type 1
Insulin
702086 INSU NOVOMIX 30 FLEXPEN 3ML Combinations INJD Accepted treatment
702089 INSU NOVOMIX 30 PENFILL 3ML Combinations INJD Accepted treatment
863572 INSU HUMULIN 30/70 3ML Insulin (human) INJD Accepted treatment
863556 INSU HUMULIN N 3.0ML CART 5 Insulin (human) INJD Accepted treatment
863564 INSU HUMULIN R 3.0ML CARTRIDGE Insulin (human) INJD Accepted treatment
733512 INSU ACTRAPH HMGE 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
816213 INSU ACTRAPH HMGE PENSET 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
714977 INSU ACTRAPHANE HM (GE) FLEXPEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
704457 HUMULIN R DISPOSABLE PEN 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712767 INSU BIOSULIN R CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712769 INSU BIOSULIN L CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712768 INSU BIOSULIN N CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712770 INSU BIOSULIN 30-70 CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
783811 INSU HUMULIN 30/70 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
704456 INSU HUMULIN 30/70 PEN 3ML DISP Insulin (human) 100IU/1ML INJD Accepted treatment
733458 INSU HUMULIN N 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
853453 INSU HUMULIN N PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
733431 INSU HUMULIN R 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
710299 INSU INSUMAN COMB 30/70 PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
733482 INSU PROTAPH HMGE 10 ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
700183 INSU PROTAPH FLEXPEN 3ML Insulin (human) 100IU/1ML INJD
897767 INSU NOVORAPID FLEXPEN 3ML PENS Insulin aspart INJD Accepted treatment
707927 INSU NOVORAPID 10ML Insulin aspart 100IU/1ML INJ Accepted treatment
897775 INSU NOVORAPID 3ML SOLUTION FOR I Insulin aspart 100U INJD Accepted treatment
705312 INSU LEVEMIR 3ML FLEXPEN PREFILLED Insulin detemir 100MG/1ML INJ Accepted treatment
705313 INSU LEVEMIR 3ML PREFILLED CARTRIDGE Insulin detemir 100MG/1ML INJ Accepted treatment
723474 OPTISULIN CARTRIDGE 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
700308 INSU LANTUS CARTRIDGE 3ML Insulin glargine INJD Accepted treatment
721502 OPTISULIN PEN 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
709860 INSU LANTUS SOLOSTAR DISPOSABLE PENS 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
722456 BASAGLAR CARTRIDGE 3ML Insulin glargine 100U/1ML INJ Accepted treatment
722454 BASAGLAR PRE-FILLED PEN 3ML Insulin glargine 100U/1ML INJ Accepted treatment
706039 INSU APIDRA CARTIDGES Insulin glulisine 100IU/1ML INJD Accepted treatment
706040 INSU APIDRA Insulin glulisine 100IU/1ML INJD Accepted treatment
709861 INSU APIDRA SOLOSTAR DISPOSABLE PENS 3ML Insulin glulisine 100IU/1ML INJD Accepted treatment
862355 INSU HUMALOG INJ 3.0ML CART Insulin lispro INJD Accepted treatment
861782 INSU HUMALOG MIX 25 CART 3ML Insulin lispro INJD Accepted treatment
819468 INSU HUMALOG Insulin lispro 100IU/1ML INJD Accepted treatment
853437 INSU HUMALOG MIX 25 10ML VIAL Insulin lispro 100IU/1ML INJD Accepted treatment
853461 INSU HUMALOG MIX 25 PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment
853445 INSU HUMALOG PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment
705074 INSU HUMALOG MIX 50 CART Insulin lispro 3ML INJD Accepted treatment
706761 INSU MIRIO PEN HUMALOG MIX 25 Insulin lispro INJD Accepted treatment
706762 INSU MIRIO PEN HUMALOG MIX 50 Insulin lispro INJD Accepted treatment
706760 INSU MIRIO PEN HUMALOG Insulin lispro INJD Accepted treatment
Applicances
Diabetic strips, needles and lancets Accepted treatment
Page 28 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Diabetes Mellitus Type 2
Biguanides
714427 ACCORD METFORMIN Metformin 500MG TAB Accepted treatment
714426 ACCORD METFORMIN Metformin 850MG TAB Accepted treatment
707670 APEX-METFORMIN Metformin 500MG TAB Accepted treatment
707669 APEX-METFORMIN FORTE Metformin 850MG TAB Accepted treatment
706672 ARROW METFORMIN Metformin 500MG TAB Accepted treatment
706673 ARROW METFORMIN Metformin 850MG TAB Accepted treatment
714683 AURO-METFORMIN Metformin 1000MG TAB Accepted treatment
714680 AURO-METFORMIN Metformin 500MG TAB Accepted treatment
714681 AURO-METFORMIN Metformin 850MG TAB Accepted treatment
705757 AUSTELL-METFORMIN 500MG Metformin 500MG TAB Accepted treatment
705758 AUSTELL-METFORMIN 850MG Metformin 850MG TAB Accepted treatment
708281 BIGSENS Metformin 500MG TAB Accepted treatment
708282 BIGSENS Metformin 850MG TAB Accepted treatment
709172 BIGSENS Metformin 1000MG TAB Accepted treatment
705358 DIABETMIN Metformin 850MG TAB Accepted treatment
719786 DIAPHAGE Metformin 1000MG TAB Accepted treatment
719784 DIAPHAGE Metformin 500MG TAB Accepted treatment
719785 DIAPHAGE Metformin 850MG TAB Accepted treatment
715936 DIAFORMIN Metformin 500MG TAB Accepted treatment
715937 DIAFORMIN FORTE Metformin 850MG TAB Accepted treatment
714186 DIAMIN Metformin 500MG TAB Accepted treatment
714187 DIAMIN Metformin 850MG TAB Accepted treatment
708009 FORMINAL Metformin 500MG TAB Accepted treatment
708010 FORMINAL Metformin 850MG TAB Accepted treatment
714525 GLUCONORM Metformin 500MG TAB Accepted treatment
714526 GLUCONORM Metformin 850MG TAB Accepted treatment
729159 GLUCOPHAGE Metformin 500MG TAB Accepted treatment
703909 GLUCOPHAGE Metformin 1000MG TAB Accepted treatment
729167 GLUCOPHAGE FORTE Metformin 850MG TAB Accepted treatment
710196 GLUCOPHAGE XR Metformin 500MG SRT Accepted treatment
720925 GLUCOPHAGE XR Metformin 750MG SRT Accepted treatment
720926 GLUCOPHAGE XR Metformin 1000MG SRT Accepted treatment
709338 INDO METFORMIN FC Metformin 500MG TAB Accepted treatment
709339 INDO METFORMIN FC Metformin 850MG TAB Accepted treatment
718828 METFORMIN ALKEM Metformin 500MG TAB Accepted treatment
718827 METFORMIN ALKEM Metformin 850MG TAB Accepted treatment
897957 MYLAN-METFORMIN Metformin 500MG TAB Accepted treatment
897957 MYLAN-METFORMIN Metformin 850MG TAB Accepted treatment
721443 MYLAN METFORMIN Metformin 1000MG TAB Accepted treatment
718231 METCHEK Metformin 500MG TAB Accepted treatment
718232 METCHEK Metformin 850MG TAB Accepted treatment
702385 METFORAL 500 Metformin 500MG TAB Accepted treatment
702363 METFORAL 850 Metformin 850MG TAB Accepted treatment
711773 METORED Metformin 1000MG TAB Accepted treatment
711636 METORED Metformin 500MG TAB Accepted treatment
711638 METORED Metformin 850MG TAB Accepted treatment
709246 METPHAGE Metformin 500MG TAB Accepted treatment
709247 METPHAGE Metformin 850MG TAB Accepted treatment
719285 ROLAB-METFORMIN HCL Metformin 500MG TAB Accepted treatment
719293 ROLAB-METFORMIN HCL Metformin 850MG TAB Accepted treatment
815225 ROLAB-METFORMIN HCL 500 FC Metformin 500MG TAB Accepted treatment
Page 29 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
815233 ROLAB-METFORMIN HCL 850 FC Metformin 850MG TAB Accepted treatment
719645 ROMIDAB Metformin 1000MG TAB Accepted treatment
719644 ROMIDAB Metformin 850MG TAB Accepted treatment
719643 ROMIDAB Metformin 500MG TAB Accepted treatment
Sulphonylureas
716714 ACCORD GLIMEPIRIDE Glimepiride 1MG TAB
716715 ACCORD GLIMEPIRIDE Glimepiride 2MG TAB
707587 ALEMBIC GLICLAZIDE Gliclazide 80MG TAB Accepted treatment
709538 ARROW GLICLAZIDE Gliclazide 80MG TAB Accepted treatment
831557 AMARYL Glimepiride 1MG TAB
831565 AMARYL Glimepiride 2MG TAB
714854 ASPEN GLIMEPIRIDE Glimepiride 1MG TAB
714855 ASPEN GLIMEPIRIDE Glimepiride 2MG TAB
705759 AUSTELL-GLICLAZIDE Gliclazide 40MG TAB Accepted treatment
705760 AUSTELL-GLICLAZIDE Gliclazide 80MG TAB Accepted treatment
717076 AUSTELL GLIMEPIRIDE Glimepiride 1MG TAB
717077 AUSTELL GLIMEPIRIDE Glimepiride 2MG TAB
717452 DAONIL Glibenclamide 5MG TAB Accepted treatment
894502 DIACARE Glibenclamide 5MG TAB Accepted treatment
868906 DIAGLUCIDE Gliclazide 80MG TAB Accepted treatment
720665 DIAGLUMED Gliclazide 80MG TAB Accepted treatment
714582 DIAGLUCIDE MR Gliclazide 30MG TAB
718247 DIAGLUCIDE MR Gliclazide 60MG SRT
702923 DIAMICRON MR Gliclazide 30MG TAB
718245 DIAMICRON MR Gliclazide 60MG SRT
714909 DIARAN MR Gliclazide 30MG SRT
716953 DYNA GLICLAZIDE SR Gliclazide 30MG SRT
721692 GLICLAZIDE UNICORN MR Gliclazide 30MG SRT
710207 EUGLIM Glimepiride 1MG TAB
710208 EUGLIM Glimepiride 2MG TAB
704362 GLAMARYL 1MG Glimepiride 1MG TAB
704363 GLAMARYL 2MG Glimepiride 2MG TAB
834599 GLUCOMED Gliclazide 80MG TAB Accepted treatment
729361 GLYCOMIN Glibenclamide 5MG TAB Accepted treatment
838209 GLYCRON Gliclazide 80MG TAB Accepted treatment
700717 GLYGARD Gliclazide 80MG TAB Accepted treatment
700639 MYLAN-GLICLAZIDE Gliclazide 80MG TAB Accepted treatment
709984 MYLAN-GLIMEPIRIDE Glimepiride 1MG TAB
709985 MYLAN-GLIMEPIRIDE Glimepiride 2MG TAB
827053 NORTON-GLIBENCLAMIDE Glibenclamide 5MG TAB Accepted treatment
781258 ROLAB-GLIBENCLAMIDE Glibenclamide 5MG TAB Accepted treatment
834866 ROLAB-GLICLAZIDE Gliclazide 80MG TAB Accepted treatment
704673 SANDOZ GLIMEPIRIDE Glimepiride 1MG TAB
704674 SANDOZ GLIMEPIRIDE Glimepiride 2MG TAB
710904 SULPHONUR Glimepiride 1MG TAB
710905 SULPHONUR Glimepiride 2MG TAB
711908 ZYDUS-GLIMEPIRIDE Glimepiride 1MG TAB
711909 ZYDUS-GLIMEPIRIDE Glimepiride 2MG TAB
Combination products
718106 AMARYL COMBI 2MG/500MG Metformin and sulfonamides 2MG/500MG TAB
701109 GLUCOVANCE 250/1,25 Metformin/Glibenclamide 250MG/1.25MG TAB
701111 GLUCOVANCE 500/2.5 Metformin/Glibenclamide 500MG/2.5MG TAB
701112 GLUCOVANCE 500/5 Metformin/Glibenclamide 500MG/5MG TAB
Page 30 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Thiazolidines
718148 ACCORD PIOGLITAZONE Pioglitazone 15MG TAB Specialist motivation/SI
718150 ACCORD PIOGLITAZONE Pioglitazone 30MG TAB Specialist motivation/SI
718151 ACCORD PIOGLITAZONE Pioglitazone 45MG TAB Specialist motivation/SI
878243 ACTOS 15MG Pioglitazone 15MG TAB Specialist motivation/SI
878251 ACTOS 30MG Pioglitazone 30MG TAB Specialist motivation/SI
707974 CIPLA PIOGLITAZONE 15 Pioglitazone 15MG TAB Specialist motivation/SI
707981 CIPLA PIOGLITAZONE 30 Pioglitazone 30MG TAB Specialist motivation/SI
Insulin
702086 INSU NOVOMIX 30 FLEXPEN 3ML Combinations INJD Accepted treatment
702089 INSU NOVOMIX 30 PENFILL 3ML Combinations INJD Accepted treatment
863572 INSU HUMULIN 30/70 3ML Insulin (human) INJD Accepted treatment
863556 INSU HUMULIN N 3.0ML CART 5 Insulin (human) INJD Accepted treatment
863564 INSU HUMULIN R 3.0ML CARTRIDGE Insulin (human) INJD Accepted treatment
733512 INSU ACTRAPH HMGE 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
816213 INSU ACTRAPH HMGE PENSET 3ML Insulin (human) 100IU/1ML INJD
714977 INSU ACTRAPHANE HM (GE) FLEXPEN 3ML Insulin (human) 100IU/1ML INJD
704457 HUMULIN R DISPOSABLE PEN 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712767 INSU BIOSULIN R CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712769 INSU BIOSULIN L CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712768 INSU BIOSULIN N CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
712770 INSU BIOSULIN 30-70 CARTRIDGE 3ML Insulin (human) 100IU/1ML INJ Accepted treatment
783811 INSU HUMULIN 30/70 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
704456 INSU HUMULIN 30/70 PEN 3ML DISP Insulin (human) 100IU/1ML INJD Accepted treatment
733458 INSU HUMULIN N 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
853453 INSU HUMULIN N PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
733431 INSU HUMULIN R 10ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
710299 INSU INSUMAN COMB 30/70 PEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
733482 INSU PROTAPH HMGE 10 ML VIAL Insulin (human) 100IU/1ML INJD Accepted treatment
700183 INSU PROTAPH FLEXPEN 3ML Insulin (human) 100IU/1ML INJD Accepted treatment
897767 INSU NOVORAPID FLEXPEN 3ML PENS Insulin aspart INJD Accepted treatment
707927 INSU NOVORAPID 10ML Insulin aspart 100IU/1ML INJ Accepted treatment
897775 INSU NOVORAPID 3ML SOLUTION FOR I Insulin aspart 100U INJD Accepted treatment
705312 INSU LEVEMIR 3ML FLEXPEN PREFILLED Insulin detemir 100MG/1ML INJ Accepted treatment
705313 INSU LEVEMIR 3ML PREFILLED CARTRIDGE Insulin detemir 100MG/1ML INJ Accepted treatment
700308 INSU LANTUS CARTRIDGE 3ML Insulin glargine INJD Accepted treatment
723474 OPTISULIN CARTRIDGE 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
721502 OPTISULIN PEN 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
709860 INSU LANTUS SOLOSTAR DISPOSABLE PENS 3ML Insulin glargine 100IU/1ML INJ Accepted treatment
722454 BASAGLAR PRE-FILLED PEN 3ML Insulin glargine 100U/1ML INJ Accepted treatment
722456 BASAGLAR CARTRIDGE 3ML Insulin glargine 100U/1ML INJ Accepted treatment
706039 INSU APIDRA CARTIDGES Insulin glulisine 100IU/1ML INJD Accepted treatment
706040 INSU APIDRA Insulin glulisine 100IU/1ML INJD Accepted treatment
709861 INSU APIDRA SOLOSTAR DISPOSABLE PENS 3ML Insulin glulisine 100IU/1ML INJD Accepted treatment
862355 INSU HUMALOG INJ 3.0ML CART Insulin lispro INJD Accepted treatment
861782 INSU HUMALOG MIX 25 CART 3ML Insulin lispro INJD Accepted treatment
819468 INSU HUMALOG Insulin lispro 100IU/1ML INJD Accepted treatment
853437 INSU HUMALOG MIX 25 10ML VIAL Insulin lispro 100IU/1ML INJD Accepted treatment
853461 INSU HUMALOG MIX 25 PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment
853445 INSU HUMALOG PEN 3ML Insulin lispro 100IU/1ML INJD Accepted treatment
705074 INSU HUMALOG MIX 50 CART Insulin lispro 3ML INJ Accepted treatment
706761 INSU MIRIO PEN HUMALOG MIX 25 Insulin lispro INJD Accepted treatment
706762 INSU MIRIO PEN HUMALOG MIX 50 Insulin lispro INJD Accepted treatment
Page 31 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
706760 INSU MIRIO PEN HUMALOG Insulin lispro INJD Accepted treatment
Appliances
Diabetic strips, needles and lancets Clinical review
Diabetes Insipidus
Desmopressin
837563 DDAVP Desmopressin 0.1MG TAB Special investigations
703639 DDAVP Desmopressin 0.2MG TAB Special investigations
837555 DDAVP 5ML Desmopressin 0.1MG/1ML NAS Special investigations
717746 DDAVP INTRANASAL SOLUTION Desmopressin 0.1MG/1ML NOD Special investigations
722060 MINIRIN MELT Desmopressin 120MCG SLT Special investigations
722061 MINIRIN MELT Desmopressin 240MCG SLT Special investigations
Dysrhythmias
Anticoagulants
778362 WARFARIN Warfarin 5MG TAB Accepted treatment
709906 CIPLA WARFARIN 1MG Warfarin 1MG TAB Accepted treatment
712390 CIPLA-WARFARIN Warfarin 3MG TAB Accepted treatment
709905 CIPLA WARFARIN 5MG Warfarin 5MG TAB Accepted treatment
Antiplatelet agents
704645 ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
798533 ASPIRIN (WHITE) Acetylsalicylic acid 300MG TAB Accepted treatment
706930 BAYER ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
862304 BAYER ASPIRIN CARDIO Acetylsalicylic acid 100MG TAB Accepted treatment
847283 DISPRIN CV Acetylsalicylic acid 100MG EEF Accepted treatment
807206 DISPRIN CV Acetylsalicylic acid 300MG EEF Accepted treatment
720577 DISPRIN REGULAR Acetylsalicylic acid 300MG EEF Accepted treatment
719673 DR DU TOITS PAIN EXPELLER Acetylsalicylic acid 300MG TAB Accepted treatment
823481 ECOTRIN Acetylsalicylic acid 81MG ECT Accepted treatment
700909 GULF ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
815160 LO-ASPIRIN (CAPRIN) Acetylsalicylic acid 125MG TAB Accepted treatment
721258 MYOPRIN Acetylsalicylic acid 100MG TAB Accepted treatment
845590 MYOPRIN Acetylsalicylic acid 100MG EEF Accepted treatment
712608 PCH ACETYLSALICYLIC ACID CARDIO Acetylsalicylic acid 80MG DSP Accepted treatment
722806 SOLUSPRIN CV Acetylsalicylic acid 100MG DSP Accepted treatment
Beta-blockers
786586 ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment
786578 ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment
703914 ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment
703913 ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment
721438 MYLAN BISOPROLOL Bisoprolol 10MG TAB Accepted treatment
721437 MYLAN BISOPROLOL Bisoprolol 5MG TAB Accepted treatment
721589 BISOPROLOL CO UNICORN 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB Accepted treatment
721588 BISOPROLOL CO UNICORN 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB Accepted treatment
704651 B-BLOCK Atenolol 100MG TAB Accepted treatment
704653 B-BLOCK Atenolol 50MG TAB Accepted treatment
706179 BETACOR Bisoprolol 10MG TAB Accepted treatment
706178 BETACOR Bisoprolol 5MG TAB Accepted treatment
704373 BILOCOR 10 Bisoprolol 10MG TAB Accepted treatment
704372 BILOCOR 5 Bisoprolol 5MG TAB Accepted treatment
719154 BISLO Bisoprolol 5MG TAB Accepted treatment
719155 BISLO Bisoprolol 10MG TAB Accepted treatment
720660 BISBETA Bisoprolol 10MG TAB Accepted treatment
Page 32 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
720659 BISBETA Bisoprolol 5MG TAB Accepted treatment
704133 BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment
704132 BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment
707393 BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment
707391 BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment
716166 BISOPROLOL UNICORN Bisoprolol 10MG TAB Accepted treatment
716167 BISOPROLOL UNICORN Bisoprolol 5MG TAB Accepted treatment
720043 BISOPROLOL ZYDUS Bisoprolol 10MG TAB Accepted treatment
720044 BISOPROLOL ZYDUS Bisoprolol 5MG TAB Accepted treatment
704441 CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment
704439 CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment
704440 CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment
818437 CONCOR Bisoprolol 10MG TAB Accepted treatment
818429 CONCOR Bisoprolol 5MG TAB Accepted treatment
720821 RETOCAR Bisoprolol 10MG TAB Accepted treatment
720820 RETOCAR Bisoprolol 5MG TAB Accepted treatment
722055 BISOPROLOL UNICHEM Bisoprolol 5MG TAB Accepted treatment
722056 BISOPROLOL UNICHEM Bisoprolol 10MG TAB Accepted treatment
715626 GULF ATENOLOL Atenolol 100MG TAB Accepted treatment
715625 GULF ATENOLOL Atenolol 50MG TAB Accepted treatment
806897 HEXA-BLOK Atenolol 100MG TAB Accepted treatment
806889 HEXA-BLOK Atenolol 50MG TAB Accepted treatment
732567 INDERAL Propranolol 10MG TAB Accepted treatment
732575 INDERAL Propranolol 40MG TAB Accepted treatment
732648 INDERAL LA Propranolol 80MG CAP
806552 INDOBLOK 10 Propranolol 10MG TAB Accepted treatment
806560 INDOBLOK 40 Propranolol 40MG TAB Accepted treatment
716483 LOVISPES Nebivolol 5MG TAB
700558 NEBILET 5MG Nebivolol 5MG TAB
826901 NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment
826898 NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment
787167 PRODOROL Propranolol 10MG TAB Accepted treatment
787175 PRODOROL Propranolol 40MG TAB Accepted treatment
758140 PURBLOKA Propranolol 10MG TAB Accepted treatment
758167 PURBLOKA Propranolol 40MG APP Accepted treatment
787914 ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment
787892 ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment
828009 SOTAHEXAL Sotalol 160MG TAB Specialist script
827991 SOTAHEXAL Sotalol 80MG TAB Specialist script
786195 TEN-BLOKA Atenolol 100MG TAB Accepted treatment
786187 TEN-BLOKA Atenolol 50MG TAB Accepted treatment
705873 TENOPRESS Atenolol 100MG TAB Accepted treatment
705872 TENOPRESS Atenolol 25MG TAB Accepted treatment
705874 TENOPRESS Atenolol 50MG TAB Accepted treatment
797693 TENORMIN Atenolol 25MG TAB
769576 TENORMIN Atenolol 100MG TAB Accepted treatment
769584 TENORMIN Atenolol 50MG TAB Accepted treatment
719657 ZETENOL Atenolol 100MG TAB Accepted treatment
719656 ZETENOL Atenolol 50MG TAB Accepted treatment
715276 ZIAPRO Bisoprolol 10MG TAB Accepted treatment
715274 ZIAPRO Bisoprolol 5MG TAB Accepted treatment
Alpha-Beta blockers
710339 ASPEN CARVEDILOL Carvedilol 12.5MG TAB
Page 33 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
710340 ASPEN CARVEDILOL Carvedilol 25MG TAB
710338 ASPEN CARVEDILOL Carvedilol 6.25MG TAB
897117 CARLOC Carvedilol 25MG TAB
705459 CARLOC 6.25 Carvedilol 6.25MG TAB
700168 CARLOC 12.5 Carvedilol 12.5MG TAB
705770 CARVEDILOL-HEXAL Carvedilol 12.5MG TAB
705767 CARVEDILOL-HEXAL Carvedilol 25MG TAB
705749 CARVEDILOL-HEXAL Carvedilol 6.25MG TAB
716743 CARVEDILOL UNICORN Carvedilol 12.5MG TAB
716744 CARVEDILOL UNICORN Carvedilol 25MG TAB
716742 CARVEDILOL UNICORN Carvedilol 6.25MG TAB
704671 CARVETREND 12.5MG Carvedilol 12.5MG TAB
704672 CARVETREND 25MG Carvedilol 25MG TAB
704670 CARVETREND 6.25MG Carvedilol 6.25MG TAB
836354 DILATREND Carvedilol 12.5MG TAB
788856 DILATREND Carvedilol 25MG APP
833428 DILATREND Carvedilol 6.25MG TAB
710959 VEDIBLOK Carvedilol 12.5MG TAB
710960 VEDIBLOK Carvedilol 25MG TAB
710958 VEDIBLOK Carvedilol 6.25MG TAB
Cardiac glycosides
735752 LANOXIN Digoxin 0.25MG TAB Accepted treatment
735744 LANOXIN PAED Digoxin 0.05MG/1ML SYR Accepted treatment
735760 LANOXIN PAED Digoxin 0.063MG TAB Accepted treatment
758280 PURGOXIN Digoxin 0.25MG TAB Accepted treatment
Calcium channel antagonists
813354 CALCICARD SR Verapamil 240MG SRT Accepted treatment
734071 ISOPTIN DRAGEES Verapamil 40MG TAB Accepted treatment
734373 ISOPTIN SR Verapamil 240MG SRT Accepted treatment
819573 RAVAMIL SR Verapamil 240MG SRT Accepted treatment
813125 TILAZEM 180 CR Diltiazem 180MG SRC Accepted treatment
813133 TILAZEM 240 CR Diltiazem 240MG SRC Accepted treatment
774944 VASOMIL Verapamil 40MG TAB Accepted treatment
774952 VASOMIL Verapamil 80MG TAB Accepted treatment
700071 VERAHEXAL 240 SR Verapamil 240MG SRT Accepted treatment
839183 ZILDEM Diltiazem 180MG SRC Accepted treatment
839191 ZILDEM Diltiazem 240MG SRC Accepted treatment
822213 ZILDEM 60 Diltiazem 60MG TAB Accepted treatment
824364 ZILDEM 90 BD Diltiazem 90MG TAB
Anti-arrhythmics
703515 ARYCOR Amiodarone 100MG TAB Accepted treatment
703513 ARYCOR Amiodarone 200MG TAB Accepted treatment
707851 BIO-AMIODARONE Amiodarone 200MG TAB Accepted treatment
800554 CORDARONE X Amiodarone 100MG TAB
716111 CORDARONE X Amiodarone 200MG TAB
863157 HEXARONE 100MG Amiodarone 100MG TAB Accepted treatment
863165 HEXARONE 200MG Amiodarone 200MG TAB Accepted treatment
Epilepsy
712493 DEGRANOL Carbamazepine 200MG TAB Accepted treatment
712523 ROLAB-CARBAMAZEPINE Carbamazepine 200MG TAB Accepted treatment
705597 SANDOZ CARBAMAZEPINE CR200 Carbamazepine 200MG SRT Accepted treatment
705602 SANDOZ CARBAMAZIPINE CR400 Carbamazepine 400MG SRT Accepted treatment
Page 34 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
769398 TEGRETOL Carbamazepine 200MG TAB
779652 TEGRETOL CR Carbamazepine 200MG SRT Accepted treatment
779660 TEGRETOL CR Carbamazepine 400MG SRT Accepted treatment
769401 TEGRETOL S Carbamazepine 100MG/5ML SUS Accepted treatment
715962 ZEPTOL Carbamazepine 200MG TAB Accepted treatment
721545 CLONAM Clonazepam .5MG TAB Accepted treatment
721546 CLONAM Clonazepam 2MG TAB Accepted treatment
761079 RIVOTRIL Clonazepam 0.5MG TAB Accepted treatment
835129 RIVOTRIL Clonazepam 2.5MG/1ML DRP Accepted treatment
761087 RIVOTRIL Clonazepam 2MG TAB Accepted treatment
779105 ZARONTIN Ethosuximide 250MG/5ML SYR Accepted treatment
721740 BIOTECH GABAPENTIN Gabapentin 100MG CAP Specialist motivation
721741 BIOTECH GABAPENTIN Gabapentin 300MG CAP Specialist motivation
721742 BIOTECH GABAPENTIN Gabapentin 400MG CAP Specialist motivation
722865 EPIGAB Gabapentin 100MG CAP Specialist motivation
722866 EPIGAB Gabapentin 300MG CAP Specialist motivation
722867 EPIGAB Gabapentin 400MG CAP Specialist motivation
707622 EPLEPTIN Gabapentin 100MG CAP Specialist motivation
707623 EPLEPTIN Gabapentin 300MG CAP Specialist motivation
707624 EPLEPTIN Gabapentin 400MG CAP Specialist motivation
708949 NEUREXAL Gabapentin 100MG CAP Specialist motivation
708994 NEUREXAL Gabapentin 300MG CAP Specialist motivation
708995 NEUREXAL Gabapentin 400MG CAP Specialist motivation
807443 NEURONTIN Gabapentin 100MG CAP Specialist motivation
807451 NEURONTIN Gabapentin 300MG CAP Specialist motivation
807478 NEURONTIN Gabapentin 400MG CAP Specialist motivation
710525 RAN-GABAPENTIN Gabapentin 100MG CAP Specialist motivation
710526 RAN-GABAPENTIN Gabapentin 300MG CAP Specialist motivation
710527 RAN-GABAPENTIN Gabapentin 400MG CAP Specialist motivation
705441 ASPEN LAMOTRIGINE 100MG Lamotrigine 100MG TAB Accepted treatment
705436 ASPEN LAMOTRIGINE 25MG Lamotrigine 25MG TAB Accepted treatment
705440 ASPEN LAMOTRIGINE 50MG Lamotrigine 50MG TAB Accepted treatment
707789 AUSTELL-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
707790 AUSTELL-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
707787 AUSTELL-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
707788 AUSTELL-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
710389 DYNA-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
710390 DYNA-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
710387 DYNA-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
710388 DYNA-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
704381 EPITEC 100MG Lamotrigine 100MG TAB Accepted treatment
704382 EPITEC 200MG Lamotrigine 200MG TAB Accepted treatment
704379 EPITEC 25MG Lamotrigine 25MG TAB Accepted treatment
704380 EPITEC 50MG Lamotrigine 50MG TAB Accepted treatment
722725 GIROTEC Lamotrigine 50MG TAB Accepted treatment
722726 GIROTEC Lamotrigine 100MG TAB Accepted treatment
722727 GIROTEC Lamotrigine 200MG TAB Accepted treatment
805521 LAMICTIN Lamotrigine 100MG TAB Accepted treatment
819034 LAMICTIN Lamotrigine 200MG TAB Accepted treatment
805505 LAMICTIN Lamotrigine 25MG TAB Accepted treatment
805513 LAMICTIN Lamotrigine 50MG TAB Accepted treatment
813907 LAMICTIN P100 Lamotrigine 100MG DSP Accepted treatment
704533 LAMICTIN P2 Lamotrigine 2MG DSP Accepted treatment
Page 35 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
891716 LAMICTIN P200 Lamotrigine 200MG DSP Accepted treatment
813893 LAMICTIN P25 Lamotrigine 25MG DSP Accepted treatment
813885 LAMICTIN P5 Lamotrigine 5MG DSP Accepted treatment
891708 LAMICTIN P50 Lamotrigine 50MG DSP Accepted treatment
710887 LAMIDUS Lamotrigine 100MG TAB Accepted treatment
710888 LAMIDUS Lamotrigine 200MG TAB Accepted treatment
710885 LAMIDUS Lamotrigine 50MG TAB Accepted treatment
704488 LAMITOR Lamotrigine 100MG TAB Accepted treatment
704486 LAMITOR Lamotrigine 25MG TAB Accepted treatment
704487 LAMITOR Lamotrigine 50MG TAB Accepted treatment
712217 LAMITOR Lamotrigine 200MG TAB Accepted treatment
705248 SANDOZ LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
705249 SANDOZ LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
705251 SANDOZ LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
705250 SANDOZ LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
718486 DYNA LEVETIRACETAM Levetiracetam 250MG TAB Accepted treatment
718485 DYNA LEVETIRACETAM Levetiracetam 500MG TAB Accepted treatment
718484 DYNA LEVETIRACETAM Levetiracetam 750MG TAB Accepted treatment
720700 DYNA LEVETIRACETAM Levetiracetam 1000MG TAB Accepted treatment
721701 EPIKEPP Levetiracetam 250MG TAB Accepted treatment
721702 EPIKEPP Levetiracetam 500MG TAB Accepted treatment
721703 EPIKEPP Levetiracetam 750MG TAB Accepted treatment
714166 KEPPRA Levetiracetam 100MG/1ML SOL Accepted treatment
700958 KEPPRA 250MG Levetiracetam 250MG TAB Accepted treatment
700959 KEPPRA 500MG Levetiracetam 500MG TAB Accepted treatment
703165 KEPPRA Levetiracetam 750MG TAB Accepted treatment
720697 LEVETIRACETAM BIOTECH Levetiracetam 250MG TAB Accepted treatment
720696 LEVETIRACETAM BIOTECH Levetiracetam 750MG TAB Accepted treatment
722150 LEVETIRACETAM UNICORN Levetiracetam 250MG TAB Accepted treatment
722151 LEVETIRACETAM UNICORN Levetiracetam 750MG TAB Accepted treatment
714662 REDILEV Levetiracetam 250MG TAB Accepted treatment
714663 REDILEV Levetiracetam 500MG TAB Accepted treatment
714664 REDILEV Levetiracetam 750MG TAB Accepted treatment
720320 TORCETAM Levetiracetam 250MG TAB Accepted treatment
720322 TORCETAM Levetiracetam 500MG TAB Accepted treatment
720323 TORCETAM Levetiracetam 750MG TAB Accepted treatment
717226 MYLAN OXCARBAZEPINE Oxcarbazepine 300MG TAB Specialist motivation
717227 MYLAN OXCARBAZEPINE Oxcarbazepine 600MG TAB Specialist motivation
892484 TRILEPTAL FCT Oxcarbazepine 300MG TAB Specialist motivation
892491 TRILEPTAL FCT Oxcarbazepine 600MG TAB Specialist motivation
754803 ADCO-PHENOBARB VITALET ELIXIR Phenobarbital 100ML SYR Accepted treatment
737844 LETHYL Phenobarbital 30MG TAB Accepted treatment
814946 SEDABARB Phenobarbital 30MG TAB Accepted treatment
723525 EPANUTIN Phenytoin 100MG APP Accepted treatment
723533 EPANUTIN FORTE Phenytoin 125MG/5ML SUS Accepted treatment
754870 PHENYTOIN SOD Phenytoin 100MG TAB Accepted treatment
710242 ADCO-TOPIRAMATE Topiramate 100MG TAB Specialist motivation
710243 ADCO-TOPIRAMATE Topiramate 200MG TAB Specialist motivation
710240 ADCO-TOPIRAMATE Topiramate 25MG TAB Specialist motivation
710241 ADCO-TOPIRAMATE Topiramate 50MG TAB Specialist motivation
718857 EPIMATE Topiramate 100MG TAB Specialist motivation
718858 EPIMATE Topiramate 200MG TAB Specialist motivation
718855 EPIMATE Topiramate 25MG TAB Specialist motivation
Page 36 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
718856 EPIMATE Topiramate 50MG TAB Specialist motivation
710901 EPITOZ Topiramate 100MG TAB Specialist motivation
710899 EPITOZ Topiramate 25MG TAB Specialist motivation
710900 EPITOZ Topiramate 50MG TAB Specialist motivation
716468 PAMIRAM Topiramate 100MG TAB Specialist motivation
716482 PAMIRAM Topiramate 200MG TAB Specialist motivation
716000 PAMIRAM Topiramate 25MG TAB Specialist motivation
716001 PAMIRAM Topiramate 50MG TAB Specialist motivation
709286 SANDOZ TOPIRAMATE Topiramate 100MG TAB Specialist motivation
709287 SANDOZ TOPIRAMATE Topiramate 200MG TAB Specialist motivation
709284 SANDOZ TOPIRAMATE Topiramate 25MG TAB Specialist motivation
709285 SANDOZ TOPIRAMATE Topiramate 50MG TAB Specialist motivation
715981 TOPALEX Topiramate 100MG TAB Specialist motivation
715978 TOPALEX Topiramate 25MG TAB Specialist motivation
715979 TOPALEX Topiramate 50MG TAB Specialist motivation
822531 TOPAMAX Topiramate 100MG TAB Specialist motivation
836753 TOPAMAX Topiramate 200MG TAB Specialist motivation
822515 TOPAMAX Topiramate 25MG TAB Specialist motivation
822523 TOPAMAX Topiramate 50MG TAB Specialist motivation
878014 TOPAMAX SC SPRINKLE Topiramate 15MG CAP Specialist motivation
878022 TOPAMAX SC SPRINKLE Topiramate 25MG CAP Specialist motivation
890728 TOPAMAX SC SPRINKLE Topiramate 50MG CAP Specialist motivation
718288 TOPIROL Topiramate 25MG TAB Specialist motivation
718290 TOPIROL Topiramate 50MG TAB Specialist motivation
718291 TOPIROL Topiramate 100MG TAB Specialist motivation
708389 TOPLEP Topiramate 25MG TAB Specialist motivation
708390 TOPLEP Topiramate 50MG TAB Specialist motivation
708391 TOPLEP Topiramate 100MG TAB Specialist motivation
708392 TOPLEP Topiramate 200MG TAB Specialist motivation
715980 CONVULEX Valproic acid 150MG CAP Accepted treatment
781541 CONVULEX Valproic acid 250MG/5ML SYR Accepted treatment
715999 CONVULEX Valproic acid 300MG CAP Accepted treatment
781568 CONVULEX Valproic acid 500MG CAP Accepted treatment
818666 EPILIM CR Valproic acid 200MG SRT Accepted treatment
818674 EPILIM CR Valproic acid 300MG SRT Accepted treatment
818682 EPILIM CR Valproic acid 500MG SRT Accepted treatment
821578 EPILIM CRUSHABLE Valproic acid 100MG TAB Accepted treatment
780545 EPILIM SUGAR FREE Valproic acid 200MG/5ML SYR Accepted treatment
718274 EPILIZINE CR Valproic acid 200MG SRT Accepted treatment
718275 EPILIZINE CR Valproic acid 300MG SRT Accepted treatment
718276 EPILIZINE CR Valproic acid 500MG SRT Accepted treatment
721460 EPROLEP CR 200 Valproic acid 200MG SRT Accepted treatment
720762 EPROLEP CR 300 Valproic acid 300MG SRT Accepted treatment
721055 EPROLEP CR 500 Valproic acid 500MG SRT Accepted treatment
718465 NAVALPRO CR Valproic acid 200MG SRT Accepted treatment
718466 NAVALPRO CR Valproic acid 300MG SRT Accepted treatment
718468 NAVALPRO CR Valproic acid 500MG SRT Accepted treatment
720026 VANAPRO Valproic acid 300MG SRT Accepted treatment
720027 VANAPRO Valproic acid 500MG SRT Accepted treatment
Glaucoma
Sympathomimetics
709410 ALPHAGAN PURITE 5ML Brimonidine 1.5MG/1ML OPD Clinical review
Page 37 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
721293 BRIMOCT 5ML Brimonidine 2MG/1ML OPD Clinical review
Parasympathomimetics
734284 ISOPTO CARPINE 15ML Pilocarpine 10MG/1ML APP Accepted treatment
734179 ISOPTO CARPINE 15ML Pilocarpine 20MG/1ML OPD Accepted treatment
734195 ISOPTO CARPINE 15ML Pilocarpine 40MG/1ML OPD Accepted treatment
Carbonic anhydrase inhibitor
701523 AZOPTIC EYE DROP Brinzolamide 10MG/1ML OPD Clinical review
819832 TRUSOPT 5ML Dorzolamide 20MG/1ML DRP Clinical review
720983 GLAUCOPRESS 5ML Dorzolamide 0.02 OPD Clinical review
Beta-blockers
708445 BETOPTIC 5ML Betaxolol 5MG/1ML OPD Accepted treatment
836052 BETOPTIC S 5ML Betaxolol 2.5MG/1ML OPD Accepted treatment
722010 LOXOPTIC 5ML Betaxolol 0.005 OPD Accepted treatment
834335 TEOPTIC 5ML Carteolol 100MG/5ML OPD Accepted treatment
781134 BETAGAN Levobunolol 0.005 OPD Accepted treatment
816728 BETA-OPTHIOLE 5ML Metipranolol 0.003 OPD Accepted treatment
816736 BETA-OPTHIOLE 5ML Metipranolol 0.006 OPD Accepted treatment
821624 GLAUCOSAN 0.5 % 5ML Timolol 5MG/1ML OPD Accepted treatment
702142 NYOGEL EYE GEL 5G Timolol 0.001 OPD Accepted treatment
720734 OCCUMOL Timolol 0.005 OPD Accepted treatment
770833 TIMOPTOL 5ML Timolol 2.5MG/1ML OPD Accepted treatment
770841 TIMOPTOL 5ML Timolol 5MG/1ML OPD Accepted treatment
819816 TIMOPTOL-XE 0.25% 2.5ML Timolol 2.5MG/1ML DRP Accepted treatment
819824 TIMOPTOL-XE 0.50 % 2.5ML Timolol 5MG/1ML DRP Accepted treatment
Combination products
717260 AZARGA 5ML Timolol, combinations OPD Accepted treatment
709863 COMBIGAN 2MG/5MG 5ML Timolol, combinations OPD Accepted treatment
860379 COSOPT 5ML Timolol, combinations 0.005 OPD Accepted treatment
722712 CO-ATANA 2.5ML Timolol, combinations OPD
708877 DUOTRAV 2.5ML Timolol, combinations OPD Accepted treatment
714110 GANFORT 3ML Timolol, combinations 0.3MG/5MG OPD Accepted treatment
721902 GLAUMIDE-CO 10ML Timolol, combinations OPD Accepted treatment
721977 GLAUOPT CO 5ML Timolol, combinations 20MG/5MG OPD Accepted treatment
702983 XALACOM 2.5ML Timolol, combinations 50MCG/5MG OPD
Prostaglandin derivatives
703666 LUMIGAN 3ML Bimatoprost 0.3MG/1ML OPD Clinical review
716754 LUMIGAN Bimatoprost 0.01% OPD Clinical review
715961 OCUPROST 3ML Latanoprost 50MCG/1ML OPD Clinical review
720401 SAFLUTAN SINGLE DOSE CONTAINER 0.3ML Tafluprost 15MCG/1ML OPD Clinical review
702534 TRAVATAN 2.5ML Travoprost OPD Clinical review
723018 SPERSATAN 2.5ML Latanoprost 50MCG OPD Clinical review
833223 XALATAN 2.5ML Latanoprost 50MCG/1ML OPD Clinical review
720971 ATANA 2.5ML Latanoprost 0.00005 OPD Clinical review
Acetazolamide
789771 AZOMID Acetazolamide 250MG TAB Clinical review
719471 DIAMOX Acetazolamide 250MG TAB Clinical review
Haemophilia
Tranexamic Acid
717134 CYKLOKAPRON Tranexamic acid 500MG TAB Accepted treatment (intermittent use)
714722 TRANEXAMIC ACID MEDWICH Tranexamic acid 500MG TAB Accepted treatment (intermittent use)
716276 TRANIC Tranexamic acid 500MG TAB Accepted treatment (intermittent use)
719414 MORWAK Tranexamic acid 500MG TAB Accepted treatment (intermittent use)
Page 38 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Desmopressin
837563 DDAVP Desmopressin 0.1MG TAB Accepted treatment (intermittent use)
703639 DDAVP Desmopressin 0.2MG TAB Accepted treatment (intermittent use)
837555 DDAVP 5ML Desmopressin 0.1MG/1ML NAS Accepted treatment (intermittent use)
717746 DDAVP INTRANASAL SOLUTION Desmopressin 0.1MG/1ML NOD Accepted treatment (intermittent use)
722060 MINIRIN MELT Desmopressin 120MCG SLT Accepted treatment (intermittent use)
722061 MINIRIN MELT Desmopressin 240MCG SLT Accepted treatment (intermittent use)
Analgesics
792101 ACTAMOL Paracetamol 120MG/5ML SYR Accepted treatment
717725 ACTAMOL Paracetamol 500MG TAB Accepted treatment
701634 DIS-CHEM PARACETAMOL Paracetamol 500MG TAB Accepted treatment
704093 ACTAMOL RED (UN-BOXED) Paracetamol 120MG/5ML SYR Accepted treatment
716045 ADCO-NAPAMOL Paracetamol 500MG TAB Accepted treatment
894281 ADCO-PARACETAMOL Paracetamol 120MG/5ML SYR Accepted treatment
805467 ANTALGIC 500 Paracetamol 500MG TAB Accepted treatment
713153 AUSTELL-PARACETAMOL Paracetamol 500MG TAB Accepted treatment
717187 BARRS PARACETAMOL Paracetamol 120MG/5ML SYR Accepted treatment
789526 BRUNOMOL Paracetamol 120MG/5ML SYR Accepted treatment
711993 CALPOL Paracetamol 120MG/5ML SUS Accepted treatment
714499 CLICKS PARACETAMOL Paracetamol 500MG TAB Accepted treatment
897124 CO CODAMOL Paracetamol and codeine 500MG/8MG EFF Accepted treatment
787043 CODOROL Paracetamol combinations payable by PBM TAB Accepted treatment
719662 COGESIC Paracetamol combinations payable by PBM 500MG/8MG TAB Accepted treatment
837652 DINO-COD (BEI) Paracetamol and codeine TAB Accepted treatment
720860 DOLOROL Paracetamol 500MG TAB Accepted treatment
720879 DOLOROL FORTE Paracetamol and codeine TAB Accepted treatment
702871 FABU PARACETAMOL ALC Paracetamol 120MG/5ML SYR Accepted treatment
863742 FEVERPAIN Paracetamol 120MG/5ML SYR Accepted treatment
824992 GENCETAMOL Paracetamol 500MG TAB Accepted treatment
895199 GO-PAIN P Paracetamol 120mg/5ml SYR Accepted treatment
715112 GRAYS PARACETAMOL Paracetamol 500MG TAB Accepted treatment
715111 GRAYS PARACETAMOL Paracetamol 120MG/5ML SYR Accepted treatment
867950 GULF PARACETAMOL Paracetamol 500MG TAB Accepted treatment
894212 JP PARACETAMOL Paracetamol 500MG TAB Accepted treatment
715280 LENNON PARACETAMOL Paracetamol 500MG TAB Accepted treatment
745707 NAPACOD Paracetamol and codeine TAB Accepted treatment
745715 NAPAMOL Paracetamol 120MG/5ML SYR Accepted treatment
745723 NAPAMOL Paracetamol 500MG TAB Accepted treatment
752118 PAINAMOL Paracetamol 120MG/5ML SYR Accepted treatment
799629 PAINAMOL (GREEN) Paracetamol 500MG TAB Accepted treatment
707910 PAINAMOL PLUS (BETACOD) Paracetamol and codeine TAB Accepted treatment
752142 PAINAMOL WHITE Paracetamol 500MG TAB Accepted treatment
889772 PAINBLOK Paracetamol 120MG/5ML SYR Accepted treatment
867969 PAINBLOK Paracetamol 500MG TAB Accepted treatment
895030 PAINCODEIN Paracetamol and codeine 500MG/8MG TAB Accepted treatment
704450 PAINOGESIC Paracetamol 120MG/5ML SYR Accepted treatment
704465 PAINOGESIC Paracetamol 500MG TAB Accepted treatment
752274 PANADO Paracetamol 500MG CAP Accepted treatment
752274 PANADO Paracetamol 500MG TAB Accepted treatment
708432 PANADO CHILDRENS Paracetamol 125MG MLT Accepted treatment
720327 PANADO BLISTER PACK Paracetamol 500MG TAB Accepted treatment
788953 PANADO ( ALCO/SUGAR FREE) Paracetamol 120MG/5ML SYR Accepted treatment
752282 PANADO PAED SYRUP Paracetamol 120MG/5ML SYR Accepted treatment
Page 39 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
703118 PANADO PAEDIATRIC SYRUP STRAWBERRY Paracetamol 120MG/5ML SYR Accepted treatment
720438 PARAFIZZ Paracetamol 500MG EFT Accepted treatment
704719 PARACET Paracetamol 500MG TAB Accepted treatment
707583 PARACETAMOL ELIXIR SAD (ALCOHOL FREE) Paracetamol 120MG/5ML SYR Accepted treatment
784443 PARAMED Paracetamol 500MG TAB Accepted treatment
752878 PARAPANE Paracetamol 500MG TAB Accepted treatment
757403 PROLIEF Paracetamol 500MG TAB Accepted treatment
714708 PYNGESIC S Paracetamol 120MG/5ML SYR Accepted treatment
714707 PYNGESIC T Paracetamol 500MG TAB Accepted treatment
758558 PYRALEN Paracetamol 120MG/5ML SYR Accepted treatment
761303 ROCODIN Paracetamol and codeine TAB Accepted treatment
765635 SPECTRAPAIN Paracetamol and codeine CAP Accepted treatment
826588 THERA-PAIN Paracetamol 500MG TAB Accepted treatment
713688 VARI-COCODAMOL 8MG/500MG Paracetamol and codeine 8MG/500MG TAB Accepted treatment
701140 VARIPAN Paracetamol 500MG TAB Accepted treatment
885863 VON PARACETAMOL Paracetamol 500MG TAB Accepted treatment
783943 WINPAIN (BRUNEL) Paracetamol 120MG/5ML SYR Accepted treatment
710452 WOODWARD'S PARACETAMOL Paracetamol 120MG/5ML SYR Accepted treatment
710211 ZYDUS-PARACETAMOL Paracetamol 500MG TAB Accepted treatment
Hyperlipidaemia
Statins
718073 ADCO ATORVASTATIN Atorvastatin 10MG TAB Special investigations
719185 ASTOR Atorvastatin 10MG TAB Special investigations
714370 ATOLIP Atorvastatin 10MG TAB Special investigations
711621 ATORVASTATIN UNICORN Atorvastatin 10MG TAB Special investigations
716615 ATORVASTATIN WINTHROP Atorvastatin 10MG TAB Special investigations
718218 DYNATOR Atorvastatin 10MG TAB Special investigations
719366 LESTAVOR Atorvastatin 10MG TAB Special investigations
831484 LIPITOR Atorvastatin 10MG TAB Special investigations
714071 LIPOGEN Atorvastatin 10MG TAB Special investigations
714075 RAN-ATORVASTATIN Atorvastatin 10MG TAB Special investigations
718933 VASTOR Atorvastatin 10MG TAB Special investigations
708121 ASPAVOR Atorvastatin 10MG TAB Special investigations
718074 ADCO ATORVASTATIN Atorvastatin 20MG TAB Special investigations
719186 ASTOR Atorvastatin 20MG TAB Special investigations
714371 ATOLIP Atorvastatin 20MG TAB Special investigations
712170 ATORVASTATIN UNICORN Atorvastatin 20MG TAB Special investigations
716616 ATORVASTATIN WINTHROP Atorvastatin 20MG TAB Special investigations
718219 DYNATOR Atorvastatin 20MG TAB Special investigations
719367 LESTAVOR Atorvastatin 20MG TAB Special investigations
831492 LIPITOR Atorvastatin 20MG TAB Special investigations
714072 LIPOGEN Atorvastatin 20MG TAB Special investigations
714076 RAN-ATORVASTATIN Atorvastatin 20MG TAB Special investigations
718934 VASTOR Atorvastatin 20MG TAB Special investigations
708122 ASPAVOR Atorvastatin 20MG TAB Special investigations
718075 ADCO ATORVASTATIN Atorvastatin 40MG TAB Special investigations
719187 ASTOR Atorvastatin 40MG TAB Special investigations
714372 ATOLIP Atorvastatin 40MG TAB Special investigations
713522 ATORVASTATIN UNICORN Atorvastatin 40MG TAB Special investigations
716617 ATORVASTATIN WINTHROP Atorvastatin 40MG TAB Special investigations
718220 DYNATOR Atorvastatin 40MG TAB Special investigations
719368 LESTAVOR Atorvastatin 40MG TAB Special investigations
Page 40 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
886015 LIPITOR Atorvastatin 40MG TAB Special investigations
714073 LIPOGEN Atorvastatin 40MG TAB Special investigations
714077 RAN-ATORVASTATIN Atorvastatin 40MG TAB Special investigations
718935 VASTOR Atorvastatin 40MG TAB Special investigations
710912 ASPAVOR Atorvastatin 40MG TAB Special investigations
719189 ASTOR Atorvastatin 80MG TAB Special investigations
714373 ATOLIP Atorvastatin 80MG TAB Special investigations
718221 DYNATOR Atorvastatin 80MG TAB Special investigations
719369 LESTAVOR Atorvastatin 80MG TAB Special investigations
704186 LIPITOR Atorvastatin 80MG TAB Special investigations
714074 LIPOGEN Atorvastatin 80MG TAB Special investigations
714078 RAN-ATORVASTATIN Atorvastatin 80MG TAB Special investigations
718936 VASTOR Atorvastatin 80MG TAB Special investigations
720211 ASPAVOR Atorvastatin 80MG TAB Special investigations
700963 LESCOL XL Fluvastatin 80MG ECT Special investigations
718208 VATICOL XL Fluvastatin 80MG TAB Special investigations
717073 AUSTELL PRAVASTATIN Pravastatin 10MG TAB Special investigations
715709 PRAVACOR Pravastatin 10MG TAB Special investigations
705212 ASPEN PRAVASTATIN Pravastatin 10MG TAB Special investigations
710974 COLITE Pravastatin 10MG TAB Special investigations
704583 PRANALIP 10 Pravastatin 10MG TAB Special investigations
705901 SANDOZ PRAVASTATIN 10 Pravastatin 10MG TAB Special investigations
717074 AUSTELL PRAVASTATIN Pravastatin 20MG TAB Special investigations
712952 NOVALES Pravastatin 20MG TAB Special investigations
715710 PRAVACOR Pravastatin 20MG TAB Special investigations
705213 ASPEN PRAVASTATIN Pravastatin 20MG TAB Special investigations
710975 COLITE Pravastatin 20MG TAB Special investigations
705902 SANDOZ PRAVASTATIN 20 Pravastatin 20MG TAB Special investigations
717075 AUSTELL PRAVASTATIN Pravastatin 40MG TAB Special investigations
839655 PRAVA Pravastatin 40MG TAB Special investigations
715711 PRAVACOR Pravastatin 40MG TAB Special investigations
705214 ASPEN PRAVASTATIN Pravastatin 40MG TAB Special investigations
710976 COLITE Pravastatin 40MG TAB Special investigations
705903 SANDOZ PRAVASTATIN 40 Pravastatin 40MG TAB Special investigations
710977 COLITE Pravastatin 80MG TAB Special investigations
701276 ADCO-SIMVASTATIN Simvastatin 10MG TAB Special investigations
715708 CHOLESTE Simvastatin 10MG TAB Special investigations
711232 REDICOR Simvastatin 10MG TAB Special investigations
700519 SIMVACOR 10 Simvastatin 10MG TAB Special investigations
783951 ZOCOR Simvastatin 10MG TAB Special investigations
707089 ARROW SIMVASTATIN Simvastatin 10MG TAB Special investigations
706714 ASPEN SIMVASTATIN Simvastatin 10MG TAB Special investigations
705464 AUSTELL-SIMVASTATIN 10MG Simvastatin 10MG TAB Special investigations
709668 BIOVAC SIMVASTATIN Simvastatin 10MG TAB Special investigations
708307 CIPLA-SIMVASTATIN Simvastatin 10MG TAB Special investigations
705076 LIPIDEX Simvastatin 10MG TAB Special investigations
710868 MICHOL Simvastatin 10MG TAB Special investigations
707870 SIMAYLA SIMVASTATIN Simvastatin 10MG TAB Special investigations
703525 SIMVOTIN 10 Simvastatin 10MG TAB Special investigations
713487 SIMZOR Simvastatin 10MG TAB Special investigations
710826 ZYSIM Simvastatin 10MG TAB Special investigations
701279 ADCO-SIMVASTATIN Simvastatin 20MG TAB Special investigations
714705 CHOLESTE Simvastatin 20MG TAB Special investigations
Page 41 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
711234 REDICOR Simvastatin 20MG TAB Special investigations
700520 SIMVACOR 20 Simvastatin 20MG TAB Special investigations
783978 ZOCOR Simvastatin 20MG TAB Special investigations
707090 ARROW SIMVASTATIN Simvastatin 20MG TAB Special investigations
706715 ASPEN SIMVASTATIN Simvastatin 20MG TAB Special investigations
705465 AUSTELL-SIMVASTATIN 20MG Simvastatin 20MG TAB Special investigations
709822 BIOVAC SIMVASTATIN Simvastatin 20MG TAB Special investigations
708308 CIPLA-SIMVASTATIN Simvastatin 20MG TAB Special investigations
705077 LIPIDEX Simvastatin 20MG TAB Special investigations
710869 MICHOL Simvastatin 20MG TAB Special investigations
705382 MYLAN-SIMVASTATIN 20MG Simvastatin 20MG TAB Special investigations
707871 SIMAYLA SIMVASTATIN Simvastatin 20MG TAB Special investigations
703526 SIMVOTIN 20 Simvastatin 20MG TAB Special investigations
713488 SIMZOR Simvastatin 20MG TAB Special investigations
710827 ZYSIM Simvastatin 20MG TAB Special investigations
701281 ADCO-SIMVASTATIN Simvastatin 40MG TAB Special investigations
714706 CHOLESTE Simvastatin 40MG TAB Special investigations
711235 REDICOR Simvastatin 40MG TAB Special investigations
836265 ZOCOR Simvastatin 40MG TAB Special investigations
707091 ARROW SIMVASTATIN Simvastatin 40MG TAB Special investigations
706716 ASPEN SIMVASTATIN Simvastatin 40MG TAB Special investigations
705467 AUSTELL-SIMVASTATIN 40MG Simvastatin 40MG TAB Special investigations
709823 BIOVAC SIMVASTATIN Simvastatin 40MG TAB Special investigations
710511 CIPLA-SIMVASTATIN Simvastatin 40MG TAB Special investigations
710870 MICHOL Simvastatin 40MG TAB Special investigations
707873 SIMAYLA SIMVASTATIN Simvastatin 40MG TAB Special investigations
708463 SIMVACOR Simvastatin 40MG TAB Special investigations
703527 SIMVOTIN 40 Simvastatin 40MG TAB Special investigations
713489 SIMZOR Simvastatin 40MG TAB Special investigations
710828 ZYSIM Simvastatin 40MG TAB Special investigations
710513 CIPLA-SIMVASTATIN Simvastatin 80MG TAB Special investigations
710871 MICHOL Simvastatin 80MG TAB Special investigations
710829 ZYSIM Simvastatin 80MG TAB Special investigations
Fibrates
710337 BEZACHOLE SR Bezafibrate 400MG TAB Special investigations
708453 BEZALIP Bezafibrate 200MG TAB Special investigations
779644 BEZALIP RETARD Bezafibrate 400MG TAB Special investigations
710122 DYNA-BEZAFIBRATE SR Bezafibrate 400MG SRT Special investigations
705708 LIPANTHYL Fenofibrate 200MG CAP
788627 LOPID Gemfibrozil 600MG TAB
828300 ROLAB-BEZAFIBRATE Bezafibrate 400MG TAB Special investigations
Nicotinic Acid
818518 NICOTINIC ACID Nicotinic acid 100MG CAP Special investigations
891322 NICOTINIC ACID Nicotinic acid 20MG TAB Special investigations
Hypertension
Sympathetic Nervous System Blockers
760048 RESERPINE Reserpine .25MG TAB Accepted treatment
701626 ADCO-DOXAZASIN Doxazosin 1MG TAB Clinical review
701628 ADCO-DOXAZASIN Doxazosin 2MG TAB Clinical review
701631 ADCO-DOXAZASIN Doxazosin 4MG TAB Clinical review
869856 CARDURA XL Doxazosin 4MG TAB
869864 CARDURA XL Doxazosin 8MG TAB
Page 42 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
714292 CARZIN XL Doxazosin 4MG TAB
806358 HYTRIN Terazosin 1MG TAB
806366 HYTRIN Terazosin 2MG TAB
701425 CARDUGEN WAS MERCK DOXAZOSIN Doxazosin 1MG TAB Clinical review
701426 CARDUGEN WAS MERCK DOXAZOSIN Doxazosin 4MG TAB Clinical review
782122 PRATSIOL Prazosin 1MG TAB Clinical review
782130 PRATSIOL Prazosin 2MG TAB Clinical review
782149 PRATSIOL Prazosin 5MG TAB Clinical review
Arterial Vasodilators
731714 HYPERPHEN Hydralazine 10MG TAB Clinical review
731722 HYPERPHEN Hydralazine 50MG TAB Clinical review
761400 ROLAB-HYDRALAZINE HCL Hydralazine 25MG TAB Clinical review
761419 ROLAB-HYDRALAZINE HCL Hydralazine 50MG TAB Clinical review
Diuretics
780618 ADCO-RETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
701807 ALDACTONE Spironolactone 100MG TAB
701793 ALDACTONE Spironolactone 25MG APP Accepted treatment
702803 AMILORETIC Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
702811 AMILORETIC HS Hydrochlorothiazide and potassium-sparing agents 2.5MG/25MG TAB Accepted treatment
807796 ARELIX Piretanide 3MG TAB
807818 ARELIX Piretanide 6MG TAB
707423 AUSTELL-FUROSEMIDE Furosemide 40MG TAB
707421 AUSTELL-FUROSEMIDE Furosemide 20MG TAB Accepted treatment
808695 BETARETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
821845 BEURISES Furosemide 40MG TAB
711152 BURINEX Bumetanide 1MG TAB
710313 CIPLA-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
819417 DAPAMAX Indapamide 2.5MG TAB Accepted treatment
833045 DAPTRIL Indapamide 2.5MG TAB Accepted treatment
719984 DEZRETIC 5MG/50MG Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
716048 DINO-RETIC Furosemide 40MG TAB Accepted treatment
705967 DIURESIX Furosemide 40MG TAB Accepted treatment
721824 DYAZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment
716962 DYNA INDAPAMIDE SR Indapamide 1.5MG SRT
890470 HEXAZIDE Hydrochlorothiazide 25MG TAB Accepted treatment
822825 HYDRO-LESS Indapamide 2.5MG TAB Accepted treatment
735930 LASIX Furosemide 20MG TAB
735949 LASIX Furosemide 40MG TAB
735957 LASIX Furosemide 500MG TAB
839515 LASIX ORAL Furosemide 10MG/1ML SLN Clinical review
857769 MYLAN FUROSEMIDE Furosemide 40MG TAB Accepted treatment
703329 MYLAN-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
744379 MODURETIC Hydrochlorothiazide and potassium-sparing agents 5MG/50MG TAB Accepted treatment
830836 NATRILIX SR Indapamide 1.5MG SRT
758272 PURESIS Furosemide 40MG TAB
780146 RENEZIDE Hydrochlorothiazide and potassium-sparing agents 25MG/50MG TAB Accepted treatment
880949 RIDAQ Hydrochlorothiazide 25MG TAB Accepted treatment
710437 RIDAQ Hydrochlorothiazide 12.5MG TAB Accepted treatment
731668 ROLAB-FUROSEMIDE Furosemide 40MG TAB
831026 ROLAB-INDAPAMIDE Indapamide 2.5MG TAB Accepted treatment
769665 ROLAB-SPIRONOLACTONE Spironolactone 25MG TAB Accepted treatment
706531 SPEC-CO-AMILORIDE Hydrochlorothiazide and potassium-sparing agents 50MG/5MG TAB Accepted treatment
898937 SPIRACTIN Spironolactone 100MG TAB
Page 43 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
765910 SPIRACTIN Spironolactone 25MG TAB Accepted treatment
774057 URIREX-K Hydrochlorothiazide and potassium TAB Accepted treatment
Beta-blockers
786586 ADCO-ATENOLOL Atenolol 100MG TAB Accepted treatment
786578 ADCO-ATENOLOL Atenolol 50MG TAB Accepted treatment
703914 ADCO BISOCOR 10MG Bisoprolol 10MG TAB Accepted treatment
703913 ADCO BISOCOR 5MG Bisoprolol 5MG TAB Accepted treatment
721438 MYLAN BISOPROLOL Bisoprolol 10MG TAB Accepted treatment
721437 MYLAN BISOPROLOL Bisoprolol 5MG TAB Accepted treatment
704651 B-BLOCK Atenolol 100MG TAB Accepted treatment
704653 B-BLOCK Atenolol 50MG TAB Accepted treatment
706179 BETACOR Bisoprolol 10MG TAB Accepted treatment
706178 BETACOR Bisoprolol 5MG TAB Accepted treatment
704373 BILOCOR 10 Bisoprolol 10MG TAB Accepted treatment
704372 BILOCOR 5 Bisoprolol 5MG TAB Accepted treatment
719154 BISLO Bisoprolol 5MG TAB Accepted treatment
719155 BISLO Bisoprolol 10MG TAB Accepted treatment
720660 BISBETA Bisoprolol 10MG TAB Accepted treatment
720659 BISBETA Bisoprolol 5MG TAB Accepted treatment
704133 BISOHEXAL 10 Bisoprolol 10MG TAB Accepted treatment
704132 BISOHEXAL 5 Bisoprolol 5MG TAB Accepted treatment
707393 BISOPROLOL HEXAL Bisoprolol 10MG TAB Accepted treatment
707391 BISOPROLOL HEXAL Bisoprolol 5MG TAB Accepted treatment
716166 BISOPROLOL UNICORN Bisoprolol 10MG TAB Accepted treatment
716167 BISOPROLOL UNICORN Bisoprolol 5MG TAB Accepted treatment
720043 BISOPROLOL ZYDUS Bisoprolol 10MG TAB Accepted treatment
720044 BISOPROLOL ZYDUS Bisoprolol 5MG TAB Accepted treatment
704441 CARDICOR 10MG Bisoprolol 10MG TAB Accepted treatment
704439 CARDICOR 2.5MG Bisoprolol 2.5MG TAB Accepted treatment
704440 CARDICOR 5MG Bisoprolol 5MG TAB Accepted treatment
818437 CONCOR Bisoprolol 10MG TAB Accepted treatment
818429 CONCOR Bisoprolol 5MG TAB Accepted treatment
720821 RETOCAR Bisoprolol 10MG TAB Accepted treatment
720820 RETOCAR Bisoprolol 5MG TAB Accepted treatment
722055 BISOPROLOL UNICHEM Bisoprolol 5MG TAB Accepted treatment
722056 BISOPROLOL UNICHEM Bisoprolol 10MG TAB Accepted treatment
715626 GULF ATENOLOL Atenolol 100MG TAB Accepted treatment
715625 GULF ATENOLOL Atenolol 50MG TAB Accepted treatment
806897 HEXA-BLOK Atenolol 100MG TAB Accepted treatment
806889 HEXA-BLOK Atenolol 50MG TAB Accepted treatment
732567 INDERAL Propranolol 10MG TAB Accepted treatment
732575 INDERAL Propranolol 40MG TAB Accepted treatment
732648 INDERAL LA Propranolol 80MG CAP
806552 INDOBLOK 10 Propranolol 10MG TAB Accepted treatment
806560 INDOBLOK 40 Propranolol 40MG TAB Accepted treatment
716483 LOVISPES Nebivolol 5MG TAB
700558 NEBILET 5MG Nebivolol 5MG TAB
826901 NORTON-ATENOLOL Atenolol 100MG TAB Accepted treatment
826898 NORTON-ATENOLOL Atenolol 50MG TAB Accepted treatment
787167 PRODOROL Propranolol 10MG TAB Accepted treatment
787175 PRODOROL Propranolol 40MG TAB Accepted treatment
758140 PURBLOKA Propranolol 10MG TAB Accepted treatment
758167 PURBLOKA Propranolol 40MG APP Accepted treatment
Page 44 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
787914 ROLAB-ATENOLOL Atenolol 100MG TAB Accepted treatment
787892 ROLAB-ATENOLOL Atenolol 50MG TAB Accepted treatment
786195 TEN-BLOKA Atenolol 100MG TAB Accepted treatment
786187 TEN-BLOKA Atenolol 50MG TAB Accepted treatment
705873 TENOPRESS Atenolol 100MG TAB Accepted treatment
705872 TENOPRESS Atenolol 25MG TAB Accepted treatment
705874 TENOPRESS Atenolol 50MG TAB Accepted treatment
797693 TENORMIN Atenolol 25MG TAB
769576 TENORMIN Atenolol 100MG TAB Accepted treatment
769584 TENORMIN Atenolol 50MG TAB Accepted treatment
719657 ZETENOL Atenolol 100MG TAB Accepted treatment
719656 ZETENOL Atenolol 50MG TAB Accepted treatment
715276 ZIAPRO Bisoprolol 10MG TAB Accepted treatment
715274 ZIAPRO Bisoprolol 5MG TAB Accepted treatment
Alpha-beta blockers
710339 ASPEN CARVEDILOL Carvedilol 12.5MG TAB
710340 ASPEN CARVEDILOL Carvedilol 25MG TAB
710338 ASPEN CARVEDILOL Carvedilol 6.25MG TAB
897117 CARLOC Carvedilol 25MG TAB
705459 CARLOC 6.25 Carvedilol 6.25MG TAB
700168 CARLOC 12.5 Carvedilol 12.5MG TAB
705770 CARVEDILOL-HEXAL Carvedilol 12.5MG TAB
705767 CARVEDILOL-HEXAL Carvedilol 25MG TAB
705749 CARVEDILOL-HEXAL Carvedilol 6.25MG TAB
716743 CARVEDILOL UNICORN Carvedilol 12.5MG TAB
716744 CARVEDILOL UNICORN Carvedilol 25MG TAB
716742 CARVEDILOL UNICORN Carvedilol 6.25MG TAB
704671 CARVETREND 12.5MG Carvedilol 12.5MG TAB
704672 CARVETREND 25MG Carvedilol 25MG TAB
704670 CARVETREND 6.25MG Carvedilol 6.25MG TAB
836354 DILATREND Carvedilol 12.5MG TAB
788856 DILATREND Carvedilol 25MG APP
833428 DILATREND Carvedilol 6.25MG TAB
710959 VEDIBLOK Carvedilol 12.5MG TAB
710960 VEDIBLOK Carvedilol 25MG TAB
710958 VEDIBLOK Carvedilol 6.25MG TAB
Beta-blocker and diuretic combinations
719202 BILOCOR CO 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
719200 BILOCOR CO 2.5MG/6.25MG Bisoprolol and thiazides 2.5MG/6.25MG TAB
719201 BILOCOR CO 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
718087 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 10M Bisoprolol and thiazides 10MG/6.25MG TAB
718082 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 2.5 Bisoprolol and thiazides 2.5MG/6.25MG TAB
718086 BISOPROLOL HYDROCHLOROTHIAZIDE ZYDUS 5MG Bisoprolol and thiazides 5MG/6.25MG TAB
789615 ROLAB-ATENOLOL/CHLORTHALIDONE 100/25 Atenolol and other diuretics 100MG/25MG TAB Accepted treatment
789607 ROLAB-ATENOLOL/CHLORTHALIDONE 50/12.5 Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment
786217 TENCHLOR Atenolol and other diuretics 100MG/25MG TAB Accepted treatment
807591 TENCHLOR HS Atenolol and other diuretics 50MG/12.5MG TAB Accepted treatment
852929 ZIAK Bisoprolol and thiazides 10MG/6.25MG TAB
840300 ZIAK Bisoprolol and thiazides 2.5MG/6.25MG TAB
840319 ZIAK Bisoprolol and thiazides 5MG/6.25MG TAB
721589 BISOPROLOL CO UNICORN 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
721588 BISOPROLOL CO UNICORN 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
717988 ZIRINAK CO 10MG/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
Page 45 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
717986 ZIRINAK CO 2.5MG/6.25MG Bisoprolol and thiazides 2.5MG/6.25MG TAB
717987 ZIRINAK CO 5MG/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
720033 ZIABETA 10/6.25MG Bisoprolol and thiazides 10MG/6.25MG TAB
720031 ZIABETA 2.5/6.25MG Bisoprolol and thiazides 6.25MG/2.5MG TAB
720032 ZIABETA 5/6.25MG Bisoprolol and thiazides 5MG/6.25MG TAB
Calcium channel antagonists
793124 ADALAT XL Nifedipine 30MG SRT Accepted treatment
719449 GITSALAT Nifedipine 30MG TAB Accepted treatment
840963 ADCO-VASCARD SR Nifedipine 20MG SRC Accepted treatment
720694 ADCO NORPENE Amlodipine 10MG TAB Accepted treatment
720693 ADCO NORPENE Amlodipine 5MG TAB Accepted treatment
708142 ALMADIN Amlodipine 10MG TAB Accepted treatment
708141 ALMADIN Amlodipine 5MG TAB Accepted treatment
707278 AMLATE Amlodipine 10MG TAB Accepted treatment
707277 AMLATE Amlodipine 5MG TAB Accepted treatment
703917 AMLOC 10 Amlodipine 10MG TAB Accepted treatment
703916 AMLOC 5 Amlodipine 5MG TAB Accepted treatment
708051 AMLODAC Amlodipine 10MG TAB Accepted treatment
708050 AMLODAC Amlodipine 5MG TAB Accepted treatment
704621 AMLOSYN 10 Amlodipine 10MG TAB Accepted treatment
704620 AMLOSYN 5 Amlodipine 5MG TAB Accepted treatment
713972 AMTAS Amlodipine 10MG TAB Accepted treatment
713971 AMTAS Amlodipine 5MG TAB Accepted treatment
714311 AURO-AMLODIPINE Amlodipine 10MG TAB Accepted treatment
714310 AURO-AMLODIPINE Amlodipine 5MG TAB Accepted treatment
708095 AUSTELL-AMLODIPINE Amlodipine 10MG TAB Accepted treatment
708094 AUSTELL-AMLODIPINE Amlodipine 5MG TAB Accepted treatment
718083 BIO NIFEDIPINE XL Nifedipine 30MG SRT Accepted treatment
708040 CALBLOC Amlodipine 10MG TAB Accepted treatment
708039 CALBLOC Amlodipine 5MG TAB Accepted treatment
813354 CALCICARD SR Verapamil 240MG SRT Accepted treatment
864153 CIPALAT RETARD Nifedipine 20MG TAB Accepted treatment
708152 CIPLAVASC Amlodipine 10MG TAB Accepted treatment
708150 CIPLAVASC Amlodipine 5MG TAB Accepted treatment
707980 CORVADIL Amlodipine 10MG TAB Accepted treatment
707979 CORVADIL Amlodipine 5MG TAB Accepted treatment
708191 CPL ALLIANCE AMLODIPINE Amlodipine 10MG TAB Accepted treatment
708190 CPL ALLIANCE AMLODIPINE Amlodipine 5MG TAB Accepted treatment
711682 FEDALOC SR Nifedipine 30MG TAB Accepted treatment
712954 GULF AMLODIPINE Amlodipine 10MG TAB Accepted treatment
712953 GULF AMLODIPINE Amlodipine 5MG TAB Accepted treatment
708648 INDO AMLODIPINE Amlodipine 5MG TAB Accepted treatment
734071 ISOPTIN DRAGEES Verapamil 40MG TAB Accepted treatment
734373 ISOPTIN SR Verapamil 240MG SRT Accepted treatment
712216 KEYSAL Amlodipine 10MG TAB Accepted treatment
712215 KEYSAL Amlodipine 5MG TAB Accepted treatment
708162 KLODIP Amlodipine 5MG TAB Accepted treatment
708352 LOMANOR Amlodipine 5MG TAB Accepted treatment
708353 LOMANOR Amlodipine 10MG TAB Accepted treatment
715000 MACOREL SR Nifedipine 30MG SRT Accepted treatment
829501 NIFEDALAT 20 SR Nifedipine 20MG SRT Accepted treatment
799122 NORVASC Amlodipine 10MG TAB Accepted treatment
791245 NORVASC Amlodipine 5MG TAB Accepted treatment
Page 46 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
710238 PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 10MG TAB Accepted treatment
710236 PHARMA DYNAMICS AMLODIPINE BESYLATE Amlodipine 5MG TAB Accepted treatment
813982 PLENDIL Felodipine 10MG SRT
805548 PLENDIL Felodipine 5MG SRT
821896 PLENDIL Felodipine 2.5MG SRT
703902 FELODIPINE HEXAL Felodipine 10MG SRT Accepted treatment
703221 FELODIPINE HEXAL Felodipine 5MG SRT Accepted treatment
819573 RAVAMIL SR Verapamil 240MG SRT Accepted treatment
715002 SPEC NIFEDIPINE SR Nifedipine 30MG SRT Accepted treatment
713491 STAMLO Amlodipine 10MG TAB Accepted treatment
713490 STAMLO Amlodipine 5MG TAB Accepted treatment
813125 TILAZEM 180 CR Diltiazem 180MG SRC
813133 TILAZEM 240 CR Diltiazem 240MG SRC
861545 VASCARD SR Nifedipine 30MG CAP Accepted treatment
774944 VASOMIL Verapamil 40MG TAB Accepted treatment
774952 VASOMIL Verapamil 80MG TAB Accepted treatment
700071 VERAHEXAL 240 SR Verapamil 240MG SRT Accepted treatment
839183 ZILDEM Diltiazem 180MG SRC
839191 ZILDEM Diltiazem 240MG SRC
822213 ZILDEM 60 Diltiazem 60MG TAB
824364 ZILDEM 90 BD Diltiazem 90MG TAB
ACE inhibitors
794058 CIBACE Benazepril 10MG TAB
852333 BIO-CAPTOPRIL Captopril 25MG TAB Accepted treatment
795267 CAPACE Captopril 25MG TAB Accepted treatment
837628 CAPTOHEXAL Captopril 12.5MG TAB Accepted treatment
837636 CAPTOHEXAL Captopril 25MG TAB Accepted treatment
837644 CAPTOHEXAL Captopril 50MG TAB Accepted treatment
712361 CAPOTEN Captopril 50MG TAB Accepted treatment
862622 HYPACE Enalapril 5MG TAB Accepted treatment
791962 MONOPRIL Fosinopril 20MG TAB Accepted treatment
890229 PERDIX 15MG Moexipril 15MG TAB
890222 PERDIX 7.5MG Moexipril 7.5MG TAB
836451 CAPTOMAX Captopril 25MG TAB Accepted treatment
836478 CAPTOMAX Captopril 50MG TAB Accepted treatment
852619 MYLAN CAPTOPRIL Captopril 25MG TAB Accepted treatment
899429 MYLAN-CAPTOPRIL Captopril 50MG TAB Accepted treatment
850896 ROLAB-CAPTOPRIL Captopril 25MG TAB Accepted treatment
850918 ROLAB-CAPTOPRIL Captopril 50MG TAB Accepted treatment
839779 ZAPTO Captopril 25MG TAB Accepted treatment
839787 ZAPTO Captopril 50MG TAB Accepted treatment
792756 INHIBACE Cilazapril 5MG TAB
886835 ADCO-ENALAPRIL Enalapril 5MG TAB Accepted treatment
886843 ADCO-ENALAPRIL 10MG Enalapril 10MG TAB Accepted treatment
886851 ADCO-ENALAPRIL 20MG Enalapril 20MG TAB Accepted treatment
881481 ALAPREN 10 Enalapril 10MG TAB Accepted treatment
881503 ALAPREN 20 Enalapril 20MG TAB Accepted treatment
881473 ALAPREN 5 Enalapril 5MG TAB Accepted treatment
721626 AUSTELL ENALAPRIL Enalapril 10MG TAB Accepted treatment
721627 AUSTELL ENALAPRIL Enalapril 20MG TAB Accepted treatment
721625 AUSTELL ENALAPRIL Enalapril 5MG TAB Accepted treatment
894324 CIPLATEC 10 Enalapril 10MG TAB Accepted treatment
701729 CIPLATEC 20MG Enalapril 20MG TAB Accepted treatment
Page 47 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
894316 CIPLATEC 5 Enalapril 5MG TAB Accepted treatment
723156 ENALAPRIL BIOTECH Enalapril 5MG TAB Accepted treatment
723157 ENALAPRIL BIOTECH Enalapril 10MG TAB Accepted treatment
723159 ENALAPRIL BIOTECH Enalapril 20MG TAB Accepted treatment
891279 ENAP 10MG Enalapril 10MG TAB Accepted treatment
891280 ENAP 20MG Enalapril 20MG TAB Accepted treatment
891272 ENAP 5MG Enalapril 5MG TAB Accepted treatment
712763 ENVAS Enalapril 10MG TAB Accepted treatment
712762 ENVAS Enalapril 5MG TAB Accepted treatment
867853 HR-ENALAPRIL 10 Enalapril 10MG TAB Accepted treatment
867861 HR-ENALAPRIL 20 Enalapril 20MG TAB Accepted treatment
867845 HR-ENALAPRIL 5 Enalapril 5MG TAB Accepted treatment
862622 HYPACE Enalapril 5MG TAB Accepted treatment
868914 PHARMAPRESS Enalapril 10MG TAB Accepted treatment
868922 PHARMAPRESS Enalapril 20MG TAB Accepted treatment
708109 PHARMAPRESS Enalapril 5MG TAB Accepted treatment
759783 RENITEC Enalapril 10MG TAB Accepted treatment
810355 RENITEC Enalapril 2.5MG TAB
759767 RENITEC Enalapril 20MG TAB Accepted treatment
759759 RENITEC Enalapril 5MG TAB Accepted treatment
791962 MONOPRIL Fosinopril 20MG TAB
705450 MYLAN-FOSINOPRIL 10 Fosinopril 10MG TAB
705453 MYLAN-FOSINOPRIL 20 Fosinopril 20MG TAB
715938 APEX-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
714678 AURO-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
714679 AURO-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
714677 AURO-LISINOPRIL Lisinopril 5MG TAB Accepted treatment
704354 AUSTELL LISINOPRIL 2.5MG Lisinopril 2.5MG TAB Accepted treatment
708189 AUSTELL LISINOPRIL 20MG Lisinopril 20MG TAB Accepted treatment
712598 AUSTELL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
701392 HEXAL-LISINOPRIL Lisinopril 10MG TAB Accepted treatment
701394 HEXAL-LISINOPRIL Lisinopril 20MG TAB Accepted treatment
701387 HEXAL-LISINOPRIL Lisinopril 5MG TAB Accepted treatment
716794 LYSIN Lisinopril 10MG TAB Accepted treatment
716792 LYSIN Lisinopril 5MG TAB Accepted treatment
707311 SIMAYLA LISINOPRIL Lisinopril 10MG TAB Accepted treatment
707312 SIMAYLA LISINOPRIL Lisinopril 20MG TAB Accepted treatment
700692 SINOPREN 10 Lisinopril 10MG TAB Accepted treatment
700694 SINOPREN 20 Lisinopril 20MG TAB Accepted treatment
700691 SINOPREN 5 Lisinopril 5MG TAB Accepted treatment
703645 ZEMAX 10 Lisinopril 10MG TAB Accepted treatment
705318 ZEMAX 20 Lisinopril 20MG TAB Accepted treatment
703646 ZEMAX 5 Lisinopril 5MG TAB Accepted treatment
781703 ZESTRIL Lisinopril 10MG TAB Accepted treatment
781711 ZESTRIL Lisinopril 20MG TAB Accepted treatment
781681 ZESTRIL Lisinopril 5MG TAB Accepted treatment
862053 ZETOMAX (ZESTOMAX) 10MG Lisinopril 10MG TAB Accepted treatment
862061 ZETOMAX (ZESTOMAX) 20MG Lisinopril 20MG TAB Accepted treatment
862045 ZETOMAX (ZESTOMAX) 5MG Lisinopril 5MG TAB Accepted treatment
715649 ACESYL Perindopril 4MG TAB
714869 ACTI-PREX (GLENMARK PERINDOPRIL) Perindopril 4MG TAB
716505 AURO PERINDOPRIL Perindopril 4MG TAB
716506 AURO PERINDOPRIL Perindopril 8MG TAB
Page 48 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
717293 BINDACE Perindopril 4MG TAB
717294 BINDACE Perindopril 8MG TAB
710302 CIPLA-PERINDOPRIL Perindopril 4MG TAB
710510 CIPLA-PERINDOPRIL Perindopril 8MG TAB
715786 CIPLASYL Perindopril 4MG TAB
715795 CIPLASYL Perindopril 8MG TAB
785121 COVERSYL Perindopril 4MG TAB
705915 COVERSYL Perindopril 10MG TAB
714527 PEARINDA Perindopril 4MG TAB
714528 PEARINDA Perindopril 8MG TAB
717783 PERINDOPRIL UNICORN Perindopril 4MG TAB
717784 PERINDOPRIL UNICORN Perindopril 8MG TAB
721339 PERISTAR Perindopril 4MG TAB
721340 PERISTAR Perindopril 8MG TAB
703541 PREXUM Perindopril 4MG TAB
720387 PREXUM Perindopril 5MG TAB
714646 PREXUM Perindopril 10MG TAB
710611 RAN-PERINDOPRIL Perindopril 4MG TAB
712615 SPEC-PERINDOPRIL Perindopril 4MG TAB
712616 SPEC-PERINDOPRIL Perindopril 8MG TAB
710297 VECTORYL Perindopril 4MG TAB
710925 VECTORYL Perindopril 8MG TAB
716680 ZYDUS PERINDOPRIL Perindopril 4MG TAB
708119 ACCUMAX Quinapril 10MG TAB Accepted treatment
708120 ACCUMAX Quinapril 20MG TAB Accepted treatment
783293 ACCUPRIL Quinapril 5MG TAB
783307 ACCUPRIL Quinapril 10MG TAB Accepted treatment
783315 ACCUPRIL Quinapril 20MG TAB Accepted treatment
853186 ACCUPRIL Quinapril 40MG TAB
708981 QUINAGEN Quinapril 5MG TAB
708982 QUINAGEN Quinapril 10MG TAB Accepted treatment
708983 QUINAGEN Quinapril 20MG TAB Accepted treatment
708985 QUINAGEN Quinapril 40MG TAB
705457 QUINASPEN 10MG Quinapril 10MG TAB Accepted treatment
705447 QUINASPEN 20MG Quinapril 20MG TAB Accepted treatment
715957 APEX-RAMIPRIL Ramipril 10MG CAP
715954 APEX-RAMIPRIL Ramipril 2.5MG CAP
715955 APEX-RAMIPRIL Ramipril 5MG CAP
705752 AUSTELL-RAMIPRIL 1.25MG Ramipril 1.25MG CAP
705755 AUSTELL-RAMIPRIL 10MG Ramipril 10MG CAP
705753 AUSTELL-RAMIPRIL 2.5MG Ramipril 2.5MG CAP
705754 AUSTELL-RAMIPRIL 5MG Ramipril 5MG CAP
704374 RAMIPRIL HEXAL Ramipril 2.5MG TAB
704375 RAMIPRIL HEXAL Ramipril 5MG TAB
704023 RAMIWIN Ramipril 2.5MG CAP
704025 RAMIWIN Ramipril 5MG CAP
705426 RAMPIL 1.25MG Ramipril 1.25MG CAP
705429 RAMPIL 10MG Ramipril 10MG CAP
705427 RAMPIL 2.5MG Ramipril 2.5MG CAP
705428 RAMPIL 5MG Ramipril 5MG CAP
704975 RAN RAMIPRIL Ramipril 10MG CAP
707383 RETACE Ramipril 2.5MG TAB
707385 RETACE Ramipril 5MG TAB
Page 49 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
707869 SIMAYLA RAMIPRIL Ramipril 10MG CAP
841579 TRITACE Ramipril 1.25MG TAB
841587 TRITACE Ramipril 2.5MG TAB
841595 TRITACE Ramipril 5MG TAB
782602 TRITACE Ramipril 10MG CAP
805068 MAVIK (PREVIOUSLY GOPTEN) Trandolapril 2MG CAP
805033 MAVIK (PREVIOUSLY GOPTEN) Trandolapril 0.5MG CAP
ACE inhibitor and calcium channel antagonist combinations
719853 COVERAM 10/10 perindopril and amlodipine 10MG/10MG TAB
719854 COVERAM 10/5 perindopril and amlodipine 10MG/5MG TAB
719852 COVERAM 5/10 perindopril and amlodipine 5MG/10MG TAB
719855 COVERAM 5/5 perindopril and amlodipine 5MG/5MG TAB
ACE inhibitor and diuretic combinations
708116 ACCUMAX CO Quinapril and diuretics 10MG/12.5MG TAB
708118 ACCUMAX CO Quinapril and diuretics 20MG/12.5MG TAB
795755 ACCURETIC Quinapril and diuretics 10MG/12.5MG TAB
805297 ACCURETIC Quinapril and diuretics 20MG/12.5MG TAB
706235 ADCO-QUINARETIC 10/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
706236 ADCO-QUINARETIC 20/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
715651 ACESYL CO Perindopril and diuretics 1.25MG/4MG TAB
717795 ARIPREL PLUS 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
716120 AURO-LISINOPRIL CO Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
716121 AURO-LISINOPRIL CO Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
718056 AURO QUINAPRIL CO 10MG/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
718057 AURO QUINAPRIL CO 20MG/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
721508 BIOPREXUM PLUS 10MG/2.5MG Perindopril and diuretics 10MG/2.5MG TAB
719873 BIQURETIC 10MG/12.5MG Quinapril and diuretics 10MG/12.5MG TAB
719874 BIQURETIC 20MG/12.5MG Quinapril and diuretics 20MG/12.5MG TAB
787035 CO-RENITEC Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
877549 COVERSYL PLUS Perindopril and diuretics 4MG/1.25MG TAB
720389 COVERSYL PLUS 5MG/1.25MG Perindopril and diuretics 5MG/1.25MG TAB
710978 DIACE CO Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
891287 ENAP-CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
815055 INHIBACE PLUS Cilazapril and diuretics 5MG/12.5MG TAB
704703 HEXAL LISINOPRIL CO 10 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704704 HEXAL LISINOPRIL CO 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
716943 LISINOPRIL CO UNICORN 10MG/12.5MG Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
716945 LISINOPRIL CO UNICORN 20MG/12.5MG Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
711989 LISINOZIDE Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
711990 LISINOZIDE Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704437 LISORETIC 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704438 LISORETIC 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
707292 LISOZIDE 10MG/12.5MG Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
707291 LISOZIDE 20MG/12.5MG Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
714952 PEARINDA PLUS Perindopril and diuretics 1.25MG/4MG TAB
717782 PERINDOPRIL CO UNICORN 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
721519 BIOCOVERSYL PLUS 10MG/2.5MG Perindopril and diuretics 10MG/2.5MG TAB
885019 PHARMAPRESS CO Enalapril and diuretics 20MG/12.5MG TAB Accepted treatment
704929 PREXUM PLUS Perindopril and diuretics 4MG/1.25MG TAB
720388 PREXUM PLUS 5MG/1.25MG Perindopril and diuretics 5MG/1.25MG TAB
707550 QUINAZIDE 10/12.5 Quinapril and diuretics 10MG/12.5MG TAB
707551 QUINAZIDE 20/12.5 Quinapril and diuretics 20MG/12.5MG TAB
713763 SPEC-PERINDOPRIL PLUS Perindopril and diuretics 1.25MG/4MG TAB
Page 50 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
718093 TRITACE PLUS 10MG/12.5MG Ramipril and diuretics 10MG/12.5MG TAB
718094 TRITACE PLUS 5MG/12.5MG Ramipril and diuretics 5MG/12.5MG TAB
718092 TRITACE PLUS 5MG/25MG Ramipril and diuretics 5MG/25MG TAB
710298 VECTORYL PLUS Perindopril and diuretics 1.25MG/4MG TAB
839795 ZAPTO-CO Captopril and diuretics 50MG/25MG TAB Accepted treatment
704597 ZETOMAX CO 10/12.5 Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
704598 ZETOMAX CO 20/12.5 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
817848 ZESTORETIC Lisinopril and diuretics 10MG/12.5MG TAB Accepted treatment
797685 ZESTORETIC Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
708260 ZESTOZIDE 20 Lisinopril and diuretics 20MG/12.5MG TAB Accepted treatment
717095 ZYDUS PERINDOPRIL CO 4MG/1.25MG Perindopril and diuretics 1.25MG/4MG TAB
Angiotensin Receptor Blockers
720582 ANTOSART Irbesartan 150MG TAB
720583 ANTOSART Irbesartan 300MG TAB
718667 ADCO IRBESARTAN Irbesartan 150MG TAB
718668 ADCO IRBESARTAN Irbesartan 300MG TAB
723123 ATERWIN Candesartan 8MG TAB Accepted treatment
723124 ATERWIN Candesartan 16MG TAB Accepted treatment
837814 APROVEL Irbesartan 150MG TAB
837822 APROVEL Irbesartan 300MG TAB
856118 ATACAND Candesartan 16MG TAB
856096 ATACAND Candesartan 8MG TAB
898635 ATACAND PLUS Candesartan and diuretics 16MG/12.5MG TAB
721629 ABECARD Candesartan 8MG TAB
721630 ABECARD Candesartan 16MG TAB
716495 AURO LOSARTAN Losartan 100MG TAB Accepted treatment
716494 AURO LOSARTAN Losartan 50MG TAB Accepted treatment
717069 AUSTELL LOSARTAN Losartan 100MG TAB Accepted treatment
717068 AUSTELL LOSARTAN Losartan 50MG TAB Accepted treatment
719453 CANDEPRES PLUS 16MG/12.5MG Candesartan and diuretics 16MG/12.5MG TAB
720319 CANDAGEN Candesartan 16MG TAB
720318 CANDAGEN Candesartan 8MG TAB
716644 CIPLAZAR Losartan 100MG TAB Accepted treatment
716643 CIPLAZAR Losartan 50MG TAB Accepted treatment
709845 CIPLA-LOSARTAN Losartan 100MG TAB Accepted treatment
709844 CIPLA-LOSARTAN Losartan 50MG TAB Accepted treatment
818739 COZAAR Losartan 50MG TAB Accepted treatment
710079 COZAAR Losartan 100MG TAB Accepted treatment
717035 DIOLO Valsartan 160MG TAB
717034 DIOLO Valsartan 80MG TAB
700710 DIOVAN 160 Valsartan 160MG TAB
700000 DIOVAN 80 Valsartan 80MG TAB
717793 DYNARB Irbesartan 150MG TAB
717794 DYNARB Irbesartan 300MG TAB
712385 IRBEWIN Irbesartan 150MG TAB
712384 IRBEWIN Irbesartan 300MG TAB
718506 IRTANEL Irbesartan 150MG TAB
718507 IRTANEL Irbesartan 300MG TAB
719162 ISART Irbesartan 150MG TAB
719163 ISART Irbesartan 300MG TAB
709924 LOS-ARB Losartan 50MG TAB Accepted treatment
720776 LOZAAN Losartan 100MG TAB Accepted treatment
Page 51 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
720775 LOZAAN Losartan 50MG TAB Accepted treatment
718366 LOSARTAN UNICORN Losartan 100MG TAB Accepted treatment
718365 LOSARTAN UNICORN Losartan 50MG TAB Accepted treatment
709909 LOSARTAN-WINTHROP Losartan 50MG TAB Accepted treatment
860387 MICARDIS Telmisartan 40MG TAB
860395 MICARDIS Telmisartan 80MG TAB
721133 MYCARBIS (NAMIBIA ONLY) Telmisartan 40MG TAB
721134 MYCARBIS (NAMIBIA ONLY) Telmisartan 80MG TAB
721678 TESAR Telmisartan 40MG TAB
721679 TESAR Telmisartan 80MG TAB
715569 MIGROBEN Valsartan 160MG TAB
715568 MIGROBEN Valsartan 80MG TAB
720439 MIZART Telmisartan 40MG TAB
720440 MIZART Telmisartan 80MG TAB
719210 MYLACAND Candesartan 16MG TAB
719209 MYLACAND Candesartan 8MG TAB
719506 MYLACAND PLUS 16MG/12.5MG Candesartan and diuretics 16MG/12.5MG TAB
714249 PRITOR Telmisartan 40MG TAB
714250 PRITOR Telmisartan 80MG TAB
717296 RASOL Losartan 100MG TAB Accepted treatment
717295 RASOL Losartan 50MG TAB Accepted treatment
715871 RENICARD Losartan 50MG TAB Accepted treatment
713254 SPEC-LOSARTAN Losartan 100MG TAB Accepted treatment
713255 SPEC-LOSARTAN Losartan 50MG TAB Accepted treatment
704696 TAREG Valsartan 160MG TAB
705060 TAREG Valsartan 80MG TAB
720592 TELGEN Telmisartan 40MG TAB
720593 TELGEN Telmisartan 80MG TAB
719851 VALANT Valsartan 160MG TAB
719849 VALANT Valsartan 40MG TAB
719850 VALANT Valsartan 80MG TAB
718364 VALSARTAN UNICORN Valsartan 160MG TAB
718363 VALSARTAN UNICORN Valsartan 80MG TAB
709225 ZARTAN Losartan 50MG TAB Accepted treatment
709964 ZARTAN Losartan 100MG TAB Accepted treatment
715556 ZOMEVEK Valsartan 160MG TAB
715555 ZOMEVEK Valsartan 80MG TAB
Angiotensin Receptor Blockers and diuretic combinations
891353 COAPROVEL Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
712386 CO-IRBEWIN Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
718571 ISART CO 150MG/12.5MG Irbesartan and diuretics 150MG/12.5MG TAB Accepted treatment
898597 COAPROVEL Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
712387 CO-IRBEWIN Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
718573 ISART CO 300MG/12.5MG Irbesartan and diuretics 300MG/12.5MG TAB Accepted treatment
720930 CO-IRBEWIN 300MG/25MG Irbesartan and diuretics 300MG/25MG TAB Accepted treatment
723331 COZAAR COMP 100MG/12.5MG Losartan and diuretics 100MG/12.5MG TAB Accepted treatment
716613 CIPLAZAR CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
887096 FORTZAAR Losartan and diuretics 100MG/25MG TAB Accepted treatment
717084 HYTENZA CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716059 LOHYPE FORTE PLUS 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
715857 LOSAAR PLUS 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
718368 LOSARTAN CO UNICORN 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
Page 52 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
715739 LOZAAN CO 100/25 Losartan and diuretics 100MG/25MG TAB Accepted treatment
715849 NETRASOL CO 100/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716515 SARTOC 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
716217 ZARTAN CO 100MG/25MG Losartan and diuretics 100MG/25MG TAB Accepted treatment
717070 AUSTELL LOSARTAN CO 50MG/12.5MG Losartan and diuretics 50MG/12.5 MG TAB Accepted treatment
828181 COZAAR COMP Losartan and diuretics 50MG/12.5 MG TAB Accepted treatment
716612 CIPLAZAR CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716476 HYTENZA CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716058 LOHYPE PLUS 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715856 LOSAAR PLUS 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716274 LOSACAR CO 50MG/12,5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
718367 LOSARTAN CO UNICORN 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715740 LOZAAN CO 50/12.5 Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
722549 MEDI-LOSARCO (NAMIBIA ONLY) 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715848 NETRASOL CO 50/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
715064 SARTOC 50/12.5 Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
716216 ZARTAN CO 50MG/12.5MG Losartan and diuretics 50MG/12.5MG TAB Accepted treatment
714251 CO-PRITOR 40/12.5 MG Telmisartan + Hydrochlorothiazide 40MG/12.5MG TAB Accepted treatment
714252 CO-PRITOR 80/12.5MG Telmisartan + Hydrochlorothiazide 80MG/12.5MG TAB Accepted treatment
716791 CO-MICARDIS 80MG/25MG Telmisartan + Hydrochlorothiazide 80MG/25MG TAB Accepted treatment
894614 CO-MICARDIS 40/12.5MG Telmisartan + Hydrochlorothiazide 40MG/12.5MG TAB Accepted treatment
894621 CO-MICARDIS 80/12.5MG Telmisartan + Hydrochlorothiazide 80MG/12.5MG TAB Accepted treatment
715672 CO-TAREG 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
718608 DIOLO CO 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
719205 DYNAVAL CO 160MG/12.5MG Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
891894 CO-DIOVAN Valsartan and diuretics 160MG/12.5MG TAB Accepted treatment
719206 DYNAVAL CO 160MG/25MG Valsartan and diuretics 160MG/25MG TAB Accepted treatment
706051 CO-DIOVAN PLUS Valsartan and diuretics 160MG/25MG TAB Accepted treatment
715673 CO-TAREG PLUS Valsartan and diuretics 160MG/25MG TAB Accepted treatment
705068 CO-TAREG 80MG/12.5MG Valsartan and diuretics 80MG TAB Accepted treatment
718607 DIOLO CO 80MG/12.5MG Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
719204 DYNAVAL CO 80MG/12.5MG Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
839884 CO-DIOVAN Valsartan and diuretics 80MG/12.5MG TAB Accepted treatment
715571 CO-MIGROBEN 160MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715572 CO-MIGROBEN 160MG/25MG Valsartan and diuretics TAB Accepted treatment
715570 CO-MIGROBEN 80MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715559 CO-ZOMEVEK 160MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715558 CO-ZOMEVEK 80MG/12.5MG Valsartan and diuretics TAB Accepted treatment
715560 CO-ZOMEVEK160MG/25MG Valsartan and diuretics TAB Accepted treatment
Combination antihypertensives
717633 CO EXFORGE 10MG/160MG/12.5MG valsartan, amlodipine and hydrochlorothiazide TAB
717634 CO EXFORGE 10MG/160MG/25MG valsartan, amlodipine and hydrochlorothiazide TAB
717631 CO EXFORGE 5MG/160MG/12.5MG valsartan, amlodipine and hydrochlorothiazide TAB
717632 CO EXFORGE 5MG/160MG/25MG valsartan, amlodipine and hydrochlorothiazide TAB
711254 EXFORGE Valsartan and Amlodipine 10MG/160MG TAB
711253 EXFORGE Valsartan and Amlodipine 5MG/160MG TAB
721594 COPALIA 10MG/160MG Valsartan and amlodipine 10MG/160MG TAB
721593 COPALIA 5MG/160MG Valsartan and amlodipine 5MG/160MG TAB
862207 TRI-PLEN Ramipril and calcium channel blockers 2.5MG/2.5MG TAB
717367 TWYNSTA 40MG/10MG telmisartan and amlodipine 40MG/10MG TAB
717366 TWYNSTA 40MG/5MG telmisartan and amlodipine 40MG/5MG TAB
717369 TWYNSTA 80MG/10MG telmisartan and amlodipine 80MG/10MG TAB
Page 53 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
717368 TWYNSTA 80MG/5MG telmisartan and amlodipine 80MG/5MG TAB
711444 ZANERIL Enalapril and Lercanidipine 10MG/10MG TAB
Hypothyroidism
722944 ELTROXIN Levothyroxine sodium 0.05MG TAB Accepted treatment
722952 ELTROXIN Levothyroxine sodium 0.1MG TAB Accepted treatment
723167 ELTROXIN NEW FORMULATION Levothyroxine sodium 25MCG TAB Accepted treatment
723168 ELTROXIN NEW FORMULATION Levothyroxine sodium 50MCG TAB Accepted treatment
723170 ELTROXIN NEW FORMULATION Levothyroxine sodium 75MCG TAB Accepted treatment
723171 ELTROXIN NEW FORMULATION Levothyroxine sodium 100MCG TAB Accepted treatment
723172 ELTROXIN NEW FORMULATION Levothyroxine sodium 200MCG TAB Accepted treatment
713169 EUTHYROX Levothyroxine sodium 100MCG TAB Accepted treatment
713172 EUTHYROX Levothyroxine sodium 25MCG TAB Accepted treatment
713168 EUTHYROX Levothyroxine sodium 50MCG TAB Accepted treatment
716576 SYNTHROID Levothyroxine sodium 100MCG TAB Accepted treatment
716577 SYNTHROID Levothyroxine sodium 112MCG TAB Accepted treatment
716571 SYNTHROID Levothyroxine sodium 25MCG TAB Accepted treatment
716574 SYNTHROID Levothyroxine sodium 50MCG TAB Accepted treatment
716575 SYNTHROID Levothyroxine sodium 88MCG TAB Accepted treatment
Multiple sclerosis
Anticholinergics
720658 DITROPAN Oxybutynin 5MG TAB Accepted treatment
872253 LENDITRO Oxybutynin 5MG TAB Accepted treatment
701893 MYLAN OXYBUTYNIN CHLORIDE 5 Oxybutynin 5MG TAB Accepted treatment
722063 OXYREST Oxybutynin 5MG TAB Accepted treatment
701170 URIHEXAL 5MG Oxybutynin 5MG TAB Accepted treatment
Immunosuppressants
782556 ABITREXATE-20ML Methotrexate 500MG/20ML INJ Accepted treatment
782548 ABITREXATE-2ML Methotrexate 50MG INJ Accepted treatment
701252 AZAMUN Azathioprine 50MG TAB Accepted treatment
706108 AZAPRESS Azathioprine 50MG TAB Accepted treatment
712609 AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment
712504 EMTHEXATE Methotrexate 2.5MG TAB Accepted treatment
825557 EMTHEXATE RTU 500-20 20ML Methotrexate 25MG/1ML INJ Accepted treatment
711328 METACHOR VIAL 2ML Methotrexate 25MG/1ML INJ Accepted treatment
723274 ENDOXAN Cyclophosphamide 50MG TAB Accepted treatment
732524 IMURAN Azathioprine 50MG TAB Accepted treatment
840815 METHOTREXATE CSV 2ML (P&U) Methotrexate 50MG/2ML INJ Accepted treatment
840807 METHOTREXATE CSV 20ML (P&U) Methotrexate 500MG/20ML INJ Accepted treatment
742465 METHOTREXATE Methotrexate 2.5MG TAB Accepted treatment
700777 ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment
Muscle relaxants
738344 LIORESAL Baclofen 10MG TAB Accepted treatment
865567 BIO-BACLOFEN Baclofen 10MG TAB Accepted treatment
712607 TEVA BACLOFEN Baclofen 10MG TAB Accepted treatment
722015 ASPEN BACLOFEN Baclofen 10MG TAB Accepted treatment
Tricyclic Antidepressants
718746 GULF AMITRIPTYLINE Amitriptyline 25MG TAB Accepted treatment
784230 ROLAB-AMITRIPTYLINE HCL Amitriptyline 25MG TAB Accepted treatment
772003 TREPILINE Amitriptyline 10MG TAB Accepted treatment
771996 TREPILINE Amitriptyline 25MG TAB Accepted treatment
816515 SANDOZ DOTHIEPIN HCL Dosulepin 75MG TAB Accepted treatment
Page 54 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
772860 TRYPTANOL Amitriptyline 25MG TAB Accepted treatment
757888 PROTHIADEN Dosulepin 25MG CAP Accepted treatment
800198 THADEN Dosulepin 25MG CAP Accepted treatment
800201 THADEN Dosulepin 75MG TAB Accepted treatment
724661 ETHIPRAMINE Imipramine 10MG TAB Accepted treatment
724688 ETHIPRAMINE Imipramine 25MG TAB Accepted treatment
771120 TOFRANIL Imipramine 10MG TAB Accepted treatment
771139 TOFRANIL Imipramine 25MG TAB Accepted treatment
Carbamazepine
712493 DEGRANOL Carbamazepine 200MG TAB Accepted treatment
712523 ROLAB-CARBAMAZEPINE Carbamazepine 200MG TAB Accepted treatment
769398 TEGRETOL Carbamazepine 200MG TAB
779652 TEGRETOL CR Carbamazepine 200MG SRT Accepted treatment
779660 TEGRETOL CR Carbamazepine 400MG SRT Accepted treatment
715962 ZEPTOL Carbamazepine 200MG TAB Accepted treatment
Analgesics
717725 ACTAMOL Paracetamol 500MG TAB Accepted treatment
701634 DIS-CHEM PARACETAMOL Paracetamol 500MG TAB Accepted treatment
716045 ADCO-NAPAMOL Paracetamol 500MG TAB Accepted treatment
805467 ANTALGIC 500 Paracetamol 500MG TAB Accepted treatment
713153 AUSTELL-PARACETAMOL Paracetamol 500MG TAB Accepted treatment
714499 CLICKS PARACETAMOL Paracetamol 500MG TAB Accepted treatment
897124 CO CODAMOL Paracetamol combinations payable by PBM 500MG/8MG EFF Accepted treatment
787043 CODOROL Paracetamol combinations payable by PBM TAB Accepted treatment
719662 COGESIC Paracetamol combinations payable by PBM 500MG/8MG TAB Accepted treatment
837652 DINO-COD (BEI) Paracetamol and codeine TAB Accepted treatment
720860 DOLOROL Paracetamol 500MG TAB Accepted treatment
720879 DOLOROL FORTE Paracetamol combinations payable by PBM TAB Accepted treatment
824992 GENCETAMOL Paracetamol 500MG TAB Accepted treatment
715112 GRAYS PARACETAMOL Paracetamol 500MG TAB Accepted treatment
867950 GULF PARACETAMOL Paracetamol 500MG TAB Accepted treatment
894212 JP PARACETAMOL Paracetamol 500MG TAB Accepted treatment
715280 LENNON PARACETAMOL Paracetamol 500MG TAB Accepted treatment
745707 NAPACOD Paracetamol combinations payable by PBM TAB Accepted treatment
745723 NAPAMOL Paracetamol 500MG TAB Accepted treatment
799629 PAINAMOL (GREEN) Paracetamol 500MG TAB Accepted treatment
707910 PAINAMOL PLUS (BETACOD) Paracetamol combinations payable by PBM TAB Accepted treatment
752142 PAINAMOL WHITE Paracetamol 500MG TAB Accepted treatment
867969 PAINBLOK Paracetamol 500MG TAB Accepted treatment
752126 PAINCOD Acetylsalicylic acid comb. excl. psycholeptics TAB Accepted treatment
895030 PAINCODEIN Paracetamol combinations payable by PBM 500MG/8MG TAB Accepted treatment
704465 PAINOGESIC Paracetamol 500MG TAB Accepted treatment
752274 PANADO Paracetamol 500MG CAP Accepted treatment
752274 PANADO Paracetamol 500MG TAB Accepted treatment
708432 PANADO CHILDRENS Paracetamol 125MG MLT Accepted treatment
720438 PARAFIZZ Paracetamol 500MG EFT Accepted treatment
704719 PARACET Paracetamol 500MG TAB Accepted treatment
784443 PARAMED Paracetamol 500MG TAB Accepted treatment
752878 PARAPANE Paracetamol 500MG TAB Accepted treatment
757403 PROLIEF Paracetamol 500MG TAB Accepted treatment
714707 PYNGESIC T Paracetamol 500MG TAB Accepted treatment
761303 ROCODIN Paracetamol and codeine TAB Accepted treatment
765635 SPECTRAPAIN Paracetamol combinations payable by PBM CAP Accepted treatment
Page 55 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
826588 THERA-PAIN Paracetamol 500MG TAB Accepted treatment
713688 VARI-COCODAMOL 8MG/500MG Paracetamol combinations payable by PBM 8MG/500MG TAB Accepted treatment
701140 VARIPAN Paracetamol 500MG TAB Accepted treatment
885863 VON PARACETAMOL Paracetamol 500MG TAB Accepted treatment
710211 ZYDUS-PARACETAMOL Paracetamol 500MG TAB Accepted treatment
Non-steroidal anti-inflammatories
786594 ADCO-DICLOFENAC Diclofenac 25MG TAB Accepted treatment
788597 ADCO-DICLOFENAC Diclofenac 50MG TAB Accepted treatment
780596 ADCO-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
717155 AUSTELL IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
717153 AUSTELL IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
710830 BRUFEN Ibuprofen 400MG TAB Accepted treatment
722843 BIO-NAPROXEN Naproxen 500MG TAB Accepted treatment
710822 BRUFEN Ibuprofen 200MG TAB Accepted treatment
701106 ADCO-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
721114 AUSTIFEN Ibuprofen 200MG TAB Accepted treatment
721117 AUSTIFEN Ibuprofen 400MG TAB Accepted treatment
883102 ADCO-MEFENAMIC ACID Mefenamic acid 250MG CAP
705376 ADCO-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
705375 ADCO-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
785245 ADCO-NAPROXEN Naproxen 250MG TAB Accepted treatment
785253 ADCO-PIROXICAM Piroxicam 10MG CAP Accepted treatment
785261 ADCO-PIROXICAM Piroxicam 20MG CAP Accepted treatment
892302 ADVIL LIQUI GEL Ibuprofen 200MG CAP Accepted treatment
716004 ADVIL LIQUI GEL Ibuprofen 400MG CAP Accepted treatment
893390 A-LENNON DICLOFENAC Diclofenac 25MG TAB Accepted treatment
893391 A-LENNON DICLOFENAC Diclofenac 50MG TAB Accepted treatment
701891 AMDOCIN Indometacin 25MG CAP Accepted treatment
707668 APEX-MELOXICAM Meloxicam 15MG TAB Accepted treatment
707667 APEX-MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
711325 ARROW MELOXICAM Meloxicam 15MG TAB Accepted treatment
711324 ARROW MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
704725 ARTHREXIN Indometacin 25MG APP Accepted treatment
704741 ARTHREXIN Indometacin 100MG SUP Accepted treatment
707374 ARTHROCOX Meloxicam 15MG TAB Accepted treatment
707373 ARTHROCOX Meloxicam 7.5MG TAB Accepted treatment
813044 ARTHROTEC Diclofenac, combinations 50MG/200MCG ECT
869805 ARTHROTEC Diclofenac, combinations 75MG/200mcg ECT
799459 BE-TABS NAPROXEN Naproxen 250MG TAB Accepted treatment
787833 BETACIN Indometacin 25MG CAP Accepted treatment
708186 BETAGESIC Ibuprofen 200MG TAB Accepted treatment
787426 BETAPROFEN Ibuprofen 200MG TAB Accepted treatment
701975 BETAPROFEN 400 FC Ibuprofen 400MG TAB Accepted treatment
715831 BIO-NAPROXEN Naproxen 250MG TAB Accepted treatment
708290 BREN Ibuprofen 400MG TAB Accepted treatment
800724 BREXECAM Piroxicam 20MG TAB Accepted treatment
710830 BRUFEN Ibuprofen 400MG TAB Accepted treatment
899070 COXFLAM Meloxicam 15MG TAB Accepted treatment
899066 COXFLAM Meloxicam 7.5MG TAB Accepted treatment
841153 DICLOHEXAL Diclofenac 50MG TAB Accepted treatment
853240 DICLOHEXAL 25T Diclofenac 25MG TAB Accepted treatment
718479 DICLOFENAC BIOTECH Diclofenac 25MG TAB Accepted treatment
718480 DICLOFENAC SR BIOTECH Diclofenac 100MG SRT Accepted treatment
Page 56 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
706314 DIFEN SR Diclofenac 100MG TAB Accepted treatment
797707 FENAMIN Mefenamic acid 250MG CAP
797715 FENAMIN Mefenamic acid 500MG TAB
717092 FLAMARYX Meloxicam 15MG TAB Accepted treatment
717091 FLAMARYX Meloxicam 7.5MG TAB Accepted treatment
726389 FLAMECID Indometacin 25MG CAP Accepted treatment
704828 FLEXOCAM Meloxicam 15MG TAB Accepted treatment
704829 FLEXOCAM Meloxicam 7.5MG TAB Accepted treatment
791547 FORTFEN SR Diclofenac 100MG SRC Accepted treatment
718305 GLENMARK MELOXICAM Meloxicam 15MG TAB Accepted treatment
718306 GLENMARK MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
868213 GULF INDOMETHACIN Indometacin 25MG CAP Accepted treatment
895196 IBOFLAM Ibuprofen 200MG TAB Accepted treatment
705940 IBU Ibuprofen 200MG TAB Accepted treatment
721114 IBUCARE Ibuprofen 200MG TAB Accepted treatment
721116 IBUCARE Ibuprofen 400MG TAB Accepted treatment
721117 IBUCARE Ibuprofen 600MG TAB Accepted treatment
704781 IBUGESIC Ibuprofen 100MG/5ML SUS Accepted treatment
700316 IBUMAX Ibuprofen 200MG TAB Accepted treatment
700318 IBUMAX Ibuprofen 400MG TAB Accepted treatment
809268 IBUMED Ibuprofen 200MG CAP Accepted treatment
868221 IBUNATE Ibuprofen 200MG TAB Accepted treatment
721335 INFLAMAX PAEDIATRIC Ibuprofen 100MG/5ML SUS Accepted treatment
733741 INZA Ibuprofen 200MG TAB Accepted treatment
733768 INZA Ibuprofen 400MG TAB Accepted treatment
822205 KETOFLAM SR Ketoprofen 200MG SRC Accepted treatment
868469 LENAFEN Ibuprofen 200MG TAB Accepted treatment
701522 LOXIFLAM 15 Meloxicam 15MG TAB Accepted treatment
701520 LOXIFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
705177 M-CAM 15MG Meloxicam 15MG TAB Accepted treatment
705176 M-CAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
788996 MEDIFLEX Indometacin 25MG CAP Accepted treatment
718382 MEDOXICAM Meloxicam 15MG TAB Accepted treatment
718381 MEDOXICAM Meloxicam 7.5MG TAB Accepted treatment
705297 MELFLAM 15 Meloxicam 15MG TAB Accepted treatment
705296 MELFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
716169 MELOXICAM UNICORN Meloxicam 15MG TAB Accepted treatment
716168 MELOXICAM UNICORN Meloxicam 7.5MG TAB Accepted treatment
786012 MYLAN DICLOFENAC (ARCANAFENAC) Diclofenac 25MG TAB Accepted treatment
786020 MYLAN DICLOFENAC SOD (ARCANAFENAC) Diclofenac 50MG TAB Accepted treatment
810185 MYLAN NAPROXEN (ARCANA-NAPROXEN) Naproxen 250MG TAB Accepted treatment
814393 METHOCAPS Indometacin 25MG CAP Accepted treatment
818615 MOBIC Meloxicam 7.5MG TAB Accepted treatment
842052 MOBIC 15MG Meloxicam 15MG TAB Accepted treatment
812625 NAFASOL EC-250 Naproxen 250MG ECT
812633 NAFASOL EC-500 Naproxen 500MG ECT
806447 NAPFLAM Naproxen 250MG TAB Accepted treatment
808474 NAPFLAM Naproxen 500MG TAB Accepted treatment
805238 NAPROSCRIPT Naproxen 250MG TAB Accepted treatment
748560 NUROFEN Ibuprofen 200MG TAB Accepted treatment
711948 NUROFEN (CAPLETS) Ibuprofen 200MG CAP Accepted treatment
897984 NUROFEN EXTRA STRENGTH Ibuprofen 400MG TAB Accepted treatment
897060 PAINIL Ibuprofen 200MG TAB Accepted treatment
Page 57 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
752398 PANAMOR AT-50 Diclofenac 50MG TAB Accepted treatment
827592 PANAMOR SR Diclofenac 100MG TAB Accepted treatment
827584 PANAMOR SR Diclofenac 75MG TAB Accepted treatment
752371 PANAMOR-25 Diclofenac 25MG TAB Accepted treatment
716517 PIROXICAM ACTOR DT Piroxicam 20MG DSP Accepted treatment
827428 PIXICAM Piroxicam 20MG DSP Accepted treatment
796433 PONAC Mefenamic acid 250MG CAP
756148 PONSTAN Mefenamic acid 250MG CAP
756156 PONSTAN Mefenamic acid 50MG/5ML SUS
756164 PONSTAN FORTE Mefenamic acid 500MG TAB
812250 PONSTEL 250 Mefenamic acid 250MG CAP
810371 PONSTEL FORTE Mefenamic acid 500MG TAB
799432 PYROCAPS Piroxicam 20MG CAP Accepted treatment
824852 RANFEN Ibuprofen 200MG TAB Accepted treatment
701654 RANFEN 400 Ibuprofen 400MG TAB Accepted treatment
821144 RHEUGESIC Piroxicam 20MG DSP Accepted treatment
719811 ROLAB-DICLOFENAC SODIUM Diclofenac 25MG TAB Accepted treatment
719838 ROLAB-DICLOFENAC SODIUM Diclofenac 50MG TAB Accepted treatment
834327 ROLAB-DICLOFENAC SR Diclofenac 100MG TAB Accepted treatment
703966 ROLAB-IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
703974 ROLAB-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
782807 ROLAB-IBUPROFEN Ibuprofen 600MG TAB
704776 ROLAB-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
701072 ROXIFEN Piroxicam 20MG CAP Accepted treatment
704589 SANDOZ MELOXICAM Meloxicam 15MG TAB Accepted treatment
704588 SANDOZ MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
787272 VELTEX CR Diclofenac 100MG SRC Accepted treatment
793663 VELTEX CR Diclofenac 75MG SRC Accepted treatment
718724 VIMOVO 500/20MG naproxen and esomeprazole TAB
778206 VOLTAREN Diclofenac 25MG TAB Accepted treatment
789240 VOLTAREN 75 Diclofenac 75MG TAB Accepted treatment
835218 VOLTAREN DROPS Diclofenac 15MG/1ML DRP
778222 VOLTAREN GT Diclofenac 50MG TAB Accepted treatment
778230 VOLTAREN SR Diclofenac 100MG TAB Accepted treatment
860654 XEFO Lornoxicam 4MG TAB
860662 XEFO Lornoxicam 8MG TAB
797030 XYCAM Piroxicam 20MG CAP Accepted treatment
797049 XYCAM DISPERS Piroxicam 20MG DSP Accepted treatment
705230 ZYDUS-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
705229 ZYDUS-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
Parkinson's Disease
Levodopa combinations
824321 CARBILEV Levodopa and decarboxylase inhibitor 25MG/100MG TAB Accepted treatment
824348 CARBILEV Levodopa and decarboxylase inhibitor 25MG/250MG TAB Accepted treatment
739928 MADOPAR Levodopa and decarboxylase inhibitor 50MG/200MG TAB Accepted treatment
828483 MADOPAR HBS Levodopa and decarboxylase inhibitor 25MG/100MG CAP Accepted treatment
764078 SINEMET Levodopa and decarboxylase inhibitor 25MG/100MG TAB Accepted treatment
764086 SINEMET Levodopa and decarboxylase inhibitor 25MG/250MG TAB Accepted treatment
794635 SINEMET CR Levodopa and decarboxylase inhibitor 50MG/200MG SRT Accepted treatment
710286 TEVA CARBI-LEVO 25/100 Levodopa and decarboxylase inhibitor 25MG/100MG TAB Accepted treatment
710468 TEVA CARBI-LEVO 25/250 Levodopa and decarboxylase inhibitor 25MG/250MG TAB Accepted treatment
Page 58 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Dopamine agonists and other
700500 SYMADIN (WAS FLUSTOP) Amantadine 100MG CAP Accepted treatment
768243 SYMMETREL Amantadine 100MG CAP Accepted treatment
701491 AKINETON Biperiden 2MG TAB Accepted treatment
713209 LENNON-BIPERIDEN Biperiden 2MG TAB Accepted treatment
704593 ASPEN BROMOCRIPTINE Bromocriptine 2.5MG TAB Clinical review
752959 PARLODEL Bromocriptine 2.5MG TAB Clinical review
720542 DISIPAL Orphenadrine (chloride) 50MG TAB Accepted treatment
722748 MYLAN PRAMIPEXOLE Pramipexole .125MG TAB Specialist motivation
722749 MYLAN PRAMIPEXOLE Pramipexole .25MG TAB Specialist motivation
722750 MYLAN PRAMIPEXOLE Pramipexole 1MG TAB Specialist motivation
719542 OXPOLA Pramipexole .125MG TAB
719543 OXPOLA Pramipexole .25MG TAB
719545 OXPOLA Pramipexole 1MG TAB
898836 PEXOLA .125MG Pramipexole 0.125MG TAB
898848 PEXOLA .25MG Pramipexole 0.25MG TAB
898828 PEXOLA 1MG Pramipexole 1MG TAB
718255 PEXOLA ER Pramipexole .75MG SRT
718256 PEXOLA ER Pramipexole 1.5MG SRT
718257 PEXOLA ER Pramipexole 3MG SRT
718258 PEXOLA ER Pramipexole 4.5MG SRT
718253 PEXOLA ER Pramipexole .375MG SRT
719844 PRAMEX Pramipexole .125MG TAB
719843 PRAMEX Pramipexole .25MG TAB
719845 PRAMEX Pramipexole 1MG TAB
717741 PRAMIOLA Pramipexole .125MG TAB
717742 PRAMIOLA Pramipexole .25MG TAB
719569 ACCORD ROPINIROLE Ropinirole .25MG TAB Specialist motivation
719570 ACCORD ROPINIROLE Ropinirole .5MG TAB Specialist motivation
719571 ACCORD ROPINIROLE Ropinirole 1MG TAB Specialist motivation
719572 ACCORD ROPINIROLE Ropinirole 2MG TAB Specialist motivation
719573 ACCORD ROPINIROLE Ropinirole 5MG TAB Specialist motivation
700647 REQUIP 0.25MG Ropinirole 0.25MG TAB Specialist motivation
700650 REQUIP 0.5MG Ropinirole 0.5MG TAB Specialist motivation
700652 REQUIP 1MG Ropinirole 1MG TAB Specialist motivation
700655 REQUIP 2MG Ropinirole 2MG TAB Specialist motivation
700658 REQUIP 5MG Ropinirole 5MG TAB Specialist motivation
711090 REQUIP XL Ropinirole 2MG SRT Specialist motivation
711091 REQUIP XL Ropinirole 4MG SRT Specialist motivation
711092 REQUIP XL Ropinirole 8MG SRT Specialist motivation
715081 RESURE Ropinirole 0.25MG TAB Specialist motivation
715082 RESURE Ropinirole 0.5MG TAB Specialist motivation
715083 RESURE Ropinirole 1MG TAB Specialist motivation
715084 RESURE Ropinirole 2MG TAB Specialist motivation
715086 RESURE Ropinirole 5MG TAB Specialist motivation
706712 PARKILYNE Selegiline 5MG TAB Accepted treatment
713210 BENZHEXOL Trihexyphenidyl 2MG TAB Accepted treatment
Rheumatoid arthritis
Disease modifying agents
782556 ABITREXATE-20ML Methotrexate 500MG/20ML INJ Accepted treatment
782548 ABITREXATE-2ML Methotrexate 50MG INJ Accepted treatment
898171 ARAVA Leflunomide 10MG TAB Specialist motivation
Page 59 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
898175 ARAVA Leflunomide 20MG TAB Specialist motivation
721609 RHEUMALEF Leflunomide 10MG TAB Specialist motivation
721610 RHEUMALEF Leflunomide 20MG TAB Specialist motivation
721806 LUNAR Leflunomide 20MG TAB Specialist motivation
712504 EMTHEXATE Methotrexate 2.5MG TAB Accepted treatment
825557 EMTHEXATE RTU 500-20 20ML Methotrexate 25MG/1ML INJ Accepted treatment
711328 METACHOR VIAL 2ML Methotrexate 25MG/1ML INJ Accepted treatment
840815 METHOTREXATE CSV 2ML (P&U) Methotrexate 50MG/2ML INJ Accepted treatment
840807 METHOTREXATE CSV 20ML (P&U) Methotrexate 500MG/20ML INJ Accepted treatment
742465 METHOTREXATE Methotrexate 2.5MG TAB Accepted treatment
878790 MIRQUIN Chloroquine 50MG/5ML SYR
747297 NIVAQUINE Chloroquine 200MG TAB Accepted treatment
794333 PLASMOQUINE Chloroquine 200MG CAP Accepted treatment
760501 RIDAURA Auranofin 3MG TAB Specialist motivation
762008 SALAZOPYRIN Sulfasalazine 500MG TAB Accepted treatment
762016 SALAZOPYRIN E.N. Sulfasalazine 500MG ECT Accepted treatment
Immunosuppressants
701252 AZAMUN Azathioprine 50MG TAB Accepted treatment
706108 AZAPRESS Azathioprine 50MG TAB Accepted treatment
712609 AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment
732524 IMURAN Azathioprine 50MG TAB
700777 ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment
Alkylating agents
723274 ENDOXAN Cyclosphosphamide 50MG TAB Specialist motivation
737887 LEUKERAN Chlorambucil 2MG TAB Specialist motivation
Non-steroidal anti-inflammatories
786594 ADCO-DICLOFENAC Diclofenac 25MG TAB Accepted treatment
788597 ADCO-DICLOFENAC Diclofenac 50MG TAB Accepted treatment
780596 ADCO-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
717155 AUSTELL IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
717153 AUSTELL IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
710822 BRUFEN Ibuprofen 200MG TAB Accepted treatment
721114 AUSTIFEN Ibuprofen 200MG TAB Accepted treatment
721117 AUSTIFEN Ibuprofen 400MG TAB Accepted treatment
710830 BRUFEN Ibuprofen 400MG TAB Accepted treatment
722843 BIO-NAPROXEN Naproxen 500MG TAB Accepted treatment
701106 ADCO-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
883102 ADCO-MEFENAMIC ACID Mefenamic acid 250MG CAP
875643 ADCO-MEFENAMIC SUS Mefenamic acid 50MG/5ML SUS
705376 ADCO-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
705375 ADCO-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
785245 ADCO-NAPROXEN Naproxen 250MG TAB Accepted treatment
785253 ADCO-PIROXICAM Piroxicam 10MG CAP Accepted treatment
785261 ADCO-PIROXICAM Piroxicam 20MG CAP Accepted treatment
892302 ADVIL LIQUI GEL Ibuprofen 200MG CAP Accepted treatment
716004 ADVIL LIQUI GEL Ibuprofen 400MG CAP Accepted treatment
893390 A-LENNON DICLOFENAC Diclofenac 25MG TAB Accepted treatment
893391 A-LENNON DICLOFENAC Diclofenac 50MG TAB Accepted treatment
701891 AMDOCIN Indometacin CAP Accepted treatment
707668 APEX-MELOXICAM Meloxicam 15MG TAB Accepted treatment
707667 APEX-MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
711325 ARROW MELOXICAM Meloxicam 15MG TAB Accepted treatment
711324 ARROW MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
Page 60 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
704725 ARTHREXIN Indometacin 25MG APP Accepted treatment
704741 ARTHREXIN Indometacin 100MG SUP Accepted treatment
707374 ARTHROCOX Meloxicam 15MG TAB Accepted treatment
707373 ARTHROCOX Meloxicam 7.5MG TAB Accepted treatment
813044 ARTHROTEC Diclofenac, combinations 50MG/200MCG ECT
869805 ARTHROTEC Diclofenac, combinations 75MG/200mcg ECT
799459 BE-TABS NAPROXEN Naproxen 250MG TAB Accepted treatment
787833 BETACIN Indometacin 25MG CAP Accepted treatment
708186 BETAGESIC Ibuprofen 200MG TAB Accepted treatment
787426 BETAPROFEN Ibuprofen 200MG TAB Accepted treatment
701975 BETAPROFEN 400 FC Ibuprofen 400MG TAB Accepted treatment
715831 BIO-NAPROXEN Naproxen 250MG TAB Accepted treatment
708290 BREN Ibuprofen 400MG TAB Accepted treatment
800724 BREXECAM Piroxicam 20MG TAB Accepted treatment
710830 BRUFEN Ibuprofen 400MG TAB Accepted treatment
710857 BRUFEN PAED SUSP Ibuprofen 100MG/5ML SUS Accepted treatment
899070 COXFLAM Meloxicam 15MG TAB Accepted treatment
899066 COXFLAM Meloxicam 7.5MG TAB Accepted treatment
841153 DICLOHEXAL Diclofenac 50MG TAB Accepted treatment
853240 DICLOHEXAL 25T Diclofenac 25MG TAB Accepted treatment
718479 DICLOFENAC BIOTECH Diclofenac 25MG TAB Accepted treatment
718480 DICLOFENAC SR BIOTECH Diclofenac 100MG SRT Accepted treatment
706314 DIFEN SR Diclofenac 100MG TAB Accepted treatment
797707 FENAMIN Mefenamic acid 250MG CAP
797715 FENAMIN Mefenamic acid 500MG TAB
797014 FENAMIN Mefenamic acid 50MG/5ML SUS
717092 FLAMARYX Meloxicam 15MG TAB Accepted treatment
717091 FLAMARYX Meloxicam 7.5MG TAB Accepted treatment
726389 FLAMECID Indometacin 25MG CAP Accepted treatment
704828 FLEXOCAM Meloxicam 15MG TAB Accepted treatment
704829 FLEXOCAM Meloxicam 7.5MG TAB Accepted treatment
791547 FORTFEN SR Diclofenac 100MG SRC Accepted treatment
718305 GLENMARK MELOXICAM Meloxicam 15MG TAB Accepted treatment
718306 GLENMARK MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
868213 GULF INDOMETHACIN Indometacin 25MG CAP Accepted treatment
895196 IBOFLAM Ibuprofen 200MG TAB Accepted treatment
705940 IBU Ibuprofen 200MG TAB Accepted treatment
721114 IBUCARE Ibuprofen 200MG TAB Accepted treatment
721116 IBUCARE Ibuprofen 400MG TAB Accepted treatment
721117 IBUCARE Ibuprofen 600MG TAB Accepted treatment
704781 IBUGESIC Ibuprofen 100MG/5ML SUS Accepted treatment
700316 IBUMAX Ibuprofen 200MG TAB Accepted treatment
700318 IBUMAX Ibuprofen 400MG TAB Accepted treatment
700315 IBUMAX PAEDIATRIC Ibuprofen 100MG/5ML SUS Accepted treatment
809268 IBUMED Ibuprofen 200MG CAP Accepted treatment
868221 IBUNATE Ibuprofen 200MG TAB Accepted treatment
721335 INFLAMAX PAEDIATRIC Ibuprofen 100MG/5ML SUS Accepted treatment
733741 INZA Ibuprofen 200MG TAB Accepted treatment
733768 INZA Ibuprofen 400MG TAB Accepted treatment
822205 KETOFLAM SR Ketoprofen 200MG SRC Accepted treatment
868469 LENAFEN Ibuprofen 200MG TAB Accepted treatment
701522 LOXIFLAM 15 Meloxicam 15MG TAB Accepted treatment
701520 LOXIFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
Page 61 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
705177 M-CAM 15MG Meloxicam 15MG TAB Accepted treatment
705176 M-CAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
788996 MEDIFLEX Indometacin 25MG CAP Accepted treatment
718382 MEDOXICAM Meloxicam 15MG TAB Accepted treatment
718381 MEDOXICAM Meloxicam 7.5MG TAB Accepted treatment
705297 MELFLAM 15 Meloxicam 15MG TAB Accepted treatment
705296 MELFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
716169 MELOXICAM UNICORN Meloxicam 15MG TAB Accepted treatment
716168 MELOXICAM UNICORN Meloxicam 7.5MG TAB Accepted treatment
786012 MYLAN DICLOFENAC (ARCANAFENAC) Diclofenac 25MG TAB Accepted treatment
786020 MYLAN DICLOFENAC SOD (ARCANAFENAC) Diclofenac 50MG TAB Accepted treatment
810185 MYLAN NAPROXEN (ARCANA-NAPROXEN) Naproxen 250MG TAB Accepted treatment
814393 METHOCAPS Indometacin 25MG CAP Accepted treatment
818615 MOBIC Meloxicam 7.5MG TAB Accepted treatment
842052 MOBIC 15MG Meloxicam 15MG TAB Accepted treatment
812625 NAFASOL EC-250 Naproxen 250MG ECT
812633 NAFASOL EC-500 Naproxen 500MG ECT
806447 NAPFLAM Naproxen 250MG TAB Accepted treatment
808474 NAPFLAM Naproxen 500MG TAB Accepted treatment
805238 NAPROSCRIPT Naproxen 250MG TAB Accepted treatment
748560 NUROFEN Ibuprofen 200MG TAB Accepted treatment
711948 NUROFEN (CAPLETS) Ibuprofen 200MG CAP Accepted treatment
897984 NUROFEN EXTRA STRENGTH Ibuprofen 400MG TAB Accepted treatment
700695 NUROFEN FOR CHILDREN SUGAR FREE Ibuprofen 100MG/5ML SUS Accepted treatment
712683 NUROFEN FOR CHILDREN STRAWBERRY Ibuprofen 100MG/5ML SUS Accepted treatment
897060 PAINIL Ibuprofen 200MG TAB Accepted treatment
752398 PANAMOR AT-50 Diclofenac 50MG TAB Accepted treatment
827592 PANAMOR SR Diclofenac 100MG TAB Accepted treatment
827584 PANAMOR SR Diclofenac 75MG TAB Accepted treatment
752371 PANAMOR-25 Diclofenac 25MG TAB Accepted treatment
716517 PIROXICAM ACTOR DT Piroxicam 20MG DSP Accepted treatment
827428 PIXICAM Piroxicam 20MG DSP Accepted treatment
796433 PONAC Mefenamic acid 250MG CAP
793264 PONAC Mefenamic acid 50MG/5ML SUS
756148 PONSTAN Mefenamic acid 250MG CAP
756156 PONSTAN Mefenamic acid 50MG/5ML SUS
756164 PONSTAN FORTE Mefenamic acid 500MG TAB
812250 PONSTEL 250 Mefenamic acid 250MG CAP
810371 PONSTEL FORTE Mefenamic acid 500MG TAB
810398 PONSTEL S Mefenamic acid 50MG/5ML SUS
799432 PYROCAPS Piroxicam 20MG CAP Accepted treatment
824852 RANFEN Ibuprofen 200MG TAB Accepted treatment
701654 RANFEN 400 Ibuprofen 400MG TAB Accepted treatment
821144 RHEUGESIC Piroxicam 20MG DSP Accepted treatment
719811 ROLAB-DICLOFENAC SODIUM Diclofenac 25MG TAB Accepted treatment
719838 ROLAB-DICLOFENAC SODIUM Diclofenac 50MG TAB Accepted treatment
834327 ROLAB-DICLOFENAC SR Diclofenac 100MG TAB Accepted treatment
703966 ROLAB-IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
703974 ROLAB-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
782807 ROLAB-IBUPROFEN Ibuprofen 600MG TAB
704776 ROLAB-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
701072 ROXIFEN Piroxicam 20MG CAP Accepted treatment
704589 SANDOZ MELOXICAM Meloxicam 15MG TAB Accepted treatment
Page 62 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
704588 SANDOZ MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
787272 VELTEX CR Diclofenac 100MG SRC Accepted treatment
793663 VELTEX CR Diclofenac 75MG SRC Accepted treatment
718724 VIMOVO 500/20MG naproxen and esomeprazole TAB
778206 VOLTAREN Diclofenac 25MG TAB Accepted treatment
789240 VOLTAREN 75 Diclofenac 75MG TAB Accepted treatment
835218 VOLTAREN DROPS Diclofenac 15MG/1ML DRP
778222 VOLTAREN GT Diclofenac 50MG TAB Accepted treatment
778230 VOLTAREN SR Diclofenac 100MG TAB Accepted treatment
860654 XEFO Lornoxicam 4MG TAB
860662 XEFO Lornoxicam 8MG TAB
797030 XYCAM Piroxicam 20MG CAP Accepted treatment
797049 XYCAM DISPERS Piroxicam 20MG DSP Accepted treatment
705230 ZYDUS-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
705229 ZYDUS-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
Oral Corticosteroids
716381 ADCO PREDNISOLONE Prednisolone 15MG/5ML LIQ Accepted treatment
714552 ASPELONE Prednisolone 15MG/5ML LIQ Accepted treatment
814407 CAPSOID Prednisolone 5MG TAB Accepted treatment
800155 LENISOLONE Prednisolone 5MG TAB Accepted treatment
742759 METICORTEN Prednisone 50MG TAB
742732 METICORTEN Prednisone 5MG TAB
752304 PANAFCORT Prednisone 5MG TAB Accepted treatment
788783 PREDNISONE (BE-TABS) Prednisone 5MG TAB Accepted treatment
700170 PREFLAM Prednisolone 15MG/5ML SYR Accepted treatment
703720 PRELONE Prednisolone 5MG TAB
805149 PRELONE Prednisolone 15MG/5ML SYR Accepted treatment
703603 PULMISON ORAL SOLUTION Prednisone 5MG/1ML SYR Accepted treatment
836826 PULMISON TABS Prednisone 20MG TAB
818267 TROLIC Prednisone 5MG TAB Accepted treatment
Schizophrenia
Antipsychotic agents
892310 SOLIAN Amisulpride 200MG TAB
892309 SOLIAN Amisulpride 50MG TAB
705634 ABILIFY 10MG Aripiprazole 10MG TAB
705635 ABILIFY 15MG Aripiprazole 15MG TAB
712192 ABILIFY 5MG Aripiprazole 5MG TAB
735884 LARGACTIL Chlorpromazine 100MG TAB Accepted treatment
735868 LARGACTIL Chlorpromazine 25MG TAB Accepted treatment
735876 LARGACTIL Chlorpromazine 50MG TAB Accepted treatment
717082 ASPEN CLOZAPINE Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
717081 ASPEN CLOZAPINE Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
700178 CLOMENT Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
700176 CLOMENT Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
736716 LEPONEX Clozapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
736708 LEPONEX Clozapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
726656 FLUANXOL Flupentixol .5MG TAB Accepted treatment
726664 FLUANXOL Flupentixol 1MG TAB Accepted treatment
726672 FLUANXOL DEPOT 1ML Flupentixol 20MG/1ML INJS Accepted treatment
726680 FLUANXOL DEPOT 2ML Flupentixol INJ Accepted treatment
744301 MODECATE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment
744328 MODECATE+SYRINGE 1ML Fluphenazine 25MG/1ML INJS Accepted treatment
Page 63 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
719549 GULF HALOPERIDOL Haloperidol 5MG TAB Accepted treatment
730335 ROLAB-HALOPERIDOL Haloperidol 1.5MG TAB Accepted treatment
730327 ROLAB-HALOPERIDOL Haloperidol 5MG TAB Accepted treatment
763411 SERENACE Haloperidol 0.5MG CAP Accepted treatment
763535 SERENACE Haloperidol 10MG TAB Accepted treatment
763454 SERENACE Haloperidol 5MG TAB Accepted treatment
720687 ADCO OLANZAPINE Olanzapine 2.5MG TAB Accepted treatment
720691 ADCO OLANZAPINE Olanzapine 5MG TAB Accepted treatment
720692 ADCO OLANZAPINE Olanzapine 10MG TAB Accepted treatment
720529 LANAZYP Olanzapine 10MG TAB Accepted treatment
720527 LANAZYP Olanzapine 2.5MG TAB Accepted treatment
720528 LANAZYP Olanzapine 5MG TAB Accepted treatment
718997 MYLAN OLANZAPINE Olanzapine 10MG TAB Accepted treatment
718995 MYLAN OLANZAPINE Olanzapine 2.5MG TAB Accepted treatment
718996 MYLAN OLANZAPINE Olanzapine 5MG TAB Accepted treatment
721389 OLAWIN Olanzapine 10MG TAB Accepted treatment
721385 OLAWIN Olanzapine 2.5MG TAB Accepted treatment
721388 OLAWIN Olanzapine 5MG TAB Accepted treatment
721390 OLAWIN ORADISPERSIBLE Olanzapine 10MG MLT Accepted treatment
721386 OLAWIN ORADISPERSIBLE Olanzapine 5MG MLT Accepted treatment
715996 OLEANZ Olanzapine 10MG TAB Accepted treatment
715994 OLEANZ Olanzapine 2.5MG TAB Accepted treatment
715995 OLEANZ Olanzapine 5MG TAB Accepted treatment
715968 OLEANZ RAPITAB Olanzapine 10MG MLT Accepted treatment
715967 OLEANZ RAPITAB Olanzapine 5MG MLT Accepted treatment
715659 OLEXAR Olanzapine 10MG TAB Accepted treatment
715657 OLEXAR Olanzapine 2.5MG TAB Accepted treatment
715658 OLEXAR Olanzapine 5MG TAB Accepted treatment
720714 PREXOLAN Olanzapine 10MG TAB Accepted treatment
720712 PREXOLAN Olanzapine 2.5MG TAB Accepted treatment
720713 PREXOLAN Olanzapine 5MG TAB Accepted treatment
719807 PREXOLAN ODT Olanzapine 10MG MLT Accepted treatment
719806 PREXOLAN ODT Olanzapine 5MG MLT Accepted treatment
715685 REDILANZ Olanzapine 10MG TAB Accepted treatment
715683 REDILANZ Olanzapine 2.5MG TAB Accepted treatment
715684 REDILANZ Olanzapine 5MG TAB Accepted treatment
721653 ZYLENA Olanzapine 10MG TAB Accepted treatment
721652 ZYLENA Olanzapine 5MG TAB Accepted treatment
827517 ZYPREXA Olanzapine 10MG TAB Accepted treatment
864188 ZYPREXA Olanzapine 2.5MG TAB Accepted treatment
827509 ZYPREXA Olanzapine 5MG TAB Accepted treatment
715666 INVEGA Paliperidone 3MG SRT Specialist motivation
715667 INVEGA Paliperidone 6MG SRT Specialist motivation
715668 INVEGA Paliperidone 9MG SRT Specialist motivation
718469 XEPLION PREFILLED SYRINGE 0.5ML Paliperidone 50MG/.5ML INJ Specialist motivation
718470 XEPLION PREFILLED SYRINGE 0.75ML Paliperidone 75MG/.75ML INJ Specialist motivation
718472 XEPLION PREFILLED SYRINGE 1.5ML Paliperidone 150MG/1.5ML INJ Specialist motivation
718471 XEPLION PREFILLED SYRINGE 1ML Paliperidone 100MG/1ML INJ Specialist motivation
751073 ORAP Pimozide 1MG TAB Specialist motivation
751081 ORAP Pimozide 4MG TAB Specialist motivation
716051 DOPAQUEL Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716052 DOPAQUEL Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716050 DOPAQUEL Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
Page 64 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
716053 DOPAQUEL Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
720981 KIZOFRIN Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
720979 KIZOFRIN Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
720980 KIZOFRIN Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
720982 KIZOFRIN Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716668 MYLAN QUETIAPINE Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716670 MYLAN QUETIAPINE Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716671 MYLAN QUETIAPINE Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716672 MYLAN QUETIAPINE Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
718353 PSYQUET Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
718354 PSYQUET Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
718352 PSYQUET Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
718355 PSYQUET Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
721745 QUETIAPINE BIOTECH Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
721746 QUETIAPINE BIOTECH Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
721744 QUETIAPINE BIOTECH Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
721747 QUETIAPINE BIOTECH Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
716652 SEREZ Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
716653 SEREZ Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
716651 SEREZ Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
716654 SEREZ Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
850535 SEROQUEL Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
850543 SEROQUEL Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
850527 SEROQUEL Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
703344 SEROQUEL Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
713747 SEROQUEL XR Quetiapine 50MG SRT Accepted treatment (clinical motivation for low-cost options)
717404 SEROQUEL XR Quetiapine 150MG SRT Accepted treatment (clinical motivation for low-cost options)
713748 SEROQUEL XR Quetiapine 200MG SRT Accepted treatment (clinical motivation for low-cost options)
713749 SEROQUEL XR Quetiapine 300MG SRT Accepted treatment (clinical motivation for low-cost options)
713750 SEROQUEL XR Quetiapine 400MG SRT Accepted treatment (clinical motivation for low-cost options)
718704 SIZONORM Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
718705 SIZONORM Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
718674 SIZONORM Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
718706 SIZONORM Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
720894 SPEC QUETIAPINE Quetiapine 100MG TAB Accepted treatment (clinical motivation for low-cost options)
721710 SPEC QUETIAPINE Quetiapine 150MG TAB Accepted treatment (clinical motivation for low-cost options)
720896 SPEC QUETIAPINE Quetiapine 200MG TAB Accepted treatment (clinical motivation for low-cost options)
720893 SPEC QUETIAPINE Quetiapine 25MG TAB Accepted treatment (clinical motivation for low-cost options)
720897 SPEC QUETIAPINE Quetiapine 300MG TAB Accepted treatment (clinical motivation for low-cost options)
711471 ASPEN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
711472 ASPEN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711473 ASPEN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
711474 ASPEN RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711475 ASPEN RISPERIDONE Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
716500 AUROPERDAL Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
716501 AUROPERDAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
716502 AUROPERDAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
716503 AUROPERDAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
716504 AUROPERDAL Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
714686 AUROPIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
714687 AUROPIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
714688 AUROPIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
714689 AUROPIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
Page 65 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
714690 AUROPIDONE Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
712212 DRL RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712211 DRL RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712210 DRL RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
712209 DRL RISPERIDONE Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
712191 MYLAN RISPERIDONE Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712190 MYLAN RISPERIDONE Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712189 MYLAN RISPERIDONE Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
720334 PERIDA Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
720335 PERIDA Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712617 PERIZAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
712618 PERIZAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
712619 PERIZAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
712621 PERIZAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
717996 RISNIA Risperidone .5MG TAB Accepted treatment (clinical motivation for low-cost options)
717997 RISNIA Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
717998 RISNIA Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
717999 RISNIA Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
714101 RISPACOR Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
713967 RISPACOR Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
713966 RISPACOR Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
713965 RISPACOR Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
713964 RISPACOR Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
891523 RISPERDAL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
828432 RISPERDAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
801860 RISPERDAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
801879 RISPERDAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
705474 RISPERDAL CONSTA Risperidone 25MG VIAL Specialist motivation
705475 RISPERDAL CONSTA Risperidone 37.5MG VIAL Specialist motivation
705476 RISPERDAL CONSTA Risperidone 50MG VIAL Specialist motivation
710790 RISPERIDONE HEXAL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
710791 RISPERIDONE HEXAL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
710793 RISPERIDONE HEXAL Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711419 RISPERLET Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
711420 RISPERLET Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711421 RISPERLET Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
718226 RISPEVON Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
718227 RISPEVON Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
718228 RISPEVON Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
718229 RISPEVON Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
723314 RISPIDE Risperidone .5MG TAB Accepted treatment
723315 RISPIDE Risperidone 1MG TAB Accepted treatment
723316 RISPIDE Risperidone 2MG TAB Accepted treatment
711537 RISPONZ Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711534 RISPONZ Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
711536 RISPONZ Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
711538 RISPONZ Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
715736 SCHIZOROL Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
715737 SCHIZOROL Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
715738 SCHIZOROL Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
721750 ZOXADON Risperidone 3MG TAB Accepted treatment (clinical motivation for low-cost options)
721752 ZOXADON Risperidone 4MG TAB Accepted treatment (clinical motivation for low-cost options)
711511 ZOXADON Risperidone 0.5MG TAB Accepted treatment (clinical motivation for low-cost options)
Page 66 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
711512 ZOXADON Risperidone 1MG TAB Accepted treatment (clinical motivation for low-cost options)
711513 ZOXADON Risperidone 2MG TAB Accepted treatment (clinical motivation for low-cost options)
705386 BIO-SULPIRIDE Sulpiride 200MG TAB Accepted treatment
766410 STELAZINE Trifluoperazine 1MG TAB Accepted treatment
766437 STELAZINE Trifluoperazine 5MG TAB Accepted treatment
703465 GEODON Ziprasidone 20MG CAP
703468 GEODON Ziprasidone 40MG CAP
703475 GEODON Ziprasidone 60MG CAP
703476 GEODON Ziprasidone 80MG CAP
789798 CLOPIXOL Zuclopenthixol 10MG TAB
796751 CLOPIXOL Zuclopenthixol 2MG TAB
714852 CLOPIXOL DEPOT Zuclopenthixol 200MG/1ML INJS Accepted treatment
Antidepressants
724661 ETHIPRAMINE Imipramine 10MG TAB Accepted treatment
724688 ETHIPRAMINE Imipramine 25MG TAB Accepted treatment
718746 GULF AMITRIPTYLINE Amitriptyline 25MG TAB Accepted treatment
816515 SANDOZ DOTHIEPIN HCL Dosulepin 75MG TAB Accepted treatment
757888 PROTHIADEN Dothiepin 25MG CAP Accepted treatment
784230 ROLAB-AMITRIPTYLINE HCL Amitriptyline 25MG TAB Accepted treatment
800198 THADEN Dothiepin 25MG CAP Accepted treatment
800201 THADEN Dothiepin 75MG TAB Accepted treatment
771120 TOFRANIL Imipramine 10MG TAB Accepted treatment
771139 TOFRANIL Imipramine 25MG TAB Accepted treatment
772003 TREPILINE Amitriptyline 10MG TAB Accepted treatment
771996 TREPILINE Amitriptyline 25MG TAB Accepted treatment
772860 TRYPTANOL Amitriptyline 25MG TAB Accepted treatment
Mood Stabilisers
705441 ASPEN LAMOTRIGINE 100MG Lamotrigine 100MG TAB Accepted treatment
705436 ASPEN LAMOTRIGINE 25MG Lamotrigine 25MG TAB Accepted treatment
705440 ASPEN LAMOTRIGINE 50MG Lamotrigine 50MG TAB Accepted treatment
707789 AUSTELL-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
707790 AUSTELL-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
707787 AUSTELL-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
707788 AUSTELL-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
715980 CONVULEX Valproic acid 150MG CAP Accepted treatment
715999 CONVULEX Valproic acid 300MG CAP Accepted treatment
781568 CONVULEX Valproic acid 500MG CAP Accepted treatment
712493 DEGRANOL Carbamazepine 200MG TAB Accepted treatment
710389 DYNA-LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
710390 DYNA-LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
710387 DYNA-LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
710388 DYNA-LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
722725 GIROTEC Lamotrigine 50MG TAB Accepted treatment
722726 GIROTEC Lamotrigine 100MG TAB Accepted treatment
722727 GIROTEC Lamotrigine 200MG TAB Accepted treatment
818666 EPILIM CR Valproic acid 200MG SRT Accepted treatment
818674 EPILIM CR Valproic acid 300MG SRT Accepted treatment
818682 EPILIM CR Valproic acid 500MG SRT Accepted treatment
821578 EPILIM CRUSHABLE Valproic acid 100MG TAB Accepted treatment
718274 EPILIZINE CR Valproic acid 200MG SRT Accepted treatment
718275 EPILIZINE CR Valproic acid 300MG SRT Accepted treatment
718276 EPILIZINE CR Valproic acid 500MG SRT Accepted treatment
721460 EPROLEP CR 200 Valproic acid 200MG SRT Accepted treatment
Page 67 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
720762 EPROLEP CR 300 Valproic acid 300MG SRT Accepted treatment
721055 EPROLEP CR 500 Valproic acid 500MG SRT Accepted treatment
704381 EPITEC 100MG Lamotrigine 100MG TAB Accepted treatment
704382 EPITEC 200MG Lamotrigine 200MG TAB Accepted treatment
704379 EPITEC 25MG Lamotrigine 25MG TAB Accepted treatment
704380 EPITEC 50MG Lamotrigine 50MG TAB Accepted treatment
805521 LAMICTIN Lamotrigine 100MG TAB Accepted treatment
819034 LAMICTIN Lamotrigine 200MG TAB Accepted treatment
805505 LAMICTIN Lamotrigine 25MG TAB Accepted treatment
805513 LAMICTIN Lamotrigine 50MG TAB Accepted treatment
813907 LAMICTIN P100 Lamotrigine 100MG DSP Accepted treatment
704533 LAMICTIN P2 Lamotrigine 2MG DSP Accepted treatment
891716 LAMICTIN P200 Lamotrigine 200MG DSP Accepted treatment
813893 LAMICTIN P25 Lamotrigine 25MG DSP Accepted treatment
813885 LAMICTIN P5 Lamotrigine 5MG DSP Accepted treatment
891708 LAMICTIN P50 Lamotrigine 50MG DSP Accepted treatment
710887 LAMIDUS Lamotrigine 100MG TAB Accepted treatment
710888 LAMIDUS Lamotrigine 200MG TAB Accepted treatment
710885 LAMIDUS Lamotrigine 50MG TAB Accepted treatment
704488 LAMITOR Lamotrigine 100MG TAB Accepted treatment
704486 LAMITOR Lamotrigine 25MG TAB Accepted treatment
704487 LAMITOR Lamotrigine 50MG TAB Accepted treatment
712217 LAMITOR Lamotrigine 200MG TAB Accepted treatment
718465 NAVALPRO CR Valproic acid 200MG SRT Accepted treatment
718466 NAVALPRO CR Valproic acid 300MG SRT Accepted treatment
718468 NAVALPRO CR Valproic acid 500MG SRT Accepted treatment
712523 ROLAB-CARBAMAZEPINE Carbamazepine 200MG TAB Accepted treatment
705597 SANDOZ CARBAMAZEPINE CR200 Carbamazepine 200MG SRT Accepted treatment
705602 SANDOZ CARBAMAZIPINE CR400 Carbamazepine 400MG SRT Accepted treatment
705248 SANDOZ LAMOTRIGINE Lamotrigine 100MG TAB Accepted treatment
705249 SANDOZ LAMOTRIGINE Lamotrigine 200MG TAB Accepted treatment
705251 SANDOZ LAMOTRIGINE Lamotrigine 25MG TAB Accepted treatment
705250 SANDOZ LAMOTRIGINE Lamotrigine 50MG TAB Accepted treatment
769398 TEGRETOL Carbamazepine 200MG TAB
779652 TEGRETOL CR Carbamazepine 200MG SRT Accepted treatment
779660 TEGRETOL CR Carbamazepine 400MG SRT Accepted treatment
720026 VANAPRO Valproic acid 300MG SRT Accepted treatment
720027 VANAPRO Valproic acid 500MG SRT Accepted treatment
715962 ZEPTOL Carbamazepine 200MG TAB Accepted treatment
Systemic Lupus Erythematosus
Non-steroidal anti-inflammatories
786594 ADCO-DICLOFENAC Diclofenac 25MG TAB Accepted treatment
788597 ADCO-DICLOFENAC Diclofenac 50MG TAB Accepted treatment
780596 ADCO-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
717155 AUSTELL IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
717153 AUSTELL IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
710822 BRUFEN Ibuprofen 200MG TAB Accepted treatment
721114 AUSTIFEN Ibuprofen 200MG TAB Accepted treatment
721117 AUSTIFEN Ibuprofen 400MG TAB Accepted treatment
701106 ADCO-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
883102 ADCO-MEFENAMIC ACID Mefenamic acid 250MG CAP
705376 ADCO-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
Page 68 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
705375 ADCO-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
785245 ADCO-NAPROXEN Naproxen 250MG TAB Accepted treatment
785261 ADCO-PIROXICAM Piroxicam 20MG CAP Accepted treatment
892302 ADVIL LIQUI GEL Ibuprofen 200MG CAP Accepted treatment
716004 ADVIL LIQUI GEL Ibuprofen 400MG CAP Accepted treatment
893390 A-LENNON DICLOFENAC Diclofenac 25MG TAB Accepted treatment
893391 A-LENNON DICLOFENAC Diclofenac 50MG TAB Accepted treatment
701891 AMDOCIN Indometacin CAP Accepted treatment
707668 APEX-MELOXICAM Meloxicam 15MG TAB Accepted treatment
707667 APEX-MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
711325 ARROW MELOXICAM Meloxicam 15MG TAB Accepted treatment
711324 ARROW MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
704725 ARTHREXIN Indometacin 25MG APP Accepted treatment
704741 ARTHREXIN Indometacin 100MG SUP Accepted treatment
707374 ARTHROCOX Meloxicam 15MG TAB Accepted treatment
707373 ARTHROCOX Meloxicam 7.5MG TAB Accepted treatment
813044 ARTHROTEC Diclofenac, combinations 50MG/200MCG ECT
869805 ARTHROTEC Diclofenac, combinations 75MG/200mcg ECT
799459 BE-TABS NAPROXEN Naproxen 250MG TAB Accepted treatment
787833 BETACIN Indometacin 25MG CAP Accepted treatment
708186 BETAGESIC Ibuprofen 200MG TAB Accepted treatment
787426 BETAPROFEN Ibuprofen 200MG TAB Accepted treatment
701975 BETAPROFEN 400 FC Ibuprofen 400MG TAB Accepted treatment
715831 BIO-NAPROXEN Naproxen 250MG TAB
708290 BREN Ibuprofen 400MG TAB Accepted treatment
800724 BREXECAM Piroxicam 20MG TAB Accepted treatment
710830 BRUFEN Ibuprofen 400MG TAB Accepted treatment
899070 COXFLAM Meloxicam 15MG TAB Accepted treatment
899066 COXFLAM Meloxicam 7.5MG TAB Accepted treatment
841153 DICLOHEXAL Diclofenac 50MG TAB Accepted treatment
853240 DICLOHEXAL 25T Diclofenac 25MG TAB Accepted treatment
718479 DICLOFENAC BIOTECH Diclofenac 25MG TAB Accepted treatment
718480 DICLOFENAC SR BIOTECH Diclofenac 100MG SRT Accepted treatment
706314 DIFEN SR Diclofenac 100MG TAB Accepted treatment
797707 FENAMIN Mefenamic acid 250MG CAP
797715 FENAMIN Mefenamic acid 500MG TAB
797014 FENAMIN Mefenamic acid 50MG/5ML SUS
717092 FLAMARYX Meloxicam 15MG TAB Accepted treatment
717091 FLAMARYX Meloxicam 7.5MG TAB Accepted treatment
726389 FLAMECID Indometacin 25MG CAP Accepted treatment
704828 FLEXOCAM Meloxicam 15MG TAB Accepted treatment
704829 FLEXOCAM Meloxicam 7.5MG TAB Accepted treatment
791547 FORTFEN SR Diclofenac 100MG SRC Accepted treatment
718305 GLENMARK MELOXICAM Meloxicam 15MG TAB Accepted treatment
718306 GLENMARK MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
868213 GULF INDOMETHACIN Indometacin 25MG CAP Accepted treatment
895196 IBOFLAM Ibuprofen 200MG TAB Accepted treatment
705940 IBU Ibuprofen 200MG TAB Accepted treatment
704781 IBUGESIC Ibuprofen 100MG/5ML SUS Accepted treatment
700316 IBUMAX Ibuprofen 200MG TAB Accepted treatment
700318 IBUMAX Ibuprofen 400MG TAB Accepted treatment
700315 IBUMAX PAEDIATRIC Ibuprofen 100MG/5ML SUS Accepted treatment
809268 IBUMED Ibuprofen 200MG CAP Accepted treatment
Page 69 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
868221 IBUNATE Ibuprofen 200MG TAB Accepted treatment
721335 INFLAMAX PAEDIATRIC Ibuprofen 100MG/5ML SUS Accepted treatment
733741 INZA Ibuprofen 200MG TAB Accepted treatment
733768 INZA Ibuprofen 400MG TAB Accepted treatment
822205 KETOFLAM SR Ketoprofen 200MG SRC Accepted treatment
868469 LENAFEN Ibuprofen 200MG TAB Accepted treatment
701522 LOXIFLAM 15 Meloxicam 15MG TAB Accepted treatment
701520 LOXIFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
705177 M-CAM 15MG Meloxicam 15MG TAB Accepted treatment
705176 M-CAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
788996 MEDIFLEX Indometacin 25MG CAP Accepted treatment
718382 MEDOXICAM Meloxicam 15MG TAB Accepted treatment
718381 MEDOXICAM Meloxicam 7.5MG TAB Accepted treatment
705297 MELFLAM 15 Meloxicam 15MG TAB Accepted treatment
705296 MELFLAM 7.5 Meloxicam 7.5MG TAB Accepted treatment
716169 MELOXICAM UNICORN Meloxicam 15MG TAB Accepted treatment
716168 MELOXICAM UNICORN Meloxicam 7.5MG TAB Accepted treatment
786012 MYLAN DICLOFENAC (ARCANAFENAC) Diclofenac 25MG TAB Accepted treatment
786020 MYLAN DICLOFENAC SOD (ARCANAFENAC) Diclofenac 50MG TAB Accepted treatment
810185 MYLAN NAPROXEN (ARCANA-NAPROXEN) Naproxen 250MG TAB Accepted treatment
814393 METHOCAPS Indometacin 25MG CAP Accepted treatment
818615 MOBIC Meloxicam 7.5MG TAB Accepted treatment
842052 MOBIC 15MG Meloxicam 15MG TAB Accepted treatment
812625 NAFASOL EC-250 Naproxen 250MG ECT
812633 NAFASOL EC-500 Naproxen 500MG ECT
806447 NAPFLAM Naproxen 250MG TAB Accepted treatment
808474 NAPFLAM Naproxen 500MG TAB Accepted treatment
805238 NAPROSCRIPT Naproxen 250MG TAB Accepted treatment
748560 NUROFEN Ibuprofen 200MG TAB Accepted treatment
711948 NUROFEN (CAPLETS) Ibuprofen 200MG CAP Accepted treatment
897984 NUROFEN EXTRA STRENGTH Ibuprofen 400MG TAB Accepted treatment
897060 PAINIL Ibuprofen 200MG TAB Accepted treatment
752398 PANAMOR AT-50 Diclofenac 50MG TAB Accepted treatment
827592 PANAMOR SR Diclofenac 100MG TAB Accepted treatment
827584 PANAMOR SR Diclofenac 75MG TAB Accepted treatment
752371 PANAMOR-25 Diclofenac 25MG TAB Accepted treatment
716517 PIROXICAM ACTOR DT Piroxicam 20MG DSP Accepted treatment
827428 PIXICAM Piroxicam 20MG DSP Accepted treatment
796433 PONAC Mefenamic acid 250MG CAP Accepted treatment
756148 PONSTAN Mefenamic acid 250MG CAP Accepted treatment
756164 PONSTAN FORTE Mefenamic acid 500MG TAB Accepted treatment
812250 PONSTEL 250 Mefenamic acid 250MG CAP Accepted treatment
810371 PONSTEL FORTE Mefenamic acid 500MG TAB Accepted treatment
799432 PYROCAPS Piroxicam 20MG CAP Accepted treatment
824852 RANFEN Ibuprofen 200MG TAB Accepted treatment
701654 RANFEN 400 Ibuprofen 400MG TAB Accepted treatment
821144 RHEUGESIC Piroxicam 20MG DSP Accepted treatment
719811 ROLAB-DICLOFENAC SODIUM Diclofenac 25MG TAB Accepted treatment
719838 ROLAB-DICLOFENAC SODIUM Diclofenac 50MG TAB Accepted treatment
834327 ROLAB-DICLOFENAC SR Diclofenac 100MG TAB Accepted treatment
703966 ROLAB-IBUPROFEN Ibuprofen 200MG TAB Accepted treatment
703974 ROLAB-IBUPROFEN Ibuprofen 400MG TAB Accepted treatment
782807 ROLAB-IBUPROFEN Ibuprofen 600MG TAB Accepted treatment
Page 70 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
704776 ROLAB-INDOMETHACIN Indometacin 25MG CAP Accepted treatment
701072 ROXIFEN Piroxicam 20MG CAP Accepted treatment
704589 SANDOZ MELOXICAM Meloxicam 15MG TAB Accepted treatment
704588 SANDOZ MELOXICAM Meloxicam 7.5MG TAB Accepted treatment
787272 VELTEX CR Diclofenac 100MG SRC Accepted treatment
793663 VELTEX CR Diclofenac 75MG SRC Accepted treatment
718724 VIMOVO 500/20MG naproxen and esomeprazole TAB
778206 VOLTAREN Diclofenac 25MG TAB Accepted treatment
789240 VOLTAREN 75 Diclofenac 75MG TAB Accepted treatment
778222 VOLTAREN GT Diclofenac 50MG TAB Accepted treatment
778230 VOLTAREN SR Diclofenac 100MG TAB Accepted treatment
860654 XEFO Lornoxicam 4MG TAB Accepted treatment
860662 XEFO Lornoxicam 8MG TAB Accepted treatment
797030 XYCAM Piroxicam 20MG CAP Accepted treatment
797049 XYCAM DISPERS Piroxicam 20MG DSP Accepted treatment
705230 ZYDUS-MELOXICAM 15MG Meloxicam 15MG TAB Accepted treatment
705229 ZYDUS-MELOXICAM 7.5MG Meloxicam 7.5MG TAB Accepted treatment
Oral Corticosteroids
814407 CAPSOID Prednisolone 5MG TAB Accepted treatment
800155 LENISOLONE Prednisolone 5MG TAB Accepted treatment
742759 METICORTEN Prednisone 50MG TAB Accepted treatment
742732 METICORTEN Prednisone 5MG TAB Accepted treatment
752304 PANAFCORT Prednisone 5MG TAB Accepted treatment
788783 PREDNISONE (BE-TABS) Prednisone 5MG TAB Accepted treatment
703720 PRELONE Prednisolone 5MG TAB Accepted treatment
836826 PULMISON TABS Prednisone 20MG TAB Accepted treatment
818267 TROLIC Prednisone 5MG TAB Accepted treatment
Anticoagulants
704645 ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
798533 ASPIRIN (WHITE) Acetylsalicylic acid 300MG TAB Accepted treatment
706930 BAYER ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
862304 BAYER ASPIRIN CARDIO Acetylsalicylic acid 100MG TAB Accepted treatment
847283 DISPRIN CV Acetylsalicylic acid 100MG EEF Accepted treatment
807206 DISPRIN CV Acetylsalicylic acid 300MG EEF Accepted treatment
720577 DISPRIN REGULAR Acetylsalicylic acid 300MG EEF Accepted treatment
719673 DR DU TOITS PAIN EXPELLER Acetylsalicylic acid 300MG TAB Accepted treatment
823481 ECOTRIN Acetylsalicylic acid 81MG ECT Accepted treatment
700909 GULF ASPIRIN Acetylsalicylic acid 300MG TAB Accepted treatment
815160 LO-ASPIRIN (CAPRIN) Acetylsalicylic acid 125MG TAB Accepted treatment
721258 MYOPRIN Acetylsalicylic acid 100MG TAB Accepted treatment
845590 MYOPRIN Acetylsalicylic acid 100MG EEF Accepted treatment
712608 PCH ACETYLSALICYLIC ACID CARDIO Acetylsalicylic acid 80MG DSP Accepted treatment
722806 SOLUSPRIN CV Acetylsalicylic acid 100MG DSP Accepted treatment
Disease modifying agents
782556 ABITREXATE-20ML Methotrexate 500MG/20ML INJ Accepted treatment
782548 ABITREXATE-2ML Methotrexate 50MG INJ Accepted treatment
712504 EMTHEXATE Methotrexate 2.5MG TAB Accepted treatment
825557 EMTHEXATE RTU 500-20 20ML Methotrexate 25MG/1ML INJ Accepted treatment
711328 METACHOR VIAL 2ML Methotrexate 25MG/1ML INJ Accepted treatment
840815 METHOTREXATE CSV 2ML (P&U) Methotrexate 50MG/2ML INJ Accepted treatment
840807 METHOTREXATE CSV 20ML (P&U) Methotrexate 500MG/20ML INJ Accepted treatment
742465 METHOTREXATE Methotrexate 2.5MG TAB Accepted treatment
Page 71 of 72
Nappi code Drug Name Active Ingredient StrengthDrug
Form
Chronic Medicine Management Reimbursement Criteria for
preferred formulary drugs
Immunosuppressants
701252 AZAMUN Azathioprine 50MG TAB Accepted treatment
706108 AZAPRESS Azathioprine 50MG TAB Accepted treatment
712609 AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment
732524 IMURAN Azathioprine 50MG TAB Accepted treatment
700777 ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment
Alkylating agents
723274 ENDOXAN Cyclosphosphamide 50MG TAB Specialist Motivation
Ulcerative colitis
Aminosalicylic acid preparations
783668 ASACOL Mesalazine 400MG TAB Accepted treatment
709076 ASACOL Mesalazine 800MG TAB Accepted treatment
792519 DIPENTUM Olsalazine 250MG CAP Accepted treatment
720355 MEZAVANT Mesalazine 1200MG ERT Accepted treatment
722335 PENTASA Mesalazine 1G SAC Accepted treatment
722336 PENTASA Mesalazine 2G SAC Accepted treatment
890775 PENTASA Mesalazine 500MG TAB Accepted treatment
762008 SALAZOPYRIN Sulfasalazine 500MG TAB Accepted treatment
762016 SALAZOPYRIN E.N. Sulfasalazine 500MG ECT Accepted treatment
716333 SALOFALK Mesalazine 1000MG SAC Accepted treatment
Immunosuppressants
701252 AZAMUN Azathioprine 50MG TAB Accepted treatment
706108 AZAPRESS Azathioprine 50MG TAB Accepted treatment
712609 AZATHIOPRINE PCH Azathioprine 50MG TAB Accepted treatment
732524 IMURAN Azathioprine 50MG TAB Accepted treatment
700777 ZAPRINE 50MG Azathioprine 50MG TAB Accepted treatment
Steroid preparations (oral)
814407 CAPSOID Prednisolone 5MG TAB Accepted treatment
716693 COVOCORT Hydrocortisone 10MG TAB Accepted treatment
800155 LENISOLONE Prednisolone 5MG TAB Accepted treatment
741124 MEDROL Methylprednisone 16MG TAB Accepted treatment
741116 MEDROL Methylprednisone 4MG TAB Accepted treatment
742759 METICORTEN Prednisone 50MG TAB Accepted treatment
742732 METICORTEN Prednisone 5MG TAB Accepted treatment
752304 PANAFCORT Prednisone 5MG TAB Accepted treatment
788783 PREDNISONE (BE-TABS) Prednisone 5MG TAB Accepted treatment
703720 PRELONE Prednisolone 5MG TAB Accepted treatment
836826 PULMISON TABS Prednisone 20MG TAB Accepted treatment
818267 TROLIC Prednisone 5MG TAB Accepted treatment
Steroid preparations (enemas)
824593 ENTOCORD ENEMAS Budesonide 2.3MG ENE Accepted treatment
Page 72 of 72