YES = formulary NO = non-formulary NO BENEFIT = excluded

Transcription

1 Benefits are subject to the following: Pre-authorisation Bestmed guidelines Bestmed protocols Mediscor Reference Price (MRP) This price represents the reasonable price in the market place for a particular group of generic equivalent medicines which is reviewed and updated regularly. MRP sets a maximum reimbursable price for a list of generically similar medicines with a cost lower than that of the original medicine. There may be instances where a generic alternative costs more than the set MRP. If you opt to use the original medicine and a generic alternative is available, or you use a medicine that costs more than the MRP, you will have to pay the difference between the price of the chosen medicine and that of MRP. This formulary is effective from 1 January This formulary is subject to change without notice. ONLY the following medicine classes will be considered for Beat 1 and Beat 2: Beta receptor-blockers Calcium channel blockers Organic Nitrates Platelet aggregation inhibitors YES = formulary NO = non-formulary NO BENEFIT = excluded CORONARY ARTERY DISEASE (CAD) ACTIVE INGREDIENT A AMLODIPINE ADCO NORPENE 10MG TAB NO YES YES ADCO NORPENE 5MG TAB NO YES YES ALMADIN 10MG TAB NO YES YES ALMADIN 5MG TAB NO YES YES AMLATE 10MG TAB NO YES YES AMLATE 5MG TAB NO YES YES AMLOC 10MG TAB NO YES YES AMLOC 5MG TAB NO YES YES AMLODAC 10MG TAB NO YES YES AMLODAC 5MG TAB NO YES YES 1

2 AMLODIPINE-WINTHROP 10MG NO YES YES AMLODIPINE-WINTHROP 5MG NO YES YES AMLOSYN 10MG TAB NO YES YES AMLOSYN 5MG TAB NO YES YES AMTAS 10MG TAB NO YES YES AMTAS 5MG TAB NO YES YES APRATE 10MG TAB NO YES YES APRATE 5MG TAB NO YES YES AUSTELL AMLODIPINE 10MG NO YES YES AUSTELL AMLODIPINE 5MG NO YES YES CALBLOC 5MG TAB NO YES YES CALBLOC 10MG TAB NO YES YES CIPLAVASC 10MG TAB NO YES YES CIPLAVASC 5MG TAB NO YES YES CPL ALLIANCE AMLODIPINE 10MG NO YES YES GULF AMLODIPINE 10MG TAB NO YES YES GULF AMLODIPINE 5MG TAB NO YES YES INDO AMLODIPINE 5MG TAB NO YES YES KEYSAL 10MG TAB NO YES YES KEYSAL 5MG TAB NO YES YES KLODIP-5 NO YES YES LOMANOR 10MG TAB NO YES YES LOMANOR 5MG TAB NO YES YES NORVASC 10MG TAB NO YES YES NORVASC 5MG TAB NO YES YES 2

3 PHARMA DYNAMICS AMLODIP NO YES YES STAMLO 10MG TAB NO YES YES STAMLO 5MG TAB NO YES YES ASPIRIN ASPIRIN 300MG TAB YES YES YES BAYER ASPIRIN CARDIO 100M YES YES YES BAYER ASPIRIN TAB YES YES YES BE-TABS ASPIRIN 300MG TAB YES YES YES DISPRIN TAB YES YES YES DISPRIN CARDIOCARE 100MG YES YES YES ECOTRIN 81MG TAB NO YES YES GULF ASPIRIN YES YES YES LO-ASPIRIN 125MG TAB YES YES YES MYOPRIN 100MG YES YES YES SOLUSPIRIN 300MG YES YES YES ATENOLOL ADCO-ATENOLOL 50MG TAB NO YES YES ADCO-ATENOLOL 100MG TAB NO YES YES B-BLOCK 100MG NO YES YES B-BLOCK 50MG NO YES YES BIO-ATENOLOL 100 NO YES YES BIO-ATENOLOL 50 NO YES YES HEXABLOK 50MG TAB NO YES YES HEXABLOK 100MG TAB NO YES YES SANDOZ ATENOLOL 100 NO YES YES SANDOZ ATENOLOL 50 NO YES YES TEN-BLOKA 100MG TAB NO YES YES TEN-BLOKA 50MG TAB NO YES YES 3

4 TENOPRESS 100MG TAB NO YES YES TENOPRESS 25MG TAB NO YES YES TENOPRESS 50MG TAB NO YES YES TENORMIN 100MG TAB NO YES YES TENORMIN 25MG TAB NO YES YES TENORMIN 50MG TAB NO YES YES ZETENOL 100MG TAB NO YES YES ZETENOL 50MG TAB NO YES YES ATENOLOL / CHLORTHALIDONE SANDOZ CO-TENIDONE 100/25 NO YES YES SANDOZ CO-TENIDON 50/12.5 NO YES YES TENCHLOR TAB NO YES YES TENCHLOR-HS TAB NO YES YES TENORET TAB NO YES YES TENORETIC TAB NO YES YES B BISOPROLOL ADCO-BISOCOR 10MG TAB NO NO YES ADCO-BISOCOR 5MG TAB NO NO YES BETACOR 10MG TAB NO NO YES BETACOR 5MG TAB NO NO YES BILOCOR 10 TAB NO NO YES BILOCOR 5 TAB NO NO YES BISBETA 10MG TAB NO NO YES BISBETA 5MG TAB NO NO YES BISOHEXAL 10MG TAB NO NO YES BISOHEXAL 5MG TAB NO NO YES 4

5 BISOPROLOL / HYDROCHLOROTHIAZ BISLO 10MG TAB NO NO YES BISLO 5MG TAB NO NO YES BISOPROLOL HEXAL 10MG TAB NO NO YES BISOPROLOL HEXAL 5MG TAB NO NO YES BISOPROLOL UNICORN 10MG NO NO YES BISOPROLOL UNICORN 5MG NO NO YES BISOPROLOL ZYDUS 10MG TAB NO NO YES BISOPROLOL ZYDUS 5MG TAB NO NO YES CARDICOR 10MG TAB NO NO YES CARDICOR 2.5MG TAB NO NO YES CARDICOR 5MG TAB NO NO YES CONCOR 10MG TAB NO NO YES CONCOR 5MG TAB NO NO YES MYLAN BISOPROLOL 5MG TAB NO NO YES MYLAN BISOPROLOL 10MG TAB NO NO YES RETOCAR 10MG TAB NO NO YES RETOCAR 5MG TAB NO NO YES ZIAPRO 10MG TAB NO NO YES ZIAPRO 5MG TABS NO NO YES BILOCOR CO 10MG/6.25MG TAB NO NO YES BILOCOR CO 2.5MG/6.25MG TAB NO NO YES BILOCOR CO 5MG/6.25MG TAB NO NO YES BISOPROLOL CO UNICORN 5MG NO NO YES 5

6 BISOPROLOL CO UNICORN 10MG NO NO YES BISOPROLOL HCTZ 10/6.25MG NO NO YES BISOPROLOL HCTZ 2.5/6.25MG NO NO YES BISOPROLOL HCTZ 5/6.25MG NO NO YES ZIABETA 10/6.25MG TAB NO NO YES ZIABETA 2.5/6.25MG TAB NO NO YES ZIABETA 5/6.25MG TAB NO NO YES ZIAK 10MG TAB NO NO YES ZIAK 2.5MG TAB NO NO YES ZIAK 5MG TAB NO NO YES ZIRINAK CO 10MG/6.25MG T NO NO YES ZIRINAK CO 2.5MG/6.25MG T NO NO YES ZIRINAK CO 5MG/6.25MG T NO NO YES C CARVEDILOL ASPEN-CARVEDILOL 12.5MG NO BENEFIT YES YES ASPEN-CARVEDILOL 25MG NO BENEFIT YES YES ASPEN-CARVEDILOL 6.25MG NO BENEFIT YES YES CARLOC 12.5MG TAB NO BENEFIT YES YES CARLOC 25MG TAB NO BENEFIT YES YES CARLOC 6.25MG TAB NO BENEFIT YES YES CARVEDILOL-HEXAL 12.5MG NO BENEFIT YES YES CARVEDILOL-HEXAL 25MG NO BENEFIT YES YES CARVEDILOL-HEXAL 6.25MG NO BENEFIT YES YES CARVEDILOL UNICORN 12.5MG NO BENEFIT YES YES CARVEDILOL UNICORN 25MG NO BENEFIT YES YES 6

7 CARVEDILOL UNICORN 6.25MG NO BENEFIT YES YES CARVETREND 12.5MG TAB NO BENEFIT YES YES CARVETREND 25MG TAB NO BENEFIT YES YES CARVETREND 6.25MG TAB NO BENEFIT YES YES DILATREND 12.5MG TAB NO BENEFIT YES YES DILATREND 25MG TAB NO BENEFIT YES YES DILATREND 6.25MG TAB NO BENEFIT YES YES VEDIBLOK 12.5MG TAB NO BENEFIT YES YES VEDIBLOK 25MG TAB NO BENEFIT YES YES VEDIBLOK 6.25MG TAB NO BENEFIT YES YES D DILTIAZEM ADCO-ZILDEM 180MG SR NO NO YES ADCO-ZILDEM 240MG SR NO NO YES ADCO-ZILDEM 60MG TAB NO NO YES ADCO-ZILDEM 90MG TAB NO NO YES TILAZEM 180 CR NO NO YES TILAZEM 240 CR NO NO YES F FELODIPINE FELODIPINE-HEXAL 10MG TAB NO NO YES FELODIPINE-HEXAL 5MG TAB NO NO YES PLENDIL 10MG TAB NO NO YES PLENDIL 2.5MG TAB NO NO YES PLENDIL 5MG TAB NO NO YES G GLYCERYL TRINITRATE ANGISED 0.5MG TAB YES YES YES 7

8 I ISOSORBIDE DINITRATE ISORDIL 5MG TAB YES YES YES ISORDIL 10MG TAB YES YES YES ISORDIL 30MG TAB YES YES YES ISORDIL TEMBID 40MG NO NO YES SANDOZ ISOSORBIDE 10 YES YES YES SANDOZ ISOSORBIDE 30 YES YES YES SANDOZ ISOSORBIDE 5 YES YES YES ISOSORBIDE MONONITRATE ELANTAN 20MG TAB NO YES YES ELANTAN LA 50MG NO YES YES IMDUR 60MG TAB NO NO YES ISMO 20MG TAB NO YES YES MONICOR SR 60MG SRT NO NO YES N NIFEDIPINE ADALAT RETARD 10MG NO NO YES ADALAT RETARD 20MG YES YES YES ADALAT XL 20MG TAB NO NO YES ADALAT XL 30MG TAB NO NO YES ADALAT XL 60MG TAB NO NO YES ADCO-VASCARD 20 SR CAP YES NO YES ADCO-VASCARD 30 SR CAP NO NO YES BIO NIFEDIPINE XL 30MG TAB NO NO YES BIO NIFEDIPINE XL 60MG TAB NO NO YES CIPALAT RETARD 20MG YES YES YES FEDALOC SR 30MG SRT NO NO YES 8

9 FEDALOC SR 60MG SRT NO NO YES GITSALAT 30MG TAB NO NO YES GITSALAT 60MG TAB NO NO YES MACOREL 30 SR TAB NO NO YES MACOREL 60 SR TAB NO NO YES NIFEDALAT 20SR TAB YES YES YES SPEC NIFEDIPINE SR 30MG NO NO YES SPEC NIFEDIPINE SR 60MG NO NO YES P PROPRANOLOL INDERAL 10MG TAB YES YES YES INDERAL 40MG TAB YES YES YES INDOBLOK 10MG YES YES YES INDOBLOK 40MG YES YES YES PRODOROL 10MG TAB YES YES YES PRODOROL 40MG TAB YES YES YES PUR-BLOKA 10MG TAB YES YES YES V VERAPAMIL ISOPTIN 40MG TAB NO YES YES ISOPTIN SR 240MG TAB NO YES YES RAVAMIL SR 240MG TAB NO YES YES VASOMIL 40MG TAB NO YES YES VASOMIL 80MG TAB NO YES YES VERAHEXAL 240 SR NO YES YES W WARFARIN SODIUM ASPEN-WARFARIN 5MG TAB NO BENEFIT YES YES CIPLA-WARFARIN 1MG TAB NO BENEFIT YES YES 9

10 CIPLA-WARFARIN 3MG TAB NO BENEFIT YES YES CIPLA-WARFARIN 5MG TAB NO BENEFIT YES YES 10