BESTMED MEDICINE FORMULARY FOR CDL-CHRONIC (CHRONIC DISEASE LIST) CONDITIONS Benefits are subject to the following: Pre-authorisation BESTmed guidelines BESTmed protocols Mediscor Reference Price (MRP) The MRP sets a maximum price for a generic medicine product, of which the cost is normally lower than that of the original or ethical product. This means that, should you choose to use the original medicine product and a generic alternative for the product is available, you will be responsible for paying the difference between the price of the chosen original medicine product and that of the MRP. This formulary is effective from 1 January 2011. CARDIOMYOPATHY Platinum Gold Topcare Comprehensive Bonus Plus Beat Beat Beat MEDICINE NAME ACCUMAX 10MG YES YES ACCUMAX 20MG YES YES ACCUMAX CO 10/12.5MG YES YES ACCUMAX CO 20/12.5MG YES YES ACCUPRIL 10MG TAB YES YES ACCUPRIL 20MG TAB YES YES ACCUPRIL 40MG TAB YES YES ACCUPRIL 5MG TAB YES YES ACCURETIC 10/12.5 TAB YES YES ACCURETIC 20/12.5 TAB YES YES ADCO-ATENOLOL 50MG TAB YES YES ADCO-ATENOLOL 100MG TAB YES YES ADCO-BISOCOR 10MG TAB YES NO ADCO-BISOCOR 5MG TAB YES NO ADCO-CAPTOMAX 25MG TAB YES YES ADCO-CAPTOMAX 50MG TAB YES YES ADCO-ENALAPRIL 5MG YES YES ADCO-ENALAPRIL 10MG YES YES ADCO-ENALAPRIL 20MG YES YES ADCO-QUINARETIC 10/12.5 T YES YES ADCO-QUINARETIC 20/12.5 T YES YES ADCO-RETIC TAB YES YES ADCO-ZETOMAX 10MG TAB YES YES ADCO-ZETOMAX 20MG TAB YES YES ADCO-ZETOMAX 5MG TAB YES YES 1
ADCO-ZETOMAX-CO 10/12.5MG YES YES ADCO-ZETOMAX-CO 20/12.5MG YES YES ALAPREN 5MG TAB YES YES ALAPREN 10MG TAB YES YES ALAPREN 20MG TAB YES YES ALDACTONE 100MG TAB YES YES ALDACTONE 25MG TAB YES YES AMILORETIC HS TAB YES NO AMILORETIC TAB YES YES ANGISED 0.5MG TAB YES YES ASPEN-CARVEDILOL 12.5MG T YES NO ASPEN-CARVEDILOL 25MG TAB YES NO ASPEN-CARVEDILOL 6.25MG T YES NO AUSTELL-FUROSEMIDE 40MG T YES YES AUSTELL-LISINOPRIL 10MG T YES YES AUSTELL-LISINOPRIL 2.5MG YES YES AUSTELL-LISINOPRIL 20MG T YES YES B-BLOCK 100MG YES YES B-BLOCK 50MG YES YES BETARETIC TAB YES YES BEURESIS 40MG TAB YES YES BILOCOR 10 TAB YES NO BILOCOR 5 TAB YES NO BIO-ATENOLOL 100 YES YES BIO-ATENOLOL 50 YES YES BIO-CAPTOPRIL 25MG YES YES BISOHEXAL 10MG TAB YES NO BISOHEXAL 5MG TAB YES NO CAPACE 25MG TAB YES YES CAPOTEN 25MG TAB YES YES CAPOTEN HS 12.5MG TAB YES YES CAPTOHEXAL 12.5MG YES YES CAPTOHEXAL 25MG YES YES CAPTOHEXAL 50MG YES YES CARDICOR 10MG TAB YES NO CARDICOR 2.5MG TAB YES NO CARDICOR 5MG TAB YES NO CARLOC 12.5MG TAB YES NO CARLOC 25MG TAB YES NO CARLOC 6.25MG TAB YES NO CARVEDILOL-HEXAL 12.5MG YES NO CARVEDILOL-HEXAL 25MG TAB YES NO CARVEDILOL-HEXAL 6.25MG YES NO CARVETREND 12.5MG TAB YES NO CARVETREND 25MG TAB YES NO CARVETREND 6.25MG TAB YES NO CIPLA LOSARTAN 100MG TAB YES NO CIPLA LOSARTAN 50MG TAB YES NO 2
CIPLA-INDAPAMIDE 2.5MG TA YES YES CIPLA-PERINDOPRIL 4MG TAB YES NO CIPLA-PERINDOPRIL 8MG TAB YES NO CIPLATEC 10MG YES YES CIPLATEC 20MG YES YES CIPLATEC 5MG YES YES CIPLA-WARFARIN 1MG TAB YES YES CIPLA-WARFARIN 3MG TABLET YES YES CIPLA-WARFARIN 5MG TAB YES YES CONCOR 10MG TAB YES NO CONCOR 5MG TAB YES NO CO-RENITEC TAB YES YES COVERSYL 4MG TAB YES NO COVERSYL PLUS TAB YES NO COZAAR 100MG TAB YES NO COZAAR 50MG TAB YES NO COZAAR COMP TAB YES NO DAPAMAX 2.5MG TAB YES YES DAPTRIL 2.5MG TAB YES YES DIACE CO 20/12.5 MG TAB YES YES DILATREND 12.5MG TAB YES NO DILATREND 25MG TAB YES NO DILATREND 6.25MG TAB YES NO DIURESIX 40MG TAB YES YES DYAZIDE TAB YES YES ELANTAN 20MG TAB YES YES ELANTAN LA 50MG YES YES ENAP 10MG TAB YES YES ENAP 20MG TAB YES YES ENAP 5MG TAB YES YES ENAP CO 20MG/12.5MG TAB YES YES FLUARIX PREFILLED SYRINGE YES YES FLUVAX 2009 PRE-FILLED SY YES YES FORTZAAR TAB YES NO HEXABLOK 50MG TAB YES YES HEXABLOK 100MG TAB YES YES HEXAL-LISINOPRIL 10MG TAB YES YES HEXAL-LISINOPRIL 20MG TAB YES YES HEXAL-LISINOPRIL 5MG TAB YES YES HEXAL-LISINOPRIL CO 10MG YES YES HEXAL-LISINOPRIL CO 20MG YES YES HEXAZIDE 25MG TAB YES YES HR-ENALAPRIL 10MG YES YES HR-ENALAPRIL 20MG YES YES HR-ENALAPRIL 5MG YES YES HYDRO-LESS 2.5MG TAB YES YES HYPERPHEN 10MG TAB YES YES HYPERPHEN 50MG TAB YES YES 3
IMDUR 60MG TAB YES NO IMOVAX PNEUMO 23 YES YES INDERAL 10MG TAB YES YES INDERAL 40MG TAB YES YES INDOBLOK 10MG YES YES INDOBLOK 40MG YES YES INFLUVAC 0.5ML YES YES ISMO 20MG TAB YES YES ISORDIL 5MG TAB YES YES ISORDIL 10MG TAB YES YES ISORDIL 30MG TAB YES YES ISORDIL TEMBID 40MG YES NO LANOXIN 0.0625MG PG TAB YES YES LANOXIN 0.25MG TAB YES YES LANOXIN PAED.05MG/ML SYR YES YES LASIX 40MG TAB YES YES LASIX ORAL SOL YES YES LEPITRIN 50MG TAB YES NO LISORETIC 10/12.5 YES YES LISORETIC 20/12.5 YES YES LISOZIDE 10MG/12.5MG TAB YES YES LISOZIDE 20MG/12.5MG TAB YES YES LOS-ARB 50MG TAB YES NO LOSARTAN-WINTHROP TAB YES NO MERCK-INDAPAMIDE 2.5 TAB YES YES MODURETIC TAB YES YES MONICOR SR 60MG SRT YES NO MUTAGRIP SINGLE DOSE YES YES MYLAN CAPTOPRIL 25MG YES YES MYLAN CAPTOPRIL 50MG YES YES MYLAN FUROSEMIDE 40MG YES YES MYLAN INDAPAMIDE 2.5MG YES YES PHARMAPRESS 10MG YES YES PHARMAPRESS 20MG YES YES PHARMAPRESS 5MG YES YES PHARMAPRESS CO YES YES PLENISH K 600MG TAB YES YES PNEUMOVAX VAC YES YES PREXUM 4MG TAB YES NO PREXUM PLUS TAB YES NO PRODOROL 10MG TAB YES YES PRODOROL 40MG TAB YES YES PUR-BLOKA 10MG TAB YES YES PUR-BLOKA 40MG TAB YES YES PURESIS 40MG TAB YES YES PURGOXIN 0.25MG TAB YES YES QUINACE 10MG TABLETS YES YES QUINACE 20MG TABLETS YES YES 4
QUINACE CO 10/12.5MG TABL YES YES QUINACE CO 20/12.5MG TABL YES YES QUINAGEN 10MG TAB YES YES QUINAGEN 20MG TAB YES YES QUINAGEN 40MG TAB YES YES QUINAGEN 5MG TAB YES YES QUINASPEN 10MG TAB YES YES QUINASPEN 20MG TAB YES YES QUINAZIDE 10/12.5 TAB YES YES QUINAZIDE 20/12.5 TAB YES YES RAN-PERINDOPRIL 4MG TAB YES NO RENEZIDE TAB YES YES RENITEC 10MG TAB YES YES RENITEC 2.5MG TAB YES YES RENITEC 20MG TAB YES YES RENITEC 5MG TAB YES YES RIDAQ 12.5MG TAB YES YES RIDAQ 25MG TAB YES YES SANDOZ ATENOLOL 100 YES YES SANDOZ ATENOLOL 50 YES YES SANDOZ CAPTOPRIL 25MG YES YES SANDOZ CAPTOPRIL 50MG YES YES SANDOZ CO-TENIDONE 100/25 YES YES SANDOZ CO-TENIDONE 50/12. YES YES SANDOZ FUROSEMIDE 40 MG T YES YES SANDOZ HYDRALAZINE 25 YES YES SANDOZ HYDRALAZINE 50 YES YES SANDOZ INDAPAMIDE 2.5MG T YES YES SANDOZ ISOSORBIDE 10 YES YES SANDOZ ISOSORBIDE 30 YES YES SANDOZ ISOSORBIDE 5 YES YES SANDOZ K-600 YES YES SANDOZ SPIRONOLACTONE 25M YES YES SIMAYLA LISINOPRIL 10MG T YES YES SIMAYLA LISINOPRIL 20MG T YES YES SINOPREN 10MG TAB YES YES SINOPREN 20MG TAB YES YES SINOPREN 5MG TAB YES YES SLOW-K 600MG TAB YES YES SPEC-CO-AMILORIDE TAB YES YES SPIRACTIN 100MG TAB YES YES SPIRACTIN 25MG TAB YES YES TEN-BLOKA 100MG TAB YES YES TEN-BLOKA 50MG TAB YES YES TENCHLOR TAB YES YES TENCHLOR-HS TAB YES YES TENOPRESS 100MG TAB YES YES TENOPRESS 25MG TAB YES YES 5
TENOPRESS 50MG TAB YES YES TENORET TAB YES YES TENORETIC TAB YES YES TENORMIN 100MG TAB YES YES TENORMIN 25MG TAB YES YES TENORMIN 50MG TAB YES YES URIREX-K TAB YES NO VAXIGRIP PREFIL S/DOSE 0. YES YES VAXIGRIP S/DOSE 0.25ML PA YES YES VECTORYL 4MG TABLETS YES NO VECTORYL PLUS TABLETS YES NO VEDIBLOK 12.5MG TAB YES NO VEDIBLOK 25MG TAB YES NO VEDIBLOK 6.25MG TAB YES NO WARFARIN 5MG TAB YES YES X-FLU PREFILLED SYR 0.5ML YES YES ZAPTO 25MG TAB YES YES ZAPTO 50MG TAB YES YES ZARTAN 100MG TAB YES NO ZARTAN 50MG TAB YES NO ZEMAX 10MG TAB YES YES ZEMAX 20MG TAB YES YES ZEMAX 5MG TAB YES YES ZESTORETIC 10MG TAB YES YES ZESTORETIC 20MG TAB YES YES ZESTOZIDE 20MG TAB YES YES ZESTRIL 10MG TAB YES YES ZESTRIL 20MG TAB YES YES ZESTRIL 5MG TAB YES YES ZIAK 10MG TAB YES NO ZIAK 2.5MG TAB YES NO ZIAK 5MG TAB YES NO The formulary is subject to change without notice. 6