BONCAP Chronic Formulary Effective July 2017

1 Therapeutic ClassNappiIngredientsProduct NameStrengthFormReimbursement criteriaAddison's disease716693 HydrocortisoneCOVOCORT10 MGTABA ccepted treatment726540 FludrocortisoneFLORINEF treatmentAsthmaInhaled B2 agonists700715 SalbutamolASTHAVENT 300D ECOHALER CFC FREEINHA ccepted treatment878219 SalbutamolASTHAVENT DPCPSA ccepted treatment849332 SalbutamolASTHAVENT ECOHALER 200 DOSEINHA ccepted treatment711213 SalbutamolVENTEZE CFC FREE 200 DOSEINHA ccepted treatment720723 SalbutamolVENTIMAX CFC FREE 200 DOSE100 MCGINHA ccepted treatmentLong acting B2 agonists704175 FormoterolFORATEC DP CAPSCPSC linical review710307 FormoterolFORATEC HFA 120 DOSEINHC linical reviewInhaled corticosteroids827088 BeclomethasoneBECEZE INHALER COMPLETE100 MCGINHA ccepted treatment819638 BeclomethasoneBECLATE INHALER100 MCGINHA ccepted treatment820083 BeclomethasoneBECLATE 200200 MCGINHA ccepted treatment827061 BeclomethasoneBECEZE 50 200 DOSE50 MCGINHA ccepted treatment819611 BeclomethasoneBECLATE INHALER50 MCGINHA ccepted treatment897462 BudesonideBUDEFLAM CFC FREE 300 DOSE INH100 MCGINHA ccepted treatment791423 BudesonidePULMICORT 100 TURB (200 DOSE)

2 100 MCGATHA ccepted treatment897469 BudesonideBUDEFLAM CFC FREE 200 MCG 300 DOSE INH200 MCGINHA ccepted treatment791431 BudesonidePULMICORT 200 TURB (200 DOSE)200 MCGATHA ccepted treatment707879 BudesonideINFLAMMIDE NOVOLIZER COMPLETE 100 DOSE400 MCGINHA ccepted treatment707881 BudesonideINFLAMMIDE NOVOLIZER REFILL 100 DOSE400 MCGREFA ccepted treatment704176 BudesonideBUDEFLAM DP CAPSCAPA ccepted treatmentOral xanthines788368 TheophyllineSANDOZ THEOPHYLLINE ANHYDROUS200 MGSRTC linical review788376 TheophyllineSANDOZ THEOPHYLLINE ANHYDROUS 300300 MGSRTC linical review770388 TheophyllineTHEOPHENSYRC linical reviewOral corticosteroids800155 PrednisoloneLENISOLONE5 MGTABS pecialist script814407 PrednisoloneCAPSOID5 MGTABS pecialist script752304 PrednisonePANAFCORT5 MGTABS pecialist

3 Script788783 PrednisoneBE-TABS PREDNISONE5 MGTABS pecialist scriptDevices577802DP HALER DEVICEUNIA ccepted treatmentBipolar Mood DisorderMood stabilisers705597 CarbamazepineSANDOZ CARBAMAZEPINE CR200200 MGSRTA ccepted treatment779652 CarbamazepineTEGRETOL CR200 MGSRTA ccepted treatment705602 CarbamazepineSANDOZ CARBAMAZIPINE CR400400 MGSRTA ccepted treatment779660 CarbamazepineTEGRETOL CR400 MGSRTA ccepted treatment769401 CarbamazepineTEGRETOL S100MG/5 MLSUSA ccepted treatment712493 CarbamazepineDEGRANOL200 MGTABA ccepted treatment712523 CarbamazepineSANDOZ CARBAMAZEPINE200 MGTABA ccepted treatment715962 CarbamazepineZEPTOL200 MGTABA ccepted treatment704381 LamotrigineEPITEC 100MG100 MGTABA ccepted treatment712217 LamotrigineLAMITOR200 MGTABA ccepted treatment722725 LamotrigineGIROTEC50 MGTABA ccepted treatment722726 LamotrigineGIROTEC100 MGTABA ccepted treatment722727 LamotrigineGIROTEC200 MGTABA ccepted treatment704382 LamotrigineEPITEC 200MG200 MGTABA ccepted treatment710389 LamotrigineDYNA-LAMOTRIGINE100 MGTABA ccepted treatment710887 LamotrigineLAMIDUS100 MGTABA ccepted treatment704380 LamotrigineEPITEC 50MG50 MGTABA ccepted treatment710390 LamotrigineDYNA-LAMOTRIGINE200 MGTABA ccepted treatment710888 LamotrigineLAMIDUS200 MGTABA ccepted

4 Treatment710387 LamotrigineDYNA-LAMOTRIGINE25 MGTABA ccepted treatment704379 LamotrigineEPITEC 25MG25 MGTABA ccepted treatment704486 LamotrigineLAMITOR25 MGTABA ccepted treatment710388 LamotrigineDYNA-LAMOTRIGINE50 MGTABA ccepted treatment710885 LamotrigineLAMIDUS50 MGTABA ccepted treatment704487 LamotrigineLAMITOR50 MGTABA ccepted treatment712078 LithiumCAMCOLIT250 MGTABA ccepted treatment712086 LithiumCAMCOLIT400 MGTABA ccepted treatment758833 LithiumQUILONUM RETARD450 MGTABA ccepted treatment715980 Valproic acidCONVULEX150 MGCAPA ccepted treatment715999 Valproic acidCONVULEX300 MGCAPA ccepted treatment781568 Valproic acidCONVULEX500 MGCAPA ccepted treatment721460 Valproic acidEPROLEP CR 200200 MGSRTA ccepted treatment720762 Valproic acidEPROLEP CR 300300 MGSRTA ccepted treatment721055 Valproic acidEPROLEP CR 500300 MGSRTA ccepted treatment718465 Valproic acidNAVALPRO CR200 MGSRTA ccepted treatment718466 Valproic acidNAVALPRO CR300 MGSRTA ccepted treatment720026 Valproic acidVANAPRO300 MGSRTA ccepted treatment718468 Valproic acidNAVALPRO CR500 MGSRTA ccepted treatment720027 Valproic acidVANAPRO500 MGSRTA ccepted treatment780545 Valproic acidEPILIM SUGAR FREE200 MGSYRA ccepted treatment781541 Valproic acidCONVULEX50MG/MLSYRA ccepted

5 Treatment821578 Valproic acidEPILIM CRUSHABLE100 MGTABA ccepted treatmentAntipsychotic agents735884 ChlorpromazineLARGACTIL100 MGTABA ccepted treatment735868 ChlorpromazineLARGACTIL25 MGTABA ccepted treatment735876 ChlorpromazineLARGACTIL50 MGTABA ccepted treatment717082 ClozapineASPEN CLOZAPINE100 MGTABA ccepted treatment717081 ClozapineASPEN CLOZAPINE25 MGTABA ccepted treatment700178 ClozapineCLOMENT100 MGTABA ccepted treatment (clinical motivation required for low cost option)700176 ClozapineCLOMENT25 MGTABA ccepted treatment (clinical motivation required for low cost option)726672 FlupentixolFLUANXOL DEPOT 1ML20 MGINJA ccepted treatment744328 FluphenazineMODECATE PLUS SYRINGE 1ML25MG/MLINJA ccepted treatment719549 HaloperidolGULF HALOPERIDOL5 MGTABA ccepted treatment730335 HaloperidolSANDOZ HALOPERIDOL treatment730327 HaloperidolSANDOZ HALOPERIDOL 55 MGTABA ccepted treatment720528 OlanzapineLANAZYP5 MGTABA ccepted treatment718997 OlanzapineMYLAN OLANZAPINE10 MGTABA ccepted treatment718995 OlanzapineMYLAN treatment718996 OlanzapineMYLAN OLANZAPINE5 MGTABA ccepted treatment721389 OlanzapineOLAW IN10 MGTABA ccepted treatment721385 OlanzapineOLAW treatment721388 OlanzapineOLAW IN5 MGTABA

6 Ccepted treatment715659 OlanzapineOLEXAR10 MGTABA ccepted treatment715658 OlanzapineOLEXAR5 MGTABA ccepted treatment720714 OlanzapinePREXOLAN10 MGTABA ccepted treatment720713 OlanzapinePREXOLAN5 MGTABA ccepted treatment721653 OlanzapineZYLENA10 MGTABA ccepted treatment721652 OlanzapineZYLENA5 MGTABA ccepted treatment716051 QuetiapineDOPAQUEL100 MGTABA ccepted treatment (clinical motivation required for low cost option)716052 QuetiapineDOPAQUEL200 MGTABA ccepted treatment (clinical motivation required for low cost option)716050 QuetiapineDOPAQUEL25 MGTABA ccepted treatment (clinical motivation required for low cost option)716053 QuetiapineDOPAQUEL300 MGTABA ccepted treatment (clinical motivation required for low cost option)720980 QuetiapineKIZOFRIN100 MGTABA ccepted treatment (clinical motivation required for low cost option)720981 QuetiapineKIZOFRIN200 MGTABA ccepted treatment (clinical motivation required for low cost option)720979 QuetiapineKIZOFRIN25 MGTABA ccepted treatment (clinical motivation required for low cost option)Accepted Treatment - will be authorised without requesting additional clinical information (unless specific concerns unusual dose requests).

7 Quantity/dosage and duration of authorisation may vary - depending on the requested to Chronic Medicine Management Reimbursement Criteria: BONCAP Chronic FormularyEffective July 2017 Special Investigations (SI) - results of recent relevant tests required before reimbursement is Motivation - will require a relevant specialist motivation before reimbursement is Script - will require a relevant specialist's prescription before reimbursement is Motivation - specific clinical information required before reimbursement is Review - will be authorised if the drug history or co-morbidity clearly indicates that use of the drug is indicated in the specific patient.

8 720982 QuetiapineKIZOFRIN300 MGTABA ccepted treatment (clinical motivation required for low cost option)716670 QuetiapineMYLAN QUETIAPINE100 MGTABA ccepted treatment (clinical motivation required for low cost option)716671 QuetiapineMYLAN QUETIAPINE200 MGTABA ccepted treatment (clinical motivation required for low cost option)716668 QuetiapineMYLAN QUETIAPINE25 MGTABA ccepted treatment (clinical motivation required for low cost option)716672 QuetiapineMYLAN QUETIAPINE300 MGTABA ccepted treatment (clinical motivation required for low cost option)718355 QuetiapinePSYQUET300 MGTABA ccepted treatment (clinical motivation required for low cost option)721745 QuetiapineQUETIAPINE BIOTECH100 MGTABA ccepted treatment (clinical motivation required for low cost option)721746 QuetiapineQUETIAPINE BIOTECH200 MGTABA ccepted treatment (clinical motivation required for low cost option)721744 QuetiapineQUETIAPINE BIOTECH25 MGTABA ccepted treatment (clinical motivation required for low cost option)721747 QuetiapineQUETIAPINE BIOTECH300 MGTABA ccepted treatment (clinical motivation required for low cost option)

9 716637 QuetiapineQUETOSER200 MGTABA ccepted treatment (clinical motivation required for low cost option)716638 QuetiapineQUETOSER300 MGTABA ccepted treatment (clinical motivation required for low cost option)716652 QuetiapineSEREZ100 MGTABA ccepted treatment (clinical motivation required for low cost option)716653 QuetiapineSEREZ200 MGTABA ccepted treatment (clinical motivation required for low cost option)716651 QuetiapineSEREZ25 MGTABA ccepted treatment (clinical motivation required for low cost option)716654 QuetiapineSEREZ300 MGTABA ccepted treatment (clinical motivation required for low cost option)718704 QuetiapineSIZONORM100 MGTABA ccepted treatment (clinical motivation required for low cost option)718705 QuetiapineSIZONORM200 MGTABA ccepted treatment (clinical motivation required for low cost option)718674 QuetiapineSIZONORM25 MGTABA ccepted treatment (clinical motivation required for low cost)