ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT

1 1 Benefits are subject to the following: 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 2017. This FORMULARY is applicable to Bestmed Pulse1 and Pulse2 options.

2 This FORMULARY is subject to change without notice. PULSE 1 AND PULSE 2 ACUTE MEDICINE FORMULARY ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT ANALGESICS ASPIRIN BAYER ASPIRIN TAB BE-TABS ASPIRIN (WHITE) TAB 300MG DISPRIN EFT GULF ASPIRIN TAB 300MG DICLOFENAC PANAMOR SUPP SUP 12,5MG MEFENAMIC ACID ADCO-MEFENAMIC ACID CAP 250MG ADCO-MEFENAMIC ACID SUS 50MG/5ML FENAMIN CAP 250MG FENAMIN SUS 50MG/5ML PONSTAN PAED SUPP SPP 125MG PARACETAMOL ACTAMOL RED (UN-BOXED) SYR 120MG/5ML ADCO-NAPAMOL TAB 500MG ADCO-PROLIEF TAB 500MG ANTALGIC TAB 500MG FEVERPAIN (BOXED) SYR 120MG/5ML PAINAMOL (GREEN) TAB 500MG PAINOGESIC SYR 120MG/5ML PYRALEN SYR 120MG/5ML IBUPROFEN / PARACETAMOL COMBINATIONS DENTOPAIN CAP DENTOPAIN FORTE CAP 2 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT GEN-PAYNE CAP IBUCOD TAB IBUMOL TAB IBUPAIN CAP 450MG IBUPAIN FORTE CAP 460MG MYBULEN CAP PARACETAMOL, COMBINATIONS ADCO-KIDDIPAYNE SYR ADCO-NAPACOD TAB ADCO-PAYNE TAB ADCO-SALTERPYN TAB CODOROL TAB GOLDGESIC SYR GOLDGESIC TAB GO-PAIN SYR 120MG/5ML GO-PAIN TAB HOPYN (BRISCOPYN)

3 TAB INFAPAIN FORTE SYR KID-EEZE SYR MEDIPYN S SYR NUCOPAIN TAB PAINAGON SYR PAINAGON TAB PAINAMOL PLUS TAB PYNMED TAB SALTERPYN SYR SPECTRAPAIN CAP SPECTRAPAIN FORTE TAB STILPANE SYR STILPANE TAB 3 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT TRAMADOL / PARACETAMOL COMBINATION TRAMACET TAB TRAMADOL AUSTELL-TRAMADOL CAP 50MG DOLOTRAM CAP 50MG DOMADOL CAP 50MG TRAMAZAC CAP 50MG ANTIHELMINTICS MEBENDAZOLE ADCO-WORMEX TAB 100MG ADCO-WORMEX TAB 500MG CIPEX SUS 100MG/5ML WORMGO TAB 100MG WORMSTOP SUS 100MG/5ML WORMSTOP TAB 100MG WORMSTOP TAB 500MG PRAZIQUANTEL BILTRICIDE TAB 600MG CYSTICIDE TAB 500MG ANTI-MICROBIALS FLUCONAZOLE AUSTELL FLUCONAZOLE CAP 150MG DIFLUZOLE CAP 150MG FLUCORIC CAP 150MG NYSTATIN CANDACIDE SUS 100000U/1ML CANSTAT ORAL SUS NYSTACID SUS METRONIDAZOLE ACUZOLE TAB 200MG ACUZOLE TAB 400MG BEMETRAZOLE TAB 200MG BEMETRAZOLE TAB 400MG FLAGYL SUS 200MG/5ML 4 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT MEDAMET TAB 200MG METAZOL TAB 200MG METAZOL TAB 400MG METRAZOLE TAB 400MG METROSTAT TAB 400MG TRICHAZOLE TAB 200MG TRICHAZOLE TAB 400MG ACICLOVIR ACITAB-200 DT DSP 200MG ACITAB-400 DT DSP 400MG ACITOP CRE 5% ADCO-ACYCLOVIR CRE ADCO-ACYCLOVIR TAB 200MG BETA-VIRA CRE 5% CYCLIVEX TAB 400MG LOVIRE CRE LOVIRE DSP 200MG LOVIRE DSP 400MG ADCO-ACYCLOVIR CRE CEFACLOR VERCEF MR TAB 375MG VERCEF SUS 187MG/5ML VERCEF SUS 375MG/5ML CEFADROXIL DACEF CAP 500MG DACEF SUS

4 250MG/5ML DACEF SUS 500MG/5ML CEFALEXIN CPL ALLIANCE CEPHALEXIN CAP 250MG CPL ALLIANCE CEPHALEXIN CAP 500MG CPL ALLIANCE CEPHALEXIN SUS 125MG/5ML RANCEPH CAP 250MG RANCEPH CAP 500MG RANCEPH SUS 125MG/5ML 5 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT RANCEPH SUS 250MG/5ML CEFPODOXIME CEPODEM SUS 40MG/5ML CEPODEM TAB 100MG CEPODEM TAB 200MG DYNA CEFPODOXIME SUS 40MG/5ML SANDOZ CEFPODOXIME TAB 100MG CEFUROXIME AUROXIME TAB 500MG SANDOZ CEFUROXIME SUS 125MG/5ML ZEFURIME TAB 250MG ZEFURIME TAB 500MG ZINOXIME TAB 250MG AZITHROMYCIN ASPEN AZITHROMYCIN TAB 500MG CLARITHROMYCIN KLARITHRAN MR SRT 500MG KLARITHRAN SUS 125MG/5ML KLARITHRAN SUS 250MG/5ML KLARITHRAN TAB 500MG SIMAYLA CLARITHROMYCIN SUS 250MG/5ML ERYTHROMYCIN BETAMYCIN SUS 125MG/5ML PURMYCIN CAP 250MG PURMYCIN SUS 125MG/5ML PURMYCIN SUS 250MG/5ML RUBIMYCIN TAB 250MG SPECTRASONE CAP 250MG SPECTRASONE SUS 125MG/5ML SPECTRASONE SUS 250MG/5ML XERAMEL CAP 250MG XERAMEL SF SUS 250MG/5ML ROXITHROMYCIN ROXXIBID TAB 150MG CIPROFLOXACIN AUSTELL CIPROFLOXACIN TAB 250MG CIPROGEN TAB 500MG 6 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT CPL ALLIANCE CIPROFLOXACIN TAB 250MG CPL ALLIANCE CIPROFLOXACIN TAB 500MG NORFLOXACIN FLOXIN TAB 400MG CLINDAMYCIN CLINDAHEXAL CAP 150MG AMOXICILLIN ADCO-AMOXYCILLIN CAP 250MG ADCO-AMOXYCILLIN SUS 125MG/5ML ADCO-AMOXYCILLIN SUS 250MG/5ML BETAMOX CAP 250MG BETAMOX CAP 500MG BETAMOX S SUS 125MG/5ML BETAMOX SF SUS 250MG/5ML

5 IPCAMOX CAP 250MG MOXYMAX 500 CAP 500MG MOXYMAX CAP 250MG RANMOXY SUS 250MG/5ML SALTERMOX S SUS 125MG/5ML SALTERMOX SF SUS 250MG/5ML AMOXICILLIN / CLAVULANIC ACID APEX-CLAVUTIN TAB 375MG APEX-CLAVUTIN TAB 625MG AUSTELL-CO-AMOXICLAV TAB 375MG AUSTELL-CO-AMOXICLAV TAB 625MG BIO-AMOKSIKLAV TAB 1000MG CLAMENTIN TAB 1000MG CURAM BD SUS 457MG/5ML RANCLAV FORTE SUS 312,5MG/5ML RANCLAV SUS 156,25MG/5ML SANDOZ CO-AMOCLAV SF SUS 312,5MG/5ML SANDOZ CO-AMOXYCLAV BD SF SUS 457MG/5ML SANDOZ CO-AMOXYCLAV S SUS 156,25MG/5ML AMOXICILLIN / FLUCLOXACILLIN MACROPEN CAP 500MG 7 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT MACROPEN S SUS 250MG/5ML AMPICILLIN AMPIPEN CAP 250MG BE-AMPICIL CAP 250MG BE-AMPICIL SUS 125MG/5ML AMPICILLIN / CLOXACILLIN APEN CAP 500MG APEN S SUS 250MG CLOXACILLIN CLOXIN CAP 250MG CLOXIN CAP 500MG FLUCLOXACILLIN FLUPEN CAP 250MG SANDOZ FLUCLOXACILLIN CAP 250MG PHENOXYMETHYL PENICILLIN K BETAPEN SUS 125MG/5ML BETAPEN TAB 250MG COTRIMOXAZOLE CASICOT SUSPENSION SUS CO-TRIM SUS COZOLE SUS COZOLE TAB LAGATRIM TAB 480MG NUCOTRIM TAB PHARMA-Q CO-TRIMOXAZOLE TAB PURBAC DS TAB 960MG PURBAC SUS SANDOZ CO-TRIMOXAZOLE 800MG/160MG TAB TRIMETHOX TAB XERAZOLE SUS DOXYCYCLINE A-LENNON DOXYCYCLINE HCL

6 CAP 100MG CYCLIDOX CAP 100MG DOXYTET CAP 100MG OXYTETRACYCLINE BE-OXYTET CAP 250MG NUCOTET CAP 250MG OXYPAN CAP 250MG 8 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT PHARMATET (YELLOW/ORANGE) CAP 250MG AUTACOIDS CETIRIZINE BETEK TAB 10MG ZETOP TAB 10MG CHLORPHENIRAMINE ALLERGEX SYR 2MG/5ML ALLERGEX TAB 4MG RHINETON TAB 4MG LORATADINE ALLERGEX NON DROWSY SYR 5MG/5ML ALLERGEX NON DROWSY TAB 10MG AP LORATADINE SYR 5MG/5ML AP-LORATADINE TAB 10MG CLARINESE SYR 5MG/5ML LAURA TAB 10MG LORANO TAB 10MG LORMEG TAB 10MG POLLENTYME S SYR 5MG/5ML PROMETHAZINE BRUNAZINE SYR 5MG/5ML LENAZINE SYR 5MG/5ML PROHIST SYR 5MG/5ML RECEPTOZINE TAB 10MG RECEPTOZINE TAB 25MG BLOOD AND HAEMOPOEITIC FEROUS FUMARATE / FOLIC ACID PREGAMAL TAB FERROUR SULPHATE CO GULF FERROUS SULPHATE COMPOUND TAB FERROUS LACTATE FERRO DROPS L DRP CARDIOVASCULAR GLYCERYL TRINITRTAE ANGISED SLT 0.

7 5MG 9 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT ISOSORBIDE DINITRATE ISORDIL SUBLINGUAL SLT 5MG SANDOZ ISOSORBIDE DINITRATE SLT 5MG CENTRAL NERVOUS SYSTEM ELETRIPTAN RELPAX TAB 20MG RELPAX TAB 40MG ERGOTAMINE / CYCLIZINE / CAFFEINE MIFRIL TAB NARATRIPTAN NARAMIG TAB 2,5MG SUMATRIPTAM IMIGEN TAB 100MG IMIGEN TAB 50MG TRIPTAM TAB 100MG TRIPTAM TAB 50MG ZOLMITRIPTAN ZOMIG RAPIMELT SLT 2,5MG CINNARIZINE SANDOZ CINNARIZINE TAB 25MG ALPRAZOLAM ADCO-ALZAM TAB 0,25MG ADCO-ALZAM TAB 0,5MG AZOR TAB 0,25MG AZOR TAB 0,5MG AZOR TAB 1MG CPL ALLIANCE ALPRAZOLAM TAB 0,25MG CPL ALLIANCE ALPRAZOLAM TAB 0,5MG MERCK-ALPRAZOLAM TAB 1MG MYLAN ALPRAZOLAM TAB 0,25MG MYLAN ALPRAZOLAM TAB 0,5MG ZOPAX TAB 0,25MG ZOPAX TAB 0,5MG ZOPAX TAB 1MG DIAZEPAM BETAPAM TAB 5MG DOVAL TAB 5MG 10 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT PAX TAB 5MG NITRAZEPAM AREM TAB 5MG OZAXEPAM MEDOPAM TAB 10MG MEDOPAM TAB 15MG PURATA TAB 10MG PURATA TAB 15MG PURATA TAB 30MG SANDOZ OXAZEPAM TAB 15MG SANDOZ OXAZEPAM TAB 30MG ZOPICLONE ALCHERA TAB 7,5MG ZOPIVANE TAB 7,5MG DERMATOLOGICALS HYDROCORTISONE / DIIODOXYQUINOLINE VIOCORT CRE CETRIMIDE WOUND-A-SEPT (STX)

8 CRE NITROFURAZONE FURASEPT OIN FUREX OIN OXYTETRACYCLINE TERRAMYCIN TOPICAL OIN POVISONE IODINE BIOCREAM CRE SEPTADINE ANTISEPTIC OIN SILVER SULPHADIAZINE BACTRAZINE CRE 1% CLOTRIMAZOLE ADCO-NORMOSPOR CRE 1% CANEX TOPICAL CRE 1% CLOMADERM CRE FUNGISPOR CRE 1% XERASPOR T CRE 1% NYSTATIN CANSTAT CRE NYSTACID OIN MEPYRAMINE ALLERGEX MEPYRAMINE (WAS MEPYRIMAL) CRE 11 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT ALSAN CRE 2% MEPYRADERM CRE 2% BENZYLBENZOATE ALPHA BENZYL BENZOATE APPLICATION LOT 25% APP BENZYL BENZ - ALLIED SCL 25% APP BENZYL BENZ (XPRESSMED) SCL APP BENZYL BENZ BPC LOT BENZYL BENZOATE APPLICATICATION BP LIT 25% CALAMINE CALAMINE - ALCHEMIST LOT CALAMINE LOTION - DAROL LOT CLICKS CALAMINE LOT LACTO CALAMINE LOT LOT CALAMINE (XPRESSMED) LOT LOT CALAMINE BP MLS LOT CALAMINE BP MLS DIPHENHYDRAMINE / CALAMINE BIOHIST LOTION LOT MEPYRAMINE / DIPHENHYDRAMINE HISTODOR CRE BECLOMETASONE BECLATE CREAM CREOXY BETAMETASONE LENOVATE OIN 0,1% REPIVATE CRE 0,1% VARI-BETAMETHASONE CRE 0,1% FLUOCINOLONE CORTODERM CRE CORTODERM OIN HYDROCORTISONE 1% BIOCORT (STX)

9 CRE LINK MEZZODERM CRE STOPITCH CRE 1% TOPIVATE CRE 0,1% AMETHOCAINE AMETHOCAINE CRE DIIODIXYQUINOLINE / BENZOCAINE VIODOR CRE 12 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT EAR, NOSE AND THROAT ZAZELASTINE RHINOLAST NASAL SPRAY NAS OXYMETAZOLINE DRINASAL METERED 10M NAS 0,025% DRINASAL PAEDIATRIC 10ML NOD 0,025% DRIXINE 20ML NAS 0,05% ILIADIN 20ML NAS 0,05% ILIADIN NOD 0,01% ILIADIN NOSE ADULT NOD 0,05% ILIADIN NOSE PAED 10ML NOD 0,025% NAZENE Z 20ML NAS PHENYLEPHRINE NAPHENSYL 10ML NOD 1% NAPHENSYL PAED 10ML NOD 0,25% PHENYLEPHRINE / NAPHAZOLINE ENT 25ML NAS ENT 25ML NOD FENOX 25ML NOD NASDRO 15ML NOD NITRO DROPS 20ML NOD SINUS S 25ML NOD PHENAZONE / BENZOCAINE / EPHEDRINE OTOPHEN FORTE 10ML EAR CHLORAMPHENICOL / NAPHAZOLINE / NEOMYCIN COVOMYCIN EEN CHLORAMPHENICOL / NEOMYCIN / DEXAMETHASONE COVOMYCIN-D EEN DOCUSATE SODIUM WAXSOL NF 10ML EAR 0.

10 05G GLYCERIN / PHENAZONE OTOPHEN 10ML EAR GLYCERIN / PHENAZONE / BENZOCAINE FAMOTIC 20ML EAR OTISED 15ML EAR 13 ACTIVE INGREDIENT ACUTE FORMULARY PRODUCT PHENAZONE / BENZOCAINE / SULPACETAMIDE COVANCAINE 20ML EAR PROCAINE / PHENAZONE UNIVERSAL EAR 15ML EAR TURPENTINE OIL CERUMOL 10ML EAR BECLOMETASONE BECLATE AQUANASE 150 DOSE AQS 50 MCG CIPLANAZE MULTICARE 150 DOSE AQS 50 MCG CLENIL AQUEOUS 200 DOSE AQS 50 MCG FLUTICASONE FLOMIST 120 DOSE AQS 50 MCG FLONASE 120 DOSE AQS 50 MCG CETALKONIUM CL / CHOLINE SALICYLATE TEEJEL GEO POVIDONE IODINE DERMADINE ORAL GARG MOW SEPTADINE ORAL ANTISEPTIC MOW STERIDINE MOUTHWASH AND GARGLE LIQUID MOW ENDOCRINE SYSTEM BETAMETASONE BETANOID SYR 0,6MG/5ML PREDNISOLONE ADCO PREDNISOLONE SYR 15MG/5ML ASPELONE LIQ 15MG/5ML PREFLAM SYR 15MG/5ML CAPSOID TAB 5MG LENISOLONE TAB 5MG PREDNISONE BE-TABS PREDNISONE TAB 5MG PANAFCORT