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ACUTE MEDICATION FORMULARY
2020
NOTE:
Reference pricing is applied. Patients are advised to discuss the availability of less expensive generics with the pharmacist at the point of dispensing.
If a product is dispensed that is more expensive than the reference price, the patient will need to pay the difference in price at the point of dispensing.
Quantity limits apply to some items on this formulary. Quantities in excess of this limit will need to be funded by the member at the point of dispensing, unless an
authorisation has been obtained for a greater quantity.
The formulary is subject to regular review. Momentum Health reserves the right to update and change the formulary when new information becomes available, prices
change or when new medicines are released.
While every effort has been made to ensure that products listed are available on the market, it is possible that some products may be discontinued by the manufacturers
during the course of the year. Should this be the case, patients are advised to discuss alternatives with the pharmacist or the prescribing doctor.
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
780081 ANTI-MICROBIALS Penicillin V Potassium Tab 250 MG BETAPEN 250MG TABS 3 fills per annum Below
751111 ANTI-MICROBIALS Penicillin V Potassium For Soln 125 MG/5ML BETAPEN 125MG/5ML SYR 3 fills per annum Below
716611 ANTI-MICROBIALS Penicillin V Potassium For Soln 125 MG/5ML ATHLONE PHENOXYMETHYLPENICIL
3 fills per annum Below
704401 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG AMOXICAPS 250MG CAPS 3 fills per annum Below
704443 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG ALLMOX 250MG CAPS 3 fills per annum Below
744689 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG MOXYPEN 250MG CAPS 3 fills per annum Below
784656 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG AMOCILLIN 250MG CAPS 3 fills per annum Above
785229 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG ADCO-AMOX 250MG CAPS 3 fills per annum Above
788155 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG BETAMOX 250MG CAPS 3 fills per annum Above
806579 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG MOXYMAX 250MG CAPS 3 fills per annum Below
808539 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG ZOXIL 250MG CAPS 3 fills per annum Above
808741 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG PROMOXIL 250MG CAPS 3 fills per annum Below
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Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
815268 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG IPCAMOX 250MG CAPS 3 fills per annum Below
707499 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG AUSTELL-AMOXICILLIN 250MG CAPS
3 fills per annum Below
708398 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG ZALOXY 250MG CAPS 3 fills per annum Above
713363 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG AURO-AMOXYCILLIN 250MG CAPS
3 fills per annum Below
714185 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG AMYN 250MG CAPS 3 fills per annum Below
716122 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG YOMAX 250MG CAPS 3 fills per annum Below
3000309 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 250 MG INDO AMOXYCILLIN 250MG CAPS
3 fills per annum Above
704444 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG ALLMOX 500MG CAPS 3 fills per annum Below
744697 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG MOXYPEN 500MG CAPS 3 fills per annum Below
788546 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG BETAMOX 500MG CAPS 3 fills per annum Above
806587 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG MOXYMAX 500MG CAPS 3 fills per annum Below
808547 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG ZOXIL 500MG CAPS 3 fills per annum Above
808768 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG PROMOXIL 500MG CAPS 3 fills per annum Below
811440 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG ADCO-AMOX 500MG CAPS 3 fills per annum Above
824879 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG RANMOXY 500MG CAPS 3 fills per annum Below
705637 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG AUSTELL-AMOXICILLIN 500MG CAPS
3 fills per annum Below
708397 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG ZALOXY 500MG CAPS 3 fills per annum Below
713364 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG AURO-AMOXYCILLIN 500MG CAPS
3 fills per annum Above
714184 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG AMYN 500MG CAPS 3 fills per annum Below
716123 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG YOMAX 500MG CAPS 3 fills per annum Above
3000310 ANTI-MICROBIALS Amoxicillin (Trihydrate) Cap 500 MG INDO AMOXYCILLIN 500MG CAPS
3 fills per annum Below
829145 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML AMOXIL S 125MG SUSP 3 fills per annum Above
829358 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML BETAMOX S 125MG/5ML SUSP 3 fills per annum Below
830275 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML MOXYMAX S 125MG/5ML SUSP
3 fills per annum Below
830291 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML MOXYPEN 125 SUSP 3 fills per annum Below
830488 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML PROMOXIL S 125MG/5ML 3 fills per annum Below
830534 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML SALTERMOX S 125MG/5ML 3 fills per annum Below
830739 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML ZOXIL S 125MG/5ML SUSP 3 fills per annum Below
708396 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML ZALOXY 125MG/5ML SUSP 3 fills per annum Below
Page 3 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
714179 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML ALLMOX S 125MG/5ML SUSP 3 fills per annum Below
714182 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 125 MG/5ML AMYN S 125MG/5ML SUSP 3 fills per annum Below
829102 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML ADCO-AMOX 250MG SUSP 3 fills per annum Below
829153 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML AMOXIL SF 250MG SUSP 3 fills per annum Above
830283 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML MOXYMAX 250 SUSP 3 fills per annum Below
830305 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML MOXYPEN 250MG/5ML SUSP 3 fills per annum Below
830496 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML PROMOXIL SF 250MG/5ML 3 fills per annum Below
830747 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML ZOXIL SF 250MG/5ML SUSP 3 fills per annum Below
708395 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML ZALOXY 250MG/5ML SUSP 3 fills per annum Below
714180 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML ALLMOX SF 250MG/5ML SUSP 3 fills per annum Below
714183 ANTI-MICROBIALS Amoxicillin (Trihydrate) For Susp 250 MG/5ML AMYN SF 250MG/5ML SUSP 3 fills per annum Below
809632 ANTI-MICROBIALS Cloxacillin Sodium Cap 250 MG CLOXIN 250MG CAPS 3 fills per annum Below
809640 ANTI-MICROBIALS Cloxacillin Sodium Cap 500 MG CLOXIN 500MG CAPS 3 fills per annum Below
781231 ANTI-MICROBIALS Floxacillin Sodium Cap 250 MG SANDOZ FLUCLOXACILLIN 250MG
3 fills per annum Below
710308 ANTI-MICROBIALS Floxacillin Sodium Cap 250 MG FLUPEN 250MG CAPS 3 fills per annum Below
723163 ANTI-MICROBIALS Floxacillin Sodium Cap 250 MG MEDREICH FLUCLOXACILLIN 250MG
3 fills per annum Below
705691 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG AUGMENTIN 375MG TABS 3 fills per annum Above
842516 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG CLAMENTIN 375MG TABS 3 fills per annum Below
861936 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG AUGMAXCIL 375MG TABS 3 fills per annum Above
865532 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG BIO-AMOKSIKLAV TABS 3 fills per annum Below
867373 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG RANCLAV 375MG TABS 3 fills per annum Above
878766 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG SANDOZ CO-AMOXYCLAV 375 MG
3 fills per annum Below
707184 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG AMOCLAN TABS 3 fills per annum Below
707407 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG AUSTELL CO-AMOXICLAV 375MG
3 fills per annum Below
707663 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG APEX-CLAVUTIN 375MG TABS 3 fills per annum Below
713381 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG AURO-AMOXICLAV 375MG TABS
3 fills per annum Below
716124 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG BINDOCLAV 375MG TABS 3 fills per annum Above
721444 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG BETACLAV 375MG TABS 3 fills per annum Below
3000394 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG MYCLAV 375MG TABS 3 fills per annum Below
Page 4 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
3000747 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 250-125 MG ADCO AMOXYCLAV 375MG TABS
3 fills per annum Below
701736 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG SANDOZ CO-AMOXICLAV 625MG TABS
3 fills per annum Below
704047 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG CURAM 625MG TABS 3 fills per annum Above
861944 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG AUGMAXCIL 625MG TABS 3 fills per annum Above
867381 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG RANCLAV 625MG TABS 3 fills per annum Above
865524 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG BIO-AMOKSIKLAV 625MG TABS 3 fills per annum Below
707185 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG AMOCLAN FORTE TABS 3 fills per annum Above
707408 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG AUSTELL CO-AMOXICLAV 625MG
3 fills per annum Below
707665 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG APEX-CLAVUTIN 625MG TABS 3 fills per annum Below
713382 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG AURO-AMOXICLAV 625MG TABS
3 fills per annum Below
716125 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG BINDOCLAV 625MG TABS 3 fills per annum Below
721445 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG BETACLAV 625MG TABS 3 fills per annum Below
3000395 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG MYCLAV 625MG TABS 3 fills per annum Below
3000748 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 500-125 MG ADCO AMOXYCLAV 625MG TABS
3 fills per annum Below
703356 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG SANDOZ CO-AMOXICLAV BD 1000
3 fills per annum Below
704049 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG CURAM 1000GM BD TABS 3 fills per annum Below
704484 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG AMOCLAN BID 1000MG TABS 3 fills per annum Above
853542 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG AUGMENTIN 1000MG BD TABS 3 fills per annum Above
708893 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG RANCLAV 1000MG TABS 3 fills per annum Below
709232 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG CLAMENTIN 1000MG TABS 3 fills per annum Below
708387 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG BIO-AMOKSIKLAV 1000MG TABS
3 fills per annum Below
713383 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG AURO-AMOXICLAV 1000MG TABS
3 fills per annum Above
714704 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG BETACLAV 1000MG TABS 3 fills per annum Below
716126 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG BINDOCLAV 1000MG TABS 3 fills per annum Above
720898 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab 875-125 MG ADCO-AMOXYCLAV BD 1000MG TABS
3 fills per annum Below
829269 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
AUGMENTIN S SUSP 3 fills per annum Above
842524 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
CLAMENTIN S 3 fills per annum Above
Page 5 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
861952 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
AUGMAXCIL S 3 fills per annum Below
865540 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
BIO-AMOKSILAV 3 fills per annum Below
878774 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
SANDOZ AMOCLAV S 3 fills per annum Below
894123 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
RANCLAV SUSPENSION 3 fills per annum Below
707186 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
AMOCLAN S SUSP 3 fills per annum Below
713358 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 125-31.25 MG/5ML
AURO-AMOXICLAV 125/31.25MG
3 fills per annum Below
704069 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 200-28.5 MG/5ML
AUGMENTIN BD S SUSP 3 fills per annum Above
722937 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 200-28.5 MG/5ML
AUSTELL CO-AMOXICLAV BD S SUSP
3 fills per annum Below
829277 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
AUGMENTIN SF SUSP 3 fills per annum Above
842532 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
CLAMENTIN SF 3 fills per annum Above
861960 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
AUGMAXCIL SF 3 fills per annum Below
865559 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
BIO-AMOKSIKLAV 3 fills per annum Below
878782 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
SANDOZ AMOCLAV SF 3 fills per annum Below
894125 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
RANCLAV FORTE SUSPENSION 3 fills per annum Below
707187 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
AMOCLAN SF SUSP 3 fills per annum Below
707666 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
APEX-CLAVUTIN SF 3 fills per annum Below
713360 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML
AURO-AMOXICLAV 250/62.5 MG
3 fills per annum Above
704068 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML AUGMENTIN BD SF SUSP 3 fills per annum Above
705471 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML SANDOZ CO-AMOCLAV BD SF 3 fills per annum Below
705832 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML CURAM BD SUSP 3 fills per annum Above
722938 ANTI-MICROBIALS Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML AUSTELL CO-AMOXICLAV BD SF SUS
3 fills per annum Below
719283 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab Disint 500-125 MG SANDOZ CO-AMOXYCLAV 625MG DISP
3 fills per annum Below
703903 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab Disint 875-125 MG FORCID SOLUTAB 875/125 3 fills per annum Below
Page 6 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
719284 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab Disint 875-125 MG SANDOZ CO-AMOXYCLAV 1000MG
3 fills per annum Below
723109 ANTI-MICROBIALS Amoxicillin & K Clavulanate Tab Disint 875-125 MG KLAVIMAXCIL 1000MG DISP TABS
3 fills per annum Below
797561 ANTI-MICROBIALS Amoxicillin-Floxacillin Sodium Cap 250-250 MG MACROPEN CAPS 3 fills per annum Below
830208 ANTI-MICROBIALS Amoxicillin-Floxacillin Sodium For Susp 125-125 MG/5ML
MACROPEN SUSP 3 fills per annum Below
830909 ANTI-MICROBIALS Cephalexin Cap 250 MG RANCEPH 250MG CAPS 3 fills per annum Above
897880 ANTI-MICROBIALS Cephalexin Cap 250 MG CPL ALLIANCE CEPHALEXIN 250MG
3 fills per annum Below
837253 ANTI-MICROBIALS Cephalexin Cap 500 MG RANCEPH 500MG CAPS 3 fills per annum Below
897887 ANTI-MICROBIALS Cephalexin Cap 500 MG CPL ALLIANCE CEPHALEXIN 500MG
3 fills per annum Below
706327 ANTI-MICROBIALS Cephalexin Cap 500 MG BELEX 500MG CAPS 3 fills per annum Below
860603 ANTI-MICROBIALS Cephalexin For Susp 125 MG/5ML RANCEPH 125MG/5ML SUSP 3 fills per annum Below
860611 ANTI-MICROBIALS Cephalexin For Susp 250 MG/5ML RANCEPH 250MG/5ML SUSP 3 fills per annum Below
700689 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG CEROXIM 250MG 3 fills per annum Below
703697 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG ZEFROXE 250MG TABS 3 fills per annum Above
703867 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG SANDOZ CEFUROXIME 250MG TABS
3 fills per annum Below
781339 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG ZINNAT 250MG TABS 3 fills per annum Above
704988 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG CEFU-HEXAL 250MG 3 fills per annum Above
707371 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG CUROAX 250MG TABS 3 fills per annum Below
713531 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG AUROXIME 250MG TABS 3 fills per annum Below
713006 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG ZEFURIME 250MG TABS 3 fills per annum Below
715142 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG ZINOXIME 250MG TABS 3 fills per annum Below
717799 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG ALKOXIME 250MG TABS 3 fills per annum Below
718658 ANTI-MICROBIALS Cefuroxime Axetil Tab 250 MG CEFASYN 250MG TABS (WAS POXIM)
3 fills per annum Below
700687 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG CEROXIM 500MG 3 fills per annum Below
703695 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ZEFROXE 500MG TABS 3 fills per annum Above
703868 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG SANDOZ CEFUROXIME 500MG TABS
3 fills per annum Below
713007 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ZEFURIME 500MG TABS 3 fills per annum Below
781347 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ZINNAT 500MG TABS 3 fills per annum Above
704990 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG CEFU-HEXAL 500MG TABS 3 fills per annum Above
Page 7 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
710531 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG BETAROXIME T 500MG TABS 3 fills per annum Below
713532 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG AUROXIME 500MG TABS 3 fills per annum Below
715261 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ZINOXIME 500MG TABS 3 fills per annum Below
717992 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ORCHID CEFUROXIME 500MG TABS
3 fills per annum Below
717801 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG ALKOXIME 500MG TABS 3 fills per annum Below
718659 ANTI-MICROBIALS Cefuroxime Axetil Tab 500 MG CEFASYN 500MG TABS (WAS POXIM)
3 fills per annum Below
814091 ANTI-MICROBIALS Cefuroxime Axetil For Susp 125 MG/5ML ZINNAT 125MG/5ML SUSP 3 fills per annum Above
710077 ANTI-MICROBIALS Cefuroxime Axetil For Susp 125 MG/5ML SANDOZ CEFUROXIME 125MG/5ML
3 fills per annum Below
723411 ANTI-MICROBIALS Cefuroxime Axetil For Susp 125 MG/5ML CEROXIM 125MG/5ML SUSP 3 fills per annum Below
715656 ANTI-MICROBIALS Cefixime Tab 400 MG FIXIME 400MG TABS 3 fills per annum Below
703460 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG SABAX CEFTRIAXONE 250MG POWD
3 fills per annum Below
761257 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG ROCEPHIN 250MG/VIAL 3 fills per annum Above
707948 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG FRESENIUS-CEFTRIAXONE 250MG
3 fills per annum Below
709240 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG CEFTRIAXONE-SAFELINE VIAL POWD
3 fills per annum Below
713200 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG MEDAXONE 250MG INJ 3 fills per annum Below
714188 ANTI-MICROBIALS Ceftriaxone Sodium For Inj 250 MG TRIAPHIN VIAL 5ML 250MG INJ 3 fills per annum Below
709334 ANTI-MICROBIALS Erythromycin Stearate Tab 250 MG MERCK-ERYTHROMYCIN 250MG TABS
3 fills per annum Below
710310 ANTI-MICROBIALS Erythromycin Stearate Tab 250 MG ERYKO 250MG TABS 3 fills per annum Below
719683 ANTI-MICROBIALS Erythromycin Stearate Tab 250 MG RACEMIN 250MG TABS 3 fills per annum Below
758388 ANTI-MICROBIALS Erythromycin Estolate Cap 250 MG PURMYCIN 250MG CAPS 3 fills per annum Above
780561 ANTI-MICROBIALS Erythromycin Estolate Cap 250 MG ADCO-ERYTHROMYCIN 250 CAPS
3 fills per annum Below
824682 ANTI-MICROBIALS Erythromycin Estolate Cap 250 MG XERAMEL 250MG CAPS 3 fills per annum Below
758396 ANTI-MICROBIALS Erythromycin Estolate Susp 125 MG/5ML PURMYCIN 125MG/5ML SUSP 3 fills per annum Below
787108 ANTI-MICROBIALS Erythromycin Estolate Susp 125 MG/5ML ERYMYCIN P 125MG SUSP 3 fills per annum Below
793329 ANTI-MICROBIALS Erythromycin Estolate Susp 125 MG/5ML BETAMYCIN 125MG SUSP 3 fills per annum Below
823570 ANTI-MICROBIALS Erythromycin Estolate Susp 125 MG/5ML XERAMEL S SUSP 3 fills per annum Below
758418 ANTI-MICROBIALS Erythromycin Estolate Susp 250 MG/5ML PURMYCIN 250MG/5ML SUSP 3 fills per annum Above
787086 ANTI-MICROBIALS Erythromycin Estolate Susp 250 MG/5ML ERYMYCIN PF 250MG SUSP 3 fills per annum Above
Page 8 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
848409 ANTI-MICROBIALS Erythromycin Estolate Susp 250 MG/5ML XERAMEL SF 250MG/5ML SUSP 3 fills per annum Below
710609 ANTI-MICROBIALS Azithromycin Cap 250 MG AZIMAX 250MG CAPS Qty limit = 12 units per annum
Above
712447 ANTI-MICROBIALS Azithromycin Cap 250 MG CLAMELLE 250MG CAPS Qty limit = 12 units per annum
Above
717496 ANTI-MICROBIALS Azithromycin Cap 250 MG VARIMAX 250MG CAPS Qty limit = 12 units per annum
Below
704032 ANTI-MICROBIALS Clarithromycin Tab 250 MG CLACEE 250MG TABS 3 fills per annum Above
707255 ANTI-MICROBIALS Clarithromycin Tab 250 MG KLARIZON 250MG TABS 3 fills per annum Below
716675 ANTI-MICROBIALS Clarithromycin Tab 250 MG KLARYVID 250MG TABS 3 fills per annum Below
720976 ANTI-MICROBIALS Clarithromycin Tab 250 MG KLARIBIN 250MG TABS 3 fills per annum Below
704033 ANTI-MICROBIALS Clarithromycin Tab 500 MG CLACEE 500MG TABS 3 fills per annum Above
704464 ANTI-MICROBIALS Clarithromycin Tab 500 MG KLARITHRAN 500MG TABS 3 fills per annum Below
705031 ANTI-MICROBIALS Clarithromycin Tab 500 MG CLARIHEXAL 500MG TABS 3 fills per annum Above
705416 ANTI-MICROBIALS Clarithromycin Tab 500 MG MYLAN CLARITHROMYCIN 500MG
3 fills per annum Below
707256 ANTI-MICROBIALS Clarithromycin Tab 500 MG KLARIZON 500MG TABS 3 fills per annum Below
707662 ANTI-MICROBIALS Clarithromycin Tab 500 MG APEX-CLARITHROMYCIN 500MG TABS
3 fills per annum Below
719921 ANTI-MICROBIALS Clarithromycin Tab 500 MG KLARYVID 500MG TABS 3 fills per annum Below
720977 ANTI-MICROBIALS Clarithromycin Tab 500 MG KLARIBIN 500MG TABS 3 fills per annum Below
704649 ANTI-MICROBIALS Clarithromycin For Susp 125 MG/5ML KLARITHRAN 125MG/5ML SUSP
3 fills per annum Below
830046 ANTI-MICROBIALS Clarithromycin For Susp 125 MG/5ML KLACID 125MG/5ML SUSP 3 fills per annum Above
706758 ANTI-MICROBIALS Clarithromycin For Susp 125 MG/5ML CLARIHEXAL 125 P SUSP 3 fills per annum Below
707357 ANTI-MICROBIALS Clarithromycin For Susp 125 MG/5ML KLARIBIN 125MG/5ML SUSP 3 fills per annum Above
704650 ANTI-MICROBIALS Clarithromycin For Susp 250 MG/5ML KLARITHRAN 250MG/5ML SUSP
3 fills per annum Below
830054 ANTI-MICROBIALS Clarithromycin For Susp 250 MG/5ML KLACID 250MG/5ML SUSP 3 fills per annum Above
706759 ANTI-MICROBIALS Clarithromycin For Susp 250 MG/5ML CLARIHEXAL 250 P SUSP 3 fills per annum Below
707358 ANTI-MICROBIALS Clarithromycin For Susp 250 MG/5ML KLARIBIN 250MG/5ML SUSP 3 fills per annum Above
721268 ANTI-MICROBIALS Clarithromycin Tab ER 24HR 500 MG CLARITHROMYCIN UNICORN 500MG X
3 fills per annum Below
841552 ANTI-MICROBIALS Clarithromycin Tab ER 24HR 500 MG KLACID XL 500MG TABS 3 fills per annum Above
707761 ANTI-MICROBIALS Clarithromycin Tab ER 24HR 500 MG KLARITHRAN MR 500MG TABS 3 fills per annum Below
717722 ANTI-MICROBIALS Clarithromycin Tab ER 24HR 500 MG CLARIHEXAL XL 500MG TABS 3 fills per annum Below
Page 9 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
798401 ANTI-MICROBIALS Doxycycline Hyclate Cap 50 MG DUMOXIN 50MG CAPS 3 fills per annum Below
808407 ANTI-MICROBIALS Doxycycline Hyclate Cap 50 MG DOXYCYL 50MG CAPS 3 fills per annum Above
809667 ANTI-MICROBIALS Doxycycline Hyclate Cap 100 MG DOXYCYL 100MG CAPS 3 fills per annum Above
893402 ANTI-MICROBIALS Doxycycline Hyclate Cap 100 MG A-LENNON DOXYCYCLINE HCL CAPS
3 fills per annum Above
714192 ANTI-MICROBIALS Doxycycline Hyclate Cap 100 MG DOXYTET 100MG CAPS 3 fills per annum Below
703224 ANTI-MICROBIALS Oxytetracycline HCl Cap 250 MG PHARMATET 250MG CAPS 3 fills per annum Below
812072 ANTI-MICROBIALS Oxytetracycline HCl Cap 250 MG TETRACEM 250MG CAPS 3 fills per annum Above
884167 ANTI-MICROBIALS Oxytetracycline HCl Cap 250 MG NUCOTET CAPS 3 fills per annum Below
700284 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CPL ALLIANCE CIPROFLOXACIN 250
3 fills per annum Below
702377 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIPLOXX 250MG TABS 3 fills per annum Above
703043 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIPROGEN 250MG TABS 3 fills per annum Below
704353 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) AUSTELL CIPROFLOX 250MG TABS
3 fills per annum Below
784354 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIPROBAY 250MG TABS 3 fills per annum Above
892140 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIFRAN 250MG TABS 3 fills per annum Above
893951 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIFLOC 250MG TABS 3 fills per annum Above
704777 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIPROL 250MG TABS 3 fills per annum Above
708015 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) SIMAYLA CIPROFLOXACIN 250MG
3 fills per annum Above
713361 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) LOXIP 250MG TABS 3 fills per annum Below
713792 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) BIOTECH CIPROFLOXACIN 250MG
3 fills per annum Below
716518 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) CIPROFLOXACIN ACTOR 250MG TABS
3 fills per annum Above
719659 ANTI-MICROBIALS Ciprofloxacin HCl Tab 250 MG (Base Equiv) PROFLOXIN 250MG TABS 3 fills per annum Above
700287 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CPL ALLIANCE CIPROFLOXACIN 500
3 fills per annum Below
700518 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) DYNAFLOC 500MG TABS 3 fills per annum Above
701210 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) ORPIC 500MG TABS 3 fills per annum Below
702379 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPLOXX 500MG TABS 3 fills per annum Above
703045 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPROGEN 500MG TABS 3 fills per annum Below
704351 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) AUSTELL CIPROFLOX 500MG TABS
3 fills per annum Above
786403 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPROBAY 500MG TABS 3 fills per annum Above
Page 10 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
892147 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIFRAN 500MG TABS 3 fills per annum Below
893955 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIFLOC 500MG TABS 3 fills per annum Above
704775 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPROL 500MG TABS 3 fills per annum Below
708014 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) SIMAYLA CIPROFLOXACIN 500MG
3 fills per annum Above
713362 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) LOXIP 500MG TABS 3 fills per annum Below
713793 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) BIOTECH CIPROFLOXACIN 500MG
3 fills per annum Below
716519 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPROFLOXACIN ACTOR 500MG TABS
3 fills per annum Above
719660 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) PROFLOXIN 500MG TABS 3 fills per annum Above
720331 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) FLOPRO 500MG TABS 3 fills per annum Below
723383 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) CIPROFLOXACIN UNICORN 500MG TA
3 fills per annum Above
3000796 ANTI-MICROBIALS Ciprofloxacin HCl Tab 500 MG (Base Equiv) BIOFLOXX 500MG TABS 3 fills per annum Below
704352 ANTI-MICROBIALS Ciprofloxacin HCl Tab 750 MG (Base Equiv) AUSTELL CIPROFLOX 750MG TABS
3 fills per annum Below
784362 ANTI-MICROBIALS Ciprofloxacin HCl Tab 750 MG (Base Equiv) CIPROBAY 750MG TABS 3 fills per annum Above
713794 ANTI-MICROBIALS Ciprofloxacin HCl Tab 750 MG (Base Equiv) BIOTECH CIPROFLOXACIN 750MG
3 fills per annum Below
729566 ANTI-MICROBIALS Griseofulvin Microsize Tab 125 MG MICROCIDAL 125MG TABS 3 fills per annum Below
729574 ANTI-MICROBIALS Griseofulvin Microsize Tab 500 MG MICROCIDAL 500MG TABS 3 fills per annum Below
721667 ANTI-MICROBIALS Fluconazole Cap 150 MG AURO FLUCONAZOLE 150MG CAPS
6 fills per annum Below
700149 ANTI-MICROBIALS Fluconazole Cap 150 MG FLUCORIC 150MG CAPS 6 fills per annum Below
700598 ANTI-MICROBIALS Fluconazole Cap 150 MG FLUZOL 150MG CAPS 6 fills per annum Above
703624 ANTI-MICROBIALS Fluconazole Cap 150 MG ASPEN FLUCONAZOLE 150MG CAPS
6 fills per annum Above
703635 ANTI-MICROBIALS Fluconazole Cap 150 MG DIFLUZOLE 150MG CAPS 6 fills per annum Below
704357 ANTI-MICROBIALS Fluconazole Cap 150 MG AUSTELL FLUCON 150MG CAPS 6 fills per annum Below
786373 ANTI-MICROBIALS Fluconazole Cap 150 MG DIFLUCAN 150MG CAPS 6 fills per annum Above
705384 ANTI-MICROBIALS Fluconazole Cap 150 MG MYLAN FLUCONAZOLE 150MG CAPS
6 fills per annum Below
711530 ANTI-MICROBIALS Fluconazole Cap 150 MG MYCOREST 150MG CAPS 6 fills per annum Below
713556 ANTI-MICROBIALS Fluconazole Cap 150 MG GULF FLUCONAZOLE 150MG CAPS
6 fills per annum Below
718565 ANTI-MICROBIALS Fluconazole Cap 150 MG FLUCONAZOLE UNICORN 150MG CAPS
6 fills per annum Above
Page 11 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
720826 ANTI-MICROBIALS Fluconazole Cap 150 MG INSEP 150MG CAPS 6 fills per annum Below
720858 ANTI-MICROBIALS Fluconazole Tab 150 MG GLENMARK FLUCONAZOLE 150MG TAB
6 fills per annum Below
824313 ANTI-MICROBIALS Acyclovir Tab 200 MG CYCLIVEX 200MG TABS 3 fills per annum Above
827282 ANTI-MICROBIALS Acyclovir Tab 200 MG ADCO-ACYCLOVIR TABS 3 fills per annum Above
717370 ANTI-MICROBIALS Acyclovir Tab 200 MG ACICLOVIR SANDOZ 200MG TABS
3 fills per annum Below
717157 ANTI-MICROBIALS Acyclovir Tab 200 MG APEX-ACYCLOVIR 200MG TABS 3 fills per annum Above
719670 ANTI-MICROBIALS Acyclovir Tab 200 MG ACYCLOVIR BIOTECH 200MG TABS
3 fills per annum Below
860581 ANTI-MICROBIALS Acyclovir Tab 400 MG CYCLIVEX 400MG TABS 3 fills per annum Below
717371 ANTI-MICROBIALS Acyclovir Tab 400 MG ACICLOVIR SANDOZ 400MG TABS
3 fills per annum Below
717158 ANTI-MICROBIALS Acyclovir Tab 400 MG APEX-ACYCLOVIR 400MG TABS 3 fills per annum Below
833703 ANTI-MICROBIALS Acyclovir Tab Disint 200 MG ZOVIRAX DISP 200MG TABS 3 fills per annum Above
838225 ANTI-MICROBIALS Acyclovir Tab Disint 200 MG LOVIRE 200MG DISP TABS 3 fills per annum Below
704778 ANTI-MICROBIALS Acyclovir Tab Disint 200 MG ACITAB-200 DISP TABS 3 fills per annum Below
838233 ANTI-MICROBIALS Acyclovir Tab Disint 400 MG LOVIRE 400MG DISP TABS 3 fills per annum Below
704779 ANTI-MICROBIALS Acyclovir Tab Disint 400 MG ACITAB-400 DISP TABS 3 fills per annum Above
876089 ANTI-PROTOZOALS Artemether-Lumefantrine Tab 20-120 MG COARTEM TABS 1 fill per annum Below
712381 ANTHELMINTICS Albendazole Tab 400 MG ZENTEL 400MG TABS 2 fills per annum Below
789720 ANTHELMINTICS Albendazole Susp 100 MG/5ML ZENTEL 100MG/5ML SUSP 2 fills per annum Below
703063 ANTHELMINTICS Mebendazole Tab 100 MG ADCO-WORMEX TABS 2 fills per annum Below
810533 ANTHELMINTICS Mebendazole Tab 100 MG WORMGO 100MG TABS 2 fills per annum Below
845671 ANTHELMINTICS Mebendazole Tab 100 MG WORMSTOP 100MG TABS 2 fills per annum Below
878227 ANTHELMINTICS Mebendazole Tab 100 MG CIPEX 100MG TABS 2 fills per annum Above
704656 ANTHELMINTICS Mebendazole Tab 500 MG ADCO-WORMEX 500MG TABS 2 fills per annum Below
807524 ANTHELMINTICS Mebendazole Tab 500 MG VERMOX SD 500MG TABS 2 fills per annum Above
833894 ANTHELMINTICS Mebendazole Tab 500 MG D-WORM SD TABS 2 fills per annum Above
845701 ANTHELMINTICS Mebendazole Tab 500 MG WORMSTOP 500MG TABS 2 fills per annum Above
775606 ANTHELMINTICS Mebendazole Susp 20 MG/ML VERMOX 100MG/5ML SUSP 2 fills per annum Above
828297 ANTHELMINTICS Mebendazole Susp 20 MG/ML CIPEX SUSP 2 fills per annum Below
845698 ANTHELMINTICS Mebendazole Susp 20 MG/ML WORMSTOP SUSP 2 fills per annum Below
881546 ANTHELMINTICS Mebendazole Susp 50 MG/ML VERMOX SD 500MG/10ML 2 fills per annum Below
Page 12 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
828424 ANTHELMINTICS Piperazine Citrate Syrup 500 MG/5ML SB TOX WORM SYR 2 fills per annum Below
708607 ANTHELMINTICS Praziquantel Tab 600 MG BILTRICIDE 600MG TABS 1 fill per annum Below
703389 ANTI-MICROBIALS Metronidazole Tab 200 MG ANAEROBYL 200MG TABS 3 fills per annum Below
726346 ANTI-MICROBIALS Metronidazole Tab 200 MG FLAGYL 200MG TABS 3 fills per annum Above
742872 ANTI-MICROBIALS Metronidazole Tab 200 MG ADCO-METRONIDAZOLE 200MG TABS
3 fills per annum Below
772216 ANTI-MICROBIALS Metronidazole Tab 200 MG TRICHAZOLE 200MG TABS 3 fills per annum Below
784710 ANTI-MICROBIALS Metronidazole Tab 200 MG MEDAMET 200MG TABS 3 fills per annum Below
821705 ANTI-MICROBIALS Metronidazole Tab 200 MG BE-METRAZOLE 200MG TABS 3 fills per annum Below
701076 ANTI-MICROBIALS Metronidazole Tab 400 MG ADCO-METRONIDAZOLE 400MG TABS
3 fills per annum Above
702148 ANTI-MICROBIALS Metronidazole Tab 400 MG AMZOLE 400MG TABS 3 fills per annum Below
726354 ANTI-MICROBIALS Metronidazole Tab 400 MG FLAGYL 400MG TABS 3 fills per annum Above
772224 ANTI-MICROBIALS Metronidazole Tab 400 MG TRICHAZOLE 400MG TABS 3 fills per annum Above
779822 ANTI-MICROBIALS Metronidazole Tab 400 MG METRAZOLE 400MG TABS 3 fills per annum Below
783544 ANTI-MICROBIALS Metronidazole Tab 400 MG METROSTAT 400MG TABS 3 fills per annum Above
788708 ANTI-MICROBIALS Metronidazole Tab 400 MG BE-METRAZOLE 400MG TABS 3 fills per annum Below
792136 ANTI-MICROBIALS Metronidazole Tab 400 MG SUPRAZOLE 400MG TABS 3 fills per annum Below
793167 ANTI-MICROBIALS Metronidazole Tab 400 MG METAZOL 400MG TABS 3 fills per annum Below
715866 ANTI-MICROBIALS Metronidazole Tab 400 MG ANAEROBYL 400MG TABS 3 fills per annum Below
726338 ANTI-MICROBIALS Metronidazole Susp 200 MG/5ML FLAGYL 200MG/5ML SUSP 3 fills per annum Below
717347 ANTI-MICROBIALS Clindamycin HCl Cap 150 MG DALACIN C 150MG CAPS 3 fills per annum Above
849960 ANTI-MICROBIALS Clindamycin HCl Cap 150 MG CLINDAHEXAL 150MG CAPS 3 fills per annum Below
704095 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG ILVITRIM TABS 3 fills per annum Below
706434 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG BACTRIM TABS 3 fills per annum Above
716731 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG COZOLE TABS 3 fills per annum Below
721751 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG DUROBAC TABS 3 fills per annum Above
735698 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG LAGATRIM 480MG TABS 3 fills per annum Below
789836 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG TRIMETHOX TABS 3 fills per annum Below
793698 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG XEROPRIM 480MG TABS 3 fills per annum Above
867977 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG NUCOTRIM 480MG TABS 3 fills per annum Below
715609 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG TRIXAZOLE 480MG TABS 3 fills per annum Below
3000786 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 400-80 MG NOVATRIM 400MG/80MG TABS
3 fills per annum Above
Page 13 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
706442 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 800-160 MG BACTRIM DS TABS 3 fills per annum Above
758256 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 800-160 MG PURBAC DS TABS 3 fills per annum Below
782793 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 800-160 MG SANDOZ CO-TRIMOXAZOLE 960 TABS
3 fills per annum Below
3000247 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Tab 800-160 MG CO-TRIMOXAZOLE ASCENDIS DS TAB
3 fills per annum Below
758221 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML
PURBAC SUSP 3 fills per annum Below
779881 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML
CO-TRIM SUSP 3 fills per annum Below
894842 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML
DOCTRIM SUSP 3 fills per annum Below
705259 ANTI-MICROBIALS Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML
ILVITRIM SUSP 3 fills per annum Below
732826 BIOLOGICALS Influenza Virus Vaccine Whole Inj INFLUVAC 0.5ML 1 fill per annum Below
813338 BIOLOGICALS Influenza Virus Vaccine Split IM Susp VAXIGRIP S/DOSE 0.5ML PREFILL
1 fill per annum Below
836591 BIOLOGICALS Influenza Virus Vaccine Split IM Susp VAXIGRIP S/DOSE 0.25ML PAED
1 fill per annum Below
797596 ENDOCRINE SYSTEM Betamethasone Syrup 0.6 MG/5ML STEROMIEN 0.6MG/5ML SYR Max age = 10; 3 fills per annum
Below
826936 ENDOCRINE SYSTEM Betamethasone Syrup 0.6 MG/5ML BETANOID 0.6MG/5ML SYR Max age = 10; 3 fills per annum
Below
703720 ENDOCRINE SYSTEM Prednisolone Tab 5 MG PRELONE 5MG TABS 3 fills per annum Above
800155 ENDOCRINE SYSTEM Prednisolone Tab 5 MG LENISOLONE 5MG TABS 3 fills per annum Below
814407 ENDOCRINE SYSTEM Prednisolone Tab 5 MG CAPSOID 5MG TABS 3 fills per annum Below
805149 ENDOCRINE SYSTEM Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent)
PRELONE 15MG/5ML SYRP Max age = 10; 3 fills per annum
Above
714552 ENDOCRINE SYSTEM Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent)
ASPELONE 15MG/5ML SYRP Max age = 10; 3 fills per annum
Below
716381 ENDOCRINE SYSTEM Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent)
ADCO PREDNISOLONE 15MG/5ML
Max age = 10; 3 fills per annum
Below
742732 ENDOCRINE SYSTEM Prednisone Tab 5 MG METICORTEN 5MG TABS 3 fills per annum Above
752304 ENDOCRINE SYSTEM Prednisone Tab 5 MG PANAFCORT 5MG TABS 3 fills per annum Below
788783 ENDOCRINE SYSTEM Prednisone Tab 5 MG BE-TABS PREDNISONE 5MG TABS
3 fills per annum Below
818267 ENDOCRINE SYSTEM Prednisone Tab 5 MG TROLIC 5MG TABS 3 fills per annum Below
757934 ENDOCRINE SYSTEM Medroxyprogesterone Acetate Tab 5 MG PROVERA 5MG TABS 3 fills per annum Below
808245 ENDOCRINE SYSTEM Medroxyprogesterone Acetate Tab 10 MG PROVERA 10MG TABS 3 fills per annum Below
702072 AUTACOIDS Chlorpheniramine Maleate Tab 4 MG ALLERGEX 4MG TABS 4 fills per annum Above
Page 14 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
703162 AUTACOIDS Chlorpheniramine Maleate Tab 4 MG RHINETON 4MG TABS 4 fills per annum Below
702145 AUTACOIDS Chlorpheniramine Maleate Syrup 2 MG/5ML ALLERGEX 2MG/5ML SYR 4 fills per annum Below
754749 AUTACOIDS Promethazine HCl Tab 10 MG PHENERGAN 10MG TABS 4 fills per annum Below
754757 AUTACOIDS Promethazine HCl Tab 25 MG PHENERGAN 25MG TABS 4 fills per annum Below
710873 AUTACOIDS Promethazine HCl Syrup 5 MG/5ML BRUNAZINE 5MG/5ML 4 fills per annum Above
736244 AUTACOIDS Promethazine HCl Syrup 5 MG/5ML LENAZINE 5MG/5ML SYRP 4 fills per annum Below
757373 AUTACOIDS Promethazine HCl Syrup 5 MG/5ML PROHIST 5MG/5ML SYRP 4 fills per annum Below
786837 AUTACOIDS Promethazine HCl Syrup 5 MG/5ML BIOHIST SYR 4 fills per annum Below
703314 AUTACOIDS Cetirizine HCl Tab 10 MG TEXA ALLERGY 10MG TABS 4 fills per annum Above
703315 AUTACOIDS Cetirizine HCl Tab 10 MG ALLECET 10MG TABS 4 fills per annum Above
703821 AUTACOIDS Cetirizine HCl Tab 10 MG ALLERMINE 10MG TABS 4 fills per annum Above
703864 AUTACOIDS Cetirizine HCl Tab 10 MG CETIRIZINE-HEXAL 10MG TABS 4 fills per annum Below
704188 AUTACOIDS Cetirizine HCl Tab 10 MG ASPEN CETIRIZINE 10MG TABS 4 fills per annum Above
704359 AUTACOIDS Cetirizine HCl Tab 10 MG AUSTELL CETIRIZINE 10MG TABS
4 fills per annum Below
704659 AUTACOIDS Cetirizine HCl Tab 10 MG ZYNCET 10MG TABS 4 fills per annum Below
785377 AUTACOIDS Cetirizine HCl Tab 10 MG ZYRTEC 10MG TABS 4 fills per annum Above
712890 AUTACOIDS Cetirizine HCl Tab 10 MG ACUZYRT 10MG TABS 4 fills per annum Above
712764 AUTACOIDS Cetirizine HCl Tab 10 MG ZETOP 10MG TABS 4 fills per annum Below
718452 AUTACOIDS Cetirizine HCl Tab 10 MG TRANTRIN 10MG TABS 4 fills per annum Below
720664 AUTACOIDS Cetirizine HCl Tab 10 MG ZINALLERG 10MG TABS 4 fills per annum Below
720846 AUTACOIDS Cetirizine HCl Tab 10 MG GULF CETIRIZINE 10MG TABS 4 fills per annum Below
720873 AUTACOIDS Cetirizine HCl Tab 10 MG CETICIT 10MG TABS 4 fills per annum Below
722334 AUTACOIDS Cetirizine HCl Tab 10 MG ZELARY 10MG TABS 4 fills per annum Above
722488 AUTACOIDS Cetirizine HCl Tab 10 MG CETIRIZINE DIS-CHEM 10MG TABS
4 fills per annum Below
723164 AUTACOIDS Cetirizine HCl Tab 10 MG SENSAHIST 10MG TABS 4 fills per annum Below
700899 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ZETOP 5MG/5ML ORAL SOLN 4 fills per annum Above
703313 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ALLECET 5MG/5ML SYRUP 4 fills per annum Below
820946 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ZYRTEC 1MG/ML ORAL SOLN 4 fills per annum Above
707224 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) CETICIT 1MG/ML SYRP 4 fills per annum Above
708117 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) CETIRIZINE-HEXAL 1MG/1ML SOLN
4 fills per annum Below
710672 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) TEXA ALLERGY 5MG/5ML SOLN 4 fills per annum Below
Page 15 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
712889 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ACUZYRT 5MG/5ML ORAL SOLN
4 fills per annum Below
713231 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ASPEN CETIRIZINE 5MG/5ML SOLN
4 fills per annum Below
717812 AUTACOIDS Cetirizine HCl Oral Soln 1 MG/ML (5 MG/5ML) ZELARY 1MG/ML ORAL SOLN 4 fills per annum Below
700092 AUTACOIDS Loratadine Tab 10 MG LAURA 10 TABS 4 fills per annum Below
701361 AUTACOIDS Loratadine Tab 10 MG POLLENTYME 10MG TABS 4 fills per annum Above
702159 AUTACOIDS Loratadine Tab 10 MG CLARINESE 10MG TABS 4 fills per annum Above
702518 AUTACOIDS Loratadine Tab 10 MG LORANO 10MG TABS 4 fills per annum Above
704275 AUTACOIDS Loratadine Tab 10 MG ALLERGEX NON DROWSY TABS 4 fills per annum Below
785113 AUTACOIDS Loratadine Tab 10 MG CLARITYNE 10MG TABS 4 fills per annum Below
899430 AUTACOIDS Loratadine Tab 10 MG AP-LORATADINE 10MG TABS 4 fills per annum Above
704780 AUTACOIDS Loratadine Tab 10 MG CIPLA-LORATADINE 10MG TABS
4 fills per annum Above
705359 AUTACOIDS Loratadine Tab 10 MG LORFAST 10MG TABS 4 fills per annum Below
705410 AUTACOIDS Loratadine Tab 10 MG RHINIGINE 10MG TABS 4 fills per annum Above
707313 AUTACOIDS Loratadine Tab 10 MG LORHAY 10MG TABS 4 fills per annum Below
713908 AUTACOIDS Loratadine Tab 10 MG LORMEG 10MG TABS 4 fills per annum Above
717051 AUTACOIDS Loratadine Tab 10 MG AUSTELL LORATADINE 10MG TABS
4 fills per annum Above
3000616 AUTACOIDS Loratadine Tab 10 MG BIOTECH LORATADINE 10MG TABS
4 fills per annum Below
701640 AUTACOIDS Loratadine Syrup 5 MG/5ML ALLERGEX NON DROWSY SYRP 4 fills per annum Below
703918 AUTACOIDS Loratadine Syrup 5 MG/5ML POLLENTYME S 4 fills per annum Below
789291 AUTACOIDS Loratadine Syrup 5 MG/5ML CLARITYNE 5MG/5ML SYRP 4 fills per annum Above
704886 AUTACOIDS Loratadine Syrup 5 MG/5ML AP LORATADINE 5MG/5ML SYRP
4 fills per annum Below
705102 AUTACOIDS Loratadine Syrup 5 MG/5ML CLARINESE SYRP 4 fills per annum Below
767212 RESPIRATORY SYSTEM Pseudoephedrine HCl Tab 60 MG SUDAFED SINUS ND TABS 3 fills per annum Above
796972 RESPIRATORY SYSTEM Pseudoephedrine HCl Tab 60 MG ADCO-SUFEDRIN 60MG TABS 3 fills per annum Below
808571 RESPIRATORY SYSTEM Pseudoephedrine HCl Tab 60 MG SINU-MED 60MG TABS 3 fills per annum Above
702620 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.025% DRINASAL PAED MET SPRAY 2 fills per annum Below
732338 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.025% ILIADIN PAED 0.25% MET SPR 2 fills per annum Above
720643 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.025% ZADIN 0.025% NASAL SPRAY 10ML
2 fills per annum Above
721387 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% DRISTAN LL N/SPRAY 15ML 2 fills per annum Below
Page 16 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
721441 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% DRIXINE 0.05% N/SPRAY 20ML 2 fills per annum Below
732265 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% ILIADIN ADULT 0.05% MET SPR 2 fills per annum Above
732303 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% ILIADIN PLASTIC NASAL SPR 20ML
2 fills per annum Above
783870 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% DRISTAN LL MET PUMP 15ML 2 fills per annum Below
814199 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% DRIXINE ADULT M/S 10ML 2 fills per annum Above
720644 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% ZADIN 0.05% NASAL SPRAY 10ML
2 fills per annum Above
721976 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% DRIXINE 0.05% METERED SPR 20ML
2 fills per annum Above
723748 EAR, NOSE AND THROAT Oxymetazoline HCl Nasal Soln 0.05% OXYSPRAY MOISTURE 0.05% NAS
2 fills per annum Above
836141 EAR, NOSE AND THROAT Phenylephrine HCl Nasal Soln 0.25% NAPHENSYL 0.25% DRP 10ML 2 fills per annum Below
836133 EAR, NOSE AND THROAT Phenylephrine HCl Nasal Soln 1% NAPHENSYL 1% DRP 10ML 2 fills per annum Below
820709 EAR, NOSE AND THROAT Beclomethasone Dipropionate Nasal Soln 0.05% BECLATE AQUANASE 50MCG 150D
3 fills per annum Above
897937 EAR, NOSE AND THROAT Beclomethasone Dipropionate Nasal Soln 0.05% CLENIL AQUEOUS 3 fills per annum Below
704383 EAR, NOSE AND THROAT Fluticasone Propionate Nasal Susp 50 MCG/ACT FLOMIST AQ NASAL SPRAY 3 fills per annum Below
787795 EAR, NOSE AND THROAT Fluticasone Propionate Nasal Susp 50 MCG/ACT FLIXONASE AQ NASAL SPRAY 3 fills per annum Above
714595 EAR, NOSE AND THROAT Fluticasone Propionate Nasal Susp 50 MCG/ACT FLONASE 120 DOSE 50MCG AQS
3 fills per annum Below
704114 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CHAMIFLOR OCEAN NASAL SPR 3 fills per annum Below
834882 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SALEX SOLN 30ML 3 fills per annum Below
705007 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% NASAL C SPRAY 25ML 3 fills per annum Below
705831 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SINUTAB COMF/CARE SALINE 3 fills per annum Below
708578 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% NAZOLEX 25ML NASAL SPRAY 3 fills per annum Below
710021 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SIMPLY SALINE NASAL SPRAY 3 fills per annum Below
710953 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CLICKS SALINE NAS 3 fills per annum Below
715096 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SPRINGBOK PAED NASAL SPRAY 50M
3 fills per annum Below
715097 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SPRINGBOK ADULT NASAL SPRAY 30
3 fills per annum Below
714893 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% JUST SALINE NASAL SPR 30ML 3 fills per annum Below
717507 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SINUSALTS NASAL SPRAY 30ML 3 fills per annum Below
717810 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% SALEX SALINE PAED MET NASAL SP
3 fills per annum Below
Page 17 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
722152 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% DISCHEM SALINE NASAL SPRAY 100
3 fills per annum Below
722153 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% DISCHEM SALINE NASAL SPRAY 50M
3 fills per annum Below
722156 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CONGIVIL SALINE NASAL SPRAY 50
3 fills per annum Below
722157 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CONGIVIL SALINE NASAL SPRAY 10
3 fills per annum Below
722155 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% DISCHEM SALINE NASAL SPRAY BAB
3 fills per annum Below
722158 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CONGIVIL SALINE NASAL SPRAY BA
3 fills per annum Below
722442 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% BRUNEL SALINE NASAL SPRAY 60ML
3 fills per annum Below
722926 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% FLO SALINE PLUS 30ML NASAL 3 fills per annum Below
723083 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% CLICKS NASAL SPRAY 100ML 3 fills per annum Below
723111 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% XCLEAR SALINE W/ XYLITOL 45ML
3 fills per annum Below
723112 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% KIDS XCLEAR SALINE W/ XYLITOL
3 fills per annum Below
724007 EAR, NOSE AND THROAT Saline Nasal Spray 0.9% NASOCLEAR NASAL SPRAY 20ML
3 fills per annum Below
703661 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
JACKS THICK NOSE DROPS 2 fills per annum Above
723363 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
ENT DROPS 25ML 2 fills per annum Above
723371 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
ENT SPRAY 25ML 2 fills per annum Above
745871 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
NASDRO DROPS 15ML 2 fills per annum Above
764175 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
SINUS S NASAL DROPS 2 fills per annum Above
773867 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
UNIVERSAL NOSE DROPS 15ML 2 fills per annum Below
783579 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
NITRO DROPS 2 fills per annum Below
840025 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
NAZO-EZZE DOSE DROPS 2 fills per annum Above
705620 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
TERINE NASAL DROPS 15ML 2 fills per annum Below
717502 EAR, NOSE AND THROAT Phenylephrine-Naphazoline Nasal Soln 2.5-0.25 MG/ML
RINOL 25ML NASAL DROPS 2 fills per annum Below
Page 18 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
755214 RESPIRATORY SYSTEM Pholcodine Syrup 4.052 MG/5ML PHOLCOLINCT 4.05MG/5ML SYR
3 fills per annum Below
704178 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML BENYLIN WET COUGH 3 fills per annum Above
799319 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LENNON COUGH SYRP 3 fills per annum Above
882829 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML DILINCT JUNIOR 3 fills per annum Below
895150 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML BENYLIN WET COUGH MENTHOL
3 fills per annum Above
708182 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML FLUTEX COUGH MIXTURE HONEY
3 fills per annum Above
708183 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML FLUTEX COUGH MIXTURE ORANG
3 fills per annum Above
708184 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML FLUTEX COUGH MIXTURE BLACK
3 fills per annum Above
708185 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LENNON COUGH MIXTURE HONEY
3 fills per annum Above
708187 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LENNON COUGH MIXTURE ORAN
3 fills per annum Above
715523 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LCC-G GUAIPHENESIN COUGH REM
3 fills per annum Below
715524 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LCC COUGH MIXTURE SYRUP 3 fills per annum Below
715455 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML LCC-G GUAIPHENESIN COUGH REM
3 fills per annum Below
715471 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML STEARNS PEPPERMINT WAS EXPIGEN
3 fills per annum Below
722013 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML STEARNS GUAIPHENESIN COUGH CHE
3 fills per annum Below
704178 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML BENYLIN WET COUGH 200MG/10ML L
3 fills per annum Above
895150 RESPIRATORY SYSTEM Guaifenesin Syrup 100 MG/5ML BENYLIN WET COUGH MENTHOL 100M
3 fills per annum Above
738263 RESPIRATORY SYSTEM *Ipecac-Squill Syrup*** LINCTUS TUSSI INFANS 3 fills per annum Below
701673 RESPIRATORY SYSTEM Ammonium Chloride & Ipecac Syrup 22-0.24 MG/5ML
SB CIROGEN COUGH MIXTURE 3 fills per annum Below
722779 RESPIRATORY SYSTEM Ammonium Chloride & Ipecac Syrup 22-0.24 MG/5ML
RESMED CHILDRENS COUGH MIX MIS
3 fills per annum Below
781169 RESPIRATORY SYSTEM Carbocysteine Syrup 125 MG/5ML MUCOSPECT PAED SYR 3 fills per annum Below
703394 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML DIS-CHEM MUCOLYTIC SYRP 3 fills per annum Above
708151 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML BETAPHLEM 250MG/5ML SYRP
3 fills per annum Below
710520 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML BRONCHETTE 250MG/5ML SYRP
3 fills per annum Below
Page 19 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
744816 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML MUCOSPECT SYRP 3 fills per annum Below
779814 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML CO-FLEM 250MG SYRP 3 fills per annum Below
785164 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML FLEMLITE SYRP 3 fills per annum Below
789739 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML FLEMGO SYRP 3 fills per annum Below
717241 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML FLUSIN MUCOUS COUGH 250MG/5ML
3 fills per annum Above
717745 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML FLUTEX MUCOUS COUGH 250MG/5ML
3 fills per annum Below
794341 RESPIRATORY SYSTEM Carbocysteine Syrup 250 MG/5ML MUCOPAN 250MG/5ML SYRP 3 fills per annum Below
826146 RESPIRATORY SYSTEM Pseudoephedrine w/ Acetaminophen Liquid 15-160 MG/5ML
SINUMAX PED SYR 3 fills per annum Below
773875 RESPIRATORY SYSTEM Pyrilamine-Phenylephrine-Acetaminophen Tab 5-5-500 MG
SINU-FLU TABS 3 fills per annum Below
715301 RESPIRATORY SYSTEM Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG
COLCLEER TABS 3 fills per annum Below
726885 RESPIRATORY SYSTEM Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG
FLUSIN TABS 3 fills per annum Above
764264 RESPIRATORY SYSTEM Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG
SINUCON TABS 3 fills per annum Above
822744 RESPIRATORY SYSTEM Chlorphen-Ephedrine-APAP-Caffeine Tab 2-6-200-20 MG
SINUEND TABS 3 fills per annum Below
704332 RESPIRATORY SYSTEM Chlorphen-PE w/ APAP-Caffeine Syrup 2-2.5-75-7.5 MG/5ML
COLCLEER PAED SYR 3 fills per annum Below
726710 RESPIRATORY SYSTEM Diphenhydramine-Phenyleph-APAP-Vit C Cap 10-5-400-50 MG
FLUEND CAPS 3 fills per annum Below
715506 RESPIRATORY SYSTEM PE-CPM-APAP-Atropine-Caff-Vit C Cap 5-2-300-0.125-30-75 MG
COLSTAT CAPS 3 fills per annum Above
725544 RESPIRATORY SYSTEM PE-CPM-APAP-Atropine-Caff-Vit C Cap 5-2-300-0.125-30-75 MG
FAMUCAPS CAPS 3 fills per annum Below
710881 RESPIRATORY SYSTEM Ephedrine-Promethazine-Codeine Syrup 7-3-9.2 MG/5ML
BRUNACOD SYRP 3 fills per annum Below
791148 RESPIRATORY SYSTEM Phenylprop-Phenyltolox w/ Cod-APAP Tab 25-22-15-300 MG
ADCO-SINAL CO TABS 3 fills per annum Below
873322 RESPIRATORY SYSTEM Phenyleph-Chlorphen-DM w/APAP Syrup 2.5-0.5-2-120 MG/5ML
KIDDYFLU SYRP 3 fills per annum Below
796824 RESPIRATORY SYSTEM DM-Phenylpropanolamine-APAP Syrup 15-25-500 MG/20ML
SINUSTAT FLU SYRP 3 fills per annum Below
807656 RESPIRATORY SYSTEM DM-Phenylpropanolamine-APAP Syrup 15-25-500 MG/20ML
FLUSTAT SYRP 3 fills per annum Below
710652 RESPIRATORY SYSTEM Dextromethorphan-AmCl Syrup 15-90 MG/5ML BRONCOL 3 fills per annum Below
710652 RESPIRATORY SYSTEM Dextromethorphan-AmCl Syrup 15-90 MG/5ML BRONCOL COUGH SYRP 3 fills per annum Below
Page 20 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
702172 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate Syr 13.33-130-54.17 MG/5ML
PHENORANT 3 fills per annum Below
703350 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate Syr 13.33-130-54.17 MG/5ML
PHENORANT (GLASS) 3 fills per annum Below
710636 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate Syrup 14.07-137-57 MG/5ML
BRONCLEER SYRP 3 fills per annum Above
720291 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate Syrup 14.07-137-57 MG/5ML
DPH EXPECTORANT SYRP 3 fills per annum Below
783595 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate-Men Syr 12.5-125-50-1MG/5ML
FAMTUSS SYRP 3 fills per annum Below
810649 RESPIRATORY SYSTEM Diphenhydramine-AmCl-Sod Citrate-Men Syr 12.5-125-50-1MG/5ML
DIPHENHYDRAMINE EXPECT SYRP
3 fills per annum Below
702080 RESPIRATORY SYSTEM DPH-AmCl-Sod Citrate-Men Syr 28.1-273.9-113.7-2.5 MG/5ML
ALLERGIN EXPECT 3 fills per annum Below
727008 RESPIRATORY SYSTEM Diphenhydramine-Pholcodine-GG Syr 15-8-100 MG/5ML
FOLCOFEN SYRP 3 fills per annum Below
757233 RESPIRATORY SYSTEM Diphenhydramine-Pholcodine-GG Syr 15-8-100 MG/5ML
PROCOF SYRP 3 fills per annum Above
700920 RESPIRATORY SYSTEM Albuterol Sulfate Syrup 2 MG/5ML VARI-SALBUTAMOL SYRUP Max age = 6; 2 fills per annum
Below
775274 RESPIRATORY SYSTEM Albuterol Sulfate Syrup 2 MG/5ML VENTOLIN 2MG/5ML SYRP Max age = 6; 2 fills per annum
Above
775452 RESPIRATORY SYSTEM Albuterol Sulfate Syrup 2 MG/5ML VENTEZE 2MG/5ML SYRP Max age = 6; 2 fills per annum
Below
824186 RESPIRATORY SYSTEM Albuterol Sulfate Syrup 2 MG/5ML ASTHAVENT 2MG/5ML SYRP Max age = 6; 2 fills per annum
Below
700715 RESPIRATORY SYSTEM Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv)
ASTHAVENT 300D ECOHALER 2 fills per annum Below
703371 RESPIRATORY SYSTEM Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv)
VENTOLIN INH 200D CFC FREE 2 fills per annum Above
849332 RESPIRATORY SYSTEM Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv)
ASTHAVENT 200D ECOHALER 2 fills per annum Below
711213 RESPIRATORY SYSTEM Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv)
VENTEZE CFC FREE 200D 100MCG
2 fills per annum Below
720723 RESPIRATORY SYSTEM Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv)
VENTIMAX CFC FREE 100MCG 200D
2 fills per annum Below
701211 SYMPATHOMIMETICS Epinephrine HCl Inj 1 MG/ML ADRENALINE FSK 1ML Max age = 7; 1 fills per annum
Below
895164 SYMPATHOMIMETICS Epinephrine HCl Inj 1 MG/ML PHARMA-Q ADRENALINE 1MG Max age = 7; 1 fills per annum
Below
739413 RESPIRATORY SYSTEM Aminophylline-Diphenhyd-Ammon Cl Syrup 32-8-30 MG/5ML
LOTUSSIN EXPECT 3 fills per annum Below
720283 RESPIRATORY SYSTEM Aminophylline-Diphenhyd-Ammon Cl-Sod Citrate Syrup
DIPHENAMILL SYRP 3 fills per annum Below
Page 21 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
700238 RESPIRATORY SYSTEM Theophylline-Etofylline-Diphenylpyraline-Ammon Cl Syrup
THEOPHEN CO ELIX (UNBOXED) 3 fills per annum Below
715681 RESPIRATORY SYSTEM Theophylline-Etofylline-Diphenylpyraline-Ammon Cl Syrup
DYNALEX SYRUP 3 fills per annum Above
701742 RESPIRATORY SYSTEM Theophylline-Etofylline-Diphenhyd-Ammon Cl-Sod Cit Syrup
ALCOPHYLLEX SYRP 3 fills per annum Below
710032 RESPIRATORY SYSTEM Metaproterenol-Bromhexine Syrup 5-4 MG/5ML BISOLVON LINCTUS 3 fills per annum Above
710687 RESPIRATORY SYSTEM Metaproterenol-Bromhexine Syrup 5-4 MG/5ML BRONKESE CO SYRP 3 fills per annum Below
819743 RESPIRATORY SYSTEM Metaproterenol-Bromhexine Syrup 5-4 MG/5ML FLEMEZE SYRP 3 fills per annum Above
827304 RESPIRATORY SYSTEM Metaproterenol-Bromhexine Syrup 5-4 MG/5ML ADCO-LINCTOPENT SYRP 3 fills per annum Below
862037 RESPIRATORY SYSTEM Metaproterenol-Bromhexine Syrup 5-4 MG/5ML BENYLIN CHESTY 3 fills per annum Above
701518 GASTRO-INTESTINAL TRACT *Sodium Phosphates - Enema*** ENA-CLEAR 1 fill per annum Below
726435 GASTRO-INTESTINAL TRACT *Sodium Phosphates - Enema*** LEN-O-LAX PAED 64ML 1 fill per annum Below
726443 GASTRO-INTESTINAL TRACT *Sodium Phosphates - Enema*** LEN-O-LAX ADULT 135ML 1 fill per annum Below
727202 GASTRO-INTESTINAL TRACT *Sodium Phosphates - Enema*** FOSENEMA 1 fill per annum Below
721549 GASTRO-INTESTINAL TRACT Bisacodyl Tab Delayed Release 5 MG DULCOLAX 5MG TABS 2 fills per annum Above
708008 GASTRO-INTESTINAL TRACT Bisacodyl Tab Delayed Release 5 MG LAXADOR BISACODYL 5MG TABS
2 fills per annum Below
715545 GASTRO-INTESTINAL TRACT Bisacodyl Tab Delayed Release 5 MG FRESHEN BISACODYL LAXATIVE 2 fills per annum Below
722655 GASTRO-INTESTINAL TRACT Bisacodyl Tab Delayed Release 5 MG BROOKLAX BISACODYL 5MG LAXATIV
2 fills per annum Above
723016 GASTRO-INTESTINAL TRACT Bisacodyl Tab Delayed Release 5 MG PURITONE BISACODYL LAXATIVE 5M
2 fills per annum Below
721530 GASTRO-INTESTINAL TRACT Bisacodyl Suppos 5 MG DULCOLAX 5MG PAED SUPP 2 fills per annum Below
721522 GASTRO-INTESTINAL TRACT Bisacodyl Suppos 10 MG DULCOLAX 10MG SUPP 2 fills per annum Below
708867 GASTRO-INTESTINAL TRACT Sennosides Tab 7.5 MG SENNA-PIN 7.5MG TABS 2 fills per annum Below
710368 GASTRO-INTESTINAL TRACT Sennosides Tab 7.5 MG LENNON SENNA 7.5MG TABS 2 fills per annum Above
710370 GASTRO-INTESTINAL TRACT Sennosides Tab 7.5 MG LAXADOR SENNA 7.5MG TABS 2 fills per annum Above
868078 GASTRO-INTESTINAL TRACT Sennosides Tab 13.5 MG SOFLAX TABS 2 fills per annum Below
797723 GASTRO-INTESTINAL TRACT Lactulose Solution 10 GM/15ML LACSON SYRP 2 fills per annum Above
817309 GASTRO-INTESTINAL TRACT Lactulose Solution 10 GM/15ML LAXETTE SYRP 2 fills per annum Above
708722 GASTRO-INTESTINAL TRACT Lactulose Solution 10 GM/15ML ACULAX 3.3G/5ML SYRUP 2 fills per annum Below
717972 GASTRO-INTESTINAL TRACT Lactulose Solution 10 GM/15ML ANLAC SYRP 2 fills per annum Below
3000645 GASTRO-INTESTINAL TRACT Lactulose Solution 10 GM/15ML LACTULAX 3.35G/5ML SYRP 2 fills per annum Above
796808 GASTRO-INTESTINAL TRACT *PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate Packet*** KLEAN-PREP SACHETS 1 fill per annum Below
Page 22 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
812900 GASTRO-INTESTINAL TRACT *PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate Packet*** GOLYTELY 68.5775G 1 fill per annum Below
716697 GASTRO-INTESTINAL TRACT *PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate Packet*** MOVIPREP 2XSACH A 122GM+B 11GM
1 fill per annum Below
703393 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG DIS-CHEM ANTI-DIARRHOEAL TABS
3 fills per annum Above
732486 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG IMODIUM 2MG TABS 3 fills per annum Above
791768 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG ADCO-PRODIUM 2MG TABS 3 fills per annum Below
792071 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG ADCO-LOPERAMIDE TABS 3 fills per annum Above
792691 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG BETAPERAMIDE 2MG TABS 3 fills per annum Above
810916 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG GASTRON 2MG TABS 3 fills per annum Below
707342 GASTRO-INTESTINAL TRACT Loperamide HCl Tab 2 MG CIPLA LOPERAMIDE TABS 3 fills per annum Below
732478 GASTRO-INTESTINAL TRACT Loperamide HCl Syrup 1 MG/5ML IMODIUM SYRP 3 fills per annum Above
811467 GASTRO-INTESTINAL TRACT Loperamide HCl Syrup 1 MG/5ML ADCO-LOPERAMIDE SYRP 3 fills per annum Below
820563 GASTRO-INTESTINAL TRACT Loperamide HCl Syrup 1 MG/5ML LOPERASTAT 1MG/5ML SYRP 3 fills per annum Below
810908 GASTRO-INTESTINAL TRACT Loperamide HCl Syrup 1 MG/5ML GASTRON 1MG/5ML SYRUP 3 fills per annum Below
728284 GASTRO-INTESTINAL TRACT Kaolin-Pectin Susp 1-0.05 GM/5ML GASTROPECT SUSP 3 fills per annum Below
823546 GASTRO-INTESTINAL TRACT Kaolin-Pectin Susp 6-0.45 GM/30ML PECTIN-K SUSP 3 fills per annum Below
892661 GASTRO-INTESTINAL TRACT Kaolin-Pectin Susp 6-0.45 GM/30ML PECTIKON SUSP 3 fills per annum Below
723428 GASTRO-INTESTINAL TRACT Kaolin-Pectin w/ Electrolytes Susp 6-0.12 GM/30ML ENTEROLYTE SUSP 3 fills per annum Below
734942 GASTRO-INTESTINAL TRACT Kaolin-Pectin w/ Electrolytes Susp 6-0.12 GM/30ML KAOSTATEX SUSP 3 fills per annum Below
708976 GASTRO-INTESTINAL TRACT Kaolin-Pectin-Bismuth Carbonate Susp 8-0.25-0.2 GM/30ML
BISKAPECT SUSP 3 fills per annum Below
740551 GASTRO-INTESTINAL TRACT Aluminum Hydroxide-Mag Oxide Susp 282-120 MG/15ML
ADCO-MAYOGEL SUSP 3 fills per annum Below
700771 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
AMGEL SUSP 3 fills per annum Below
702725 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
DICYCLOMINE CO GEL 3 fills per annum Below
703640 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
ALUMAG D SUSP 3 fills per annum Below
782173 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
CO-GEL SUSP 3 fills per annum Above
786810 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
NEUTRAGEL D SUSP 3 fills per annum Below
789933 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
GELUMEN SUSP 3 fills per annum Below
797499 GASTRO-INTESTINAL TRACT Alum Hydrox-Mag Oxide-Dicyclomine Susp 400-200-5 MG/10ML
ALUMITE D SUSP 3 fills per annum Above
Page 23 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
765538 GASTRO-INTESTINAL TRACT Alum Oxide-Mag Oxide-Dicyclomine Gel 200-200-5 MG/10ML
SPASMOGEL 3 fills per annum Below
740683 GASTRO-INTESTINAL TRACT Al & Mg Oxides-Dicycl-Methylcell-Simeth Susp MEDIGEL SUSP 3 fills per annum Below
711276 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Tab 10 MG BUSCOPAN 10MG TABS Above
731951 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Tab 10 MG HYOSPASMOL 10MG TABS Below
762725 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Tab 10 MG SCOPEX 10MG TABS Below
703383 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Syrup 5 MG/5ML SCOPEX SYRUP Below
797413 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Syrup 5 MG/5ML BUSCOPAN 5MG/5ML SYRP Above
707213 GASTRO-INTESTINAL TRACT Scopolamine N-Butylbromide Syrup 5 MG/5ML HYOSPASMOL 5MG/5ML SYRUP
Below
701892 GASTRO-INTESTINAL TRACT Mebeverine HCl Tab 135 MG MYLAN MEBEVERINE HCL TABS 3 fills per annum Below
715476 GASTRO-INTESTINAL TRACT Mebeverine HCl Tab 135 MG COLOFAC 135MG TABS 3 fills per annum Above
822019 GASTRO-INTESTINAL TRACT Mebeverine HCl Tab 135 MG BEVISPAS 135MG TABS 3 fills per annum Below
825328 GASTRO-INTESTINAL TRACT Mebeverine HCl Tab 135 MG SANDOZ MEBEVERINE TABS 3 fills per annum Above
700119 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG CPL ALLIANCE RANITIDINE 150MG
Qty limit = 90 units per annum
Below
841609 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG RANIHEXAL 150MG TABS Qty limit = 90 units per annum
Above
867934 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG ULTAK 150MG TABS Qty limit = 90 units per annum
Below
713553 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG GULF RANITIDINE 150MG TABS Qty limit = 90 units per annum
Below
717160 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG APEX-RANITIDINE 150MG TABS Qty limit = 90 units per annum
Below
719669 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 150 MG RANITIDINE BIOTECH 150MG TABS
Qty limit = 90 units per annum
Below
700120 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 300 MG CPL ALLIANCE RANITIDINE 300MG
Qty limit = 90 units per annum
Below
867942 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 300 MG ULTAK 300MG TABS Qty limit = 90 units per annum
Below
713554 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 300 MG GULF RANITIDINE 300MG TABS Qty limit = 90 units per annum
Below
717159 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 300 MG APEX-RANITIDINE 300MG TABS Qty limit = 90 units per annum
Below
718482 GASTRO-INTESTINAL TRACT Ranitidine HCl Tab 300 MG RANITIDINE BIOTECH 300MG TABS
Qty limit = 90 units per annum
Below
704752 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG LANSOLOC 15MG OTC CAPS Qty limit = 90 units per annum
Above
715079 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG LANSOPRAZOLE UNICORN 15MG CAPS
Qty limit = 90 units per annum
Below
Page 24 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
704839 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG ASPEN LANSOPRAZOLE 15MG CAPS
Qty limit = 90 units per annum
Above
707192 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG BURNLOC 15MG (WAS ADCO-ROZNAL
Qty limit = 90 units per annum
Below
707192 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG ADCO-ROZNAL Qty limit = 90 units per annum
Below
708052 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG LANCAP 15MG CAPS Qty limit = 90 units per annum
Below
715812 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG LANCAP OTC 15MG CAPS Qty limit = 90 units per annum
Below
716841 GASTRO-INTESTINAL TRACT Lansoprazole Cap Delayed Release 15 MG ROZNAL 15MG CAPS OTC Qty limit = 90 units per annum
Above
772143 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG TRIAZINE 50MG TABS Below
774634 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG VALOID 50MG TABS Above
792853 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG MEDAZINE NAUSEA 50MG TABS
Above
799424 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG NAUZINE 50MG TABS Below
808954 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG ADCO-CYCLIZINE 50MG TABS Below
809322 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG COVAMET 50MG TABS Below
811513 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG DISCHEM EMITEX 50MG TABS Above
792217 CENTRAL NERVOUS SYSTEM Cyclizine HCl Tab 50 MG ACULOID 50MG TABS Below
774642 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML VALOID 2.5MG/ML SYRP Above
792225 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML ACULOID 12.5MG/5ML SYRP Below
792845 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML MEDAZINE-S 2.5MG/ML SYRP Below
796700 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML TRIAZINE PEAD SYRP Below
808962 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML ADCO-CYCLIZINE 2.5MG SYRP Below
820571 CENTRAL NERVOUS SYSTEM Cyclizine HCl Syrup 12.5 MG/5ML NAUZINE S 12.5MG/5 SYRP Below
772135 CENTRAL NERVOUS SYSTEM Cyclizine HCl Supp 50 MG TRIAZINE 50MG SUPP Qty limit = 6 units per annum; 3 fills per annum
Below
774618 CENTRAL NERVOUS SYSTEM Cyclizine HCl Supp 50 MG VALOID 50MG SUPP Qty limit = 6 units per annum; 3 fills per annum
Above
774626 CENTRAL NERVOUS SYSTEM Cyclizine HCl Supp 100 MG VALOID 100MG SUPP Qty limit = 6 units per annum; 3 fills per annum
Below
784346 CENTRAL NERVOUS SYSTEM Phosphorated Carbohydrate Syrup EMEX SYR Below
778265 CENTRAL NERVOUS SYSTEM Buclizine-Pyridoxine Tab 25-50 MG VOMIFENE TABS Max age = 45; Females only
Below
Page 25 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
723037 CENTRAL NERVOUS SYSTEM *Fructose-Dextrose-Phosphoric Acid Oral Soln*** EMETROL LIQ Below
700712 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Tab 10 MG (Salt Equivalent) CLOMAX 10MG TABS Below
714828 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Tab 10 MG (Salt Equivalent) CLOPAMON 10MG TABS Above
715875 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Tab 10 MG (Salt Equivalent) ADCO-CONTROMET 10MG TABS
Below
717891 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Tab 10 MG (Salt Equivalent) BIO METOCLOPRAMIDE 10MG TABS
Below
757845 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Tab 10 MG (Salt Equivalent) METOCLOPRAMIDE 10MG TABS OETHM
Above
714844 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Syrup 5 MG/5ML CLOPAMON 5MG/5ML SYRP Above
783064 CENTRAL NERVOUS SYSTEM Metoclopramide HCl Syrup 5 MG/5ML ADCO-CONTROMET 5MG/5ML Below
745685 URINARY SYSTEM Nalidixic Acid Tab 500 MG PUROMYLON 500MG TABS 3 fills per annum Below
778672 URINARY SYSTEM Nalidixic Acid Susp 250 MG/5ML WINLOMYLON SUSP 3 fills per annum Below
739839 URINARY SYSTEM Nitrofurantoin Macrocrystalline Cap 50 MG MACRODANTIN 50MG CAPS 3 fills per annum Below
739847 URINARY SYSTEM Nitrofurantoin Macrocrystalline Cap 100 MG MACRODANTIN 100MG CAPS 3 fills per annum Below
703548 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% CANESTEN 1% VCR 3 fills per annum Above
826960 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% A-POR VCR 3 fills per annum Below
831875 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% CANALBA VCR 3 fills per annum Below
831883 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% CANDASPOR VCR 3 fills per annum Above
831913 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% CANEX VAG CREAM 3 fills per annum Below
832332 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% COVOSPOR VAGINAL CREAM 3 fills per annum Above
832391 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% MEDASPOR VCR 3 fills per annum Above
832405 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% MICOMISAN VAG CREAM 3 fills per annum Below
832421 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% ADCO-NORMOSPOR VCR 10MG/GM
3 fills per annum Above
832499 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% XERASPOR-V CREAM 3 fills per annum Below
832596 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% CANDIZOLE VCR 3 fills per annum Below
846341 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% FUNGISPOR VCR 3 fills per annum Below
878448 GENITAL SYSTEM Clotrimazole Vaginal Cream 1% GYNEZOL 10MG/GM VCR 3 fills per annum Below
839760 URINARY SYSTEM Potassium Citrate & Citric Acid Soln 45-21 MG/15ML GENCIT SIMPLEX 3 fills per annum Below
778702 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG XANOR 0.25MG TABS Qty limit = 90 units per annum
Above
821071 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG ADCO-ALZAM 0.25MG TABS Qty limit = 90 units per annum
Below
823244 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG AZOR 0.25MG TABS Qty limit = 90 units per annum
Below
Page 26 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
826685 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG ZOPAX 0.25MG TABS Qty limit = 90 units per annum
Below
897929 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG CPL ALLIANCE ALPRAZOLAM 0.25MG
Qty limit = 90 units per annum
Below
897965 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.25 MG MYLAN ALPRAZOLAM 0.25MG TABS
Qty limit = 90 units per annum
Below
778710 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG XANOR 0.5MG TABS Qty limit = 90 units per annum
Above
821098 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG ADCO-ALZAM 0.5MG TABS Qty limit = 90 units per annum
Below
823252 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG AZOR 0.5MG TABS Qty limit = 90 units per annum
Below
826693 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG ZOPAX 0.5MG TABS Qty limit = 90 units per annum
Below
895173 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG MYLAN ALPRAZOLAM 0.5MG TABS
Qty limit = 90 units per annum
Below
897930 CENTRAL NERVOUS SYSTEM Alprazolam Tab 0.5 MG CPL ALLIANCE ALPRAZOLAM 0.5MG
Qty limit = 90 units per annum
Below
778729 CENTRAL NERVOUS SYSTEM Alprazolam Tab 1 MG XANOR 1MG TABS Qty limit = 90 units per annum
Above
821101 CENTRAL NERVOUS SYSTEM Alprazolam Tab 1 MG ADCO-ALZAM 1MG TABS Qty limit = 90 units per annum
Below
823260 CENTRAL NERVOUS SYSTEM Alprazolam Tab 1 MG AZOR 1MG TABS Qty limit = 90 units per annum
Below
826707 CENTRAL NERVOUS SYSTEM Alprazolam Tab 1 MG ZOPAX 1MG TABS Qty limit = 90 units per annum
Below
897968 CENTRAL NERVOUS SYSTEM Alprazolam Tab 1 MG MYLAN ALPRAZOLAM 1MG TABS
Qty limit = 90 units per annum
Below
710784 CENTRAL NERVOUS SYSTEM Bromazepam Tab 3 MG SANDOZ BROMAZEPAM 3MG TABS
Qty limit = 90 units per annum
Below
737933 CENTRAL NERVOUS SYSTEM Bromazepam Tab 3 MG LEXOTAN 3MG TABS Qty limit = 90 units per annum
Above
796999 CENTRAL NERVOUS SYSTEM Bromazepam Tab 3 MG BRAZEPAM 3MG TABS Qty limit = 90 units per annum
Below
710792 CENTRAL NERVOUS SYSTEM Bromazepam Tab 6 MG SANDOZ BROMAZEPAM 6MG TABS
Qty limit = 90 units per annum
Below
737941 CENTRAL NERVOUS SYSTEM Bromazepam Tab 6 MG LEXOTAN 6MG TABS Qty limit = 90 units per annum
Above
800066 CENTRAL NERVOUS SYSTEM Bromazepam Tab 6 MG BRAZEPAM 6MG TABS Qty limit = 90 units per annum
Below
821616 CENTRAL NERVOUS SYSTEM Bromazepam Tab 6 MG BROMAZE 6MG TABS Qty limit = 90 units per annum
Above
708062 CENTRAL NERVOUS SYSTEM Diazepam Tab 5 MG BETAPAM 5MG TABS Qty limit = 90 units per annum
Below
Page 27 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
721174 CENTRAL NERVOUS SYSTEM Diazepam Tab 5 MG DOVAL 5MG TABS Qty limit = 90 units per annum
Below
774472 CENTRAL NERVOUS SYSTEM Diazepam Tab 5 MG VALIUM 5MG TABS Qty limit = 90 units per annum
Above
758183 CENTRAL NERVOUS SYSTEM Oxazepam Tab 10 MG PURATA 10MG TABS Qty limit = 90 units per annum
Below
763500 CENTRAL NERVOUS SYSTEM Oxazepam Tab 10 MG SEREPAX 10MG TABS Qty limit = 90 units per annum
Above
751758 CENTRAL NERVOUS SYSTEM Oxazepam Tab 15 MG SANDOZ OXAZEPAM 15MG TABS
Qty limit = 90 units per annum
Below
758191 CENTRAL NERVOUS SYSTEM Oxazepam Tab 15 MG PURATA 15MG TABS Qty limit = 90 units per annum
Below
763519 CENTRAL NERVOUS SYSTEM Oxazepam Tab 15 MG SEREPAX 15MG TABS Qty limit = 90 units per annum
Above
751766 CENTRAL NERVOUS SYSTEM Oxazepam Tab 30 MG SANDOZ OXAZEPAM 30MG TABS
Qty limit = 90 units per annum
Below
758205 CENTRAL NERVOUS SYSTEM Oxazepam Tab 30 MG PURATA 30MG TABS Qty limit = 90 units per annum
Below
763527 CENTRAL NERVOUS SYSTEM Oxazepam Tab 30 MG SEREPAX 30MG TABS Qty limit = 90 units per annum
Above
772003 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 10 MG TREPILINE 10MG TABS Qty limit = 60 units per annum
Below
980013 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 10 MG NOV AMITRIPTYLINE 10MG CAPS NA
Qty limit = 60 units per annum
Below
771996 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 25 MG TREPILINE 25MG TABS Qty limit = 60 units per annum
Above
784230 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 25 MG SANDOZ AMITRIPTYL 25MG TABS
Qty limit = 60 units per annum
Below
718746 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 25 MG GULF AMITRIPTYLINE 25MG TABS
Qty limit = 60 units per annum
Below
980014 CENTRAL NERVOUS SYSTEM Amitriptyline HCl Tab 25 MG NOV AMITRIPTYLINE 25MG CAPS NA
Qty limit = 60 units per annum
Above
724661 CENTRAL NERVOUS SYSTEM Imipramine HCl Tab 10 MG ETHIPRAMINE 10MG TABS Qty limit = 60 units per annum
Below
771120 CENTRAL NERVOUS SYSTEM Imipramine HCl Tab 10 MG TOFRANIL 10MG TABS Qty limit = 60 units per annum
Above
724688 CENTRAL NERVOUS SYSTEM Imipramine HCl Tab 25 MG ETHIPRAMINE 25MG TABS Qty limit = 60 units per annum
Below
771139 CENTRAL NERVOUS SYSTEM Imipramine HCl Tab 25 MG TOFRANIL 25MG TABS Qty limit = 60 units per annum
Above
744182 CENTRAL NERVOUS SYSTEM Prochlorperazine Maleate Tab 5 MG (Base Equivalent)
MITIL 5MG TABS Below
762849 CENTRAL NERVOUS SYSTEM Prochlorperazine Maleate Tab 5 MG (Base Equivalent)
SCRIPTO-METIC 5MG TABS Below
Page 28 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
766542 CENTRAL NERVOUS SYSTEM Prochlorperazine Maleate Tab 5 MG (Base Equivalent)
STEMETIL 5MG TABS Above
700722 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG ZOPIVANE 7.5MG TABS Qty limit = 90 units per annum
Below
732494 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG IMOVANE 7.5MG TABS Qty limit = 90 units per annum
Above
857785 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG SANDOZ ZOPICLONE TABS Qty limit = 90 units per annum
Below
867365 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG ADCO-ZOPIMED 7.5MG TABS Qty limit = 90 units per annum
Above
874728 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG ALCHERA 7.5MG TABS Qty limit = 90 units per annum
Below
894220 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG Z-DORM TABS Qty limit = 90 units per annum
Above
705115 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG ZOPIGEN 7.5MG TABS Qty limit = 90 units per annum
Below
707688 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG ZOPICLONE UNICORN 7.5MG TABS
Qty limit = 90 units per annum
Below
712508 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG AUSTELL-ZOPICLONE 7.5MG TABS
Qty limit = 90 units per annum
Above
718473 CENTRAL NERVOUS SYSTEM Zopiclone Tab 7.5 MG BIO ZOPICLONE 7.5MG TABS Qty limit = 90 units per annum
Below
700909 ANALGESICS Aspirin Tab 300 MG GULF ASPIRIN 300MG TABS Qty limit = 400 units per annum
Below
706930 ANALGESICS Aspirin Tab 300 MG BAYER ASPIRIN TABS Qty limit = 400 units per annum
Below
701634 ANALGESICS Acetaminophen Tab 500 MG DIS-CHEM PARACETAMOL Qty limit = 200 units per annum
Above
704465 ANALGESICS Acetaminophen Tab 500 MG PAINOGESIC TABS Qty limit = 200 units per annum
Below
704643 ANALGESICS Acetaminophen Tab 500 MG CETAPON TABS Qty limit = 200 units per annum
Below
720860 ANALGESICS Acetaminophen Tab 500 MG DOLOROL 500MG TABS Qty limit = 200 units per annum
Above
745723 ANALGESICS Acetaminophen Tab 500 MG ADCO-NAPAMOL 500MG TABS Qty limit = 200 units per annum
Below
752274 ANALGESICS Acetaminophen Tab 500 MG PANADO 500MG TABS Qty limit = 200 units per annum
Above
752878 ANALGESICS Acetaminophen Tab 500 MG PARAPANE 500MG TABS Qty limit = 200 units per annum
Below
757403 ANALGESICS Acetaminophen Tab 500 MG ADCO-PROLIEF 500MG TABS Qty limit = 200 units per annum
Below
784443 ANALGESICS Acetaminophen Tab 500 MG PARAMED 500MG TABS Qty limit = 200 units per annum
Above
Page 29 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
805467 ANALGESICS Acetaminophen Tab 500 MG ANTALGIC 500MG TABS Qty limit = 200 units per annum
Below
824992 ANALGESICS Acetaminophen Tab 500 MG GENCETAMOL 500MG TABS Qty limit = 200 units per annum
Below
867950 ANALGESICS Acetaminophen Tab 500 MG GULF PARACETAMOL 500MG TABS
Qty limit = 200 units per annum
Below
867969 ANALGESICS Acetaminophen Tab 500 MG PAINBLOK 500MG TABS Qty limit = 200 units per annum
Above
885863 ANALGESICS Acetaminophen Tab 500 MG VON PARACETAMOL TABS Qty limit = 200 units per annum
Below
894212 ANALGESICS Acetaminophen Tab 500 MG JP PARACETAMOL TABS Qty limit = 200 units per annum
Below
713153 ANALGESICS Acetaminophen Tab 500 MG AUSTELL-PARACETAMOL 500MG
Qty limit = 200 units per annum
Above
714499 ANALGESICS Acetaminophen Tab 500 MG CLICKS PARACETAMOL 500MG TABS
Qty limit = 200 units per annum
Above
714707 ANALGESICS Acetaminophen Tab 500 MG PYNGESIC T 500MG TABS Qty limit = 200 units per annum
Below
715860 ANALGESICS Acetaminophen Tab 500 MG GRAND-PA PARACETAMOL TABS
Qty limit = 200 units per annum
Above
716045 ANALGESICS Acetaminophen Tab 500 MG ADCO-NAPAMOL 500MG TABS Qty limit = 200 units per annum
Above
717725 ANALGESICS Acetaminophen Tab 500 MG ACTAMOL 500MG TABS Qty limit = 200 units per annum
Below
720327 ANALGESICS Acetaminophen Tab 500 MG PANADO 500MG TABS BLISTER PACK
Qty limit = 200 units per annum
Above
703118 ANALGESICS Acetaminophen Elixir 120 MG/5ML PANADO SYRUP STRAWBERRY Above
703349 ANALGESICS Acetaminophen Elixir 120 MG/5ML PAINBLOK 120MG/5ML (GLASS BOT
Above
703820 ANALGESICS Acetaminophen Elixir 120 MG/5ML FEVERPAIN (UNBOXED) Below
704093 ANALGESICS Acetaminophen Elixir 120 MG/5ML ACTAMOL RED (UN-BOXED) Below
704450 ANALGESICS Acetaminophen Elixir 120 MG/5ML PAINOGESIC SYRP Below
745715 ANALGESICS Acetaminophen Elixir 120 MG/5ML ADCO-NAPAMOL 120MG/5ML SYRP
Below
752118 ANALGESICS Acetaminophen Elixir 120 MG/5ML PAINAMOL 120MG/5ML SYRP Below
752282 ANALGESICS Acetaminophen Elixir 120 MG/5ML PANADO SYRUP Above
758558 ANALGESICS Acetaminophen Elixir 120 MG/5ML PYRALEN 120MG/5ML SYRP Below
792101 ANALGESICS Acetaminophen Elixir 120 MG/5ML ACTAMOL 120MG/5ML SYRP Below
863742 ANALGESICS Acetaminophen Elixir 120 MG/5ML FEVERPAIN ELIX Below
889772 ANALGESICS Acetaminophen Elixir 120 MG/5ML PAINBLOK 120MG/5ML SYRP Below
Page 30 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
788953 ANALGESICS Acetaminophen Syrup 120 MG/5ML PANADO(NO ALCOHOL) SYRP Above
895199 ANALGESICS Acetaminophen Syrup 120 MG/5ML GO-PAIN P Below
710452 ANALGESICS Acetaminophen Syrup 120 MG/5ML WOODWARDS PARACETAMOL Below
717187 ANALGESICS Acetaminophen Syrup 120 MG/5ML BARRS PARACETAMOL 120MG/5ML
Below
819697 ANALGESICS Acetaminophen Suppos 125 MG EMPAPED 125MG SUPP 3 fills per annum Below
819700 ANALGESICS Acetaminophen Suppos 250 MG EMPAPED 250MG SUPP 3 fills per annum Below
711292 GASTRO-INTESTINAL TRACT Dipyrone-Scopolamine Butylbromide Tab 250-10 MG BUSCOPAN CO TABS 3 fills per annum Below
797146 ANALGESICS Tramadol HCl Cap 50 MG TRAMAL 50MG CAPS Qty limit = 60 units per annum
Above
864900 ANALGESICS Tramadol HCl Cap 50 MG TRAMAHEXAL 50MG CAPS Qty limit = 60 units per annum
Below
705175 ANALGESICS Tramadol HCl Cap 50 MG DOMADOL 50MG CAPS Qty limit = 60 units per annum
Below
705379 ANALGESICS Tramadol HCl Cap 50 MG DOLOTRAM 50MG CAPS Qty limit = 60 units per annum
Below
706475 ANALGESICS Tramadol HCl Cap 50 MG TRAMAZAC 50MG CAPS Qty limit = 60 units per annum
Below
710250 ANALGESICS Tramadol HCl Cap 50 MG AUSTELL-TRAMADOL 50MG CAPS
Qty limit = 60 units per annum
Below
717391 ANALGESICS Tramadol HCl Cap 50 MG TRAMASPEN 50MG CAPS Qty limit = 60 units per annum
Below
765635 ANALGESICS Acetaminophen w/ Codeine Cap 320-8 MG SPECTRAPAIN CAPS Qty limit = 200 units per annum
Below
700742 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG AMSTIL TABS Qty limit = 200 units per annum
Below
707910 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG PAINAMOL PLUS Qty limit = 200 units per annum
Below
720879 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG DOLOROL FORTE TABS Qty limit = 200 units per annum
Above
761303 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG ROCODIN TABS Qty limit = 200 units per annum
Above
787043 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG CODOROL TABS Qty limit = 200 units per annum
Below
837652 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG DINO-COD TABS Qty limit = 200 units per annum
Below
895030 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG PAINCODEIN TABS Qty limit = 200 units per annum
Above
713688 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG VARI-COCODAMOL 8MG/500MG TABS
Qty limit = 200 units per annum
Below
719662 ANALGESICS Acetaminophen w/ Codeine Tab 500-8 MG COGESIC TABS Qty limit = 200 units per annum
Below
Page 31 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
745707 ANALGESICS Acetaminophen w/ Codeine Tab 500-10 MG ADCO-NAPACOD TABS Qty limit = 200 units per annum
Below
795402 ANALGESICS Acetaminophen w/ Codeine Tab 500-10 MG KODAPON TABS Qty limit = 200 units per annum
Below
732753 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
INFAPAIN FORTE SYRP 3 fills per annum Below
736589 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
LENTOGESIC SYRP 3 fills per annum Above
752185 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
PAINAGON SYRP 3 fills per annum Below
766801 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
STILPANE SYRP 3 fills per annum Below
766941 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
STOPAYNE SYRP 3 fills per annum Above
789984 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
PYNMED PAIN AND FEVER SYRUP
3 fills per annum Above
793566 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
GOLDGESIC SYRP 3 fills per annum Below
807583 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
ADCO-SALTERPYN SYRP 3 fills per annum Below
823511 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
GO-PAIN SYRP 3 fills per annum Below
833746 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
MEDIPYN S 3 fills per annum Below
836605 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
KID-EEZE SYRP 3 fills per annum Below
894289 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
ADCO-KIDDIPAYNE 3 fills per annum Below
710248 ANALGESICS Acetaminophen-Promethazine w/ Codeine Syrup 120-6.5-5 MG/5ML
BAN PAIN SYRUP 3 fills per annum Above
766828 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
STILPANE TABS Qty limit = 200 units per annum
Above
793892 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
XEROGESIC TABS Qty limit = 200 units per annum
Below
800325 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
BRISCOPYN TABS Qty limit = 200 units per annum
Above
809055 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
ADCO-SALTERPYN TABS Qty limit = 200 units per annum
Below
834440 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
SPECTRAPAIN FORTE TABS Qty limit = 200 units per annum
Below
892662 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
NUCOPAIN TABS Qty limit = 200 units per annum
Below
793574 ANALGESICS Acetaminophen-Meprobamate-Caff-Cod Tab 320-150-32-8 MG
GOLDGESIC TABS Qty limit = 200 units per annum
Below
Page 32 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
700243 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG TRAMACET TABS Qty limit = 60 units per annum
Above
719052 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG TRAMAZAC CO 37.5/325MG TABS
Qty limit = 60 units per annum
Below
719300 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG ULTRACET TABS Qty limit = 60 units per annum
Above
721680 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG TRAMAHEXAL CO 37.5/325 TABS
Qty limit = 60 units per annum
Below
723073 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG PATRAM 37.5MG/325MG TABS Qty limit = 60 units per annum
Below
723749 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG TAMOLTRA 37.5MG/325MG TABS
Qty limit = 60 units per annum
Below
967949 ANALGESICS Tramadol-Acetaminophen Tab 37.5-325 MG TRAMADOL+PARACETA BELUPO 37.5/
Qty limit = 60 units per annum
Above
718479 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 25 MG DICLOFENAC BIOTECH 25MG TABS
Qty limit = 200 units per annum
Below
752371 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 25 MG PANAMOR 25MG TABS Qty limit = 200 units per annum
Above
786012 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 25 MG MYLAN DICLOFENAC 25 MG TABS
Qty limit = 200 units per annum
Below
893390 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 25 MG A-LENNON DICLOFENAC 25MG TABS
Qty limit = 200 units per annum
Below
752398 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 50 MG PANAMOR AT 50MG TABS Qty limit = 200 units per annum
Below
778222 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 50 MG VOLTAREN GT 50MG TABS Qty limit = 200 units per annum
Above
786020 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 50 MG MYLAN DICLOFENAC 50MG TABS
Qty limit = 200 units per annum
Below
893391 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Tab Delayed Release 50 MG A-LENNON DICLOFENAC 50MG TABS
Qty limit = 200 units per annum
Below
780855 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Suppos 12.5 MG VOLTAREN 12.5MG SUP Max age = 6; 3 fills per annum
Above
807605 MUSCULO-SKELETAL AGENTS Diclofenac Sodium Suppos 12.5 MG PANAMOR 12.5MG SUPP Max age = 6; 3 fills per annum
Below
708186 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG BETAGESIC 200MG TABS Qty limit = 200 units per annum
Above
733741 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG INZA 200MG TABS Qty limit = 200 units per annum
Below
748560 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG NUROFEN TABS Qty limit = 200 units per annum
Above
787426 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG BETAPROFEN 200MG TABS Qty limit = 200 units per annum
Below
809268 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG IBUMED 200MG TABS Qty limit = 200 units per annum
Above
Page 33 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
824852 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG RANFEN 200MG TABS Qty limit = 200 units per annum
Below
868221 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG IBUNATE 200MG TABS Qty limit = 200 units per annum
Below
868469 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG LENAFEN 200MG TABS Qty limit = 200 units per annum
Above
705940 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG IBU 200MG TABS Qty limit = 200 units per annum
Below
721118 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG AUSTIFEN 200MG TABS Qty limit = 200 units per annum
Above
708536 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG IBUSOR 200MG TABS Qty limit = 200 units per annum
Below
710822 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG BRUFEN 200MG TABS Qty limit = 200 units per annum
Above
721114 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG IBUCARE 200MG TABS Qty limit = 200 units per annum
Above
717155 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 200 MG AUSTELL IBUPROFEN 200MG TABS
Qty limit = 200 units per annum
Above
701654 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG RANFEN 400MG TABS Qty limit = 200 units per annum
Below
701975 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG BETAPROFEN 400 TABS Qty limit = 200 units per annum
Below
733768 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG INZA 400MG TABS Qty limit = 200 units per annum
Below
708290 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG BREN 400MG TABS Qty limit = 200 units per annum
Below
721119 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG AUSTIFEN 400MG TABS Qty limit = 200 units per annum
Above
721116 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG IBUCARE 400MG TABS Qty limit = 200 units per annum
Above
717153 MUSCULO-SKELETAL AGENTS Ibuprofen Tab 400 MG AUSTELL IBUPROFEN 400MG TABS
Qty limit = 200 units per annum
Above
700315 ANALGESICS Ibuprofen Susp 100 MG/5ML IBUCINE SUSP 3 fills per annum Below
700695 ANALGESICS Ibuprofen Susp 100 MG/5ML NUROFEN CHILDREN SUGAR FR 3 fills per annum Above
710857 ANALGESICS Ibuprofen Susp 100 MG/5ML BRUFEN PAED SUSP 3 fills per annum Above
704781 ANALGESICS Ibuprofen Susp 100 MG/5ML IBUGESIC 100MG/5ML SUSP 3 fills per annum Below
712683 ANALGESICS Ibuprofen Susp 100 MG/5ML NUROFEN FOR CHILD STRAWBERRY
3 fills per annum Above
721335 ANALGESICS Ibuprofen Susp 100 MG/5ML INFLAMAX PAED 100MG/5ML SUSP
3 fills per annum Below
704725 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG ARTHREXIN 25MG CAPS Qty limit = 200 units per annum
Above
Page 34 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
704725 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG ARTHREXIN 25MG CAPS Qty limit = 200 units per annum
Above
704776 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG SANDOZ INDOMETHACIN 25MG CAPS
Qty limit = 200 units per annum
Below
787833 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG BETACIN 25MG CAPS Qty limit = 200 units per annum
Below
788996 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG MEDIFLEX 25MG CAPS Qty limit = 200 units per annum
Above
814393 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG METHOCAPS 25MG CAPS Qty limit = 200 units per annum
Below
868213 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG GULF INDOMETHACIN 25MG CAPS
Qty limit = 200 units per annum
Below
788996 MUSCULO-SKELETAL AGENTS Indomethacin Cap 25 MG MEDIFLEX 25MG CAPS Qty limit = 200 units per annum
Above
796433 ANALGESICS Mefenamic Acid Cap 250 MG PONAC 250MG CAPS Qty limit = 200 units per annum
Below
797707 ANALGESICS Mefenamic Acid Cap 250 MG FENAMIN 250MG CAPS Qty limit = 200 units per annum
Below
812250 ANALGESICS Mefenamic Acid Cap 250 MG PONSTEL 250MG CAPS Qty limit = 200 units per annum
Above
883102 ANALGESICS Mefenamic Acid Cap 250 MG ADCO-MEFENAMIC ACID CAPS Qty limit = 200 units per annum
Below
756156 ANALGESICS Mefenamic Acid Susp 50 MG/5ML PONSTAN 10MG/ML SUSP 3 fills per annum Below
756156 ANALGESICS Mefenamic Acid Susp 50 MG/5ML PONSTAN 50MG/5ML SUSP 3 fills per annum Below
793264 ANALGESICS Mefenamic Acid Susp 50 MG/5ML PONAC 50MG/5ML SUSP 3 fills per annum Below
797014 ANALGESICS Mefenamic Acid Susp 50 MG/5ML FENAMIN 50MG/5ML SUSP 3 fills per annum Below
810398 ANALGESICS Mefenamic Acid Susp 50 MG/5ML PONSTEL S 50MG/5ML SUSP 3 fills per annum Above
875643 ANALGESICS Mefenamic Acid Susp 50 MG/5ML ADCO-MEFENAMIC ACID 3 fills per annum Below
807435 ANALGESICS Mefenamic Acid Supp 125 MG PONSTAN PEAD 125MG SUP 3 fills per annum Below
701520 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG LOXIFLAM 7.5MG TABS Qty limit = 90 units per annum
Above
818615 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG MOBIC 7.5MG TABS Qty limit = 90 units per annum
Above
899066 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG COXFLAM 7.5MG TABS Qty limit = 90 units per annum
Below
704829 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG FLEXOCAM 7.5MG TABS Qty limit = 90 units per annum
Below
705176 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG M-CAM 7.5MG TABS Qty limit = 90 units per annum
Below
705229 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG ZYDUS-MELOXICAM 7.5MG TABS
Qty limit = 90 units per annum
Below
Page 35 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
705296 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG MELFLAM 7.5 MG TABS Qty limit = 90 units per annum
Above
705375 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG ADCO-MELOXICAM 7.5MG TABS
Qty limit = 90 units per annum
Above
707667 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG APEX-MELOXICAM 7.5MG TABS
Qty limit = 90 units per annum
Below
711324 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG ARROW MELOXICAM 7.5MG TABS
Qty limit = 90 units per annum
Above
716168 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG MELOXICAM UNICORN 7.5MG TABS
Qty limit = 90 units per annum
Below
717091 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG FLAMARYX 7.5MG TABS Qty limit = 90 units per annum
Above
718381 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG MEDOXICAM 7.5MG TABS Qty limit = 90 units per annum
Below
718306 MUSCULO-SKELETAL AGENTS Meloxicam Tab 7.5 MG COXITEC 7.5MG TABS Qty limit = 90 units per annum
Above
805238 MUSCULO-SKELETAL AGENTS Naproxen Tab 250 MG NAPROSCRIPT 250MG TABS Qty limit = 200 units per annum
Below
810185 MUSCULO-SKELETAL AGENTS Naproxen Tab 250 MG MYLAN NAPROXEN TABS Qty limit = 200 units per annum
Below
722843 MUSCULO-SKELETAL AGENTS Naproxen Tab 500 MG BIO-NAPROXEN 500MG TABS Qty limit = 200 units per annum
Below
808474 MUSCULO-SKELETAL AGENTS Naproxen Tab 500 MG NAPFLAM 500MG TABS Qty limit = 200 units per annum
Below
810177 ANALGESICS Ibuprofen-Acetaminophen Cap 200-250 MG MYPAID CAPS Qty limit = 200 units per annum
Above
705266 ANALGESICS Ibuprofen-Acetaminophen Cap 200-250 MG DENTOPAIN CAPS Qty limit = 200 units per annum
Below
716543 ANALGESICS Ibuprofen-Acetaminophen Cap 200-250 MG PANADO PLUS CAPS Qty limit = 200 units per annum
Above
719663 ANALGESICS Ibuprofen-Acetaminophen Cap 200-250 MG IBUPAIN CAPS BLISTER PACK Qty limit = 200 units per annum
Below
707087 CENTRAL NERVOUS SYSTEM Sumatriptan Succinate Tab 50 MG MIGREX 50MG TABS Qty limit = 4 units per annum; 3 fills per annum
Below
707088 CENTRAL NERVOUS SYSTEM Sumatriptan Succinate Tab 100 MG MIGREX 100MG TABS Qty limit = 4 units per annum; 3 fills per annum
Below
738778 MUSCULO-SKELETAL AGENTS Allopurinol Tab 100 MG SANDOZ ALLOPURINOL 100MG TABS
Below
758310 MUSCULO-SKELETAL AGENTS Allopurinol Tab 100 MG PURICOS 100MG TABS Below
779466 MUSCULO-SKELETAL AGENTS Allopurinol Tab 100 MG ZYLOPRIM 100MG TABS Above
721623 MUSCULO-SKELETAL AGENTS Allopurinol Tab 100 MG AUSTELL ALLOPURINOL 100MG TABS
Below
Page 36 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
738786 MUSCULO-SKELETAL AGENTS Allopurinol Tab 300 MG SANDOZ ALLOPURINOL 300MG TABS
Below
758329 MUSCULO-SKELETAL AGENTS Allopurinol Tab 300 MG PURICOS 300MG TABS Below
779474 MUSCULO-SKELETAL AGENTS Allopurinol Tab 300 MG ZYLOPRIM 300MG TABS Above
721624 MUSCULO-SKELETAL AGENTS Allopurinol Tab 300 MG AUSTELL ALLOPURINOL 300MG TABS
Below
719128 MUSCULO-SKELETAL AGENTS Allopurinol Tab 300 MG ADCO-ALLOPURINOL 300MG TABS
Below
715298 MUSCULO-SKELETAL AGENTS Colchicine Tab 1 MG COLCHICINE HOUDE 1MG TABS 3 fills per annum Above
722289 MUSCULO-SKELETAL AGENTS Colchicine Tab 1 MG ASPEN COLCHICINE DS 1MG TABS
3 fills per annum Below
704600 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Vitamin Tab** CALCIPREG TABS Females only; 9 consecutive fills
Below
707079 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Vitamin Tab** PURITANS PRENATAL VITAMIN TABS
Females only; 9 consecutive fills
Below
716965 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Vitamin Tab** PREGWISE TABS Females only; 9 consecutive fills
Below
713206 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Multivitamins & Minerals w/ Iron Cap*** BAO FILIVIT CAPSULES Females only; 9 consecutive fills
Below
710638 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Multivitamins & Minerals w/Iron & FA Tab 0.8 MG***
RDA-PREG TABS Females only; 9 consecutive fills
Below
721203 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Multivitamins & Minerals w/Iron & FA Tab 0.8 MG***
CLICKS PAY LESS PRENATAL SUPPL
Females only; 9 consecutive fills
Below
723505 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Multivitamins & Minerals w/Iron & FA Tab 0.8 MG***
9 MONTHS + TABS Females only; 9 consecutive fills
Below
711165 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Multivitamins & Minerals w/Iron & FA Cap 0.5 MG***
CLICKS PREGNANCY SUPPL CAPS
Females only; 9 consecutive fills
Below
894052 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Vit w/ Fe Fumarate-FA Cap 30-0.8 MG*** NIKIBON CAPS Females only; 9 consecutive fills
Below
726257 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Prenatal Vit w/ Fe Fumarate-FA Cap 30-1 MG*** FILIBON CAPS Females only; 9 consecutive fills
Below
779687 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDROL SACH Qty limit = 6 units per annum
Below
781444 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** ELECTROPAK Qty limit = 6 units per annum
Below
815187 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT BLACKCURR PACK Qty limit = 6 units per annum
Below
815209 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT ORANGE PACK 14G Qty limit = 6 units per annum
Below
709761 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PIN-HYDRATE (ORANGE) SAC Qty limit = 6 units per annum
Below
709762 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PIN-HYDRATE BLACKCURRANT SAC
Qty limit = 6 units per annum
Below
Page 37 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
710641 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SMART ORS SACH Qty limit = 6 units per annum
Below
711128 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** ELECTRAL WITH ORANGE FLAVOUR
Qty limit = 6 units per annum
Below
815187 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT 14G BLACKCURRANT SAC
Qty limit = 6 units per annum
Below
712551 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT HYDRATION 14G LEMON
Qty limit = 6 units per annum
Below
712885 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDRACHOICE CREME SODA SACH
Qty limit = 6 units per annum
Below
712886 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDRACHOICE NAARTJIE SACH Qty limit = 6 units per annum
Below
712887 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDRACHOICE TROPICAL SACH Qty limit = 6 units per annum
Below
713528 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT VANILLA 14G SACHET
Qty limit = 6 units per annum
Below
714655 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SPRINGBOK ELECTROLYTE 14G SAC
Qty limit = 6 units per annum
Below
715953 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** RESTORE HYDRATION 6G SACHETS
Qty limit = 6 units per annum
Below
714609 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** REHIDRAT SPORT NAARTJIE 14G
Qty limit = 6 units per annum
Below
716210 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SMART ORS 21G SACH Qty limit = 6 units per annum
Below
716411 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SMART ORS BLACK CURRENT 4.2G S
Qty limit = 6 units per annum
Below
716412 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SMART ORS BLACK CURRENT 21G SA
Qty limit = 6 units per annum
Below
718332 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** NUDRATE CITRUS 5.3G SACHET Qty limit = 6 units per annum
Below
720393 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** NUDRATE BLACKCURRANT 5.6G SACH
Qty limit = 6 units per annum
Below
720966 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** NETCARE HYDRATION POWD BLACKCU
Qty limit = 6 units per annum
Below
721469 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SPAR HYDRATION POWDER BLACKCUR
Qty limit = 6 units per annum
Below
721504 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** MEDIRITE ELECTROLYTES TANGY TA
Qty limit = 6 units per annum
Below
721526 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** MEDIRITE HYDRATION POWDER BLAC
Qty limit = 6 units per annum
Below
721146 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** OS BLACKCURRANT 5.3G SACH Qty limit = 6 units per annum
Below
721147 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** OS ORANGE 5.3G SACH Qty limit = 6 units per annum
Below
Page 38 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
721487 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SPAR ELECTROLYTES TANGY TANGER
Qty limit = 6 units per annum
Below
721488 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** SPAR ELECTROLYTES LUSTY LEMON
Qty limit = 6 units per annum
Below
723175 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDRASSIST ORS 4.31G SACH Qty limit = 6 units per annum
Below
723540 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PROHYDRATE BLACKCURRENT SACH
Qty limit = 6 units per annum
Below
779687 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDROL 24.69G SACHET Qty limit = 6 units per annum
Below
3000067 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PROGAST ADVANCED HYDRATION POW
Qty limit = 6 units per annum
Below
3000059 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PAEDHYDRATE ORS 5.16G SACHET
Qty limit = 6 units per annum
Below
3000358 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** CLICKS HYDRATION POWD SACH BLA
Qty limit = 6 units per annum
Below
3000355 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PROGAST ADVANCED HYDRATION POW
Qty limit = 6 units per annum
Below
3000356 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** PROGAST ADVANCED HYDRATION POW
Qty limit = 6 units per annum
Below
3000443 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** ELECTROLYTE ORS VH 26.4G SACH
Qty limit = 6 units per annum
Below
3000524 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** DYNAFORCE BLUEBERRY 60G SACHET
Qty limit = 6 units per annum
Below
3000525 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** DYNAFORCE NAARTJIE 60G SACHET
Qty limit = 6 units per annum
Below
3000526 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** DYNAFORCE TROPICAL 60G SACHET
Qty limit = 6 units per annum
Below
3000527 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** DYNAFORCE CHERRY GRAPE 60G SAC
Qty limit = 6 units per annum
Below
723175 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** HYDRASSIST ORS 4.31G SACHET
Qty limit = 6 units per annum
Below
718332 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** NUDRATE 5.3G SACHET CITRUS Qty limit = 6 units per annum
Below
720393 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** NUDRATE 5.3G SACHET BLACKCURRA
Qty limit = 6 units per annum
Below
967911 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
*Oral Electrolyte - Packet*** ELECTRAL ORAL REHYDR SALT BP B
Qty limit = 6 units per annum
Below
810967 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
Folic Acid Tab 5 MG BE-TABS FOLIC ACID 5MG TABS Below
711922 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
Folic Acid Tab 5 MG FOLIC ACID 5MG TABS Below
720727 VITAMINS, TONICS, MINERALS AND ELECTROLYTES
Folic Acid Tab 5 MG GULF FOLIC ACID 5MG TABS Below
Page 39 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
877832 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 30 MG FERROUS SULPHATE 30MG 3 fills per annum Below
705532 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 30 MG AHA FERROUS SULPH 30MG TABS
3 fills per annum Below
710580 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 30 MG EGOLI FERROUS SULPHATE 30 3 fills per annum Below
723552 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 30 MG FERROUS SULPHATE 30MG TABS
3 fills per annum Below
721690 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 75 MG FERROUS SULPHATE 75MG TABS
3 fills per annum Below
710372 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 75 MG FERROUS SULPHATE 75MG TABS
3 fills per annum Below
713558 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 75 MG BODY BALANCE FERROUS SULPH
3 fills per annum Below
723553 BLOOD AND HAEMOPOEITIC Ferrous Sulfate Tab 75 MG FERROUS SULPHATE 75MG TABS
3 fills per annum Below
756571 BLOOD AND HAEMOPOEITIC Ferrous Fumarate-Folic Acid Tab 200-0.1 MG PREGAMAL TABS 3 fills per annum Below
723551 BLOOD AND HAEMOPOEITIC Ferrous Sulfate-Folic Acid Tab 100-0.5 MG FERROUS SULPHATE FOLIC ACID CO
3 fills per annum Below
713274 BLOOD AND HAEMOPOEITIC Iron Polymaltose w/FA & B12 Syrup 33-0.6-0.002 MG/5ML(Fe Eq)
FEROFOL SYRP 3 fills per annum Below
713724 OPHTHALMICS Chloramphenicol Ophth Oint 1% CHLORAMEX 3.5GM 1% EYE OINT
3 fills per annum Above
713759 OPHTHALMICS Chloramphenicol Ophth Oint 1% CHLORCOL EYE OINT 3 fills per annum Below
765880 OPHTHALMICS Chloramphenicol Ophth Oint 1% SPERSANICOL EYE OINT 3 fills per annum Above
817201 OPHTHALMICS Chloramphenicol Ophth Oint 1% CHLORPHEN 1% 3.5G EYE OINT 3 fills per annum Below
783641 OPHTHALMICS Fusidic Acid Ophth Soln 10 MG/GM (1%) FUCITHALMIC 5ML DROPS 3 fills per annum Below
702935 OPHTHALMICS Ofloxacin Ophth Soln 0.3% OCTIN OPTH DROPS 3 fills per annum Below
839957 OPHTHALMICS Ofloxacin Ophth Soln 0.3% EXOCIN 5ML EYE DROPS 3 fills per annum Above
767360 OPHTHALMICS Sulfacetamide Sodium Ophth Oint 10% LENNON SULPHACETAMIDE EYE 3.5G
3 fills per annum Below
716634 OPHTHALMICS Neomycin-Chloramphenicol-Naphazoline Oph Soln 0.5-0.2-0.05%
COVOMYCIN 7.5ML DROPS 3 fills per annum Below
708267 OPHTHALMICS Betamethasone Sodium Phosphate Ophth-Otic-Nasal Soln 0.1%
BETNESOL 5ML DROPS 3 fills per annum Below
765821 OPHTHALMICS Dexamethasone Sodium Phosphate Ophth Soln 0.1% SPERSADEX 0.1% 10ML DROPS 3 fills per annum Below
756466 OPHTHALMICS Prednisolone Acetate Ophth Susp 0.125% PRED-MILD 5ML DROPS 3 fills per annum Below
750271 OPHTHALMICS Naphazoline 0.005% w/ Zinc Sulfate Ophth Soln OCULOSAN 10ML EYE DROPS 3 fills per annum Below
728608 OPHTHALMICS Tetrahydrozoline-Antazoline Ophth Soln 0.04-0.05% GEMINI EYE 15ML 3 fills per annum Below
765856 OPHTHALMICS Tetrahydrozoline-Antazoline Ophth Soln 0.04-0.05% SPERSALLERG DROPS 3 fills per annum Above
827150 OPHTHALMICS Tetrahydrozoline-Antazoline Ophth Soln 0.04-0.05% OCULERGE 20ML EYE DROPS 3 fills per annum Below
Page 40 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
701668 OPHTHALMICS Phenylephrine-Boric Acid Ophth Soln 1.25-20 MG/ML SB UNIVERSAL EYE DROPS 15ML
3 fills per annum Below
773883 OPHTHALMICS Phenylephrine-Boric Acid Ophth Soln 1.25-20 MG/ML UNIVERSAL 15ML EYE SOLN 3 fills per annum Below
706558 OPHTHALMICS Azelastine HCl Ophth Soln 0.05% OPTILAST 3 fills per annum Below
804630 OPHTHALMICS Cromolyn Sodium Ophth Soln 2% VIVIDRIN EYE 10ML EYE DROPS 3 fills per annum Below
822698 OPHTHALMICS Cromolyn Sodium Ophth Soln 2% CROMOHEXAL EYE DROPS 3 fills per annum Above
894605 OPHTHALMICS Cromolyn Sodium Ophth Soln 2% STOP ALLERG 13.5ML 3 fills per annum Below
827762 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% SWIMMERS EAR CLEANSER 3 fills per annum Below
707464 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% AQUA 7.5ML EAR 3 fills per annum Below
711967 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% ACETIC ACID 1% ML 3 fills per annum Below
80539 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% SWIMMERS EAR DROPS 3 fills per annum Below
721264 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% SPORT SWIMMERS EAR LIQUID 3 fills per annum Below
723092 EAR, NOSE AND THROAT Acetic Acid Otic Soln 1% CLICKS EAR DROPS 30ML 3 fills per annum Below
721221 EAR, NOSE AND THROAT Acetic Acid Otic Soln 2% ACETIC ACID 2% 3 fills per annum Below
746568 EAR, NOSE AND THROAT Neomycin-Sodium Propionate Otic Soln 3-50 MG/ML NEOPAN 15ML EAR DROPS 1 fill per annum Below
701100 ANTI-MICROBIALS Nystatin Susp 100000 Unit/ML CANDACIDE SUSP 20ML 3 fills per annum Above
701100 ANTI-MICROBIALS Nystatin Susp 100000 Unit/ML CANDACIDE SUSP 30ML 3 fills per annum Above
835056 ANTI-MICROBIALS Nystatin Susp 100000 Unit/ML CANSTAT ORAL DROPS 3 fills per annum Below
835285 ANTI-MICROBIALS Nystatin Susp 100000 Unit/ML NYSTACID ORAL 100000 SUSP 3 fills per annum Above
731005 DISINFECTANTS Chlorhexidine Gluconate Soln 0.2% CORSODYL 2MG/ML SOLN 3 fills per annum Below
808377 DISINFECTANTS Chlorhexidine Gluconate Soln 0.2% CORSODYL 2MG/ML MINT SOLN
3 fills per annum Below
3000520 DISINFECTANTS Chlorhexidine Gluconate Soln 0.2% SEPTOCHLOR 2MG/1ML MOUTHWASH
3 fills per annum Below
785210 EAR, NOSE AND THROAT Povidone-Iodine Mouthwash 1% PODINE MOUTHW & GARGLE 3 fills per annum Below
799688 EAR, NOSE AND THROAT Povidone-Iodine Mouthwash 1% DERMADINE GARGLE 3 fills per annum Below
819859 EAR, NOSE AND THROAT Povidone-Iodine Mouthwash 1% SEPTADINE ORAL ANTISEPTIC 3 fills per annum Above
890365 EAR, NOSE AND THROAT Povidone-Iodine Mouthwash 1% STERIDINE MOUTHWASH AND GAR
3 fills per annum Below
751340 EAR, NOSE AND THROAT Benzocaine Lozenge 10 MG OROCAINE LOZ 3 fills per annum Below
772674 EAR, NOSE AND THROAT Benzocaine Lozenge 10 MG TROCHAIN LOZ 3 fills per annum Below
826391 EAR, NOSE AND THROAT Tetracaine HCl Ointment 0.5% DYNEXAN OINT 1 fill per annum Below
756849 GASTRO-INTESTINAL TRACT *Rectal Protectant-Emollient Ointments** PREPARATION H OINT 3 fills per annum Below
756830 GASTRO-INTESTINAL TRACT *Rectal Protectant-Emollient Suppositories** PREPARATION H SUPP 3 fills per annum Below
Page 41 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
826375 SUPPOSITORIES / ANAL OINTMENTS Pramoxine w/ Zinc Oxide in Mineral Oil Rectal Oint 1-12.5%
ANUSOL OINT 3 fills per annum Below
807842 DERMATOLOGICALS Benzoyl Peroxide Gel 5% BENZAC AC 5 GEL 3 fills per annum Above
896079 DERMATOLOGICALS Benzoyl Peroxide Gel 5% CREME CLASSIQUE ACNE 5 GEL 3 fills per annum Below
727377 DERMATOLOGICALS Fusidate Sodium Oint 2% FUCIDIN OINT 3 fills per annum Below
727431 DERMATOLOGICALS Fusidic Acid Cream 2% FUCIDIN CREAM 3 fills per annum Below
706493 DERMATOLOGICALS Mupirocin Oint 2% BACTROBAN TOPICAL OINT 3 fills per annum Above
721587 DERMATOLOGICALS Mupirocin Oint 2% NUBAN 2GM/100GM OINTMENT
3 fills per annum Below
80631 DERMATOLOGICALS Mupirocin Oint 2% MUPIROCIN:POVID-I 1:5 3 fills per annum Below
715837 DERMATOLOGICALS Mupirocin Oint 2% SUPIROBAN 2GM/100GM OINTMENT
3 fills per annum Below
721693 DERMATOLOGICALS Mupirocin Oint 2% DERMOBAN 20MG/1G OINT 3 fills per annum Below
723040 DERMATOLOGICALS Mupirocin Oint 2% BANOGON 2% OINTMENT 3 fills per annum Below
702504 DERMATOLOGICALS Mupirocin Calcium Cream 2% BACTROBAN CREAM 3 fills per annum Below
797022 DERMATOLOGICALS Nystatin Oint 100000 Unit/GM NYSTACID OINT 3 fills per annum Below
712205 DERMATOLOGICALS Clotrimazole Cream 1% CANESTEN TOPICAL CREAM 3 fills per annum Above
788554 DERMATOLOGICALS Clotrimazole Cream 1% CANDASPOR CREAM 3 fills per annum Above
793493 DERMATOLOGICALS Clotrimazole Cream 1% ADCO-NORMOSPOR CREAM 3 fills per annum Below
796336 DERMATOLOGICALS Clotrimazole Cream 1% CANALBA CREAM 3 fills per annum Above
797006 DERMATOLOGICALS Clotrimazole Cream 1% CANDIZOLE CREAM 3 fills per annum Above
799505 DERMATOLOGICALS Clotrimazole Cream 1% MICOMISAN CREAM 3 fills per annum Above
799696 DERMATOLOGICALS Clotrimazole Cream 1% MEDASPOR CREAM 3 fills per annum Above
816299 DERMATOLOGICALS Clotrimazole Cream 1% XERASPOR-T CREAM 3 fills per annum Below
824011 DERMATOLOGICALS Clotrimazole Cream 1% CANEX TOPICAL CREAM 3 fills per annum Below
826952 DERMATOLOGICALS Clotrimazole Cream 1% A-POR CREAM 3 fills per annum Below
839639 DERMATOLOGICALS Clotrimazole Cream 1% TRIMAZE CREAM 3 fills per annum Above
846422 DERMATOLOGICALS Clotrimazole Cream 1% FUNGISPOR CREAM 3 fills per annum Below
878421 DERMATOLOGICALS Clotrimazole Cream 1% CLOMADERM CREAM 3 fills per annum Below
705246 DERMATOLOGICALS Clotrimazole Cream 1% DIS-CHEM CLOTRIMAZOLE CREAM
3 fills per annum Below
716106 DERMATOLOGICALS Clotrimazole Cream 1% INNOSPORE 1% CREAM 3 fills per annum Below
776300 DERMATOLOGICALS Iodoquinol-Chlorobutanol-Benzocaine Cream 30-10-10 MG/GM
VIODOR CREAM 3 fills per annum Below
776297 DERMATOLOGICALS Iodoquinol-Chlorobutanol-HC Cream 3-1-0.25% VIOCORT CREAM 3 fills per annum Below
Page 42 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
701102 DERMATOLOGICALS Pyrilamine Maleate Cream 2% MEPYRADERM CREAM 3 fills per annum Below
703834 DERMATOLOGICALS Pyrilamine Maleate Cream 2% ANTHISAN CREAM 3 fills per annum Above
800511 DERMATOLOGICALS Pyrilamine Maleate Cream 2% MEPYRIMAL 2% CREAM 3 fills per annum Below
897334 DERMATOLOGICALS Pyrilamine Maleate Cream 2% ALSAN 2% CREAM 3 fills per annum Above
731269 DERMATOLOGICALS Diphenhydramine-Pyrilamine Cream 1-1% HISTODOR CREAM 3 fills per annum Below
794120 DERMATOLOGICALS Diphenhydramine-Calamine-Phenol Lotion 1-15-0.4% BIOHIST LOT 3 fills per annum Below
828076 MUSCULO-SKELETAL AGENTS Ibuprofen Gel 5% IBULEVE GEL 2 fills per annum Below
833096 MUSCULO-SKELETAL AGENTS Ibuprofen Gel 5% DEEP RELIEF GEL 50MG/1GM 2 fills per annum Above
823473 ANTI-MICROBIALS Acyclovir Cream 5% ACTIVIR PUMP CREAM 3 fills per annum Above
824674 ANTI-MICROBIALS Acyclovir Cream 5% ADCO-ACYCLOVIR 50MG/GM CREAM
3 fills per annum Below
826340 ANTI-MICROBIALS Acyclovir Cream 5% ZOVIRAX 50MG/GM CREAM 3 fills per annum Above
873551 ANTI-MICROBIALS Acyclovir Cream 5% ACITOP 5% CREAM 3 fills per annum Below
713942 ANTI-MICROBIALS Acyclovir Cream 5% BETA-VIRA 5% CREAM 3 fills per annum Below
784524 ANTI-MICROBIALS Nitrofurazone Oint 0.2% FURASEPT OINT 3 fills per annum Below
805416 DERMATOLOGICALS Nitrofurazone Oint 0.2% FUREX OINT 3 fills per annum Below
701138 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
VARI-BETAMETHASONE CREAM
3 fills per annum Below
754064 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
PERSIVATE CREAM 3 fills per annum Above
800163 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
LENOVATE 0.1% CREAM 3 fills per annum Above
827290 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
ADCO-BETAMETHASONE CREAM
3 fills per annum Above
833037 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
TOPIVATE 1MG/GM CREAM 3 fills per annum Below
882934 DERMATOLOGICALS Betamethasone Valerate Cream 0.1% (Base Equivalent)
REPIVATE CREAM 3 fills per annum Below
754072 DERMATOLOGICALS Betamethasone Valerate Oint 0.1% (Base Equivalent) PERSIVATE OINT 3 fills per annum Above
800171 DERMATOLOGICALS Betamethasone Valerate Oint 0.1% (Base Equivalent) LENOVATE 0.1% OINT 3 fills per annum Below
807249 DERMATOLOGICALS Clobetasol Propionate Cream 0.05% DOVATE .5MG/GM CREAM 3 fills per annum Below
807230 DERMATOLOGICALS Clobetasol Propionate Oint 0.05% DOVATE .5MG/GM OINT 3 fills per annum Below
764353 DERMATOLOGICALS Hydrocortisone Cream 0.5% SKINCALM CREAM 3 fills per annum Above
700445 DERMATOLOGICALS Hydrocortisone Cream 1% VARI-HYDROCORTISONE 1% CREAM
3 fills per annum Below
720011 DERMATOLOGICALS Hydrocortisone Acetate Cream 0.5% DILUCORT CREAM 3 fills per annum Below
Page 43 of 43
Nappi code
Therapeutic group Active ingredient Product label name Limitation Above/ below medicine reference price
745472 DERMATOLOGICALS Hydrocortisone Acetate Cream 1% MYLOCORT 1GM/100GM CREAM
3 fills per annum Above
807834 DERMATOLOGICALS Hydrocortisone Acetate Cream 1% BIOCORT CREAM 3 fills per annum Below
810223 DERMATOLOGICALS Hydrocortisone Acetate Cream 1% STOPITCH CREAM 3 fills per annum Above
703591 ANAESTHETICS Tetracaine HCl Cream 1% ANETHAINE CREAM 3 fills per annum Above
799211 ANAESTHETICS Tetracaine HCl Cream 1% AMETHOCAINE CREAM 3 fills per annum Below
700205 DERMATOLOGICALS Benzyl Benzoate Emulsion 25% APP BENZYL BENZOATE 1 fill per annum Below
704857 DERMATOLOGICALS Benzyl Benzoate Emulsion 25% ASCABIOL EMULSION 1 fill per annum Above
885588 DERMATOLOGICALS Benzyl Benzoate Emulsion 25% BENZYL BENZOATE APPL 1 fill per annum Below
706448 DERMATOLOGICALS Benzyl Benzoate Emulsion 25% BENZYL BENZOATE APPLICATION
1 fill per annum Above
770116 DERMATOLOGICALS Sulfiram Bar 5% TETMOSOL 5% 75GM BAR 1 fill per annum Below
722436 DERMATOLOGICALS Sulfiram Bar 5% TEMODERM 5% SOAP 75G 1 fill per annum Below
715602 DERMATOLOGICALS *Calamine Lotion*** CALAMINE LOTION - DAROL LOTION
3 fills per annum Below
861758 DERMATOLOGICALS *Calamine Phenolated Lotion*** LINK LOT CALAMINE 3 fills per annum Below
865311 DERMATOLOGICALS *Calamine Phenolated Lotion*** CALAMINE LOTION 3 fills per annum Below
872490 DERMATOLOGICALS *Calamine Phenolated Lotion*** CALAMINE LOTION BP 3 fills per annum Below
705561 DERMATOLOGICALS *Calamine Phenolated Lotion*** CALAMINE LOTION BP 3 fills per annum Below
706615 DERMATOLOGICALS *Calamine Phenolated Lotion*** ARM CALAMINE LOT 3 fills per annum Below
712969 DERMATOLOGICALS *Calamine Phenolated Lotion*** CLICKS CALAMINE LOT 3 fills per annum Below
717243 DERMATOLOGICALS *Calamine Phenolated Lotion*** CALAMINE - ALCHEMIST LOTN 3 fills per annum Below
3000385 DERMATOLOGICALS *Calamine Phenolated Lotion*** CALAMINE LOTN 3 fills per annum Below
704716 DISINFECTANTS Chlorhexidine Gluconate Soln 0.2 MG/ML HIBITANE 0.2% IN WATER 1 fill per annum Below
702549 DERMATOLOGICALS Povidone-Iodine Oint 10% BARRS POVIDONE IODINE 3 fills per annum Above
755834 DERMATOLOGICALS Povidone-Iodine Oint 10% PODINE OINT 3 fills per annum Above
821713 DERMATOLOGICALS Povidone-Iodine Oint 10% SEPTADINE ANTISEPT OINT 3 fills per annum Above
717217 DERMATOLOGICALS Povidone-Iodine Oint 10% BARRS POVIDONE-IODINE 10%OINT
3 fills per annum Below