MEDISCOR PMB MAIN LIST - MEDiPOS Medical Scheme

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MEDISCOR PMB MAIN LIST

Effective: 1 January 2020

Please note Products contained on the PMB main list will not be reimbursed from the acute medication benefit after one claim from acute benefits for one of the following reasons:

1. Specific clinical criteria are required to be met before funding will be approved from the chronic medication benefit. Applications for this medication should be submitted with the specified clinical information (as indicated) to the Medicine Risk Management department for pre-authorisation.

2. Pre-auth required* indicates that the product may be considered for reimbursement from the chronic medication benefit upon motivation, if the requested diagnosis is covered within the Scheme's schedule of benefits.

Medication name Active ingredient Therapeutic group Product code Total package quantity

Pre-auth required

NOV PHENOBARB 30MG CAP NAM ON Phenobarbital tab 30 mg Barbiturates 87527001 30 Y

ADCO-PHENOBARB VITAL Phenobarbital w/ vitamins elixir 16 mg/5ml Barbiturates 754803007 100 Y

LETHYL 30MG TABS Phenobarbital tab 30 mg Barbiturates 737844019 1000 Y

SEDABARB 30MG TABS Phenobarbital tab 30 mg Barbiturates 814946003 1000 Y

PHENOBARBITONE 30MG BOTS Phenobarbital tab 30 mg Barbiturates 967082001 1000 Y

PHENOBARBITONE 30MG BOTS Phenobarbital tab 30 mg Barbiturates 967082002 100 Y

CAMCOLIT 250MG TABS Lithium carbonate tabs Lithium 712078002 100 Y



QUILONUM RET 450MG TABS Lithium carbonate tbcr Lithium 758833008 60 Y

LARGACTIL 25MG TABS Chlorpromazine hcl tabs Phenothiazines 735868019 56 Y



ORAP 1MG TABS Pimozide tab 1 mg Phenothiazines 751073008 75 Y

ORAP 4MG TABS Pimozide tab 4 mg Phenothiazines 751081019 100 Y

MELLERIL 5MG/5ML Thioridazine hcl susp Phenothiazines 80424001 180 Y

STELAZINE 1MG TABS Trifluoperazine hcl tabs Phenothiazines 766410005 50 Y



MODECATE 25MG INJ 1ML Fluphenazine decanoate soln Phenothiazines 744301009 5 Y

MODECATE+SYRIN 25MG 1ML INJ Fluphenazine decanoate soln Phenothiazines 744328004 1 Y

MODECATE 25MG INJ 10ML Fluphenazine decanoate soln Phenothiazines 744344018 1 Y

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Pre-auth required

CHLORPROMAZINE 25MG BOTS Chlorpromazine hcl tabs Phenothiazines 967360001 100 Y



APO TRIFLUPERAZINE 5MG BOTS Trifluoperazine hcl tabs Phenothiazines 967320001 100 Y

NOV HALOPERIDOL 0.5MG NAM ONLY Haloperidol Butyrophenones 87573001 30 Y

NOV HALOPERIDOL 0.1MG NAM ONLY Haloperidol Butyrophenones 87574001 30 Y

SERENACE 0.5MG CAPS Haloperidol Butyrophenones 763411019 60 Y

NOV HALOPERIDOL 2.5MG CAPS NAM Haloperidol Butyrophenones 980015001 30 Y

NOV HALOPERIDOL 1.5MG NAM ONLY Haloperidol tabs Butyrophenones 87575001 30 Y

NOV HALOPERIDOL 2MG NAM ONLY Haloperidol tabs Butyrophenones 87576001 30 Y

SERENACE 10MG TABS Haloperidol tabs Butyrophenones 763535001 100 Y

SERENACE 5MG TABS Haloperidol tabs Butyrophenones 763454001 100 Y

HALOMAC NAM ONLY 5MG TABS Haloperidol tabs Butyrophenones 717759001 30 Y

HALOMAC NAM ONLY 5MG TABS Haloperidol tabs Butyrophenones 717759002 100 Y

GULF HALOPERIDOL 5MG TABS Haloperidol tabs Butyrophenones 719549001 100 Y

SANDOZ HALOPERIDOL 5MG TABS Haloperidol tabs Butyrophenones 730327019 30 Y



SANDOZ HALOPERIDOL 1.5MG TABS Haloperidol tabs Butyrophenones 730335003 60 Y

APO HALOPERIDOL 5MG BOTS Haloperidol tabs Butyrophenones 967310001 100 Y

HALOXEN 5MG BOTS Haloperidol tabs Butyrophenones 967398001 100 Y

HALOXEN 10MG BOTS Haloperidol tabs Butyrophenones 967399001 100 Y

SOLIAN 50MG TABS Amisulpride tab 50 mg Atypical Anti-Psychotics 892309005 30 Y



XEPLION 50MG/0.5ML PREFILL SYR Paliperidone palm er susp pref syr 50 mg/0.5ml (ba

Atypical Anti-Psychotics 718469001 1 Y

XEPLION 75MG/0.75ML PREFILL SY Paliperidone palm er susp pref syr 75 mg/0.75ml (b


XEPLION 100MG/1ML PREFILL SYR Paliperidone palm er susp pref syr 100 mg/ml (base


XEPLION 150MG/1.5ML PREFILL SY Paliperidone palm er susp pref syr 150 mg/1.5ml (b


INVEGA 3MG SR TABS Paliperidone tab sr 24hr 3 mg Atypical Anti-Psychotics 715666001 28 Y



GEODON 20MG CAPS Ziprasidone hcl cap 20 mg Atypical Anti-Psychotics 703465001 60 Y



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Pre-auth required

NOV ZIPRASIDONE 60MG NAM ONLY Ziprasidone hcl cap 60 mg Atypical Anti-Psychotics 980034001 30 Y


ABILIFY 5MG TABS Aripiprazole tab 5 mg Atypical Anti-Psychotics 712192001 30 Y



ABILIFY 10MG TABS Aripiprazole tabs Atypical Anti-Psychotics 705634001 30 Y



LEPONEX 25MG TABS Clozapine tab 25 mg Atypical Anti-Psychotics 736708006 100 Y

LEPONEX 100MG TABS Clozapine tab 100 mg Atypical Anti-Psychotics 736716009 100 Y

ARIZOFY 5MG TABS Aripiprazole tab 5 mg Atypical Anti-Psychotics 723961001 30 Y


NOV ARIPIPRAZOLE 10MG NAM Aripiprazole tab 10 mg Atypical Anti-Psychotics 980061001 30 Y


ARIZOFY 5MG TABS Aripiprazole tabs Atypical Anti-Psychotics 723961001 30 Y



NOV ARIPIPRAZOLE 10MG NAM Aripiprazole tabs Atypical Anti-Psychotics 980061001 30 Y

CLOMENT 25MG TABS Clozapine tab 25 mg Atypical Anti-Psychotics 700176001 100 Y

ASPEN CLOZAPINE 25MG TABS Clozapine tab 25 mg Atypical Anti-Psychotics 717081001 100 Y

CLOMENT 100MG TABS Clozapine tab 100 mg Atypical Anti-Psychotics 700178001 100 Y

ASPEN CLOZAPINE 100MG TABS Clozapine tab 100 mg Atypical Anti-Psychotics 717082001 100 Y







FLUANXOL DEP 20MG/1ML INJ Flupentixol decanoate Other Anti-psychotics 726672009 1 Y

FLUANXOL DEP 20MG/1ML INJ Flupentixol decanoate Other Anti-psychotics 726672025 5 Y

CLOPIXOL DEPOT 200MG IJ Zuclopenthixol decanoate Other Anti-psychotics 714852007 1 Y

CLOPIXOL DEPOT 200MG IJ Zuclopenthixol decanoate Other Anti-psychotics 714852023 5 Y

CLOPIXOL 2MG TABS Zuclopenthixol dihydrochloride tab 2 mg Other Anti-psychotics 796751005 100 Y

CLOPIXOL 10MG TABS Zuclopenthixol dihydrochloride tab 10 mg Other Anti-psychotics 789798018 100 Y

TEGRETOL 100MG/5ML SUSP Carbamazepine susp 100 mg/5ml Anti-epileptics 769401007 250 Y

ZARONTIN SECT21 250MG CAPS Ethosuximide cap 250 mg Anti-epileptics 3000190001 100 Y

ETHYMAL SECT21 250MG CAPS Ethosuximide cap 250 mg Anti-epileptics 3000700001 50 Y

ZARONTIN SYR Ethosuximide soln 250 mg/5ml Anti-epileptics 779105001 200 Y

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Pre-auth required

NEURONTIN 600MG TABS Gabapentin tabs Anti-epileptics 705262001 100 Y

LAMICTIN P 2MG DISP TABS Lamotrigine tab chewable dispe Anti-epileptics 704533001 30 Y


LEVETIRACET 30MG/ML Levetiracetam oral soln 100 mg/ml Anti-epileptics 80326001 150 Y



LEVETIRACETAM 250MG/5ML NAM ON Levetiracetam oral soln 100 mg/ml Anti-epileptics 87416001 100 Y

KEPPRA 100MG/ML SOLN Levetiracetam oral soln 100 mg/ml Anti-epileptics 714166001 300 Y

NOV LEVETIRACETAM 40MG/2ML NAM Levetiracetam oral soln 100 mg/ml Anti-epileptics 980040001 150 Y

NOV LEVETIRACETAM 100MG/5ML NA Levetiracetam oral soln 100 mg/ml Anti-epileptics 980046001 300 Y

NOV LEVETIRACETAM 20MG/2ML Levetiracetam oral soln 100 mg/ml Anti-epileptics 980100001 100 Y

NOV LEVETIRACETAM 25MG/2ML Levetiracetam oral soln 100 mg/ml Anti-epileptics 980101001 100 Y

EPANUTIN 125MG/5ML SUSP Phenytoin sodium susp 125 mg/5ml Anti-epileptics 723533016 237 Y

MYSOLINE 250MG TABS Primidone tab 250 mg Anti-epileptics 745588018 100 Y

TOPAMAX SC SPRINKLE 15MG CAPS Topiramate cpsp Anti-epileptics 878014004 60 Y

EPILIM 200MG/5ML LIQ Valproate sodium liqd 200 mg/5ml Anti-epileptics 780545001 300 Y

CONVULEX 50MG/ML SYR Valproate sodium oral soln 250 mg/5ml (base equiv)

Anti-epileptics 781541018 100 Y

EPIVULEX NAM ONLY 50MG/ML SYRP Valproate sodium oral soln 250 mg/5ml (base equiv)

Anti-epileptics 3001339001 100 Y

EPILIM 100MG CRUSH TABS Valproate sodium tab 100 mg Anti-epileptics 821578006 100 Y

CONVULEX 150MG CAPS Valproic acid cap 150 mg Anti-epileptics 715980009 100 Y

CONVULEX 300MG CAPS Valproic acid cap 300 mg Anti-epileptics 715999001 100 Y

CONVULEX 500MG CAPS Valproic acid cap delayed release 500 mg Anti-epileptics 781568005 100 Y

SABRIL 500MG TABS Vigabatrin Anti-epileptics 809594005 100 Y

TEGRETOL 200MG TABS Carbamazepine tabs Anti-epileptics 769398007 50 Y

TEGRETOL CR 200MG TABS Carbamazepine tb24 Anti-epileptics 779652002 30 Y

TEGRETOL CR 400MG TABS Carbamazepine tb24 Anti-epileptics 779660005 30 Y

NEURONTIN 100MG CAPS Gabapentin cap 100 mg Anti-epileptics 807443018 100 Y



LAMICTIN 25MG TABS Lamotrigine tabs Anti-epileptics 805505008 60 Y




KEPPRA 250MG TABS Levetiracetam tabs Anti-epileptics 700958003 60 Y



TRILEPTAL FCT 300MG Oxcarbazepine tab 300 mg Anti-epileptics 892484008 50 Y

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Pre-auth required

TRILEPTAL FCT 600MG Oxcarbazepine tab 600 mg Anti-epileptics 892491020 50 Y

EPANUTIN 100MG CAPS Phenytoin sodium prompt cap 100 mg Anti-epileptics 723525005 100 Y

TOPAMAX 25MG TABS Topiramate tabs Anti-epileptics 822515008 60 Y




EPILIM CR 200MG TABS Valproate sodium tab cr 200 mg Anti-epileptics 818666005 100 Y



DEGRANOL 200MG TABS Carbamazepine tabs Anti-epileptics 712493018 100 Y

SANDOZ CARBAMAZEPINE 200MG Carbamazepine tabs Anti-epileptics 712523006 100 Y

ZEPTOL 200MG TABS Carbamazepine tabs Anti-epileptics 715962001 50 Y

ZEPTOL 200MG TABS Carbamazepine tabs Anti-epileptics 715962002 100 Y

CARBATOL 200MG TABS BOTS Carbamazepine tabs Anti-epileptics 967133001 100 Y

APO CARBAMAZEPINE 200MG BOTS Carbamazepine tabs Anti-epileptics 967159001 100 Y

STORILAT 200MG BOTS Carbamazepine tabs Anti-epileptics 967447001 100 Y

GULF CARBAMAZEPINE 200MG TABS Carbamazepine tabs Anti-epileptics 3001174002 100 Y

SANDOZ CARBAMAZEPINE CR 200MG Carbamazepine tb24 Anti-epileptics 705597001 30 Y

SANDOZ CARBAMAZEPINE CR 400MG Carbamazepine tb24 Anti-epileptics 705602001 30 Y

STORILAT RETARD 200MG BOTS Carbamazepine tb24 Anti-epileptics 967448001 30 Y

EPLEPTIN 100MG CAPS Gabapentin cap 100 mg Anti-epileptics 707622001 100 Y

NEUREXAL 100MG CAPS Gabapentin cap 100 mg Anti-epileptics 708949001 100 Y

BIOTECH GABAPENTIN 100MG CAPS Gabapentin cap 100 mg Anti-epileptics 721740001 100 Y

EPIGAB 100MG CAPS Gabapentin cap 100 mg Anti-epileptics 722865001 100 Y





GABENIL BOTS Gabapentin cap 300 mg Anti-epileptics 967663001 50 Y





GABENIL BOTS Gabapentin cap 400 mg Anti-epileptics 967664001 50 Y


EPITEC 25MG TABS Lamotrigine tabs Anti-epileptics 704379001 60 Y



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Pre-auth required


LAMITOR 25MG TABS Lamotrigine tabs Anti-epileptics 704486001 60 Y



SANDOZ LAMOTRIG 100MG TABS Lamotrigine tabs Anti-epileptics 705248001 60 Y




ASPEN LAMOTRIGINE 25MG TABS Lamotrigine tabs Anti-epileptics 705436001 60 Y



AUSTELL-LAMOTRIGINE 25MG TABS Lamotrigine tabs Anti-epileptics 707787001 60 Y




DYNA-LAMOTRIGINE 25MG TABS Lamotrigine tabs Anti-epileptics 710387001 60 Y




LAMIDUS 50MG TABS Lamotrigine tabs Anti-epileptics 710885002 60 Y




GIROTEC 50MG TABS Lamotrigine tabs Anti-epileptics 722725001 60 Y



SERINEM 25MG TABS Lamotrigine tabs Anti-epileptics 3000448001 60 Y




LAMICTIN P 100MG DISP TABS Lamotrigine tbso Anti-epileptics 813907004 60 Y



REDILEV 250MG TABS Levetiracetam tabs Anti-epileptics 714662001 30 Y



DYNA LEVETIRACETAM 750MG TABS Levetiracetam tabs Anti-epileptics 718484001 60 Y


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Pre-auth required


TORCETAM 250MG TABS Levetiracetam tabs Anti-epileptics 720320001 60 Y



LEVETIRACETAM BIOTECH 750MG Levetiracetam tabs Anti-epileptics 720696001 60 Y

LEVETIRACETAM BIOTECH 250MG Levetiracetam tabs Anti-epileptics 720697001 60 Y


EPIKEPP 250MG TABS Levetiracetam tabs Anti-epileptics 721701001 60 Y



LEVETIRACETAM UNICORN 250MG TA Levetiracetam tabs Anti-epileptics 722150001 60 Y

LEVETIRACETAM UNICORN 750MG TA Levetiracetam tabs Anti-epileptics 722151001 60 Y

MYLAN OXCARBAZEPINE 300MG Oxcarbazepine tab 300 mg Anti-epileptics 717226001 50 Y

MYLAN OXCARBAZEPINE 600MG Oxcarbazepine tab 600 mg Anti-epileptics 717227001 50 Y

NOV PHENYTOIN SOD 100MG NAM O Phenytoin sodium prompt cap 100 mg Anti-epileptics 980030001 30 Y

PHENYTOIN SOD 100MG TABS Phenytoin sodium prompt tab 100 mg Anti-epileptics 754870015 1000 Y

PHENYTOIN SOD 100MG TABS Phenytoin sodium prompt tab 100 mg Anti-epileptics 754870016 90 Y



TOPLEP 25MG TABS Topiramate tabs Anti-epileptics 708389001 60 Y




SANDOZ TOPIRAM 25MG TABS Topiramate tabs Anti-epileptics 709284001 60 Y




ADCO-TOPIRAMATE 25MG TABS Topiramate tabs Anti-epileptics 710240001 60 Y




EPITOZ 25MG TABS Topiramate tabs Anti-epileptics 710899001 60 Y



TOPALEX 25MG TABS Topiramate tabs Anti-epileptics 715978001 60 Y



PAMIRAM 25MG TABS Topiramate tabs Anti-epileptics 716000001 60 Y

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TOPIROL 25MG TABS Topiramate tabs Anti-epileptics 718288002 30 Y




EPIMATE 25MG TABS Topiramate tabs Anti-epileptics 718855001 60 Y




EPILIZINE CR 200MG TABS Valproate sodium tab cr 200 mg Anti-epileptics 718274001 100 Y

NAVALPRO CR 200MG TABS Valproate sodium tab cr 200 mg Anti-epileptics 718465001 100 Y

EPROLEP CR 200MG TABS Valproate sodium tab cr 200 mg Anti-epileptics 721460001 100 Y

VALPARIN CHRONO BOTS Valproate sodium tab cr 200 mg Anti-epileptics 967537001 100 Y



VALEPTIC CR 300MG TABS Valproate sodium tab cr 300 mg Anti-epileptics 720026001 100 Y




VALEPTIC CR 500MG TABS Valproate sodium tab cr 500 mg Anti-epileptics 720027001 100 Y


VALPARIN CHRONO 500 BOTS Valproate sodium tab cr 500 mg Anti-epileptics 967538001 100 Y

MADOPAR HBS CAPS Benserazide & levodopa cap 25-100 mg Anti-Parkinson Dopaminergics 828483019 100 Y

MADOPAR TABS Benserazide & levodopa tab 50-200 mg Anti-Parkinson Dopaminergics 739928007 100 Y

SINEMET CR 50/200MG TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 794635008 100 Y

PEXOLA ER 0.75MG TABS Pramipexole dihydrochloride tab sr 24hr 0.75 mg Anti-Parkinson Dopaminergics 718255001 30 Y

PEXOLA ER 0.375MG TABS Pramipexole dihydrochloride tab sr 24hr 0.375 mg

Anti-Parkinson Dopaminergics 718253001 30 Y


PEXOLA ER 3MG TABS Pramipexole dihydrochloride tab sr 24hr 3 mg Anti-Parkinson Dopaminergics 718257001 30 Y


REQUIP XL 2MG SR TABS Ropinirole hydrochloride tab s Anti-Parkinson Dopaminergics 711090001 28 Y



SYMMETREL 100MG CAPS Amantadine hcl caps Anti-Parkinson Dopaminergics 768243009 20 Y

SINEMET 25/100 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 764078003 100 Y

SINEMET 25/250 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 764086006 100 Y

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PEXOLA 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 898828012 100 Y

PEXOLA 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 898836007 100 Y

PEXOLA 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 898848008 100 Y

REQUIP 0.25MG TABS Ropinirole hydrochloride tabs Anti-Parkinson Dopaminergics 700647003 210 Y






SYMADIN 100MG CAPS Amantadine hcl caps Anti-Parkinson Dopaminergics 700500003 20 Y

TEVA CARBI-LEVO 25/100 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 710286001 100 Y

TEVA CARBI-LEVO 25/250 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 710468001 100 Y

CARBILEV 25/100 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 824321006 100 Y

CARBILEV 25/250 TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 824348001 100 Y

CREDANIL BOTS Carbidopa-levodopa Anti-Parkinson Dopaminergics 967374001 100 Y

CREDANIL BOTS Carbidopa-levodopa Anti-Parkinson Dopaminergics 967375001 100 Y

LECARDOP 25/100MG TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 3000000001 100 Y

LECARDOP 25/250MG TABS Carbidopa-levodopa Anti-Parkinson Dopaminergics 3000001001 100 Y

PRAMIOLA 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 717741001 100 Y

PRAMIOLA 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 717742001 100 Y

OXPOLA 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719542001 100 Y

OXPOLA 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719543001 100 Y

OXPOLA 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719545001 100 Y

PRAMEX 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719843001 100 Y

PRAMEX 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719844001 100 Y

PRAMEX 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 719845001 100 Y

PAZORAM 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 721391001 100 Y

PAZORAM 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 721392001 100 Y

PAZORAM 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 721393001 100 Y

MYLAN PRAMIPEXOLE 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 722748001 100 Y

MYLAN PRAMIPEXOLE 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 722749001 100 Y

MYLAN PRAMIPEXOLE 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 722750001 100 Y

PEXASP 0.25MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 723740001 100 Y

PEXASP 0.125MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 723741001 100 Y

PEXASP 1MG TABS Pramipexole dihydrochloride tabs Anti-Parkinson Dopaminergics 723742001 100 Y

ACCORD ROPINIROLE 0.25MG TABS Ropinirole hydrochloride tabs Anti-Parkinson Dopaminergics 719569001 84 Y

ACCORD ROPINIROLE 0.5MG TABS Ropinirole hydrochloride tabs Anti-Parkinson Dopaminergics 719570001 84 Y

ACCORD ROPINIROLE 1MG TABS Ropinirole hydrochloride tabs Anti-Parkinson Dopaminergics 719571001 84 Y

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AKINETON 2MG TABS Biperiden hcl tabs Anti-Parkinson Anti-cholinergics 701491019 50 Y

AKINETON 2MG TABS Biperiden hcl tabs Anti-Parkinson Anti-cholinergics 701491027 500 Y

LENNON-BIPERIDEN 2MG TABS Biperiden hcl tabs Anti-Parkinson Anti-cholinergics 713209001 500 Y

BENZHEXOL 2MG TABS Trihexyphenidyl hcl tab 2 mg Anti-Parkinson Anti-cholinergics 713210001 100 Y

TRIHEXYPHENIDYL 5MG BOTS Trihexyphenidyl hcl tab 5 mg Anti-Parkinson Anti-cholinergics 967204001 100 Y

APO TRIHEX 5MG BOTS Trihexyphenidyl hcl tab 5 mg Anti-Parkinson Anti-cholinergics 967251001 100 Y

STALEVO 50/12.5 TABS Carbidopa-levodopa-entacapone tabs 12.5-50-200 mg

Other Anti-Parkinson Agents 707999001 100 Y

STALEVO 100/25MG TABS Carbidopa-levodopa-entacapone tabs 25-100-200 mg


STALEVO 150/37.5 TABS Carbidopa-levodopa-entacapone tabs 37.5-150-200 mg


COMTAN 200MG TABS Entacapone tabs Other Anti-Parkinson Agents 868590002 100 Y

AZILECT 1MG TABS Rasagiline mesylate tab 1 mg ( Other Anti-Parkinson Agents 711769001 28 Y

TASMAR 100MG TABS Tolcapone tabs Other Anti-Parkinson Agents 839108001 100 Y

PARKILYNE 5MG TABS Selegiline hcl tabs Other Anti-Parkinson Agents 706712001 30 Y

ORENCIA 250MG VIAL 15ML POWD Abatacept for iv soln 250 mg Other Musculo-skeletal Agents 715401001 1 Y

ORENCIA 125MG PREFILLED SYRING Abatacept subcutaneous soln prefilled syringe 125

Other Musculo-skeletal Agents 722109001 4 Y

SALAZOPYRIN-EN 500MG TABS Sulfasalazine tab delayed release 500 mg Other Musculo-skeletal Agents 762016019 100 Y

ACTEMRA 80MG/4ML VIAL Tocilizumab iv inj 80 mg/4ml Other Musculo-skeletal Agents 715813001 1 Y



ACTEMRA SC 162MG/0.9ML PREFILL Tocilizumab subcutaneous soln prefilled syringe 16

Other Musculo-skeletal Agents 723506001 4 Y

ARAVA 10MG TABS Leflunomide tab 10 mg Other Musculo-skeletal Agents 898171008 30 Y

ARAVA 20MG TABS Leflunomide tab 20 mg Other Musculo-skeletal Agents 898175005 30 Y

RHEUMALEF 10MG TABS Leflunomide tab 10 mg Other Musculo-skeletal Agents 721609001 30 Y

RAVALEF 10MG TABS Leflunomide tab 10 mg Other Musculo-skeletal Agents 3000528001 30 Y

RHEUMALEF 20MG TABS Leflunomide tab 20 mg Other Musculo-skeletal Agents 721610001 30 Y

LUNAR 20MG TABS Leflunomide tab 20 mg Other Musculo-skeletal Agents 721806001 30 Y

RAVALEF 20MG TABS Leflunomide tab 20 mg Other Musculo-skeletal Agents 3000529001 30 Y

NOV EPLERENONE 25MG CAPS Eplerenone tab 25 mg Other Cardiovascular Agents 87450001 30 Y

INSPRA 25MG TABS Eplerenone tab 25 mg Other Cardiovascular Agents 706121001 30 Y


INSPRA SECT21 25MG TABS Eplerenone tab 25 mg Other Cardiovascular Agents 3000342001 30 Y

NOV EPLERENONE 50MG CAPS Eplerenone tab 50 mg Other Cardiovascular Agents 87451001 30 Y


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INSPRA SECT21 50MG TABS Eplerenone tab 50 mg Other Cardiovascular Agents 3000307001 30 Y

ENTRESTO 50MG TABS Sacubitril-valsartan tab 24-26 mg Other Cardiovascular Agents 723103001 28 Y




RYTHMODAN SECT21 100MG CAPS Disopyramide phosphate cap 100 mg Anti-arrhythmics 723334001 40 Y

TAMBOCOR CR 100MG CAPS Flecainide acetate cap sr 24hr 100 mg Anti-arrhythmics 717802001 30 Y

TAMBOCOR CR 200MG CAPS Flecainide acetate cap sr 24hr 200 mg Anti-arrhythmics 717803001 30 Y

TAMBOCOR 100MG TABS Flecainide acetate tabs Anti-arrhythmics 813915007 60 Y

MEXITIL SECT21 250MG CAPS Mexiletine hcl caps Anti-arrhythmics 721192001 100 Y

RYTHMOL 150MG TABS Propafenone hcl tabs Anti-arrhythmics 784869014 100 Y

RYTHMOL 300MG TABS Propafenone hcl tabs Anti-arrhythmics 784877017 100 Y

CORDARONE X 200MG TABS Amiodarone hcl tabs Anti-arrhythmics 716111004 30 Y

CORDARONE X 100MG TABS Amiodarone hcl tabs Anti-arrhythmics 800554019 30 Y

ARYCOR 200MG TABS Amiodarone hcl tabs Anti-arrhythmics 703513001 30 Y

ARYCOR 100MG TABS Amiodarone hcl tabs Anti-arrhythmics 703515001 30 Y

BIO-AMIODARONE 200MG TABS Amiodarone hcl tabs Anti-arrhythmics 707851001 30 Y

HEXARONE 100MG TABS Amiodarone hcl tabs Anti-arrhythmics 863157009 30 Y

HEXARONE 200MG TABS Amiodarone hcl tabs Anti-arrhythmics 863165001 30 Y

CARDILOR BOTS Amiodarone hcl tabs Anti-arrhythmics 967358001 30 Y

RYTHMODAN 100MG CAPS Disopyramide phosphate cap 100 mg Anti-arrhythmics 761826009 100 Y

PHYSIOTENS 0.2MG TABS Moxonidine tab 0.2 mg Central Acting Anti-hypertensives 851892019 28 Y



DOPAMAC 250MG TABS NAMIBIA Methyldopa tab 250 mg Central Acting Anti-hypertensives 717755001 100 Y

HY-PO-TONE 250MG TABS Methyldopa tab 250 mg Central Acting Anti-hypertensives 732052009 100 Y


SANDOZ METHYLDOPA 250MG TABS Methyldopa tab 250 mg Central Acting Anti-hypertensives 764116010 500 Y

SANDOZ METHYLDOPA 250MG TABS Methyldopa tab 250 mg Central Acting Anti-hypertensives 764116037 90 Y

MYLAN METHYLDOPA 250MG TABS Methyldopa tab 250 mg Central Acting Anti-hypertensives 785962018 100 Y

MYLAN METHYLDOPA 250MG TABS Methyldopa tab 250 mg Central Acting Anti-hypertensives 785962026 500 Y

HYPOTENS 250MG TABS BOTS Methyldopa tab 250 mg Central Acting Anti-hypertensives 967048001 1000 Y

APO METHYLDOPA 250MG TAB BOTS Methyldopa tab 250 mg Central Acting Anti-hypertensives 967174001 1000 Y

DOPATAB 250MG BOTS Methyldopa tab 250 mg Central Acting Anti-hypertensives 967264001 1000 Y

METHYLDOPA BOTS Methyldopa tab 250 mg Central Acting Anti-hypertensives 967409001 100 Y

DOPAMAC BOTS Methyldopa tab 250 mg Central Acting Anti-hypertensives 967484001 100 Y


APO METHYLDOPA BOTS Methyldopa tab 500 mg Central Acting Anti-hypertensives 967747001 100 Y

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Pre-auth required

MOXOTENS 0.2MG TABS Moxonidine tab 0.2 mg Central Acting Anti-hypertensives 710744001 28 Y

CYNT 0.2MG TABS Moxonidine tab 0.2 mg Central Acting Anti-hypertensives 712382001 28 Y



CYNT 0.4MG TABS Moxonidine tab 0.4 mg Central Acting Anti-hypertensives 712383001 28 Y

CARDURA XL 8MG TABS Doxazosin mesylate Alpha-receptor Blockers 869864009 30 Y

NOV PRAZOSIN 2.5MG CAP NAM Prazosin hcl Alpha-receptor Blockers 980099001 30 Y

HYTRIN 1MG TABS Terazosin hcl tabs Alpha-receptor Blockers 806358009 10 Y




CARDURA XL 4MG TABS Doxazosin mesylate Alpha-receptor Blockers 869856006 30 Y

CARZIN XL 4MG TABS Doxazosin mesylate Alpha-receptor Blockers 714292001 30 Y

CARDUGEN 1MG TABS Doxazosin mesylate tabs Alpha-receptor Blockers 701425001 30 Y

CARDUGEN 4MG TABS Doxazosin mesylate tabs Alpha-receptor Blockers 701426001 30 Y

ADCO-DOXAZOSIN 1MG TABS Doxazosin mesylate tabs Alpha-receptor Blockers 701626001 30 Y



APO DOXAZOCIN 1MG BOTS Doxazosin mesylate tabs Alpha-receptor Blockers 967307001 100 Y

URODOXA 4MG TABS Doxazosin mesylate tabs Alpha-receptor Blockers 3000184001 30 Y

PRAZOSIN 0.05MG/ML SUSP Prazosin hcl Alpha-receptor Blockers 87246001 100 Y

PRATSIOL 1MG TABS Prazosin hcl Alpha-receptor Blockers 782122019 100 Y

PRATSIOL 2MG TABS Prazosin hcl Alpha-receptor Blockers 782130003 100 Y

APO PRAZO 5MG TAB BOTS Prazosin hcl Alpha-receptor Blockers 967182001 100 Y

ATODEL BOTS Prazosin hcl Alpha-receptor Blockers 967353001 30 Y



NOV PRAZOSIN 1MG CAPS NAM Prazosin hcl Alpha-receptor Blockers 980063001 100 Y

NOV PRAZOSIN 2MG CAPS NAM Prazosin hcl Alpha-receptor Blockers 980064001 100 Y

SECTRAL 100MG CAPS Acebutolol hcl caps Beta-receptor Blockers 763020001 60 Y

SECTRAL 200MG CAPS Acebutolol hcl caps Beta-receptor Blockers 763039004 60 Y

CARDICOR 2.5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704439001 30 Y

LOPRESOR 100MG TABS Metoprolol tartrate tabs Beta-receptor Blockers 739251016 40 Y

PROPRANOLOL NAM ONLY 40MG TABS Propranolol hcl tabs Beta-receptor Blockers 80863001 100 Y

PROPRA-RATIOPHARM SECT21 10MG Propranolol hcl tabs Beta-receptor Blockers 721143001 100 Y

PROPRA-RATIOPHARM SECT21 40MG Propranolol hcl tabs Beta-receptor Blockers 721144001 100 Y

SOTACOR SECT21 80MG TABS Sotalol hcl tabs Beta-receptor Blockers 720937001 30 Y

TENORET TABS Atenolol & chlorthalidone tab 50-12.5 mg Beta-receptor Blockers 769592007 30 Y

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Pre-auth required

TENORETIC TABS Atenolol & chlorthalidone tab 100-25 mg Beta-receptor Blockers 769568009 30 Y

TENORMIN 25MG TABS Atenolol tab 25 mg Beta-receptor Blockers 797693009 30 Y



ZIAK 2.5MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 840300018 30 Y

ZIAK 5MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 840319002 30 Y

ZIAK 10MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 852929005 30 Y

CONCOR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 818429003 30 Y

CONCOR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 818437006 30 Y

CONCOR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 818429003 30 Y

CONCOR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 818437006 30 Y

NEBILET 5MG TABS Nebivolol hcl tab 5 mg (base equivalent) Beta-receptor Blockers 700558003 30 Y

INDERAL 10MG TABS Propranolol hcl tabs Beta-receptor Blockers 732567009 50 Y

BUTOBLOC 400MG TABS Acebutolol hcl tabs Beta-receptor Blockers 705056001 30 Y

SANDOZ CO-TENIDONE 50/12. Atenolol & chlorthalidone tab 50-12.5 mg Beta-receptor Blockers 789607018 30 Y

TENCHLOR-HS TABS Atenolol & chlorthalidone tab 50-12.5 mg Beta-receptor Blockers 807591017 30 Y

TENCHLOR TABS Atenolol & chlorthalidone tab 100-25 mg Beta-receptor Blockers 786217014 30 Y

SANDOZ CO-TENIDONE 100/25 Atenolol & chlorthalidone tab 100-25 mg Beta-receptor Blockers 789615002 30 Y

TENOPRESS 25MG TABS Atenolol tab 25 mg Beta-receptor Blockers 705872001 30 Y

B-BLOCK 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 704653001 30 Y



GULF ATENOLOL 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 715625001 28 Y

TENOMAC 50MG TABS NAMIBIA Atenolol tab 50 mg Beta-receptor Blockers 717749001 30 Y

ZETENOL 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 719656001 30 Y

TEN-BLOKA 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 786187026 30 Y

ADCO-ATENOLOL 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 786578017 30 Y

SANDOZ ATENOLOL 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 787892009 30 Y

HEXABLOK 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 806889004 30 Y

BIO-ATENOLOL 50MG TABS Atenolol tab 50 mg Beta-receptor Blockers 826898025 30 Y

APO ATENOLOL 50MG TABS BOTS Atenolol tab 50 mg Beta-receptor Blockers 967157001 100 Y

APO ATENOLOL 50MG TABS BOTS Atenolol tab 50 mg Beta-receptor Blockers 967157002 500 Y

BETACARD 50MG TABS BOTS Atenolol tab 50 mg Beta-receptor Blockers 967222001 30 Y

TERNOLOL 50MG BOTS Atenolol tab 50 mg Beta-receptor Blockers 967271001 100 Y

VELORIN BOTS Atenolol tab 50 mg Beta-receptor Blockers 967451001 30 Y

B-BLOCK 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 704651001 30 Y


GULF ATENOLOL 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 715626001 28 Y

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ZETENOL 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 719657001 30 Y

TEN-BLOKA 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 786195010 30 Y

ADCO-ATENOLOL 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 786586001 28 Y



HEXABLOK 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 806897007 30 Y

BIO-ATENOLOL 100MG TABS Atenolol tab 100 mg Beta-receptor Blockers 826901034 30 Y

BETACARD 100MG BOTS Atenolol tab 100 mg Beta-receptor Blockers 967130001 30 Y

APO ATENOLOL 100MG BOTS Atenolol tab 100 mg Beta-receptor Blockers 967226001 100 Y

APO ATENOLOL 100MG BOTS Atenolol tab 100 mg Beta-receptor Blockers 967226002 500 Y

TERNOLOL 100MG BOTS Atenolol tab 100 mg Beta-receptor Blockers 967272001 100 Y



ALTOL TABS BOTS Atenolol tab 100 mg Beta-receptor Blockers 967469001 100 Y

BISOZYD CO 2.5/6.25 TABS Bisoprolol & HCTZ Beta-receptor Blockers 718082001 30 Y

BISOZYD CO 5/6.25 TABS Bisoprolol & HCTZ Beta-receptor Blockers 718086001 30 Y

BISOZYD 10/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 718087001 30 Y

BILOCOR CO 2.5MG/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 719200001 30 Y

BILOCOR CO 5MG/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 719201001 30 Y

BILOCOR CO 10MG/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 719202001 30 Y

ZIABETA 2.5/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 720031001 30 Y

ZIABETA 5/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 720032001 30 Y

ZIABETA 10/6.25MG TABS Bisoprolol & HCTZ Beta-receptor Blockers 720033001 30 Y

BISOPROLOL CO UNICORN 5MG/6.25 Bisoprolol & HCTZ Beta-receptor Blockers 721588001 30 Y

BISOPROLOL CO UNICORN 10MG/6.2 Bisoprolol & HCTZ Beta-receptor Blockers 721589001 30 Y

ADCO-BISOCOR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 703913001 30 Y

BISOHEXAL 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 704132001 30 Y

BILOCOR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 704372001 30 Y

CARDICOR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 704440001 30 Y

BETACOR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 706178001 30 Y

BISOPROLOL HEXAL 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 707391001 30 Y

ZIAPRO 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 715274001 30 Y

BISOPROLOL UNICORN 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 716167001 30 Y

BISLO 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 719154001 30 Y

BISOZYD 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 720043001 30 Y

BISBETA 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 720659001 30 Y

RETOCAR 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 720820001 30 Y

MYLAN BISOPROLOL 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 721437001 30 Y

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Pre-auth required

BISOPROLOL UNICHEM 5MG TABS Bisoprolol fumarate tab 5 mg Beta-receptor Blockers 722055001 30 Y

ADCO-BISOCOR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 703914001 30 Y

BISOHEXAL 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 704133001 30 Y

BILOCOR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 704373001 30 Y

CARDICOR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 704441001 30 Y

BETACOR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 706179001 30 Y

BISOPROLOL HEXAL 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 707393001 30 Y

ZIAPRO 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 715276001 30 Y

BISOPROLOL UNICORN 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 716166001 30 Y

BISLO 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 719155001 30 Y

BISOZYD 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 720044001 30 Y

BISBETA 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 720660001 30 Y

RETOCAR 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 720821001 30 Y

MYLAN BISOPROLOL 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 721438001 30 Y

BISOPROLOL UNICHEM 10MG TABS Bisoprolol fumarate tab 10 mg Beta-receptor Blockers 722056001 30 Y

ADCO-BISOCOR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 703913001 30 Y

ADCO-BISOCOR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 703914001 30 Y

BISOHEXAL 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704132001 30 Y

BISOHEXAL 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704133001 30 Y

BILOCOR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704372001 30 Y

BILOCOR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704373001 30 Y

CARDICOR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704440001 30 Y

CARDICOR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 704441001 30 Y

BETACOR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 706178001 30 Y

BETACOR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 706179001 30 Y

BISOPROLOL HEXAL 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 707391001 30 Y

BISOPROLOL HEXAL 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 707393001 30 Y

ZIAPRO 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 715274001 30 Y

ZIAPRO 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 715276001 30 Y

BISOPROLOL UNICORN 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 716166001 30 Y

BISOPROLOL UNICORN 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 716167001 30 Y

BISLO 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 719154001 30 Y

BISLO 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 719155001 30 Y

BISOZYD 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720043001 30 Y

BISOZYD 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720044001 30 Y

BISBETA 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720659001 30 Y

BISBETA 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720660001 30 Y

RETOCAR 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720820001 30 Y

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Pre-auth required

RETOCAR 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 720821001 30 Y

MYLAN BISOPROLOL 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 721437001 30 Y

MYLAN BISOPROLOL 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 721438001 30 Y

BISOPROLOL UNICHEM 5MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 722055001 30 Y

BISOPROLOL UNICHEM 10MG TABS Bisoprolol fumarate tabs Beta-receptor Blockers 722056001 30 Y

LOVISPES 5MG TABS Nebivolol hcl tab 5 mg (base equivalent) Beta-receptor Blockers 716483001 30 Y

PUR-BLOKA 10MG TABS Propranolol hcl tabs Beta-receptor Blockers 758140002 50 Y





INDOBLOK 10MG TABS Propranolol hcl tabs Beta-receptor Blockers 806552034 1000 Y

INDOBLOK 40MG TABS Propranolol hcl tabs Beta-receptor Blockers 806560029 1000 Y

REXIGEN 40MG TABLETS BOTS Propranolol hcl tabs Beta-receptor Blockers 967087001 500 Y



APO PROPRANOLOL 40MG TAB BOTS Propranolol hcl tabs Beta-receptor Blockers 967183001 1000 Y

APO PROPANOLOL 10MG BOTS Propranolol hcl tabs Beta-receptor Blockers 967246001 100 Y

APO PROPRANOLOL BOTS Propranolol hcl tabs Beta-receptor Blockers 967316001 100 Y

EMFORAL 10MG TABS BOTS Propranolol hcl tabs Beta-receptor Blockers 967383001 100 Y

EMFORAL BOTS Propranolol hcl tabs Beta-receptor Blockers 967384001 1000 Y



SOTAHEXAL 80MG TABS Sotalol hcl tabs Beta-receptor Blockers 827991002 100 Y

SOTAHEXAL 160MG TABS Sotalol hcl tabs Beta-receptor Blockers 828009007 100 Y

APO SOTALOL 80MG TAB BOTS Sotalol hcl tabs Beta-receptor Blockers 967185001 100 Y

SERVATRIN TABS Timolol-amiloride-hydrochlorot Beta-receptor Blockers 780472004 30 Y

TRANDATE 100MG TABS Labetalol hcl tabs Alpha/Beta-receptor Blockers 771627017 60 Y

DILATREND 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 833428004 30 Y

DILATREND 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 836354001 30 Y

DILATREND 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 788856006 30 Y

CARVETREND 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 704670001 30 Y

CARLOC 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 705459001 30 Y

CARVEDILOL-HEXAL 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 705749001 30 Y

ASPEN-CARVEDILOL 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 710338001 30 Y

VEDIBLOK 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 710958001 30 Y

CARVEDILOL UNICORN 6.25MG TABS Carvedilol tab 6.25 mg Alpha/Beta-receptor Blockers 716742001 30 Y

CARLOC 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 700168001 30 Y

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Pre-auth required

CARVETREND 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 704671001 30 Y

CARVEDILOL-HEXAL 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 705770001 30 Y

ASPEN-CARVEDILOL 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 710339001 30 Y

VEDIBLOK 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 710959001 30 Y

CARVEDILOL UNICORN 12.5MG TABS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 716743001 30 Y

CARZEPIN BOTS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 967552001 100 Y

KARVIL 12.MG BOTS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 967633001 30 Y

CARVEDI DENK BOTS Carvedilol tab 12.5 mg Alpha/Beta-receptor Blockers 967681001 30 Y

CARVETREND 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 704672001 30 Y

CARVEDILOL-HEXAL 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 705767001 30 Y

ASPEN-CARVEDILOL 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 710340001 30 Y

VEDIBLOK 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 710960001 30 Y

CARVEDILOL UNICORN 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 716744001 30 Y

CARLOC 25MG TABS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 897117006 30 Y

KARVIL 25MG BOTS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 967634001 30 Y

CARVEDI DENK BOTS Carvedilol tab 25 mg Alpha/Beta-receptor Blockers 967682001 30 Y

LONITEN 5MG TAB Minoxidil tab 5 mg Direct Acting Vasodilators 739235001 100 Y

LONITEN 10MG TABS Minoxidil tab 10 mg Direct Acting Vasodilators 739243004 100 Y

HYPERPHEN 10MG TABS Hydralazine hcl tab 10 mg Direct Acting Vasodilators 731714008 100 Y

SANDOZ HYDRALAZINE 25MG TABS Hydralazine hcl tab 25 mg Direct Acting Vasodilators 761400001 30 Y




APO HYDRALAZINE 25MG BOTS Hydralazine hcl tab 25 mg Direct Acting Vasodilators 967241001 100 Y

APO HYDRALAZINE BOTS Hydralazine hcl tab 25 mg Direct Acting Vasodilators 967311001 100 Y

HYDRALAZINE BOTS Hydralazine hcl tab 25 mg Direct Acting Vasodilators 967401001 20 Y








ZANERIL 10MG/10MG TABS Enalapril maleate-lercanidipine tab 10-10 mg Calcium Channel Blockers 711444001 28 Y

ZANERIL 10MG/20MG TABS Enalapril maleate-lercanidipine tab 10-20 mg Calcium Channel Blockers 711445001 28 Y

PLENDIL 2.5MG TABS Felodipine Calcium Channel Blockers 821896008 30 Y

DYNACIRC SRO 5MG CAPS Isradipine cap cr 5 mg Calcium Channel Blockers 788325019 30 Y

DYNACIRC 2.5MG TABS Isradipine tab 2.5 mg Calcium Channel Blockers 782963005 60 Y

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Pre-auth required

NORVASC 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 791245004 30 Y

NORVASC 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 799122009 30 Y

PLENDIL 5MG TABS Felodipine Calcium Channel Blockers 805548009 30 Y

ZANIDIP 10MG TABS Lercanidipine hcl tabs Calcium Channel Blockers 704035002 28 Y

ZANIDIP 20MG TABS Lercanidipine hcl tabs Calcium Channel Blockers 708037001 28 Y

AMLOSYN 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 704620001 30 Y

PENDINE 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 707979001 30 Y

CALBLOC 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708039001 30 Y

AMLODAC 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708050001 30 Y

AUSTELL AMLODIPINE 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708094001 30 Y

ALMADIN 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708141001 30 Y

CIPLAVASC 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708150001 30 Y

KLODIP 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708162001 30 Y

NORCARD 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708190001 30 Y

LOMANOR 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708352001 30 Y

AMLODIPINE ASCENDIS 5 TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 708648001 30 Y

AMLODIPINE 5MG PHARMA DYNAMICS Amlodipine besylate tab 5 mg Calcium Channel Blockers 710236001 30 Y

KEYSAL 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 712215001 30 Y

GULF AMLODIPINE 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 712953001 30 Y

STAMLO 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 713490001 30 Y

AMTAS 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 713971001 30 Y

APRATE 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 714310001 30 Y

ADCO-NORPENE 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 720693001 30 Y

AMLODIPINE UNICORN 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 723783001 30 Y

AMLOCOR 5MG TABS BOTS Amlodipine besylate tab 5 mg Calcium Channel Blockers 967127001 30 Y

JUBILENT AMLODIPINE BOTS Amlodipine besylate tab 5 mg Calcium Channel Blockers 967604001 30 Y

AMLOSIN NAM ONLY 5MG TABS Amlodipine besylate tab 5 mg Calcium Channel Blockers 3000200001 30 Y

AMLOSYN 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 704621001 30 Y

PENDINE 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 707980001 30 Y

CALBLOC 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708040001 30 Y

AMLODAC 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708051001 30 Y

AUSTELL AMLODIPINE 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708095001 30 Y

ALMADIN 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708142001 30 Y

CIPLAVASC 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708152001 30 Y

NORCARD 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708191001 30 Y

LOMANOR 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 708353001 30 Y

AMLODIPINE 10MG PHARMA DYNAMIC

Amlodipine besylate tab 10 mg Calcium Channel Blockers 710238001 30 Y

KEYSAL 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 712216001 30 Y

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Pre-auth required

GULF AMLODIPINE 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 712954001 30 Y

STAMLO 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 713491001 30 Y

AMTAS 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 713972001 30 Y

APRATE 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 714311001 30 Y

ADCO-NORPENE 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 720694001 30 Y

AMLODIPINE UNICORN 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 723784001 30 Y

AMLOCOR 10MG TABLETS BOTS Amlodipine besylate tab 10 mg Calcium Channel Blockers 967128001 30 Y

JUBILENT AMLODIPINE BOTS Amlodipine besylate tab 10 mg Calcium Channel Blockers 967605001 30 Y

AMLOSIN NAM ONLY 10MG TABS Amlodipine besylate tab 10 mg Calcium Channel Blockers 3000202001 30 Y

AMLOC 5MG TABS Amlodipine maleate tab 5 mg Calcium Channel Blockers 703916001 30 Y

AMLATE 5MG TABS Amlodipine maleate tab 5 mg Calcium Channel Blockers 707277001 30 Y

AMLO-DENK 5MG BOTS Amlodipine maleate tab 5 mg Calcium Channel Blockers 967513001 50 Y

AMLOC 10MG TABS Amlodipine maleate tab 10 mg Calcium Channel Blockers 703917001 30 Y

AMLATE 10MG TABS Amlodipine maleate tab 10 mg Calcium Channel Blockers 707278001 30 Y

AMLO-DENK 10MG BOTS Amlodipine maleate tab 10 mg Calcium Channel Blockers 967514001 50 Y

FELODIPINE-HEXAL 5MG TABS Felodipine Calcium Channel Blockers 703221001 30 Y

FELODIPINE-HEXAL 10MG TABS Felodipine Calcium Channel Blockers 703902001 30 Y

LERCANIDIPINE TEVA 10MG TABS Lercanidipine hcl tabs Calcium Channel Blockers 723574001 28 Y

LERCANIDIPINE TEVA 20MG TABS Lercanidipine hcl tabs Calcium Channel Blockers 723575001 28 Y

COVERAM 5/5MG TABS Amlodipine besylate-perindopril arginine tab 5-5 m

ACE Inhibitors 719855001 30 Y

COVERAM 10/5MG TABS Amlodipine besylate-perindopril arginine tab 5-10






CIBADREX 10MG TABS Benazepril & HCTZ ACE Inhibitors 800279019 28 Y

CIBACE 10MG TABS Benazepril hcl tabs ACE Inhibitors 794058020 28 Y

CAPTOPRIL 3MG/5ML Captopril tabs ACE Inhibitors 80215001 100 Y

CAPTOPRIL 1MG/5ML Captopril tabs ACE Inhibitors 80576001 100 Y

CAPTOPRIL 5.0 MG/5ML Captopril tabs ACE Inhibitors 80577001 100 Y

CAPTOPRIL 6.25MG/5ML Captopril tabs ACE Inhibitors 80578001 100 Y

INHIBACE PLUS TABS Cilazapril-hydrochlorthiazide ACE Inhibitors 815055005 28 Y

INHIBACE 5MG TABS Cilazapril tab 5 mg ACE Inhibitors 792756002 28 Y

RENITEC 2.5MG TABS Enalapril maleate tabs ACE Inhibitors 810355019 14 Y

AUSTELL-LISINOPRIL 2.5MG TABS Lisinopril tabs ACE Inhibitors 704354001 28 Y

PERDIX 7.5MG TABS Moexipril hcl tabs ACE Inhibitors 890222001 30 Y

PERDIX 15MG TABS Moexipril hcl tabs ACE Inhibitors 890229001 30 Y

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Pre-auth required

TRIPLIXAM NAM ONLY 5/1.25/5MG Perindopril-amlodipine-indapamide tab 5-5-1.25 mg








BIOPREXUM PLUS 10MG/2.5MG TABS Perindopril arginine-indapamide tab 10-2.5 mg ACE Inhibitors 721508001 30 Y

TRI-PLEN 2.5MG TABS Ramipril-felodipine tab 2.5-2.5 mg ACE Inhibitors 862207002 30 Y

TRI-PLEN FORTE 5MG TABS Ramipril-felodipine tab 5-5 mg ACE Inhibitors 862215005 30 Y

CO-RAMIWIN 2.5MG/12.5MG TABS Ramipril-hydrochlorothiazide tab 2.5-12.5 mg ACE Inhibitors 723564001 30 Y

TRITACE PLUS 5MG/12.5MG TABS Ramipril-hydrochlorothiazide tab 5-12.5 mg ACE Inhibitors 718094001 28 Y

TRITACE PLUS 5MG/25MG TABS Ramipril-hydrochlorothiazide tab 5-25 mg ACE Inhibitors 718092001 28 Y

MAVIK 0.5MG CAPS Trandolapril ACE Inhibitors 805033017 30 Y

MAVIK 2MG CAPS Trandolapril ACE Inhibitors 805068015 30 Y

TARKA 180MG/2MG CR TABS Trandolapril-verapamil hcl tab cr 2-180 mg ACE Inhibitors 714624001 30 Y

TARKA 240MG/4MG CR TABS Trandolapril-verapamil hcl tab cr 4-240 mg ACE Inhibitors 714625001 30 Y

CO-RENITEC TABS Enalapril maleate & hctz ACE Inhibitors 787035009 28 Y

RENITEC 5MG TABS Enalapril maleate tabs ACE Inhibitors 759759006 28 Y



MONOPRIL 20MG TABS Fosinopril sodium tabs ACE Inhibitors 791962016 30 Y

ZESTORETIC 20MG TABS Lisinopril & HCTZ ACE Inhibitors 797685006 30 Y

ZESTORETIC 10MG TABS Lisinopril & HCTZ ACE Inhibitors 817848002 30 Y

ZESTRIL 5MG TABS Lisinopril tabs ACE Inhibitors 781681006 30 Y



COVERSYL PLUS TABS Perindopril erbumine-indapamid ACE Inhibitors 877549001 30 Y

COVERSYL PLUS TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 877549001 30 Y

COVERSYL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 785121005 30 Y

ACCURETIC 10/12.5 TABS Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 795755007 28 Y

ACCURETIC 20/12.5 TABS Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 805297006 28 Y

ACCUPRIL 5MG TABS Quinapril hcl tab 5 mg ACE Inhibitors 783293003 28 Y




TRITACE 2.5MG TABS Ramipril ACE Inhibitors 841587019 30 Y

TRITACE 5MG TABS Ramipril ACE Inhibitors 841595003 30 Y

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Pre-auth required

TRITACE PLUS 10MG/12.5MG TABS Ramipril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 718093001 28 Y

TRITACE 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 782602002 30 Y

REAPTAN 5/5MG TABS Amlodipine besylate-perindopril arginine tab 5-5 m


REAPTAN 10/5MG TABS Amlodipine besylate-perindopril arginine tab 5-10






ZAPTO-CO TABS Captopril & HCTZ ACE Inhibitors 839795009 28 Y

CAPACE 25MG TABS Captopril tabs ACE Inhibitors 795267002 60 Y

ADCO-CAPTOMAX 25MG TABS Captopril tabs ACE Inhibitors 836451007 60 Y




CAPTOHEXAL 12.5MG TABS Captopril tabs ACE Inhibitors 837628008 100 Y

CAPTOHEXAL 25MG TABS Captopril tabs ACE Inhibitors 837636019 60 Y

CAPTOHEXAL 50MG TABS Captopril tabs ACE Inhibitors 837644003 60 Y

ZAPTO 25MG TABS Captopril tabs ACE Inhibitors 839779003 60 Y

ZAPTO 50MG TABS Captopril tabs ACE Inhibitors 839787006 60 Y

SANDOZ CAPTOPRIL 25MG TABS Captopril tabs ACE Inhibitors 850896002 60 Y

SANDOZ CAPTOPRIL 50MG TABS Captopril tabs ACE Inhibitors 850918006 60 Y

ACETEN 25MG TABS Captopril tabs ACE Inhibitors 852333005 60 Y

MYLAN CAPTOPRIL 25MG TABS Captopril tabs ACE Inhibitors 852619006 60 Y

MYLAN CAPTOPRIL 50MG TABS Captopril tabs ACE Inhibitors 899429009 60 Y

ANGIOPRIL 25MG BOTS Captopril tabs ACE Inhibitors 967129001 60 Y

APO CAPTOPRIL 25MG BOTS Captopril tabs ACE Inhibitors 967227001 100 Y

APO CAPTOPRIL 50MG BOTS Captopril tabs ACE Inhibitors 967303001 100 Y

EPSITRON 25MG BOTS Captopril tabs ACE Inhibitors 967385001 60 Y

EPSITRON 50MG BOTS Captopril tabs ACE Inhibitors 967386001 100 Y

PHARMAPRESS CO TABS Enalapril maleate & hctz ACE Inhibitors 885019005 30 Y

ENAP CO 20MG/12.5MG TABS Enalapril maleate & hctz ACE Inhibitors 891287008 30 Y

CIPLATEC 20MG TABS Enalapril maleate tabs ACE Inhibitors 701729001 30 Y

PHARMAPRESS 5MG TABS Enalapril maleate tabs ACE Inhibitors 708109001 30 Y

ENVAS 5MG TABS Enalapril maleate tabs ACE Inhibitors 712762001 30 Y

ENVAS 10MG TABS Enalapril maleate tabs ACE Inhibitors 712763001 30 Y

AUSTELL ENALAPRIL 5MG TABS Enalapril maleate tabs ACE Inhibitors 721625001 30 Y


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Pre-auth required


ENALAPRIL BIOTECH 5MG TABS Enalapril maleate tabs ACE Inhibitors 723156001 30 Y



HYPACE 5MG TABS Enalapril maleate tabs ACE Inhibitors 862622034 200 Y

HR-ENALAPRIL 5MG TABS Enalapril maleate tabs ACE Inhibitors 867845007 30 Y





ALAPREN 5MG TABS Enalapril maleate tabs ACE Inhibitors 881473006 28 Y



ADCO-ENALAPRIL 5MG TABS Enalapril maleate tabs ACE Inhibitors 886835005 28 Y



ENAP 5MG TABS Enalapril maleate tabs ACE Inhibitors 891272005 30 Y





KORANDIL BOTS Enalapril maleate tabs ACE Inhibitors 967215001 30 Y



APO ENALAPRIL BOTS Enalapril maleate tabs ACE Inhibitors 967308001 100 Y

APO ENALAPRIL BOTS Enalapril maleate tabs ACE Inhibitors 967309001 100 Y

LISORETIC 10/HCTZ TABS Lisinopril & HCTZ ACE Inhibitors 704437001 30 Y

LISORETIC 20/HCTZ TABS Lisinopril & HCTZ ACE Inhibitors 704438001 30 Y

ADCO-ZETOMAX-CO 10/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 704597001 30 Y

ADCO-ZETOMAX-CO 20/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 704598001 30 Y

HEXAL-LISINOPRIL CO 10MG TABS Lisinopril & HCTZ ACE Inhibitors 704703001 30 Y

HEXAL-LISINOPRIL CO 20MG TABS Lisinopril & HCTZ ACE Inhibitors 704704001 30 Y

LISOZIDE 20MG/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 707291001 30 Y

LISOZIDE 10MG/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 707292001 30 Y

ZESTOZIDE 20MG TABS Lisinopril & HCTZ ACE Inhibitors 708260001 30 Y

LISINOZIDE 20MG/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 711989001 30 Y

LISINOZIDE 10MG/12.5MG TABS Lisinopril & HCTZ ACE Inhibitors 711990001 30 Y

AURO-LISINOPRIL CO 10MG TABS Lisinopril & HCTZ ACE Inhibitors 716120001 30 Y

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Pre-auth required

AURO-LISINOPRIL CO 20MG TABS Lisinopril & HCTZ ACE Inhibitors 716121001 30 Y

LISINOPRIL CO UNICORN 10/12.5M Lisinopril & HCTZ ACE Inhibitors 716943001 30 Y

LISINOPRIL CO UNICORN 20/12.5M Lisinopril & HCTZ ACE Inhibitors 716945001 30 Y

SINOPREN 5MG TABS Lisinopril tabs ACE Inhibitors 700691001 30 Y



HEXAL-LISINOPRIL 5MG TABS Lisinopril tabs ACE Inhibitors 701387003 30 Y



CIPLA LISINOPRIL 10MG TABS Lisinopril tabs ACE Inhibitors 703645001 30 Y

CIPLA LISINOPRIL 5MG TABS Lisinopril tabs ACE Inhibitors 703646001 30 Y

ZEMAX 20MG TABS (LISINOHEXAL) Lisinopril tabs ACE Inhibitors 705318001 30 Y

SIMAYLA LISINOPRIL 10MG TABS Lisinopril tabs ACE Inhibitors 707311001 30 Y

SIMAYLA LISINOPRIL 20MG TABS Lisinopril tabs ACE Inhibitors 707312001 30 Y

AUSTELL-LISINOPRIL 20MG TABS Lisinopril tabs ACE Inhibitors 708189001 30 Y

AUSTELL-LISINOPRIL 10MG TABS Lisinopril tabs ACE Inhibitors 712598001 30 Y

LIZRO 5MG TABS Lisinopril tabs ACE Inhibitors 714677001 30 Y



APEX-LISINOPRIL 20MG TABS Lisinopril tabs ACE Inhibitors 715938001 30 Y

LYSIN 5MG TABS Lisinopril tabs ACE Inhibitors 716792001 30 Y

LYSIN 20MG TABS Lisinopril tabs ACE Inhibitors 716794001 30 Y

ADCO-ZETOMAX 5MG TABS Lisinopril tabs ACE Inhibitors 862045002 30 Y



LISTRIL 10MG TABS BOTS Lisinopril tabs ACE Inhibitors 967143001 30 Y

LISTRIL 5MG TABS BOTS Lisinopril tabs ACE Inhibitors 967144001 30 Y

LISO 5MG TABS Lisinopril tabs ACE Inhibitors 3000546001 30 Y



PREXUM PLUS 2.5MG/0.625MG TABS Perindopril arginine-indapamide tab 2.5-0.625 mg


PREXUM PLUS 5MG/1.25MG TABS Perindopril arginine-indapamide tab 5-1.25 mg ACE Inhibitors 720388001 30 Y

COVERSYL PLUS 5MG/1.25MG TABS Perindopril arginine-indapamide tab 5-1.25 mg ACE Inhibitors 720389001 30 Y

COVERSYL 5MG TABS Perindopril arginine tab 5 mg ACE Inhibitors 705914001 30 Y

PREXUM 5MG TABS Perindopril arginine tab 5 mg ACE Inhibitors 720387001 30 Y

COVERSYL 10MG TABS Perindopril arginine tab 10 mg ACE Inhibitors 705915001 30 Y

PREXUM 10MG TABS Perindopril arginine tab 10 mg ACE Inhibitors 714646001 30 Y

PRETERAX TABS Perindopril erbumine-indapamid ACE Inhibitors 700512001 30 Y

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Pre-auth required

PREXUM PLUS TABS Perindopril erbumine-indapamid ACE Inhibitors 704929001 30 Y

CIRCATOR PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamid ACE Inhibitors 708650001 30 Y

VECTORYL PLUS TABS Perindopril erbumine-indapamid ACE Inhibitors 710298001 30 Y

SPEC-PERINDOPRIL PLUS 2MG/0.62 Perindopril erbumine-indapamid ACE Inhibitors 713762001 30 Y

SPEC-PERINDOPRIL PLUS 4MG/1.25 Perindopril erbumine-indapamid ACE Inhibitors 713763001 30 Y

PEARINDA PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamid ACE Inhibitors 714952001 30 Y

ACESYL CO 2MG/0.625MG TABS Perindopril erbumine-indapamid ACE Inhibitors 715650001 30 Y

ACESYL CO 4MG/1.25MG TABS Perindopril erbumine-indapamid ACE Inhibitors 715651001 30 Y

CIPLASYL PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamid ACE Inhibitors 717095001 30 Y

PERINDOPRIL CO UNICORN 4/1.25 Perindopril erbumine-indapamid ACE Inhibitors 717782001 30 Y

ARIPREL PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamid ACE Inhibitors 717795001 30 Y

PRETERAX TABS Perindopril erbumine-indapamide tab 2-0.625 mg


SPEC-PERINDOPRIL PLUS 2MG/0.62 Perindopril erbumine-indapamide tab 2-0.625 mg


ACESYL CO 2MG/0.625MG TABS Perindopril erbumine-indapamide tab 2-0.625 mg


PREXUM PLUS TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 704929001 30 Y

CIRCATOR PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 708650001 30 Y

VECTORYL PLUS TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 710298001 30 Y

SPEC-PERINDOPRIL PLUS 4MG/1.25 Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 713763001 30 Y

PEARINDA PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 714952001 30 Y

ACESYL CO 4MG/1.25MG TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 715651001 30 Y

CIPLASYL PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 717095001 30 Y

PERINDOPRIL CO UNICORN 4/1.25 Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 717782001 30 Y

ARIPREL PLUS 4MG/1.25MG TABS Perindopril erbumine-indapamide tab 4-1.25 mg ACE Inhibitors 717795001 30 Y

PREXUM 4MG TABS Perindopril erbumine tabs ACE Inhibitors 703541003 30 Y

CIRCATOR 4MG TABS Perindopril erbumine tabs ACE Inhibitors 708649001 30 Y

VECTORYL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 710297001 30 Y

CIPLA-PERINDOPRIL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 710302001 30 Y

CIPLA-PERINDOPRIL 8MG TABS Perindopril erbumine tabs ACE Inhibitors 710510001 30 Y

RAN-PERINDOPRIL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 710611001 30 Y

VECTORYL 8MG TABS Perindopril erbumine tabs ACE Inhibitors 710925001 30 Y

SPEC-PERINDOPRIL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 712615001 30 Y

SPEC-PERINDOPRIL 8MG TABS Perindopril erbumine tabs ACE Inhibitors 712616001 30 Y

PEARINDA 4MG TABS Perindopril erbumine tabs ACE Inhibitors 714527001 30 Y

PEARINDA 8MG TABS Perindopril erbumine tabs ACE Inhibitors 714528001 30 Y

ACTI-PREX 4MG TABS GLENMARK P Perindopril erbumine tabs ACE Inhibitors 714869001 30 Y

ACESYL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 715649001 30 Y

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Pre-auth required

CIPLASYL 4MG TABS Perindopril erbumine tabs ACE Inhibitors 715786001 30 Y

CIPLASYL 8MG TABS Perindopril erbumine tabs ACE Inhibitors 715795001 30 Y

REPREX 4MG (WAS AURO PERINDOP Perindopril erbumine tabs ACE Inhibitors 716505001 30 Y

REPREX 8MG (WAS AURO PERINDOP Perindopril erbumine tabs ACE Inhibitors 716506001 30 Y

ZYACE 4MG TABS (ZYDUS PERIND) Perindopril erbumine tabs ACE Inhibitors 716680001 30 Y

BINDACE 4MG TABS Perindopril erbumine tabs ACE Inhibitors 717293001 30 Y

BINDACE 8MG TABS Perindopril erbumine tabs ACE Inhibitors 717294001 30 Y

PERINDOPRIL UNICORN 4MG TABS Perindopril erbumine tabs ACE Inhibitors 717783001 30 Y

PERINDOPRIL UNICORN 8MG TABS Perindopril erbumine tabs ACE Inhibitors 717784001 30 Y

PERISTAR 4MG TABS Perindopril erbumine tabs ACE Inhibitors 721339001 30 Y

PERISTAR 8MG TABS Perindopril erbumine tabs ACE Inhibitors 721340001 30 Y

PERIGARD BOTS Perindopril erbumine tabs ACE Inhibitors 967342001 200 Y

CIRCATOR 8MG TABS Perindopril erbumine tabs ACE Inhibitors 3000236001 30 Y

ADCO-QUINARETIC 10/12.5 TABS Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 706235001 30 Y

QUINAZIDE 10/12.5 TABS Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 707550001 30 Y

ACCUMAX CO 10/12.5MG TABS Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 708116001 30 Y

KWINCO 10/12.5MG (WAS AURO QUI Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 718056001 30 Y

BIQURETIC 10MG/12.5MG TABS Quinapril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 719873001 30 Y

ADCO-QUINARETIC 20/12.5 TABS Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 706236001 30 Y

QUINAZIDE 20/12.5 TABS Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 707551001 30 Y

ACCUMAX CO 20/12.5MG TABS Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 708118001 30 Y

KWINCO 20/12.5MG (WAS AURO QUI Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 718057001 30 Y

BIQURETIC 20MG/12.5MG TABS Quinapril-hydrochlorothiazide tab 20-12.5 mg ACE Inhibitors 719874001 30 Y

QUINAGEN 5MG TABS Quinapril hcl tab 5 mg ACE Inhibitors 708981001 30 Y

QUINASPEN 10MG TABS Quinapril hcl tab 10 mg ACE Inhibitors 705457001 30 Y

ACCUMAX 10MG TABS Quinapril hcl tab 10 mg ACE Inhibitors 708119001 30 Y


QUINASPEN 20MG TABS Quinapril hcl tab 20 mg ACE Inhibitors 705447001 30 Y

ACCUMAX 20MG TABS Quinapril hcl tab 20 mg ACE Inhibitors 708120001 30 Y



RAMIPRIL HEXAL 2.5MG TABS Ramipril ACE Inhibitors 704374001 30 Y

RAMIPRIL HEXAL 5MG TABS Ramipril ACE Inhibitors 704375001 30 Y

RETACE 5MG TABS Ramipril ACE Inhibitors 707385001 30 Y

CO-RAMIWIN 5MG/12.5MG TABS Ramipril-hydrochlorothiazide tab 5-12.5 mg ACE Inhibitors 723565001 30 Y

CO-RAMIWIN 10MG/12.5MG TABS Ramipril-hydrochlorothiazide tab 10-12.5 mg ACE Inhibitors 723566001 30 Y

RAMPIL 1.25MG CAPS Ramipril cap 1.25 mg ACE Inhibitors 705426001 30 Y

AUSTELL-RAMIPRIL 1.25MG CAPS Ramipril cap 1.25 mg ACE Inhibitors 705752001 30 Y

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Pre-auth required

RAMIWIN 2.5MG CAPS Ramipril cap 2.5 mg ACE Inhibitors 704023001 30 Y

RAMPIL 2.5MG CAPS Ramipril cap 2.5 mg ACE Inhibitors 705427001 30 Y

AUSTELL-RAMIPRIL 2.5MG CAPS Ramipril cap 2.5 mg ACE Inhibitors 705753001 30 Y

APEX-RAMIPRIL 2.5MG CAPS Ramipril cap 2.5 mg ACE Inhibitors 715954001 28 Y

RAMIWIN 5MG CAPS Ramipril cap 5 mg ACE Inhibitors 704025001 30 Y

RAMPIL 5MG CAPS Ramipril cap 5 mg ACE Inhibitors 705428001 30 Y

AUSTELL-RAMIPRIL 5MG CAPS Ramipril cap 5 mg ACE Inhibitors 705754001 30 Y

APEX-RAMIPRIL 5MG CAPS Ramipril cap 5 mg ACE Inhibitors 715955001 28 Y

LIRACEN 5MG CAPS Ramipril cap 5 mg ACE Inhibitors 3000178001 30 Y

RAN-RAMIPRIL 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 704975001 30 Y

RAMPIL 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 705429001 30 Y

AUSTELL-RAMIPRIL 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 705755001 30 Y

SIMAYLA RAMIPRIL 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 707869001 30 Y

APEX-RAMIPRIL 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 715957001 28 Y

LIRACEN 10MG CAPS Ramipril cap 10 mg ACE Inhibitors 3000179001 30 Y

CO EXFORGE 5/160/12.5MG TABS Amlodipine-valsartan-hydrochlorothiazide tab 5-160

Angiotensin Receptor Antagonists 717631001 28 Y

CO EXFORGE 5/160/25MG TABS Amlodipine-valsartan-hydrochlorothiazide tab 5-160


CO EXFORGE 10/160/12.5MG TABS Amlodipine-valsartan-hydrochlorothiazide tab 10-16


CO EXFORGE 10/160/25MG TABS Amlodipine-valsartan-hydrochlorothiazide tab 10-16


CO EXFORGE 10MG/320MG/25MG Amlodipine-valsartan-hydrochlorothiazide tab 10-32


EXFORGE 5MG/320MG EC TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 719125001 28 Y

EXFORGE 10MG/320MG EC TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 719126001 28 Y

EXFORGE 5MG/320MG EC TABS Amlodipine besylate-valsartan tab 5-320 mg Angiotensin Receptor Antagonists 719125001 28 Y

EXFORGE 10MG/320MG EC TABS Amlodipine besylate-valsartan tab 10-320 mg Angiotensin Receptor Antagonists 719126001 28 Y

AMZAAR 5MG/50MG TABS Amlodipine camsylate-losartan potassium tab 5-50 m


AMZAAR 5MG/100MG TABS Amlodipine camsylate-losartan potassium tab 5-100


ATACAND PLUS 32/12.5MG TABS Candesartan cilexetil-hydrochl Angiotensin Receptor Antagonists 717580001 28 Y

ATACAND PLUS 32/25MG TABS Candesartan cilexetil-hydrochl Angiotensin Receptor Antagonists 717723001 28 Y

TEVETEN PLUS 600MG/12.5MG Eprosartan mesylate-hydrochlor Angiotensin Receptor Antagonists 708096001 28 Y

CO-IRBEWIN 300/25MG TABS Irbesartan-hydrochlorothiazide tab 300-25 mg Angiotensin Receptor Antagonists 720930001 28 Y

COZAAR COMP 100MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 100-1


TWYNSTA 40/5MG TABS Telmisartan-amlodipine tab 40-5 mg Angiotensin Receptor Antagonists 717366001 28 Y


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Pre-auth required



CO-MICARDIS 80MG/25MG TABS Telmisartan-hydrochlorothiazide tab 80-25 mg Angiotensin Receptor Antagonists 716791001 28 Y

CO-DIOVAN 320MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 320-12.5 mg Angiotensin Receptor Antagonists 710048001 28 Y

CO-DIOVAN 320MG/25MG TABS Valsartan-hydrochlorothiazide tab 320-25 mg Angiotensin Receptor Antagonists 710050001 28 Y

DIOVAN 320MG TABS Valsartan tab 320 mg Angiotensin Receptor Antagonists 710051001 28 Y

EXFORGE 5MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 711253001 28 Y

EXFORGE 10MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 711254001 28 Y

EXFORGE 10MG/160MG TABS Amlodipine besylate-valsartan tab 10-160 mg Angiotensin Receptor Antagonists 711254001 28 Y

ATACAND PLUS 16/12.5MG TABS Candesartan cilexetil-hydrochl Angiotensin Receptor Antagonists 898635005 28 Y

ATACAND 8MG TABS Candesartan cilexetil tab 8 mg Angiotensin Receptor Antagonists 856096009 28 Y



CO-APROVEL 150/12.5 TABS Irbesartan-hydrochlorothiazide tab 150-12.5 mg Angiotensin Receptor Antagonists 891353004 28 Y

CO-APROVEL 300/12.5 TABS Irbesartan-hydrochlorothiazide tab 300-12.5 mg Angiotensin Receptor Antagonists 898597005 28 Y

APROVEL 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 837814006 28 Y

APROVEL 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 837822009 28 Y

COZAAR COMP 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


FORTZAAR TABS Losartan potassium & hydrochlorothiazide tab 100-2


COZAAR 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 710079001 30 Y

COZAAR 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 818739002 30 Y

CO-MICARDIS 40/12.5MG TABS Telmisartan-hydrochlorothiazide tab 40-12.5 mg Angiotensin Receptor Antagonists 894614002 28 Y

CO-MICARDIS 80/12.5MG TABS Telmisartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 894621009 28 Y

MICARDIS 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 860387003 28 Y

MICARDIS 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 860395006 28 Y

CO-DIOVAN 80/12.5MG TABS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 839884002 28 Y

CO-DIOVAN 160/12.5MG TABS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 891894005 28 Y

CO-DIOVAN 160MG PLUS TABS Valsartan-hydrochlorothiazide tab 160-25 mg Angiotensin Receptor Antagonists 706051001 28 Y

DIOVAN 40MG F/COATED TABS Valsartan tab 40 mg Angiotensin Receptor Antagonists 705488001 28 Y



COPALIA 5MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 721593001 28 Y

COPALIA 10MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 721594001 28 Y

VALDUO 5MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 3000682001 30 Y

VALDUO 10MG/160MG TABS Amlodipine besylate-valsartan Angiotensin Receptor Antagonists 3000683001 30 Y

COPALIA 10MG/160MG TABS Amlodipine besylate-valsartan tab 10-160 mg Angiotensin Receptor Antagonists 721594001 28 Y

VALDUO 10MG/160MG TABS Amlodipine besylate-valsartan tab 10-160 mg Angiotensin Receptor Antagonists 3000683001 30 Y

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Pre-auth required

CANDEPRES PLUS 16MG/12.5MG Candesartan cilexetil-hydrochl Angiotensin Receptor Antagonists 719453001 30 Y

MYLACAND PLUS 16MG/12.5MG Candesartan cilexetil-hydrochl Angiotensin Receptor Antagonists 719506001 30 Y

MYLACAND 8MG TABS Candesartan cilexetil tab 8 mg Angiotensin Receptor Antagonists 719209001 30 Y

CANDAGEN 8MG TABS Candesartan cilexetil tab 8 mg Angiotensin Receptor Antagonists 720318001 30 Y

ABECARD 8MG TABS Candesartan cilexetil tab 8 mg Angiotensin Receptor Antagonists 721629001 30 Y

ATERWIN 8MG TABS Candesartan cilexetil tab 8 mg Angiotensin Receptor Antagonists 723123001 30 Y

MYLACAND 16MG TABS Candesartan cilexetil tab 16 mg Angiotensin Receptor Antagonists 719210001 30 Y

CANDAGEN 16MG TABS Candesartan cilexetil tab 16 mg Angiotensin Receptor Antagonists 720319001 30 Y





CO-IRBEWIN 150/12.5MG TABS Irbesartan-hydrochlorothiazide tab 150-12.5 mg Angiotensin Receptor Antagonists 712386001 28 Y


ISART CO 150MG/12.5MG TABS Irbesartan-hydrochlorothiazide tab 150-12.5 mg Angiotensin Receptor Antagonists 718571001 28 Y



ISART CO 300MG/12.5MG TABS Irbesartan-hydrochlorothiazide tab 300-12.5 mg Angiotensin Receptor Antagonists 718573001 28 Y

IRBEWIN 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 712385001 28 Y


DYNARB 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 717793001 30 Y

IRTANEL 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 718506001 28 Y

ADCO-IRBESARTAN 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 718667001 28 Y

ISART 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 719162001 28 Y

ANTOSART 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 720582001 28 Y

JUBITAN 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 723194001 28 Y

IRBIS BOTS ONLY 150MG TABS Irbesartan tab 150 mg Angiotensin Receptor Antagonists 967716001 10 Y



DYNARB 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 717794001 30 Y

IRTANEL 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 718507001 28 Y

ADCO-IRBESARTAN 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 718668001 28 Y

ISART 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 719163001 28 Y

ANTOSART 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 720583001 28 Y

JUBITAN 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 723203001 28 Y

IRBIS BOTS ONLY 300MG TABS Irbesartan tab 300 mg Angiotensin Receptor Antagonists 967717001 10 Y

SARTOC-CO 50/12.5 TABS Losartan potassium & hydrochlorothiazide tab 50-12


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Pre-auth required

LOZAAN CO 50/12.5 TABS Losartan potassium & hydrochlorothiazide tab 50-12


NETRASOL CO 50/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


LOSAAR PLUS 50/12.5 TABS Losartan potassium & hydrochlorothiazide tab 50-12


LOHYPE PLUS 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


ZARTAN CO 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


LOSACAR CO 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


HYTENZA CO 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


AUSTELL LOSARTAN CO 50MG/12.5 Losartan potassium & hydrochlorothiazide tab 50-12


LOSARTAN CO UNICORN 50MG/12.5 Losartan potassium & hydrochlorothiazide tab 50-12


MEDI-LOSARCO 50MG/12.5MG NAM O Losartan potassium & hydrochlorothiazide tab 50-12


COLOSAR DENK BOTS Losartan potassium & hydrochlorothiazide tab 50-12


LOSAR DENK BOTS Losartan potassium & hydrochlorothiazide tab 50-12


CO-NORMOTEN 50MG/12.5MG TABS Losartan potassium & hydrochlorothiazide tab 50-12


LOSARTAN COMP BIOTECH 50MG/12. Losartan potassium & hydrochlorothiazide tab 50-12


LOZAAN CO 100/25 TABS Losartan potassium & hydrochlorothiazide tab 100-2


NETRASOL CO 100/25MG TABS Losartan potassium & hydrochlorothiazide tab 100-2


LOSAAR PLUS 100/25 TABS Losartan potassium & hydrochlorothiazide tab 100-2


LOHYPE FORTE PLUS 100MG/25MG Losartan potassium & hydrochlorothiazide tab 100-2


ZARTAN CO 100MG/25MG TABS Losartan potassium & hydrochlorothiazide tab 100-2


SARTOC-CO 100/25 TABS Losartan potassium & hydrochlorothiazide tab 100-2


HYTENZA CO 100MG/25MG TABS Losartan potassium & hydrochlorothiazide tab 100-2


LOSARTAN CO UNICORN 100/25MG T Losartan potassium & hydrochlorothiazide tab 100-2


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Pre-auth required

CO-NORMOTEN 100MG/25MG TABS Losartan potassium & hydrochlorothiazide tab 100-2


LOSARTAN COMP BIOTECH 100MG/25 Losartan potassium & hydrochlorothiazide tab 100-2


ZARTAN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709225001 30 Y

CIPLA LOSARTAN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709844001 30 Y

CIPLA LOSARTAN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709845001 30 Y

LOSARTAN-WINTHROP TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709909001 30 Y

LOS-ARB 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709924001 30 Y

ZARTAN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 709964001 30 Y

SPEC-LOSARTAN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 713254001 30 Y

SPEC-LOSARTAN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 713255001 30 Y

RENICARD 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 715871001 30 Y

ANNIN 50MG (WAS AURO LOSART Losartan potassium tabs Angiotensin Receptor Antagonists 716494001 30 Y

ANNIN 100MG (WAS AURO LOSART Losartan potassium tabs Angiotensin Receptor Antagonists 716495001 30 Y

CIPLAZAR 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 716643001 30 Y

CIPLAZAR 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 716644001 30 Y

HYTENZA 50MG FILM COATED TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717024001 30 Y

HYTENZA 100MG FILM COATED TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717042001 30 Y

AUSTELL LOSARTAN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717068001 30 Y

AUSTELL LOSARTAN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717069001 30 Y

RASOL 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717295001 30 Y

RASOL 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 717296001 30 Y

LOSARTAN UNICORN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 718365001 30 Y

LOSARTAN UNICORN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 718366001 30 Y

LOZAAN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 720775001 30 Y

LOZAAN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 720776001 30 Y

NORMOTEN 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 721259001 30 Y

NORMOTEN 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 721260001 30 Y

TOZAAR 50MG TABS BOTS Losartan potassium tabs Angiotensin Receptor Antagonists 967196001 30 Y

LOSAR DENK BOTS Losartan potassium tabs Angiotensin Receptor Antagonists 967645001 28 Y

LOSAR DENK BOTS Losartan potassium tabs Angiotensin Receptor Antagonists 967650001 28 Y

LOSAGEN NAM ONLY 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 3000460001 30 Y

LOSAGEN NAM ONLY 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 3000461001 30 Y

ZAARIO 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 3000512001 30 Y

ZAARIO 100MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 3000513001 30 Y

LOSARTAN BIOTECH 50MG TABS Losartan potassium tabs Angiotensin Receptor Antagonists 3000575001 30 Y

CO-PRITOR 40/12.5 MG TABS Telmisartan-hydrochlorothiazide tab 40-12.5 mg Angiotensin Receptor Antagonists 714251001 28 Y

CO-ACTAPRESS NAM ONLY 40/12.5M Telmisartan-hydrochlorothiazide tab 40-12.5 mg Angiotensin Receptor Antagonists 722689001 30 Y

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Pre-auth required

TELPRES PLUS 40MG/12.5MG TABS Telmisartan-hydrochlorothiazide tab 40-12.5 mg Angiotensin Receptor Antagonists 3000422001 28 Y

CO-PRITOR 80/12.5MG TABS Telmisartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 714252001 28 Y

CO-ACTAPRESS NAM ONLY 80/12.5M Telmisartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 722690001 30 Y

TELPRES PLUS 80MG/12.5MG TABS Telmisartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 3000423001 28 Y

PRITOR 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 714249001 28 Y

MIZART 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 720439001 30 Y

TELGEN 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 720592001 30 Y

ACTAPRESS 40MG TABS NAM ONLY Telmisartan tab 40 mg Angiotensin Receptor Antagonists 721133001 30 Y

TESAR 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 721678001 30 Y

ADCO TELMISARTAN 40MG TABS Telmisartan tab 40 mg Angiotensin Receptor Antagonists 3000736001 30 Y

PRITOR 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 714250001 28 Y

MIZART 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 720440001 30 Y

TELGEN 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 720593001 30 Y

ACTAPRESS 80MG TABS NAM ONLY Telmisartan tab 80 mg Angiotensin Receptor Antagonists 721134001 30 Y

TESAR 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 721679001 30 Y

ADCO TELMISARTAN 80MG TABS Telmisartan tab 80 mg Angiotensin Receptor Antagonists 3000737001 30 Y

CO-TAREG 80/12.5MG TABS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 705068001 28 Y

CO-ZOMEVEK 80MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 715558001 28 Y

CO-MIGROBEN 80/12.5MG TABS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 715570001 28 Y

DIOLO CO 80MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 718607001 28 Y

JUBILENT VALSARTAN + HCTZ BOTS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 967607001 30 Y

VALZAAR H BOTS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 967643001 30 Y

COVALSAR DENK BOTS Valsartan-hydrochlorothiazide tab 80-12.5 mg Angiotensin Receptor Antagonists 967810001 28 Y

CO-ZOMEVEK 160/12.5MG TABS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 715559001 28 Y

CO-MIGROBEN 160MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 715571001 28 Y

CO-TAREG 160MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 715672001 28 Y

DIOLO CO 160MG/12.5MG TABS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 718608001 28 Y

JUBILENT VALSARTAN + HCTZ BOTS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 967608001 30 Y

VALZAAR H BOTS Valsartan-hydrochlorothiazide tab 160-12.5 mg Angiotensin Receptor Antagonists 967662001 30 Y


CO-ZOMEVEK 160/25MG TABS Valsartan-hydrochlorothiazide tab 160-25 mg Angiotensin Receptor Antagonists 715560001 28 Y

CO-MIGROBEN 160/25MG TABS Valsartan-hydrochlorothiazide tab 160-25 mg Angiotensin Receptor Antagonists 715572001 28 Y

CO-TAREG PLUS 160/25MG TABS Valsartan-hydrochlorothiazide tab 160-25 mg Angiotensin Receptor Antagonists 715673001 28 Y


VALANT 40MG TABS Valsartan tab 40 mg Angiotensin Receptor Antagonists 719849001 28 Y

TAREG 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 705060001 28 Y

ZOMEVEK 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 715555001 28 Y

MIGROBEN 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 715568001 28 Y

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Pre-auth required

DIOLO 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 717034001 28 Y

VALSARTAN UNICORN 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 718363001 28 Y


DYNAVAL 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 723724001 30 Y

VASOVAN 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 723770001 28 Y

ADCO-VALSARTAN 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 723946001 30 Y

VALSAR DENK BOTS Valsartan tab 80 mg Angiotensin Receptor Antagonists 967813001 28 Y

VALHEFT 80MG TABS Valsartan tab 80 mg Angiotensin Receptor Antagonists 3000480001 30 Y

TAREG 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 704696001 28 Y

ZOMEVEK 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 715556001 28 Y

MIGROBEN 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 715569001 28 Y

DIOLO 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 717035001 28 Y

VALSARTAN UNICORN 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 718364001 28 Y


DYNAVAL 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 723725001 30 Y

VASOVAN 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 723771001 28 Y

ADCO-VALSARTAN 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 723947001 30 Y

VALHEFT 160MG TABS Valsartan tab 160 mg Angiotensin Receptor Antagonists 3000481001 30 Y

VALSAR DENK BOTS Valsartan tab 320 mg Angiotensin Receptor Antagonists 967815001 28 Y

CADUET 5MG/10MG TABS Amlodipine besylate-atorvastatin calcium tab 5-10

Other Hypertensive Agents 705837001 30 Y















DILTIAZEM SECT21 60MG TABS Diltiazem hcl tab 60 mg Calcium Channel Blockers 3000663001 90 Y

ADALAT RETARD 10MG TABS Nifedipine tab sr 12hr 10 mg Calcium Channel Blockers 796891001 60 Y

ADALAT XL 20MG TABS Nifedipine tab sr 24hr 20 mg Calcium Channel Blockers 711607001 28 Y

ADALAT RETARD 20MG TABS Nifedipine tab sr 12hr 20 mg Calcium Channel Blockers 783889003 60 Y



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Pre-auth required

ISOPTIN 40MG TABS Verapamil hcl tab 40 mg Calcium Channel Blockers 734071019 100 Y

ISOPTIN SR 240MG TABS Verapamil hcl tbcr Calcium Channel Blockers 734373007 30 Y

ISOPTIN SR 240MG TABS Verapamil hcl tbcr Calcium Channel Blockers 734373015 100 Y

ADCO-ZILDEM 180MG SR CAPS Diltiazem hcl cap sr 24hr 180 mg Calcium Channel Blockers 839183003 30 Y

ADCO-ZILDEM 240MG SR CAPS Diltiazem hcl cap sr 24hr 240 mg Calcium Channel Blockers 839191006 30 Y

ADCO-ZILDEM 60MG TABS Diltiazem hcl tab 60 mg Calcium Channel Blockers 822213001 50 Y

ADCO-ZILDEM 60MG TABS Diltiazem hcl tab 60 mg Calcium Channel Blockers 822213029 60 Y

APO DILTIAZ 60MG BOTS Diltiazem hcl tab 60 mg Calcium Channel Blockers 967236001 100 Y

ZILDEM 90MG TABS Diltiazem hcl tab 90 mg Calcium Channel Blockers 824364007 60 Y

ADCO-VASCARD 20MG SR CAPS Nifedipine cap er 12hr 20 mg Calcium Channel Blockers 840963009 60 Y



NIFEDALAT 20SR TABS Nifedipine tab sr 12hr 20 mg Calcium Channel Blockers 829501002 60 Y

CIPALAT RETARD 20MG TABS Nifedipine tab sr 12hr 20 mg Calcium Channel Blockers 864153007 60 Y

CALCIGARD RETARD 20MG BOTS Nifedipine tab sr 12hr 20 mg Calcium Channel Blockers 967132001 100 Y

CALCIGARD RETARD 20MG BOTS Nifedipine tab sr 12hr 20 mg Calcium Channel Blockers 967132002 60 Y

NIFEDI-DENK RETARD BOTS Nifedipine tab sr 24hr 20 mg Calcium Channel Blockers 967517001 100 Y

FEDALOC SR 30MG TABS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 711682001 30 Y

MACOREL 30 SR TABS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 715000001 30 Y

SPEC NIFEDIPINE SR 30MG SR Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 715002001 30 Y

BIO NIFEDIPINE XL 30MG TABS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 718083001 30 Y

GITSALAT 30MG TABS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 719449001 28 Y

CIPALAT XR 30MG TABS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 723283001 30 Y

NIFELAT LA 30MG BOTS Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 967414001 30 Y

EUROWIN NIFEDIPINE 30MG XR BOT Nifedipine tab sr 24hr 30 mg Calcium Channel Blockers 967936001 30 Y

FEDALOC SR 60MG TABS Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 711714001 30 Y

MACOREL 60 SR TABS Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 715001001 30 Y

SPEC NIFEDIPINE SR 60MG SRT Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 715003001 30 Y

BIO NIFEDIPINE XL 60MG TABS Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 718085001 30 Y

GITSALAT 60MG TABS Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 719450001 28 Y

CIPALAT XR 60MG TABS Nifedipine tab sr 24hr 60 mg Calcium Channel Blockers 723284001 30 Y

VASOMIL 40MG TABS Verapamil hcl tab 40 mg Calcium Channel Blockers 774944013 100 Y


CAVERIL BOTS Verapamil hcl tab 40 mg Calcium Channel Blockers 967359001 50 Y



VERAHEXAL 240 SR TABS Verapamil hcl tbcr Calcium Channel Blockers 700071003 30 Y

VERAHEXAL 240 SR TABS Verapamil hcl tbcr Calcium Channel Blockers 700071006 100 Y

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Pre-auth required

CALCICARD SR 240MG Verapamil hcl tbcr Calcium Channel Blockers 813354005 30 Y

RAVAMIL SR 240MG TABS Verapamil hcl tbcr Calcium Channel Blockers 819573019 30 Y

RAVAMIL SR 240MG TABS Verapamil hcl tbcr Calcium Channel Blockers 819573027 100 Y

ISORDIL 40MG TABS Isosorbide dinitrate tbcr Organic Nitrates 734438001 30 Y

ISORDIL 40MG TABS Isosorbide dinitrate tbcr Organic Nitrates 734438028 100 Y

ELANTAN LA 50MG CAPS Isosorbide mononitrate cap er 24hr 50 mg Organic Nitrates 860115003 30 Y

CORALAN 5MG TABS Ivabradine hcl tab 5 mg (base Organic Nitrates 710620001 56 Y

CORALAN 7.5MG TABS Ivabradine hcl tab 5 mg (base Organic Nitrates 710621001 56 Y

NITROLINGUAL .4MG 200 AER Nitroglycerin aers Organic Nitrates 787256005 1 Y

ANGISED 0.5MG TABS Nitroglycerin subl Organic Nitrates 703605003 50 Y

ISORDIL 5MG SL TABS Isosorbide dinitrate subl Organic Nitrates 734411006 50 Y

ISORDIL 10MG TABS Isosorbide dinitrate tabs Organic Nitrates 734381018 50 Y



IMDUR 60MG TABS Isosorbide mononitrate Organic Nitrates 821500007 30 Y

ISMO 20MG TABS Isosorbide mononitrate tabs Organic Nitrates 734055005 60 Y

SANDOZ ISOSORBIDE 5MG SL TABS Isosorbide dinitrate subl Organic Nitrates 784192006 50 Y

ISOREM SUBLINGUAL BOTS Isosorbide dinitrate subl Organic Nitrates 967403001 100 Y

ISOREM BOTS Isosorbide dinitrate subl Organic Nitrates 967404001 50 Y

SANDOZ ISOSORBIDE 10MG TABS Isosorbide dinitrate tabs Organic Nitrates 784206007 50 Y

SANDOZ ISOSORBIDE 10MG TABS Isosorbide dinitrate tabs Organic Nitrates 784206016 84 Y

ISOSORBIDE DINITRATE BOTS Isosorbide dinitrate tabs Organic Nitrates 967296001 100 Y

APO ISOSORBIDE BOTS Isosorbide dinitrate tabs Organic Nitrates 967313001 100 Y

MONICOR SR 60MG TABS Isosorbide mononitrate Organic Nitrates 710251001 30 Y

ELANTAN 20MG TABS Isosorbide mononitrate tabs Organic Nitrates 793418003 60 Y

ELANTAN 20MG TABS Isosorbide mononitrate tabs Organic Nitrates 793418011 500 Y

BEZALIP 200MG TABS Bezafibrate tab 200 mg Fibrates 708453007 90 Y

LIPANTHYL 200MG CAPS Fenofibrate micronized cap 200 mg Fibrates 705708001 30 Y

LOPID 600MG TABS Gemfibrozil tab 600 mg Fibrates 788627007 60 Y

BEZALIP RET 400MG TABS Bezafibrate tab cr 400 mg Fibrates 779644018 30 Y

LACROMID BOTS Bezafibrate tab 200 mg Fibrates 967406001 100 Y

DYNA-BEZAFIBRATE SR 400MG TABS Bezafibrate tab cr 400 mg Fibrates 710122001 30 Y

BEZACHOLE SR 400MG TABS Bezafibrate tab cr 400 mg Fibrates 710337001 30 Y

SANDOZ BEZAFIBRATE 400 CR TABS Bezafibrate tab cr 400 mg Fibrates 828300003 30 Y

INEGY 10/10 MG TABS Ezetimibe-simvastatin tab 10-10 mg HMG-CoA Reductase Inhibitors 715237001 30 Y



LESCOL 20MG CAPS Fluvastatin sodium caps HMG-CoA Reductase Inhibitors 813664004 28 Y

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Pre-auth required

LESCOL 40MG CAPS Fluvastatin sodium caps HMG-CoA Reductase Inhibitors 813672007 28 Y

LOVACHOL 20MG TABS Lovastatin tab 20 mg HMG-CoA Reductase Inhibitors 703906002 30 Y

LOVACHOL 40MG TABS Lovastatin tab 40 mg HMG-CoA Reductase Inhibitors 703905002 30 Y

LOVACHOL 40MG TABS Lovastatin tabs HMG-CoA Reductase Inhibitors 703905002 30 Y

LOVACHOL 20MG TABS Lovastatin tabs HMG-CoA Reductase Inhibitors 703906002 30 Y

LOVASTATIN SECT21 10MG TABS Lovastatin tabs HMG-CoA Reductase Inhibitors 3000836001 100 Y

COLITE 80MG TABS Pravastatin sodium tab 80 mg HMG-CoA Reductase Inhibitors 710977001 30 Y

LIPITOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 831484006 30 Y




LESCOL XL 80MG TABS Fluvastatin sodium tab sr 24 hr 80 mg HMG-CoA Reductase Inhibitors 700963002 28 Y

CRESTOR 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 710892001 30 Y




ZOCOR 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 783951019 28 Y



ASPAVOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 708121001 30 Y

ATORVASTATIN UNICORN 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 711621001 30 Y

LIPOGEN 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 714071001 30 Y

RAN-ATORVASTATIN 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 714075001 30 Y

ATORVASTATIN SUN 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 714370001 30 Y

ATORVASTATIN WINTHROP 10MG Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 716615001 30 Y

ADCO-ATORVASTATIN 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 718073001 30 Y

DYNATOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 718218001 30 Y

VASTOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 718933001 30 Y

ASTOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 719185001 30 Y

LESTAVOR 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 719366001 30 Y

ATORVASTATIN LHC 10MG TABS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 723710001 30 Y

APO ATORVASTATIN 10MG BOTS Atorvastatin calcium tab 10 mg (base equivalent) HMG-CoA Reductase Inhibitors 967621001 30 Y







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Pre-auth required





























VATICOL XL 80MG TABS Fluvastatin sodium tab sr 24 hr 80 mg HMG-CoA Reductase Inhibitors 718208001 28 Y

PRANALIP 10MG TABS Pravastatin sodium tab 10 mg HMG-CoA Reductase Inhibitors 704583001 30 Y

ASPEN PRAVASTATIN 10MG TABS Pravastatin sodium tab 10 mg HMG-CoA Reductase Inhibitors 705212001 30 Y

SANDOZ PRAVASTATIN 10MG TABS Pravastatin sodium tab 10 mg HMG-CoA Reductase Inhibitors 705901001 30 Y


PIXETA 10MG TABS Pravastatin sodium tab 10 mg HMG-CoA Reductase Inhibitors 715709001 30 Y

AUSTELL PRAVASTATIN 10MG TABS Pravastatin sodium tab 10 mg HMG-CoA Reductase Inhibitors 717073001 30 Y




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Pre-auth required

NOVALES 20MG FC TABS Pravastatin sodium tab 20 mg HMG-CoA Reductase Inhibitors 712952001 30 Y








VUSOR 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 719081001 30 Y

ROSVATOR 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 719249001 30 Y

ROSUVOR 5MG TABS NAM ONLY Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 721714001 30 Y

ROSTOR 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 721857001 30 Y

CRESAGEN 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 723097001 28 Y


ZUVAMOR 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 723655001 28 Y

ROSUVASTATIN UNICORN 5MG TABS Rosuvastatin calcium tab 5 mg HMG-CoA Reductase Inhibitors 3000400001 30 Y



STORWIN 10MG TABS Rosuvastatin calcium tab 10 mg HMG-CoA Reductase Inhibitors 719194001 30 Y



ROCREST 10MG TABS Rosuvastatin calcium tab 10 mg HMG-CoA Reductase Inhibitors 721807001 30 Y


ROSTATIN NAM ONLY 10MG TABS Rosuvastatin calcium tab 10 mg HMG-CoA Reductase Inhibitors 722687001 30 Y



ROSTAB BOTS ONLY 10MG TABS Rosuvastatin calcium tab 10 mg HMG-CoA Reductase Inhibitors 967890001 30 Y









ROSTATIN NAM ONLY 20MG TABS Rosuvastatin calcium tab 20 mg HMG-CoA Reductase Inhibitors 722688001 30 Y



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Pre-auth required

ROSTAB BOTS ONLY 20MG TABS Rosuvastatin calcium tab 20 mg HMG-CoA Reductase Inhibitors 967891001 30 Y












SIMVACOR 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 700519002 30 Y

ADCO-SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 701276003 30 Y

SIMVOTIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 703525001 28 Y

LIPIDEX 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 705076001 30 Y

AUSTELL-SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 705464001 30 Y


ASPEN SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 706714001 30 Y

ARROW SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 707089001 28 Y


SIMAYLA SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 707870001 28 Y

CIPLA-SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 708307001 30 Y

BIOVAC SIMVASTATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 709668001 30 Y

ZYSIM 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 710826001 30 Y

NOVATIN 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 710868001 30 Y

REDICOR 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 711232001 30 Y

SIMCOR 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 713487001 30 Y

CHOLESTE 10MG TABS Simvastatin tab 10 mg HMG-CoA Reductase Inhibitors 715708001 30 Y




LIPIDEX 20MG TABS Simvastatin tab 20 mg HMG-CoA Reductase Inhibitors 705077001 30 Y

MYLAN SIMVASTATIN 20MG TABS Simvastatin tab 20 mg HMG-CoA Reductase Inhibitors 705382001 30 Y





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SIMVA-DENK BOTS Simvastatin tab 20 mg HMG-CoA Reductase Inhibitors 967516001 30 Y
















SIMVA DENK 40 BOTS Simvastatin tab 40 mg HMG-CoA Reductase Inhibitors 967544001 30 Y



EZETROL 10MG TABS Ezetimibe tab 10 mg Other Hyperlipidaemic Agents 704378001 30 Y

KOGENATE 250IU FS POWDER FOR I Antihemophilic factor (recombinant) for inj 250 un

Haemostatics 711415001 1 Y

KOGENATE 500IU FS POWDER FOR Antihemophilic factor (recombinant) for inj 500 un


KOGENATE 1000IU FS POWDER FOR Antihemophilic factor (recombinant) for inj 1000 u


XYNTHA 1000IU POWD FOR SOLN VI Antihemophilic factor (recombinant) for inj kit 10 Haemostatics 3000376001 1 Y

XYNTHA 500IU POWD FOR SOLN VIA Antihemophilic factor (recombinant) for inj kit 50 Haemostatics 3000375001 1 Y

FACTOR DRIED ANTI-HAEMOPH V111 Antihemophilic factor/vwf (human) for inj 250 unit


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OCTANATE VIAL 5ML 250IU I Antihemophilic factor/vwf (human) for inj 250 unit


HAEMOSOLVATE 300IU Antihemophilic factor/vwf (human) for inj 300 unit


HAEMOSOLVATE 1000U Antihemophilic factor/vwf (human) for inj 500-1000


FACTOR DRIED ANTI-HAEMOPHIL Antihemophilic factor/vwf (human) for inj 500 unit


OCTANATE VIAL 10ML 500IU Antihemophilic factor/vwf (human) for inj 500 unit


EMOCLOT 500IU NAMIBIA 10ML Antihemophilic factor/vwf (human) for inj 500 unit


UMAN COMPLEX NAMIBIA 500IU Antihemophilic factor/vwf (human) for inj 500 unit


HAEMOSOLVATE 500U Antihemophilic factor/vwf (human) for inj 500 unit


EMOCLOT 500 IU SOLR FOR INF BO Antihemophilic factor/vwf (human) for inj 500 unit


OCTANATE VIAL 10ML 1000IU Antihemophilic factor/vwf (human) for inj 1000 uni


EMOCLOT 1000IU NAMIBIA 10ML Antihemophilic factor/vwf (human) for inj 1000 uni


FEIBA 1000U VH VIAL Antiinhibitor coagulant comple Haemostatics 852899009 1 Y

FEIBA 500U VH VIAL Antiinhibitor coagulant comple Haemostatics 852902018 1 Y

OCTANINE F 30ML VIAL 250IU Coagulation factor ix for inj 250 unit Haemostatics 713054001 1 Y

HAEMOSOLVEX FACTOR IX 500U Coagulation factor ix for inj 500-1500 unit Haemostatics 800767004 1 Y

OCTANINE F 30ML VIAL 500IU Coagulation factor ix for inj 500 unit Haemostatics 713100001 1 Y

AIMAFIX 500IU VIAL NAMIBIA Coagulation factor ix for inj 500 unit Haemostatics 720012001 1 Y

OCTANINE F VIAL 30ML 1000IU Coagulation factor ix for inj 1000 unit Haemostatics 713099001 1 Y

PRADAXA 75MG CAPS Dabigatran etexilate mesylate cap 75 mg (etexilate

Anti-coagulants 714548001 30 Y

PRADAXA 75MG CAPS Dabigatran etexilate mesylate cap 75 mg (etexilate


PRADAXA 110MG CAPS Dabigatran etexilate mesylate cap 110 mg (etexilat






XARELTO 10MG TABS Rivaroxaban tab 10 mg Anti-coagulants 714238002 30 Y



CIPLA-WARFARIN 1MG TABS Warfarin sodium tabs Anti-coagulants 709906001 100 Y

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WARFARIN SECT21 1MG TABS Warfarin sodium tabs Anti-coagulants 3000653001 28 Y

ASPEN WARFARIN 5MG TABS Warfarin sodium tabs Anti-coagulants 778362019 100 Y

CIPLA-WARFARIN 5MG TABS Warfarin sodium tabs Anti-coagulants 709905001 100 Y

ARANESP PREFIL SYR 10MCG/0.4ML Darbepoetin alfa soln prefilled syringe 10 mcg/0.4

Haematinics 714017001 1 Y

ARANESP PREFIL SYR 20MCG/0.5 Darbepoetin alfa soln prefilled syringe 20 mcg/0.5












ARANESP PREFIL SYR 100MCG/0.5M Darbepoetin alfa soln prefilled syringe 100 mcg/0.






REPOTIN 2000U 1ML Epoetin alfa inj 2000 unit/ml Haematinics 839264003 5 Y

REPOTIN 4000U 1ML Epoetin alfa inj 4000 unit/ml Haematinics 839272006 5 Y

EPREX PREFILL 2000U INJ Epoetin alfa soln prefilled syringe 1000 unit/0.5m Haematinics 837318009 6 Y

EPREX PREFILL 4000U INJ Epoetin alfa soln prefilled syringe 2000 unit/0.5m Haematinics 820741019 6 Y

EPREX PREFILL 6000U/0.6ML Epoetin alfa soln prefilled syringe 6000 unit/0.6m Haematinics 712391001 6 Y

EPREX PREFILL 10000U INJ Epoetin alfa soln prefilled syringe 10000 unit/ml Haematinics 839876009 6 Y

EPREX PREFILL 40000U/ML Epoetin alfa soln prefilled syringe 40000 unit/ml Haematinics 705487001 1 Y

RECORMON 500U PRE-FILL Epoetin beta soln prefilled syringe 500 unit/0.3ml


RECORMON 2000 PRE-FILL 0.3 Epoetin beta soln prefilled syringe 2000 unit/0.3m


RECORMON 4000U PRE-FILL Epoetin beta soln prefilled syringe 4000 unit/0.3m


RECORMON 6000U PRE-FILL 0.3ML Epoetin beta soln prefilled syringe 6000 unit/0.3m


RECORMON 10000 PRE-FILL Epoetin beta soln prefilled syringe 10000 unit/ml Haematinics 705261001 6 Y

RECORMON 30000 PREFILL Epoetin beta soln prefilled syringe 30000 unit/0.6


MIRCERA 30MCG/0.3ML P/FILL SYR Methoxy peg-epoetin beta soln prefilled syr 30 mcg


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MIRCERA 100MCG/0.3ML P/FILL SY Methoxy peg-epoetin beta soln prefilled syr 100 mc












ULTIBRO BREEZHALER 30 CAPS & I Indacaterol-glycopyrrolate inhal cap 110-50 mcg Bronchial/Uterine Sympathomimetics 723867001 1 Y

ONBREZ BREEZHALER 30 CAPS & IN Indacaterol maleate inhal powder cap 150 mcg (base

Bronchial/Uterine Sympathomimetics 717402001 1 Y

SEEBRI BREEZHALER 30 CAPS & IN Glycopyrrolate inhal cap 50 mcg Respiratory Anti-cholinergics 721596001 1 Y

SPIRIVA RESPIMAT INH 60 DOSE Tiotropium bromide monohydrate inhal aerosol 2.5 m

Respiratory Anti-cholinergics 710897001 1 Y

SPIRIVA INH CAPS&HANDIH KIT Tiotropium bromide monohydrate inhal cap 18 mcg (b


SPIRIVA INH CAPS REFILL Tiotropium bromide monohydrate inhal cap 18 mcg (b


FORVENT 18MCG INH CAPS REFILL Tiotropium bromide monohydrate inhal cap 18 mcg (b


FORVENT HANDIHALER COMPL & Tiotropium bromide monohydrate inhal cap 18 mcg (b


DAXAS 0.5MG TABS Roflumilast tab 500 mcg Other Respiratory System Agents 715321002 30 Y

SALAZOPYRIN 500MG TABS Sulfasalazine tab 500 mg Other Gastro-intestinal Tract Agents 762008008 100 Y

BETOPTIC S SINGLE DOSE Betaxolol hcl (ophth) susp Glaucoma 822868008 50 Y

BETOPTIC S 2.5MG/ML 5ML DROPS Betaxolol hcl (ophth) susp Glaucoma 836052005 1 Y

BETOPTIC S SECT21 0.25% 0.25ML Betaxolol hcl (ophth) susp Glaucoma 3001039001 50 Y

GANFORT SECT21 SINGLE DOSE 0.4 Bimatoprost-timolol maleate (pf) ophth soln 0.03-0

Glaucoma 722457001 30 Y

GANFORT 3ML OPTH DROPS Bimatoprost-timolol maleate ophth soln 0.03-0.5%

Glaucoma 714110001 1 Y

LUMIGAN 0.01% Bimatoprost ophth soln 0.01% Glaucoma 716754001 1 Y

LUMIGAN 0.03% 3ML Bimatoprost ophth soln 0.03% Glaucoma 703666003 1 Y

COMBIGAN 2MG/5MG 5ML OPD Brimonidine tartrate-timolol maleate ophth soln 0.


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ALPHAGAN PURITE 1.5MG/1ML 5ML Brimonidine tartrate soln Glaucoma 709410001 1 Y

BRIMOCT 2MG/1ML OPHTH DRP 5ML Brimonidine tartrate soln Glaucoma 721293001 1 Y

AZARGA DROPS 5ML Brinzolamide-timolol ophth susp 1-0.5% Glaucoma 717260001 1 Y

AZOPTIC 5ML EYE SUSPENSION Brinzolamide susp Glaucoma 701523001 1 Y

TEOPTIC EYE DROPS 5ML Carteolol hcl (ophth) soln Glaucoma 834335018 1 Y

COSOPT-S SECT21 EYE DROPS SING Dorzolamide hcl-timolol maleat Glaucoma 3000588001 30 Y

MONOPROST SECT21 50MCG/ML EYE Latanoprost soln Glaucoma 3000587001 30 Y

BETAGAN LIQUIFILM 0.5% OPHTH 5 Levobunolol hcl soln Glaucoma 723286001 1 Y

BETAGAN 7.5ML DROPS Levobunolol hcl soln Glaucoma 781134005 1 Y

BETA-OPTHIOLE 0.3% DRP Metipranolol soln Glaucoma 816728003 1 Y

BETA-OPTHIOLE 0.6% DRP Metipranolol soln Glaucoma 816736006 1 Y

SAFLUTAN 15MCG/ML SINGLE DOSE Tafluprost ophth soln 0.0015% Glaucoma 720401001 30 Y

DUOTRAV 2.5ML OPD Travoprost-timolol maleate ophth soln 0.004-0.5%


TRAVATAN 2.5ML EYE DROPS Travoprost ophth soln 0.004% Glaucoma 702534003 1 Y

BETOPTIC 5MG/ML 5ML DROPS Betaxolol hcl (ophth) soln Glaucoma 708445004 1 Y

COSOPT 5ML DROPS Dorzolamide-timolol ophth soln 2-0.5% (base equiv)


COSOPT 5ML DROPS Dorzolamide hcl-timolol maleat Glaucoma 860379019 1 Y

TRUSOPT 2% 5ML EYE DRP Dorzolamide hcl soln Glaucoma 819832006 1 Y

XALACOM 2.5ML EYE DROPS Latanoprost-timolol maleate ophth soln 0.005-0.5%


XALATAN 2.5ML DROPS Latanoprost ophth soln 0.005% Glaucoma 833223003 1 Y

XALATAN 2.5ML DROPS Latanoprost soln Glaucoma 833223003 1 Y

TIMOPTOL-XE .25% 2.5ML Timolol maleate (ophth) solg Glaucoma 819816019 1 Y

TIMOPTOL 0.25% 5ML DROPS Timolol maleate (ophth) soln Glaucoma 770833004 1 Y

TIMOPTOL 0.5% 5ML DROPS Timolol maleate (ophth) soln Glaucoma 770841007 1 Y

LOXOPTIC 0.5% 5ML DROPS Betaxolol hcl (ophth) soln Glaucoma 722010001 1 Y

IOBRIM BOTS EYE DROPS Brimonidine tartrate soln Glaucoma 967713001 1 Y

BRIMOCHEK 0.2% BOTS Brimonidine tartrate soln Glaucoma 967847001 1 Y

GLAUMIDE-CO 5ML DRP Dorzolamide-timolol ophth soln 2-0.5% (base equiv)


GLAUOPT CO 5ML OPHTHAL DRP Dorzolamide-timolol ophth soln 2-0.5% (base equiv)


OCUDOR CO 5ML DROPS Dorzolamide-timolol ophth soln 2-0.5% (base equiv)

Glaucoma 3000372001 1 Y

GLAUMIDE-CO 5ML DRP Dorzolamide hcl-timolol maleat Glaucoma 721902001 1 Y

GLAUOPT CO 5ML OPHTHAL DRP Dorzolamide hcl-timolol maleat Glaucoma 721977001 1 Y

OCUDOR CO 5ML DROPS Dorzolamide hcl-timolol maleat Glaucoma 3000372001 1 Y

GLAUCOPRESS 2% OPHT DRP 5ML Dorzolamide hcl soln Glaucoma 720983001 1 Y

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CO-ATANA 2.5ML EYE DRP Latanoprost-timolol maleate ophth soln 0.005-0.5%


IOPROST-T NAM ONLY 2.5ML EYE D Latanoprost-timolol maleate ophth soln 0.005-0.5%

Glaucoma 3000853001 1 Y

OCUPROST 3ML DROPS Latanoprost ophth soln 0.005% Glaucoma 715961001 1 Y

ATANA 50MCG/ML OPHTH DRP 2.5ML Latanoprost ophth soln 0.005% Glaucoma 720971001 1 Y

SPERSATAN 50MCG/ML 2.5ML Latanoprost ophth soln 0.005% Glaucoma 723018001 1 Y

OCUPROST 3ML DROPS Latanoprost soln Glaucoma 715961001 1 Y

ATANA 50MCG/ML OPHTH DRP 2.5ML Latanoprost soln Glaucoma 720971001 1 Y

SPERSATAN 50MCG/ML 2.5ML Latanoprost soln Glaucoma 723018001 1 Y

NYOGEL 5GM EYE GEL Timolol maleate (ophth) solg Glaucoma 702142001 1 Y

TIMOPTOL-XE .5% 2.5ML DROPS Timolol maleate (ophth) solg Glaucoma 819824003 1 Y

TIMOLOL 0.25% ED NAM ONLY Timolol maleate (ophth) soln Glaucoma 87365001 10 Y

OCCUMOL 0.5% DROPS Timolol maleate (ophth) soln Glaucoma 720734001 1 Y

GLAUCOSAN 0.5% 5ML Timolol maleate (ophth) soln Glaucoma 821624008 1 Y

APO TIMOPTOL OPTH SOL BOTS Timolol maleate (ophth) soln Glaucoma 967319001 1 Y

BURINEX 1MG TABS Bumetanide tabs Diuretics 711152004 100 Y

BURINEX 1MG TABS Bumetanide tabs Diuretics 711152005 30 Y

HYGROTON 50MG TABS Chlorthalidone tabs Diuretics 731919009 30 Y

LASIX RET 60MG CAPS Furosemide Diuretics 735973008 30 Y

LASIX ORAL SOL Furosemide oral soln 10 mg/ml Diuretics 839515006 100 Y

FURO DENK BOTS Furosemide tab 40 mg Diuretics 967874001 100 Y

LASIX 80MG TABS Furosemide tab 80 mg Diuretics 780839005 30 Y


URIREX-K TABS Hydrochlorothiazide-potassium chloride tab 50-300

Diuretics 774057009 1000 Y

ZAROXOLYN SECT21 5MG TABS Metolazone tabs Diuretics 719301001 50 Y

ARELIX 6MG TABS Piretanide tab 6 mg Diuretics 807818003 30 Y

MODURETIC TABS Amiloride & HCTZ Diuretics 744379008 100 Y

MODURETIC TABS Amiloride & HCTZ Diuretics 744379016 500 Y




NATRILIX SR 1.5MG TABS Indapamide tab cr 1.5 mg Diuretics 830836004 30 Y

ALDACTONE 25MG TABS Spironolactone tabs Diuretics 701793007 60 Y

ALDACTONE 100MG TABS Spironolactone tabs Diuretics 701807016 30 Y

UNAT 2.5MG TABS Torsemide tab 2.5 mg Diuretics 820369004 30 Y

UNAT 5MG TABS Torsemide tab 5 mg Diuretics 820377007 30 Y

UNAT 10MG TABS Torsemide tab 10 mg Diuretics 820385018 30 Y

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DYAZIDE TABS Triamterene & HCTZ Diuretics 721824005 28 Y

AMILORETIC TABS Amiloride & HCTZ Diuretics 702803014 100 Y

AMILORETIC TABS Amiloride & HCTZ Diuretics 702803022 1000 Y

AMILORETIC HS TABS Amiloride & HCTZ Diuretics 702811009 30 Y

SPEC-CO-AMILORIDE TABS Amiloride & HCTZ Diuretics 706531001 500 Y

DEZRETIC 5MG/50MG TABS Amiloride & HCTZ Diuretics 719984001 1000 Y

ADCO-RETIC TABS Amiloride & HCTZ Diuretics 780618009 100 Y

ADCO-RETIC TABS Amiloride & HCTZ Diuretics 780618017 1000 Y

BETARETIC TABS Amiloride & HCTZ Diuretics 808695029 1000 Y

URAZIDE TABLETS BOTS Amiloride & HCTZ Diuretics 967100001 1000 Y

APO AMILZIDE 50/5MG BOTS Amiloride & HCTZ Diuretics 967223001 100 Y

MILOREX BOTS Amiloride & HCTZ Diuretics 967412001 30 Y

AUSTELL-FUROSEMIDE 20MG TABS Furosemide tab 20 mg Diuretics 707421002 28 Y

DIURESIX 40MG TABS Furosemide tab 40 mg Diuretics 705967001 250 Y

AUSTELL-FUROSEMIDE 40MG TABS Furosemide tab 40 mg Diuretics 707423001 30 Y

DINO-RETIC 40MG TABS Furosemide tab 40 mg Diuretics 716048001 1000 Y



SANDOZ FUROSEMIDE 40MG TABS Furosemide tab 40 mg Diuretics 731668006 30 Y




PURESIS 40MG TABS Furosemide tab 40 mg Diuretics 758272006 30 Y

PURESIS 40MG TABS Furosemide tab 40 mg Diuretics 758272014 250 Y

BEURESIS 40MG TABS Furosemide tab 40 mg Diuretics 821845012 250 Y

MYLAN FUROSEMIDE 40 MG TABS Furosemide tab 40 mg Diuretics 857769022 250 Y

FRUGEX 40MG TABLETS BOTS Furosemide tab 40 mg Diuretics 967039001 1000 Y

APO FUROSEMIDE BOTS Furosemide tab 40 mg Diuretics 967166001 1000 Y

APO FUROSEMIDE BOTS Furosemide tab 40 mg Diuretics 967166002 100 Y

SALUREX BOTS Furosemide tab 40 mg Diuretics 967444001 100 Y

RIDAQ 25MG TABS Hydrochlorothiazide tab 25 mg Diuretics 880949007 500 Y

HEXAZIDE 25MG TABS Hydrochlorothiazide tab 25 mg Diuretics 890470007 100 Y

STAPLEX 25MG TABLETS BOTS Hydrochlorothiazide tab 25 mg Diuretics 967093001 1000 Y

APO HYDROCHLOROTHIAZ 25MG BOTS Hydrochlorothiazide tab 25 mg Diuretics 967167001 1000 Y

HYDROCHLORTHIAZIDE BOTS Hydrochlorothiazide tab 25 mg Diuretics 967400001 50 Y

HETERO HYDROCHLORTHIAZ BOTS Hydrochlorothiazide tab 25 mg Diuretics 967714001 100 Y

GULF HYDROCHLOROTHIAZIDE 25MG Hydrochlorothiazide tab 25 mg Diuretics 3001173001 30 Y


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RIDAQ 12.5MG TABS Hydrochlorothiazide tabs Diuretics 710437001 30 Y

RIDAQ 25MG TABS Hydrochlorothiazide tabs Diuretics 880949007 500 Y

HEXAZIDE 25MG TABS Hydrochlorothiazide tabs Diuretics 890470007 100 Y

STAPLEX 25MG TABLETS BOTS Hydrochlorothiazide tabs Diuretics 967093001 1000 Y

STAPLEX 50MG TABLETS BOTS Hydrochlorothiazide tabs Diuretics 967094001 1000 Y

APO HYDROCHLOROTHIAZ 25MG BOTS Hydrochlorothiazide tabs Diuretics 967167001 1000 Y

HYDROCHLORTHIAZIDE BOTS Hydrochlorothiazide tabs Diuretics 967400001 50 Y

HETERO HYDROCHLORTHIAZ BOTS Hydrochlorothiazide tabs Diuretics 967714001 100 Y

GULF HYDROCHLOROTHIAZIDE 25MG Hydrochlorothiazide tabs Diuretics 3001173001 30 Y



CATEXAN 2.5MG Indapamide tab 2.5 mg Diuretics 700820005 30 Y

MYLAN INDAPAMIDE 2.5 TABS Indapamide tab 2.5 mg Diuretics 703329001 30 Y

CIPLA-INDAPAMIDE 2.5MG TABS Indapamide tab 2.5 mg Diuretics 710313001 30 Y

ADCO-DAPAMAX 2.5MG TABS Indapamide tab 2.5 mg Diuretics 819417009 30 Y



HYDRO-LESS 2.5MG TABS Indapamide tab 2.5 mg Diuretics 822825007 30 Y

SANDOZ INDAPAMIDE 2.5 TABS Indapamide tab 2.5 mg Diuretics 831026006 30 Y

DAPTRIL 2.5MG TABS Indapamide tab 2.5 mg Diuretics 833045008 30 Y

DAPTRIL 2.5MG TABS Indapamide tab 2.5 mg Diuretics 833045016 600 Y

LORVAS 2.5MG TABS BOTS Indapamide tab 2.5 mg Diuretics 967146001 100 Y

BENDROFLUAZIDE BOTS Indapamide tab 2.5 mg Diuretics 967202001 30 Y

DYNA INDAPAMIDE SR 1.5MG TABS Indapamide tab cr 1.5 mg Diuretics 716962001 30 Y

CATEXAN 2.5MG Indapamide tabs Diuretics 700820005 30 Y

MYLAN INDAPAMIDE 2.5 TABS Indapamide tabs Diuretics 703329001 30 Y

CIPLA-INDAPAMIDE 2.5MG TABS Indapamide tabs Diuretics 710313001 30 Y

ADCO-DAPAMAX 2.5MG TABS Indapamide tabs Diuretics 819417009 30 Y



HYDRO-LESS 2.5MG TABS Indapamide tabs Diuretics 822825007 30 Y

SANDOZ INDAPAMIDE 2.5 TABS Indapamide tabs Diuretics 831026006 30 Y

DAPTRIL 2.5MG TABS Indapamide tabs Diuretics 833045008 30 Y

DAPTRIL 2.5MG TABS Indapamide tabs Diuretics 833045016 600 Y

LORVAS 2.5MG TABS BOTS Indapamide tabs Diuretics 967146001 100 Y

BENDROFLUAZIDE BOTS Indapamide tabs Diuretics 967202001 30 Y

SPIRACTIN 25MG TABS Spironolactone tabs Diuretics 765910004 30 Y

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SANDOZ SPIRONOLACTONE 25MG Spironolactone tabs Diuretics 769665004 30 Y

SANDOZ SPIRONOLACTONE 25MG Spironolactone tabs Diuretics 769665012 200 Y


SPIRONOLACTONE TABS BOTS Spironolactone tabs Diuretics 967445001 100 Y

SPIRONOLACTONE TABS BOTS Spironolactone tabs Diuretics 967445002 50 Y

TORAHEXAL 5MG TABS Torsemide tab 5 mg Diuretics 707190001 30 Y

TORASEMIDE BIOTECH 5MG TABS Torsemide tab 5 mg Diuretics 723757001 30 Y

TORAS-DENK BOTS Torsemide tab 5 mg Diuretics 967518001 30 Y

RISAT 5MG TABS Torsemide tab 5 mg Diuretics 3000185001 30 Y

TORAHEXAL 10MG TABS Torsemide tab 10 mg Diuretics 707191001 30 Y

TORASEMIDE BIOTECH 10MG TABS Torsemide tab 10 mg Diuretics 723758001 30 Y

TORAS DENK BOTS Torsemide tab 10 mg Diuretics 967809001 30 Y

RISAT 10MG TABS Torsemide tab 10 mg Diuretics 3000186001 30 Y

RENEZIDE TABS Triamterene & HCTZ Diuretics 780146018 28 Y

RENEZIDE TABS Triamterene & HCTZ Diuretics 780146026 250 Y

HUMULIN N 10ML VIAL Insulin isophane (human) inj 100 unit/ml Insulins 733458009 1 Y

PROTAPHANE 10ML VIAL Insulin isophane (human) inj 100 unit/ml Insulins 733482007 1 Y

PROTAPHANE FLEXPEN 3ML Insulin isophane (human) susp pen-injector 100 uni

Insulins 700183001 5 Y

HUMULIN N KWIKPEN 3ML Insulin isophane (human) susp pen-injector 100 uni


NOVORAPID 10ML INJ Insulin aspart inj 100 unit/ml Insulins 707927001 1 Y

NOVOMIX 30 FLEXPEN 3ML Insulin aspart prot & aspart sus pen-inj 100 unit/ Insulins 702086003 5 Y

NOVOMIX 30 PENFILL 3ML Insulin aspart prot & aspart susp cart 100 unit/ml Insulins 702089003 5 Y

NOVORAPID PENFILL 3ML Insulin aspart soln cartridge 100 unit/ml Insulins 897775004 5 Y

NOVORAPID FLEXPEN 3ML Insulin aspart soln pen-injector 100 unit/ml Insulins 897767001 5 Y

RYZODEG FLEXTOUCH 100IU/ML PRE Insulin degludec & aspart soln pen-inj 100 unit/ml


RYZODEG FLEXTOUCH 100IU/ML PRE Insulin degludec & aspart soln pen-inj 100 unit/ml


TRESIBA 100U/ML PENFILL 3ML Insulin degludec soln cartridge 100 unit/ml Insulins 720490001 5 Y

TRESIBA 100U/ML FLEXTOUCH 3ML Insulin degludec soln pen-injector 100 unit/ml Insulins 723864001 5 Y

TRESIBA NAM ONLY 100U/1ML INJ Insulin degludec soln pen-injector 100 unit/ml Insulins 3000721001 1 Y

LEVEMIR 3ML PREFILLED CART Insulin detemir soln cartridge 100 unit/ml Insulins 705313001 5 Y

LEVEMIR 3ML FLEXPEN Insulin detemir soln pen-injector 100 unit/ml Insulins 705312001 5 Y

LANTUS VIAL 1000IU/10ML Insulin glargine inj 100 unit/ml Insulins 700310001 1 Y

TOUJEO PEN 300IU/1ML INJ 1.5ML Insulin glargine soln pen-injector 300 unit/ml (1 Insulins 723815001 3 Y

APIDRA 3ML CART Insulin glulisine soln cartridge inj 100 unit/ml Insulins 706039001 5 Y

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APIDRA SOLOSTAR DISP PEN 3ML Insulin glulisine soln pen-injector inj 100 unit/m Insulins 709861001 5 Y

APIDRA 10ML VIAL Insulin glulisine subcutaneous inj 100 unit/ml Insulins 706040001 1 Y

ACTRAPHANE 10ML Insulin isophane & regular (human) inj 100 unit/ml


HUMULIN 30/70 10ML VIAL Insulin isophane & regular (human) inj 100 unit/ml


BIOSULIN 30-70 CARTRIDGE Insulin isophane & regular susp cart 100 unit/ml ( Insulins 712770001 5 Y

HUMULIN 30/70 CART 3ML Insulin isophane & regular susp cart 100 unit/ml ( Insulins 863572006 5 Y

HUMULIN 30/70 KWIKPEN 3ML Insulin isophane & regular susp pen-inj 100 unit/m


INSUMAN COMB 30/70 3ML CART Insulin isophane & regular susp pen-inj 100 unit/m


ACTRAPHANE HM FLEXPEN 3ML Insulin isophane & regular susp pen-inj 100 unit/m


ACTRAPHANE PSET 3ML Insulin isophane & regular susp pen-inj 100 unit/m


HUMALOG MIX25 10ML VIAL Insulin lispro & lispro prot (human) inj 100 unit/ Insulins 853437009 1 Y

HUMALOG 10ML Insulin lispro (human) inj 100 unit/ml Insulins 819468002 1 Y

HUMALOG 3ML CARTRIDGE Insulin lispro (human) inj 100 unit/ml Insulins 862355001 5 Y

HUMALOG MIX50 CART 3ML Insulin lispro prot & lispro sus pen-inj 100 unit/ Insulins 705074001 5 Y

HUMALOG MIX 25 KWIKPEN Insulin lispro prot & lispro sus pen-inj 100 unit/ Insulins 706761001 5 Y

HUMALOG MIX 50 KWIKPEN Insulin lispro prot & lispro sus pen-inj 100 unit/ Insulins 706762001 5 Y

HUMALOG MIX25 CART 3ML Insulin lispro prot & lispro sus pen-inj 100 unit/ Insulins 861782003 5 Y

HUMALOG KWIKPEN 100U/ML 3ML Insulin lispro soln pen-injector 100 unit/ml (1 un Insulins 706760001 5 Y

HUMALOG KWIKPEN 200U/ML 3ML Insulin lispro soln pen-injector 200 unit/ml Insulins 723920001 5 Y

ACTRAPID HM(GE) NAM ONLY VIAL Insulin regular (human) inj 100 unit/ml Insulins 87162001 1 Y

HUMULIN R 10ML VIAL Insulin regular (human) inj 100 unit/ml Insulins 733431003 1 Y

BIOSULIN R CARTRIDGE 3ML Insulin regular (human) soln cartridge 100 unit/ml


HUMULIN R CART 3ML Insulin regular (human) soln cartridge 100 unit/ml


LANTUS CART 300IU/3ML Insulin glargine soln cartridge 100 unit/ml Insulins 700308001 5 Y

BASAGLAR 100U/ML 3ML CARTRIDGE Insulin glargine soln cartridge 100 unit/ml Insulins 722456001 5 Y

LANTUS SOLOSTAR 100IU/ML 3ML Insulin glargine soln pen-injector 100 unit/ml Insulins 709860001 5 Y

BASAGLAR 100U/ML 3ML PREFILL Insulin glargine soln pen-injector 100 unit/ml Insulins 722454001 5 Y

HUMULIN N CART 3ML Insulin isophane (human) susp cartridge 100 unit/m


OPTISULIN CARTRIDGE 100IU/1ML Insulin glargine soln cartridge 100 unit/ml Insulins 723474001 5 Y

OPTISULIN PEN 100IU/ML 3ML INJ Insulin glargine soln pen-injector 100 unit/ml Insulins 721502001 5 Y

BIOSULIN N CARTRIDGE 3ML Insulin isophane (human) susp cartridge 100 unit/m


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BIOSULIN L CARTRIDGE 3ML Insulin zinc (human) inj 100 unit/ml Insulins 712769001 5 Y

GLUCOBAY 50MG TABS Acarbose tabs Oral Anti-diabetic Agents 808156012 90 Y

GLUCOBAY 100MG TABS Acarbose tabs Oral Anti-diabetic Agents 808164015 90 Y

AUSTELL-GLICLAZIDE 40MG TABS Gliclazide Oral Anti-diabetic Agents 705759001 30 Y

AMARYL M 1MG/250MG NAMIBIA Glimepiride-metformin hcl tab 1-250 mg Oral Anti-diabetic Agents 716110001 30 Y

ILET B1 NAM ONLY 500MG/1MG TAB Glimepiride-metformin hcl tab 1-500 mg Oral Anti-diabetic Agents 723288001 30 Y

MINIDIAB 5MG TABS Glipizide tabs Oral Anti-diabetic Agents 743666003 100 Y

GLUCOPHAGE XR 750MG TABS Metformin hcl tab sr 24hr 750 mg Oral Anti-diabetic Agents 720925001 30 Y

GLUCOPHAGE XR 750MG TABS Metformin hcl tab sr 24hr 750 mg Oral Anti-diabetic Agents 720925002 60 Y

STARLIX 120MG F/COATED TABS Nateglinide tab 120 mg Oral Anti-diabetic Agents 893900001 84 Y

ACCORD PIOGLITAZONE 45MG TABS Pioglitazone hcl tabs Oral Anti-diabetic Agents 718151001 30 Y

NOVONORM 0.5MG TABS Repaglinide tabs Oral Anti-diabetic Agents 861324005 90 Y

NOVONORM 1MG TABS Repaglinide tabs Oral Anti-diabetic Agents 861332008 90 Y

NOVONORM 2MG TABS Repaglinide tabs Oral Anti-diabetic Agents 861340019 90 Y

DIAMICRON MR 30MG TABS Gliclazide Oral Anti-diabetic Agents 702923001 60 Y

DIAMICRON MR 60MG TABS Gliclazide Oral Anti-diabetic Agents 718245001 30 Y

GLICLAZIDE UNICORN 80 Gliclazide Oral Anti-diabetic Agents 719463009 60 Y

AMARYL M 2MG/500MG NAMIBIA Glimepiride-metformin hcl tab 2-500 mg Oral Anti-diabetic Agents 716112001 30 Y

AMARYL COMBI 2MG/500MG TABS Glimepiride-metformin hcl tab 2-500 mg Oral Anti-diabetic Agents 718106001 30 Y

AMARYL 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 831557001 30 Y



GLUCOPHAGE 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 729159027 500 Y


GLUCOPHAGE F 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 729167003 60 Y

GLUCOPHAGE F 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 729167011 300 Y



GLUCOPHAGE XR 500MG TABS Metformin hcl tab sr 24hr modified release 500 mg

Oral Anti-diabetic Agents 710196001 90 Y







ACTOS 15MG TABS Pioglitazone hcl tabs Oral Anti-diabetic Agents 878243003 28 Y

ACTOS 30MG TABS Pioglitazone hcl tabs Oral Anti-diabetic Agents 878251006 28 Y

MYLAN GLICLAZIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 700639003 60 Y

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GLYGARD 80MG TABS Gliclazide Oral Anti-diabetic Agents 700717003 60 Y

AUSTELL-GLICLAZIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 705760001 60 Y

GLYCOBETA 80MG TABS Gliclazide Oral Anti-diabetic Agents 707587001 60 Y

ARROW GLICLAZIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 709538001 60 Y

DIAGLUCIDE MR 30MG TABS Gliclazide Oral Anti-diabetic Agents 714582001 60 Y

DIARAN MR 30MG TABS Gliclazide Oral Anti-diabetic Agents 714909001 60 Y

DYNA GLICLAZIDE SR 30MG TABS Gliclazide Oral Anti-diabetic Agents 716953001 60 Y

DIAGLUCIDE MR 60MG TABS Gliclazide Oral Anti-diabetic Agents 718247001 30 Y

DIAGLUMED 80MG TABS Gliclazide Oral Anti-diabetic Agents 720665001 60 Y

GLICLAZIDE UNICORN MR 30MG TAB Gliclazide Oral Anti-diabetic Agents 721692001 60 Y

ADCO-GLUCOMED 80MG TABS Gliclazide Oral Anti-diabetic Agents 834599007 60 Y

ADCO-GLUCOMED 80MG TABS Gliclazide Oral Anti-diabetic Agents 834599015 500 Y

SANDOZ GLICLAZIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 834866005 60 Y

SANDOZ GLICLAZIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 834866014 504 Y

GLYCRON 80MG TABS Gliclazide Oral Anti-diabetic Agents 838209009 60 Y

DIAGLUCIDE 80MG TABS Gliclazide Oral Anti-diabetic Agents 868906018 60 Y

GLYTAB MR 30MG TABS Gliclazide Oral Anti-diabetic Agents 3000684001 60 Y

ILET B2 NAM ONLY 500MG/2MG TAB Glimepiride-metformin hcl tab 2-500 mg Oral Anti-diabetic Agents 723289001 30 Y

GLAMARYL 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 704362001 30 Y



SANDOZ GLIMEPIRIDE 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 704673001 30 Y



EUGLIM 1GM TABS Glimepiride tabs Oral Anti-diabetic Agents 710207001 30 Y

EUGLIM 2MG TABS Glimepiride tabs Oral Anti-diabetic Agents 710208001 30 Y

EUGLIM 4MG TABS Glimepiride tabs Oral Anti-diabetic Agents 710209001 30 Y

SULPHONUR 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 710904001 30 Y



ASPEN GLIMEPIRIDE 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 714854001 30 Y



ACCORD GLIMEPIRIDE 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 716714001 30 Y



AUSTELL GLIMEPIRIDE 1MG TABS Glimepiride tabs Oral Anti-diabetic Agents 717076001 30 Y


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AZULIX BOTS Glimepiride tabs Oral Anti-diabetic Agents 967220001 30 Y

AZULIX 1MG BOTS Glimepiride tabs Oral Anti-diabetic Agents 967253001 30 Y

AZULIX 2MG TABLETS BOTS Glimepiride tabs Oral Anti-diabetic Agents 967254001 30 Y

GLIMULIN BOTS Glimepiride tabs Oral Anti-diabetic Agents 967340001 30 Y

GLIMEPIRIDE DENK 3 BOTS Glimepiride tabs Oral Anti-diabetic Agents 967542001 30 Y

GLIMEPIRIDE DENK 2 BOTS Glimepiride tabs Oral Anti-diabetic Agents 967637001 30 Y

METFORAL 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 702385001 100 Y

AUSTELL-METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 705757001 100 Y


ARROW METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 706672001 100 Y

APEX-METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 707670001 100 Y

APEX-METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 707670002 500 Y

FORMINAL 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 708009002 100 Y


BIGSENS 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 708281001 100 Y

METPHAGE 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 709246001 100 Y

METFORMIN ASCENDIS 500 Metformin hcl tab 500 mg Oral Anti-diabetic Agents 709338001 100 Y

METFORMIN ASCENDIS 500 Metformin hcl tab 500 mg Oral Anti-diabetic Agents 709338002 500 Y

METORED 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 711636001 90 Y

DIAMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 714186001 100 Y


ACCORD METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 714427001 100 Y

GLUCONORM 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 714525001 100 Y

MENGEN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 714680001 100 Y

DIAFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 715936001 100 Y

METCHEK 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 718231001 100 Y

METFORMIN ALKEM 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 718828001 100 Y


SANDOZ METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 719285003 100 Y

ROMIDAB 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 719643001 100 Y

DIAPHAGE 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 719784001 90 Y

SANDOZ METFORMIN 500 FC TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 815225008 100 Y

MYLAN METFORMIN 500MG TABS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 897957016 500 Y


DIABETMIN F/C TAB BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967263001 100 Y

GLYFORMIN BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967396001 100 Y

METCHEK BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967474001 100 Y

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METFORMIN DENK 500MG BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967508001 100 Y

METFORMIN DENK BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967646001 30 Y

MELOREM BOTS Metformin hcl tab 500 mg Oral Anti-diabetic Agents 967666001 30 Y

METFORAL 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 702363001 60 Y

DIABETMIN 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 705358001 100 Y



ARROW METFORMIN 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 706673001 60 Y

APEX-METFORMIN FORTE 850MG Metformin hcl tab 850 mg Oral Anti-diabetic Agents 707669001 60 Y

APEX-METFORMIN FORTE 850MG Metformin hcl tab 850 mg Oral Anti-diabetic Agents 707669002 300 Y




METPHAGE 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 709247001 60 Y

METFORMIN ASCENDIS 850MG FCT Metformin hcl tab 850 mg Oral Anti-diabetic Agents 709339001 60 Y

METFORMIN ASCENDIS 850 MG FCT Metformin hcl tab 850 mg Oral Anti-diabetic Agents 709339002 300 Y




ACCORD METFORMIN 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 714426001 60 Y

GLUCONORM 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 714526001 60 Y


DIAFORMIN FORTE 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 715937001 60 Y

METCHEK 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 718232001 60 Y




SANDOZ METFORMIN 850MG TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 719293006 30 Y



SANDOZ METFORMIN 850 FC TABS Metformin hcl tab 850 mg Oral Anti-diabetic Agents 815233019 60 Y








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METSAFE ER NAM ONLY 500MG TABS Metformin hcl tab sr 24hr modified release 500 mg


METFORMIN XR ACCORD 500MG TABS Metformin hcl tab sr 24hr modified release 500 mg


BIGSENS XR 500MG TABS Metformin hcl tab sr 24hr modified release 500 mg


BIGSENS XR 500MG TABS Metformin hcl tab sr 24hr modified release 500 mg


METSAFE ER NAM ONLY 1000MG TAB Metformin hcl tab sr 24hr modified release 1000 mg


CIPLA PIOGLITAZONE 15MG TABS Pioglitazone hcl tabs Oral Anti-diabetic Agents 707974001 30 Y

CIPLA PIOGLITAZONE 30MG TABS Pioglitazone hcl tabs Oral Anti-diabetic Agents 707981001 30 Y



PIOGLITAZONE HCL MACLEODS 15MG Pioglitazone hcl tabs Oral Anti-diabetic Agents 3000543001 30 Y

PIOGLITAZONE HCL MACLEODS 30MG Pioglitazone hcl tabs Oral Anti-diabetic Agents 3000544001 30 Y

BYETTA 1.2ML DISP PEN 5MCG D Exenatide soln pen-injector 5 mcg/0.02ml GLP-1 Agonists (was other anti-diabetic) 711678001 1 Y

BYETTA 2.4ML DISP PEN 10MCG D Exenatide soln pen-injector 10 mcg/0.04ml GLP-1 Agonists (was other anti-diabetic) 711684001 1 Y

VICTOZA NAMIBIA 6MG/ML PRE-FI Liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)

GLP-1 Agonists (was other anti-diabetic) 80991001 1 Y

VICTOZA 6MG/ML PRE-FILLED PEN Liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)


VICTOZA 6MG/ML PRE-FILLED PEN Liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)


VICTOZA NAM ONLY 6MG/1ML PREFI Liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)


KOMBIGLYZE XR NAMIBIA 2.5-1000 Saxagliptin-metformin hcl tab sr 24hr 2.5-1000 mg

DPP-4 antagonists 720212001 60 Y

KOMBIGLYZE XR NAMIBIA 5-1000MG Saxagliptin-metformin hcl tab sr 24hr 5-1000 mg DPP-4 antagonists 720213001 30 Y

ONGLYZA 2.5MG TABS Saxagliptin hcl tab 2.5 mg (base equiv) DPP-4 antagonists 716640001 30 Y

ONGLYZA 5MG TABS Saxagliptin hcl tab 5 mg (base equiv) DPP-4 antagonists 716641001 30 Y

JANUMET 50MG/500 MG TABS Sitagliptin-metformin hcl tab 50-500 mg DPP-4 antagonists 717788001 56 Y

JANUMET 50MG/850MG TABS Sitagliptin-metformin hcl tab 50-850 mg DPP-4 antagonists 717790001 56 Y

JANUMET 50MG/1000MG TABS Sitagliptin-metformin hcl tab 50-1000 mg DPP-4 antagonists 717791001 56 Y

JANUVIA 25MG TABS Sitagliptin phosphate tab 25 mg (base equiv) DPP-4 antagonists 717785001 28 Y



GALVUS MET 50/850MG TABS Vildagliptin-metformin hcl tab 50-850 mg DPP-4 antagonists 717636001 30 Y

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GALVUS 50MG TABS Vildagliptin tab 50 mg DPP-4 antagonists 715554001 28 Y

GALVUS 50MG TABS Vildagliptin tab 50 mg DPP-4 antagonists 715554002 56 Y

JALRAMET 50/850 TABS Vildagliptin-metformin hcl tab 50-850 mg DPP-4 antagonists 3000953001 30 Y




JALRA 50MG TABS Vildagliptin tab 50 mg DPP-4 antagonists 721592001 28 Y

JALRA 50MG TABS Vildagliptin tab 50 mg DPP-4 antagonists 721592002 56 Y

FORXIGA 5MG TABS Dapagliflozin propanediol tab 5 mg (base equivalen

SGLT2 inhibitors 723708001 30 Y

FORXIGA 10MG TABS Dapagliflozin propanediol tab 10 mg (base equivale

SGLT2 inhibitors 723709001 30 Y

JARDIANCE 10MG TABS Empagliflozin tab 10 mg SGLT2 inhibitors 720929001 30 Y




DIOTROXIN TABS Levothyroxine-liothyronine tab 90-10 mcg Thyroid Agents 720224004 100 Y

PROTHYRID SECT21 100/10 TABS Levothyroxine-liothyronine tab 100-10 mcg Thyroid Agents 723840001 100 Y

ELTROXIN 75MCG TABS NEW FORMUL Levothyroxine sodium tab 75 mcg Thyroid Agents 723170001 30 Y

ELTROXIN 200MCG TABS NEW FORMU Levothyroxine sodium tab 200 mcg Thyroid Agents 723172001 30 Y

TERTROXIN 20MCG TABS Liothyronine sodium tabs Thyroid Agents 769983006 50 Y

TERTROXIN 20MCG TABS Liothyronine sodium tabs Thyroid Agents 769983007 100 Y

EUTHYROX 25MCG TABS Levothyroxine sodium tab 25 mcg Thyroid Agents 713172002 30 Y


ELTROXIN 50MCG TABS Levothyroxine sodium tab 50 mcg Thyroid Agents 722944004 100 Y


ELTROXIN 100MCG TABS Levothyroxine sodium tab 100 mcg Thyroid Agents 722952007 100 Y

ELTROXIN 100MCG TABS NEW FORMU Levothyroxine sodium tab 100 mcg Thyroid Agents 723171001 30 Y



HUMIRA 40MG/0.8ML PRE-FILLED Adalimumab inj 40 mg/0.8ml (50 mg/ml) Immunosuppressants 705335001 2 Y

HUMIRA PEN 40MG/0.8ML INJ Adalimumab inj 40 mg/0.8ml (50 mg/ml) Immunosuppressants 716266001 2 Y

ENBREL 25MG POWD PREFILL KIT Etanercept for subcutaneous inj kit 25 mg Immunosuppressants 702509001 4 Y

ENBREL PS 25MG/0.5ML PREFILL S Etanercept subcutaneous soln prefilled syringe 25

Immunosuppressants 715037001 4 Y

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ENBREL PS 50MG/1ML PREFILL SYR Etanercept subcutaneous soln prefilled syringe 50


ENBREL PS 50MG/1ML PREFILL SYR Etanercept subcutaneous soln prefilled syringe 50


ENBREL PS 50MG PREF MYCLIC Etanercept subcutaneous solution auto-injector 50


SIMPONI 50MG/0.5ML PREFIL Golimumab subcutaneous inj 50 mg/0.5ml Immunosuppressants 719211001 1 Y

REVELLEX 100MG/10ML PER ML Infliximab for iv inj 100 mg Immunosuppressants 707507001 10 Y

REVELLEX 100MG VIAL POWDER 10 Infliximab for iv inj 100 mg Immunosuppressants 874930006 1 Y

COPAXONE PREFILLED SYR 1ML Glatiramer acetate inj kit 20 mg/ml Immunostimulants 708286001 28 Y

COPAXONE PREFILLED SYR 1ML Glatiramer acetate inj kit 20 mg/ml Immunostimulants 708286002 1 Y

AVONEX PREFILLED 30MCG INJ Interferon beta-1a for im inj kit 30mcg (33mcg(6.6

Immunostimulants 712306001 4 Y

REBIF 22MCG/0.5ML REBIDOSE PRE Interferon beta-1a inj 22 mcg/0.5ml (12mu/ml) (44


REBIF 22MCG/0.5ML PREFILL SYR Interferon beta-1a inj 22 mcg/0.5ml (12mu/ml) (44


REBIF 44MCG/0.5ML REBIDOSE PRE Interferon beta-1a inj 44 mcg/0.5ml (24mu/ml) (88


REBIF 44MCG/0.5ML PREFILL SYR Interferon beta-1a inj 44 mcg/0.5ml (24mu/ml) (88


REBIF 22 66MCG/1.5ML M/DOSE Interferon beta-1a soln cart 66 mcg/1.5ml (18 mu/1


REBIF 44 132MCG/1.5ML M/DOSE Interferon beta-1a soln cart 132 mcg/1.5ml (36 mu/


BETAFERON PRE-FILLED SYR Interferon beta-1b for inj 0.3 mg Immunostimulants 700474003 15 Y

PLEGRIDY 63MCG/94MCG 0.5ML PR Peginterferon beta-1a soln pref syr 63 & 94 mcg/0.


PLEGRIDY 125MCG/0.5ML INJ PREF Peginterferon beta-1a soln prefilled syringe 125 m


PHOSPHOSORB 660 TABS Calcium acetate (phosphate binder) tab 667 mg Chelating Agents/Ion Exchange Preparations 718735001 200 Y

FOSRENOL 500MG CHEW Lanthanum carbonate chew tab 500 mg Chelating Agents/Ion Exchange Preparations 711080002 90 Y

FOSRENOL 750MG CHEW Lanthanum carbonate chew tab 750 mg Chelating Agents/Ion Exchange Preparations 711081002 90 Y

RENVELA 800MG TABS Sevelamer carbonate tab 800 mg Chelating Agents/Ion Exchange Preparations 720512001 180 Y

RENAGEL 800MG TABS Sevelamer hcl tab 800 mg Chelating Agents/Ion Exchange Preparations 711329001 180 Y

MEDISCOR PMB MAIN LIST - MEDiPOS Medical Scheme

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Transcript of MEDISCOR PMB MAIN LIST - MEDiPOS Medical Scheme