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GENERAL PRACTITIONER

Sum

mar

y of

ben

efits

/ser

vice

sM

edica

l Sch

emes

Bene

fits

AECI

Med

ical A

id

Socie

tyCo

mpC

are

Wel

lnes

s M

edica

l Sch

eme

Mas

smar

t Hea

lth P

lan

Old

Mut

ual S

taff

Med

ical A

id F

und

Tige

r Bra

nds M

edica

l Sc

hem

eTr

ansm

ed M

edica

l Fu

ndU

mvu

zo H

ealth

Witb

ank

Coal

field

s M

edica

l Aid

Sch

eme

Valu

e O

ption

Net

wor

X &

Net

wor

X ED

* O

ption

sN

etw

ork

Opti

onEs

senti

al O

ption

Net

wor

k &

Net

wor

k SE

LECT

Pla

nsPr

imar

y Pl

us O

ption

(N

ame

chan

ge)

Link

Plan

(N

ame

chan

ge)

Stan

dard

opti

onU

ltra

Affor

dabl

e O

ption

Ultr

a Aff

orda

ble

Valu

e O

ption

(NEW

)N

tsik

a O

ption

Gene

ral

prac

tition

er

cons

ulta

tions

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Clin

ical m

otiva

tion

may

be

requ

ired

to a

utho

rise

mor

e th

an 3

GP

visit

s pe

r ben

eficia

ry p

er

annu

m.

Limite

d to

6 v

isits

pe

r ben

eficia

ry p

er

annu

m a

t a U

nive

rsal

N

etw

ork

GP, w

ithou

t pe

r-aut

horis

ation

Limite

d to

6 v

isits

pe

r ben

eficia

ry p

er

annu

m a

t a U

nive

rsal

N

etw

ork

GP, w

ithou

t pe

r-aut

horis

ation

.

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Limite

d to

:M

: 8M

+1: 1

2M

+2: 1

4M

+3+:

15

visit

s per

ann

um a

t a

nom

inat

ed U

nive

rsal

N

etw

ork

GP.

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Bene

ficia

ries a

re

requ

ired

to n

omin

ate

a U

nive

rsal

Net

wor

k GP

afte

r 10

visit

s.

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Bene

ficia

ries a

re

requ

ired

to n

omin

ate

a U

nive

rsal

Net

wor

k GP

afte

r 8 v

isits

.

Unl

imite

d at

sele

ct

Uni

vers

al N

etw

ork

GP.

Bene

ficia

ries a

re

requ

ired

to u

tilise

se

lect

ed N

etw

ork

Prov

ider

from

the

first

visi

t

Unl

imite

d at

a

Uni

vers

al N

etw

ork

GP.

Clin

ical m

otiva

tion

may

be

requ

ired

to a

utho

rise

mor

e th

an 6

GP

visit

s pe

r ben

eficia

ry p

er

annu

m.

Acut

e M

edica

tion

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.

Chro

nic

Med

icatio

n

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

36 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

26 P

MB

CDL

cond

ition

s + H

RT

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

&

auth

orisa

tion

requ

ired.

Path

olog

y

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Radi

olog

y (x

-rays

)

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

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rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

N

etw

ork

GP.

HIV

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Regi

stra

tion

on

RX H

ealth

HIV

Pr

ogra

mm

e an

d fo

rmul

ary

med

icine

s on

ly.

Regi

stra

tion

on

RX H

ealth

HIV

Pr

ogra

mm

e an

d fo

rmul

ary

med

icine

s on

ly.

Regi

stra

tion

on

RX H

ealth

HIV

Pr

ogra

mm

e an

d fo

rmul

ary

med

icine

s on

ly.

Regi

stra

tion

on

the

Uni

vers

al H

IV

Prog

ram

me

and

form

ular

y m

edici

nes

only.

Spec

ialis

t

Subj

ect t

o da

y-to

-day

be

nefit

of R

4 51

0 pe

r fa

mily

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

6 ad

ditio

nal

ante

-nat

al v

isits

pe

r pre

gnan

cy a

t a

Uni

vers

al N

etw

ork

GP

or g

ynae

colo

gist

.

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

3 vi

sits p

er

bene

ficia

ry, m

ax 3

pe

r fam

ily. S

ubje

ct to

AF

B**

2 ad

ditio

nal a

nte-

nata

l visi

ts p

er

preg

nanc

y su

bjec

t to

AFB*

*

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

2 vi

sits p

er

bene

ficia

ry, m

ax 3

per

fa

mily

.

8 ad

ditio

nal

ante

-nat

al v

isits

pe

r pre

gnan

cy a

t a

Uni

vers

al N

etw

ork

GP, m

idw

ife o

r gy

naec

olog

ist.

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

2 vi

sits p

er

bene

ficia

ry, m

ax 3

per

fa

mily

.

6 ad

ditio

nal

ante

-nat

al v

isits

pe

r pre

gnan

cy a

t a

Uni

vers

al N

etw

ork

GP, m

idw

ife o

r gy

naec

olog

ist.

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

Limite

d to

PM

B’s o

nly.

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

2 vi

sits p

er

bene

ficia

ry, m

ax 3

per

fa

mily

.

2 ad

ditio

nal a

nte-

nata

l visi

ts p

er

preg

nanc

y su

bjec

t to

AFB*

*

Limite

d to

:M

: R2

990

M+R

4 38

0

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

3 vi

sits p

er

bene

ficia

ry, m

ax 5

per

fa

mily

.

2 ad

ditio

nal a

nte-

nata

l visi

ts p

er

preg

nanc

y

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired

from

RX

Heal

th.

RX H

ealth

cont

act

num

ber:

0861

083

084

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired

from

RX

Heal

th.

RX H

ealth

cont

act

num

ber:

0861

083

084

Refe

rral

by

sele

cted

N

etw

ork

GP.

Pre-

auth

orisa

tion

requ

ired

from

RX

Heal

th.

RX H

ealth

cont

act

num

ber:

0861

083

084

Limite

d to

:M

: R1

550

M+R

3 38

0

Refe

rral

by

Net

wor

k GP

.

Pre-

auth

orisa

tion

requ

ired.

2 vi

sits p

er

bene

ficia

ry, m

ax 3

per

fa

mily

.

12 a

dditi

onal

an

te-n

atal

visi

ts p

er

preg

nanc

y

ED*

= Effi

cien

cy D

iscou

nted

AFB*

* =

Annu

al F

lexi

Ben

efit

General Practitioner Provider Manual / 2019

Occ

upati

onal

Hea

lth P

rodu

ct

Bene

fits

Uni

vers

al W

orke

r Pla

n

truV

ALU

Etr

uCAR

Etr

uHEA

LTH

truW

ELLN

ESS

Gene

ral p

racti

tione

r con

sulta

tions

Unl

imite

d at

a U

nive

rsal

Net

wor

k GP

.U

nlim

ited

at a

Uni

vers

al N

etw

ork

GP.

Unl

imite

d at

a U

nive

rsal

Net

wor

k GP

.U

nlim

ited

at a

Uni

vers

al N

etw

ork

GP.

Acut

e M

edica

tion

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Chro

nic M

edica

tion

No

Bene

fit

6 PM

B CD

L con

ditio

ns

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

& a

utho

risati

on re

quire

d.

32 P

MB

CDL c

ondi

tions

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

& a

utho

risati

on re

quire

d.

33 P

MB

CDL c

ondi

tions

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

& a

utho

risati

on re

quire

d.

Path

olog

ySp

ecifi

c co

des

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Radi

olog

y (x

-rays

)Sp

ecifi

c co

des

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

Spec

ific

code

s

Refe

rral

by

a U

nive

rsal

Net

wor

k GP

.

HIV

No

Bene

fitRe

gist

ratio

n on

the

Uni

vers

al H

IV P

rogr

amm

e an

d fo

rmul

ary

med

icine

s onl

y.N

o Be

nefit

Regi

stra

tion

on th

e U

nive

rsal

HIV

Pro

gram

me

and

form

ular

y m

edici

nes o

nly.

Spec

ialis

tN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Uni

vers

al In

sura

nce

Plan

Bene

fits

Uni

vers

al H

ealth

& A

ccid

ent P

lan

Esse

ntial

& E

ssen

tial A

dvan

ceSt

anda

rd &

Sta

ndar

d Ad

vanc

eCo

mpr

ehen

sive

& C

ompr

ehen

sive

Adv

ance

Gene

ral p

racti

tione

r con

sulta

tions

Limite

d to

3 v

isits

per

insu

red

pers

on a

t a U

nive

rsal

Net

wor

k GP

.

Stat

ed B

enefi

t am

ount

s app

ly

Limite

d to

5 v

isits

per

insu

red

pers

on a

t a U

nive

rsal

Net

wor

k GP

.

Stat

ed B

enefi

t am

ount

s app

ly

Unl

imite

d at

a U

nive

rsal

Net

wor

k GP

.

Stat

ed B

enefi

t am

ount

s app

ly

Acut

e M

edica

tion

Acut

e fo

rmul

ary

med

icine

s onl

y.Ac

ute

form

ular

y m

edici

nes o

nly.

Acut

e fo

rmul

ary

med

icine

s onl

y.

Chro

nic M

edica

tion

11 P

MB

CDL c

ondi

tions

. Sub

ject

to S

tate

d be

nefit

am

ount

per

cond

ition

.

Chro

nic

form

ular

y m

edici

ne o

nly

Regi

stra

tion

& a

utho

risati

on re

quire

d.

15 co

nditi

ons.

Subj

ect t

oSt

ated

ben

efit a

mou

ntpe

r con

ditio

nCh

roni

c fo

rmul

ary

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INDEX1. Introduction 1

1.1 Universal Network – Clients 1

1.2 Identifying beneficiaries/employees/insured persons 2

2. GP Reimbursement (excluding Universal Health & Accident Plans) 3

2.1 Consultation fees 3

2.2 Tariff Codes included in consultation fee 4

2.3 Tariff codes reimbursable over and above the consultation fee 5

3. GP Reimbursement for Universal Health & Accident Plan 6

3.1 Consultation fees 6

3.2 Stated Benefits reimbursable per event 6

4. Pathology 7

5. Radiology 8

6. Specialist Referrals 9

7. HIV Benefits 11

8. Screening and Preventative Care 13

9. Medicines and Medicine Formularies 15

9.1 Acute Medicines 15

9.2 Chronic Medicines 16

9.3 Universal Acute Medicines Formulary 20

9.4 Universal Chronic Medicines Formulary 30

10. Forms 56

10.1 Pathology Request Form 57

10.2 Radiology Request Form – Universal 58

10.3 Radiology Request Form – Universal Health & Accident Plan 59

10.4 Specialist Referral Form 60

10.5 Chronic Medicine Application Form 61

10.6 Patient Consent Form (HIV) 63

HIV Registration Form (excluding Umvuzo Health) Please use Chronic Medicine Application Form


1. IntroductionWelcome to the Universal Healthcare Provider Network (“Universal Network”).

Universal Network is the Network Division of Universal Care, an accredited managed care organisation within the Universal Healthcare Group.

Universal Care is contracted to Medical Schemes and Health Plans to establish and manage networks of healthcare providers to service patients in the lower income segments. Our goal is to provide affordable access to primary healthcare, within a provider network arrangement, without compromising quality of care.

The market the Universal Group is targeting for participation in these network arrangements is not the current existing insured market. The concern of “buy downs” is not only a threat to the General Practitioners’ practices but seriously challenges the sustainability of these network arrangements from a funding perspective. Therefore, the Universal Provider Network Agreements are definitely not a mechanism to discount the General Practitioners’ fee structure but rather a conduit to facilitate access to basic primary healthcare for patients who are currently not insured.

This manual contains information to assist you, the General Practitioner, when servicing patients on any of the medical scheme options and health plans using the Universal Provider Network.

Patients are required to use a General Practitioner from the list of Universal Network General Practitioners.

1.1 Universal Network – Clients

Medical Schemes Options/Plans

AECI Medical Aid Society Value Option

CompCare Wellness Medical SchemeNetworX Option

NetworX ED* Option

Massmart Health PlanNetwork Option

Essential Option

Old Mutual Staff Medical Aid FundNetwork Plan

Network SELECT Plan

Tiger Brands Medical Scheme Primary Plus Option (Name change)

Transmed Medical Fund Link Plan (Name change)

Umvuzo Health

Standard Option

Ultra Affordable Option

Ultra Affordable Value Option (New)

Witbank Coalfields Medical Aid Scheme Ntsika Option

ED* = Efficiency Discounted

1General Practitioner Provider Manual / 2019

Occupational Health Product Plans

Universal WorkerPlan

truVALUE

truCARE

truHEALTH

truWELLNESS

Universal Insurance Plan Plans

Universal Health & Accident Plan

Essential

Essential Advance

Standard

Standard Advance

Comprehensive

Comprehensive Advance

1.2 Identifying beneficiaries/insured persons/employeesAll beneficiaries/employees/insured persons will carry a membership/policy card which will indicate that they are beneficiaries/employees/insured persons. We urge you to confirm membership/employee/insured persons eligibility to avoid claim rejections.

Confirmation of membership/employee/insured persons eligibility can be obtained from:• The Universal Call Centre on (011) 208-1000/1010/1020• The Universal website at www.universal.co.za.• Service providers are urged to contact the Universal Call Centre to confirm membership validity/employee eligibility/insured

person validity and available benefits before providing services to the beneficiaries/employees/insured persons.

Please also check the patient’s details against the patient’s identity book/passport.

2 General Practitioner Provider Manual / 2019

2. GP Reimbursement (excluding Universal Health and Accident Plans)

Each Medical Scheme, Occupational Health Product or Insurance Plan on the Universal Provider Network has specific GP benefits which must be obtained from a Universal Network General Practitioner.

2.1 Consultation feesThe following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192

Category Category Description 2019 Fees (inclusive of VAT)

Category A Dispensing doctors: Consultation fee including acute medication R392

Category B Non-dispensing doctors: Consultation fee including acute medication dispensed by a Universal Network Pharmacy R392

Category C Non-dispensing doctors: Consultation fee excluding acute medication (consultations only) R271

Capitation Fees where agreed, if more than 50 patients:

Capitation Fees 2019 Fees (inclusive of VAT)

Capitation fee per beneficiary/employee per month

Age under 18 years R45

Age 18 – 59 years R57

Age 60 years or older R65

Plus: Category A and BConsultation fee per beneficiary/employee per visit.• The consultation fee includes the cost of acute medication.• All fees are inclusive of VAT.• The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192

R185

Plus: Category CConsultation fee per beneficiary/employee per visit.• The consultation fee excludes the cost of acute medication.• All fees are inclusive of VAT.• The following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192

R66


2.2 Tariff Codes included in consultation feesWhere clinically indicated and where the Universal Network GP is able and willing to perform the services, no additional fees will be paid for the following codes. These services are included in the consultation fee paid to the Network GP and therefore may not be claimed as a separate item and members/employees will not be required to pay for them.

Tariff Code Tariff Description0146 For emergency or unscheduled consultation/visit at the doctor’s home or rooms, all hours0147 For emergency or unscheduled consultation/visit away from the doctor's home or rooms, all hours0201 Cost of material0202 Setting of sterile tray0206 Intravenous infusions (push-in)0207 Intravenous treatment: Intravenous infusions (cut-down)0222 Intralesional injection into areas of pathology e.g. Keloid: Single0223 Intralesional injection into areas of pathology e.g. Keloids: Multiple0225 Epilation: Per session

0227 Special treatment of severe acne cases, including draining of cysts, expressing of cleaning of Comedones and/or steaming, abrasive cleaning of skin and UVR per session

0228 PUVA Treatment: Maximum of 210229 PUVA: Follow-up or maintenance therapy once a week0230 UVR-Treatment0231 UVR-Follow-up - for use of ultraviolet lamp -Treatment of benign skin lesion by chemo-cryotherapy0233 Biopsy without suturing: First lesion0234 Biopsy without suturing: Subsequent lesions (each)0235 Biopsy without suturing: Maximum for multiple additional lesions0237 Deep skin biopsy by surgical incision with local anaesthetic and suturing0241 Treatment of benign skin lesion by chemo-cryotherapy: First Lesion0242 Treatment of benign skin lesion by chemo-cryotherapy: Subsequent lesions (each)0243 Treatment of benign skin lesion by chemo-cryotherapy: Maximum for multiple additional lesions0316 Fine needle aspiration for soft tissue (all areas)0317 Aspiration of cyst or tumour1037 Diathermy to nose or pharynx1136 Nebulisation (in rooms)1186 Flow volume test: Inspiration/expiration1188 Flow volume test: Inspiration/expiration/pre- and post-bronchodilator1189 Forced expirogram only1190 Determination of resistance to airflow in paediatric patients, impulse oscilimetry1191 N2 single breath distribution1192 Peak expiratory flow only1228 General Practitioner's fee for the taking of an ECG only: Without effort1229 General Practitioner's fee for the taking of an ECG only: Without and with effort1230 Physician's fee for interpreting an ECG: Without effort1231 Physician's fee for interpreting an ECG: Without and with effort1232 Electrocardiogram: Without effort1233 Electrocardiogram: Without and with effort

1234 Effort electrocardiogram with the aid of a special bicycle ergometer, monitoring apparatus and availability of associated apparatus

1235 Multi-stage treadmill test


Tariff Code Tariff Description2125 Destruction of condylomata/chemo- or cryotherapy: Limited number: Male2127 Destruction of condylomata2129 Electrodesiccation: Limited number2131 Electrodesiccation: Multiple extensive2271 Removal of tag or polyp2272 Removal of small superficial benign lesions2316 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: First lesion: Female2317 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Repeat: Female2318 Destruction of condylomata by chemo-, cryo-, or electrotherapy, or harmonic scalpel: Widespread: Female2399 Punch biopsy (excluding after-care)2400 Biopsy during pregnancy (excluding after-care)2403 Wedge biopsy: Cervix (excluding after-care)2404 Biopsy: Wedge during pregnancy: Cervix (excluding after-care)2405 Cone biopsy: Cervix (excluding after-care)2957 Individual psychotherapy: Per short session (20 minutes)2958 Psychoanalytic therapy: Per 60-minute session2962 Directive therapy to family, parent(s), spouse: Per 20-minute session2963 Pairs, marriage or sex therapy: Per 20-minute session

2968 Group therapy: Adults (specify number): Tariff per person per 80-minute session; Children (specify number): Tariff per person per 80-minute session

3171 Excision of Meibomian cyst. Additional fee for sterile tray3304 All other physical treatments carried out: Complete physical treatment: Specify treatment3762 Full blood count (including items 3739, 3762, 3783, 3785, 3791)4050 Glucose strip-test with photometric reading4188 Urine dipstick, per stick (irrespective of the number of tests on stick)

2.3 Tariff codes reimbursable over and above the consultation feeThe codes listed in the Table below will be the only codes paid for and these will be paid for at the fees listed. No other codes or fees will be paid unless pre-authorisation is obtained and members/employees will not be required to pay for them.

Please note: The fee includes any consumables that may be used.

Tariff Code Tariff Description 2019 Fees (inclusive of VAT)

0255 Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail R316

0259 Removal of foreign body superficial to deep fascia (except hands) R451

0300 Stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia): Including normal after-care) R432

0301 Stitching of soft-tissue injuries: Additional wounds stitched at same session (each) R90

0307 Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude R540

0887 Limb cast (excluding after-care) (modifier 0005 not applicable) R477


6

3. GP Reimbursement for Universal Health & Accident PlanAn event consists primarily of a Consultation and Treatment. Any other related events, as listed below, may be claimed for in addition to the Consultation and Treatment per event, depending on the health treatment required, and claimed for according to the tariff. Only listed stated benefits amounts will be reimbursed.

3.1 Consultation feesThe following codes must be used for all consultations for any acute, follow-up or chronic visits: 0190, 0191 or 0192

Category Category Description 2019 Fees (inclusive of VAT)

Category A Dispensing doctors: Consultation fee including acute medication R392

Category B Non-dispensing doctors: Consultation fee including acute medication dispensed by a Universal Network Pharmacy R392

Category C Non-dispensing doctors: Consultation fee excluding acute medication (consultations only) R271

3.2 Stated Benefits reimbursable per eventProcedures that may be claimed for in addition to the Consultation and Treatment per event.

Tariff Code Tariff Description 2019 Fees (inclusive of VAT)

0233 Biopsy without suturing: First lesion R80

0234 Biopsy without suturing: Subsequent lesions (each) R119

0237 Deep skin biopsy by surgical incision with local anaesthetic and suturing R433

0255 Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail R316

0259 Removal of foreign body superficial to deep fascia (except hands) R452

0300 Stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia): Including normal after-care) R432

0301 Stitching of soft-tissue injuries: Additional wounds stitched at same session (each) R90

0302 Stitching of soft-tissue injuries: Deep laceration involving limited muscle damage R612

0307 Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude R540

0887 Limb cast (excluding after-care) (modifier 0005 not applicable) R477

3615 Routine obstetric ultrasound at 10 to 20 weeks gestational age preferable at 10 to 14 weeks gestational age to include nuchal translucency assessment R674

3617 Routine obstetric ultrasound at 20 to 24 weeks to include detailed anatomical assessment R674


7

4. PathologyPathology BenefitsOnly certain Pathology tests are covered. See page 57 for the Pathology Request Form.

Pathology tests that are not listed on the Universal Network Pathology request form will not be funded unless pre-authorisation is obtained from Universal Care.

Pathology Services may only be rendered by a Universal Network Preferred Pathology Provider except in the case of emergencies.


5. RadiologyRadiology BenefitsOnly certain Radiology tests are covered. See page 58 for the Radiology Request Forms.

Radiology tests that are not listed on the Universal Network Radiology request form will not be funded unless pre-authorisation is obtained from Universal Care.

Radiology tests on the Universal Health & Accident Plan are paid according to the negotiated stated benefit for x-rays, as part of the allocated GP event. Please refer to page 59 for the Universal Health & Accident Radiology Request Form.

Advanced Radiology (i.e. any other radiology investigations including CT and MRI scans) are limited to benefits as stipulated in the rules of the Scheme and must be pre-authorised.

Medical Scheme Options/Plans Advanced Radiology

AECI Medical Aid Society Value Option Limited to PMB’s only, subject to pre-authorisation

CompCare Wellness Medical SchemeNetworX Option Limited to PMB’s only, subject to pre-

authorisationNetworX ED* Option

Massmart Health PlanNetwork Option Limited to R12 700 per family (combined

in-and-out-of-hospital limit)

Essential Option Limited to PMB’s only, subject to pre-authorisation

Old Mutual Staff Medical Aid FundNetwork Plan Limited to a combined in-and-out-of-

hospital benefit limit of R13 400 per family per year, subject to pre-authorisationNetwork SELECT Plan

Tiger Brands Medical Scheme Primary Plus Option Limited to PMB’s only, subject to pre-authorisation

Transmed Medical Fund Link Plan Limited to R21 890 per family per year, subject to pre-authorisation

Umvuzo HealthStandard Option

Limited to PMB’s only, subject to pre-authorisationUltra Affordable Option

Ultra Affordable Value Option

Witbank Coalfields Medical Aid Scheme Ntsika Option Limited to PMB’s only, subject to pre-authorisation

Occupational Health Plans Advanced Radiology


truVALUE

No BenefittruCAREtruHEALTHtruWELLNESS

Universal Insurance Plan Plans Advanced Radiology


Essential

No Benefit

Essential AdvanceStandardStandard AdvanceComprehensiveComprehensive Advance


9

6. Specialist ReferralsSpecialist benefits/consultations are only available on the following Medical Schemes/Occupational Health Product/Insurance Plan. These benefits are subject to specific conditions.

Medical Schemes Options/Plans Specialist Consultations Ante-natal Consultations

Referral by Universal Network Provider

Pre-authorisation

required

AECI Medical Aid Society Value Option

Subject to day-to- day benefit of R4 510 per member family

Limited to 6 additional ante-natal consultations with a Network GP or Gynaecologist and limited to two 2D Scans per pregnancy

CompCare Wellness Medical Scheme

NetworX Option Limited to 2 per beneficiary, max 3 per family. Subject to AFB**

Limited to 2 additional ante-natal visits per pregnancy, subject to AFB**NetworX ED*

Option

Massmart Health Plan

Network Option Limited to 4 per family

Limited to 8 additional ante-natal visits per pregnancy by a GP, midwife or Gynaecologist

Essential OptionLimited to 2 per beneficiary max 3 per family

Limited to 6 additional ante-natal visits per pregnancy by a GP, midwife or Gynaecologist

Old Mutual Staff Medical Aid Fund

Network PlanPMB’s only

Limited to any Universal Network GP and limited to two 2D Scans per pregnancy.

Network SELECT Plan

Tiger Brands Medical Scheme

Primary Plus Option

Limited to 2 per beneficiary max 3 per family

Limited to 2 additional ante-natal visits per pregnancy, subject to AFB**

Transmed Medical Fund Link Plan

Limited to 3 per beneficiary max 5 per family

Limited to 2 additional ante-natal visits per pregnancy.Limited to rand limit of:M: R2 850M+ R4 170

Umvuzo Health

Standard Option

Subject to available benefits No Benefit

Pre-authorisationby Rx Health.

Telephonenumber:

0861 083 084

Ultra Affordable Option


Witbank Coalfields Medical Aid Scheme

Ntsika Option

Limited to 2 per beneficiary max 3 per family.Limited to a rand value of:M: R1 550M+ R3 380

Limited to 12 additional ante-natal visits per pregnancy and two 2D scans


Occupational Health Product Plans Specialist

Consultations Ante-natal Consultations


Pre-authorisation

required


truVALUE

No Benefit No Benefit No Benefit No BenefittruCAREtruHEALTHtruWELLNESS

Universal Insurance Plan Plans Specialist

Consultations Ante-natal Consultations


Pre-authorisation

required


Essential

No Benefit No Benefit No Benefit No Benefit


Specialist Referral procedureOut-of-hospital Specialist visits require referral by a Network GP and must be pre-authorised by Universal Care prior to the visit.

A Specialist referral form must be completed by the referring Network GP when referring a patient to a Specialist. See page 60 for the Specialist Referral Form.

NB: *To obtain pre-authorisation please see Contact Details (back cover).

Specialist costs are funded at Scheme rates and are subject to the beneficiary’s available Medical Scheme day-to-day benefits.

Authorisations are only valid for a specified date period and the beneficiary must visit the Specialist within the authorised date period.

No additional authorisation is required should the Specialist require Pathology tests as specified on the Universal Network Pathology request form.

No additional authorisation is required should the Specialist require Radiology tests as specified on the Universal Network Radiology request form.

NB: Pre-authorisation is required for any Pathology tests or Radiology procedures required by the Specialist, that are not listed on the Universal Network Pathology and/or Universal Network Radiology request forms. (Please refer to pages 57 and 58 for the Pathology and Radiology request forms).

Any medicine prescribed by a Specialist is subject to the Universal Network medicine formulary.


11

7. HIV BenefitsBeneficiaries employees of the Medical Scheme/Occupational Health Product managed within the Universal Network have access to an HIV Disease Management programme; this excludes insured persons on the Universal Health & Accident Plan and certain Universal WorkerPlan options.

All HIV+ve beneficiaries/employees should be registered on the HIV Disease Management programme. HIV positive patients on the HIV programme receive telephonic supportive counselling for HIV from specially trained HIV nurse counsellors. The HIV nurses follow up regularly with each patient registered on the programme to monitor disease progression and compliance.

The table below shows the HIV Programme providers per Medical Scheme/Occupational Health Product.

Medical Schemes Options/PlansRegistration on

the Universal HIV Programme

HIV Programme Provider

Universal Medicines Formulary

AECI Medical Aid Society Value Option Universal Care

CompCare Wellness Medical Scheme

NetworX OptionUniversal Care

NetworX ED* Option

Massmart Health PlanNetwork Option Universal Care

Essential Option Universal Care

Old Mutual Staff Medical Aid Fund

Network PlanUniversal Care

Network SELECT Plan

Tiger Brands Medical Scheme Primary Plus Option Universal Care

Transmed Medical Fund Link Plan Universal Care

Umvuzo Health

Standard OptionRegistration on

the Rx Health HIVProgramme

Rx HealthUltra Affordable Option


Witbank Coalfields Medical Aid Scheme Ntsika Option Universal Care

Occupational Health Product Plans

Registration on the Universal HIV

Programme




truVALUE No Benefit No Benefit No Benefit

truCARE Universal Care

truHEALTH No Benefit No Benefit No Benefit

truWELLNESS Universal Care

Universal Insurance Plan Plans

Registration on the Universal HIV

Programme



Universal Health & Accident Plan(Insurance Plan)

Essential

No Benefit No Benefit No Benefit



12

Each HIV patient has access to the following benefits for HIV:• Supportive HIV counselling and HIV disease information.• Regular follow up GP visits.• Antiretroviral treatment (ART) prescribed according to the HIV formulary.• Appropriate pathology tests for HIV management.• Monitoring and treatment during pregnancy to prevent Mother to Child Transmission (PMTCT). Access to Post Exposure Prophylaxis

(PEP) after accidental exposure to HIV or sexual assault.• Treatment is to be commenced as soon as possible after exposure and four weeks treatment will be authorised.• Prophylactic treatment for TB and PCP (Isoniazid, Purbac)• Vaccination (Flu, Pneumonia)

Patients registered on the HIV programme qualify for the following GP consultations and pathology tests for the management of their condition:

Tariff code Tariff Description No. of procedures or tests per year, dependent on patient’s control

0190-0192 GP consultations 2-43816 CD4 cell count 2-34057 Fasting glucose 13755 Full blood count 2-34531 Hepatitis Screen (Hep B) 14025 Lipogram 14130-4131 Liver function test 2-33974 PCR qualitative, in PMTCT only (newborn) 13881,3885,3893,3916,4188,4651 TB screen 14032, 41151 Urea and creatinine 2-34429 Viral load 2-3

If the patient requires antiretroviral medicine (ART), these medicines must be prescribed according to the Universal Chronic Medicine Formulary. The prescribed medicines must be pre-authorised by the HIV Programme.

A completed chronic application or a prescription may be emailed or faxed to the HIV Programme. The HIV programme performs a review of the treatment prior to the authorisation of the medicine. After the medicines have been authorised the HIV counsellors contact the patient to arrange for the medicine to be obtained from the Scheme’s Preferred Pharmacy or from the doctor’s practice.

A patient consent form is available on page 63. Please refer to the chronic medicines formulary for a list of medicines covered for HIV.

The HIV nurses from the HIV programme regularly contact the patient telephonically to monitor disease progression and compliance to the HIV treatment plan.

Universal Care HIV Programme Contact details:Tel: 086 011 1900Fax: 086 295 7305

E-mail: [email protected]: www.universal.co.za

Umvuzo Health (HIV Programme)Tel: 0861 083 084 / (012) 845 0099

Fax: 0866 859 709E-mail: [email protected]


8. S

cree

ning

and

Pre

vent

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Car

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Pro

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Bene

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15

9. M

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ines

and

Med

icin

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s9.

1 Ac

ute

Med

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All m

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r acu

te m

edic

ines

acc

ordi

ng to

the

Uni

vers

al N

etw

ork

Acut

e M

edic

ine

Form

ular

y an

d ar

e su

bjec

t to

the

Form

ular

y Re

fere

nce

Pric

e (F

RP).

Med

icin

es th

at a

re n

ot o

n th

e m

edic

ine

form

ular

y w

ill n

ot b

e pa

id fo

r.

• Th

e co

st o

f any

acu

te m

edic

ine

pres

crib

ed b

y a

Uni

vers

al N

etw

ork

GP

and

disp

ense

d by

a p

harm

acy,

form

s pa

rt o

f the

con

sulta

tion

fee

and

will

be

subt

ract

ed fr

om th

e fix

ed ra

te c

onsu

ltatio

n fe

e as

list

ed in

Sec

tion

2 of

this

Man

ual.

(Cat

egor

y B

doct

ors)

.

• Fo

r di

spen

sing

doct

ors

regi

ster

ed a

s su

ch o

n th

e U

nive

rsal

GP

netw

ork,

the

cos

t of

any

acu

te m

edic

ines

disp

ense

d by

the

GP

form

s pa

rt o

f th

e co

nsul

tatio

n fe

e an

d m

ay n

ot b

e ch

arge

d se

para

tely.

(Cat

egor

y A

doct

ors)

.

On

the

Uni

vers

al H

ealth

& A

ccid

ent P

lan,

acu

te m

edic

ines

form

par

t of t

he co

nsul

tatio

n an

d tr

eatm

ent e

vent

and

are

pai

d ac

cord

ing

to S

tate

d Be

nefit

val

ues.

Ple

ase

refe

r to

Stat

ed B

enefi

ts p

er e

vent

.


16

9.2

Chro

nic

Med

icin

es:

All c

hron

ic m

edic

ines

(as p

er th

e lis

t of c

ondi

tions

cov

ered

in th

e Ta

bles

bel

ow),

are

subj

ect t

o th

e U

nive

rsal

Chr

onic

Med

icin

e Fo

rmul

ary

and

the

Form

ular

y Re

fere

nce

Pric

e (F

RP).

A St

ated

Ben

efit

valu

e is

appl

icab

le p

er c

ondi

tion

on th

e U

nive

rsal

Hea

lth&

Acc

iden

t Pla

n.

Thes

e ch

roni

c m

edic

ines

may

be

disp

ense

d by

a c

ontr

acte

d di

spen

sing

GP

or o

btai

ned

from

a p

harm

acy

with

in th

e U

nive

rsal

Net

wor

k. T

he c

ost o

f chr

onic

med

icati

on d

oes

not f

orm

par

t of t

he

cons

ulta

tion

fee.

All c

hron

ic p

atien

ts n

eed

to r

egist

er o

n th

e U

nive

rsal

Chr

onic

Pro

gram

me

and

all c

hron

ic m

edic

ines

mus

t be

pre

-aut

horis

ed. A

Chr

onic

Med

icin

e ap

plic

ation

may

be

com

plet

ed b

y th

e G

P, o

r al

tern

ative

ly th

e G

P m

ay c

onta

ct 0

860

111

900

to re

gist

er th

e co

nditi

on te

leph

onic

ally.

Ple

ase

refe

r to

page

61

for t

he C

hron

ic M

edic

ine

appl

icati

on fo

rm.

Cond

ition

s

AECI

Med

ical

Aid

So

ciet

y

Com

pCar

e W

elln

ess M

edica

l Sc

hem

e

Mas

smar

t Hea

lth

Plan

Old

Mut

ual S

taff

Med

ical

Aid

Fun

dTi

ger B

rand

s M

edic

al S

chem

eTr

ansm

ed

Med

ical

Fun

dUm

vuzo

Hea

lthW

itban

k Co

alfie

lds

Med

ical A

id S

chem

e

Valu

e O

ption

Net

wor

X &

N

etw

orX

ED*

Opti

ons

Net

wor

k &

Es

senti

al O

ption

s

Net

wor

k &

N

etw

ork

SELE

CT

Plan

s

Prim

ary

Plus

O

ption

Link

Pla

nSt

anda

rd O

ption

Ultr

a Aff

orda

ble

& U

ltra

Affor

dabl

e Va

lue

Opti

ons

Nts

ika

Opti

on

Acne

(cys

tic n

odul

ar)

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Addi

son’

s Dis

ease

Alle

rgic

rhin

itis (

if be

nefic

iary

has

ast

hma

or is

und

er 1

2 ye

ars)

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Anxi

ety

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Asth

ma

Atop

ic E

czem

aN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Beni

gn P

rost

atic

Hype

rtro

phy

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Bipo

lar M

ood

Diso

rder

Bron

chie

ctas

is

Card

iac

Arrh

ythm

ias

Card

iom

yopa

thy

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

eCh

roni

c Re

nal F

ailu

reCo

nges

tive

Card

iac

Failu

reCo

rona

ry A

rter

y Di

seas

e

Croh

n’s D

isea

se

Depr

essi

onN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Diab

etes

Insi

pidu

s

Diab

etes

Mel

litus

Typ

e 1

Diab

etes

Mel

litus

Typ

e 2


Cond

ition

s

AECI

Med

ical

Aid

So

ciet

y

Com

pCar

e W

elln

ess M

edica

l Sc

hem

e

Mas

smar

t Hea

lth

Plan

Old

Mut

ual S

taff

Med

ical

Aid

Fun

dTi

ger B

rand

s M

edic

al S

chem

eTr

ansm

ed

Med

ical

Fun

dUm

vuzo

Hea

lthW

itban

k Co

alfie

lds

Med

ical A

id S

chem

e

Valu

e O

ption

Net

wor

X &

N

etw

orX

ED*

Opti

ons

Net

wor

k &

Es

senti

al O

ption

s

Net

wor

k &

N

etw

ork

SELE

CT

Plan

s

Prim

ary

Plus

O

ption

Link

Pla

nSt

anda

rd O

ption

Ultr

a Aff

orda

ble

& U

ltra

Affor

dabl

e Va

lue

Opti

ons

Nts

ika

Opti

on

Epile

psy

Gla

ucom

a

Gou

tN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Haem

ophi

lia

HIV

Horm

one

Repl

acem

ent

Ther

apy

(Fem

ale

HRT)

No

Bene

fit

Hype

r-ch

oles

tero

lem

ia /

Hy

per-

lipid

aem

iaHy

pert

ensi

on

Hype

r-pa

rath

yroi

dism

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Hypo

thyr

oidi

sm

Maj

or D

epre

ssio

nN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Mig

rain

e pr

ophy

lacti

cs

(pre

venti

on)

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Mul

tiple

Scl

eros

is

Ost

eoar

thriti

sN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Park

inso

n’s D

isea

sePo

st-t

raum

atic

Stre

ss

Diso

rder

(PTS

D)N

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Perip

hera

l Vas

cula

r Di

seas

eN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Psor

iasi

sN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

Rayn

aud’

s Dis

ease

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Rheu

mat

oid

Arth

ritis

Schi

zoph

reni

a

Stro

keN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fitN

o Be

nefit

No

Bene

fit

Syst

emic

Lup

us

Eryt

hem

atos

usU

lcer

ative

Col

itis

Tota

l num

ber o

f Chr

onic

Co

nditi

ons c

over

ed28

2728

3728

2831

2828


Cond

ition

sO

ccup

ation

al H

ealth

Pro

duct

Uni

vers

al W

orke

rPla

ntr

uHEA

LTH

truC

ARE

truW

ELLN

ESS

Addi

son’

s Dis

ease

No

Bene

fit

Asth

ma

Atop

ic E

czem

aN

o Be

nefit

Beni

gn P

rost

atic

Hype

rtro

phy

No

Bene

fit

Bipo

lar M

ood

Diso

rder

No

Bene

fit

Bron

chie

ctas

isN

o Be

nefit

Card

iac

Arrh

ythm

ias

No

Bene

fit

Card

iom

yopa

thy

No

Bene

fit

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

eN

o Be

nefit

Chro

nic

Rena

l Fai

lure

No

Bene

fit

Cong

estiv

e Ca

rdia

c Fa

ilure

No

Bene

fit

Coro

nary

Art

ery

Dise

ase

No

Bene

fit

Croh

n’s D

isea

seN

o Be

nefit

Diab

etes

Insi

pidu

sN

o Be

nefit

Diab

etes

Mel

litus

Typ

e 1

Diab

etes

Mel

litus

Typ

e 2

Epile

psy

No

Bene

fit

Gla

ucom

aN

o Be

nefit

HIV

No

Bene

fit

Horm

one

Repl

acem

ent T

hera

py (F

emal

e HR

T)N

o Be

nefit

Hype

rcho

lest

erol

emia

/Hyp

erlip

idae

mia

Hype

rten

sion

Hypo

thyr

oidi

smN

o Be

nefit

Park

inso

n’s D

isea

seN

o Be

nefit

Pepti

c U

lcer

ation

No

Bene

fit

Perip

hera

l Vas

cula

r Dis

ease

No

Bene

fit

Psor

iasi

sN

o Be

nefit

Rayn

aud’

s Dis

ease

No

Bene

fit

Rheu

mat

oid

Arth

ritis

No

Bene

fit

Schi

zoph

reni

aN

o Be

nefit

Syst

emic

Lup

us E

ryth

emat

osus

No

Bene

fit

Ulc

erati

ve C

oliti

sN

o Be

nefit

Tota

l num

ber o

f Chr

onic

Con

ditio

ns c

over

ed32

633


Cond

ition

sU

nive

rsal

Hea

lth &

Acc

iden

t Pla

n

Esse

ntial

&

Esse

ntial

Adv

ance

Stan

dard

&

Stan

dard

Adv

ance

Com

preh

ensi

ve &

Co

mpr

ehen

sive

Adv

ance

Addi

son’

s Dis

ease

No

Bene

fitN

o Be

nefit

Asth

ma

Bron

chie

ctas

isN

o Be

nefit

Card

iac

Arrh

ythm

ias

Card

iom

yopa

thy

No

Bene

fit

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e

Chro

nic

Rena

l Fai

lure

No

Bene

fitN

o Be

nefit

Cong

estiv

e Ca

rdia

c Fa

ilure

Coro

nary

Art

ery

Dise

ase

Croh

n’s D

isea

seN

o Be

nefit

No

Bene

fit

Diab

etes

Mel

litus

Typ

e 1

Diab

etes

Mel

litus

Typ

e 2

Epile

psy

Gla

ucom

aN

o Be

nefit

Hype

rcho

lest

erol

emia

/Hyp

erlip

idae

mia

Hype

rten

sion

Hypo

thyr

oidi

sm

Men

opau

seN

o Be

nefit

No

Bene

fit

Mul

tiple

Scl

eros

isN

o Be

nefit

No

Bene

fit

Park

inso

n’s D

isea

seN

o Be

nefit

Psor

iasi

sN

o Be

nefit

No

Bene

fit

Rheu

mat

oid

Arth

ritis

No

Bene

fitN

o Be

nefit

Stro

keN

o Be

nefit

No

Bene

fit

Syst

emic

Lup

us E

ryth

emat

osus

No

Bene

fitN

o Be

nefit

Ulc

erati

ve C

oliti

sN

o Be

nefit

No

Bene

fit

Tota

l num

ber o

f Chr

onic

Con

ditio

ns c

over

ed11

1525


9.3

Uni

vers

al A

cute

Med

icin

es F

orm

ular

y

Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Acne

Topi

cal a

cne

agen

tsBe

nzoy

l Per

oxid

eBe

nzac

AC

Gel

Treti

noin

Iloty

cin

A G

el

Alle

rgic

rhin

itis

Corti

cost

eroi

ds - N

asal

Becl

omet

haso

neBe

clat

e Aq

uana

se S

pray

Fluti

caso

neFl

onas

e Aq

Nas

al S

pray

Alle

rgy

and

derm

atitis

Antih

istam

ines

Cetir

izin

e G

ulf C

etiriz

ine

Tab,

Zin

alle

rg T

ab

Cetir

izin

e H

exal

Syr

Chlo

rphe

nira

min

e Al

lerg

ex T

ab

Alle

rgex

Syr

Lora

tadi

ne

Clar

ityne

Tab

, Lor

meg

Tab

, Lor

ano

Tab

AP L

orat

adin

e Sy

r

Prom

etha

zine

Phen

erga

n 10

mg

Tab

Phen

erga

n 25

mg

Tab

Proh

ist S

yr, L

enaz

ine

Syr

Antih

istam

ine

Topi

cal

Diph

enhy

dram

ine

+ Ca

lam

ine

+ Ph

enol

Bi

ohist

Loti

on

Prom

etha

zine

Ph

ener

gan

Crea

m

Alle

rgy

and

infla

mm

ation

Corti

cost

eroi

ds - O

ral

Beta

met

haso

ne

Beta

noid

Tab

Beta

noid

Syr

, Ste

rom

ien

Syr

Pred

niso

lone

Ca

psoi

d Ta

b, L

eniso

lone

Tab

Adco

-Pre

dniso

lone

Syr

Pred

niso

ne

Be-t

abs

Pred

niso

ne T

ab, P

anaf

cort

Tab

Corti

cost

eroi

ds -T

opic

al

Beta

met

haso

ne

Topi

vate

Cre

am

Leno

vate

Oin

t

Betn

ovat

e SC

Sca

lp A

pplic

ation

Clob

etas

ol

Dova

te C

ream

Derm

ovat

e O

int,

Dova

te O

int

Clob

ex S

ham

poo

Hyd

roco

rtiso

ne

Bioc

ort C

ream

Myl

ocor

t Oin

t

Amen

orrh

oea

Prog

esto

gens

Med

roxy

prog

este

rone

H

exal

-MPA

5m

g Ta

b

Hex

al-M

PA 1

0mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Anae

mia

Hae

mati

nics

Ferr

ous

Fum

arat

e +

Folic

Preg

amal

Tab

Ferr

ous

Sulp

hate

Ferr

ous

Sulp

hate

30m

g Ta

b

Ferr

ous

Sulp

hate

75m

g

Iron

Poly

mal

tose

Fero

fols

Syr

Anth

elm

inth

ics

Anth

elm

inth

ics

Albe

ndaz

ole

Zent

el T

ab

Zent

el S

usp

Meb

enda

zole

Adco

-Wor

mex

100

mg

Tab

Adco

-Wor

mex

500

mg

Tab,

Wor

mst

op 5

00m

g Ta

b

Cipe

x 10

0mg/

5ml S

usp,

Wor

mst

op 1

00m

g/5m

l Sus

p

Verm

ox S

D 50

0mg/

10m

l Sus

p

Pipe

razi

neSB

Tox

Wor

m S

yr

Praz

iqua

ntel

Cysti

cide

500

mg

Tab

Biltr

icid

e 60

0mg

Tab

Anxi

ety

and

stre

ssBe

nzod

iaze

pine

s

Alpr

azol

am

Myl

an A

lpra

zola

m 0

.25m

g Ta

b, Z

opax

0.2

5mg

Tab

Myl

an A

lpra

zola

m 0

.5m

g Ta

b, Z

opax

0.5

mg

Tab

Myl

an A

lpra

zola

m 1

mg

Tab,

Zop

ax 1

mg

Tab

Brom

azep

amSa

ndoz

Bro

maz

epam

3m

g Ta

b

Sand

oz B

rom

azep

am 6

mg

Tab

Diaz

epam

Dova

l 5m

g Ta

b

Pax

10m

g Ta

b

Bron

chos

pasm

Antic

holin

ergi

csIp

ratr

opiu

m

Atro

vent

20m

cg H

FA In

h

Ipve

nt 4

0mcg

Inh

Adco

-Ipra

trop

ium

0.2

5mg/

2ml N

eb

Adco

-Ipra

trop

ium

0.5

mg/

2ml N

eb

B 2 ago

nist

sSa

lbut

amol

Asth

aven

t Inh

, Ven

teze

Inh

Vent

eze

2mg

Tab

Vent

eze

4mg

Tab

Asth

aven

t Syr

, Ven

teze

Syr

Vent

olin

2.5

mg/

2.5m

l Neb

Vent

olin

5m

g/2.

5ml N

eb

Vent

eze

Resp

Sol

ution

Met

hylx

anth

ines

Amin

ophy

lline

Nor

stan

-Ted

100

mg

Tab

Nor

stan

-Ted

200

mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Bron

chos

pasm

(c

ontin

ued)

Met

hylx

anth

ines

(con

tinue

d)Th

eoph

yllin

e

Sand

oz T

heop

hylli

ne 2

00m

g Ta

b

Sand

oz T

heop

hylli

ne 3

00m

g Ta

b

Alco

phyl

lin S

yr

Theo

phyl

line

+ Et

ofyl

line

Theo

phen

Elix

ir

Coag

ulati

on

diso

rder

sH

aem

osta

tics

Tran

exam

ic A

cid

Tran

ic T

ab

Cold

s and

sinu

s

Deco

nges

tant

- Nas

al

Oxy

met

azol

ine

Drin

asal

0.0

25%

Dro

ps, Z

adin

Pae

d 0.

025%

Dro

ps, D

rinas

al 0

.025

% N

asal

Spr

ay

Zadi

n Ad

ult 0

.05%

Dro

ps, D

rixin

e 0.

05%

Nas

al S

pray

Iliad

in 0

.1%

Dro

ps

Phen

ylep

hrin

eN

aphe

nsyl

Dro

ps, N

aphe

nsyl

Pae

d Dr

ops

Phen

ylep

hrin

e +

Nap

hazo

line

Nas

dro

Drop

s, S

inus

S D

rops

Deco

nges

tant

s - O

ral

Pseu

doep

hedr

ine

Adco

-Suf

edrin

Tab

, Sud

afed

Sin

us T

ab

Sinu

med

Syr

Trip

rolid

ine

+ Ps

eudo

ephe

drin

e +

Vit C

Cory

x Pa

ed S

yr

Deco

nges

tant

s, a

nalg

esic

co

mbi

natio

ns

Chlo

rphe

n +

Ephe

drin

e +P

arac

etam

ol +

Caff

eine

Colc

leer

Tab

, Sin

uend

Tab

Chlo

rphe

n +

Phen

ylep

h +P

arac

etam

ol +

Caff

eine

Colc

leer

Pae

d Sy

r

DM +

Phe

nylp

ropa

nola

min

e +

Para

ceta

mol

Flus

tat S

yr

Phen

ylep

h +

Chlo

rphe

n +

DM +

Para

ceta

mol

Kidd

yflu

Syr

Pseu

doep

hedr

ine

+ Pa

race

tam

olSi

nuge

sic T

ab

Pseu

doep

hedr

ine

+ Pa

race

tam

olSi

num

ax P

aed

Syr

Salin

e na

sal a

gent

sSa

line

Just

Sal

ine

Nas

al S

pray

, Sim

ply

Salin

e N

asal

Spr

ay

Cont

race

ption

Hor

mon

al-p

roge

ster

one

Levo

norg

estr

elH

y-an

Tab

, Mic

rova

l Tab

Med

roxy

prog

este

rone

Depo

Pro

vera

Inj,

Peto

gen

Fres

eniu

s In

j

Nor

ethi

ster

one

Nur

-iste

rate

Inj

Hor

mon

al- o

estr

ogen

and

pr

oges

tero

ne c

ombi

natio

n

Ethi

nyl O

estr

adio

l + C

ypro

tero

neDi

va T

ab

Ethi

nyl O

estr

adio

l + D

esog

estr

elM

arve

lon

Tab

Ethi

nyl O

estr

adio

l + G

esto

dene

Min

ulett

e Ta

b

Ethi

nyl O

estr

adio

l + L

evon

orge

stre

lBi

phas

il Ta

b, L

evett

e Ta

b, L

ogyn

on E

D Ta

b,

Ethi

nyl O

estr

adio

l + N

orge

stre

lFa

myn

or T

ab, O

vral

Tab

Coug

hsAn

titus

sives

and

exp

ecto

rant

s

Amin

ophy

lline

+ D

iphe

nhyd

+Am

ClLo

tuss

in E

xpec

tora

nt

Brom

hexi

ne +

Orc

ipre

nalin

eAd

co-L

inct

open

t Syr

, Dur

o-Tu

ss S

yr

Coci

llana

+ T

erpi

n H

ydr

Coci

llana

Com

poun

d Sy

r

Code

ine

Phos

phat

eSy

r Cod

eine

Pho

s


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Coug

hs (c

ontin

ued)

Antit

ussiv

es a

nd e

xpec

tora

nts

(con

tinue

d)

Dext

rom

etho

rpha

n (D

M) +

Am

ClBr

onco

l Syr

, Hist

ador

Lin

ct

Diph

enhy

d +

AmCl

+ S

od C

itrat

e +

Men

thAl

lerg

in E

xpec

tora

nt, C

lear

Cou

gh S

yr, P

heno

rant

Syr

, Fam

tuss

Syr

Ephe

drin

e +

DM +

Am

ClLi

ncto

dyl S

yr

Ephe

drin

e +

Prom

etha

zine

+ C

odBr

unac

od S

yr, D

equa

-Coff

Syr

Ephe

drin

e +

Pyril

amin

e +

Phol

cod

Acug

est S

yr, D

ocse

d Sy

r

Gua

ifene

sinBe

nylin

wet

cou

gh S

yr, B

ronc

holin

Exp

ect S

yr, L

CC G

Gua

iphe

nesin

Cou

gh

Rem

edy

Syr,

Flut

ex C

ough

Mix

ture

Ipec

ac +

Squ

ill +

Tol

uLi

nctu

s Tu

ssi I

nfan

s Sy

r

Pseu

doep

hedr

ine

+ Tr

ipro

lidin

eDe

cofe

d Sy

r

Pseu

doep

hedr

ine

+ Tr

ipro

lidin

e +

Cod

Acug

est C

o Li

nctu

s, F

luda

ctil C

o Sy

r

Pseu

doep

hedr

ine

+ Tr

ipro

lidin

e +

DMAc

uges

t DM

Adu

lt Li

nctu

s

Theo

phyl

line

+ Et

ofyl

line

+ Di

phen

hyd

+ Am

ClAl

coph

ylle

x Sy

r

Theo

phyl

line

+ Et

ofyl

line

+ Di

phen

ylpy

ralin

eTh

eoph

en C

o El

ixir

Coug

hs a

nd c

olds

Muc

olyti

csCa

rboc

yste

ine

Muc

okle

er C

ap

Muc

ospe

ct P

aed

Syr

Bron

chett

e Sy

r, Co

Flem

Syr

, Fle

mgo

Syr

Depr

essi

onAn

ti-de

pres

sant

s

Amitr

ipty

line

Trep

iline

10m

g Ta

b

Gul

f am

itryp

tylin

e 25

mg

Tab,

Tre

pilin

e 25

mg

Tab

Cita

lopr

amAu

stel

l-Cita

lopr

am 1

0mg

Tab

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Fluo

xetin

eDe

proz

an C

ap, P

rola

x Ca

p, R

anflo

cs C

ap

Diar

rhoe

aAn

ti-di

arrh

oeal

s

Kaol

in +

Pec

tinCo

lope

ct S

usp,

Ent

erol

yte

Susp

, Gas

trop

ect S

usp

Kaol

in +

Pec

tin +

Bism

Car

bBi

skap

ect S

usp

Lope

ram

ide

Cipl

a lo

pera

mid

e Ta

b, N

orim

ode

Tab

Adco

Lop

eram

ide

Syr,

Gas

tron

Syr

Elec

trol

yte

repl

acem

ent

NaC

l + N

a Bi

carb

+ K

Cl +

Dex

tros

eEl

ectr

opak

Pow

der,

Rehi

drat

Sac

hets

Dysp

epsi

a,

hear

tbur

n, g

astr

ic

& p

eptic

ulc

ers

Anta

cids

Al H

Cl +

Mg

Oxi

de +

Dic

yclo

min

eAl

umag

D S

usp

Al H

ydro

x +

Mg

Trisi

licat

eM

ayog

el S

usp

Anta

cids

+ A

ntisp

asm

odic

sAl

Hyd

rox

+ M

g O

xide

+ D

icyc

l + D

imet

hM

edig

el S

usp

Al H

ydro

x +

Mg

Oxi

de +

Dic

yclo

min

eAm

gel S

usp,

Neu

trag

el D

Sus

p

H2 r

ecep

tor a

ntag

onist

s

Cim

etidi

neAc

idow

n 20

0mg

Tab,

Bio

-cim

etidi

ne 2

00m

g Ta

b

Bio-

Cim

etidi

ne 4

00m

g Ta

b, L

enam

et 4

00m

g Ta

b

Rani

tidin

eG

ulf-r

aniti

dine

150

mg

Tab,

Ran

it 15

0mg

Tab

CPL

Allia

nce-

rani

tidin

e 30

0mg

Tab,

Ran

it 30

0mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Dysp

epsi

a,

hear

tbur

n, g

astr

ic

& p

eptic

ulc

ers

(con

tinue

d)

Prot

on p

ump

inhi

bito

rs (P

PIs)

Om

epra

zole

Alto

sec

10m

g Ca

p, R

apac

id 1

0mg

Cap

Adco

-om

epra

zole

20m

g Ca

p, P

robi

tor 2

0mg

Cap

Lans

opra

zole

Lanc

ap 1

5mg

Cap,

Bur

nloc

15m

g Ca

p

Adco

rozn

al 3

0mg

Cap,

Lan

cap

30m

g Ca

p, L

anso

praz

ole

Uni

corn

30m

g Ca

p

Pant

opra

zole

Myl

an P

anto

praz

ole

20m

g Ta

b, P

eplo

c 20

mg

Tab,

Pra

zolo

c 20

mg

Tab

Myl

an-P

anto

praz

ole

40m

g Ta

b, P

anto

cid

40m

g Ta

b, P

razo

loc

40m

g Ta

b

Ear i

nfec

tions

Anti-

infe

ctive

s

Phen

azon

eO

toph

en E

ar D

rops

Benz

ocai

ne +

Phe

nazo

neO

tised

Ear

Dro

ps

Neo

myc

in +

Sod

ium

Pro

pion

ate

Neo

pan

Ear D

rops

Gas

tric

an

tispa

smod

ics

Antis

pasm

odic

s

Dipy

rone

+ S

copo

lam

ine

+ Bu

tylb

rom

ide

Busc

opan

Co

Tab

Meb

ever

ine

Bevi

spas

Tab

, Myl

an m

ebev

erin

e Ta

b

Scop

olam

ine

+ Bu

tylb

rom

ide

Hyo

spas

mol

Tab

, Sco

pex

Tab

Hyo

spas

mol

Syr

, Sco

pex

Syr

Gou

tAn

ti-go

utAl

lopu

rinol

Aust

ell A

llopu

rinol

100

mg

Tab

Lono

l 300

mg

Tab,

San

doz

allo

purin

ol 3

00m

g Ta

b

Colc

hici

neAs

pen

Colc

hici

ne 0

.5m

g Ta

b

Haem

orrh

oids

Supp

osito

ries

and

anal

oin

t

Bism

uth

+ Re

sorc

inol

+ Z

inc

+ Ba

lsam

+ B

oric

aci

dAn

usol

Sup

p

Bism

uth

+ Re

sorc

inol

+ Z

inc

+ Ba

lsam

Anus

ol O

int

Pred

niso

lone

+ C

inch

ocai

neSc

herip

roct

Sup

p

Pred

niso

lone

+ C

inch

ocai

neSc

herip

roct

Oin

t

Infe

ction

s

Anti-

bact

eria

l anti

septi

c ag

ents

Fusid

ic A

cid

Fuci

din

Crea

m

Fuci

din

Oin

t

Iodo

quin

ol +

Chl

orob

utan

ol +

Ben

zoca

ine

Viod

or C

ream

Mup

iroci

nBa

ctro

ban

Topi

cal C

ream

Bano

gon

Topi

cal O

int,

Nub

an O

int

Povi

done

+ Io

dine

Sept

adin

e O

int,

Ger

mad

ine

Oin

t

Antib

iotic

s - C

epha

losp

orin

s

Cefa

clor

Verc

ef 3

75 m

g Ta

b

Verc

ef 3

75m

g/ 5

ml S

usp

Ceph

alex

in

Bele

x 25

0mg

Tab,

CPL

Alli

ance

Cep

hale

xin

250m

g Ca

p

Bele

x 50

0mg

Cap,

CPL

Alli

ance

500

mg

Cap

Ranc

eph

125m

g/5m

l Sus

p

Ranc

eph

250m

g/5m

l Sus

p


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Infe

ction

s (c

ontin

ued)

Antib

iotic

s - C

hlor

amph

enic

olCh

lora

mph

enic

olCh

lorp

hen

Cap

Chlo

rcol

Sus

p

Antib

iotic

s - E

ryth

rom

ycin

and

ot

her m

acro

lides

Azith

rom

ycin

Clam

elle

250

mg

Tab,

Var

imax

250

mg

Cap

Azer

o 50

0mg

Tab

Clar

ithro

myc

in

Klar

ibin

250

mg

Tab

Klar

ithra

n 50

0mg

MR

Tab,

Myl

an C

larit

hrom

ycin

500

mg

Tab

Clar

en 1

25m

g/5m

l Sus

pCl

aren

250

mg/

ml S

usp,

Kla

rithr

an 2

50m

g/5m

l Sus

p

Eryt

hrom

ycin

Est

olat

eAd

co e

ryth

rom

ycin

250

mg

Cap

Beta

myc

in 1

25m

g/5m

l Sus

p, E

rym

ycin

P S

yrPu

rmyc

in 2

50m

g/5m

l Sus

p, X

eram

el 2

50/5

ml S

usp

Eryt

hrom

ycin

Ste

arat

eEr

yko

Tab,

Mer

ck E

ryth

rom

ycin

Tab

Antib

iotic

s - O

ther

age

nts

Clin

dam

ycin

Clin

dahe

xal C

ap

Antib

iotic

s - P

enic

illin

s

Amox

icill

in

Aust

ell A

mox

icill

in 2

50m

g Ca

p, Ip

cam

ox 2

50m

g Ca

pAl

lmox

500

mg

Cap,

Aus

tell

Amox

icill

in 5

00m

g Ca

pAl

lmox

S 1

25m

g/5m

l Sus

p, P

rom

oxil

125m

g/5m

l Sus

pAm

yn S

F 25

0mg/

5ml S

usp,

Pro

mox

il 25

0mg/

5ml S

usp

Amox

icill

in +

Flo

xaci

llin

Mac

rope

n Su

spM

acro

pen

Cap

Amox

icill

in +

K C

lavu

lana

te

Aust

ell C

o Am

oxic

lav

375m

g Ta

b, C

lam

entin

375

mg

Tab

Aust

ell C

o Am

oxic

lav

625m

g Ta

b, A

uro

Amox

icla

v 62

5mg

Tab

Aust

ell A

mox

icla

v 10

00m

g Ta

b, C

uram

100

0mg

Tab

Aust

ell A

mox

icla

v 10

00m

g Ta

b, C

uram

100

0mg

Tab

Antib

iotic

s - P

enic

illin

s (c

ontin

ued)

Amox

icill

in +

K C

lavu

lana

te (c

ontin

ued)

Amoc

lan

125m

g/31

.25m

g /5

ml S

usp,

Aug

max

cil S

125

mg/

31.2

5mg/

5ml S

usp,

Sa

ndoz

Am

oxic

lav

S 12

5mg/

5ml S

usp

Amoc

lan

SF 2

50m

g/62

.5m

g /5

ml S

usp,

San

doz

Co A

moc

lav

SF

250m

g/62

.5/5

ml S

usp

Sand

oz C

o Am

ocla

v BD

400

mg/

57m

g/5m

l Sus

p

Clox

acill

inCl

oxin

250

mg

Cap

Clox

in 5

00m

g Ca

p

Peni

cilli

n V

Pota

ssiu

mBe

tape

n Ta

bAt

hlon

e Ph

enox

ymet

hylp

enic

illin

Syr

, Bet

apen

Syr

Antib

iotic

s - Q

uino

lone

sCi

profl

oxac

inBi

otec

h Ci

profl

oxac

in 2

50m

g Ta

b, C

ipro

gen

250m

g Ta

bAu

stel

l Cip

roflo

xaci

n 50

0mg

Tab,

Cifr

an 5

00m

g Ta

b, F

lopr

o 50

0mg

Tab

Aust

ell C

ipro

flox

750m

g Ta

b, B

iote

ch C

ipro

floxa

cin

750m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Infe

ction

s (c

ontin

ued)

Antib

iotic

s - S

ulph

onam

ides

&

com

bina

tions

Sulp

ham

etho

xazo

le +

Trim

etho

prim

Cozo

le 4

00/8

0mg

Tab,

Ilvi

trim

400

/80m

g Ta

b

Duro

bac

DS 8

00/1

60m

g Ta

b, S

ando

z Co

-Trim

oxaz

ole

800/

160m

g Ta

b

Cotr

im S

usp,

Doc

trim

Sus

p

Antib

iotic

s - T

etra

cycl

ines

Doxy

cycl

ine

Dum

oxin

50m

g Ca

p

Doxy

cyl 1

00m

g Ca

p, D

oxyt

et 1

00m

g Ca

p

Oxy

tetr

acyc

line

Nuc

otet

Cap

, Pha

rmat

et C

ap

Antif

unga

l age

nts

Fluc

onaz

ole

Aric

on 5

0mg

Cap

Auro

Flu

cona

zole

150

mg

Cap,

Gul

f fluc

onaz

ole

150m

g Ca

p

Diflu

can

50m

g/5m

l Sus

p

Diflu

can

200m

g/5m

l Sus

p

Gris

eofu

lvin

Mic

roci

dal 1

25m

g Ta

b

Mic

roci

dal 5

00m

g Ta

b

Nys

tatin

Cand

acid

e Su

sp, C

anst

at S

usp

Antif

unga

l age

nts-

Top

ical

Clot

rimaz

ole

Cane

x To

pica

l Cre

am, G

ynez

ol C

ream

, Inn

ospo

re C

ream

Keto

cona

zole

Keta

zol C

ream

Nys

tatin

Cans

tat C

ream

Nys

taci

d O

int

Anae

robi

c an

d an

tipro

tozo

al

agen

tsM

etro

nida

zole

Anae

roby

l 200

mg

Tab,

Met

azol

200

mg

Tab

Amzo

le 4

00m

g Ta

b, S

upra

zole

400

mg

Tab

Flag

yl S

usp

Anti-

vira

l age

nts -

Ora

lAc

yclo

vir

Acyc

lovi

r Bio

tech

200

mg

Tab,

Acy

clovi

r San

doz 2

00m

g Ta

b, Lo

vire

200

mg

Disp

Tab

Acyc

lovi

r Bio

tech

400

mg

Tab,

Lov

ire 4

00 D

isp T

ab

Zovi

rax

Susp

Adco

acy

clov

ir Cr

eam

, Bet

a Vi

ra C

ream

Corti

cost

eroi

ds w

ith a

nti-

infe

ctive

age

nts

Iodo

quin

ol +

Hyd

roco

rtiso

neVi

ocor

t Cre

am

Vagi

nal p

repa

ratio

nsCl

inda

myc

inDa

laci

n Va

gina

l Cre

am

Clot

rimaz

ole

A-Po

r Vag

Cre

am, C

anex

Vag

Cre

am, G

ynez

ol V

ag C

ream

, Fun

gisp

or V

ag C

ream

Infla

mm

ation

Non

-Ste

roid

al A

nti-

infla

mm

ator

ies

(NSA

IDs)

Ibup

rofe

n

Ibuc

ine

200m

g Ta

b, Ib

unat

e 20

0mg

Tab

Bren

400

mg

Tab,

Bet

apro

fen

fc 4

00m

g Ta

b, R

anfe

n 40

0mg

Tab

Ibug

esic

Sus

p, In

flum

ax P

aed

Susp

Mel

oxic

amAp

ex m

elox

icam

7.5

mg

Tab,

Med

oxic

am 7

.5m

g Ta

b

Nap

roxe

nM

ylan

nap

roxe

n 25

0mg

Tab,

Nap

rosc

ript 2

50m

g Ta

b

Bio

napr

oxen

500

mg

Tab,

Nap

flam

500

mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Infla

mm

ation

(c

ontin

ued)

NSA

IDs

Topi

cal

Dicl

ofen

acPa

nam

or G

el 1

.16%

, Vol

tare

n 1.

3% G

el

Ibup

rofe

nDe

ep R

elie

f Gel

Inso

mni

aSe

dativ

e hy

pnoti

csZo

picl

one

Bio

Zopi

clon

e Ta

b, S

ando

z Zo

picl

one

Tab

Laxa

tives

Laxa

tives

Bisa

cody

l

Laxa

dor B

isaco

dyl T

ab

Dulc

olax

5m

g Pa

ed S

uppo

sitor

y

Dulc

olax

10m

g Su

ppos

itory

Lact

ulos

eAn

lac

Syr,

Acul

ax S

yr

PEG

335

0 +

KCl +

Na

Bica

rb +

NaC

l + N

aSKl

ean

Prep

Sod

pico

sulp

h +M

g O

xide

+ Ci

tric

Ac

Pico

prep

Pow

Sodi

um P

hosp

hate

sAd

co-fo

sene

ma,

Len

-O-L

ax A

dult,

Len

-O-L

ax P

aed

, Ena

clea

r

Mal

aria

Anti-

mal

aria

ls

Atov

aquo

ne +

Pro

guan

ilM

alat

eq T

ab, M

ozite

c Ta

b

Chlo

roqu

ine

Plas

moq

uine

Cap

Mirq

uin

Syr

Mefl

oqui

neM

eflia

m T

ab

Mig

rain

eAn

ti-m

igra

ine

Clon

idin

eM

enog

rain

e Ta

b

Mus

cle

Rela

xant

sCe

ntra

lly a

cting

mus

cle re

laxa

nts

Orp

hena

drin

eN

orfle

x Ta

b

Nau

sea

and

vom

iting

Anti-

verti

go a

nd a

nti-e

meti

c ag

ents

Bucl

izin

e +

Pyrid

oxin

eVo

mife

ne T

ab

Cycl

izin

e

Cova

met

Tab

, Nau

zine

Tab

Tria

zine

50m

g Su

ppos

itory

Valo

id 1

00m

g Su

ppos

itory

Med

azin

e Sy

r, N

auzi

ne S

yr

Fruc

tose

+ D

extr

ose

+ Ph

osph

oric

Aci

dEm

etro

l Liq

uid,

Em

ex S

yr

Met

oclo

pram

ide

Bio

met

oclo

pram

ide

Tab,

Con

trom

et T

ab, C

lopa

mon

Tab

Adco

-Con

trom

et S

yr, C

lopa

mon

Syr

Proc

hlor

pera

zine

Miti

l Tab

, Scr

ipto

-Meti

c Ta

b

Stem

etil 5

mg

Supp

osito

ry

Stem

etil 2

5mg

Supp

osito

ry

Oph

thal

mic

an

aest

hetic

sO

phth

alm

ic- O

ther

sTe

trac

aine

Min

Tet

raca

ine

Drop

s

Oph

thal

mic

an

tialle

rgy

Mas

t cel

l sta

biliz

erCr

omol

ynSt

op a

llerg

Dro

ps

Oph

thal

mic

anti

-in

flam

mat

ory

Corti

cost

eroi

dsDe

xam

etha

sone

Sper

sade

x Dr

ops


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Oph

thal

mic

de

cong

esta

ntDe

cong

esta

nt

Nap

hazo

line

+ Zi

nc S

ulph

ate

Ocu

losa

n Dr

ops

Phen

ylep

hrin

e +

Boric

Aci

dSB

Uni

vers

al E

ye S

oluti

on, U

nive

rsal

Eye

Sol

n

Tetr

ahyd

rozo

line

+ An

tazo

line

Ocu

lerg

e Ey

e Dr

ops

Oph

thal

mic

in

fecti

ons

Anti-

infe

ctive

s

Chlo

ram

phen

icol

Chlo

rphe

n O

int

Chlo

ram

phen

icol

+ N

apha

zolin

e +

Neo

myc

inCo

vom

ycin

Dro

ps

Fusid

ic A

cid

Fuci

thal

mic

Dro

ps

Oflo

xaci

nO

ctin

Drop

s

Dexa

met

haso

ne +

Cip

roflo

xaci

nCi

lode

x Dr

ops

Opt

halm

ic a

nti-v

iral

Anti-

vira

l age

nts

Acyc

lovi

rZo

vira

x O

phth

alm

ic O

int

Oph

thal

mic

M

ydria

tics

Myd

riatic

sAt

ropi

neAt

ropi

ne D

rops

Ora

l loc

al

anae

sthe

tics a

nd

antis

eptic

s

Ora

l ana

esth

etics

Tetr

acai

neDy

nexa

n O

int

Ora

l anti

septi

csCh

lorh

exid

ine

Glu

cona

teCo

rsod

yl S

oln,

Cor

sody

l Sol

n M

int

Povi

done

+ Io

dine

Sept

adin

e O

ral A

ntise

p Li

q, D

erm

adin

e G

argl

e

Ora

l anti

septi

cs &

ana

esth

etics

Cety

lpiri

dium

+ B

enzo

cain

eEn

dcol

Loz

enge

s, O

roch

lor S

ol

Pain

Anal

gesic

s - c

ombi

natio

n

Para

ceta

mol

+ C

odei

ne +

Caff

eine

+ M

epro

bam

ate

Go-

Pain

Tab

, Nuc

opai

n Ta

b, S

pect

rapa

in fo

rte

Tab

Para

ceta

mol

+ C

odei

neSp

ectr

apai

n Ca

p

Adco

-Nap

acod

Tab

, Am

stil T

ab, C

odor

ol T

ab, C

oges

ic T

ab, E

mpa

cod

Tab

Para

ceta

mol

+ P

rom

etha

zine

+ C

odei

neG

oldg

esic

Syr

, Kid

-Eez

e Sy

r, M

edip

yn S

yr

Anal

gesic

s - p

lain

Aspi

rinBa

yer A

spiri

n 30

0mg

Tab,

Dr T

oits

Pai

n Ex

pelle

r 300

mg

Tab,

Gul

f Asp

irin

Tab

Para

ceta

mol

Anta

lgic

Tab

, Gul

f Par

acet

amol

Tab

, Pai

nges

ic T

ab

Barr

s Pa

race

tam

ol S

yr, F

ever

pain

Syr

, Pai

noge

sic S

yr

Empa

ped

125m

g Su

ppos

itory

Empa

ped

250m

g Su

ppos

itory

Tram

adol

Dolo

tram

50m

g Ca

p, T

ram

azac

50m

g Ca

p

Psor

iasi

sAn

ti-ps

oria

tics

Coal

Tar

Coal

Tar

Sol

n Al

lied,

Coa

l Tar

Sol

n BP

, Med

itar S

ham

p

Scab

ies

Anti-

para

sitics

Benz

yl B

enzo

ate

Benz

yl B

enzo

ate

Lotio

n

Mon

osul

firam

Tem

oder

m S

oap

Urin

ary

Infe

ction

sU

rinar

y An

tisep

tics

Nitr

ofur

anto

in

Mac

roda

ntin

50m

g Ca

p

Mac

roda

ntin

100m

g Ca

p

Fura

ndan

tin 2

5mg/

5ml S

usp

Urin

ary

Syst

emAn

ticho

liner

gics

Oxy

buty

nin

Myl

an o

xybu

tyni

n Ta

b, O

xyre

st T

ab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Vacc

ines

Vacc

ines

(Chi

ldho

od v

acci

nes

acco

rdin

g to

the

Stat

e EP

I Sc

hedu

le) (

Not

reim

burs

ed

on O

MSM

AF N

etw

ork

and

Net

wor

k SE

LECT

Pla

ns)

BCG

BCG

Vac

Dipt

heria

, Tet

anus

, Who

opin

g co

ugh,

In

fanr

ix D

TP In

jDi

phth

eria

, Tet

anus

, Who

opin

g co

ugh,

Pol

io, H

aem

in

fluen

zae

BAd

acel

Qua

dra

Inj

Hep

atitis

BH

eber

bio

hbv

Inj

Mea

sles

Rouv

ax In

j

Polio

Polio

ral D

rops

Rota

viru

sRo

tate

q So

ln

Teta

nus

Teta

vax

Inj

Vacc

ines

(Rei

mbu

rsed

on

all

plan

s)In

fluen

za V

irus

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

occa

lPr

even

ar 1

3 In

j, Sy

nflor

ix, P

neum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Vita

min

sVi

tam

ins

Vita

min

AVi

tafo

rce

Vita

min

A C

ap

Folic

Aci

dBe

-tab

s Fo

lic A

cid

Tab,

Gul

f Fol

ic A

cid

Tab

Mul

tivita

min

sBa

ba C

Syr

, Ego

li M

ultiv

itam

in S

yr,E

goli

Vita

min

B C

o M

alt S

yr, F

itvit

Vit B

Co

Mal

t + Ir

on S

yr, V

itam

in B

Co

Mal

t + Ir

on S

yr, V

iday

lin P

lus

Iron

Drp

Pren

atal

Mul

tivita

min

s +

Min

eral

s +

Iron

Preg

amal

Tab

, Cal

cipr

eg T

ab

Pyrid

oxin

ePy

ridox

ine

Tab


9.4

Uni

vers

al C

hron

ic M

edic

ines

For

mul

ary

Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Acne

Topi

cal a

cne

agen

tsBe

nzoy

l Per

oxid

eBe

nzac

AC

Gel

Treti

noin

Iloty

cin

A G

el

Antib

iotic

s - E

ryth

rom

ycin

Eryt

hrom

ycin

Est

olat

eAd

co e

ryth

rom

ycin

250

mg

Cap

Antib

iotic

s - T

etra

cycl

ines

Doxy

cycl

ine

Doxy

cyl 1

00m

g Ca

p, D

oxyt

et 1

00m

g Ca

p

Addi

sons

Dis

ease

Corti

cost

eroi

ds- O

ral

Flud

roco

rtiso

neFl

orin

ef T

ab

Hyd

roco

rtiso

neCo

voco

rt T

ab

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Alle

rgic

rhin

itis

Corti

cost

eroi

ds - N

asal

Becl

omet

haso

neBe

clat

e Aq

uana

se S

pray

, Cle

nil A

q N

asal

Spr

ay

Bude

soni

deSp

ec b

udes

onid

e N

asal

Spr

ay

Rhin

ocor

t 32m

cg N

asal

Spr

ay

Fluti

caso

neFl

onas

e Aq

Nas

al S

pray

, Flo

mist

Aq

Nas

al S

pray

Alle

rgic

rhin

itis

(con

tinue

d)An

tihist

amin

es-O

ral

Cetir

izin

eCe

tiriz

ine

Hex

al T

ab, Z

inal

lerg

Tab

Cetir

izin

e H

exal

Syr

, Zel

ary

Syr

Anxi

ety

Benz

odia

zepi

nes

Alpr

azol

am

Myl

an a

lpra

zola

m 0

.25m

g Ta

b, Z

opax

0.2

5mg

Tab

Myl

an a

lpra

zola

m 0

.5m

g Ta

b, Z

opax

0.5

mg

Tab

Myl

an a

lpra

zola

m 1

mg

Tab,

Zop

ax 1

mg

Tab

Brom

azep

amSa

ndoz

Bro

maz

epam

3m

g Ta

b

Sand

oz B

rom

azep

am 6

mg

Tab

Diaz

epam

Dova

l 5m

g Ta

b

Pax

10m

g Ta

b

Clon

azep

am

Clon

am 0

.5m

g Ta

b

Clon

am 2

mg

Tab

Rivo

tril

Drop

s

Antid

epre

ssan

tsCi

talo

pram

Aust

ell-C

italo

pram

10m

g Ta

b

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Asth

ma

Antic

holin

ergi

cs- i

nhal

edIp

ratr

opiu

mIp

vent

40m

cg In

h

B 2 Ago

nist

s- In

hale

dFo

rmot

erol

Fora

tec

HFA

Inh

Salb

utam

olAs

thav

ent I

nh, V

ente

ze In

h

Corti

cost

eroi

ds-O

ral

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Asth

ma

(con

tinue

d)

Corti

cost

eroi

ds-In

hale

d

Becl

omet

haso

neBe

ceze

50m

cg In

h, B

ecla

te 5

0mcg

Inh

Bece

ze 1

00m

cg In

h, B

ecla

te 1

00m

cg In

hBe

clat

e 20

0mcg

Inh

Bude

soni

deBu

defla

m 1

00m

cg H

FA In

h, P

ulm

icor

t 100

mcg

Tur

buha

ler

Bude

flam

200

mcg

HFA

Inh,

Pul

mic

ort 2

00m

cg T

urbu

hale

r

Fluti

caso

neFl

ixotid

e 50

mcg

Inh

Flixo

tide

125m

cg In

hFl

ixotid

e 20

0mcg

Inh

Corti

cost

eroi

ds/ B

-ago

nist

co

mbi

natio

nsFl

utica

sone

+ Sa

lmet

erol

Sere

flo 2

5/50

mcg

HFA

, Ser

eflo

25/5

0mcg

sync

hrob

reat

heSe

reflo

25/

125m

cg H

FA, S

erefl

o 25

/125

mcg

sync

hrob

reat

heSe

reflo

25/

250m

cg H

FA, S

erefl

o 25

/250

mcg

sync

hrob

reat

he

Met

hylx

anth

ines

Theo

phyl

line

Sand

oz T

heop

hylli

ne 2

00m

g Ta

bSa

ndoz

The

ophy

lline

300

mg

Tab

Leuk

otrie

ne a

ntag

onist

sM

onte

luka

stLu

mon

t 4 m

g Ta

bLu

mon

t 5m

g Ta

bLu

mon

t 10

mg

Tab

Flu

Vacc

ine

Influ

enza

Viru

s Va

ccin

eIn

fluva

c In

j, Va

xigr

ip In

jPn

eum

onia

Vac

cine

Pneu

moc

occa

lPr

even

ar 1

3 In

j, Pn

eum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Atop

ic E

czem

a

Antih

istam

ines

- Ora

l

Cetir

izin

eCe

tiriz

ine

Hex

al T

ab, Z

inal

lerg

Tab

Cetir

izin

e H

exal

Syr

, Zel

ary

Syr

Chlo

rphe

nira

min

eAl

lerg

ex T

ab, R

hine

ton

Tab

Alle

rgex

Syr

Prom

etha

zine

Phen

erga

n 10

mg

Tab

Phen

erga

n 25

mg

Tab

Lena

zine

Syr

, Pro

hist

Syr

Antih

istam

ine

Topi

cal

Diph

enhy

dram

ine

+ Ca

lam

ine

+ Ph

enol

Bioh

ist L

otion

Mep

yram

ine

Alle

rgex

Mep

yram

ine

Crea

m, A

lsan

Crea

mPr

omet

hazi

nePh

ener

gan

Crea

m

Corti

cost

eroi

ds - O

ral

Beta

met

haso

neBe

tano

id T

abBe

tano

id S

yr, S

tero

mie

n Sy

r

Pred

niso

lone

Caps

oid

Tab,

Len

isolo

ne T

abAd

co-P

redn

isolo

ne S

yrPr

edni

sone

Be-t

abs

Pred

niso

ne T

ab, P

anaf

cort

Tab

, Tro

lic T

abIm

mun

osup

pres

sant

sM

etho

trex

ate

Abitr

exat

e Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Beni

gn P

rost

atic

Hype

rtro

phy

Alph

a Bl

ocke

rsDo

xazo

sin

Card

ugen

1m

g Ta

b

Card

ugen

4m

g Ta

b, C

arzi

n 4m

g XL

Tab

Hor

mon

e In

hibi

tors

Fina

ster

ide

Acco

rd F

inas

terid

e Ta

b

Uro

logi

cals

Tam

sulo

sin

Beni

pros

in S

R Ta

b

Bipo

lar M

ood

Diso

rder

Moo

d St

abili

sers

Carb

amaz

epin

e

Degr

anol

200

mg

Tab,

Zep

tol 2

00m

g Ta

b, T

egre

tol C

R 20

0mg

Tab

Tegr

etol

CR

400m

g Ta

b

Tegr

etol

Sus

p

Lam

otrig

ine

Dyna

-Lam

otrig

ine

25m

g Ta

b, E

pite

c 25

mg

Tab

Lam

itor 5

0mg

Tab,

Epi

tec

50m

g Ta

b

Epite

c 10

0mg

Tab

Dyna

Lam

otrig

ine

200m

g Ta

b

Valp

roat

e

Epro

lep

CR 2

00m

g Ta

b, N

aval

pro

CR 2

00m

g Ta

b

Epro

lep

CR 3

00m

g, V

alep

tic C

R 30

0mg

Tab

Epro

lep

CR 5

00m

g, V

alep

tic C

R 50

0mg

Tab

Epili

m L

iq

Lith

ium

Lith

ium

Cam

colit

250

mg

Tab

Cam

colit

400

mg

Tab

Antip

sych

otics

Cloz

apin

eAs

pen

Cloz

apin

e 25

mg

Tab

Aspe

n Cl

ozap

ine

100m

g Ta

b

Risp

erid

one

Zoxa

don

0.5m

g Ta

b

Risn

ia 1

mg

Tab,

Zox

adon

1m

g Ta

b

Risn

ia 2

mg

Tab

Que

tiapi

ne

Sero

quel

50

mg

XR T

ab

Myl

an Q

uetia

pine

100

mg

Tab

Myl

an Q

uetia

pine

200

mg

Tab

Myl

an Q

uetia

pine

300

mg

Tab

SSRI

sCi

talo

pram

Aust

ell-C

italo

pram

10m

g Ta

b

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Arro

w C

italo

prim

40m

g Ta

b

Fluo

xetin

eDe

proz

an C

ap, P

rola

x Ca

p, R

anflo

cs C

ap

Bron

chie

ctas

isAn

tibio

tics -

Pen

icill

ins

Ampi

cilli

nAm

pipe

n 25

0mg

Cap

Be-A

mpi

cil 1

25m

g Su

sp


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Bron

chie

ctas

is

(con

tinue

d)

Antib

iotic

s - P

enic

illin

s (c

ontin

ued)

Amox

icill

in

Aust

ell A

mox

icill

in 2

50m

g Ca

p, Ip

cam

ox 2

50m

g Ca

p

Allm

ox 5

00m

g Ca

p, A

uste

ll Am

oxic

illin

500

mg

Cap

Allm

ox S

125

mg/

5ml S

usp,

Pro

mox

il 12

5mg/

5ml S

usp

Amyn

SF

250m

g/5m

l Sus

p, P

rom

oxil

250m

g/5m

l Sus

p

Peni

cilli

n V

Pota

ssiu

mBe

tape

n Ta

b

Athl

one

Phen

oxym

ethy

lpen

icill

in S

yr, B

etap

en S

yr

Antib

iotic

s - Q

uino

lone

sCi

profl

oxac

in

Biot

ech

Cipr

oflox

acin

250

mg

Tab,

Cip

roge

n 25

0mg

Tab

Aust

ell C

ipro

floxa

cin

500m

g Ta

b, C

ifran

500

mg

Tab,

Flo

pro

500m

g Ta

b

Aust

ell C

ipro

flox

750m

g Ta

b, B

iote

ch C

ipro

floxa

cin

750m

g Ta

b

Antib

iotic

s - S

ulph

onam

ides

an

d co

mbi

natio

nsSu

lpha

met

hoxa

zole

Cozo

le 4

00/8

0mg

Tab,

Ilvi

trim

400

/80m

g Ta

b

Duro

bac

DS 8

00/1

60m

g Ta

b, S

ando

z Co

-Trim

oxaz

ole

800/

160m

g Ta

b

Cotr

im S

usp,

Doc

trim

Sus

p

Antib

iotic

s- T

etra

cycl

ines

Doxy

cycl

ine

Dum

oxin

50m

g Ca

p

Doxy

cyl 1

00m

g Ca

p, D

oxyt

et 1

00m

g Ca

p

Antic

holin

ergi

cs- I

nhal

edIp

ratr

opiu

mIp

vent

40m

cg In

hale

r

Tiot

ropi

umFo

rven

t Inh

alan

t Cap

s

B 2 ago

nist

s -In

hale

dFo

rmot

erol

Fora

tec

HFA

Inh

Salb

utam

olAs

thav

ent I

nh, V

ente

ze In

h

Corti

cost

eroi

ds- I

nhal

ed

Becl

omet

haso

ne

Bece

ze 5

0mcg

Inh,

Bec

late

50m

cg In

h

Bece

ze 1

00m

cg In

h, B

ecla

te 1

00m

cg In

h

Becl

ate

200m

cg In

h

Bude

soni

deBu

defla

m 1

00m

cg H

FA In

h, P

ulm

icor

t 100

mcg

Tur

buha

ler

Bude

flam

200

mcg

HFA

Inh,

Pul

mic

ort 2

00m

cg T

urbu

hale

r

Corti

cost

eroi

ds/ B

-ago

nist

co

mbi

natio

nsFl

utica

sone

+ S

alm

eter

ol

Sere

flo 2

5/50

mcg

HFA

, Ser

eflo

25/5

0 m

cg sy

nchr

obea

the

Sere

flo 2

5/12

5 m

cg H

FA, S

erefl

o 25

/125

mcg

sync

hrob

reat

he

Sere

flo 2

5/25

0 m

cg H

FA, S

erefl

o 25

/250

mcg

sync

hrob

reat

he

Met

hylx

anth

ines

Theo

phyl

line

Sand

oz T

heop

hylli

ne 2

00m

g Ta

b

Sand

oz T

heop

hylli

ne 3

00m

g Ta

b

Muc

olyti

csCa

rboc

yste

ine

Muc

okle

er C

ap

Bron

chett

e 25

0mg/

5ml S

yr, C

oFle

m S

yr, F

lem

go S

yr

Vacc

ines

Flu

vacc

ine

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

occa

l vac

cine

Prev

enar

13

Inj,

Pneu

mov

ax In

j, Im

ovax

Pne

umo

23 In

j


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Card

iac

Arrh

ythm

ia

Anti-

Arrh

ythm

ics

Amio

daro

neH

exar

one

100m

g Ta

bBi

o-Am

ioda

rone

200

mg

Tab

Antic

oagu

lant

sW

arfa

rinCi

pla-

War

farin

5m

g Ta

b

Beta

Blo

cker

sAt

enol

ol

Bio-

Aten

olol

50m

g Ta

b, B

-blo

ck 5

0mg

Tab,

Ten

sopr

ess

50m

g Ta

bB-

bloc

k 10

0mg

Tab,

Ten

sopr

ess

100m

g Ta

b

Calc

ium

cha

nnel

blo

cker

s

Nife

dipi

neCi

pala

t Ret

ard

20m

g Ta

bBi

o N

ifedi

pine

30m

g XL

Tab

Bio

Nife

dipi

ne 6

0mg

XL T

ab

Vera

pam

ilVa

som

il 40

mg

Tab

Vaso

mil

80m

g Ta

bVe

rahe

xal 2

40 S

R Ta

b

Card

iac

Gly

cosid

esDi

goxi

nLa

noxi

n 0.

0625

mg

PG T

abLa

noxi

n 0.

25m

g Ta

bLa

noxi

n Pa

ed 0

.05m

g/m

l Syr

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g Ta

b, M

yopr

in 1

00m

g Ta

b

Card

iac

Failu

re,

Card

io-m

yopa

thy

ACE

Inhi

bito

rs +

com

bina

tions

Capt

opril

Capt

ohex

al 1

2.5m

g Ta

bAd

co-C

apto

max

25m

g Ta

b, M

ylan

-Cap

topr

il 25

mg

Tab

Adco

Cap

tom

ax 5

0mg,

Myl

an C

apto

pril

50m

g Ta

bEn

alap

ril +

Hyd

roch

loro

thia

zide

Phar

map

ress

Co

20/1

2.5m

g Ta

b

Enal

april

Alap

ren

5mg

Tab,

Ena

lapr

il bi

otec

h 5m

g Ta

bAl

apre

n 10

mg

Tab,

Ena

lapr

il bi

otec

h 10

mg

Tab

Alap

ren

20m

g Ta

b, E

nala

pril

biot

ech

20m

g Ta

b

Lisin

opril

+ H

ydro

chlo

roth

iazi

deZe

stor

etic

10/1

2.5m

g Ta

bZe

stor

etic

20/1

2.5m

g Ta

b

Lisin

opril

Sino

pren

5m

g Ta

b, Z

estr

il 5m

g Ta

bAu

stel

l Lisi

nopr

il 10

mg

Tab,

Sin

opre

n 10

mg

Tab

Perin

dopr

il

Ran-

perin

dopr

il 4m

g Ta

bPr

exum

5m

g Ta

bSp

ec P

erin

dopr

il 8m

g Ta

bPr

exum

10m

g Ta

b

Perin

dopr

il +

Inda

pam

ide

Spec

-per

indo

pril

plus

2m

g/0.

625m

g Ta

bPe

arin

da p

lus

4mg/

1.25

mg

Tab

Prex

um P

lus

5/1.

25m

g Ta

b

Bio-

Prex

um P

lus

10/2

.5m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Card

iac

Failu

re,

Card

io-m

yopa

thy

(con

tinue

d)

ACE

Inhi

bito

rs +

com

bina

tions

(c

ontin

ued)

Perin

dopr

il +

Amlo

dipi

ne

Cove

ram

5/5

mg

Tab

Cove

ram

5/1

0mg

Tab

Cove

ram

10/

5mg

Tab

Cove

ram

10/

10m

g Ta

b

Angi

oten

sin II

ant

agon

ists

+ co

mbi

natio

ns

Losa

rtan

Reni

card

50m

g Ta

bAn

nin

100m

g Ta

b, C

ipla

zar 1

00m

g Ta

b

Losa

rtan

+ H

ydro

chlo

roth

iazi

deLo

saar

Plu

s 50

/12.

5mg

Tab,

Net

raso

l co

50/1

2.5m

g Ta

bLo

saar

Plu

s 10

0/25

mg

Tab,

Net

raso

l Co

100/

25m

g Ta

b

Valsa

rtan

Dyna

val 8

0mg

Tab

Dyna

val 1

60m

g Ta

bAn

ticoa

gula

nts

War

farin

Cipl

a-W

arfa

rin 5

mg

Tab

Beta

Blo

cker

s

Aten

olol

Bio-

Aten

olol

50m

g Ta

b, B

-blo

ck 5

0mg

Tab,

Ten

sopr

ess

50m

g Ta

bB-

bloc

k 10

0mg

Tab,

Ten

sopr

ess

100m

g Ta

b

Biso

prol

olAd

co-b

isoco

r 5m

g Ta

b, B

isopr

olol

-uni

chem

5m

g Ta

bBi

sopr

olol

-uni

chem

10m

g Ta

b, B

islo

10m

g Ta

b

Biso

prol

ol +

Hyd

roch

loro

thia

zide

Biso

zyd

Co 2

.5/6

.25m

g Ta

bBi

sozy

d Co

5/6

.25m

g Ta

bBi

sozy

d Co

10/

6.25

mg

Tab

Carv

edilo

lVe

dibl

ok 6

.25m

g Ta

bCa

rloc

12,5

mg

Tab

Vedi

blok

25m

g Ta

b

Card

iac

Gly

cosid

esDi

goxi

nLa

noxi

n 0.

0625

mg

Tab

Lano

xin

0.25

mg

Tab

Lano

xin

Paed

0.0

5mg/

ml S

yr

Dire

ct A

cting

Vas

odila

tors

Hyd

rala

zine

Hyp

erph

en 1

0mg

Tab

Sand

oz-H

ydra

lazi

ne 2

5mg

Tab

Hyp

erph

en 5

0mg

Tab

Diur

etics

Furo

sem

ide

Diur

esix

40m

g Ta

bLa

six O

ral S

oln

Hyd

roch

loro

thia

zide

+ K

Cl

Urir

ex K

Tab

Hyd

roch

loro

thia

zide

Rida

q 12

.5m

g Ta

bH

exaz

ide

25m

g Ta

bIn

dapa

mid

eDa

ptril

2.5

mg

Tab,

Myl

an In

dapa

mid

e 2.

5mg

Tab

Spiro

nola

cton

eAl

dact

one

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Card

iac

Failu

re,

Card

io-m

yopa

thy

(con

tinue

d)

Org

anic

Nitr

ates

Isos

orbi

de D

initr

ate

Sand

oz Is

osor

bide

5m

g SL

Tab

Sand

oz Is

osor

bide

10m

g Ta

b

Isor

dil 3

0mg

Tab

Isos

orbi

de M

onon

itrat

eM

onic

or 6

0mg

Tab

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g Ta

b, M

yopr

in 1

00m

g Ta

b

Pota

ssiu

m S

uppl

emen

tsPo

tass

ium

Chl

orid

eU

ltipo

t Tab

Vacc

ines

Influ

enza

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

occa

lPr

even

ar 1

3 In

j, Pn

eum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Cere

bro-

vasc

ular

Ac

cide

ntAC

E In

hibi

tors

+ C

ombi

natio

ns

Capt

opril

Capt

ohex

al 1

2.5m

g Ta

b

Adco

-Cap

tom

ax 2

5mg

Tab,

Myl

an-C

apto

pril

25m

g Ta

b

Adco

Cap

tom

ax 5

0mg,

Myl

an C

apto

pril

50m

g Ta

b

Enal

april

+ H

ydro

chlo

roth

iazi

dePh

arm

apre

ss C

o 20

/12.

5mg

Tab

Enal

april

Alap

ren

5mg

Tab,

Ena

lapr

il bi

otec

h 5m

g Ta

b

Alap

ren

10m

g Ta

b, E

nala

pril

biot

ech

10m

g Ta

b

Alap

ren

20m

g Ta

b, E

nala

pril

biot

ech

20m

g Ta

b

Lisin

opril

+ H

ydro

chlo

roth

iazi

deZe

stor

etic

10/1

2.5m

g Ta

b

Zest

oreti

c 20

/12.

5mg

Tab

Lisin

opril

Sino

pren

5m

g Ta

b, Z

estr

il 5m

g Ta

b

Aust

ell L

isino

pril

10m

g Ta

b, S

inop

ren

10m

g Ta

b

Aust

ell L

isino

pril

20m

g Ta

b, S

inop

ren

20m

g Ta

b

Perin

dopr

il

Ran-

perin

dopr

il 4m

g Ta

b

Prex

um 5

mg

Tab

Spec

Per

indo

pril

8mg

Tab

Prex

um 1

0mg

Tab

Perin

dopr

il+ In

dapa

mid

e

Spec

-per

indo

pril

plus

2m

g/0.

625m

g Ta

b

Pear

inda

plu

s 4m

g/1.

25m

g Ta

b

Prex

um P

lus

5/1.

25m

g Ta

b

Bio-

Prex

um P

lus

10/2

.5m

g Ta

b

Perin

dopr

il+ A

mlo

dipi

ne

Cove

ram

5/5

mg

Tab

Cove

ram

5/1

0mg

Tab

Cove

ram

10/

5mg

Tab

Cove

ram

10/

10m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Cere

bro-

vasc

ular

Ac

cide

nt

(con

tinue

d)

Antic

oagu

lant

sW

arfa

rinCi

pla-

War

farin

5m

g Ta

b

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g, M

yopr

in 1

00m

g Ta

b

Chro

nic

Obs

truc

tive

Pulm

onar

y Di

seas

e

Antic

holin

ergi

cs- I

nhal

edIp

ratr

opiu

mAt

rove

nt 2

0mcg

HFA

Inh

Ipve

nt 4

0mcg

Inh

Tiot

ropi

umFo

rven

t Inh

alan

t Cap

s

B 2 ago

nist

s -In

hale

d

Form

oter

olFo

rate

c H

FA In

h

Salb

utam

ol

Asth

aven

t Inh

, Ven

teze

Inh

Vent

olin

2.5

mg/

2.5m

l Neb

Vent

olin

5m

g/2.

5ml N

eb

Vent

eze

Resp

Sol

n

Corti

cost

eroi

ds- I

nhal

ed

Becl

omet

haso

ne

Bece

ze 5

0mcg

Inh,

Bec

late

50m

cg In

h

Bece

ze 1

00m

cg In

h, B

ecla

te 1

00m

cg In

h

Becl

ate

200m

cg In

h

Bude

soni

deBu

defla

m 1

00m

cg H

FA In

h, P

ulm

icor

t 100

mcg

Tur

buha

ler

Bude

flam

200

mcg

HFA

Inh,

Pul

mic

ort 2

00m

cg T

urbu

hale

r

Corti

cost

eroi

ds +

B-a

goni

st

com

bina

tions

Fluti

caso

ne+

Salm

eter

ol

Sere

flo 2

5/50

mcg

HFA

, Ser

eflo

25/5

0mcg

sync

hrob

reat

he

Sere

flo 2

5/12

5mcg

HFA

, Ser

eflo

25/1

25m

cg sy

nchr

obre

athe

Sere

flo 2

5/25

0mcg

HFA

Ser

eflo

25/2

50m

cg sy

nchr

obre

athe

Corti

cost

eroi

ds-O

ral

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Met

hylx

anth

ines

Theo

phyl

line

Sand

oz T

heop

hylli

ne 2

00m

g Ta

b

Sand

oz T

heop

hylli

ne 3

00m

g Ta

b

Vacc

ines

Influ

enza

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

occa

lPr

even

ar 1

3 In

j, Pn

eum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Chro

nic

Rena

l Di

seas

eAC

E In

hibi

tors

+ C

ombi

natio

ns

Capt

opril

Capt

ohex

al 1

2.5m

g Ta

b

Adco

-Cap

tom

ax 2

5mg

Tab,

Myl

an-C

apto

pril

25m

g Ta

b

Adco

Cap

tom

ax 5

0mg,

Myl

an C

apto

pril

50m

g Ta

b

Enal

april

+ H

ydro

chlo

roth

iazi

dePh

arm

apre

ss C

o 20

/12.

5mg

Tab

Enal

april

Alap

ren

5mg

Tab,

Ena

lapr

il bi

otec

h 5m

g Ta

b

Alap

ren

10m

g Ta

b, E

nala

pril

biot

ech

10m

g Ta

b

Alap

ren

20m

g Ta

b, E

nala

pril

biot

ech

20m

g Ta

b

Lisin

opril

+ H

ydro

chlo

roth

iazi

deZe

stor

etic

10/1

2.5m

g Ta

b

Zest

oreti

c 20

/12.

5mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Chro

nic

Rena

l Di

seas

e (c

ontin

ued)

ACE

Inhi

bito

rs +

Com

bina

tions

(c

ontin

ued)

Lisin

opril

Sino

pren

5m

g Ta

b, Z

estr

il 5m

g Ta

bAu

stel

l Lisi

nopr

il 10

mg

Tab,

Sin

opre

n 10

mg

Tab

Aust

ell L

isino

pril

20m

g Ta

b, S

inop

ren

20m

g Ta

b

Perin

dopr

il

Ran-

perin

dopr

il 4m

g Ta

bPr

exum

5m

g Ta

bSp

ec P

erin

dopr

il 8m

g Ta

bPr

exum

10m

g Ta

b

Perin

dopr

il+ In

dapa

mid

e

Spec

-per

indo

pril

plus

2m

g/0.

625m

g Ta

bPe

arin

da p

lus

4mg/

1.25

mg

Tab

Prex

um P

lus

5/1.

25m

g Ta

bBi

o-Pr

exum

Plu

s 10

/2.5

mg

Tab

Perin

dopr

il+ A

mlo

dipi

ne

Cove

ram

5/5

mg

Tab

Cove

ram

5/1

0mg

Tab

Cove

ram

10/

5mg

Tab

Cove

ram

10/

10m

g Ta

bAn

ticoa

gula

nts

War

farin

Cipl

a-W

arfa

rin 5

mg

Tab

Angi

oten

sin II

ant

agon

ists

+ co

mbi

natio

ns

Losa

rtan

Reni

card

50m

g Ta

bAn

nin

100m

g Ta

b, C

ipla

zar 1

00m

g Ta

b

Losa

rtan

+ H

ydro

chlo

roth

iazi

deLo

saar

Plu

s 50

/12.

5mg

Tab,

Net

raso

l co

50/1

2.5m

g Ta

bLo

saar

Plu

s 10

0/25

mg

Tab,

Net

raso

l Co

100/

25m

g Ta

b

Valsa

rtan

Dyna

val 8

0mg

Tab

Dyna

val 1

60m

g Ta

b

Beta

Blo

cker

s

Aten

olol

Bio-

Aten

olol

50m

g Ta

b, B

-blo

ck 5

0mg

Tab,

Ten

sopr

ess

50m

g Ta

bB-

bloc

k 10

0mg

Tab,

Ten

sopr

ess

100m

g Ta

b

Biso

prol

olAd

co-b

isoco

r 5m

g Ta

b, B

isopr

olol

-uni

chem

5m

g Ta

bBi

sopr

olol

-uni

chem

10m

g Ta

b, B

islo

10m

g Ta

b

Biso

prol

ol+

Hyd

roch

loro

thia

zide

Biso

zyd

Co 2

.5/6

.25m

g Ta

bBi

sozy

d Co

5/6

.25m

g Ta

bBi

sozy

d Co

10/

6.25

mg

Tab

Carv

edilo

lVe

dibl

ok 6

.25m

g Ta

bCa

rloc

12,5

mg

Tab

Vedi

blok

25m

g Ta

b

Calc

ium

Sup

plem

ents

Calc

ium

Glu

cona

teCa

lciu

m G

luco

nate

300

mg

Chew

Tab

, Cal

cium

Glu

cona

te 3

00m

g Ta

bCa

lciu

m C

arbo

nate

Eno

Tum

s 50

0mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Chro

nic

Rena

l Di

seas

e (c

ontin

ued)

Calc

ium

Cha

nnel

Blo

cker

s

Amlo

dipi

ne B

esyl

ate

Cipl

avas

c 5m

g Ta

b, G

ulf a

mlo

dipi

ne 5

mg

Tab

Cipl

avas

c 10

mg

Tab,

Gul

f am

lodi

pine

10m

g Ta

b

Amlo

dipi

ne M

alea

teAm

late

5m

g Ta

bAm

late

10m

g Ta

b

Nife

dipi

neCi

pala

t Ret

ard

20m

g Ta

bBi

o N

ifedi

pine

30m

g XL

Tab

Bio

Nife

dipi

ne 6

0mg

XL T

ab

Diur

etics

Amilo

ride+

Hyd

roch

loro

thia

zide

Spec

-co-

amilo

ride

5/50

mg

Tab

Furo

sem

ide

Diur

esix

40m

g Ta

bLa

six o

ral S

oluti

on

Hyd

roch

loro

thia

zide

Rida

q 12

.5m

g Ta

b, H

exaz

ide

25m

g Ta

bH

exaz

ide

25m

g Ta

bIn

dapa

mid

eDa

ptril

2.5

mg

Tab,

Myl

an In

dapa

mid

e 2.

5mg

Tab

Hae

mati

nics

Ferr

ous

Fum

arat

e +

Folic

Preg

amal

Tab

Ferr

ous

Sulp

hate

Ferr

ous

Sulp

hate

30m

g Ta

bFe

rrou

s Su

lpha

te 7

5mg

Tab

Iron

Com

bina

tion

Fero

glob

in S

yrIro

n Po

lym

alto

seFe

rofo

ls Sy

r

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g, M

yopr

in 1

00m

g Ta

bPo

tass

ium

Pota

ssiu

m C

hlor

ide

Ulti

pot T

ab

Vacc

ines

Influ

enza

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

occa

lPr

even

ar 1

3 In

j, Pn

eum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Vita

min

D A

nalo

gues

Alfa

calc

idol

One

Alp

ha 0

.25m

cg C

apEr

goca

lcife

rol

Calc

ifero

l Tab

Coro

nary

Art

ery

Dise

ase

ACE

Inhi

bito

rs +

Com

bina

tions

Capt

opril

Capt

ohex

al 1

2.5m

g Ta

bAd

co-C

apto

max

25m

g Ta

b, M

ylan

-Cap

topr

il 25

mg

Tab

Adco

Cap

tom

ax 5

0mg,

Myl

an C

apto

pril

50m

g Ta

bEn

alap

ril +

Hyd

roch

loro

thia

zide

zPh

arm

apre

ss C

o 20

/12.

5mg

Tab

Enal

april

Alap

ren

5mg

Tab,

Ena

lapr

il bi

otec

h 5m

g Ta

bAl

apre

n 10

mg

Tab,

Ena

lapr

il bi

otec

h 10

mg

Tab

Alap

ren

20m

g Ta

b, E

nala

pril

biot

ech

20m

g Ta

b

Lisin

opril

+ H

ydro

chlo

roth

iazi

deZe

stor

etic

10/1

2.5m

g Ta

bZe

stor

etic

20/1

2.5m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Coro

nary

Art

ery

Dise

ase

(con

tinue

d)

ACE

Inhi

bito

rs +

Com

bina

tions

(c

ontin

ued)

Lisin

opril

Sino

pren

5m

g Ta

b, Z

estr

il 5m

g Ta

bAu

stel

l Lisi

nopr

il 10

mg

Tab,

Sin

opre

n 10

mg

Tab

Aust

ell L

isino

pril

20m

g Ta

b, S

inop

ren

20m

g Ta

b

Perin

dopr

il

Ran-

perin

dopr

il 4m

g Ta

bPr

exum

5m

g Ta

bSp

ec P

erin

dopr

il 8m

g Ta

bPr

exum

10m

g Ta

b

Perin

dopr

il+ In

dapa

mid

eSp

ec-p

erin

dopr

il pl

us 2

mg/

0.62

5mg

Tab

Pear

inda

plu

s 4m

g/1.

25m

g Ta

b

Perin

dopr

il+ A

mlo

dipi

ne

Cove

ram

5/5

mg

Tab

Cove

ram

5/1

0mg

Tab

Cove

ram

10/

5mg

Tab

Cove

ram

10/

10m

g Ta

bAn

ticoa

gula

nts

War

farin

Cipl

a-W

arfa

rin 5

mg

Tab

Beta

Blo

cker

s

Aten

olol

Bio-

Aten

olol

50m

g Ta

b, B

-blo

ck 5

0mg

Tab,

Ten

sopr

ess

50m

g Ta

bB-

bloc

k 10

0mg

Tab,

Ten

sopr

ess

100m

g Ta

b

Biso

prol

olAd

co-b

isoco

r 5m

g Ta

b, B

isopr

olol

-uni

chem

5m

g Ta

bBi

sopr

olol

-uni

chem

10m

g Ta

b, B

islo

10m

g Ta

b

Biso

prol

ol+

Hyd

roch

loro

thia

zide

Biso

zyd

Co 2

.5/6

.25m

g Ta

bBi

sozy

d Co

5/6

.25m

g Ta

bBi

sozy

d Co

10/

6.25

mg

Tab

Carv

edilo

lVe

dibl

ok 6

.25m

g Ta

bCa

rloc

12,5

mg

Tab

Vedi

blok

25m

g Ta

b

Calc

ium

Cha

nnel

Blo

cker

s

Amlo

dipi

ne B

esyl

ate

Cipl

avas

c 5m

g Ta

b, G

ulf a

mlo

dipi

ne 5

mg

Tab

Cipl

avas

c 10

mg

Tab,

Gul

f am

lodi

pine

10m

g Ta

b

Amlo

dipi

ne M

alea

teAm

late

5m

g Ta

bAm

late

10m

g Ta

b

Nife

dipi

ne

Card

ifen

10m

g Ca

pCi

pala

t Ret

ard

20m

g Ta

bBi

o N

ifedi

pine

30m

g XL

Tab

Bio

Nife

dipi

ne 6

0mg

XL T

ab

Card

iac

Gly

cosid

esDi

goxi

nLa

noxi

n 0.

0625

mg

PG T

abLa

noxi

n 0.

25m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Coro

nary

Art

ery

Dise

ase

(con

tinue

d)

Dire

ct A

cting

Vas

odila

tors

Hyd

rala

zine

Hyp

erph

en 1

0mg

Tab

Sand

oz-H

ydra

lazi

ne 2

5mg

Tab

Hyp

erph

en 5

0mg

Tab

Diur

etics

Amilo

ride

+ H

ydro

chlo

roth

iazi

deSp

ec-c

o-am

ilorid

e 5/

50m

g Ta

b

Furo

sem

ide

Diur

esix

40m

g Ta

b

Hyd

roch

loro

thia

zide

Rida

q 12

.5m

g Ta

b

Hex

azid

e 25

mg

Tab

Inda

pam

ide

Dapt

ril 2

.5m

g Ta

b, M

ylan

Inda

pam

ide

2.5m

g Ta

b

Org

anic

Nitr

ates

Isos

orbi

de D

initr

ate

Sand

oz Is

osor

bide

5m

g SL

Tab

Sand

oz Is

osor

bide

10m

g Ta

b

Isor

dil 3

0mg

Tab

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g Ta

b, M

yopr

in 1

00m

g Ta

b

Baye

r Asp

irin

300m

g Ta

b, D

r Toi

ts P

ain

Expe

ller 3

00m

g Ta

b

Clop

idog

rel

Plag

rol T

ab

Pota

ssiu

mPo

tass

ium

Chl

orid

eU

ltipo

t Tab

Croh

ns D

isea

se

Antib

iotic

s - Q

uino

lone

sCi

profl

oxac

in

Biot

ech

Cipr

oflox

acin

250

mg

Tab,

Cip

roge

n 25

0mg

Tab

Aust

ell C

ipro

floxa

cin

500m

g Ta

b, C

ifran

500

mg

Tab,

Flo

pro

500m

g Ta

b

Aust

ell C

ipro

flox

750m

g Ta

b, B

iote

ch C

ipro

floxa

cin

750m

g Ta

b

Anti-

Fung

al A

gent

sFl

ucon

azol

eAu

ro F

luco

nazo

le 1

50m

g Ca

p, G

ulf fl

ucon

azol

e 15

0mg

Cap

Diflu

can

200m

g/5m

l Sus

p

Anti-

Mic

robi

als -

Anae

robi

cM

etro

nida

zole

Anae

roby

l 200

mg

Tab,

Met

azol

200

mg

Tab

Amzo

le 4

00m

g Ta

b, S

upra

zole

400

mg

Tab

Flag

yl S

usp

Corti

cost

eroi

ds- O

ral

Pred

niso

neBe

Tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Imm

unos

uppr

essa

nts

Met

hotr

exat

eAb

itrex

ate

Tab

Oth

er G

astr

o-in

testi

nal T

ract

Ag

ents

Sulfa

sala

zine

Sala

zopy

rin T

ab, S

alaz

opyr

en-E

N T

ab

Mes

alaz

ine

Asac

ol 4

00m

g Ta

b

Pent

asa

500m

g Ta

b

Asac

ol 8

00m

g Ta

b

Salo

falk

100

0mg

Sac

Vita

min

sFo

lic A

cid

Folic

Aci

d Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Depr

essi

onAn

ti-de

pres

sant

s

Amitr

ipty

line

Trep

iline

10m

g Ta

b

Gul

f am

itryp

tylin

e 25

mg

Tab,

Tre

pilin

e 25

mg

Tab

Cita

lopr

amAu

stel

l-Cita

lopr

am 1

0mg

Tab

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Fluo

xetin

eDe

proz

an C

ap, P

rola

x Ca

p, R

anflo

cs C

ap

Diab

etes

Insi

pidu

sAn

ti-Di

ureti

csDe

smop

ress

in

Ddav

p 0.

01%

Nas

al S

oln

Ddav

p 0.

01%

Nas

al S

pray

Ddav

p 0.

1mg

Tab

Ddav

p 0.

2mg

Tab

Diab

etes

Mel

litus

Ty

pe 1

& T

ype

2

Anti-

Hyp

ogly

cem

ic A

gent

sG

luca

gon

Glu

cage

n In

j

Glu

com

eter

Tes

t Str

ips

Glu

cose

test

strip

sAc

cu c

hek

Inst

ant T

est S

trip

, Car

eSen

s N

Str

ips

Glu

com

eter

sG

luco

met

erAc

cu c

hek

Inst

ant K

it, C

areS

ens

N G

luco

met

er

Insu

lins

Biph

asic

Insu

lin A

spar

t Pro

t + A

spar

t (H

uman

)N

ovom

ix 3

0 Fl

expe

n an

d Pe

nfill

Insu

lin Is

opha

ne +

Reg

ular

(Hum

an)

Actr

apha

ne 1

0ml v

ial,

Bios

ulin

30/

70 In

j, H

umul

in 3

0/70

Inj

Insu

lin L

ispro

Pro

t + L

ispro

(Hum

an)

Hum

alog

Mix

50

Kwik

pen,

Car

trid

ge

Hum

alog

Mix

25

Kwik

pen,

Car

trid

ge a

nd V

ial

Insu

lins

Inte

rmed

iate

Insu

lin Is

opha

ne (H

uman

)Bi

osul

in L

Inj,

Bios

ulin

N K

wik

pen

and

cart

ridge

, Hum

ulin

N 1

0ml V

ial

Insu

lins

Rapi

d Ac

ting

Insu

lin A

spar

tN

ovor

apid

Pen

set,

Penfi

ll an

d Vi

al

Insu

lin G

lulis

ine

Apid

ra C

artr

idge

, Pen

s an

d Vi

al

Insu

lin L

ispro

(Hum

an)

Hum

alog

Kw

ikpe

n, C

artr

idge

and

Via

l

Insu

lins

Shor

t Acti

ngIn

sulin

Reg

ular

(Hum

an)

Bios

ulin

R C

artr

idge

, Hum

ulin

R V

ial

Lanc

ets

Lanc

ets

Glu

coch

eck

Pro

Safe

ty L

ance

ts, G

luco

chec

k N

ovic

heck

Lan

cets

, Mic

role

t Lan

cets

Nee

dles

Nee

dles

Nee

dle

Accu

fine

Ins

Pen,

Nee

dle

Insu

pen

4mm

32g

, Nee

dle

Insu

pen

12m

m x

29

g, N

eedl

e in

sulin

6m

m x

31g

Ora

l Dia

betic

Age

nts

Glic

lazi

de

Diar

an S

R 30

mg

Tab,

Glic

lazi

de U

nico

rn M

R 30

mg

Tab

Diag

luci

de S

R 60

mg

Tab

Aust

ell-G

licla

zide

40m

g Ta

b

Diag

lum

ed 8

0mg

Tab,

San

doz

Glic

lazi

de 8

0mg

Tab

Metf

orm

in

Acco

rd m

etfor

min

500

mg

Tab,

Big

sens

500

mg

Tab,

Glu

coph

age

500m

g XR

Tab

Glu

coph

age

750m

g XR

Tab

Diap

hage

850

mg

Tab,

Met

chek

850

mg

Tab

Bigs

ens

1000

mg

Tab,

Dia

phag

e 10

00m

g Ta

b, G

luco

phag

e 10

00m

g XR

Tab

Piog

litaz

one

Acco

rd P

iogl

itazo

ne 1

5mg

Tab

Acco

rd P

iogl

itazo

ne 3

0mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Diab

etes

Mel

litus

Ty

pe 1

& T

ype

2 (c

ontin

ued)

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g Ta

b, M

yopr

in 1

00m

g Ta

bFl

u Va

ccin

esIn

fluen

za v

irus

vacc

ine

Influ

vac

Inj,

Vaxi

grip

Inj

Epile

psy

Anti-

Epile

ptics

Carb

amaz

epin

eDe

gran

ol 2

00m

g Ta

b, Z

epto

l 200

mg

Tab,

Teg

reto

l CR

200m

g Ta

bTe

gret

ol C

R 40

0mg

Tab

Tegr

etol

Sus

p

Clon

azep

amCl

onam

0.5

mg

Tab

Clon

am 2

mg

Tab

Rivo

tril

Drop

sEt

hosu

xim

ide

Zaro

ntin

Syr

Lam

otrig

ine

Dyna

-Lam

otrig

ine

25m

g Ta

b, E

pite

c 25

mg

Tab

Lam

itor 5

0mg

Tab,

Epi

tec

50m

g Ta

bEp

itec

100m

g Ta

bDy

na L

amot

rigin

e 20

0mg

Tab

Phen

ytoi

nEp

anuti

n Ca

pPh

enyt

oin

Sod

Tab

Epan

utin

Susp

Valp

roat

e

Epro

lep

200m

g CR

Tab

, Nav

alpr

o 20

0mg

CR T

abEp

role

p 30

0mg

CR T

ab, V

alep

tic 3

00m

g CR

Tab

Epro

lep

500m

g CR

Tab

, Val

eptic

500

mg

CR T

abEp

ilim

Liq

Valp

roic

Conv

ulex

150

mg

Cap

Conv

ulex

300

mg

Cap

Conv

ulex

500

mg

Cap

Conv

ulex

Liq

Barb

itura

tes

Phen

obar

bita

lSe

daba

rb T

ab, L

ethy

l Tab

Phen

obar

bita

l + V

itAd

co-P

heno

barb

Vita

l Elix

Gla

ucom

a

Alph

a 2

Agon

istBr

imon

idin

eBr

imoc

t Dro

psAl

pha

2 Ag

onist

+ B

- Blo

cker

Brim

onid

ine

+ Ti

mol

olCo

mbi

gan

Drop

s

B-Bl

ocke

r + C

arbo

nic

Anhy

dras

e In

hib

Brin

zola

mid

e +

Tim

olol

Azar

ga D

rops

Dorz

olam

ide

+ Ti

mol

olG

laum

ide-

co D

rops

, Ocu

dor C

o Dr

ops

B-Bl

ocke

r + P

rost

agla

ndin

An

alog

ue

Bim

atop

rost

+ T

imol

olG

anfo

rt D

rops

Lata

nopr

ost +

Tim

olol

Co-A

tana

Dro

ps

Trav

opro

st +

Tim

olol

Duot

rav

Drop

s


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Gla

ucom

a (c

ontin

ued)

B-Bl

ocke

rsTi

mol

olTi

mop

tol X

E 0.

25%

Dro

ps, T

imop

tol 0

.25%

Dro

ps

Tim

opto

l XE

0.5%

Dro

ps, O

ccum

ol 0

.5%

Dro

ps

Carb

onic

Anh

ydra

se In

hib

Dorz

olam

ide

Gla

ucop

ress

Dro

ps

Diur

etics

Acet

azol

amid

eAz

omid

Tab

Mio

tics

Pilo

carp

ine

Isop

to C

arpi

ne 1

% D

rops

Isop

to C

arpi

ne 2

% D

rops

Isop

to C

arpi

ne 4

% D

rops

Pros

tagl

andi

n An

alog

ue

Lata

nopr

ost

Atan

a Dr

ops

Bim

atop

rost

Lum

igan

Dro

ps

Trav

opro

stTr

avat

an D

rops

Gou

tAn

ti-go

utAl

lopu

rinol

Aust

ell A

llopu

rinol

100

mg

Tab

Lono

l 300

mg

Tab,

San

doz

allo

purin

ol 3

00m

g Ta

b

Haem

ophi

lia

Anal

gesic

s -Pl

ain

Para

ceta

mol

Anta

lgic

Tab

, Gul

f Par

acet

amol

Tab

, Pai

nges

ic T

ab

Barr

s Pa

race

tam

ol S

yr, F

ever

pain

Syr

, Pai

noge

sic S

yr

Tram

adol

Dolo

tram

50m

g Ca

p, T

ram

azac

50m

g Ca

p

Anti-

Diur

etics

Desm

opre

ssin

Ddav

p 0.

01%

Intr

anas

al S

oln

Ddav

p 0.

01%

Nas

al S

pr

Ddav

p 0.

1mg

Tab

Ddav

p 0.

2mg

Tab

Hae

mos

tatic

sTr

anex

amic

Aci

dTr

anic

Tab

HIV

Anti-

Retr

ovira

l–Si

ngle

And

Fi

xed

Dose

Com

bina

tions

Abac

avir

Adco

Aba

cavi

r Tab

Adco

Aba

cavi

r Sus

p

Abac

avir

+ La

miv

udin

eAb

acav

ir an

d La

miv

udin

e Ci

pla

Tab

Abac

avir

+ La

miv

udin

e +

Zido

vudi

neSo

nke

Abac

lam

izid

Tab

Ataz

anav

ir

Reya

taz

150m

g Ca

p

Reya

taz

200m

g Ca

p

Ataz

or 3

00m

g Ca

p

Dida

noso

ne

Sonk

e Di

dano

sine

25m

g Ta

b

Dela

dex

250m

g Ca

p

Vide

x EC

400

mg

Cap

Efav

irenz

Adco

-Efa

vire

nz 5

0mg

Tab

Adco

-Efa

vire

nz 2

00m

g Ta

b

Adco

-Efa

vire

nz 6

00m

g Ta

b, S

onke

Efa

vire

nz 6

00m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

HIV

(con

tinue

d)

Anti-

Retr

ovira

l–Si

ngle

And

Fi

xed

Dose

Com

bina

tions

(c

ontin

ued)

Emtr

icita

bine

+ T

enof

ovir

Adco

-Em

tevi

r Tab

Emtr

icita

bine

+ T

enof

ovir

+ Ef

avire

nzEft

enem

Tab

, Tre

nvir

Tab,

Triv

age

Tab,

Triv

enz

Tab

Lam

ivud

ine

Adco

Lam

ivud

ine

Tab,

Son

ke L

amiv

udin

e Ta

b

Adco

Lam

ivud

ine

Susp

Lam

ivud

ine

+ N

evira

pine

+ S

tavu

dine

Nev

asta

Tab

Lam

ivud

ine

+ Te

nofo

vir +

Efa

vire

nzAr

ion

Tab,

Elte

no T

ab

Lopi

navi

r + R

itona

vir

Aluv

ia T

ab

Kale

tra

Susp

Nev

irapi

neAd

co N

evira

pine

Tab

, Son

ke N

evira

pine

Tab

Cipl

a N

evira

pine

Sus

p

Ripi

lviri

neEd

uran

t Tab

Rito

navi

rRi

navo

100

mg

Tab

Nor

vir S

oluti

on

Stav

udin

e

Aspe

n St

avud

ine

15m

g Ca

p

Aspe

n St

avud

ine

20m

g Ca

p

Sonk

e St

avud

ine

30m

g Ta

b

Teno

fovi

rAd

co T

enof

ovir

Tab

Zido

vudi

ne

Adco

-Zid

ovud

ine

Susp

Aspe

n Zi

dovu

dine

100

mg

Cap

Aspe

n Zi

dovu

dine

250

mg

Cap

Adco

Zid

ovud

ine

300m

g Ta

b

Zido

vudi

ne +

Lam

ivud

ine

Sonk

e La

miv

udin

e Zi

dovu

dine

Tab

Zido

vudi

ne +

Lam

ivud

ine

+ N

evira

pine

Miv

irdo

Tab

Anti-

Fung

al A

gent

sFl

ucon

azol

e

Auro

Flu

cona

zole

150

mg

Cap,

Gul

f fluc

onaz

ole

150m

g Ca

p

Auro

Flu

cona

zole

200

mg

Cap,

Myc

ores

t 200

mg

Cap

Diflu

can

50m

g/5m

l Sus

p

Diflu

can

200m

g/5m

l Sus

p

Antib

iotic

s –

Sulp

hona

mid

es

And

Com

bina

tions

Sulp

ham

etho

xazo

le +

Trim

etho

prim

Cozo

le 4

00/8

0mg

Tab,

Ilvi

trim

400

/80m

g Ta

b

Duro

bac

DS 8

00/1

60m

g Ta

b, S

ando

z Co

-Trim

oxaz

ole

800/

160m

g Ta

b

Cotr

im S

usp,

Doc

trim

Sus

p

Anti-

infe

ctive

s (A

nti-P

CP)

Daps

one

Daps

one

Tab

Tube

rcul

osta

tics

Etha

mbu

tol

Sand

oz E

tham

buto

l Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

HIV

(con

tinue

d)

Tube

rcul

osta

tics

(con

tinue

d)

Ison

iazi

d +

Rifa

mpi

n

Rim

acta

zid

Paed

60/

60m

g Ta

b

Rim

acta

zid

150/

75m

g Ta

b

Ebsa

r2-D

S 30

0/15

0mg

Tab

Ison

iazi

dN

orst

an-Is

onia

zid

200m

g Ta

b

Ison

iazi

d +

Rifa

mpi

n +

Etha

mb

+ Py

razi

nam

ide

Rifa

four

E-2

75 T

ab

Pyra

zina

mid

ePy

razi

de T

ab

Rifa

mpi

n

Rim

acta

ne 1

50m

g Ca

p

R-Ci

n 60

0mg

Cap

R-Ci

n Su

sp

Vacc

ines

Influ

enza

Influ

vac

Inj,

Vaxi

grip

Inj

Pneu

moc

coca

lPr

even

ar 1

3 In

j, Pn

eum

ovax

Inj,

Imov

ax P

neum

o 23

Inj

Vita

min

s

Ferr

ous

Sulp

hate

Ferr

ous

Sulp

hate

30m

g Ta

b

Folic

aci

dFo

lic A

cid

Tab

Pyrid

oxin

ePy

ridox

ine

Tab

Mul

tivita

min

+ M

iner

als

Opti

life

VMA

Tab,

Imm

unac

e Ta

b, N

ovav

it Pl

us T

ab

Esse

ntial

s Ki

divi

te S

yr

Horm

one

Repl

acem

ent

Ther

apy

(Men

opau

se/

Fem

ale)

Oes

trog

en - P

roge

stog

en

Com

bina

tions

Oes

trad

iol +

Nor

ethi

ster

one

Estr

o-Pa

use

N T

ab

Oes

trad

iol +

Nor

gest

rel

Post

oval

Tab

Oes

trog

ens

Estr

adio

lEs

tro-

Paus

e 1m

g Ta

b

Estr

o-Pa

use

2mg

Tab

Estr

ogen

s, c

onju

gate

d

Prem

arin

0.3

mg

Tab

Prem

arin

0.6

25m

g Ta

b

Prem

arin

1.2

5mg

Tab

Oes

trad

iol

Estr

adot

25u

g Pa

tch

Estr

adot

37.

5ug

Patc

h

Estr

adot

50u

g Pa

tch

Estr

adot

75u

g Pa

tch

Estr

adot

100

ug P

atch

Prog

esto

gens

Med

roxy

prog

este

rone

Hex

al-M

PA 5

mg

Tab

Hex

al-M

PA 1

0mg

Tab

Hype

rlipi

daem

iaFi

brat

esBe

zafib

rate

Beza

lip 2

00m

g Ta

b

Dyna

-Bez

afibr

ate

400m

g SR

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Hype

rlipi

daem

ia

(con

tinue

d)

HM

G-C

oa R

educ

tase

In

hibi

tors

(Sta

tins)

Ator

vast

atin

Adco

ato

rvas

tatin

10m

g Ta

b, A

spav

or 1

0mg

Tab

Adco

ato

rvas

tatin

20m

g Ta

b, A

tolip

20m

g Ta

b

Adco

-ato

rvas

tatin

40m

g Ta

b, A

tolip

40m

g Ta

b

Lipo

gen

80m

g Ta

b, L

esta

vor 8

0mg

Tab

Sim

vast

atin

Aust

ell-S

imva

stati

n 10

mg

Tab,

Zys

im 1

0mg

Tab

Aust

ell-S

imva

stati

n 20

mg

Tab,

Zys

im 2

0mg

Tab

Adco

-Sim

vast

atin

40m

g Ta

b, C

ipla

Sim

vast

atin

40m

g Ta

b

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g Ta

b, M

yopr

in 1

00m

g Ta

b

Hype

rten

sion

ACE

Inhi

bito

rs +

Com

bina

tions

Capt

opril

Myl

an-C

apto

pril

25m

g Ta

b

Adco

Cap

tom

ax 5

0mg,

Myl

an C

apto

pril

50m

g Ta

b

Enal

april

+ H

ydro

chlo

roth

iazi

dePh

arm

apre

ss C

o 20

/12.

5mg

Tab

Enal

april

Alap

ren

5mg

Tab,

Ena

lapr

il bi

otec

h 5m

g Ta

b

Alap

ren

10m

g Ta

b, E

nala

pril

biot

ech

10m

g Ta

b

Alap

ren

20m

g Ta

b, E

nala

pril

biot

ech

20m

g Ta

b

Lisin

opril

+ H

ydro

chlo

roth

iazi

deZe

stor

etic

10/1

2.5m

g Ta

b

Zest

oreti

c 20

/12.

5mg

Tab

Lisin

opril

Sino

pren

5m

g Ta

b, Z

estr

il 5m

g Ta

b

Aust

ell L

isino

pril

10m

g Ta

b, S

inop

ren

10m

g Ta

b

Aust

ell L

isino

pril

20m

g Ta

b, S

inop

ren

20m

g Ta

b

Perin

dopr

il

Ran-

perin

dopr

il 4m

g Ta

b

Prex

um 5

mg

Tab

Spec

Per

indo

pril

8mg

Tab

Prex

um 1

0mg

Tab

Perin

dopr

il+ In

dapa

mid

e

Spec

-per

indo

pril

plus

2m

g/0.

625m

g Ta

b

Pear

inda

plu

s 4m

g/1.

25m

g Ta

b

Prex

um P

lus

5/1.

25m

g Ta

b

Bio-

Prex

um P

lus

10/2

.5m

g Ta

b

Perin

dopr

il+ A

mlo

dipi

ne

Cove

ram

5/5

mg

Tab

Cove

ram

5/1

0mg

Tab

Cove

ram

10/

5mg

Tab

Cove

ram

10/

10m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Hype

rten

sion

(c

ontin

ued)

Alph

a Bl

ocke

rsDo

xazo

sinCa

rdug

en 1

mg

Tab

Card

ugen

4m

g Ta

b, C

arzi

n 4m

g XL

Tab

Angi

oten

sin II

+ c

ombi

natio

ns

Losa

rtan

Reni

card

50m

g Ta

b

Anni

n 10

0mg

Tab,

Cip

laza

r 100

mg

Tab

Losa

rtan

+ H

ydro

chlo

roth

iazi

deLo

saar

Plu

s 50

/12.

5mg

Tab,

Net

raso

l co

50/1

2.5m

g Ta

b

Losa

ar P

lus

100/

25m

g Ta

b, N

etra

sol C

o 10

0/25

mg

Tab

Valsa

rtan

Dyna

val 8

0mg

Tab

Dyna

val 1

60m

g Ta

b

Beta

Blo

cker

s

Aten

olol

Bio-

Aten

olol

50m

g Ta

b, B

-blo

ck 5

0mg

Tab,

Ten

sopr

ess

50m

g Ta

b

B-bl

ock

100m

g Ta

b, T

enso

pres

s 10

0mg

Tab

Biso

prol

olAd

co-b

isoco

r 5m

g Ta

b, B

isopr

olol

-uni

chem

5m

g Ta

b

Biso

prol

ol-u

nich

em 1

0mg

Tab,

Bisl

o 10

mg

Tab

Beta

Blo

cker

s (c

ontin

ued)

Biso

prol

ol +

Hyd

roch

loro

thia

zide

Biso

zyd

Co 2

.5/6

.25m

g Ta

b

Biso

zyd

Co 5

/6.2

5mg

Tab

Biso

zyd

Co 1

0/6.

25m

g Ta

b

Carv

edilo

l

Vedi

blok

6.2

5mg

Tab

Carlo

c 12

,5m

g Ta

b

Vedi

blok

25m

g Ta

b

Calc

ium

Cha

nnel

Blo

cker

s

Amlo

dipi

ne B

esyl

ate

Cipl

avas

c 5m

g Ta

b, G

ulf a

mlo

dipi

ne 5

mg

Tab

Cipl

avas

c 10

mg

Tab,

Gul

f am

lodi

pine

10m

g Ta

b

Amlo

dipi

ne M

alea

teAm

late

5m

g Ta

b

Amla

te 1

0mg

Tab

Nife

dipi

ne

Cipa

lat R

etar

d 20

mg

Tab

Bio

Nife

dipi

ne 3

0mg

XL T

ab

Bio

Nife

dipi

ne 6

0mg

XL T

ab

Vera

pam

il

Vaso

mil

40m

g Ta

b

Vaso

mil

80m

g Ta

b

Vera

hexa

l 240

SR

Tab

Cent

ral A

cting

An

tihyp

erte

nsiv

es

Rese

rpin

eRe

serp

ine

Tab

Met

hyld

opa

Myl

an M

ethy

ldop

a 25

0mg

Tab

Hyp

oton

e 50

0mg

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Hype

rten

sion

(c

ontin

ued)

Dire

ct A

cting

Vas

odila

tors

Hyd

rala

zine

Hyp

erph

en 1

0mg

Tab

Sand

oz-H

ydra

lazi

ne 2

5mg

Tab

Hyp

erph

en 5

0mg

Tab

Diur

etics

Acet

azol

amid

eAz

omid

Tab

Amilo

ride

+ H

ydro

chlo

roth

iazi

deSp

ec-c

o-am

ilorid

e 5/

50m

g Ta

b

Furo

sem

ide

Diur

esix

40m

g Ta

b

Hyd

roch

loro

thia

zide

+ K

CLU

rirex

K T

ab

Hyd

roch

loro

thia

zide

Rida

q 12

.5m

g Ta

b

Hex

azid

e 25

mg

Tab

Inda

pam

ide

Dapt

ril 2

.5m

g Ta

b, M

ylan

Inda

pam

ide

2.5m

g Ta

b

Spiro

nola

cton

eAl

dact

one

Tab

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Baye

r Asp

irin

100m

g, M

yopr

in 1

00m

g Ta

b

Pota

ssiu

mPo

tass

ium

Chl

orid

eU

ltipo

t Tab

Hypo

thyr

oidi

smTh

yroi

dLe

voth

yrox

ine

Euth

yrox

25m

cg T

ab

Euth

yrox

50m

cg T

ab

Eltr

oxin

75m

cg T

ab

Euth

yrox

100

mcg

Tab

Eltr

oxin

200

mcg

Tab

Mig

rain

e pr

ophy

laxi

sAn

ti-m

igra

ine

Clon

idin

eM

enog

rain

e Ta

b

Amitr

ipty

line

Trep

iline

10m

g Ta

b

Gul

f am

itryp

tylin

e 25

mg

Tab,

Tre

pilin

e 25

mg

Tab

Carb

amaz

epin

e De

gran

ol 2

00m

g Ta

b, Z

epto

l 200

mg

Tab

Tegr

etol

Sus

p

Topi

ram

ate

Epito

z 25

mg

Tab

Epito

z 10

0mg

Tab

Valp

roat

e

Epro

lep

200m

g CR

Tab

, Nav

alpr

o 20

0mg

CR T

ab

Epro

lep

300m

g CR

Tab

, Val

eptic

300

mg

CR T

ab

Epro

lep

500m

g CR

Tab

, Val

eptic

500

mg

CR T

ab

Prop

anol

olIn

dera

l 10m

g Ta

b

Indo

blok

40m

g Ta

b, P

urbl

oka

40m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Mul

tiple

Scl

eros

is

Anal

gesic

s -Pl

ain

Para

ceta

mol

Anta

lgic

Tab

, Gul

f Par

acet

amol

Tab

, Pai

nges

ic T

ab

Barr

s Pa

race

tam

ol S

yr, F

ever

pain

Syr

, Pai

noge

sic S

yr

Tram

adol

Dolo

tram

50m

g Ca

p, T

ram

azac

50m

g Ca

p

Antic

holin

ergi

csO

xybu

tyni

nM

ylan

oxy

buty

nin

Tab,

Oxy

rest

Tab

Anti-

Neu

ralg

ic A

gent

s

Amitr

ipty

line

Trep

iline

10m

g Ta

b

Gul

f am

itryp

tylin

e 25

mg

Tab,

Tre

pilin

e 25

mg

Tab

Imip

ram

ine

Ethi

pram

ine

10m

g Ta

b

Ethi

pram

ine

25m

g Ta

b

Carb

amaz

epin

e

Degr

anol

200

mg

Tab,

Zep

tol 2

00m

g Ta

b, T

egre

tol 2

00m

g CR

Tab

Tegr

etol

400

mg

CR T

ab

Tegr

etol

Sus

pCe

ntra

lly A

cting

Mus

cle

Rela

xant

sBa

clof

enBi

o-Ba

clof

en 1

0mg

Tab,

Tev

a Ba

clof

en 1

0mg

Tab

Corti

cost

eroi

ds- O

ral

Pred

niso

lone

Leni

solo

ne T

ab

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Imm

unos

uppr

essa

nts

Met

hotr

exat

eAb

itrex

ate

Tab

Flu

Vacc

ine

Influ

enza

viru

s va

ccin

eIn

fluva

c In

j, Va

xigr

ip In

j

Vita

min

sFo

lic A

cid

Folic

Aci

d Ta

b

Ost

eoar

thriti

s

Anal

gesic

s -Pl

ain

Para

ceta

mol

Anta

lgic

Tab

, Gul

f Par

acet

amol

Tab

, Pai

nges

ic T

ab

Barr

s Pa

race

tam

ol S

yr, F

ever

pain

Syr

, Pai

noge

sic S

yr

Non

-ste

roid

al a

nti-

infla

mm

ator

ies

(NSA

IDs)

Ibup

rofe

n

Ibuc

ine

200m

g Ta

b, Ib

unat

e 20

0mg

Tab

Bren

400

mg

Tab,

Bet

apro

fen

fc 4

00m

g Ta

b, R

anfe

n 40

0mg

Tab

Ibug

esic

Sus

p, In

flum

ax P

aed

Susp

Mel

oxic

amAp

ex m

elox

icam

7.5

mg

Tab,

Med

oxic

am 7

.5m

g Ta

b

Adco

Mel

oxic

am 1

5mg

Tab,

Zyd

us M

elox

icam

15m

g Ta

b

Nap

roxe

nM

ylan

nap

roxe

n 25

0mg

Tab,

Nap

rosc

ript 2

50m

g Ta

b

Bio

napr

oxen

500

mg

Tab,

Nap

flam

500

mg

Tab

Park

inso

ns D

isea

se

Antic

holin

ergi

cs A

nti-P

arkin

son'

sBi

perid

enAk

inet

on T

ab

Trih

exyp

heni

dyl

Benz

hexo

l Tab

Dopa

min

ergi

cs A

nti-P

arki

nson

's

Aman

tadi

neSy

mm

etre

l Cap

, Sym

adin

Cap

Carb

idop

a +

Levo

dopa

Leca

rdop

25/

100m

g Ta

b, T

eva

Carb

i-Lev

o 25

/100

mg

Tab

Leca

rdop

25/

250m

g Ta

b, T

eva

Carb

i-Lev

o 25

/250

mg

Tab

Levo

dopa

+ B

ense

razi

deM

adop

ar H

bs T

ab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Park

inso

ns D

isea

se

(con

tinue

d)Do

pam

iner

gics

Anti

-Par

kins

on's

(con

tinue

d)

Pram

ipex

ole

Myl

an p

ram

ipex

ole

0.12

5mg

Tab

Pexa

sp 0

.25m

g Ta

bPe

xasp

1m

g Ta

b

Ropi

niro

le

Acco

rd R

opin

irole

0.2

5mg

Tab

Acco

rd R

opin

irole

0.5

mg

Tab

Acco

rd R

opin

irole

1m

g Ta

bAc

cord

Rop

iniro

le 2

mg

Tab

Pepti

c ul

cera

tion

Anta

cids

Al H

Cl +

Mg

Oxi

de +

Dic

yclo

min

eAl

umag

D S

usp

Al H

ydro

x +

Mg

Trisi

licat

eM

ayog

el S

usp

Anta

cids

+ A

ntisp

asm

odic

sAl

Hyd

rox

+ M

g O

xide

+ D

icyc

l + D

imet

hM

edig

el S

usp

Al H

ydro

x +

Mg

Oxi

de +

Dic

yclo

min

eAm

gel S

usp,

Neu

trag

el D

Sus

p

H2 r

ecep

tor a

ntag

onist

sCi

meti

dine

Acid

own

200m

g Ta

b, B

io-c

imeti

dine

200

mg

Tab

Bio-

Cim

etidi

ne 4

00m

g Ta

b, L

enam

et 4

00m

g Ta

b

Rani

tidin

eG

ulf-r

aniti

dine

150

mg

Tab,

Ran

it 15

0mg

Tab

CPL

Allia

nce-

rani

tidin

e 30

0mg

Tab,

Ran

it 30

0mg

Tab

Prot

on p

ump

inhi

bito

rs (P

PIs)

Om

epra

zole

Alto

sec

10m

g Ca

p, R

apac

id 1

0mg

Cap

Adco

-om

epra

zole

20m

g Ca

p, P

robi

tor 2

0mg

Cap

Lans

opra

zole

Lanc

ap 1

5mg

Cap,

Bur

nloc

15m

g Ca

pAd

co ro

znal

30m

g Ca

p, L

anca

p 30

mg

Cap,

Lan

sopr

azol

e U

nico

rn 3

0mg

Cap

Pant

opra

zole

Myl

an P

anto

praz

ole

20m

g Ta

b, P

eplo

c 20

mg

Tab,

Pra

zolo

c 20

mg

Tab

Myl

an-P

anto

praz

ole

40m

g Ta

b, P

anto

cid

40m

g Ta

b, P

razo

loc

40m

g Ta

b

Perip

hera

l Vas

cula

r Di

seas

e

Antic

oagu

lant

sW

arfa

rinCi

pla-

War

farin

5m

g Ta

b

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Dipy

ridam

ole

Plat

o 25

mg

Tab

Vaso

dila

tors

Pent

oxyf

yllin

eDy

na P

ento

xify

llin

400m

g Ta

b

Post

-Tra

umati

c St

ress

Dis

orde

rAn

xiol

ytics

Alpr

azol

am

Myl

an A

lpra

zola

m 0

.5m

g Ta

b, Z

opax

0.5

mg

Tab

Myl

an A

lpra

zola

m 1

mg

Tab,

Zop

ax 1

mg

Tab

Brom

azep

amSa

ndoz

Bro

maz

epam

3m

g Ta

bSa

ndoz

Bro

maz

epam

6m

g Ta

b

Diaz

epam

Dova

l 5m

g Ta

bPa

x 10

mg

Tab

Clon

azep

am

Clon

am 0

.5m

g Ta

bCl

onam

0.5

mg

Tab

Clon

am 2

mg

Tab

Rivo

tril

Drop

s


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Post

-Tra

umati

c St

ress

Dis

orde

r (c

ontin

ued)

Antid

epre

ssan

tsCi

talo

pram

Aust

ell-C

italo

pram

10m

g Ta

b

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Fluo

xetin

eDe

proz

an C

ap, P

rola

x Ca

p, R

anflo

cs C

ap

Psor

iasi

s

Corti

cost

eroi

ds - O

ral

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Corti

cost

eroi

ds - T

opic

al

Beta

met

haso

ne

Topi

vate

Cre

am

Leno

vate

Oin

t

Betn

ovat

e Sc

alp

Appl

icati

on

Clob

etas

ol

Dova

te C

ream

Dova

te O

int

Clob

ex S

ham

poo

Hyd

roco

rtiso

neBi

ocor

t Cre

am

Myl

ocor

t Oin

t

Rayn

auds

Sy

ndro

me

Antic

oagu

lant

sW

arfa

rinCi

pla-

War

farin

5m

g Ta

b

Calc

ium

Cha

nnel

Blo

cker

s

Amlo

dipi

ne B

esyl

ate

Cipl

avas

c 5m

g Ta

b, G

ulf a

mlo

dipi

ne 5

mg

Tab

Cipl

avas

c 10

mg

Tab,

Gul

f am

lodi

pine

10m

g Ta

b

Amlo

dipi

ne M

alea

teAm

late

5m

g Ta

b

Amla

te 1

0mg

Tab

Plat

elet

agg

rega

tion

inhi

bito

rsAs

pirin

Aspi

rin T

eva

80m

g Ta

b, E

cotr

in 8

1mg

Tab

Dipy

ridam

ole

Plat

o 25

mg

Tab

Vaso

dila

tors

Pent

oxify

lline

Dyna

Pen

toxi

fylli

n 40

0mg

Tab

Psor

iasi

s

Imm

uno-

supp

ress

ants

Met

hotr

exat

eAb

itrex

ate

Tab

Phar

mac

opoe

ial P

rodu

cts

Coal

Tar

Coal

Tar

Sol

ution

Alli

ed, L

iq P

icis

Carb

Sol

n

Brun

el P

icis

Carb

Shp

, Med

itar S

hp

Zinc

Oxi

deZi

nc +

Cas

tor O

il O

int

Zinc

Oin

t BP

Oin

t

Rheu

mat

oid

Arth

ritis

Vita

min

sFo

lic A

cid

Folic

Aci

d Ta

b

Anal

gesic

s -Pl

ain

Para

ceta

mol

Anta

lgic

Tab

, Gul

f Par

acet

amol

Tab

, Pai

nges

ic T

ab

Barr

s Pa

race

tam

ol S

yr, F

ever

pain

Syr

, Pai

noge

sic S

yr

Dise

ase

Mod

ifyin

g Ag

ents

Azat

hiop

rine

Azat

hiop

rine

PCH

Tab

, Aza

mun

Tab

Chlo

roqu

ine

Plas

moq

uine

Cap

Cycl

opho

spha

mid

eEn

doxa

n Ta

b

Sulp

hasa

lazi

neSa

lazo

pyrin

Tab

, Sal

azop

yrin

-EN

Tab

Met

hotr

exat

eAb

itrex

ate

Tab


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Rheu

mat

oid

Arth

ritis

(con

tinue

d)

Corti

cost

eroi

ds- O

ral

Pred

niso

neBe

-tab

s Pr

edni

sone

Tab

, Pan

afco

rt T

ab, T

rolic

Tab

Non

-ste

roid

al a

nti-

infla

mm

ator

ies

(NSA

IDs)

Ibup

rofe

n

Ibuc

ine

200m

g Ta

b, Ib

unat

e 20

0mg

Tab

Bren

400

mg

Tab,

Bet

apro

fen

fc 4

00m

g Ta

b, R

anfe

n 40

0mg

Tab

Ibug

esic

Sus

p, In

flum

ax P

aed

Susp

Mel

oxic

amAp

ex m

elox

icam

7.5

mg

Tab,

Med

oxic

am 7

.5m

g Ta

b

Adco

Mel

oxic

am 1

5mg

Tab,

Zyd

us M

elox

icam

15m

g Ta

b

Nap

roxe

nM

ylan

nap

roxe

n 25

0mg

Tab,

Nap

rosc

ript 2

50m

g Ta

b

Bio

napr

oxen

500

mg

Tab,

Nap

flam

500

mg

Tab

Schi

zoph

reni

a

Antid

epre

ssan

ts-O

ther

Sulp

iride

Espi

ride

50m

g Ca

p

Antid

epre

ssan

ts - S

SRIs

Cita

lopr

am

Aust

ell-C

italo

pram

10m

g Ta

b

Adco

-Tal

omil

20m

g Ta

b, C

ilate

20m

g Ta

b

Aust

ell-C

italo

pram

10m

g Ta

b

Fluo

xetin

eRa

nfloc

s Ca

p, D

epro

zan

Cap,

Pro

lax

Cap

Antip

sych

otics

Cloz

apin

eAs

pen

Cloz

apin

e 25

mg

Tab

Aspe

n Cl

ozap

ine

100m

g Ta

b

Flup

entix

olFl

uanx

ol D

ep In

j

Que

tiapi

ne

Sero

quel

XR

50 m

g Ta

b

Myl

an Q

uetia

pine

100

mg

Tab

Myl

an Q

uetia

pine

200

mg

Tab

Myl

an Q

uetia

pine

300

mg

Tab

Risp

erid

one

Zoxa

don

0.5m

g Ta

b

Risn

ia 1

mg

Tab,

Zox

adon

1m

g Ta

b

Risn

ia 2

mg

Tab

Zucl

open

thixo

lCl

opixo

l 2m

g Ta

b

Clop

ixol 1

0mg

Tab

Moo

d St

abili

sers

Carb

amaz

epin

e

Degr

anol

200

mg

Tab,

Zep

tol 2

00m

g Ta

b, T

egre

tol 2

00m

g CR

Tab

Tegr

etol

400

mg

CR T

ab

Tegr

etol

Sus

p

Lam

otrig

ine

Dyna

-Lam

otrig

ine

25m

g Ta

b, E

pite

c 25

mg

Tab

Lam

itor 5

0mg

Tab,

Epi

tec

50m

g Ta

b

Epite

c 10

0mg

Tab

Dyna

Lam

otrig

ine

200m

g Ta

b


Cate

gory

Th

erap

eutic

Des

crip

tion

Activ

e In

gred

ient

Exam

ple

of p

rodu

ct n

ame

Schi

zoph

reni

a (c

ontin

ued)

Moo

d St

abili

sers

(con

tinue

d)

Valp

roat

e

Epro

lep

200m

g CR

Tab

, Nav

alpr

o 20

0mg

CR T

ab

Epro

lep

300m

g CR

Tab

, Nav

alpr

o 30

0mg

CR T

ab

Epro

lep

500m

g CR

Tab

, Val

eptic

500

mg

CR T

ab

Epili

m L

iqui

d

Valp

roic

Aci

d

Conv

ulex

150

mg

Cap

Conv

ulex

300

mg

Cap

Conv

ulex

500

mg

Cap

Conv

ulex

50m

g/m

l Liq

Buty

roph

enon

esH

alop

erid

olSe

rena

ce 0

.5m

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10. Forms10.1 Pathology Request Form

10.2 Radiology Request Form – Universal

10.3 Radiology Request Form – Universal Health & Accident Plan

10.4 Specialist Referral Form

10.5 Chronic Medicine Application Form

10.6 Patient Consent Form (HIV)

HIV Registration Form (excluding Umvuzo Health) Please use Chronic Medicine Application Form on page 61

HIV Registration for Umvuzo Health. Please contact Rx Health on 0861 083 084 / 012 845 0099


PREGNANCY/ANTENATAL:

4451 HCG: Quantitave

3764 Blood Group: A B O

3765 Grouping: Rh Ag

3709 Coombs Antigen test

3762 Hb estimation

3946/3948 Rubella

Random Fasting

M F

PATIENT DETAILS

REFERRING PRACTITIONER

Initials & First name:

Initials & First name:

Age: Gender:

Contact no:

Contact no:Contact no:

Employer:

Dep. Code:

Surname:

Name: ICD10 code(s):

Collection Date & Time: Dr Signature:

MAIN MEMBER / PERSON RESPONSIBLE FOR PAYMENT OF ACCOUNT

MEDICAL SCHEME / UNIVERSAL HEALTH & ACCIDENT PLAN DETAILS

Surname:

Practice no:

Specimen:

Medical Scheme/Universal Health & Accident Plan/WorkerPlan: Option:

Pathology tests that are not listed above will not be covered. If any other pathology tests are requested, please advise members upfront so that they understand the possible financial implications. Should any other pathology tests be requested for the diagnosis or management of a chronic condition, a motivation is required and pre-authorisation must be obtained on 0860 111 090.

UNIVERSAL NETWORK PATHOLOGY REQUEST FORM

Postal address:

Postal code:

LIPID PROFILE:

4027 Total Cholesterol

4026 LDL

4028 HDL

4147 Triglycerides

4025 Lipogram

CARDIAC ENZYMES:

4152/4153 CK-MB

4161 Troponin I/T

THYROID FUNCTIONS:

4507 TSH

4482 Free-T4

INFLAMMATION MARKERS:

3947 CRP

3743 ESR

LIVER AND PANCREAS:

4130 AST

4131 ALT

4001 ALP

4134 GGT

4009 Billirubin Total

4010 Billirubin Conjugated

4006 Amylase

Drug

DRUG MONITORING:

4493 Therapeutic drug:

HIV-AIDS:

4614 HIV Ab - Rapid Test

3932 HIV Elisa

4429 Viral Load

3816 CD4 count

3974 PCR-Newborn baby

INFERTILITY TESTS:

Needs pre-authorisation

MICROBIOLOGY:

Specimen: Sputum

Urine

Faecal

Other

Microscopy only

MC&S

4352 Occult Blood

HISTOLOGY: BIOPSY/LESION

Only with code 0307

M. TUBERCULOSIS:

3881/3885 AFB Microscopy

3916/4651 Culture (No PCR)

SEROLOGY:

4531 Hep A IgM Ab

4531 Hep B Surface Ag

3949/3951 Syphilis

COAGULATION:

3805 PI / INR

3806 PI / INR Dosage

MALARIA:

3865/3883 Smears

3792 P.Falciparum Antigen

CYTOLOGY:

4566 Pap Smear (one slide)

BILHARZIA:

3883 Urine only

KIDNEYS:

4113 Potassium

4114 Sodium

4151 Urea

4171 Electrolytes & Urea

4032 S-Creatinine

4155 Uric acid

GLUCOSE, DIABETES:

4057 Glucose random

4057 Glucose fasting

4049 GTT - 2 specimens

4052 GTT - Standard

4053 GTT - Pregnancy

4064 HbA1c

TUMOUR MARKER:

4519 PSA

HAEMATOLOGY:

3762 Hb estimation

3783 WCC - diff. count

3785 WCC - total

3755 Full Blood Count

3797 Platelet count

IRON STUDIES:

4528 Ferritin

4144/4071 Transferrin/Iron

MembershipEmployee/Policy no:

ID no./Passport no:

ID no./Passport no:

AECI Value Option, CompCare NetworX and NetworX Efficiency Discounted Options, Massmart Health Plan Essential and Network Options, Tiger Brands Primary Plus Option, Transmed Link Plan, Umvuzo Standard, Ultra Affordable Options and Ultra Affordable Value Option, Witbank Coalfields Medical Aid Scheme Ntsika Option and Universal WorkerPlan truVALUE, truCARE, truHEALTH, truWELLNESS Options, Old Mutual Staff Fund Network & Network SELECT Plans, Universal Health & Accident Plan Essential, Universal Health & Accident Plan Essential Advance, Universal Health & Accident Plan Standard, Universal Health & Accident Plan Standard Advance, Universal Health & Accident Plan Comprehensive, Universal Health & Accident Plan Comprehensive Advance

Universal Healthcare Provider Network, a division of Universal CareUniversal House, 15 Tambach Road, Sunninghill Park, Sandton 2191

P O Box 1411, Rivonia 2128Tel: +27 11 208 1100 / 0860 111 900 / Fax: 0862 108 743

Email: [email protected] / www.universal.co.za


UNIVERSAL NETWORK RADIOLOGY REQUEST FORM

Initials:Member’s surname:

Doctor’s name:

ICD10 code: Date of appointment:

Membership/employee no.:Medical Scheme/WorkerPlan

Patient name:

Patient surname:

Age: Dependant code:

Physical Address: Postal Address:Postal code: Postal code:

Practice no.:

RADIOLOGY

SKULL WRIST AND HAND10100 Skull 65100 Hand – Left

CHEST 65105 Hand – Right30100 Chest, single view 65120 Finger30110 Chest, two views, PA and lateral 65140 Scaphoid – Left30150 Ribs 65145 Scaphoid – Right30155 Chest and ribs UPPER ARM

ABDOMEN 62100 Humerus – Left40100 Abdomen 62105 Humerus – Right40105 Abdomen supine, erect or decubitus ELBOW

REPRODUCTIVE SYSTEM 63100 Elbow – Left

ULTRASOUND Only in pregnancy: Not available on WorkerPlan truCARE and WorkerPlan truVALUE. Other schemes/plans: TWO investigations per pregnancy. Additional Ultrasound for complicated pregnancy to be motivated.

63105 Elbow – RightKNEE

72100 Knee, one or two views – Left43250 Ultrasound of pregnant uterus – 1st Trimester 72105 Knee, one or two views – Right43260 Ultrasound of pregnant uterus – 2nd Trimester 72120 Knee including patella – Left43270 Ultrasound of pregnant uterus – 3rd Trimester – First Visit 72125 Knee including patella – Right43273 Ultrasound of pregnant uterus – 3rd Trimester – Follow up 72140 Patella – Left

SPINE, PELVIS AND HIPS 72145 Patella – Right51110 Cervical spine – one or two views LOWER LIMBS FEMUR52100 Thoracic spine – one or two views 71100 Femur – Left53110 Lumbar spine – one or two views 71105 Femur – Right55100 Pelvis LOWER LEG56100 Hip – Left 73100 Lower leg – Left56110 Hip – Right 73105 Lower leg – Right56120 Pelvis and hips ANKLE AND FOOT

UPPER LIMBS – SHOULDER 74100 Ankle – Left61100 Clavicle – Left 74105 Ankle – Right61105 Clavicle – Right 74120 Foot – Left61110 Scapula – Left 74125 Foot – Right61115 Scapula – Right 74130 Calcaneus – Left61120 Acromio – Clavicular joint – Left 74135 Calcaneus – Right61125 Acromio – Clavicular joint – Right 74145 Toe61130 Shoulder – Left OTHER61135 Shoulder – Right 34100 Mammogram including ultrasound

FOREARM 34101 Mammography including ultrasound64100 Forearm – Left 34200 Ultrasound of the breast64105 Forearm – Right 40210 Ultrasound study of the whole abdomen, including pelvis65130 Wrist – Left 41200 Ultrasound study of the upper abdomen65135 Wrist – Right 43200 Ultrasound of the pelvis

Radiology codes that are not listed above will not be covered. If other radiology tests are required, please advise members upfront so that they understand possible financial implications.

DOCTOR SIGNATURE

UNIVERSAL NETWORK RADIOLOGY REQUEST FORMAECI Value Option, CompCare NetworX and NetworX Efficiency Discounted Options, Massmart Health Plan Essential and Network Options, Tiger Brands Primary Plus Option, Transmed Link Plan, Umvuzo Standard, Ultra Affordable and Ultra Affordable Value Options, Witbank Coalfields Medical Aid Scheme Ntsika Option and Universal WorkerPlan truVALUE, truCARE, truHEALTH truWELLNESS Options, Old Mutual Staff Fund Network & Network SELECT Plans

MEMBER’S DETAILS:

CLINICAL INFORMATION:

PATIENT’S DETAILS:

REFERRING PRACTITIONER:

ID no./Passport no:

ID no./Passport no:




DATE

D D M M Y Y Y Y


UNIVERSAL NETWORK RADIOLOGY REQUEST FORMUNIVERSAL HEALTH & ACCIDENT PLAN RADIOLOGY REQUEST FORM

Initials:Surname:

Doctor’s name:

ICD10 code: Date of appointment:

Universal Healthcare Provider Network, a division of Universal Care Universal House, 15 Tambach Road, Sunninghill Park, Sandton 2191

PO Box 1411, Rivonia 2128Telephone: +27 11 208 1000 / Fax: 0862 957 301 / www.universal.co.za

Policy no.:

Patient name:

Patient surname:


Physical Address: Postal Address:Postal code: Postal code:

Practice no.:

RADIOLOGY

WRIST AND HANDSKULL UPPER ARM

10100 Skull 62100 Humerus – LeftCHEST 62105 Humerus – Right

30100 Chest, single view ELBOW30110 Chest, two views, PA and lateral 63100 Elbow – Left30150 Ribs 63105 Elbow – Right30155 Chest and ribs KNEE

ABDOMEN 72100 Knee, one or two views – Left40100 Abdomen 72105 Knee, one or two views – Right40105 Abdomen supine, erect or decubitus 72120 Knee including patella – Left

SPINE, PELVIS AND HIPS 72125 Knee including patella – Right51110 Cervical spine – one or two views 72140 Patella – Left52100 Thoracic spine – one or two views 72145 Patella – Right53110 Lumbar spine – one or two views LOWER LIMBS FEMUR55100 Pelvis 71100 Femur – Left56100 Hip – Left 71105 Femur – Right56110 Hip – Right LOWER LEG56120 Pelvis and hips 73100 Lower leg – Left

UPPER LIMBS – SHOULDER 73105 Lower leg – Right61100 Clavicle – Left ANKLE AND FOOT61105 Clavicle – Right 74100 Ankle – Left61110 Scapula – Left 74105 Ankle – Right61115 Scapula – Right 74120 Foot – Left61120 Acromio – Clavicular joint – Left 74125 Foot – Right61125 Acromio – Clavicular joint – Right 74130 Calcaneus – Left61130 Shoulder – Left 74135 Calcaneus – Right61135 Shoulder – Right 74145 Toe

FOREARM OTHER64100 Forearm – Left 40210 Ultrasound study of the whole abdomen, including pelvis64105 Forearm – Right 41200 Ultrasound study of the upper abdomen65130 Wrist – Left 42200 Ultrasound study of the renal tract, including bladder65135 Wrist – Right 43200 Ultrasound of the pelvis65100 Hand – Left 43210 Ultrasound study of prostate, transrectal65105 Hand - Right 43220 Ultrasound study of the testes65120 Finger65140 Scaphoid – Left65145 Scaphoid – Right

Radiology codes that are not listed above will not be covered. If other radiology tests are required, please advise members upfront so that they understand possible financial implications.

DETAILS OF INSURED:


REFERRING PRACTITIONER

CLINICAL INFORMATION

ID no./Passport no:

ID no./Passport no:

Health Plan Options:

Essential, Essential Advance, Standard, Standard Advance, Comprehensive and Comprehensive Advance

DOCTOR SIGNATURE DATE

D D M M Y Y Y Y



PO Box 1411, Rivonia 2128Telephone: +27 11 208 1000 / Fax: 0862 957 355 / www.universal.co.za

Initials: Initials:Member’s surname:

Treatment date:

Secondary ICD10 code:

Patient date of birth:

UNIVERSAL NETWORK SPECIALIST REFERRAL FORM

Patient surname:

Membership no.:Medical scheme:

Primary ICD10 code:

Doctor’s name:

Doctor’s name:

Contact details:

Contact details:

Authorisation no.:

Date of appointment:

Practice no.:

Practice no.:

NB:

1. Members must contact (011) 208-1100 for prior authorisation2. Members are to ensure that the referral form from the General Practitioneris handed to the specialist on the day of the visit3. The authorisation number must appear on the specialists account4. Accounts are to be submitted to the Medical Scheme

Make a diagnosis: Perform a procedure: Suggest a treatment: Consider an admission:

MEMBER’S DETAILS:

REFERRING GENERAL PRACTITIONER:

SPECIALIST REFERRED TO:

INDICATE DESIRED INPUT FROM THE SPECIALIST:

DETAILED REASON FOR REFERRAL:

Patient ID no./Passport no:

DOCTOR SIGNATURE DATE

D D M M Y Y Y Y





Fax no.:

E-mail address:

Telephone no.:

DOCTORS DETAILS:

Doctor’s name:


Patient’s name:

Patient’s surname:


Practice no.:

CHRONIC MEDICINE APPLICATION FORM

(H)

(W)

(Cell)

Fax no.:

E-mail address:

Telephone no.:

PATIENT’S MEDICAL HISTORY:

Gender: M F Weight: Height: BMI: Smoker: Y N

Waist circumference: /

Blood glucose results:

Lipogram Results:

Chronic renal disease:

COPD:

HIV: CD4 cell count:

Ischaemic heart disease:

TIA/Stroke:

Familial hyperlipidaemia

Peripheral vascular disease:

Viral load:

Thyroid: TSH

Random

Total cholesterol

Creatinine clearance

Lung function result

Fasting

HDL LDL Triglyceride

Most recent HbA1c result:

TO BE COMPLETED BY APPLICANT. PLEASE PRINT USING BLOCK LETTERS

MEMBER’S DETAILS:

Initials: ID no./Passport no:Member/Employee surname:

Membership no.:First Name:


TO BE COMPLETED BY TREATING DOCTOR. PLEASE PRINT USING BLOCK LETTERS. COMPLETE WHICHEVER IS APPLICABLE TO THE PATIENT’S CHRONIC CONDITION.

Latest blood pressure ( sitting, having rested for 5 min):

Please indicate if the patient has a history of the following:

First degree relative with premature heart disease; (MI in Female <65 years, Male < 55 years)


Physical address:

Postal code:

Postal address:

Postal code:

mmHg

Universal Healthcare Provider Network requires a copy of blood results (Initial and Latest) where applicable for prompt assessment of the chronic medication application.

ID no./Passport no:

Medical Scheme:AECI Medical Scheme Value Option Umvuzo Standard Option WorkerPlan truCARE Option

CompCare Wellness NetworX Option Umvuzo Ultra Affordable Option WorkerPlan truHEALTH Option

CompCare Wellness NetworX Efficiency Discount option Universal Health & Accident Plan Essential WorkerPlan truWELLNESS Option

Massmart Network Option Universal Health & Accident Plan Essential Advance Witbank Coalfields Medical Aid Scheme Ntsika Option

Massmart Essential Option Universal Health & Accident Plan Standard Old Mutual Staff Fund Network Option

Tiger Brands Medical Scheme Mzansi Option Universal Health & Accident Plan Standard Advance Old Mutual Staff Fund Network SELECT Option

Transmed Medical Scheme State Plus Network Option Universal Health & Accident Plan Comprehensive

Umvuzo Activator Option Universal Health & Accident Plan Comprehensive Advance


CHRONIC MEDICATION: TO BE COMPLETED BY TREATING DOCTOR. PLEASE PRINT USING BLOCK LETTERS

New application Update Change in treatment

Please prescribe medicine according to the Universal Provider Network Chronic Formulary.

Diagnosis / Chronic Conditions/ICD10 code Medicine and Strength Dosage Number of Repeats

PATIENT CONSENT

I understand that my personal and clinical information will be kept confidential I give permission for my doctor to state the diagnosis of my condition I confirm that the information contained in the application form is correct

Patient’s signature

Doctor’s signature

I have verified this application against the Universal Chronic Formulary and the Chronic Condition list. I hereby declare that the information provided is true and correct.

DATE

DATE

D D M M Y Y Y Y

D D M M Y Y Y Y

DOCTOR DECLARATION

Once completed please fax APPLICATION and DOCUMENTS to 086 210 8743 or e-mail to [email protected]


PATIENT CONSENT FORM (HIV) TREATING DOCTOR’S DETAILS

Doctor Name:

Telephone no.:

Cell no.:

Fax no.:

E-mail address:

Practice No.:

ID/Passportno.:

Dependant Code:Age:

Membership No:

PATIENT CONSENT FOR THE RELEASE OF MEDICAL INFORMATION

MEMBER’S DETAILS

PATIENT’S DETAILS

Surname: Initials:

Surname:

First Name:

Physical address: Postal address:

Postal code: Postal code:

Telephone no.: Fax no.:

PATIENT’S CONSENT

I, , hereby give consent to: • Allow the Universal Care HIV counsellors to obtain clinical information and records relating to me or my dependants’ (child or legal beneficiary) health, treatment and any other aspects of medical care provided,• Allow any health care worker responsible for the management of my treatment to share my clinical information with the Universal Care HIV counsellors or Case Managers.

I confirm/understand that:• Counselling/education on HIV/AIDS has been offered to me in a language that I understand,• I am able to make an informed decision to voluntarily join the Universal Care HIV programme,• A Universal Care counsellor will be available for me to consult should I require it,• The purpose of performing diagnostic pathology tests is to establish my HIV status, to monitor, clinically treat and manage my HIV and that I understand the implications of knowing my HIV status,• Ongoing testing and monitoring of my condition is required as part of the programme and that the treatment protocol may change based on the outcome of any test,• Should I not comply with the programme protocols or prescribed treatment that the Medical Scheme, at its sole discretion, may elect to exercise its right to limit my benefits to the statutory prescribed minimum benefits,• I voluntarily consent to the drawing of blood samples and to the testing of such blood samples in order to establish my HIV status, as well as the subsequent drawing and testing of blood samples to monitor and treat my HIV condition,• Universal Care is the administrator of the programme and that my selected GP is responsible for the management of my condition, including the prescription of medication. Therefore Universal Care or the Medical Scheme will not be liable for claims by me or my dependants arising from my participation in the programme.• My clinical information regarding my HIV status will not be shared with my employer without my written consent,• I may voluntarily withdraw from the programme, but understand the implication thereof,• That all the information I have provided for the completion of this form is accurate and complete,• I have been given a copy of this document.

This consent is in respect of any matter on file with any physician or health care provider. The information obtained will not be divulged to any other individual, institution or organization, except to such persons who are required to receive such information in the ordinary course of their employment at Universal Care or the Medical Scheme’s administrator or the Medical Scheme itself. Universal Care and its employees shall not be held liable should my personal information or HIV status be unauthorised and unintentionally disclosed to a third party or revealed to a third party through coding of accounts using ICD10 codes.

SIGNED AT: PATIENT SIGNATURE:

WITNESS FULL NAME: WITNESS SIGNATURE:


PO Box 1411, Rivonia 2128Tel: 0860 111 900 / +27 11 208 1100 / Fax: 0862 957 305 / www.universal.co.za

ID/Passportno:

Medical Scheme/ Health Plan: Occupational Health and Wellness Health Plan:

AECI Medical Scheme Value Option Massmart Network Option WorkerPlan truCARE Option

CompCare Wellness NETWORX Option Massmart Essential Option WorkerPlan truWELLNESS Option

CompCare Wellness NETWORX Efficiency Discount Option Old Mutual Staff Fund Network Plan Witbank Coalfields Medical Aid Scheme Ntsika Option

Tiger Brands Medical Scheme Primary Plus Option Old Mutual Staff Fund Network SELECT Plan

Transmed Medical Scheme Link Plan

DATE

D D M M Y Y Y Y


Notes



Notes


Notes


Notes

UNIVERSAL HEALTHCARE PROVIDER NETWORKTel: +27 11 208 1000/1010/1020 / Fax: +27 11 807 4496

Email: Claims queries: [email protected] / Provider Network queries: [email protected]: www.universal.co.za

CHRONIC MEDICINE BENEFITQueries or applications for the Chronic Benefit

E-mail: [email protected] / Tel: 0860 111 900/(011) 208 1100 / Fax: 0862 108 743

SPECIALIST REFERRAL PRE-AUTHORISATION (EXCLUDING UMVUZO HEALTH)Tel: 0860 111 090 / Fax: 0862 957 355 / E-mail: [email protected]

UMVUZO STANDARD AND ULTRA AFFORDABLE OPTIONSTel: 0861 083 084 / Fax: 0866 865 091 / E-mail: [email protected]

DISEASE MANAGEMENT AND HIV PROGRAMME (EXCLUDING UMVUZO HEALTH)Tel: 0860 111 900 / Fax: 0862 957 305 / E-mail: [email protected]

UMVUZO STANDARD, ULTRA AFFORDABLE AND ULTRA AFFORDABLE VALUE OPTIONS (HIV PROGRAMME)Tel: 0861 083 084 / (012) 845 0099 / Fax: 0866 859 709 / E-mail: [email protected]

UNIVERSAL HEALTHCAREUniversal House, 15 Tambach Road, Sunninghill Park, Sandton

PO Box 1411, Rivonia, 2128

Documents

GENERAL PRACTITIONER - DocWeb · Universal Network is the Network Division of Universal Care, an accredited managed care organisation within the Universal Healthcare Group. Universal