Transcript Med Elite - Mediscor

Selfmed MED Elite Formulary : Menopause
Publication Date : 2015-01-01
*
NAPPI Code
---------819875007
750301007
893919004
825883008
706049001
823007006
706052001
706053001
810290006
706054001
823015009
706055001
823023001
824631005
824658019
823449009
794252001
822477009
757330002
822485001
757349005
827452004
832464007
756725038
756733030
756741033
832448001
797111018
795682018
706705001
808245007
706704001
757934005
757934013
757012019
851957005
717195001
847461009
853429006
705895001
853402019
853410003
703438001
825913004
881112003
704903001
820024007
822493004
825980003
822507005
818550007
703108001
Medicine Name
------------------------FEMIGEL PUMP
OESTRADIOL 20MG IMP
ESTROFEM 1MG TABS
ESTROFEM 2MG TABS
ESTRADOT 25MCG TD PATCH
EVOREL 25MCG TDS
ESTRADOT 37.5MCG TD PATCH
ESTRADOT 50MCG TD PATCH
EVOREL 50MCG TDS
ESTRADOT 75MCG TD PATCH
EVOREL 75MCG TDS
ESTRADOT 100MCG TD PATCH
EVOREL 100MCG TDS
CLIMARA 50 PATCH
CLIMARA 100 PATCH
ESTRING 2MG VAG RING
VAGIFEM VAG TABS
ESTRO-PAUSE 1MG TABS
PROGYNOVA 1MG TABS
ESTRO-PAUSE 2MG TABS
PROGYNOVA 2MG TABS
SYNAPAUSE E TABS
SYNAPAUSE VCR 1MG/GM
PREMARIN 0.3MG TABS
PREMARIN 0.625MG TABS
PREMARIN 1.25MG TABS
PREMARIN VCR
LIVIFEM 2.5MG TABS
DUPHASTON 10MG TABS
HEXAL-MPA 10MG TABS
PROVERA 10MG TABS
HEXAL-MPA 5MG TABS
PROVERA 5MG TABS
PROVERA 5MG TABS
PRIMOLUT N 5MG TABS
UTROGESTAN 100MG CAPS
UTROGESTAN 200MG CAPS
EVISTA 60MG
PREMELLE-CYCLE 5 TABS
PREMELLE LD TABS
PREMELLE 2.5MG TABS
PREMELLE 5MG TABS
ANGELIQ FILM COATED TABS
TRISEQUENS TABS
ACTIVELLE TABS
NOVOFEM
KLIOGEST TABS
ESTRO-PAUSE N TABS
POSTOVAL TABS
ESTRO-PAUSE N FORTE TABS
CLIMEN TABS
FEMOSTON 1/10
Active Ingredient
-----------------------------------------------------------ESTRADIOL GEL 0.06% (0.75 MG/1.25 GM METERED-DOSE PUMP)
ESTRADIOL IMPLANT 20 MG
ESTRADIOL TAB 1 MG
ESTRADIOL TAB 2 MG
ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.025 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.0375 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.05 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.075 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR
ESTRADIOL TD PATCH TWICE WEEKLY 0.1 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR
ESTRADIOL TD PATCH WEEKLY 0.1 MG/24HR
ESTRADIOL VAGINAL RING 2 MG (7.5 MCG/24HRS)
ESTRADIOL VAGINAL TAB 25 MCG
ESTRADIOL VALERATE TAB 1 MG
ESTRADIOL VALERATE TAB 1 MG
ESTRADIOL VALERATE TAB 2 MG
ESTRADIOL VALERATE TAB 2 MG
ESTRIOL SUCCINATE TAB 2 MG
ESTRIOL VAGINAL CREAM 1 MG/GM (0.1%)
ESTROGENS, CONJUGATED TAB 0.3 MG
ESTROGENS, CONJUGATED TAB 0.625 MG
ESTROGENS, CONJUGATED TAB 1.25 MG
ESTROGENS, CONJUGATED VAGINAL CREAM 0.625 MG/GM
TIBOLONE TAB 2.5 MG
DYDROGESTERONE TAB 10 MG
MEDROXYPROGESTERONE ACETATE TAB 10 MG
MEDROXYPROGESTERONE ACETATE TAB 10 MG
MEDROXYPROGESTERONE ACETATE TAB 5 MG
MEDROXYPROGESTERONE ACETATE TAB 5 MG
MEDROXYPROGESTERONE ACETATE TAB 5 MG
NORETHINDRONE TAB 5 MG
PROGESTERONE CAP 100 MG
PROGESTERONE CAP 200 MG
RALOXIFENE HCL TAB 60 MG
CONJ EST 0.625(14)/CONJ EST-MEDROXYPRO AC TAB 0.625-5MG(14)
CONJUGATED ESTROGEN-MEDROXYPROGEST ACETATE TAB 0.3-1.5 MG
CONJUGATED ESTROGEN-MEDROXYPROGEST ACETATE TAB 0.625-2.5 MG
CONJUGATED ESTROGEN-MEDROXYPROGEST ACETATE TAB 0.625-5 MG
DROSPIRENONE-ESTRADIOL TAB 2-1 MG
ESTRAD 2MG(12) &ESTRAD-NORETHIN 2-1MG(10) &ESTRAD TAB 1MG(6)
ESTRADIOL & NORETHINDRONE ACETATE TAB 1-0.5 MG
ESTRADIOL & NORETHINDRONE ACETATE TAB 1-1 MG
ESTRADIOL & NORETHINDRONE ACETATE TAB 2-1 MG
ESTRADIOL VAL 1 MG (16) & ESTRADIOL-NORETHIN TAB 1-1 MG (12)
ESTRADIOL VAL 2 MG (11) &ESTRADIOL-NORGEST TAB 2-0.5 MG(10)
ESTRADIOL VAL 2 MG (16) & ESTRADIOL-NORETHIN TAB 2-1 MG (12)
ESTRADIOL VAL 2 MG &ESTRADIOL VAL-CYPROTERONE ACE TAB 2-1 MG
ESTRADIOL 1MG (14) &ESTRADIOL-DYDROGESTERONE TAB 1-10MG (14)
Therapeutic Group
-------------------------------------------------OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OESTROGENS
OTHER SEX HORMONES
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
PROGESTOGENS
SELECTIVE OESTROGEN RECEPTOR MODULATORS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
* Generic Indicator: Y = Generic; O = Original with generics; N = Original with no generics
** Pre Auth: Y = Product requires additional pre-authorisation; N = No pre-authorisation required. Product is in formulary.
Copyright Mediscor PBM (Pty) Ltd. This document is the property of Mediscor PBM (Pty) Ltd. Unauthorised use and distribution is prohibited.
Generic
Indicator
--------N
N
N
N
Y
Y
N
Y
Y
Y
Y
Y
Y
N
N
N
N
Y
O
Y
O
N
N
N
N
N
N
N
N
Y
O
Y
O
O
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Mediscor PBM
Page 1
**
MRP
Pre Auth
Co-Pay
Y/N
-------- -------N
Y
N
Y
N
Y
N
Y
N
Y
Y
Y
N
Y
N
Y
Y
Y
N
Y
Y
Y
N
Y
Y
Y
N
Y
N
Y
N
Y
N
Y
N
Y
Y
Y
N
Y
Y
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
Y
Y
N
Y
Y
Y
Y
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
Selfmed MED Elite Formulary : Menopause
Publication Date : 2015-01-01
*
NAPPI Code
---------837865018
703107001
708907001
714289001
837873002
Medicine Name
------------------------EVOREL SEQUI
FEMOSTON-CONTI
ESTALIS PATCH 50/140
ESTALIS SEQUI PLUS 50/140
EVOREL CONTI
Active Ingredient
-----------------------------------------------------------ESTRADIOL 50 MCG & ESTRADIOL-NORETHIN 50-170 MCG TD SYS KIT
ESTRADIOL-DYDROGESTERONE TAB 1-5 MG
ESTRADIOL-NORETHINDRONE ACE TD PTTW 0.05-0.14 MG/DAY
ESTRADIOL-NORETHINDRONE ACE TD PTTW 0.05-0.14 MG/DAY
ESTRADIOL-NORETHINDRONE ACE TD SYS 50-170 MCG/24HR
Therapeutic Group
-------------------------------------------------SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
SEX HORMONE COMBINATIONS
* Generic Indicator: Y = Generic; O = Original with generics; N = Original with no generics
** Pre Auth: Y = Product requires additional pre-authorisation; N = No pre-authorisation required. Product is in Formulary.
DISCLAIMER: Please note that these formularies are reviewed reqularly by the Mediscor Pharmaceutical and Therapeutics Committee
to ensure that they comply with the latest industry norms for the treatment of the listed conditions. Mediscor PBM Pty Ltd reserves
the right to change medicines to comply with the latest industry norms for the treatment of the listed conditions. Mediscor PBM Pty Ltd
reserves the right to change medicines included in the formulary when important or new information is made available,
e.g. on new findings regarding the safety of medicine.
COPYRIGHT: Mediscor PBM reserves its copyright and all its other rights in or in respect of the Mediscor Formularies.
No part of the Mediscor Formularies may be reproduced, photocopied, recorded or stored in any retrieval system, or transmitted by
any means, electronic, mechanical or otherwise, without the written permission of Mediscor PBM
Generic
Indicator
--------N
N
N
N
N
Mediscor PBM
Page 2
**
MRP
Pre Auth
Co-Pay
Y/N
-------- -------N
Y
N
Y
N
Y
N
Y
N
Y