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Otc) Benefit Medication Formulary

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Otc) Benefit Medication Formulary OVER-THE-COUNTER (OTC) BENEFIT MEDICATION FORMULARY The OTC formulary is a list of medicines (Schedule 0-3) that will be paid from the OTC benefit, subject to the limit specified by the scheme. Metropolitan Generic Reference Price (METREF) will apply. Co-payments will apply for items amounting to more than the reference price. The formulary is subject to regular review. Metropolitan Health reserves the right to update and change the formulary when new information becomes available. IMPORTANT: Please note that the medication on this list is published on an annual basis. Medication and prices are subject to change based on new clinical information and/or pricing updates which may not be reflected on the list below. Product name Active Ingredient Strength Dosage form Schedule Nappi code Oral antiseptics and sore throat Andolex C Benzydamide SPR 1 710149 Andolex Oral Rinse Benzydamide . MOW 1 810576 Andolex Spray Benzydamide . SPR 1 816167 Betadine oral Povidone-iodine MOW 0 707937 Dermadine oral garg Povidone-iodine 1g/100ml MOW 0 799688 Iodised throat Antiseptics LOZ 1 892670 Iodised throat Antiseptics LOZ 1 810010 Medi-keel A Cetylpyridinium LOZ 1 741035 Medi-Keel A black currant Cetylpyridinium LOZ 1 884233 Medi-Keel A honey & lemon Cetylpyridinium LOZ 1 884225 Podine mouth wash Povidone-iodine MOW 0 785210 Septadine oral antiseptic Povidone-iodine MOW 0 819859 Steridine mouthwash and gargle liquid Povidone-iodine MOW 0 890365 Tcp antiseptic Antiseptics SLN 1 815950 Throflam Benzydamide MOW 1 712171 Throflam Benzydamine 22.5mg/15ml SPR 1 722122 Trochain Antiseptics LOZ 1 772674 Antifungal agents - Oral Canstat oral Nystatin 100000u/ml SUS 2 835056 Nystacid Nystatin 100000u/ml SUS 2 835285 Page 1 of 26 Vari Miconazole Oral Miconazole 2% GEL 2 718641 Anti-fungal - Topical Adco-dermed Ketoconazole 20mg/ml CRE 1 899101 Almatil Terbinafine 10mg/g CRE 1 720777 A-por Clotrimazole 1% CRE 1 826952 Benzoic acid compound ointment bp No ATC level 5 currently allocated Non Specified OIN 0 707914 Canalba Clotrimazole 1% CRE 1 796336 Candaspor Clotrimazole 1% CRE 1 788554 Candizole Clotrimazole 1% CRE 1 797006 Canesten Clotrimazole 1% CRE 1 712205 Canex topical Clotrimazole 1% CRE 1 824011 Canstat Nystatin 100000u/g CRE 2 784966 Clomaderm Clotrimazole 1% CRE 1 878421 Covarex Miconazole 2% CRE 1 877719 Covospor Clotrimazole 1% CRE 1 814423 Dermazole Miconazole 2% CRE 2 700595 Dis-chem Clotrimazole Clotrimazole 1% CRE 1 705246 Dynaspor Clotrimazole 1% CRE 1 798150 Innospore Clotrimazole 1% CRE 1 711138 Ketazol Ketoconazole 20mg CRE 1 890760 Kez Shampoo Ketoconazole 20mg/ml SHA 1 701565 Lamisil Terbinafine 10mg/g CRE 1 792705 Lamisil dern gel Terbinafine 10mg/g CRE 1 880892 Medaspor topical Clotrimazole 1% CRE 1 799696 Micomisan Clotrimazole 1% CRE 1 799505 Mycopsor Bifonazole CRE 2 745251 Mycopsor Bifonazole LOT 2 835862 Mycostatin Nystatin 100000u/g CRE 2 745278 Mycostatin Nystatin 100000u/g OIN 2 745286 Normospor Clotrimazole 1% CRE 1 793493 Nystacid Nystatin 100000u/g OIN 2 797022 Terbane Terbinafine 10mg/g CRE 1 711199 Page 2 of 26 Terbicil Terbinafine 10mg/g CRE 1 706073 Trimaze Clotrimazole 1% CRE 1 839639 Ung ac benz co No ATC level 5 currently allocated OIN 0 891457 Ung ac benz co bpc Other antifungals for topical use OIN 0 773662 Vari-clotrimazole Clotrimazole 1% CRE 1 709885 Xeraspor t Clotrimazole 1% CRE 1 816299 Anti-fungal - Vaginal A-por Clotrimazole 1% VCR 2 826960 Canalba vag Clotrimazole 1% VCR 2 831875 Canesten Clotrimazole 1% VCR 2 703548 Candaspor vag Clotrimazole 1% VCR 2 831883 Candizole v Clotrimazole 1% VCR 2 832596 Canex vag Clotrimazole 1% VCR 2 831913 Covospor vaginal Clotrimazole 1% VCR 2 832332 Dis-chem Clotrimazole 50g Clotrimazole 1% VCR 2 705247 Gynezol Clotrimazole 1% VCR 2 878448 Gyno-trimaze Clotrimazole 1% VCR 2 839620 Medaspor vag Clotrimazole 1% VCR 2 832391 Micomisan vag Clotrimazole 1% VCR 2 832405 Normospor vag Clotrimazole 1% VCR 2 832421 Pinaspor v Clotrimazole 1% VCR 2 702574 Xeraspor v Clotrimazole 1% VCR 2 832499 Antacids Mist mag hydrox Magnesium hydroxide MLS 0 744077 Mist mag hydrox fams Magnesium hydroxide MLS 0 808555 Mist mag hydroxide Magnesium hydroxide MLS 0 897400 Alusil (stx) Magnesium hydroxide Non Specified CHU 0 702544 Gelusil peppermint Ordinary salt combinations Non Specified TAB 0 812137 Mayogel Ordinary salt combinations SUS 0 740551 Mist mag trisil Ordinary salt combinations MLS 0 894838 Mist mag trisil Ordinary salt combinations MLS 0 823031 Mist mag trisil fams Ordinary salt combinations MLS 0 828521 Page 3 of 26 Alumag D Ordinary salt combinations 5/400/200mg SUS 0 703640 Alumite d Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 797499 Amgel Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 700771 Co-gel Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 782173 Dicyclomine Co Gel Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 702725 Gelumen Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 789933 Gelusil s Ordinary salt combinations and antiflatulents Non Specified TAB 0 788465 Medigel Ordinary salt combinations and antiflatulents SUS 0 740683 Neutragel d Ordinary salt combinations and antiflatulents 5/400/200mg SUS 0 786810 Propan gel s Ordinary salt combinations and antiflatulents SUS 0 757675 Acidown Ordinary salt combinations and antiflatulents 200mg TAB 0 796735 Adco-cimetidine Cimetidine 200mg TAB 3 811459 Acidown Cimetidine 200mg TAB 3 796735 Adco-cimetidine Cimetidine 400mg TAB 3 800252 Bio-cimetidine Cimetidine 200mg TAB 3 886978 Bio-cimetidine Cimetidine 400mg TAB 3 887003 Cimlok Cimetidine 200mg TAB 3 854247 Cimlok Cimetidine 400mg TAB 3 854255 Hexamet 400 Cimetidine 400mg TAB 3 806919 Lenamet Cimetidine 200mg TAB 3 736252 Lenamet Cimetidine 400mg TAB 3 736260 Adco-cimetidine Cimetidine 400mg TAB 3 800252 Lenamet otc Cimetidine 200mg TAB 3 832901 Secadine Cimetidine 200mg TAB 3 797464 Secadine Cimetidine 400mg TAB 3 797472 Austac-150 Cimetidine 150mg TAB 3 712134 Austac-300 Ranitidine 300mg TAB 3 712135 Austac-75 Ranitidine 75mg TAB 3 712136 Gulf Ranitidine Ranitidine 150mg TAB 3 713553 Gulf Ranitidine Ranitidine 300mg TAB 3 713554 Ranihexal 150 Ranitidine 150mg TAB 3 841609 Ranihexal 300 Ranitidine 300mg TAB 3 841617 Page 4 of 26 Ranit Ranitidine 150mg TAB 3 705361 Ranit Ranitidine 300mg TAB 3 705360 Ultak Ranitidine 300mg TAB 3 867942 Ultak Ranitidine 150mg TAB 3 867934 Zantac efferves 150 Ranitidine 150mg EFT 3 811882 Zantac efferves 300 Ranitidine 300mg EFT 3 791733 Ranitidine Biotech Ranitidine 300mg TAB 3 718482 Lanzor HB Lansoprazole 15mg CAP 2 703141 Lancap Lansoprazole 15mg CAP 2 715812 Lansoloc OTC Lansoprazole 15mg CAP 2 704752 Lansoprazole Unicorn Lansoprazole 15mg CAP 2 704752 Irritable bowel syndrome and abdominal cramps Buscopan Butylscopolamine 10mg TAB 3 711276 Bevispas Mebeverine 135mg TAB 2 822019 Buscopan Butylscopolamine 5mg/5ml SYR 2 797413 Hyospasmol Butylscopolamine 10mg TAB 2 731951 Hyospasmol Butylscopolamine 5mg/5ml SYR 2 707213 Scopex Butylscopolamine 10mg TAB 2 762725 Buscopan compound Butylscopolamine and analgesics 10mg/250mg TAB 2 711292 Scopex Butylscopolamine 5mg/5ml SYR 2 703383 Constipation Dulcolax Bisacodyl 5mg TAB 0 721549 Dulcolax Bisacodyl 10mg SUP 0 721522 Adco-liquilax Lactulose 3.3g/5ml SYR 0 878707 Anlac 3300mg/5ml Lactulose 3.3g/5ml SYR 1 717972 Duphalac Lactulose 3.3g/5ml SYR 0 721611 Lacson Lactulose 3.3g/5ml SYR 0 797723 Laxette Lactulose 3.3g/5ml SYR 0 817309 Aculax Senna glycosides 3.3g/5ml SYR 0 708722 Dis-chem senna Senna glycosides 7.5mg TAB 0 705231 Laxador Senna Senna glycosides 7.5mg TAB 0 710370 Lennon Senna Senna glycosides 7.5mg TAB 0 710368 Page 5 of 26 Sennamed Senna glycosides 300mg CAP 0 710432 Senokot Senna glycosides 7.5mg TAB 0 763225 Soflax Senna glycosides 13.5mg TAB 0 868078 Tummy-lax 7 5mg Senna glycosides 7.5mg TAB 1 714464 Senna-Pin Senna glycosides 7.5mg TAB 0 708867 Lenolax paed enema Sodium phosphate ENE 0 726435 Lenolax(fleet) Sodium phosphate ENE 0 726443 Oral Rehydration Lectro solution Oral rehydration salt formulations SLN 0 768191 Lectro solution Oral rehydration salt formulations SYR 0 787191 Purity oral rehydration solution Oral rehydration salt formulations SYR 0 701466 Scriptolyte Oral rehydration salt formulations SYR 0 762873 Anti-diarrhoeal agents Lomotil Diphenoxylate TAB 0 738980 Adco-loperamide Loperamide 1mg/5ml SYR 2 811467 Adco-loperamide Loperamide 2mg TAB 2 792071 Betaperamide Loperamide 2mg TAB 2 792691 Cipla-Loperamide Loperamide 2mg TAB 2 707342 Dis-chem anti-diarrhoeal Loperamide 2mg TAB 2 703393 Gastron Loperamide 2mg TAB 2 810916 Gastron Loperamide 1mg/5ml SYR 2 810908 Imodium Loperamide 2mg TAB 2 732486 Imodium Loperamide 2mg CAP 2 807761 Imodium Loperamide 1mg/5ml SYR 2 732478 Imodium Melt Loperamide 2mg TAB 2 703518 Lopedium Loperamide 2mg EFT 2 823759 Loperastat Loperamide 1mg/5ml SYR 2 820563 Norimode Loperamide 2mg TAB 2 796697 Prodium Loperamide 2mg TAB 2 791768 Anticoagulants Disprin cardiocare Acetylsalicylic acid 100mg TAB 0 847283 Bayer aspirin Acetylsalicylic acid 100mg TAB 0 862304 Page 6 of 26 Ecotrin Acetylsalicylic acid 81mg ECT 0 823481 Myoprin Acetylsalicylic acid 100mg EFT 0 845590 Disprin cv 300 disp Acetylsalicylic acid 300mg DSP 0 807206 Anti-anaemic agents Ferrous sulphate 75mg body balance Ferrous sulfate 75mg TAB 0 713558 Ferrous sulphate Ferrous sulfate 75mg TAB 0 710372 Be-tabs Folic acid Folic acid 5mg TAB 0 810967 Aha Folic acid Folic acid 5mg TAB 0 709874 Folic acid Folic acid 5mg TAB 0 711922 Methylcobalamin 1mg Cyanocobalamin 1mg TAB 0 700419 Lifeforce
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