CHRONIC MEDICATION COMPREHENSIVE FORMULARY Effective 1 June 2013

 This formulary represents drugs covered for chronic use for 25 Chronic Disease List (CDL) conditions and individual Diagnosis and Treatment Pairs (DTP) conditions.  Reimbursement of medicines for non-CDL and non-DTP conditions is subject to Scheme Rules and the Metropolitan Health Risk Management Medicine Reimbursement Policy.  Unless stipulated, all active ingredients listed in this formulary are subject to the Metropolitan Health Reference Price (MetRef).  The examples below serve as a guide on the trade names available for the active ingredients listed and not for marketing a specific brand.  Any product within the MetRef category may be used, however a co-payment may be attracted if the product selected is above the generic reference threshold.  The dispensing pharmacist may make a generic substitution to assist members in avoiding a co-payment.  Treatment designated as "Accepted treatment" indicates that this is a medicine covered as first line, according to the Metropolitan Health Risk Management Medicine Reimbursement Policy.  For treatment designated as "Motivation required", certain criteria as specified in the Metropolitan Health Risk Management Medicine Reimbursement Policy should be met.  For treatment designated as "Special investigation", the relevant clinical investigation reports as specified in the Metropolitan Health Risk Management Medicine Reimbursement Policy are required.

Abbreviations of dosage form CAP Capsule ENE Enema OPD Eye drops CPS Capsule (Inhaler) INH Inhaler SLN Sublingual CRM Cream INJ Injection SRC Slow release capsule DRP Drops LOT Lotion SRT Slow release tablet DSP Dispersable NAS Nasal spray SUP Suppository SYR Syrup TAB Tablet UNG Ointment ECT Enteric-coated tablet NOD Nasal drops SUS Suspension

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM

CHRONIC DISEASE LIST CONDITIONS (CDLs) ADDISON'S DISEASE ICD10: E27.1

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Fludrocortisone 0.1mg TAB Florinef acetate Corticosteroids , oral Motivation required Hydrocortisone 10mg TAB Covocort Corticosteroids , oral Accepted treatment Prednisolone 5mg TAB Capsoid Lenisolone Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Accepted treatment

ASTHMA ICD10: J45.0, J45.1, J45.8, J45.9 Aminophylline 225mg SRT Phyllocontin Xanthines Motivation required Beclometasone 100mcg INH Beclate 100 Becotide 100 comp Corticosteroids, inhaled Accepted treatment Beclometasone 200mcg INH Beclate 200 Becloforte inhaler Corticosteroids, inhaled Accepted treatment Beclometasone 50mcg INH Beclate 50 Becotide Corticosteroids, inhaled Accepted treatment Budesonide 100mcg INH Budeflam 300 dose gentle- Inflammide 100 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose Budesonide 200mcg INH Budeflam 300 dose gentle- Inflammide 200 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose Budesonide 200mcg CPS Budeflam DP Caps Inflacor 200 Corticosteroids, inhaled Accepted treatment Budesonide 100mcg CPS Inflacor 100 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg CPS Inflacor 400 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg INH Inflammide 400 Novolizer Pulmicort Corticosteroids, inhaled Accepted treatment turbuhaler 100dose Ciclesonide 160mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 80mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 160mcg INH Alvesco (120 doses) Corticosteroids, inhaled Motivation required Fenoterol INH Berotec HFA Beta agonists , short acting Motivation required Fenoterol and other drugs for 200mcg INH Duovent HFA 200 dose Beta agonists & anticholinergic Accepted treatment obstructive airway diseases combination Fluticasone 125mcg INH Flixotide 125 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 250mcg INH Flixotide 250 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 50mcg INH Flixotide 50 CFC FREE 120 Corticosteroids, inhaled Motivation required Fluticasone 100mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 250mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 500mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 50mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Formoterol 12mcg CPS Foradil dry powder inhalation Foratec DP Caps Beta agonists, long acting Accepted treatment Formoterol 12mcg INH Foratec HFA Beta agonists, long acting Accepted treatment Formoterol 9mcg INH Oxis turbuhaler 9mcg 60 dose Beta agonists, long acting Motivation required Formoterol and other drugs for 160/4.5mcg INH Symbicord turboh Corticosteroids and beta agonists, Motivation required obstructive airway disease 160mcg;45mc long acting Formoterol and other drugs for 80/4.5mcg INH Symbicord turboh 80:4 5mcg Corticosteroids and beta agonists, Motivation required obstructive airway disease long acting Ipratropium bromide 40mcg INH Ipvent anticholinergics Accepted treatment Ipratropium bromide 20mcg INH Atrovent anticholinergics Accepted treatment Ketotifen 1mg SYR Adco-ketotifen Antihistamines for systemic use Motivation required Ketotifen 1mg SYR Zaditen Antihistamines for systemic use Motivation required Ketotifen 1mg SYR Zetofen Antihistamines for systemic use Motivation required Montelukast 10mg TAB Singulair Sintrine Leukotriene receptor antagonists Motivation required Montelukast 4mg CHU Singulair Sintrine Leukotriene receptor antagonists Motivation required Montelukast 5mg CHU Singulair Sintrine Leukotriene receptor antagonists Motivation required Montelukast 4mg SAC Singulair Sprinkles Leukotriene receptor antagonists Motivation required Prednisolone 5mg TAB Capsoid Lenisolone Corticosteroids , oral Motivation required Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Motivation required Salbutamol 100mcg INH Asthavent Venteze CFC free Beta agonists , short acting Accepted treatment Salbutamol 200mcg CAP Asthavent DP Ventodisks(8 s) Beta agonists , short acting Accepted treatment Salbutamol 400mcg CPS Ventodisks(8 s) Beta agonists , short acting Motivation required Salbutamol 2.5mg SLN Ventolin nebules Salbu-neb Beta agonists , short acting Motivation required Salbutamol and other drugs for INH Combivent Beta agonists & anticholinergic Accepted treatment obstructive airway diseases combination Salmeterol 50mcg INH Serevent accuhaler Beta agonists, long acting Motivation required Salmeterol 25mcg INH Serevent inhal (120) Beta agonists, long acting Motivation required Salmeterol and other drugs for 25mcg/125mcg INH Foxair Sereflo HFA 25/125 Salmeterol and fluticasone Accepted treatment obstructive airway diseases Dose 120 Salmeterol and other drugs for 25mcg/50mcg INH Foxair Sereflo HFA 25/50 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 Dose long acting Salmeterol and other drugs for 50/100mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 50/100 long acting Salmeterol and other drugs for 50/250mcg ACC Foxair Seretide Accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/250 long acting Salmeterol and other drugs for 50/500mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/500 long acting

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Salmeterol and other drugs for 25mcg/250mcg INH Sereflo HFA 25/250 Dose 120 Seretide 25/250 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 dose long acting Terbutaline 05mg INH Bricanyl turbuhaler 200dose Beta agonists , short acting Motivation required Theophylline 250mg SRT Euphyllin retard Microphyllin Xanthines Motivation required Theophylline 125mg SRC Microphyllin Xanthines Motivation required Theophylline 300mg SRT Pulmophyllin sr 300 SANDOZ Xanthines Motivation required Theophyllin Anhydrous SR Theophylline 200mg SRT SANDOZ Theophyllin Theoplus Xanthines Motivation required Anhydrous SR Theophylline 400mg SRT Uniphyl 400 Xanthines Motivation required Theophylline 600mg SRT Uniphyl 600 Xanthines Motivation required Zafirlukast 20mg TAB Accolate 20 Leukotriene receptor antagonists Motivation required

BIPOLAR MOOD DISORDER ICD10: F31.0, F31.1, F31.2, F31.3, F31.4, F31.5, F31.6, F31.8, F31.9 Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Bupropion 150mg SRT Wellbutrin SR OTHER NERVOUS SYSTEM DRUGS Motivation required Bupropion Extended release 150mg SRT Wellbutrin XL OTHER NERVOUS SYSTEM DRUGS Motivation required Bupropion Extended release 300mg SRT Wellbutrin XL OTHER NERVOUS SYSTEM DRUGS Motivation required Carbamazepine 200mg TAB CPL-Carbamazepine Degranol Mood Stabilisers Accepted treatment Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Mood Stabilisers Accepted treatment Chlorpromazine 100mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 25mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 50mg TAB Largactil Antipsychotics Accepted treatment Citalopram 20mg TAB Adco-Talomil Arrow Citalopram Selective serotonin receptor Accepted treatment inhibitors Citalopram 10mg TAB Austell-Citalopram Selective serotonin receptor Accepted treatment inhibitors Citalopram 40mg TAB Ran-Citalopram Depramil Selective serotonin receptor Accepted treatment inhibitors Clomipramine 75mg SRT Anafranil simple reg Heterocyclic antidepressant Motivation required Clomipramine 10mg TAB Equinorm Anafranil Heterocyclic antidepressant Accepted treatment Clomipramine 25mg TAB Equinorm Clomidep Heterocyclic antidepressant Accepted treatment Dosulepin 25mg CAP Prothiaden Thaden Heterocyclic Antidepressants Accepted treatment Dosulepin 75mg TAB Thaden Selective serotonin receptor Accepted treatment inhibitors Page 4 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Duloxetine 30mg CAP Cymgen Cymbalta Antidepressants Motivation required Duloxetine 60mg CAP Cymgen Cymbalta Antidepressants Motivation required Escitalopram 10mg TAB Be-Tabs Escitalopram Aspen-Escitalopram Selective serotonin receptor Motivation required inhibitors Escitalopram 20mg TAB Lexamil Citraz Selective serotonin receptor Motivation required inhibitors Escitalopram 5mg TAB Lexamil Selective serotonin receptor Motivation required inhibitors Fluoxetine 20mg CAP Nuzak Ranflocs 20 Selective serotonin receptor Accepted treatment inhibitors Fluvoxamine 100mg TAB Faverin Fluvoxamine- Hexal Selective serotonin receptor Motivation required inhibitors Haloperidol 1.5mg TAB SANDOZ Haloperidol Antipsychotics Motivation required Haloperidol 5mg TAB SANDOZ Haloperidol Serenace Antipsychotics Motivation required Haloperidol 0.5mg CAP Serenace Antipsychotics Motivation required Haloperidol 10mg TAB Serenace Antipsychotics Motivation required Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Lamotrigine 100mg TAB Arrow lamotrigine Aspen Lamotrigine Mood stabilisers Accepted treatment Lamotrigine 50mg TAB Arrow lamotrigine Epitec Mood stabilisers Accepted treatment Lamotrigine 200mg TAB Epitec Dyna-Lamotrigine Mood stabilisers Accepted treatment Lamotrigine 25mg TAB Mylan-Lamotrigine Lamitor Mood stabilisers Accepted treatment Lithium 250mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 400mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 50mg CAP Lithium succinate Mood stabilisers Accepted treatment Lithium 450mg TAB Quilonum retard Mood stabilisers Accepted treatment Lofepramine 70mg TAB Emdalen Non-selective monoamine Motivation required reuptake inhibitors Maprotiline 25mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Maprotiline 75mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Mianserin 10mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mianserin 30mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mirtazapine 30mg TAB Beron Auro-Mirtazapine Antidepressants Motivation required Mirtazapine 15mg TAB Mylan-Mirtazapine Sandoz Mirtazapine Antidepressants Motivation required Moclobemide 150mg TAB Depnil Monoamine oxidase type A Motivation required inhibitors Moclobemide 300mg TAB Depnil 300 Monoamine oxidase type A Motivation required inhibitors

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Olanzapine 2.5mg TAB Olexar Redilanz Antipsychotics Motivation required Olanzapine 5mg TAB Olexar Redilanz Antipsychotics Motivation required Olanzapine 10mg TAB Olexar Redilanz Antipsychotics Motivation required Paroxetine 25mg TAB Aropax CR Selective serotonin receptor Motivation required inhibitors Paroxetine 30mg TAB Austell-Paroxetine Serrapress Selective serotonin receptor Motivation required inhibitors Paroxetine 20mg TAB Deparoc Paxil Selective serotonin receptor Motivation required inhibitors Quetiapine 25mg TAB Dopaquel Serez Antipsychotics Motivation required Quetiapine 100mg TAB Truvalin Quetoser Antipsychotics Motivation required Quetiapine 200mg TAB Mylan Quetiapine Dopaquel Antipsychotics Motivation required Quetiapine 300mg TAB Serez Truvalin Antipsychotics Motivation required Quetiapine 200mg TAB Seroquel XR 200 Antipsychotics Motivation required Quetiapine 300mg TAB Seroquel XR 300 Antipsychotics Motivation required Quetiapine 400mg TAB Seroquel XR 400 Antipsychotics Motivation required Reboxetine 4mg TAB Edronax Monoamine oxidase type A Motivation required inhibitors Risperidone 0.5mg TAB Aspen Risperidone Risperlet Antipsychotics Motivation required Risperidone 2mg TAB Aspen Risperidone Risperdal Quicklet Antipsychotics Motivation required Risperidone 3mg TAB Aspen Risperidone Risperidone-Hexal Antipsychotics Motivation required Risperidone 1.0mg TAB DRL-Risperidone Auroperdal Antipsychotics Motivation required Risperidone 1mg/ml SYR Risperdal Antipsychotics Motivation required Risperidone 4mg TAB Risperdal Risponz Antipsychotics Motivation required Sertraline 100mg TAB Arrow Sertraline Austell-Sertraline Selective serotonin receptor Motivation required inhibitors Sertraline 50mg TAB Serlife Serdep Selective serotonin receptor Motivation required inhibitors Sulpiride 200mg TAB Bio-Sulpiride Substituted benzamide Accepted treatment Sulpiride 50mg CAP Espiride SANDOZ Sulpiride Substituted benzamide Accepted treatment topiramate 100mg TAB Adco-topiramate Epitoz Anticonvulsants Motivation required Topiramate 25mg TAB Epitoz Adco-topiramate Anticonvulsants Motivation required Topiramate 200mg TAB Toplep Sandoz Topiramate Anticonvulsants Motivation required Topiramate 50mg TAB Toplep Topalex Anticonvulsants Motivation required Trazodone 100mg CAP Aspen Trazodone Molipaxin Antidepressants Motivation required Trazodone 50mg CAP Aspen Trazodone Molipaxin Antidepressants Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Trifluoperazine 1mg TAB Stelazine Antipsychotics Motivation required Trifluoperazine 5mg TAB Stelazine Antipsychotics Motivation required Trimipramine 25mg TAB Tydamine Heterocyclic Antidepressants Motivation required Trimipramine 50mg CAP Tydamine Heterocyclic Antidepressants Motivation required Valproic acid 150mg CAP Convulex Mood stabilisers Accepted treatment Valproic acid 300mg CAP Convulex Epilim cr 300 Mood stabilisers Accepted treatment Valproic acid 500mg CAP Convulex Epilim cr 500 Mood stabilisers Accepted treatment Valproic acid 200mg SRT Epilim cr 200 Mood stabilisers Accepted treatment Venlafaxine 50mg TAB Efexor Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 37.5mg TAB Illovex SR Odiven Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 150mg TAB Illovex SR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 75mg TAB Odiven Illovex SR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 150mg CAP Sandoz Velafaxine 150mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 75mg CAP Sandoz Velafaxine 75mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 37.5mg CAP Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Zuclopenthixol 10mg TAB Clopixol Antipsychotics Motivation required Zuclopenthixol 2mg TAB Clopixol Antipsychotics Motivation required

BRONCHIECTASIS ICD10: Q33.4, J47 Oral antibiotics will be reimbursed in the treatment of Bronchiectasis Aminophylline 100mg TAB Norstan-ted Xanthines Motivation required Aminophylline 200mg TAB Norstan-ted Xanthines Motivation required Aminophylline 225mg SRT Phyllocontin Xanthines Motivation required Beclometasone 200mcg INH Beclate 200 Becloforte inhaler Corticosteroids, inhaled Accepted treatment Beclometasone 100mcg ATH Qvar autohaler 200dose Beclate 100 Corticosteroids, inhaled Accepted treatment Beclometasone 50mcg ATH Qvar autohaler 200dose Beclate 50 Corticosteroids, inhaled Accepted treatment Budesonide 100mcg INH Budeflam 300 dose gentle- Inflammide 100 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Budesonide 200mcg INH Budeflam 300 dose gentle- Inflammide 200 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose Budesonide 200mcg CPS Budeflam DP Caps Inflacor 200 Corticosteroids, inhaled Accepted treatment Budesonide 100mcg CPS Inflacor 100 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg CPS Inflacor 400 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg INH Inflammide 400 Novolizer Pulmicort Corticosteroids, inhaled Accepted treatment turbuhaler 100dose Ciclesonide 160mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 80mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 160mcg INH Alvesco (120 doses) Corticosteroids, inhaled Motivation required Fenoterol 100mcg INH Berotec HFA Beta agonists , short acting Motivation required Fenoterol and other drugs for 200mcg INH Duovent HFA 200 dose Beta agonists and anticholinergic Accepted treatment obstructive airway diseases combination Fluticasone 125mcg INH Flixotide 125 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 250mcg INH Flixotide 250 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 50mcg INH Flixotide 50 CFC FREE 120 Corticosteroids, inhaled Motivation required Fluticasone 100mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 250mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 500mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 50mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Formoterol 12mcg CPS Foradil dry powder inhalation Foratec DP Caps Beta agonists, long acting Accepted treatment Formoterol 12mcg INH Foratec HFA Beta agonists, long acting Accepted treatment Formoterol 9mcg INH Oxis turbuhaler 9mcg 60 dose Beta agonists, long acting Motivation required Formoterol and other drugs for 160/4.5mcg INH Symbicord turboh 120 dose Corticosteroids and beta agonists, Motivation required obstructive airway disease 160mcg;45mcg long acting Formoterol and other drugs for 80/4.5mcg INH Symbicord turboh 120dose Corticosteroids and beta agonists, Motivation required obstructive airway disease 80mcg;45mcg long acting Formoterol and other drugs for 160/4.5mcg INH Symbicord turboh 60 dose Corticosteroids and beta agonists, Motivation required obstructive airway disease 160mcg;45mcg long acting Formoterol and other drugs for 320/9mcg INH Symbicord turboh 60dose Corticosteroids and beta agonists, Motivation required obstructive airway disease 320:9mcg long acting Ipratropium bromide 0.25mg/ml INH Atrovent 20 HFA MDI Ipvent-40 300 dose Anticholinergic Accepted treatment 200dose 10ml Salbutamol 100mcg INH Asthavent Venteze CFC free Beta agonists , short acting Accepted treatment Salbutamol 200mcg CAP Asthavent DP Ventodisks(8 s) Beta agonists , short acting Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Salbutamol 400mcg CPS Ventodisks(8 s) Beta agonists , short acting Motivation required Salbutamol 2.5mg SLN Ventolin nebules Beta agonists , short acting Motivation required Salmeterol 50mcg INH Serevent accuhaler Beta agonists, long acting Motivation required Salmeterol 25mcg INH Serevent inhal(120) Beta agonists, long acting Motivation required Salmeterol and other drugs for 25mcg/125mcg INH Foxair Sereflo HFA 25/125 Salmeterol and fluticasone Accepted treatment obstructive airway diseases Dose 120 Salmeterol and other drugs for 25mcg/50mcg INH Foxair Sereflo HFA 25/50 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 Dose long acting Salmeterol and other drugs for 50/100mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/100 long acting Salmeterol and other drugs for 50/250mcg ACC Foxair Seretide Accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/250 long acting Salmeterol and other drugs for 50/500mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/500 long acting Salmeterol and other drugs for 25mcg/250mcg INH Sereflo HFA 25/250 Dose 120 Seretide 25/250 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 dose long acting Terbutaline 05mg INH Bricanyl turbuhaler 200dose Beta agonists , short acting Motivation required Theophylline 26.6mg/5ml SYR Alcophyllin Xanthines Motivation required Theophylline 25mg/5ml SYR Nuelin liquid Xanthines Motivation required Theophylline 250mg SRT Euphyllin retard Microphyllin Xanthines Motivation required Theophylline 125mg SRC Microphyllin Xanthines Motivation required Theophylline 200mg SRT SANDOZ Theophyllin Theoplus Xanthines Motivation required Anhydrous SR Theophylline 300mg SRT SANDOZ Theophyllin Theoplus Xanthines Motivation required Anhydrous SR Theophylline 400mg SRT Uniphyl 400 Xanthines Motivation required Theophylline 600mg SRT Uniphyl 600 Xanthines Motivation required

CARDIOMYOPATHY ICD10: I42.0, I42.1, I42.2, I42.3, I42.4, I42.5, I42.6, I42.7, I42.8, I42.9, I25.5 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acebutolol 100mg CAP Sectral Beta blockers Motivation required Acebutolol 200mg CAP Sectral Beta blockers Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amlodipine 10mg TAB Almadin Amloc Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Amlodac Amlosyn Calcium channel blockers Accepted treatment Amlodipine besylate 10mg TAB Austell-Amlodipine Calbloc Calcium channel blockers Accepted treatment Amlodipine Besylate 5mg TAB Lomanor Ciplavasc Calcium channel blockers Accepted treatment Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Bumetanide 0.5mg TAB Burinex Duiretics Motivation required Bisoprolol 5mg TAB Bisoprolol Unicorn Adco-Bisocor Beta blockers Accepted treatment Bisoprolol 10mg TAB Adco-Bisocor Betacor Beta blockers Accepted treatment Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Candesartan and diuretics 32.mg/12.5 TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Candesartan and diuretics 32mg/25mg TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Captopril 25mg TAB Bio-Captopril Capace ACE -inhibitors Accepted treatment Captopril 12.5mg TAB Capoten hs Captohexal ACE - inhibitors Accepted treatment Captopril 50mg TAB Captohexal Captomax ACE - inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Captoretic Zapto-co ACE -inhibitors and combinations Accepted treatment Carvedilol 12.5mg TAB Aspen-Carvidelol Carloc 12.5 Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Aspen-Carvidelol Carloc 25 Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Aspen-Carvidelol Carloc 6.25 Alpha/beta blockers Accepted treatment Chlorthalidone 50mg TAB Hygroton Diuretics Motivation required Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.25mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Page 10 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Digoxin 0.25mg TAB Purgoxin Cardiac glycosides Accepted treatment Diltiazem 60mg TAB Adco-Zildem Calcium channel blockers Motivation required Diltiazem 90mg TAB Adco-Zildem Calcium channel blockers Motivation required Diltiazem 180mg SRC Tilazem 180mg CR Calcium channel blockers Motivation required Diltiazem 240mg SRC Tilazem 240 CR Calcium channel blockers Motivation required Elperone 25mg TAB Inspra Diuretics Motivation required Elperone 50mg TAB Inspra Diuretics Motivation required Enalapril 10mg TAB Adco-enalapril Alapren 10 ACE - inhibitors Accepted treatment Enalapril 20mg TAB Adco-enalapril Alapren 20 ACE - inhibitors Accepted treatment Enalapril 5mg TAB Alapren 5 Ciplatec 5 ACE -inhibitors Accepted treatment Enalapril 2.5mg TAB Renitec 2.5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Co-renitec Enap co ACE -inhibitors Accepted treatment Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Furosemide 40mg TAB Austell- Furosemide Beurises Diuretics Accepted treatment Furosemide 20mg TAB Lasix Diuretics Accepted treatment Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Hydralazine 10mg TAB Hyperphen Vasodilators Accepted treatment Hydralazine 50mg TAB SANDOZ Hydralazine Hyperphen Vasodilators Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide 25mg TAB Ridaq Hexazide Diuretics Accepted treatment Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Hydrochlorothiazide and 50mg/5mg TAB Adco-retic Betaretic Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Dyazide Renezide Diuretics Accepted treatment potassium-sparing agents Indapamide 2.5mg TAB Cipla-Indapamide Dapamax Diuretics Accepted treatment Irbesartan 150mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required Irbesartan 300mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required Page 11 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Irbesartan and diuretics 150mg/12.5mg TAB Co-Iberwin Coaprovel Angiotensin receptor blockers and Motivation required combinations Irbesartan and diuretics 300mg/12.5mg TAB Co-Iberwin Coaprovel Angiotensin receptor blockers and Motivation required combinations Isosorbide dinitrate 40mg TAB Isordil tembid Organic nitrates Accepted treatment Isosorbide dinitrate 30mg TAB SANDOZ Isosorbide Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 10mg TAB SANDOZ Isosorbide Dinitrate Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 5mg TAB SANDOZ Isosorbide Dinitrate Isordil sublingual Organic nitrates Accepted treatment Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Lisinopril 10mg TAB Auro-Lisinopril Austell-Lisinopril ACE-inhibitors Accepted treatment Lisinopril 5mg TAB Auro-Lisinopril Hexal-lisinopril 5 ACE - inhibitors Accepted treatment Lisinopril 2.5mg TAB Austell-lisinopril ACE-inhibitors Accepted treatment Lisinopril 20mg TAB Zestril Zetomax ACE -inhibitors Accepted treatment Lisinopril and diuretics 10mg/12.5mg TAB Auro-Lisinopril Co HEXAL-Lisinopril Co ACE - inhibitors and combinations Accepted treatment Lisinopril and diuretics 20mg/12.5mg TAB Auro-Lisinopril Co HEXAL-Lisinopril Co ACE - inhibitors and combinations Accepted treatment Losartan 100mg TAB Cipla Losartan Cozaar Angiotensin receptor blockers Accepted treatment Losartan 50mg TAB Cipla Losartan Cozaar Angiotensin receptor blockers Accepted treatment Losartan and diuretics 50mg/12.5mg TAB Zartan Co Losaar plus 50/12.5 Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 100mg/25mg TAB Zartan Co Lohype forte plus Angiotensin receptor blockers and Accepted treatment combinations Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Accepted treatment Nifedipine 20mg SRT Adco-Nifedpine Nifedalat SR 20mg Calcium channel blockers Accepted treatment Nifedipine 30mg TAB Adco-Vascard Fedaloc SR Calcium channel blockers Accepted treatment Nifedipine 60mg TAB Adco-Vascard Fedaloc SR Calcium channel blockers Accepted treatment Perindopril 4mg TAB Cipla Perindopril Ciplasyl ACE-inhibitors Accepted treatment Perindopril 8mg TAB Cipla-Perindopril Ciplasyl ACE-inhibitors Accepted treatment Perindopril 10mg TAB Prexum Coversyl ACE -inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Preterax ACE -inhibitors and combinations Accepted treatment Perindopril and diuretics 4mg/1.25mg TAB Acesyl Co 4/1.25 BiPreterax ACE -inhibitors and combinations Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Potassium chloride 600mg TAB Plenish k SANDOZ K-600 Potassium supplements Accepted treatment Propranolol 10mg TAB Prodorol Purbloka Beta blockers Accepted treatment Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Quinapril 10mg TAB Accumax Accupril ACE -inhibitors Accepted treatment Quinapril 20mg TAB Accumax Accupril ACE -inhibitors Accepted treatment Ramipril 10mg CAP Austell-Ramipril ACE-inhibitors Accepted treatment Ramipril 5mg CAP Austell-Ramipril ACE-inhibitors Accepted treatment Ramipril 5mg CAP Apex-Ramipril 5mg ACE-inhibitors Accepted treatment Ramipril 10mg CAP Apex-Ramipril 10mg ACE-inhibitors Accepted treatment Ramipril 2.5mg TAB Ramace RamiprilHexal ACE - inhibitors Accepted treatment Ramipril 5mg TAB Ramace RamiprilHexal ACE - inhibitors Accepted treatment Ramipril 2.5mg CAP Ramiwin ACE-inhibitors Accepted treatment Ramipril 5mg CAP RamiWin ACE-inhibitors Accepted treatment Ramipril 10mg CAP Rampil ACE-inhibitors Accepted treatment Ramipril 2.5mg CAP Rampil ACE-inhibitors Accepted treatment Ramipril 5mg CAP Rampil ACE-inhibitors Accepted treatment Ramipril 10mg CAP Ran-Ramipril ACE-inhibitors Accepted treatment Ramipril 10mg CAP Simayla Ramipril ACE-inhibitors Accepted treatment Ramipril 10mg CAP Tritace ACE-inhibitors Accepted treatment Spironolactone 25mg TAB Spiractin SANDOZ Diuretics Accepted treatment Spironolactone Spironolactone 100mg TAB Spiractin Aldactone Diuretics Accepted treatment Telimisartan 40mg TAB Pritor Micardis ACE-Inhibitor Accepted treatment Telimisartan 80mg TAB Pritor Micardis ACE-Inhibitor Accepted treatment Telimisatan and diuretic 40mg/12.5mg TAB Co-Pritor Co-Micardis ACE-Inhibitor and diuretic Accepted treatment Telimisatan and diuretic 80mg/12.5mg TAB Co-Pritor Co-Micardis ACE-Inhibitor and diuretic Accepted treatment Telimisatan and diuretic 80mg/25mg TAB Co-Pritor Co-Micardis ACE-Inhibitor and diuretic Accepted treatment Torasemide 2.5mg TAB Unat ToraHexal Diuretics Motivation required Torasemide 5mg TAB Unat ToraHexal Diuretics Motivation required Torasemide 10mg TAB Unat ToraHexal Diuretics Motivation required Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Valsartan 160mg TAB Migroben Diovan Angiotensin receptor blockers Accepted treatment Valsartan 80mg TAB Migroben Diovan Angiotensin receptor blockers Accepted treatment Valsartan and amlodipine 10mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan and amlodipine 5mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan, Amlodipine and 10mg/160mg/12.5mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 10mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/12.mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan and diuretics 320/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Migroben Co-diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Migroben Co-Diovan Plus Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-Migroben Co-diovan Angiotensin receptor blockers and Accepted treatment combinations Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment

CHRONIC OBSTRUCTIVE PULMONARY DISEASE ICD10: J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.8, J44.9 Aminophylline 100mg TAB Norstan-ted Xanthines Motivation required Aminophylline 200mg TAB Norstan-ted Xanthines Motivation required Aminophylline 225mg SRT Phyllocontin Xanthines Motivation required Beclometasone 100mcg INH Beclate 100 Becotide 100 comp Corticosteroids, inhaled Accepted treatment Beclometasone 200mcg INH Beclate 200 Becloforte inhaler Corticosteroids, inhaled Accepted treatment Page 14 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Beclometasone 50mcg INH Beclate 50 Becotide Corticosteroids, inhaled Accepted treatment Budesonide 100mcg INH Budeflam 300 dose gentle- Inflammide 100 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose Budesonide 200mcg INH Budeflam 300 dose gentle- Inflammide 200 Corticosteroids, inhaled Accepted treatment haler hfa mac 300 dose Budesonide 200mcg CPS Budeflam DP Caps Inflacor 200 Corticosteroids, inhaled Accepted treatment Budesonide 100mcg CPS Inflacor 100 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg CPS Inflacor 400 Corticosteroids, inhaled Accepted treatment Budesonide 400mcg INH Inflammide 400 Novolizer Pulmicort Corticosteroids, inhaled Accepted treatment turbuhaler 100dose Ciclesonide 160mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 80mcg INH Alvesco ( 60 doses) Corticosteroids, inhaled Motivation required Ciclesonide 160mcg INH Alvesco (120 doses) Corticosteroids, inhaled Motivation required Fenoterol 100mcg INH Berotec HFA Beta agonists , short acting Motivation required Fenoterol and other drugs for 200mcg INH Duovent HFA 200 dose Beta agonists & antichoinergic Accepted treatment obstructive airway diseases combination Fluticasone 125mcg INH Flixotide 125 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 250mcg INH Flixotide 250 cfc free 120 Corticosteroids, inhaled Motivation required actuations Fluticasone 50mcg INH Flixotide 50 CFC FREE 120 Corticosteroids, inhaled Motivation required Fluticasone 100mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 250mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 500mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Fluticasone 50mcg ACC Flixotide accuhaler Corticosteroids, inhaled Motivation required Formoterol 12mcg CPS Foradil dry powder inhalation Foratec DP Caps Beta agonists, long acting Accepted treatment Formoterol 12mcg INH Foratec HFA Beta agonists, long acting Accepted treatment Formoterol 9mcg INH Oxis turbuhaler 9 60 dose Beta agonists, long acting Motivation required Ipratropium bromide INH Atrovent 20 HFA MDI Ipvent-40 300 dose Anticholinergics, inhaled Accepted treatment 200dose 10ml Salbutamol 100mcg INH Asthavent Venteze CFC free Beta agonists , short acting Accepted treatment Salbutamol 200mcg CAP Asthavent DP Ventodisks(8 s) Beta agonists , short acting Accepted treatment Salbutamol 400mcg CPS Ventodisks(8 s) Beta agonists , short acting Motivation required Salbutamol 2.5mg SLN Ventolin nebules Beta agonists , short acting Motivation required Salmeterol 50mcg INH Serevent accuhaler Beta agonists, long acting Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Salmeterol 25mcg INH Serevent inhal(120) Beta agonists, long acting Motivation required Salmeterol and other drugs for 25mcg/125mcg INH Foxair Sereflo HFA 25/125 Salmeterol and fluticasone Accepted treatment obstructive airway diseases Dose 120 Salmeterol and other drugs for 25mcg/50mcg INH Foxair Sereflo HFA 25/50 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 Dose long acting Salmeterol and other drugs for 50/100mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/100 long acting Salmeterol and other drugs for 50/250mcg ACC Foxair Seretide Accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/250 long acting Salmeterol and other drugs for 50/500mcg ACC Foxair Seretide accuhaler Corticosteroids and beta agonists, Motivation required obstructive airway diseases 50/500 long acting Salmeterol and other drugs for 25mcg/250mcg INH Sereflo HFA 25/250 Dose 120 Seretide 25/250 Corticosteroids and beta agonists, Accepted treatment obstructive airway diseases 120 dose long acting Terbutaline 05mg INH Bricanyl turbuhaler 200dose Beta agonists , short acting Motivation required Theophylline 26.6mg/5ml SYR Alcophyllin Xanthines Motivation required Theophylline 25mg/5ml SYR Nuelin liquid Xanthines Motivation required Theophylline 125mg SRC Microphyllin Xanthines Motivation required Theophylline 250mg SRC Microphyllin Nuelin sa 250 Xanthines Motivation required Theophylline 200mg SRT SANDOZ Theophyllin Theoplus Xanthines Motivation required Anhydrous SR Theophylline 300mg SRT SANDOZ Theophyllin Theoplus Xanthines Motivation required Anhydrous SR Theophylline 400mg SRT Uniphyl 400 Xanthines Motivation required Theophylline 600mg SRT Uniphyl 600 Xanthines Motivation required Tiotropium bromide 18µg CPS Forvent Spiriva Anticholinergics, inhaled Motivation required CHRONIC RENAL FAILURE ICD10: N03.0, N03.1, N03.2, N03.4, N03.5, N03.6, N03.7, N03.8, N03.9, N11.0, N11.1, N11.8, N11.9, N18.0, N18.1, N18.2, N18.3, N18.4, N18.5, I12.0, I13.2, I13.2, O10.2 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acetylsalicylic acid 300mg TAB Bayer aspirin Be-tabs aspirin Aspirin Accepted treatment (white) Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Alfacalcidol 0.25mcg CAP One alpha Alfacalcidol Accepted treatment Alfacalcidol 1mcg CAP One alpha Alfacalcidol Accepted treatment Amlodipine 10mg TAB Amlodac Amlosyn Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Corvadil besylate CPL Alliance Calcium channel blockers Accepted treatment Amlodipine Page 16 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM besylate

Amlodipine besylate 10mg TAB Calbloc Ciplavasc Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Ciplavasc Pharma Dynamics Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 50mg TAB Bio-atenolol Gulf Atenolol Beta blockers Accepted treatment Atenolol 100mg TAB Sandoz Atenolol Hexa-blok Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB Tenchlor Tenoretic Beta blockers and combinations Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Tenchlor hs Tenoret 50 Beta blockers and combinations Accepted treatment Benazepril 10mg TAB Cibace ACE-inhibitors Motivation required Benazepril and diuretics TAB CIBADREX 30 Benazepril and diuretics Accepted treatment Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Benazepril and diuretics Motivation required Bisoprolol 10mg TAB Betacor Bilocor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Cardicor Concor Beta blockers Accepted treatment Bisoprolol and thiazides 10mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bisoprolol and thiazides 2.5mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bisoprolol and thiazides 5mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Accepted treatment Calcitriol 0.25mg/0.3ml TAB Rocaltrol Vitamin D Derivate Accepted treatment Calcium carbonate TAB Titralac Mineral Supplement Accepted treatment Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers Motivation required Candesartan and diuretics 32.mg/12.5 TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Candesartan and diuretics 32mg/25mg TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Captopril 12.5mg TAB Capoten hs Captohexal ACE - inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Captopril 25mg TAB Mylan-captopril 25 SANDOZ Captopril ACE - inhibitors Accepted treatment Captopril 50mg TAB Mylan-captopril 50 Zapto ACE -inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Zapto-co Captoretic ACE -inhibitors and combinations Accepted treatment Carvedilol 12.5mg TAB Carloc 12.5 Aspen-Carvidelol Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Carvedilol-Hexal Vediblok Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Carvetrend Carvedilol-Hexal Alpha/beta blockers Accepted treatment Chlortalidone 50mg TAB Hygroton Low Ceiling Diuretic Motivation required Cilazapril 5mg TAB Inhibace ACE-inhibitors Motivation required Cilazapril and diuretics 5mg/12.5mg TAB Inhibace plus ACE inhibitors and diuretics Motivation required Cinacalcet 30mg TAB Sensipar Hormone inhibitors Motivation required Cinacalcet 60mg TAB Sensipar Hormone inhibitors Motivation required Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Darbepoetin alfa 10mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Darbepoetin alfa 150mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Darbepoetin alfa 20mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Darbepoetin alfa 300mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Darbepoetin alfa 30mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Darbepoetin alfa 60mcg INJ Aranesp Erythropoetin, combinations Special investigation, CCR/GFR Dextriferron 50mg/ml INJ CosmoFer Iron Supplements Special investigation, full blood count Dextriferron 50mg/2ml INJ CosmoFer Iron Supplements Special investigation, full blood count Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Zildem 180 sr Tilazem 180 cr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Zildem 240 sr Tilazem 240 cr Calcium channel blockers Accepted treatment Enalapril 10mg TAB Ciplatec 10 Enap 10 ACE -inhibitors Accepted treatment Enalapril 20mg TAB HR-Enalapril MAL FP Pharmapress ACE - inhibitors Accepted treatment Enalapril 2.5mg TAB Renitec 2 5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Pharmapress co Enap co ACE -inhibitors and combinations Accepted treatment Enalapril and Lercandipine 10mg/10mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Enalapril and Lercandipine 10mg/20mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Eprosartan 600mg TAB Teveten 600 Angiotensin receptor blockers Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Ergocalciferol 1.25mg TAB Calciferol Vitamin D Derivate Accepted treatment Erythropoietin 6000iu INJ Eprex Recormon Pre- Erythropoietin Special investigation, CCR/GFR Filled Erythropoietin 40000iu INJ Eprex 1ml Prefilled Erythropoietin Special investigation, CCR/GFR Erythropoietin 10000u/ml INJ Eprex prefill Recormon Pre- Erythropoietin Special investigation, CCR/GFR Filled Erythropoietin 2000iu/ml INJ Eprex prefill Recormon Pre- Erythropoietin Special investigation, CCR/GFR Filled Erythropoietin 4000iu INJ Eprex prefill Recormon Pre- Erythropoietin Special investigation, CCR/GFR Filled Erythropoietin 30000iu INJ Recormon Pre-filled Erythropoietin Special investigation, CCR/GFR Erythropoietin 500iu INJ Recormon Pre-Filled Erythropoietin Special investigation, CCR/GFR Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 2.5mg SRT Plendil Calcium channel blockers Accepted treatment Ferric oxide polymaltose complex SYR Feroglobin Iron in other combinations Special investigation, full blood count Ferric oxide polymaltose complex 50mg SYR Ferrimed Iron in other combinations Special investigation, full blood count Ferric oxide polymaltose complex CAP Ferrimed Iron in other combinations Special investigation, full blood count Ferric oxide polymaltose complex 100mg CHU Ferrimed ds chewable Iron in other combinations Special investigation, full blood count Ferrous fumarate TAB Pregamal Iron supplementation, oral Special investigation, full blood count Ferrous lactate 25mg/ml DRP Ferro L drops Iron supplementation, oral Special investigation, full blood count Ferrous sulfate TAB Ferrous forte chelated iron Iron Supplements Special investigation, full blood count Ferrous sulfate TAB Ferrous sulph co Iron Supplements Special investigation, full blood count Ferrous sulfate 100mg TAB Ferrous sulphate Iron Supplements Special investigation, full blood count Ferrous sulfate 30mg TAB Ferrous sulphate Iron Supplements Special investigation, full blood count Ferrous sulfate CAP Fefol spansule Iron supplementation, oral Special investigation, full blood count Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Folic acid Accepted treatment Fosinopril 10mg TAB Mylan-Fosinopril ACE-inhibitors Motivation required Page 19 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Furosemide 20mg TAB Lasix Diuretics Accepted treatment Furosemide 500mg TAB Lasix Diuretics Accepted treatment Furosemide 80mg TAB Lasix Diuretics Accepted treatment Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Furosemide 60mg CAP Lasix retard Diuretics Accepted treatment Furosemide 40mg TAB SANDOZ Furosemide Puresis Diuretics Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Renezide Dyazide Diuretics Accepted treatment potassium-sparing agents Indapamide 2.5mg TAB Cipla-Indapamide Dapamax Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Indapamide Diuretics Accepted treatment SR Irbesartan 150mg TAB Iberwin Aprovel Angiotensin receptor blockers Motivation required Irbesartan 300mg TAB Iberwin Aprovel Angiotensin receptor blockers Motivation required Irbesartan & HCTZ 150/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Irbesartan & HCTZ 300/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Iron and multivitamins TAB Fero-grad Iron Supplements Special investigation, full blood count Iron in other combinations 20mg/ml INJ Venofer Iron in other combinations Special investigation, full blood count Iron multivitamins and folic acid CAP Autrin Iron Supplements Special investigation, full blood count Iron multivitamins and folic acid 500mg TAB Fero-folic Iron Supplements Special investigation, full blood count Iron multivitamins and folic acid 100mg TAB Foliferr Iron multivitamins and folic acid Special investigation, full blood count Iron vitamin B12 and folic acid TAB Foliglobin Iron Supplements Special investigation, full blood count Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required lanthanum carbonate 500mg TAB Fosrenol Phosphate binder Motivation required lanthanum carbonate 750mg TAB Fosrenol Phosphate binder Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Lisinopril 2.5mg TAB Austell-lisinopril ACE-inhibitors Accepted treatment Lisinopril 10mg TAB Simayla Lisinopril Hexal-lisinopril 10 ACE - inhibitors Accepted treatment Page 20 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Lisinopril 20mg TAB Simayla Lisinopril Sinopren 20 ACE - inhibitors Accepted treatment Lisinopril and diuretics 20mg/12.5mg TAB HEXAL-Lisinopril Co Zetomax-Co ACE - inhibitors and combinations Accepted treatment Lisinopril and diuretics 10mg/12.5mg TAB Zestoretic 10 Lisinozide ACE-inhibitors and combinations Accepted treatment Lisinopril and diuretics 20/12.5mg TAB Zestozide ACE-inhibitors and combinations Accepted treatment Losartan 100mg TAB Zartan Cipla Losartan Angiotensin receptor blockers Accepted treatment Losartan 50mg TAB Zartan Spec Losartan 50 Angiotensin receptor blockers Accepted treatment Losartan and diuretics 100mg/25mg TAB Lozaan Co Fortzaar Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 50mg/12.5mg TAB Sartoc Lozaan Co Angiotensin receptor blockers and Accepted treatment combinations Methoxy polyethhylene glycol- 0.05mg/03ml INJ Mircera Erythropoetin Special investigation, CCR/GFR epoetin beta Methoxy polyethhylene glycol- 0.075mg/0.3ml INJ Mircera Erythropoetin Special investigation, CCR/GFR epoetin beta Methoxy polyethhylene glycol- 0.15mg/0.3ml INJ Mircera Erythropoetin Special investigation, CCR/GFR epoetin beta Methoxy polyethhylene glycol- 0.25mg/0.3ml INJ Mircera Erythropoetin Special investigation, CCR/GFR epoetin beta Methoxy polyethhylene glycol- 0.2mg/0.3ml INJ Mircera Erythropoetin Special investigation, CCR/GFR epoetin beta Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Moexipril 75mg TAB Perdix ACE-inhibitors Accepted treatment Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Nifedipine 30mg SRT Adco-Vascard SR Fedaloc Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Macorel 60 SR Fedaloc Calcium channel blockers Accepted treatment Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Calcium channel blockers Accepted treatment Perindopril 10mg TAB Prexum Coversyl ACE -inhibitors Accepted treatment Perindopril 8mg TAB Spec-Perindopril Vectoryl ACE-inhibitors Accepted treatment Perindopril 4mg TAB Acesyl Vectoryl ACE-inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Preterax ACE -inhibitors and combinations Accepted treatment Perindopril and diuretics 4mg/1.25mg TAB Prexum Plus Pearinda Plus ACE-inhibitors and combinations Accepted treatment Piretanide 3mg TAB Arelix Diuretics Accepted treatment Piretanide 6mg TAB Arelix Diuretics Accepted treatment Potassium chloride 600mg TAB SANDOZ K-600 Slow-k Potassium supplements Accepted treatment Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Propranolol 10mg TAB Purbloka Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Purbloka Prodorol Beta blockers Accepted treatment Quinapril 40mg TAB Accupril Quinagen ACE-inhibitors Accepted treatment Quinapril 10mg TAB Quinagen Quinaspen ACE - inhibitors Accepted treatment Quinapril 20mg TAB Quinagen Accupril ACE -inhibitors Accepted treatment Quinapril 5mg TAB Quinagen Accupril ACE -inhibitors Accepted treatment Quinapril and diuretics 10/12.5mg TAB Accumax Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Quinapril and diuretics 20mg/12.5mg TAB Accuretic 20/12.5 ACE-inhibitors and diuretics Accepted treatment Quinapril and diuretics 20/12.5mg TAB Adco-Quinaretic Accumax ACE-inhibitors and diuretics Accepted treatment Quinapril and diuretics 10mg/12.5mg TAB Quinazide Accuretic 10/12.5 ACE - inhibitors and diuretics Accepted treatment Ramipril 1.25mg CAP Austell-Ramipril RamiprilHexal ACE - inhibitors Accepted treatment Ramipril 5mg TAB RamiprilHexal Apex-Ramipril 5mg ACE-inhibitors Accepted treatment Ramipril 2.5mg CAP Rampil Ramiwin ACE -inhibitors Accepted treatment Ramipril 10mg CAP Tritace Simayla Ramipril ACE-inhibitors Accepted treatment Ramipril and calcium channel 2.5mg/2.5mg TAB Tri-plen ACE inhibitors and calcium Motivation required blockers channel blockers Ramipril and calcium channel 5mg/5mg TAB Tri-plen forte ACE inhibitors and calcium Motivation required blockers channel blockers Sevelamer Hydrochloride 800mg TAB Renagel Phosphate binder Motivation required Spironolactone 100mg TAB Spiractin Aldactone Diuretics Accepted treatment Telmisartan 40mg TAB Pritor Micardis Angiotensin receptor blockers Accepted treatment Telmisartan 80mg TAB Pritor Micardis Angiotensin receptor blockers Accepted treatment Telmisartan and diuretics 40mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor anatgonist Accepted treatment 40/12.5mg and Diuretics Telmisartan and diuretics 80mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor anatgonist Accepted treatment 80/12.5mg and Diuretics Telmisartan and diuretics 80mg/25mg TAB Co-micardis Angiotensin receptor anatgonist Motivation required and Diuretics Timolol; thiazides and other 10/2.5/25mg TAB Servatrin Beta blocker and diuretics Motivation required diuretics Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Trandolapril and calcium channel 180mg/2mg SRC Tarka ACE inhibitors and calcium Motivation required blockers channel blockers Trandolapril and calcium channel 180mg TAB Tarka Bilayer ACE inhibitors and calcium Motivation required blockers channel blockers Trandolapril and calcium channel 240mg TAB Tarka Bilayer ACE inhibitors and calcium Motivation required blockers channel blockers Valsartan 320mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 40mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 160mg TAB Tareg Migroben Angiotensin receptor blockers Accepted treatment Valsartan 80mg TAB Zomevek Tareg Angiotensin receptor blockers Accepted treatment Valsartan and amlodipine 10mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan and amlodipine 5mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Tareg Co-Migroben Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Zomevek Co-Tareg Plus Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-Zomevek Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Verapamil 240mg SRT Verahexal 240 sr Calcicard sr 240 Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment

CORONARY ARTERY DISEASE ICD10: I20.0, I20.1, I20.8, I20.9, I25.0, I25.1, I25.2, I25.3, I25.4, I25.5, I25.6, I25.8, I25.9 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg TAB Be-tabs aspirin (white) Disprin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Amlodipine 10mg TAB Amlodac Keysal Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Klodip Stamlo Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Austell-Amlodipine Lomanor Calcium channel blockers Accepted treatment Amlodipine besylate 10mg TAB Calbloc Pharma Dynamics Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 50mg TAB Adco-atenolol B-Block Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Sandoz Atenolol Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB Tenchlor Tenoretic Beta blocker and diuretics Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Tenchlor hs Tenoret 50 Beta blocker and diuretics Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Cardicor Concor Beta blockers Accepted treatment Bisoprolol 10mg TAB Concor Bilocor Beta blockers Accepted treatment Carvedilol 12.5mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Clopidogrel 75mg TAB Clopivas Mistro Antithrombotic agent Motivation required Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment Dipyridimole 200mg SRC Persantin 200 Regards Antithrombotic agent Motivation required Dipyridimole 100mg TAB Plato Antithrombotic agent Motivation required Dipyridimole & Acetylsalicylic acid 200mg/25 CAP Asasantin Antithrombotic agent Motivation required Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Glyceryl trinitrate 0.5mg TAB Angised Organic nitrates Accepted treatment Isosorbide dinitrate 40mg TAB Isordil tembid Organic nitrates Accepted treatment Isosorbide dinitrate 30mg TAB SANDOZ Isosorbide Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 10mg TAB SANDOZ Isosorbide Dinitrate Isordil Organic nitrates Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Isosorbide dinitrate 5mg TAB SANDOZ Isosorbide Dinitrate Isordil sublingual Organic nitrates Accepted treatment Isosorbide mononitrate 20mg TAB Elantan Ismo 20 Organic nitrates Accepted treatment Isosorbide mononitrate 50mg SRC Elantan la Organic nitrates Accepted treatment Isosorbide-5-mononitrate 60mg SRT Imdur Monicor SR Organic nitrates Accepted treatment Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Ivabradine 5mg TAB Coralan If-Channel Blocker Motivation required Ivabradine 7.5mg TAB Coralan If-Channel Blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Nifedipine 30mg TAB Adalat xl Calcium channel blockers Accepted treatment Nifedipine 60mg TAB Adalat xl Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Fedaloc Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Macorel 60 SR Calcium channel blockers Accepted treatment Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Calcium channel blockers Accepted treatment Nifedipine 30mg SRT Spec Nifedipine SR Macorel 30 SR Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Spec Nifedipine SR Calcium channel blockers Accepted treatment Propranolol 10mg TAB Prodorol Purbloka Beta blockers Accepted treatment Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Verapamil 240mg SRT Ravamil sr Calcicard sr 240 Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment

CROHN'S DISEASE ICD10: K50.0, K50.1, K50.8, K50.9 Adalimumab 40mg/0.8ml INJ Humira Prefilled Biological Motivation required Azathioprine 50mg TAB Azapress Zaprine Immunosuppressants Accepted treatment Betamethasone 0.5mg TAB Betanoid Oral corticosteroid Motivation required Budesonide 3mg CAP Entocord Corticosteroids, oral Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Budesonide ENE Entocord INTESTINAL ANTIINFLAMMATORY Motivation required AGENTS Etanercept 25mg INJ Enbrel Sales Pack Biological Motivation required Folic acid 5mg TAB Be-tabs folic acid Folic acid Folic acid Accepted treatment Infliximab 100mg INF Revellex Biological Motivation required Loperamide 10mg TAB Prodium Imodium Antipropulsives Accepted treatment Mesalazine 800mg TAB Asacol 5-ASA agents Motivation required Mesalazine 2g/50ml ENE Asacol 5-ASA agents Motivation required Mesalazine 400mg TAB Asacol 5-ASA agents Motivation required Mesalazine 500mg SUP Asacol 5-ASA agents Motivation required Mesalazine 1000mg SUP Pentasa 5-ASA agents Motivation required Mesalazine 500mg TAB Pentasa 5-ASA agents Motivation required Methotrexate 2.5mg TAB Methotrexate Emthexate Immunosuppressants Accepted treatment Methylprednisolone 4mg TAB Medrol Oral corticosteroids Accepted treatment Methotrexate 2.5mg TAB Methotrexate Emthexate Immunosuppressants Accepted treatment Metronidazole 200mg TAB Bemetrazole Acuzole Antibacterial Accepted treatment Metronidazole 400mg TAB Adco-Metronidazole Metazol Antibacterial Accepted treatment Olsalazine 250mg CAP Dipentum 5-ASA agents Motivation required Prednisolone 5mg TAB Prelone Lenisolone Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Panafcort Be-tabs prednisone Corticosteroids , oral Accepted treatment Sulfasalazine 500mg TAB Salazopyrin Salazopyrin e n 5 - ASA agents Accepted treatment

DIABETES INSIPIDUS ICD10: E23.2 Carbamazepine 200mg TAB Degranol SANDOZ Anticonvulsants Accepted treatment Carbamazepine Carbamazepine 400mg SRT SANDOZ Carbamazepine CR Tegretol CR Anticonvulsants Accepted treatment Carbamazepine 200mg SRT SANDOZ Carbamazepine CR Tegretol CR Anticonvulsants Accepted treatment Desmopressin 0.1mg TAB Ddavp Vasopressin analogues Motivation required Desmopressin 0.2mg TAB Ddavp Vasopressin analogues Motivation required Desmopressin 0.1mg/ml NOD Ddavp 2 5ml Vasopressin analogues Motivation required Desmopressin 0.1mg/ml NAS Ddavp nasal spray 5ml Vasopressin analogues Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM DYSRHYTHMIAS ICD10: I47.2, I48.0, I48.1, I48.2, I48.3, I48.4, I48.9 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acebutolol 100mg CAP Sectral Beta blockers Motivation required Acebutolol 200mg CAP Sectral Beta blockers Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Gulf aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Tilazem 240 cr Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amiodarone 100mg TAB AryCor Hexarone Antiarrhythmics Motivation required Amiodarone 200mg TAB AryCor Bio-Amiodarone Antiarrhythmics Motivation required Atenolol 50mg TAB Bio-atenolol Gulf Atenolol Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Hexa-blok Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Bisoprolol 10mg TAB Betacor Bilocor Beta blockers Accepted treatment Bisoprolol 5mg TAB Betacor Bilocor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.25mg TAB Lanoxin Purgoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Diltiazem 180mg SRC Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Zildem 240 sr Tilazem 180 cr Calcium channel blockers Accepted treatment Disopyramide 100mg CAP Rythmodan Antiarrhythmics Motivation required Disopyramide 250mg TAB Rythmodan retard Antiarrhythmics Motivation required Flecainide 100mg TAB Tambocor Antiarrhythmics Motivation required Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Propafenone 150mg TAB Rythmol Antiarrhythmics Motivation required Propafenone 300mg TAB Rythmol Antiarrhythmics Motivation required Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Propranolol 10mg TAB Purbloka Indoblok 10 Beta blockers Accepted treatment Quinidine 200mg TAB Quinidine sulph Antiarrhythmics Motivation required Sotalol 160mg TAB Sotahexal Beta blockers Motivation required Sotalol 80mg TAB Sotahexal Beta blockers Motivation required Verapamil 240mg SRT Ravamil sr Isoptin sr Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment

EPILEPSY ICD10: G40.0, G40.1, G40.2, G40.3, G40.4, G40.5, G40.6, G40.7, G40.8, G40.9, G41.0, G41.1, G41.2, G41.8, G41.9 Carbamazepine 100mg/5ml SUS Tegretol s Anticonvulsants Accepted treatment Carbamazepine 200mg TAB CPL-Carbamazepine Degranol Anticonvulsants Accepted treatment Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Anticonvulsants Accepted treatment Clonazepam 0.5mg TAB Rivotril Benzodiazepine derivatives Motivation required Clonazepam 2.5mg DRP Rivotril Benzodiazepine derivatives Motivation required Clonazepam 2mg TAB Rivotril Benzodiazepine derivatives Motivation required Ethosuximide 250mg/5ml SYR Zarontin Anticonvulsants Accepted treatment Felbamate 400mg TAB Taloxa Anticonvulsants Motivation required Felbamate SUS Taloxa Anticonvulsants Motivation required Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Folic acid Accepted treatment Gabapentin 100mg CAP Ran-Gabapentin Epleptin Anticonvulsants Motivation required Gabapentin 300mg CAP Epleptin Ran-Gabapentin Anticonvulsants Motivation required Gabapentin 600mg TAB Neurontin Anticonvulsants Motivation required Gabapentin 800mg TAB Neurontin Anticonvulsants Motivation required Gabapentin 400mg CAP Ran-Gabapentin Epleptin Anticonvulsants Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Lamotrigine 2mg DSP Lamictin P 2 Anticonvulsants Accepted treatment Lamotrigine 5mg DSP Lamictin p5 Anticonvulsants Accepted treatment Lamotrigine 25mg TAB Dyna-Lamotrigine Austell-Lamotrigine Anticonvulsants Accepted treatment Lamotrigine 100mg TAB Epitec Arrow lamotrigine Anticonvulsants Accepted treatment Lamotrigine 100mg DSP Lamictin p100 Anticonvulsants Accepted treatment Lamotrigine 50mg DSP Lamictin p50 Anticonvulsants Accepted treatment Lamotrigine 50mg TAB Lamitor Lamidus Anticonvulsants Accepted treatment Lamotrigine 200mg TAB SANDOZ Lamotrigine Epitec Anticonvulsants Accepted treatment Levetiracetam 100mg/ml SOL Keppra Anticonvulsants Motivation required Levetiracetam 250mg TAB Keppra Redilev Anticonvulsants Motivation required Levetiracetam 750mg TAB Keppra Redilev Anticonvulsants Motivation required Levetiracetam 500mg TAB Redilev Anticonvulsants Motivation required Oxcarbazepine 300mg TAB Trileptal fct Mylan Anticonvulsants Motivation required Oxcarbazepine Oxcarbazepine 600mg TAB Trileptal fct Mylan Anticonvulsants Motivation required Oxcarbazepine Phenobarbital SYR Adco-phenobarb vital Anticonvulsants Accepted treatment Phenobarbital 30mg TAB Lethyl Sedabarb Anticonvulsants Accepted treatment Phenytoin 100mg CAP Epanutin Anticonvulsants Accepted treatment Phenytoin 125mg/5ml SUS Epanutin Anticonvulsants Accepted treatment Phenytoin 100mg TAB Phenytoin sod Anticonvulsants Accepted treatment Topiramate 15mg CAP Topamax sc sprinkle Anticonvulsants Motivation required topiramate 100mg TAB Adco-topiramate Epitoz Anticonvulsants Motivation required topiramate 50mg TAB Adco-topiramate Toplep Anticonvulsants Motivation required Topiramate 200mg TAB Sandoz Topiramate Toplep Anticonvulsants Motivation required Topiramate 25mg TAB Topalex Sandoz Topiramate Anticonvulsants Motivation required Valproic acid 50mg/ml SYR Convulex Anticonvulsants Accepted treatment Valproic acid 100mg TAB Epilim 100 crushable Anticonvulsants Accepted treatment Valproic acid 200mg/5ml SYR Epilim sugar free Anticonvulsants Accepted treatment Valproic acid 150mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 300mg CAP Convulex Epilim cr 300 Anticonvulsants Accepted treatment Valproic acid 500mg CAP Convulex Epilim cr 500 Anticonvulsants Accepted treatment Valproic acid 200mg SRT Epilim cr 200 Anticonvulsants Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Vigabatrin 500mg TAB Sabril Anticonvulsants Motivation required

GLAUCOMA ICD10: H40.0, H40.1, H40.2, H40.3, H40.5, H40.6, H40.8, H40.8, H40.9, Q15.0 Acetazolamide 250mg TAB Azomid Diamox Sympathomimetics Motivation required Betaxolol 5mg/ml OPD Betoptic 5ml Beta blockers Accepted treatment Betaxolol 0.25% OPD Betoptic s 5ml Beta blockers Accepted treatment Bimatoprost 0.3mg/3ml OPD Lumigan 3ml Prostaglandin analogues Accepted treatment Brimonidine 1.5mg/1ml OPD Alphagan 5ml Sympathomimetics Motivation required Brinzolamide 1% OPD Azoptic 5ml eye suspension Carbonic anhydrase inhibitor Accepted treatment Carteolol 2% OPD Teoptic 5ml Beta blockers Accepted treatment Dorzolamide 2% OPD Trusopt 5ml owi Parasympathomimetics Accepted treatment Latanoprost 50ug OPD Xalatan 2 5ml Ocuprost Prostaglandin analogues Accepted treatment Levobunolol 0.50% OPD Betagan 7 5ml Beta blockers Accepted treatment Metipranolol 3% OPD Beta-opthiole 5ml Beta blockers Accepted treatment Metipranolol 6% OPD Beta-opthiole 5ml Beta blockers Accepted treatment Pilocarpine 10mg/ml OPD Isopto carpine 1% 15ml Parasympathomimetics Accepted treatment Pilocarpine 20mg/ml OPD Isopto carpine 2% 15ml Parasympathomimetics Accepted treatment Pilocarpine 40mg/ml OPD Isopto carpine 4% 15ml Pilogel gel Parasympathomimetics Accepted treatment Timolol 5mg/ml OPD Glaucosan 5ml Timoptol 5ml Beta blockers Accepted treatment Timolol 1mg/g OPD Nyogel eye gel 5g Beta blockers Accepted treatment Timolol 2.5mg/ml OPD Timoptol 5ml Timoptol-xe 2 5ml Beta blockers Accepted treatment Timolol combinations 0.50% OPD Cosopt 5ml Beta blockers combination Motivation required Timolol combinations 5mg/ml OPD DuoTrav 2.5ml Beta blockers combination Motivation required Timolol combinations 0.3mg/5mg/ml OPD Ganfort Beta blockers combination Motivation required Timolol combinations 5mg/ml OPD Xalacom 2 5ml Beta blockers combination Motivation required Travoprost 40ug/ml OPD Travatan 25ml Prostaglandin analogues Accepted treatment

HAEMOPHILIA ICD10: D66, D67 Paracetamol will be reimbursed in the treatment of Haemophilia

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Coagulation factor VIII 500iu INJ Kogenate fs powder for Haemosolvate viii Blood coagulation factor Special investigations, pathology report injection vial Coagulation factor IX 1000iu/10ml INJ Octanine F1000 Blood coagulation factor Special investigations, pathology report Coagulation factor IX 250iu/5ml INJ Octanine F250 Blood coagulation factor Special investigations, pathology report Coagulation factor IX 500iu/5ml INJ Octanine F500 Blood coagulation factor Special investigations, pathology report Coagulation Factor II, VII, IX, X 1000iu INJ Haemosolvex Factor IX Blood coagulation factor Special investigations, pathology report Coagulation Factor II, VII, IX, X 300iu INJ Haemosolvex Factor IX Blood coagulation factor Special investigations, pathology report Coagulation Factor II, VII, IX, X 500iu INJ Haemosolvex Factor IX Blood coagulation factor Special investigations, pathology report Desmopressin 0.1mg TAB Ddavp Vasopressin analogues Motivation required Desmopressin 0.2mg TAB Ddavp Vasopressin analogues Motivation required Desmopressin 0.1mg/ml NOD Ddavp 2 5ml Vasopressin analogues Motivation required Desmopressin 0.1mg/ml NAS Ddavp nasal spray 5ml Vasopressin analogues Motivation required Tranexamic acid 500mg TAB Cyklokapron Tranexamic acid Antifibrinolytics Special investigations, pathology report Medwich

HEART FAILURE ICD10: I50.0, I50.1, I50.9, I11.0, I13.0, I3.2 Acebutolol 400mg TAB Butobloc Sectral Beta Blocker Motivation required Acebutolol 100mg CAP Sectral Beta Blocker Motivation required Acebutolol 200mg CAP Sectral Beta Blocker Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp Bayer aspirin cardio Aspirin Accepted treatment Acetylsalicylic acid 300mg TAB Be-tabs aspirin (white) Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amlodipine 10mg TAB Amlodac Amlosyn Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Gulf Amlodipine Indo-Amlodipine Calcium channel blockers Accepted treatment Amlodipine besylate 10mg TAB Ciplavasc Lomanor Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Norvasc Pharma Dynamics Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Atenolol 50mg TAB Hexa-blok SANDOZ Atenolol Beta blockers Accepted treatment Atenolol 100mg TAB Tenopress Tenormin Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB SANDOZ Co-tenidone Tenchlor Beta blockers and diuretic Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor hs Beta blockers and diuretic Accepted treatment 50mg/12.5mg Benazepril 10mg TAB Cibace Ace Inhibitor Motivation required Benazepril and diuretics 10mg TAB CIBADREX 30 Benazepril and diuretics Accepted treatment Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Benazepril and diuretics Motivation required Bisoprolol 10mg TAB Bisohexal 10 Bisoprolol Hexal Beta blockers Accepted treatment Bisoprolol 5mg TAB Bisohexal 5 Bisoprolol Hexal Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol and thiazides 10mg/6.25mg TAB Ziak Beta blockers and diuretic Accepted treatment Bisoprolol and thiazides 2.5mg/6.25mg TAB Ziak Beta blockers and diuretic Accepted treatment Bisoprolol and thiazides 5mg/6.25mg TAB Ziak Beta blockers and diuretic Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Accepted treatment Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers Motivation required Captopril 25mg TAB Bio-Captopril Capace ACE -inhibitors Accepted treatment Captopril 12.5mg TAB Capoten hs Captohexal ACE - inhibitors Accepted treatment Captopril 50mg TAB SANDOZ Captopril Zapto ACE -inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Captoretic Zapto-co ACE -inhibitors and combinations Accepted treatment Carvedilol 6.25mg TAB Aspen-Carvidelol Carvedilol-Hexal Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Carloc 25 Vediblok Alpha/beta blockers Accepted treatment Carvedilol 12.5mg TAB Carvetrend Carvedilol-Hexal Alpha/beta blockers Accepted treatment Chlortalidone 50mg TAB Hygroton Low Ceiling Diuretic Motivation required Cilazapril 5mg TAB Inhibace Ace Inhibitor Motivation required Cilazapril and diuretics 5mg/12.5mg TAB Inhibace plus ACE inhibitors and diuretics Motivation required Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Digoxin 0.25mg TAB Purgoxin Lanoxin Cardiac glycosides Accepted treatment Enalapril 10mg TAB Alapren 10 Adco-enalapril ACE - inhibitors Accepted treatment Enalapril 5mg TAB Enap 5 Alapren 5 ACE -inhibitors Accepted treatment Enalapril 20mg TAB Pharmapress HR-Enalapril MAL ACE-inhibitors Accepted treatment FP Enalapril 2.5mg TAB Renitec 2 5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Pharmapress co Enap co ACE -inhibitors and combinations Accepted treatment Eplerenone 25mg TAB Inspra Potassium-sparing diuretics Motivation required Eplerenone 50mg TAB Inspra Potassium-sparing diuretics Motivation required Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 2.5mg SRT Plendil Calcium channel blockers Accepted treatment Fosinopril 10mg TAB Mylan-Fosinopril Ace Inhibitors Motivation required Furosemide 500mg TAB Lasix Diuretics Accepted treatment Furosemide 80mg TAB Lasix Diuretics Accepted treatment Furosemide 10mg/ml SYR Lasix oral Diuretics Accepted treatment Furosemide 60mg CAP Lasix retard Diuretics Accepted treatment Furosemide 40mg TAB SANDOZ Furosemide Puresis Diuretics Accepted treatment Hydralazine 10mg TAB Hyperphen Vasodilators Accepted treatment Hydralazine 50mg TAB Hyperphen SANDOZ Vasodilators Accepted treatment Hydralazine Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide 25mg TAB Ridaq Hexazide Diuretics Accepted treatment Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Renezide Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/5mg TAB Betaretic Amiloretic Diuretics Accepted treatment potassium-sparing agents Indapamide 2.5mg TAB Lixamide Hydro-less Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Indapamide Diuretics Accepted treatment SR Irbesartan 150mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Irbesartan 300mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required Irbesartan & HCTZ 150/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Irbesartan & HCTZ 300/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Isosorbide dinitrate 40mg TAB Isordil tembid Organic nitrates Accepted treatment Isosorbide dinitrate 30mg TAB SANDOZ Isosorbide Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 10mg TAB SANDOZ Isosorbide Dinitrate Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 5mg TAB SANDOZ Isosorbide Dinitrate Isordil sublingual Organic nitrates Accepted treatment Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Lisinopril 10mg TAB Auro-Lisinopril Austell-Lisinopril ACE-inhibitors Accepted treatment Lisinopril 5mg TAB Auro-Lisinopril Hexal-lisinopril 5 ACE - inhibitors Accepted treatment Lisinopril 2.5mg TAB Austell-lisinopril ACE-inhibitors Accepted treatment Lisinopril 20mg TAB Sinopren 20 Zemax ACE -inhibitors Accepted treatment Lisinopril and diuretics 10mg/12.5mg TAB HEXAL-Lisinopril Co Auro-Lisinopril Co ACE-inhibitors and combinations Accepted treatment Lisinopril and diuretics 20/12.5mg TAB Lisinopril Co-Unicorn ACE-inhibitors and combinations Accepted treatment Losartan 100mg TAB Cozaar Cipla Losartan Angiotensin receptor blockers Accepted treatment Losartan 50mg TAB Renicard Angiotensin receptor blockers Accepted treatment Losartan and diuretics 100mg/25mg TAB Lohype forte plus Zartan Co Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 50mg/12.5mg TAB Sartoc Lozaan Co Angiotensin receptor blockers and Accepted treatment combinations Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Moexipril 75mg TAB Perdix Ace Inhibitor Accepted treatment Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Perindopril 4mg TAB Cipla Perindopril Ciplasyl ACE-inhibitors Accepted treatment Perindopril 10mg TAB Prexum Coversyl ACE -inhibitors Accepted treatment Perindopril 8mg TAB Vectoryl Spec-Perindopril ACE-inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Preterax ACE -inhibitors and combinations Accepted treatment Perindopril and diuretics 4mg/1.25mg TAB Acesyl Co 4/1.25 BiPreterax ACE -inhibitors and combinations Accepted treatment Piretanide 3mg TAB Arelix Diuretics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Piretanide 6mg TAB Arelix Diuretics Accepted treatment Potassium chloride 600mg TAB Plenish k SANDOZ K-600 Potassium supplements Accepted treatment Propranolol 10mg TAB Inderal Purbloka Beta blockers Accepted treatment Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Quinapril 10mg TAB Accumax Accupril ACE -inhibitors Accepted treatment Quinapril 20mg TAB Accupril Quinaspen ACE - inhibitors Accepted treatment Quinapril 40mg TAB Accupril Quinagen ACE-inhibitors Accepted treatment Quinapril 5mg TAB Accupril Quinagen ACE-inhibitors Accepted treatment Quinapril & diuretics 10mg/12.5mg TAB Quinazide ACE-inhibitors and diuretics Accepted treatment Quinapril and diuretics 10mg/12.5mg TAB Accumax Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Quinapril and diuretics 20mg/12.5mg TAB Accumax Accuretic 20/12.5 ACE - inhibitors and diuretics Accepted treatment Ramipril 1.25mg CAP Austell-Ramipril RamiprilHexal ACE - inhibitors Accepted treatment Ramipril 2.5mg CAP Austell-Ramipril Apex-Ramipril ACE-inhibitors Accepted treatment 2.5mg Ramipril 5mg CAP Austell-Ramipril Apex-Ramipril 5mg ACE-inhibitors Accepted treatment Ramipril 1.25mg TAB RamiprilHexal ACE-inhibitors Accepted treatment Ramipril 10mg CAP Rampil Ran-Ramipril ACE - inhibitors Accepted treatment Spironolactone 100mg TAB Spiractin Aldactone Potassium -sparing diuretics Accepted treatment Spironolactone 25mg TAB Spiractin SANDOZ Potassium-sparing diuretics Accepted treatment Spironolactone Telmisartan 40mg TAB Pritor Micardis Angiotensin receptor anatgonist Accepted treatment Telmisartan 80mg TAB Pritor Micardis Angiotensin receptor anatgonist Accepted treatment Telmisartan and diuretics 40mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor anatgonist Accepted treatment 40/12.5mg and Diuretics Telmisartan and diuretics 80mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor anatgonist Accepted treatment 80/12.5mg and Diuretics Telmisartan and diuretics 80mg/25mg TAB Co-micardis Angiotensin receptor anatgonist Motivation required and Diuretics Timolol; thiazides and other 10/2.5/25mg TAB Servatrin Beta blockers and diuretic Motivation required diuretics Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Valsartan 320mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 40mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 160mg TAB Migroben Tareg Angiotensin receptor blockers Accepted treatment Valsartan 80mg TAB Migroben Tareg Angiotensin receptor blockers Accepted treatment Valsartan and diuretics 320/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Tareg Co-Migroben Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-Tareg Co-Migroben Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Tareg Plus Co-Migroben Angiotensin receptor blockers and Accepted treatment combinations Verapamil 240mg SRT Ravamil sr Isoptin sr Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment Xipamide 20mg TAB Diurexan Low Ceiling Diuretic Accepted treatment

HYPERLIPIDAEMIA ICD10: E78.0,E78.1, E78.2, E78.3, E78.4, E78.5 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted therapy Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted therapy 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Gulf aspirin Aspirin Accepted therapy Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted therapy Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted therapy Atorvastatin 10mg TAB Aspavor Lipogen Statins Motivation and special investigation, lipogram Atorvastatin 40mg TAB Aspavor Ran-Atorvastatin Statins Motivation and special investigation, lipogram Atorvastatin 80mg TAB Atolip Lipogen Statins Motivation and special investigation, lipogram

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Atorvastatin 20mg TAB Ran-Atorvastatin Atolip Statins Motivation and special investigation, lipogram Atorvastatin and amlodipine 10mg/40mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 10mg/80mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 5mg/40mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 5mg/80mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 10mg/10mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 10mg/20mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 5mg/10mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Atorvastatin and amlodipine 5mg/20mg TAB Caduet Statin and Calcium cannel blocker Motivation and special investigation, lipogram Bezafibrate 200mg TAB Bezalip Fibrates Special investigation, lipogram Bezafibrate 400mg TAB Dyna-Bezafibrate SR SANDOZ Fibrates Special investigation, lipogram Bezafibrate Ezetimibe 10mg TAB Ezetrol CHOLESTEROL AND TRIGLYCERIDE Motivation and special investigation, lipogram REDUCERS Fenofibrate 200mg CAP Lipanthyl Fibrates Motivation and special investigation, lipogram Fluvastatin 20mg CAP Lescol Statins Motivation and special investigation, lipogram Fluvastatin 40mg CAP Lescol Statins Motivation and special investigation, lipogram Fluvastatin 80mg TAB Lescol xl Statins Motivation and special investigation, lipogram Gemfibrozil 600mg TAB Lopid Fibrates Motivation and special investigation, lipogram Lovastatin 20mg TAB Lovachol Statins Special investigation, lipogram Lovastatin 40mg TAB Lovachol Statins Special investigation, lipogram Nicotinic acid 100mg TAB Be-tabs Nicotinic acid Special investigation, lipogram Nicotinic acid derivatives: 250mg CAP Olbetam Special investigation, lipogram Acipimox Nicotinic acid /Laropiprant 100mg/20mg TAB Tredaptive Motivation and special investigation, lipogram Pravastatin 10mg TAB Aspen Pravastatin Pravacor Statins Motivation and special investigation, lipogram Pravastatin 20mg TAB Aspen Pravastatin Novales Statins Motivation and special investigation, lipogram Pravastatin 40mg TAB SANDOZ Pravastatin Aspen Pravastatin Statins Motivation and special investigation, lipogram Probucol 250mg TAB Lurselle Other serum lipid modifiying Motivation and special investigation, lipogram agents Rosuvastatin 5mg TAB Crestor Statins Motivation and special investigation, lipogram Rosuvastatin 10mg TAB Crestor Zuvamor Statins Motivation and special investigation, lipogram Rosuvastatin 20mg TAB Crestor Zuvamor Statins Motivation and special investigation, lipogram Rosuvastatin 40mg TAB Crestor Zuvamor Statins Motivation and special investigation, lipogram

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Simvastatin 10mg TAB Adco-Simvastatin Arrow Simvastatin Statins Special investigation, lipogram Simvastatin 20mg TAB Aspen Simvastatin Austell-Simvastatin Statins Special investigation, lipogram Simvastatin 40mg TAB Michol Cipla-Simvastatin Statins Special investigation, lipogram Simvastatin 80mg TAB Zysim Cipla-Simvastatin Statins Special investigation, lipogram Simvastatin/Ezetimibe 10mg/10mg TAB Inegy Statin and Calcium cannel blocker Motivation and special investigation, lipogram Simvastatin/Ezetimibe 10mg/20mg TAB Inegy Statin and Calcium cannel blocker Motivation and special investigation, lipogram Simvastatin/Ezetimibe 10mg/40mg TAB Inegy Statin and Calcium cannel blocker Motivation and special investigation, lipogram

HYPERTENSION ICD10: I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.1, I13.2, I13.9, I15.0, I15.1, I15.1, I15.2, I15.8, I15.9, O10.0, O10.1, O10.2, O10.3, O10.4, O10.9, O11 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acebutolol 100mg CAP Sectral Beta blockers Motivation required Acebutolol 200mg CAP Sectral Beta blockers Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg TAB Bayer aspirin Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amlodipine 10mg TAB Amtas Auro-Amlodipine Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Klodip Stamlo Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Austell-Amlodipine Calbloc Calcium channel blockers Accepted treatment Amlodipine besylate 10mg TAB Norvasc Pharma Dynamics Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 100mg TAB Adco-atenolol B-Block Beta blockers Accepted treatment Atenolol 50mg TAB Ten-bloka Tenopress Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB Tenchlor Tenoretic Beta blocker and diuretics Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Tenchlor hs Tenoret 50 Beta blocker and diuretics Accepted treatment Benazepril 10mg TAB Cibace Ace Inhibitor Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Benazepril and diuretics 10mg TAB CIBADREX 30 Benazepril and diuretics Accepted treatment Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Benazepril and diuretics Motivation required Bisoprolol 10mg TAB Cardicor Concor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Cardicor Concor Beta blockers Accepted treatment Bisoprolol and thiazides 10mg/6.25mg TAB Ziak Beta blocker and diuretics Accepted treatment Bisoprolol and thiazides 2.5mg/6.25mg TAB Ziak Beta blocker and diuretics Accepted treatment Bisoprolol and thiazides 5mg/6.25mg TAB Ziak Beta blocker and diuretics Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Accepted treatment Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers and Accepted treatment combinations Candesartan and diuretics 32mg/12.5mg TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Candesartan and diuretics 32mg/25mg TAB Atacand plus Angiotensin receptor blockers and Motivation required combinations Captopril 12.5mg TAB Capoten hs Captohexal ACE - inhibitors Accepted treatment Captopril 25mg TAB Captohexal Captomax ACE - inhibitors Accepted treatment Captopril 50mg TAB Captohexal Mylan-captopril 50 ACE - inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Captoretic Zapto-co ACE -inhibitors and combinations Accepted treatment Carvedilol 6.25mg TAB Carloc 6 25 Aspen-Carvidelol Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Carvetrend Vediblok Alpha/beta blockers Accepted treatment Chlortalidone 50mg TAB Hygroton Low Ceiling Diuretic Motivation required Cilazapril 5mg TAB Inhibace Ace Inhibitor Motivation required Cilazapril and diuretics 5mg/12.5mg TAB Inhibace plus ACE inhibitors and diuretics Motivation required Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Zildem 180 sr Tilazem 180 cr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Zildem 240 sr Tilazem 240 cr Calcium channel blockers Accepted treatment Doxazosin 1mg TAB Adco-doxazosin Cardugen (Prev Alpha blockers Motivation required Mylan-Doxasozin)

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Doxazosin 2mg TAB Adco-doxazosin Alpha blockers Motivation required Doxazosin 4mg TAB Cardugen (prev Mylan- Adco-doxazosin Alpha blockers Motivation required Doxasozin) Doxazosin 8mg TAB Cardura xl Alpha blockers Motivation required Doxazosin Extended release 4mg TAB Cardura XL Carzin XL Alpha blockers Motivation required Enalapril 10mg TAB Ciplatec 10 Alapren 10 ACE - inhibitors Accepted treatment Enalapril 20mg TAB Enap 20 Pharmapress ACE - inhibitors Accepted treatment Enalapril 5mg TAB Hr-enalapril 5 Ciplatec 5 ACE -inhibitors Accepted treatment Enalapril 2.5mg TAB Renitec 2 5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Pharmapress co Enap co ACE -inhibitors and combinations Accepted treatment Enalapril and Lercandipine 10mg/10mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Enalapril and Lercandipine 10mg/20mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 2.5mg SRT Plendil Calcium channel blockers Accepted treatment Fosinopril 10mg TAB Mylan-Fosinopril Ace Inhibitors Motivation required Furosemide 500mg TAB Lasix Diuretics Motivation required Furosemide 80mg TAB Lasix Diuretics Motivation required Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Furosemide 60mg CAP Lasix retard Diuretics Motivation required Furosemide 40mg TAB SANDOZ Furosemide Mylan -furosemide Diuretics Accepted treatment Hydralazine 10mg TAB Hyperphen Vasodilators Accepted treatment Hydralazine 50mg TAB SANDOZ Hydralazine Hyperphen Vasodilators Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide 25mg TAB Ridaq Hexazide Diuretics Accepted treatment Hydrochlorothiazide and 50mg/5mg TAB Adco-retic Spec-Co-Amiloride Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Page 40 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Indapamide 2.5mg TAB Mylan-Indapamide Lixamide Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Indapamide Diuretics Accepted treatment SR Irbesartan 150mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required Irbesartan 300mg TAB Iberwin Aprovel Angiotension receptor antagonist Motivation required Irbesartan and diuretics 150mg/12.5mg TAB Co-Iberwin Coaprovel Angiotensin receptor blockers and Motivation required combinations Irbesartan and diuretics 300mg/12.5mg TAB Co-Iberwin Coaprovel Angiotensin receptor blockers and Motivation required combinations Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Lisinopril 2.5mg TAB Austell-lisinopril ACE-inhibitors Accepted treatment Lisinopril 10mg TAB Hexal-lisinopril 10 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 5mg TAB Sinopren 5 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 20mg TAB Zestril Zetomax ACE -inhibitors Accepted treatment Lisinopril and diuretics 20mg/12.5mg TAB Lisoretic Zetomax-Co ACE - inhibitors and combinations Accepted treatment Losartan 50mg TAB Renicard Cozaar Angiotensin receptor blockers Accepted treatment Losartan 100mg TAB Zartan Spec Losartan 100 Angiotensin receptor blockers Accepted treatment Losartan and diuretics 50mg/12.5mg TAB Zartan Co Cozaar comp Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 100mg/25mg TAB Fortzaar Lozaan Co Angiotensin receptor blockers and Accepted treatment combinations Methyldopa (levorotatory) 250mg TAB Hypotone SANDOZ Antiadrenegic agents, centrally Accepted treatment Methyldopa acting Methyldopa (levorotatory) 500mg TAB Hypotone Antiadrenegic agents, centrally Accepted treatment acting Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Minoxidil 10mg TAB Loniten Alpha/beta blockers Motivation required Minoxidil 5mg TAB Loniten Alpha/beta blockers Motivation required Moexipril 75mg TAB Perdix ACE-inhibitors Accepted treatment Moxonidine 0.2mg TAB Cynt Moxotens Antiadrenegic agents, centrally Motivation required acting Moxonidine 0.4mg TAB Cynt Moxotens Antiadrenegic agents, centrally Motivation required acting Moxonidine 0.3mg TAB Moxotens Physiotens Antiadrenegic agents, centrally Motivation required acting

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Nifedipine 60mg SRT Macorel 60 SR Spec Nifedipine SR Calcium channel blockers Accepted treatment Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Calcium channel blockers Accepted treatment Nifedipine 30mg SRT Spec Nifedipine SR Macorel 30 SR Calcium channel blockers Accepted treatment Perindopril 8mg TAB Ciplasyl Cipla-Perindopril ACE-inhibitors Accepted treatment Perindopril 10mg TAB Prexum Coversyl ACE -inhibitors Accepted treatment Perindopril 4mg TAB Ran-Perindopril Prexum ACE -inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Preterax ACE -inhibitors and combinations Accepted treatment Perindopril and diuretics 4mg/1.25mg TAB Vectoryl plus Prexum Plus ACE - inhibitors and combinations Accepted treatment Piretanide 3mg TAB Arelix Diuretics Accepted treatment Piretanide 6mg TAB Arelix Diuretics Accepted treatment Potassium chloride 600mg TAB Plenish k Slow-k Potassium supplements Accepted treatment Prazosin 1mg TAB Pratsiol Alpha blockers Motivation required Prazosin 2mg TAB Pratsiol Alpha blockers Motivation required Prazosin 5mg TAB Pratsiol Alpha blockers Motivation required Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required Propranolol 10mg TAB Prodorol Purbloka Beta blockers Accepted treatment Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Quinapril 20mg TAB Accumax Quinaspen ACE - inhibitors Accepted treatment Quinapril 40mg TAB Accupril Quinagen ACE-inhibitors Accepted treatment Quinapril 5mg TAB Accupril Quinagen ACE-inhibitors Accepted treatment Quinapril 10mg TAB Quinagen Quinaspen ACE - inhibitors Accepted treatment Quinapril & diuretics 10mg/12.5mg TAB Quinazide ACE-inhibitors and diuretics Accepted treatment Quinapril and diuretics 10mg/12.5mg TAB Accumax Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Quinapril and diuretics 20mg/12.5mg TAB Accuretic 20/12.5 Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Ramipril 5mg TAB RamiprilHexal Ramace ACE -inhibitors Accepted treatment Ramipril 2.5mg CAP Rampil Retace ACE-inhibitors Accepted treatment Ramipril 10mg CAP Ran-Ramipril Simayla Ramipril ACE-inhibitors Accepted treatment Ramipril and calcium channel 2.5mg/2.5mg TAB Tri-plen ACE inhibitors and calcium Motivation required blockers channel blockers Ramipril and calcium channel 5mg/5mg TAB Tri-plen forte ACE inhibitors and calcium Motivation required blockers channel blockers

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Reserpine 0.25mg TAB Reserpine Antiadrenegic agents, centrally Accepted treatment acting Reserpine and diuretics TAB Brinerdin Antiadrenegic agents, centrally Motivation required acting Spironolactone 100mg TAB Spiractin Aldactone Potassium sparing diuretic Accepted treatment Spironolactone 25mg TAB Spiractin SANDOZ Potassium sparing diuretic Accepted treatment Spironolactone Telmisartan 40mg TAB Pritor Micardis Angiotensin receptor anatgonist Accepted treatment Telmisartan 80mg TAB Pritor Micardis Angiotensin receptor anatgonist Accepted treatment Telmisartan and diuretics 40mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor blockers and Accepted treatment 40/12.5mg combinations Telmisartan and diuretics 80mg/12.5mg TAB Co-Pritor Co-micardis Angiotensin receptor blockers and Accepted treatment 80/12.5mg combinations Telmisartan and diuretics 80mg/25mg TAB Co-micardis Angiotensin receptor blockers and Accepted treatment combinations Terazosin 10mg TAB Hytrin Alpha blockers Motivation required Terazosin 1mg TAB Hytrin Alpha blockers Motivation required Terazosin 2mg TAB Hytrin Alpha blockers Motivation required Terazosin 5mg TAB Hytrin Alpha blockers Motivation required Timolol; thiazides and other 10/2.5/25mg TAB Servatrin Beta blocker and diuretics Accepted treatment diuretics Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril and calcium channel 180mg/2mg SRC Tarka ACE inhibitors and calcium Motivation required blockers channel blockers Trandolapril and calcium channel 180mg TAB Tarka Bilayer ACE inhibitors and calcium Motivation required blockers channel blockers Trandolapril and calcium channel 240mg TAB Tarka Bilayer ACE inhibitors and calcium Motivation required blockers channel blockers Valsartan 320mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 40mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 160mg TAB Tareg Zomevek Angiotensin receptor blockers Accepted treatment Valsartan 80mg TAB Tareg Zomevek Angiotensin receptor blockers Accepted treatment Valsartan and amlodipine 10mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Valsartan and amlodipine 5mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan, Amlodipine and 10mg/160mg/12.5mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 10mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/12.mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan and diuretics 320/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Zomevek Co-Migroben Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-Zomevek Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Zomevek Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Xipamide 20mg TAB Diurexan Low Ceiling Diuretic Accepted treatment

HYPOTHYROIDISM ICD10: E01.8, E02, E03.0, E03.1, E03.2, E03.3, E03.4, E03.5, E03.8, E03.9, E89.0 Levothyroxine sodium 50mcg TAB Eltroxin Euthyrox Thyroid hormones Accepted treatment Levothyroxine sodium 100mcg TAB Eltroxin Euthyrox Thyroid hormones Accepted treatment Levothyroxine sodium 25mcg TAB Euthyrox Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 112mcg TAB Sythroid Thyroid hormones Accepted treatment Levothyroxine sodium 88mcg TAB Sythroid Thyroid hormones Accepted treatment Liothyronine sodium 90mcg/10mcg TAB Diotroxin Thyroid hormones Accepted treatment Liothyronine sodium 20mcg TAB Tertroxin Thyroid hormones Accepted treatment

INSULIN-DEPENDANT DIABETES ICD10: E10.0, E10.1, E10.2, E10.3, E10.4, E10.5, E 10.6, E10.7, E10.8, E10.9, E12.0, E12.1, E12.5, E12.6, E12.7, E12.8, E12.9, O24.0, O24.2, O24.3

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Insulin (human) 100u/ml INJ Insu protaphane Insu Actraphane Insulin Accepted treatment Insulin aspart 100u/ml INJ Insu Novorapid Insu Novomix 30 Insulin Accepted treatment Insulin detemir INJ Insu Levemir Insulin Accepted treatment Insulin glargine 100iu/ml INJ Lantus 1000iu/10ml Insulin Accepted treatment Insulin glulisine 100iu/ml INJ Insu Apidra 100iu Insulin Accepted treatment Insulin lispro 100IU/ml INJ Insu Humalog Insu Humalog Mix Insulin Accepted treatment

MULTIPLE SCLEROSIS ICD10: G35 Amitriptyline 10mg TAB Trepiline Heterocyclic antidepressant Accepted treatment Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Azathioprine 50mg TAB Azamun Azapress Immunosuppressants Accepted treatment Baclofen 10mg TAB Bio-Baclofen Lioresal Muscle relaxants Accepted treatment Baclofen 25mg TAB Lioresal Muscle relaxants Accepted treatment Carbamazepine 200mg SRT SANDOZ Carbamazepine CR Tegretol 200 Anticonvulsants Accepted treatment Carbamazepine 200mg TAB CPL-Carbamazepine Degranol Mood Stabilisers Accepted treatment Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Mood Stabilisers Accepted treatment Clomipramine 10mg TAB Equinorm Anafranil Heterocyclic antidepressant Accepted treatment Cyclophosphamide 50mg TAB Endoxan Immunosuppressants Motivation required Darifenacin 15mg TAB Enablex CR Anticholinergics, oral Motivation required Darifenacin 7.5mg TAB Enablex CR Anticholinergics, oral Motivation required Folic acid 5mg TAB Be-tabs folic acid Folic acid Folic acid Accepted treatment Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Imipramine 10mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Interferon beta-1a 30mcg INJ Avonex powder for injection Avonex solution for Interferon Motivation required inj. Interferon beta-1a 22mcg INJ Rebif 22 05ml Interferon Motivation required Interferon beta-1a 44mcg INJ Rebif 44 05ml Interferon Motivation required Interferon beta-1b 96miu INJ Betaferon pre-filled syr Interferon Motivation required Interferon Gamma 0.1mg/5ml INJ Immukine Interferon Motivation required Methotrexate 2.5mg TAB Emthexate Methotrexate Immunosuppressants Accepted treatment Page 45 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Orphenadrine (citrate) 100mg TAB Norflex Muscle relaxants Accepted treatment Oxybutynin 5mg TAB Urihexal Lenditro Anticholinergics, oral Accepted treatment Oxybutynin extended release 10mg TAB Lyrinel Anticholinergics, oral Motivation required Oxybutynin extended release 5mg TAB Lyrinel Anticholinergics, oral Motivation required Prednisolone 5mg TAB Lenisolone Capsoid Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids, oral Accepted treatment Pregabalin 25mg CAP Lyrica Anticonvulsants Motivation required Pregabalin 75mg CAP Lyrica Anticonvulsants Motivation required Pregabalin 15mg CAP Lyrica Anticonvulsants Motivation required Propiverine 15mg TAB Detrunorm Anticholinergics, oral Motivation required Solifenacin 10mg TAB Vesicare Anticholinergics, oral Motivation required Solifenacin 5mg TAB Vesicare Anticholinergics, oral Motivation required Tolterodine 2mg CAP Detrusitol SR Anticholinergics, oral Motivation required Tolterodine 4mg CAP Detrusitol SR Anticholinergics, oral Motivation required Trospium 20mg TAB Uricon Anticholinergics, oral Motivation required

NON-INSULIN-DEPENDANT DIABETES ICD10: E11.0, E11.1, E11.02, E11.3, E11.4, E11.5, E11.6, E11.7, E11.8, E11.9 Acarbose 100mg TAB Glucobay 100 Biguanides & Sulphonylureas Motivation required Acarbose 50mg TAB Glucobay 50 Biguanides & Sulphonylureas Motivation required Glibenclamide 5mg TAB SANDOZ Glibenclamide Bio -Glibenclamide Suphonylureas Accepted treatment (prev.norton- glibencl) Gliclazide 40mg TAB Austell-Gliclazide Suphonylureas Accepted treatment Gliclazide 30mg TAB Diaglucide MR 30mg Diamicron MR Suphonylureas Accepted treatment Gliclazide 80mg TAB Glucomed Diaglucide Suphonylureas Accepted treatment Glimepiride 1mg TAB Glamaryl Adco-Glimepiride Suphonylureas Motivation required Glimepiride 4mg TAB Mylan-Glimepiride Diaglim Suphonylureas Motivation required Glimepiride 2mg TAB SANDOZ Glimepiride Aspen Glimepiride Suphonylureas Motivation required Insulin (human) 100IU/ml INJ Insu humulin n Insu humulin 30/70 Insulin Accepted treatment Insulin aspart 100u/ml INJ Insu Novorapid Insu Novomix 30 Insulin Accepted treatment Insulin detemir INJ Insu Levemir Insulin Accepted treatment Insulin glargine 100iu/ml INJ Lantus 1000iu/10ml Insulin Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Insulin glulisine 100iu/ml INJ Insu Apidra 100iu Insulin Accepted treatment Insulin lispro 100IU/ml INJ Insu Humalog Insu Humalog Mix Insulin Accepted treatment Metformin 1000mg TAB Auro-Metformin Bigsens Biguanides Accepted treatment Metformin 850mg TAB Metphage SANDOZ Metformin Biguanides Accepted treatment HCL Metformin 500mg TAB SANDOZ Metformin HCL FC Metforal Biguanides Accepted treatment Metformin and sulfonamides 250mg/1.25mg TAB Glucovance 250/125 Biguanides & Sulphonylureas Motivation required Metformin and sulfonamides 500mg/2.5mg TAB Glucovance 500/25 Biguanides & Sulphonylureas Motivation required Metformin and sulfonamides 500mg/5mg TAB Glucovance 500/5 Biguanides & Sulphonylureas Motivation required Nateglinide 120mg TAB Starlix film coated Meglitinides Motivation required Pioglitazone 15mg TAB Cipla Pioglitazone Actos Thiazolidinediones Motivation required Pioglitazone 30mg TAB Cipla Pioglitazone Actos Thiazolidinediones Motivation required Repaglinide 0.5mg TAB Novonorm Meglitinides Motivation required Repaglinide 1mg TAB Novonorm Meglitinides Motivation required Repaglinide 2mg TAB Novonorm Meglitinides Motivation required Saxagliptin 2.5mg TAB Onglyza DPP-4 Motivation required Saxagliptin 5mg TAB Onglyza DPP-4 Motivation required Sitagliptin 25mg TAB Januvia DPP-4 Motivation required Sitagliptin 50mg TAB Januvia DPP-4 Motivation required Sitagliptin 100mg TAB Januvia DPP-4 Motivation required Vildagliptin 50mg TAB Galvus DPP-4 Motivation required

PARKINSON'S DISEASE ICD10: G20, G21.0, G21.1, G21.2, G21.3, G21.4, G21.8, G21.9 Amantadine 100mg CAP Symadin (was Flu-stop) Symmetrel Amantadane derivates Accepted treatment Biperiden 2mg TAB Akineton Anticholinergics, oral Accepted treatment Bromocriptine 2.5mg TAB Aspen Bromocriptine Parlodel Dopamine agonists Motivation required Entacapone 200mg TAB Comtan Cateschol-o-methyltransferase Motivation required inhibitors Levodopa and decarboxylase 25mg/100mg TAB Carbilev 25/100 Sinemet Dopa and dopa derivatives Accepted treatment inhibitor Levodopa and decarboxylase 25mg/250mg TAB Carbilev 25/250 Teva Carbi-Levo Dopa and dopa derivatives Accepted treatment inhibitor Levodopa and decarboxylase 200mg/50mg TAB Madopar Dopa and dopa derivatives Accepted treatment inhibitor

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Levodopa and decarboxylase 100mg/25mg CAP Madopar hbs Dopa and dopa derivatives Accepted treatment inhibitor Levodopa and decarboxylase 50mg/200mg SRT Sinemet cr Dopa and dopa derivatives Accepted treatment inhibitor Levodopa and decarboxylase 100mg/25mg/200mg TAB Stalevo FCT Dopa and dopa derivatives Motivation required inhibitor Levodopa and decarboxylase 150mg/37.5mg/200m TAB Stalevo FCT Dopa and dopa derivatives Motivation required inhibitor g Levodopa and decarboxylase 50mg/12.5mg/200mg TAB Stalevo FCT Dopa and dopa derivatives Motivation required inhibitor Orphenadrine (chloride) 50mg TAB Disipal Muscle relaxants Accepted treatment Orphenadrine (citrate) 100mg TAB Norflex Muscle relaxants Accepted treatment Pramipexole 0.125mg TAB Pexola Dopamine agonists Motivation required Pramipexole 0.25mg TAB Pexola Dopamine agonists Motivation required Pramipexole 1mg TAB Pexola Dopamine agonists Motivation required Rasagiline 1mg TAB Azilect Monoamine oxidase type B Motivation required inhibitors Ropinirole 0.25mg TAB Resure Requip 0.25 Dopamine agonists Motivation required Ropinirole 0.5mg TAB Resure Requip 0.5 Dopamine agonists Motivation required Ropinirole 1mg TAB Resure Requip 1.0 Dopamine agonists Motivation required Ropinirole 2mg TAB Resure Requip 2.0 Dopamine agonists Motivation required Ropinirole 5mg TAB Resure Requip 5.0 Dopamine agonists Motivation required Ropinirole Extended release 2mg TAB Requip XL Dopamine agonists Motivation required Ropinirole Extended release 4mg TAB Requip XL Dopamine agonists Motivation required Ropinirole Extended release 8mg TAB Requip XL Dopamine agonists Motivation required Selegiline 5mg TAB Parkilyne Monoamine oxidase type B Accepted treatment inhibitors Tolcapone 100mg TAB Tasmar Cateschol-o-methyltransferase Motivation required inhibitors Trihexyphenidyl 2mg TAB Benzhexol Anticholinergics, oral Accepted treatment

RHEUMATOID ARTHRITIS ICD10: M05.00-M05.29, M05.80-M05.99, M06.00-M06.49, M06.80-M06.99, M08.00-M08.09, M05 Paracetamol will be reimbursed for Rheumatoid Arthritis

Abatacept 250mg/ml INF Orencia Biological Motivation required Adalimumab 40mg/0.8ml INJ Humira Prefilled Biological Motivation required Azathioprine 50mg TAB Azathioprine Zaprine Immunosuppressants Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Celecoxib 100mg CAP Celebrex COXIB Motivation required Celecoxib 200mg CAP Celebrex COXIB Motivation required Chloroquine 200mg TAB Nivaquine Plasmoquine Aminoquinolines Accepted treatment Chloroquine 250mg TAB SANDOZ Chloroquine Aminoquinolines Accepted treatment phosphate Ciclosporin 100mg CAP Sandimmun Neoral soft gel Immuosuppressants Motivation required Ciclosporin 25mg CAP Sandimmun Neoral soft gel Immuosuppressants Motivation required Diclofenac 25mg TAB Adco-diclofenac Panamor-25 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SUP Diclohexal 100s Panamor supp-100 Non-steroidal anti-inflammatory Motivation required drugs Diclofenac 50mg TAB Diclohexal 50t Panamor at-50 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg CAP Fortfen SR Non-steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SRT Panamor-100 sr SANDOZ Diclofenac Non -steroidal anti-inflammatory Accepted treatment drugs Diclofenac 75mg SRT Panamor-75 sr Voltaren 75 Non - steroidal anti-inflammatory Accepted treatment drugs Etanercept 25mg INJ Enbrel Sales Pack Biological Motivation required Flurbiprofen 200mg CAP Froben sr Non-steroidal anti-inflammatory Accepted treatment drugs Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Folic acid Accepted treatment Ibuprofen 400mg TAB Adco-ibuprofen Ranfen Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 100mg/5ml SUS Brufen paed susp Ibumax Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 200mg TAB SANDOZ Ibuprofen Inza Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 600mg TAB SANDOZ Ibuprofen Brufen Non -steroidal anti-inflammatory Accepted treatment drugs Indomethacin 100mg SUP Arthrexin Indocid Non -steroidal anti-inflammatory Motivation required drugs Indomethacin 25mg CAP SANDOZ Idomethacin Arthrexin Non -steroidal anti-inflammatory Accepted treatment drugs Infliximab 100mg INF Revellex Biological Motivation required Ketoprofen 200mg SRC Ketoflam Non-steroidal anti-inflammatory Accepted treatment drugs Ketoprofen 200mg SRC Ketoflam Non-steroidal anti-inflammatory Accepted treatment drugs

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Leflunomide 10mg TAB Arava Immunosuppressants Motivation required Leflunomide 20mg TAB Arava Immunosuppressants Motivation required Lornoxicam 4mg TAB Xefo Non-steroidal anti-inflammatory Motivation required drugs Lornoxicam 8mg TAB Xefo Non-steroidal anti-inflammatory Motivation required drugs Mefenamic acid 250mg CAP Adco-mefenamic acid Fenamin Non-steroidal anti-inflammatory Motivation required drugs Mefenamic acid 500mg CAP Adco-mefenamic acid Non-steroidal anti-inflammatory Motivation required drugs Mefenamic acid 500mg TAB Fenamin Ponstel Non-steroidal anti-inflammatory Motivation required drugs Meloxicam 15mg TAB Loxiflam Arrow Meloxicam Non-steroidal anti-inflammatory Accepted treatment drugs Meloxicam 7.5mg TAB SANDOZ Meloxicam Coxflam Non -steroidal anti-inflammatory Accepted treatment drugs Methotrexate 2.5mg TAB Emthexate Methotrexate Immunosuppressants Accepted treatment Methylprednisolone 4mg TAB Medrol Oral corticosteroids Accepted treatment Naproxen 250mg TAB Adco-naproxen Mylan-naproxen Non - steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg SUP Nafasol Non-steroidal anti-inflammatory Motivation required drugs Naproxen 250mg ECT Nafasol ec-250 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg ECT Nafasol ec-500 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg TAB Napflam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 10mg CAP Adco-piroxicam Rolab-piroxicam Non - steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg CAP Adco-piroxicam Xycam Non -steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg TAB Brexecam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg DSP Pixicam Xycam dispers Non - steroidal anti-inflammatory Accepted treatment drugs Prednisolone 5mg TAB Capsoid Lenisolone Corticosteroids , oral Motivation required Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Motivation required Sulfasalazine 500mg TAB Salazopyrin Salazopyrin e n 5 - ASA agents Accepted treatment Rituximab 100mg INF Mabthera Monoclonal antibodies Motivation required Rituximab 500mg INF Mabthera Monoclonal antibodies Motivation required Tocilizumab 80mg/4ml INF Actemra INTERLEUKIN INHIBITORS Motivation required Tocilizumab 200mg/10ml INF Actemra INTERLEUKIN INHIBITORS Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Tocilizumab 400mg/20ml INF Actemra INTERLEUKIN INHIBITORS Motivation required SCHIZOPHRENIA ICD10: F20.0, F20.1, F20.2, F20.3, F20.4, F20.5, F20.6, F20.8, F20.9 Amisulpride 200mg TAB Solian Antipsychotics Accepted treatment Amisulpride 50mg TAB Solian Antipsychotics Accepted treatment Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Aripiprazole 5mg TAB Abilify Antipsychotics Accepted treatment Aripiprazole 10mg TAB Abilify Antipsychotics Accepted treatment Aripiprazole 15mg TAB Abilify Antipsychotics Accepted treatment Bupropion 150mg SRT Wellbutrin SR Other antidepressant Motivation required Bupropion 150mg SRT Wellbutrin XL Other antidepressant Motivation required Bupropion 300mg SRT Wellbutrin XL Other antidepressant Motivation required Chlorpromazine 100mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 25mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 50mg TAB Largactil Antipsychotics Accepted treatment Citalopram 20mg TAB Adco-Talomil Depramil Selective serotonin receptor Accepted treatment inhibitors Citalopram 10mg TAB Austell-Citalopram Selective serotonin receptor Accepted treatment inhibitors Citalopram 40mg TAB Citalopram-Winthrop Ran-Citalopram Selective serotonin receptor Accepted treatment inhibitors Clomipramine 75mg SRT Anafranil simple reg Heterocyclic antidepressant Accepted treatment Clomipramine 25mg TAB Clomidep Equinorm Heterocyclic antidepressant Accepted treatment Clomipramine 10mg TAB Equinorm Anafranil Heterocyclic antidepressant Accepted treatment Clozapine 100mg TAB Cloment Leponex Antipsychotics Accepted treatment Clozapine 25mg TAB Cloment Leponex Antipsychotics Accepted treatment Dosulepin 25mg CAP Prothiaden Thaden Heterocyclic Antidepressants Accepted treatment Dosulepin 75mg TAB Thaden Heterocyclic Antidepressants Accepted treatment Duloxetine 30mg CAP Cymgen Cymbalta Other antidepressant Motivation required Duloxetine 60mg CAP Cymgen Cymbalta Other antidepressant Motivation required Escitalopram 10mg TAB Aspen-Escitalopram Be-Tabs Selective serotonin receptor Motivation required Escitalopram inhibitors Escitalopram 20mg TAB Citraz Lexamil Selective serotonin receptor Motivation required inhibitors Escitalopram 5mg TAB Lexamil Selective serotonin receptor Motivation required inhibitors

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Flupenthixol 0.5mg TAB Fluanxol Antipsychotics Accepted treatment Flupenthixol 1mg TAB Fluanxol Antipsychotics Accepted treatment Fluoxetine 20mg TAB Lorien Rezak Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 20mg CAP Nuzak Lilly-fluoxetine Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 20mg DSP Prohexal 20t Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 40mg DSP Prohexal 40t Selective serotonin receptor Accepted treatment inhibitors Fluvoxamine 100mg TAB Fluvoxamine- Hexal Faverin Selective serotonin receptor Motivation required inhibitors Haloperidol 1.5mg TAB SANDOZ Haloperidol Antipsychotics Accepted treatment Haloperidol 5mg TAB SANDOZ Haloperidol Serenace Antipsychotics Accepted treatment Haloperidol 0.5mg CAP Serenace Antipsychotics Accepted treatment Haloperidol 10mg TAB Serenace Antipsychotics Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Lithium 250mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 400mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 50mg CAP Lithium succinate Mood stabilisers Accepted treatment Lithium 450mg TAB Quilonum retard Mood stabilisers Accepted treatment Lofepramine 70mg TAB Emdalen Heterocyclic Antidepressants Accepted treatment Maprotiline 25mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Maprotiline 75mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Mianserin 10mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mianserin 30mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mirtazapine 15mg TAB Adco-Mirteron Aspen Mirtazapine Other antidepressant Motivation required Mirtazapine 30mg TAB Mylan-Mirtazapine Sandoz Mirtazapine Other antidepressant Motivation required Moclobemide 150mg TAB Depnil Selective serotonin receptor Motivation required inhibitors Moclobemide 300mg TAB Depnil 300 Selective serotonin receptor Motivation required inhibitors Olanzapine 10mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 5mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 2.5mg TAB Redilanz Zyprexa Antipsychotics Accepted treatment Paleperidone 3mg TAB Invega Antipsychotics Accepted treatment Paleperidone 6mg TAB Invega Antipsychotics Accepted treatment Page 52 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Paleperidone 9mg TAB Invega Antipsychotics Accepted treatment Paroxetine 20mg TAB Paxil Adco-Paroxetine Selective serotonin receptor Motivation required inhibitors Pimozide 1mg TAB Orap Antipsychotics Accepted treatment Pimozide 4mg TAB Orap Antipsychotics Accepted treatment Quetiapine 25mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 100mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 200mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 300mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 50mg TAB Seroquel XR 50 Antipsychotics Accepted treatment Quetiapine 200mg TAB Seroquel XR 200 Antipsychotics Accepted treatment Quetiapine 300mg TAB Seroquel XR Antipsychotics Accepted treatment Quetiapine 400mg TAB Seroquel XR 400 Antipsychotics Accepted treatment Reboxetine 4mg TAB Edronax Other antidepressant Motivation required Risperidone 0.5mg TAB Aspen Risperidone Auropidone Antipsychotics Accepted treatment Risperidone 4mg TAB Auropidone Risponz Antipsychotics Accepted treatment Risperidone 1mg TAB DRL-Risperidone Mylan-Risperidone Antipsychotics Accepted treatment Risperidone 2mg TAB Perizal Rispacor Antipsychotics Accepted treatment Risperidone 3mg TAB Rispacor Risperdal Antipsychotics Accepted treatment Risperidone 1mg/ml SYR Risperdal Antipsychotics Accepted treatment Sertraline 100mg TAB Arrow Sertraline Austell-Sertraline Selective serotonin receptor Motivation required inhibitors Sertraline 50mg TAB Serdep Serlife Selective serotonin receptor Motivation required inhibitors Sulpiride 200mg TAB Bio-Sulpiride Other antidepressant Accepted treatment Sulpiride 50mg CAP SANDOZ Sulpiride Espiride Other antidepressant Accepted treatment Trazodone 100mg CAP Aspen Trazodone Molipaxin Other antidepressant Motivation required Trazodone 50mg CAP Aspen Trazodone Molipaxin Other antidepressant Motivation required Trifluoperazine 1mg TAB Stelazine Antipsychotics Accepted treatment Trifluoperazine 5mg TAB Stelazine Antipsychotics Accepted treatment Trimipramine 25mg TAB Tydamine Heterocyclic Antidepressants Motivation required Trimipramine 50mg CAP Tydamine Heterocyclic Antidepressants Motivation required Venlafaxine 50mg TAB Efexor Serotonin and noradrenaline re- Motivation required uptake inhibitors

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Venlafaxine 37.5mg TAB Illovex SR Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 150mg CAP Sandoz Velafaxine 150mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 75mg CAP Sandoz Velafaxine 75mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Ziprasidone 20mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 40mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 60mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 80mg CAP Geodon Antipsychotics Accepted treatment Zuclopenthixol 10mg TAB Clopixol Antipsychotics Accepted treatment Zuclopenthixol 2mg TAB Clopixol Antipsychotics Accepted treatment

SYSTEMIC LUPUS ERYTHEMATOSUS ICD10: L93.0, L93.1, L93.2, M32.0, M32.8, M32.9 Paracetamol will be reimbursed for Systemic Lupus Erythematosus

Azathioprine 50mg TAB Zaprine Azathioprine 50 Immunosuppressants Accepted treatment PCH Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Beclometasone 0.25mg/g CRE Beclate cream Corticosteroids, topical Accepted treatment Betamethasone 0.10% CRE Adco-betamethasone Lenovate Corticosteroids, topical Accepted treatment Betamethasone 0.05% OIN Diprosone Corticosteroids, topical Motivation required Betamethasone 0.05% CRE Diprosone Corticosteroids, topical Motivation required Celecoxib 100mg CAP Celebrex Coxib Motivation required Celecoxib 200mg CAP Celebrex Coxib Motivation required Chloroquine 200mg TAB Nivaquine Plasmoquine Aminoquinolines Accepted treatment Chloroquine 250mg TAB SANDOZ Chloroquine Aminoquinolines Accepted treatment phosphate Clobetasol 0.05g/100g CRE Dermovate Dovate Corticosteroids, topical Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Clobetasol 0.05g/100g OIN Dermovate Xenovate Corticosteroids, topical Motivation required Clobetasol 0.05g/100g LOT Dermovate scalp Corticosteroids, topical Motivation required Clobetasone 0.05g/100g CRE Eumovate Corticosteroids, topical Accepted treatment Clobetasone 0.05g/100g OIN Eumovate Corticosteroids, topical Accepted treatment Diclofenac 25mg TAB Adco-diclofenac Panamor-25 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SUP Diclohexal 100s Panamor supp-100 Non-steroidal anti-inflammatory Motivation required drugs Diclofenac 50mg TAB Diclohexal 50t Panamor at-50 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg CAP Fortfen SR Non-steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SRT Panamor-100 sr SANDOZ Diclofenac Non -steroidal anti-inflammatory Accepted treatment drugs Diclofenac 75mg SRT Panamor-75 sr Voltaren 75 Non - steroidal anti-inflammatory Accepted treatment drugs Diflucortolone 1mg/g CRE Nerisone Corticosteroids, topical Motivation required Diflucortolone 1mg/g OIN Nerisone fatty Corticosteroids, topical Motivation required Diflucortolone 3mg/g OIN Nerisone forte Corticosteroids, topical Motivation required Fluocinolone acetonide 0.25mg/g CRE Cortoderm Synalar Corticosteroids, topical Accepted treatment Fluocinolone acetonide 0.25mg/g OIN Cortoderm Corticosteroids, topical Accepted treatment Fluocinolone acetonide 1.25mg/5g CRE CORTODERM (PPF) Corticosteroids, topical Accepted treatment Fluocinolone acetonide 1.25mg/5g OIN CORTODERM (PPF) Corticosteroids, topical Accepted treatment Fluocinolone acetonide 0.25mg/g OIN Synalar Corticosteroids, topical Accepted treatment Fluocinolone acetonide 0.25mg/g JEL Synalar gel Corticosteroids, topical Motivation required Fluticasone 0.05g/100g CRE Cutivate Corticosteroids, topical Motivation required Fluticasone 0.05g/100g OIN Cutivate Corticosteroids, topical Motivation required Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Folic acid Accepted treatment Hydrocortisone 0.50% LOT Cutaderm Corticosteroids, topical Accepted treatment Hydrocortisone 0.5g OIN Dilucort Corticosteroids, topical Accepted treatment Hydrocortisone 10mg/g OIN Mylocort Procutan Corticosteroids, topical Accepted treatment Hydrocortisone 1% CRE Mylocort Stopitch Corticosteroids, topical Accepted treatment Hydrocortisone 5mg/g CRE Skincalm Dilucort Corticosteroids, topical Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Hydrocortisone butyrate 1mg/g CRE Locoid Locoid lipocream Corticosteroids, topical Motivation required Hydrocortisone butyrate 1mg/g OIN Locoid Corticosteroids, topical Motivation required Hydrocortisone butyrate 1mg/g LOT Locoid Locoid crelo Corticosteroids, topical Motivation required Ibuprofen 400mg TAB Adco-ibuprofen Ranfen Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 100mg/5ml SUS Brufen paed susp Ibumax Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 200mg TAB SANDOZ Ibuprofen Inza Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 600mg TAB SANDOZ Ibuprofen Brufen Non -steroidal anti-inflammatory Accepted treatment drugs Indomethacin 100mg SUP Arthrexin Indocid Non -steroidal anti-inflammatory Motivation required drugs Indomethacin 25mg CAP SANDOZ Idomethacin Arthrexin Non -steroidal anti-inflammatory Accepted treatment drugs Ketoprofen 200mg SRC Ketoflam Non-steroidal anti-inflammatory Accepted treatment drugs Mefenamic acid 250mg CAP Adco-mefenamic acid Fenamin Non-steroidal anti-inflammatory Motivation required drugs Mefenamic acid 500mg CAP Adco-mefenamic acid Non-steroidal anti-inflammatory Motivation required drugs Mefenamic acid 500mg TAB Fenamin Ponstel Non-steroidal anti-inflammatory Motivation required drugs Meloxicam 15mg TAB Loxiflam Arrow Meloxicam Non-steroidal anti-inflammatory Accepted treatment drugs Meloxicam 7.5mg TAB SANDOZ Meloxicam Coxflam Non -steroidal anti-inflammatory Accepted treatment drugs Methotrexate 2.5mg TAB Emthexate Methotrexate Immunosuppressants Accepted treatment Methylprednisolone 16mg TAB Medrol Oral corticosteroids Motivation required Methylprednisolone 4mg TAB Medrol Oral corticosteroids Accepted treatment Methylprednisolone aceponate 1mg/g OIN Advantan Advantan fatty oint Corticosteroids, topical Motivation required Methylprednisolone aceponate 1mg/g CRE Advantan Advantan milk Corticosteroids, topical Motivation required Mometasone 1mg/g CRE Aspen Mometasone Mometagen Corticosteroids, topical Motivation required Mometasone 1mg/g LOT Elocon Corticosteroids, topical Motivation required Mometasone 1mg/g OIN Elocon Corticosteroids, topical Motivation required Naproxen 250mg TAB Adco-naproxen Mylan-naproxen Non - steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg SUP Nafasol Non-steroidal anti-inflammatory Motivation required drugs Naproxen 250mg ECT Nafasol ec-250 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg ECT Nafasol ec-500 Non-steroidal anti-inflammatory Accepted treatment drugs

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Naproxen 500mg TAB Napflam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 10mg CAP Adco-piroxicam Rolab-piroxicam Non - steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg CAP Adco-piroxicam Xycam Non -steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg TAB Brexecam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg DSP Pixicam Xycam dispers Non - steroidal anti-inflammatory Accepted treatment drugs Prednisolone 5mg TAB Lenisolone Capsoid Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Panafcort Meticorten Corticosteroids , oral Accepted treatment

ULCERATIVE COLITIS ICD10: K51.0, K51.2, K51.3, K51.4, K51.5, K51.8, K51.9 Azathioprine 50mg TAB Zaprine Azapress Immunosuppressants Accepted treatment Betamethasone 0.5mg TAB Betanoid Celestone Corticosteriod, oral Motivation required Budesonide 3mg CAP Entocord Corticosteriod, oral Motivation required Budesonide 0.02mg/ml ENE Entocord INTESTINAL ANTIINFLAMMATORY Motivation required AGENTS Hydrocortisone 10mg TAB Covocort Corticosteroids , oral Accepted treatment INFLIXIMAB 100mg INF Revellex Multidose Motivation required Loperamide 2mg TAB Adco-loperamide Prodium Antipropulsives Accepted treatment Mesalazine 800mg TAB Asacol 5-ASA agents Accepted treatment Mesalazine 2g/50ml ENE Asacol 5-ASA agents Accepted treatment Mesalazine 400mg TAB Asacol 5-ASA agents Accepted treatment Mesalazine 500mg SUP Asacol 5-ASA agents Accepted treatment Mesalazine 1000mg SUP Pentasa 5-ASA agents Accepted treatment Mesalazine 500mg TAB Pentasa 5-ASA agents Accepted treatment Methotrexate 2.5mg TAB Emthexate Methotrexate Immunosuppressants Accepted treatment Methylprednisolone 4mg TAB Medrol Corticosteriod, oral Accepted treatment Methylprednisolone 16mg TAB Medrol Corticosteroids , oral Accepted treatment Methylprednisolone 4mg TAB Medrol Corticosteriod, oral Accepted treatment Olsalazine 250mg CAP Dipentum 5-ASA agents Accepted treatment Prednisolone 5mg TAB Lenisolone Prelone Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Sulfasalazine 500mg TAB Salazopyrin Salazopyrin e n 5 - ASA agents Accepted treatment

DIAGNOSES AND TREATMENT PAIRS (DTP) CONDITIONS ADRENOCORTICAL HYPERSECRETION ICD 10: E25.0 E25.8 E25.9 E26.0 E26.1 E26.8 E26.9 Eplerenone 25mg TAB Inspra Aldosterone antagonists Motivation required Eplerenone 50mg TAB Inspra Aldosterone antagonists Motivation required Hydrochlorothiazide and 50mg/5mg TAB Amiloretic Betaretic Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Dyazide Renezide Diuretics Accepted treatment potassium-sparing agents Spironolactone 25mg TAB Aldactone SANDOZ Diuretics Accepted treatment Spironolactone Spironolactone 100mg TAB Spiractin Aldactone Diuretics Accepted treatment

ADRENOCORTICAL INSUFFICIENCY ICD 10: E27.0 E27.1 E27.2 E27.3 E27.4 E27.5 E27.8 E27.9 Fludrocortisone 0.1mg TAB Florinef acetate Corticosteroids , oral Motivation required Hydrocortisone 10mg TAB Covocort Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Accepted treatment Prednisolone 5mg TAB Lenisolone Capsoid Corticosteroids , oral Accepted treatment

ANAEMIA ICD 10: D50.0 D51.0 D50.8 D50.9 D51.0 D51.1 D51.2 D51.3 D51.8 D51.9 D52.0 D52.1 D52.8 D52.9 D53.0 D53.1 D53.2 D53.8 D53.9 D55.0 D55.1 D55.2 D55.3 D55.8 D55.9 D57.0 D57.1 D57.2 D57.8 D58.0 D58.1 D59.0 D59.1 D59.2 D59.3 D59.4 D59.6 D59.8 D59.9 D60.0 D60.1 D60.8 D60.9 D61.0 D61.1 D61.2 D61.3 D61.8 D61.9 D62 D63.0 Cyanocobalamin 1000mcg/ml INJ Vitamin b12 10ml Iron supplementation, oral Motivation required, FULL BLOOD COUNT Cyanocobalamin 1000mcg/ml INJ Vitamin b12 1ml Iron supplementation, oral Motivation required, FULL BLOOD COUNT Ferric oxide polymaltose complex SYR Feroglobin Iron supplementation, oral Motivation required, FULL BLOOD COUNT

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Ferric oxide polymaltose complex 50mg SYR Ferrimed Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferric oxide polymaltose complex CAP Ferrimed Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferric oxide polymaltose complex 100mg CHU Ferrimed ds chewable Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferrous fumarate TAB Pregamal Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferrous Lactate 25mg DRP Ferro L drops Iron supplementation, oral special investigations, Full blood count Ferrous sulfate TAB Ferrous forte chelated iron Ferrous sulph co Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferrous sulfate 100mg TAB Ferrous sulphate Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferrous sulfate 30mg TAB Ferrous sulphate Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Ferrous sulfate CAP Fefol spansule Iron supplementation, oral Special ivestigations, FULL BLOOD COUNT Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Accepted treatment Iron and multivitamins TAB Fero-grad Iron preparations Special ivestigations, FULL BLOOD COUNT Iron multivitamins and folic acid CAP Autrin Iron preparations Special ivestigations, FULL BLOOD COUNT Iron multivitamins and folic acid 500mg TAB Fero-folic Iron preparations Special ivestigations, FULL BLOOD COUNT Iron multivitamins and folic acid 100mg TAB Foliferr Iron multivitamins and folic acid Special ivestigations, FULL BLOOD COUNT Iron vitamin B12 and folic acid TAB Foliglobin Iron preparations Special ivestigations, FULL BLOOD COUNT

ARRHYTHMIAS ICD 10: I44.0 I44.1 I44.2 I44.3 I44.4 I44.5 I44.6 I44.7 I45.0 I45.0 I45.1 I45.2 I45.3 I45.4 I45.5 I45.6 I45.8 I46.0 I46.9 I47.0 I47.1 I47.2 I47.9 I49.0 I49.1 I49.3 I49.4 I49.5 I49.8 I49.9 P29.1 Acebutolol 400mg TAB Butobloc Sectral Beta Blocker Motivation required Acebutolol 100mg CAP Sectral Beta Blocker Motivation required Acebutolol 200mg CAP Sectral Beta Blocker Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amiodarone 100mg TAB AryCor Hexarone Antiarrhythmics Accepted treatment Amiodarone 200mg TAB AryCor Hexarone Antiarrhythmics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Atenolol 100mg TAB Sandoz Atenolol Tenopress Beta blockers Accepted treatment Atenolol 50mg TAB SANDOZ Atenolol Tenopress Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Beta blockers Accepted treatment Bisoprolol 10mg TAB Cardicor Bilocor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Cardicor Bilocor Beta blockers Accepted treatment Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.25mg TAB Lanoxin Purgoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Accepted treatment Disopyramide 100mg CAP Rythmodan Antiarrhythmics Motivation required Disopyramide 250mg TAB Rythmodan retard Antiarrhythmics Motivation required Flecainide 100mg TAB Tambocor Antiarrhythmics Motivation required Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Potassium chloride 600mg TAB Plenish k SANDOZ K-600 Potassium supplements Accepted treatment Propafenone 150mg TAB Rythmol Antiarrhythmics Motivation required Propafenone 300mg TAB Rythmol Antiarrhythmics Motivation required Propranolol 10mg TAB Indoblok 10 Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Indoblok 40 Prodorol Beta blockers Accepted treatment Quinidine 200mg TAB Quinidine sulph Antiarrhythmics Motivation required Sotalol 160mg TAB Sotahexal Beta blockers Motivation required Sotalol 80mg TAB Sotahexal Beta blockers Motivation required Verapamil 40mg TAB Isoptin Vasomil Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment

BENIGN PROSTATIC HYPERTROPHY ICD 10: N40, N42.3 Alfuzosin 10mg TAB Rantral MR Xatral xl Alpha -adrenoreceptor antagonists Motivation required Doxazosin 1mg TAB Adco-doxazosin Cardugen (Prev Alpha-adrenoreceptor antagonists Accepted treatment Mylan-Doxasozin) Doxazosin 2mg TAB Adco-doxazosin Cardugen (prev Alpha-adrenoreceptor antagonists Accepted treatment Mylan-Doxasozin) Doxazosin 4mg TAB Adco-doxazosin Alpha-adrenoreceptor antagonists Accepted treatment Doxazosin (extended release) 4mg TAB Cardura XL Carzin XL Alpha-adrenoreceptor antagonists Accepted treatment Doxazosin (extended release) 8mg TAB Cardura xl Alpha-adrenoreceptor antagonists Accepted treatment Dutasteride CAP Avodart Testosterone-5-alpha reductase Motivation required inhibitors Finasteride 5mg TAB Fincar Finpro Testosterone-5-alpha reductase Motivation required inhibitors Prazosin 1mg TAB Pratsiol Alpha-adrenoreceptor antagonists Accepted treatment Prazosin 2mg TAB Pratsiol Alpha-adrenoreceptor antagonists Accepted treatment Prazosin 5mg TAB Pratsiol Alpha-adrenoreceptor antagonists Accepted treatment Tamsulosin 0.4mg SRC Uromax Beniprosin Alpha-adrenoreceptor antagonists Motivation required Terazosin 10mg TAB Hytrin Alpha-adrenoreceptor antagonists Motivation required Terazosin 1mg TAB Hytrin Alpha-adrenoreceptor antagonists Motivation required Terazosin 2mg TAB Hytrin Alpha-adrenoreceptor antagonists Motivation required Terazosin 5mg TAB Hytrin Alpha-adrenoreceptor antagonists Motivation required

COAGULATION DEFECTS ICD 10: D68.0 D68.1 D68.2 D68.3 D68.4 D68.8 D68.9 D69.1 D69.3 D69.4 D69.5 D69.6 D69.8 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Heparin 5000u/ml INJ Bio-heparin Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 5000u/ml INJ Bio-Heparin 5000 Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 100ml INF Trasylol Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 1000u/ml INJ Heparin sod 1ml-fresenius Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 5000u/ml INJ Heparin sod 1ml-fresenius Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 5000u/ml INJ Heparin sod 5ml-fresenius Antithrombotic Motivation required, PATHOLOGY REPORT Heparin 2500u/ml INJ Heparin sod 5ml-fresenius Antithrombotic Motivation required, PATHOLOGY REPORT Tranexamic acid 500mg TAB Tranexamic acid Medwich Cyklokapron Antifibrinolytics Motivation required, PATHOLOGY REPORT Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment

COMPLICATIONS OF HYPERTENSION ICD 10: I27.0 I27.2 I67.4 Q27.1 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amlodipine 10mg TAB Almadin Gulf Amlodipine Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Almadin Gulf Amlodipine Calcium channel blockers Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Motivation required Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.25mg TAB Lanoxin Purgoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Accepted treatment Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 2.5mg SRT Plendil Calcium channel blockers Accepted treatment Furosemide 40mg TAB Beurises Mylan-furosemide Diuretics Accepted treatment Furosemide 20mg TAB Lasix Diuretics Accepted treatment Furosemide 500mg TAB Lasix Diuretics Motivation required Furosemide 80mg TAB Lasix Diuretics Motivation required Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Furosemide 60mg CAP Lasix retard Diuretics Motivation required Hydrochlorothiazide and 50mg/5mg TAB Adco-retic Spec-Co-Amiloride Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Dyazide Renezide Diuretics Accepted treatment potassium-sparing agents Hydralazine 10mg TAB Hyperphen Vasodilators Accepted treatment Hydralazine 50mg TAB Hyperphen Vasodilators Accepted treatment Indapamide 2.5mg TAB Cipla-Indapamide Daptril Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Inadapamide Diuretics Accepted treatment SR Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Methyldopa (levorotatory) 250mg TAB Hypotone SANDOZ Antiadrenegic agents, centrally Accepted treatment Methyldopa acting Methyldopa (levorotatory) 500mg TAB Hypotone Antiadrenegic agents, centrally Accepted treatment acting Nifedipine 20mg SRT Cipalat Retard Nifedalat SR Calcium channel blockers Accepted treatment Nifedipine 30mg SRT Fedaloc Spec Nifedipine SR Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Fedaloc Spec Nifedipine SR Calcium channel blockers Accepted treatment Piretanide 3mg TAB Arelix Diuretics Accepted treatment Piretanide 6mg TAB Arelix Diuretics Accepted treatment Reserpine 0.25mg TAB Reserpine Antiadrenegic agents, centrally Accepted treatment Page 63 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM acting Sildenafil 20mg TAB Revatio Vasodilators Motivation required Spironolactone 100mg TAB Aldactone Spiractin Diuretics Accepted treatment Spironolactone 25mg TAB SANDOZ Spironolactone Spiractin Diuretics Accepted treatment Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Verapamil 40mg TAB Isoptin Vasomil Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment

CONGENITAL IODINE DEFICIENCY ICD 10: E00.0 E00.1 E00.2 E00.9 Levothyroxine sodium 0.05mg TAB Eltroxin Thyroid hormones Accepted treatment Levothyroxine sodium 0.1mg TAB Eltroxin Thyroid hormones Accepted treatment Levothyroxine sodium 100mcg TAB Euthyrox Synthroid 100mcg Thyroid hormones Accepted treatment Levothyroxine sodium 25mcg TAB Euthyrox Synthroid 25mcg Thyroid hormones Accepted treatment Levothyroxine sodium 50mcg TAB Euthyrox Synthroid 50mcg Thyroid hormones Accepted treatment Levothyroxine sodium 88mcg TAB Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 112mcg TAB Synthroid Thyroid hormones Accepted treatment Liothyronine sodium 90mcg TAB Diotroxin Thyroid hormones Accepted treatment Liothyronine sodium 20mcg TAB Tertroxin Thyroid hormones Accepted treatment

CUSHING'S SYNDROME ICD 10: E24.0 E24.1 E24.2 E24.3 E24.8 E24.9 Octreotide 0.05mg INJ Sandostatin Growth hormone release inhibitor Motivation required Octreotide 0.1mg INJ Sandostatin Growth hormone release inhibitor Motivation required Octreotide 0.2mg INJ Sandostatin Growth hormone release inhibitor Motivation required Octreotide 10mg INJ Sandostatin LAR prefilled Growth hormone release inhibitor Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Octreotide 20mg INJ Sandostatin LAR prefilled Growth hormone release inhibitor Motivation required

DELUSIONAL DISORDERS ICD 10: F22.0 F22.8 F22.9 Amitriptyline 10mg TAB Trepiline Heterocyclic antidepressant Accepted treatment Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Amisulpiride 50mg TAB Solian Antipsychotics Accepted treatment Amisulpiride 200mg TAB Solian Antipsychotics Accepted treatment Aripiprazole 10mg TAB Abilify Antipsychotics Accepted treatment Aripiprazole 15mg TAB Abilify Antipsychotics Accepted treatment Bupropion 150mg SRT Wellbutrin SR Antidepressant Motivation required Bupropion 150mg SRT Wellbutrin XL Antidepressant Motivation required Bupropion 300mg SRT Wellbutrin XL Antidepressant Motivation required Chlorpromazine 100mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 25mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 50mg TAB Largactil Antipsychotics Accepted treatment Citalopram 10mg TAB Austell-Citalopram Selective serotonin receptor Accepted treatment inhibitors Citalopram 20mg TAB Austell-Citalopram Depramil Selective serotonin receptor Accepted treatment inhibitors Citalopram 40mg TAB Austell-Citalopram Depramil Selective serotonin receptor Accepted treatment inhibitors Clomipramine 75mg SRT Anafranil simple reg Heterocyclic antidepressant Motivation required Clomipramine 25mg TAB Clomidep Equinorm Heterocyclic antidepressant Accepted treatment Clomipramine 10mg TAB Anafranil Equinorm Heterocyclic antidepressant Accepted treatment Clozapine 100mg TAB Cloment Leponex Antipsychotics Accepted treatment Clozapine 25mg TAB Cloment Leponex Antipsychotics Accepted treatment Dosulepin 25mg CAP Prothiaden Thaden Heterocyclic Antidepressants Accepted treatment Dosulepin 75mg TAB Thaden Heterocyclic Antidepressants Accepted treatment Duloxetine 30mg CAP Cymbalta Cymgen Selective serotonin reuptake Motivation required inhibitors Duloxetine 60mg CAP Cymbalta Cymgen Selective serotonin reuptake Motivation required inhibitors Escitalopram 10mg TAB Citraz Zytomil Selective serotonin reuptake Motivation required inhibitors Escitalopram 20mg TAB Citraz Zytomil Selective serotonin reuptake Motivation required inhibitors Page 65 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Fluoxetine 20mg CAP A-Lennon Fluoxetine Zydus-Fluoxetine Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 20mg TAB Lorien Rezak Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 40mg DSP Prohexal 40t Selective serotonin receptor Accepted treatment inhibitors Flupenthixol 0.5mg TAB Fluanxol Antipsychotics Accepted treatment Flupenthixol 1mg TAB Fluanxol Antipsychotics Accepted treatment Fluvoxamine 100mg TAB Faverin Fluvoxamine- Hexal Selective serotonin reuptake Motivation required inhibitors Haloperidol 1.5mg TAB SANDOZ Haloperidol Antipsychotics Accepted treatment Haloperidol 5mg TAB SANDOZ Haloperidol Serenace Antipsychotics Accepted treatment Haloperidol 0.5mg CAP Serenace Antipsychotics Accepted treatment Haloperidol 10mg TAB Serenace Antipsychotics Accepted treatment Imipramine 10mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Lithium 250mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 400mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 50mg CAP Lithium succinate Mood stabilisers Accepted treatment Lithium 450mg TAB Quilonum retard Mood stabilisers Accepted treatment Lofepramine 70mg TAB Emdalen Heterocyclic Antidepressants Accepted treatment Maprotiline 25mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Maprotiline 75mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Mianserin 10mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mianserin 30mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mirtazapine 15mg TAB Adco-Mirteron Mylan-Mirtazapine Antidepressants Motivation required Mirtazapine 30mg TAB Adco-Mirteron Mylan-Mirtazapine Antidepressants Motivation required Moclobemide 150mg TAB Depnil Monoamine oxidase type A Motivation required inhibitors Moclobemide 300mg TAB Depnil 300 Monoamine oxidase type A Motivation required inhibitors Olanzapine 10mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 2.5mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 5mg TAB Olexar Redilanz Antipsychotics Accepted treatment Paliperidone 3mg TAB Invega Antipsychotics Accepted treatment Paliperidone 6mg TAB Invega Antipsychotics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Paliperidone 9mg TAB Invega Antipsychotics Accepted treatment Paroxetine 12.5mg TAB Aropax CR Selective serotonin receptor Motivation required inhibitors Paroxetine 25mg TAB Aropax CR Selective serotonin receptor Motivation required inhibitors Paroxetine 20mg TAB Austell-Paroxetine Serrapress Selective serotonin receptor Motivation required inhibitors Paroxetine 30mg TAB Austell-Paroxetine Serrapress Selective serotonin receptor Motivation required inhibitors Pimozide 1mg TAB Orap Antipsychotics Motivation required Pimozide 4mg TAB Orap Antipsychotics Motivation required Quetiapine 100mg TAB Seroquel Dopaquel Antipsychotics Accepted treatment Quetiapine 200mg TAB Seroquel Dopaquel Antipsychotics Accepted treatment Quetiapine 25mg TAB Seroquel Dopaquel Antipsychotics Accepted treatment Quetiapine 300mg TAB Seroquel Truvalin Antipsychotics Accepted treatment Quetiapine 300mg TAB Seroquel XR Antipsychotics Accepted treatment Reboxetine 4mg TAB Edronax Monoamine oxidase type A Motivation required inhibitors Risperidone 0.5mg TAB DRL-Risperidone Risperidone-Hexal Antipsychotics Accepted treatment Risperidone 1.0mg TAB DRL-Risperidone Risperidone-Hexal Antipsychotics Accepted treatment Risperidone 2mg TAB DRL-Risperidone Risperidone-Hexal Antipsychotics Accepted treatment Risperidone 3mg TAB DRL-Risperidone Risperidone-Hexal Antipsychotics Accepted treatment Sertraline 100mg TAB Austell-Sertraline Sertzol Selective serotonin receptor Motivation required inhibitors Sertraline 50mg TAB Austell-Sertraline Sertzol Selective serotonin receptor Motivation required inhibitors Sulpiride 50mg CAP Eglonyl Espiride Substituted benzamide Accepted treatment Sulpiride 200mg TAB Bio-Sulpiride Substituted benzamide Accepted treatment Trazodone 100mg CAP Aspen Trazodone Molipaxin Antidepressants Motivation required Trazodone 50mg CAP Aspen Trazodone Molipaxin Antidepressants Motivation required Trifluoperazine 1mg TAB Stelazine Selective serotonin receptor Accepted treatment inhibitors Trifluoperazine 5mg TAB Stelazine Selective serotonin receptor Accepted treatment inhibitors Trimipramine 25mg TAB Tydamine Heterocyclic Antidepressants Motivation required Trimipramine 50mg CAP Tydamine Heterocyclic Antidepressants Motivation required Venlafaxine 50mg TAB Efexor Serotonin and noradrenaline re- Motivation required uptake inhibitors

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Venlafaxine 37.5mg TAB Illovex SR Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 75mg TAB Illovex SR Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 150mg TAB Illovex SR Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Ziprasidone 20mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 40mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 60mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 80mg CAP Geodon Antipsychotics Accepted treatment Zuclopenthixol 10mg TAB Clopixol Antipsychotics Accepted treatment Zuclopenthixol 2mg TAB Clopixol Antipsychotics Accepted treatment

DISSEMINATED BULLOUS SKIN DISEASE ICD 10: L10.0 L10.1 L10.2 L10.3 L10.4 L10.5 L10.8 L10.9 L12.0 L12.1 L12.2 L12.3 L12.8 L12.9 L13.0 L13.1 L13.8 L13.9 Q81.0 Q81.1 Q81.2 Q81.8 Q81.9 Azathioprine 50mg TAB Azamun Azathioprine Immunosuppressants Accepted treatment Betamethasone 0.5mg TAB Betanoid Celestone Corticosteroids , oral Motivation required Ciclosporin 100mg CAP Sandimmun Neoral soft gel Immuosuppressants Motivation required Ciclosporin 25mg CAP Sandimmun Neoral soft gel Immuosuppressants Motivation required Cyclophosphamide 50mg TAB Endoxan Immunosuppressants Motivation required Methotrexate 2.5mg TAB Emthexate Methotrexate Immunosuppressants Accepted treatment Methylprednisolone 16mg TAB Medrol Corticosteroids , oral Motivation required Methylprednisolone 4mg TAB Medrol Corticosteroids , oral Accepted treatment Prednisolone 5mg TAB Lenisolone Prelone Corticosteroids , oral Accepted treatment Prednisone 50mg TAB Meticorten Corticosteroids , oral Motivation required Prednisone 20mg TAB Pulmison Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Accepted treatment

ENDOMETRIOSIS ICD 10: N80.0 N80.1 N80.2 Cyproterone & Estrogen 2mg TAB Diva-35 Claro 35 Hormonal preparations, oral Motivation required Cyproterone acetate 50mg TAB Cipla-cyproterone acetate Cyproplex Hormonal preparations, oral Motivation required Cyproterone acetate 2mg TAB Adco-fem Diane-35 Hormonal preparations, oral Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Danazol 100mg CAP Danogen Ladazol (Ladogar) Antigonadotropins Motivation required Danazol 200mg CAP Danogen Ladazol (Ladogar) Antigonadotropins Motivation required Desogestrel and estrogen TAB Marvelon 150/30 Progestogens and estrogens fixed Motivation required combinations Desogestrel and estrogen TAB Mercilon Progestogens and estrogens fixed Motivation required combinations Drospirenone and estrogen TAB Yasmin Ruby Hormonal preparations, oral Motivation required Drospirenone and estrogen TAB Yaz Hormonal preparations, oral Motivation required Gestodene and estrogen TAB Femodene ed Minulette Hormonal preparations, oral Motivation required Gestodene and estrogen TAB Melodene Hormonal preparations, oral Motivation required Gestodene and estrogen TAB Mirelle Minesse Hormonal preparations, oral Motivation required Gestodene and estrogen TAB Tri-minulet Hormonal preparations, oral Motivation required Gestodene and estrogen TAB Triodene ed Hormonal preparations, oral Motivation required Goserelin 10.8mg INJ Zoladex Gonadotropin releasing hormone Motivation required analogues Goserelin 3.6mg INJ Zoladex Gonadotropin releasing hormone Motivation required analogues Leuprorelin 3.75mg INJ Lucrin Hormones and related agents Motivation required Leuprorelin 11.25mg INJ Lucrin Hormones and related agents Motivation required Levonorgestrel and estrogen TAB Biphasil Progestogens and estrogens Motivation required sequential preparations Levonorgestrel and estrogen TAB Logynon ed Progestogens and estrogens Motivation required sequential preparations Levonorgestrel and estrogen TAB Triphasil Progestogens and estrogens Motivation required sequential preparations Medroxyprogesterone 10mg TAB HEXAL-MPA 10 Provera Hormonal preparations, oral Accepted treatment Medroxyprogesterone 5mg TAB HEXAL-MPA 5 Provera Hormonal preparations, oral Accepted treatment Nafarelin NAS Synarel Gonadotrophin Releasing Motivation required Hormones and analogues Norethisterone 5mg TAB Primolut N Hormonal preparations, oral Accepted treatment Norethisterone and estrogen TAB Trinovum Hormonal preparations, oral Motivation required Norgestimate & oestrogen TAB Tricilest Hormonal preparations, oral Motivation required

HYPERPARATHYROIDISM ICD 10: E21.0 E21.1 E21.2 E21.3 E21.4 E21.5 Calcitonin (salmon synthetic) 200iu NAS Miacalcic nas spray Calcitonin preparations Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Calcitonin (salmon synthetic) 100iu INJ Miacalcic(calcitonin) Calcitonin preparations Motivation required Chloroquine 200mg TAB Nivaquine Aminoquinolines Accepted treatment Chloroquine 200mg CAP Plasmoquine Aminoquinolines Accepted treatment Chloroquine 250mg TAB SANDOZ Chloroquine Aminoquinolines Accepted treatment phosphate Cinacalcet 30mg TAB Sensipar Antiparathyroid hormones Motivation required Cinacalcet 60mg TAB Sensipar Antiparathyroid hormones Motivation required

HYPERTHYROIDISM ICD 10: E05.0 E05.1 E05.2 E05.3 E05.4 E05.5 E05.8 E05.9 Carbimazole 5mg TAB Neo-mercazole Imidazole derivatives Motivation required Propranolol 10mg TAB Indoblok 10 Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Indoblok 40 Prodorol Beta blockers Accepted treatment

HYPOPARATHYROIDISM ICD 10: E20.0 E20.1 E20.8 E20.9 E89.2 Calcium 500mg CHU B-cal Mineral Supplement Accepted treatment Calcium (different salts in 500mg CHU Virtual Care Calcium D Mineral Supplement Accepted treatment combination) Chewy Calcium (different salts in 500mg TAB Virtual Care Calcium D solid Mineral Supplement Accepted treatment combination) Calcium carbonate 500mg CHU Calcichew 500mg chewable Mineral Supplement Accepted treatment Calcium carbonate 500mg SAC Calcidose vit d oral powder Mineral Supplement Accepted treatment Calcium carbonate 500mg EFT Calcium-hexal 500 Fizzical 500 Mineral Supplement Accepted treatment Calcium carbonate 500mg TAB Calsuba calcium Mineral Supplement Accepted treatment Calcium carbonate 300mg CHU Caltrate 300 Link calcium Mineral Supplement Accepted treatment Calcium carbonate 600mg EFT Caltrate 600 + D Mineral Supplement Accepted treatment effervescent Calcium carbonate 600mg TAB Caltrate d Mineral Supplement Accepted treatment Calcium gluconate 300mg TAB Calcium gluconate (fams) Calcium gluconate Mineral Supplement Accepted treatment chew Calcium, combinations with other 500mg CHU B-cal-d vitamin & Mineral Supplement Accepted treatment drugs Calcium, combinations with other 500mg TAB B-cal-d vitamin & Mineral Supplement Accepted treatment drugs

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM ISCHAEMIC HEART DISEASE ICD 10: I21.0 I21.1 I21.2 I21.3 I21.4 I21.9 I22.0 I22.1 I22.8 I22.9 I23.0 I23.1 I23.2 I23.5 I23.6 I23.8 I24.1 I24.8 I24.9 I51.0 I51.1 I51.2 I51.3 I51.5 I51.7 Acebutolol 400mg TAB Butobloc Sectral Beta blockers Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg TAB Be-tabs aspirin (white) Disprin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amlodipine 10mg TAB Amlodac Keysal Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Klodip Stamlo Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Austell-Amlodipine Lomanor Calcium channel blockers Accepted treatment Amlodipine besylate 10mg TAB Calbloc Pharma Dynamics Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 50mg TAB Adco-atenolol B-Block Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Sandoz Atenolol Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB Tenchlor Tenoretic Beta blocker and diuretics Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Tenchlor hs Tenoret 50 Beta blocker and diuretics Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Cardicor Concor Beta blockers Accepted treatment Bisoprolol 10mg TAB Concor Bilocor Beta blockers Accepted treatment Carvedilol 12.5mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Carvedilol-Hexal Carvetrend Alpha/beta blockers Accepted treatment Clopidogrel 75mg TAB Clopivas Mistro Antithrombotic agent Motivation required Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Dipyridamole 100mg TAB Plato Antithrombotic agents Motivation required Dipyridimole 200mg SRC Persantin 200 Regards Antithrombotic agent Motivation required Dipyridimole & Acetylsalicylic acid 200mg/25 CAP Asasantin Antithrombotic agent Motivation required Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Glyceryl trinitrate 0.5mg TAB Angised Organic nitrates Accepted treatment Isosorbide dinitrate 40mg TAB Isordil tembid Organic nitrates Accepted treatment Isosorbide dinitrate 30mg TAB SANDOZ Isosorbide Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 10mg TAB SANDOZ Isosorbide Dinitrate Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 5mg TAB SANDOZ Isosorbide Dinitrate Isordil sublingual Organic nitrates Accepted treatment Isosorbide mononitrate 20mg TAB Elantan Ismo 20 Organic nitrates Accepted treatment Isosorbide mononitrate 50mg SRC Elantan la Organic nitrates Accepted treatment Isosorbide-5-mononitrate 60mg SRT Imdur Monicor SR Organic nitrates Accepted treatment Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Ivabradine 5mg TAB Corolan If-Channel Blocker Motivation required Ivabradine 7.5mg TAB Corolan If-Channel Blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Nifedipine 30mg TAB Adalat xl Calcium channel blockers Accepted treatment Nifedipine 60mg TAB Adalat xl Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Fedaloc Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Macorel 60 SR Calcium channel blockers Accepted treatment Nifedipine 20mg SRT Nifedalat SR Cipalat Retard Calcium channel blockers Accepted treatment Nifedipine 30mg SRT Spec Nifedipine SR Macorel 30 SR Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Spec Nifedipine SR Calcium channel blockers Accepted treatment Propranolol 10mg TAB Prodorol Purbloka Beta blockers Accepted treatment Propranolol 40mg TAB Prodorol Purbloka Beta blockers Accepted treatment Verapamil 240mg SRT Ravamil sr Calcicard sr 240 Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment

MENOPAUSE ICD 10: N95.0 N95.1 N95.2 N95.3 N95.8 N95.9 Clonidine 0.025mg TAB Dixarit Menograine Alpha-2 agonists Accepted treatment Conjugated estrogens 0.3mg TAB Premarin Hormone replacement therapy Accepted treatment Conjugated estrogens 0.625mg TAB Premarin Hormone replacement therapy Accepted treatment Conjugated estrogens 0.625mg/g VCR Premarin Hormone replacement therapy Motivation required Conjugated estrogens 1.25mg TAB Premarin Hormone replacement therapy Accepted treatment Cyproterone and estrogen TAB Climen Hormone replacement therapy Accepted treatment Drospirenone and estrogen 1mg/2mg TAB Angeliq Hormone replacement therapy Accepted treatment Dydrogesterone 10mg TAB Duphaston 10mg Testosterone-5-alpha reductase Accepted treatment inhibitors Dydrogesterone 50g CRE Progesterone cream 3 Hormone replacement therapy Motivation required Dydrogesterone and estrogen TAB Femoston 1/10 Hormone replacement therapy Accepted treatment Dydrogesterone and estrogen TAB Femoston-Conti Hormone replacement therapy Accepted treatment Estradiol 7.8mg PAD Climara 100 Hormone replacement therapy Accepted treatment Estradiol 3.9mg PAD Climara 50 Hormone replacement therapy Accepted treatment Estradiol 100mcg/day PAD Estraderm tts Estradot Hormone replacement therapy Accepted treatment Estradiol 25mcg/day PAD Estraderm tts Estradot Hormone replacement therapy Accepted treatment Estradiol 37.5mcg PAD Estradot Hormone replacement therapy Accepted treatment Estradiol 50mcg PAD Estradot Evorel 50 tts Hormone replacement therapy Accepted treatment Estradiol 75mcg PAD Estradot Evorel 75 tts Hormone replacement therapy Accepted treatment Estradiol 1mg TAB Estrofem Hormone replacement therapy Accepted treatment Estradiol 2mg TAB Estrofem Hormone replacement therapy Accepted treatment Estradiol 1mg TAB Estro-pause 1mg Hormone replacement therapy Accepted treatment Estradiol 2mg TAB Estro-pause 2mg Hormone replacement therapy Accepted treatment Estradiol JEL Femigel pump Hormone replacement therapy Accepted treatment Estradiol 20mg IMP Oestradiol Hormone replacement therapy Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Estradiol 1mg TAB Progynova Hormone replacement therapy Accepted treatment Estradiol 2mg TAB Progynova Hormone replacement therapy Accepted treatment Estradiol VAT Vagifem Hormone replacement therapy Motivation required Estradiol; combinations TAB Menoflush Hormone replacement therapy Accepted treatment Estriol VCR Synapause vag Hormone replacement therapy Motivation required Estriol 2mg TAB Synapause-e3 Hormone replacement therapy Accepted treatment Medrogestone and estrogen 25mg TAB Premelle Hormone replacement therapy Accepted treatment Medrogestone and estrogen 5mg TAB Premelle Hormone replacement therapy Accepted treatment Medrogestone and estrogen 0.3mg/1.5mg TAB Premelle LD Hormone replacement therapy Accepted treatment Medrogestone and estrogen TAB Premelle-cycle 5 Hormone replacement therapy Accepted treatment Medrogestone and estrogen 1.25mg TAB Prempak-n Hormone replacement therapy Accepted treatment Medroxyprogesterone 10mg TAB HEXAL-MPA 10 Provera Hormone replacement therapy Accepted treatment Medroxyprogesterone 5mg TAB HEXAL-MPA 5 Provera Hormone replacement therapy Accepted treatment Medroxyprogesterone and TAB Divina Hormone replacement therapy Accepted treatment estrogen Norethisterone 5mg TAB Primolut n Hormone replacement therapy Accepted treatment Norethisterone and estrogen TAB Activelle Hormone replacement therapy Accepted treatment Norethisterone and estrogen 50/140 PAD Estalis Hormone replacement therapy Accepted treatment Norethisterone and estrogen 50/250 PAD Estalis Hormone replacement therapy Accepted treatment Norethisterone and estrogen PAD Evorel conti Evorel sequi Hormone replacement therapy Accepted treatment Norethisterone and estrogen TAB Novofem Hormone replacement therapy Accepted treatment Norethisterone and estrogen TAB Estro-pause n Hormone replacement therapy Accepted treatment Norethisterone and estrogen TAB Estro-pause n forte Hormone replacement therapy Accepted treatment Norethisterone and estrogen 2mg/1mg TAB Kliogest Hormone replacement therapy Accepted treatment Norethisterone and estrogen TAB Trisequens Hormone replacement therapy Accepted treatment Norgestimate and estrogen TAB Cilest Hormone replacement therapy Accepted treatment Norgestrel and estrogen TAB Postoval Hormone replacement therapy Accepted treatment Progesterone 100mg CAP Utrogestan Hormone replacement therapy Accepted treatment Progesterone 200mg CAP Utrogestan Hormone replacement therapy Accepted treatment Tibolone 2.5mg TAB Livifem Progestogens Motivation required

MUSCULAR DYSTROPHY ICD 10: G71.0 Page 74 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Acebutolol 400mg TAB Butobloc Sectral Beta Blocker Motivation required Acebutolol 100mg CAP Sectral Beta Blocker Motivation required Acebutolol 200mg CAP Sectral Beta Blocker Motivation required Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 300mg TAB Gulf aspirin Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Amiodarone 100mg TAB AryCor Hexarone Antiarrhythmics Accepted treatment Amiodarone 200mg TAB AryCor Hexarone Antiarrhythmics Accepted treatment Amlodipine besylate 10mg TAB Austell-Amlodipine Calbloc Calcium channel blockers Accepted treatment Amlodipine Besylate 5mg TAB Lomanor Ciplavasc Calcium channel blockers Accepted treatment Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 50mg TAB Gulf Atenolol Tenopress Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Tenopress Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB SANDOZ Co-tenidone Tenchlor Beta blockers and combinations Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor hs Beta blockers and combinations Accepted treatment 50mg/12.5mg Atenolol and thiazides 100mg/25mg TAB Adco-loten Beta blockers and combinations Accepted treatment Benazepril 10mg TAB Cibace Ace Inhibitor Motivation required Benazepril and diuretics 10mg/12.5mg TAB CIBADREX 30 Benazepril and diuretics Accepted treatment Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Benazepril and diuretics Motivation required Bisoprolol 10mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Accepted treatment Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers Motivation required Captopril 25mg TAB Bio-Captopril ACE-inhibitors Accepted treatment Captopril 12.5mg TAB Captohexal ACE-inhibitors Accepted treatment Captopril 25mg TAB Captohexal Mylan-captopril 25 ACE - inhibitors Accepted treatment Captopril 50mg TAB Captohexal Mylan-captopril 50 ACE - inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Captoretic ACE-inhibitors and combinations Accepted treatment Captopril and diuretics 50mg/25mg TAB Zapto-co ACE-inhibitors and combinations Accepted treatment Carbamazepine 100mg/5ml SUS Tegretol s Anticonvulsants Accepted treatment Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Anticonvulsants Accepted treatment Carbamazepine 200mg TAB SANDOZ Carbamazepine Tegretol 200 Anticonvulsants Accepted treatment Carbamazepine 200mg SRT SANDOZ Carbamazepine CR Tegretol 200 Anticonvulsants Accepted treatment Carvedilol 12.5mg TAB Aspen-Carvidelol Carloc Alpha/beta blockers Accepted treatment Carvedilol 25mg TAB Aspen-Carvidelol Carloc Alpha/beta blockers Accepted treatment Carvedilol 6.25mg TAB Aspen-Carvidelol Carloc Alpha/beta blockers Accepted treatment Chlortalidone 50mg TAB Hygroton Low Ceiling Diuretic Motivation required Cilazapril 5mg TAB Inhibace Ace Inhibitor Motivation required Cilazapril and diuretics 5mg/12.5mg TAB Inhibace plus ACE inhibitors and diuretics Motivation required Clonazepam 0.5mg TAB Rivotril Benzodiazepine derivatives Motivation required Clonazepam 2.5mg DRP Rivotril Benzodiazepine derivatives Motivation required Clonazepam 2mg TAB Rivotril Benzodiazepine derivatives Motivation required Digoxin 0.0625mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.25mg TAB Lanoxin Cardiac glycosides Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment Diltiazem 60mg TAB Adco-Zildem Calcium channel blockers Motivation required Diltiazem 90mg TAB Adco-Zildem Calcium channel blockers Motivation required Disopyramide 100mg CAP Rythmodan Antiarrhythmics Motivation required Disopyramide 250mg TAB Rythmodan retard Antiarrhythmics Motivation required Enalapril 5mg TAB Pharmapress Ciplatec 5 ACE -inhibitors Accepted treatment Enalapril 10mg TAB Pharmapress Ciplatec 10 ACE -inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Enalapril 20mg TAB Pharmapress Ciplatec 20 ACE -inhibitors Accepted treatment Enalapril 2.5mg TAB Renitec 2 5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Enap co Pharmapress co ACE - inhibitors and combinations Accepted treatment Enalapril and Lercandipine 10mg/10mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Enalapril and Lercandipine 10mg/20mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Eplerenone 25mg TAB Inspra Aldosterone antagonists Motivation required Eplerenone 50mg TAB Inspra Aldosterone antagonists Motivation required Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Ethosuximide 250mg/5ml SYR Zarontin Anticonvulsants Accepted treatment Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felbamate 400mg TAB Taloxa Anticonvulsants Motivation required Felbamate 600mg/5ml SUS Taloxa Anticonvulsants Motivation required Flecainide 100mg TAB Tambocor Antiarrhythmics Motivation required Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Accepted treatment Folic acid 5mg CAP Folic acid Folic acid Accepted treatment Fosinopril 10mg TAB Mylan-Fosinopril Ace Inhibitors Accepted treatment Furosemide 40mg TAB Beurises Mylan-furosemide Diuretics Accepted treatment Furosemide 20mg TAB Lasix Diuretics Accepted treatment Furosemide 500mg TAB Lasix Diuretics Motivation required Furosemide 80mg TAB Lasix Diuretics Motivation required Furosemide 60mg CAP Lasix retard Diuretics Motivation required Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Gabapentin 100mg CAP Epleptin Ran-Gabapentin Anticonvulsants Motivation required Gabapentin 300mg CAP Epleptin Anticonvulsants Motivation required Gabapentin 400mg CAP Ran-Gabapentin Anticonvulsants Motivation required Gabapentin 600mg TAB Neurontin Anticonvulsants Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Gabapentin 800mg TAB Neurontin Anticonvulsants Motivation required Hydralazine 10mg TAB Hyperphen Vasodilators Accepted treatment Hydralazine 50mg TAB SANDOZ Hydralazine Hyperphen Vasodilators Accepted treatment Hydrochlorothiazide 25mg TAB Hexazide Ridaq Diuretics Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Hydrochlorothiazide and 25mg;25mg TAB Aldazide Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Dyazide Renezide Diuretics Accepted treatment potassium-sparing agents Indapamide 2.5mg TAB Dapamax Daptril Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Indapamide Diuretics Accepted treatment SR Irbesartan 150mg TAB Aprovel Iberwin Angiotension receptor antagonist Motivation required Irbesartan 300mg TAB Aprovel Iberwin Angiotension receptor antagonist Motivation required Irbesartan & HCTZ 150/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Irbesartan & HCTZ 300/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Isosorbide dinitrate 40mg TAB Isordil tembid Organic nitrates Accepted treatment Isosorbide dinitrate 30mg TAB SANDOZ Isosorbide Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 10mg TAB SANDOZ Isosorbide Dinitrate Isordil Organic nitrates Accepted treatment Isosorbide dinitrate 5mg TAB SANDOZ Isosorbide Dinitrate Isordil sublingual Organic nitrates Accepted treatment Lamotrigine 2mg DSP Lamictin P 2 Anticonvulsants Accepted treatment Lamotrigine 5mg DSP Lamictin p5 Anticonvulsants Accepted treatment Lamotrigine 100mg TAB Dyna-Lamotrigine Lamidus Anticonvulsants Accepted treatment Lamotrigine 200mg TAB Dyna-Lamotrigine Lamidus Anticonvulsants Accepted treatment Lamotrigine 25mg TAB Dyna-Lamotrigine Austell-Lamotrigine Anticonvulsants Accepted treatment Lamotrigine 50mg TAB Dyna-Lamotrigine Lamidus Anticonvulsants Accepted treatment Levetiracetam 100mg/ml SOL Keppra Other antiepileptics Motivation required Levetiracetam 250mg TAB Keppra Redilev Other antiepileptics Motivation required Levetiracetam 750mg TAB Keppra Redilev Other antiepileptics Motivation required Levetiracetam 500mg TAB Redilev Other antiepileptics Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Lisinopril 2.5mg TAB Austell-lisinopril ACE-inhibitors Accepted treatment Lisinopril 10mg TAB Sinopren 10 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 20mg TAB Sinopren 20 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 5mg TAB Sinopren 5 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril and diuretics 10mg/12.5mg TAB Lisoretic Lisozide ACE-inhibitors and combinations Accepted treatment Lisinopril and diuretics 20mg/12.5mg TAB Lisoretic Lisozide ACE-inhibitors and combinations Accepted treatment Losartan 100mg TAB Cipla Losartan Zartan Angiotensin receptor blockers Accepted treatment Losartan 50mg TAB Cipla Losartan Zartan Angiotensin receptor blockers Accepted treatment Losartan and diuretics 50mg/12.5mg TAB Zartan Co Losaar plus 50/12.5 Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 100mg/25mg TAB Zartan Co Losaar plus Angiotensin receptor blockers and Accepted treatment combinations Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Moexipril 75mg TAB Perdix Ace Inhibitor Accepted treatment Nifedipine 20mg SRT Adco-Nifedpine Nifedalat SR 20mg Calcium channel blockers Accepted treatment Nifedipine 30mg TAB Adco-Vascard Fedaloc SR Calcium channel blockers Accepted treatment Nifedipine 60mg TAB Adco-Vascard Fedaloc SR Calcium channel blockers Accepted treatment Oxcarbazepine 300mg TAB Trileptal fct Anticonvulsants Accepted treatment Oxcarbazepine 600mg TAB Trileptal fct Anticonvulsants Accepted treatment Perindopril 4mg TAB Cipla Perindopril Spec-Perindopril ACE-inhibitors Accepted treatment Perindopril 8mg TAB Cipla-Perindopril Spec-Perindopril ACE-inhibitors Accepted treatment Perindopril 10mg TAB Coversyl Prexum ACE-inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Spec-Perindopril ACE-inhibitors and combinations Accepted treatment Plus 2 Perindopril and diuretics 4mg/1.25mg TAB Pearinda Plus Spec-Perindopril ACE-inhibitors and combinations Accepted treatment Plus 4 Phenobarbital 10mg/5ml SYR Adco-phenobarb vital Anticonvulsants Accepted treatment Phenobarbital 30mg TAB Lethyl Sedabarb Anticonvulsants Accepted treatment Phenytoin 100mg CAP Epanutin Anticonvulsants Accepted treatment Phenytoin 125mg/5ml SUS Epanutin Anticonvulsants Accepted treatment Phenytoin 100mg TAB Phenytoin sod Anticonvulsants Accepted treatment Piretanide 3mg TAB Arelix Diuretics Accepted treatment Piretanide 6mg TAB Arelix Diuretics Accepted treatment Prednisone 5mg/ml SYR Pulmison paed oral solution Corticosteroids , oral Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Prednisone 50mg TAB Meticorten Corticosteroids , oral Motivation required Prednisone 20mg TAB Pulmison Corticosteroids , oral Accepted treatment Prednisone 5mg TAB Be-tabs prednisone Panafcort Corticosteroids , oral Accepted treatment Propafenone 150mg TAB Rythmol Antiarrhythmics Motivation required Propafenone 300mg TAB Rythmol Antiarrhythmics Motivation required Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required Propranolol 10mg TAB Indoblok 10 Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Indoblok 40 Prodorol Beta blockers Accepted treatment Quinapril 10mg TAB Accumax Quinaspen ACE - inhibitors Accepted treatment Quinapril 20mg TAB Accumax Quinaspen ACE - inhibitors Accepted treatment Quinapril and diuretics 10/12.5mg TAB Adco-Quinaretic Quinazide ACE-inhibitors and diuretics Accepted treatment Quinapril and diuretics 20/12.5mg TAB Adco-Quinaretic Accumax ACE-inhibitors and diuretics Accepted treatment Quinidine 200mg TAB Quinidine sulph Antiarrhythmics Motivation required Ramipril 1.25mg CAP Austell-Ramipril Rampil ACE -inhibitors Accepted treatment Ramipril 2.5mg CAP Austell-Ramipril Rampil ACE -inhibitors Accepted treatment Ramipril 10mg CAP Austell-Ramipril Rampil ACE -inhibitors Accepted treatment Ramipril 5mg CAP Austell-Ramipril Rampil ACE -inhibitors Accepted treatment Sotalol 160mg TAB Sotahexal Beta blockers Motivation required Sotalol 80mg TAB Sotahexal Beta blockers Motivation required Spironolactone 25mg TAB SANDOZ Spironolactone Spiractin Diuretics Accepted treatment Spironolactone 100mg TAB Aldactone Spiractin Diuretics Accepted treatment Telmisartan 40mg TAB Micardis Pritor Angiotensin receptor anatgonist Accepted treatment Telmisartan 80mg TAB Micardis Pritor Angiotensin receptor anatgonist Accepted treatment Telmisartan and diuretics 40mg/12.5mg TAB Co-Pritor Angiotensin receptor anatgonist Accepted treatment and Diuretics Telmisartan and diuretics 80mg/12.5mg TAB Co-Pritor Angiotensin receptor anatgonist Accepted treatment and Diuretics Telmisartan and diuretics 80mg/25mg TAB Co-micardis Angiotensin receptor anatgonist Accepted treatment and Diuretics Topiramate 15mg CAP Topamax sc sprinkle Anticonvulsants Motivation required Topiramate 200mg TAB Adco-topiramate Toplep Anticonvulsants Motivation required Topiramate 100mg TAB Epitoz Topalex Anticonvulsants Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Topiramate 25mg TAB Epitoz Topalex Anticonvulsants Motivation required Topiramate 50mg TAB Epitoz Topalex Anticonvulsants Motivation required Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Valproic acid 50mg/ml SYR Convulex Anticonvulsants Accepted treatment Valproic acid 100mg TAB Epilim 100 crushable Anticonvulsants Accepted treatment Valproic acid 200mg/5ml SYR Epilim sugar free Anticonvulsants Accepted treatment Valproic acid 150mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 300mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 500mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 200mg SRT Epilim cr 200 Anticonvulsants Accepted treatment Valproic acid 300mg SRT Epilim cr 300 Anticonvulsants Accepted treatment Valproic acid 500mg SRT Epilim cr 500 Anticonvulsants Accepted treatment Valsartan 320mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 160 mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 40mg TAB Diovan Angiotensin receptor blockers Accepted treatment Valsartan 80 mg TAB Diovan Migroben Angiotensin receptor blockers Accepted treatment Valsartan 160mg TAB Migroben Tareg Angiotensin receptor blockers Accepted treatment Valsartan and amlodipine 10mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan and amlodipine 5mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan, Amlodipine and 10mg/160mg/12.5mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 10mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/12.mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan and diuretics 320mg/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-diovan Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Migroben Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Migroben Co-Tareg Plus Angiotensin receptor blockers and Accepted treatment combinations Verapamil 40mg TAB Isoptin Vasomil Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Vigabatrin 500mg TAB Sabril Anticonvulsants Motivation required Warfarin 1mg TAB Cipla Warfarin Anticoagulants Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Anticoagulants Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Anticoagulants Accepted treatment Xipamide 20mg TAB Diurexan Low Ceiling Diuretic Accepted treatment MYCOBACTERIAL INFECTION (EXCL TB) ICD 10: A30.0 A30.1 A30.2 A30.3 A30.4 A30.5 A30.8 A30.9 A31.0 Amikacin 1000mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Amikacin 100mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Amikacin 250mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Amikacin 500mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Ciprofloxacin 250mg TAB Austell-Ciprofloxacin Cpl alliance Fluoroquinolones Motivation required, Sputum test ciprofloxacin Ciprofloxacin 500mg TAB Austell-Ciprofloxacin Cpl alliance Fluoroquinolones Motivation required, Sputum test ciprofloxacin Cycloserine 250mg CAP Aspen Cycloserine Antimycobacterial Motivation required, Sputum test Dapsone 100mg TAB Dapsone Antimycobacterial Special investigations, Sputum test Ethambutol 400mg TAB Sandoz ethambutol Antimycobacterial Special investigations, Sputum test Ethionamide 250mg TAB Ethatyl Antimycobacterial Motivation required, Sputum test Isoniazid 100mg TAB Norstan Isoniazid Be-tabs isoniazid Antimycobacterial Special investigations, Sputum test Kanamycin 1g/3ml INJ Kanamycin Aminoglycoside antibacterial Motivation required Ofloxacin 200mg TAB Tafloc Tarivid Quinolone antibacterial Motivation required Ofloxacin 400mg TAB Tafloc Quinolone antibacterial Motivation required Pyrazinamide 500mg TAB Pyrazide Sandoz Antimycobacterial Special investigations, Sputum test pyrazinamide Page 82 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Pyridoxine (vit B6) 25mg TAB Be-tabs pyridoxine hcl Pyridoxine Vitamin supplement Special investigations, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Pyridoxine Vitamin B6 Vitamin supplement Special investigations, Pathology report indicating deficiency Rifampicin 150mg CAP Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin 450mg TAB Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin 600mg TAB Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 150/150mg TAB Rifinah Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 300mg TAB Rifinah Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 150/75mg TAB Rimactazid Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 300/150mg TAB Rimactazid Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 60/30mg TAB Rimactazid paed Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 60/60mg TAB Rimactazid paed Antimycobacterial Special investigations, Sputum test Rifampicin, isoniazid, 150/75/400/275mg TAB Rifafour E-275 Rimstar 4-FDC Antimycobacterial Special investigations, Sputum test pyrazinamide & ethambutol Terizidone 250mg CAP Terivalidin Antimycobacterial Motivation required, Sputum test

NEONATAL CARDIAC DYSRHYTHMIA ICD 10: P29.1 Adenosine 6mg/2mg INJ Adenosine Antiarrhythmics Motivation required Acebutolol 100mg CAP Sectral Beta Blocker Motivation required Acebutolol 200mg CAP Sectral Beta Blocker Motivation required Acebutolol 400mg TAB Sectral Butobloc Beta Blocker Motivation required Amiodarone 100mg TAB Hexarone Cordarone x Antiarrhythmics Accepted treatment Amiodarone 200mg TAB Hexarone Cordarone x Antiarrhythmics Accepted treatment Atenolol 50mg TAB Gulf Atenolol Tenopress Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Tenopress Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Tenormin 25 Beta blockers Accepted treatment Bisoprolol 10mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Disopyramide 100mg CAP Rythmodan Antiarrhythmics Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Disopyramide 250mg TAB Rythmodan retard Antiarrhythmics Motivation required Flecainide 100mg TAB Tambocor Antiarrhythmics Motivation required Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Nicotinic acid 100mg TAB Be-tabs nicotinic acid Vitamin Supplement Motivation required, Pathology report indicating deficiency Propafenone 150mg TAB Rythmol Antiarrhythmics Motivation required Propafenone 300mg TAB Rythmol Antiarrhythmics Motivation required Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required Propranolol 10mg TAB Indoblok 10 Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Indoblok 40 Prodorol Beta blockers Accepted treatment Quinidine 200mg TAB Quinidine sulph Antiarrhythmics Motivation required Sotalol 160mg TAB Sotahexal Beta blockers Motivation required Sotalol 80mg TAB Sotahexal Beta blockers Motivation required

NEONATAL CARDIAC FAILURE ICD 10: P29.0 Digoxin 0.05mg/ml SYR Lanoxin paed Cardiac glycosides Accepted treatment Furosemide 10mg/ml SYR Lasix oral Diuretics Accepted treatment

NEPHRITIC SYNDROME ICD 10: N01.0 N01.1 N01.2 N01.3 N01.4 N01.5 N01.6 N01.7 N01.8 N01.9 N04.0 N04.1 N04.2 N04.3 N04.4 N04.5 N04.6 N04.7 N04.8 N04.9 N11.8 N11.9 N12 Acebutolol 400mg TAB Butobloc Sectral Beta Blocker Motivation required Acebutolol 100mg CAP Sectral Beta Blocker Motivation required Acebutolol 200mg CAP Sectral Beta Blocker Motivation required Alfacalcidol 0.25mcg CAP One alpha Alfacalcidol Accepted treatment Alfacalcidol 1mcg CAP One alpha Alfacalcidol Accepted treatment Amlodipine 10mg TAB Almadin Gulf Amlodipine Calcium channel blockers Accepted treatment Amlodipine 5mg TAB Almadin Gulf Amlodipine Calcium channel blockers Accepted treatment Amlodipine besylate 5mg TAB Calbloc Ciplavasc Calcium channel blockers Accepted treatment Amlodipine Besylate 10mg TAB Pharma Dynamics Norvasc Calcium channel blockers Accepted treatment Amlodipine Besylate Amlodipine maleate 10mg TAB Amlate Calcium channel blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Amlodipine maleate 5mg TAB Amlate Calcium channel blockers Accepted treatment Atenolol 50mg TAB Gulf Atenolol Tenormin 50 Beta blockers Accepted treatment Atenolol 100mg TAB Gulf Atenolol 100 Tenormin Beta blockers Accepted treatment Atenolol 25mg TAB Tenopress Beta blockers Accepted treatment Atenolol and other diuretics 100mg/25mg TAB SANDOZ Co-tenidone Tenchlor Beta blockers and combinations Accepted treatment Atenolol and other diuretics 50mg/12.5mg TAB Sandoz Co-tenidone Tenchlor hs Beta blockers and combinations Accepted treatment 50mg/12.5mg Benazepril 10mg TAB Cibace Ace Inhibitor Motivation required Benazepril and diuretics 10mg TAB CIBADREX 30 Benazepril and diuretics Accepted treatment Benazepril and diuretics 10mg/12.5mg TAB Cibadrex FCT Benazepril and diuretics Motivation required Bisoprolol 10mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 5mg TAB Bilocor Cardicor Beta blockers Accepted treatment Bisoprolol 2.5mg TAB Cardicor Beta blockers Accepted treatment Bisoprolol and thiazides 10mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bisoprolol and thiazides 2.5mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bisoprolol and thiazides 5mg/6.25mg TAB Ziak Bisoprolol and thiazides Accepted treatment Bumetanide 1mg TAB Burinex High Ceiling Diuretic Motivation required Calcitriol 0.25mcg CAP Rocaltrol Calcitriol special investigations, CCL/GFR Calcium carbonate TAB Titralac Mineral Supplement Accepted treatment ,CCL / GFR Candesartan 32mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 16mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan 8mg TAB Atacand Angiotensin receptor blockers Motivation required Candesartan and diuretics 16mg/12.5mg TAB Atacand plus Angiotensin receptor blockers Motivation required Captopril 12.5mg TAB Captohexal ACE-inhibitors Accepted treatment Captopril 25mg TAB Captohexal Mylan-captopril 25 ACE - inhibitors Accepted treatment Captopril 50mg TAB Captohexal Mylan-captopril 50 ACE - inhibitors Accepted treatment Captopril and diuretics 50mg/25mg TAB Captoretic Zapto-co ACE -inhibitors and combinations Accepted treatment Carvedilol 6.25mg TAB Carloc Carvetrend Alpha/ Beta Blocker combinations Accepted treatment Carvedilol 12.5mg TAB Carloc Carvetrend Alpha/ Beta Blocker combinations Accepted treatment Carvedilol 25mg TAB Carloc Carvetrend Alpha/ Beta Blocker combinations Accepted treatment Chlortalidone 50mg TAB Hygroton Low Ceiling Diuretic Motivation required Cilazapril 5mg TAB Inhibace Ace Inhibitor Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Cilazapril and diuretics 5mg/12.5mg TAB Inhibace plus ACE inhibitors and diuretics Motivation required Cinacalcet 30mg TAB Sensipar Antiparathyroid hormones Motivation required Cinacalcet 60mg TAB Sensipar Antiparathyroid hormones Motivation required Darbepoetin alfa 10mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Darbepoetin alfa 150mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Darbepoetin alfa 20mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Darbepoetin alfa 300mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Darbepoetin alfa 30mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Darbepoetin alfa 60mcg INJ Aranesp Erythropoietin, combinations Motivation required, CCL/ GFR Dextriferron 50mg/ml INJ CosmoFer Erythropoietin, combinations Motivation required, FULL BLOOD COUNT Dextriferron 50mg/2ml INJ CosmoFer Erythropoietin, combinations Motivation required, FULL BLOOD COUNT Diltiazem 60mg TAB Zildem 60 Calcium channel blockers Accepted treatment Diltiazem 90mg TAB Zildem 90 Calcium channel blockers Accepted treatment Diltiazem 180mg SRC Tilazem 180 cr Zildem 180 sr Calcium channel blockers Accepted treatment Diltiazem 240mg SRC Tilazem 240 cr Zildem 240 sr Calcium channel blockers Accepted treatment Enalapril 5mg TAB Pharmapress Ciplatec 5 ACE -inhibitors Accepted treatment Enalapril 10mg TAB Pharmapress Ciplatec 10 ACE -inhibitors Accepted treatment Enalapril 20mg TAB Pharmapress Ciplatec 20 ACE -inhibitors Accepted treatment Enalapril 2.5mg TAB Renitec 2 5 ACE-inhibitors Accepted treatment Enalapril and diuretics 20mg/12.5mg TAB Enap co Pharmapress co ACE - inhibitors and combinations Accepted treatment Enalapril and Lercandipine 10mg/10mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Enalapril and Lercandipine 10mg/20mg TAB Zaneril ACE inhibitors and calcium Motivation required channel blockers Eprosartan 600mg TAB Teveten 600 Angiotensin receptor anatagonist Motivation required Eprosartan 600mg/12.5mg TAB Teveten Plus Angiotensin receptor anatagonist Motivation required and diuretic Ergocalciferol 50000u TAB Calciferol Ergocalciferol Motivation required, Pathology report indicating deficiency Erythropoeitin 6000iu INJ Eprex Erythropoietin Motivation required, CCL/ GFR Erythropoietin 40000iu INJ Eprex 1ml Prefilled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 10000u/ml INJ Eprex prefill Erythropoietin Motivation required, CCL/ GFR Erythropoietin 2000u/05ml INJ Eprex prefill Erythropoietin Motivation required, CCL/ GFR Erythropoietin 4000u/04ml INJ Eprex prefill Erythropoietin Motivation required, CCL/ GFR

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Erythropoietin 10000iu INJ Recormon Pre-Filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 2000iu INJ Recormon Pre-Filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 30000iu INJ Recormon Pre-filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 4000iu INJ Recormon Pre-Filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 500iu INJ Recormon Pre-Filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 6000iu INJ Recormon Pre-Filled Erythropoietin Motivation required, CCL/ GFR Erythropoietin 2000iu INJ Repotin 1ml Erythropoietin Motivation required, CCL/ GFR Erythropoietin 4000iu INJ Repotin 1ml Iron Preparations Motivation required, CCL/ GFR Felodipine 10mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 5mg SRT Felodipine-Hexal Plendil Calcium channel blockers Accepted treatment Felodipine 2.5mg SRT Plendil Calcium channel blockers Accepted treatment Ferric oxide polymaltose complex SYR Feroglobin Iron supplementation, oral Motivation required, FULL BLOOD COUNT Ferric oxide polymaltose complex 50mg SYR Ferrimed Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferric oxide polymaltose complex CAP Ferrimed Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferric oxide polymaltose complex 100mg CHU Ferrimed ds chewable Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous fumarate TAB Pregamal Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous Lactate 25mg DRP Ferro L drops Iron Supplements Special investigations, Full blood count Ferrous sulfate TAB Ferrous Forte Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous sulfate TAB Ferrous forte chelated iron Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous sulfate TAB Ferrous sulph co Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous sulfate 100mg TAB Ferrous sulphate Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous sulfate 30mg TAB Ferrous sulphate Iron supplementation, oral Special investigations , FULL BLOOD COUNT Ferrous sulfate CAP Fefol spansule Iron supplementation, oral Special investigations , FULL BLOOD COUNT Folic acid 0.5mg TAB Folic acid Folic acid Accepted treatment Folic acid CAP Folic acid forte Folic acid Accepted treatment Folic acid 5mg TAB Be-tabs folic acid Folic acid Folic acid Accepted treatment Fosinopril 10mg TAB Mylan-Fosinopril Ace Inhibitors Accepted treatment Furosemide 40mg TAB Diuresix Mylan-furosemide Diuretics Accepted treatment Furosemide 20mg TAB Lasix Diuretics Accepted treatment Furosemide 500mg TAB Lasix Diuretics Motivation required Furosemide 80mg TAB Lasix Diuretics Motivation required Furosemide 60mg CAP Lasix retard Diuretics Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Furosemide 10mg/ml SYR Lasix oral Diuretics Motivation required Hydrochlorothiazide 25mg TAB Hexazide Ridaq Diuretics Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide and 50mg/300mg TAB Urirex-k Diuretics Accepted treatment potassium Hydrochlorothiazide and 50mg/5mg TAB Amiloretic Betaretic Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Hydrochlorothiazide and 50mg/25mg TAB Dyazide Renezide Diuretics Accepted treatment potassium-sparing agents Indapamide 2.5mg TAB Cipla-Indapamide Daptril Diuretics Accepted treatment Indapamide 1.5mg SRT Natrilix sr Dyna Indapamide Diuretics Accepted treatment SR Irbesartan 150mg TAB Aprovel Iberwin Angiotension receptor antagonist Motivation required Irbesartan 300mg TAB Aprovel Iberwin Angiotension receptor antagonist Motivation required Irbesartan & HCTZ 150/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Irbesartan & HCTZ 300/12.5mg TAB Co-Iberwin Coaprovel Angiotensin II antagonists and Motivation required diuretics Iron and multivitamins TAB Fero-grad Iron preparations Motivation required, FULL BLOOD COUNT Iron in other combinations 20mg/ml INJ Venofer Iron in other combinations Motivation required, FULL BLOOD COUNT Iron multivitamins and folic acid CAP Autrin Iron preparations Motivation required, FULL BLOOD COUNT Iron multivitamins and folic acid 500mg TAB Fero-folic Iron preparations Motivation required, FULL BLOOD COUNT Iron multivitamins and folic acid 100mg TAB Foliferr Iron multivitamins and folic acid Motivation required, FULL BLOOD COUNT Iron vitamin B12 and folic acid TAB Foliglobin Iron preparations Motivation required, FULL BLOOD COUNT Isradipine 2.5mg TAB Dynacirc Selective calcium channel blocker Motivation required Isradipine 5mg CAP Dynacirc sro Selective calcium channel blocker Motivation required Lercanidipine 20mg TAB Zanidip Selective Calcium Channel Blocker Motivation required Lercanidipine 10mg TAB Zanidip 10 Selective Calcium Channel Blocker Motivation required Lisinopril 10mg TAB Sinopren 10 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 20mg TAB Sinopren 20 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril 5mg TAB Sinopren 5 Simayla Lisinopril ACE-inhibitors Accepted treatment Lisinopril and diuretics 10mg/12.5mg TAB Lisoretic Lisozide ACE-inhibitors and combinations Accepted treatment Lisinopril and diuretics 20mg/12.5mg TAB Lisoretic Lisozide ACE-inhibitors and combinations Accepted treatment Losartan 100mg TAB Cipla Losartan Zartan Angiotensin receptor blockers Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Losartan 50mg TAB Cipla Losartan Zartan Angiotensin receptor blockers Accepted treatment Losartan and diuretics 50mg/12.5mg TAB Zartan Co Losaar plus 50/12.5 Angiotensin receptor blockers and Accepted treatment combinations Losartan and diuretics 100mg/25mg TAB Zartan Co Losaar plus Angiotensin receptor blockers and Accepted treatment combinations Erythropoietin 0.05mg/03ml INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 0.075mg/0.3ml INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 0.15mg/0.3ml INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 0.25mg/0.3ml INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 0.2mg/0.3ml INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 360mcg INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 120mcg INJ Mircera Erythropoietin Motivation required, CCL/ GFR Erythropoietin 30mcg INJ Mircera Erythropoietin Motivation required, CCL/ GFR Metoprolol 100mg TAB Lopresor Beta blocking agents selective Motivation required Moexipril 75mg TAB Perdix Ace Inhibitor Accepted treatment Nebivolol 5mg TAB Nebilet Lovispes Beta blockers Motivation required Nifedipine 20mg SRT Cipalat Retard Nifedalat SR Calcium channel blockers Accepted treatment Nifedipine 30mg SRT Macorel 30 SR Spec Nifedipine SR Calcium channel blockers Accepted treatment Nifedipine 60mg SRT Macorel 60 SR Spec Nifedipine SR Calcium channel blockers Accepted treatment Perindopril 4mg TAB Cipla Perindopril Vectoryl ACE-inhibitors Accepted treatment Perindopril 8mg TAB Cipla Perindopril Ciplasyl ACE-inhibitors Accepted treatment Perindopril 10mg TAB Coversyl Prexum ACE-inhibitors Accepted treatment Perindopril and diuretics 2mg/0.625mg TAB Acesyl Co Spec-Perindopril ACE-inhibitors and combinations Accepted treatment Plus 2 Perindopril and diuretics 4mg/1.25mg TAB Pearinda Plus Spec-Perindopril ACE-inhibitors and combinations Accepted treatment Plus 4 Piretanide 3mg TAB Arelix Diuretics Accepted treatment Piretanide 6mg TAB Arelix Diuretics Accepted treatment Potassium chloride 600mg TAB Plenish k SANDOZ K-600 Potassium supplements Accepted treatment Propranolol 160mg CAP Inderal la 160 Beta blockers Motivation required Propranolol 80mg CAP Inderal la 80 Beta blockers Motivation required Propranolol 10mg TAB Indoblok 10 Prodorol Beta blockers Accepted treatment Propranolol 40mg TAB Indoblok 40 Prodorol Beta blockers Accepted treatment Quinapril 10mg TAB Accumax Quinaspen ACE - inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Quinapril 20mg TAB Accumax Quinaspen ACE - inhibitors Accepted treatment Quinapril and diuretics 10/12.5mg TAB Accumax Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Quinapril and diuretics 20/12.5mg TAB Accumax Adco-Quinaretic ACE - inhibitors and diuretics Accepted treatment Ramipril 2.5mg CAP Ramiwin Rampil ACE -inhibitors Accepted treatment Ramipril 5mg CAP RamiWin Rampil ACE -inhibitors Accepted treatment Ramipril 10mg CAP Rampil Tritace ACE -inhibitors Accepted treatment Ramipril and calcium channel 2.5mg/2.5mg TAB Tri-plen ACE INHIBITORS COMBINATIONS Motivation required blockers Ramipril and calcium channel 5mg/5mg TAB Tri-plen forte ACE INHIBITORS COMBINATIONS Motivation required blockers Spironolactone 100mg TAB Aldactone Spiractin Diuretics Accepted treatment Telmisartan 40mg TAB Micardis Pritor Angiotensin receptor anatgonist Accepted treatment Telmisartan 80mg TAB Micardis Pritor Angiotensin receptor anatgonist Accepted treatment Telmisartan and diuretics 40mg/12.5mg TAB Co-Pritor Angiotensin receptor anatgonist Accepted treatment and Diuretics Telmisartan and diuretics 80mg/12.5mg TAB Co-Pritor Angiotensin receptor anatgonist Accepted treatment and Diuretics Telmisartan and diuretics 80mg/25mg TAB Co-micardis Angiotensin receptor anatgonist Motivation required and Diuretics Timolol; thiazides and other 10/2.5/25mg TAB Servatrin Beta blocker and diuretics Motivation required diuretics Torasemide 10mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 2.5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Torasemide 5mg TAB ToraHEXAL Unat High ceiling diuretics Motivation required Trandolapril 0.5mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Trandolapril 2mg CAP Mavik (was Gopten) ACE-inhibitors Accepted treatment Valsartan 160mg TAB Tareg Migroben Angiotensin receptor blockers Accepted treatment Valsartan 80mg TAB Tareg Migroben Angiotensin receptor blockers Accepted treatment Valsartan and amlodipine 10mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan and amlodipine 5mg/160mg TAB Exforge Angiotensin receptor blockers and Accepted treatment combinations Valsartan, Amlodipine and 10mg/160mg/12.5mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 10mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan, Amlodipine and 5mg/160mg/12.mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Valsartan, Amlodipine and 5mg/160mg/25mg TAB Co Exforge Angiotensin receptor blockers and Accepted treatment diuretic combinations Valsartan and diuretics 320/12.5mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 320mg/25mg TAB Co-Diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-diovan Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/12.5mg TAB Co-Migroben Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 160mg/25mg TAB Co-Migroben Co-Tareg Plus Angiotensin receptor blockers and Accepted treatment combinations Valsartan and diuretics 80mg/12.5mg TAB Co-Migroben Co-Tareg Angiotensin receptor blockers and Accepted treatment combinations Verapamil 240mg SRT Calcicard sr 240 Verahexal 240 sr Calcium channel blockers Accepted treatment Verapamil 40mg TAB Vasomil Isoptin Calcium channel blockers Accepted treatment Verapamil 80mg TAB Vasomil Calcium channel blockers Accepted treatment Xipamide 20mg TAB Diurexan Low Ceiling Diuretic Accepted treatment

NEPHROGENIC DIABETES INSIPIDUS ICD 10: N25.1 Carbamazepine 200mg TAB Degranol SANDOZ Anticonvulsants Accepted treatment Carbamazepine Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Anticonvulsants Accepted treatment Carbamazepine 200mg SRT SANDOZ Carbamazepine CR Tegretol CR Anticonvulsants Accepted treatment Diclofenac 25mg TAB Adco-diclofenac Panamor-25 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SUP Diclohexal 100s Panamor supp-100 Non-steroidal anti-inflammatory Motivation required drugs Diclofenac 50mg TAB Diclohexal 50t Panamor at-50 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg CAP Fortfen SR Non-steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SRT Panamor-100 sr SANDOZ Diclofenac Non-steroidal anti-inflammatory Accepted treatment Sodium SR drugs Diclofenac 75mg SRT Panamor-75 sr Voltaren 75 Non - steroidal anti-inflammatory Accepted treatment drugs Hydrochlorothiazide 25mg TAB Hexazide Ridaq Diuretics Accepted treatment Hydrochlorothiazide 12.5mg TAB Ridaq Diuretics Accepted treatment Hydrochlorothiazide and 50mg/5mg TAB Adco-retic Moduretic Diuretics Accepted treatment potassium-sparing agents Page 91 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Hydrochlorothiazide and 25mg/2.5mg TAB Amiloretic hs Diuretics Accepted treatment potassium-sparing agents Ibuprofen 400mg TAB Adco-ibuprofen Ranfen Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 100mg/5ml SUS Brufen paed susp Ibumax Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 200mg TAB SANDOZ Ibuprofen Inza Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 600mg TAB SANDOZ Ibuprofen Brufen Non -steroidal anti-inflammatory Accepted treatment drugs Indomethacin 100mg SUP Arthrexin Indocid Non -steroidal anti-inflammatory Motivation required drugs Indomethacin 25mg CAP SANDOZ Idomethacin Arthrexin Non -steroidal anti-inflammatory Accepted treatment drugs Ketoprofen 200mg SRC Ketoflam Non-steroidal anti-inflammatory Motivation required drugs Meloxicam 15mg TAB Loxiflam Arrow Meloxicam Non-steroidal anti-inflammatory Accepted treatment drugs Meloxicam 7.5mg TAB SANDOZ Meloxicam Coxflam Non -steroidal anti-inflammatory Accepted treatment drugs Methotrexate 2.5mg TAB Emthexate Emthexate Immunosuppressants Accepted treatment Naproxen 250mg TAB Adco-naproxen Mylan-naproxen Non - steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg SUP Nafasol Non-steroidal anti-inflammatory Motivation required drugs Naproxen 250mg ECT Nafasol ec-250 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg ECT Nafasol ec-500 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg TAB Napflam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 10mg CAP Adco-piroxicam Rolab-piroxicam Non - steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg CAP Adco-piroxicam Xycam Non -steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg TAB Brexecam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg DSP Pixicam Xycam dispers Non - steroidal anti-inflammatory Accepted treatment drugs

NEUROLOGICAL ABNORMALITIES OF THE NEWBORN ICD 10: G80.0 G80.1 G80.2 G80.3 G80.4 G80.8 G80.9 Baclofen 10mg TAB Bio-Baclofen Teva Baclofen Muscle relaxants Accepted treatment Baclofen 25mg TAB Lioresal Muscle relaxants Motivation required Carbamazepine 100mg/5ml SUS Tegretol s Anticonvulsants Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Carbamazepine 200mg TAB CPL-Carbamazepine Degranol Anticonvulsants Accepted treatment Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Anticonvulsants Accepted treatment Dantrolene 25mg CAP Dantrium Muscle relaxants Motivation required Valproic acid 50mg/ml SYR Convulex Anticonvulsants Accepted treatment Valproic acid 100mg TAB Epilim 100 crushable Anticonvulsants Accepted treatment Valproic acid 200mg/5ml SYR Epilim sugar free Anticonvulsants Accepted treatment Valproic acid 150mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 300mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 500mg CAP Convulex Anticonvulsants Accepted treatment Valproic acid 200mg SRT Epilim cr 200 Anticonvulsants Accepted treatment Valproic acid 300mg SRT Epilim cr 300 Anticonvulsants Accepted treatment Valproic acid 500mg SRT Epilim cr 500 Anticonvulsants Accepted treatment

NUTRITIONAL DEFICIENCIES ICD 10: E40 E41 E42 E43 E46 E50.0-E50.9 E51.1 E51.2 E51.8 E51.9 E52 E53.0 E53.1 E53.8 E53.9 E54 E55.0 E55.9 E56.1 E56.9 E61.1 E61.7 E63.0 Alfacalcidol 0.25mcg CAP One alpha Vitamin supplement Special Investigations, Pathology report indicating deficiency Alfacalcidol 1mcg CAP One alpha Vitamin supplement Special Investigations, Pathology report indicating deficiency Ascorbic acid (vit C) 100mg TAB Ascorbic acid Ascorbic acid Vitamin supplement Motivation required, Pathology report indicating (xpressmed) deficiency Ascorbic acid (vit C) 200mg TAB Ascorbic acid Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 250mg TAB Ascorbic acid Ascorbic acid Vitamin supplement Motivation required, Pathology report indicating (xpressmed) deficiency Ascorbic acid (vit C) 50mg TAB Ascorbic acid Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 250mg CHU Ascorbic Acid Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 500mg TAB Ascorbic Acid Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 100mg TAB Ascorbic acid (fams) Vitaforce acerola Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 500mg TAB Be-tabs ascorbic acid Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 300mg TAB Vitaforce Acerola Vital vit c Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 500mg TAB Vitaforce acerola Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 600mg TAB Vital vit c hp Vitamin c Vitamin supplement Motivation required, Pathology report indicating Page 93 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM deficiency Ascorbic acid (vit C) 150mg TAB Vitamin c (150mg) bio- Vitamin supplement Motivation required, Pathology report indicating organics deficiency Ascorbic acid (vit C) 1000mg TAB Vitamin C 1000mg Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 500mg TAB Vitamin c 500 Vitamin supplement Motivation required, Pathology report indicating deficiency Ascorbic acid (vit C) 500mg CAP Vitamin c 500 Vitamin supplement Motivation required, Pathology report indicating deficiency Calcitriol 0.25mg CAP Rocaltrol Vitamin supplement Motivation required, Pathology report indicating deficiency Combinations of vitamins TAB Vitaforce vit a+d+e Combinations of vitamins Motivation required, Pathology report indicating deficiency Ergocalciferol 50000u TAB Calciferol Vitamin supplement Motivation required, Pathology report indicating deficiency Ergocalciferol DRP Calciferol oily Vitamin supplement Motivation required, Pathology report indicating deficiency MULTIVITAMINS COMBINATIONS TAB VIT B CO CHOCOLATE MULTIVITAMINS COMBINATIONS Motivation required, Pathology report indicating deficiency MULTIVITAMINS COMBINATIONS TAB VIT B CO PINK MULTIVITAMINS COMBINATIONS Motivation required, Pathology report indicating deficiency Nicotinamide 100mg TAB Be-tabs nicotinamide Vitaforce Vitamin supplement Motivation required, Pathology report indicating nicotinamide deficiency Nicotinic acid 100mg TAB Holland and barrett niacin Vitamin supplement Motivation required, Pathology report indicating b3 deficiency Nicotinic acid 330mg CAP Niacin (flush free) Vitamin supplement Motivation required, Pathology report indicating deficiency Nicotinic acid 100mg TAB Niacin(Nicotinic Be-tabs nicotinic Vitamin supplement Motivation required, Pathology report indicating Acid)(Vitamin B3) acid deficiency Nicotinic acid CAP Vitamin B3 Vitamin supplement Motivation required, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Be-tabs pyridoxine hcl Vitamin supplement Motivation required, Pathology report indicating deficiency Pyridoxine (vit B6) 200mg TAB Lactosec Vitamin supplement Motivation required, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Pyridoxine Vitamin supplement Motivation required, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Pyridoxine Vitamin supplement Motivation required, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Vitamin B6 Vitamin supplement Motivation required, Pathology report indicating deficiency Retinol (vit A) 50000u TAB Arovit Vitamin supplement Motivation required, Pathology report indicating deficiency Riboflavin (vit B2) 100mg TAB Holland and barrett b2 Vitamin supplement Motivation required, Pathology report indicating riboflavin deficiency Thiamine (vit B1) 100mg TAB Thiamine hcl Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 1000iu CAP Vital vit e Vitamin supplement Motivation required, Pathology report indicating deficiency Page 94 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Tocopherol (vit E) 100iu CAP Vital vit e Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 400iu CAP Vital vit e Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 50iu CAP Vital vit e Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 200iu CAP Vitamin e Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 50mg CAP Vitamin e Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) 500iu CAP VITAMIN E 500IU Vitamin supplement Motivation required, Pathology report indicating deficiency Tocopherol (vit E) TAB Vitamin e bio-organics Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain SYR Vitamin b co Vitamin b co syrup Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain TAB Vitamin b co Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain TAB Vitamin b co (pink) Vitamin b co pink Vitamin supplement Motivation required, Pathology report indicating xpressmed deficiency Vitamin B-complex; plain TAB Vitamin b co (xpressmed) Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain TAB Vitamin b co chocolate Vitamin b co forte Vitamin supplement Motivation required, Pathology report indicating chocolate deficiency Vitamin B-complex; plain TAB Vitamin b co forte Vitamin supplement Motivation required, Pathology report indicating (xpressmed) deficiency Vitamin B-complex; plain SYR VITAMIN B CO SYRUP Vitamin b co Vitamin supplement Motivation required, Pathology report indicating syrup(fams) deficiency Vitamin B-complex; plain TAB VITAMIN B CO TAB Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain TAB Vitamin B Complex Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain CAP Vitamin b complex Vitamin supplement Motivation required, Pathology report indicating deficiency Vitamin B-complex; plain INJ Vitamin b complex Vitamin supplement Motivation required, Pathology report indicating deficiency

OVARIAN DYSFUNCTION ICD 10: E28.0 E28.1 E28.2 E28.3 E28.8 E28.9 L68.0 N34.2 N83.3 N91.0 N91.1 N91.2 N91.4 Cyproterone & Estrogen 2mg TAB Diva-35 Hormonal preparations, oral Motivation required Cyproterone acetate 50mg TAB Androcur Hormonal preparations, oral Motivation required Cyproterone acetate 50mg TAB Cipla-cyproterone acetate Hormonal preparations, oral Motivation required Cyproterone acetate 50mg TAB Cyproplex Hormonal preparations, oral Motivation required Cyproterone acetate 2mg TAB Adco-fem Hormonal preparations, oral Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Cyproterone acetate 2mg TAB Cyprene Hormonal preparations, oral Motivation required Cyproterone acetate 2mg TAB Diane-35 Ginette Hormonal preparations, oral Motivation required Cyproterone acetate 2mg TAB Minerva Hormonal preparations, oral Motivation required Cyproterone and Estrogen 2mg TAB Claro 35 Hormonal preparations, oral Motivation required Desogestrel and estrogen TAB Marvelon 150/30 Progestogens and estrogens Motivation required Desogestrel and estrogen TAB Mercilon Progestogens and estrogens Motivation required Drospirenone and estrogen TAB Yasmin Ruby Progestogens and estrogens Motivation required Drospirenone and estrogen TAB Yaz Progestogens and estrogens Motivation required Gestodene and estrogen TAB Femodene ed Minulette Progestogens and estrogens Motivation required Gestodene and estrogen TAB Melodene Progestogens and estrogens Motivation required Gestodene and estrogen TAB Mirelle Progestogens and estrogens Motivation required Gestodene and estrogen TAB Minesse Progestogens and estrogens Motivation required Gestodene and estrogen TAB Tri-minulet Progestogens and estrogens Motivation required Gestodene and estrogen TAB Triodene ed Progestogens and estrogens Motivation required Levonorgestrel and estrogen TAB Biphasil Progestogens and estrogens Motivation required Levonorgestrel and estrogen TAB Logynon ed Progestogens and estrogens Motivation required Levonorgestrel and estrogen TAB Triphasil Progestogens and estrogens Motivation required Norethisterone and estrogen TAB Trinovum Progestogens and estrogens Motivation required Norgestimate & oestrogen TAB Tricilest Progestogens and estrogens Motivation required

PEPTIC ULCER DISEASE ICD 10: K25.0 K25.1 K25.2 K25.4 K25.5 K25.6 K26.0 K26.1 K26.2 K26.4 K26.5 K27.0 K27.1 K27.2 K27.4 K27.5 K27.6 K28.0 K28.1 K28.2 K28.4 K28.5 K28.6 K29.0 K26.6 K26.6 Cimetidine 200mg TAB Bio-cimetidine Cimlok H2 -receptor antagonists Accepted treatment Cimetidine 400mg TAB Bio-cimetidine Cimlok H2 -receptor antagonists Accepted treatment Esomeprazole 10mg GRA Nexiam Proton Pump Inhibitors Motivation required Esomeprazole 20mg TAB Nexiam Proton Pump Inhibitors Motivation required Esomeprazole 40mg TAB Nexiam Proton Pump Inhibitors Motivation required Lansoprazole 15mg TAB Lancap Lansoloc Proton Pump Inhibitors Motivation required Lansoprazole 30mg TAB Lancap Lansoloc Proton Pump Inhibitors Motivation required Omeprazole 10mg CAP Altosec Omez Proton Pump Inhibitors Accepted treatment Omeprazole 20mg CAP Altosec Omez Proton Pump Inhibitors Accepted treatment Omeprazole 40mg TAB Losec mups Omez Proton Pump Inhibitors Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Pantoprazole 20mg ECT Topzole Pantoloc Proton Pump Inhibitors Motivation required Pantoprazole 40mg ECT Topzole Pantoloc Proton Pump Inhibitors Motivation required Pantoprazole 40mg IV Aspen-Pantoprazole Pantoloc Proton Pump Inhibitors Motivation required Rabeprazole 10mg TAB Pariet Proton Pump Inhibitors Motivation required Rabeprazole 20mg TAB Pariet Proton Pump Inhibitors Motivation required Ranitidine 75mg TAB Austac Histak 75 H2 - receptor antagonists Accepted treatment Ranitidine 150mg TAB Ranihexal 150 Ranit H2 -receptor antagonists Accepted treatment Ranitidine 300mg TAB Ranihexal 300 Ranit H2 -receptor antagonists Accepted treatment Ranitidine 150mg/10ml SYR Zantac H2-receptor antagonists Motivation required

PERIPHERAL VASCULAR DISEASE ICD 10: I73.1 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Motivation required Warfarin 1mg TAB Cipla Warfarin Antithrombotic agents Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Antithrombotic agents Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Antithrombotic agents Accepted treatment

PITUITARY HYPERFUNCTION ICD 10: E22.0 E22.1 E22.2 E22.8 E22.9 E23.7 Bromocriptine 2.5mg TAB Aspen Bromocriptine Parlodel Dopamine agonists Motivation required Cabergoline 0.5mg TAB Dostinex Prolactine inhibitors Special investigations, Prolactin levels Octreotide 0.05mg INJ Sandostatin Growth hormone release inhibitor Motivation required Octreotide 0.1mg INJ Sandostatin Growth hormone release inhibitor Motivation required Page 97 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Octreotide 0.2mg INJ Sandostatin Growth hormone release inhibitor Motivation required Octreotide 10mg INJ Sandostatin LAR prefilled Growth hormone release inhibitor Motivation required Octreotide 20mg INJ Sandostatin LAR prefilled Growth hormone release inhibitor Motivation required Quinagolide 150mg TAB Norprolac Dopamine Agonists Special investigations, Prolactin levels Quinagolide 75mg TAB Norprolac Dopamine Agonists Special investigations, Prolactin levels

PITUITARY HYPOFUNCTION ICD 10: E23.7 Conjugated estrogens 0.3mg TAB Premarin Hormone replacement therapy Accepted treatment Conjugated estrogens 0.625mg TAB Premarin Hormone replacement therapy Accepted treatment Hydrocortisone 10mg TAB Covocort Corticosteroids , oral Accepted treatment Levothyroxine sodium 0.05mg TAB Eltroxin Thyroid hormones Accepted treatment Levothyroxine sodium 0.1mg TAB Eltroxin Thyroid hormones Accepted treatment Levothyroxine sodium 100mcg TAB Euthyrox Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 25mcg TAB Euthyrox Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 50mcg TAB Euthyrox Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 88mcg TAB Synthroid Thyroid hormones Accepted treatment Levothyroxine sodium 112mcg TAB Synthroid Thyroid hormones Accepted treatment Liothyronine sodium 90mcg TAB Diotroxin Thyroid hormones Accepted treatment Liothyronine sodium 20mcg TAB Tertroxin Thyroid hormones Accepted treatment Somatropin 6mg TAB Humatrope Growth Hormone Motivation required Somatropin 12mg TAB Humatrope Growth Hormone Motivation required Testosterone cypionate 100mg/ml IMP Depo-testosterone 10ml Androgen Motivation required

SCHIZOAFFECTIVE DISORDER ICD 10: F25.0 F25.1 F25.2 F25.8 F25.9 Amisulpride 200mg TAB Solian Antipsychotics Accepted treatment Amisulpride 50mg TAB Solian Antipsychotics Accepted treatment Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Aripiprazole 5mg TAB Abilify Antipsychotics Accepted treatment Aripiprazole 10mg TAB Abilify Antipsychotics Accepted treatment Aripiprazole 15mg TAB Abilify Antipsychotics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Bupropion 150mg SRT Wellbutrin SR Other antidepressant Motivation required Bupropion 150mg SRT Wellbutrin XL Other antidepressant Motivation required Bupropion 300mg SRT Wellbutrin XL Other antidepressant Motivation required Chlorpromazine 100mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 25mg TAB Largactil Antipsychotics Accepted treatment Chlorpromazine 50mg TAB Largactil Antipsychotics Accepted treatment Citalopram 20mg TAB Adco-Talomil Depramil Selective serotonin receptor Accepted treatment inhibitors Citalopram 10mg TAB Austell-Citalopram Selective serotonin receptor Accepted treatment inhibitors Citalopram 40mg TAB Citalopram-Winthrop Ran-Citalopram Selective serotonin receptor Accepted treatment inhibitors Clomipramine 75mg SRT Anafranil simple reg Heterocyclic antidepressant Accepted treatment Clomipramine 25mg TAB Clomidep Equinorm Heterocyclic antidepressant Accepted treatment Clomipramine 10mg TAB Equinorm Anafranil Heterocyclic antidepressant Accepted treatment Clozapine 100mg TAB Cloment Leponex Antipsychotics Accepted treatment Clozapine 25mg TAB Cloment Leponex Antipsychotics Accepted treatment Dosulepin 25mg CAP Prothiaden Thaden Heterocyclic Antidepressants Accepted treatment Dosulepin 75mg TAB Thaden Heterocyclic Antidepressants Accepted treatment Duloxetine 30mg CAP Cymgen Cymbalta Other antidepressant Motivation required Duloxetine 60mg CAP Cymgen Cymbalta Other antidepressant Motivation required Escitalopram 10mg TAB Aspen-Escitalopram Be-Tabs Selective serotonin receptor Motivation required Escitalopram inhibitors Escitalopram 20mg TAB Citraz Lexamil Selective serotonin receptor Motivation required inhibitors Escitalopram 5mg TAB Lexamil Selective serotonin receptor Motivation required inhibitors Flupenthixol 0.5mg TAB Fluanxol Antipsychotics Accepted treatment Flupenthixol 1mg TAB Fluanxol Antipsychotics Accepted treatment Fluoxetine 20mg TAB Lorien Rezak Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 20mg CAP Nuzak Lilly-fluoxetine Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 20mg DSP Prohexal 20t Selective serotonin receptor Accepted treatment inhibitors Fluoxetine 40mg DSP Prohexal 40t Selective serotonin receptor Accepted treatment inhibitors Fluvoxamine 100mg TAB Fluvoxamine- Hexal Faverin Selective serotonin receptor Motivation required inhibitors Haloperidol 1.5mg TAB SANDOZ Haloperidol Antipsychotics Accepted treatment Page 99 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Haloperidol 5mg TAB SANDOZ Haloperidol Serenace Antipsychotics Accepted treatment Haloperidol 0.5mg CAP Serenace Antipsychotics Accepted treatment Haloperidol 10mg TAB Serenace Antipsychotics Accepted treatment Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic Antidepressants Accepted treatment Lithium 250mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 400mg TAB Camcolit Mood stabilisers Accepted treatment Lithium 50mg CAP Lithium succinate Mood stabilisers Accepted treatment Lithium 450mg TAB Quilonum retard Mood stabilisers Accepted treatment Lofepramine 70mg TAB Emdalen Heterocyclic Antidepressants Accepted treatment Maprotiline 25mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Maprotiline 75mg TAB Ludiomil Heterocyclic Antidepressants Motivation required Mianserin 10mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mianserin 30mg TAB Lantanon Heterocyclic Antidepressants Motivation required Mirtazapine 15mg TAB Adco-Mirteron Aspen Mirtazapine Other antidepressant Motivation required Mirtazapine 30mg TAB Mylan-Mirtazapine Sandoz Mirtazapine Other antidepressant Motivation required Moclobemide 150mg TAB Depnil Selective serotonin receptor Motivation required inhibitors Moclobemide 300mg TAB Depnil 300 Selective serotonin receptor Motivation required inhibitors Olanzapine 10mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 5mg TAB Olexar Redilanz Antipsychotics Accepted treatment Olanzapine 2.5mg TAB Redilanz Zyprexa Antipsychotics Accepted treatment Paleperidone 3mg TAB Invega Antipsychotics Accepted treatment Paleperidone 6mg TAB Invega Antipsychotics Accepted treatment Paleperidone 9mg TAB Invega Antipsychotics Accepted treatment Paroxetine 20mg TAB Paxil Adco-Paroxetine Selective serotonin receptor Motivation required inhibitors Pimozide 1mg TAB Orap Antipsychotics Accepted treatment Pimozide 4mg TAB Orap Antipsychotics Accepted treatment Quetiapine 25mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 100mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 200mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 300mg TAB Dopaquel Seroquel Antipsychotics Accepted treatment Quetiapine 50mg TAB Seroquel XR 50 Antipsychotics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Quetiapine 200mg TAB Seroquel XR 200 Antipsychotics Accepted treatment Quetiapine 300mg TAB Seroquel XR Antipsychotics Accepted treatment Quetiapine 400mg TAB Seroquel XR 400 Antipsychotics Accepted treatment Reboxetine 4mg TAB Edronax Other antidepressant Motivation required Risperidone 0.5mg TAB Aspen Risperidone Auropidone Antipsychotics Accepted treatment Risperidone 4mg TAB Auropidone Risponz Antipsychotics Accepted treatment Risperidone 1mg TAB DRL-Risperidone Mylan-Risperidone Antipsychotics Accepted treatment Risperidone 2mg TAB Perizal Rispacor Antipsychotics Accepted treatment Risperidone 3mg TAB Rispacor Risperdal Antipsychotics Accepted treatment Risperidone 1mg/ml SYR Risperdal Antipsychotics Accepted treatment Sertraline 100mg TAB Arrow Sertraline Austell-Sertraline Selective serotonin receptor Motivation required inhibitors Sertraline 50mg TAB Serdep Serlife Selective serotonin receptor Motivation required inhibitors Sulpiride 200mg TAB Bio-Sulpiride Other antidepressant Accepted treatment Sulpiride 50mg CAP SANDOZ Sulpiride Espiride Other antidepressant Accepted treatment Trazodone 100mg CAP Aspen Trazodone Molipaxin Other antidepressant Motivation required Trazodone 50mg CAP Aspen Trazodone Molipaxin Other antidepressant Motivation required Trifluoperazine 1mg TAB Stelazine Antipsychotics Accepted treatment Trifluoperazine 5mg TAB Stelazine Antipsychotics Accepted treatment Trimipramine 25mg TAB Tydamine Heterocyclic Antidepressants Motivation required Trimipramine 50mg CAP Tydamine Heterocyclic Antidepressants Motivation required Venlafaxine 50mg TAB Efexor Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 37.5mg TAB Illovex SR Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 150mg CAP Sandoz Velafaxine 150mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Venlafaxine 75mg CAP Sandoz Velafaxine 75mg XL Venlor XR Serotonin and noradrenaline re- Motivation required uptake inhibitors Ziprasidone 20mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 40mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 60mg CAP Geodon Antipsychotics Accepted treatment Ziprasidone 80mg CAP Geodon Antipsychotics Accepted treatment Zuclopenthixol 10mg TAB Clopixol Antipsychotics Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Zuclopenthixol 2mg TAB Clopixol Antipsychotics Accepted treatment

SPINAL CORD INJURIES ICD 10: G81.0 G81.1 G81.9 G82.0 G82.1 G82.2 G82.3 G82.4 G82.5 N31.0 N31.1 N31.2 N31.8 N31.9 Paracetamol will be reimbursed in the treatment of Rheumatoid Arthritis. Amitriptyline 10mg TAB Trepiline Heterocyclic antidepressant Accepted treatment Amitriptyline 25mg TAB SANDOZ Amitryptyline Trepiline Heterocyclic antidepressant Accepted treatment Baclofen 10mg TAB Bio-Baclofen Teva Baclofen Muscle relaxants Accepted treatment Baclofen 25mg TAB Lioresal Muscle relaxants Motivation required Bisacodyl 10mg SUP Dulcolax Laxatives Accepted treatment Bisacodyl 5mg TAB Dulcolax Laxatives Accepted treatment Bisacodyl paed SUP Dulcolax Laxatives Accepted treatment Bisacodyl TAB Megalax Laxatives Accepted treatment Carbamazepine 200mg TAB Degranol SANDOZ Anticonvulsants Accepted treatment Carbamazepine Carbamazepine 400mg SRT SANDOZ Cabamazepine CR Tegretol CR Anticonvulsants Accepted treatment Carbamazepine 200mg SRT SANDOZ Carbamazepine CR Tegretol CR Anticonvulsants Accepted treatment Dantrolene 25mg CAP Dantrium Muscle relaxants Motivation required Diclofenac 25mg TAB Adco-diclofenac Panamor-25 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SUP Diclohexal 100s Panamor supp-100 Non-steroidal anti-inflammatory Motivation required drugs Diclofenac 50mg TAB Diclohexal 50t Panamor at-50 Non - steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg CAP Fortfen SR Non-steroidal anti-inflammatory Accepted treatment drugs Diclofenac 100mg SRT Panamor-100 sr SANDOZ Diclofenac Non-steroidal anti-inflammatory Accepted treatment Sodium SR drugs Diclofenac 75mg SRT Panamor-75 sr Voltaren 75 Non - steroidal anti-inflammatory Accepted treatment drugs Diphenoxylate/Atropine 2.5mf/0.025mg TAB Lomotil Antipropulsives Accepted treatment

Gabapentin 300mg CAP Epleptin Ran-Gabapentin Anticonvulsants Motivation required

Gabapentin 600mg TAB Neurontin Anticonvulsants Motivation required

Gabapentin 800mg TAB Neurontin Anticonvulsants Motivation required

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Gabapentin 400mg CAP Ran-Gabapentin Epleptin Anticonvulsants Motivation required

Glycerol SUP Glycerine Adult Glycerine Infant Laxatives Accepted treatment

Glycerol LIQ GLYCERINE BP Laxatives Accepted treatment

Ibuprofen 400mg TAB Adco-ibuprofen Ranfen Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 100mg/5ml SUS Brufen paed susp Ibumax Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 200mg TAB SANDOZ Ibuprofen Inza Non -steroidal anti-inflammatory Accepted treatment drugs Ibuprofen 600mg TAB SANDOZ Ibuprofen Brufen Non -steroidal anti-inflammatory Accepted treatment drugs Imipramine 10mg TAB Ethipramine Tofranil Heterocyclic antidepressants Accepted treatment

Imipramine 25mg TAB Ethipramine Tofranil Heterocyclic antidepressants Accepted treatment Indomethacin 100mg SUP Arthrexin Indocid Non -steroidal anti-inflammatory Motivation required drugs Indomethacin 25mg CAP SANDOZ Idomethacin Arthrexin Non -steroidal anti-inflammatory Accepted treatment drugs Ketoprofen 200mg SRC Ketoflam Non-steroidal anti-inflammatory Motivation required drugs Ispaghula 3.5g GRA Ispagel Agiobulk Laxatives Accepted treatment Ispaghula (psylla seeds) SAC Dis-Chem Ispaghula Fybogel orange Laxatives Accepted treatment Ispaghula; combinations POW Fibrelle Laxatives Accepted treatment Lactulose 3.3g/5ml SYR Aculax Duphalac Laxatives Accepted treatment Lactulose SAC Duphalac dry 10g Laxatives Accepted treatment Lactulose 10g SAC Laxette dry (10g) Laxatives Accepted treatment Lactulose SYR Senokot-Lactulose (banana) Senokot -Lactulose Laxatives Accepted treatment (creme caramel) Laurilsulfate; incl. combinations ENE Microlax 5ml Laxatives Accepted treatment Loperamide 2mg TAB Adco-loperamide Betaperamide Antipropulsives Accepted treatment Loperamide 1mg/5ml SYR Gastron Imodium Antipropulsives Accepted treatment Magnesium carbonate MLS Be-lax Laxatives Accepted treatment Meloxicam 15mg TAB Loxiflam Arrow Meloxicam Non-steroidal anti-inflammatory Accepted treatment drugs Meloxicam 7.5mg TAB SANDOZ Meloxicam Coxflam Non -steroidal anti-inflammatory Accepted treatment drugs

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Methotrexate 2.5mg TAB Emthexate Emthexate Immunosuppressants Accepted treatment Naproxen 250mg TAB Adco-naproxen Mylan-naproxen Non - steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg SUP Nafasol Non-steroidal anti-inflammatory Motivation required drugs Naproxen 250mg ECT Nafasol ec-250 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg ECT Nafasol ec-500 Non-steroidal anti-inflammatory Accepted treatment drugs Naproxen 500mg TAB Napflam Non-steroidal anti-inflammatory Accepted treatment drugs Oxybutynin 5mg TAB Urihexal Lenditro Anticholinergics, oral Accepted treatment Piroxicam 10mg CAP Adco-piroxicam Rolab-piroxicam Non - steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg CAP Adco-piroxicam Xycam Non -steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg TAB Brexecam Non-steroidal anti-inflammatory Accepted treatment drugs Piroxicam 20mg DSP Pixicam Xycam dispers Non - steroidal anti-inflammatory Accepted treatment drugs Mineral salts in combination PDR Golytely Laxatives Accepted treatment Mineral salts in combination POW Go-lytely 68 5775g Laxatives Accepted treatment Mineral salts in combination SAC Klean-prep Laxatives Accepted treatment Nalidixic acid 500mg TAB Puromylon Quinolone antibacterial Motivation required Nalidixic acid SUS Winlomylon susp Quinolone antibacterial Motivation required Nitrofurantoin 25mg/5ml SUS Furadantin Antibiotics, oral Motivation required Nitrofurantoin 100mg CAP Macrodantin Antibiotics, oral Motivation required Nitrofurantoin 50mg CAP Macrodantin Antibiotics, oral Motivation required Nitroxoline TAB Nicene-n Other antibacterial Motivation required Orphenadrine (citrate) 100mg TAB Norflex Muscle relaxants Accepted treatment Osmotically acting laxatives SAC Movicol Laxatives Accepted treatment Pipemidic acid CAP Deblaston Quinolone antibacterial Motivation required Senna glycosides CAP Depuran Laxatives Accepted treatment Senna glycosides PDR Senna fruit Laxatives Accepted treatment Senna glycosides TAB Senokot Soflax Laxatives Accepted treatment Senna glycosides combinations SAC AgioGel Agiolax Laxatives Accepted treatment Senna glycosides combinations GRA Agiolax Laxatives Accepted treatment Sodium phosphate ENE Fosenema enema 150ml Lenolax(fleet) Laxatives Accepted treatment

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Sodium phosphate ENE Lenolax paed enema Laxatives Accepted treatment Sorbitol PDR Sorbitol Laxatives Accepted treatment Sterculia GRA Normacol/special Laxatives Accepted treatment Sterculia; combinations GRA Alvercol Normacol plus Laxatives Accepted treatment

STROKE ICD 10: I64 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Motivation required Warfarin 1mg TAB Cipla Warfarin Antithrombotic agents Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Antithrombotic agents Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Antithrombotic agents Accepted treatment

THALASSEMIA ICD 10: D56.0 D56.1 D56.2 D56.3 D56.4 D56.8 D56.9 D58.2 D74.0 D74.8 D74.9 Deferasirox 125mg DSP Exjade Chelating agents Motivation required Deferasirox 250mg DSP Exjade Chelating agents Motivation required Deferasirox 500mg DSP Exjade Chelating agents Motivation required Deferoxamine 500mg INJ Desferal Chelating agents Motivation required THROMBOEMBOLIC DISEASE ICD 10: G08 I26.0 I26.9 I67.6 I70.00 I70.01 I70.10 I70.11 I70.20 I70.21 I70.80 I70.81I74.0 I74.1 I74.4 I74.5 I74.8 I80.1 I80.2 I80.3 I80.8 I82.1 I82.2 I82.3 I82.8 K75.1 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Motivation required Warfarin 1mg TAB Cipla Warfarin Antithrombotic agents Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Antithrombotic agents Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Antithrombotic agents Accepted treatment

TRANSIENT ISCHAEMIC ATTACK ICD 10: G45.0 G45.1 G45.2 G45.3 G45.4 G45.8 G45.9 I65.0 I65.1 I65.2 I65.3 I65.8 I65.9 I66.0 I66.0 I66.1 I66.2 I66.3 I66.4 I66.8 I66.8 Acetylsalicylic acid 81mg ECT Ecotrin Aspirin Accepted treatment Acetylsalicylic acid 100mg TAB Disprin CV 100 disp TAB Bayer aspirin cardio Aspirin Accepted treatment 100mg Acetylsalicylic acid 300mg DSP Disprin cv 300 disp Bayer aspirin Aspirin Accepted treatment Acetylsalicylic acid 60mg TAB Genpharma Children Aspirin Accepted treatment Aspirin(prev.Asp.jnr) Acetylsalicylic acid 125mg TAB Lo-aspirin Aspirin Accepted treatment Clopidogrel 75mg TAB Plagrol Pharma Dynamics Antithrombotic agents Motivation required Clopidogrel Dipyridamole 200mg/25mg CAP Asasantin 200/25 retard Antithrombotic agents Accepted treatment Dipyridamole 200mg SRC Persantin 200 retard Antithrombotic agents Accepted treatment Dipyridamole 100mg TAB Plato Antithrombotic agents Motivation required Warfarin 1mg TAB Cipla Warfarin Antithrombotic agents Accepted treatment Warfarin 5mg TAB Cipla Warfarin Aspen Warfarin Antithrombotic agents Accepted treatment Warfarin 3mg TAB Cipla-Warfarin Antithrombotic agents Accepted treatment

TUBERCULOSIS ICD 10: A15.0-A15.9 A16.0 A16.1 A16.2 A16.3 A16.4 A16.5 A16.7 A16.8 A16.9 A17.8 A17.9 A18.0 A18.8 A18.9 A31.0 A98.0 A19.0 A19.1 A19.2 A19.8 A19.9 Amikacin 1000mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Amikacin 100mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Page 106 of 108

ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Amikacin 250mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Amikacin 500mg INJ Amikacin-fresenius Aminoglycoside Antibacterial Motivation required, Sputum test Ciprofloxacin 250mg TAB Austell-Ciprofloxacin Cpl alliance Fluoroquinolones Motivation required, Sputum test ciprofloxacin Ciprofloxacin 500mg TAB Austell-Ciprofloxacin Cpl alliance Fluoroquinolones Motivation required, Sputum test ciprofloxacin Cycloserine 250mg CAP Aspen Cycloserine Antimycobacterial Motivation required, Sputum test Dapsone 100mg TAB Dapsone Antimycobacterial Special investigations, Sputum test Ethambutol 400mg TAB Sandoz ethambutol Antimycobacterial Special investigations, Sputum test Ethionamide 250mg TAB Ethatyl Antimycobacterial Motivation required, Sputum test Isoniazid 100mg TAB Norstan Isoniazid Be-tabs isoniazid Antimycobacterial Special investigations, Sputum test Kanamycin 1g/3ml INJ Kanamycin Aminoglycoside antibacterial Motivation required Ofloxacin 200mg TAB Tafloc Tarivid Quinolone antibacterial Motivation required Ofloxacin 400mg TAB Tafloc Quinolone antibacterial Motivation required Pyrazinamide 500mg TAB Pyrazide Sandoz Antimycobacterial Special investigations, Sputum test pyrazinamide Pyridoxine (vit B6) 25mg TAB Be-tabs pyridoxine hcl Pyridoxine Vitamin supplement Special investigations, Pathology report indicating deficiency Pyridoxine (vit B6) 25mg TAB Pyridoxine Vitamin B6 Vitamin supplement Special investigations, Pathology report indicating deficiency Rifampicin 150mg CAP Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin 450mg TAB Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin 600mg TAB Rimactane Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 150/150mg TAB Rifinah Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 300mg TAB Rifinah Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 150/75mg TAB Rimactazid Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 300/150mg TAB Rimactazid Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 60/30mg TAB Rimactazid paed Antimycobacterial Special investigations, Sputum test Rifampicin & isoniazid 60/60mg TAB Rimactazid paed Antimycobacterial Special investigations, Sputum test Rifampicin, isoniazid, 150/75/400/275mg TAB Rifafour E-275 Rimstar 4-FDC Antimycobacterial Special investigations, Sputum test pyrazinamide & ethambutol Terizidone 250mg CAP Terivalidin Antimycobacterial Motivation required, Sputum test

VALVULAR DISEASE ICD 10: I05.0 I05.01 I05.2 I05.8 I05.9 I09.0 I09.1 I09.2 I09.8 I09.9 I34.0 I34.1 I34.2 I34.8 I34.9 I35.0 I35.1 I35.2 I35.8 I35.9

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ACTIVE INGREDIENT STRENGTH DOSAGE EXAMPLE 1 EXAMPLE 2 CLASS COMMENT FORM Note: medicines under "heart failure" will also be reimbursed under this condition.

Benzylpenicillin INJ Bio-pen Bio-Pen 5 M U Antibiotics Accepted treatment

Erythromycin 250mg TAB Betamycin Adco-erythromycin Antibiotics, oral Accepted treatment Phenoxymethylpenicillin 250mg TAB Betapen Len vk Antibiotics, oral Accepted treatment

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