GEMS REO ACUTE OUT OF FORMULARY LIST 1-Nov-13 Products listed on this formulary will attract a 30% co-payment if claimed on acute for the REO options. In conjunction with this, other rules may apply. ATC CLASS ATC Code ATC Description Nappi Drug Name Strength Drg Frm DRUGS FOR ACID RELATED DISORDERS A02 A02BC02 Pantoprazole 717376 ASPEN PANTOPRAZOLE 20MG ECT A02BC02 Pantoprazole 717377 ASPEN PANTOPRAZOLE 40MG ECT A02BC02 Pantoprazole 892291 CONTROLOC 20MG ECT A02BC02 Pantoprazole 812153 GASTRIWIN (WAS CONTROLOC) 40MG ECT A02BC02 Pantoprazole 717420 MYLAN PANTOPRAZOLE 20MG ECT A02BC02 Pantoprazole 717421 MYLAN PANTOPRAZOLE 40MG ECT A02BC02 Pantoprazole 708031 PANTOCID 40MG ECT A02BC02 Pantoprazole 881589 PANTOLOC 20MG ECT A02BC02 Pantoprazole 811793 PANTOLOC 40MG ECT A02BC02 Pantoprazole 714674 PENTOZ 20MG ECT A02BC02 Pantoprazole 714675 PENTOZ 40MG ECT A02BC02 Pantoprazole 718886 PENTOZ OTC 20MG TAB A02BC02 Pantoprazole 705368 TOPZOLE 20MG TAB A02BC02 Pantoprazole 705369 TOPZOLE 40MG TAB A02BC02 Pantoprazole 718142 TOPZOLE OTC 20MG ECT A02BC02 Pantoprazole 715312 CONORAN 20MG ECT A02BC02 Pantoprazole 715313 CONORAN 40MG ECT A02BC02 Pantoprazole 715610 PANTOCID 20MG ECT A02BC02 Pantoprazole 715306 PEPLOC 20MG ECT A02BC02 Pantoprazole 715307 PEPLOC 40MG ECT A02BC04 Rabeprazole 863106 PARIET 10MG TAB A02BC04 Rabeprazole 863114 PARIET 20MG TAB A02BC04 Rabeprazole 718384 RABEMED 10MG TAB A02BC04 Rabeprazole 718385 RABEMED 20MG TAB A02BC05 Esomeprazole 897132 NEXIAM 20MG TAB A02BC05 Esomeprazole 897125 NEXIAM 40MG TAB A02BC05 Esomeprazole 718879 NEXMEZOL 20MG TAB A02BC05 Esomeprazole 718880 NEXMEZOL 40MG TAB A02BX13 Alginic acid 711145 GAVISCON ADVANCE 10ML SAC A02BX13 Alginic acid 711031 GAVISCON ADVANCE PEPPERMINT SUS A02BX13 Alginic acid 862282 GAVISCON ADVANCE 500ML/5ML SUS A02BX99 Alginic acid and Combinations 715428 GAVISCON PLUS SUS LAXATIVES A06 A06AB04 Phenolphthalein 758345 PURITONE NO 1 250MG TAB A06AB04 Phenolphthalein 865370 SURGE LAXATIVE GRANULES 10G SAC DIGESTIVES, INCLUDING ENZYMES A09 A09AA Enzyme preparations 711079 LACTAZE EXTRA STRENGTH TAB A09AA02 Multienzymes (lipase protease etc.) 752479 PANKREOFLAT 170MG TAB DRUGS USED IN DIABETES A10 A10BB02 Chlorpropamide 719412 DIABINESE 250MG TAB A10BB02 Chlorpropamide 719439 DIABITEX 250MG TAB A10BB02 Chlorpropamide 714062 HYPOMIDE 250MG TAB A10BB07 Glipizide 743666 MINIDIAB 5MG TAB A10BB12 Glimepiride 716716 ACCORD GLIMEPIRIDE 4MG TAB A10BB12 Glimepiride 704895 ADCO-GLIMEPIRIDE 4MG TAB A10BB12 Glimepiride 831573 AMARYL 4MG TAB A10BB12 Glimepiride 711377 AMARYL 3MG TAB A10BB12 Glimepiride 714856 ASPEN GLIMEPIRIDE 4MG TAB A10BB12 Glimepiride 708007 DIAGLIM 4MG TAB A10BB12 Glimepiride 710209 EUGLIM 4MG TAB A10BB12 Glimepiride 704364 GLAMARYL 4MG 4MG TAB A10BB12 Glimepiride 707390 GLIMEHEXAL 4MG TAB A10BB12 Glimepiride 709986 MYLAN-GLIMEPIRIDE 4MG TAB A10BB12 Glimepiride 704675 SANDOZ GLIMEPIRIDE 4MG TAB A10BB12 Glimepiride 710906 SULPHONUR 4MG TAB A10BB12 Glimepiride 711910 ZYDUS-GLIMEPIRIDE 4MG TAB A10BF01 Acarbose 808164 GLUCOBAY 100MG TAB A10BF01 Acarbose 808156 GLUCOBAY 50MG TAB ANTITHROMBOTIC AGENTS B01 B01AC07 Dipyridamole 720526 PLATO 100MG TAB B01AC07 Dipyridamole 755656 PLATO 25MG TAB ANTIANEMIC PREPARATIONS B03 B03AB04 Iron and folic acid 710642 FEROFOL CAP B03AD Iron in combination with folic acid 866628 CHELA-FER 15MG/5ML SYR B03AD01 Ferrous amino acid complex 852279 CHELA-FER 15MG TAB B03AD01 Ferrous amino acid complex 703117 CHELA-FER 30MG TAB B03AD Iron in combination with folic acid 714891 FERRAMINO TAB B03AD Iron in combination with folic acid 714892 FERRAMINO FORTE TAB B03AD02 Ferrous fumarate 708229 FOLIRON FEF CAP B03AE Iron in other combinations 715834 ASTYFER CAP B03AE Iron in other combinations 715835 ASTYFER LIQ B03AE01 Iron vitamin B12 and folic acid 711147 CHELIRON FORTE TAB B03AE01 Iron vitamin B12 and folic acid 711148 CHELIRON TAB B03AE01 Iron vitamin B12 and folic acid 718728 CHELIRON SYRUP SYR B03AE01 Iron, vitamin B12 and folic acid 713274 FEROFOL SYR B03AE01 Iron vitamin B12 and folic acid 876917 FERROUS FORTE CHELATED IRON TAB B03AE01 Iron vitamin B12 and folic acid 893031 FERROUS FORTE CHELATED IRON SYR B03AE02 Iron multivitamins and folic acid 877917 FERROUS FORTE CHELATED IRON TAB B03AE10 Various combinations 710212 HAEMOFER JNR CAP B03AE10 Various combinations 710213 HAEMOFER CAP B03AE10 Various combinations 714956 HAEMOFER 10MG/5ML SYR B03BB01 Folic acid 702348 FOLIC ACID 5MG CAP B03BB01 Folic acid 874841 FOLIC ACID FORTE SR CAP CARDIAC THERAPY C01 C01DA02 Glyceryl trinitrate 787256 NITROLINGUAL AEROSOL SPRAY 0.4MG INH ANTIHYPERTENSIVES C02 C02AB01 Methyldopa 732079 HYPOTONE 500MG TAB DIURETICS C03 C03BA04 Chlortalidone 731919 HYGROTON 50MG TAB C03CA01 Furosemide 780839 LASIX 80MG TAB C03CA01 Furosemide 735973 LASIX RETARD 60MG CAP C03EA01 Hydrochlorothiazide and potassium-sparing agents 701815 ALDAZIDE 2.5MG/25MG TAB PERIPHERAL VASODILATORS C04 C04AD03 Pentoxifylline 703629 ASPEN PENTOXIFYLLINE 400MG SR 400MG TAB C04AD03 Pentoxifylline 709077 DYNA-PENTOXYFILLIN SR 400MG TAB C04AD03 Pentoxifylline 771961 TRENTAL 400 400MG TAB C04AX20 Buflomedil 738948 LOFTYL 150MG TAB VASOPROTECTIVES C05 C05CA01 Rutoside 752983 PAROVEN 250MG CAP BETA-BLOCKING AGENTS C07 C07AA05 Propranolol 732605 INDERAL LA 160MG CAP C07AA12 Nadolol 716189 CORGARD 80MG TAB C07AA12 Nadolol 716219 CORGARD-HS 40MG TAB C07AB02 Metoprolol 739251 LOPRESOR 100MG TAB C07AB02 Metoprolol 783323 LOPRESOR OROS 95MG TAB C07AB04 Acebutolol 705056 BUTOBLOC 400MG 400MG TAB C07AB04 Acebutolol 763020 SECTRAL 100MG CAP C07AB04 Acebutolol 763039 SECTRAL 200MG CAP C07AB04 Acebutolol 763047 SECTRAL 400MG TAB C07AG01 Labetalol 771627 TRANDATE 100MG TAB C07BA12 Nadolol and thiazides 716197 CORGARETIC-40 40MG TAB C07BA12 Nadolol and thiazides 716200 CORGARETIC-80 80MG TAB C07CB03 Atenolol and other diuretics 769592 TENORET 50 50MG/12.5MG TAB C07CB03 Atenolol and other diuretics 769568 TENORETIC 100MG/25MG TAB C07DA06 Timolol thiazides and other diuretics 744352 MODUCREN TAB C07DA06 Timolol thiazides and other diuretics 780472 SERVATRIN TAB CALCIUM CHANNEL BLOCKERS C08 C08CA02 Felodipine 821896 PLENDIL 2.5MG SRT C08CA03 Isradipine 782963 DYNACIRC 2.5MG TAB C08CA03 Isradipine 788325 DYNACIRC SRO 5MG CAP C08CA05 Nifedipine 796891 ADALAT RETARD 10MG TAB C08CA05 Nifedipine 783889 ADALAT RETARD 20MG TAB C08CA05 Nifedipine 793132 ADALAT XL 60MG SRT C08CA05 Nifedipine 711607 ADALAT XL 20MG TAB C08CA05 Nifedipine 711714 FEDALOC SR 60MG TAB C08CA05 Nifedipine 715001 MACOREL SR 60MG SRT C08CA05 Nifedipine 718085 BIO NIFEDIPINE XL 60MG SRT C08CA05 Nifedipine 715003 SPEC NIFEDIPINE SR 60MG SRT C08CA13 Lercanidipine 704035 ZANIDIP 10 10MG TAB C08CA13 Lercanidipine 708037 ZANIDIP 20MG TAB AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM C09 C09AA07 Benazepril 794066 CIBACE 20MG TAB C09BA04 Perindopril and diuretics 715650 ACESYL CO 0.625MG/2MG TAB C09BA04 Perindopril and diuretics 700512 PRETERAX TAB C09BA04 Perindopril and diuretics 713762 SPEC-PERINDOPRIL PLUS 0.625MG/2MG TAB C09BA09 Fosinopril and diuretics 836524 MONOZIDE 20MG/12.5MG TAB C09BB02 Enalapril and Lercanidipine 711445 ZANERIL 10MG/20MG 10MG/20MG TAB C09BB05 Ramipril and calcium channel blockers 862215 TRI-PLEN FORTE 5MG/5MG TAB C09BB10 Trandolapril and calcium channel blockers 836680 TARKA 180MG/2MG SRC C09CA02 Eprosartan 701855 TEVETEN 600 600MG TAB C09CA03 Valsartan 705488 DIOVAN 40 40MG TAB C09CA03 Valsartan 710051 DIOVAN 320MG TAB C09CA04 Irbesartan 837806 APROVEL 75MG TAB C09CA06 Candesartan 856118 ATACAND 16MG TAB C09CA06 Candesartan 856096 ATACAND 8MG TAB C09CA06 Candesartan 711287 ATACAND 32MG TAB C09CA06 Candesartan 719209 MYLACAND 8MG TAB C09CA06 Candesartan 719210 MYLACAND 16MG TAB C09DA02 Eprosartan and diuretics 708096 TEVETEN PLUS 600MG/12.5MG TAB C09DA03 Valsartan and diuretics 710048 CO-DIOVAN 320MG/12.5MG 320MG/12.5MG TAB C09DA03 Valsartan and diuretics 710050 CO-DIOVAN 320MG/25MG 320MG/25MG TAB C09DB01 Valsartan and amlodipine 719125 EXFORGE 5MG/320MG 5MG/320MG TAB C09DB01 Valsartan and amlodipine 719126 EXFORGE 10MG/320MG 10MG/320MG TAB C09DB01 Valsartan and amlodipine 719127 CO EXFORGE 10MG/320MG/25MG 10MG/320MG TAB C09DA06 Candesartan and diuretics 898635 ATACAND PLUS TAB C09DA06 Candesartan and diuretics 717580 ATACAND PLUS 32MG/12.5MG TAB C09DA06 Candesartan and diuretics 717723 ATACAND PLUS 32MG/25MG TAB LIPID MODIFYING AGENTS C10 C10AA04 Fluvastatin 813664 LESCOL 20MG CAP C10AA04 Fluvastatin 813672 LESCOL 40MG CAP C10AA04 Fluvastatin 700963 LESCOL XL 80MG ECT C10AA04 Fluvastatin 718208 VATICOL XL 80MG ECT C10AA07 Rosuvastatin 705989 CRESTOR 10MG 10MG TAB C10AA07 Rosuvastatin 705988 CRESTOR 20MG 20MG TAB C10AA07 Rosuvastatin 710892 CRESTOR 5MG TAB C10AA08 Rosuvastatin 705990 CRESTOR 40MG 40MG TAB C10AA07 Rosuvastatin 717520 ZUVAMOR 10MG TAB C10AA07 Rosuvastatin 717521 ZUVAMOR 20MG TAB C10AA08 Rosuvastatin 717522 ZUVAMOR 40MG TAB C10AA07 Rosuvastatin 719081 VUSOR 5MG TAB C10AA07 Rosuvastatin 719082 VUSOR 10MG TAB C10AA07 Rosuvastatin 719083 VUSOR 20MG TAB C10AA07 Rosuvastatin 719084 VUSOR 40MG TAB C10AA07 Rosuvastatin 719249 ROSVATOR 5MG TAB C10AA07 Rosuvastatin 719251 ROSVATOR 10MG TAB C10AA07 Rosuvastatin 719252 ROSVATOR 20MG TAB C10AA07 Rosuvastatin 719253 ROSVATOR 40MG TAB C10AD02 Nicotinic acid 899151 FLUSH FREE NIACIN TAB C10BX03 Atorvastatin and amlodipine 705835 CADUET 10MG/10MG 10MG/10MG TAB C10BX03 Atorvastatin and amlodipine 705836 CADUET 10MG/20MG 10MG/20MG TAB C10BX03 Atorvastatin and amlodipine 708835 CADUET 10MG/40MG 10MG/40MG TAB C10BX03 Atorvastatin and amlodipine 708837 CADUET 10MG/80MG 10MG/80MG