Nappi Name Action Status Rules
894559 CUTANPLAST DENTAL 10X10X1 Non-F Excluded Excluded - Non formulary item
894567 CUTANPLAST FILM 200X70X0 Non-F Excluded Excluded - Non formulary item
894556 CUTANPLAST SPECIAL 70X50X Non-F Excluded Excluded - Non formulary item
894548 CUTANPLAST STD 70X50X10MM Non-F Excluded Excluded - Non formulary item
852287 CUTICURA 100G Excl Excluded Excluded - Soap, scrubs, cleanser
851981 CUTICURA FACE WASH CONTRO Excl Excluded Excluded - Soap, scrubs, cleanser
852007 CUTICURA FACE WASH INTENS Excl Excluded Excluded - Soap, scrubs, cleanser
874698 CUTICURA TEA TREE FACE WA Excl Excluded Excluded - Soap, scrubs, cleanser
809985 CUTIVATE Allow Acute - no application Price limitation & limited to 3 fills per year. Considered for chronic benefits for certain conditions.
809977 CUTIVATE CREAM Allow Acute - no application Price limitation & limited to 3 fills per year. Considered for chronic benefits for certain conditions.
895121 CUVETTES GLUCOSE HEMOCUE Allow Reject / Chronic Step therapy: Allowed with insulin and oral diabetes tablets. Type 2 diabetes - limited to 150 per year on chronic
895118 CUVETTES HB HEMOCUE Allow Reject / Chronic Step therapy: Allowed with insulin and oral diabetes tablets. Type 2 diabetes - limited to 150 per year on chronic
704595 CUVETTES HEMOCUE GLUCOSE 201 Allow Reject / Chronic Step therapy: Allowed with insulin and oral diabetes tablets. Type 2 diabetes - limited to 150 per year on chronic
894397 CYBUTOL 200 CYCLOCAPS 200mcg. Capsules Allow Chronic - no application Price limitation. A generic salbutamol MDI and spacer are preferred.
894400 CYBUTOL 400 CYCLOCAPS 400mcg. Capsules Allow Chronic - no application Price limitation - payment is limited to salbutamol generic MDI
716944 CYCLIDOX 100mg. Capsules Allow Acute - no application Price limitation & limited to 7 capsules
825727 CYCLIDOX EC Allow Acute - no application Price limitation & limited to 7 capsules
812692 CYCLIDOX EC 100mg. Capsules Allow Acute - no application Price limitation & limited to 7 tablets
812684 CYCLIDOX EC 50mg. Capsules Allow Acute - no application Price limitation. Limited to 30 capsules & 6 fills per year.
716952 CYCLIMORPH 10mg. x1ml.amp Inject. Excl Excluded Excluded, injections included in consultation fee
716960 CYCLIMORPH 15mg. x1ml.amp Inject. Non-F Excluded Excluded, injections included in consultation fee
788295 CYCLIMYCIN 100mg. Capsules Allow Acute - no application Price limitation & limited to 10 tablets per fill
788287 CYCLIMYCIN 50mg. Capsules Allow Acute - no application Price limitation & limited to 60 tablets
824313 CYCLIVEX 200mg. Tablets Allow Acute - no application Price limitation. Limited to 25 tablets & 2 fills per year
717126 CYCLOBLASTIN 1000mg. vial Inject. CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
717088 CYCLOBLASTIN 200mg. vial Inject. CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
717118 CYCLOBLASTIN 500mg. vial Inject. CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
717053 CYCLOBLASTIN 50mg. Tablets CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
810215 CYCLOGEST 200mg. Pessaries Excl Excluded Excluded - Infertility products
717029 CYCLOGYL 15ML Allow Acute - no application Limited to 1 unit per fill & 12 fills per year
898191 CYCLOHALER INHALATION DEV Excl Excluded Excluded - Non formulary item
717037 CYCLOMYDRIL 5ML Allow Acute - no application Price limitation. Limited to 1 unit per fill & 2 fills per year
894405 CYCLOSON 100 CYCLOCAPS CEF Chronic/MAC - no application MAC: Price limitation & limited to 60 capsules per month. Budesonide/beclomethasone generic MDI is preferred.
894413 CYCLOSON 200 CYCLOCAPS CEF Chronic/MAC - no application MAC: Price limitation & limited to 60 capsules per month. Budesonide/beclomethasone generic MDI is preferred.
717150 CYKLOKAPRON Excl Excluded Excluded, injections included in consultation fee
717134 CYKLOKAPRON 500mg. Tablets Allow Acute - no application Limited to 5 days & 4 fills
897973 CYKLOKAPRON EFF 1000mg. (3x16's) Tablets Excl Excluded Excluded, cost effective dosage form available on the automated list
703911 CYMBALTA 30MG Capsules Non-F Reject Rejected, alternative first line therapy available.
703910 CYMBALTA 60MG CAPS Non-F Reject Rejected, alternative first line therapy available.
834122 CYMEVENE 250mg. CAPSULES Non-F Excluded Excluded - unacceptable benefit/cost ratio
878723 CYMEVENE 500mg. CAPSULES Non-F Excluded Excluded - unacceptable benefit/cost ratio
793175 CYMEVENE IV 500mg. INJECT. Non-F Excluded Excluded - unacceptable benefit/cost ratio
704026 CYPHER SELECT SIROLIMUS-E Excl Excluded Excluded, for in hospital use
703535 CYPHER SIROLIMUS-ELUTING Excl Excluded Excluded, for in hospital use
705607 CYPRENCE-35 ED TABS Excl Excluded Excluded, oral contraceptives for the skin.
704144 CYPROPLEX TABS 50 MG Allow Acute - no application Price limitation. Available on acute for short term use.
717169 CYSTICIDE TABLETS Allow Acute - no application Price limitation. Limited to 1 fill per year
861839 CYTARABINE FAULDING 5ML CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
861847 CYTARABINE FAULDING 5ML CEF-Apply Reject/ PreAuth Specialist initiated only. Pre Auth for Oncology benefits. Obtain application form by dialling Fax on Demand Service from fax machine (Form no. 2004)
704665 CYTOKIDZ Excl Excluded Excluded, unregistered vitamins.
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