Nappi Name Action Status Rules
704154 I-123 SOIDUM IODIDE 5MCI Excl Excluded Excluded - Diagnostics
895196 IBOFLAM TABLETS TABLETS CEF Acute - no application Price limitation, limited to 30 tablets & 4 fills per year. Doctor to apply telephonically for longterm use.
703845 IBUCOD Allow Acute - no application Price limitation. Limited to 20 tablets & 6 fills per year
828076 IBULEVE Gel Allow Acute - no application Price limitation & limited to 1 fill per year
700316 IBUMAX Allow Acute - no application Price limitation, limited to 30 tablets & 4 fills per year. Doctor to apply telephonically for longterm use.
700318 IBUMAX Allow Acute - no application Price limitation, limited to 20 tablets & 4 fills per year. Doctor to apply telephonically for longterm use.
700315 IBUMAX SUSP Allow Acute - no application Price limitation, limited to 200ml & 4 fills per year.
809268 IBUMED 200mg. Caplets TABLETS CEF Acute - no application Price limitation, limited to 30 tablets & 4 fills per year. Doctor to apply telephonically for longterm use.
864706 IBUMED SR CAPSULES Allow Acute - no application Price limitation, limited to 20 tablets & 4 fills per year
703719 IBUMOL Allow Acute - no application Price limitation, limited to 20 tablets & 6 fills per year. Telephonic motivation for certain conditions to be considered on chronic.
868221 IBUNATE TABLETS CEF Acute - no application Price limitation, limited to 30 tablets & 4 fills per year. Doctor to apply telephonically for longterm use.
704586 IBUPAIN Allow Acute - no application Price limitation, limited to 20 capsules & 6 fills per year. Telephonic motivation for certain conditions to be considered on chronic.
704587 IBUPAIN FORTE CEF Acute/MAC - no application MAC: Price limitation on acute - limited to 20 capsules & 6 fills per year
700326 ICHTHAMMOL Excl Excluded Excluded - Patent medicine
700331 ICHTHAMMOL BP Excl Excluded Excluded - Patent medicine
891159 ICTYANE Excl Excluded Excluded - Moisturizers
878804 ICY HOT JAR Excl Excluded Excluded - Patent medicine
428895 IINFUSION CATHETER WITH F Non-F Excluded Non formulary item, apply with MAS dept
732265 ILIADIN ADULT METER 10ML Allow Acute - no application Limited to 1 unit & 4 fills per year
732303 ILIADIN ADULT PLAST 20ML SPRAY Allow Acute - no application Limited to 1 unit & 4 fills per year
732257 ILIADIN NASAL ADULT 10ML Allow Acute - no application Price limitation. Limited to 1 unit & 4 fills per year
732338 ILIADIN PAED METER 10ML Allow Acute - no application Limited to 1 unit & 4 fills per year
732281 ILIADIN PAED NASAL 10ML Allow Acute - no application Limited to 1 unit & 4 fills per year
732354 ILOSONE 125P 125mg./5ml. ml. Susp. Allow Reject / Acute Price limitation - limited to 100ml & 3 fills per 3 months
732346 ILOSONE 250 250mg. Capsules Allow Acute - no application Price limitation. Limited to 20 tablets & 3 fills per 3 months
732362 ILOSONE 250P 250mg./5ml. ml. Susp. Allow Reject / Acute Price limitation - limited to 100ml & 3 fills per 3 months
703131 ILOSUN OINTMENT Excl Excluded Excluded - Moisturizers
842591 ILOTYCIN A Allow Acute - no application Price limitation & limited to 4 fills per year.
842605 ILOTYCIN A Allow Acute - no application Price limitation & limited to 4 fills per year.
828874 ILOTYCIN TS 20mg./ml. ml. Soln. Allow Acute - no application Price limitation & limited to 4 fills per year.
732400 ILVICO Allow Acute - no application Price limitation & limited to 4 fills per year
732419 ILVICO Allow Acute - no application Price limitation & limited to 4 fills per year
732427 ILVISPECT Excl Excluded Excluded - Inconclusive benefit/risk ratio
704095 ILVITRIM TAB 480 MG TABLETS Allow Acute - no application Price limitation.
821500 IMDUR 60mg. TABLETS Allow Chronic - no application
886425 IMERON 250 50ML Excl Excluded Excluded - Diagnostics
886448 IMERON 300 100ML Excl Excluded Excluded - Diagnostics
886456 IMERON 300 200ML Excl Excluded Excluded - Diagnostics
886441 IMERON 300 50ML Excl Excluded Excluded - Diagnostics
886472 IMERON 350 100ML Excl Excluded Excluded - Diagnostics
886479 IMERON 350 200ML Excl Excluded Excluded - Diagnostics
886464 IMERON 350 50ML Excl Excluded Excluded - Diagnostics
886487 IMERON 400 100ML Excl Excluded Excluded - Diagnostics
886495 IMERON 400 200ML Excl Excluded Excluded - Diagnostics
886480 IMERON 400 50ML Excl Excluded Excluded - Diagnostics
791857 IMIGRAN 100mg. TABLETS CEF Acute - no application Price limitation. Limited to 4 tablets and 2 fills per year. Amitriptyline/betablocker available as prophylaxis on chronic without application
815640 IMIGRAN 50mg. TABLETS CEF Acute - no application Price limitation. Limited to 6 tablets & 2 fills per year. Amitriptyline/betablocker available as prophylaxis on chronic without application
828246 IMIGRAN NASAL 20mg. Single SPRAY NASAL CEF Acute - no application Price limitation. Amitriptyline/betablocker available as prophylaxis on chronic without application
839507 IMIGRAN REFILL 6mg. x0.5ml. INJECT. Excl Excluded Excluded, injections included in consultation fee
839493 IMIGRAN S/PACK 6mg. x0.5ml. INJECT. Excl Excluded Excluded, injections included in consultation fee
4451 - 4500 of 9613 Medicine's

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