Drug Benefit List

20:00 BLOOD FORMATION COAGULATION AND THROMBOSIS

20:04.04 IRON PREPARATIONS

FERROUS FUMARATE

300MG Capsule

02237556     EURO-FER     EUR

00482064     NEO FER     NEO

01923420     PALAFER     GSK

60MG/ML Suspension

01923439     PALAFER     GSK

200MG Tablet

02138751     FERROUS FUMARATE     VTH

300MG Tablet

00031089     FERROUS FUMARATE     PED

FERROUS GLUCONATE

300MG Tablet

00545031     APO-FERROUS GLUCONATE     APX

00041157     FERROUS GLUCONATE     PMS

00031097     FERROUS GLUCONATE     PED

00021458     NOVO-FERROGLUC SCT     NOP

324MG Tablet

00582727     FERROUS GLUCONATE     VTH     *

FERROUS SULFATE

15MG/ML Drop

02237385     FERODAN PED     ODN

02232202     PEDIAFER     EUR

02222574     PMS-FERROUS SULFATE     PMS

75MG/ML Drop

00762954     FER-IN-SOL     MJO

6MG/ML Syrup

00017884     FER-IN-SOL     MJO

02242863     PEDIAFER     EUR

30MG/ML Syrup

00758469     FERODAN     ODN

00792675     PMS-FERROUS SULFATE     PMS

300MG Tablet

01912518     APO-FERROUS SULFATE FC     APX

02246733     EURO-FERROUS SULFATE     EUR

00179655     FERROUS SULFATE     SDR

00031100     FERROUS SULFATE     PED

00782114     FERROUS SULFATE     VTH     *

00346918     FERROUS SULFATE     PMT

02125471     FERROUS SULFATE     PDL

00586323     PMS-FERROUS SULFATE     PMS

IRON DEXTRAN

50MG/ML Injection

02205963     DEXIRON     GEN

02221780     INFUFER     SDZ

20:12.04 ANTICOAGULANTS

DALTEPARIN SODIUM

10,000IU/0.4ML Injection

09853790     FRAGMIN     PMJ     *

99004143     FRAGMIN     PMJ     *

10,000IU/ML Injection

02132664     FRAGMIN     PMJ

12,500IU/0.5ML Injection

99004151     FRAGMIN     PMJ     *

15,000IU/0.6ML Injection

09853880     FRAGMIN     PMJ     *

99004178     FRAGMIN     PMJ     *

18,000IU/0.72ML Injection

09853910     FRAGMIN     PMJ     *

99004186     FRAGMIN     PMJ     *

25,000IU/ML Injection (Multi-Dose)

02231171     FRAGMIN     PMJ

2,500IU/0.2ML Injection (Pre-filled Syringe)

02132621     FRAGMIN     PMJ

5,000IU/0.2ML Injection (Pre-filled Syringe)

02132648     FRAGMIN     PMJ

ENOXAPARIN SODIUM

30MG/0.3ML Injection

02012472     LOVENOX     SAC

40MG/0.4ML Injection

02236883     LOVENOX     SAC

60MG/0.6ML Injection

99002965     LOVENOX     AVT     *

80MG/0.8ML Injection

99003058     LOVENOX     AVT     *

100MG/1.0ML Injection

99002981     LOVENOX     AVT     *

120MG/0.8ML Injection

99004941     LEVENOX HP     AVT

150MG/1.0ML Injection

02242692     LEVONEX HP     SAC

300MG/3ML Injection

02236564     LOVENOX     SAC

HEPARIN SODIUM

1,000 U/ML Injection

00740519     HEPALEAN     ORG

10,000 U/ML Injection

00740497     HEPALEAN     ORG

10U/ML Lock Flush

02230084     HEPALEAN-LOK FLUSH     ORG

00725323     HEPARIN LOCK FLUSH     ABB

100U/ML Lock Flush

00740578     HEPALEAN LOK     ORG

00727520     HEPARIN LEO     LEO

00725315     HEPARIN LOCK FLUSH     ABB

NADROPARIN CALCIUM

9,500IU/ML Injection

02236913     FRAXIPARINE     GSK

19,000IU/ML Injection

02240114     FRAXIPARINE FORTE     GSK

NICOUMALONE

1MG Tablet

00010383     SINTROM     PED

4MG Tablet

00010391     SINTROM     PED

TINZAPARIN SODIUM

10,000IU/ML (2ML) Injection

02167840     INNOHEP     LEO

20,000IU/ML (2ML) Injection

02229515     INNOHEP     LEO

20,000IU/ML Injection (Graduated Syringe)

02231478     INNOHEP     LEO

10,000IU/ML Injection (Pre-filled Syringe)

02229755     INNOHEP     LEO

09853898     INNOHEP     LEO     *

20,000IU/ML Injection (Pre-filled Syringe)

09853901     INNOHEP     LEO     *

09853928     INNOHEP     LEO     *

WARFARIN SODIUM

1MG Tablet

02242924     APO-WARFARIN     APX

01918311     COUMADIN     BMS

02244462     GEN-WARFARIN     GEN

02265273     NOVO-WARFARIN     NOP

02242680     TARO-WARFARIN     TAR

2MG Tablet

02242925     APO-WARFARIN     APX

01918338     COUMADIN     BMS

02244463     GEN-WARFARIN     GEN

02265281     NOVO-WARFARIN     NOP

02242681     TARO-WARFARIN     TAR

2.5MG Tablet

02242926     APO-WARFARIN     APX

01918346     COUMADIN     BMS

02244464     GEN-WARFARIN     GEN

02265303     NOVO-WARFARIN     NOP

02242682     TARO-WARFARIN     TAR

3MG Tablet

02245618     APO-WARFARIN     APX

02240205     COUMADIN     BMS

02265311     NOVO-WARFARIN     NOP

02242683     TARO-WARFARIN     TAR

4MG Tablet

02242927     APO-WARFARIN     APX

02007959     COUMADIN     BMS

02244465     GEN-WARFARIN     GEN

02265338     NOVO-WARFARIN     NOP

02242684     TARO-WARFARIN     TAR

5MG Tablet

02242928     APO-WARFARIN     APX

01918354     COUMADIN     BMS

02244466     GEN-WARFARIN     GEN

02265346     NOVO-WARFARIN     NOP

02242685     TARO-WARFARIN     TAR

6MG Tablet

02242686     TARO-WARFARIN     TAR

7.5MG Tablet

02242697     TARO-WARFARIN     TAR

10MG Tablet

02242929     APO-WARFARIN     APX

01918362     COUMADIN     BMS

02244467     GEN-WARFARIN     GEN

02242687     TARO-WARFARIN     TAR

20:12.18 PLATELET AGGREGATION INHIBITORS

ANAGRELIDE HCL

0.5MG Capsule

02236859     AGRYLIN     SHI

02253054     GEN-ANAGRELIDE     GEN

02274949     PMS-ANAGRELIDE     PMS

02260107     RHOXAL-ANAGRELIDE     RHO

TICLOPIDINE HCL

250MG Tablet

02237701     APO-TICLOPIDINE     APX

02239744     GEN-TICLOPIDINE     GEN

02236848     NOVO-TICLOPIDINE     NOP

02237560     NU-TICLOPIDINE     NXP

02238208     PDL-TICLOPIDINE     PDL

02243587     RHOXAL-TICLOPIDINE     SDZ

20:16.00 HEMATOPOIETIC AGENTS

FILGRASTIM

300MCG/ML Injection

01968017     NEUPOGEN     AMG

99001454     NEUPOGEN     AMG     *

480MCG/1.6ML Injection

09853464     NEUPOGEN     AMG

PEGFILGRASTIM

Limited use benefit (prior approval required).

a. - To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive antineoplastic drugs with curative intent.
and
b. - Where access to a health care facility is problematic.

10MG/ML Injection

02249790     NEULASTA     AMG

20:24.00 HEMORRHEOLOGIC AGENTS

PENTOXIFYLLINE

400MG Sustained Release Tablet

02230090     APO-PENTOXIFYL     APX

02230401     NU-PENTOXIFYL     NXP

01968432     RATIO-PENTOXIFYLLINE     RPH

02221977     TRENTAL     SAC

20:28.16 HEMOSTATICS

AMINOCAPROIC ACID

500MG Tablet

02169754     AMICAR     WAY

TRANEXAMIC ACID

500MG Tablet

02064405     CYKLOKAPRON     PFI