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
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