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Epilepsy - Mediscor
Provisional Mediscor Formulary Reference Price (FRP) for 2013 : Epilepsy Effective date : 1 February 2013 Publication date : 12 December 2012 Medicine Name Active Ingredient Therapeutic Group NAPPI Code Pack Size SEP per Pack (Incl VAT) SEP per Unit (Incl VAT) FRP per Pack (Incl VAT) FRP per Unit (Incl VAT) FRP Copayment TEGRETOL 100MG/5ML SUSP DEGRANOL 200MG TABS SANDOZ CARBAMAZEPINE 200M TEGRETOL 200MG TABS SANDOZ CARBAMAZEPINE CR 2 TEGRETOL CR 200MG TABS SANDOZ CARBAMAZEPINE CR 4 TEGRETOL CR 400MG TABS RIVOTRIL DRP RIVOTRIL 0.5MG TAB RIVOTRIL 2MG TAB ZARONTIN SYR EPLEPTIN 100MG CAPS NEUREXAL 100MG CAPS NEURONTIN 100MG CAPS RAN-GABAPENTIN 100MG CAPS EPLEPTIN 300MG CAPS NEUREXAL 300MG CAPS NEURONTIN 300MG CAPS RAN-GABAPENTIN 300MG CAP EPLEPTIN 400MG CAPS NEUREXAL 400MG CAPS NEURONTIN 400MG CAPS RAN-GABAPENTIN 400MG CAPS NEURONTIN 600MG TAB NEURONTIN 800MG TAB LAMICTIN P 100MG DISP TAB LAMICTIN P 200MG DISP TAB LAMICTIN P 50MG DISP TABS ASPEN LAMOTRIGINE 100MG AUSTELL-LAMOTRIGINE 100MG DYNA-LAMOTRIGINE 100MG TA EPITEC 100MG TABS LAMICTIN 100MG TABS LAMIDUS 100MG TABS LAMITOR 100MG TABS SANDOZ LAMOTRIGINE 100MG AUSTELL-LAMOTRIGINE 200MG DYNA-LAMOTRIGINE 200MG TA EPITEC 200MG TABS LAMICTIN 200MG TABS LAMIDUS 200MG TABS LAMITOR 200MG TABS SANDOZ LAMOTRIGINE 200MG ASPEN LAMOTRIGINE 25MG AUSTELL-LAMOTRIGINE 25MG DYNA-LAMOTRIGINE 25MG TAB EPITEC 25MG TABS LAMICTIN 25MG TABS LAMITOR 25MG TABS SANDOZ LAMOTRIGINE 25MG T ASPEN LAMOTRIGINE 50MG AUSTELL-LAMOTRIGINE 50MG DYNA-LAMOTRIGINE 50MG TAB EPITEC 50MG TABS LAMICTIN 50MG TABS LAMIDUS 50MG TABS LAMITOR 50MG TABS SANDOZ LAMOTRIGINE 50MG T LAMICTIN P 2MG DISP TAB Carbamazepine Susp 100 MG/5ML Carbamazepine Tab 200 MG Carbamazepine Tab 200 MG Carbamazepine Tab 200 MG Carbamazepine Tab SR 12HR 200 MG Carbamazepine Tab SR 12HR 200 MG Carbamazepine Tab SR 12HR 400 MG Carbamazepine Tab SR 12HR 400 MG Clonazepam Soln 2.5 MG/ML Clonazepam Tab 0.5 MG Clonazepam Tab 2 MG Ethosuximide Soln 250 MG/5ML Gabapentin Cap 100 MG Gabapentin Cap 100 MG Gabapentin Cap 100 MG Gabapentin Cap 100 MG Gabapentin Cap 300 MG Gabapentin Cap 300 MG Gabapentin Cap 300 MG Gabapentin Cap 300 MG Gabapentin Cap 400 MG Gabapentin Cap 400 MG Gabapentin Cap 400 MG Gabapentin Cap 400 MG Gabapentin Tab 600 MG Gabapentin Tab 800 MG Lamotrigine Orally Disintegrating Tab 10 Lamotrigine Orally Disintegrating Tab 20 Lamotrigine Orally Disintegrating Tab 50 Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 100 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 200 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 25 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab 50 MG Lamotrigine Tab Chewable Dispersible 2 M Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics 769401007 712493018 712523006 769398007 705597001 779652002 705602001 779660005 835129004 761079009 761087001 779105001 707622001 708949001 807443018 710525001 707623001 708994001 807451002 710526001 707624001 708995001 807478008 710527001 705262001 705263001 813907004 891716002 891708006 705441001 707789001 710389001 704381001 805521003 710887002 704488001 705248001 707790001 710390001 704382001 819034002 710888002 712217001 705249001 705436001 707787001 710387001 704379001 805505008 704486001 705251001 705440001 707788001 710388001 704380001 805513019 710885002 704487001 705250001 704533001 250 100 100 50 30 30 30 30 10 90 90 200 100 100 100 100 100 100 100 100 100 100 100 100 100 100 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 30 143.09 169.20 85.93 148.02 72.07 94.36 134.28 174.51 132.66 122.33 280.99 233.02 119.96 112.77 196.56 127.85 299.49 281.50 490.74 319.27 299.49 281.50 490.72 319.27 932.39 992.47 319.31 547.71 184.92 260.81 319.88 210.75 281.32 319.31 121.58 260.64 306.92 520.50 272.70 484.60 547.71 121.58 400.17 515.17 124.04 119.37 86.81 115.28 121.41 112.89 120.09 156.32 194.81 116.52 174.66 184.92 114.00 156.65 184.38 32.36 0.57 1.69 0.86 2.96 2.40 3.15 4.48 5.82 13.27 1.36 3.12 1.17 1.20 1.13 1.97 1.28 2.99 2.82 4.91 3.19 2.99 2.82 4.91 3.19 9.32 9.92 5.32 9.13 3.08 4.35 5.33 3.51 4.69 5.32 2.03 4.34 5.12 8.68 4.54 8.08 9.13 2.03 6.67 8.59 2.07 1.99 1.45 1.92 2.02 1.88 2.00 2.61 3.25 1.94 2.91 3.08 1.90 2.61 3.07 1.08 n/a 169.86 169.86 84.93 47.69 47.69 47.69 47.69 n/a n/a n/a n/a 120.84 120.84 120.84 120.84 299.82 299.82 299.82 299.82 299.82 299.82 299.82 299.82 502.88 502.88 261.29 484.96 157.32 261.29 261.29 261.29 261.29 261.29 261.29 261.29 261.29 484.96 484.96 484.96 484.96 484.96 484.96 484.96 115.60 115.60 115.60 115.60 115.60 115.60 115.60 157.32 157.32 157.32 157.32 157.32 157.32 157.32 157.32 150.87 n/a 1.70 1.70 1.70 1.59 1.59 1.59 1.59 n/a n/a n/a n/a 1.21 1.21 1.21 1.21 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 5.03 5.03 4.35 8.08 2.62 4.35 4.35 4.35 4.35 4.35 4.35 4.35 4.35 8.08 8.08 8.08 8.08 8.08 8.08 8.08 1.93 1.93 1.93 1.93 1.93 1.93 1.93 2.62 2.62 2.62 2.62 2.62 2.62 2.62 2.62 5.03 N N N Y Y Y Y Y N N N N N N Y Y N N Y Y N N Y Y Y Y Y Y Y N Y N Y Y N N Y Y N N Y N N Y Y Y N N Y N Y N Y N Y Y N N Y N FRP Plus per FRP Plus per Pack (Incl VAT) Unit (Incl VAT) n/a 169.86 169.86 84.93 72.16 72.16 134.41 134.41 n/a n/a n/a n/a 120.84 120.84 120.84 120.84 299.82 299.82 299.82 299.82 299.82 299.82 299.82 299.82 502.74 502.74 261.29 484.96 157.32 261.29 261.29 261.29 261.29 261.29 261.29 261.29 261.29 484.96 484.96 484.96 484.96 484.96 484.96 484.96 115.60 115.60 115.60 115.60 115.60 115.60 115.60 157.32 157.32 157.32 157.32 157.32 157.32 157.32 157.32 n/a n/a 1.70 1.70 1.70 2.41 2.41 4.48 4.48 n/a n/a n/a n/a 1.21 1.21 1.21 1.21 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 5.03 5.03 4.35 8.08 2.62 4.35 4.35 4.35 4.35 4.35 4.35 4.35 4.35 8.08 8.08 8.08 8.08 8.08 8.08 8.08 1.93 1.93 1.93 1.93 1.93 1.93 1.93 2.62 2.62 2.62 2.62 2.62 2.62 2.62 2.62 n/a FRP Plus Copayment Pre Auth Req N N N Y N Y N Y N N N N N N Y Y N N Y Y N N Y Y Y Y Y Y Y N Y N Y Y N N Y Y N N Y N N Y Y Y N N Y N Y N Y N Y Y N N Y N Y N N N N N N N Y Y Y Y N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N LAMICTIN P 25MG DISP TABS LAMICTIN P 5MG DISP TAB KEPPRA 100MG/ML SOLN KEPPRA 250MG TABS REDILEV 250MG TABS REDILEV 500MG TABS KEPPRA 750MG TABS REDILEV 750MG TABS MYLAN OXCARBAZEPINE 300MG TRILEPTAL FCT 300MG MYLAN OXCARBAZEPINE 600MG TRILEPTAL FCT 600MG EPANUTIN 100MG CAPS PHENYTOIN SOD 100MG TABS PHENYTOIN SOD 100MG TABS EPANUTIN 125MG/5ML SUSP MYSOLINE 250MG TAB TOPAMAX SC SPRIN 15MG TOPAMAX SC SPRIN 25MG TOPAMAX SC SPRIN 50MG ADCO-TOPIRAMATE 100MG TAB EPITOZ 100MG TABS SANDOZ TOPIRAMATE 100MG T TOPALEX 100MG TABS TOPAMAX 100MG TABS TOPLEP 100MG TABS ADCO-TOPIRAMATE 200MG TAB SANDOZ TOPIRAMATE 200MG T TOPAMAX 200MG TABS TOPLEP 200MG TABS ADCO-TOPIRAMATE 25MG TABS EPITOZ 25MG TABS SANDOZ TOPIRAMATE 25MG TA TOPALEX 25MG TABS TOPAMAX 25MG TABS TOPLEP 25MG TABS ADCO-TOPIRAMATE 50MG TAB EPITOZ 50MG TABS SANDOZ TOPIRAMATE 50MG TA TOPALEX 50MG TABS TOPAMAX 50MG TABS TOPLEP 50MG TABS EPILIM 200MG/5ML LIQ CONVULEX 50MG/ML SYR EPILIM 100MG CRUSH TAB EPILIM CR 200MG TAB EPILIM CR 300MG TAB EPILIM CR 500MG TAB CONVULEX 150MG CAPS CONVULEX 300MG CAPS CONVULEX 500MG CAPS SABRIL 500MG TAB ADCO-PHENOBARB VITAL LETHYL 30MG TAB SEDABARB 30MG TAB Lamotrigine Tab Chewable Dispersible 25 Lamotrigine Tab Chewable Dispersible 5 M Levetiracetam Oral Soln 100 MG/ML Levetiracetam Tab 250 MG Levetiracetam Tab 250 MG Levetiracetam Tab 500 MG Levetiracetam Tab 750 MG Levetiracetam Tab 750 MG Oxcarbazepine Tab 300 MG Oxcarbazepine Tab 300 MG Oxcarbazepine Tab 600 MG Oxcarbazepine Tab 600 MG Phenytoin Sodium Prompt Cap 100 MG Phenytoin Sodium Prompt Tab 100 MG Phenytoin Sodium Prompt Tab 100 MG Phenytoin Sodium Susp 125 MG/5ML Primidone Tab 250 MG Topiramate Sprinkle Cap 15 MG Topiramate Sprinkle Cap 25 MG Topiramate Sprinkle Cap 50 MG Topiramate Tab 100 MG Topiramate Tab 100 MG Topiramate Tab 100 MG Topiramate Tab 100 MG Topiramate Tab 100 MG Topiramate Tab 100 MG Topiramate Tab 200 MG Topiramate Tab 200 MG Topiramate Tab 200 MG Topiramate Tab 200 MG Topiramate Tab 25 MG Topiramate Tab 25 MG Topiramate Tab 25 MG Topiramate Tab 25 MG Topiramate Tab 25 MG Topiramate Tab 25 MG Topiramate Tab 50 MG Topiramate Tab 50 MG Topiramate Tab 50 MG Topiramate Tab 50 MG Topiramate Tab 50 MG Topiramate Tab 50 MG Valproate Sodium Liqd 200 MG/5ML Valproate Sodium Syrup 250 MG/5ML (Base Valproate Sodium Tab 100 MG Valproate Sodium Tab CR 200 MG Valproate Sodium Tab CR 300 MG Valproate Sodium Tab CR 500 MG Valproic Acid Cap 150 MG Valproic Acid Cap 300 MG Valproic Acid Cap Delayed Release 500 MG Vigabatrin Tab 500 MG *Phenobarbital w/ Vitamins Elixir 16 MG/ Phenobarbital Tab 30 MG Phenobarbital Tab 30 MG Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Anti-Epileptics Barbiturates Barbiturates Barbiturates DISCLAIMER: Please note that these formularies are reviewed regularly by the Mediscor Pharmaceutical and Therapeutics Committee to ensure that they comply with the latest industry norms for the treatment of the listed conditions. Mediscor PBM Pty Ltd reserves the right to change medicines to comply with the latest industry norms for the treatment of the listed conditions. Mediscor PBM Pty Ltd reserves the right to change medicines included in the formulary when important or new information is made available, e.g. on new findings regarding the safety of medicine. COPYRIGHT: Mediscor PBM reserves its copyright and all its other rights in or in respect of the Mediscor Formularies. No part of the Mediscor Formularies may be reproduced, photocopied, recorded or stored in any retrieval system, or transmitted by any means, electronic, mechanical or otherwise, without the written permission of Mediscor PBM. 813893003 813885019 714166001 700958003 714662001 714663001 703165001 714664001 717226001 892484008 717227001 892491020 723525005 754870015 754870016 723533016 745588018 878014004 878022007 890728003 710242001 710901001 709286001 715981001 822531003 708391001 710243001 709287001 836753003 708392001 710240001 710899001 709284001 715978001 822515008 708389001 710241001 710900001 709285001 715979001 822523019 708390001 780545001 781541018 821578006 818666005 818674008 818682019 715980009 715999001 781568005 809594005 754803007 737844019 814946003 60 100 300 60 30 30 60 30 50 50 50 50 100 1000 90 237 100 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 60 300 100 100 100 100 100 100 100 100 100 100 1000 1000 121.41 119.93 299.40 319.99 81.51 163.02 958.18 244.52 179.39 229.04 326.37 431.25 201.89 433.37 38.85 224.36 241.22 218.01 218.01 368.06 425.86 341.49 526.83 439.61 837.85 439.50 632.34 801.59 1274.82 652.55 122.60 124.18 150.41 134.52 315.94 134.51 255.26 245.15 236.64 247.48 497.02 247.33 219.51 91.46 217.82 303.31 454.71 752.61 234.06 406.41 602.08 1176.63 68.39 135.84 74.65 2.02 1.20 1.00 5.33 2.72 5.43 15.97 8.15 3.59 4.58 6.53 8.63 2.02 0.43 0.43 0.95 2.41 3.63 3.63 6.13 7.10 5.69 8.78 7.33 13.96 7.33 10.54 13.36 21.25 10.88 2.04 2.07 2.51 2.24 5.27 2.24 4.25 4.09 3.94 4.12 8.28 4.12 0.73 0.91 2.18 3.03 4.55 7.53 2.34 4.06 6.02 11.77 0.68 0.14 0.07 115.60 502.88 224.46 163.48 81.74 145.76 489.06 244.53 179.55 179.55 326.61 326.61 43.32 433.20 38.99 n/a 502.88 134.75 134.75 247.61 439.81 439.81 439.81 439.81 439.81 439.81 653.22 653.22 653.22 653.22 134.75 134.75 134.75 134.75 134.75 134.75 247.61 247.61 247.61 247.61 247.61 247.61 n/a 74.82 502.88 n/a n/a n/a n/a n/a n/a 502.88 n/a n/a n/a 1.93 5.03 0.75 2.72 2.72 4.86 8.15 8.15 3.59 3.59 6.53 6.53 0.43 0.43 0.43 n/a 5.03 2.25 2.25 4.13 7.33 7.33 7.33 7.33 7.33 7.33 10.89 10.89 10.89 10.89 2.25 2.25 2.25 2.25 2.25 2.25 4.13 4.13 4.13 4.13 4.13 4.13 n/a 0.75 5.03 n/a n/a n/a n/a n/a n/a 5.03 n/a n/a n/a Y N Y Y N Y Y N N Y N Y Y Y N N N Y Y Y N N Y N Y N N Y Y N N N Y N Y N Y N N N Y N N Y N N N N N N N Y N N N 115.60 n/a 227.98 163.48 81.74 150.82 489.06 244.53 179.55 179.55 326.61 326.61 43.32 433.20 38.99 n/a 502.74 n/a 134.75 247.61 439.81 439.81 439.81 439.81 439.81 439.81 653.22 653.22 653.22 653.22 134.75 134.75 134.75 134.75 134.75 134.75 247.61 247.61 247.61 247.61 247.61 247.61 n/a n/a n/a n/a n/a n/a n/a n/a n/a 485.85 n/a n/a n/a 1.93 n/a 0.76 2.72 2.72 5.03 8.15 8.15 3.59 3.59 6.53 6.53 0.43 0.43 0.43 n/a 5.03 n/a 2.25 4.13 7.33 7.33 7.33 7.33 7.33 7.33 10.89 10.89 10.89 10.89 2.25 2.25 2.25 2.25 2.25 2.25 4.13 4.13 4.13 4.13 4.13 4.13 n/a n/a n/a n/a n/a n/a n/a n/a n/a 4.86 n/a n/a n/a Y N Y Y N Y Y N N Y N Y Y Y N N N N Y Y N N Y N Y N N Y Y N N N Y N Y N Y N N N Y N N N N N N N N N N Y N N N N N Y N N N N N N N N N N N N Y N N N N N N N N N N N N N N N N N N N N N N N N N N Y Y N N N N N N N N N N N
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