GUIDELINES FOR PANEL HOSPITALS BY TNB HEALTHCARE, TGBS VERSION 2.0, SEPTEMBER 2022
INTRODUCTION The o b j e c t i v e o f t h i s i n i t i a t i v e i s t o i m p r o v e t h e T u r n a r o u n d T i m e f o r F i n a l G u a r a n t e e L e t t e r i s s u a n c e , e n s u r e s y s t e m a t i c a n d s t a n d a r d i z e d f l o w o f i n f o r m a t i o n a n d w o r k p r o c e s s . T h i s g u i d e l i n e i s a i m e d t o e n h a n c e a p p r o p r i a t e n e s s o f p r a c t i c e , i m p r o v e q u a l i t y c a r e a n d t o p r o v i d e c a r e t h a t i s i n a c c o r d a n c e t o K e m e n t e r i a n K e s i h a t a n M a l a y s i a ( K K M ) g u i d e l i n e s t o a l l o u r T N B s t a f f s , r e t i r e e s a n d d e p e n d e n t s . T h i s b o o k l e t s e r v e s a s a r e f e r e n c e f o r a l l T N B p a n e l h o s p i t a l s. T h e c o n t e n t s o f t h e b o o k l e t c o n s i s t o f T N B g u i d e l i n e s o n c o v e r a g e o f V i t a m i n s , S u p p l e m e n t s , V a c c i n e s & P r o c e d u r e , e t c . The c o v e r a g e o f v i t a m i n s a n d s u p p l e m e n t t o t h e r e l e v a n t d i a g n o s i s a n d c o n d i t i o n s a r e a s m e n t i o n e d i n t h i s g u i d e l i n e s . A l l v i t a m i n s s h o u l d b e p r e s c r i b e d i n o r a l f o r m a n d i n a c c o r d a n c e t o t h e c o v e r a g e . T h i s g u i d e l i n e w i l l b e r e v i e w e d f r o m t i m e t o t i m e , i n a c c o r d a n c e t o t h e l a t e s t a n d b e s t m e d i c a l p r a c t i c e s . Version 2.0, September 2022
SUMMARY OF CHANGES PAGE NO. CONTENT ITEM NO. 6 (A) Vitamin 1 and 2 7 (A) Vitamin 6, 8 and 10 9 (B) Supplement 2 and 5 10 (B) Supplement 14 12 (C) Dermatological Condition Coverages 1 and 2 14 (D) Other Coverages 1 16 (E) Alternative Medicine Not Covered 1, 2 and 3 17 (E) Alternative Medicine Not Covered 15 – 22 20 (F) Medical Procedure Intra-vitreal VEGF Inhibitor (Eylea / Accentrix) 21 (F) Medical Procedure Repatha / Sybrava Injection indications 23 (G) Medical Supplies / AID 3, 5 and 8 25 (H) Coverages of Psychotropic Drugs All contents 27 (I) Maximum Quantity allowed Analgesic Coverage 28 (I) Maximum Quantity allowed Other acute Symptomatic Medical Coverage Version 2.0, September 2022
A B C D E F G H Vitamin Supplement Alternative Medicine Not Covered Maximum quantity allowed Other Coverages Medical Procedure 9 - 10 12 14 16 - 17 19 – 21 23 25 TABLE OF CONTENT 6 - 7 “ I 27 - 28 Coverage of Psychotropic Drugs Medical Supplies / Aid Dermatological Condition Coverages Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
6 NO. VITAMIN VITAMERS DIAGNOSIS COVERAGE 1 A Beta-carotene • Vitamin A Deficiency • Cancer patient Covered 2 B1 Thiamine • Anti-Convulsant treatment (Epilepsy treatment) • Anti-TB treatment (Isoniazid) • Brain Disorder (Encephalopathy) / Dementia / Alzheimer’s Disease • Cancer patient • Chronic Liver Disease / Cirrhosis • Seborrheic Dermatitis • Sideroblastic Anemia • Stroke (CVA) Covered 3 B2 Riboflavin • Anti-Convulsant treatments (Epilepsy treatment) • Anti-TB treatment (Isoniazid) • Brain Disorder (Encephalopathy) / Dementia / Alzheimer’s Disease • Cancer patient • Chronic Liver Disease / Cirrhosis • Seborrheic Dermatitis • Sideroblastic Anemia • Stroke (CVA) Covered 4 B6 Pyridoxine • Anti-Convulsant treatment (Epilepsy treatment) • Anti-TB treatment (Isoniazid) • Brain Disorder (Encephalopathy) / Dementia / Alzheimer’s Disease • Cancer patient • Chronic Liver Disease / Cirrhosis • Seborrheic Dermatitis • Sideroblastic Anemia • Stroke (CVA) Covered 5 B9 Folic Acid (Folate) • Anemia • Anti-Tuberculosis treatment • Cancer patient / Anti-Cancer treatment • End Stage Renal Failure (ESRF) • Epilepsy • Medical condition treated with Methotrexate: o Placenta Previa / Placenta Accreta / Ectopic Pregnancy / Molar Pregnancy o All types of Cancers o Autoimmune Diseases o Psoriasis o Rheumatoid Arthritis o Crohn's Disease Covered A V I TA M I N Version 2.0, September 2022
7 NO. VITAMIN VITAMERS DIAGNOSIS COVERAGE • Patient On Tuberculosis Medication • Pregnancy • Rheumatoid Arthritis • Thalassemia Covered 6 B12 Neurobion / Methylcobalamin • Cancer patient • Fracture of Limbs • Multiple Sclerosis • Neuropathy Disorder (e.g. Diabetic Neuropathy) • Prolapsed Intervertebral Disc (PID) with Sciatica • Stroke (CVA) • Vitamin B12 Deficiency / Megaloblastic Anemia / Pernicious Anemia • Vestibular Neuritis Covered 7 C Ascorbic Acid • Acute Infectious Disease • Anemia • Cancer patient • Chronic Wound • Pregnancy • Thalassemia • URTI / Viral Fever / Dengue Fever (Max: 1 week supply) • Vitamin C Deficiency / Scurvy Covered 8 D / D3 / Rocaltrol / Alpha (α) - Vitamin D (D2) Cholecalciferol (D3) / Ergocalciferol (D2) • Any Bony Pathology Diseases • Cancer patient • ESRF / CKD • Nephropathy • Osteoporosis • Post-Thyroidectomy • SLE • Stroke (CVA) • Vitamin D Deficiency Covered 9 E Tocopherols / Tocotrienols • Antioxidants Not covered 10 K Phylloquinone / Menaquinones • Cancer patient • Bleeding Diathesis / Bleeding Disorders • Vitamin K Deficiency in newborn Covered A V I TA M I N Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
9 NO. SUPPLEMENT DIAGNOSIS COVERAGE 1 Bio Quinone Q 10 (For 6 months only) • Acute Heart Disease: o (Acute MI / ACS (Acute Coronary Syndrome) / STEMI / NSTEMI / CAD) • Heart Failure / CCF (Congestive Cardiac Failure) • Post Coronary Artery Bypass Grafting (Bypass Surgery) Covered 2 Calcium • Bone Disorders • Cancer patient • End Stage Renal Failure (ESRF) / Chronic Kidney Disease (CKD) • Hypocalcemia • Hypoparathyroidism • Hypothyroidism • Osteoporosis • Post-Thyroidectomy • Pregnancy • Tetany (muscle cramps) Covered 3 Essential Forte • Dengue Fever with Transaminitis (3 months only) • Fatty Liver Disease (6 months only) • Hepatitis • Liver Cirrhosis Covered 4 Fiber • Anorectal Disorder (Hemorrhoid, anal fistula) • Constipation • Gastrointestinal Disorder / GIT Cancer • Irritable Bowel Syndrome • Parkinson’s Disease • Stroke Covered 5 Ginkgo Biloba • Alzheimer Disease • Dementia • Encephalopathy • Meniere's Disease (Sensory Neural Hearing Loss) • Peripheral Vascular Disease (PVD) • Stroke (CVA) • Transient Ischemic Attack (TIA) • Vestibular Neuritis Covered 6 Glucosamine Phosphate & Chondroitin Sulphate • Osteoarthritis (OA) • Systemic Lupus Erythematosus (SLE) / Rheumatoid Arthritis (RA) Covered 7 Iberet Folic / Sangobion • Anemia • Chronic Kidney Disease (CKD) • Cancer Patient • ESRF • Hemoglobin low • Stroke (CVA) • Thalassemia Covered B S U P P L E M E N T Version 2.0, September 2022
10 NO. SUPPLEMENT DIAGNOSIS COVERAGE 8 Iron / Ferrous Fumarate • Anemia / Iron Deficicency • Pregnancy • Thalassemia • Cancer patient Covered 9 Ketosteril • Chronic Kidney Disease (CKD) • End Stage Renal Failure (ESRF) Covered 10 Legalon • Dengue Fever with Transaminitis (3 months only) • Fatty Liver Disease (6 months only) • Hepatitis • Liver Cirrhosis Covered 11 Magnesium • Magnesium Deficiency • Pregnancy (Pre-Eclampsia / Eclampsia) Covered 12 Probiotics • Acute Gastroenteritis (e.g. Rotavirus) • Crohn’s Disease • Gastrointestinal Disorder • Infective Colitis • Irritable Bowel Syndrome Covered 13 Sodium Chloride • Chronic Hyponatremia Covered 14 Vitamins + Folic Acid + Minerals (Obimin / Obimin Plus / Obi Combo) • Anemia • Pregnancy Covered B S U P P L E M E N T Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
12 D E R M AT O L O G I C A L C O N D I T I O N C O V E R A G E S C NO. TYPE OF TREATMENT DERMATOLOGY CONDITIONS COVERAGE 1 Emollients / Moisturizer Dermavion Sodium Hyaluronate Moisturizer • Acne Vulgaris • Atopic Dermatitis • Bed Sores • Burns • Cancer patient • Chemotherapy Induced Xerosis • Chronic Dry Wound • Dermatitis (All types) • Dry skin • Eczema (Adult and Paediatrics) • Ichthyosis • Lichen Planus • Nappy rash • Pruritus (Uremic / Hepatic Disorder, Pregnancy) • Psoriasis • Radiation Dermatitis • Stasis Eczema (Varicose Vein) • Scars • Striae (All types) Covered 2 Anti-Comodolytics / Anti-Keratolytics Dermavion Salicylic Acid 2% cleanser • Acne Vulgaris • Dermatitis (All types) • Eczema • Freckles • Ichthyosis • Lentigines • Melasma • Photo Damage • Post Inflammatory Hyperpigmentation • Psoriasis Covered Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
14 D O T H E R C O V E R A G E S NO. DRUGS DIAGNOSIS COVERAGE 1 Viagra / Cialis • Benign Prostate Hypertrophy (BPH) (Resistant to first line and Anti-BPH treatment) • Pulmonary Artery Hypertension (PAH) • Pulmonary Venous Hypertension (PVH) Covered Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
16 NO. SUPPLEMENT / DRUG (NOT COVERED BY TNB) SUBSTITUTE (COVERED BY TNB) 1 Alanerve, Bionerv Methylcobalamin / Neurobion / Vitamin B12 2 Any non-medical items, e.g. • Flexiseq Gel • Perskindol Gel / Spray • Olivenol Plus Essence (olive fruit extract) • Polar Frost Voltaren Gel / Flanil / Ketoprofen / Arnica / Reparil Gel / Acustop 3 Any type of cleanser: • Cetaphil • Sebamed • Selsun shampoo • Ointment Bar Soap • QV Gentle Wash Dermavion Salicylic Acid 2% cleanser / Ketoconazole shampoo / cleanser / Tar preparations 4 Any type of cosmetic treatment / medicines • Dermatix • Duromine tablets • Sunblock UVA / UVB SPF 50 / 100 • Tri-Luma Cream • Vitamin C & E Cream / Gel Dermavion Sodium Hyaluronate Moisturizer 5 Any type of dietary / food supplement, e.g. • Evening primrose oil • Piascledine • Prelief • Nutren product • Oat based products • Piascledine • Prelief Glucosamine & Chondroitin Sulphate - - - - 6 Any type of milk powder (e.g. Isomil / Enfalac / MamexGold / Peptamen / Enfamil / Ensure / Anlene) - 7 Any type of multivitamin (e.g. Appetton, Kiddo Pharmaton, Surbex zinc, Revicon Forte, Pharmaton) - 8 Any type of related herbal products except in lozenges and cough medicines Prospan, Benadryl, Cough Linctus 9 Bio Marine Plus Vitamin D / Vitamin D3 10 Bion 3 Multivitamin Vitamin D / Vitamin D3 11 Cell renew (protein + enzymes + oxyten) - 12 Cranberry Tablet / Juice Ural / Mist Potassium Citrate 13 Family Planning • HRT / IUCD - 14 Ginsana (Ginseng) - A LT E R N AT I V E M E D I C I N E N O T C O V E R E D E Version 2.0, September 2022
17 NO. SUPPLEMENT / DRUG (NOT COVERED BY TNB) SUBSTITUTE (COVERED BY TNB) 15 Glujoint (collagen peptide) Glucosamine & Chondroitin Sulphate 16 Neuroaid (herbal mixture) Methylcobalamin / Neurobion / Vitamin B12 17 Neurogain - 18 Omega 3 based products (Provas, fish oil, krill oil) - 19 Other vitamins and supplements not listed in List A & B - 20 Pregnancy test - 21 Product under research - 22 Strepsils / Fishermans Friends Difflam / Mac dual lozenges A LT E R N AT I V E M E D I C I N E N O T C O V E R E D E Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
19 M E D I C A L P R O C E D U R E BOTOLUNIUM TOXIN INJECTION (BOTOX) NO. MEDICAL CONDITION COVERAGE 1 Bladder Dysfunction • Detrusor over activity associated with a Neurologic condition • Overactive Bladder • Urinary incontinence Covered 2 Blepharospasm and Strabismus • Benign Essential Blepharospasm • Strabismus and Blepharospasm associated with Dystonia • VII Nerve / Carnial Nerve Disorders Covered 3 Cervical Dystonia • All Mucular Dystonia Covered 4 Chronic Migraine • Prophylaxis of Headache Not Covered 5 Primary Axillary Hyperhydrosis • Excessive Sweating Not Covered Need Special Approval 6 Spasticity • Upper Limb Spasticity • Lower Limb Spasticity Covered NEONATAL HEARING TEST NO. INDICATION COVERAGE 1 Apgar Scores Of 0-4 at 1 minute Or 0-6 at 5 minutes Covered 2 Associated Syndromes 3 Bacterial Meningitis 4 Carnio Facial Anomalies 5 Family History 6 Head Trauma 7 Hyperbilirubinemia 8 In-Utero Infections (CMV) 9 Neurodegenerative Disorders 10 Nicu Stay > 2 Days 11 Ototoxic Medications 12 Newborn Screening / Routine Not Covered F Version 2.0, September 2022
20 INTRA –ARTICULAR INJECTION (HYALURONIC ACID (HA)) NO. INDICATION COVERAGE 1 Shoulder Joint Osteoarthritis (SJ OA) Maximum 2 HA injection per joint per calendar year 2 Knee Joint Osteoarthritis (KJ OA) Maximum 3 HA injection per joint per calendar year 3 Hip Joint Osteoarthritis (HJ OA) Maximum 3 HA injection per joint per calendar year 4 Spine Disorder Needs TNBHC approval with valid justification 5 Other Joints Disorder Not Covered INTRA-VITREAL VEGF INHIBITOR (EYLEA / ACCENTRIX) NO. INDICATION COVERAGE 1 Age-Related Macular Degeneration with Sub Foveal Choroidal Neovascularization 1st year Maximum 5 times per eye with additional 2 more injections per eye 2 Diabetic Macular Edema with valid justification 3 Macular Edema Secondary to Retinal Vein Occlusion (RVO) 2nd year Maximum 5 times per eye only per calendar year 4 Myopic Choroidal Neovascularization 3rd year & onwards Maximum 3-5 injections per eye per calendar year F M E D I C A L P R O C E D U R E Version 2.0, September 2022
21 KERATOCONUS (KC) NO. PROCEDURE COVERAGE 1 Advanced Corneal Topographic Modeling Covered 2 General Examination 3 Fitting of Contact Lenses or Scleral Lenses Not Covered HORMONAL INTRA-UTERINE DEVICE (E.g. MIRENA) NO. PROCEDURE COVERAGE 1 Abnormal growth of the lining of the uterus (Endometrial Hyperplasia) Covered 2 Abnormal growth of uterine-lining tissue into the muscular wall of the uterus (Adenomyosis) 3 Anemia secondary to Gynecological pathology 4 Cramping or pain with periods 5 Endometriosis 6 Fibroids 7 Heavy menstrual bleeding REPATHA / SYBRAVA INJECTION INDICATION Repatha injection are allowed within stipulated time period in accordance to medical specialist for the given diagnosis only: • Homozygous Familial Hypercholesterolemia (FH) • Primary Hyperlipidemia (Heterozygous Familial Hypercholesterolemia (FH)) • Resistant / Failed Conventional Statin Therapy (Suggested 3 months to 1 year with the approval of TNB prior to treatment) Remark: Repatha / Sybrava injection will not be covered once LDL cholesterol level return to normal reading F M E D I C A L P R O C E D U R E Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
23 NO. MEDICAL SUPPLIES MEDICAL CONDITION COVERAGE 1 Alcohol Swabs For Insulin Dependent Diabetes Mellitus (IDDM) (100 swabs / 1 box per month only) Covered 2 Arm Sling Fracture / Dislocation / Phlebitis Covered 3 Braces (Spine, Knee, etc.) Fracture / Dislocation Covered 4 Compression Socks Deep Vein Thrombosis DVT Prophylaxis Intra and Post-Operative Varicose Veins Covered 5 Crutches Fracture of lower limbs Covered 6 Glucometer For Insulin Dependent Diabetes Mellitus (IDDM) (once in lifetime) Covered 7 Strips and Lancets For Insulin Dependent Diabetes Mellitus (IDDM) (60 strips / 1 bottle per month only) Covered 8 Sterno Brace Post Sternotomy Covered G M E D I C A L S U P P L I E S / A I D Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
25 C O V E R A G E O F P S Y C H O T R O P I C D R U G S H All types of PSYCHOTROPIC & ANTI-DEPRESSANT MEDICINE can be prescribed for SHORT TERM ONLY (Not more than 3 months) by a NonPsychiatrist / Non-Neurologist / Non-Pain Management Specialist. Psychiatrist / Neurologist / Pain Management Specialist can prescribe Psychotropic, Antidepressant including Narcotic drugs for LONG TERM (More than 3 months). GROUP OF PSYCHOTROPIC MEDICINES EXAMPLES Barbiturates a) Phenobarbitone Benzodiazepines a) Alprazolam ( e.g. Xanax, Xanapam ) b) Clonazepam ( e.g. Rivotril, Rivopam ) c) Diazepam (e.g. Valium, Diapo) d) Lorazepam ( e.g. Ativan, Tranpam, Lorans ) e) Midazolam ( e.g Dormicum ) Non-Benzodiazepines a) Zolpidem ( e,g. Stilnox ) b) Zopiclone ( e.g. Imovane ) Opioid Analgesic / Narcotic Derivatives a) Buprenorphine b) Codeine c) Dihydrocodeine ( e.g. DF118, Dicogesic ) d) Fentanyl ( e.g. Durogesic, Actiq ) e) Hydrocodone ( e.g. Zohydro ER, Vicodin, Lortab ) f) Hydromorphone ( e.g. Dilaudid, Exalgo ) g) Methadone ( e.g. Methadose, Diskets, Dolophine ) h) Morphine ( e.g. Avinza, Kardian, MSIR, MS Contin ) i) Oxycodone ( e.g Oxycontin, Roxicodone, Percocet ) j) Oxymorphone ( e.g. Opana ) k) Pethidine Other common Anti-Depressants a) Duloxetine (e.g. Cymbalta) b) Mirtazepine (e.g. Remeron) c) Venlafaxine (e.g. Efexor) d) Vortioxetine (e.g. Brintellix) SSRI Anti-Depressants a) Escitalopram ( e.g. Lexapro ) b) Fluoxetine ( e.g. Prozac ) c) Fluvoxamine ( e.g. Luvox ) d) Paroxetine ( e.g Seroxat CR ) e) Sertraline ( e.g. Zoloft ) Version 2.0, September 2022
GUIDELINES FOR PANEL HOSPITALS A - V I T A M I N B - S U P P L E M E N T C – D E R M A T O L O G I C A L C O N D I T I O N C O V E R A G E S D – O T H E R C O V E R A G E S E - A L T E R N A T I V E M E D I C I N E N O T C O V E R E D F - M E D I C A L P R O C E D U R E G - M E D I C A L S U P P L I E S / A I D H – C O V E R A G E S O F P S Y C H O T R O P I C D R U G S I – M A X I M U M Q U A N T I T Y A L L O W E D Version 2.0, September 2022
27 DOSAGE FORM MEDICINE /DRUG MAXIMUM COVERAGE PER DIAGNOSIS Oral analgesic (Non-Opioids) • COX-2 Inhibitors e.g. Celecoxib, Etoricoxib • NSAIDs e.g Mefenamic Acid, Ibuprofen, Naproxen, Diclofenac, Ketoprofen, Aspirin • Others e.g. Meloxicam, Piroxicam • Paracetamol Not more than 60 tablets per month Oral analgesic (Opioids) • Combined Opiod-Analgesic e.g. Ultracet (Paracetamol + Tramadol) Panedeine (Paracetamol + Codeine) • Tramadol Not more than 90 tablets per month Topical (Cream / Gel / Ointment) • Anti-inflammatory (e.g. Reparil Gel & Arnica Gel • Diclofenac (e.g. Voltaren, Voren, Voren Plus, Dicloran) • Ketoprofen (e.g. Fastum) • Methyl salicylate (e.g. Flanil) Not more than 120g Topical (Plaster) • Esflurbiprofen (e.g. Locoa) • Flurbiprofen (e.g. Acustop) • Ketoprofen (e.g. Ketotop, Kenhancer, Kefentech) Not more than 30 patches per month • Lignocaine ( e.g Lignopad 5% ) Not more than 15 patches per month Topical (Spray) • Diclofenac ( e.g. Uniren ) Not more than 120ml I M A X I M U M Q U A N T I T Y A L L O W E D The above analgesics coverage is not applicable for the following conditions: • Cancer Patients • Chronic Illness that requires prolonged analgesic treatments (needs valid justification from the Treating Specialist) • Any other conditions with valid justification needs prior approval from TNB Healthcare ANALGESIC COVERAGE Version 2.0, September 2022
28 DOSAGE FORM MEDICINE /DRUG MAXIMUM COVERAGE PER DIAGNOSIS Dermatological Emollient / Moisturizer • Dermavion Sodium Hyaluronate Moisturizer (DH) BSA (Body Surface Area) • <3% - not more than 125g • 3%-10% - not more than 250g • >10% - not more than 500g Dermatological Topical (Cream / Gel / Ointment / Powder) • Antibiotic ( e.g. Fusidic Acid, Neomycin, Mupirocin ) • Antifungal ( e.g. Miconazole, Clotrimazole, Ketoconazole, Terbinafine ) • Steroid ( e.g. Hydrocortisone, Betamethasone, Clobetasone, Mometasone ) BSA (Body Surface Area) • <3% - not more than 60g • 3%-10% - not more than 90g • >10% - not more than 125g (Extemporaneous creams with combination formula allowed by TNB) Liquid • Antacid ( e.g. Gaviscon, Maalox, Gelusil, MMT Syrup ) • Gargle & Mouth Wash ( e.g. Betadine Gargle, Difflam Gargle, Thymol Gargle ) • Laxatives ( e.g. Duphalac, Lactulose) Not more than 400mls per month • Anti-fungal / Anti-acne cleansers ( e.g Ketoconozole, Nizoral, Pristine, Dezor, Dermavion 2% salicylic acid Cleanser (DSA)) Not more than 400mls per month I M A X I M U M Q U A N T I T Y A L L O W E D OTHER ACUTE SYMPTOMATIC MEDICATION COVERAGE Version 2.0, September 2022
Endorsed by, Nurmurniza Md Zakaria Head (TNB HealthCare) TNB Global Business Solutions Division Tenaga Nasional Berhad This guidelines is STRICTLY private, confidential and personal to its recipient and should not be copied or distributed in whole or in part nor passed to any third party. GUIDELINES FOR PANEL HOSPITALS Version 2.0, September 2022