Pharmaceutical Schedule - effective 1 April 2005 (text extract)

This is the text extract for Pharmaceutical Schedule - effective 1 April 2005, browse documents here.

Contents

INTRODUCING PHARMAC .......................................... 5 PHARMAC AND THE PHARMACEUTICAL SCHEDULE ....6 PURPOSE OF THE PHARMACEUTICAL SCHEDULE ........8 FINDING INFORMATION IN THE PHARMACEUTICAL SCHEDULE..........................8 EXPLAINING DRUG ENTRIES ..........................................9 Example .....................................................................9 GLOSSARY ...................................................................10 Units of Measure .....................................................10 Abbreviations ...........................................................10 PATIENT COSTS ...........................................................11 SPECIAL AUTHORITY APPLICATIONS ...........................12 EXCEPTIONAL CIRCUMSTANCES POLICIES .................13 HOSPITAL EXCEPTIONAL CIRCUMSTANCES ................13 COMMUNITY EXCEPTIONAL CIRCUMSTANCES............14 SECTION A: GENERAL RULES .....................................15 INTRODUCTION ............................................................15 PART I ..........................................................................15 INTERPRETATION AND DEFINITIONS ............................15 PART II .........................................................................20 COMMUNITY PHARMACEUTICALS SUBSIDY ...............20 PART III.........................................................................21 PERIOD AND QUANTITY OF SUPPLY.............................21 3.1 Doctors’, Midwives’ and Nurse Prescribers’ Prescriptions (other than oral contraceptives) ....21 3.2 Oral Contraceptives ...........................................22 3.3 Dentists’ Prescriptions .......................................22 3.4 Original Packs, and Certain Antibiotics ...............22 PART IV .......................................................................23 MISCELLANEOUS PROVISIONS...................................23 4.1 Bulk Supply Orders.............................................23 4.2 Practitioner’s Supply Orders ...............................23 4.3 Wholesale Supply Orders ...................................24 4.4 Retail Pharmacy and Hospital Pharmacy - Specialist Restriction .......................................24 4.5 Amendment of Schedule ....................................24 4.6 Conﬂict in Provisions..........................................24 SECTION B: ALIMENTARY TRACT AND METABOLISM .......... 25 ANTACIDS AND ANTIFLATULENTS ...............................25 Antacids and Reﬂux Barrier Agents...........................25 Phosphate Binding Agents........................................25 ANTIDIARRHOEALS......................................................26 Agents Which Reduce Motility ..................................26 Rectal and Colonic Anti-inﬂammatories ....................26 ANTIHAEMORRHOIDALS ..............................................27 Corticosteroids ........................................................27 Rectal Sclerosants ...................................................27 Soothing Agents .......................................................27 ANTISPASMODICS AND OTHER AGENTS ALTERING GUT MOTILITY ........................................27 ANTIULCERANTS .........................................................28 Antisecretory and Cytoprotective ..............................28 Helicobacter Pylori Eradication ................................28 H2 Antagonists ........................................................28 Proton Pump Inhibitors .............................................29 Site Protective Agents ..............................................29 DIABETES.....................................................................30 Hyperglycaemic Agents............................................30 Insulin – Short-acting Preparations...........................30 Insulin – Intermediate and Long-acting Preparations ................................30 Insulin – Rapid acting insulin analogues ...................31 Alpha glucosidase inhibitors .....................................31 Oral Hypoglycaemic Agents .....................................32 DIABETES MANAGEMENT ............................................33 Glucose/Urine Testing...............................................33 Glucose &/or Ketones/Urine Testing .........................33 Glucose/Blood Testing ..............................................33 Insulin Syringes and Needles ....................................34 DIGESTIVES INCLUDING ENZYMES ..............................34 LAXATIVES ...................................................................35 Bulk-forming Agents ................................................35 Faecal Softeners.......................................................35 Osmotic Laxatives ....................................................36 Stimulant Laxatives ..................................................36 METABOLIC DISORDER AGENTS..................................36 Gaucher’s Disease ...................................................36 MOUTH AND THROAT ..................................................36 Agents Used in Mouth Ulceration..............................36 Oropharyngeal Anti-Infectives...................................37 Other Oral Agents .....................................................37 VITAMINS .....................................................................38 Vitamin A .................................................................38 Vitamin B Group .......................................................38 Vitamin C .................................................................38 Vitamin D .................................................................38 Vitamin E..................................................................39 Vitamin K .................................................................39 Multivitamin Preparations .........................................39 MINERALS....................................................................39 Calcium....................................................................39 Fluoride ....................................................................39 Iron ..........................................................................40 Magnesium ..............................................................40 Zinc ..........................................................................40 BLOOD AND BLOOD FORMING ORGANS .....................41 ANTIANAEMICS............................................................41 Hypoplastic and Haemolytic .....................................41 Megaloblastic ...........................................................42 ANTIFIBRINOLYTICS, HAEMOSTATICS AND LOCAL SCLEROSANTS ....................................43 Vitamin K .................................................................43 ANTITHROMBOTIC AGENTS .........................................43 Antiplatelet Agents....................................................43 Heparin and Antagonist Preparations ........................45 Oral Anticoagulants ..................................................45 1

FLUIDS AND ELECTROLYTES .......................................46 Intravenous Administration .......................................46 Oral Administration ...................................................47 LIPID MODIFYING AGENTS ...........................................47 Fibrates ....................................................................47 Other lipid modifying agents .....................................47 Resins......................................................................47 HMG CoA Reductase Inhibitors (Statins) ..................48 Selective Cholesterol Absorption Inhibitors ...............50 New Zealand Cardiovascular Guideline Group statement. ...................................51 CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS .... 51 CARDIOVASCULAR SYSTEM .......................................55 ALPHA ADRENOCEPTOR BLOCKERS ...........................55 AGENTS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM...................................................................55 ACE Inhibitors ..........................................................55 ACE Inhibitors with Diuretics ....................................57 Angiotensin II Antagonists ........................................57 ANTIARRHYTHMICS.....................................................59 ANTIHYPOTENSIVES ....................................................59 BETA ADRENOCEPTOR BLOCKERS ..............................60 CALCIUM CHANNEL BLOCKERS ..................................61 Dihydropyridine Calcium Channel Blockers (DHP CCBs) ..........................................................61 Other Calcium Channel Blockers ..............................62 CENTRALLY ACTING AGENTS ......................................62 DIURETICS ...................................................................63 Loop Diuretics ..........................................................63 Potassium Sparing Diuretics.....................................63 Potassium Sparing Combination Diuretics ................63 Thiazide and Related Diuretics ..................................63 NITRATES .....................................................................64 SMOKING CESSATION..................................................64 SYMPATHOMIMETICS ..................................................65 VASODILATORS ...........................................................65 DERMATOLOGICALS ....................................................66 ANTIACNE PREPARATIONS ..........................................66 ANTIBACTERIALS TOPICAL ..........................................66 ANTIFUNGALS TOPICAL ...............................................67 ANTIPRURITIC PREPARATIONS ....................................68 CORTICOSTEROIDS - TOPICAL ....................................68 Corticosteroids - Plain..............................................68 Corticosteroids - Combination..................................70 DISINFECTING AND CLEANSING AGENTS ....................70 DUSTING POWDERS ....................................................71 BARRIER CREAMS AND EMOLLIENTS .........................71 Barrier Creams .........................................................71 Emollients ................................................................71 Other Dermatological Bases .....................................72 MINOR SKIN INFECTIONS.............................................72 PARASITICIDAL PREPARATIONS ..................................72 PSORIASIS AND ECZEMA PREPARATIONS ...................73 SCALP PREPARATIONS ................................................74 2

SUNSCREENS ..............................................................75 WART AND CORN PREPARATIONS...............................75 OTHER SKIN PREPARATIONS .......................................75 Antineoplastics.........................................................75 Topical Analgesia .....................................................75 Wound Management Products .................................75 GENITO URINARY SYSTEM .........................................76 CONTRACEPTIVES – NON-HORMONAL .......................76 Condoms .................................................................76 Spermicidal Agents ..................................................76 Contraceptive Devices ..............................................76 CONTRACEPTIVES – HORMONAL ................................77 Combined Oral Contraceptives .................................77 Progestogen-only Contraceptives .............................79 Emergency Contraceptives .......................................79 ANTIANDROGEN ORAL CONTRACEPTIVES ..................79 GYNAECOLOGICAL ANTI-INFECTIVES ..........................80 IMPOTENCE TREATMENT.............................................80 MYOMETRIAL AND VAGINAL HORMONE PREPARATIONS .....................................80 PREGNANCY TESTS - HCG URINE ...............................81 URINARY AGENTS........................................................81 Other urinary agents .................................................81 URINARY TRACT INFECTIONS ......................................81 HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES .........82 ANABOLIC AGENTS......................................................82 CALCIUM HOMEOSTASIS .............................................82 Alendronate for Osteoporosis ...................................82 Alendronate for Pagets Disease ................................82 Other Treatments ......................................................82 CORTICOSTEROIDS AND RELATED AGENTS FOR SYSTEMIC USE ................................................83 SEX HORMONES NON CONTRACEPTIVE ......................84 Androgen Agonists and Antagonists .........................84 HORMONE REPLACEMENT THERAPY - SYSTEMIC ......85 Oestrogens ..............................................................85 Progestogens ...........................................................86 Progestogen and oestrogen combined preparations ..........................................87 OTHER OESTROGEN PREPARATIONS ..........................87 OTHER PROGESTOGEN PREPARATIONS ......................88 THYROID AND ANTITHYROID AGENTS .........................89 TROPHIC HORMONES ..................................................89 GnRH Analogues ......................................................89 VASOPRESSIN AGONISTS............................................91 OTHER ENDOCRINE AGENTS .......................................91 INFECTIONS - AGENTS FOR SYSTEMIC USE ..............92 ANTHELMINTICS ..........................................................92 ANTIBACTERIALS.........................................................92 Cephalosporins and Cephamycins ...........................92 Macrolides ...............................................................94 Penicillins .................................................................95 Tetracyclines ............................................................96 Other Antibiotics .......................................................96

ANTIFUNGALS ..............................................................98 ANTIMALARIALS ..........................................................98 ANTITRICHOMONAL AGENTS ......................................98 ANTITUBERCULOTICS AND ANTILEPROTICS ...............99 ANTIVIRALS ...............................................................100 Hepatitis B Treatment .............................................100 HERPES TREATMENT.................................................101 First episode genital herpes ....................................101 Recurrent episodes of genital herpes ......................101 Acute herpes zoster................................................101 ANTIRETROVIRALS ....................................................102 Non-nucleoside reverse transcriptase inhibitors ......103 Nucleoside reverse transcriptase inhibitors .............103 Protease inhibitors..................................................103 ANTIRETROVIRALS - ADDITIONAL THERAPY .............104 URINARY TRACT INFECTIONS ....................................104 VACCINES ..................................................................105 Inﬂuenza Vaccine ...................................................105 MUSCULO-SKELETAL SYSTEM .................................106 ANTICHOLINESTERASES............................................106 ANTI-INFLAMMATORY NON STEROIDAL DRUGS (NSAIDS) ...............................................................106 NSAIDs Other .........................................................107 ANTIRHEUMATOIDAL AGENTS ...................................108 TUMOUR NECROSIS FACTOR (TNF) INHIBITORS.........109 ENZYMES ...................................................................110 HYPERURICAEMIA AND ANTIGOUT ...........................110 MUSCLE RELAXANTS ................................................110 NERVOUS SYSTEM....................................................111 ANAESTHETICS..........................................................111 Local ......................................................................111 ANALGESICS..............................................................111 Antipyretics and Non-Opioid Analgesics .................111 Antipyretics with Codeine .......................................112 Opioid Analgesics ..................................................112 ANTIDEPRESSANTS ...................................................114 Cyclic and Related Agents ......................................114 Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective ....................................................115 Monoamine-Oxidase Type A Inhibitors ....................115 Selective Serotonin Reuptake Inhibitors ..................115 Other Antidepressants ............................................116 ANTIEPILEPSY DRUGS ...............................................116 Agents for Control of Status Epilepticus ..................116 Control of Epilepsy .................................................117 New antiepilepsy drugs ..........................................118 ANTIMIGRAINE PREPARATIONS .................................119 Acute Migraine Treatment .......................................119 Prophylaxis of Migraine ..........................................119 ANTINAUSEA AND VERTIGO AGENTS ........................120 ANTIPARKINSON AGENTS ..........................................121 Dopamine Agonists and Related Agents .................121 Anticholinergics......................................................122

ANTIPSYCHOTICS ......................................................123 General ..................................................................123 Depot Injections .....................................................125 Orodispersible Antipsychotics ................................126 ANXIOLYTICS..............................................................126 SEDATIVES AND HYPNOTICS .....................................127 OTHER CNS AGENTS .................................................128 ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS ....................... 130 CHEMOTHERAPEUTIC AGENTS .................................130 Alkylating Agents....................................................130 Antimetabolites ......................................................130 Other Cytotoxic Agents ...........................................131 Protein-tyrosine Kinase Inhibitors ...........................131 ENDOCRINE THERAPY ...............................................132 IMMUNOSUPPRESSANTS ..........................................134 Cytotoxic Immunosuppressants .............................134 Immune Modulators ...............................................134 Multiple Sclerosis Treatment ...................................137 Other Immunosuppressants ...................................139 RESPIRATORY SYSTEM AND ALLERGIES .................141 ANTIALLERGY PREPARATIONS ..................................141 ANTIHISTAMINES .......................................................141 INHALED CORTICOSTEROIDS - METERED DOSE INHALERS.................................142 Low dose ...............................................................142 Medium dose .........................................................142 High dose...............................................................142 Very high dose .......................................................142 INHALED CORTICOSTEROIDS - BREATH ACTIVATED DEVICES .............................143 Medium dose .........................................................143 High dose...............................................................143 Very high dose .......................................................143 INHALED CORTICOSTEROIDS - NEBULISER SOLUTION ........................................143 NEDOCROMIL ............................................................144 SODIUM CROMOGLYCATE..........................................144 INHALED BETA-ADRENOCEPTOR AGONISTS - METERED DOSE INHALERS.................................144 Low dose ...............................................................144 INHALED BETA-ADRENOCEPTOR AGONISTS - BREATH ACTIVATED DEVICES .............................144 Medium dose .........................................................144 High dose...............................................................144 INHALED BETA-ADRENOCEPTOR AGONISTS - LONG ACTING......................................................145 Breath activated devices .........................................145 Metered dose inhalers ............................................147 INHALED BETA-ADRENOCEPTOR AGONISTS - NEBULISER SOLUTIONS ......................................147 Low dose ...............................................................147 High dose...............................................................147 Very high dose .......................................................147

INHALED ANTICHOLINERGIC AGENTS - BREATH ACTIVATED DEVICES .............................147 INHALED ANTICHOLINERGIC AGENTS - METERED DOSE INHALERS.................................148 Low dose ...............................................................148 INHALED ANTICHOLINERGIC AGENTS - NEBULISER SOLUTIONS ......................................148 Low dose ...............................................................148 High dose...............................................................148 INHALED BETA-ADRENOCEPTOR AGONIST AND ANTICHOLINERGIC AGENTS - METERED DOSE INHALERS.................................148 INHALED BETA-ADRENOCEPTOR AGONIST AND ANTICHOLINERGIC AGENTS - NEBULISER SOLUTION ........................................148 Salbutamol .............................................................148 BETA-ADRENOCEPTOR AGONISTS - LONG-ACTING TABLETS ......................................148 Low dose ...............................................................148 High dose...............................................................149 BETA-ADRENOCEPTOR AGONISTS - ORAL LIQUIDS .....................................................149 BETA-ADRENOCEPTOR AGONISTS - INJECTION ...........................................................149 THEOPHYLLINE DERIVATIVES ....................................149 COUGH PREPARATIONS .............................................149 CYSTIC FIBROSIS .......................................................149 NASAL PREPARATIONS ..............................................150 Allergy Prophylactics ..............................................150 RESPIRATORY DEVICES .............................................150 SENSORY ORGANS....................................................151 EAR PREPARATIONS ..................................................151 EAR/EYE PREPARATIONS ...........................................151 EYE PREPARATIONS ...................................................152 Anti-Infective Preparations ......................................152 Corticosteroids and Other Anti-Inﬂammatory Preparations ...........................153 Glaucoma Preparations - Beta Blockers ..................153 Glaucoma Preparations - Carbonic Anhydrase Inhibitors ..........................154 Glaucoma Preparations - Prostaglandin Analogues ...................................154 Glaucoma Preparations - Other...............................155 Mydriatics and Cycloplegics ...................................155 Preparations for Tear Deﬁciency .............................156 Other Eye Preparations ...........................................156 VARIOUS ...................................................................157 AGENTS USED IN THE TREATMENT OF POISONINGS.....................................................157 DETECTION OF SUBSTANCES IN URINE .....................157 SECTION C: EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS ........................158 INTRODUCTION ..........................................................158 Glossary ................................................................158 Explanatory notes...................................................159 4

Standard Formulae .................................................162 SECTION D: SPECIAL FOODS ................................. 164 NUTRIENT MODULES .................................................165 Carbohydrate .........................................................165 Carbohydrate and Fat .............................................166 Fat ........................................................................167 Protein ...................................................................168 ORAL SUPPLEMENTS ................................................168 ORAL SUPPLEMENTS/COMPLETE DIET (NASOGASTRIC/GASTROSTOMY TUBE FEED) .......169 Respiratory Products..............................................169 Diabetic Products ...................................................170 Fat Modiﬁed Products.............................................171 High Protein Products.............................................171 Paediatric Products for Children awaiting Liver Transplant .....................................172 Paediatric Products for Children with Chronic Renal Failure ...................................172 Paediatric Products ................................................173 Renal Products .......................................................174 Specialised and Elemental Products .......................175 Undyalised End Stage Renal Failure ........................176 Adult Products Standard .........................................176 Adult Products High Calorie ....................................178 FOOD THICKENERS ....................................................179 GLUTEN FREE FOODS ................................................180 FOODS AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - OTHER .....................................181 Supplements for Homocystinuria ...........................181 Supplements for MSUD ..........................................181 FOODS AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - PKU .........................................182 Foods for PKU ........................................................182 Supplements for PKU .............................................183 Multivitamin and Mineral Supplements ...................183 MULTI VITAMIN SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM ...............183 INFANT FORMULAE ....................................................184 For Premature Infants .............................................184 For Williams Syndrome ..........................................184 For Gastrointestinal and other Malabsorptive Problems ......................185 For Milk Intolerance ................................................186 Infant Formulae - Lactose Intolerance and Cows’ Milk Protein Intolerance ......................187 SECTION E PART I: PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS ...................... 188 Pharmaceuticals that may be obtained on a Practitioner’s Supply Order ..........................188 Pharmaceuticals that may be obtained on a Wholesale Supply Order ..............................191 SECTION E PART II: RURAL AREAS ........................ 192 SECTION F: COMMUNITY PHARMACEUTICAL DISPENSING PERIOD EXEMPTIONS................... 193 SECTION G: SAFETY CAP MEDICINES .................... 195 AUTHORITY TO SUBSTITUTE FORM ....................... 219

Introducing PHARMAC

PHARMAC, the Pharmaceutical Management Agency, is a Crown entity established pursuant to the New Zealand Public Health and Disability Act 2000. The primary objective of PHARMAC is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided. The PHARMAC Board consists of up to six members appointed by the Minister of Health. All decisions relating to PHARMAC’s operation are made by or under the authority of the Board. In particular, Board members decide on the strategic direction of PHARMAC and may decide which community pharmaceuticals should be subsidised and at what levels, and determine national prices for some pharmaceuticals to be purchased by and used in DHB Hospitals, and whether or not special conditions are to be applied to such purchases.

Members of the PHARMAC Board

Richard Waddel Gregor Coster Karen Guilliland Helmut Modlik David Moore Adrienne von Tunzelmann Decisions taken by the PHARMAC Board members, or made under the authority of the Board, incorporate a balanced view of the needs of prescribers and patients. The aim is to achieve long-term gains and efﬁcient ways of making pharmaceuticals available to the community and for DHB Hospitals to purchase them. Syd Bradley, chair DHBNZ, attends PHARMAC’s Board meetings as an observer. The functions of PHARMAC are to perform the following, within the amount of funding provided to it in the Pharmaceutical Budget or to DHBs from their own budgets for the use of pharmaceuticals in their hospitals, as applicable, and in accordance with its annual plan and any directions given by the Minister (Section 65 of the Act): a) to maintain and manage a pharmaceutical schedule that applies consistently throughout New Zealand, including determining eligibility and criteria for the provision of subsidies; b) to manage incidental matters arising out of (a), including in exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the pharmaceutical schedule; c) to engage as it sees ﬁt, but within its operational budget, in research to meet its objectives as set out in Section 47(a) of the Act; d) to promote the responsible use of pharmaceuticals; e) to manage the purchasing of any or all pharmaceuticals, whether used either in a hospital or outside it, on behalf of DHBs; f) any other functions given to PHARMAC by or under any enactment or authorised by the Minister.

Decision Criteria

PHARMAC updates the Pharmaceutical Schedule at regular intervals to notify prescribers, pharmacists, hospital managers and patients of changes to Community Pharmaceutical subsidies and the prices for Hospital Pharmaceuticals. In making decisions about amendments to the Pharmaceutical Schedule, PHARMAC is guided by its Operating Policies and Procedures, as amended or supplemented from time to time. PHARMAC takes into account the following criteria when making decisions about Community Pharmaceuticals: • the health needs of all eligible people within New Zealand (eligible deﬁned by the Government’s then current rules of eligibility); • the particular health needs of Maori and Paciﬁc peoples; • the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; • the clinical beneﬁts and risks of pharmaceuticals; • the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; • the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Pharmaceutical Schedule; • the direct cost to health service users; • the Government’s priorities for health funding, as set out in any objectives notiﬁed by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere; and • such other criteria as PHARMAC thinks ﬁt. PHARMAC will carry out appropriate consultation when it intends to take any such “other criteria” into account. The Operating Policies and Procedures, including any supplements, also describe the way in which PHARMAC determines the level of subsidy or purchase price payable for each Community Pharmaceutical or Hospital Pharmaceutical, respectively. The decision criteria for Hospital Pharmaceuticals are set out in the hospital supplement to the Operating Policies and Procedures and in the introductory part of Section H of the Pharmaceutical Schedule.

Copies of PHARMAC’s Operating Policies and Procedures and of any applicable supplements are available on the PHARMAC website (www.pharmac.govt.nz), or on request.

PHARMAC and the Pharmaceutical Schedule:

PHARMAC manages the national Pharmaceutical Schedule, which lists: • Pharmaceuticals available in the community and subsidised by the Government with funding from the Pharmaceutical Budget; and • some Pharmaceuticals purchased by DHBs for use in their hospitals, and includes those Hospital Pharmaceuticals for which national prices have been negotiated by PHARMAC. In the community approximately 1848 Pharmaceuticals are subsidised by the Government. Most are available to all eligible people within New Zealand on prescription by a medical doctor. Some are listed with guidelines or conditions such as ‘only if prescribed for a dialysis patient’ or ‘Special Authority – Retail Pharmacy’, to ensure that Pharmaceuticals are used by those people who are most likely to beneﬁt from them. Pharmaceuticals provided to patients for use while in DHB hospitals are not covered by Sections A to G of the Pharmaceutical Schedule. Section H of the Pharmaceutical Schedule is not a comprehensive list of Pharmaceuticals that are used within the DHB Hospitals. Section H of the Pharmaceutical Schedule includes Pharmaceuticals that can be purchased at a national price by DHBs for use in their hospitals. These are referred to as National Contract Pharmaceuticals. Section H of the Pharmaceutical Schedule also identiﬁes Pharmaceutical Cancer Treatments that DHBs have been directed to fund for use in their hospitals and/or in association with services provided in their hospitals, as well as new Pharmaceuticals used in hospitals, which have been or are being assessed by PHARMAC, the results of that analysis being available to DHB Hospitals via PHARMAC’s website. A list of Discretionary Community Supply Pharmaceuticals, in Section H of the Pharmaceutical Schedule, identiﬁes those products that currently are not subsidised from the Pharmaceutical Budget as Community Pharmaceuticals in Sections A to G of the Pharmaceutical Schedule but which DHBs can at their discretion fund for use in the community from their own budgets without speciﬁc Hospital Exceptional Circumstances approval.

The PHARMAC Team

The PHARMAC team has a wide range of expertise in health, medicine, economics, commerce, critical analysis, and policy development and implementation. Wayne McNee Jason Arnold Mike Bignall Matthew Brougham Chief Executive Senior Analyst Tender Analyst Manager, Analysis and Assessment Stuart Bruce Manager, Corporate and External Relations Karyn Brown Receptionist Hayley Bythell Receptionist Jayne Chaulk Community Exceptional Circumstances Panel Co-ordinator Mary Chesterﬁeld High Cost Drugs Co-ordinator Deepti Chotai Therapeutic Group Manager Steffan Crausaz Therapeutic Group Manager Andrew Davies Hospital Pharmaceuticals Contracts Manager Cristine Della Barca Manager, Supply Side Andrea Dick Hospital Pharmaceuticals Contracts Manager Sean Dougherty Therapeutic Group Manager Simon England Communications Advisor John Geering IT Manager Rachel Grocott Hospital Pharmaceuticals Senior Analyst Katie Harris Hospital Exceptional Circumstances Panel Co-ordinator Karolina Johnson Demand Side Assistant/ Designer Derek Kan Analyst Carolyn Macaltao Therapeutic Group Manager Intern Rachel MacKay Manager, Demand Side Adam McRae Demand Side Manager Peter Moodie Medical Director Jessica Nisbet Therapeutic Group Assistant Jan Quin Project Manager Marama Parore-Katene Maori Health Manager Melanie Pemberton Executive Assistant to Chief Executive Matthew Perkins Hospital Pharmaceuticals Contracts Manager Dilky Rasiah Project Manager Sarah Schmitt Manager, Hospital Pharmaceuticals Liz Skelley Finance Manager Wiebke Tod Panel Co-ordinator Linda Wellington Schedule Analyst Thomas Wilkinson Therapeutic Group Manger Intern Kaye Wilson Schedule Analyst

PHARMAC’s clinical advisors

Pharmacology and Therapeutics Advisory Committee (PTAC) PHARMAC works closely with the Pharmacology and Therapeutics Advisory Committee (PTAC), an expert medical committee which provides independent advice to PHARMAC on health needs and the clinical beneﬁts of particular pharmaceuticals for use in the community and/or in DHB Hospitals. The committee members are all senior, practising clinicians. The chair of PTAC sits with the PHARMAC Board in an advisory capacity. PTAC helps decide which community pharmaceuticals are to be subsidised from public monies by making recommendations to PHARMAC. Part of the role of PTAC is to review whether Community Pharmaceuticals already listed on the Schedule should continue to receive Government funds. The resources freed up can be used to subsidise other community pharmaceuticals with a greater therapeutic worth. PHARMAC may obtain clinical advice from PTAC in relation to national purchasing strategies for Hospital Pharmaceuticals. There may be additional specialist hospital representatives on PTAC subcommittees, or additional PTAC subcommittees, where PHARMAC considers this necessary. PTAC members are: Carl Burgess MBChB, MD, MRCP (UK), FRACP FRCP physician/clinical pharmacologist, Chair , , Ian Hosford MBChB, FRANZCP psychiatrist , Sisira Jayathissa MBBS, MD, MRCP FAFPHM, FRCP FRACP physician , , , Peter Jones BMedSci, MB, ChB, PhD, FRCP FRACP physician , , Jim Lello BHB, MBChB, DCH, FRNZCGP general practitioner , Peter Pillans MBBCh, MD, FCP FRACP clinical pharmacologist , , Anthony Ruakere MBChB, Dip Obst, FRNZCGP general practitioner , Tom Thompson MBChB, FRACP physician , Paul Tomlinson MBChB, MD, MRCP FRACP BSc, paediatrician, Deputy Chair , , Howard Wilson BSc, PhD, MB, BS, Dip Obst, FRNZCGP general practitioner , Contact PTAC C/- PTAC Secretary Pharmaceutical Management Agency PO Box 10 254, WELLINGTON

Purpose of the Pharmaceutical Schedule

The purpose of the Schedule is to list: • the Community Pharmaceuticals that are subsidised by the Government and to show the amount of the subsidy paid to contractors, as well as the manufacturer’s price (if it differs from the Subsidy) and any access conditions that may apply; and • some Hospital Pharmaceuticals that are purchased and used by DHB Hospitals, including those for which national prices have been negotiated by PHARMAC. The purpose of the Schedule is not to show the ﬁnal cost to Government of subsidising each Community Pharmaceutical or to DHBs in purchasing each Hospital Pharmaceutical since that will depend on any rebate and other arrangements PHARMAC has with the supplier and, for some Hospital Pharmaceuticals, on any logistics arrangements put in place by individual DHB Hospitals.

Finding Information in the Pharmaceutical Schedule

Community Pharmaceuticals

For Community Pharmaceuticals, the Schedule is organised in a way to help the reader ﬁnd Community Pharmaceuticals, which may be used to treat similar conditions. To do this, Community Pharmaceuticals are ﬁrst classiﬁed anatomically, originally based on the Anatomical Therapeutic Chemical (ATC) system, and then further classiﬁed under section headings structured for the New Zealand medical system. • Section A lists the General Rules in relation to Community Pharmaceuticals and related products. • Section B lists Community Pharmaceuticals and related products by anatomical classiﬁcation, which are further divided into one or more therapeutic headings. Community Pharmaceuticals used to treat similar conditions are grouped together. • Section C lists the rules in relation to Extemporaneously Compounded Products (ECPs) and Community Pharmaceuticals that will be subsidised when extemporaneously compounded. • Section D lists the rules in relation to Special Foods and the Special Foods that are subsidised. • Section E Part I lists the Community Pharmaceuticals that are subsidised on a Practitioner’s Supply Order (PSO) and Wholesale Supply Order (WSO). • Section E Part II lists rural areas for the purpose of PSOs. • Section F lists the Community Pharmaceutical dispensing period exemptions. • Section G lists the Community Pharmaceuticals eligible for reimbursement of safety cap and related rules. The listings are displayed alphabetically (where practical) within each level of the classiﬁcation system. Each anatomical section contains a series of therapeutic headings, some of which may contain a further classiﬁcation level. Where a Community Pharmaceutical is used in more than one therapeutic area, they may be cross-referenced. The therapeutic headings in the Pharmaceutical Schedule do not necessarily correspond to the therapeutic groups and therapeutic subgroups, which PHARMAC establishes for the separate purpose of determining the level of subsidy to be paid for each Community Pharmaceutical. The index located at the back of the book in which Sections A–G of the Pharmaceutical Schedule are published can be used to ﬁnd page numbers for generic chemical entities, or product brand names.

Hospital Pharmaceuticals

• Section H lists Pharmaceuticals that DHBs fund from their own budgets. The Hospital Pharmaceuticals are grouped into the following Parts in Section H: - Part I lists the rules in relation to Hospital Pharmaceuticals. - Part II lists Hospital Pharmaceuticals for which national contracts exist (National Contract Pharmaceuticals). These are listed alphabetically by generic chemical entity name and line item, the relevant Price negotiated by PHARMAC and, if applicable, an indication of whether it has Hospital Supply Status (HSS) and any associated Discretionary Variance (DV) Pharmaceuticals and DV Limit. - Part III lists Assessed Pharmaceuticals, which have been or are being assessed by PHARMAC and, where such assessment is available, PHARMAC’s opinion regarding the use of the Assessed Pharmaceuticals in hospitals. DHB Hospitals are not obliged to implement those recommendations. - Part IV lists Discretionary Community Supply Pharmaceuticals, which are not Community Pharmaceuticals, but which a DHB Hospital can, in its discretion, fund for use in the community from its own budget. - Part V lists Pharmaceutical Cancer Treatments that DHBs must fund for use in their hospitals and/or in association with services provided in their hospitals. The index located at the back of the Section H supplement can be used to ﬁnd page numbers for generic chemical entities, or product brand names, for Hospital Pharmaceuticals.

Explaining drug entries

The Pharmaceutical Schedule lists pharmaceuticals subsidised by the Government, the amount of that subsidy paid to contractors, the supplier’s price and the access conditions that may apply.

Example

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

Brand or manufacturer’s name Interchangeable Multisource Medicine Sole subsidised supply product

Practitioner’s Supply Order (or WSO for Wholesale Supply Order) Safety cap reimbursed

Fully subsidised product Original Pack - Subsidy is rounded up to a multiple of whole packs Subsidy paid on a product before mark-ups and GST

Conditions of and restricitions on prescribing (including Special Authority where it applies) Three months or six months, as applicable, dispensed all-at once

❋

Quantity the Subsidy applies to Manufacturer’s Price if different from Subsidy

Glossary

Units of Measure

gram ............................................................. g kilogram ......................................................kg international unit ...........................................iu microgram ................................................mcg

Abbreviations Ampoule ...................................................... Amp Capsule .........................................................Cap Cream........................................................... Crm Device ...........................................................Dev Dispersible ....................................................Disp Effervescent .................................................... Eff Emulsion...................................................... Emul Enteric Coated ................................................ EC Gelatinous.......................................................Gel Granules ...................................................... Gran Infusion ...........................................................Inf

BSO CBS

milligram.................................................... mg millilitre ........................................................ml millimole .................................................mmol unit ............................................................... u

Injection ........................................................... Inj Linctus ......................................................... Linc Liquid ............................................................. Liq Long Acting .................................................... LA Ointment ........................................................Oint Sachet .........................................................Sach Solution ........................................................Soln Suppository .................................................Supp Tablet ............................................................. Tab Tincture ........................................................ Tinc Trans Dermal Delivery System .....................TDDS

Bulk Supply Order. Cost Brand Source. There is no set manufacturer’s price, and the Government subsidises the product at the price it is obtained by pharmacy. CE Compounded Extemporaneously. CPD Cost Per Dose. The Funder (as deﬁned in Part I of the General Rules) cost of a standard dose, without mark-ups or fees and excluding GST. HSS Hospital supply status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part II as HSS, that DHBs are obliged to purchase subject to any DV Limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. IMM Interchangeable Multi-source Medicine. The Ministry of Health publishes the list of products tested as being therapeutically equivalent, and which are therefore interchangeable by pharmacists. Such substitutions can only be made if the prescriber has provided the dispensing pharmacist with a signed authority to substitute. PSO Practitioner’s Supply Order. WSO Wholesale Supply Order. ▲ Three months supply may be dispensed at one time if the exempted medicine is endorsed ‘certiﬁed exemption’ by the practitioner. ❋ Three months dispensed all-at-once or, in the case of oral contraceptives, six months dispensed all-at-once, unless medicine is endorsed “close control” or “cc” and the endorsement is intialled by the prescriber. ‡ Safety cap required and subsidised for oral liquid formulations, including extemporaneously compounded preparations. ✓ Fully subsidised brand of a given medicine. Brands without the tick are not fully subsidised and may cost the patient a manufacturer’s surcharge. Sole Subsidised Supplier Only brand of this medicine subsidised. [HP1] Available from hospital pharmacies providing an outpatient dispensing service, and selected retail pharmacies in the Northern, Western Bay of Plenty, Wellington, Christchurch or South Canterbury regions that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP1] pharmaceuticals. [HP2] Available from any retail pharmacy in the Southern region. [HP3] Available from hospital pharmacies providing an outpatient dispensing service, and any retail pharmacy in the Northern, Midland, Central (including Nelson and Blenheim) and South Canterbury regions, and selected retail pharmacies in the Christchurch region that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP3] pharmaceuticals. [HP4] Available from hospital pharmacies and retail pharmacies with a Funder contract to dispense particular medicines. 10

Patient costs

Most of the cost of a subsidised prescription Community Pharmaceutical is met by the Government through the Pharmaceutical Budget. The Government pays a subsidy for the Community Pharmaceutical to Contractors, and a fee covering distribution and pharmacy dispensing services. The subsidy paid to Contractors does not necessarily represent the ﬁnal cost to Government of subsidising a particular Community Pharmaceutical. The ﬁnal cost will depend on the nature of PHARMAC’s contractual arrangements with the supplier. Fully subsidised medicines are identiﬁed with a ✓ in the product’s Schedule listing. CARBAMAZEPINE Tab 200 mg......................................14.53 ✓ Fully subsidised brand (19.14) Higher priced brand Community Pharmaceutical costs met by the patient Some Community Pharmaceutical costs are met by the patient. Generally a patient pays a prescription charge. In addition a patient will sometimes pay a manufacturer’s surcharge, after hours service fee and any special packaging fee. PRESCRIPTION CHARGE The only cost a patient should incur for a fully subsidised Community Pharmaceutical (✓) is the standard government prescription charge, or the full cost of the Community Pharmaceutical, whichever is less. The Government prescription charge for a three month course of a particular Community Pharmaceutical ranges up to $15.00 and represents the patient’s contribution to the cost of the Community Pharmaceutical. The Government pays the rest of the cost. Maximum prescription charges vary by patient status as set out below. More information about prescription charges is contained in the pamphlet, Community Services Card, available from Work and Income.

Patient’s subsidy entitlement(s) Not a low-cost PHO enrolee or No Card Adult Child 6 - 17 Child under 6 Contraceptives No other card No other card No other card No other card With HUHC only With CSC Low-cost PHO Maximum prescription charge $15 $10 $0 $3 $3 $3 $3 $2 $2 $0 $0

Community Pharmaceutical costs met by the Government

Low-cost PHO enrolee or Care plus patient Community Services Card (CSC) High Use Health Card (HUHC) Prescription Subsidy Card

for families after ﬁrst 20 prescriptions since previous February* * Except prescriptions with $0 charge

MANUFACTURER’S SURCHARGE Not all Community Pharmaceuticals are fully subsidised. Although PHARMAC endeavours to fully subsidise at least one Community Pharmaceutical in each therapeutic group, and has contracts with some suppliers to maintain the price of a particular product, manufacturers are able to set their own price to pharmacies. When these prices exceed the subsidy, the pharmacist may recoup the difference from the patient. To estimate the amount a patient will pay on top of the prescription charge, take the difference between the manufacturer’s price and the subsidy, and multiply this by 1.86. The 1.86 factor represents the pharmacy mark-up on the surcharge plus other costs such as GST. Pharmacies charge different mark-ups so this may vary.

Manufacturer’s surcharge to patient = (price - subsidy) x 1.86

For example, a Community Pharmaceutical with a supplier (ex-manufacturer) cost of $11.00 per pack with a $10.00 subsidy will cost the patient a surcharge of $1.86 on top of the prescription charge. The most a patient should pay is therefore $16.86 – being $15.00 maximum prescription charge, plus $1.86. Hospital Pharmaceutical costs The cost of purchasing Hospital Pharmaceuticals is met by the Funder (in particular, the relevant DHB) from its own budget. PHARMAC web site PHARMAC has set up an interactive Schedule on the Internet. It can be used to calculate the cost of a prescribed Community Pharmaceutical. This site at http://www.pharmac.govt.nz takes into account the quantity of Community Pharmaceutical prescribed as well as the patient’s age, whether the patient has a community services card, high use health card or prescription subsidy card, the fee for pharmacy services and prescription charges. Other information about PHARMAC is also available on our website. This includes copies of the Annual Review, Annual Report and Annual Plan, as well as information such as the Pharmaceutical Schedule, Pharmaceutical Schedule Updates, National Hospital Pharmaceutical Strategy, other publications and recent press releases.

Special Authority Applications

Subsidy

Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person. Once approved, the prescriber and the patient are provided a Special Authority number which must appear on the prescription. Specialists who make an application must communicate the valid authority number to the prescriber who will be writing the prescriptions. The authority number can provide access to subsidy, increased subsidy, or waive certain restrictions otherwise present on the Community Pharmaceutical. Some approvals are dependent on the availability of funding from the Pharmaceutical Budget.

Criteria

The criteria for approval of Special Authority applications are included below each Community Pharmaceutical listing, and on the application forms availabe on PHARMAC’s website. For some Special Authority Community Pharmaceuticals, not all indications that have been approved by Medsafe are subsidised. Criteria for each Special Authority Community Pharmaceutical are updated regularly, based on the decision criteria of PHARMAC. The appropriateness of the listing of a Community Pharmaceutical in the Special Authority category will also be regularly reviewed. Applications for inclusion of further Community Pharmaceuticals in the Special Authority category will generally be made by a pharmaceutical supplier.

Special Authority Applications

Application forms can be found at www.pharmac.govt.nz. Requests for fax copies should be made to PHARMAC, phone 04 460 4990. Applications are processed by HealthPAC (Wanganui), and should be sent to: HealthPAC, Private Bag 3015, WANGANUI Fax: (06) 345 1121 or free fax 0800 100 131 For inquiries, phone the Call Centre, free phone 0800 CHEM NO (0800 243 666). Note: HealthPAC can only provide information on Special Authority applications to prescribers and pharmacists. Each application must: • Include the patients name, date of birth and NHI number (codes for AIDS patients’ applications) • Include the practitioner’s name, address and Medical Council registration number • Clearly indicate that the relevant criteria, have been met. • Be signed by the practitioner.

Exceptional Circumstances policies

The purposes of the Exceptional Circumstances policies are to provide: • funding from the Community Exceptional Circumstances budget for medication, to be used in the community, in circumstances where the provision of a funded community medication is appropriate, but funding from the Pharmaceutical Budget is not able to be provided through the Pharmaceutical Schedule (“Community Exceptional Circumstances”); or • an assessment process for DHB Hospitals to determine whether they can fund medication, to be used in the community, in circumstances where the medication is neither a Community Pharmaceutical nor a Discretionary Community Supply Pharmaceutical and where the patient does not meet the criteria for Community Exceptional Circumstances (“Hospital Exceptional Circumstances”). Upon receipt of an application for approval for Community Exceptional Circumstances or Hospital Exceptional Circumstances, the Exceptional Circumstances Panel ﬁrst decides whether an application will be assessed initially under the Community Exceptional Circumstances criteria or the Hospital Exceptional Circumstances criteria.

Hospital Exceptional Circumstances

If the application is ﬁrst assessed but not approved under the Community Exceptional Circumstances criteria, the Exceptional Circumstances Panel may recommend the funding of the pharmaceutical for use in the community by a speciﬁc patient from a DHB Hospital’s own budget under Hospital Exceptional Circumstances. If the application is ﬁrst assessed under the Hospital Exceptional Circumstances criteria, the Exceptional Circumstances Panel may: a) recommend against the funding of the pharmaceutical for use in the community by a speciﬁc patient from a DHB Hospital’s own budget, in which case a DHB Hospital must not fund the pharmaceutical from its own budget; b) recommend the funding of the pharmaceutical for use in the community by a speciﬁc patient from a DHB Hospital’s own budget under Hospital Exceptional Circumstances, in which case a DHB Hospital may, but is not obliged to, fund the pharmaceutical from its own budget; c) defer its decision until further assessment under the Community Exceptional Circumstances criteria can be undertaken; or d) recommend interim funding of the pharmaceutical for use in the community by a speciﬁc patient from a DHB Hospital’s own budget under Hospital Exceptional Circumstances until further assessment under the Community Exceptional Circumstances criteria can be undertaken. Permission to fund a pharmaceutical for use in the community by a speciﬁc patient from a DHB Hospital’s own budget under Hospital Exceptional Circumstances will only be granted by PHARMAC where it has been demonstrated that such funding is cost-effective for the relevant DHB in the region in which the patient resides. If the patient being treated with a pharmaceutical under Hospital Exceptional Circumstances usually resides in a district other than that within the jurisdiction of the DHB initiating the treatment, then the DHB initiating the treatment must either agree to fund any on-going treatment required once the patient has returned to his/her usual DHB, or obtain written consent from the DHB or DHBs in which the patient will reside following the commencement of treatment. Applications for Hospital Exceptional Circumstances should be made on the standard application form available from the PHARMAC website www.pharmac.govt.nz or the address below: The Coordinator, Hospital Exceptional Circumstances Panel PHARMAC, PO Box 10 254 Wellington Phone (04) 916 7521 or fax (09) 523 6870 Email: ecpanel@pharmac.govt.nz

Community Exceptional Circumstances

In order to qualify for Community Exceptional Circumstances approval one of the following entry criteria must be met: a) the condition must be rare; or b) the reaction to alternative funded treatment must be unusual; or c) an unusual combination of circumstances applies. Rare and unusual are considered to be in the order of less than 10 people nationally. Where one of the above Community Exceptional Circumstances entry criteria is met, the application may then be further examined under supplementary criteria, assessing suitability of the pharmaceutical, clinical beneﬁt, the cost effectiveness of the treatment, and the patient’s ability to pay for the treatment. Where these documented criteria are met, a subsidy sufﬁcient to fully fund the pharmaceutical will be made available to the speciﬁc patient on whose behalf the application was made. Community Exceptional Circumstances funding is only available where the criteria are met and is not available for ﬁnancial reasons alone. Applications for Community Exceptional Circumstances should be made on the standard application form available from the PHARMAC website www.pharmac.govt.nz or the address below: The Coordinator, Community Exceptional Circumstances Panel PO Box 10 254 Wellington Phone (04) 916 7553 or fax (09) 523 6870 Email: ecpanel@pharmac.govt.nz

SECTION A: GENERAL RULES

INTRODUCTION

Section A contains the restrictions and other general rules that apply to Subsidies on Community Pharmaceuticals. The amounts payable by the Funder to Contractors are currently determined by: • the quantities, forms, and strengths, of subsidised Community Pharmaceuticals dispensed under valid prescription by each Contractor; • the amount of the Subsidy on the Manufacturer’s Price payable for each unit of the Community Pharmaceuticals dispensed by each Contractor and; • the contractual arrangements between the Contractor and the Funder for the payment of the Contractor’s dispensing services. The Pharmaceutical Schedule shows the level of subsidy payable in respect of each Community Pharmaceutical so that the amount payable by the Government to Contractors, for each Community Pharmaceutical, can be calculated. The Pharmaceutical Schedule also shows the standard price (exclusive of GST) at which a Community Pharmaceutical is supplied ex-manufacturer to wholesalers if it differs from the subsidy. The manufacturer’s surcharge to patients can be estimated using the subsidy and the standard manufacturer’s price as set out in this Schedule. The cost to Government of subsidising each Community Pharmaceutical and the manufacturer’s prices may vary, in that suppliers may provide rebates to other stakeholders in the primary health care sector, including dispensers, wholesalers, and the Government. Rebates are not speciﬁed in the Pharmaceutical Schedule. This Schedule is dated the 1st day of April 2005 and is to be referred to as the Pharmaceutical Schedule Volume 12 Number 1, 2005. Distribution will be from 20th April 2005. This Schedule comes into force on the 1st day of April 2005.

PART I INTERPRETATION AND DEFINITIONS

1.1 In this Schedule, unless the context otherwise requires: “90 Day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 90 consecutive days’ treatment; “180 Day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 180 consecutive days’ treatment; “Access Exemption Criteria” means the criteria under which patients may receive greater than one Month’s supply of a Community Pharmaceutical covered by Section F Part II (b) subsidised in one Lot. The speciﬁcs of these criteria are conveyed in the Ministry of Health guidelines, which are issued from time to time. The criteria the patient must meet are that they: a) have limited physical mobility; b) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; c) are relocating to another area; d) are travelling extensively and will be out of town when the repeat prescriptions are due. “Act” means the New Zealand Public Health and Disability Act 2000.” “Advisory Committee” means the Pharmaceutical Services Advisory Committee convened by the Ministry of Health under the terms of the Advice Notice issued to Contractors pursuant to Section 88 of the Act. “Alternate Subsidy” means a higher level of subsidy that the Government will pay contractors for a particular community Pharmaceutical dispensed to a person who has either been granted a Special Authority for that pharmaceutical, or where the prescription is endorsed in accordance with the requirements of this Pharmaceutical Schedule. “Assessed Pharmaceuticals” means the list of Pharmaceuticals set out in Section H Part III of the Schedule, that have been or are being assessed by PHARMAC. “Bulk Supply Order” means a written order, on a form supplied by the Ministry of Health, or approved by HealthPAC, made by the licensee or manager of an institution certiﬁed to provide hospital care under the Health and Disability Services (Safety) Act 2001 for the supply of such Community Pharmaceuticals as are expected to be required for the treatment of persons who are under the medical or dental supervision of such a Private Hospital or institution. “Class B Controlled Drug” means a Class B controlled drug within the meaning of the Misuse of Drugs Act 1975. “Close Control” means the dispensing of a Community Pharmaceutical, in accordance with a Prescription, in quantities less than one 90 Day Lot or, in the case of oral contraceptives, less than one 180 Day Lot for a Community Pharmaceutical referred to in Section F Part I, or in quantities less than a Monthly Lot for any other Community Pharmaceutical, as applicable, where all of the following conditions are met: i) the Community Pharmaceutical is a tri-cyclic antidepressant, antipsychotic, benzodiazepine, a Class B Controlled Drug, or any other Community Pharmaceutical that has been prescribed for a patient who:

SECTION A: GENERAL RULES

A) is not a resident in a Penal Institution, Rest Home or Residential Disability Care Institution; and B) in the opinion of the prescribing Doctor, Midwife or Nurse Prescriber is: 1) frail; or 2) inﬁrm; or 3) unable to manage their medication without additional support; or 4) intellectually impaired; and C) requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded; and ii) the prescribing Doctor, Midwife or Nurse Prescriber has A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “close control” or “CC”; and B) initialled the endorsement in the prescribers own handwriting; and C) speciﬁed the maximum quantity or period of supply to be dispensed at any one time. “Community Exceptional Circumstances” means the policies and criteria administered by the Exceptional Circumstances Panel relating to funding from the Community Exceptional Circumstances budget for medication, to be used in the community, in circumstances where the provision of a funded community medication is appropriate, but funding from the Pharmaceutical Budget is not able to be provided through the Pharmaceutical Schedule. “Community Pharmaceutical” means a Pharmaceutical listed in Sections A to G of the Pharmaceutical Schedule that is subsidised by the Funder from the Pharmaceutical Budget for use in the community. “Contractor” means a person who is entitled to receive a payment from the Crown or a DHB under a notice issued by the Crown or a DHB under Section 88 of the Act or under a contract with the Ministry of Health or a DHB for the supply of Community Pharmaceuticals. “Controlled Drug” means a controlled drug within the meaning of the Misuse of Drugs Act 1975 (other than a controlled drug speciﬁed in Part VI of the Third Schedule to that Act). “Cost, Brand, Source of Supply” means that the Community Pharmaceutical is eligible for Subsidy on the basis of the Contractor’s annotated purchase price, brand, and source of supply. “Dentist” means a person registered with the Dental Council, and who holds a current annual practising certiﬁcate, under the HPCA Act 2003. “DHB” means an organisation established as a District Health Board by or under Section 19 of the Act. “DHB Hospital” means a DHB, including its hospital or associated provider unit that the DHB purchases Hospital Pharmaceuticals for. “Discretionary Community Supply Pharmaceutical” means the list of Pharmaceuticals set out in Section H Part IV of the Schedule, which may be funded by a DHB Hospital from its own budget for use in the community. “Doctor” means a medical Practitioner registered with the Medical Council of New Zealand and, who holds a current annual practising certiﬁcate under the HPCA Act 2003. “DV Limit” means, for a particular Hospital Pharmaceutical with HSS, the National DV Limit or the Individual DV Limit. “DV Pharmaceutical” means a discretionary variance Pharmaceutical, that does not have HSS and which: a) is either listed in Section H Part II of the Schedule as being a DV Pharmaceutical in association with the relevant Hospital Pharmaceutical with HSS; or b) is the same chemical entity, at the same strength, and in the same or a similar presentation or form, as the relevant Hospital Pharmaceutical with HSS, but which is not yet listed as being a DV Pharmaceutical. “Endorsements” – unless otherwise speciﬁed, endorsements should be either handwritten or computer generated by the practitioner prescribing the medication. The endorsement can be written as “certiﬁed condition”, or state the condition of the patient, where that condition is speciﬁed for the Community Pharmaceutical in Section B of the Pharmaceutical Schedule. Where the practitioner writes “certiﬁed condition” as the endorsement, he/she is making a declaration that the patient meets the criteria as set out in Section B of the Pharmaceutical Schedule. “Exceptional Circumstances Panel” means the panel of clinicians, appointed by the PHARMAC Board, that is responsible for administering policies in relation to Community Exceptional Circumstances and Hospital Exceptional Circumstances. “Funder” means the body or bodies responsible, pursuant to the Act, for the funding of pharmaceuticals listed on the Schedule (which may be one or more DHBs and/or the Ministry of Health) and their successors. “GST” means goods and services tax under the Goods and Services Tax Act 1985. “Hospital Exceptional Circumstances” means the policies and criteria administered by the Exceptional Circumstances Panel relating to the ability to fund, from a DHB Hospital’s own budget, pharmaceuticals for use in the community by a speciﬁc patient where a subsidy is not available from the Pharmaceutical Budget or under Community Exceptional

SECTION A: GENERAL RULES

Circumstances. “Hospital Pharmaceuticals” means National Contract Pharmaceuticals, DV Pharmaceuticals, Discretionary Community Supply Pharmaceuticals, Assessed Pharmaceuticals and Pharmaceutical Cancer Treatments. “Hospital Pharmacy” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy to an Outpatient on the Prescription of a Doctor. “Hospital Pharmacy-Dermatologist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy: a) to an Outpatient; and b) on a Prescription signed by a Specialist in dermatology “Hospital Pharmacy-Specialist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy: a) to an Outpatient; and b) on a Prescription signed by a Specialist; or if the treatment of an Outpatient with the Community Pharmaceutical has been recommended by a Specialist, on the Prescription of a Practitioner endorsed with the words “recommended by [name of specialist and year of authorisation]” and signed by the Practitioner. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the specialist and the General Practitioner must keep a written record of the consultation. For the purposes of the deﬁnition it makes no difference whether or not the Specialist is employed by a hospital. “Hospital Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy: a) to an Outpatient; and b) on a Prescription signed by a Specialist. “HSS” means hospital supply status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part II as HSS, that DHBs are obliged to purchase subject to any DV Limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. “In Combination” means that the Community Pharmaceutical is only subsidised when prescribed in combination with another subsidised pharmaceutical as speciﬁed in Section B or C of the Pharmaceutical Schedule. “Individual DV Limit” means, for a particular Hospital Pharmaceutical with HSS and a particular DHB Hospital, the discretionary variance limit, being the speciﬁed percentage of that DHB Hospital’s Total Market Volume up to which that DHB Hospital may purchase DV Pharmaceuticals of that Hospital Pharmaceutical. “Licensed Hospital” means a place or institution that is certiﬁed to provide hospital care within the meaning of the Health and Disability Services (Safety) Act 2001. “Lot” means a quantity of a Community Pharmaceutical supplied in one dispensing. “Manufacturer’s Price” means the standard price at which a Community Pharmaceutical is supplied to wholesalers (excluding GST), as notiﬁed to PHARMAC by the supplier. “Maternity hospital” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied pursuant to a Bulk Supply Order to a maternity hospital certiﬁed under the Health and Disability Services (Safety) Act 2001. “Midwife” means a person registered as a midwife with the Midwifery Council, and who holds a current annual practising certiﬁcate under the HPCA Act 2003. “Month” means a period of 30 consecutive days. “Month restriction” means that no Subsidy is available: a) unless the Community Pharmaceutical is dispensed on the Prescription of a Practitioner; and b) for any quantity of that Community Pharmaceutical dispensed on the Prescription (whether or not dispensed as a repeat) in excess of a Monthly Lot. “Monthly Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 30 consecutive days’ treatment; “National Contract Pharmaceutical” means a Hospital Pharmaceutical for which PHARMAC has negotiated a national

SECTION A: GENERAL RULES

contract and the Price. “National DV Limit” means, for a particular Hospital Pharmaceutical with HSS, the discretionary variance limit, being the speciﬁed percentage of the Total Market Volume up to which all DHB Hospitals may collectively purchase DV Pharmaceuticals of that Hospital Pharmaceutical. “Not In Combination” means that no Subsidy is available: a) unless the Community Pharmaceutical is dispensed on the Prescription of a Practitioner; and b) for any Prescription containing the Community Pharmaceutical in combination with other ingredients unless the particular combination of ingredients is separately speciﬁed in Section B or C of the Schedule, and then only to the extent speciﬁed. “Nurse Prescriber” means a nurse registered with the Nursing Council and who holds a current annual practicing certiﬁcate under the HPCA Act 2003 and who is approved by the Nursing Council, to prescribe speciﬁed prescription medicines relating to his/her scope of practice. “Outpatient”, in relation to a Community Pharmaceutical, means a person who, as part of treatment at a hospital or other institution under the control of a DHB, is prescribed the Community Pharmaceutical for consumption or use in the person’s home. “Penal Institution” means a penal institution, as that term is deﬁned in The Penal Institutions Act 1954; “PHARMAC” means the Pharmaceutical Management Agency established by Section 46 of the Act (PHARMAC). “Pharmaceutical” means a medicine, therapeutic medical device, or related product or related thing listed in Sections B to H of the Schedule. “Pharmaceutical Beneﬁts” means the right of: a) a person; and b) any member under 16 years of age of that person’s family, to have made by the Government on his or her behalf, subject to any conditions for the time being speciﬁed in the Schedule, such payment in respect of any Community Pharmaceutical supplied to that person or family member under the order of a Practitioner in the course of his or her practice. “Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals. “Pharmaceutical Cancer Treatments” means Pharmaceuticals listed in Part V of Section H of the Pharmaceutical Schedule, and their associated indications, that DHBs must fund, from their own budgets, for use in their hospitals, and/or in association with Outpatient services provided in their DHB Hospitals, in relation to the treatment of cancers. “Practitioner” means a Doctor, a Dentist, a Midwife or a Nurse Prescriber as those terms are deﬁned in the Pharmaceutical Schedule. “Practitioner’s Supply Order” means a written order made by a Practitioner on a form supplied by the Ministry of Health, or approved by HealthPAC, for the supply of Community Pharmaceuticals to the Practitioner, which the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. “Prescription” means a quantity of a Community Pharmaceutical prescribed for a named person on a document signed by a Practitioner. “Private Hospital” means a hospital certiﬁed under the Health and Disability Services (Safety) Act 2001 that is not owned or operated by a DHB. “Residential Disability Care Institution” means premises used to provide residential disability care in accordance with the Health and Disability Services (Safety) Act 2001. “Rest Home” means premises used to provide rest home care in accordance with the Health and Disability Services (Safety) Act 2001. “Retail Pharmacy-Specialist” means that the Community Pharmaceutical is only eligible for Subsidy if it is supplied on a Prescription or Practitioner’s Supply Order signed by a Specialist, or, in the case of treatment recommended by a Specialist, a Prescription or Practitioner’s Supply Order and endorsed with the words “recommended by [name of Specialist and year of authorisation]” and signed by the Practitioner. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the Specialist and the General Practitioner must keep a written record of consultation. “Retail Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is only eligible for Subsidy if it is

SECTION A: GENERAL RULES

supplied on a Prescription, or Practitioner’s Supply Order, signed by a Specialist. “Schedule” means this Pharmaceutical Schedule and all its sections and appendices. “Section B” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for Subsidies included in the Schedule. “Section C” of this Pharmaceutical Schedule means the list of community extemporaneously compounded preparations and galenicals eligible for Subsidies included in the Schedule. “Section D” of this Pharmaceutical Schedule means the list of community special foods eligible for Subsidies included in the Schedule. “Section E Part I” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for Subsidies and available on a Practitioner’s Supply Order or a Wholesale Supply Order included in the Schedule. “Section E Part II” of this Pharmaceutical Schedule means the list of rural areas for the purpose of community Practitioner’s Supply Orders included in the Schedule. “Section F Part I” of this Pharmaceutical Schedule means the part of Section F relating to the exemption from dispensing in Monthly Lots, and requirement to dispense in 90 Day Lots or 180 Day Lots, as applicable, in respect of the Community Pharmaceuticals referred to in this part of Section F; “Section F Part II” of this Pharmaceutical Schedule means the part of Section F relating to the exemption from dispensing in Monthly Lots in respect of the Community Pharmaceuticals referred to in this part of Section F; “Section G” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for reimbursement of safety caps. “Section H” of this Pharmaceutical Schedule means the general rules for Hospital Pharmaceuticals and the lists of National Contract Pharmaceuticals and any associated DV Pharmaceuticals, of Discretionary Community Supply Pharmaceuticals, of Assessed Pharmaceuticals and of Pharmaceutical Cancer Treatments included in Section H of the Schedule. “Section H Part I” of this Pharmaceutical Schedule means the general rules for Hospital Pharmaceuticals. “Section H Part II” of this Pharmaceutical Schedule means the list of National Contract Pharmaceuticals, the relevant Price, an indication of whether the Pharmaceutical has HSS and any associated DV Pharmaceuticals and DV Limit. “Section H Part III” of this Pharmaceutical Schedule means the list of Assessed Pharmaceuticals. “Section H Part IV” of this Pharmaceutical Schedule means the list of Discretionary Community Supply Pharmaceuticals. “Section H Part V” of the Pharmaceutical Schedule means the list of Pharmaceutical Cancer Treatments. “Special Authority” means that the Community Pharmaceutical is only eligible for Subsidy or additional Subsidy for a particular person if an application meeting the criteria speciﬁed in the Schedule has been approved, and the valid Special Authority number is present on the prescription. “Specialist”, in relation to a Prescription, a doctor who holds a current annual practising certiﬁcate and who satisﬁes the criteria set out in paragraphs (a) or (b) or (c) or (d) below: a) i) the doctor is vocationally registered in accordance with the criteria set out by the Medical Council of New Zealand and the HPCA Act 2003 and who has written the Prescription in the course of practising in that area of medicine; and ii) the doctor’s vocational scope of practice is one of those listed below: – anaesthetics, cardiothoracic surgery, dermatology, diagnostic radiology, emergency medicine, general surgery, internal medicine, neurosurgery, obstetrics and gynaecology, occupational medicine, ophthalmology, otolaryngology head and neck surgery, orthopaedic surgery, paediatric surgery, paediatrics, pathology, plastic and reconstructive surgery, psychological medicine or psychiatry, public health medicine, radiation oncology, rehabilitation medicine, urology and venereology; b) the doctor is recognised by the Ministry of Health as a specialist for the purposes of this Schedule and receives remuneration from a DHB at a level which that DHB considers appropriate for specialists and who has written that Prescription in the course of practising in that area of medicine; c) the doctor is recognised by the Ministry of Health as a specialist in relation to a particular area of medicine for the purpose of writing Prescriptions and who has written the Prescription in the course of practising in that area of medicine; d) the doctor writes the Prescription on DHB stationery and is appropriately authorised by the relevant DHB to do so. “Subsidy” means the maximum amount that the Government will pay Contractors for a Community Pharmaceutical dispensed to a person eligible for Pharmaceutical Beneﬁts and is different from the cost to Government of subsidising that Community Pharmaceutical . “Supply Order” means a Bulk Supply Order, a Practitioner’s Supply Order or a Wholesale Supply Order. “Wholesale Supply Order” means a written order by a Practitioner, on a form supplied by the Ministry of Health for the

SECTION A: GENERAL RULES

supply of certain Community Pharmaceuticals as listed in Section B and Section E Part I of the Schedule. 1.2 In addition to the above interpretations and deﬁnitions, unless the content requires otherwise, a reference in the Schedule to: a) the singular includes the plural; and b) any legislation includes a modiﬁcation and re-enactment of, legislation enacted in substitution for, and a regulation, Order in Council, and other instrument from time to time issued or made under that legislation, where that legislation, regulation, Order in Council or other instrument has an effect on the prescribing, dispensing or subsidising of Community Pharmaceuticals.

PART II COMMUNITY PHARMACEUTICALS SUBSIDY

2.1 Community Pharmaceuticals eligible for Subsidy include every medicine, therapeutic medical device or related product, or related thing listed in Sections B to G of the Schedule, and every preparation (having an inert base) of any of them, is hereby declared to be a Community Pharmaceutical for the purposes of the Schedule, subject to: 2.1.1 clauses 2.2 and 2.3 of the Schedule; and 2.1.2 clauses 3.1 to 4.4 of the Schedule; and 2.1.3 the conditions (if any) speciﬁed in Sections B to G of the Schedule; 2.2 The following medicines, therapeutic medical devices, or related products or related things are not eligible for Subsidy: 2.2.1 substances, or combinations of substances, ordered for any purpose other than: a) treatment of a patient’s medical or dental condition; or b) pregnancy tests; or c) the prevention of sexually transmitted disease; or d) contraception. 2.2.2 substances and combinations of substances packed under pressure in aerosol cans or other similar devices, unless it is speciﬁed in Sections B to G of the Schedule that they may be so packed; 2.2.3 electrode jellies; 2.2.4 eye drops packed in single-dose units, unless it is speciﬁed in Sections B to G of the Schedule that they may be so packed; 2.2.5 insect repellents and similar preparations; 2.2.6 oral preparations in long-acting form, unless it is speciﬁed in Sections B to G of the Schedule that they may be in such a form; 2.2.7 substances or combinations of substances in lozenge or similar form, unless it is speciﬁed in Sections B to G of the Schedule that they may be in such a form; 2.2.8 machine-spread plasters; 2.2.9 preparations prescribed as foods, unless they are speciﬁed in Section D of the Schedule; 2.2.10 substances, combinations of substances, or articles, in the form of proprietary medicines or proprietary articles, unless they are deemed or declared to be Pharmaceuticals elsewhere in the Schedule; 2.2.11 shampoos, other than extemporaneously prepared medicated shampoos, or shampoos speciﬁed in Sections B to G of the Schedule intended for the treatment of a patient’s medical condition; 2.2.12 toilet preparations; 2.2.13 tooth pastes and powders; 2.2.14 lubricating jellies and catheter lubricants; 2.2.15 sterile diluents for nebulising solutions; 2.2.16 substances in a form intended to enable delivery by transdermal diffusion or osmosis or by the insertion of any solid object or substance into the eye cavity, unless it is speciﬁed in Sections B to G of the Schedule that they may be in such a form; 2.2.17 substances in a form intended for intravenous delivery (other than by injection), unless it is speciﬁed in Sections B to G of the Schedule that they may be in such a form; 2.2.18 substances packed in pre-loaded syringes known as Min-I-Jets, unless it is speciﬁed in Sections B to G of the Schedule that they may be so packed; 2.2.19 Community Pharmaceuticals prescribed as cough mixtures, unless they are speciﬁed in Sections B to G of the Schedule otherwise than in combination with other ingredients; 2.2.20 vitamin preparations in capsule form, unless they are speciﬁed in Sections B to G of the Schedule;

SECTION A: GENERAL RULES

2.2.21 substances prescribed for use as irrigating solutions, unless it is speciﬁed in Sections B to G of the Schedule that they may be prescribed for such use. 2.3 No claim by a Contractor for payment in respect of the supply of Community Pharmaceuticals will be allowed unless the Community Pharmaceuticals so supplied: 2.3.1 comply with the appropriate standards prescribed by regulations for the time being in force under the Medicines Act 1981; or 2.3.2 in the absence of any such standards, comply with the appropriate standards for the time being prescribed by the British Pharmacopoeia; or 2.3.3 in the absence of the standards prescribed in clauses 2.3.1 and 2.3.2, comply with the appropriate standards for the time being prescribed by the British Pharmaceutical Codex; or 2.3.4 in the absence of the standards prescribed in clauses 2.3.1, 2.3.2 and 2.3.3, are of a grade and quality not lower than those usually applicable to Community Pharmaceuticals intended to be used for medical purposes.

PART III PERIOD AND QUANTITY OF SUPPLY

3.1 Doctors’, Midwives’ and Nurse Prescribers’ Prescriptions (other than oral contraceptives) The following provisions apply to all Prescriptions, other than those for an oral contraceptive, written by a Doctor, Midwife or Nurse Prescriber: 3.1.1 For a Community Pharmaceutical other than a Class B Controlled Drug, only a quantity sufﬁcient to provide treatment for a period not exceeding three Months will be subsidised. 3.1.2 For methylphenidate hydrochloride and dexamphetamine sulphate, only a quantity sufﬁcient to provide treatment for a period not exceeding one Month will be subsidised. 3.1.3 For a Class B Controlled Drug other than methylphenidate hydrochloride and dexamphetamine sulphate, only a quantity: a) sufﬁcient to provide treatment for a period not exceeding 10 days; and b) which has been dispensed pursuant to a Prescription sufﬁcient to provide treatment for a period not exceeding one Month, will be subsidised. 3.1.4 Subject to clauses 3.1.3 and 3.1.7, where a Doctor, Midwife or Nurse Prescriber has prescribed a quantity of a Community Pharmaceutical sufﬁcient to provide treatment for: a) one Month or less than one Month, but dispensed by the Contractor in quantities smaller than the quantity prescribed, the Community Pharmaceutical will only be subsidised as if that Community Pharmaceutical had been dispensed in a Monthly Lot; b) more than one Month, the Community Pharmaceutical will be subsidised only if it is dispensed: i) in a 90 Day Lot, where the Community Pharmaceutical is a Pharmaceutical covered by Section F Part I of the Pharmaceutical Schedule; or ii) if the Community Pharmaceutical is not a Pharmaceutical referred to in Section F Part I of the Pharmaceutical Schedule, in Monthly Lots, unless: A) the eligible person or his/her nominated representative endorses the back of the Prescription form with a statement identifying which Access Exemption Criterion (Criteria) applies and signs that statement to this effect; or B) both: 1) the Practitioner endorses the Community Pharmaceutical on the Prescription with the words “certiﬁed exemption” written in the Practitioner’s own handwriting or signed or initialled by the Practitioner; and 2) every Community Pharmaceutical endorsed as “certiﬁed exemption” is covered by Section F Part II of the Pharmaceutical Schedule. 3.1.5 A Community Pharmaceutical is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor: a) for a Class B Controlled Drug, within eight days of the date on which the Prescription was written; or b) for any other Community Pharmaceutical, within three Months of the date on which the Prescription was written. 3.1.6 No subsidy will be paid for any Prescription, or part thereof, that is not fulﬁlled within: a) in the case of a Prescription for a total supply of from one to three Months, three Months from the date the Community Pharmaceutical was ﬁrst dispensed; or b) in any other case, one Month from the date the Community Pharmaceutical was ﬁrst dispensed. Only that part of any Prescription that is dispensed within the time frames speciﬁed above is eligible for Subsidy. 3.1.7 If a Community Pharmaceutical:

SECTION A: GENERAL RULES

a) is stable for a limited period only, and the Doctor, Midwife, or Nurse Prescriber has endorsed the Prescription with the words “unstable medicine” and has speciﬁed the maximum quantity that may be dispensed at any one time; or b) is stable for a limited period only, and the Contractor has endorsed the Prescription with the words “unstable medicine” and has speciﬁed the maximum quantity that should be dispensed at any one time in all the circumstances of the particular case; or c) is Close Control, the actual quantity dispensed will be subsidised in accordance with any such speciﬁcation. 3.2 Oral Contraceptives The following provisions apply to all Prescriptions written by a Doctor, Midwife or Nurse Prescriber for an oral contraceptive: 3.2.1 The prescribing Doctor, Midwife or Nurse Prescriber must specify on the Prescription the period of treatment for which the Community Pharmaceutical is to be supplied. This period must not exceed: a) three Months if prescribed by a Midwife; or b) six Months if prescribed by a Doctor or Nurse Practitioner. 3.2.2 Where the period of treatment speciﬁed in the Prescription does not exceed six Months, the Community Pharmaceutical is to be dispensed: a) in Lots as speciﬁed in the Prescription if the Community Pharmaceutical is Close Control; or b) where no Lots are speciﬁed, in one Lot sufﬁcient to provide treatment for the period prescribed. 3.2.3 An oral contraceptive is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor within three Months of the date on which it was written. 3.2.4 An oral contraceptive prescribed by a Midwife is only eligible for Subsidy if the Prescription under which it has been dispensed has been written within the period of post natal care of the eligible person. 3.2.5 Where a Community Pharmaceutical in a Prescription is Close Control and a repeat on the Prescription remains unfulﬁlled after six Months from the date the Community Pharmaceutical was ﬁrst dispensed only the actual quantity supplied by the Contractor within this time limit will be eligible for Subsidy. 3.3 Dentists’ Prescriptions The following provisions apply to every Prescription written by a Dentist: 3.3.1 The maximum quantity of a Community Pharmaceutical that will be subsidised is as follows: a) where the Community Pharmaceutical is a Controlled Drug, only such quantity as is necessary to provide treatment for a period not exceeding ﬁve days; and b) in any other case, only such quantity as is necessary to provide treatment for a period not exceeding ﬁve days and, where the Prescription speciﬁes a repeat, one further period not exceeding ﬁve days. 3.3.2 Notwithstanding clause 3.3.1, if, in the opinion of the Dentist, an eligible person needs extended treatment with sodium ﬂuoride for up to three Months, the Community Pharmaceutical will be subsidised for that extended period. A Prescription for any such extended supply of sodium ﬂuoride will be subsidised only if it is dispensed in Monthly Lots, unless the eligible person or his/her nominated representative endorses the back of the Prescription form with a statement identifying which Access Exemption Criterion (Criteria) applies and signs that statement to this effect. 3.3.3 A Community Pharmaceutical is only eligible for Subsidy if the Prescription under which it has been dispensed has been presented to the Contractor: a) for a Class B Controlled Drug, within eight days of the date on which the Prescription was written; or b) for any other Community Pharmaceutical, within three Months of the date on which the Prescription was written. 3.3.4 No Subsidy will be paid for any Prescription, or part thereof, that is not fulﬁlled within: a) one Month from the date the Community Pharmaceutical was ﬁrst dispensed; or b) in the case of sodium ﬂuoride, three Months from the date the Community Pharmaceutical was ﬁrst dispensed. Only that part of any Prescription that is dispensed within the time frames speciﬁed above is eligible for Subsidy. 3.4 Original Packs, and Certain Antibiotics 3.4.1 Notwithstanding clauses 3.1 and 3.3 of the Schedule, if a Practitioner prescribes or orders a Community Pharmaceutical that is identiﬁed as an Original Pack (OP) on the Pharmaceutical Schedule and is packed in a container from which it is not practicable to dispense lesser amounts, every reference in those clauses to an amount or quantity eligible for Subsidy, is deemed to be a reference: a) where an amount by weight or volume of the Community Pharmaceutical is speciﬁed in the Prescription, to the smallest container of the Community Pharmaceutical, or the smallest number of containers of the Community

SECTION A: GENERAL RULES

Pharmaceutical, sufﬁcient to provide that amount; and b) in every other case, to the amount contained in the smallest container of the Community Pharmaceutical that is manufactured in, or imported into, New Zealand. 3.4.2 If a Community Pharmaceutical is the liquid oral form of an antibiotic to which a diluent must be added by the Contractor at the time of dispensing and it is prescribed or ordered by a Practitioner in an amount that does not coincide with the amount contained in one or more standard packs of that Community Pharmaceutical, Subsidy will only be made for the amount prescribed or ordered by the Practitioner in accordance with either clause 3.1 or clause 3.3 of the Schedule, unless the Contractor satisﬁes the Funder that he or she has not been able to dispense the balance of the pack or packs from which the Community Pharmaceutical has been dispensed. In such cases all of that pack or those packs is eligible for Subsidy.

PART IV MISCELLANEOUS PROVISIONS

4.1 Bulk Supply Orders The following provisions apply to the supply of Community Pharmaceuticals under Bulk Supply Orders: 4.1.1 No Community Pharmaceutical supplied under a Bulk Supply Order will be subsidised if it is speciﬁcally restricted in Section B, C or D of the Schedule. 4.1.2 The person who placed the Bulk Supply Order may be called upon by the Ministry of Health to justify the amount ordered. 4.1.3 Class B Controlled Drugs will be subsidised only if supplied under Bulk Supply Orders placed by an institution certiﬁed to provide hospital care under the Health and Disability Services (Safety) Act 2001. 4.1.4 Any order for a Class B Controlled Drug or for buprenorphine hydrochloride must be written on a Special Bulk Supply Order Controlled Drug Form supplied by the Ministry of Health. 4.1.5 Community Pharmaceuticals listed in Part I of the First Schedule to the Medicines Regulations 1984 will be subsidised only if supplied under a Bulk Supply Order placed by an institution certiﬁed to provide hospital care under the Health and Disability Services (Safety) Act 2001 and: a) that institution employs a registered general nurse, registered with the Nursing Council and who holds a current annual practicing certiﬁcate under the HPCA Act 2003; and b) the Bulk Supply Order is supported by a written requisition signed by a Practitioner. 4.1.6 No Subsidy will be paid for any quantity of a Community Pharmaceutical supplied under a Bulk Supply Order in excess of what is a reasonable monthly allocation for the particular institution, after taking into account stock on hand. 4.1.7 The Ministry of Health may, at any time, by public notiﬁcation, declare that any approved institution within its particular region, is not entitled to obtain supplies of Community Pharmaceuticals under Bulk Supply Orders with effect from the date speciﬁed in that declaration. Any such notice may in like manner be revoked by the Ministry of Health at any time. 4.2 Practitioner’s Supply Orders The following provisions apply to the supply of Community Pharmaceuticals to Practitioners under a Practitioner’s Supply Order: 4.2.1 Subject to clause 4.2.3, a Practitioner may only order under a Practitioner’s Supply Order those Community Pharmaceuticals listed in Section E Part I and only in such quantities as set out in Section E Part I that the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. 4.2.2 Any order for a Class B Controlled Drug or for buprenorphine hydrochloride must be written on a Special Practitioner’s Supply Order Controlled Drug Form supplied by the Ministry of Health. 4.2.3 A Practitioner may order such Community Pharmaceuticals as he or she expects to be required for personal administration to patients under the Practitioner’s care if: a) the Practitioner’s normal practice is in the speciﬁed areas listed in Section E Part II of the Schedule, or if the Practitioner is a locum for a Practitioner whose normal practice is in such an area. b) the quantities ordered are reasonable for up to one Month’s supply under the conditions normally existing in the practice. c) no Subsidy is available under Clause 4.2.3 for any Community Pharmaceutical speciﬁcally restricted in Section B and C of the Schedule and the Practitioner may be called on by the Ministry of Health to justify the amounts of Community Pharmaceuticals ordered. 4.2.4 No Community Pharmaceutical ordered under a Practitioner’s Supply order will be eligible for Subsidy unless the

SECTION A: GENERAL RULES

Practitioner’s Supply Order is made on a form supplied for that purpose by the Ministry of Health, or approved by HealthPAC’s and which: a) is personally signed and dated by the Practitioner; and b) sets out the Practitioner’s address; and c) sets out the Community Pharmaceuticals and quantities. 4.2.5 The Ministry of Health may, at any time, on the recommendation of an Advisory Committee appointed by the Ministry of Health for that purpose, by public notiﬁcation, declare that a Practitioner speciﬁed in such a notice is not entitled to obtain supplies of Community Pharmaceuticals under Practitioner’s Supply Orders until such time as the Ministry of Health notiﬁes otherwise. 4.3 Wholesale Supply Orders The following provisions apply to the supply of Community Pharmaceuticals to Practitioners under Wholesale Supply Orders: 4.3.1 Notwithstanding anything contained in the Schedule, but subject nevertheless to subclause 4.3.3 of this clause, a Practitioner may obtain from a wholesaler or distributor, pursuant to a Wholesale Supply Order made on a form supplied by the Ministry of Health, any Community Pharmaceutical speciﬁed in Section B and Section E Part I of the Schedule as being available on a Wholesale Supply Order. 4.3.2 Subject to clause 4.3.3, Community Pharmaceuticals supplied to Practitioners under Wholesale Supply Orders will be subsidised at a rate not exceeding the Manufacturer’s Price for each such Community Pharmaceutical as set out in Section B and Section E Part I of the Schedule. 4.3.3 No subsidy will be paid for any quantity of a Community Pharmaceutical supplied to a Practitioner under a Wholesale Supply Order in excess of what is a reasonable monthly allocation for that particular Practitioner, after taking into account stock on hand. 4.3.4 The Ministry of Health may, at any time, on the recommendation of an Advisory Committee appointed by the Ministry of Health for that purpose, by public notiﬁcation, declare that a Practitioner speciﬁed in such a notice is not entitled to obtain supplies of Community Pharmaceuticals under Wholesale Supply Orders until such time as the Ministry of Health notiﬁes otherwise. 4.4 Retail Pharmacy and Hospital Pharmacy-Specialist Restriction The following provisions apply to Prescriptions for Community Pharmaceuticals eligible to be subsidised as “Retail Pharmacy-Specialist” and “Hospital Pharmacy-Specialist”: 4.4.1 Record Keeping It is expected that a record will be kept by both the General Practitioner and the Specialist of the fact of consultation and enough of the clinical details to justify the recommendation. This means referral by telephone will need to be followed up by written consultation. 4.4.2 Expiry The recommendation expires at the end of two years and can be renewed by a further consultation. 4.4.3 The circulation by Specialists of the circumstances under which they are prepared to recommend a particular Community Pharmaceutical is acceptable as a guide. It must however be followed up by the procedure in subclauses 4.4.1 and 4.4.2, for the individual Patient. 4.4.4 The use of preprinted forms and named lists of Specialists (as circulated by some pharmaceutical companies) is regarded as inappropriate. 4.4.5 The Rules for Retail Pharmacy-Specialist and Hospital Pharmacy-Specialist will be audited as part of HealthPAC’s routine auditing procedures. 4.5 Amendment of Schedule PHARMAC may amend the terms of the Schedule from time to time by notice in writing given in such manner as PHARMAC thinks ﬁt, and in accordance with such protocols as agreed with the Pharmacy Guild of New Zealand (Inc) from time to time. 4.6 Conﬂict in Provisions If any rules in Sections B–G of this Schedule conﬂict with the rules in Section A, the rules in Sections B–G apply.

SECTION B: ALIMENTARY TRACT AND METABOLISM

Antacids and Antiﬂatulents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTACIDS AND ANTIFLATULENTS Antacids and Reﬂux Barrier Agents

ALGINIC ACID

Tab 500 mg with magnesium trisil 25 mg, aluminium hydroxide gel, dried 100 mg, and sodium bicarbonate 170 mg - peppermint ﬂavour .........1.80

60 Gaviscon 30 ✓ Gaviscon Infant

(7.81) Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet ........................................................4.50

CALCIUM CARBONATE ❋ Tab 420 mg and aminoacetic acid 180 mg with or without dimethicone 21 mg - Higher subsidy by endorsement available ..................................................................................30.00 1,000 (37.60) Titralac Higher subsidy by endorsement: Calcium carbonate tablets x 1,000 (Titralac) up to $35.10 is available for pregnant women. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibilty are “certiﬁed condition” however these particular words are not a requirement. POLYSILOXANE ❋ Tab aluminium hydroxide 250 mg with magnesium trisil 120 mg, magnesium hydroxide 120 mg and polysiloxane 10 mg .............15.00 (18.70) SIMETHICONE ❋ Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml .......................1.50 (4.05) SODIUM ALGINATE ❋ Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) .....1.50 (7.07)

500 Gastrogel

500 ml Mylanta P 500 ml Gaviscon

Phosphate Binding Agents

ALUMINIUM HYDROXIDE Tab 600 mg ...................................................................................12.56 100 ✓ Alu-Tab

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Antidiarrhoeals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIDIARRHOEALS Agents Which Reduce Motility

DIPHENOXYLATE HYDROCHLORIDE WITH ATROPINE SULPHATE ❋ Tab 2.5 mg with atropine sulphate 25 mcg .......................................6.00 LOPERAMIDE HYDROCHLORIDE - Available on a PSO ❋ Cap 2 mg ........................................................................................8.50 100 250 ✓ Diastop ✓ Dicap

Rectal and Colonic Anti-inﬂammatories

BUDESONIDE - Special Authority - Retail Pharmacy Cap 3 mg ....................................................................................153.57 100 ✓ Entocort CIR

Special Authority for Subsidy - Form: SA0698 Initial application only from a gastroenterologist, general surgeon or general physician. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Mild to moderate ileal, ileocaecal or proximal Crohn’s disease; and 2 Any of the following: 2.1 Diabetes; or 2.2 Cushingoid habitus; or 2.3 Osteoporosis where there is signiﬁcant risk of fracture; or 2.4 Severe acne following treatment with conventional corticosteroid therapy. Renewal only from a gastroenterologist, general surgeon or general physician. Approvals valid for 3 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. The patient has had no more than 1 prior approval in the last year. Note Clinical trials for Entocort CIR use beyond three months demonstrated no improvement in relapse rate.

HYDROCORTISONE ACETATE Rectal foam 10%, CFC-Free ...........................................................19.06 MESALAZINE Tab 400 mg - Retail pharmacy-specialist .......................................68.40 Tab long-acting 500 mg - Retail pharmacy-specialist .....................69.06 Enema 1 g per 100 ml - Retail pharmacy-specialist ..........................7.90 Suppos 500 mg.............................................................................27.95 OLSALAZINE - Retail pharmacy-specialist Cap 250 mg ..................................................................................31.51 Tab 500 mg ...................................................................................59.86 SODIUM CROMOGLYCATE - Hospital pharmacy [HP3]-specialist Cap 100 mg ..................................................................................89.21 SULPHASALAZINE ❋ Tab 500 mg .....................................................................................8.86 ❋ Tab EC 500 mg ................................................................................9.94 ❋ Enema 3 g per 100 ml - Retail pharmacy-specialist ........................37.40 (43.00) 21.1 g OP 100 100 1 OP 20 100 100 100 100 100 7 ✓ Colifoam ✓ Asacol ✓ Pentasa ✓ Asacol ✓ Asacol ✓ Dipentum ✓ Dipentum ✓ Nalcrom ✓ Salazopyrin ✓ Salazopyrin EN Salazopyrin

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Antihaemorrhoidals Antispasmodics and Other Agents Altering Gut Motility

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ALIMENTARY TRACT AND METABOLISM

ANTIHAEMORRHOIDALS Corticosteroids

FLUOCORTOLONE CAPROATE WITH FLUOCORTOLONE PIVALATE AND CINCHOCAINE Oint 950 mcg, with ﬂuocortolone pivalate 920 mcg and cinchocaine hydrochloride 5 mg per g .................................................................7.05 30 g OP Suppos 630 mcg, with ﬂuocortolone pivalate 610 mcg, and cinchocaine hydrochloride 1 mg................................................2.95 12 ✓ Ultraproct ✓ Ultraproct

Rectal Sclerosants

OILY PHENOL ❋ Inj 5%, 5 ml .................................................................................. 71.71 5 ✓ Mayne

Soothing Agents

ZINC OXIDE Oint zinc oxide with balsam peru ......................................................4.50 (6.50) Suppos zinc oxide with balsam peru ...............................................4.47 (6.35) 50 g OP Anusol 12 Anusol

ANTISPASMODICS AND OTHER AGENTS ALTERING GUT MOTILITY

ATROPINE SULPHATE ❋ Inj 400 mcg, 1 ml - Available on a PSO ..........................................29.95 ❋ Inj 600 mcg, 1 ml - Available on a PSO ..........................................24.00 ❋ Inj 1200 mcg 1 ml - Available on a PSO .........................................29.95 DICYCLOMINE HYDROCHLORIDE ❋ Tab 10 mg - Available on a PSO .......................................................4.95 HYOSCINE N-BUTYLBROMIDE ❋ Tab 10 mg .......................................................................................6.83 (10.85) ❋ Inj 20 mg, 1 ml - Available on a PSO ................................................6.15 MEBEVERINE HYDROCHLORIDE - Retail pharmacy-specialist ❋ Tab 135 mg ...................................................................................10.72 (12.00) 50 50 50 100 100 5 90 Colofac Buscopan ✓ Buscopan ✓ AstraZeneca ✓ AstraZeneca ✓ AstraZeneca ✓ Merbentyl

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Antiulcerants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIULCERANTS Antisecretory and Cytoprotective

MISOPROSTOL - Retail pharmacy-specialist ❋ Tab 200 mcg ................................................................................52.70 120 ✓ Cytotec

Helicobacter Pylori Eradication

OMEPRAZOLE, AMOXYCILLIN AND CLARITHROMYCIN Omeprazole cap 20 mg x 14, amoxycillin cap 500 mg x 28, clarithromycin tab 500 mg x 14 ........................................55.00 (Klacid Hp7 to be delisted 1 May 2005) 1 OP ✓ Klacid Hp7 ✓ Losec Hp7 OAC

H2 Antagonists

CIMETIDINE

a) Only on a prescription. b) Not as an effervescent or dispersible tab.

❋ Tab 200 mg .....................................................................................5.00 ❋ Tab 400 mg ...................................................................................10.00 FAMOTIDINE - Only on a prescription. ❋ Tab 20 mg .......................................................................................4.66 ❋ Tab 40 mg .......................................................................................9.98 RANITIDINE HYDROCHLORIDE - Only on a prescription. ❋ Tab 150 mg .....................................................................................9.90 ❋ Tab 300 mg ...................................................................................13.90 ❋ Inj 25 mg per ml, 2ml ......................................................................8.75 ❋ Oral liq 150 mg per 10 ml - Subsidy by endorsement .....................20.04

100 100 250 250 250 250 5 300 ml

✓ Apo-Cimetidine ✓ Apo-Cimetidine ✓ FamoxIMM ✓ Famox IMM ✓ Arrow-Ranitidine ✓ Arrow-Ranitidine ✓ Zantac ✓ Zantac

Subsidy by endorsement: Oral liquid is subsidised only for patients: - with oesophageal stricture, or - in terminal care, or - who are either too young or too old to swallow conventional tablets and the prescription is endorsed accordingly. Note: the cost of treatment with ranitidine oral liquid is more than 10 times higher than that of ranitidine tablets. Following the derestriction of access PHARMAC will be monitoring expenditure on ranitidine oral liquid more closely and may, subject to consultation and PHARMAC Board approval, restrict access again if the expenditure was to grow substantially.

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Antiulcerants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Proton Pump Inhibitors

LANSOPRAZOLE ❋ Cap 30 mg ......................................................................................8.09 (53.60) OMEPRAZOLE ❋ Cap 10 mg ....................................................................................17.37 ❋ Cap 20 mg ....................................................................................24.81 ❋ Cap 40 mg ....................................................................................44.66 ❋ Inj 40 mg.......................................................................................12.50 ❋ Suspension (refer to page 162)......................................................CE PANTOPRAZOLE ❋ Tab 20 mg .......................................................................................6.57 (22.00) ❋ Tab 40 mg .......................................................................................8.36 (28.00) 30 Zoton 30 30 30 1 100 ml 30 Somac 30 Somac ✓ Losec ✓ Losec ✓ Losec ✓ Losec ✓

Site Protective Agents

SUCRALFATE Tab 1 g ..........................................................................................35.50 (48.28) TRIPOTASSIUM DICITRATOBISMUTHATE Tab 120 mg ...................................................................................38.00 120 Carafate 112 ✓ De-nol

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Diabetes

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

DIABETES Hyperglycaemic Agents

GLUCAGON HYDROCHLORIDE - Available on PSO Inj 1 mg syringe kit ........................................................................27.00 1 ✓ Glucagen Hypokit

Insulin – Short-acting Preparations

INSULIN NEUTRAL ▲ Inj human 100 u per ml, 3 ml .........................................................42.66

▲

5 10 ml OP 10 ml OP

Inj human 100 u per ml..................................................................25.26

INSULIN ANIMAL - Special Authority - Retail pharmacy ▲ Inj animal 100 u per ml, 10 ml ...................................................... 25.26

✓ Actrapid Penﬁll ✓ Humulin R ✓ Actrapid ✓ Humulin R ✓ Actrapid ✓ Velosulin

Special Authority for Subsidy - Form: SA0750 Initial application only from a relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Continuation of previous therapy.

Insulin – Intermediate and Long-acting Preparations

INSULIN ISOPHANE ▲ Inj human 100 u per ml, 3 ml .........................................................29.86

▲

5 10 ml OP

Inj human inj 100 u per ml ...........................................................17.68

✓ Humulin N ✓ Protaphane Penﬁll ✓ Humulin N ✓ Protaphane ✓ Humulin 70/30 ✓ PenMix 10 ✓ PenMix 20 ✓ PenMix 30 ✓ PenMix 40 ✓ PenMix 50 ✓ Humulin 70/30 ✓ Mixtard 30 ✓ Mixtard 50 ✓ Humulin L ✓ Monotard ✓ Ultratard ✓ Insulatard ✓ Protaphane ✓ Mixtard 30

INSULIN ISOPHANE WITH INSULIN NEUTRAL ▲ Inj human with neutral insulin 100 u per ml, 3 ml ...........................42.66

▲

Inj human with neutral insulin 100 u per ml ....................................25.26

10 ml OP

INSULIN ZINC SUSPENSION ▲ Inj human 100 u per ml..................................................................25.26

▲

10 ml OP 10 ml OP 10 ml OP

Inj crystalline human 100 u per ml .................................................25.26

INSULIN ANIMAL - Special Authority - Retail pharmacy ▲ Inj animal 100 u per ml, 10 ml ...................................................... 25.26

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Diabetes

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Insulin – Rapid acting insulin analogues

Rapid acting analogues are subsidised when: 1) Prescribed with insulin isophane but are on a different prescription and the prescription is endorsed accordingly; or prescribed on the same prescription as insulin isophane in which case the prescription is deemed to be endorsed: or 2) A Special Authorty has been approved. For 1) and 2) ﬁrst prescription to be written by a Specialist (diabetologist, general physician or peadiatrician). Any medical practioner can write subsequent prescriptions. Special Authority available to waive restriction - Form: SA0641 Initial application only from a diabetologist, general physician or paediatrician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Both: 1.1 Use alone (monotherapy); and 1.2 The patient is unable to use any other insulins including those on insulin pump treatment; or 2 Both: 2.1 Use with insulin other than insulin isophane (including ready-mixed preparations); and 2.2 A reasonable trial of insulin isophane has been undertaken and it is not effective or not well tolerated. Note “Reasonable trial”, “unable to use”, “not effective”, “not well tolerated”, and “not well tolerated” are not deﬁned and we ask clinicians to use their clinical judgement in interpreting these terms.

INSULIN ASPART - Special Authority available - Retail pharmacy ▲ Inj 100 u per ml, 3 ml ....................................................................59.52 ▲ Inj 100 u per ml, 10 ml ..................................................................34.92 INSULIN LISPRO - Special Authority available - Retail pharmacy ▲ Inj 100 u per ml, 3 ml ....................................................................59.52 ▲ Inj 100 u per ml, 10 ml ..................................................................34.92 5 1 5 10 ml OP ✓ NovoRapid Penﬁll ✓ NovoRapid ✓ Humalog ✓ Humalog

Alpha glucosidase inhibitors

ACARBOSE - Special Authority - Retail pharmacy ❋ Tab 50 mg .....................................................................................22.00 ❋ Tab 100 mg ...................................................................................31.00 90 90 ✓ Glucobay ✓ Glucobay

Special Authority for Subsidy - Form: SA0490 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Requires but is not able to tolerate metformin therapy; or 2 Requires metformin but metformin is contraindicated; or 3 Has not responded to or tolerated the maximum appropriate dose of metformin. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Diabetes

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Oral Hypoglycaemic Agents

GLIBENCLAMIDE ❋ Tab 2.5 mg ......................................................................................1.98 ❋ Tab 5 mg .........................................................................................2.10 GLICLAZIDE ❋ Tab 80 mg .....................................................................................39.08 GLIPIZIDE ❋ Tab 5 mg .........................................................................................3.65 METFORMIN HYDROCHLORIDE ❋ Tab 500 mg ...................................................................................11.75 ❋ Tab 850 mg .....................................................................................8.25 100 100 500 100 500 250 ✓ Gliben ✓ Gliben ✓ Apo-Gliclazide ✓ Minidiab ✓ Metomin ✓ Metomin

PIOGLITAZONE - Special Authority - Retail pharmacy Tab 15 mg .....................................................................................61.04 28 ✓ Actos Tab 30 mg .....................................................................................93.90 28 ✓ Actos Tab 45 mg ................................................................................... 119.18 28 ✓ Actos Special Authority for Subsidy - Form: SA0738 Initial application only from a relevant specialist. Approvals valid for one year for applications meeting the following criteria: Either: 1 All of the following: 1.1 To be used as monotherapy for patients with type 2 diabetes who after six months of diet and lifestyle changes do not have adequate glycaemic control (inadequate control deﬁned as HbA1c > 8.0% in tests carried out at least two months apart); and 1.2 Metformin is not tolerated or contraindicated. Intolerance and contraindications as deﬁned in the notes below, a minimum of a four week trial period of metformin is required; and 1.3 Sulphonylurea is not tolerated or contraindicated. Overweight patients are only eligible under the criteria of contraindication to sulphonylureas if their body mass index (BMI) exceeds 35; or 2 Both: 2.1 For use in combination with a sulphonylurea when diet and lifestyle changes and a twelve month trial of sulphonylurea results in inadequate glycaemic control (inadequate control deﬁned as HbA1c > 8.0% in tests carried out at least two months apart); and 2.2 Metformin is not tolerated or contraindicated. Intolerance and contraindications as deﬁned in the notes below, a minimum of a four-week trial period of metformin is required. Renewal only from a relevant specialist. Approvals valid for one year for applications meeting the following criteria: All of the following: 3 Patient has had their HbA1c levels tests twice in the last six-month period of pioglitazone treatment; and 4 HbA1c level test 1 < 8.0%; and 5 HbA1c level test 2 < 8.0% (measured at least two months after test 1). Note Pioglitazone is not to be used in combination with metformin. Pioglitazone is not to be used in combination with insulin. Pioglitazone is not to be used in triple oral combination (deﬁned as a combination of metformin, sulphonylurea and pioglitazone). Pioglitazone is not to be used in patients with heart failure. Liver function tests should be performed at baseline. Gastrointestinal side effects are relatively common when initiating metformin therapy. Upward titration of metformin dose over several weeks and taking metformin with food will help to minimize these side effects. continued...

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Diabetes Diabetes Management

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued... Intolerance and contraindications for metformin: i) Serum creatinine >=0.15 or creatinine clearance < 60 ml/min ii) Signiﬁcant liver impairment iii) Severe left ventricular dysfunction iv) Intolerable gastrointestinal side effects that persist beyond 4 weeks duration. TOLBUTAMIDE ❋ Tab 500 mg ...................................................................................12.00 100 ✓ Diatol

DIABETES MANAGEMENT Glucose/Urine Testing

COPPER - Not on a bulk supply order ❋ Tab, diagnostic ................................................................................3.35 (7.80) 24 OP Clinitest

GLUCOSE OXIDASE - Not on a bulk supply order Urine diagnostic test with peroxidase ..............................................8.26 100 strip OP (9.09) Urine diagnostic test with peroxidase ...............................................4.11 50 strip OP (4.83) Urine diagnostic test ........................................................................4.11 50 strip OP (7.00)

Clinistix Diastix Diabur 5000

Glucose &/or Ketones/Urine Testing

GLUCOSE OXIDASE - Not on a bulk supply order Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid ....................................................................4.53 50 stick OP (8.00) Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid ..................................9.06 100 strip OP (11.47) SODIUM NITROPRUSSIDE - Not on a bulk supply order ❋ Urine diagnostic strips, buffered.......................................................3.39 50 strip OP (6.00) ❋ Urine diagnostic strips, buffered.......................................................6.79 100 strip OP (8.43)

Keto-Diabur 5000 Keto-Diastix

Ketur-Test Ketostix

Glucose/Blood Testing

GLUCOSE BLOOD DIAGNOSTIC TEST METER Meter ............................................................................................19.00 1 ✓ Accu-Chek Advantage ✓ Medisense Optium Meter ..............................................................................................9.00 1 A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005. Only one meter per patient. No further prescriptions will be subsidised. The prescription must be endorsed accordingly.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Diabetes Management Digestives Including Enzymes

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer GLUCOSE DEHYDROGENASE Blood/glucose test strips ...............................................................11.00 22.00 GLUCOSE OXIDASE Blood diagnostic test with peroxidase ............................................26.95 (27.85) Blood diagnostic test with peroxidase ............................................53.90 (55.70) 25 test OP 50 test OP ✓ Medisense Optium ✓ Accu-Chek Advantage ✓ Medisense Optium ✓ Ascensia Glucodisc Glucocard Precision Plus

50 test OP 100 test OP

Insulin Syringes and Needles

Subsidy is available for disposable insulin syringes, needles, and pen needles if prescribed on the same form as the one used for the supply of insulin or when prescribed for an insulin patient and the prescription is endorsed accordingly. Disposable supplies INSULIN SYRINGES, disposable with attached needle a) Maximum of 100 plastic syringes with attached needles per prescription. ❋ Syringe 0.3 ml with 29 g x 12.7 mm needle ...................................15.92 ❋ Syringe 0.3 ml with 30 g x 8 mm needle ........................................15.92 ❋ Syringe 0.5 ml with 29 g x 12.7 mm needle ...................................15.92 ❋ Syringe 0.5 ml with 30 g x 8 mm needle ........................................15.92 ❋ Syringe 1 ml with 29 g x 12.7 mm needle ......................................15.92 ❋ Syringe 1 ml with 30 g x 8 mm needle ...........................................15.92

100 100 100 100 100 100

✓ B-D Ultra Fine ✓ B-D Ultra Fine II ✓ B-D Ultra Fine ✓ B-D Ultra Fine II ✓ B-D Ultra Fine ✓ B-D Ultra Fine II

INSULIN PEN NEEDLES a) Maximum 100 pen needles per prescription. b) NovoFine pen needles 31 g x 6 mm are subsidised for children under 12 years of age. ❋ 29 g x 12.7 mm.............................................................................13.09 100 ❋ 31 g x 8 mm..................................................................................13.09 100 ❋ 31 g x 5 mm..................................................................................13.09 100 ❋ 31 g x 6 mm..................................................................................26.00 100

✓ B-D Micro-Fine ✓ B-D Micro-Fine ✓ B-D Micro-Fine ✓ NovoFine

DIGESTIVES INCLUDING ENZYMES

PANCREATIC ENZYME Tab EC 1,900 BP u lipase, 1,700 BP u amylase, 110 BP u protease .........32.46 Tab EC 5,600 BP u lipase, 5,000 BP u amylase, 330 BP u protease ..........58.44 Cap 8,000 BP u lipase, 9,000 BP u amylase, 430 BP u protease ..67.26 Cap 8,000 USP u lipase, 30,000 USP u amylase, 30,000 USP u protease - Retail pharmacy-specialist ...................85.00 Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease - Retail pharmacy-specialist ....................34.93 Cap EC 25,000 BP u lipase, 18,000 BP u amylase, 1,000 BP u protease - Retail pharmacy-specialist .......................94.38 Cap EC 5,000 BP u lipase, 3,000 BP u amylase, 350 BP u protease - Retail pharmacy-specialist ..........................50.00 Cap EC 25,000 BP u lipase, 22,500 BP u amylase, 1,250 BP u protease - Retail pharmacy-specialist .......................94.40 300 300 300 250 100 100 250 100 ✓ Pancrex V ✓ Pancrex V Forte ✓ Pancrex V ✓ Cotazym ECS ✓ Creon 10000 ✓ Creon Forte ✓ Pancrease ✓ Panzytrat

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Digestives Including Enzymes Laxatives

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer URSODEOXYCHOLIC ACID - Special Authority - Retail pharmacy – specialist prescription Cap 300 mg ................................................................................298.54 100 ✓ Actigall Prescriptions must be written by a gastroenterologist. Special Authority for Subsidy - Form: SA0458 Initial application only from a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Primary biliary cirrhosis conﬁrmed by antimitochondrial antibody titre (AMA) > 1:80, and raised cholestatic liver enzymes with or without raised serum IgM or, if AMA is negative, by liver biopsy; and 2 Patient not requiring a liver transplant (bilirubin > 170umol/l; decompensated cirrhosis). Note Liver biopsy is not usually required for diagnosis but is helpful to stage the disease Renewal only from a gastroenterologist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Note Actigall is not an appropriate therapy for patients requiring a liver transplant (bilirubin > 170 micromol/l; decompensated cirrhosis). These patients should be referred to an appropriate transplant centre. Treatment failure - doubling of serum bilirubin levels, absence of a signiﬁcant decrease in ALP or ALT and AST, development of varices, ascites or encephalopathy, marked worsening of pruritus or fatigue, histological progression by two stages, or to cirrhosis, need for transplantation.

LAXATIVES Bulk-forming Agents

MUCILAGINOUS LAXATIVES - Only on a prescription ❋ Sugar Free .......................................................................................4.84 (10.60) ❋ Dry .............................................................................................5.28 (8.18) ❋ Dry ..............................................................................................7.92 (12.34) ❋ Dry - original ﬂavour, regular texture only .........................................5.91 (12.38) ❋ Dry ..............................................................................................8.80 (14.90) MUCILAGINOUS LAXATIVES WITH STIMULANTS ❋ Dry ..............................................................................................4.40 (10.80) ❋ Dry ..............................................................................................3.52 (7.50) ❋ Dry ..............................................................................................8.80 (14.90) 275 g OP Mucilax 300 g OP Mucilax IMM 450 g OP Isogel 336 g OP MetamucilIMM 500 g OP Normacol 250 g OP Granocol 200 g OP Normacol Plus 500 g OP Normacol Plus

Faecal Softeners

DOCUSATE SODIUM - Only on a prescription ❋ Tab 50 mg .......................................................................................4.25 ❋ Tab 120 mg .....................................................................................4.80 ❋ Oral drops 10% ...............................................................................3.95 ❋ Enema conc 18% ............................................................................5.40 DOCUSATE SODIUM WITH BISACODYL ❋ Suppos 100 mg with bisacodyl 10 mg .............................................2.95 ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once 100 100 30 ml OP 100 ml OP 5 ✓ Coloxyl ✓ Coloxyl ✓ Coloxyl ✓ Coloxyl ✓ Coloxyl

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Laxatives Metabolic Disorder Agents Mouth and Throat

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer DOCUSATE SODIUM WITH SENNOSIDES ❋ Tab 50 mg with total sennosides 8 mg .............................................7.98 200 ✓ Laxsol

Osmotic Laxatives

GLYCEROL - Only on a prescription ❋ Suppos 2.55 g.................................................................................3.12 ❋ Suppos 3.6 g...................................................................................5.00 LACTULOSE - Only on a prescription ❋ Oral liq 10 g per 15 ml ....................................................................6.60 SODIUM ACID PHOSPHATE - Only on a prescription Enema 16% with sodium phosphate 8% ...........................................2.50 1 ✓ Fleet Phosphate Enema ✓ Microlax SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE - Only on a prescription Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ..7.30 12 12 20 1000 ml ✓ Fleet Glycerin Suppositories ✓ HMG ✓ Laevolac

Stimulant Laxatives

BISACODYL - Only on a prescription ❋ Tab 5 mg .........................................................................................5.55 ❋ Suppos 5 mg...................................................................................2.35 (3.00) ❋ Suppos 10 mg.................................................................................3.96 200 6 12 ✓ AFT Dulcolax ✓ Fleet

DANTHRON WITH POLOXAMER - Only on a prescription Note: Danthron with poloxamer is only approved for the prevention or treatment of constipation in the terminally ill. Studies in rats have associated use of danthron with tumours. Oral liq 25 mg with poloxamer 200 mg per 5 ml ...............................4.00 300 ml ✓ Codalax Oral liq 75 mg with poloxamer 1g per 5 ml .......................................8.30 300 ml ✓ Codalax Forte SENNA - Only on a prescription ❋ Tab, standardised ............................................................................2.17 (6.04) 100 Senokot

METABOLIC DISORDER AGENTS Gaucher’s Disease

IMIGLUCERASE - Special Authority - Hospital pharmacy [HP4] Inj 40 iu per ml, 200 iu vial ....................................................... 1,188.79 1 ✓ Cerezyme

Special Authority approved by the Gaucher treatment panel. a) Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from: The Coordinator, Gaucher Treatment Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: wiebke.tod@pharmac.govt.nz

MOUTH AND THROAT Agents Used in Mouth Ulceration

BENZYDAMINE HYDROCHLORIDE - Retail pharmacy-specialist prescription Soln 0.15% .....................................................................................9.00 (14.91) 500 ml Difﬂam

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Mouth and Throat

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer CHLORHEXIDINE Mouthwash 0.2% ............................................................................2.75 (2.85) CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE ❋ Adhesive gel 8.7% with cetalkonium chloride 0.01%.........................2.06 (4.00) SODIUM CARBOXYMETHYLCELLULOSE With pectin and gelatin paste ...........................................................1.52 (3.60) With pectin and gelatin paste ..........................................................4.55 (7.90) With pectin and gelatin paste .........................................................17.20 With pectin and gelatin paste ........................................................21.81 (25.90) With pectin and gelatin powder ........................................................8.48 (10.95) TRIAMCINOLONE ACETONIDE 0.1% in Dental Paste USP ................................................................4.66 200 ml OP Orion 15 g OP Bonjela 5 g OP Orabase 15 g OP 56 g OP 80 g OP 28 g OP Stomahesive 5 g OP ✓ Oracort Orabase ✓ Stomahesive Orabase

Oropharyngeal Anti-Infectives

AMPHOTERICIN B Lozenges 10 mg .............................................................................5.86 MICONAZOLE Oral gel 20 mg per g ........................................................................8.95 NYSTATIN Oral liq 100,000 u per ml .................................................................4.28 Pastilles 100,000 u .........................................................................6.30 (8.20) 20 40 g OP 24 ml OP 28 OP ✓ Fungilin ✓ Daktarin ✓ Mycostatin Mycostatin

Other Oral Agents

FOLINIC ACID - Hospital pharmacy [HP3]-specialist Mouthwash 15 mg per 500 ml .......................................................CE a) maximum 500 ml per prescription (refer page 162) HYDROGEN PEROXIDE ❋ Soln 10 vol ......................................................................................0.75 (1.80) a) maximum 200 ml per prescription PILOCARPINE ❋ Oral liq (refer page 162) .................................................................CE SALIVA SUBSTITUTE Oral liq (refer page 162) .................................................................CE a) maximum 500 ml per prescription THYMOL GLYCERIN ❋ Compound, BPC ..............................................................................7.30 (11.00) 500 ml ✓

100 ml HMG

500 ml 500 ml

✓ ✓

500 ml HMG

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Vitamins

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

VITAMINS Vitamin A

VITAMIN A WITH VITAMINS D AND C Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops ...............................................................4.38 (4.55) 10 ml OP Vitadol C

Vitamin B Group

HYDROXOCOBALAMIN ❋ Inj 1 mg per ml, 1 ml .......................................................................2.80 (10.84) PYRIDOXINE HYDROCHLORIDE a) Only on a prescription not exceeding a strength of 100 mg per dose. ❋ Tab 25 mg .......................................................................................3.06 (4.66) ❋ Tab 50 mg .....................................................................................12.59 (17.63) ❋ Tab 100 mg .....................................................................................5.38 (11.35) THIAMINE HYDROCHLORIDE – only on a prescription ❋ Tab 10 mg .......................................................................................3.36 (4.59) ❋ Tab 25 mg .......................................................................................3.85 (5.21) ❋ Tab 50 mg .......................................................................................4.18 (5.62) (Apo-Thiamine tab 25 mg to be delisted 1 May 2005) VITAMIN B COMPLEX ❋ Tab, strong, BPC............................................................................12.10 3 Neo-Cytamen

90 500

✓ Healtheries Apo-Pyridoxine Apo-Pyridoxine

100 Apo-Pyridoxine 100 Apo-Thiamine 100 Apo-Thiamine 100 Apo-Thiamine

500

✓ Apo-B-Complex

Vitamin C

ASCORBIC ACID Only on a prescription not exceeding a strength of 100 mg per dose ❋ Tab 50 mg .......................................................................................2.60 (3.25) ❋ Tab 100 mg ...................................................................................13.00 (17.25) (Apo-Ascorbic Acid tab 50 mg to be delisted 1 May 2005) ASCORBIC ACID AND SODIUM ASCORBATE Only on a prescription not exceeding a strength of 100 mg per dose ❋ Tab 100 mg .....................................................................................2.60 100 Apo-Ascorbic Acid 500 Apo-Ascorbic Acid

100

✓ Healtheries Vitamin C

Vitamin D

ALFACALCIDOL - Retail pharmacy-specialist Cap 0.25 mcg ..............................................................................26.32 Cap 1 mcg ...................................................................................87.98 Oral drops 2 mcg per ml ................................................................60.68

✓

100 100 20 ml OP

✓ One-Alpha ✓ One-Alpha ✓ One-Alpha

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Vitamins Minerals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer CALCIFEROL ❋ Tab 1.25 mg (50,000 iu) ................................................................11.50 a) Maximum 12 tablets per prescription CALCITRIOL - Retail pharmacy-specialist ❋ Cap 0.25 mcg .............................................................................52.63 ❋ Cap 0.5 mcg .................................................................................87.98 ❋ Oral liq 1 mcg per ml .....................................................................39.40

✓ HMG

100 100 10 ml OP

✓ Rocaltrol ✓ Rocaltrol ✓ Rocaltrol solution

Vitamin E

ALPHA TOCOPHERYL ACETATE - Special Authority - Hopsital Pharmacy [HP3] Water solubilised soln 156 iu/ml, with calibrated dropper ...............13.50 50 ml OP ✓ Micelle E Special Authority for Subsidy - Form: SA0264 Initial application only from a paediatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Cystic ﬁbrosis patient; or 2 Both: 2.1 Infant or child with liver disease or short gut syndrome; and 2.2 Requires vitamin supplementation. Renewal only from a paediatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

Vitamin K

Refer to BLOOD, Antiﬁbrinolytics, page 43

Multivitamin Preparations

VITAMINS ❋ Tab (BPC cap strength) ..................................................................15.60 1000 ✓ Healtheries Multi-vitamin tablets

MINERALS Calcium

CALCIUM CARBONATE ❋ Tab 1.25 g .......................................................................................4.50 ❋ Tab 1.5 g .........................................................................................3.20 CALCIUM CHLORIDE ❋ Inj 10%, 10 ml ...............................................................................10.45 CALCIUM GLUCONATE ❋ Inj 10%, 10 ml ...............................................................................99.50 CALCIUM LACTATE-GLUCONATE ❋ Tab 1 g ..........................................................................................10.52 100 60 5 50 30 ✓ Osteo~500 ✓ Osteo~600 ✓ Mayne ✓ Mayne ✓ Calcium-Sandoz 1000

Fluoride

SODIUM FLUORIDE Tab 1.1 mg ......................................................................................3.00 (5.00) ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once 100 HMG

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

ALIMENTARY TRACT AND METABOLISM

Minerals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Iron

FERROUS GLUCONATE WITH ASCORBIC ACID ❋ Tab 170 mg with ascorbic acid 40 mg ...........................................12.04 FERROUS SULPHATE ❋ Tab long-acting 325 mg ...................................................................5.06 (13.55) ❋‡Oral liq 150 mg per 5ml ................................................................14.50 150 250 ml Ferro-Gradumet ✓ Ferodan 500 ✓ Healtheries Iron with Vitamin C

Ferodan is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. FERROUS SULPHATE WITH FOLIC ACID ❋ Tab long-acting 325 mg with folic acid 350 mcg ..............................9.02 (16.20) IRON POLYMALTOSE Inj 50 mg per ml, 2 ml ...................................................................29.95 150 Ferrograd-Folic 5 ✓ Ferrosig

Magnesium

MAGNESIUM HYDROXIDE a) Not subsidised as a laxative Oral liq (Refer page 162)................................................................CE MAGNESIUM SULPHATE Inj 49.3% ..................................................................................... 161.40 50 ✓ Mayne

Zinc

ZINC SULPHATE ❋ Cap 220 mg ....................................................................................5.56 (8.82) 100 Zincaps

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Antianaemics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIANAEMICS Hypoplastic and Haemolytic

ERYTHROPOIETIN ALPHA - Special Authority - Hospital pharmacy [HP3] Inj human recombinant 1,000 u, pre-ﬁlled syringe ........................... 76.02 (162.90) Inj human recombinant 2,000 u pre-ﬁlled syringe .......................... 152.04 (325.80) Inj human recombinant 3,000 u pre-ﬁlled syringe .......................... 228.06 (455.34) Inj human recombinant 4,000 u pre-ﬁlled syringe .......................... 304.08 (572.40) Inj human recombinant 10,000 u pre-ﬁlled syringe ........................ 760.20 (1322.82) 6 Eprex 6 Eprex 6 Eprex 6 Eprex 6 Eprex

Special Authority for Subsidy - Form: SA0626 Initial application only from a renal physician. Approvals valid for 2 years for applications meeting the following criteria: All of the following: General Criteria: 1 Anaemia of end-stage renal failure (other treatable causes of anaemia being excluded); and 2 Been on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD) for at least three months; and 3 Not under evaluation for, or awaiting, a live donor kidney transplant; and 4 Any of the following: Speciﬁc Criteria: 4.1 Anephric; or 4.2 Dependent on regular blood transfusion (1 unit each 4-8 weeks) to maintain haemoglobin > 60g/L; or 4.3 Dependent on regular blood transfusion but cannot be transfused because of severe transfusion reactions; or 4.4 Transfusion induced haemosiderosis (clinical manifestations, serum ferritin >1500 ug/L); or 4.5 Haemoglobin < 70 g/L (mean of at least 4 haemoglobin concentrations over 4 months); or 4.6 Both: 4.6.1 Haemoglobin < 90 g/L; and 4.6.2 Either: 4.6.2.1 Heart failure (low cardiac output, LV ejection fraction <40%); or 4.6.2.2 Persistent angina. Renewal only from a renal physician. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. ERYTHROPOIETIN BETA- Special Authority - Hospital Pharmacy [HP3] Inj 1,000 u, pre-ﬁlled syringe .......................................................... 76.02 Inj 2,000 u pre-ﬁlled syringe ......................................................... 152.04 Inj 3,000 u pre-ﬁlled syringe ......................................................... 228.06 Inj 4,000 u pre-ﬁlled syringe ......................................................... 304.08 Inj 5,000 u pre-ﬁlled syringe ......................................................... 380.10 Inj 6,000 u pre-ﬁlled syringe ......................................................... 456.12 Inj 10,000 u pre-ﬁlled syringe ....................................................... 760.20 6 6 6 6 6 6 6 ✓ Recormon ✓ Recormon ✓ Recormon ✓ Recormon ✓ Recormon ✓ Recormon ✓ Recormon

Special Authority for Subsidy - Form: SA0646 Initial application only from a renal physician. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Both: 1.1 patient in chronic renal failure; and 1.2 Haemoglobin £ 100 g/L; and continued... ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

BLOOD AND BLOOD FORMING ORGANS

Antianaemics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… 2 Any of the following: 2.1 Both: 2.1.1 Patient is not diabetic; and 2.1.2 Glomerular ﬁltration rate £ 30 ml/min; or 2.2 Both: 2.2.1 Patient is diabetic; and 2.2.2 Glomerular ﬁltration rate £ 45 ml/min; or 2.3 Patient is on haemodialysis or peritoneal dialysis. Renewal only from a renal physician. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Note: Erythropoietin beta is indicated in the treatment of anaemia associated with chronic renal failure (CRF) where no cause for anaemia other than CRF is detected and there is adequate monitoring of iron stores and iron replacement therapy. The Cockroft-Gault Formula may be used to estimate glomerular ﬁltration rate (GFR) in persons 18 years and over: GFR (ml/min) (male) = (140 - age) x Ideal Body Weight (kg) / 814 x serum creatinine (mmol/l) GFR (ml/min) (female) = Estimated GFR (male) x 0.85

Megaloblastic

✓ Apo-Folic Acid ✓ Apo-Folic Acid (s29) Apo-Folic Acid (s29) is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. ❋ Tab 5 mg .......................................................................................... 6.59 Oral liq 50 mcg per ml - Retail pharmacy-specialist ......................... 21.05 500 25 ml OP ✓ Apo-Folic Acid ✓ Healtheries ✓ Biomed FOLIC ACID ❋ Tab 0.8 mg ..................................................................................... 16.50 1,000

Specialist must be a paediatrician or paediatric cardiologist.

(Apo-Folic Acid (s29) tab 0.8 mg to be delisted 1 September 2005) (Healtheries tab 5 mg to be delisted 1 August 2005)

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Antiﬁbrinolytics, Haemostatics and Local Sclerosants Antithrombotic Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

BLOOD AND BLOOD FORMING ORGANS

ANTIFIBRINOLYTICS, HAEMOSTATICS AND LOCAL SCLEROSANTS

APROTININ - Hospital pharmacy [HP3]-specialist ❋ Inj 10,000 mcg per ml 50 ml .......................................................... 63.60 (69.90) SODIUM TETRADECYL SULPHATE ❋ Inj 0.5% 2 ml .................................................................................. 23.20 (45.52) ❋ Inj 1% 2 ml ..................................................................................... 25.00 (48.98) ❋ Inj 3% 2 ml ..................................................................................... 28.50 (55.91) TRANEXAMIC ACID Tab 500 mg .................................................................................... 49.14 1 Trasylol 5 Fibro-vein 5 Fibro-vein 5 Fibro-vein 100 ✓ Cyklokapron

Vitamin K

MENADIONE SODIUM BISULPHITE ❋ Tab 10 mg ........................................................................................ 4.75 PHYTOMENADIONE Tab 10 mg ........................................................................................ 5.60 Inj 2 mg per 0.2 ml - Available on a PSO ........................................... 8.00 Inj 10 mg per ml, 1 ml - Available on a PSO ...................................... 9.21 100 10 5 5 ✓ K-Thrombin ✓ Konakion ✓ Konakion MM ✓ Konakion MM

ANTITHROMBOTIC AGENTS Antiplatelet Agents

ASPIRIN ❋ Tab 300 mg .................................................................................... 26.50 (36.42) ❋ Tab, soluble 300 mg - Available on a PSO ....................................... 30.69 (103.68) (121.44) DIPYRIDAMOLE ❋ Tab 25 mg - Special Authority available ............................................. 0.21 (9.95) 1000 1152 HMG ✓ SolprinIMM Disprin IMM Aspro ClearIMM Persantin

100

Special Authority for Manufacturers Price - Form: SA0648 Initial application - (Conditions other than transient ischaemic episodes) only from a cardiothoracic surgeon, cardiologist or general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Patients with prosthetic heart valves - as an adjunct to oral anticoagulation for prophylaxis of thromboembolism; or 2 Patients after coronary artery vein bypass graft - as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant. Note Aspirin intolerant patients are deﬁned as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with signiﬁcant aspirin induced bleeding, excluding bruising. Initial application - (Transient ischaemic episodes) only from a neurologist, neuro surgeon, cardiologist, vascular surgeon or general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: continued... ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

BLOOD AND BLOOD FORMING ORGANS

Antithrombotic Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Patients who continue to have transient ischaemic episodes despite aspirin therapy or have transient ischaemic episodes and are aspirin intolerant. Note Aspirin intolerant patients are deﬁned as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with signiﬁcant aspirin induced bleeding, excluding bruising. Renewal - (Existing 2 year approvals) only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. ❋ Tab long-acting 150 mg - Special Authority - Retail pharmacy ......... 11.95 60 ✓ Pytazen SR Special Authority for Subsidy - Form: SA0649 Initial application - (Conditions other than transient ischaemic episodes) only from a cardiothoracic surgeon, cardiologist or general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Patients with prosthetic heart valves - as an adjunct to oral anticoagulation for prophylaxis of thromboembolism; or 2 Patients after coronary artery vein bypass graft - as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant. Note Aspirin intolerant patients are deﬁned as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with signiﬁcant aspirin induced bleeding, excluding bruising. Initial application - (Transient ischaemic episodes) only from a neurologist, neuro surgeon, cardiologist, vascular surgeon or general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Patients who continue to have transient ischaemic episodes despite aspirin therapy or have transient ischaemic episodes and are aspirin intolerant. Note Aspirin intolerant patients are deﬁned as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with signiﬁcant aspirin induced bleeding, excluding bruising. Renewal - (Existing 2 year approvals) only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Antithrombotic Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Heparin and Antagonist Preparations

HEPARINISED SALINE ❋ Inj 10 iu per ml, 5 ml ...................................................................... 20.00 ❋ Inj 100 iu per ml, 5 ml .................................................................... 96.50 HEPARIN SODIUM Inj 1,000 iu per ml, 5 ml ................................................................. 66.80 Inj 1,000 iu per ml, 35 ml ................................................................. 7.25 Inj 5,000 iu per ml, 1 ml ................................................................... 9.60 Inj 5,000 iu per ml, 5 ml ............................................................... 138.65 (153.35) Inj 25,000 iu per ml, 0.2 ml - Hospital pharmacy [HP3]-specialist ..... 7.50 PROTAMINE SULPHATE ❋ Inj 10 mg per ml, 5 ml .................................................................... 22.40 (49.85) 50 50 50 1 5 50 5 10 Artex ✓ AstraZeneca ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne Multiparin ✓ Mayne

Oral Anticoagulants

WARFARIN SODIUM ❋ Tab 1 mg .......................................................................................... 3.46 ❋ Tab 1 mg .......................................................................................... 5.69 ❋ Tab 2 mg .......................................................................................... 4.31 ❋ Tab 3 mg .......................................................................................... 8.00 ❋ Tab 5 mg .......................................................................................... 5.93 ❋ Tab 5 mg .......................................................................................... 9.64 Note: Marevan and Coumadin are not interchangeable. 50 100 50 100 50 100 ✓ Coumadin ✓ Marevan ✓ Coumadin ✓ Marevan ✓ Coumadin ✓ Marevan

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

BLOOD AND BLOOD FORMING ORGANS

Fluids and Electrolytes

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

FLUIDS AND ELECTROLYTES Intravenous Administration

DEXTROSE - Available on a PSO ❋ Inj 50% 10 ml ................................................................................... 5.28 (8.25) POTASSIUM CHLORIDE ❋ Inj 75 mg per ml, 10 ml .................................................................. 26.00 ❋ Inj 150 mg per ml, 10 ml ................................................................ 26.00 SODIUM BICARBONATE – Not in combination Inj 8.4%, 10 ml ............................................................................. 100.60 Inj 8.4%, 100 ml ............................................................................. 10.80 5 Baxter 50 50 50 1 ✓ AstraZeneca ✓ AstraZeneca ✓ Mayne ✓ Mayne

SODIUM CHLORIDE a) Only if prescribed on a prescription for renal dialysis, maternity or post-natal care in the home of the patient or on a PSO for emergency use. (500 ml and 1,000 ml pack size) Inf 0.9% - Available on a PSO ........................................................... 3.06 500 ml ✓ Baxter Inf 0.9% - Available on a PSO .......................................................... 4.06 1,000 ml ✓ Baxter Inj 0.9%, 5 ml - Available on a PSO ................................................. 16.00 50 ✓ Pharmacia Inj 0.9%, 10 ml - Available on a PSO ............................................... 21.55 50 ✓ Pharmacia Inj 0.9%, 20 ml ............................................................................... 23.58 30 ✓ Pharmacia Inj 20%, 10 ml .............................................................................. 149.88 50 ✓ Baxter TOTAL PARENTERAL NUTRITION (TPN) - Special Authority ✓ Hospital Pharmacy [HP1] ................................................................ CBS Special Authority for Subsidy - Form: SA0610 Initial application from any specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 Quantity used by patient on a weekly volume intraveneously (Details to be attached to application); and 2 Amount of nutrition patient is able to receive orally (Details to be attached to application); and 3 Exact formula of TPN (Details to be attached to application); and 4 Who has paid for TPN so far (Details to be attached to application); and 5 Place of manufacture (Details to be attached to application); and 6 Complete medical history of patient including details of previous therapies. (Details to be attached to application). Renewal - (Previous approval has expired) from any specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. WATER a) On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent, or b) On a bulk supply order, or c) When used in the extemporaneous compounding of eye drops. ✓ Baxter Puriﬁed for inj 2 ml ......................................................................... 21.90 50 Puriﬁed for inj 5 ml ......................................................................... 12.50 50 ✓ AstraZeneca Puriﬁed for inj 10 ml ....................................................................... 13.95 50 ✓ AstraZeneca Puriﬁed for inj 20 ml ....................................................................... 21.00 30 ✓ Pharmacia

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Fluids and Electrolytes Lipid Modifying Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Oral Administration

CALCIUM POLYSTYRENE SULPHONATE - Retail pharmacy-specialist Powder ........................................................................................ 141.54 COMPOUND ELECTROLYTES Powder for soln for oral use 5 g - Available on a PSO ........................ 5.52 (9.89) 300 g 10 ✓ Calcium Resonium ✓ Gastrolyte (Natural) Gastrolyte (Fruit) Gastrolyte (Orange) ✓ Plasma-Lyte Oral Pedialyte Fruit

DEXTROSE WITH ELECTROLYTES Soln with electrolytes........................................................................ 3.44 500 ml OP Soln with electrolytes........................................................................ 6.66 946 ml OP (7.39) POTASSIUM BICARBONATE - Retail pharmacy-specialist Tab 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg, effervescent ................................... 75.00 POTASSIUM CHLORIDE ❋ Tab 548 mg (14 m eq) with chloride 285 mg (8 m eq) eff ................. 5.26 (11.85) ❋ Tab long-acting 600 mg .................................................................... 4.92 SODIUM POLYSTYRENE SULPHONATE - Retail pharmacy-specialist Powder........................................................................................... 89.10

100 60 200 450 g

✓ Phosphate-Sandoz

Chlorvescent ✓ Span-K ✓ Resonium-A

LIPID MODIFYING AGENTS Fibrates

BEZAFIBRATE ❋ Tab 200 mg ...................................................................................... 7.80 ❋ Tab long-acting 400 mg .................................................................... 8.00 90 30 ✓ Fibalip ✓ Bezalip Retard

Other lipid modifying agents

ACIPIMOX - Retail pharmacy-specialist ❋ Cap 250 mg ................................................................................... 18.75 NICOTINIC ACID ❋ Tab 25 mg ...................................................................................... 13.27 ❋ Tab 50 mg ........................................................................................ 4.79 ❋ Tab 100 mg ...................................................................................... 6.97 ❋ Tab 500 mg .................................................................................... 16.15 30 500 100 100 100 ✓ Olbetam ✓ Apo-Nicotinic Acid ✓ Apo-Nicotinic Acid ✓ Apo-Nicotinic Acid ✓ Apo-Nicotinic Acid

Resins

CHOLESTYRAMINE WITH ASPARTAME Sachets 4 g with aspartame ........................................................... 19.25 (27.50) COLESTIPOL HYDROCHLORIDE Sachets 5 g .................................................................................... 11.55 50 Questran-Lite 30 ✓ Colestid

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

BLOOD AND BLOOD FORMING ORGANS

Lipid Modifying Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

HMG CoA Reductase Inhibitors (Statins)

ATORVASTATIN - See Prescribing Guideline on page 49 or Additional subsidy by Special Authority - Retail pharmacy ❋ Tab 10 mg ........................................................................................ 4.38 30 (18.32) Lipitor ❋ Tab 20 mg ........................................................................................ 6.38 30 (26.70) Lipitor ❋ Tab 40 mg ........................................................................................ 8.85 30 (37.02) Lipitor Special Authority for Manufacturers Price - Form: SA0724 Initial application only from a relevant specialist or general practitioner. Approvals valid for 12 weeks for applications meeting the following criteria: Both: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Either: 2.1 Patient has severe documented intolerance to simvastatin (blood tests are not required); or 2.2 Both: 2.2.1 Patient has been compliant with a dose of simvastatin of 80 mg per day for at least 2 months; and 2.2.2 Either: 2.2.2.1 All of the following: 2.2.2.1.1 Patient has venous CABG; and 2.2.2.1.2 LDL cholesterol test 1 ≥ 2.0 mmol/litre; and 2.2.2.1.3 LDL cholesterol test 2 ≥ 2.0 mmol/litre (at least 1 week after test 1); or 2.2.2.2 All of the following: 2.2.2.2.1 Patient does not have venous CABG; and 2.2.2.2.2 LDL cholesterol test 1 ≥ 2.5 mmol/litre; and 2.2.2.2.3 LDL cholesterol test 2 ≥ 2.5 mmol/litre (at least 1 week after test 1). Note To conﬁrm that cholesterol levels are not still improving, two lipid tests must be carried out during treatment with simvastatin 80 mg, and have results for LDL cholesterol that have reduced by <10% in the second test. The tests must be carried out while the patient is in a fasted state (with the exception of patients with IDDM). The following indications of intolerance to simvastatin, are known as class effects for all statins, and hence are likely to mean that the patient may also be intolerant of atorvastatin: - Constipation, ﬂatulence (may occur in >1% of patients) - Asthenia, abdominal pain, headache (may occur in >1% of patients) - Myopathy, rhabdomyolysis (may occur in <3% of patients) - Elevated serum transaminase levels (may occur in <1% of patients) Statins have been shown to be generally well tolerated in clinical studies, with the rate of discontinuation due to adverse reactions being less than 5%, and similar to the discontinuation rate for patients taking a placebo. Renewal only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 3 Both: 3.1 Patient has severe documented intolerance to simvastatin (blood tests are not required); and 3.2 The intolerance is resolved by treatment with atorvastatin, or signifcantly less severe on treatment with atorvastatin; or continued...

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Lipid Modifying Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued... 4 All of the following: 4.1 Patient has not reached target LDL cholesterol levels on simvastatin 80 mg; and 4.2 Patient has had lipid levels tested during the twelve week initial approval period for atorvastatin. (The tests must be carried out while the patient is in a fasted state, with the exception of patients with IDDM); and 4.3 Either: 4.3.1 Both: 4.3.1.1 Patient has venous CABG; and 4.3.1.2 Either: 4.3.1.2.1 LDL cholesterol < 2.0 mmol/litre; or 4.3.1.2.2 LDL cholesterol during twelve week initial approval £ =0.9 × LDL cholesterol level during treatment with simvastatin 80 mg; or 4.3.2 Both: 4.3.2.1 Patient does not have venous CABG; and 4.3.2.2 LDL cholesterol during twelve week initial approval £ 0.9 × LDL cholesterol level during treatment with simvastatin 80 mg. SIMVASTATIN - See prescribing guideline below ❋ Tab 5 mg .......................................................................................... 9.30 ❋ Tab 10 mg ...................................................................................... 11.10 ❋ Tab 20 mg ...................................................................................... 13.50 ❋ Tab 40 mg ...................................................................................... 24.00 ❋ Tab 80 mg ...................................................................................... 28.00 30 30 30 30 30 ✓ Zocor ✓ Lipex ✓ Lipex ✓ Lipex ✓ Lipex

Prescribing Guideline Treatment with HMG CoA Reductase Inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

BLOOD AND BLOOD FORMING ORGANS

Lipid Modifying Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Selective Cholesterol Absorption Inhibitors

EZETIMIBE - Special Authority - Retail pharmacy Tab 10 mg ...................................................................................... 57.60 30 ✓ Ezetrol Special Authority for Subsidy - Form: SA0723 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 All of the following: 1.1 Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years; and 1.2 Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day; and 1.3 Either: 1.3.1 All of the following: 1.3.1.1 Patient has venous CABG; and 1.3.1.2 LDL cholesterol ≥ 2.0 mmol/litre (see note); and 1.3.1.3 LDL cholesterol ≥ 2.0 mmol/litre (at least 1 week after test 1 - see note); or 1.3.2 All of the following: 1.3.2.1 Patient does not have venous CABG; and 1.3.2.2 LDL cholesterol ≥ 2.5 mmol/litre (see note); and 1.3.2.3 LDL cholesterol ≥ 2.5 mmol/litre (at least 1 week after test 1 - see note); or 2 All of the following: 2.1 Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia; and 2.2 Patient has been compliant for at least two months with maximum dose statin therapy; and 2.3 LDL cholesterol ≥ 5 mmol/litre (see note); and 2.4 LDL cholesterol ≥ 5 mmol/litre (at least 1 week after test 1 - see note). Note Two lipid tests are required to assess LDL cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with IDDM). The results for LDL cholesterol levels in both tests must be above those speciﬁed. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Note When ezetimibe 10 mg tablets are used in combination with a statin, that statin may only be simvastatin For New Zealand Cardiovascular Group statement refer pages 51–54. For Cardiovascular Risk Charts, refer pages 52–53.

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

Risk level women

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

✓

fully subsidised [HP1], [HP2], [ HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

Risk level men

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Alpha Adrenoceptor Blockers Agents Affecting the Renin-Angiotensin System

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

CARDIOVASCULAR SYSTEM

ALPHA ADRENOCEPTOR BLOCKERS

DOXAZOSIN MESYLATE ❋ Tab 2 mg ........................................................................................ 13.23 ❋ Tab 4 mg ........................................................................................ 17.05 PHENOXYBENZAMINE HYDROCHLORIDE ❋ Cap 10 mg ..................................................................................... 26.05 PHENTOLAMINE MESYLATE ❋ Inj 10 mg per ml, 1 ml .................................................................... 17.97 (27.50) PRAZOSIN HYDROCHLORIDE ❋ Tab 0.5 mg ....................................................................................... 3.97 ❋ Tab 1 mg .......................................................................................... 2.99 ❋ Tab 2 mg .......................................................................................... 4.00 ❋ Tab 5 mg .......................................................................................... 6.50 TERAZOSIN HYDROCHLORIDE ❋ Tab 7 x 1 mg and 7 x 2 mg ............................................................... 0.74 ❋ Tab 2 mg .......................................................................................... 1.48 (4.66) ❋ Tab 5 mg .......................................................................................... 1.91 (5.60) 250 250 100 5 Regitine 100 100 100 100 14 OP 28 28 Hytrin ✓ Hyprosin ✓ Hyprosin ✓ Hyprosin ✓ Hyprosin ✓ Hytrin Starter Pack Hytrin ✓ Dosan ✓ Dosan ✓ Dibenyline

AGENTS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM ACE Inhibitors

Perindopril and trandolapril will be funded to the level of the ex-manufacturer price listed in the Schedule for patients who were taking these ACE inhibitors for the treatment of congestive heart failure prior to 1 June 1998. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are “certiﬁed condition” or an appropriate description of the patient such as “congestive heart failure”, “CHF”, “congestive cardiac failure” or “CCF”. Deﬁnition of Congestive Heart Failure At the request of some prescribers the PTAC Cardiovascular subcommittee has provided a deﬁnition of congestive heart failure for the purposes of the funding of the manufacturer’s surcharge: “Clinicians should use their clinical judgement. Existing patients would be eligible for the funding of the surcharge if the patient shows signs and symptoms of congestive heart failure, and requires or has in the past required concomitant treatment with a diuretic. The deﬁnition could also be considered to include patients post myocardial infarction with an ejection fraction of less than 40%.”

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR SYSTEM

Agents Affecting the Renin-Angiotensin System

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer CAPTOPRIL ❋ Tab 12.5 mg ..................................................................................... 9.86 ❋ Tab 25 mg ...................................................................................... 12.73 ❋ Tab 50 mg ...................................................................................... 17.95 ❋‡Oral liq 5 mg per ml - (restricted to children under 12 years of age)........ 51.04 CILAZAPRIL ❋ Tab 0.5 mg ....................................................................................... 2.20 ❋ Tab 2.5 mg ....................................................................................... 4.39 ❋ Tab 5 mg .......................................................................................... 6.44 ENALAPRIL ❋ Tab 5 mg .......................................................................................... 2.19 ❋ Tab 10 mg ........................................................................................ 2.76 ❋ Tab 20 mg ........................................................................................ 3.68 LISINOPRIL ❋ Tab 5 mg .......................................................................................... 4.91 ❋ Tab 10 mg ........................................................................................ 7.14 ❋ Tab 20 mg ...................................................................................... 10.10 PERINDOPRIL ❋ Tab 2 mg .......................................................................................... 3.00 (18.50) ❋ Tab 4 mg .......................................................................................... 4.05 (25.00) QUINAPRIL ❋ Tab 5 mg .......................................................................................... 3.14 ❋ Tab 10 mg ........................................................................................ 5.02 ❋ Tab 20 mg ........................................................................................ 9.55 TRANDOLAPRIL ❋ Cap 0.5 mg ...................................................................................... 1.87 (13.83) ❋ Cap 1 mg ......................................................................................... 3.06 (18.67) (22.59) ❋ Cap 2 mg ......................................................................................... 4.43 (27.00) (32.67) (Odrik cap 0.5 mg to be delisted 1 October 2005)

500 500 500 95 ml OP 30 30 30 90 90 90 30 30 30 30

✓ Apo-Captopril ✓ Apo-Captopril ✓ Apo-Captopril ✓ Capoten ✓ Inhibace ✓ Inhibace ✓ Inhibace ✓ m-Enalapril ✓ m-Enalapril ✓ m-Enalapril ✓ Prinivil ✓ Prinivil ✓ Prinivil

Coversyl 30 Coversyl 30 30 30 28 Odrik 28 GoptenIMM OdrikIMM 28 GoptenIMM OdrikIMM ✓ Accupril ✓ Accupril ✓ Accupril

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Agents Affecting the Renin-Angiotensin System

CARDIOVASCULAR SYSTEM

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ACE Inhibitors with Diuretics

CILAZAPRIL WITH HYDROCHLOROTHIAZIDE ❋ Tab 5 mg with hydrochlorothiazide 12.5 mg ...................................... 6.30 ENALAPRIL WITH HYDROCHLOROTHIAZIDE ❋ Tab 20 mg with hydrochlorothiazide 12.5 mg .................................... 3.32 (8.70) QUINAPRIL WITH HYDROCHLOROTHIAZIDE ❋ Tab 10 mg with hydrochlorothiazide 12.5 mg .................................... 5.62 ❋ Tab 20 mg with hydrochlorothiazide 12.5 mg .................................. 10.15 28 30 Co-Renitec 30 30 ✓ Accuretic 10 ✓ Accuretic 20 ✓ Inhibace Plus

Angiotensin II Antagonists

CANDESARTAN - Special Authority - Retail pharmacy ❋ Tab 4 mg ........................................................................................ 22.19 28 ✓ Atacand No more than 1.5 tabs per day ❋ Tab 8 mg ........................................................................................ 26.42 28 ✓ Atacand No more than 1.5 tabs per day ❋ Tab 16 mg ...................................................................................... 32.23 28 ✓ Atacand No more than 1 tab per day Special Authority for Subsidy - Form: SA0706 Initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Both: 1.1 Patient with congestive heart failure; and 1.2 Either: 1.2.1 Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough; or 1.2.2 Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years; or 2 All of the following: 2.1 Patient with raised blood pressure; and 2.2 Use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufﬁcient to control blood pressure adequately at appropriate doses; and 2.3 Either: 2.3.1 Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough; or 2.3.2 Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years. Renewal - (Previous approval has expired) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. LOSARTAN - Special Authority - Retail pharmacy ❋ Tab 12.5 mg ................................................................................... 23.84 ❋ Tab 50 mg ...................................................................................... 31.79 30 30 ✓ Cozaar ✓ Cozaar

Special Authority for Subsidy - Form: SA0706 Initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria:

continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR SYSTEM

Agents Affecting the Renin-Angiotensin System

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Either: 1 Both: 1.1 Patient with congestive heart failure; and 1.2 Either: 1.2.1 Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough; or 1.2.2 Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years; or 2 All of the following: 2.1 Patient with raised blood pressure; and 2.2 Use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufﬁcient to control blood pressure adequately at appropriate doses; and 2.3 Either: 2.3.1 Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough; or 2.3.2 Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years. Renewal - (Previous approval has expired) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. LOSARTAN with HYDROCHLOROTHIAZIDE- Special Authority - Retail pharmacy ✓ Hyzaar Tab 50 mg with hydrochlorothiazide 12.5 mg ................................. 31.79 30 Special Authority for Subsidy - Form: SA0703 Initial application only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient has raised blood pressure; and 2 The use of fully funded beta blockers is contraindicated, or not well tolerated; or where use of fully funded beta blockers and diuretics are insufﬁcient to control blood pressure adequately at appropriate doses; and 3 Either: 3.1 Has been treated with, and cannot tolerate two ACE inhibitors, due to persistent cough; or 3.2 Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years. Renewal only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Antiarrhythmics Antihypotensives

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIARRHYTHMICS

AMIODARONE HYDROCHLORIDE - Retail pharmacy-specialist ▲ Tab 100 mg .................................................................................... 18.65

▲

30 30 10 250 250 60 ml 100 100 60 60 30 30 5 2

Tab 200 mg .................................................................................... 30.52 Inj 50 mg per ml, 3 ml .................................................................... 60.84

✓ Aratac ✓ Cordarone-X ✓ Aratac ✓ Cordarone-X ✓ Cordarone-X ✓ Lanoxin PG ✓ Lanoxin ✓ Lanoxin

DIGOXIN ❋ Tab 62.5 mcg - Available on a PSO ................................................... 6.51 ❋ Tab 250 mcg - Available on a PSO .................................................... 9.96 ❋‡Oral liq 50 mcg per ml...................................................................... 8.11 DISOPYRAMIDE PHOSPHATE ▲ Cap 100 mg ................................................................................... 15.00 (23.87) ▲ Cap 150 mg ................................................................................... 26.21 FLECAINIDE ACETATE - Retail pharmacy-specialist ▲ Tab 50 mg ...................................................................................... 42.82 ▲ Tab 100 mg .................................................................................... 75.63 ▲ Cap long-acting 100 mg ................................................................. 42.82 ▲ Cap long-acting 200 mg ................................................................. 75.63 Inj 10 mg per ml 15 ml ................................................................... 49.02 LIGNOCAINE HYDROCHLORIDE - Only on a PSO Inj twin pack 100 mg per 5 ml ......................................................... 8.50 (15.30) MEXILETINE HYDROCHLORIDE ▲ Cap 50 mg ..................................................................................... 22.52 ▲ Cap 200 mg ................................................................................... 53.05 PROPAFENONE HYDROCHLORIDE - Retail pharmacy-specialist ▲ Tab 150 mg ................................................................................... 40.90

Rythmodan ✓ Rythmodan ✓ Tambocor ✓ Tambocor ✓ Tambocor CR ✓ Tambocor CR ✓ Tambocor

a) Subsidised only on a PSO for patients with ventricular arrhythmia and PSO is endorsed accordingly.

100 100 50 ✓ Mexitil ✓ Mexitil ✓ Rytmonorm

Xylocard

ANTIHYPOTENSIVES

MIDODRINE - Special Authority - Hospital pharmacy [HP3] Tab 2.5 mg ..................................................................................... 53.00 100 ✓ Gutron Tab 5 mg ........................................................................................ 79.00 100 ✓ Gutron Special Authority for Subsidy - Form: SA0361 Initial application only from a geriatrician, neurologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Disabling orthostatic hypotension not due to drugs; and 2 Patient has tried ﬂudrocortisone (unless contra-indicated) with unsatisfactory results; and 3 Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night. Note: Treatment should be started with small doses and titrated upwards as necessary. Hypertesion should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg. Renewal only from a geriatrician, neurologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR SYSTEM

Beta Adrenoceptor Blockers

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

BETA ADRENOCEPTOR BLOCKERS

ACEBUTOLOL ❋ Cap 100 mg ..................................................................................... 9.50 ❋ Cap 200 mg ................................................................................... 15.94 ❋ Tab 400 mg .................................................................................... 27.63 ATENOLOL ❋ Tab 50 mg ........................................................................................ 7.50 ❋ Tab 100 mg .................................................................................... 13.90 100 100 100 500 500 ✓ ACB ✓ ACB ✓ ACB ✓ Loten ✓ Loten

CARVEDILOL - Special Authority - Retail pharmacy Tab 6.25 mg ................................................................................... 21.00 30 ✓ Dilatrend 30 ✓ Dilatrend Tab 12.5 mg ................................................................................... 27.00 30 ✓ Dilatrend Tab 25 mg ...................................................................................... 33.75 Special Authority for Subsidy - Form: SA0633 Initial application only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Patient is already on an ACE inhibitor or Angiotensin II Antagonist; and 2 Any of the following: 2.1 Both: 2.1.1 Symptomatic heart failure NYHA functional class II-III; and 2.1.2 Patient has been treated with metoprolol and is intolerant to metoprolol or has demonstrated a sub-optimal response to metoprolol; or 2.2 Symptomatic heart failure NYHA functional class III-IV; or 2.3 Patient has left ventricular systolic dysfunction with an ejection fraction of less than 35%. Note: Where possible treatment should be initiated by or on the recommendation of a specialist. CELIPROLOL ❋ Tab 200 mg .................................................................................... 19.00 LABETALOL ❋ Tab 50 mg ........................................................................................ 8.66 ❋ Tab 100 mg .................................................................................... 10.59 ❋ Tab 200 mg .................................................................................... 18.47 ❋ Tab 400 mg .................................................................................... 34.44 ❋ Inj 5 mg per ml, 20 ml .................................................................... 59.06 (88.60) METOPROLOL SUCCINATE ❋ Tab long-acting 23.75 mg ................................................................. 5.20 ❋ Tab long-acting 47.5 mg ................................................................... 6.50 ❋ Tab long-acting 95 mg .................................................................... 11.20 ❋ Tab long-acting 190 mg .................................................................. 20.25 METOPROLOL TARTRATE ❋ Tab 50 mg ...................................................................................... 15.00 (16.50) ❋ Tab 100 mg .................................................................................... 21.80 ❋ Tab long-acting 200 mg .................................................................. 22.70 ❋ Inj 1 mg per ml, 5 ml ...................................................................... 24.08 (27.22) NADOLOL ❋ Tab 40 mg ...................................................................................... 14.97 ❋ Tab 80 mg ...................................................................................... 22.19 180 100 100 100 100 5 ✓ Celol ✓ Hybloc ✓ Hybloc ✓ Hybloc ✓ Hybloc Trandate ✓ Betaloc CR ✓ Betaloc CR ✓ Betaloc CR ✓ Betaloc CR

30 30 30 30 100 60 28 5

Lopresor ✓ Lopresor ✓ Slow-Lopresor Betaloc ✓ Apo-Nadolol ✓ Apo-Nadolol

100 100

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Beta Adrenoceptor Blockers Calcium Channel Blockers

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer PINDOLOL ❋ Tab 5 mg .......................................................................................... 4.50 ❋ Tab 10 mg ........................................................................................ 8.35 ❋ Tab 15 mg ...................................................................................... 12.00 PROPRANOLOL ❋ Tab 10 mg ........................................................................................ 2.00 ❋ Tab 40 mg ........................................................................................ 2.60 ❋ Cap long-acting 160 mg ................................................................. 15.50 SOTALOL ❋ Tab 80 mg ...................................................................................... 26.00 ❋ Tab 160 mg .................................................................................... 10.00 ❋ Inj 10 mg per ml, 4 ml .................................................................... 41.34 TIMOLOL ❋ Tab 10 mg ...................................................................................... 11.11 100 100 100 100 100 100 500 100 5 100 ✓ Pindol ✓ Pindol ✓ Pindol ✓ Cardinol ✓ Cardinol ✓ Cardinol LA ✓ Paciﬁc ✓ Paciﬁc ✓ Sotacor ✓ Apo-Timolol

CALCIUM CHANNEL BLOCKERS Dihydropyridine Calcium Channel Blockers (DHP CCBs)

AMLODIPINE - Special Authority available - Retail pharmacy- see below ❋ Tab 5 mg .......................................................................................... 4.69 (22.82) ❋ Tab 10 mg ........................................................................................ 7.01 (34.85) FELODIPINE ❋ Tab long-acting 2.5 mg ................................................................... 12.81 No more than 1 tab per day ❋ Tab long-acting 5 mg ...................................................................... 16.50 ❋ Tab long-acting 10 mg .................................................................... 24.00 NIFEDIPINE - Special Authority available - Retail pharmacy ❋ Tab long-acting 10 mg .................................................................... 17.16 (17.72) ❋ Tab long-acting 20 mg ...................................................................... 6.95 ❋ Tab long-acting 30 mg ...................................................................... 4.69 (19.90) ❋ Tab long-acting 60 mg ...................................................................... 7.01 (29.50) 30 Norvasc 30 Norvasc 30 90 90 60 100 30 30 Adalat Oros Adalat 10 ✓ Nyefax Retard Adalat Oros ✓ Plendil ER ✓ Felo 5 ERIMM ✓ Felo 10 ERIMM

Special Authority for Alternate Subsidy - Form: SA0510 Initial application only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Angina that is not controlled by other anginal medications (including felodipine); or 2 Patient was taking amlodipine or Adalat Oros for the treatment of angina prior to 1 June 1999; or 3 Receiving maximal antihypertensive therapy, requires a DHP CCB, and cannot tolerate felodipine. Renewal only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR SYSTEM

Calcium Channel Blockers Centrally Acting Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Other Calcium Channel Blockers

DILTIAZEM HYDROCHLORIDE ❋ Tab 30 mg ........................................................................................ 4.50 ❋ Tab 60 mg ........................................................................................ 8.50 ❋ Cap long-acting 90 mg ..................................................................... 7.65 ❋ Cap long-acting 120 mg (once per day) ............................................ 5.10 ❋ Cap long-acting 120 mg (twice per day) ......................................... 18.00 ❋ Tab long-acting 180 mg .................................................................... 7.65 ❋ Cap long-acting 180 mg ................................................................... 7.65 ❋ Tab long-acting 240 mg .................................................................. 10.20 ❋ Cap long-acting 240 mg ................................................................. 10.20 PERHEXILINE MALEATE - Special Authority - Hospital pharmacy [HP3] ❋ Tab 100 mg .................................................................................... 52.42 100 100 60 30 100 30 30 30 30 100 ✓ Dilzem ✓ Dilzem ✓ Dilzem SR ✓ Cardizem CD ✓ Dilzem SR ✓ Dilzem LA ✓ Cardizem CD ✓ Dilzem LA ✓ Cardizem CD ✓ Pexsig

Special Authority for Subsidy - Form: SA0256 Initial application only from a cardiologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Refractory angina; and 2 Patient is already on maximal anti-anginal therapy. Renewal only from a cardiologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. VERAPAMIL HYDROCHLORIDE ❋ Tab 40 mg ........................................................................................ 4.75 ❋ Tab 80 mg ........................................................................................ 6.00 ❋ Tab long-acting 120 mg .................................................................. 16.38 ❋ Tab long-acting 240 mg .................................................................. 27.00 ❋ Inj 2.5 mg per ml, 2 ml - Available on a PSO ..................................... 7.54 100 100 250 250 5 ✓ Verpamil ✓ Verpamil ✓ Verpamil SR ✓ Verpamil SR ✓ Isoptin

CENTRALLY ACTING AGENTS

CLONIDINE ❋ Tab 150 mcg ................................................................................. 29.33 ❋ TDDS 2.5 mg, 100 mcg per day ..................................................... 19.30 ❋ TDDS 5 mg, 200 mcg per day ....................................................... 28.80 ❋ TDDS 7.5 mg, 300 mcg per day ..................................................... 37.10 a) All transdermal patches are only on a prescription. ❋ Inj 150 mcg per ml, 1 ml ................................................................ 13.00 METHYLDOPA ❋ Tab 125 mg ...................................................................................... 6.39 ❋ Tab 250 mg ...................................................................................... 9.30 ❋ Tab 500 mg .................................................................................... 15.99 METHYLDOPA WITH HYDROCHLOROTHIAZIDE ❋ Tab 250 mg with hydrochlorothiazide 15 mg ................................... 24.80 (Hydromet tab 250 mg to be delisted 1 July 2005) 100 4 4 4 5 100 100 100 100 ✓ Catapres ✓ Catapres-TTS-1 ✓ Catapres-TTS-2 ✓ Catapres-TTS-3 ✓ Catapres ✓ Prodopa ✓ Prodopa ✓ Prodopa ✓ Hydromet

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Diuretics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

DIURETICS Loop Diuretics

BUMETANIDE ❋ Tab 1 mg ........................................................................................ 16.36 ❋ Inj 500 mcg per ml, 4 ml .................................................................. 7.95 FRUSEMIDE ❋ Tab 40 mg - Available on a PSO ..................................................... 10.15 ❋ Tab 500 mg - Retail pharmacy-specialist .......................................... 9.50 ❋‡Oral liq 10 mg per ml ..................................................................... 10.66 ❋ Inj 10 mg per ml, 2 ml - Available on a PSO .................................... 41.00 ❋ Infusion 10 mg per ml, 25 ml - Retail pharmacy-specialist .............. 48.14 100 5 1,000 100 30 ml OP 50 5 ✓ Burinex ✓ Burinex ✓ Diurin 40 ✓ Diurin 500 ✓ Lasix ✓ Mayne ✓ Lasix

Potassium Sparing Diuretics

AMILORIDE ‡Oral liq 1 mg per ml - Retail pharmacy-specialist........................... 26.20 Specialist must be a paediatrician or paediatric cardiologist. SPIRONOLACTONE ❋ Tab 25 mg ........................................................................................ 8.50 ❋ Tab 100 mg .................................................................................... 21.70 ‡Oral liq 5 mg per ml - Retail pharmacy-specialist .......................... 26.80 Specialist must be a paediatrician or paediatric cardiologist. 25 ml OP ✓ Biomed

100 100 25 ml OP

✓ Spirotone ✓ Spirotone ✓ Biomed

Potassium Sparing Combination Diuretics

AMILORIDE WITH FRUSEMIDE ❋ Tab 5 mg with frusemide 40 mg ....................................................... 4.67 (7.50) AMILORIDE WITH HYDROCHLOROTHIAZIDE ❋ Tab 5 mg with hydrochlorothiazide 50 mg ....................................... 13.00 TRIAMTERENE WITH HYDROCHLOROTHIAZIDE ❋ Tab 50 mg with hydrochlorothiazide 25 mg ....................................... 5.00 28 Frumil 500 100 ✓ Amizide ✓ Triamizide

Thiazide and Related Diuretics

BENDROFLUAZIDE ❋ Tab 2.5 mg - Available on a PSO ..................................................... 13.50 ❋ Tab 5 mg ........................................................................................ 21.50 CHLOROTHIAZIDE ‡Oral liq 50 mg per ml - Retail pharmacy-specialist......................... 22.60 Specialist must be a paediatrician or paediatric cardiologist. 500 500 25 ml OP ✓ Neo-Naclex ✓ Neo-Naclex ✓ Biomed

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

CARDIOVASCULAR SYSTEM

Diuretics Nitrates Smoking Cessation

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer CHLORTHALIDONE ❋ Tab 25 mg ........................................................................................ 6.70 INDAPAMIDE ❋ Tab 2.5 mg ....................................................................................... 3.37

50 100

✓ Hygroton ✓ Napamide

NITRATES

GLYCERYL TRINITRATE ❋ Tab 600 mcg - Available on a PSO .................................................... 3.27 100 ❋ Oral pump spray 400 mcg per dose - Available on a PSO .................. 5.16 250 dose OP ❋ TDDS 5 mg .................................................................................... 18.40 30 ❋ TDDS 10 mg .................................................................................. 24.50 30 (Anginine tab 600 mcg to be delisted 1 August 2005) ISOSORBIDE DINITRATE ❋ Tab 10 mg ........................................................................................ 4.13 ISOSORBIDE MONONITRATE ❋ Tab 20 mg ...................................................................................... 18.00 ❋ Tab long-acting 40 mg .................................................................... 14.84 ❋ Tab long-acting 60 mg .................................................................... 24.18 100 30 500 ✓ Ismo 20 ✓ Corangin ✓ Duride 100 ✓ Anginine ✓ Nitrolingual Pumpspray ✓ Nitroderm TTS ✓ Nitroderm TTS

✓ Coronex

SMOKING CESSATION

NICOTINE Patch 7 mg ..................................................................................... 10.53 Patch 14 mg ................................................................................... 11.63 Patch 21 mg ................................................................................... 12.32 Gum 2 mg (Mint ﬂavour) ................................................................ 14.97 Gum 2 mg (Fruit ﬂavour) ............................................................... 14.97 Gum 4 mg (Mint ﬂavour) ................................................................ 20.02 Gum 4 mg (Fruit ﬂavour) ............................................................... 20.02 7 7 7 96 96 96 96 ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol

Nicotine patches and gum are only available/subsidised on presentation of a Quitline Exchange Card

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Sympathomimetics Vasodilators

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

SYMPATHOMIMETICS

ADRENALINE Inj 1 in 1,000, 1 ml - Available on a PSO ........................................... 4.95 Inj 1 in 10,000, 10 ml - Available on a PSO ................................... 125.00 ISOPRENALINE HYDROCHLORIDE ❋ Inj 200 mcg per ml, 1 ml ............................................................... 36.80 (135.00) 5 50 25 Isuprel ✓ Mayne ✓ Mayne

VASODILATORS

AMYL NITRITE ❋ Ampoule, 0.3 ml crushable ............................................................. 62.92 (73.40) HYDRALAZINE ❋ Inj 20 mg per ml, 1 ml .................................................................... 30.50 (42.00) OXYPENTIFYLLINE - Special Authority - Hospital pharmacy [HP3] Tab 400 mg .................................................................................... 36.94 (40.63) 12 Baxter 5 Apresoline 50 Trental 400

Special Authority for Subsidy - Form: SA0125 Initial application - (Chronic post-thrombotic venous stasis ulcers) from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Chronic post-thrombotic venous stasis ulcers of more than 4 months duration; and 2 Other interventions have failed. Initial application - (Sudden hearing loss) only from an otolaryngologist. Approvals valid for 2 years for applications meeting the following criteria: Sudden hearing loss. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

DERMATOLOGICALS

Antiacne Preparations Antibacterials Topical

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIACNE PREPARATIONS

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 92 ISOTRETINOIN - Hospital pharmacy [HP3]-dermatologist Cap 10 mg ..................................................................................... 40.00 Cap 20 mg ..................................................................................... 60.00 100 100 ✓ Isotane 10 ✓ Isotane 20

ANTIBACTERIALS TOPICAL

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 92 FUSIDIC ACID a) Only on a prescription,

b) Not in combination,

c) Maximum 15 g per prescription. Crm 2% ............................................................................................ 6.60 (9.26) Oint 2% ............................................................................................ 6.60 (9.26) MUPIROCIN a) Only on a prescription, b) Not in combination. Oint 2% ............................................................................................ 6.60 (9.26) POLYNOXYLIN a) Only on a prescription, b) Not in combination. Gel ................................................................................................... 3.50 (6.46) SILVER SULPHADIAZINE a) Available on a PSO, b) Not in combination. Crm 1% with chlorhexidine digluconate 0.2% .................................. 15.04

15 g OP Fucidin 15 g OP Fucidin

15 g OP Bactroban

15 g OP Ponoxylan

100 g OP

✓ Silvazine

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

DERMATOLOGICALS

Antifungals Topical

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIFUNGALS TOPICAL

For systemic antifungals, refer to INFECTIONS, Antifungals, page 98 AMOROLFINE - Not in combination Nail soln 5% ................................................................................... 37.86 (61.87) 5 ml OP Loceryl

CICLOPIROXOLAMINE - Not in combination Crm 1% ............................................................................................ 1.00 20 g OP (11.65) Soln 1% ........................................................................................... 4.36 20 ml OP (10.99) Nail soln 8% .................................................................................. 37.81 3.5 ml OP (41.59) CLOTRIMAZOLE - Not in combination ❋ Crm 1% ............................................................................................ 0.80 ❋ Soln 1% .......................................................................................... 4.36 (7.55) ECONAZOLE NITRATE - Not in combination Crm 1% ........................................................................................... 1.00 (1.30) 1.00 (6.50) Foaming soln 1%, 10 ml sachets ...................................................... 9.89 (12.95) KETOCONAZOLE - Not in combination Crm 2% ........................................................................................... 1.00 (10.00) MICONAZOLE NITRATE - Not in combination ❋ Crm 2% ............................................................................................ 0.90 ❋ Lotn 2% ........................................................................................... 4.36 (10.32) Tincture 2% ...................................................................................... 4.36 (12.46) NYSTATIN - Not in combination Crm 100,000 u per g ........................................................................ 1.00 (4.64) TOLCICLATE - Not in combination ❋ Crm 1% ........................................................................................... 1.00 (5.76) TOLNAFTATE - Not in combination Crm 1% ............................................................................................ 1.00 (8.60) Soln 1% ........................................................................................... 4.36 (6.87) (Tinaderm crm 1% and soln 1% to be delisted 1 July 2005) 20 g OP 20 ml OP

Batrafen Batrafen Batrafen ✓ Clocreme Canesten

15 g OP Ecreme 20 g OP Pevaryl 3 Pevaryl 15 g OP Nizoral 20 g OP 30 ml OP 30 ml OP Daktarin 15 g OP Mycostatin 30 g OP Tolmicen 20 g OP Tinaderm 10 ml OP Tinaderm ✓ Micreme Daktarin

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

Antipruritic Preparations Corticosteroids Topical

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

DERMATOLOGICALS

ANTIPRURITIC PREPARATIONS

CALAMINE - Not in combination Crm, aqueous, BP .......................................................................... 17.10 (21.75) Lotn, BP ......................................................................................... 21.60 (27.00) 500 g HMG 2,000 ml HMG

CROTAMITON - Not in combination Crm 10% .......................................................................................... 4.26 20 g OP Eurax (4.45) Lotn 10% ......................................................................................... 7.56 50 ml (7.70) Eurax MENTHOL Crystals.......................................................................................... 29.60 100 g ✓ MidWest (40.00) HMG a) Only in combination with aqueous cream, 10% urea cream, wool fat with mineral oil lotion, 1% hydrocortisone with wool fat and mineral oil lotion, and glycerol, parafﬁn and cetyl alcohol lotion.

CORTICOSTEROIDS - TOPICAL

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS, page 83

Corticosteroids - Plain

BETAMETHASONE DIPROPIONATE Crm 0.05% ...................................................................................... 2.96 (6.28) Crm 0.05% ...................................................................................... 8.97 (16.69) Crm 0.05% in propylene glycol base ................................................. 4.33 (12.57) Oint 0.05% ...................................................................................... 2.96 (5.92) Oint 0.05% ...................................................................................... 8.97 (15.55) Oint 0.05% in propylene glycol base ................................................. 4.33 (12.57) BETAMETHASONE VALERATE ❋ Crm 0.1% ......................................................................................... 1.20 ❋ Crm 0.1% ......................................................................................... 4.00 ❋ Oint 0.1% ......................................................................................... 1.20 ❋ Oint 0.1% ......................................................................................... 4.00 ❋ Lotn 0.1% ...................................................................................... 10.05 CLOBETASOL PROPIONATE ❋ Crm 0.05% ...................................................................................... 1.40 ❋ Oint 0.05% ...................................................................................... 1.20 15 g OP Diprosone 50 g OP Diprosone 30 g OP 15 g OP 50 g OP Diprosone 30 g OP Diprosone OV 30 g OP 100 g OP 30 g OP 100 g OP 50 ml OP 30 g OP 30 g OP ✓ Beta Cream ✓ Beta Cream ✓ Beta Ointment ✓ Beta Ointment ✓ Betnovate ✓ Dermol ✓ Dermol Diprosone OV Diprosone

CLOBETASONE BUTYRATE Crm 0.05% ...................................................................................... 5.38 30 g OP (7.09) Crm 0.05% ..................................................................................... 16.13 100 g OP (22.00) fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

Eumovate Eumovate

✓

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Corticosteroids Topical

DERMATOLOGICALS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer DIFLUCORTOLONE VALERATE Crm 0.1% ......................................................................................... 8.97 (13.85) Fatty Oint 0.1% ................................................................................. 8.97 (13.85) Oint 0.1% ......................................................................................... 8.97 (13.85) 50 g OP Nerisone 50 g OP Nerisone 50 g OP Nerisone

HYDROCORTISONE - Only on a prescription ❋ Crm 1% ............................................................................................ 2.44 100 g ✓ Lemnis Fatty Cream HC (2.86) HMG ❋ Powder........................................................................................... 46.20 25 g ✓ m-Hydrocortisone a) Up to 5%; b) In a dermatological base (not proprietary Topical Corticosteroid - Plain); (refer page 158) c) With or without other dermatological galenicals. HYDROCORTISONE WITH WOOL FAT AND MINERAL OIL - Only on the prescription of a doctor Lotn 1% with wool fat hydrous 3% and mineral oil ............................ 5.92 250 ml (9.13) HYDROCORTISONE BUTYRATE Crm 0.1% ......................................................................................... 5.00 Crm 0.1% ....................................................................................... 15.00 Oint 0.1% ....................................................................................... 15.00 Lipocream 0.1% ............................................................................... 5.00 Lipocream 0.1% ............................................................................. 15.00 Milky emulsion 0.1% ........................................................................ 5.00 Milky emulsion 0.1% ...................................................................... 15.00 METHYLPREDNISOLONE ACEPONATE Crm 0.1% ......................................................................................... 4.95 Oint 0.1% ......................................................................................... 4.95 MOMETASONE FUROATE Crm 0.1% ......................................................................................... 3.96 Crm 0.1% ...................................................................................... 10.82 Oint 0.1% ......................................................................................... 3.96 Oint 0.1% ...................................................................................... 10.82 Lotn 0.1% ........................................................................................ 4.80 Lotn 0.1% ........................................................................................ 8.00 (Elocon lotn 0.1% 50 ml OP to be delisted 1 July 2005) 30 g OP 100 g OP 100 g OP 30 g OP 100 g OP 30 g OP 100 g OP 15 g OP 15 g OP 15 g OP 45 g OP 15 g OP 45 g OP 30 ml OP 50 ml OP

DP Lotn HC ✓ Locoid ✓ Locoid ✓ Locoid ✓ Locoid Lipocream ✓ Locoid Lipocream ✓ Locoid Crelo ✓ Locoid Crelo ✓ Advantan ✓ Advantan ✓ Elocon ✓ Elocon ✓ Elocon ✓ Elocon ✓ Elocon ✓ Elocon

TRIAMCINOLONE ACETONIDE Crm 0.02% ....................................................................................... 6.45 100 g OP (7.34) Oint 0.02% ....................................................................................... 6.45 100 g OP (7.34)

Aristocort Aristocort

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

DERMATOLOGICALS

Corticosteroids Topical Disinfecting and Cleansing Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Corticosteroids - Combination

BETAMETHASONE DIPROPIONATE WITH CLOTRIMAZOLE - Only on a prescription Crm 0.05% with clotrimazole 1% ...................................................... 3.49 15 g OP (8.19) (Lotricomb crm to be delisted 1 July 2005) BETAMETHASONE DIPROPIONATE WITH SALICYLIC ACID - Only on a prescription Oint 0.05% with salicylic acid 3%...................................................... 8.10 30 g OP (11.28) Lotn 0.05% with salicylic acid 2% ..................................................... 9.74 50 ml OP (14.21) (Diprosalic oint and lotn to be delisted 1 July 2005) BETAMETHASONE VALERATE WITH CLIOQUINOL - Only on a prescription Crm 0.1% with clioquinol 3% ............................................................ 3.49 (4.90) Oint 0.1% with clioquinol 3%............................................................. 3.49 (4.90) BETAMETHASONE VALERATE WITH FUSIDIC ACID a) Only on a prescription; b) Maximum 15 g per prescription. Crm 0.1% with fusidic acid 2% ......................................................... 3.49 (6.98) HYDROCORTISONE WITH MICONAZOLE - Only on a prescription ❋ Crm 1% with miconazole nitrate 2% ................................................. 1.89 Lotricomb

Diprosalic Diprosalic

15 g OP 15 g OP

Betnovate-C Betnovate-C

15 g OP Fucicort 15 g OP ✓ Micreme H ✓ Pimafucort ✓ Pimafucort ✓ Locoid C

HYDROCORTISONE WITH NATAMYCIN AND NEOMYCIN - Only on a prescription Crm 1% with natamycin 1% and neomycin sulphate 0.5% ................. 3.49 15 g OP Oint 1% with natamycin 1% and neomycin sulphate 0.5% ................. 3.49 15 g OP HYDROCORTISONE BUTYRATE WITH CHLORQUINALDOL - Only on a prescription Crm 0.1% with chlorquinaldol 3% .................................................... 3.49 15 g OP

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN - Only on a prescription Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g .......................................... 3.49 15 g OP ✓ Viaderm KC Oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g .......................................... 3.49 15 g OP ✓ Viaderm KC

DISINFECTING AND CLEANSING AGENTS

CHLORHEXIDINE GLUCONATE a) Only if prescribed for a dialysis patient and the prescription is endorsed accordingly; and b) Maximum of 500 ml per month. ❋ Soln 4% ........................................................................................... 9.34 500 ml ❋ Handrub 0.5% with ethanol 70% ....................................................... 5.70 500 ml SODIUM HYPOCHLORITE ❋ Soln ............................................................................................... 2.71 2,500 ml a) only if prescribed for a dialysis patient and the prescription is endorsed accordingly.

✓ Orion ✓ Microshield Handrub ✓ Janola

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Dusting Powders Barrier Creams and Emollients

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

DERMATOLOGICALS

DUSTING POWDERS

DIPHEMANIL METHYLSULPHATE a) Subsidised only if prescribed for an amputee with an artiﬁcial limb, or for a paraplegic patient; and b) On a prescription endorsed accordingly. Powder 2% ...................................................................................... 6.81 (11.77) 50 g OP Prantal

BARRIER CREAMS AND EMOLLIENTS Barrier Creams

ZINC Cream BP ......................................................................................... 6.55 (9.79) ZINC AND CASTOR OIL Ointment BP ..................................................................................... 6.20 500 g HMG 500 g ✓ Sigma

Emollients

AQUEOUS ❋ Cream .............................................................................................. 2.65 CETOMACROGOL ❋ Cream BP ......................................................................................... 2.80 (4.35) EMULSIFYING ❋ Ointment BP ..................................................................................... 4.09 500 g 500 g HMG IPW 500 g ✓ AFT ✓ AFT

GLYCEROL WITH PARAFFIN AND CETYL ALCOHOL - Only on the prescription of a doctor ❋ Lotn 5% with parafﬁn liq 5% and cetyl alcohol 2% ............................ 1.40 250 ml (8.10) OILY ❋ Cream BP ......................................................................................... 2.80 (13.60) (15.40) OIL IN WATER EMULSION ❋ Crm ............................................................................................... 2.80 UREA ❋ Crm 10% ........................................................................................ 2.52 500 g

David Craig HMG 500 g 100 g OP ✓ Lemnis Fatty Cream ✓ Nutraplus

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

DERMATOLOGICALS

Barrier Creams and Emollients Minor Skin Infections Parasiticidal Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer WOOL FAT WITH MINERAL OIL - Only on the prescription of a doctor � Lotn hydrous 3% with mineral oil ...................................................... 1.12 200 ml OP (5.00) � Lotn hydrous 3% with mineral oil ...................................................... 1.40 250 ml OP (2.18) (2.50) (7.73) � Lotn hydrous 3% with mineral oil ...................................................... 2.10 375 ml OP (9.38) � Lotn hydrous 3% with mineral oil ...................................................... 5.60 1,000 ml (8.70) (18.43) (23.91)

Alpha-Keri Lotion DP Lotion Hydroderm Lotion BK Lotion Alpha-Keri Lotion DP Lotion Hydroderm Lotion Alpha-Keri Lotion BK Lotion

Other Dermatological Bases

PARAFFIN White soft....................................................................................... 17.89 2,500 g ✓ IPW (43.45) HMG a) Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid - Plain.

MINOR SKIN INFECTIONS

POVIDONE IODINE Antiseptic soln 10% ......................................................................... 6.42 500 ml ✓ Betadine ✓ Biocil Viodine ✓ Betadine Skin Prep Viodine ✓ Biocil Betadine Betadine

(7.20) Alcohol skin preparation 10% ............................................................ 8.13 500 ml (14.20) Oint 10% - Only on a prescription, maximum 100 g per prescription .... 2.88 25 g OP (3.27) Oint 10% - Only on a prescription, maximum 100 g per prescription .... 6.87 100 g OP (7.02)

PARASITICIDAL PREPARATIONS

GAMMA BENZENE HEXACHLORIDE Crm 1% ............................................................................................ 3.20 (4.00) MALATHION Liq 0.5%........................................................................................... 5.80 MALDISON Crm shampoo 1%............................................................................. 2.86 (5.27) Shampoo 1% .................................................................................... 2.86 50 g OP Benhex 200 ml 40 g OP 30 ml OP Prioderm ✓ A-Lices ✓ AFT

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Parasiticidal Preparations Psoriasis and Eczema Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer PERMETHRIN Crm 5% ............................................................................................ 3.80 30 g OP ✓ Lyderm Lotn 5% ........................................................................................... 4.50 50 ml OP (7.00) Quellada-P a) Should be strictly reserved for use as second line therapy in: - patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema; - cases of scabies which are resistant to gamma benzene hexachloride and resistant to malathion. b) Veriﬁcation of drug resistance is dependent on the persistence of the condition after treatment. In order to establish whether there is drug resistance, the following criteria should be fulﬁlled: - a deﬁnite diagnosis of scabies should be made; - it should be ascertained that the medication was administered properly; - the possibility of reinfestation should have been excluded.

DERMATOLOGICALS

PSORIASIS AND ECZEMA PREPARATIONS

ACITRETIN - Hospital pharmacy [HP3]-dermatologist Cap 10 mg ..................................................................................... 94.75 Cap 25 mg ................................................................................... 203.70 CALCIPOTRIOL Crm 50 mcg per g ......................................................................... 22.44 Oint 50 mcg per g.......................................................................... 22.44 Crm 50 mcg per g ......................................................................... 62.58 Oint 50 mcg per g.......................................................................... 62.58 Soln 50 mcg per ml ........................................................................ 22.47 Soln 50 mcg per ml ........................................................................ 37.54 100 100 30 g OP 30 g OP 100 g OP 100 g OP 30 ml OP 60 ml OP ✓ Neotigason ✓ Neotigason ✓ Daivonex ✓ Daivonex ✓ Daivonex ✓ Daivonex ✓ Daivonex ✓ Daivonex

COAL TAR Soln BP .......................................................................................... 32.45 500 ml (40.50) David Craig (50.55) HMG a) Up to 10%; b) Only in combination with a dermatological base or proprietary Topical Corticosteroid - Plain; (refer page 158) c) With or without other dermatological galenicals. COAL TAR WITH ALLANTOIN, MENTHOL, PHENOL AND SULPHUR Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin 2.5% crm .................................................................. 3.43 (4.35) Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin 2.5% crm .................................................................. 6.59 (8.00) COAL TAR WITH SALICYLIC ACID AND SULPHUR Solution 12% with salicylic acid 2% and sulphur 4% ointment ........... 7.95

30g OP Egopsoryl TA 75 g OP Egopsoryl TA 40 g OP ✓ Coco-Scalp

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

DERMATOLOGICALS

Psoriasis and Eczema Preparations Scalp Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer DITHRANOL Crm 1% .......................................................................................... 27.50 METHOXSALEN - Retail pharmacy-specialist Cap 10 mg ..................................................................................... 11.66

50 g OP 25

✓ Micanol ✓ Oxsoralen

SALICYLIC ACID Powder........................................................................................... 29.52 500 g (46.00) HMG (55.63) David Craig a) Only in combination with a dermatological base or proprietary Topical Corticosteroid - Plain; (refer page 158) b) With or without other dermatological galenicals. SULPHUR Precipitated ...................................................................................... 7.92 100 g (9.25) HMG a) Only in combination with a dermatological base or proprietary Topical Corticosteroid - Plain; (refer page 158) b) With or without other dermatological galenicals. TAR WITH CADE OIL Bath emulsion 7.5% coal tar, 2.5% cade oil, 7.5% compound ............ 9.70 (29.60) 350 ml Polytar Emollient

TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN - Only on the prescription of a doctor ❋ Soln 2.3% with triethanolamine lauryl sulphate and ﬂuorescein sodium ................................................................. 2.20 500 ml ✓ Pinetarsol

SCALP PREPARATIONS

BETAMETHASONE DIPROPIONATE Scalp lotn 0.05% ............................................................................ 12.29 100 ml OP (22.91) (Diprosone scalp lotn to be delisted 1 July 2005) BETAMETHASONE VALERATE ❋ Scalp app 0.1% ................................................................................ 4.00 CLOBETASOL PROPIONATE ❋ Scalp app 0.05% .............................................................................. 2.50 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% ............................................................................... 7.16 Scalp lotn 0.1% .............................................................................. 17.90 KETOCONAZOLE Shampoo 2% ................................................................................... 4.69 Shampoo subsidised: a) Only on a prescription; b) Maximum 100 ml per prescription. 100 ml OP 30 ml OP 100 ml OP 250 ml OP 100 ml OP Diprosone

✓ Beta Scalp ✓ Dermol ✓ Locoid ✓ Locoid ✓ Ketopine

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Sunscreens Wart and Corn Preparations Other Skin Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

DERMATOLOGICALS

SUNSCREENS

SUNSCREENS, PROPRIETARY - Retail pharmacy-specialist Crm ............................................................................................... 1.74 50 g OP (6.00) Crm ............................................................................................... 3.39 100 g OP (5.89) Oint ............................................................................................... 5.00 14 g OP (15.00) Lotn ............................................................................................... 4.80 125 ml OP (9.45) Aquasun 30+ Hamilton Sunscreen R V Paque Aquasun 30+ Aquabloc 30+

WART AND CORN PREPARATIONS

PODOPHYLLOTOXIN Soln 0.5 % ..................................................................................... 32.00 a) Only on a prescription; b) Maximum 3.5 ml per prescription. SALICYLIC ACID a) Maximum 20 g or 20 ml per prescription (refer page 162). Oint 20% ........................................................................................ CE Oint 40% ........................................................................................ CE Oint 60% ........................................................................................ CE Soln 20% ....................................................................................... CE Soln 40% ....................................................................................... CE 3.5 ml OP ✓ Condyline

20 g 20 g 20 g 20 ml 20 ml

✓ ✓ ✓ ✓ ✓

OTHER SKIN PREPARATIONS Antineoplastics

FLUOROURACIL SODIUM - Retail pharmacy-specialist Crm 5% .......................................................................................... 23.89 20 g OP ✓ Efudix

Topical Analgesia

ASPIRIN & CHLOROFORM Application (refer page 162) ........................................................... CE ✓

Wound Management Products

HYDROGEN PEROXIDE ❋ Soln 20 vol ....................................................................................... 3.13 (7.00) a) Maximum 500 ml per prescription. MAGNESIUM SULPHATE Paste ............................................................................................... 2.98 (4.90) 500 ml HMG

80 g HMG

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

GENITO URINARY SYSTEM

Contraceptives – Non-hormonal

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

CONTRACEPTIVES – NON-HORMONAL Condoms

❋ CONDOMS WITHOUT SPERMICIDE - Available on a PSO................... 1.24 14.84 12 144 ✓ Shield Blue ✓ Durex Conﬁdence ✓ Gold Knight ✓ Lifestyles Flared ✓ Marquis Supalite ✓ Shield Blue R3 Superfeucht ✓ Marquis Protecta

(68.40) ❋ CONDOMS EXTRA STRENGTH - Available on a PSO ........................ 16.21 144

Spermicidal Agents

❋ APPLICATOR - when ordered with spermicide ................................... 4.10 (4.34) each Ortho

NONOXYNOL-9 – Available on a PSO Jelly 2% ........................................................................................... 8.37 108 g OP (10.95)

Gynol II

Contraceptive Devices

❋ DIAPHRAGM - Available on a PSO .................................................. 42.90 ❋ INTRA-UTERINE DEVICE - Only on a WSO....................................... 28.00 39.50 1 OP 1 OP ✓ Ortho All-ﬂex ✓ Ortho Coil ✓ Nova-T ✓ Multiload Cu 375 ✓ Multiload Cu 375SL

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

GENITO URINARY SYSTEM

Contraceptives – Hormonal

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

CONTRACEPTIVES – HORMONAL

Special Authority for Alternate Subsidy - Form: SA0500 Initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Either: 1.1 Patient is on a Social Welfare beneﬁt; or 1.2 Patient has an income no greater than the beneﬁt; and 2 Has tried at least one of the fully funded options and has been unable to tolerate it. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 3 Patient is on a Social Welfare beneﬁt; or 4 Patient has an income no greater than the beneﬁt. Note: The approval numbers of Special Authorities approved after 1 November 1999 are interchangeable between Mercilon, Marvelon, Minulet and Femodene. The additional subsidy will fund Mercilon, Marvelon, Minulet and Femodene up to the manufacturer’s price for each of these products as identiﬁed on the Schedule at 1 November 1999. Special Authorities approved before 1 November 1999 remain valid until the expiry date and can be renewed providing that women are still either: - on a Social Welfare beneﬁt; or - have an income no greater than the beneﬁt. The approval numbers of Special Authorities approved before 1 November 1999 are interchangeable for products within the combined oral contraceptives and progestogen-only contraceptives groups, except Loette, Melodene and Microgynon 20 ED.

Combined Oral Contraceptives

Additional subsidy by Special Authority - Retail pharmacy – refer above. ETHINYLOESTRADIOL WITH DESOGESTREL - Available on a PSO ❋ Tab 20 mcg with desogestrel 150 mcg ............................................ 6.62 (16.50) ❋ Tab 20 mcg with desogestrel 150 mcg and 7 inert tab ...................... 6.62 (16.50) ❋ Tab 30 mcg with desogestrel 150 mcg ............................................ 6.62 (16.50) ❋ Tab 30 mcg with desogestrel 150 mcg and 7 inert tab ...................... 6.62 (16.50) ETHINYLOESTRADIOL WITH GESTODENE - Available on a PSO ❋ Tab 20 mcg with gestodene 75 mcg and 7 inert tab .......................... 2.21 (Special Authority does not apply) (6.00) ❋ Tab 30 mcg with gestodene 75 mcg ................................................. 6.62 (16.50) ❋ Tab 30 mcg with gestodene 75 mcg and 7 inert tab .......................... 6.62 (14.49) (16.50) 63 Mercilon 21 84 Mercilon 28 63 Marvelon 21 84 Marvelon 28 28 Melodene 63 Femodene 21 84 Minulet 28 Femodene 28

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

GENITO URINARY SYSTEM

Contraceptives – Hormonal

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer ETHINYLOESTRADIOL WITH LEVONORGESTREL - Available on a PSO ❋ Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab (Special Authority does not apply) ................................................ 6.62 (16.50) ❋ Tab 30 mcg with levonorgestrel 150 mcg ......................................... 6.62 (16.50) ❋ Tab 30 mcg with levonorgestrel 150 mcg and 7 inert tab................... 6.62 (14.49) (16.50) ❋ Tab ethinyloestradiol 30 mcg with levonorgestrel 50 mcg (6) and tab ethinyloestradiol 40 mcg with levonorgestrel 75 mcg (5) and tab ethinyloestradiol 30 mcg with levonorgestrel 125 mcg (10) and 7 inert tab ............................................................................. 6.62 (9.45) (14.49) ❋ Tab 50 mcg with levonorgestrel 125 mcg and 7 inert tab................... 9.45 ❋ Tab 50 mcg with levonorgestrel 250 mcg ....................................... 6.62 (13.80) (Nordiol 21 tab to be delisted 1 June 2005) ETHINYLOESTRADIOL WITH NORETHISTERONE - Available on a PSO ❋ Tab 35 mcg with norethisterone 500 mcg ........................................ 6.62 (14.52) ❋ Tab 35 mcg with norethisterone 500 mcg and 7 inert tab .................. 6.62 ❋ Tab ethinyloestradiol 35 mcg with norethisterone 500 mcg (7 )and tab ethinyloestradiol 35 mcg with norethisterone 1 mg (9) and tab ethinyloestradiol 35 mcg with norethisterone 500 mcg (5) and 7 inert tab ................................................................................... 6.62 (13.80) ❋ Tab 35 mcg with norethisterone 1 mg .............................................. 6.62 (14.52) ❋ Tab 35 mcg with norethisterone 1 mg and 7 inert tab ........................ 6.62 (14.52) NORETHISTERONE WITH MESTRANOL - Available on a PSO ❋ Tab 1 mg with mestranol 50 mcg ...................................................... 6.62 (13.80) ❋ Tab 1mg with mestranol 50 mcg and 7 inert tab ................................ 6.62 (13.80)

84 Loette Microgynon 20 ED 63 84 Microgynon 30 ✓ Levlen ED ✓ Monofeme Nordette 28 Microgynon 30 ED

84 84 63

✓ Trifeme Triquilar ED Triphasil 28 ✓ Microgynon 50 ED Nordiol 21

63 84 Brevinor 21 ✓ Norimin

84 Synphasic 28 63 Brevinor 1/21 84 Brevinor 1/28 63 Norinyl-1/21 84 Norinyl-1/28

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Contraceptives – Hormonal Antiandrogen Oral Contraceptives

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

GENITO URINARY SYSTEM

Progestogen-only Contraceptives

Additional subsidy by Special Authority - Retail pharmacy – refer page 77. ETHYNODIOL DIACETATE - Available on a PSO ❋ Tab 500 mcg .................................................................................... 6.62 LEVONORGESTREL - Available on a PSO ❋ Tab 30 mcg ...................................................................................... 6.62 (14.50) MEDROXYPROGESTERONE ACETATE - Available on a PSO ❋ Inj 150 mg per ml, 1 ml syringe ........................................................ 8.47 NORETHISTERONE - Available on a PSO ❋ Tab 350 mcg .................................................................................... 9.10 84 84 Microlut each 84 ✓ Depo-Provera ✓ Noriday 28 ✓ Femulen

Emergency Contraceptives

LEVONORGESTREL - Available on a PSO ❋ Tab 750 mcg .................................................................................... 8.50 a) Maximum of 4 tablets per prescription. 2 ✓ Postinor-2

ANTIANDROGEN ORAL CONTRACEPTIVES

CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL ❋ Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs ................. 6.30 84 ✓ Estelle 35 a) Prescribers may code prescriptions “contraceptive” (code “O”) when used as indicated for contraception. The period of supply and prescription charge will be as per other contraceptives, as follows: - $3.00 prescription charge (patient co-payment) will apply; - prescription may be written for up to six months supply. b) Prescriptions coded in any other way are subject to the non-contraceptive prescription charges, and the non-contraceptive period of supply. ie. Prescriptions may be written for up to three months supply.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

GENITO URINARY SYSTEM

Gynaecological Anti-infectives Impotence Treatment

Myometrial and Vaginal Hormone Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

GYNAECOLOGICAL ANTI-INFECTIVES

ACETIC ACID WITH HYDROXYQUINOLINE AND RICINOLEIC ACID Jelly with glacial acetic acid 0.94%, hydroxyquinoline sulphate 0.025%, glycerol 5% and ricinoleic acid 0.75% with applicator...... 8.43 100 g OP (11.32) CLOTRIMAZOLE ❋ Pessaries 100 mg with applicator(s) ................................................. 1.93 6 ❋ Pessary 500 mg with applicator ........................................................ 1.93 each ❋ Vaginal crm 1% with applicator(s) ..................................................... 1.56 35 g OP ❋ Vaginal crm 2% with applicators ....................................................... 3.99 25 g OP (Clotrihexal pessaries 100 mg and 500 mg to be delisted 1 September 2005) ECONAZOLE NITRATE Pessaries 150 mg with applicators.................................................... 2.75 (9.71) Vaginal crm 1% with applicators ....................................................... 2.75 (8.97) MICONAZOLE NITRATE ❋ Vaginal crm 2% with applicator ......................................................... 2.75 (3.70) NYSTATIN Vaginal crm 100,000 u per 5 g with applicator .................................. 4.40 (4.66) 3 Pevaryl Ovules 40 g OP Gyno-Pevaryl 40 g OP Micreme 75 g OP Nilstat

Aci-Jel ✓ Clotrihexal ✓ Clotrihexal ✓ Clomazol ✓ Clotrimaderm 2%

IMPOTENCE TREATMENT

PAPAVERINE HYDROCHLORIDE ❋ Inj 12 mg per ml, 10 ml .................................................................. 68.00 5 ✓ Mayne

MYOMETRIAL AND VAGINAL HORMONE PREPARATIONS

ERGOMETRINE MALEATE Inj 500 mcg per ml, 1 ml - Available on a PSO ................................ 11.60 GEMEPROST - Special Authority - Hospital pharmacy [HP1] Pessaries 1 mg............................................................................. 258.14 (283.95) (Cervagem pessaries 1 mg to be delisted 1 July 2005) 5 5 Cervagem ✓ Mayne

Special Authority for Subsidy - Form: SA0094 Initial application only from a relevant specialist (Only for Epsom Day Unit in Auckland). Approvals valid for 1 month for applications meeting the following criteria: Termination of advanced pregnancy i.e. beyond 12 weeks. Only for Epsom Day Unit in Auckland. OESTRIOL ❋ Pessaries 500 mcg ........................................................................... 7.25 ❋ Crm 1 mg per g with applicator ......................................................... 7.00 OXYTOCIN - Available on a PSO Inj 5 iu per ml, 1 ml .......................................................................... 4.94 Inj 10 iu per ml, 1 ml ........................................................................ 6.18 Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml .................... 8.40 15 15 g OP 5 5 5 ✓ Ovestin ✓ Ovestin ✓ Syntocinon ✓ Syntocinon ✓ Syntometrine

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Pregnancy Tests - HCG Urine Urinary Agents & Urinary Tract Infections

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

GENITO URINARY SYSTEM

PREGNANCY TESTS - HCG URINE

PREGNANCY TEST - HCG URINE - Only on a WSO

Cassette ......................................................................................... 29.50 25 tests ✓ MDS Quick Card

URINARY AGENTS Other urinary agents

OXYBUTYNIN ❋ Tab 5 mg ........................................................................................ 44.79 ❋ Oral liq 5 mg per 5 ml ..................................................................... 45.00 SODIUM CITRO-TARTRATE ❋ Grans effervescent 4 g sachets ......................................................... 2.75 500 473 ml OP 28 ✓ Apo-Oxybutynin ✓ Apo-Oxybutynin ✓ Ural

URINARY TRACT INFECTIONS

Refer also to INFECTIONS, Antibacterials, page 92 and INFECTIONS, Urinary Tract Infections, page 104.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Anabolic Agents Calcium Homeostasis

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANABOLIC AGENTS

NANDROLONE DECANOATE - Retail pharmacy-specialist Inj 50 mg per ml, 1 ml .................................................................... 21.15 1 ✓ Deca-Durabolin Orgaject

CALCIUM HOMEOSTASIS Alendronate for Osteoporosis

ALENDRONATE - Special Authority - Retail pharmacy Tab 10 mg ...................................................................................... 47.30 30 ✓ Fosamax Tab 70 mg ...................................................................................... 44.15 4 ✓ Fosamax Special Authority for Subsidy - Form: SA0693 Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 Severe osteoporosis; and 2 History of one previous signiﬁcant osteoporotic fracture demonstrated radiologically; and 3 T-Score £ -3.0 (bone mass density (BMD) £ 3.0 standard deviations below the mean normal value in young adults). Note In line with the Australian guidelines for funding alendronate, a vertebral fracture is deﬁned as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. Renewal - (2 year approvals granted before February 2002) only from a geriatrician, rheumatologist, endocrinologist, gynaecologist or general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

Alendronate for Pagets Disease

ALENDRONATE - Special Authority - Retail pharmacy Tab 40 mg .................................................................................... 133.00 30 ✓ Fosamax Special Authority for Subsidy - Form: SA0467 Initial application only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications due to site (base of skull, spine, long bones of lower limbs); or 2.5 Preparation for orthopaedic surgery. Renewal only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

Other Treatments

CALCITONIN - Hospital pharmacy [HP3]-specialist ❋ Inj 100 iu per ml, 1 ml .................................................................. 100.00 5 ✓ Miacalcic ETIDRONATE DISODIUM ❋ Tab 200 mg .................................................................................... 38.00 100 ✓ Etidrate Prescribing guideline Etidronate for osteoporosis should be prescribed for 14 days (400 mg in the morning) and repeated every three months. It should not be taken at the same time of the day as any calcium supplementation (minimum dose - 500 mg per day of elemental calcium). Etidronate should be taken at least 2 hours before or after any food or ﬂuid, except water.

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Calcium Homeostasis Corticosteroids and Related Agents for Systemic Use

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer PAMIDRONATE DISODIUM - Special Authority - Hospital pharmacy [HP3] Inj 3 mg per ml, 5 ml ...................................................................... 51.19 Inj 3 mg per ml, 10 ml .................................................................... 76.00 Inj 6 mg per ml, 10 ml .................................................................. 152.00

1 1 1

Special Authority for Subsidy - Form: SA0091 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Paget’s disease; or 2 Both: 2.1 Patients under hospice care; and 2.2 Either: 2.2.1 Tumour-induced hypercalcaemia; or 2.2.2 Tumour-induced osteolysis without hypercalcaemia. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

✓ Mayne ✓ Mayne ✓ Pamisol ✓ Mayne ✓ Pamisol

CORTICOSTEROIDS AND RELATED AGENTS FOR SYSTEMIC USE

BETAMETHASONE SODIUM PHOSPHATE WITH BETAMETHASONE ACETATE ❋ Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1 ml ............... 19.20 (28.00) CORTISONE ACETATE ❋ Tab 5 mg .......................................................................................... 8.09 (12.65) ❋ Tab 25 mg ...................................................................................... 18.68 (25.00) DEXAMETHASONE - Retail pharmacy-specialist ❋ Tab 1 mg - Available on a PSO ........................................................ 16.08 ❋ Tab 4 mg - Available on a PSO ....................................................... 61.89 Oral liq 1 mg per ml ........................................................................ 39.90 Oral liq prescriptions: a) Must be written by a paediatrician or paediatric cardiologist; or b) On the recommendation of a paediatrician or paediatric cardiologist. DEXAMETHASONE SODIUM PHOSPHATE - Available on a PSO or BSO ❋ Inj 4 mg per ml, 1 ml ...................................................................... 22.60 ❋ Inj 4 mg per ml, 2 ml ...................................................................... 32.60 FLUDROCORTISONE ACETATE ❋ Tab 100 mcg .................................................................................... 7.62 HYDROCORTISONE ❋ Tab 5 mg .......................................................................................... 7.95 ❋ Tab 20 mg ...................................................................................... 14.27 ❋ Inj 50 mg per ml, 2 ml - Only on a PSO ............................................. 3.72 METHYLPREDNISOLONE - Retail pharmacy-specialist ❋ Tab 4 mg ........................................................................................ 48.57 ❋ Tab 100 mg .................................................................................. 166.52 5 Celestone Chronodose 100 Douglas 100 Douglas 100 100 25 ml OP ✓ Douglas ✓ Douglas ✓ Biomed

5 5 100 100 100 1 100 20

✓ Mayne ✓ Mayne ✓ Florinef ✓ Douglas ✓ Douglas ✓ Solu-Cortef ✓ Medrol ✓ Medrol

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Corticosteroids and Related Agents for Systemic Use Sex Hormones Non Contraceptive

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer METHYLPREDNISOLONE ACETATE Inj 40 mg per ml, 1 ml ...................................................................... 6.03 METHYLPREDNISOLONE ACETATE WITH LIGNOCAINE Inj 40 mg per ml with lignocaine 1 ml................................................ 6.03 METHYLPREDNISOLONE SODIUM SUCCINATE - Retail pharmacy-specialist Inj 40 mg per ml, 1 ml .................................................................. 151.40 Inj 62.5 mg per ml, 2 ml ............................................................... 412.59 Inj 500 mg...................................................................................... 39.16 Inj 1 g ............................................................................................ 70.95 PREDNISOLONE SODIUM PHOSPHATE - Available on a PSO ❋ Oral liq 5 mg per ml .......................................................................... 9.95 a) Restricted to children under 12 years of age. PREDNISONE ❋ Tab 1 mg .......................................................................................... 9.99 ❋ Tab 2.5 mg ..................................................................................... 11.41 ❋ Tab 5 mg - Available on a PSO ........................................................ 11.98 ❋ Tab 20 mg ...................................................................................... 35.41 TETRACOSACTRIN ❋ Inj 250 mcg .................................................................................. 177.18 ❋ Inj 1 mg per ml, 1 ml ...................................................................... 26.88 TRIAMCINOLONE ACETONIDE Inj 10 mg per ml, 1 ml .................................................................... 11.11 Inj 10 mg per ml, 5 ml .................................................................... 10.31 Inj 40 mg per ml, 1 ml .................................................................... 28.09 1 1 ✓ Depo-Medrol ✓ Depo-Medrol with lidocaine ✓ Solu-Medrol ✓ Solu-Medrol ✓ Solu-Medrol ✓ Solu-Medrol ✓ Redipred

25 25 1 1 30 ml OP

500 500 500 500 10 1 5 1 5

✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Synacthen ✓ Synacthen Depot ✓ Kenacort-A ✓ Kenacort-A ✓ Kenacort-A40

SEX HORMONES NON CONTRACEPTIVE Androgen Agonists and Antagonists

CYPROTERONE ACETATE - Hospital pharmacy [HP3]-specialist Tab 50 mg ...................................................................................... 27.00 Inj 100 mg per ml, 3 ml ................................................................ 196.82 TESTOSTERONE CYPIONATE - Retail pharmacy-specialist Inj long-acting 100 mg per ml, 10 ml .............................................. 61.41 TESTOSTERONE ENANTHATE - Retail pharmacy-specialist Inj long-acting 250 mg - preﬁlled syringe ........................................ 45.00 TESTOSTERONE ESTERS - Retail pharmacy-specialist Inj 250 mg per ml, 1 ml ................................................................. 12.98 (Sustanon 250 Orgaject inj 250 mg to be delisted 1 July 2005) TESTOSTERONE UNDECANOATE - Retail pharmacy-specialist Cap 40 mg ..................................................................................... 60.71 60 50 3 1 3 1 ✓ Paciﬁc Cyproterone ✓ Androcur Depot ✓ Depo-Testosterone ✓ Primoteston ✓ Sustanon Ampoules ✓ Sustanon 250 Orgaject

✓ Panteston

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Hormone Replacement Therapy - Systemic

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

HORMONE REPLACEMENT THERAPY - SYSTEMIC

Special Authority for Alternate Subsidy - Form: SA0312 Initial application only from an obstetrician, gynaecologist, general practitioner or general physician. Approvals valid for 5 years for applications meeting the following criteria: Any of the following: 1 Acute or signiﬁcant liver disease - a declaration must be provided from a gastroenterologist or general physician stating that oral oestrogens are contraindicated due to liver disease (Details to be attached to application); or 2 Oestrogen induced hypertension requiring antihypertensive therapy - documented evidence must be provided that raised blood pressure levels or inability to control blood pressure adequately occurred post oral oestrogens(Details to be attached to application); or 3 Hypertriglyceridaemia - documented evidence must be provided that triglyceride levels increased to at least 2 x normal triglyceride levels post oral oestrogens (Details to be attached to application). Note Prescriptions with a valid Special Authority (CHEM) number will be reimbursed at the level of the lowest priced TDDS product within the speciﬁed dose group. Renewal only from an obstetrician, gynaecologist, general practitioner or general physician. Approvals valid for 5 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Prescribing Guideline HRT should be taken at the lowest dose for the shortest period of time necessary to control symptoms. Patients should be reviewed 6 monthly in line with the updated NZGG “Evidence-based Best Practice Guideline on Hormone Replacement Therapy March 2004”.

Oestrogens

Oestrogens – Low Dose OESTRADIOL – See prescribing guideline above ❋ TDDS 25 mcg per day ...................................................................... 3.01 8 (10.86) Estraderm TTS 25 a) Only on a prescription; b) Maximum of 2 patches per week; c) Additional subsidy by Special Authority available to fully fund to the level of the lowest priced TDDS brand within the low dose oestrogens. OESTROGENS – See prescribing guideline above ❋ Conjugated, equine tab 300 mcg....................................................... 3.01 Oestrogens – Medium/Low Dose OESTRADIOL – See prescribing guideline above ❋ Tab 1 mg ......................................................................................... 4.12 (6.50) OESTRADIOL VALERATE – See prescribing guideline above ❋ Tab 1 mg .......................................................................................... 4.12 (5.40) 28 ✓ Premarin

28 OP Estrofem 28 Progynova

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Hormone Replacement Therapy - Systemic

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Oestrogens – Medium Dose OESTRADIOL – See prescribing guideline on page 85 ❋ TDDS 50 mcg per day ..................................................................... 4.12 8 (13.18) Estraderm TTS 50 a) Only on a prescription; b) Maximum of 2 patches per week; c) Additional subsidy by Special Authority available to fully fund to the level of the lowest priced TDDS brand within the medium dose oestrogens. ❋ TDDS 3.9 mg per day (releases 50 mcg of oestradiol per day) .......... 4.12 4 (11.53) Climara 50 (12.47) Femtran 50 a) Only on a prescription; b) Maximum of 1 patch per week; c) Additional subsidy by Special Authority available to fully fund to the level of the lowest priced TDDS brand within the medium dose oestrogens. OESTROGENS – See prescribing guideline on page 85 ❋ Conjugated, equine tab 625 mcg....................................................... 4.12 Oestrogens – Medium/High Dose OESTRADIOL – See prescribing guideline on page 85 ❋ Tab 2 mg ......................................................................................... 5.40 (7.00) OESTRADIOL VALERATE – See prescribing guideline on page 85 ❋ Tab 2 mg ......................................................................................... 5.40 28 ✓ Premarin

28 OP Estrofem 28 ✓ Progynova

Oestrogens – High Dose OESTRADIOL – See prescribing guideline on page 85 ❋ TDDS 100 mcg per day .................................................................... 7.05 8 (16.14) Estraderm TTS 100 a) Only on a prescription; b) Maximum of 2 patches per week; c) Additional subsidy by Special Authority available to fully fund to the level of the lowest priced TDDS brand within the high dose oestrogens. ❋ TDDS 7.8 mg per day (releases 100 mcg of oestradiol per day) ........ 7.05 4 (14.33) Climara 100 (15.26) Femtran 100 a) Only on a prescription; b) Maximum of 1 patch per week; c) Additional subsidy by Special Authority available to fully fund to the level of the lowest priced TDDS brand within the high dose oestrogens. OESTROGENS – See prescribing guideline on page 85 ❋ Conjugated, equine tab 1.25 mg ....................................................... 7.05 28 ✓ Premarin

Progestogens

Progestogens – Low Dose MEDROXYPROGESTERONE ACETATE – See prescribing guideline on page 85 ❋ Tab 2.5 mg ....................................................................................... 2.07 Progestogens – Medium Dose MEDROXYPROGESTERONE ACETATE – See prescribing guideline on page 85 ❋ Tab 5 mg ........................................................................................ 13.75 30 100 ✓ Provera ✓ Provera

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Hormone Replacement Therapy - Systemic Other Oestrogen Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Progestogens – High Dose MEDROXYPROGESTERONE ACETATE – See prescribing guideline on page 85 ❋ Tab 10 mg ........................................................................................ 7.57

✓ Provera

Progestogen and oestrogen combined preparations

OESTRADIOL WITH LEVONORGESTREL – See prescribing guideline on page 85 ❋ Tab 2 mg with 75 mcg levonorgestrel (12) and 2 mg oestradiol tab (16)...... 5.40 OESTRADIOL WITH NORETHISTERONE – See prescribing guideline on page 85 ❋ Tab 1 mg with 0.5 mg norethisterone acetate .................................... 5.40 (11.45) ❋ Tab 2 mg with 1 mg norethisterone acetate ....................................... 5.40 (7.00) (11.45) ❋ Tab 2 mg with 1 mg norethisterone acetate (10) and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6) .................... 5.40 (10.00) 28 28 OP Kliovance 28 OP Cliane IMM KliogestIMM 28 OP Trisequens ✓ Nuvelle

OESTROGENS WITH MEDROXYPROGESTERONE – See prescribing guideline on page 85 ❋ Tab 625 mcg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28) .................................... 5.40 28 OP (11.45) ❋ Tab 625 mcg conjugated equine with 5 mg medroxyprogesterone acetate tab (28) .................................... 5.40 (11.45) ❋ Tab 625 mcg conjugated equine (14), with 5 mg medroxyprogesterone acetate tab (14) ........................................ 5.40 (10.45) ❋ Tab 625 mcg conjugated equine (28) and 5 mg medroxyprogesterone acetate tab (28) ................................ 5.40 (11.00) ❋ Tab 625 mcg conjugated equine (28) and 10 mg medroxyprogesterone acetate tab (14) .............................. 5.40 (10.00) 28 OP

Premia 2.5 Continuous

Premia 5 Continuous 28 OP Premia 5 56 OP Menoprem Continuous 42 OP Menoprem

OTHER OESTROGEN PREPARATIONS

ETHINYLOESTRADIOL ❋ Tab 10 mcg .................................................................................... 16.52 (17.60) OESTRIOL ❋ Tab 2 mg .......................................................................................... 7.00 100 Paines and Byrne 30 ✓ Ovestin

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Other Progestogen Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

OTHER PROGESTOGEN PREPARATIONS

DYDROGESTERONE Tab 10 mg ...................................................................................... 27.50 (29.90) 50 Duphaston

LEVONORGESTREL - Special Authority - Retail Pharmacy Levonorgestrel – releasing intrauterine system ❋ 20 mcg/24 hr Levonorgestrel ........................................................ 269.50 1 ✓ Mirena Special Authority for Subsidy - Form: SA0639 Initial application - (No previous use) only from a relevant specialist or general practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has a clinical diagnosis of heavy menstrual bleeding; and 2 The patient has failed to respond to or is unable to tolerate other appropriate pharmaceutical therapies as per the Heavy Menstrual Bleeding Guidelines; and 3 Either: 3.1 serum ferritin level < 16 mg/l (within the last 12 months); or 3.2 haemoglobin level < 120 g/l. Note Applications are not to be made for use in patients as contraception except where they meet the above criteria. Initial application - (Previous use before 1 October 2002) only from a relevant specialist or general practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 4 The patient had a clinical diagnosis of heavy menstrual bleeding; and 5 Patient demonstrated clinical improvement of heavy menstrual bleeding; and 6 Applicant to state date of the previous insertion (Details to be attached to application). Note Applications are not to be made for use in patients as contraception except where they meet the above criteria Renewal only from a relevant specialist or general practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 7 Either: 7.1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 7.2 Previous insertion was removed or expelled within 3 months of insertion; and 8 Applicant to state date of the previous insertion (Details to be attached to application). MEDROXYPROGESTERONE ACETATE - Retail pharmacy-specialist ❋ Tab 100 mg ................................................................................. 104.26 ❋ Tab 200 mg .................................................................................... 78.06 (87.82) ❋ Tab 500 mg .................................................................................. 211.68 NORETHISTERONE - Available on a PSO ❋ Tab 5 mg ........................................................................................ 25.00 PROGESTERONE Inj 50 mg per ml, 2 ml .................................................................... 35.97 (44.85) 100 30 56 100 10 Gestone ✓ Provera Provera ✓ Farlutal ✓ Primolut N

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Thyroid and Antithyroid Agents Trophic Hormones

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

THYROID AND ANTITHYROID AGENTS

CARBIMAZOLE ❋ Tab 5 mg .......................................................................................... 3.13 THYROXINE ❋ Tab 50 mcg .................................................................................... 34.00 ❋ Tab 100 mcg .................................................................................. 38.00 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. 100 1000 1000 ✓ Neo-Mercazole ✓ Eltroxin ✓ Eltroxin

TROPHIC HORMONES

GROWTH HORMONE BIOSYNTHETIC HUMAN - Special Authority - Access by application Inj 10 iu per vial 2,000.00 10 Inj 24 iu per vial ......................................................................... 2,400.00 5 Cartridge 16 iu per vial .............................................................. 1,600.00 5 Cartridge 24 iu per vial .............................................................. 2,400.00 5 Cartridge 36 iu per vial .............................................................. 3,600.00 5 ✓ Saizen ✓ Saizen ✓ Genotropin ✓ Saizen ✓ Genotropin

Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Note: Applications to be made on the approved forms which are available from: Theresa Delany, Administrative Co-ordinator, Liggins Institute, Faculty of Medicine and Health Science, University of Auckland, Private Bag 92019, AUCKLAND Tel: (09) 373 7599 ext 86229, Fax: (09) 373 8763, Email: t.delany@auckland.ac.nz RECOMBINANT HUMAN GROWTH HORMONE - Special Authority - Access by application Inj 5 mg........................................................................................ 300.00 1 Inj 10 mg...................................................................................... 600.00 1 Inj 15 mg...................................................................................... 900.00 1 ✓ Norditropin SimpleXx 5mg ✓ Norditropin SimpleXx 10mg ✓ Norditropin SimpleXx 15mg

GnRH Analogues

BUSERELIN ACETATE - Special Authority - Hospital pharmacy [HP3] Inj 1 mg per ml, 5.5 ml ................................................................. 195.00 (272.53) GOSERELIN ACETATE - Special Authority - Hospital pharmacy [HP3] Inj 3.6 mg..................................................................................... 277.00 Inj 10.8 mg - Subsidised only for treatment of prostate cancer. ...... 739.60 LEUPRORELIN - Special Authority - Hospital pharmacy [HP3] Inj 3.75 mg Subsidised only for treatment of prostate cancer, endometriosis and precocious puberty ..................................... 277.00 Inj 11.25 mg Subsidised only for treatment of prostate cancer....... 739.60 NAFARELIN ACETATE - Special Authority - Hospital pharmacy [HP3] Nasal soln 2 mg per ml ................................................................ 221.60 (311.63) 2 Suprefact 1 1 ✓ Zoladex ✓ Zoladex

1 1 8 ml OP

✓ Lucrin Depot ✓ Lucrin Depot

Synarel

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Trophic Hormones

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Special Authority for Subsidy - Form: SA0471 Initial application - (Breast cancer) from any medical practitioner. Approvals valid for 1 year for applications meeting the following criteria: Breast cancer in premenopausal women unwilling or unable to undergo surgical or radiation oophorectomy. Initial application - (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year for applications meeting the following criteria: Advanced prostatic cancer when orchidectomy is contraindicated or where the patient strongly opposes orchidectomy. Note Not to be prescribed with an anti-androgen except for a period of three weeks, if necessary, when GnRH analogue therapy is intiated. Initial application - (Endometriosis) only from a gynaecologist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Endometriosis; and 2 Either: 2.1 6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has proven ineffective; or 2.2 The patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months. Note The maximum treatment period for a GnRH analogue is: - 3 months to assess whether surgery is appropriate - 3 months for infertile patients after surgery - 6 months for patients with symptoms of endometriosis. After the ﬁrst 3 months patients should be assessed to determine whether there has been a satisfactory response to the ﬁrst 3 months treatment. Initial application - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year for applications meeting the following criteria: Patients affected by gonadotropin dependent precocious puberty. Renewal - (Breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Renewal - (Endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Either: 3 Both: 3.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 3.2 Surgery is inappropriate; or 4 The ﬁrst three months of therapy did not follow surgery for infertility. Renewal - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

✓

fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC excluding Contraceptive Hormones

Vasopressin Agonists Other Endocrine Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

VASOPRESSIN AGONISTS

DESMOPRESSIN Inj 4 mcg per ml, 1 ml - Special Authority - Hospital pharmacy [HP3] ... 67.18 ▲ Nasal spray 10 mcg per dose 50 dose - Retail pharmacy-specialist 78.06 ▲ Nasal drops 100 mcg per ml - Retail pharmacy-specialist ............... 39.03 10 5 ml OP 2.5 ml OP ✓ Minirin ✓ Minirin ✓ Minirin

Special Authority for Subsidy - Form: SA0090 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Patient cannot use desmopressin nasal spray or nasal drops. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

OTHER ENDOCRINE AGENTS

CABERGOLINE a) Restriction of two tablets per prescription. b) Special Authority available to waive the above quantity restriction. - Retail pharmacy Tab 0.5 mg ................................................................................... 105.03 8 ✓ Dostinex Special Authority for Waiver of Rule - Form: SA0175 Initial application only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years for applications meeting the following criteria: Pathological hyperprolactinemia. Renewal only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. CLOMIPHENE CITRATE - Retail pharmacy-specialist Subsidised only on a prescription for a female patient. Tab 50 mg ........................................................................................ 2.50 DANAZOL - Retail pharmacy-specialist Cap 100 mg ................................................................................... 18.00 Cap 200 mg ................................................................................... 26.00 GESTRINONE - Retail pharmacy-specialist Cap 2.5 mg .................................................................................. 101.87 METYRAPONE - Hospital pharmacy [HP3]-specialist Cap 250 mg ................................................................................. 217.08

5 30 30 8 50

✓ Phenate ✓ D-Zol ✓ D-Zol ✓ Dimetriose ✓ Metopirone

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

Anthelmintics Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTHELMINTICS

MEBENDAZOLE - Only on a prescription Tab 100 mg .................................................................................... 3.79 (7.59) Oral liq 100 mg per 5 ml ................................................................... 2.18 (7.17) PYRANTEL EMBONATE Tab 125 mg ...................................................................................... 5.31 (7.00) Tab 250 mg ...................................................................................... 3.76 (4.95) Oral liq 50 mg per ml ........................................................................ 2.52 (4.45) 6 Vermox 15 ml Vermox 18 Combantrin 6 Combantrin 15 ml Combantrin

ANTIBACTERIALS

For topical antibacterials, refer to DERMATOLOGICALS, page 66, and SENSORY ORGANS page 151.

Cephalosporins and Cephamycins

CEFACLOR MONOHYDRATE Cap 250 mg ................................................................................... 28.90 Grans for oral liq 125 mg per 5 ml .................................................... 3.92 CEFAMANDOLE NAFATE - Hospital pharmacy [HP3]-specialist a) Subsidised only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly. Inj 500 mg........................................................................................ 3.60 (4.30) Inj 1 g .............................................................................................. 4.30 CEFAZOLIN SODIUM - Hospital pharmacy [HP3] a) Only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly. Inj 500 mg........................................................................................ 2.03 Inj 1 g .............................................................................................. 4.16 CEFOXITIN SODIUM - Hospital pharmacy [HP3]-specialist a) Subsidised only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly. Inj 1 g ............................................................................................ 46.25 CEFTRIAXONE SODIUM - Hospital pharmacy [HP3]-specialist a) Subsidised only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly. Inj 250 mg........................................................................................ 4.00 Inj 500 mg........................................................................................ 7.00 39.60 Inj 1 g .............................................................................................. 9.00 62.50 1 1 Mandol ✓ Mandol 100 100 ml ✓ Ranbaxy-Cefaclor ✓ Ranbaxy-Cefaclor

1 1

✓ Novartis ✓ Novartis

✓ Mayne

1 1 5 1 5

✓ Rocephin IV ✓ Rocephin ✓ Novartis ✓ Rocephin ✓ Novartis

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer CEFUROXIME AXETIL a) Only if prescribed for prophlyaxis of endocarditis; and b) The prescription is endorsed accordingly. Tab 250 mg .................................................................................... 98.75 CEFUROXIME SODIUM a) Hospital pharmacy [HP3] - Maximum of 750 mg per prescription; or b) Hospital pharmacy [HP3]-specialist - Only if prescribed for a dialysis or cystic ﬁbrosis patient; and - The prescription is endorsed accordingly. Inj 250 mg...................................................................................... 20.97 Inj 750 mg...................................................................................... 48.00 Inj 1.5 g ....................................................................................... 123.55 CEPHALEXIN MONOHYDRATE - Hospital pharmacy [HP3] Cap 250 mg ..................................................................................... 6.00 Tab 500 mg .................................................................................... 10.90 Grans for oral liq 125 mg per 5 ml .................................................... 7.00 Grans for oral liq 250 mg per 5 ml .................................................... 9.50 CEPHRADINE - Hospital pharmacy [HP3] Cap 250 mg ................................................................................... 14.50 Cap 500 mg ................................................................................... 19.85 Inj 500 mg...................................................................................... 16.78 Inj 1 g ............................................................................................ 31.59 Injections (both 500 mg and 1 g) subsidised: a) Only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly.

✓ Zinnat

10 10 10

✓ Mayne ✓ Zinacef ✓ Mayne ✓ Zinacef ✓ Keﬂex ✓ Keﬂex ✓ Keﬂex ✓ Keﬂex ✓ Velosef ✓ Velosef ✓ Velosef ✓ Velosef

20 20 100 ml 100 ml 24 24 5 5

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Macrolides

AZITHROMYCIN Tab 500 mg ................................................................................... 15.53 2 tab OP ✓ Zithromax a) Subsidised only if prescribed for patients with uncomplicated urethritis or cervicitis proven or presumed to be due to chlamydia trachomatis and their sexual contacts and prescription is endorsed “certiﬁed condition”. b) Maximum one pack (two 500 mg tablets) per prescription. CLARITHROMYCIN – Special Authority available - Retail pharmacy Tab 250 mg ..................................................................................... 9.40 10 ✓ Klacid Grans for oral liq 125 mg per 5 ml ................................................. 23.12 70 ml ✓ Klacid a) Maximum of 500 mg per prescription; or Special Authority for Subsidy - Form: SA0657 Initial application - (Helicobacter pylori infections) only from a general practitioner or relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Eradication of Helicobacter pylori in patient with proven infection; and 2 Peptic ulcer disease proven by endoscopy. Note Maximum of two prescriptions (two courses) per patient. Initial application - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 3 Mycobacterium Avium Intracellulare Complex infections in patient with AIDS; or 4 Atypical and drug-resistant mycobacterial infection; or 5 All of the following: 5.1 Prophylaxis against disseminated Mycobacterium Avium Intracellulare Complex infection; and 5.2 HIV infection; and 5.3 CD4 count £ 50 cells/mm3. Renewal - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg - Available on a PSO .................................................... 14.99 Grans for oral liq 200 mg per 5 ml - Available on a PSO .................... 2.75 Grans for oral liq 400 mg per 5 ml - Available on a PSO .................... 4.99 ERYTHROMYCIN LACTOBIONATE Inj 300 mg........................................................................................ 5.34 Inj 1 g ............................................................................................. 6.50 ERYTHROMYCIN STEARATE Tab 250 mg - Available on a PSO .................................................... 14.95 (22.29) Tab 500 mg .................................................................................... 29.90 (44.58) ROXITHROMYCIN Tab 150 mg .................................................................................... 14.95 Tab 300 mg .................................................................................... 29.90 100 100 ml 100 ml 1 1 100 ERA 100 ERA 50 50 ✓ Romicin ✓ Romicin ✓ E-Mycin ✓ E-Mycin ✓ E-Mycin ✓ Mayne ✓ ERA

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Penicillins

AMOXYCILLIN Cap 250 mg - Available on a PSO ................................................... 17.33 Cap 500 mg ................................................................................... 27.72 Grans for oral liq 125 mg per 5 ml - Available on a PSO .................... 1.08 Grans for oral liq 250 mg per 5 ml - Available on a PSO .................... 1.38 Drops 125 mg per 1.25 ml ............................................................... 4.75 Inj 250 mg ...................................................................................... 8.43 Inj 500 mg .................................................................................... 11.06 Inj 1 g - Available on a PSO .......................................................... 15.66 AMOXYCILLIN CLAVULANATE - Available on a PSO Tab amoxycillin 500 mg with potassium clavulanate 125 mg ............. 6.40 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml........................................................ 2.75 Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml ....................................................... 4.75 BENZATHINE PENICILLIN Inj 1.2 mega u per 2 ml - Available on a PSO................................. 112.00 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u - Available on a PSO .................................................... 6.99 DICLOXACILLIN Cap 250 mg .................................................................................... 2.47 (4.14) Cap 500 mg ..................................................................................... 3.83 (8.24) Grans for oral liq 125 mg per 5 ml .................................................... 3.55 (3.60) Inj 500 mg........................................................................................ 5.45 Inj 1 g .............................................................................................. 7.54 FLUCLOXACILLIN SODIUM Cap 250 mg - Available on a PSO ................................................... 20.40 Cap 500 mg ................................................................................... 68.50 Grans for oral liq 125 mg per 5 ml - Available on a PSO ...................... 2.55 Grans for oral liq 250 mg per 5 ml - Available on a PSO ...................... 3.35 Inj 250 mg ....................................................................................... 4.66 Inj 500 mg........................................................................................ 5.45 Inj 1 g - Available on a PSO............................................................... 7.54 PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg - Available on a PSO .............................. 4.29 Cap potassium salt 500 mg .............................................................. 8.15 Grans for oral liq benzathine 125 mg per 5 ml - Available on a PSO ........ 1.48 Grans for oral liq benzathine 250 mg per 5 ml - Available on a PSO ........ 1.68 PROCAINE PENICILLIN - Available on a PSO Inj 1.5 mega u ............................................................................... 47.60 500 500 100 ml 100 ml 30 ml OP 5 5 5 20 100 ml 100 ml 10 10 24 Diclocil 24 Diclocil 100 ml 5 5 250 500 100 ml 100 ml 5 5 5 50 50 100 ml 100 ml 5 Diclocil ✓ Diclocil ✓ Diclocil ✓ Staphlex ✓ Staphlex ✓ AFT ✓ AFT ✓ Flucloxin ✓ Flucloxin ✓ Flucloxin ✓ Cilicaine VK ✓ Cilicaine VK ✓ AFT ✓ AFT ✓ Cilicaine ✓ Apo-Amoxi ✓ Apo-Amoxi ✓ Ospamox ✓ Ospamox ✓ Ospamox Paediatric Drops ✓ Ibiamox ✓ Ibiamox ✓ Ibiamox ✓ Augmentin ✓ Augmentin ✓ Augmentin ✓ Bicillin ✓ Biochemie

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Tetracyclines

DOXYCYCLINE HYDROCHLORIDE - Available on a PSO ❋ Tab 50 mg ........................................................................................ 2.90 (6.00) ❋ Tab 100 mg ...................................................................................... 8.10 MINOCYCLINE HYDROCHLORIDE ❋ Tab 50 mg ........................................................................................ 5.79 (12.05) ❋ Cap 100 mg ................................................................................... 19.32 (52.04) 30 250 60 Mino-tabs 100 Minomycin Doxy-50 ✓ Doxine

Other Antibiotics

For Topical Antibiotics, refer also to DERMATOLOGICALS, Antibactierials Topical, page 66 CIPROFLOXACIN - Retail pharmacy-specialist Tab 250 mg .................................................................................. 11.42 28 Tab 500 mg .................................................................................... 20.44 28 Tab 750 mg .................................................................................... 29.87 28 CLINDAMYCIN a) Maximum of 450 mg per prescription; or b) Retail pharmacy-specialist. Cap hydrochloride 150 mg ............................................................. 11.39 Inj phosphate 150 mg per ml, 4 ml ................................................. 19.45 COLISTIN SULPHOMETHATE - Hospital pharmacy [HP3]-specialist a) Only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly. Inj 150 mg...................................................................................... 49.54 CO-TRIMOXAZOLE ❋ Tab trimethoprim 80 mg and sulphamethoxazole 400 mg (Available on a PSO) .................................................................. 20.80 ❋ Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml (Available on a PSO) .......................................... 7.20

✓ Cipﬂox ✓ Cipﬂox ✓ Cipﬂox

16 1

✓ Dalacin C ✓ Dalacin C

✓ Colymycin-M

500 500 ml

✓ Trisul ✓ Trisul

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antibacterials

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer FUSIDIC ACID - Hospital pharmacy [HP3]-specialist Tab 250 mg .................................................................................... 34.50 Inj 500 mg sodium fusidate per 10 ml ............................................. 12.87 (16.95) Injection 500 mg subsidised: 12 1 ✓ Fucidin Fucidin

a) Only if prescribed for a dialysis or cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly.

GENTAMICIN SULPHATE - Hospital pharmacy [HP3]

a) Only if prescribed for a dialysis or cystic ﬁbrosis patient or for prophylaxis of endocarditis and; b) The prescription is endorsed accordingly.

Inj 10 mg per ml, 1 ml ...................................................................... 6.00 Inj 10 mg per ml, 2 ml .................................................................... 16.00 Inj 40 mg per ml, 2 ml ...................................................................... 5.70 5 5 10

✓ Mayne ✓ Mayne ✓ Pharmacia

TOBRAMYCIN - Hospital pharmacy [HP3]

a) Only if prescribed for a dialysis or a cystic ﬁbrosis patient; and b) The prescription is endorsed accordingly.

Inj 40 mg per ml, 2 ml .................................................................... 24.75 TRIMETHOPRIM ❋ Tab 300 mg - Available on a PSO ..................................................... 6.50 VANCOMYCIN HYDROCHLORIDE - Hospital pharmacy [HP3] 5 50 ✓ Mayne ✓ TMP

a) Only if prescribed for a dialysis or cystic ﬁbrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis; and b) The prescription is endorsed accordingly.

Inj 50 mg per ml, 10 ml .................................................................... 6.40 1 3 DBL

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antifungals Antimalarials Antitrichomonal Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIFUNGALS

For topical antifungals refer to DERMATOLOGICALS page 67, GENITO URINARY, page 80 FLUCONAZOLE - Hospital pharmacy [HP2] & [HP3]-specialist Cap 50 mg ................................................................................... 156.88 Cap 150 mg ................................................................................... 16.81 Cap 200 mg ................................................................................. 627.59 ITRACONAZOLE - Hospital pharmacy [HP2] & [HP3]-specialist Cap 100 mg ................................................................................... 37.09 KETOCONAZOLE - Retail pharmacy-specialist Tab 200 mg .................................................................................... 38.12 NYSTATIN Tab 500,000 u ................................................................................. 9.60 Cap 500,000 u ............................................................................... 11.64 TERBINAFINE - Hospital pharmacy [HP2] & [HP3]-specialist Tab 250 mg .................................................................................... 25.00 53.57 28 1 28 15 30 50 50 14 30 ✓ Diﬂucan ✓ Diﬂucan ✓ Diﬂucan ✓ Sporanox ✓ Nizoral ✓ Nilstat ✓ Nilstat ✓ Lamisil ✓ Terbaﬁn

ANTIMALARIALS

HYDROXYCHLOROQUINE SULPHATE ❋ Tab 200 mg .................................................................................... 28.26 100 ✓ Plaquenil

ANTITRICHOMONAL AGENTS

METRONIDAZOLE Tab 200 mg - Available on a PSO ...................................................... 9.50 Tab 400 mg ................................................................................... 17.50 Oral liq benzoate 200 mg per 5 ml .................................................. 17.81 (28.56) Suppos 500 mg.............................................................................. 22.25 Suppos 1 g..................................................................................... 30.28 ORNIDAZOLE Tab 500 mg .................................................................................... 12.38 TINIDAZOLE Tab 500 mg .................................................................................. 41.67 100 100 100 ml 10 10 10 40 ✓ Trichozole ✓ Trichozole Flagyl - S ✓ Flagyl ✓ Flagyl ✓ Tiberal ✓ Dyzole

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antituberculotics and Antileprotics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTITUBERCULOTICS AND ANTILEPROTICS

Note: Effective 1 February 1999 there is no co-payment charge for all pharmaceuticals listed in the Antituberculotics and Antileprotics group. ETHAMBUTOL - Retail pharmacy-specialist ❋ Tab 400 mg .................................................................................... 28.00 ISONIAZID - Retail pharmacy-specialist ❋ Tab 100 mg ................................................................................. 21.00 ❋ Tab 100 mg with rifampicin 150 mg ................................................ 90.04 ❋ Tab 150 mg with rifampicin 300 mg .............................................. 179.57 100 ✓ Apo-Ethambutol ✓ Myambutol ✓ HMG ✓ Riﬁnah ✓ Riﬁnah

100 100 100

PYRAZINAMIDE - Retail pharmacy-specialist Tab 500 mg .................................................................................... 59.00 100 ✓ AFT-Pyrazinamide AFT-Pyrazinamide is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b)be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. RIFABUTIN - Hospital pharmacy [HP3]-specialist ❋ Cap 150 mg ................................................................................ 213.19 RIFAMPICIN - Retail pharmacy-specialist ❋ Cap 150 mg .................................................................................. 58.66 ❋ Cap 300 mg ................................................................................ 122.36 ❋ Tab 600 mg ................................................................................. 114.40 ❋ Oral liq 100 mg per 5 ml ................................................................. 12.66 30 100 100 30 60 ml ✓ Mycobutin ✓ Rifadin ✓ Rifadin ✓ Rifadin ✓ Rifadin

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antivirals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIVIRALS Hepatitis B Treatment

Special Authority for Subsidy - Form: SA0538 Initial application only from a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Any of the following: 1.1 All of the following: 1.1.1 HBsAg positive for more than 6 months; and 1.1.2 HBeAg positive or HBV DNA positive deﬁned as >0.6 pg/ml by quantitative PCR at reference laboratory; and 1.1.3 ALT greater than twice upper limit of normal or stage 3 or 4 ﬁbrosis on liver histology clinical/radiological evidence of cirrhosis; or 1.2 HBV DNA positive cirrhosis prior to liver transplantation; or 1.3 HBsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant; and 2 All of the following: 2.1 No continuing alcohol abuse or intravenous drug use; and 2.2 Not coinfected with HCV, HDV, or HIV; and 2.3 Neither ALT nor AST greater than 10 times upper limit of normal; and 2.4 No known or suspected hepatocellular carcinoma (AFP > 100 or liver mass on imaging) unless awaiting liver transplantation or other curative treatment; and 2.5 Not pregnant or breast feeding; and 2.6 No history of hypersensitivity to lamivudine; and 2.7 No previous lamivudine therapy with breakthrough (presumed YMDD mutant). Renewal only from a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 3 Have maintained continuous treatment with lamivudine; and 4 Any of the following: 4.1 Most recent test result shows continuing biochemical response (normal ALT); or 4.2 HBeAg negative; or 4.3 HBV DNA negative deﬁned as < 0.6 pg/ml by quantitative PCR at reference laboratory; and 5 Either: 5.1 Have had less than three years of access to treatment with lamivudine; or 5.2 There is evidence of cirrhosis. LAMIVUDINE - Special Authority - Retail pharmacy Tab 100 mg .................................................................................. 143.00 Oral liq 5 mg per ml ........................................................................ 90.00 28 240 ml ✓ Zefﬁx ✓ Zefﬁx

100

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Herpes Treatment

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

HERPES TREATMENT

Refer also to SENSORY, Eye Preparations, Anti-infective, page 152.

First episode genital herpes

ACICLOVIR ❋ Tab dispersible 200 mg - Special Authority available - Retail Pharmacy ....10.00 100 ✓ Acicvir a) Maximum of 25 tablets per prescription or b) Special Authority for Waiver of Rule - Form: SA0303 Initial application only from a paediatric surgeon or paediatrician. Approvals valid for 1 year for applications meeting the following criteria: Children post liver transplant. Renewal only from a paediatric surgeon or paediatrician. Approvals valid for 1 year for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

Recurrent episodes of genital herpes

ACICLOVIR ❋ Tab dispersible 400 mg................................................................... 36.00 240 ✓ Acicvir

Acute herpes zoster

ACICLOVIR ❋ Tab dispersible 800 mg................................................................... 26.70 a) Maximum of 35 tablets per prescription. 100 ✓ Acicvir

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

101

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antiretrovirals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIRETROVIRALS

Special Authority for Subsidy - Form: SA0575 Initial application - (Conﬁrmed HIV/AIDS) only from a named general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Conﬁrmed HIV/AIDS; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Both: 2.2.1 Asymptomatic patient; and 2.2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Asymptomatic patient; and 2.3.2 Patient has viral load counts > 10,000 copies per ml or equivalent value on the Chiron test; or 2.4 All of the following: 2.4.1 Asymptomatic patient; and 2.4.2 Patient aged 1 to 5 years; and 2.4.3 CD4 counts < 1,000 cells/mm3; or 2.5 All of the following: 2.5.1 Asymptomatic patient; and 2.5.2 Patient aged 1 to 5 years; and 2.5.3 CD4 counts < 0.25 × total white cell count; or 2.6 All of the following: 2.6.1 Asymptomatic patient; and 2.6.2 Patient aged 6 years and over; and 2.6.3 CD4 counts < 500 cells/mm3. Note Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors, Combinations including ritonavir plus indinavir or saquinavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. Initial application - (Percutaneous exposure) only from a named general physician. Approvals valid for 6 weeks for applications meeting the following criteria: Person with percutaneous exposure to blood known to be HIV positive. Note Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. Initial application - (Prevention of maternal transmission) only from a named general physician. Approvals valid for 1 year for applications meeting the following criteria: Both: 3 Treatment with zidovudine; and 4 Either: 4.1 Prevention of maternal foetal transmission; or 4.2 Treatment of the newborn for up to six weeks. Renewal - (Conﬁrmed HIV/AIDS) only from a named general physician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

102

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antiretrovirals

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Non-nucleoside reverse transcriptase inhibitors

Special Authority – anti-retrovirals refer page 102

EFAVIRENZ - Special Authority - Hospital pharmacy [HP1] Cap 50 mg ................................................................................... 158.33 Cap 100 mg ................................................................................. 158.33 Cap 200 mg ................................................................................. 474.99 Tab 600 mg .................................................................................. 474.99 NEVIRAPINE - Special Authority - Hospital pharmacy [HP1] Tab 200 mg .................................................................................. 319.80 30 30 90 30 60 ✓ Stocrin ✓ Stocrin ✓ Stocrin ✓ Stocrin ✓ Viramune

Nucleoside reverse transcriptase inhibitors

Special Authority – anti-retrovirals refer page 102 ABACAVIR SULPHATE - Special Authority - Hospital pharmacy [HP1] Tab 300 mg .................................................................................. 458.00 Oral liq 20 mg per ml .................................................................... 100.00 DIDANOSINE (ddI) - Special Authority - Hospital pharmacy [HP1] Cap 125 mg ................................................................................. 115.05 Cap 200 mg ................................................................................. 184.08 Cap 250 mg ................................................................................. 230.10 Cap 400 mg ................................................................................. 368.16 LAMIVUDINE - Special Authority - Hospital pharmacy [HP1] Tab 150 mg .................................................................................. 307.20 Oral liq 10 mg per ml .................................................................... 100.00 STAVUDINE (d4T) - Special Authority - Hospital pharmacy [HP1] Cap 20 mg .................................................................................. 317.10 Cap 30 mg .................................................................................. 377.80 Cap 40 mg .................................................................................. 503.80 Powder for oral soln 1 mg per ml .................................................. 100.76 ZIDOVUDINE (AZT) - Special Authority - Hospital pharmacy [HP1] Cap 100 mg ................................................................................. 290.00 Oral liq 10 mg per ml ...................................................................... 58.00 60 240 ml OP 30 30 30 30 60 240 ml OP 60 60 60 200 ml OP 100 200 ml OP ✓ Ziagen ✓ Ziagen ✓ Videx EC ✓ Videx EC ✓ Videx EC ✓ Videx EC ✓ 3TC ✓ 3TC ✓ Zerit ✓ Zerit ✓ Zerit ✓ Zerit ✓ Retrovir ✓ Retrovir ✓ Combivir

ZIDOVUDINE (AZT) with LAMIVUDINE - Special Authority - Hospital pharmacy [HP1] Tab 300 mg with lamivudine 150 mg ............................................ 667.20 60

Note: Combivir counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority

Protease inhibitors

Special Authority – anti-retrovirals refer page 102 INDINAVIR - Special Authority - Hospital pharmacy [HP1] Cap 200 mg ................................................................................. 519.75 Cap 400 mg ................................................................................. 519.75 NELFINAVIR - Special Authority - Hospital pharmacy [HP1] Tab 250 mg .................................................................................. 600.00 Powder 50 mg per g ....................................................................... 55.44 RITONAVIR - Special Authority - Hospital pharmacy [HP1] Cap 100 mg ................................................................................. 242.55 Oral liq 80 mg per ml .................................................................... 277.28 ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once 360 180 270 144 g OP 168 240 ml OP ✓ Crixivan ✓ Crixivan ✓ Viracept ✓ Viracept ✓ Norvir ✓ Norvir

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

103

INFECTIONS - AGENTS FOR SYSTEMIC USE

Antiretrovirals Antiretrovirals - Additional Therapy Urinary Tract Infections

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer SAQUINAVIR - Special Authority - Hospital pharmacy [HP1] Cap 200 mg ................................................................................. 271.00 519.75

180 270

✓ Fortovase ✓ Invirase

ANTIRETROVIALS - ADDITIONAL THERAPY

LOPINAVIR WITH RITONAVIR - Special Authority - Hospital Pharmacy [HP1] Cap 133.3 mg with ritonavir 33.3 mg ............................................ 735.00 Oral liq 80 mg with ritonavir 20 mg per ml..................................... 735.00 180 300 ml ✓ Kaletra ✓ Kaletra

Special Authority for Subsidy - Form: SA0721 Initial application only from a named specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 The patient already has a Special Authority approval for anti-retroviral therapy (Details to be attached to application); and 2 Kaletra is to be used as a salvage therapy in place of one protease inhibitor; and 3 The patient must have trialed for at least six months and have failed on currently funded NNRTI based regimens or triple NRTI regimens; and 4 The patient must have trialed for at least six months and have failed on currently funded PI based regimens. Note Failure is deﬁned as: a) not achieving HIV RNA < 400 copies/ml after 24 weeks of a regimen, or b) an increase of HIV RNA to > 400 copies/ml on two separate occasions not less than one month apart, after suppression to < 400 copies/ml in a patient taking the regimen.

URINARY TRACT INFECTIONS

HEXAMINE HIPPURATE ❋ Tab 1 g ........................................................................................... 18.40 (36.99) NITROFURANTOIN ❋ Tab 50 mg ..................................................................................... 15.80 ❋ Tab 100 mg .................................................................................... 27.70 NORFLOXACIN a) Maximum of 6 tablets per prescription; or b) Retail pharmacy-specialist. Tab 400 mg .................................................................................. 92.00 100 Hiprex 100 100 ✓ Nifuran ✓ Nifuran

100

✓ Noroxin

104

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Vaccines

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

VACCINES Inﬂuenza Vaccine

INFLUENZA VACCINE (a) Subsidy is available between 1 March and 30 June of each year for patients who meet the following criteria, as set by the Ministry of Health: a) all people 65 years of age and over; b) people under 65 years of age with: i) the following cardiovascular disease: 1) ischaemic heart disease, 2) congestive heart disease, 3) rheumatic heart disease, 4) congenital heart disease, or 5) cerebo-vascular disease; ii) the following chronic respiratory disease: 1) asthma, if on a regular preventative therapy, or 2) other chronic respiratory disease with impaired lung function; iii) diabetes; iv) chronic renal disease; v) any cancer, excluding basal and squamous skin cancers if not invasive; vi) the following other conditions: 1) autoimmune disease, 2) immune suppression, 3) HIV, 4) transplant recipients, 5) neuromuscular and CNS diseases, 6) haemoglobinopathies, or 7) children on long term aspirin. The following conditions are excluded from funding: i) asthma not requiring regular preventative therapy, ii) hypertension and/or dyslipidaemia without evidence of end-organ disease, iii) pregnancy in the absence of another risk factor. (b) Doctors are the only Contractors entitled to claim payment from the Funder for the supply of inﬂuenza vaccine to patients eligible under (a) above for subsidised immunisation and they may only do so in respect of the inﬂuenza vaccine listed in the Pharmaceutical Schedule. (c) Individual DHBs may fund patients over and above the criteria in (a) above. The claiming process for these additional patients should be determined between the DHB and Contractor. (d) The manufacturer’s price as listed for Vaxigrip includes four deliveries to each address per calendar month on which freight will not be charged. (e) Inﬂuenza Vaccine does not fall within the deﬁnition Community Pharmaceutical as it is not funded directly from the Pharmaceutical Budget. Pharmacists are unable to claim for the dispensing of inﬂuenza vaccine from the Funder. Inj ........................................................................................... 59.50 10 ✓ Vaxigrip

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

105

MUSCULO-SKELETAL SYSTEM

Anticholinesterases Anti-inﬂammatory Non Steroidal Drugs (NSAIDs)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTICHOLINESTERASES

NEOSTIGMINE Inj 2.5 mg per ml, 1 ml ................................................................... 22.50 PHYSOSTIGMINE SALICYLATE Inj 500 mcg per ml, 2 ml ................................................................ 55.20 PYRIDOSTIGMINE BROMIDE ▲ Tab 60 mg ...................................................................................... 28.60 50 5 100 ✓ AstraZeneca ✓ Mayne ✓ Mestinon

ANTI-INFLAMMATORY NON STEROIDAL DRUGS (NSAIDs)

Special Authority for Manufacturers Price - Form: SA0291 Initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Inﬂammatory arthritis (including osteoarthritis with an inﬂammatory component); and 2 Stabilised and are well controlled on the particular NSAID medication. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. DICLOFENAC SODIUM - Special Authority available - Retail pharmacy, refer above ❋ Tab EC 25 mg .................................................................................. 3.51 ❋ Tab EC 50 mg ................................................................................ 27.30 ❋ Tab 50 mg dispersible....................................................................... 1.50 (3.67) ❋ Tab long-acting 75 mg .................................................................... 26.86 ❋ Tab long-acting 100 mg .................................................................. 38.17 ❋ Suppos 12.5 mg............................................................................... 1.85 ❋ Suppos 25 mg.................................................................................. 2.22 ❋ Suppos 50 mg - Available on a PSO .................................................. 3.84 ❋ Suppos 100 mg................................................................................ 6.36 ❋ Inj 25 mg per ml, 3 ml - Available on a PSO .................................... 12.00 IBUPROFEN - Special Authority available - Retail pharmacy, refer above ❋ Tab 200 mg ...................................................................................... 2.07 ❋ Tab 400 mg ...................................................................................... 1.78 (7.60) ❋ Tab 600 mg ...................................................................................... 5.32 (22.80) ❋ Tab long-acting 800 mg .................................................................... 3.01 (11.87) ❋‡Oral liq 100 mg per 5 ml .................................................................. 3.49 KETOPROFEN - Special Authority available - Retail pharmacy, refer to page 106 ❋ Cap 100 mg ..................................................................................... 6.72 (19.60) ❋ Cap long-acting 100 mg ................................................................... 6.72 (21.56) ❋ Cap long-acting 200 mg ................................................................. 13.44 (43.12) 100 500 20 500 500 10 10 10 10 5 100 50 100 Brufen 60 200 ml 100 Orudis 100 Oruvail 100 100 Oruvail 200 Brufen Retard ✓ Fenpaed ✓ Apo-Diclofenac ✓ Apo-Diclofenac Voltaren D ✓ Apo-Diclo SR ✓ Apo-Diclo SR ✓ Voltaren ✓ Voltaren ✓ Voltaren ✓ Voltaren ✓ Voltaren ✓ I-Profen Brufen

106

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Anti-inﬂammatory Non Steroidal Drugs (NSAIDs)

MUSCULO-SKELETAL SYSTEM

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer MEFENAMIC ACID - Special Authority available - Retail pharmacy, refer to page 106 ❋ Cap 250 mg ..................................................................................... 2.50 (18.33) NAPROXEN - Special Authority available - Retail pharmacy, refer to page 106 ❋ Tab 250 mg .................................................................................... 26.50 ❋ Tab 500 mg .................................................................................... 53.00 ❋ Tab long-acting 750 mg .................................................................. 18.00 ❋ Tab long-acting 1000 mg ................................................................ 21.00 100 Ponstan 500 500 90 90 ✓ Naxen ✓ Naxen ✓ Naprosyn SR 750 ✓ Naprosyn SR 1000 ✓ Synﬂex ✓ Synﬂex

NAPROXEN SODIUM - Special Authority available - Retail pharmacy, refer to page 106 ❋ Tab 275 mg ...................................................................................... 6.40 100 ❋ Tab 550 mg .................................................................................... 12.80 100 SULINDAC - Special Authority available - Retail pharmacy, refer to page 106 ❋ Tab 100 mg ...................................................................................... 5.32 (12.00) ❋ Tab 200 mg ...................................................................................... 6.72 (20.00) (31.74) TENOXICAM - Special Authority available - Retail pharmacy, refer to page 106 ❋ Tab 20 mg ...................................................................................... 23.75 ❋ Suppos 20 mg.................................................................................. 5.30 ❋ Inj 10 mg per ml, 2 ml vial - Available on a PSO .............................. 10.00 100

Daclin 100 DaclinIMM Clinoril IMM 100 10 5 ✓ Tilcotil ✓ Tilcotil ✓ Tilcotil

TIAPROFENIC ACID - Special Authority available - Retail pharmacy, refer to page 106 ❋ Tab 300 mg ...................................................................................... 4.03 60 (19.26) ❋ Cap long-acting 300 mg ................................................................... 3.77 56 (17.51)

Surgam Surgam SA

NSAIDs Other

INDOMETHACIN ❋ Cap 25 mg ....................................................................................... 5.50 ❋ Cap 50 mg ....................................................................................... 6.50 ❋ Cap long-acting 75 mg ................................................................... 12.50 ❋ Suppos 100 mg.............................................................................. 12.00 PIROXICAM ❋ Tab dispersible 10 mg....................................................................... 3.25 ❋ Tab dispersible 20 mg....................................................................... 5.50 100 100 100 30 50 100 ✓ Rheumacin ✓ Rheumacin ✓ Rheumacin SR ✓ Arthrexin ✓ Piram-D ✓ Piram-D

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

107

MUSCULO-SKELETAL SYSTEM

Antirheumatoidal Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIRHEUMATOIDAL AGENTS

AURANOFIN - Retail pharmacy-specialist Tab 3 mg ........................................................................................ 68.99 (70.97) 60 Ridaura

LEFLUNOMIDE - Special Authority - Retail pharmacy Tab 10 mg .................................................................................... 176.70 30 ✓ Arava Tab 20 mg .................................................................................... 242.10 30 ✓ Arava Tab 100 mg .................................................................................. 121.35 3 ✓ Arava Special Authority for Subsidy - Form: SA0635 Initial application only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Rheumatoid arthritis; and 2 Patient is not a pregnant woman, or a woman of child-bearing age without adequate contraception; and 3 Patient has been unable to tolerate or has a contraindication to or has had an inadequate response to sulphasalazine and methotrexate (individually or in combination). Renewal only from a rheumatologist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 4 Compliance (prescriber determined) with medication; and 5 Improved rheumatoid arthritis symptom control. Note Patient should have full blood count and liver function tests regularly monitored. PENICILLAMINE - Retail pharmacy-specialist Tab 125 mg .................................................................................... 56.30 100 (61.93) D-Penamine Tab 250 mg .................................................................................... 89.98 100 (98.98) D-Penamine D-Penamine is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b)be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. SODIUM AUROTHIOMALATE - Retail pharmacy-specialist Inj 10 mg per 0.5 ml ....................................................................... 76.87 Inj 20 mg per 0.5 ml ..................................................................... 113.17 Inj 50 mg per 0.5 ml ..................................................................... 217.23 10 10 10 ✓ Myocrisin ✓ Myocrisin ✓ Myocrisin

108

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

MUSCULO-SKELETAL SYSTEM

Antirheumatoidal Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Tumour Necrosis Factor (TNF) Inhibitors

ETANERCEPT – Special Authority - Retail pharmacy - Specialist prescription Inj 25 mg...................................................................................... 899.96 4 ✓ Enbrel

Special Authority for Subsidy - Form: SA0667 Initial application only from a named specialist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: 1 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Patient is less than 18 years of age at commencement of treatment; and 3 Patient has had severe active polyarticular course Juvenile Idiopathic Arthritis (JIA) for 6 months duration or longer; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of 10-20mg/m2 weekly in combination with oral corticosteroids (prednisone 0.25 mg/kg); and 5 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15mg/m2 weekly) in combination with one other disease-modifying agent; and 6 Both: 6.1 Either: 6.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swolllen, tender joints; or 6.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 6.2 Physician’s global assessment indicating severe disease; and 7 The patient or their legal guardian consents to details of their treatment being held on a central registry and has signed a consent form outlining conditions of ongoing treatment. Renewal only from a named specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 8 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 9 Either: 9.1 Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count and an improve ment in physician’s global assessment from baseline; or 9.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician’s global assessment from baseline.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

109

MUSCULO-SKELETAL SYSTEM

Enzymes Hyperuricaemia and Antigout Muscle Relaxants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ENZYMES

HYALURONIDASE Inj 1,500 iu per ml .......................................................................... 18.32 (151.50) 10 Hyalase

HYPERURICAEMIA AND ANTIGOUT

ALLOPURINOL ❋Tab 100 mg ....................................................................................... 5.25 14.26 ❋Tab 300 mg ....................................................................................... 2.59 28.00 COLCHICINE ❋ Tab 600 mcg .................................................................................. 16.50 PROBENECID ❋ Tab 500 mg ................................................................................... 55.00 250 500 60 500 100 100 ✓ Allohexal ✓ Progout ✓ Allohexal ✓ Progout ✓ Abbott ✓ AFT

MUSCLE RELAXANTS

BACLOFEN - Retail pharmacy-specialist ❋ Tab 10 mg ........................................................................................ 3.75 DANTROLENE SODIUM - Retail pharmacy-specialist ❋ Cap 25 mg ..................................................................................... 32.96 (37.08) ❋ Cap 50 mg ..................................................................................... 51.70 (58.16) ORPHENADRINE CITRATE Tab 100 mg .................................................................................... 18.54 Inj 30 mg per ml, 2ml ....................................................................... 9.60 (20.50) 100 100 Dantrium 100 Dantrium 100 3 ✓ Norﬂex Norﬂex ✓ Q 200 ✓ Q 300 ✓ Pacifen

QUININE SULPHATE ❋ Tab 200 mg .................................................................................... 16.50 250 ❋ Tab 300 mg .................................................................................... 35.00 500 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations of quinine sulphate.

110

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Anaesthetics Analgesics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANAESTHETICS Local

BUPIVACAINE HYDROCHLORIDE - Special Authority - Hospital pharmacy [HP3] Inj 0.5%, 4 ml ................................................................................ 29.95 5 ✓ Marcain Isobaric Inj 0.5%, 8% glucose, 4 ml ............................................................ 25.00 5 ✓ Marcain Heavy Special Authority for Subsidy - Form: SA0140 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Pain management in the terminally ill; and 2 Standard therapy has failed. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. LIGNOCAINE HYDROCHLORIDE - Available on a PSO Inj 0.5%, 5 ml ................................................................................ 45.00 50 ✓ Xylocaine 0.5% Inj 1%, 5 ml ................................................................................... 42.00 50 ✓ Xylocaine 1.0% Inj 1% 20 ml .................................................................................. 23.50 5 ✓ Xylocaine 1.0% a) Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use. LIGNOCAINE WITH PRILOCAINE HYDROCHLORIDE - Special Authority - Hospital pharmacy [HP3] Crm 2.5% with prilocaine hydrochloride 2.5% ................................ 44.50 30 g OP ✓ Emla Crm 2.5% with prilocaine hydrochloride 2.5% 5 g ........................ 45.00 5 ✓ Emla Special Authority for Subsidy - Form: SA0323 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Children receiving frequent parenteral injections (i.e. intradermal, subcutaneous, intravenous or intramuscular) requiring a 21 gauge or larger bore needle. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

ANALGESICS

Refer also to MUSCULO-SKELETAL, Anti-inﬂammatory, NSAIDs, page 106.

Antipyretics and Non-Opioid Analgesics

ASPIRIN ❋ Tab 300 mg, EC ................................................................................ 7.25 (8.10) ❋ Tab 650 mg, EC ................................................................................ 6.88 NEFOPAM HYDROCHLORIDE Tab 30 mg ...................................................................................... 23.40 Inj 20 mg per ml, 1 ml ...................................................................... 9.10 (72.50) PARACETAMOL ❋ Tab 500 mg - Available on a PSO ...................................................... 9.80 ❋‡Oral liq 120 mg per 5 ml .................................................................. 7.29 a) Available on a PSO b) Not in combination ❋‡Oral liq 250 mg per 5 ml .................................................................. 7.70 a) Available on a PSO b) Not in combination ❋ Suppos 125 mg................................................................................ 4.51 ❋ Suppos 250 mg................................................................................ 9.38 ❋ Suppos 500 mg.............................................................................. 19.50 ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once 100 100 90 5 1,000 1,000 ml 1,000 ml 20 20 50 Aspec 300 ✓ Ecotrin ✓ Acupan Acupan ✓ Pacimol ✓ Junior Parapaed ✓ Six Plus Parapaed ✓ Panadol ✓ Panadol ✓ Paracare

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

111

NERVOUS SYSTEM

Analgesics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Antipyretics with Codeine

PARACETAMOL WITH CODEINE ❋ Tab paracetamol 500 mg with codeine phosphate 8 mg ................... 3.28 100 ✓ Codalgin

Opioid Analgesics

BUPRENORPHINE HYDROCHLORIDE - Only on a controlled drug form Inj 0.3 mg per ml, 1 ml ..................................................................... 7.42 (9.38) CODEINE PHOSPHATE Tab 15 mg ........................................................................................ 7.00 Tab 30 mg ...................................................................................... 10.00 Tab 60 mg ...................................................................................... 20.00 DEXTROPROPOXYPHENE Cap napsylate 100 mg ...................................................................... 8.96 (11.83) DEXTROPROPOXYPHENE WITH PARACETAMOL Tab napsylate 50 mg with paracetamol 325 mg .............................. 14.50 (22.50) Cap hydrochloride 32.5 mg with paracetamol 325 mg..................... 19.91 (24.50) DIHYDROCODEINE TARTRATE Tab long-acting 60 mg .................................................................... 35.70 5 Temgesic ✓ HMG ✓ HMG ✓ HMG

100 100 100 100

Doloxene

500 500

Paradex Capadex ✓ DHC Continus

FENTANYL - Only on a controlled drug form - Special Authority - Retail pharmacy Transdermal patch 2.5 mg, 25 mcg per hour ................................... 55.23 5 ✓ Durogesic 5 ✓ Durogesic Transdermal patch 5 mg, 50 mcg per hour .................................... 100.52 5 ✓ Durogesic Transdermal patch 7.5 mg, 75 mcg per hour ................................. 139.18 5 ✓ Durogesic Transdermal patch 10 mg, 100 mcg per hour ................................ 171.22 Special Authority for Subsidy - Form: SA0743 Initial application only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient is terminally ill and is opioid-responsive; and 2 Either: 2.1 Is unable to take oral medication; or 2.2 Is intolerant to morphine, or morphine is contraindicated. Renewal only from a relevant specialist or general practitioner. Approvals valid for 3 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. METHADONE HYDROCHLORIDE a) Only on a controlled drug form. b) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). Tab 5 mg ......................................................................................... 2.78 10 ✓ Pallidone ‡ Oral liq 2 mg per ml .......................................................................... 6.55 200 ml ✓ Biodone ‡ Oral liq 5 mg per ml .......................................................................... 6.52 200 ml ✓ Biodone Forte ‡ Oral liq 10 mg per ml ........................................................................ 9.50 200 ml ✓ Biodone Extra Forte ✓ Mayne Inj 10 mg per ml, 1 ml .................................................................... 18.95 5 ‡ Oral liq (refer page 162) .................................................................. CE ✓

112

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Analgesics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer MORPHINE HYDROCHLORIDE - Only on a controlled drug form ‡ Oral liq 1 mg per ml .......................................................................... 7.68 ‡ Oral liq 2 mg per ml .......................................................................... 8.15 ‡ Oral liq 5 mg per ml .......................................................................... 9.18 ‡ Oral liq 10 mg per ml ...................................................................... 11.96 MORPHINE SULPHATE - Only on a controlled drug form. Tab immediate release 10 mg ........................................................... 2.64 Cap long-acting 10 mg ..................................................................... 1.48 Tab long-acting 10 mg ...................................................................... 1.80 (4.00) Tab immediate release 20 mg ........................................................... 5.10 Tab long-acting 30 mg ...................................................................... 3.60 (12.00) Cap long-acting 30 mg ..................................................................... 2.95 Tab long-acting 60 mg ...................................................................... 7.20 (16.75) Cap long-acting 60 mg ..................................................................... 5.90 Tab long-acting 100 mg .................................................................... 8.50 Cap long-acting 100 mg ................................................................... 6.97 Cap long-acting 200 mg ................................................................. 13.94 Suppos 5 mg ................................................................................. 17.74 Suppos 10 mg................................................................................ 19.14 Suppos 20 mg................................................................................ 20.31 Suppos 30 mg................................................................................ 31.39 200 ml 200 ml 200 ml 200 ml 10 10 10 10 10 10 10 10 10 10 10 12 12 12 12 ✓ RA-Morph ✓ RA-Morph ✓ RA-Morph ✓ RA-Morph ✓ Sevredol ✓ m-Eslon ✓ LA-Morph MST Continus ✓ Sevredol ✓ LA-Morph MST Continus ✓ m-Eslon ✓ LA-Morph MST Continus ✓ m-Eslon ✓ LA-Morph ✓ m-Eslon ✓ m-Eslon ✓ RMS ✓ RMS ✓ Martindale ✓ RMS ✓ Martindale ✓ RMS ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne

Inj 5 mg per ml, 1 ml - Available on a PSO ........................................ 5.17 5 Inj 10 mg per ml, 1 ml - Available on a PSO ...................................... 4.75 5 Inj 15 mg per ml, 1 ml - Available on a PSO ...................................... 4.70 5 Inj 30 mg per ml, 1 ml - Available on a PSO ...................................... 5.16 5 (MST Continus tab long-acting 10 mg, 30 mg and 60 mg to be delisted 1 October 2005) Martindale brand of morphine suppositories is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b)be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. MORPHINE TARTRATE - Only on a controlled drug form Inj 80 mg per ml, 1.5 ml ................................................................. 20.20 Inj 80 mg per ml, 5 ml .................................................................... 67.37 PETHIDINE HYDROCHLORIDE - Only on a controlled drug form Tab 50 mg ........................................................................................ 3.50 Tab 100 mg ...................................................................................... 4.35 Inj 50 mg per ml, 1 ml - Available on a PSO ...................................... 3.40 Inj 50 mg per ml, 1.5 ml - Available on a PSO ................................... 4.35 Inj 50 mg per ml, 2 ml - Available on a PSO ...................................... 3.80 5 5 10 10 5 5 5 ✓ Mayne ✓ Mayne ✓ HMG ✓ HMG ✓ Mayne ✓ Mayne ✓ Mayne

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

113

NERVOUS SYSTEM

Antidepressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIDEPRESSANTS Cyclic and Related Agents

AMITRIPTYLINE Tab 10 mg ........................................................................................ 2.75 Tab 25 mg ........................................................................................ 3.10 Tab 50 mg ........................................................................................ 4.75 CLOMIPRAMINE HYDROCHLORIDE - Retail pharmacy-specialist Tab 10 mg ...................................................................................... 10.00 Tab 25 mg ...................................................................................... 26.00 DESIPRAMINE HYDROCHLORIDE - Hospital pharmacy [HP3] Tab 25 mg ...................................................................................... 32.32 (36.62) DOTHIEPIN HYDROCHLORIDE Cap 25 mg ....................................................................................... 4.50 Tab 75 mg ........................................................................................ 8.75 DOXEPIN HYDROCHLORIDE Cap 10 mg ....................................................................................... 4.99 Cap 25 mg ....................................................................................... 4.19 (5.20) Cap 50 mg ....................................................................................... 6.99 Cap 75 mg ..................................................................................... 10.99 IMIPRAMINE HYDROCHLORIDE Tab 10 mg ........................................................................................ 4.98 Tab 25 mg ........................................................................................ 8.00 100 100 100 100 500 50 Pertofran 100 100 100 100 100 100 50 50 ✓ Dopress ✓ Dopress ✓ Anten Anten ✓ Anten ✓ Anten ✓ Tofranil ✓ Tofranil ✓ Amitrip ✓ Amitrip ✓ Amitrip ✓ Clopress ✓ Clopress

MAPROTILINE HYDROCHLORIDE - Retail pharmacy-specialist Tab 25 mg ...................................................................................... 33.88 100 Ludiomil (38.18) Tab 75 mg ...................................................................................... 28.46 30 (32.76) Ludiomil MIANSERIN - Special Authority - Hospital pharmacy [HP3]- specialist prescription Specialist must be a psychiatrist. Tab 30 mg ...................................................................................... 29.25 30 ✓ Tolvon Special Authority for Subsidy - Form: SA0057 Initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Depression; and 2 Any of the following: 2.1 Both: 2.1.1 Failed trials with other antidepressants; and 2.1.2 Patient has been maintained on mianserin prior to December 1993; or 2.2 Co-existent bladder neck obstruction; or 2.3 Cardiovascular disease. Renewal only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. NORTRIPTYLINE HYDROCHLORIDE Tab 10 mg ........................................................................................ 4.50 Tab 25 mg ...................................................................................... 30.00 100 500 ✓ Norpress ✓ Norpress

114

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Antidepressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer TRIMIPRAMINE MALEATE Cap 25 mg ....................................................................................... 6.38 Cap 50 mg ..................................................................................... 12.00

100 100

✓ Tripress ✓ Tripress

Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective

TRANYLCYPROMINE SULPHATE Tab 10 mg ...................................................................................... 22.94 50 ✓ Parnate

Monoamine-Oxidase Type A Inhibitors

MOCLOBEMIDE - Retail pharmacy-specialist. Tab 150 mg .................................................................................... 46.00 500 ✓ Apo-Moclobemide Tab 300 mg .................................................................................... 26.11 100 ✓ Apo-Moclobemide Note: There is a signiﬁcant cost differential between moclobemide and ﬂuoxetine (moclobemide being about three times more expensive). For depressive syndromes it is therefore more cost-effective to start treatment with ﬂuoxetine ﬁrst before considering prescribing moclobemide.

Selective Serotonin Reuptake Inhibitors

CITALOPRAM HYDROBROMIDE - Higher subsidy by endorsement available ❋ Tab 20 mg ........................................................................................ 1.58 (4.00) (31.45) 5.49 (Celapram and Cipramil tab 20 mg to be delisted 1 June 2005) 28 28 CelapramIMM CipramilIMM ✓ Arrow-Citalopram

FLUOXETINE HYDROCHLORIDE ❋ Cap 20 mg ....................................................................................... 4.75 90 ✓ Fluox ❋ Tab disp 20 mg, scored .................................................................... 5.90 30 ✓ Fluox a) Fluoxetine hydrochloride tab dispersible 20 mg restricted to a maximum daily dose of 10 mg. b) Tablets can be combined with capsules to facilitate incremental 10 mg doses. PAROXETINE HYDROCHLORIDE - Higher subsidy by endorsement available Tab 20 mg ........................................................................................ 1.90 30 Aropax (35.02) Higher subsidy by endorsement for: Citalopram tab 20 mg x 28 (Celapram) up to $4.00 Citalopram tab 20 mg x 28 (Cipramil) up to $10.00 Paroxetine hydrochloride tab 20 mg x 30 (Aropax) up to $35.02 is available for patients who: • were taking citalopram on 1 February 2000; or paroxetine hydrochloride on February 2001; or • have previously responded to treatment with citalopram or paroxetine hydrochloride; or • have had a trial of ﬂuoxetine and have had to discontinue due to - inability to tolerate the drug due to side effects; or - failed to respond to an adequate dose and duration of treatment; or • have contraindications to ﬂuoxetine (eg pre-existing signiﬁcant levels of nausea, breastfeeding, potential drug interactions). The prescription must be endorsed accordingly.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

115

NERVOUS SYSTEM

Antidepressants Antiepilepsy Drugs

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Other Antidepressants

VENLAFAXINE - Special Authority - Retail pharmacy Cap 75 mg ..................................................................................... 37.27 28 ✓ Efexor XR Cap 150 mg ................................................................................... 45.68 28 ✓ Efexor XR Special Authority for Subsidy - Form: SA0661 Initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 The patient has “treatment resistant” depression; and 2 Either: 2.1 The patient must have had a trial of two different antidepressants and failed to respond to an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 Both: 2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 The patient must have had a trial of one other antidepressant and failed to respond to an adequate dose over an adequate period of time. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Patient has a high risk of relapse (prescriber determined). Note First prescription can be written by a psychiatrist or psychiatric registrar. Subsequent prescriptions may be written by a General Practitioner.

ANTIEPILEPSY DRUGS Agents for Control of Status Epilepticus

CLONAZEPAM Inj 1 mg per ml, 1 ml ........................................................................ 9.36 5 ✓ Rivotril ✓ Stesolid ✓ Stesolid ✓ Mayne Diazemuls

DIAZEPAM Rectal tubes 5 mg - Available on a PSO .......................................... 26.50 5 Rectal tubes 10 mg - Available on a PSO ........................................ 32.38 5 Inj 5 mg per ml, 2 ml - Only on a PSO ............................................... 8.32 5 (15.41) a) Injection subsidised only on a PSO and PSO is endorsed “not for anaesthetic procedures”. PARALDEHYDE ❋ Inj 5 ml ........................................................................................... 58.00 PHENYTOIN SODIUM - Available on a PSO ❋ Inj 50 mg per ml, 2 ml ................................................................... 69.24 ❋ Inj 50 mg per ml, 5 ml ................................................................... 77.27 5 5 5

✓ Mayne ✓ Mayne ✓ Mayne

116

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Antiepilepsy Drugs

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Control of Epilepsy

CARBAMAZEPINE ❋ Tab 200 mg .................................................................................... 14.53 ❋ Tab long-acting 200 mg .................................................................. 16.98 ❋ Tab 400 mg .................................................................................... 34.58 ❋ Tab long-acting 400 mg .................................................................. 39.17 ❋‡Oral liq 100 mg per 5 ml ................................................................ 26.37 CLOBAZAM - Retail pharmacy-specialist Tab 10 mg ........................................................................................ 9.12 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. CLONAZEPAM Tab 500 mcg .................................................................................... 6.00 Tab 2 mg ........................................................................................ 11.00 ‡ Oral drops 2.5 mg per ml .................................................................. 7.38 ETHOSUXIMIDE ❋ Cap 250 mg ................................................................................... 32.90 ❋‡Oral liq 250 mg per 5 ml ................................................................ 11.96 PHENOBARBITONE ❋ Tab 15 mg ...................................................................................... 23.68 ❋ Tab 30 mg ...................................................................................... 24.59 ❋ Oral liq (refer to page 162) .............................................................. CE PHENYTOIN SODIUM ❋ Cap 30 mg ..................................................................................... 15.50 ❋ Tab 50 mg ...................................................................................... 15.63 ❋ Cap 100 mg ................................................................................... 14.69 ❋‡Oral liq 30 mg per 5 ml .................................................................. 11.19 PRIMIDONE ❋ Tab 250 mg .................................................................................... 17.25 SODIUM VALPROATE ❋ Tab 100 mg .................................................................................... 13.65 ❋ Tab 200 mg EC ............................................................................... 27.44 ❋ Tab 500 mg EC ............................................................................... 52.24 ❋‡Oral liq 200 mg per 5 ml ................................................................ 20.48 ❋ Inj 100 mg per ml, 4 ml .................................................................. 41.50 100 100 100 100 250 ml 50 ✓ Tegretol ✓ Teril ✓ Tegretol CR ✓ Tegretol ✓ Teril ✓ Tegretol CR ✓ Tegretol ✓ Frisium

100 100 10 ml OP 200 200 ml 500 500 100 ml 200 200 200 500 ml 100 100 100 100 300 ml 1

✓ Paxam ✓ Paxam ✓ Rivotril ✓ Zarontin ✓ Zarontin ✓ HMG ✓ HMG ✓ ✓ Dilantin ✓ Dilantin Infatab ✓ Dilantin ✓ Dilantin ✓ Apo-Primidone ✓ Epilim Crushable ✓ Epilim ✓ Epilim ✓ Epilim S/F Liquid ✓ Epilim Syrup ✓ Epilim IV

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

117

NERVOUS SYSTEM

Antiepilepsy Drugs

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

New antiepilepsy drugs

Special Authority for Subsidy - Form: SA0652 Initial application - (Single NAED Therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 15 months for applications meeting the following criteria: Any of the following: 1 Was on NAED therapy before 1 September 2000; or 2 Seizures are not adequately controlled with optimal older anti-epilepsy drug treatment; or 3 Seizures are controlled adequately but who experience unacceptable side effects from older anti-epilepsy drug treatment. Note “Optimal older anti-epilepsy drug therapy” is deﬁned as treatment with those older anti-epilepsy drugs which are indicated and clinically appropriate for the patient, given singly and in combination in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Initial application - (Dual NAED Therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 18 months for applications meeting the following criteria: Either: 4 Stabilised on two NAEDs on or before 31 July 2000; or 5 Both: 5.1 A second NAED has been added; and 5.2 An attempt to withdraw one NAED has been made and was unsuccessful. Renewal - (Single or Dual NAED Therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 18 months for applications meeting the following criteria: Either: 6 Both: 6.1 Patient has been prescribed adequate doses of gabapentin, lamotrigine, topiramate or vigabatrin; and 6.2 Patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and/or quality of life ; or 7 Patient has had a previous approval but has not yet trialed monotherapy with all available NAEDs. Note As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anti-convulsant therapy and have assessed quality of life from the patient’s perspective. Renewal - (Triple NAED Therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 6 months for applications meeting the following criteria: Both: 8 Patient is on dual therapy; and 9 Patient switching from vigabatrin to another NAED. Note: Special Authority applications and reapplications must be made by a neurologist or paediatric neurologist. Applications from a general physician or paediatrician will be accepted if access to neurology or paediatric neurology services is limited in the locality in which they practice. GABAPENTIN - Special Authority - Retail pharmacy ▲ Cap 100 mg ................................................................................... 42.08 ▲ Cap 300 mg ................................................................................. 126.23 ▲ Cap 400 mg ................................................................................. 168.30 LAMOTRIGINE - Special Authority - Retail pharmacy ▲ Tab 5 mg dispersible ........................................................................ 9.64 ▲ Tab 25 mg dispersible..................................................................... 51.07 ▲ Tab 50 mg dispersible..................................................................... 86.82 ▲ Tab 100 mg dispersible................................................................. 149.81 100 100 100 30 56 56 56 ✓ Neurontin ✓ Neurontin ✓ Neurontin ✓ Lamictal ✓ Lamictal ✓ Lamictal ✓ Lamictal

118

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Antiepilepsy Drugs Antimigraine Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer TOPIRAMATE - Special Authority - Retail pharmacy ▲ Sprinkle cap 15 mg ........................................................................ 41.20 ▲ Sprinkle cap 25 mg ........................................................................ 51.50 ▲ Tab 25 mg ...................................................................................... 51.50 ▲ Tab 50 mg ...................................................................................... 87.54 ▲ Tab 100 mg .................................................................................. 148.83 ▲ Tab 200 mg .................................................................................. 256.82 VIGABATRIN - Special Authority - Retail Pharmacy ▲ Tab 500 mg .................................................................................. 119.30

NERVOUS SYSTEM

60 60 60 60 60 60 100

✓ Topamax ✓ Topamax ✓ Topamax ✓ Topamax ✓ Topamax ✓ Topamax ✓ Sabril

ANTIMIGRAINE PREPARATIONS Acute Migraine Treatment

Refer also to MUSCULO-SKELETAL, Anti-inﬂammatory NSAIDS, page 106 ERGOTAMINE TARTRATE WITH CAFFEINE Tab 1 mg with caffeine 100 mg ....................................................... 31.00 METOCLOPRAMIDE HYDROCHLORIDE WITH PARACETAMOL Tab 5 mg with paracetamol 500 mg .................................................. 3.25 SUMATRIPTAN Tab 50 mg ...................................................................................... 34.00 Tab 100 mg .................................................................................... 32.00 Inj 12 mg per ml, 0.5 ml - Hospital pharmacy [HP2] & [HP3]-specialist ... 80.00 a) Injection subsidised only if not more than 10 inj per prescription.

100 60 4 2 2 inj OP

✓ Cafergot ✓ Paramax ✓ Imigran ✓ Imigran ✓ Imigran

Prophylaxis of Migraine

Refer also to Cardiovascular System, Beta Adrenoceptor Blockers, page 60 CLONIDINE HYDROCHLORIDE ❋ Tab 25 mcg ................................................................................... 15.53 PIZOTIFEN ❋ Tab 500 mcg .................................................................................. 21.10 (24.10) 100 100 Sandomigran ✓ Dixarit

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

119

NERVOUS SYSTEM

Antinausea and Vertigo Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTINAUSEA AND VERTIGO AGENTS

Refer also to ALIMENTARY TRACT, Antispasmodics, page 27 BETAHISTINE DIHYDROCHLORIDE - Retail pharmacy-specialist ❋ Tab 16 mg ........................................................................................ 9.00 100 ✓ Vergo 16

CYCLIZINE HYDROCHLORIDE - Special Authority available - Retail pharmacy Tab 50 mg ........................................................................................ 1.26 10 (4.05) Marzine Special Authority for Manufacturers Price - Form: SA0178 Initial application from any medical practitioner. Approvals valid for 6 months for applications meeting the following criteria: Control of nausea and vomiting in the treatment of terminal care patients. Renewal from any medical practitioner. Approvals valid for 6 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml .................................................................... 14.58 DIMENHYDRINATE ❋ Tab 50 mg ........................................................................................ 0.59 (3.07) 5 10 Dramamine ✓ Valoid (AFT)

DOMPERIDONE - Special Authority available - Retail pharmacy ❋ Tab 10 mg ........................................................................................ 3.90 100 (7.99) Motilium Special Authority for Manufacturers Price - Form: SA0435 Initial application from any medical practitioner. Approvals valid for 6 months for applications meeting the following criteria: Control of nausea and vomiting in the treatment of terminal care patients. Renewal from any medical practitioner. Approvals valid for 6 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. HYOSCINE HYDROBROMIDE ❋ Inj 400 mcg per ml, 1 ml .................................................................. 6.00 5 ✓ Mayne

HYOSCINE (SCOPOLAMINE) - Special Authority - Hospital pharmacy [HP3] Patches, 1.5 mg ............................................................................... 9.56 2 (12.40) Scopoderm TTS Special Authority for Subsidy - Form: SA0727 Initial application from any medical practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease; and 2 Patient cannot tolerate or does not adequately respond to oral anti-nausea agents; and 3 The applicant must specify the underlying malignancy or chronic disease (Details to be attached to application). Renewal from any medical practitioner. Approvals valid for 1 year for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. METOCLOPRAMIDE HYDROCHLORIDE ❋ Tab 10 mg ........................................................................................ 5.15 3.95 (6.00) ❋‡Oral liq 5 mg per 5 ml ...................................................................... 2.74 (5.20) ❋ Inj 5 mg per ml, 2 ml - Available on a PSO ...................................... 26.50 (Maxolon tab 10 mg to be delisted 1 July 2005) 100 100 ml 50 Maxolon ✓ AstraZeneca ✓ Metamide Maxolon

120

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Antinausea and Vertigo Agents AntiParkinson Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer ONDANSETRON - Hospital pharmacy [HP3]-specialist a) Maximum of 6 tablets per dispensing; and b) Maximum of 12 tablets per prescription. Not more than one prescription per month. Tab 4 mg ........................................................................................ 64.50 Tab disp 4 mg ................................................................................ 86.00 Tab 8 mg ...................................................................................... 185.70 Tab disp 8 mg .............................................................................. 123.80 PROCHLORPERAZINE ❋ Tab 3 mg buccal ............................................................................... 5.97 (14.42) ❋ Tab 5 mg - Available on a PSO ........................................................ 16.85 ❋ Suppos 5 mg.................................................................................... 9.52 (16.48) ❋ Suppos 25 mg................................................................................ 12.54 (21.70) ❋ Inj 12.5 mg per ml, 1 ml - Available on a PSO ................................. 14.91 (23.46) PROMETHAZINE THEOCLATE ❋ Tab 25 mg ........................................................................................ 1.20 (6.24) TROPISETRON - Hospital pharmacy [HP3]-specialist Cap 5 mg ....................................................................................... 77.41 a) Maximum of 3 capsules per dispensing; and b) Maximum of 6 capsules per prescription. Not more than one prescription per month.

NERVOUS SYSTEM

10 10 20 10 50 500 5 5

✓ Zofran ✓ Zofran Zydis ✓ Zofran ✓ Zofran Zydis

Buccastem ✓ Antinaus Stemetil Stemetil

10 Stemetil 10 Avomine 5 ✓ Navoban

ANTIPARKINSON AGENTS Dopamine Agonists and Related Agents

AMANTADINE HYDROCHLORIDE - Retail pharmacy-specialist ▲ Cap 100 mg ................................................................................... 47.81 APOMORPHINE HYDROCHLORIDE - Special Authority - Hospital pharmacy [HP3] ▲ Inj 10 mg per ml, 1 ml .................................................................... 50.43 60 5 ✓ Symmetrel ✓ Mayne

Special Authority for Subsidy - Form: SA0309 Initial application only from a neurologist or physician for the elderly (FRACP). Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Idiopathic Parkinson’s disease; and 2 The patient does not have dementia and/or neuropsychiatric disorders; and 3 Has responded to L-dopa; and 4 Any of the following: 4.1 Has resistance to conventional treatment of severe motor ﬂuctuations; or 4.2 Has severe “off” period disability; or 4.3 Has severe “off” period dystonic cramps. Renewal only from a neurologist or physician for the elderly (FRACP). Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

121

NERVOUS SYSTEM

AntiParkinson Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer BROMOCRIPTINE MESYLATE ❋ Tab 2.5 mg ..................................................................................... 33.24 ❋ Tab 10 mg .................................................................................... 123.96 LEVODOPA WITH BENSERAZIDE ❋ Cap 50 mg with benserazide 12.5 mg .............................................. 8.00 ❋ Tab dispersible 50 mg with benserazide 12.5 mg ............................ 10.00 ❋ Cap 100 mg with benserazide 25 mg .............................................. 12.50 ❋ Cap long acting 100 mg with benserazide 25 mg - Retail pharmacy-specialist .................. 17.00 ❋ Cap 200 mg with benserazide 50 mg .............................................. 25.00 LEVODOPA WITH CARBIDOPA ❋ Tab 100 mg with carbidopa 25 mg ................................................. 20.00 ❋ Tab 250 mg with carbidopa 25 mg .................................................. 57.50 ❋ Tab long-acting 200 mg with carbidopa 50 mg - Retail pharmacy-specialist ............................ 70.00 LISURIDE HYDROGEN MALEATE ▲ Tab 200 mcg .................................................................................. 27.50 PERGOLIDE - Retail pharmacy-specialist ▲ Tab 0.25 mg ................................................................................... 74.75 ▲ Tab 1 mg ...................................................................................... 299.00 100 100 100 100 100 100 100 100 100 100 30 100 100 ✓ Alpha-Bromocriptine ✓ Alpha-Bromocriptine ✓ Madopar 62.5 ✓ Madopar Dispersible ✓ Madopar 125 ✓ Madopar HBS ✓ Madopar 250 ✓ SindopaIMM ✓ SinemetIMM ✓ Sinemet ✓ Sinemet CR ✓ Dopergin ✓ Permax ✓ Permax

SELEGILINE HYDROCHLORIDE - Retail pharmacy-specialist ❋ Tab 5 mg ........................................................................................ 16.91 100 ✓ Apo-Selegiline Note: Due to uncertainty around the long term effects of Selegiline it is not recommended as a ﬁrst line agent. TOLCAPONE - Retail pharmacy-specialist prescription ▲ Tab 100 mg ................................................................................. 128.75 a) Specialist must be either a neurologist, geriatrician or general physician. 100 ✓ Tasmar

Anticholinergics

BENZTROPINE MESYLATE Tab 2 mg .......................................................................................... 7.25 Inj 1 mg per ml, 2 ml - Only on a PSO ............................................. 36.35 ORPHENADRINE HYDROCHLORIDE Tab 50 mg ...................................................................................... 31.93 PROCYCLIDINE HYDROCHLORIDE Tab 5 mg .......................................................................................... 7.40 60 5 250 100 ✓ Benztrop ✓ Cogentin ✓ Disipal ✓ Kemadrin

122

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Antipsychotics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIPSYCHOTICS

Guidelines for the use of atypical anti-psychotic agents Diagnosis: Schizophrenia and related psychoses when positive symptoms (delusions, hallucinations and thought disorder) are prominent and/or disabling or when both positive symptoms and negative symptoms (ﬂattened affect, emotional and social withdrawal and poverty of speech) are present. Treatment: Before initiating atypical anti-psychotic therapy, physicians should consider whether the patient is likely to respond to and/or tolerate conventional anti-psychotic therapy and, where appropriate, trial one or more conventional agents prior to use of an atypical agent.

General

CHLORPROMAZINE HYDROCHLORIDE - Available on a PSO Tab 10 mg ...................................................................................... 12.36 Tab 25 mg ...................................................................................... 13.02 Tab 100 mg .................................................................................... 30.61 ‡ Oral liq 100 mg per 5 ml ................................................................ 15.00 Inj 25 mg per ml, 2 ml .................................................................... 25.66 CLOZAPINE - Hospital pharmacy [HP4]-specialist prescription Tab 25 mg ...................................................................................... 22.00 Tab 100 mg .................................................................................... 57.00 HALOPERIDOL Tab 500 mcg - Available on a PSO .................................................... 4.93 Tab 1.5 mg - Available on a PSO ....................................................... 7.45 Tab 5 mg - Available on a PSO ........................................................ 23.49 Oral liq 2 mg per ml - Available on a PSO ........................................ 18.06 Inj 5 mg per ml, 1 ml - Available on a PSO ..................................... 14.82 LITHIUM CARBONATE Tab 250 mg .................................................................................... 25.45 Cap 250 mg ..................................................................................... 6.38 Tab 400 mg ...................................................................................... 9.17 Tab long-acting 400 mg .................................................................. 14.25 METHOTRIMEPRAZINE Tab 25 mg ...................................................................................... 16.93 Tab 100 mg .................................................................................... 43.96 Inj 25 mg per ml, 1 ml .................................................................... 73.68 OLANZAPINE - Special Authority - Retail pharmacy Tab 2.5 mg ..................................................................................... 54.72 Tab 5 mg ...................................................................................... 108.44 Tab 10 mg .................................................................................... 219.10 100 100 100 100 ml 10 50 50 ✓ Largactil ✓ Largactil ✓ Largactil ✓ Largactil Forte ✓ Largactil ✓ Clopine ✓ Clozaril ✓ Clopine ✓ Clozaril ✓ Serenace ✓ Serenace ✓ Serenace ✓ Serenace ✓ Serenace ✓ Lithicarb ✓ Douglas ✓ Lithicarb ✓ Priadel ✓ Nozinan ✓ Nozinan ✓ Nozinan ✓ Zyprexa ✓ Zyprexa ✓ Zyprexa

100 100 100 100 ml 10 500 100 100 100 100 100 10 30 30 30

Special Authority for Subsidy - Form: SA0741 Initial application only from a psychiatrist. Approvals valid for two years for applications meeting the following criteria: Any of the following: 1. Patients presenting with ﬁrst episode schizophrenia or related psychoses; 2. Both 2.1 Patients suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who are likely to beneﬁt from anti-psychotic treatment and

continued…

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

123

NERVOUS SYSTEM

Antipsychotics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

continued…

2.2 Either 2.2.1 An effective dose of risperidone had been trialled and has been discontinued because of unacceptable side effects; or 2.2.2. An effective dose of risperidone had been trialled and has been discontinued because of inadequate clinical response after four weeks; or 3. The patient has suffered from an acute episode of schizophrenia or bipolar mania and has been treated with olanzapine short-acting intra-muscular injection. Renewal only from a psychiatrist. Approvals valid for two years for applications meeting the following criteria. The treatment remains appropriate and the patient is beneﬁting from treatment. Note: Initial prescriptions to be written by psychiatrists or psychiatric registrars and subsequent prescriptions can be written by General Practitioners. PERICYAZINE Tab 2.5 mg ..................................................................................... 12.49 Tab 10 mg ...................................................................................... 44.45 PIMOZIDE - Retail pharmacy-specialist Tab 2 mg ........................................................................................ 14.72 100 100 50 ✓ Neulactil ✓ Neulactil ✓ Orap

QUETIAPINE - Subsidy by endorsement Tab 25 mg ...................................................................................... 55.00 60 ✓ Seroquel Tab 100 mg .................................................................................. 110.00 60 ✓ Seroquel Tab 150 mg .................................................................................. 159.00 60 ✓ Seroquel Tab 200 mg .................................................................................. 189.00 60 ✓ Seroquel Retail pharmacy – subsidy by endorsement a) Subsidised for: i) Patients presenting with ﬁrst episode schizophrenia or related psychoses, or manic episodes associated with bipolar disorder; and ii) Patients suffering from schizophrenia or related psychoses, or manic episodes associated with bipolar disorder, after a trial of an effective dose of risperidone that has been discontinued because of unacceptable side effects or inadequate response. b) Initial prescription must be written by a relevant specialist. c) Subsequent prescriptions may be written by a general practitioner. d) The prescription must be endorsed “certiﬁed condition”. RISPERIDONE - Retail pharmacy-specialist Tab 1 mg ........................................................................................ 91.84 Tab 2 mg ...................................................................................... 183.66 Tab 3 mg ...................................................................................... 275.56 Tab 4 mg ...................................................................................... 367.30 Oral liq 1 mg per ml ........................................................................ 45.92 THIORIDAZINE HYDROCHLORIDE Tab 10 mg ........................................................................................ 6.88 Tab 25 mg ........................................................................................ 7.85 Tab 50 mg ...................................................................................... 10.66 Tab 100 mg .................................................................................... 17.14 Tab long-acting 200 mg .................................................................. 45.00 60 60 60 60 30 ml 90 90 90 90 100 ✓ Risperdal ✓ Risperdal ✓ Risperdal ✓ Risperdal ✓ Risperdal ✓ Aldazine ✓ Aldazine ✓ Aldazine ✓ Aldazine ✓ Melleril Retard

124

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Antipsychotics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer THIOTHIXENE Tab 2 mg ........................................................................................ 11.22 (13.46) Tab 10 mg ...................................................................................... 32.50 (39.00) (Thixit tab 2 mg and 10 mg to be delisted 1 May 2005) TRIFLUOPERAZINE HYDROCHLORIDE Tab 1 mg .......................................................................................... 9.83 (10.22) Tab 2 mg ........................................................................................ 13.63 (15.61) Tab 5 mg ........................................................................................ 15.79 (17.77) Cap long-acting 15 mg ................................................................... 33.05 (35.03) ‡ Oral liq 1 mg per ml ........................................................................ 74.80 (Stelazine Spansules cap long-acting 15 mg to be delisted 1 May 2005) 100 Thixit 100 Thixit

100 Stelazine 100 Stelazine 100 Stelazine 50 1,000 ml Stelazine Spansules ✓ Stelazine

Depot Injections

FLUPENTHIXOL DECANOATE - Retail pharmacy-specialist Inj 20 mg per ml, 1 ml - Available on a PSO .................................... 13.14 Inj 20 mg per ml, 2 ml - Available on a PSO .................................... 20.90 Inj 100 mg per ml, 1 ml - Available on a PSO .................................. 40.87 FLUPHENAZINE DECANOATE - Retail pharmacy-specialist Inj 12.5 mg per 0.5 ml, 0.5 ml - Available on a PSO ........................ 17.60 Inj 25 mg per ml, 1 ml - Available on a PSO .................................... 27.90 Inj 25 mg per ml, 2 ml - Available on a PSO .................................... 97.50 Inj 100 mg per ml, 1 ml - Available on a PSO ................................ 154.50 HALOPERIDOL DECANOATE - Retail pharmacy-specialist Inj 50 mg per ml, 1 ml - Available on a PSO .................................... 28.39 Inj 100 mg per ml, 1 ml - Available on a PSO .................................. 55.90 PIPOTHIAZINE PALMITATE - Retail pharmacy-specialist Inj 50 mg per ml, 1 ml - Available on a PSO .................................. 178.48 Inj 50 mg per ml, 2 ml - Available on a PSO .................................. 353.32 ZUCLOPENTHIXOL DECANOATE - Retail pharmacy - specialist Inj 200 mg per ml, 1 ml - Available on a PSO .................................. 19.80 5 5 5 5 5 5 5 5 5 10 10 5 ✓ Fluanxol ✓ Fluanxol ✓ Fluanxol ✓ Modecate ✓ Modecate ✓ Mayne ✓ Modecate ✓ Haldol ✓ Haldol Concentrate ✓ Piportil ✓ Piportil ✓ Clopixol

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

125

NERVOUS SYSTEM

Antipsychotics Anxiolytics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Orodispersible Antipsychotics

OLANZAPINE - Special Authority - Retail pharmacy Wafer 5 mg ...................................................................................... 102.19 Wafer 10 mg .................................................................................... 204.37 28 28 ✓ Zyprexa Zydis ✓ Zyprexa Zydis

Special Authority for Subsidy - Form: SA0739 Initial application only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1. The patient meets the current criteria for standard olanzapine tablets; and 2. The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; or the patient is non-adherent to oral therapy with standard olanzapine tablets; and 3. The patient is under direct professional supervision for administration of medicine. Renewal only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: Both: 4. The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; and 5. The patient is under direct professional supervision for administration of medicine. Note: Initial prescriptions to be written by psychiatrists and subsequent prescriptions can be written by psychiatric registrars or General Practitioners.

ANXIOLYTICS

ALPRAZOLAM a) Retail pharmacy-specialist b) Month restriction Tab 250 mcg .................................................................................... 4.77 (8.11) Tab 500 mcg .................................................................................... 9.54 (16.26) Tab 1 mg ........................................................................................ 19.08 (32.51) ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations.

100 Xanax 100 Xanax 100 Xanax

BUSPIRONE HYDROCHLORIDE a) Month restriction b) Special Authority - Hospital pharmacy [HP3] Tab 5 mg .......................................................................................... 7.00 100 ✓ Paciﬁc Buspirone Tab 10 mg ........................................................................................ 7.00 100 ✓ Paciﬁc Buspirone Special Authority for Subsidy - Form: SA0055 Initial application only from a psychiatrist, geriatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 For use only as an anxiolytic; and 2 Other agents are contraindicated or have failed. Renewal only from a psychiatrist, geriatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. DIAZEPAM - Month restriction Tab 2 mg .......................................................................................... 8.40 Tab 5 mg .......................................................................................... 5.00 Tab 10 mg ........................................................................................ 3.45 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. 500 250 100 ✓ Pro-Pam ✓ Pro-Pam ✓ Pro-Pam

126

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Anxiolytics Sedatives and Hypnotics

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer LORAZEPAM - Month restriction Tab 1 mg .......................................................................................... 4.04 Tab 2.5 mg ....................................................................................... 3.92 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. OXAZEPAM - Month restriction Tab 10 mg ........................................................................................ 1.98 (4.90) Tab 15 mg ........................................................................................ 2.45 (6.90) ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations.

NERVOUS SYSTEM

250 100

✓ Ativan ✓ Ativan

100 Ox-Pam 100 Ox-Pam

SEDATIVES AND HYPNOTICS

LORMETAZEPAM - Month restriction Tab 1 mg .......................................................................................... 3.11 (19.50) ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. MIDAZOLAM Tab 7.5 mg - Month restriction ........................................................ 10.38 (12.00) Inj 1 mg per ml, 5 ml - Special Authority - Hospital pharmacy [HP3]..... 12.65 Inj 5 mg per ml, 3 ml - Special Authority - Hospital pharmacy [HP3] .... 14.00 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. 30 Noctamid

100 10 5 Hypnovel ✓ Hypnovel ✓ Hypnovel

Special Authority for Subsidy - Form: SA0050 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Terminally ill patient. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Terminally ill patient. NITRAZEPAM - Month restriction Tab 5 mg .......................................................................................... 2.00 (3.90) (4.05) ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. TEMAZEPAM - Month restriction Cap 10 mg ....................................................................................... 2.94 Cap 20 mg ....................................................................................... 5.50 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. (Euhypnos cap 20 mg to be delisted 1 July 2005) TRIAZOLAM - Month restriction Tab 125 mcg .................................................................................... 1.93 Tab 250 mcg .................................................................................... 3.45 ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. ZOPICLONE - Month restriction Tab 7.5 mg ....................................................................................... 2.25 100 Insoma Nitrados

100 100

✓ Euhypnos ✓ Euhypnos

100 100

✓ Halcion ✓ Hypam

✓ Imovane

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

127

NERVOUS SYSTEM

Other CNS Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

OTHER CNS AGENTS

DEXAMPHETAMINE SULPHATE - Special Authority - as for methylphenidate hydrochloride below - Retail pharmacy, Controlled Drug Form Tab 5 mg ........................................................................................ 19.00 100 ✓ HMG METHYLPHENIDATE HYDROCHLORIDE - Special Authority - Retail pharmacy, Controlled Drug Form Tab 10 mg ........................................................................................ 5.95 30 ✓ Rubifen Tab long-acting 20 mg .................................................................... 75.00 100 ✓ Ritalin SR Special Authority for Subsidy - Form: SA0696 Initial application (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months for applications meeting the following criteria: Narcolepsy. Initial application (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or general practitioner on the recommendation of such a specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients aged 5 years or over; and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a specialist; or 3.2 Both: 3.2.1 Applicant is a GP and a specialist has recommended treatment; and 3.2.2 Provide name of specialist (Details to be attached to application). Initial application (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 4 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients under 5 years of age; and 5 Diagnosed according to DSM-IV or ICD 10 criteria. Renewal (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Renewal (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or general practitioner. Approvals valid for 24 months for applications meeting the following criteria: Either: 6 Applicant is a specialist; or 7 Both: 7.1 Applicant is a GP and a specialist has recommended treatment; and 7.2 Provide name of specialist (Details to be attached to application). Renewal - (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. DISULFIRAM Tab 200 mg .................................................................................... 24.30 100 ✓ Antabuse

128

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

NERVOUS SYSTEM

Other CNS Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer NALTREXONE HYDROCHLORIDE – Special Authority - Retail pharmacy Tab 50 mg .................................................................................... 180.00

✓ ReVia

Special Authority for Subsidy - Form: SA0714 Initial application from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence in a service accredited against the New Zealand Alcohol and Other Drug Sector Standard or the National Mental Health Sector Standard; and 2 Applicant works in an Alcohol & Drug Service; and 3 Applicant must include the address of the service (Details to be attached to application). Renewal from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 4 Compliance with the medication (prescriber determined); and 5 Any of the following: 5.1 Patient is still unstable and requires further treatment; or 5.2 Patient achieved signiﬁcant improvement but requires further treatment; or 5.3 Patient is well controlled but requires maintenance therapy. The patient has had no more than 1 prior approval in the last 12 months. TETRABENAZINE Tab 25 mg .................................................................................... 243.00 112 ✓ Xenazine 25

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

129

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Chemotherapeutic Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

CHEMOTHERAPEUTIC AGENTS Alkylating Agents

BUSULPHAN - Retail pharmacy-specialist Tab 2 mg ........................................................................................ 47.89 CHLORAMBUCIL- Retail pharmacy-specialist Tab 2 mg ........................................................................................ 22.35 CYCLOPHOSPHAMIDE - Retail pharmacy-specialist Tab 50 mg ...................................................................................... 25.71 Inj 1 g .......................................................................................... 127.80 MELPHALAN - Retail pharmacy-specialist Tab 2 mg ........................................................................................ 31.31 THIOTEPA - Retail pharmacy-specialist Inj 15 mg........................................................................................ 14.65 100 25 50 6 25 each ✓ Myleran ✓ Leukeran FC ✓ Cycloblastin ✓ Cytoxan ✓ Alkeran ✓ Thiotepa

Antimetabolites

CALCIUM FOLINATE - Hospital pharmacy [HP1] or [HP3]-specialist Tab 15 mg [HP3] ............................................................................ 38.90 (55.60) Inj 3 mg per ml, 1 ml [HP1] ............................................................ 17.10 Inj 15 mg [HP1].............................................................................. 57.20 Inj 50 mg [HP1].............................................................................. 29.95 CYTARABINE - Retail pharmacy-specialist Inj 100 mg...................................................................................... 80.00 Inj 500 mg...................................................................................... 67.00 Inj 1 g .......................................................................................... 118.00 FLUOROURACIL SODIUM - Retail pharmacy-specialist Inj 250 mg per 10 ml ...................................................................... 18.24 Inj 500 mg per 10 ml ...................................................................... 28.75 Inj 500 mg per 20 ml ...................................................................... 55.60 MERCAPTOPURINE - Retail pharmacy-specialist Tab 50 mg ..................................................................................... 47.06 10 5 5 each 5 each each 5 5 10 25 ✓ Mayne Leucovorin ✓ Leucovorin Calcium ✓ Leucovorin Calcium ✓ Mayne ✓ Mayne ✓ Pharmacia ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Purinethol

130

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Chemotherapeutic Agents

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer METHOTREXATE - Hospital pharmacy [HP1] & [HP3]-specialist ❋ Tab 2.5 mg [HP3] ............................................................................ 5.80 ❋ Tab 10 mg [HP3] .......................................................................... 40.93 ❋ Inj 5 mg per 2 ml vial [HP1] ........................................................... 23.65 ❋ Inj 20 mg per 2 ml vial [HP1] ......................................................... 28.55 ❋ Inj 50 mg per 2 ml vial [HP1] .........................................................46.10 ❋ Inj 100 mg per 4 ml vial [HP1] ........................................................ 92.50 ❋ Inj 5 g per 50 ml vial [HP1] ........................................................... 900.24 ❋ Inj 500 mg, 20 ml vial [HP1] ...........................................................80.25 ❋ Inj 1 g per 10 ml vial [HP1] ............................................................. 72.90 THIOGUANINE - Hospital pharmacy [HP3]-specialist Tab 40 mg ...................................................................................... 97.16 30 50 5 5 5 5 each each each 25 ✓ Methoblastin ✓ Methoblastin ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Lanvis

Other Cytotoxic Agents

ETOPOSIDE - Hospital pharmacy [HP1] & [HP3]-specialist Cap 50 mg [HP3] ......................................................................... 340.73 Cap 100 mg [HP3] ....................................................................... 340.73 Inj 20 mg per ml, 5 ml [HP1] .......................................................... 61.22 HYDROXYUREA - Retail pharmacy-specialist Cap 500 mg ................................................................................... 31.76 VINBLASTINE SULPHATE - Retail pharmacy-specialist Inj 10 mg...................................................................................... 137.50 VINCRISTINE SULPHATE - Retail pharmacy-specialist Inj 1 mg per ml, 1 ml .................................................................... 133.00 Inj 1 mg per ml, 2 ml .................................................................... 266.20 20 10 each 100 5 5 5 ✓ Vepesid ✓ Vepesid ✓ Mayne ✓ Vepesid ✓ Hydrea ✓ Mayne ✓ Mayne ✓ Mayne

Protein-tyrosine Kinase Inhibitors

IMATINIB MESYLATE - Special Authority - access by application Cap 100 mg ............................................................................. 4,800.00 Special Authority criteria and guidelines for Glivec: Application forms are available from, and prescriptions should be sent to: The Glivec Coordinator Tel: (04) 460 4990 Fax: (04) 916 7571 Email: mary.chesterﬁeld@pharmac.govt.nz PHARMAC, PO Box 10 254, Wellington Special Authority criteria for CML - access by application a) Funded for patients with diagnosis (conﬁrmed by a haematologist) of a chronic myeloid leukaemia (CML) in blast crisis, accelerated phase, or in chronic phase. b) Maximum dose of 600 mg/day for accelerated or blast phase, and 400 mg/day for chronic phase CML. c) Subsidised for use as monotherapy only. d) Initial approvals valid seven months. e) Subsequent approval(s) are granted on application and are valid for six months. The ﬁrst re-application (after seven months) should provide details of the haematological response. The third re-application should provide details of the cytogenetic response after 14–18 months from initiating therapy. All other re-applications should provide details of haematological response, and cytogenetic response if such data is available. Applications to be made and subsequent prescriptions can be written by a haematologist or an oncologist. continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

120

✓ Glivec

if endorsed “certiﬁed exemption” by the prescriber.

131

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Chemotherapeutic Agents Endocrine Therapy

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Guideline on discontinuation of treatment for patients with CML a) Prescribers should consider discontinuation of treatment if after 6 months from initiating therapy a patient did not obtain a haematological response as deﬁned as any one of the following three levels of response: - complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 x 109/L, platelets > 100 x 109/L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0–35% metaphases), and absence of extramedullary disease); or - no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 x 109/L, platelets > 20 x 109/L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0-35% metaphases), and absence of extramedullary disease); or - return to chronic phase (as characterised by BM and PB blasts < 15%, BM and PB blasts and promyelocytes < 30%, PB basophils < 20% and absence of extramedullary disease other than spleen and liver). b) Prescribers should consider discontinuation of treatment if after 18 months from initiating therapy a patient did not obtain a major cytogenetic response deﬁned as 0–35% Ph+ metaphases. Special Authority criteria for GIST - access by application a) Funded for patients: - with a diagnosis (conﬁrmed by an oncologist) of unresectable and/or metastatic malignant gastrointestinal stromal tumour (GIST); and - who have immunohistochemical documentation of c-kit (CD117) expression by the tumour. b) Maximum dose of 400 mg/day. c) Applications to be made and subsequent prescriptions can be written by an oncologist. d) Initial and subsequent applications are valid for one year. The re-application criterion is an adequate clinical response to the treatment with imatinib (prescriber determined).

ENDOCRINE THERAPY

GnRH ANALOGUES - refer to HORMONE PREPARATIONS, Trophic Hormones, page 89. AMINOGLUTETHIMIDE - Retail pharmacy-specialist Tab 250 mg ................................................................................. 244.10 100 ✓ Cytadren

ANASTROZOLE - Special Authority available - Retail pharmacy Tab 1 mg ...................................................................................... 146.46 30 (240.00) Arimidex Special Authority for Manufacturers Price - Form: SA0640 Initial application only from a relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Patients being treated for advanced breast cancer who are refractory to tamoxifen. Renewal only from a relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. FLUTAMIDE Tab 250 mg - Hospital pharmacy [HP3]-specialist........................... 39.50 100 ✓ Flutamin

132

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Endocrine Therapy

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer LETROZOLE - Special Authority available - Retail pharmacy Tab 2.5 mg ................................................................................... 146.46 30 (200.00) Femara Special Authority for Manufacturers Price - Form: SA0753 Initial application only from a relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1. Patient is a postmenopausal woman; and 2. Patient has hormone receptor positive advanced breast cancer (Stage IIIb, or metastatic Stage IV). Renewal only from a relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. MEGESTROL ACETATE - Retail pharmacy-specialist Tab 160 mg .................................................................................... 74.25 30 ✓ Megace ✓ Sandostatin ✓ Sandostatin ✓ Sandostatin ✓ Sandostatin LAR ✓ Sandostatin LAR ✓ Sandostatin LAR

OCTREOTIDE (somatostatin analogue) - Special Authority - Hospital pharmacy [HP3] Inj 50 mcg per ml, 1 ml .................................................................. 43.50 5 Inj 100 mcg per ml, 1 ml ................................................................ 81.00 5 Inj 500 mcg per ml, 1 ml .............................................................. 399.00 5 LAR 10 mg pre-ﬁlled syringe ...................................................... 1772.50 1 LAR 20 mg pre-ﬁlled syringe ...................................................... 2358.75 1 LAR 30 mg pre-ﬁlled syringe ...................................................... 2951.25 1

Special Authority for Subsidy - Form: SA0563 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Both: 1.1 Acromegaly; and 1.2 Patient has failed surgery, radiotherapy, bromocriptine and other oral therapies; or 2 VIPomas and Glucagonomas - for patients who are seriously ill in order to improve their clinical state prior to deﬁnitive surgery; or 3 Both: 3.1 Gastrinoma; and 3.2 Either: 3.2.1 Patient has failed surgery; or 3.2.2 Patient in metastatic disease after H2 antagonists (or proton pump inhibitors) have failed; or 4 Both: 4.1 Insulinomas; and 4.2 Surgery is contraindicated or has failed; or 5 For pre-operative control of hypoglycaemia and for maintenance therapy; or 6 Both: 6.1 Carcinoid syndrome (diagnosed by tissue pathology and/or urinary 5HIAA analysis); and 6.2 Disabling symptoms not controlled by maximal medical therapy. Note The use of octretide in patients with ﬁstulae, oesophageal varices, miscellaneous diarrhoea and hypotension will not be funded as a Special Authority item. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. TAMOXIFEN CITRATE ❋ Tab 10 mg ........................................................................................ 7.00 ❋ Tab 20 mg ....................................................................................... 8.85 100 100 ✓ Genox ✓ Genox

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

133

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

IMMUNOSUPPRESSANTS Cytotoxic Immunosuppressants

AZATHIOPRINE - Retail pharmacy-specialist ❋ Tab 50 mg ...................................................................................... 25.00 (34.90) ❋ Inj 50 mg........................................................................................ 46.33 (47.72) MYCOPHENOLATE MOFETIL - Special Authority - Hospital pharmacy [HP3] Cap 250 mg ................................................................................. 206.66 Tab 500 mg .................................................................................. 206.66 100 each Imuran 100 50 ✓ Cellcept ✓ Cellcept ✓ Thioprine IMM ✓ Azamun IMM Imuran IMM

Special Authority for Subsidy - Form: SA0403 Initial application only from a nephrologist or transplant surgeon. Approvals valid for 12 months for applications meeting the following criteria: Renal transplant recipient. Renewal only from a nephrologist or transplant surgeon. Approvals valid for 12 months for applications meeting the following criteria: Re-graft patient.

Immune Modulators

INTERFERON ALPHA-2A - Special Authority - Hospital pharmacy [HP3] Inj 3 m iu preﬁlled syringe ............................................................... 31.32 Inj 4.5 m iu preﬁlled syringe ............................................................ 46.98 Inj 6 m iu preﬁlled syringe ............................................................... 62.64 Inj 9 m iu preﬁlled syringe ............................................................... 93.96 Inj 18 m iu multidose cartridge ..................................................... 187.92 Inj 18 m iu multidose cartridge starter pack .................................. 187.92 1 1 1 1 1 1 ✓ Roferon-A ✓ Roferon-A ✓ Roferon-A ✓ Roferon-A ✓ Roferon-A ✓ Roferon-A

Only one multidose cartridge starter pack to be prescribed and dispensed per patient per approval. Special Authority for Subsidy - Form: SA0401 Initial application - (Basal cell carcinoma) only from a dermatologist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Basal cell carcinoma unable to be treated surgically or by radiotherapy; and 2 Unsuitability for surgery conﬁrmed by a Plastic Surgeon or Oncologist. Note Maximum reimbursable dosage 15 million iu/week Initial application - (Chronic hepatitis C) only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Chronic hepatitis C. Initial application - (Indications other than Basal cell carcinoma and Chronic hepatitis C) only from a relevant specialist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 3 Chronic myelogenous leukaemia; or 4 Hairy cell leukaemia; or 5 Cutaneous T cell lymphoma; or 6 Essential thrombocythaemia; or continued…

134

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… 7 Multiple myeloma; or 8 Chronic active hepatitis B. Renewal - (Basal cell carcinoma) only from a dermatologist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: Unsuitablity for surgery conﬁrmed by a Plastic Surgeon or Oncologist. Renewal - (Indications other than Basal cell carcinoma and Chronic hepatitis C) only from a relevant specialist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. INTERFERON ALPHA-2B - Special Authority - Hospital pharmacy [HP3] Inj 18 m iu, 1.2 ml multidose pen .................................................. 187.92 Inj 30 m iu, 1.2 ml multidose pen .................................................. 313.20 Inj 60 m iu, 1.2 ml multidose pen .................................................. 626.40 1 1 1 ✓ Intron-A ✓ Intron-A ✓ Intron-A

Special Authority for Subsidy - Form: SA0461 Initial application - (Basal cell carcinoma) only from a dermatologist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Basal cell carcinoma unable to be treated surgically or by radiotherapy; and 2 Unsuitablity for surgery conﬁrmed by a Plastic Surgeon or Radiation Oncologist. Note The maximum reimbursable dosage is 15 million iu per week Initial application - (Chronic hepatitis C) only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Chronic hepatitis C. Initial application - (Indications other than Basal cell carcinoma and Chronic hepatitis C) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 3 Chronic myelogenous leukaemia; or 4 Hairy cell leukaemia; or 5 Multiple myeloma; or 6 Chronic active hepatitis B. Renewal - (Basal cell carcinoma) only from a dermatologist, plastic surgeon or radiation oncologist. Approvals valid for 2 years for applications meeting the following criteria: Unsuitability for surgery conﬁrmed by a Plastic Surgeon or Oncologist. Renewal - (Indications other than Basal cell carcinoma and Chronic hepatitis C) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. INTERFERON ALPHA-N - Special Authority - Hospital pharmacy [HP3] Inj 3 m iu per ml, 1 ml .................................................................... 31.32 1 (36.26) Wellferon Special Authority for Subsidy - Form: SA0108 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Hairy cell leukaemia; or 2 Chronic active hepatitis B. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

135

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… PEGYLATED INTERFERON ALPHA-2A – Special Authority - Hospital pharmacy [HP3] Inj 135 mcg preﬁlled syringe ......................................................... 362.00 1 Inj 180 mcg preﬁlled syringe ......................................................... 450.00 1 ✓ Pegasys ✓ Pegasys

Special Authority for Subsidy - Form: SA0742 Initial application – (genotype 1, 4, 5 or 6 infection) from any specialist. Approvals valid for 11 months for applications meeting the following criteria: Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection. Initial application – (genotype 2 or 3 infection) from any specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1. Patient has chronic hepatitis C, genotype 2 or 3 infection; and 2. Patient has bridging ﬁbrosis or cirrhosis (Metavir stage 3 or 4 or equivalent). PEGYLATED INTERFERON ALPHA-2B – Special Authority - Hospital pharmacy [HP3] Inj 50 mcg .................................................................................... 666.00 4 Inj 80 mcg ................................................................................. 1,065.60 4 Inj 100 mcg ............................................................................... 1,332.00 4 Inj 120 mcg ............................................................................... 1,598.40 4 Inj 150 mcg ............................................................................... 1,998.00 4 ✓ PEG-Intron ✓ PEG-Intron ✓ PEG-Intron ✓ PEG-Intron ✓ PEG-Intron

Special Authority for Subsidy - Form SA0713 Initial application from any specialist. Approvals valid for 11 months for applications meeting the following criteria: Either: 1. Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 2. Patient has chronic hepatitis C, genotype 2 or 3 infection with bridging ﬁbrosis or cirrhosis (Metavir stage 3 or 4, or equivalent). PEGYLATED INTERFERON ALPHA-2B WITH RIBAVIRIN – Special Authority - Hospital pharmacy [HP3] Inj 50 mcg x 4 with ribavirin cap 200 mg x 84 ............................... 976.80 1 OP ✓ Pegatron Inj 50 mcg x 4 with ribavirin cap 200 mg x 112 .......................... 1,080.40 1 OP ✓ Pegatron Inj 80 mcg x 4 with ribavirin cap 200 mg x 84 ............................ 1,376.40 1 OP ✓ Pegatron Inj 80 mcg x 4 with ribavirin cap 200 mg x 140 .......................... 1,583.60 1 OP ✓ Pegatron Inj 80 mcg x 4 with ribavirin cap 200 mg x 168 .......................... 1,687.20 1 OP ✓ Pegatron Inj 100 mcg x 4 with ribavirin cap 200 mg x 84 .......................... 1,642.80 1 OP ✓ Pegatron Inj 100 mcg x 4 with ribavirin cap 200 mg x 112 ........................ 1,746.40 1 OP ✓ Pegatron Inj 120 mcg x 4 with ribavirin cap 200 mg x 84 .......................... 1,909.20 1 OP ✓ Pegatron Inj 120 mcg x 4 with ribavirin cap 200 mg x 140 ........................ 2,116.40 1 OP ✓ Pegatron Inj 150 mcg x 4 with ribavirin cap 200 mg x 84 .......................... 2,308.80 1 OP ✓ Pegatron Inj 150 mcg x 4 with ribavirin cap 200 mg x 140 ........................ 2,516.00 1 OP ✓ Pegatron Inj 150 mcg x 4 with ribavirin cap 200 mg x 168 ........................ 2,619.60 1 OP ✓ Pegatron Special Authority for Subsidy - Form: SA0713 Initial application from any specialist. Approvals valid for 11 months for applications meeting the following criteria: Either: 1 Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 2 Patient has chronic hepatitis C, genotype 2 or 3 infection with bridging ﬁbrosis or cirrhosis (Metavir stage 3 or 4, or equivalent). Guidelines for the use of interferon in the treatment of hepatitis C: Physicians considering treatment of patients with hepatitis C should discuss cases with a gastroenterologist or an infectious disease physician. All subjects undergoing treatment require careful monitoring for side effects. Patients should be otherwise ﬁt. Hepatocellular carcinoma should be excluded by ultrasound examination and alpha-fetoprotein level. ✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10 “IMM” interchangeable multi-source medicines Sole Subsidised Supply

136

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Criteria for Treatment a) Diagnosis - Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably conﬁrmed by a supplementary RIBA test; or - PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or - Anti-HCV positive on at least two occasions with a positive supplementary RIBA test with a negative PCR for HCV RNA but with a liver biopsy consistent with 2(b) following. b) Establishing Active Chronic Liver Disease - Conﬁrmed HCV infection and serum ALT/AST levels measured on at least three occasions over six months averaging > 1.5 x upper limit of normal. (ALT is the preferable enzyme); or - Liver biopsy showing signiﬁcant inﬂammatory activity (active hepatitis) with or without cirrhosis. This is not a necessary requirement for those patients with coagulopathy. (Some patients have active disease on histology with normal transaminase enzymes). Exclusion Criteria a) Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). b) Pregnancy. c) Neutropenia (<2.0 x 109) and/or thrombocytopenia. d) Continuing alcohol abuse and/or continuing intravenous drug users. Dosage The current recommended dosage is 3 million units of interferon alpha-2a or interferon alpha-2b administered subcutaneously three times a week for 52 weeks (twelve months). Exit Criteria The patient’s response to interferon treatment should be reviewed at either three or four months. Interferon treatment should be discontinued in patients who do not show a substantial reduction (50%) in their mean pre-treatment ALT level at this stage.

Multiple Sclerosis Treatment

INTERFERON BETA-1-ALPHA - Access by application Inj 6 million iu per vial ................................................................ 1,219.26 INTERFERON BETA-1-BETA - Access by application Inj 8 million iu per 1 ml ............................................................. 1,292.63 4 15 ✓ Avonex ✓ Betaferon

Access by application a) Budget managed by appointed clinicians on the Multiple Sclerosis Treatment Assessments Committee (MSTAC). b) Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). c) Applications to be made on the approved forms which are available from the co-ordinator for MSTAC: The Co-ordinator Phone: (04) 460 4990 Multiple Sclerosis Treatment Assessments Committee Facsimile: (04) 916 7571 PHARMAC, PO Box 10 254 Email: wiebke.tod@pharmac.govt.nz Wellington d) Completed application forms must be sent to the co-ordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. e) Notiﬁcation of MSTAC’s decision will be sent to the patient, the applying clinician and the patient’s GP (if speciﬁed). f) These agents will NOT be subsidised if dispensed from a community or hospital pharmacy. Regular supplies will be distributed to all approved patients or their clinicians by courier. g) Prescribers must fax quarterly prescriptions for approved patients to the MSTAC co-ordinator. h) Only prescriptions for 6 million iu of interferon beta-1-alpha per week or 8 million iu of interferon beta-1-beta every other day will be subsidised. continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

137

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… i) Appeals against MSTAC’s decision and/or the processing of any application may be lodged with the MSTAC co-ordinator. Concerns that cannot be or have not been adequately addressed by MSTAC will be forwarded to a separate Appeal Committee if necessary. j) Entry and Stopping criteria Entry Criteria • Diagnosis of multiple sclerosis (MS) must be conﬁrmed by a neurologist. Diagnosis should as a rule include MRI conﬁrmation. For patients diagnosed before MRI was widely utilised in New Zealand, conﬁrmation of diagnosis via clinical assessment and laboratory/ancillary data must be provided; and • patients must have active relapsing MS (conﬁrmed by MR scan where necessary) with or without underlying progression; and • patients must have experienced at least two signiﬁcant relapses of MS in the previous 12 months. Each relapse must: - be conﬁrmed by a neurologist or general physician; - be associated with new symptom(s)/sign(s) of MS or exacerbation of previously experienced symptom(s)/sign(s); - last at least one week; - follow a period of stability of at least one month; - be severe enough to change EDSS or Kurtzke functional systems score by at least 1 point; - be distinguishable from the effects of general fatigue; and - not be associated with a fever (T > 37.5 °C); and • applications must be made not less than four weeks after the date of the onset of the last known relapse; and • patients must have an EDSS score of between 3.0 and 6.5 inclusive; and • patients must have no previous history of lack of response to beta-interferon (see criteria for stopping beta-interferon). • Applications must be submitted to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) by the patient’s neurologist or a general physician; and • patients must agree (via informed consent) to co-operate if as a result of their meeting the stopping criteria, funding is withdrawn. Patients must agree to the collection of clinical data relating to their MS and use of those data by PHARMAC; and • patients must agree to allow clinical data to be collected and reviewed by the MSTAC annually for each year in which they receive funding for beta-interferon. Stopping Criteria • Conﬁrmed progression of disability that is sustained for three months after a minimum of one year of treatment. Progression of disability is deﬁned as either a loss of 1 EDSS point on the Kurtzke scale or an increase in EDSS score to 7.0 or more; or • stable or increasing (relative to 12 months preceding commencement of treatment) relapse rate over 12 months of treatment; or • pregnancy and/or lactation; or • intolerance to both interferon beta-1-alpha and interferon beta-1-beta; or • non-compliance with treatment, including refusal to undergo annual assessment and/or for the results of the assessment to be submitted to MSTAC; or • patients may, subject to conclusions drawn from published evidence available at the time, be excluded if they develop a high titre of neutralising anti-bodies to beta-interferon.

138

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Other Immunosuppressants

CYCLOSPORIN A - Special Authority - Hospital pharmacy [HP3] Cap 25 mg ..................................................................................... 85.00 Cap 50 mg ................................................................................... 169.34 Cap 100 mg ................................................................................. 338.69 Oral liq 100 mg per ml .................................................................. 377.38 50 50 50 50 ml OP ✓ Neoral ✓ Neoral ✓ Neoral ✓ Neoral

Special Authority for Subsidy - Form: SA0470 Initial application - (Organ transplant) only from a relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Organ transplant. Initial application - (Bone marrow transplant or Graft v host disease) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Bone marrow transplant; or 2 Graft v host disease. Initial application - (Psoriasis) only from a dermatologist. Approvals valid for 2 years for applications meeting the following criteria: Both: 3 Psoriasis; and 4 Applicant must state which systemic and topical therapies have failed. Initial application - (Severe atopic dermatitis) only from a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 5 Severe atopic dermatitis; and 6 Not responsive to topical therapy, oral antihistamines and other commonly used orthodox therapies. Initial application - (Nephrotic Syndrome) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 7 Nephrotic Syndrome; and 8 Corticosteroid dependent patients who have failed on cytotoxic therapy. Initial application - (Endogenous uveitis) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Endogenous uveitis. Initial application - (Severe rheumatoid arthritis) only from a rheumatologist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 9 Severe rheumatoid arthritis; and 10 The patient must be either unresponsive to or unable to tolerate, both sulphasalazine and methotrexate; and 11 Patients must have 2 serum creatinine test results within the normal range within the three months prior to initiation of therapy. Renewal - (Severe atopic dermatitis) only from a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. Renewal - (Indications other than severe atopic dermatitis) only from a dermatologist, rheumatologist or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

139

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Immunosuppressants

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Guidelines for use of cyclosporin A in rheumatoid arthritis Monitoring: All patients require frequent monitoring for creatinine levels and blood pressure: • fortnightly, in the ﬁrst three months of therapy and then monthly, if results are stable; • if dose is increased or there is a rise in serum creatinine or blood pressure, then more frequent monitoring is required. Cyclosporin A is contraindicated in patients with the following conditions: • current or past malignancy; • uncontrolled hypertension; • renal dysfunction (abnormal serum creatinine for age and sex); • immunodeﬁciency and neutropenia; • abnormally low white blood cell count or platelet count; or • liver function tests more than twice the upper limit of normal. Caution in use: • age above 65 years; • controlled hypertension; • use of anti-epileptic medication; • use of ketoconazole, ﬂuconazole, trimethoprim, erythromycin, verapamil, and diltiazem; • concurrent or previous use of alkylating agents such as cyclophosphamide; • use of any experimental drug within the past three months; • premalignant conditions such as leukoplakia, monoclonal paraprotoinaemia, myelodysplastic syndrome and dysplastic naevi; • active infection may necessitate temporary discontinuation; • pregnancy and lactation. Therapy should be discontinued if there has been no improvement after 6 months with the patient on the maximum tolerated dose. For further information please consult the data sheet. TACROLIMUS - Special Authority - Hospital pharmacy Cap 0.5 mg .................................................................................. 214.00 Cap 1 mg ..................................................................................... 428.00 Cap 5 mg .................................................................................. 1,070.00 100 100 50 ✓ Prograf ✓ Prograf ✓ Prograf

Special Authority for Subsidy - Form: SA0669 Initial application only from a relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Organ transplant recipients. Note Subsidy applies for either primary or rescue therapy.

140

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

RESPIRATORY SYSTEM AND ALLERGIES

Antiallergy Preparations Antihistamines

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

ANTIALLERGY PREPARATIONS

ALLERGY TREATMENT SET Extract of inhaled allergens .............................................................CBS (Allpyral extract of inhaled allergens to be delisted 1 September 2005) BEE VENOM ALLERGY TREATMENT - Special Authority - Hospital Pharmacy [HP3] Treatment kit - 1 vial 550 mcg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ................................................154.30 1 OP Maintenance kit - 6 vials 120 mcg freeze dried venom, 6 diluent 1.8 ml ....................................................................... 154.30 1 OP WASP VENOM ALLERGY TREATMENT - Special Authority - Hospital Pharmacy [HP3] Treatment kit (Yellow jacket venom) - 1 vial 550 mcg freeze dried vespula venom, 1 diluent 9 ml, 1 diluent 1.8 ml ...............154.30 1 OP Treatment kit (Paper wasp venom) - 1 vial 550 mcg freeze dried polister venom, 1 diluent 9 ml, 1 diluent 1.8 ml ...............154.30 1 OP ✓ Allpyral

✓ Albay ✓ Albay

Special Authority for Subsidy - Form: SA0053 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

ANTIHISTAMINES

AZATADINE MALEATE ❋ Tab 1 mg .........................................................................................6.94 (16.90) ❋‡Oral liq 500 mcg per 5 ml................................................................2.27 (10.29) (Zadine oral liq 500 mcg to be delisted 1 July 2005) CETIRIZINE HYDROCHLORIDE ❋ Tab 10 mg .......................................................................................2.50 CHLORPHENIRAMINE MALEATE ❋‡Oral liq 2 mg per 5 ml .....................................................................3.74 (7.26) CYPROHEPTADINE HYDROCHLORIDE ❋ Tab 4 mg .........................................................................................6.27 DEXTROCHLORPHENIRAMINE MALEATE ❋ Tab 2 mg .........................................................................................2.52 (9.08) ❋ Tab long-acting 6 mg .......................................................................6.75 (14.28) ❋‡Oral liq 2 mg per 5 ml .....................................................................1.77 (9.35) FEXOFENADINE HYDROCHLORIDE ❋ Tab 60 mg .......................................................................................4.34 (11.19) ❋ Tab 120 mg ...................................................................................14.22 (28.94) ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once 100 50 50 100 ml ✓ Periactin 50 100 ml Zadine Zadine

30 500 ml

✓ Razene

Histafen

Polaramine Polaramine Repetab Polaramine

20 30

Telfast Telfast

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

141

RESPIRATORY SYSTEM AND ALLERGIES

Antihistamines Inhaled Corticosteroids - Metered Dose Inhalers

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer KETOTIFEN ❋ Oral liq 1 mg per 5 ml ......................................................................4.90 (5.90) LORATADINE ❋ Tab 10 mg .......................................................................................6.70 ❋ Oral liq 1 mg per ml .........................................................................4.00 (9.85) PHENIRAMINE MALEATE ❋ Tab long-acting 75 mg .....................................................................3.56 (12.82) (Avil Retard tab long-acting 75 mg to be delisted 1 August 2005) PROMETHAZINE HYDROCHLORIDE ❋ Tab 10 mg ......................................................................................2.37 (7.80) ❋ Tab 25 mg .......................................................................................4.74 (13.15) ❋‡Oral liq 5 mg per 5 ml ....................................................................3.53 (7.40) ❋ Inj 25 mg per ml, 1 ml - Available on a PSO ...................................12.68 (20.24) ❋ Inj 25 mg per ml, 2 ml - Available on a PSO .....................................7.75 TRIMEPRAZINE TARTRATE ❋‡Oral liq 30 mg per 5 ml ...................................................................2.79 (8.06) 200 ml 100 100 ml

Asmafen ✓ Apo-Loratadine Claratyne

Avil Retard

50 50 100 ml 10 5 100 ml

Phenergan Phenergan Phenergan Phenergan ✓ Mayne

Vallergan Forte

INHALED CORTICOSTEROIDS - METERED DOSE INHALERS Low dose

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 50 mcg per dose .....................................................8.54 FLUTICASONE Aerosol inhaler, 25 mcg per dose .....................................................5.12 (Flixotide aerosol inhaler to be delisted 1 August 2005) 200 dose OP 120 dose OP ✓ Beclazone 50 ✓ Flixotide

Medium dose

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 100 mcg per dose .................................................12.50 FLUTICASONE Aerosol inhaler, 50 mcg per dose CFC-free ......................................7.50 200 dose OP 120 dose OP ✓ Beclazone 100 ✓ Flixotide

High dose

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 250 mcg per dose .................................................22.67 FLUTICASONE Aerosol inhaler, 125 mcg per dose CFC-free ..................................13.60 120 dose OP ✓ Flixotide 200 dose OP ✓ Beclazone 250

Very high dose

FLUTICASONE Aerosol inhaler, 250 mcg per dose CFC-free ..................................27.20 120 dose OP ✓ Flixotide

142

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Inhaled Corticosteroids - Breath Activated Devices Inhaled Corticosteroids - Nebuliser Solution

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

RESPIRATORY SYSTEM AND ALLERGIES

INHALED CORTICOSTEROIDS - BREATH ACTIVATED DEVICES Medium dose

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 100 mcg per dose, breath activated ......................12.50 BUDESONIDE Powder for inhalation, 100 mcg per dose .......................................17.00 FLUTICASONE Powder for inhalation, 50 mcg per dose, breath activated ..............5.10 (8.67) 200 dose OP 200 dose OP 60 dose OP Flixotide Accuhaler ✓ Respocort 100 Autohaler ✓ Pulmicort Turbuhaler

High dose

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 250 mcg per dose, breath activated ..................... 22.67 BUDESONIDE Powder for inhalation, 200 mcg per dose ...................................... 19.00 FLUTICASONE Powder for inhalation, breath activated, 100 mcg per dose ............. 5.70 (13.87) 200 dose OP ✓ Respocort Forte Autohaler ✓ Pulmicort Turbuhaler

200 dose OP 60 dose OP

Flixotide Accuhaler

Very high dose

BUDESONIDE Powder for inhalation, 400 mcg per dose ...................................... 32.00 FLUTICASONE Powder for inhalation, breath activated, 250 mcg per dose ............ 12.00 (24.51) 200 dose OP 60 dose OP Flixotide Accuhaler ✓ Pulmicort Turbuhaler

INHALED CORTICOSTEROIDS - NEBULISER SOLUTION

BUDESONIDE Nebuliser soln, 500 mcg per ml, 2 ml - Special Authority - Hospital Pharmacy [HP3] .......................... 124.00

✓ Pulmicort

Special Authority for Subsidy - Form: SA0047 Initial application only from a paediatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Child under 2 years of age; or 2 Both: 2.1 Child with major physical or intellectual disabilities; and 2.2 Lacks the necessary coordination to use aerosols with a spacer device. Note The cost of nebuliser therapy greatly exceeds other inhaled forms. Steroid nebulising solution can cause cataract formation. Renewal only from a paediatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

143

RESPIRATORY SYSTEM AND ALLERGIES

Nedocromil Inhaled Beta-Adrenoceptor Agonists - Breath Activated Devices

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

NEDOCROMIL

NEDOCROMIL Aerosol inhaler, 2 mg per dose CFC-free ....................................... 23.20 112 dose OP (25.52) Tilade

SODIUM CROMOGLYCATE

SODIUM CROMOGLYCATE Aerosol inhaler, 5 mg per dose CFC-free ....................................... 23.20 112 dose OP (25.52) Powder for inhalation, 20 mg per dose .......................................... 16.31 50 (17.94) Vicrom Intal Spincaps

INHALED BETA-ADRENOCEPTOR AGONISTS - METERED DOSE INHALERS Low dose

SALBUTAMOL - Available on a PSO Aerosol inhaler, 100 mcg per dose CFC-free .................................. 3.72 200 dose OP (6.00) AiromirIMM 4.00 200 dose OP ✓Salamol 6.00 200 dose OP ✓ Ventolin Aerosol inhaler, 100 mcg per dose ................................................. 3.72 200 dose OP ✓ Asmol IMM (Airomir, Asmol and Ventolin aerosol inhaler, 100 mcg per dose CFC-free to be delisted 1 July 2005) TERBUTALINE SULPHATE ✓ Bricanyl Aerosol Aerosol inhaler, 250 mcg per dose ................................................. 7.44 400 dose OP

INHALED BETA-ADRENOCEPTOR AGONISTS - BREATH ACTIVATED DEVICES Medium dose

SALBUTAMOL - Available on a PSO Aerosol inhaler, 100 mcg per dose, breath activated ......................21.22 400 dose OP (31.53) (Respolin Autohaler aerosol inhaler, 100 mcg per dose, breath activated to be delisted 1 June 2005) Respolin Autohaler

High dose

TERBUTALINE SULPHATE Powder for inhalation, 250 mcg per dose, breath activated ............ 18.20 200 dose OP ✓ Bricanyl Turbuhaler

144

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Inhaled Beta-Adrenoceptor Agonists - Long Acting

RESPIRATORY SYSTEM AND ALLERGIES

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

INHALED BETA-ADRENOCEPTOR AGONISTS - LONG ACTING Breath activated devices

EFORMOTEROL FUMARATE Powder for inhalation, 6 mcg per dose, breath activated - Subsidy by endorsement ..........................................................21.50 60 dose OP ✓ Oxis Turbuhaler

Subsidy is available for patients with poorly controlled asthma where: a) at least three months of 750 mcg or more daily of inhaled beclomethasone or budesonide (or 400 mcg of ﬂuticasone) for adults has been used; or b) at least three months of 400 mcg or more daily of inhaled beclomethasone or budesonide (or 200 mcg of ﬂuticasone) for children has been used; The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are “poor control with ICS” or “certiﬁed condition”. BUDESONIDE WITH EFORMOTEROL - Special Authority - Retail pharmacy Powder for inhalation 100 mcg with eformoterol fumarate 6 mcg ...74.10 Powder for inhalation 200 mcg with eformoterol fumarate 6 mcg ...90.80 EFORMOTEROL FUMARATE - Special Authority - Retail pharmacy Powder for inhalation, 12 mcg per dose, and monodose device ...........35.80 Powder for inhalation, 12 mcg per dose, breath activated ...............35.80 SALMETEROL - Special Authority - Retail pharmacy Powder for inhalation, 50 mcg per dose, breath activated .................. 35.80 120 dose OP 120 dose OP ✓ Symbicort Turbuhaler 100/6 ✓ Symbicort Turbuhaler 200/6 ✓ Foradil ✓ Oxis Turbuhaler ✓ Serevent Accuhaler

60 doses 60 dose OP 60 dose OP

Special Authority for Subsidy - Form: SA0609 Initial application - (Serevent MDI, Serevent Accuhaler, Foradil, Oxis Turbuhaler 12 mcg, Symbicort Turbuhaler) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Both: 1.1 Child under the age of 12 with poorly controlled asthma; and 1.2 Either: 1.2.1 Required at least three months of 400 mcg or more daily inhaled beclomethasone or budesonide; or 1.2.2 Required at least three months of 200 mcg or more of ﬂuticasone; or 2 Both: 2.1 Adult with poorly controlled asthma; and 2.2 Either: 2.2.1 Required at least three months of 1500 mcg or more daily inhaled beclomethasone or budesonide; or 2.2.2 Required at least three months of 750 mcg or more of ﬂuticasone. Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy. Special Authority approvals are interchangeable among all presentations of inhaled long-acting beta agonists and eformoterol fumarate with budesonide. Renewal - (Serevent MDI, Serevent Accuhaler, Foradil, Oxis Turbuhaler 12 mcg, Symbicort Turbuhaler) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 3 Patient demonstrates compliance (prescriber determined) with medication; and 4 Patient obtains improved asthma symptom control. continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

145

RESPIRATORY SYSTEM AND ALLERGIES

Inhaled Beta-Adrenoceptor Agonists - Long Acting

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy. Initial application - (Serevent MDI, Serevent Accuhaler) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 5 Patients aged 12 and over with poorly controlled asthma; and 6 Any of the following: 6.1 Patient is hypersensitive to eformoterol; or 6.2 Patient has developed a product related adverse event that resolved on cessation and recurred on rechallenge with Oxis Turbuhaler 6 mcg; or 6.3 Failed to show evidence of improved asthma control after a six week trial of Oxis Turbuhaler 6 mcg (with doses of 12-24 mcg daily); and 7 Any of the following: For an adult: 7.1 Required at least three months of 750 mcg or more daily inhaled beclomethasone or budesonide; or 7.2 Required at least three months of 400 mcg or more of ﬂuticasone; or For a child over 12: 7.3 Required at least three months of 400 mcg or more daily inhaled beclomethasone or budesonide; or 7.4 Required at least three months of 200 mcg or more of ﬂuticasone. Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy. Special Authority approvals are interchangeable among all presentations of inhaled long-acting beta agonists and eformoterol fumarate with budesonide. Renewal - (Serevent MDI, Serevent Accuhaler) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 8 Patient demonstrates compliance (prescriber determined) with medication; and 9 Patient obtains improved asthma symptom control. Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy. Initial application - (Serevent MDI and spacer) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 10 Patient aged 12 and over with poorly controlled asthma; and 11 Patient has documented serious mental or physical disability and is incapable of being taught to use the appropriate breath activated device; and 12 Any of the following: For an adult 12.1 Required at least three months of 750 mcg or more daily inhaled beclomethasone or budesonide; or 12.2 Required at least three months of 400 mcg or more of ﬂuticasone; or For a child over 12 12.3 Required at least three months of 400 mcg or more daily inhaled beclomethasone or budesonide; or 12.4 Required at least three months of 200 mcg or more of ﬂuticasone. Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy. Special Authority approvals are interchangeable among all presentations of inhaled long-acting beta agonists and eformoterol fumarate with budesonide. Hand grips for the Turbuhaler are available free of charge from AstraZeneca for patients with problems with manual dexterity. continued…

146

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Inhaled Beta-Adrenoceptor Agonists - Long Acting Inhaled Beta-Adrenoceptor Agonists - Nebuliser Solutions Inhaled Anticholinergic Agents - Breath Activated Devices

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Renewal - (Serevent MDI and spacer) only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 13 Patient demonstrates compliance (prescriber determined) with medication; and 14 Patient obtains improved asthma symptom control. Note Patients are to be reviewed at least at six months to assess compliance and effectiveness of therapy.

RESPIRATORY SYSTEM AND ALLERGIES

Metered dose inhalers

SALMETEROL - Special Authority (See page 145-147) Aerosol inhaler, 25 mcg per dose ...................................................33.75 120 dose OP ✓ SereventINHALED

INHALED BETA-ADRENOCEPTOR AGONISTS - NEBULISER SOLUTIONS Low dose

SALBUTAMOL - Available on a PSO Nebuliser soln, 1 mg per ml, 2.5 ml .................................................4.83 20 ✓ Ventolin Nebules

High dose

SALBUTAMOL - Available on a PSO Nebuliser soln, 2 mg per ml, 2.5 ml .................................................5.10 20 ✓ Ventolin Nebules

Very high dose

TERBUTALINE SULPHATE Nebuliser soln, 10 mg per ml .........................................................16.02 (Bricanyl nebuliser soln, 10 mg per ml to be delisted 1 May 2005) 50 ml OP ✓ Bricanyl

INHALED ANTICHOLINERGIC AGENTS - BREATH ACTIVATED DEVICES

TIOTROPIUM BROMIDE – Special Authority – Retail pharmacy Powder for inhalation, monodose device, 18 mcg per dose ........................................................................70.00 30 monodoses ✓ Spiriva

Special Authority for Subsidy – Form: SA0758 Initial application only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 To be used for the long-term maintenance treatment of bronchospasm and dyspnoea associated with COPD; and 2 In addition to standard treatment, the patient has trialled a dose of at least 40 mcg ipratropium q.i.d for one month; and 3 The patient’s breathlessness ≥ grade 4 according to the Medical Research Council (UK) dyspnoea scale (see note). Grade must be stated on the application; and 4 FEV1 < 40% of predicted (copy of actual result and predicted value to be included in application, or values to be stated on form); and 5 Either: 5.1 Patient is not a smoker; or 5.2 Patient is a smoker and been offered smoking cessation counselling; and 6 The patient has been offered annual inﬂuenza immunisation. continued… ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

147

RESPIRATORY SYSTEM AND ALLERGIES

Inhaled Anticholinergic Agents - Breath Activated Devices Beta-Adrenoceptor Agonists - Long-Acting Tablets

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued… Renewal only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 7 Patient is compliant with the medication; and 8 Patient has experienced improved COPD symptom control (prescriber determined); and 9 Applicant must supply recent measurement of FEV1 (% of predicted). Details must be attached to the application (for reporting purposes only). Note Grade 4 = stops for breath after walking about 100 meters or after a few minutes on the level; Grade 5 = too breathless to leave the house, or breathless when dressing or undressing

INHALED ANTICHOLINERGIC AGENTS - METERED DOSE INHALERS Low dose

IPRATROPIUM BROMIDE Aerosol inhaler, 21 mcg per dose CFC-free ....................................16.20 200 dose OP ✓ Atrovent

INHALED ANTICHOLINERGIC AGENTS - NEBULISER SOLUTIONS Low dose

IPRATROPIUM BROMIDE - Available on a PSO Nebuliser soln, 250 mcg per 1 ml, 1 ml ...........................................5.50 20 ✓ Steri-Neb

High dose

IPRATROPIUM BROMIDE - Available on a PSO Nebuliser soln, 500 mcg per 2 ml, 2 ml ...........................................6.50 20 ✓ Steri-Neb

INHALED BETA-ADRENOCEPTOR AGONIST AND ANTICHOLINERGIC AGENTS - METERED DOSE INHALERS

SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 mcg with ipratropium bromide, 20 mcg per dose ......................................12.19 200 dose OP ✓ Combivent

INHALED BETA-ADRENOCEPTOR AGONIST AND ANTICHOLINERGIC AGENTS - NEBULISER SOLUTION Salbutamol

SALBUTAMOL WITH IPRATROPIUM BROMIDE - Available on a PSO Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per 2.5 ml vial, 2.5 ml ...................10.45 20 ✓ Duolin

BETA-ADRENOCEPTOR AGONISTS - LONG-ACTING TABLETS Low dose

SALBUTAMOL Tab long-acting 4 mg .....................................................................11.18 ✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10 56 ✓ Volmax

148

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Beta-Adrenoceptor Agonists - Long-Acting Tablets Beta-Adrenoceptor Agonists - Oral Liquids Cystic Fibrosis

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

RESPIRATORY SYSTEM AND ALLERGIES

High dose

SALBUTAMOL Tab long-acting 8 mg .....................................................................15.30 56 ✓ Volmax

BETA-ADRENOCEPTOR AGONISTS - ORAL LIQUIDS

SALBUTAMOL ‡ Oral liq 2 mg per 5 ml ......................................................................2.45 4.76 150 ml ✓ Salapin ✓ Ventolin

BETA-ADRENOCEPTOR AGONISTS - INJECTION

SALBUTAMOL Inj 500 mcg per ml, 1 ml - Available on a PSO ...............................12.90 Infusion 1 mg per ml, 5 ml ...........................................................118.38 (130.21) TERBUTALINE SULPHATE Inj 500 mcg per ml, 1 ml ...............................................................10.21 5 10 ✓ Ventolin Ventolin 5 ✓ Bricanyl

THEOPHYLLINE DERIVATIVES

AMINOPHYLLINE ❋ Inj 25 mg per ml, 10 ml - Available on a PSO .................................11.95 THEOPHYLLINE ❋ Tab long-acting 250 mg .................................................................21.51 ❋ Tab long-acting 350 mg .................................................................29.28 ❋‡Oral liq 80 mg per 15 ml .................................................................4.06 (15.50) 5 100 100 500 ml ✓ Mayne ✓ Nuelin-SR ✓ Nuelin-SR Nuelin

COUGH PREPARATIONS

CODEINE PHOSPHATE ‡ Linctus diabetic 15 mg per 5 ml (refer page 162) ...........................CE ‡ Linctus paediatric 3 mg per 5 ml (refer page 162) ..........................CE

CYSTIC FIBROSIS

DORNASE ALFA - Special Authority Nebuliser soln, 2.5 mg per 2.5 ml ampoule ..................................294.30 6 ✓ Pulmozyme

Special Authority - Hospital pharmacy [HP1] a) Dornase alfa will be subsidised for patients meeting the treatment guidelines and who are approved by the Cystic Fibrosis DN’ase Advisory Panel. Application details may be obtained from: The Co-ordinator Phone: (04) 460 4990 Cystic Fibrosis DN’ase Advisory Panel Facsimile: (04) 916 7571 PHARMAC, PO Box 10 254 Email: wiebke.tod@pharmac.govt.nz Wellington b) Prescriptions for patients approved for treatment must be written by respiratory physicians or paediatricians who have experience and expertise in treating cystic ﬁbrosis.

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲ Three months supply may be dispensed at one time

if endorsed “certiﬁed exemption” by the prescriber.

149

RESPIRATORY SYSTEM AND ALLERGIES

Nasal Preparations Respiratory Devices

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

NASAL PREPARATIONS Allergy Prophylactics

BECLOMETHASONE DIPROPIONATE Metered aqueous nasal spray, 50 mcg per dose ..............................2.14 Metered aqueous nasal spray, 100 mcg per dose ............................2.24 BUDESONIDE Metered aqueous nasal spray, 50 mcg per dose ...............................2.35 Metered aqueous nasal spray, 100 mcg per dose ............................2.61 IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% ..........................................................11.79 SODIUM CROMOGLYCATE Nasal spray, 4% .............................................................................16.08 (25.63) 200 dose OP 200 dose OP 200 dose OP 200 dose OP 15 ml OP 22 ml OP Rynacrom Forte ✓ Alanase ✓ Alanase ✓ Butacort Aqueous ✓ Butacort Aqueous ✓ Atrovent Nasal Aqueous

RESPIRATORY DEVICES

PEAK FLOW METERS - Only on a WSO Low range - maximum 10 per WSO ...............................................14.90 Normal range - maximum 10 per WSO ...........................................14.90 SPACER DEVICES AND MASKS- Only on a WSO Spacer device - maximum 5 per WSO ............................................12.50 Mask, size 2 - maximum 5 per WSO ................................................4.10 1 OP 1 OP OP OP ✓ Breath-Alert ✓ Breath-Alert ✓ Space Chamber ✓ Foremount Child’s Silicone Mask

a) Spacer devices and masks also available to paediatricians employed by a DHB on a wholesale supply order signed by the paediatrician. Limited to one pack of 20 per order. Orders via a hospital pharmacy. b) Only available for children aged six years and under. c) For Space Chamber and Foremount Child’s Silicone Mask wholesale supply order must indicate clearly if either the spacer device, the mask, or both are required. d) Distributed by Airﬂow Products. Forward orders to: Airﬂow Products Telephone: 04 499 1240 or 0800 AIR FLOW PO Box 1485, Wellington Facsimile: 04 499 1245 or 0800 323 270

150

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

SENSORY ORGANS

Ear Preparations Ear/Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

EAR PREPARATIONS

ACETIC ACID WITH 1, 2-PROPANEDIOL DIACETATE AND BENZETHONIUM Ear drops 2% with 1, 2-propanediol diacetate 3% and benzethonium chloride 0.02% ...................................................... 5.83 Ear drops 2% with 1, 2-propanediol diacetate 3% and benzethonium chloride 0.02% and hydrocortisone 1% (refer page 162) ............................................................................ CE CHLORAMPHENICOL Ear drops 0.5%................................................................................. 1.87 35 ml OP ✓ Vosol

✓ 5 ml OP ✓ Chloromycetin

FLUMETASONE PIVALATE Ear drops 0.02% with clioquinol 1% .................................................. 4.46 7.5 ml OP (4.65) TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g ............................. 2.57 7.5 ml OP

Locorten-Vioform

✓ Kenacomb

EAR/EYE PREPARATIONS

DEXAMETHASONE WITH FRAMYCETIN AND GRAMICIDIN Ear/Eye drops 500 mcg with framycetin sulphate 5 mg and gramicidin 50 mcg per ml ............................................................. 4.50 (8.06) Ear/Eye oint 0.5 mg with framycetin sulphate 5 mg and gramicidin 50 mcg per g ............................................................... 4.50 (8.06) (Sofradex ear/eye oint to be delisted 1 September 2005) FRAMYCETIN SULPHATE Ear/Eye drops 0.5% .......................................................................... 4.13 (7.52) 8 ml OP Sofradex 5 g OP Sofradex

8 ml OP Soframycin

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

151

SENSORY ORGANS

Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

EYE PREPARATIONS Anti-Infective Preparations

See also Corticosteroids & Other Anti-Inﬂammatory Preparations, page 153 ACICLOVIR - Retail pharmacy-specialist ❋ Eye oint 3% ................................................................................... 37.53 CHLORAMPHENICOL Eye drops 0.5% ............................................................................... 1.02 Eye oint 1% ...................................................................................... 1.80 4.5 g OP 10 ml OP 4 g OP ✓ Zovirax ✓ Chlorsig ✓ Chlorsig

CIPROFLOXACIN - Retail pharmacy-specialist prescription Eye drops 0.3% .............................................................................. 12.43 5 ml OP ✓ Ciloxan a) Specialist must be an ophthalmologist. b) For treatment of bacterial keratitis or severe bacterial conjunctivitis resistant to chloramphenicol. DIBROMOPROPAMIDINE ISETHIONATE ❋ Eye oint 0.15% ................................................................................ 2.97 (7.26) FUSIDIC ACID Eye drops 1% ................................................................................... 4.50 (9.10) GENTAMICIN SULPHATE - Retail pharmacy-specialist Eye drops 0.3% ............................................................................. 11.40 PROPAMIDINE ISETHIONATE ❋ Eye drops 0.1% ............................................................................... 2.97 (7.26) SULPHACETAMIDE SODIUM ❋ Eye drops 10% ................................................................................ 3.60 4.41 TOBRAMYCIN - Retail pharmacy-specialist Eye drops 0.3% ............................................................................. 11.48 Eye oint 0.3% ................................................................................. 10.45 5 g OP Brolene 5 g OP Fucithalmic 5 ml OP 10 ml OP Brolene 15 ml OP 15 ml OP 5 ml OP 3.5 g OP ✓ Acetopt ✓ Bleph 10 ✓ Tobrex ✓ Tobrex ✓ Genoptic

152

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

SENSORY ORGANS

Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Corticosteroids and Other Anti-Inﬂammatory Preparations

DEXAMETHASONE - Retail pharmacy-specialist ❋ Eye drops 0.1% ............................................................................... 4.50 ❋ Eye oint 0.1% ................................................................................... 5.86 5 ml OP 3.5 g OP ✓ Maxidex ✓ Maxidex

DEXAMETHASONE WITH NEOMYCIN AND POLYMYXIN B SULPHATE - Retail pharmacy-specialist ❋ Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml ....................................... 4.50 5 ml OP ✓ Maxitrol ❋ Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g......................................... 5.39 3.5 g OP ✓ Maxitrol DICLOFENAC SODIUM - Retail pharmacy-specialist ❋ Eye drops 1 mg per ml ................................................................... 13.80 FLUOROMETHOLONE - Retail pharmacy-specialist ❋ Eye drops 0.1% ................................................................................ 4.39 LEVOCABASTINE Eye drops 0.5 mg per ml .................................................................. 8.71 (11.26) LODOXAMIDE TROMETAMOL Eye drops 0.1% ................................................................................ 8.71 PREDNISOLONE ACETATE - Retail pharmacy-specialist ❋ Eye drops 0.12% .............................................................................. 4.50 (7.53) ❋ Eye drops 1% ................................................................................... 4.50 (9.44) SODIUM CROMOGLYCATE Eye drops 2% ................................................................................... 4.99 5 ml OP 5 ml OP 4 ml OP Livostin 10 ml OP 5 ml OP Pred Mild 5 ml OP Pred Forte 10 ml OP ✓ Cromolux ✓ Lomide ✓ Voltaren Ophtha ✓ Flucon

Glaucoma Preparations – Beta Blockers

BETAXOLOL HYDROCHLORIDE - Retail pharmacy-specialist ❋ Eye drops 0.25% ............................................................................ 11.80 ❋ Eye drops 0.5% ................................................................................ 7.50 LEVOBUNOLOL - Retail pharmacy-specialist ❋ Eye drops 0.25% .............................................................................. 7.00 ❋ Eye drops 0.5% ................................................................................ 7.00 TIMOLOL MALEATE - Retail pharmacy-specialist ❋ Eye drops 0.25%, gel forming ........................................................... 8.00 ❋ Eye drops 0.25% .............................................................................. 2.37 ❋ Eye drops 0.5%, gel forming ............................................................. 8.50 ❋ Eye drops 0.5% ............................................................................... 2.29 TIMOLOL MALEATE WITH PILOCARPINE - Retail pharmacy-specialist ❋ Eye drops 0.5% with pilocarpine 2% ............................................... 13.95 ❋ Eye drops 0.5% with pilocarpine 4% ............................................... 13.95 5 ml OP 5 ml OP 5 ml OP 5 ml OP 2.5 ml OP 5 ml OP 2.5 ml OP 5 ml OP 5 ml OP 5 ml OP ✓ Betoptic S ✓ Betoptic ✓ Betagan ✓ Betagan ✓ Timoptol XE ✓ Apo-Timop ✓ Timoptol XE ✓ Apo-Timop ✓ Timpilo 2 ✓ Timpilo 4

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

153

SENSORY ORGANS

Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Glaucoma Preparations – Carbonic Anhydrase Inhibitors

ACETAZOLAMIDE ❋ Tab 250 mg ...................................................................................... 8.75 (10.52) ❋ Sodium inj 500 mg ......................................................................... 13.95 BRINZOLAMIDE ▲ Eye Drops 1%................................................................................... 9.77 See Prescribing Guidelines below DORZOLAMIDE HYDROCHLORIDE - Retail pharmacy-specialist ❋ Eye drops 2% ................................................................................... 9.77 (13.95) See prescribing guidelines below. 100 1 5 ml OP Diamox ✓ Diamox ✓ Azopt

5 ml OP Trusopt

DORZOLAMIDE HYDROCHLORIDE WITH TIMOLOL MALEATE - Retail pharmacy-specialist ❋ Eye drops 2% with timolol maleate 0.5% ......................................... 23.95 5 ml OP

✓ Cosopt

Prescribing Guidelines Trusopt, Cosopt and Azopt are subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Trusopt, Cosopt and Azopt should not be prescribed for a person in whom less expensive ﬁrst line agents for the treatment of glaucoma are not contraindicated unless: a) that person has previously trialled all other such subsidised agents (except brimonidine tartrate); and b) those trials have indicated that that person does not respond adequately to treatment with those other agents.

Glaucoma Preparations – Prostaglandin Analogues

Special Authority for Subsidy - Form: SA0751 Initial application only from an ophthalmologist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Either: 1.1 Monotherapy in primary open-angle glaucoma; or 1.2 Adjunctive use for the treatment of open-angle glaucoma in a patient who has met the initial application criteria, and in whom prostaglandin analogue monotherapy has been ineffective in controlling intraocular pressure; and 2 Any of the following: 2.1 Patient cannot tolerate beta-blockers, pilocarpine, and carbonic anhydrase inhibitors; or 2.2 Beta-blockers, pilocarpine and carbonic anhydrase inhibitors are contraindicated; or 2.3 A reduction in intraocular pressure of 15% or more is not achieved or maintained using carbonic anhydrase inhibitor either alone or in combination with a beta blocker; or 2.4 There is progressive visual ﬁeld loss and/or optic nerve damage persists after treatment with carbonic anhydrase inhibitor either alone or in combination with a beta blocker. Note An adjunctive agent may be added without a further Special Authority application. Renewal only from an ophthalmologist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. LATANOPROST - Special Authority - Retail pharmacy ▲ Eye drops 50 mcg per ml, 2.5 ml .................................................... 24.18 TRAVOPROST - Special Authority - Retail pharmacy ▲ Eye drops 0.004% .......................................................................... 24.18 2.5 ml OP 2.5 ml OP ✓ Xalatan ✓ Travatan

154

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

SENSORY ORGANS

Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Glaucoma Preparations – Other

BRIMONIDINE TARTRATE - Retail pharmacy-specialist ❋ Eye drops 0.2% .............................................................................. 14.00 5 ml OP ✓ Alphagan

Prescribing Guidelines Alphagan is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Alphagan should not be prescribed for a person in whom less expensive ﬁrst line agents for the treatment of glaucoma are not contraindicated unless: a) that person has previously trialled all other such subsidised agents (except dorzolamide hydrochloride); and b) those trials have indicated that that person does not respond adequately to or does not tolerate treatment with those other agents. CARBACHOL - Retail pharmacy-specialist ❋ Eye drops 1.5% ................................................................................ 6.82 ❋ Eye drops 3% ................................................................................... 6.99 DIPIVEFRIN HYDROCHLORIDE - Retail pharmacy-specialist ▲ Eye drops 0.1% ................................................................................ 5.50 15 ml OP 15 ml OP 10 ml OP Isopto Carbachol Isopto Carbachol ✓ Propine

PILOCARPINE ❋ Eye drops 0.5% ................................................................................ 2.77 15 ml OP ✓ Pilopt ❋ Eye drops 1% ................................................................................... 2.95 15 ml OP ✓ Pilopt ❋ Eye drops 2% ................................................................................... 3.76 15 ml OP ✓ Pilopt ❋ Eye drops 3% ................................................................................... 4.75 15 ml OP ✓ Pilopt ❋ Eye drops 4% ................................................................................... 5.48 15 ml OP ✓ Pilopt ❋ Eye drops 6% ................................................................................... 7.78 15 ml OP ✓ Pilopt ❋ Eye drops 2%, single dose - Special Authority - Hospital pharmacy [HP3] .. 31.95 20 (32.72) Minims Special Authority for Subsidy - Form: SA0121 Initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Patient has to use an unpreserved solution due to an allergy to the preservative; or 2 Patient wears soft contact lenses. Note Minims for a general practice are considered to be “tools of trade” and are not approved as special authority items. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment.

Mydriatics and Cycloplegics

ATROPINE SULPHATE ❋ Eye drops 0.5% ............................................................................... 4.02 ❋ Eye drops 1% .................................................................................. 4.02 CYCLOPENTOLATE HYDROCHLORIDE ❋ Eye drops 1% ................................................................................... 8.76 HOMATROPINE HYDROBROMIDE ❋ Eye drops 2% ................................................................................... 7.18 ❋ Eye drops 5% .................................................................................. 8.73 HYOSCINE HYDROBROMIDE ❋ Eye drops 0.25% .............................................................................. 6.79 TROPICAMIDE ❋ Eye drops 0.5% ............................................................................... 7.15 ❋ Eye drops 1% ................................................................................... 8.66 ‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP

✓ Atropt ✓ Atropt ✓ Cyclogyl ✓ Isopto Homatropine ✓ Isopto Homatropine ✓ Isopto Hyoscine ✓ Mydriacyl ✓ Mydriacyl

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

155

SENSORY ORGANS

Eye Preparations

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Preparations for Tear Deﬁciency

ACETYLCYSTEINE - Special Authority - Hospital pharmacy [HP1] Eye drops (refer page 162) ............................................................... CE Special Authority for Subsidy - Form: SA0122 Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Filamentary keratitis. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: The treatment remains appropriate and the patient is beneﬁting from treatment. HYPROMELLOSE ❋ Eye drops 0.3% ................................................................................ 2.65 ❋ Eye drops 0.5% ............................................................................... 1.79 ❋ Eye drops 1% ................................................................................... 1.91 POLYVINYL ALCOHOL ❋ Eye drops 1.4% ................................................................................ 3.62 ❋ Eye drops 3% ................................................................................... 3.88 POLYVINYL ALCOHOL WITH POVIDONE ❋ Eye drops 1.4% with povidone 0.6% ................................................. 3.62 TYLOXAPOL ❋ Eye drops 0.25% .............................................................................. 8.63 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP ✓ Poly-Tears ✓ Methopt ✓ Methopt Forte ✓ Liquiﬁlm Tears ✓ Liquiﬁlm Forte ✓ Tears Plus ✓ Enuclene

Other Eye Preparations

NAPHAZOLINE HYDROCHLORIDE ❋ Eye drops 0.1% ................................................................................ 4.15 PARAFFIN LIQUID WITH SOFT WHITE PARAFFIN ❋ Eye oint with soft white parafﬁn ........................................................ 3.63 PARAFFIN LIQUID WITH WOOL FAT LIQUID ❋ Eye oint 3% with wool fat liq 3% ....................................................... 3.63 PHENYLEPHRINE HYDROCHLORIDE ❋ Eye drops 0.12% .............................................................................. 3.25 (4.18) PHENYLEPHRINE HYDROCHLORIDE WITH ZINC SULPHATE ❋ Eye drops 0.12% with zinc sulphate 0.25% ...................................... 4.51 15 ml OP 3.5 g OP 3.5 g OP 15 ml OP ✓ Naphcon Forte ✓ Lacri-Lube ✓ Poly-Visc ✓ Isopto Frin Prefrin ✓ Zincfrin

15 ml OP

156

✓ fully subsidised [HP1], [HP2], [HP3], [HP4] refer page 10

“IMM” interchangeable multi-source medicines Sole Subsidised Supply

Agents Used in the Treatment of Poisonings Detection of Substances in Urine

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

VARIOUS

AGENTS USED IN THE TREATMENT OF POISONINGS

Refer also to MUSCULO-SKELETAL, Anticholinesterases, page 106 CHARCOAL ❋ Tab 300 mg .....................................................................................7.13 ❋ Oral liq 50 g per 300 ml – Only on a PSO ........................................ 19.95 DESFERRIOXAMINE MESYLATE - Hospital pharmacy [HP3] ❋ Inj 500 mg...................................................................................... 99.00 IPECACUANHA ❋ Tincture .......................................................................................... 41.20 (43.40) NALOXONE HYDROCHLORIDE - Only on a PSO ❋ Inj 20 mcg per ml, 2 ml .................................................................. 59.90 ❋ Inj 400 mcg per ml, 1 ml ................................................................ 27.00 SODIUM CALCIUM EDETATE ❋ Inj 200 mg per ml, 5 ml .................................................................. 53.31 (55.99) 100 300 ml OP 10 500 ml HMG 10 5 6 Calcium Disodium Versenate ✓ Mayne ✓ Mayne ✓ Red Seal ✓ Carbosorb ✓ Mayne

DETECTION OF SUBSTANCES IN URINE

ORTHO-TOLIDINE ❋ Compound diagnostic sticks ............................................................. 7.50 50 stick OP (8.25) TETRABROMOPHENOL ❋ Blue diagnostic strips ....................................................................... 7.02 100 strip OP (13.92) Hemastix

Albustix

‡ safety cap reimbursed ❋ Three months or six months, as applicable, dispensed all-at-once

▲

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

157

SECTION C EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

INTRODUCTION

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

The following extemporaneously compounded products are eligible for subsidy:

• The “Standard Formulae”. • Oral liquid mixtures for patients unable to swallow subsidised solid dose oral formulations. • The preparation of syringe drivers when prescribed by a general practitioner. • Dermatological preparations; - One or more subsidised dermatological galenical(s) in a subsidised dermatological base. - Dilution of proprietary Topical Corticosteroid-Plain preparations with a dermatological base (Retail pharmacy-specialist). - Menthol crystals only in the following bases: Aqueous cream (AFT) Urea cream 10% (Nutraplus) Wool fat with mineral oil lotion (Alpha Keri, BK, DP and Hydroderm) Hydrocortisone 1% with wool fat and mineral oil lotion (DP lotn HC) Glycerol, parafﬁn and cetyl alcohol lotion (QV).

Glossary

Dermatological base: The products listed in the Barrier creams and Emollients section and the Topical Corticosteroids-Plain section of the Pharmaceutical Schedule are classiﬁed as dermatological bases for the purposes of extemporaneous compounding and are the bases to which the dermatological galenicals can be added. Also the dermatological bases in the Barrier Creams and Emollients section of the Pharmaceutical Schedule can be used for diluting proprietary Topical Corticosteroid-Plain preparations. The following products are dermatological bases: • • • • • • • • • • • • • Aqueous cream Cetomacrogol cream BP Emulsifying ointment BP Glycerol with parafﬁn and cetyl alcohol lotion Hydrocortisone with wool fat and mineral oil lotion Oil in water emulsion Oily cream Urea cream 10% White soft parafﬁn Wool fat with mineral oil lotion Zinc cream BP Zinc and castor oil ointment BP Proprietary Topical Corticosteroid-Plain preparations

158

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

Dermatological galenical: Dermatological galenicals will only be subsidised when Subsidised dermatological base. added to a Generic (Manufacturer’s Price) $ ✓ Manufacturer More than one dermatological galenical can be added to a dermatological base.Per The following are dermatological galenicals: • • • • Coal tar solution BP – up to 10% Hydrocortisone powder – up to 5% Salicylic acid powder Sulphur precipitated powder

Subsidy

Fully Brand or

Standard formulae: Standard formulae are a list of fomulae for ECPs that are subsidised. They are listed under the appropriate therapeutic heading in Section B of the Pharmaceutical Schedule and also in Section C.

Explanatory notes

Oral liquid mixtures Oral liquid mixtures are subsidised for patients unable to swallow subsidised solid oral dose forms where no suitable alternative proprietary formulation is subsidised. Suitable alternatives include dispersible and sublingual formulations, oral liquid formulations or rectal formulations. Before extemporaneously compounding an oral liquid mixture, other alternatives such as dispersing the solid dose form (if appropriate) or crushing the solid dose form in jam, honey or soft foods such as yoghurt should be explored. Subsidy for extemporaneously compounded oral liquid mixtures is based on: Solid dose form Preservative Suspending agent Water to qs qs qs 100%

Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients such as ﬂavouring and colouring agents, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. The majority of extemporaneously compounded oral liquid mixtures should contain a preservative and suspending agent. Methylcellulose 3% is considered a suitable suspending agent and compound hydroxybenzoate solution or methyl hydroxybenzoate 10% solution are considered to be suitable preservatives. Usually 1 ml of these preservative solutions is added to 100 ml of oral liquid mixture. Some solid oral dose forms are not appropriate for compounding into oral liquid mixtures and should therefore not be used/considered for extemporaneously compounded oral liquid mixtures. This includes long-acting solid dose formulations, enteric coated tablets or capsules, sugar coated tablets, hard gelatin capsules and chemotherapeutic agents. The following practices will not be subsidised: • • • • Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). Extemporaneously compounding an oral liquid with more than one solid dose chemical. Mixing more than one extemporaneously compounded oral liquid mixture. Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. • The addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture.

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

159

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

Standard formulae (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer A list of standard formulae is contained in this section. All ingredients associated with a standard formula will be subsidised and an appropriate compounding fee paid. Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. Dermatological Preparations Proprietary topical corticosteroid preparations may be diluted with a dermatological base (see page 158) from the Barrier Creams and Emollients section of the Pharmaceutical Schedule (Retail pharmacy-Specialist). Dilution of proprietary topical corticosteroid preparations should only be prescribed for withdrawing patients off higher strength proprietary topical corticosteroid products where there is no suitable proprietary product of a lower strength available or an extemporaneously compounded product with up to 5% hydrocortisone is not appropriate. (In general proprietary topical corticosteroid preparations should not be diluted because dilution effects can be unpredictable and may not be linear, and usually there is no stability data available for diluted products). One or more dermatological galenicals may be added to a dermatological base (including proprietary topical corticosteroid preparations). Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. The addition of dermatological galenicals to diluted proprietary Topical Corticosteroids-Plain will not be subsidised. The ﬂow diagram on page 161 may assist you in deciding whether or not a dermatological ECP is subsidised.

Subsidy

Fully Brand or

160

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Dermatological ECPs

IS IT SUBSIDISED?

No Does the formula contain a subsidised dermatological base? Yes Is there only one dermatological base (e.g. aqueous cream)? Yes Is the galenical(s) a subsidised dermatological galenical? No Yes Entire product is NSS No Entire product is NSS

Is the second base a proprietary topical corticosteriod-plain? No Yes Entire product is NSS

Is prescription written by a specialist or on the recommendation of a specialist? No Yes Entire product is NSS

This part of the product is subsidised

Has a non-subsidised ingredient been added: e.g. glycerol? Yes The non-subsidised ingredient is not subsidised but the rest is

Has a dermatological galenical or other nonsubsidised ingredient been added? Yes The dermatological galenicals & nonsubsidised ingredients are NSS

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

161

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

Standard Formulae

ACETYLCYSTEINE EYE DROPS Acetylcysteine inj 200 mg per ml, 10 ml Suitable eye drop base qs qs

Subsidy Fully (Manufacturer’s Price) Subsidised $ Per ✓ PHENOBARBITONE ORAL LIQUID Phenobarbitone Sodium Glycerol BP Water

Brand or Generic Manufacturer 1g 70 ml to 100 ml

ASPIRIN & CHLOROFORM APPLICATION Aspirin Soluble tabs 300 mg 12 tabs Chloroform to 100 ml CODEINE LINCTUS PAEDIATRIC (3 mg per 5 ml) Codeine phosphate 60 mg Glycerol 40 ml Preservative qs Water to 100 ml CODEINE LINCTUS DIABETIC (15 mg per 5 ml) Codeine phosphate 300 mg Glycerol 40 ml Preservative qs Water to 100 ml FOLINIC MOUTHWASH Folinic acid 15 mg tab 1 tab Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days. Maximum 500 ml per prescription.) MAGNESIUM HYDROXIDE MIXTURE Magnesium hydroxide paste Methyl hydroxybenzoate Water METHADONE MIXTURE Methadone powder Glycerol Water 275 g 1.5 g 770 ml

PILOCARPINE ORAL LIQUID Pilocarpine 6% eye drops qs Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days.) SALICYLIC ACID 20% SOLUTION Maximum 20 ml per prescription Salicylic acid 4g Collodion ﬂexible to 20 ml SALICYLIC ACID 40% SOLUTION Maximum 20 ml per prescription Salicylic acid 8g Collodion ﬂexible to 20 ml SALICYLIC ACID 20% OINTMENT Maximum 20 g per prescription Salicylic acid White soft parafﬁn SALICYLIC ACID 40% OINTMENT Maximum 20 g per prescription Salicylic acid White soft parafﬁn SALICYLIC ACID 60% OINTMENT Maximum 20 g per prescription Salicylic acid White soft parafﬁn

4g 16 g

8g 12 g

qs qs to 100 ml

12 g 8g

METHYL HYDROXYBENZOATE 10% SOLUTION Methyl hydroxybenzoate 10 g to 100 ml Propylene glycol (Use 1 ml of the 10% solution per 100 ml of oral liquid mixture.) OMEPRAZOLE SUSPENSION Omerprazole capsules qs Sodium bicarbonate powder BP 8.4 g Water to 100 ml

SALIVA SUBSTITUTE FORMULA Methylcellulose 5g Preservative qs Water to 500 ml (Preservative should be used if quanitity supplied is for more than 5 days. Maximum 500 ml per prescription.) VOSOL EAR DROPS with HYDROCORTISONE POWDER 1% Hydrocortisone powder 1% Vosol ear drops to 35 ml

162

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS & GALENICALS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer ACETYLCYSTEINE Inj 200 mg per ml, 10 ml .............................................................. 137.06 (242.50) BENZOIN Tincture compound BP ................................................................... 24.42 (38.00) CHLOROFORM BP............................................................................... 21.30 (Only in aspirin and chloroform application) (30.00) 10

Parvolex

500 ml 500 ml

HMG HMG

CODEINE PHOSPHATE Powder........................................................................................... 63.09 25 g (72.55) ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. (Only in extemporaneously compounded codeine linctus diabetic or codeine linctus paediatric) COLLODION FLEXIBLE ......................................................................... 14.60 (24.00) COMPOUND HYDROXYBENZOATE Solution .......................................................................................... 34.18 (Only in extemporaneously compounded oral mixtures) 100 ml

Douglas

HMG ✓ David Craig

100 ml

GLYCEROL ❋ Liquid ............................................................................................. 24.75 2,000 ml ✓ MidWest (33.00) HMG (Only in extemporaneously compounded methadone mixture, codeine linctus diabetic, codeine linctus paediatric or phenobarbitone oral liquid) MAGNESIUM HYDROXIDE Paste ............................................................................................. 22.61 500 g ✓ HMG

METHADONE HYDROCHLORIDE a) Only on a controlled drug form. b) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). Powder............................................................................................. 8.35 1g ✓ AFT ‡ Safety caps reimbursed for extemporaneously compounded oral liquid preparations. METHYLCELLULOSE Powder........................................................................................... 17.72 METHYLHYDROXYBENZOATE .............................................................. 15.62 (18.45) PHENOBARBITONE SODIUM Powder......................................................................................... 325.00 a) Only in combination b) Only in children up to 12 years. 100 g 25 g ✓ MidWest HMG ✓ Midwest

100 g

PROPYLENE GLYCOL .......................................................................... 16.20 500 ml (19.20) (Only in extemporaneously compounded methylhydroxybenzoate 10% solution) SODIUM BICARBONATE Powder BP ..................................................................................... 11.99 (17.50) (Only in extemporaneously compounded omeprazole suspension) 500 g

HMG

✓ Biomed David Craig

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

163

SECTION D: SPECIAL FOODS

EXPLANATORY NOTES

The list of special foods to which Subsidies apply is contained in this section. The list of available products, guidelines for use, subsidies and charges is reviewed as required. Applications for new listings and changes to subsidies and access criteria will be considered by the special foods sub-committee of PTAC which meets as and when required. In all cases, subsidies are available by Special Authority only. This means that, unless a patient has a valid Special Authority number for their special food requirements, they must pay the full cost of the products themselves.

Eligibility for Special Authority

Special Authorities will be approved for patients meeting conditions speciﬁed under the Conditions and Guidelines for each product. In some cases there are also limits to how products can be prescribed (for example quantity, use or duration). Only those brands, presentations and ﬂavours of special foods listed in this section are subsidised. Initial applications: Only specialists Reapplications: Specialist or general practitioner on recommendation of specialist. Reapplications by general practitioners on specialist recommendation must include the name of the specialist and the date the specialist was contacted. All applications must be made on an ofﬁcial form available from the PHARMAC website www.pharmac.govt.nz. All applications must include speciﬁc details as requested on the form relating to the application. A supporting letter may be included if desired. Applications must be forwarded to: HealthPAC Special Authorities Section Private Bag 3015 Wanganui Freefax 0800 100 131 The Subsidies for some special foods are based on the lowest priced product within each group. Where this is so, or where special foods are otherwise not fully subsidised, a manufacturer’s surcharge may be payable by the patient. The manufacturer’s surcharge is the difference between the price of the product and the subsidy attached to it and may be subject to mark-ups applied at a pharmacy level. As a result the manufacturer’s surcharge may vary. Fully subsidised alternatives are available in most cases (as indicated by a tick in the left hand column). Patients should only have to pay a co-payment on these products. Distribution arrangements for special foods vary from region to region. Special foods are available from hospital pharmacies providing an outpatient dispensing service as well as retail pharmacies in the Northern, Midland and Central (including Nelson and Blenheim) regions. Failure to thrive Growth deﬁciency An inability to gain or maintain weight resulting in physiological impairment. Where the weight of the child is less than the ﬁfth or possibly third percentile for their age, with evidence of malnutrition.

Who can apply for Special Authority?

Subsidies and manufacturer’s surcharges

Where are special foods available from?

Deﬁnitions

164

SPECIAL FOODS

Nutrient Modules

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

NUTRIENT MODULES Carbohydrate

Special Authority for Subsidy – Form: SA0579 Initial application - Cystic ﬁbrosis or renal failure Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Either: 1) Cystic ﬁbrosis; or 2) Chronic renal failure or continuous ambulatory peritoneal dialysis (CAPD) patient. Initial application - Indications other than cystic ﬁbrosis or renal failure Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) Cancer in children; or 2) Cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 3) Failure to thrive; or 4) Growth deﬁciency; or 5) Bronchopulmonary dysplasia; or 6) Premature and post premature infant Renewal - Cystic ﬁbrosis or renal failure Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. Renewal - Indications other than cystic ﬁbrosis or renal failure Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. CARBOHYDRATE SUPPLEMENT Powder........................................................................................... 36.50 5,000 g 1.30 400 g OP (5.29) 1.14 350 g OP (7.85) 1.30 368 g OP (12.00) ✓ Morrex Maltodextrin Polycal Polycose Moducal

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

165

SPECIAL FOODS

Nutrient Modules

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Carbohydrate and Fat

Special Authority for Subsidy – Form: SA0581 Initial application - Cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Infant aged four years or under; and 2) Cystic ﬁbrosis Initial application - Indications other than cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Infant aged four years or under; and 2) Any of the following: 2.1) Cancer in children; or 2.2) Failure to thrive; or 2.3) Growth deﬁciency; or 2.4) Bronchopulmonary dysplasia; or 2.5) Premature and post premature infants. Renewal - Cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. Renewal - Indications other than cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. CARBOHYDRATE AND FAT SUPPLEMENT Powder (neutral) ............................................................................. 50.26 400 g OP ✓ Duocal Super Soluble Powder

166

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

SPECIAL FOODS

Nutrient Modules

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Fat

Special Authority for Subsidy – Form: SA0580 Initial application - Inborn errors of metabolism Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Inborn errors of metabolism Initial application - Indications other than inborn errors of metabolism Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) Failure to thrive ; or 2) Growth deﬁciency; or 3) Bronchopulmonary dysplasia ; or 4) Fat malabsorption ; or 5) Lymphangiectasia; or 6) Short bowel syndrome ; or 7) Infants with necrotising enterocolitis; or 8) Biliary atresia. Renewal - Inborn errors of metabolism Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. Renewal - Indications other than inborn errors of metabolism Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. FAT SUPPLEMENT Emulsion (neutral) .......................................................................... 61.50 1,000 ml OP Emulsion (strawberry) ................................................................... 15.38 250 ml OP Oil ................................................................................................. 95.75 1,000 ml OP 25.00 500 ml OP ✓ Calogen ✓ Calogen ✓ Liquigen ✓ MCT oil (Nutricia)

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

167

SPECIAL FOODS

Nutrient Modules Oral Supplements

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Protein

Special Authority for Subsidy – Form: SA0582 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1) Protein losing enteropathy; or 2) High protein needs (eg burns). Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. PROTEIN SUPPLEMENT Powder............................................................................................. 7.90 Powder (vanilla) ............................................................................. 12.90 225 g OP 275 g OP ✓ Protifar 90 ✓ Promod

ORAL SUPPLEMENTS

These products are to be used only as supplements to a person’s dietary needs. Subsidy for up to 500 ml a day. Amounts prescribed in excess of this amount must be paid for by the patient. Special Authority for Subsidy – Form: SA0583 Initial application - Cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Cystic ﬁbrosis Initial application - Indications other than cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) Cancer in children; or 2) Inﬂammatory bowel disease; or 3) Cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 4) Malnutrition requiring nutritional support. Renewal - Cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. Renewal - Indications other than cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted.

168

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer ORAL SUPPLEMENT 1KCAL/ML Powder (chocolate) .......................................................................... 9.22 900 g OP ✓ Sustagen Hospital Formula Ensure Ensure ✓ Nutridrink ✓ Sustagen Hospital Formula Ensure

SPECIAL FOODS

4.75 400 g OP (7.22) Powder (strawberry) ......................................................................... 4.75 400 g OP (7.22) Powder (vanilla) ............................................................................. 11.50 900 g OP 9.22 4.75 400 g OP (7.22)

ORAL SUPPLEMENTS/COMPLETE DIET (nasogastric/gastrostomy tube feed) Respiratory Products

Special Authority for Subsidy – Form: SA0588 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) CORD patients who have hypercapnia; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. CORD ORAL FEED 1.5KCAL/ML Liquid ............................................................................................... 1.66 237 ml OP ✓ Pulmocare

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

169

SPECIAL FOODS

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Diabetic Products

Special Authority for Subsidy – Form: SA0594 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Type I and II diabetics who require nutritional supplementation; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. DIABETIC ENTERAL FEED 1KCAL/ML Liquid ............................................................................................... 8.70 1,000 ml OP ✓ Diason RTH ✓ Glucerna RTH ✓ Resource Diabetic RTH ✓ Resource Diabetic ✓ Resource Diabetic ✓ Diasip ✓ Glucerna ✓ Resource Diabetic

ORAL FEED 1KCAL/ML Liquid (chocolate) ............................................................................ 2.06 Liquid (strawberry) ........................................................................... 2.06 Liquid (vanilla) .................................................................................. 1.74 2.17 2.06

237 ml OP 237 ml OP 200 ml OP 250 ml OP 237 ml OP

170

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Fat Modiﬁed Products

Special Authority for Subsidy – Form: SA0615 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The product is to be used as a complete diet; and 2) Either: 2.1) Patient has metabolic disorders of fat metabolism; or 2.2) Patient has chylothorax. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. FAT MODIFIED FEED Powder........................................................................................... 50.40 400 g OP ✓ Monogen

High Protein Products

Special Authority for Subsidy – Form: SA0589 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) Anorexia and weight loss; and 2) Either: 2.1) Decompensating liver disease without encephalopathy; or 2.2) Protein losing gastro-enteropathy; and 3) Either: 3.1) The product is to be used as a supplement (maximum 500 ml per day); or 3.2) The product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. ORAL FEED 1KCAL/ML Liquid ............................................................................................... 1.50 200 ml OP ✓ Fortimel

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

171

SPECIAL FOODS

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Paediatric Products for Children awaiting Liver Transplant

Special Authority for Subsidy – Form: SA0607 Initial application Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Child (up to 18 years) who is awaiting liver transplant; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Renewal Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. ENTERAL/ORAL FEED 1KCAL/ML Powder........................................................................................... 65.81 400 g OP ✓ Generaid Plus

Paediatric Products for Children with Chronic Renal Failure

Special Authority for Subsidy – Form: SA0606 Initial application Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Child (up to 18 years) with chronic renal failure; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet. Renewal Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet. ENTERAL/ORAL FEED 1KCAL/ML Liquid ............................................................................................. 45.00 400 g OP ✓ Kindergen

172

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Paediatric Products

Special Authority for Subsidy – Form: SA0590 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) Infant aged one to six years; and 2) Any of the following: 2.1) Any condition causing malabsorption ; or 2.2) Failure to thrive; or 2.3) Increased nutritional requirements; and 3) Either: 3.1) The product is to be used as a supplement (maximum 500 ml per day); or 3.2) The product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. PAEDIATRIC ENTERAL FEED 1.5KCAL/ML Liquid ............................................................................................... 1.60 6.00 PAEDIATRIC ENTERAL FEED 1KCAL/ML Liquid ............................................................................................... 1.07 2.68 PAEDIATRIC ORAL FEED 1.5KCAL/ML Liquid (strawberry) ........................................................................... 1.60 Liquid (vanilla) .................................................................................. 1.60 Paediatric oral feed 1kcal/ml Liquid (chocolate) ............................................................................ 1.27 Liquid (strawberry) ........................................................................... 1.27 Liquid (vanilla) .................................................................................. 1.27 PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML Liquid (chocolate) ............................................................................ 1.60 Liquid (strawberry) ........................................................................... 1.60 Liquid (vanilla) .................................................................................. 1.60 200 ml OP 500 ml OP 200 ml OP 500 ml OP 200 ml OP 200 ml OP 237 ml OP 237 ml OP 237 ml OP ✓ Nutrini Energy RTH ✓ Nutrini Energy RTH ✓ Nutrini RTH ✓ Pediasure RTH ✓ Fortini ✓ Fortini ✓ Pediasure ✓ Resource Just for Kids ✓ Pediasure ✓ Pediasure ✓ Resource Just for Kids ✓ Fortini Multiﬁbre ✓ Fortini Multiﬁbre ✓ Fortini Multiﬁbre

200 ml OP 200 ml OP 200 ml OP

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

173

SPECIAL FOODS

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Renal Products

Special Authority for Subsidy – Form: SA0587 Initial application Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Acute or chronic renal failure; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. ENTERAL FEED 2KCAL/ML Liquid ............................................................................................... 6.08 RENAL ORAL FEED 2KCAL/ML Liquid ............................................................................................... 2.88 500 ml OP 237 ml OP ✓ Nutrison Concentrated ✓ Nepro (vanilla) ✓ NovaSource Renal

174

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Specialised and Elemental Products

Special Authority for Subsidy – Form: SA0592 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Any of the following: 1.1) Malabsorption; or 1.2) Short bowel syndrome; or 1.3) Enterocutaneous ﬁstulas; or 1.4) Pancreatitis; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Note: Each of these products is highly specialised and would be prescribed only by an expert for a speciﬁc disorder. The alternative is hospitalisation. Elemental 028 Extra is more expensive than other products listed in this section and should only be used where the alternatives have been tried ﬁrst and/or are unsuitable. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML Powder............................................................................................. 7.50 4.40 ORAL ELEMENTAL FEED 0.8KCAL/ML Liquid (grapefruit) ............................................................................. 8.70 Liquid (pineapple & orange) .............................................................. 8.70 Liquid (summer fruit) ........................................................................ 8.70 ORAL ELEMENTAL FEED 1KCAL/ML Powder (unﬂavoured) ....................................................................... 4.00 76 g OP 79 g OP 250 ml OP 250 ml OP 250 ml OP 80.4 g OP ✓ Alitraq ✓ Vital HN ✓ Elemental 028 Extra ✓ Elemental 028 Extra ✓ Elemental 028 Extra ✓ Vivonex TEN ✓ Peptisorb ✓ Peptisorb ✓ Stresson Multi-Fibre

SEMI-ELEMENTAL ENTERAL FEED 1KCAL/ML Liquid ............................................................................................... 6.02 500 ml OP 12.04 1,000 ml OP SPECIALIST ENTERAL FEED 1.25KCAL/ML Liquid ............................................................................................... 9.98 (Stresson Multi-Fibre liquid to be delisted 1 October 2005) 500 ml OP

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

175

SPECIAL FOODS

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Undyalised End Stage Renal Failure

Special Authority for Subsidy – Form: SA0586 Initial application Applications only from gastroenterologist or renal physician. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Undialysed end stage renal patients; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet. Note: Where possible, the requirements for oral supplementation should be established in conjunction with assessment by a dietician. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement (maximum 500 ml per day); or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. RENAL ORAL FEED 1KCAL/ML Liquid ............................................................................................... 3.80 237 ml OP ✓ Suplena

Adult Products Standard

Special Authority for Subsidy – Form: SA0702 Initial application - Oral feed for cystic ﬁbrosis patient Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) Cystic ﬁbrosis; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet. Initial application - Oral feed for indications other than cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Any of the following: 1.1) Any condition causing malabsorption; or 1.2) Failure to thrive; or 1.3) Increased nutritional requirements; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet.

176

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer Initial application - Enteral feed Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Any of the following: 1.1) Enteral feeding; or 1.2) Nasogastric; or 1.3) Nasoduodenal ; or 1.4) Nasojejunal; or 1.5) Gastrostomy/jejunostomy; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet. Renewal - Oral feed cystic ﬁbrosis patient Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. Renewal - Enteral feed or Oral feed for indications other than cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Either: 2.1) The product is to be used as a supplement; or 2.2) The product is to be used as a complete diet; and 3) General Practitioners must include the name of the specialist and date contacted. Note: This group of products can be used either as a supplement or as a complete diet. If a product is being used as a supplement, the limit is 500 ml per day. Cystic ﬁbrosis patients are exempt the 500 ml per day volume restriction when using Ensure Plus, Fortisip or Resource Plus as a supplement. ENTERAL FEED 1KCAL/ML Liquid ............................................................................................... 1.24 250 ml OP 2.65 500 ml OP 4.69 946 ml OP 5.29 1,000 ml OP ENTERAL FEED WITH FIBRE 1 KCAL/ML Liquid ............................................................................................... 1.24 250 ml OP 2.65 500 ml OP 5.00 946 ml OP 5.29 1,000 ml OP ✓ Isosource Standard ✓ Nutrison Standard RTH ✓ Osmolite ✓ Isosource Standard RTH ✓ Nutrison Standard RTH ✓ Osmolite RTH ✓ Fibresource ✓ Nutrison Multi Fibre ✓ Jevity ✓ Fibresource RTH ✓ Jevity RTH ✓ Nutrison Multi Fibre

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

177

SPECIAL FOODS

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed)

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer ENTERAL FEED WITH FIBRE 1.5KCAL/ML Liquid ............................................................................................... 7.00 1,000 ml OP 1.75 3.50 250 ml OP 500 ml OP ✓ Ensure Plus RTH ✓ Isosource 1.5 ✓ Nutrison Energy ✓ Isosource 1.5 ✓ Nutrison Energy ✓ Fortisip Ensure Plus ✓ Fortisip Ensure Plus ✓ Ensure Plus ✓ Resource Plus ✓ Ensure Plus Ensure Plus ✓ Fortisip Ensure Plus ✓ Ensure Plus ✓ Resource Plus ✓ Fortisip ✓ Fortisip ✓ Fortisip Ensure Plus ✓ Ensure Plus ✓ Resource Plus

ORAL FEED 1.5KCAL/ML Liquid (banana) ................................................................................ 1.12 200 ml OP (1.45) Liquid (chocolate) ............................................................................ 1.12 200 ml OP (1.45) 1.33 237 ml OP Liquid (coffee) .................................................................................. 1.33 Liquid (fruit of the forest) .................................................................. 1.12 (1.45) Liquid (strawberry) ........................................................................... 1.12 (1.45) 1.33 Liquid (toffee) .................................................................................. 1.12 Liquid (tropical fruit) ......................................................................... 1.12 Liquid (vanilla) .................................................................................. 1.12 (1.45) 1.33 237 ml OP 200 ml OP 200 ml OP 237 ml OP 200 ml OP 200 ml OP 200 ml OP 237 ml OP

Adult Products High Calorie

Special Authority for Subsidy – Form: SA0585 Initial application - Cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) Cystic ﬁbrosis; and 2) Other lower calorie products have been tried; and 3) Patient has substantially increased metabolic requirements; and 4) Either: 4.1) The product is to be used as a supplement; or 4.2) The product is to be used as a complete diet. Initial application - Indications other than cystic ﬁbrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) Any of the following: 1.1) Any condition causing malabsorption; or 1.2) Failure to thrive; or 1.3) Increased nutritional requirements; and 2) Other lower calorie products have been tried; and 3) Patient has substantially increased metabolic requirements; and 4) Either: 4.1) The product is to be used as a supplement; or 4.2) The product is to be used as a complete diet.

178

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Oral Supplements/Complete Diet (nasogastric/gastrostomy tube feed) Food Thickeners

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer continued... Renewal - Cystic ﬁbrosis Applications only from relevant specialist or general practitioner (on the recommendation of a specialist). Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted; and 3) Either: 3.1) The product is to be used as a supplement; or 3.2) The product is to be used as a complete diet. Renewal - Indications other than cystic ﬁbrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted; and 3) Either: 3.1) The product is to be used as a supplement; or 3.2) The product is to be used as a complete diet. Note: This product can be used either as a supplement or as a complete diet. If it is being used as a supplement, the limit is 500 ml per day. ORAL FEED 2KCAL/ML Liquid (vanilla) .................................................................................. 2.25 237 ml OP ✓ Two Cal HN

SPECIAL FOODS

FOOD THICKENERS

Special Authority for Subsidy – Form: SA0595 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Patient has motor neurone disease with swallowing disorder. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. MAIZE STARCH Powder............................................................................................. 3.20 8.00 4.00 GLUTEN FREE FOODS 200 g OP 500 g OP 250 g OP ✓ Karicare Food Thickener ✓ Karicare Food Thickener ✓ Resource Thicken Up

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

179

Gluten Free Foods

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

GLUTEN FREE FOODS

Special Authority for Subsidy – Form: SA0722 Initial application Applications only from relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1) Gluten enteropathy has been diagnosed by biopsy; or 2) Patient suffers from dermatitis herpetiformis. GLUTEN FREE BAKING MIX Powder............................................................................................. 2.81 1,000 g OP (5.15) GLUTEN FREE BREAD MIX Powder............................................................................................. 3.93 1,000 g OP (4.61) 3.51 (5.49) 4.77 (7.23) GLUTEN FREE FLOUR Powder ............................................................................................ 5.62 (9.46) GLUTEN FREE PASTA Buckwheat Spirals ............................................................................ 2.00 (2.85) Corn and Parsley Fettucine................................................................ 2.00 (2.63) Corn and Spinach Rigatini................................................................. 2.00 (2.63) Corn and Vegetable Shells ................................................................ 2.00 (2.63) Garlic and Parsley Spirals ................................................................. 2.00 (2.63) Rice and Corn Garden Herb Pasta ..................................................... 2.00 (2.63) Rice and Corn Lasagne Sheets ......................................................... 1.60 (2.80) Rice and Corn Macaroni ................................................................... 2.00 (2.63) Rice and Corn Penne ........................................................................ 2.00 (2.63) Rice and Maize Pasta Spirals ............................................................ 2.00 (2.63) Rice and Maize Spaghetti .................................................................. 2.00 (2.63) Rice and Millet Spirals ...................................................................... 2.00 (2.63) Tomato and Basil Spirals................................................................... 2.00 (2.63) Vegetable and Rice Spirals ................................................................ 2.00 (2.85) ✓ fully subsidised 2,000 g OP 250 g OP 250 g OP 250 g OP 250 g OP 250 g OP 250 g OP 200 g OP 250 g OP 250 g OP 250 g OP 250 g OP 250 g OP 250 g OP 250 g OP

Healtheries Wheat and Gluten Free Baking

NZB Low Gluten BreadMix Horleys Bread Mix Gluten Free Bread Mix 100% Bakels Horleys Flour Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran Orgran

180

[HP1], [HP2], [HP3], [HP4] refer page 10

Food and Supplements for Inborn Errors of Metabolism - Other

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

FOOD AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - OTHER

Special Authority for Subsidy – Form: SA0732 Initial application Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Either: 1) Dietary management of homocystinuria; or 2) Dietary management of maple syrup urine disease. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. It can cost up to $70,000 a year to keep an adult on protein supplements. Because protein substitutes are so expensive and because they are only effective in controlling PKU if a restricted diet is followed, adults with PKU will be required to demonstrate they are following the prescribed diet by regular blood testing. The requirement for testing applies to those aged over 16 years. Failure to follow an appropriate diet results in high blood phenylalanine levels. The subsidy for these products reﬂects the philosophy that the patient incurs no additional ﬁnancial burden for purchasing specialised more expensive products.

Supplements for Homocystinuria

AMINOACID FORMULA WITHOUT METHIONINE Powder......................................................................................... 384.95 500 g OP ✓ XMET Maxamum

Supplements for MSUD

AMINOACID FORMULA WITHOUT VALINE, LEUCINE AND ISOLEUCINE Powder......................................................................................... 250.45 364.35 487.38 500 g OP ✓ Maxamaid MSUD ✓ Maxamum MSUD ✓ MSUD Aid

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

181

Food and Supplements for Inborn Errors of Metabolism - PKU

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

FOOD AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - PKU

Special Authority for Subsidy – Form: SA0733 Initial application - Patient aged over 16 Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) Dietary management of PKU; and 2) Blood phenylalanine level < 900 mmol/litre (average of tests over last 12 months). Initial application - Patient aged 16 or under Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Dietary management of PKU Renewal - Patient aged over 16 Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Blood phenylalanine level < 900 mmol/litre (average of tests over last 12 months) Renewal - Patient aged 16 or under Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. It can cost up to $70,000 a year to keep an adult on protein supplements. Because protein substitutes are so expensive and because they are only effective in controlling PKU if a restricted diet is followed, adults with PKU will be required to demonstrate they are following the prescribed diet by regular blood testing. The requirement for testing applies to those aged over 16 years. Failure to follow an appropriate diet results in high blood phenylalanine levels. The subsidy for these products reﬂects the philosophy that the patient incurs no additional ﬁnancial burden for purchasing specialised more expensive products.

Foods for PKU

PHENYL FREE BAKING MIX Powder............................................................................................. 6.70 (8.22) PHENYL FREE PASTA Low protein rice pasta .................................................................... 10.65 (11.91) Macaroni ........................................................................................ 10.65 (11.91) Spaghetti ........................................................................................ 10.65 (11.91) Spirals............................................................................................ 10.65 (11.91) 500 g OP Loproﬁn Mix 500 g OP Aproten 500 g OP Loproﬁn 500 g OP Loproﬁn 500 g OP Loproﬁn

182

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

Food and Supplements for Inborn Errors of Metabolism - PKU Multivitamin Supplements for Inborn Errors of Metabolism

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

SPECIAL FOODS

Supplements for PKU

AMINOACID FORMULA WITHOUT PHENYLALANINE Caps ........................................................................................... 110.12 Sachets (pineapple/vanilla) 29 g .................................................. 320.10 Sachets (tropical) ......................................................................... 270.00 Infant formula ............................................................................... 145.60 Powder (orange)........................................................................... 195.00 305.00 Powder (unﬂavoured). .................................................................. 244.18 195.00 305.00 200 OP 30 OP 30 400 g OP 500 g OP 500 g OP ✓ Phlexy 10 ✓ Minaphlex ✓ Phlexy 10 ✓ Analog LCP ✓ Maxamaid XP ✓ Maxamum XP ✓ Aminogran Food Supplement ✓ Maxamaid XP ✓ Maxamum XP

Multivitamin and Mineral Supplements

AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE Powder........................................................................................... 45.06 48.70 250 g OP ✓ Aminogran Mineral Mix ✓ Metabolic Mineral Mixture

MULTIVITAMIN SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM

Special Authority for Subsidy – Form: SA0600 Initial application Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: Inborn errors of metabolism. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. MULTIVITAMINS Tab ................................................................................................. 19.65 100 Powder........................................................................................... 30.00 100 g OP Oral liq ............................................................................................. 8.98 150 ml OP (13.50) ✓ Ketovite ✓ Paediatric Seravite Ketovite Syrup

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

183

Infant Formulae

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

INFANT FORMULAE For Premature Infants

Special Authority for Subsidy – Form: SA0602 Initial application Applications only from relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Infant weighing less than 1.5 kg at birth. PREMATURE BIRTH FORMULA Powder............................................................................................. 7.41 0.98 454 g OP 120 ml OP ✓ S26LBW ✓ Similac Special Care

For Williams Syndrome

Special Authority for Subsidy – Form: SA0601 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. LOW CALCIUM INFANT FORMULA Powder........................................................................................... 36.99 400 g OP ✓ Locasol

184

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

SPECIAL FOODS

Infant Formulae

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

For Gastrointestinal and other Malabsorptive Problems

Neocate should be used only as a last resort when the infant is unable to absorb any of the below formulae. The objective with each of the formulae prescribed is to get the infant off them as soon as possible. This may take six months, it may take three years. Because of this, variation on age limit is not regarded as appropriate.These formulae will be available only from a hospital pharmacy. Vivonex Pediatric may be a suitable and less expensive alternative for many children that would otherwise be eligible for a subsidy for Neocate and should, therefore, be tried ﬁrst in these cases. The subsidy for these products reﬂects the philosophy that the patient incurs no additional ﬁnancial burden for purchasing specialised more expensive products. Special Authority for Subsidy – Form: SA0603 Initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Infant suffering from malabsorption and other gastrointestinal problems. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) General Practitioners must include the name of the specialist and date contacted. ELEMENTAL FORMULA Powder........................................................................................... 15.52 450 g OP (19.01) 63.97 400 g OP (67.08) 5.62 48.5 g OP (6.00)

Pepti Junior Neocate Vivonex Pediatric

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

185

Infant Formulae

SPECIAL FOODS

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

For Milk Intolerance

Special Authority for Subsidy – Form: SA0604 Initial application - Lactase deﬁciency or disaccharide intolerance Applications only from relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1) Patient is less than 3 years of age; and 2) Either: 2.1) Diagnosed as suffering from congenital lactase deﬁciency; or 2.2) Suffering from disaccharide intolerance. Note: Secondary lactose intolerance in children is usually short lasting, and can be controlled by dietary measures and by giving sufﬁcient calories to regenerate digestive enzymes. The subsidy for these products reﬂects the philosophy that the patient incurs no additional ﬁnancial burden for purchasing specialised more expensive products. Initial application - Infant with intolerance to cows’ milk Applications only from relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1) Intolerant to cows’ milk; and 2) Patient is less than 3 years of age. Note: The subsidy for these products reﬂects the philosophy that the patient incurs no additional ﬁnancial burden for purchasing specialised more expensive products. Renewal - Infant with intolerance to cows’ milk Applications only from relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1) The treatment remains appropriate and the patient is beneﬁting from treatment; and 2) Patient is less than 3 years of age. GOATS MILK INFANT FORMULA Powder............................................................................................. 9.42 900 g OP (18.75) LACTOSE FREE INFANT FORMULA Powder............................................................................................. 5.66 900 g OP (13.08) SOYA INFANT FORMULA Powder............................................................................................. 9.03 900 g OP (18.11) 6.34 (18.32)

Karicare Goats Milk Infant Formula

Delact

Karicare Infant Soya Formula Infasoy

(Karicare Infant Soya Formula powder to be delisted 1 June 2005)

186

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

SPECIAL FOODS

Infant Formulae

Subsidy Fully Brand or (Manufacturer’s Price) Subsidised Generic $ Per ✓ Manufacturer

Infant Formulae - Lactose Intolerance and Cows’ Milk Protein Intolerance

Special Authority for Subsidy – Form: SA0757 Initial application only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient is less than 2 years of age; and 2 Intolerant to cows’ milk; and 3 Diagnosed as suffering from congenital lactase deﬁciency. Renewal only from a relevant specialist. Approvals valid for 6 months where the treatment remains appropriate and the patient is beneﬁting from treatment. INFANT SOYA FORMULA Powder............................................................................................. 7.27 (16.35) 900 g

Karicare All Ages

✓ fully subsidised

[HP1], [HP2], [HP3], [HP4] refer page 10

187

SECTION E PART I PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

Pharmaceuticals that may be obtained on a Practitioner’s Supply Order

Therapeutic group Chemical Alimentary Tract Atropine Sulphate and Metabolism Dicyclomine Hydrochloride Glucagon Hydrochloride Hyoscine N-Butylbromide Loperamide Hydrochloride Aspirin Compound Electrolytes Dextrose Phytomenadione Sodium Chloride Water for Injection Presentation Inj 400 mcg, 1 ml Inj 600 mcg, 1 ml Inj 1200 mcg, 1 ml Tab 10 mg Inj 1 mg syringe kit Inj 20 mg, 1 ml Cap 2 mg Tab, soluble 300 mg Powder for soln for oral use 5 g Inj 50%, 10 ml Inj 2 mg per 0.2 ml Inj 10 mg per ml, 1 ml Inf 0.9% Inj 0.9%, 5 ml Inj 0.9%, 10 ml Puriﬁed for inj 2 ml Puriﬁed for inj 5 ml Puriﬁed for inj 10 ml Puriﬁed for inj 20 ml Tab 2.5 mg (May be supplied for reasons other than emergency) Tab 62.5 mcg Tab 250 mcg Tab 40 mg Inj 10 mg per ml, 2 ml Tab 600 mcg Aerosol spray, 400 mcg per dose CFC-free Oral pump spray 400 mcg per dose Inj twin pack 100 mg per 5 ml Inj 2.5 mg per ml, 2 ml Crm 1% with chlorhexidine digluconate 0.2% Condoms, proprietary Condoms, proprietary Diaphragm Quantity 5 5 5 30 5 5 30 30 10 5 5 5 2000 ml 5 5 5 5 5 5 150 30 30 30 5 100 200 dose 250 dose 6 5 500 g 144 72 1 each size 5 63 84 63 84 84 63 84 84

Blood and Blood Forming Organs

Cardiovascular System

Bendroﬂuazide Digoxin Frusemide Glyceryl Trinitrate Lignocaine Hydrochloride Verapamil Hydrochloride Silver Sulphadiazine Condoms Extra Strength Condoms without Spermicide Diaphragm Ergometrine Maleate Ethinyloestradiol with Desogestrel

Dermatologicals Genito-Urinary System

Inj 500 mcg per ml, 1 ml Tab 20 mcg with desogestrel 150 mcg Tab 20 mcg with desogestrel 150 mcg and 7 inert tab Tab 30 mcg with desogestrel 150 mcg Tab 30 mcg with desogestrel 150 mcg and 7 inert tab Ethinyloestradiol with Gestodene Tab 20 mcg with gestodene 75 mcg and 7 inert tab Tab 30 mcg with gestodene 75 mcg Tab 30 mcg with gestodene 75 mcg and 7 inert tab Ethinyloestradiol with Levonorgestrel Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab Tab ethinyloestradiol 30 mcg with levonorgestrel 50 mcg (6) and ethinyloestradiol 40 mcg with levonorgestrel 75 mcg (5), and ethinyloestradiol 30 mcg with levonorgestrel 125 mcg (10) and 7 inert tab Tab 30 mcg with levonorgestrel 150 mcg Tab 30 mcg with levonorgestrel 150 mcg and 7 inert tab Tab 50 mcg with levonorgestrel 250 mcg Tab 50 mcg with levonorgestrel 125 mcg and 7 inert tab

84 63 84 63 84

188

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

Presentation Tab 35 mcg with norethisterone 500 mcg Tab 35 mcg with norethisterone 500 mcg and 7 inert tab Tab ethinyloestradiol 35 mcg with norethisterone 500 mcg (7) and tab ethinyloestradiol 35 mcg with norethisterone 1 mg (9) and tab ethinyloestradiol 35 mcg with norethisterone 500 mcg (5) and 7 inert Tab 35 mcg with norethisterone 1 mg Tab 35 mcg with norethisterone 1 mg and 7 inert tab Ethynodiol Diacetate Tab 500 mcg Levonorgestrel Tab 30 mcg Tab 750 mcg Medroxyprogesterone Acetate Inj 150 mg per ml 1 ml syringe Nonoxynol-9 Jelly 2% Norethisterone Tab 350 mcg Norethisterone with Mestranol Tab 1 mg with mestranol 50 mcg Tab 1 mg with mestranol 50 mcg and 7 inert tab Oxytocin Inj 5 iu per ml, 1 ml Inj 10 iu per ml, 1 ml Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml Hormone Dexamethasone Tab 1 mg Preparations Tab 4 mg Systemic Dexamethasone Sodium Phosphate Inj 4 mg per ml, 1 ml Excluding Inj 4 mg per ml, 2 ml Contraceptive Hydrocortisone Inj 50 mg per ml, 2 ml Hormones Norethisterone Tab 5 mg Prednisolone Sodium Phosphate Oral liq 5 mg per ml Prednisone Tab 5 mg Infections - Agents Amoxycillin Cap 250 mg for Systemic Use Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Inj 1 g Amoxycillin Clavulanate Tab 500 mg with potassium clavulanate 125 mg Grans for oral liq 125 mg with potassium clavulanate 31.25 mg per 5 ml Grans for oral liq 250 mg with potassium clavulante 62.5 mg per 5 ml Benzathine Penicillin Inj 1.2 mega u per 2 ml Inj 1 mega u Benzylpenicillin Sodium (Penicillin G) Co-Trimoxazole Tab trimethoprim 80 mg and sulphamethoxazole 400 mg Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml Doxycycline Hydrochloride Tab 50 mg Tab 100 mg Erythromycin Ethyl Succinate Tab 400 mg Grans for oral liq 200 mg per 5 ml Grans for oral liq 400 mg per 5 ml Erythromycin Stearate Tab 250 mg Flucloxacillin Sodium Cap 250 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Inj 1 g Metronidazole Tab 200 mg

Therapeutic group Chemical Genito-Urinary Ethinyloestradiol with Norethisterone System (continued)

Quantity 63 84

84 63 84 84 84 10 5 108 g 84 63 84 5 5 5 30 30 5 5 5 30 30 ml 30 30 200 ml 200 ml 5 30 200 ml 200 ml 5 5 30 200 ml 30 30 30 200 ml 200 ml 30 30 200 ml 200 ml 5 30

189

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

Therapeutic group Chemical Infections - Agents Phenoxymethylpenicillin for Systemic Use (Penicillin V) (continued) Procaine Penicillin Trimethoprim Diclofenac Sodium Tenoxicam Benztropine Mesylate Chlorpromazine Hydrochloride

Presentation Cap 250 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Inj 1.5 mega u Tab 300 mg Inj 25 mg per ml, 3 ml Suppos 50 mg Inj 10 mg per ml, 2 ml Inj 1 mg per ml, 2 ml Tab 10 mg Tab 25 mg Tab 100 mg Oral liq 100 mg per 5 ml Inj 25 mg per ml, 2 ml Inj 5 mg per ml, 2 ml Rectal tubes 5 mg Rectal tubes 10 mg Inj 20 mg per ml, 1 ml Inj 20 mg per ml, 2 ml Inj 100 mg per ml, 1 ml Inj 12.5 mg per 0.5 ml, 0.5 ml Inj 25 mg per ml, 1 ml Inj 25 mg per ml, 2 ml Inj 100 mg per ml, 1 ml Tab 500 mcg Tab 1.5 mg Tab 5 mg Oral liq 2 mg per ml Inj 5 mg per ml, 1 ml Inj 50 mg per ml, 1 ml Inj 100 mg per ml, 1 ml Inj 0.5% , 5 ml Inj 1% 5 ml Inj 1% 20 ml Inj 5 mg per ml, 2 ml Inj 5 mg per ml, 1 ml Inj 10 mg per ml, 1 ml Inj 15 mg per ml, 1 ml Inj 30 mg per ml, 1 ml Tab 500 mg Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Inj 50 mg per ml, 1 ml Inj 50 mg per ml, 1.5 ml Inj 50 mg per ml, 2 ml Inj 50 mg per ml, 2 ml Inj 50 mg per ml, 5 ml Inj 50 mg per ml, 1 ml Inj 50 mg per ml, 2 ml Tab 5 mg Inj 12.5 mg per ml, 1 ml Inj 200mg per ml, 1 ml

Quantity 30 200 ml 200 ml 5 30 5 10 5 5 30 30 30 200 ml 5 5 5 5 5 5 5 5 5 5 5 30 30 30 200 ml 5 5 5 5 5 5 5 5 5 5 5 30 200 ml 100 ml 5 5 5 5 5 5 5 30 5 5

Musculoskeletal System Nervous System

Diazepam Flupenthixol Decanoate Fluphenazine Decanoate

Haloperidol

Haloperidol Decanoate Lignocaine Hydrochloride Metoclopramide Hydrochloride Morphine Sulphate

Paracetamol Pethidine Hydrochloride Phenytoin Sodium Pipothiazine Palmitate Prochlorperazine Zuclopenthixol decanoate

190

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

Therapeutic group Chemical Respiratory Adrenaline System and Allergies Aminophylline Ipratropium Bromide Promethazine Hydrochloride Salbutamol

Presentation Inj 1 in 1,000, 1 ml Inj 1 in 10,000, 10 ml Inj 25 mg per ml, 10 ml Nebuliser soln, 250 mcg per 1 ml Nebuliser soln, 500 mcg per 2 ml Inj 25 mg per ml, 1 ml Inj 25 mg per ml, 2 ml Aerosol Inhaler, 100 mcg per dose Aerosol inhaler, 100 mcg per dose CFC free Aerosol inhaler, 100 mcg per dose, breath activated Nebuliser soln, 1 mg per ml, 2.5 ml Nebuliser soln, 2 mg per ml, 2.5 ml Inj 500 mcg per ml, 1 ml Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per 2.5 ml vial Oral liq 50 g per 300 ml Inj 20 mcg per ml, 2 ml Inj 400 mcg per ml, 1 ml

Various

Salbutamol with Ipratropium Bromide Charcoal Naloxone Hydrochloride

Quantity 5 5 5 40 40 5 5 1000 dose 1000 dose 2000 dose 30 30 5 20 300 ml 5 5

Pharmaceuticals that may be obtained on a Wholesale Supply Order

Therapeutic group Genito-Urinary System Respiratory System and Allergies Chemical Intra-Uterine Device Pregnancy Tests - HCG Urine Peak Flow Meters Spacer Devices and Masks Presentation IUD Urine diagnostic test Peak ﬂow meters-low range Peak ﬂow meters-normal range Mask, size 2 Spacer Device

191

SECTION E PART II: RURAL AREAS

No subsidy is available for any pharmaceutical speciﬁcally restricted in Section B and C of the Schedule. In effect, this means that doctors practising in the following areas may order any item in the Pharmaceutical Schedule excepting those which are subject to any restriction, for example ‘only on a prescription’ and ‘not in combination’.

Rural Areas for Practitioner’s Supply Orders

NORTH ISLAND Northland DHB Dargaville Hikurangi Kaikohe Kaitaia Kawakawa Kerikeri Mangonui Maungaturoto Moerewa Ngunguru Paihia Rawene Ruakaka Russell Tutukaka Waipu Whangaroa Waitemata DHB Helensville Huapai Kumeu Snells Beach Waimauku Warkworth Wellsford Auckland DHB Great Barrier Island Oneroa Ostend Counties Manukau DHB Tuakau Waiuku Waikato DHB Coromandel Huntly Kawhia Matamata Morrinsville Ngatea Otorohanga Paeroa Pauanui Beach Putaruru Raglan Tairua Taumarunui Te Aroha Te Kauwhata Te Kuiti Tokoroa Waihi Whangamata Whitianga Bay of Plenty DHB Edgecumbe Katikati Kawerau Murupara Opotiki Taneatua Te Kaha Waihi Beach Whakatane Lakes DHB Mangakino Turangi Tairawhiti DHB Ruatoria Te Araroa Te Karaka Te Puia Springs Tolaga Bay Taranaki DHB Eltham Inglewood Manaia Oakura Okato Opunake Patea Stratford Waverley Hawkes Bay DHB Chatham Islands Waipawa Waipukurau Wairoa Whanganui DHB Bulls Marton Ohakune Raetihi Taihape Waiouru MidCentral DHB Dannevirke Foxton Otaki Pahiatua Wairarapa DHB Carterton Featherston Greytown Martinborough Methven Oxford Rakaia Rolleston Rotherham Templeton Waikari South Canterbury DHB Fairlie Geraldine Pleasant Point Temuka Twizel Waimate

Otago DHB Alexandra Balclutha Cromwell SOUTH ISLAND Kurow Nelson/Marlborough DHB Lawrence Havelock Milton Mapua Oamaru Motueka Outram Murchison Owaka Picton Palmerston Takaka Ranfurly Wakeﬁeld Roxburgh Tapanui West Coast DHB Wanaka Dobson Greymouth Hokitika Karamea Reefton South Westland Westport Whataroa Canterbury DHB Akaroa Amberley Cheviot Darﬁeld Diamond Harbour Hanmer Springs Kaikoura Leeston Lincoln Southland DHB Gore Lumsden Mataura Otautau Queenstown Riverton Te Anau Tokonui Tuatapere Winton

192

SECTION F: COMMUNITY PHARMACEUTICAL DISPENSING PERIOD EXEMPTIONS

SECTION F: PART I

A Community Pharmaceutical identiﬁed with a ❋ within the other sections of the Pharmaceutical Schedule: (a) is exempt from any requirement to dispense in Monthly Lots; (b) will only be subsidised if it is dispensed in a 90 Day Lot unless it is Close Control. A Community Pharmaceutical that is an oral contraceptive and that is identiﬁed with a ❋ within the other sections of the Pharmaceutical Schedule: (a) is exempt from any requirement to dispense in Monthly Lots; (b) will only be subsidised if it is dispensed in a 180 Day Lot unless it is Close Control.

SECTION F: PART II: CERTIFIED EXEMPTIONS AND ACCESS EXEMPTIONS TO MONTHLY DISPENSING

A Community Pharmaceutical, other than a Community Pharmaceutical identiﬁed with a ❋ within the other sections of the Pharmaceutical Schedule, may be dispensed in a 90 Day Lot if: (a) the Community Pharmaceutical is identiﬁed with a ▲ within the other sections of the Pharmaceutical Schedule and the prescriber has endorsed the Prescription item(s) on the Prescription to which the exemption applies “certiﬁed exemption” or signed or initialled the prescription item(s) in his/her own handwriting. In endorsing the Prescription items for a certiﬁed exemption, the prescriber is certifying that: (i) the patient wished to have the medicine dispensed in a quantity greater than a Monthly Lot; and (ii) the patient has been stabilised on the same medicine for a reasonable period of time; and (iii) the prescriber has reason to believe the patient will continue on the medicine and is compliant; (b) a patient, who has difﬁculty getting to and from a pharmacy, signs the back of the Prescription to qualify for an Access Exemption. In signing the Prescription, the patient or his or her nominated representative must also certify which of the following criteria they meet: (i) have limited physical mobility; (ii) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; (iii) are relocating to another area; (iv) are travelling extensively and will be out of town when the repeat prescriptions are due. The following Community Pharmaceuticals are identiﬁed with a ▲ within the other sections of the Pharmaceutical Schedule and may be dispensed in a 90 Day Lot if endorsed as a certiﬁed exemption in accordance with paragraph (a) in Section F Part II above.

193

SECTION F: PART II

INSULIN Insulin – Short-acting Preparations INSULIN NEUTRAL INSULIN ANIMAL Insulin – Intermediate and Longacting Preparations INSULIN ISOPHANE INSULIN ISOPHANE WITH INSULIN NEUTRAL INSULIN ZINC SUSPENSION INSULIN ANIMAL Insulin – Rapid-acting insulin analogues INSULIN ASPART INSULIN LISPRO ANTIARRHYTHMICS AMIODARONE HYDROCHLORIDE Tab 100 mg Tab 200 mg DISOPYRAMIDE PHOSPHATE FLECAINIDE ACETATE Tab 50 mg Tab 100 mg Cap long-acting 100 mg Cap long-acting 200 mg MEXILETINE HYDROCHLORIDE PROPAFENONE HYDROCHLORIDE

VASOPRESSIN AGONISTS DESMOPRESSIN NASAL SPRAY 10 mcg per dose NASAL DROPS 100 mcg per ml ANTICHOLINESTERASES PYRIDOSTIGMINE BROMIDE CONTROL OF EPILEPSY New Antiepilepsy Drugs GABAPENTIN LAMOTRIGINE TOPIRAMATE VIGABATRIN DOPAMINE AGONISTS AND RELATED AGENTS AMANTADINE HYDROCHLORIDE APOMORPHINE HYDROCHLORIDE LISURIDE HYDROGEN MALEATE PERGOLIDE TOLCAPONE GLAUCOMA PREPARATIONS BRINZOLAMIDE DIPIVEFRIN HYDROCHLORIDE LATANOPROST TRAVOPROST

194

SECTION G: SAFETY CAP MEDICINES

Pharmacists are required, under their agreement with the Government, to use safety caps when dispensing any of the medicines listed in Section G in an oral liquid formulation pursuant to a prescription or Practitioner’s Supply Order. This includes all proprietary and extemporaneously compounded oral liquid preparations of those pharmaceuticals listed in Section G of the Pharmaceutical Schedule. These medicines will be identiﬁed throughout Section B of the Pharmaceutical Schedule with the symbol ’‡’.

Exemptions

Oral liquid preparations of the pharmaceuticals listed in Section G of the Pharmaceutical Schedule will be dispensed in a container with a safety cap unless: • The practitioner has endorsed the Prescription or Practitioner’s Supply Order, stating that, the Pharmaceutical is not to be dispensed in a container with a safety cap; or • The Contractor has annotated the Prescription or Practitioner’s Supply Order stating that, because of inﬁrmity of the particular person, the Pharmaceutical to be used by that person should not be dispensed in a container with a safety cap; or • The Pharmaceutical is packaged in an Original Pack so designed that on the professional judgement of the Contractor, transfer to a container with a safety cap would be inadvisable or a retrograde procedure.

Reimbursment

Pharmacists will be reimbursed according to their agreement. Where an additional fee is paid on safety caps it will be paid on all dispensings of oral liquid preparations for those pharmaceuticals listed in Section G of the Pharmaceutical Schedule unless the practitioner has endorsed or the contractor has annotated the Prescription or Practitioners Supply Order that a safety cap has not been supplied.

Safety caps (NZS 5825:1991)

20 mm ......................................Clic-Loc, United Closures & Plastics PLC, England Kerr, Cormack Packaging, Sydney, under licence to Kerr USA 20 mm ......................................Clic-Loc, United Closures & Plastics PLC, England Clic-Loc, ACI Closures under license to Owens-Illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr USA 28 mm ......................................Clic-Loc, United Closures & Plastics PLC, England Clic-Loc, ACI Closures under license to Owens-Illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr USA PDL Squeezlok PDL FG

195

SAFETY CAP MEDICINES

BLOOD AND BLOOD FORMING ORGANS FERROUS SULPHATE Oral liq 150 mg per 5 ml CARDIOVASCULAR SYSTEM AMILORIDE Oral liq 1 mg per ml CAPTOPRIL Oral liq 5 mg per ml CHLOROTHIAZIDE Oral liq 50 mg per ml DIGOXIN Oral liq 50 mcg per ml FRUSEMIDE Oral liq 10 mg per ml SPIRONOLACTONE Oral liq 5 mg per ml

Ferodan

Biomed Capoten Biomed Lanoxin Lasix Biomed

NERVOUS SYSTEM ALPRAZOLAM Tab 1 mg Xanax Tab 250 mcg Xanax Tab 500 mcg Xanax (Extemporaneously compounded oral liquid preparations) CARBAMAZEPINE Oral liq 100 mg per 5 ml Tegretol CHLORPROMAZINE HYDROCHLORIDE Oral liq 100 mg per 5 ml Largactil Forte CLOBAZAM Tab 10 mg Frisium (Extemporaneously compounded oral liquid preparations) CLONAZEPAM Oral drops 2.5 mg per ml Rivotril DIAZEPAM Tab 10 mg Pro-Pam Tab 2 mg Pro-Pam Tab 5 mg Pro-Pam (Extemporaneously compounded oral liquid preparations) ETHOSUXIMIDE Oral liq 250 mg per 5 ml Zarontin LORAZEPAM Tab 1 mg Ativan Tab 2.5 mg Ativan (Extemporaneously compounded oral liquid preparations) LORMETAZEPAM Tab 1 mg Noctamid (Extemporaneously compounded oral liquid preparations) METHADONE HYDROCHLORIDE Oral liq 10 mg per ml Biodone Extra Forte Oral liq 2 mg per ml Biodone Oral liq 5 mg per ml Biodone Forte METOCLOPRAMIDE HYDROCHLORIDE Oral liq 5 mg per 5 ml Maxolon MIDAZOLAM Tab 7.5 mg Hypnovel (Extemporaneously compounded oral liquid preparations) MORPHINE HYDROCHLORIDE Oral liq 1 mg per ml Oral liq 10 mg per ml Oral liq 2 mg per ml Oral liq 5 mg per ml RA-Morph RA-Morph RA-Morph RA-Morph

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS CODEINE PHOSPHATE Powder Douglas (Extemporaneously compounded oral liquid preparations) METHADONE HYDROCHLORIDE Powder AFT (Extemporaneously compounded oral liquid preparations) PHENOBARBITONE SODIUM Powder MidWest (Extemporaneously compounded oral liquid preparations) HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES THYROXINE Tab 100 mcg Eltroxin Tab 50 mcg Eltroxin (Extemporaneously compounded oral liquid preparations) MUSCULOSKELETAL SYSTEM IBUPROFEN Oral liq 100 mg per 5 ml

Brufen Fenpaed

QUININE SULPHATE Tab 200 mg Q 200 Tab 300 mg Q 300 (Extemporaneously compounded oral liquid preparations)

196

SAFETY CAP MEDICINES

NERVOUS SYSTEM (continued) NITRAZEPAM Tab 5 mg

Insoma Nitrados (Extemporaneously compounded oral liquid preparations) OXAZEPAM Tab 10 mg Ox-Pam Tab 15 mg Ox-Pam (Extemporaneously compounded oral liquid preparations) PARACETAMOL Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Junior Parapaed Six Plus Parapaed

RESPIRATORY SYSTEM AND ALLERGIES AZATADINE MALEATE Oral liq 500 mcg per 5 ml Zadine CHLORPHENIRAMINE MALEATE Oral liq 2 mg per 5 ml Histafen DEXTROCHLORPHENIRAMINE MALEATE Oral liq 2 mg per 5 ml Polaramine PROMETHAZINE HYDROCHLORIDE Oral liq 5 mg per 5 ml Phenergan SALBUTAMOL Oral liq 2 mg per 5 ml Ventolin THEOPHYLLINE Oral liq 80 mg per 15 ml Nuelin TRIMEPRAZINE TARTRATE Oral liq 30 mg per 5 ml Vallergan Forte

PHENYTOIN SODIUM Oral liq 30 mg per 5 ml Dilantin SODIUM VALPROATE Oral liq 200 mg per 5 ml Epilim S/F Liquid Epilim Syrup TEMAZEPAM Cap 10 mg Euhypnos Cap 20 mg Euhypnos (Extemporaneously compounded oral liquid preparations) TRIAZOLAM Tab 0.125 mg Halcion Tab 0.250 mg Hypam (Extemporaneously compounded oral liquid preparations) TRIFLUOPERAZINE HYDROCHLORIDE Oral liq 1 mg per ml Stelazine

197

INDEX

Generic Chemicals and Brands

Symbols A

3TC ...............................................................................103 A-Lices ............................................................................72 Abacavir sulphate...........................................................103 Acarbose .........................................................................31 ACB .................................................................................60 Accu-Chek Advantage ...............................................33, 34 Accupril ...........................................................................56 Accuretic 10 ....................................................................57 Accuretic 20 ....................................................................57 Acebutolol .......................................................................60 Acetazolamide ...............................................................154 Acetic acid with 1, 2-propanediol diacetate and benzethonium ............................................................151 Acetic acid with hydroxyquinoline and ricinoleic acid ........80 Acetopt ..........................................................................152 Acetylcysteine.......................................................156, 163 Aci-Jel .............................................................................80 Aciclovir Eye ointment ..............................................................152 Tablet .........................................................................101 Acicvir ...........................................................................101 Acipimox .........................................................................47 Acitretin ...........................................................................73 Actigall ............................................................................35 Actos ...............................................................................32 Actrapid ...........................................................................30 Actrapid Penﬁll .................................................................30 Acupan ..........................................................................111 Adalat 10 .........................................................................61 Adalat Oros ......................................................................61 Adrenaline........................................................................65 Advantan .........................................................................69 AFT-Pyrazinamide ............................................................99 Airomir ..........................................................................144 Alanase..........................................................................150 Albay .............................................................................141 Albustix..........................................................................157 Aldazine .........................................................................124 Alendronate .....................................................................82 Alfacalcidol ......................................................................38 Alginic acid ......................................................................25 Alitraq ............................................................................175 Alkeran ..........................................................................130 Allergy treatment set ......................................................141 Allohexal ........................................................................110 Allopurinol .....................................................................110 Allpyral ..........................................................................141 Alpha-Bromocriptine ......................................................122 Alpha-Keri Lotion .............................................................72 Alphagan .......................................................................155 Alpha tocopheryl acetate ..................................................39 Alprazolam .....................................................................126 Aluminium hydroxide........................................................25

AluTab .............................................................................25 Amantadine hydrochloride ..............................................121 Amiloride .........................................................................63 Amiloride with frusemide ..................................................63 Amiloride with hydrochlorothiazide ...................................63 Aminoglutethimide .........................................................132 Aminogran Food Supplement..........................................183 Aminogran Mineral Mix...................................................183 Aminophylline ................................................................149 Amiodarone hydrochloride ...............................................59 Amitrip ...........................................................................114 Amitriptyline ...................................................................114 Amizide............................................................................63 Amlodipine.......................................................................61 Amorolﬁne .......................................................................67 Amoxycillin ......................................................................95 Amoxycillin clavulanate ....................................................95 Amphotericin B ................................................................37 Amyl nitrite ......................................................................65 Analog LCP ....................................................................183 Anastrozole ....................................................................132 Androcur Depot ................................................................84 Anginine ..........................................................................64 Antabuse .......................................................................128 Anten .............................................................................114 Antinaus ........................................................................121 Anusol .............................................................................27 Apo-Amoxi.......................................................................95 Apo-Ascorbic Acid ...........................................................38 Apo-B-Complex ...............................................................38 Apo-Captopril ...................................................................56 Apo-Cimetidine ................................................................28 Apo-Diclofenac ..............................................................106 Apo-Diclo SR .................................................................106 Apo-Ethambutol ...............................................................99 Apo-Folic Acid .................................................................42 Apo-Folic Acid (s29) ........................................................42 Apo-Gliclazide ..................................................................32 Apo-Loratadine ..............................................................142 Apo-Moclobemide..........................................................115 Apo-Nadolol .....................................................................60 Apo-Nicotinic Acid ...........................................................47 Apo-Oxybutynin ...............................................................81 Apo-Prednisone ...............................................................84 Apo-Primidone ...............................................................117 Apo-Pyridoxine ................................................................38 Apo-Selegiline ................................................................122 Apo-Thiamine...................................................................38 Apo-Timolol .....................................................................61 Apo-Timop .....................................................................153 Apomorphine hydrochloride ...........................................121 Apresoline........................................................................65 Aproten ..........................................................................182 Aprotinin ..........................................................................43 Aquabloc 30+ .................................................................75

198

Generic Chemicals and Brands

INDEX

Aquasun 30+ ..................................................................75 Aqueous cream ................................................................71 Aratac ..............................................................................59 Arava .............................................................................108 Arimidex ........................................................................132 Aristocort ........................................................................69 Aropax ...........................................................................115 Arrow-Citalopram...........................................................115 Arrow-Ranitidine ..............................................................28 Arthrexin ........................................................................107 Asacol .............................................................................26 Ascensia Glucodisc..........................................................34 Ascorbic acid ...................................................................38 Ascorbic acid and sodium ascorbate ................................38 Asmafen ........................................................................142 Asmol ............................................................................144 Aspec 300 .....................................................................111 Aspirin Analgesics .................................................................111 Antithrombotic agents ..................................................43 Aspirin & chloroform ........................................................75 Aspro Clear ......................................................................43 Atacand ...........................................................................57 Atenolol ...........................................................................60 Ativan ............................................................................127 Atorvastatin .....................................................................48 Atropine sulphate Eye drops ..................................................................155 Injection .......................................................................27 Atropt ............................................................................155 Atrovent .........................................................................148 Atrovent Nasal Aqueous .................................................150 Augmentin .......................................................................95 Auranoﬁn .......................................................................108 Avil Retard .....................................................................142 Avomine ........................................................................121 Avonex...........................................................................137 Azamun .........................................................................134 Azatadine maleate ..........................................................141 Azathioprine ...................................................................134 Azithromycin ....................................................................94 Azopt .............................................................................154 AZT................................................................................103

B-D Micro-Fine ................................................................34 B-D Ultra Fine ..................................................................34 B-D Ultra Fine II ................................................................34 Baclofen ........................................................................110 Bactroban ........................................................................66 Batrafen ...........................................................................67 Beclazone 100 ...............................................................142 Beclazone 250 ...............................................................142 Beclazone 50 .................................................................142

Beclomethasone dipropionate Inhaled cortosteroids ........................................142, 143 Nasal preparations .....................................................150 Bee venom allergy treatment ..........................................141 Bendroﬂuazide .................................................................63 Benhex ............................................................................72 Benzathine penicillin .........................................................95 Benzoin tincture .............................................................163 Benztrop ........................................................................122 Benztropine mesylate .....................................................122 Benzydamine hydrochloride..............................................36 Benzylpenicillin sodium (Penicillin G) ................................95 Betadine ..........................................................................72 Betadine Skin Prep ...........................................................72 Betaferon .......................................................................137 Betagan .........................................................................153 Betahistine dihydrochloride.............................................120 Betaloc ............................................................................60 Betaloc CR .......................................................................60 Betamethasone dipropionate Cream, ointment ..........................................................68 Scalp lotion ..................................................................74 Betamethasone dipropionate with clotrimazole ..................70 Betamethasone dipropionate with salicylic acid.................70 Betamethasone sodium phosphate with betamethasone acetate .........................................................................83 Betamethasone valerate Cream, oint, lotion ........................................................68 Scalp application ..........................................................74 Betamethasone valerate with clioquinol.............................70 Betamethasone valerate with fusidic acid ..........................70 Betaxolol hydrochloride ..................................................153 Beta Cream ......................................................................68 Beta Ointment ..................................................................68 Beta Scalp .......................................................................74 Betnovate.........................................................................68 Betnovate-C .....................................................................70 Betoptic .........................................................................153 Betoptic S ......................................................................153 Bezaﬁbrate .......................................................................47 Bezalip Retard ..................................................................47 Bicillin ..............................................................................95 Biocil ...............................................................................72 Biodone .........................................................................112 Biodone Extra Forte ........................................................112 Biodone Forte ................................................................112 Bisacodyl .........................................................................36 BK Lotion .........................................................................72 Bleph 10 ........................................................................152 Bonjela ............................................................................37 Breath-Alert ...................................................................150 Brevinor 1/21 ...................................................................78 Brevinor 1/28 ...................................................................78 Brevinor 21 ......................................................................78

199

INDEX

Generic Chemicals and Brands

Bricanyl Injection .....................................................................149 Nebuliser solution ......................................................147 Bricanyl Aerosol .............................................................144 Bricanyl Turbuhaler ........................................................144 Brimonidine tartrate........................................................155 Brinzolamide ..................................................................154 Brolene ..........................................................................152 Bromocriptine mesylate..................................................122 Brufen ...........................................................................106 Brufen Retard.................................................................106 Buccastem ....................................................................121 Budesonide Cap ..............................................................................26 Inhalers, Nebuliser solution.........................................143 Nasal spray ................................................................150 Budesonide with eformoterol ..........................................145 Bumetanide......................................................................63 Bupivacaine hydrochloride .............................................111 Buprenorphine hydrochloride ..........................................112 Burinex ............................................................................63 Buscopan ........................................................................27 Buserelin acetate ..............................................................89 Buspirone hydrochloride.................................................126 Busulphan......................................................................130 Butacort Aqueous ..........................................................150

Cabergoline......................................................................91 Cafergot .........................................................................119 Calamine .........................................................................68 Calciferol .........................................................................39 Calcipotriol.......................................................................73 Calcitonin.........................................................................82 Calcitriol ..........................................................................39 Calcium-Sandoz 1000 ......................................................39 Calcium carbonate Antacids & antiﬂatulents ...............................................25 Minerals .......................................................................39 Calcium chloride ..............................................................39 Calcium Disodium Versenate ..........................................157 Calcium folinate .............................................................130 Calcium gluconate ...........................................................39 Calcium lactate-gluconate ................................................39 Calcium polystyrene sulphonate .......................................47 Calcium Resonium ...........................................................47 Calogen .........................................................................167 Candesartan ....................................................................57 Canesten .........................................................................67 Capadex ........................................................................112 Capoten ...........................................................................56 Captopril ..........................................................................56 Carafate ...........................................................................29 Carbachol ......................................................................155 Carbamazepine ..............................................................117 Carbimazole .....................................................................89

Carbosorb ......................................................................157 Cardinol ...........................................................................61 Cardinol LA ......................................................................61 Cardizem CD ....................................................................62 Carvedilol ........................................................................60 Catapres ..........................................................................62 Catapres-TTS-1................................................................62 Catapres-TTS-2................................................................62 Catapres-TTS-3................................................................62 Cefaclor monohydrate ......................................................92 Cefamandole nafate .........................................................92 Cefazolin sodium .............................................................92 Cefoxitin sodium ..............................................................92 Ceftriaxone sodium ..........................................................92 Cefuroxime axetil..............................................................93 Cefuroxime sodium ..........................................................93 Celapram .......................................................................115 Celestone Chronodose .....................................................83 Celiprolol .........................................................................60 Cellcept .........................................................................134 Celol ................................................................................60 Cephalexin monohydrate ..................................................93 Cephradine ......................................................................93 Cerezyme ........................................................................36 Cervagem ........................................................................80 Cetirizine hydrochloride ..................................................141 Cetomacrogol cream ........................................................71 Charcoal ........................................................................157 Chlorambucil .................................................................130 Chloramphenicol Ear drops ...................................................................151 Eye drops/oint ............................................................152 Chlorhexidine gluconate ...................................................70 Chlorhexidine mouthwash ................................................37 Chloroform BP ...............................................................163 Chloromycetin................................................................151 Chlorothiazide ..................................................................63 Chlorpheniramine maleate ..............................................141 Chlorpromazine hydrochloride ........................................123 Chlorsig .........................................................................152 Chlorthalidone .................................................................64 Chlorvescent ....................................................................47 Cholestyramine with aspartame .......................................47 Choline salicylate with cetalkonium chloride .....................37 Ciclopiroxolamine.............................................................67 Cilazapril ..........................................................................56 Cilazapril with hydrochlorothiazide ....................................57 Cilicaine ...........................................................................95 Cilicaine VK......................................................................95 Ciloxan ..........................................................................152 Cimetidine........................................................................28 Cipﬂox .............................................................................96 Cipramil .........................................................................115

200

Generic Chemicals and Brands

INDEX

Ciproﬂoxacin Eye drops ..................................................................152 Tab ..............................................................................96 Citalopram hydrobromide ...............................................115 Claratyne .......................................................................142 Clarithromycin .................................................................94 Cliane ..............................................................................87 Climara 100 .....................................................................86 Climara 50 .......................................................................86 Clindamycin .....................................................................96 Clinistix ............................................................................33 Clinitest ...........................................................................33 Clinoril ...........................................................................107 Clobazam.......................................................................117 Clobetasol propionate Cream, oint ..................................................................68 Scalp appl ....................................................................74 Clobetasone butyrate .......................................................68 Clocreme Cream ..........................................................................67 Clomazol .........................................................................80 Clomiphene citrate ...........................................................91 Clomipramine hydrochloride ...........................................114 Clonazepam Injection .....................................................................116 Tab, oral drops ...........................................................117 Clonidine..........................................................................62 Clonidine hydrochloride ..................................................119 Clopine ..........................................................................123 Clopixol .........................................................................125 Clopress ........................................................................114 Clotrihexal ........................................................................80 Clotrimaderm 2% .............................................................80 Clotrimazole Cream, solution ............................................................67 Pessaries, vaginal cream ..............................................80 Clozapine .......................................................................123 Clozaril ..........................................................................123 Co-Renitec .......................................................................57 Co-trimoxazole .................................................................96 Coal tar ............................................................................73 Coal tar with allantoin, menthol, phenol and sulphur ..........73 Coal tar with salicylic acid and sulphur .............................73 Coco-Scalp ......................................................................73 Codalax ...........................................................................36 Codalax Forte ...................................................................36 Codalgin ........................................................................112 Codeine phosphate Linctus.......................................................................149 Powder ......................................................................163 Tab ............................................................................112 Cogentin ........................................................................122 Colchicine ......................................................................110 Colestid ...........................................................................47 Colestipol hydrochloride ...................................................47

Colifoam ..........................................................................26 Colistin sulphomethate .....................................................96 Collodion ﬂexible ............................................................163 Colofac ............................................................................27 Coloxyl ............................................................................35 Colymycin-M ...................................................................96 Combantrin ......................................................................92 Combivent .....................................................................148 Combivir ........................................................................103 Compound electrolytes.....................................................47 Compound hydroxybenzoate ..........................................163 Condoms extra strength ...................................................76 Condoms without spermicide ...........................................76 Condyline.........................................................................75 Copper.............................................................................33 Corangin ..........................................................................64 Cordarone-X.....................................................................59 Coronex ...........................................................................64 Cortisone acetate .............................................................83 Cosopt ...........................................................................154 Cotazym ECS ...................................................................34 Coumadin ........................................................................45 Coversyl ..........................................................................56 Cozaar .............................................................................57 Creon 10000....................................................................34 Creon Forte ......................................................................34 Crixivan..........................................................................103 Cromolux .......................................................................153 Crotamiton .......................................................................68 Cyclizine hydrochloride ..................................................120 Cyclizine lactate .............................................................120 Cycloblastin ...................................................................130 Cyclogyl ........................................................................155 Cyclopentolate hydrochloride .........................................155 Cyclophosphamide ........................................................130 Cyclosporin A ................................................................139 Cyklokapron .....................................................................43 Cyproheptadine hydrochloride ........................................141 Cyproterone acetate .........................................................84 Cyproterone acetate with ethinyloestradiol ........................79 Cytadren ........................................................................132 Cytarabine .....................................................................130 Cytotec ............................................................................28 Cytoxan .........................................................................130

D-Penamine ...................................................................108 D-Zol ...............................................................................91 d4T ................................................................................103 Daclin ............................................................................107 Daivonex ..........................................................................73 Daktarin Lotn, tincture................................................................67 Oral gel ........................................................................37 Dalacin C .........................................................................96 Danazol ...........................................................................91

201

INDEX

Generic Chemicals and Brands

Danthron with poloxamer .................................................36 Dantrium ........................................................................110 Dantrolene sodium .........................................................110 ddI .................................................................................103 De-nol .............................................................................29 Deca-Durabolin Orgaject ..................................................82 Delact ............................................................................186 Depo-Medrol ....................................................................84 Depo-Medrol with lidocaine ..............................................84 Depo-Provera ...................................................................79 Depo-Testosterone ...........................................................84 Dermol Cream, oint ..................................................................68 Scalp appl ....................................................................74 Desferrioxamine mesylate ..............................................157 Desipramine hydrochloride .............................................114 Desmopressin ..................................................................91 Dexamethasone Eye drops, ointment ...................................................153 Tab, Oral liq ..................................................................83 Dexamethasone sodium phosphate ..................................83 Dexamethasone with framycetin and gramicidin..............151 Dexamethasone with neomycin and polymyxin b sulphate .................................................153 Dexamphetamine sulphate..............................................128 Dextrochlorpheniramine maleate .....................................141 Dextropropoxyphene ......................................................112 Dextropropoxyphene with paracetamol ...........................112 Dextrose ..........................................................................46 Dextrose with electrolytes.................................................47 DHC Continus ................................................................112 Diabur 5000 .....................................................................33 Diamox ..........................................................................154 Diaphragm .......................................................................76 Diasip ............................................................................170 Diason RTH....................................................................170 Diastix .............................................................................33 Diastop ............................................................................26 Diatol ...............................................................................33 Diazemuls ......................................................................116 Diazepam Rectal tubes, inj .........................................................116 Tab ............................................................................126 Dibenyline ........................................................................55 Dibromopropamidine isethionate ....................................152 Dicap ...............................................................................26 Diclocil ............................................................................95 Diclofenac sodium Eye drops ..................................................................153 Tab, suppos, inj ..........................................................106 Dicloxacillin......................................................................95 Dicyclomine hydrochloride ...............................................27 Didanosine .....................................................................103 Difﬂam .............................................................................36 Diﬂucan ...........................................................................98

Diﬂucortolone valerate ....................................................69 Digoxin ............................................................................59 Dihydrocodeine tartrate ..................................................112 Dilantin ..........................................................................117 Dilantin Infatab ...............................................................117 Dilatrend ..........................................................................60 Diltiazem hydrochloride ....................................................62 Dilzem .............................................................................62 Dilzem LA ........................................................................62 Dilzem SR ........................................................................62 Dimenhydrinate ..............................................................120 Dimetriose .......................................................................91 Dipentum .........................................................................26 Diphemanil methylsulphate ...............................................71 Diphenoxylate hydrochloride with atropine sulphate ..........26 Dipivefrin hydrochloride ..................................................155 Diprosalic ........................................................................70 Diprosone Cream, ointment ..........................................................68 Scalp lotion ..................................................................74 Diprosone OV...................................................................68 Dipyridamole.............................................................43, 44 Disipal ...........................................................................122 Disopyramide phosphate ..................................................59 Disprin .............................................................................43 Disulﬁram ......................................................................128 Dithranol ..........................................................................74 Diurin 40 ..........................................................................63 Diurin 500 ........................................................................63 Dixarit ............................................................................119 Docusate sodium .............................................................35 Docusate sodium with bisacodyl ......................................35 Docusate sodium with sennosides ...................................36 Doloxene........................................................................112 Domperidone .................................................................120 Dopergin ........................................................................122 Dopress .........................................................................114 Dornase alfa ..................................................................149 Dorzolamide hydrochloride .............................................154 Dorzolamide hydrochloride with timolol maleate .............154 Dosan ..............................................................................55 Dostinex ..........................................................................91 Dothiepin hydrochloride..................................................114 Doxazosin mesylate .........................................................55 Doxepin hydrochloride....................................................114 Doxine .............................................................................96 Doxy-50...........................................................................96 Doxycycline hydrochloride ...............................................96 DP Lotion .........................................................................72 DP Lotn HC ......................................................................69 Dramamine ....................................................................120 Dulcolax...........................................................................36 Duocal Super Soluble Powder ........................................166 Duolin ............................................................................148 Duphaston .......................................................................88

202

Generic Chemicals and Brands

INDEX

Durex Conﬁdence .............................................................76 Duride ..............................................................................64 Durogesic ......................................................................112 Dydrogesterone ...............................................................88 Dyzole .............................................................................98

E-Mycin ...........................................................................94 Econazole nitrate Cream, foaming soln ....................................................67 Pessaries, vaginal cream ..............................................80 Ecotrin ...........................................................................111 Ecreme ............................................................................67 Efavirenz ........................................................................103 Efexor XR .......................................................................116 Eformoterol fumarate .....................................................145 Efudix ..............................................................................75 Egopsoryl TA ...................................................................73 Elemental 028 Extra .......................................................175 Elocon .............................................................................69 Eltroxin ............................................................................89 Emla ..............................................................................111 Emulsifying ointment BP ..................................................71 Enalapril ...........................................................................56 Enalapril with hydrochlorothiazide .....................................57 Enbrel ............................................................................109 Ensure ...........................................................................169 Ensure Plus....................................................................178 Ensure Plus RTH ............................................................178 Entocort CIR ....................................................................26 Enuclene ........................................................................156 Epilim ............................................................................117 Epilim Crushable ............................................................117 Epilim IV ........................................................................117 Epilim S/F Liquid ............................................................117 Epilim Syrup ..................................................................117 Eprex ...............................................................................41 ERA .................................................................................94 Ergometrine maleate ........................................................80 Ergotamine tartrate with caffeine ....................................119 Erythromycin ethyl succinate............................................94 Erythromycin lactobionate ................................................94 Erythromycin stearate ......................................................94 Erythropoietin alpha .........................................................41 Erythropoietin beta ...........................................................41 Estelle 35 .........................................................................79 Estraderm TTS 100 ..........................................................86 Estraderm TTS 25 ............................................................85 Estraderm TTS 50 ............................................................86 Estrofem ...................................................................85, 86 Etanercept .....................................................................109 Ethambutol ......................................................................99 Ethinyloestradiol ...............................................................87 Ethinyloestradiol with desogestrel .....................................77 Ethinyloestradiol with gestodene .......................................77 Ethinyloestradiol with levonorgestrel .................................78

Ethinyloestradiol with norethisterone .................................78 Ethosuximide .................................................................117 Ethynodiol diacetate .........................................................79 Etidrate ............................................................................82 Etidronate disodium .........................................................82 Etoposide.......................................................................131 Euhypnos.......................................................................127 Eumovate.........................................................................68 Eurax ...............................................................................68 Ezetimibe .........................................................................50 Ezetrol .............................................................................50

Famotidine .......................................................................28 Famox..............................................................................28 Farlutal .............................................................................88 Felodipine ........................................................................61 Felo 10 ER .......................................................................61 Felo 5 ER .........................................................................61 Femara ..........................................................................133 Femodene 21 ...................................................................77 Femodene 28 ...................................................................77 Femtran 100 ....................................................................86 Femtran 50 ......................................................................86 Femulen ...........................................................................79 Fenpaed .........................................................................106 Fentanyl .........................................................................112 Ferodan ...........................................................................40 Ferro-Gradumet ................................................................40 Ferrograd-Folic .................................................................40 Ferrosig ...........................................................................40 Ferrous gluconate with ascorbic acid ................................40 Ferrous sulphate ..............................................................40 Ferrous sulphate with folic acid ........................................40 Fexofenadine hydrochloride ............................................141 Fibalip ..............................................................................47 Fibresource ....................................................................177 Fibresource RTH ............................................................177 Fibro-vein.........................................................................43 Flagyl ...............................................................................98 Flagyl-S ...........................................................................98 Flecainide acetate.............................................................59 Fleet Bisacodyl Suppositories ...........................................36 Fleet Glycerin Suppositories .............................................36 Fleet Phosphate Enema ....................................................36 Flixotide .........................................................................142 Flixotide Accuhaler .........................................................143 Florinef ............................................................................83 Fluanxol .........................................................................125 Flucloxacillin sodium ........................................................95 Flucloxin ..........................................................................95 Flucon ...........................................................................153 Fluconazole ......................................................................98 Fludrocortisone acetate ....................................................83 Flumetasone pivalate ......................................................151

203

INDEX

Generic Chemicals and Brands

Fluocortolone caproate with ﬂuocortolone pivalate and cinchocaine .................................................................27 Fluorometholone ............................................................153 Fluorouracil sodium Dermatologicals ...........................................................75 Oncology agents and immunosuppressants ................130 Fluox..............................................................................115 Fluoxetine hydrochloride .................................................115 Flupenthixol decanoate ...................................................125 Fluphenazine decanoate .................................................125 Flutamide .......................................................................132 Flutamin .........................................................................132 Fluticasone ...........................................................142, 143 Folic acid .........................................................................42 Folinic acid.......................................................................37 Foradil............................................................................145 Foremount Child’s Silicone Mask ....................................150 Fortimel .........................................................................171 Fortini ............................................................................173 Fortini Multiﬁbre .............................................................173 Fortisip ..........................................................................178 Fortovase.......................................................................104 Fosamax ..........................................................................82 Framycetin sulphate .......................................................151 Frisium ..........................................................................117 Frumil ..............................................................................63 Frusemide ........................................................................63 Fucicort ...........................................................................70 Fucidin Crm, oint......................................................................66 Tab, inj .........................................................................97 Fucithalmic ....................................................................152 Fungilin ............................................................................37 Fusidic acid Cream, oint ..................................................................66 Eye drops ..................................................................152 Tab, inj .........................................................................97

Gestrinone .......................................................................91 Gliben ..............................................................................32 Glibenclamide ..................................................................32 Gliclazide .........................................................................32 Glipizide ...........................................................................32 Glivec ............................................................................131 Glucagen Hypokit .............................................................30 Glucagon hydrochloride ...................................................30 Glucerna ........................................................................170 Glucerna RTH ................................................................170 Glucobay .........................................................................31 Glucocard ........................................................................34 Glucose blood diagnostic test meter .................................33 Glucose dehydrogenase ...................................................34 Glucose oxidase........................................................33, 34 Gluten Free Bread Mix 100% Bakels ................................180 Glycerol Liquid ........................................................................163 Suppositories ...............................................................36 Glycerol with parafﬁn and cetyl alcohol .............................71 Glyceryl trinitrate ..............................................................64 Gold Knight ......................................................................76 Gopten .............................................................................56 Goserelin acetate .............................................................89 Granocol ..........................................................................35 Growth hormone biosynthetic human ...............................89 Gutron .............................................................................59 Gyno-Pevaryl ...................................................................80 Gynol II ............................................................................76

Gabapentin ....................................................................118 Gamma benzene hexachloride ..........................................72 Gastrogel .........................................................................25 Gastrolyte (Fruit) ..............................................................47 Gastrolyte (Natural) ..........................................................47 Gastrolyte (Orange) ..........................................................47 Gaviscon .........................................................................25 Gaviscon Infant ................................................................25 Gemeprost .......................................................................80 Generaid Plus.................................................................172 Genoptic ........................................................................152 Genotropin .......................................................................89 Genox ............................................................................133 Gentamicin sulphate Eye drops ..................................................................152 Inj ................................................................................97 Gestone ...........................................................................88

Habitrol ............................................................................64 Halcion ..........................................................................127 Haldol ............................................................................125 Haldol Concentrate .........................................................125 Haloperidol ....................................................................123 Haloperidol decanoate ....................................................125 Hamilton Sunscreen .........................................................75 Healtheries Iron with Vitamin C .........................................40 Healtheries Multi-vitamin tablets .......................................39 Healtheries Vitamin C .......................................................38 Healtheries Wheat and Gluten Free Baking ......................180 Hemastix .......................................................................157 Heparinised saline ............................................................45 Heparin sodium................................................................45 Hexamine hippurate........................................................104 Hiprex ............................................................................104 Histafen .........................................................................141 Homatropine hydrobromide ............................................155 Horleys Bread Mix ..........................................................180 Horleys Flour .................................................................180 Humalog ..........................................................................31 Humulin 70/30 .................................................................30 Humulin L ........................................................................30 Humulin N ........................................................................30 Humulin R........................................................................30

204

Generic Chemicals and Brands

INDEX

Hyalase .........................................................................110 Hyaluronidase ................................................................110 Hybloc .............................................................................60 Hydralazine ......................................................................65 Hydrea ...........................................................................131 Hydrocortisone Crm, powder ................................................................69 Tab, inj .........................................................................83 Hydrocortisone acetate ....................................................26 Hydrocortisone butyrate Cream, oint, lipocream, milky emulsion ........................69 Scalp lotion ..................................................................74 Hydrocortisone butyrate with chlorquinaldol .....................70 Hydrocortisone with miconazole ......................................70 Hydrocortisone with natamycin and neomycin..................70 Hydrocortisone with wool fat and mineral oil ....................69 Hydroderm Lotion ............................................................72 Hydrogen peroxide 10 vol ..........................................................................37 20 vol ..........................................................................75 Hydromet .........................................................................62 Hydroxocobalamin ...........................................................38 Hydroxychloroquine sulphate ...........................................98 Hydroxyurea ..................................................................131 Hygroton..........................................................................64 Hyoscine (scopolamine) ................................................120 Hyoscine hydrobromide Eye drops ..................................................................155 Inj ..............................................................................120 Hyoscine N-butylbromide .................................................27 Hypam ...........................................................................127 Hypnovel .......................................................................127 Hypromellose.................................................................156 Hyprosin ..........................................................................55 Hytrin...............................................................................55 Hytrin Starter Pack ...........................................................55 Hyzaar .............................................................................58

I-Profen .........................................................................106 Ibiamox............................................................................95 Ibuprofen .......................................................................106 Imatinib mesylate ...........................................................131 Imiglucerase ....................................................................36 Imigran ..........................................................................119 Imipramine hydrochloride ...............................................114 Imovane.........................................................................127 Imuran ...........................................................................134 Indapamide ......................................................................64 Indinavir .........................................................................103 Indomethacin .................................................................107 Infasoy ..........................................................................186 Inﬂuenza vaccine ...........................................................105 Inhibace ...........................................................................56 Inhibace Plus ...................................................................57 Insoma ..........................................................................127

Insulatard .........................................................................30 Insulin animal...................................................................30 Insulin aspart ...................................................................31 Insulin isophane ...............................................................30 Insulin isophane with insulin neutral..................................30 Insulin lispro ....................................................................31 Insulin neutral ..................................................................30 Insulin pen needles ..........................................................34 Insulin syringes ................................................................34 Insulin zinc suspension ....................................................30 Intal Spincaps ................................................................144 Interferon alpha-2A ........................................................134 Interferon alpha-2B ........................................................135 Interferon alpha-N ..........................................................135 Interferon beta-1-alpha ...................................................137 Interferon beta-1-beta ....................................................137 Intra-uterine devices .........................................................76 Intron-A .........................................................................135 Invirase ..........................................................................104 Ipecacuanha ..................................................................157 Ipratropium bromide Inhaler, Nebules ..........................................................148 Nasal preparations .....................................................150 Iron polymaltose ..............................................................40 Ismo 20 ...........................................................................64 Isogel ..............................................................................35 Isoniazid ..........................................................................99 Isoprenaline hydrochloride ...............................................65 Isoptin .............................................................................62 Isopto Carbachol ............................................................155 Isopto Frin......................................................................156 Isopto Homatropine ........................................................155 Isopto Hyoscine .............................................................155 Isosorbide dinitrate...........................................................64 Isosorbide mononitrate.....................................................64 Isosource 1.5.................................................................178 Isosource Standard ........................................................177 Isosource Standard RTH.................................................177 Isotane 10........................................................................66 Isotane 20........................................................................66 Isotretinoin .......................................................................66 Isuprel .............................................................................65 Itraconazole .....................................................................98

Janola ..............................................................................70 Jevity .............................................................................177 Jevity RTH .....................................................................177 Junior Parapaed .............................................................111

K-Thrombin ......................................................................43 Kaletra ...........................................................................104 Karicare All Ages ............................................................187 Karicare Food Thickener .................................................179 Karicare Goats Milk Infant Formula .................................186 Karicare Infant Soya Formula ..........................................186

205

INDEX

Generic Chemicals and Brands

Keﬂex ..............................................................................93 Kemadrin .......................................................................122 Kenacomb ear drops ......................................................151 Kenacort-A ......................................................................84 Kenacort-A40 ..................................................................84 Keto-Diabur 5000.............................................................33 Keto-Diastix .....................................................................33 Ketoconazole Crm .............................................................................67 Scalp preparations .......................................................74 Tab ..............................................................................98 Ketopine ..........................................................................74 Ketoprofen .....................................................................106 Ketostix............................................................................33 Ketotifen ........................................................................142 Ketovite .........................................................................183 Ketovite Syrup ...............................................................183 Ketur-Test .........................................................................33 Kindergen ......................................................................172 Klacid ..............................................................................94 Klacid Hp7 .......................................................................28 Kliogest ...........................................................................87 Kliovance .........................................................................87 Konakion..........................................................................43 Konakion MM...................................................................43

LA-Morph ......................................................................113 Labetalol ..........................................................................60 Lacri-Lube .....................................................................156 Lactulose .........................................................................36 Laevolac ..........................................................................36 Lamictal .........................................................................118 Lamisil .............................................................................98 Lamivudine Anti-retrovirals ...........................................................103 Hepatitis B treatment ..................................................100 Lamotrigine....................................................................118 Lanoxin ............................................................................59 Lanoxin PG ......................................................................59 Lansoprazole ...................................................................29 Lanvis ............................................................................131 Largactil.........................................................................123 Largactil Forte ................................................................123 Lasix ................................................................................63 Latanoprost ...................................................................154 Laxsol ..............................................................................36 Leﬂunomide ...................................................................108 Lemnis Fatty Cream .........................................................71 Lemnis Fatty Cream HC ....................................................69 Letrozole ........................................................................133 Leucovorin .....................................................................130 Leucovorin Calcium .......................................................130 Leukeran FC ...................................................................130 Leuprorelin.......................................................................89 Levlen ED ........................................................................78

Levobunolol ...................................................................153 Levocabastine ................................................................153 Levodopa with benserazide ............................................122 Levodopa with carbidopa ...............................................122 Levonorgestrel ..........................................................79, 88 Lifestyles Flared ...............................................................76 Lignocaine hydrochloride Anaesthetics ..............................................................111 Anti-arrhythmics ..........................................................59 Lignocaine with prilocaine hydrochloride ........................111 Lipex................................................................................49 Lipitor ..............................................................................48 Liquiﬁlm Forte ................................................................156 Liquiﬁlm Tears................................................................156 Liquigen .........................................................................167 Lisinopril ..........................................................................56 Lisuride hydrogen maleate .............................................122 Lithicarb ........................................................................123 Lithium carbonate ..........................................................123 Livostin ..........................................................................153 Locasol..........................................................................184 Loceryl ............................................................................67 Locoid Cream, oint ..................................................................69 Scalp lotion ..................................................................74 Locoid C ..........................................................................70 Locoid Crelo ....................................................................69 Locoid Lipocream ............................................................69 Locorten-Vioform ...........................................................151 Lodoxamide trometamol .................................................153 Loette ..............................................................................78 Lomide ..........................................................................153 Loperamide Hydrochloride ...............................................26 Lopinavir with ritonavir ...................................................104 Lopresor ..........................................................................60 Loproﬁn .........................................................................182 Loproﬁn Mix ...................................................................182 Loratadine......................................................................142 Lorazepam .....................................................................127 Lormetazepam ...............................................................127 Losartan ..........................................................................57 Losartan with hydrochlorothiazide ....................................58 Losec ..............................................................................29 Losec Hp7 OAC ...............................................................28 Loten ...............................................................................60 Lotricomb ........................................................................70 Lucrin Depot ....................................................................89 Ludiomil.........................................................................114 Lyderm ............................................................................73

m-Enalapril ......................................................................56 m-Eslon .........................................................................113 m-Hydrocortisone ............................................................69 Madopar 125 .................................................................122 Madopar 250 .................................................................122

206

Generic Chemicals and Brands

INDEX

Madopar 62.5 ................................................................122 Madopar Dispersible ......................................................122 Madopar HBS ................................................................122 Magnesium hydroxide Minerals .......................................................................40 Paste .........................................................................163 Magnesium sulphate Inj ................................................................................40 Paste ...........................................................................75 Malathion .........................................................................72 Maldison ..........................................................................72 Mandol ............................................................................92 Maprotiline hydrochloride ...............................................114 Marcain Heavy ...............................................................111 Marcain Isobaric ............................................................111 Marevan ..........................................................................45 Marquis Protecta ..............................................................76 Marquis Supalite ..............................................................76 Marvelon 21 ....................................................................77 Marvelon 28 ....................................................................77 Marzine .........................................................................120 Maxamaid MSUD ...........................................................181 Maxamaid XP .................................................................183 Maxamum MSUD ...........................................................181 Maxamum XP ................................................................183 Maxidex .........................................................................153 Maxitrol .........................................................................153 Maxolon .........................................................................120 MCT oil ..........................................................................167 MDS Quick Card ..............................................................81 Mebendazole....................................................................92 Mebeverine hydrochloride ................................................27 Medisense Optium ....................................................33, 34 Medrol .............................................................................83 Medroxyprogesterone acetate HRT - systemic ..............................................86, 87, 88 Progestogen-only contraceptives ..................................79 Mefenamic acid .............................................................107 Megace..........................................................................133 Megestrol acetate...........................................................133 Melleril Retard ................................................................124 Melodene .........................................................................77 Melphalan ......................................................................130 Menadione sodium bisulphite ...........................................43 Menoprem .......................................................................87 Menoprem Continuous .....................................................87 Menthol ...........................................................................68 Merbentyl.........................................................................27 Mercaptopurine ..............................................................130 Mercilon 21 .....................................................................77 Mercilon 28 .....................................................................77 Mesalazine .......................................................................26 Mestinon........................................................................106 Metabolic Mineral Mixture ..............................................183 Metamide.......................................................................120

Metamucil ........................................................................35 Metformin hydrochloride ..................................................32 Methadone hydrochloride Analgesics .................................................................112 Powder ......................................................................163 Methoblastin ..................................................................131 Methopt .........................................................................156 Methopt Forte ................................................................156 Methotrexate ..................................................................131 Methotrimeprazine .........................................................123 Methoxsalen ....................................................................74 Methylcellulose ..............................................................163 Methyldopa ......................................................................62 Methyldopa with hydrochlorothiazide ................................62 Methylhydroxybenzoate ..................................................163 Methylphenidate hydrochloride .......................................128 Methylprednisolone ..........................................................83 Methylprednisolone aceponate .........................................69 Methylprednisolone acetate ..............................................84 Methylprednisolone acetate with lignocaine ......................84 Methylprednisolone sodium succinate ..............................84 Metoclopramide hydrochloride .......................................120 Metoclopramide hydrochloride with paracetamol ............119 Metomin ..........................................................................32 Metopirone ......................................................................91 Metoprolol succinate ........................................................60 Metoprolol tartrate ...........................................................60 Metronidazole ..................................................................98 Metyrapone......................................................................91 Mexiletine hydrochloride ...................................................59 Mexitil ..............................................................................59 Miacalcic .........................................................................82 Mianserin .......................................................................114 Micanol............................................................................74 Micelle E ..........................................................................39 Miconazole ......................................................................37 Miconazole nitrate Crm, lotn, tincture ........................................................67 Vaginal crm ..................................................................80 Micreme Crm .............................................................................67 Vaginal crm ..................................................................80 Micreme H .......................................................................70 Microgynon 20 ED ...........................................................78 Microgynon 30 ................................................................78 Microgynon 30 ED ...........................................................78 Microgynon 50 ED ...........................................................78 Microlax ...........................................................................36 Microlut ...........................................................................79 Microshield Handrub ........................................................70 Midazolam .....................................................................127 Midodrine ........................................................................59 Minaphlex ......................................................................183 Minidiab ...........................................................................32 Minirin .............................................................................91

207

INDEX

Generic Chemicals and Brands

Mino-tabs ........................................................................96 Minocycline hydrochloride................................................96 Minomycin .......................................................................96 Minulet 28 .......................................................................77 Mirena .............................................................................88 Misoprostol......................................................................28 Mixtard 30 .......................................................................30 Mixtard 50 .......................................................................30 Moclobemide .................................................................115 Modecate.......................................................................125 Moducal ........................................................................165 Mometasone furoate ........................................................69 Monofeme .......................................................................78 Monogen .......................................................................171 Monotard .........................................................................30 Morphine hydrochloride..................................................113 Morphine sulphate .........................................................113 Morphine tartrate ...........................................................113 Morrex Maltodextrin .......................................................165 Motilium ........................................................................120 MST Continus ................................................................113 MSUD Aid ......................................................................181 Mucilaginous laxatives .....................................................35 Mucilaginous laxatives with stimulants .............................35 Mucilax ............................................................................35 Multiload Cu 375..............................................................76 Multiload Cu 375SL..........................................................76 Multiparin.........................................................................45 Mupirocin ........................................................................66 Myambutol.......................................................................99 Mycobutin........................................................................99 Mycophenolate mofetil ...................................................134 Mycostatin Crm .............................................................................67 Oral liq, pastilles ...........................................................37 Mydriacyl .......................................................................155 Mylanta P ........................................................................25 Myleran .........................................................................130 Myocrisin.......................................................................108

Nadolol ............................................................................60 Nafarelin acetate ..............................................................89 Nalcrom ...........................................................................26 Naloxone hydrochloride ..................................................157 Naltrexone hydrochloride ................................................129 Nandrolone decanoate......................................................82 Napamide ........................................................................64 Naphazoline hydrochloride .............................................156 Naphcon Forte ...............................................................156 Naprosyn SR 1000.........................................................107 Naprosyn SR 750...........................................................107 Naproxen .......................................................................107 Naproxen sodium ...........................................................107 Navoban ........................................................................121 Naxen ............................................................................107

Nedocromil ....................................................................144 Nefopam hydrochloride ..................................................111 Nelﬁnavir........................................................................103 Neo-Cytamen ...................................................................38 Neo-Mercazole .................................................................89 Neo-Naclex ......................................................................63 Neocate .........................................................................185 Neoral ............................................................................139 Neostigmine...................................................................106 Neotigason ......................................................................73 Nepro ............................................................................174 Nerisone ..........................................................................69 Neulactil.........................................................................124 Neurontin .......................................................................118 Nevirapine ......................................................................103 Nicotine ...........................................................................64 Nicotinic acid ...................................................................47 Nifedipine.........................................................................61 Nifuran ...........................................................................104 Nilstat Cap, tab .......................................................................98 Vaginal crm ..................................................................80 Nitrados .........................................................................127 Nitrazepam ....................................................................127 Nitroderm TTS .................................................................64 Nitrofurantoin .................................................................104 Nitrolingual Pumpspray ....................................................64 Nizoral Crm .............................................................................67 Tab ..............................................................................98 Noctamid .......................................................................127 Nonoxynol-9 ....................................................................76 Nordette 28 ......................................................................78 Nordiol 21 ........................................................................78 Norditropin SimpleXx 10mg ..............................................89 Norditropin SimpleXx 15mg ..............................................89 Norditropin SimpleXx 5mg ................................................89 Norethisterone Tab 350 mcg................................................................79 Tab 5 mg .....................................................................88 Norethisterone with mestranol ..........................................78 Norﬂex ...........................................................................110 Norﬂoxacin ....................................................................104 Noriday 28 .......................................................................79 Norimin ............................................................................78 Norinyl-1/21 ....................................................................78 Norinyl-1/28 ....................................................................78 Normacol .........................................................................35 Normacol Plus .................................................................35 Noroxin ..........................................................................104 Norpress ........................................................................114 Nortriptyline hydrochloride .............................................114 Norvasc ...........................................................................61 Norvir ............................................................................103 Nova-T .............................................................................76

208

Generic Chemicals and Brands

INDEX

NovaSource Renal..........................................................174 NovoFine .........................................................................34 NovoRapid .......................................................................31 NovoRapid Penﬁll .............................................................31 Nozinan .........................................................................123 Nuelin ............................................................................149 Nuelin-SR ......................................................................149 Nutraplus .........................................................................71 Nutridrink .......................................................................169 Nutrini Energy RTH .........................................................173 Nutrini RTH ....................................................................173 Nutrison Concentrated ....................................................174 Nutrison Energy .............................................................178 Nutrison Multi Fibre ........................................................177 Nutrison Standard RTH ...................................................177 Nuvelle.............................................................................87 Nyefax Retard ..................................................................61 Nystatin Crm .............................................................................67 Oral liq & pastilles ........................................................37 Tab, cap & oral liq ........................................................98 Vaginal crm ..................................................................80 NZB Low Gluten BreadMix ..............................................180

Octreotide ......................................................................133 Odrik................................................................................56 Oestradiol Tab .......................................................................85, 86 TDDS ....................................................................85, 86 Oestradiol valerate.....................................................85, 86 Oestradiol with levonorgestrel ...........................................87 Oestradiol with norethisterone ..........................................87 Oestriol Pessaries, vaginal crm .................................................80 Tab ..............................................................................87 Oestrogens ...............................................................85, 86 Oestrogens with Medroxyprogesterone .............................87 Oily cream .......................................................................71 Oily phenol .......................................................................27 Oil in water emulsion ........................................................71 Olanzapine ............................................................123, 126 Olbetam ...........................................................................47 Olsalazine ........................................................................26 Omeprazole......................................................................29 Omeprazole, amoxycillin and clarithromycin .....................28 Ondansetron ..................................................................121 One-Alpha ........................................................................38 Orabase ...........................................................................37 Oracort ............................................................................37 Orap ..............................................................................124 Orgran Buckwheat Spirals......................................................180 Corn and Parsley Fettucine .........................................180 Corn and Spinach Rigatini ..........................................180 Corn and Vegetable Shells ..........................................180

Garlic and Parsley Spirals ...........................................180 Rice and Corn Garden Herb Pasta ...............................180 Rice and Corn Lasagne Sheets ...................................180 Rice and Corn Macaroni .............................................180 Rice and Corn Penne ..................................................180 Rice and Maize Pasta Spirals ......................................180 Rice and Maize Spaghetti ...........................................180 Rice and Millet Spirals ................................................180 Tomato and Basil Spirals ............................................180 Vegetable and Rice Spirals .........................................180 Ornidazole........................................................................98 Orphenadrine citrate .......................................................110 Orphenadrine hydrochloride............................................122 Ortho-tolidine .................................................................157 Ortho All-ﬂex ....................................................................76 Ortho applicator ...............................................................76 Ortho Coil ........................................................................76 Orudis ...........................................................................106 Oruvail 100 ....................................................................106 Oruvail 200 ....................................................................106 Osmolite ........................................................................177 Osmolite RTH .................................................................177 Ospamox .........................................................................95 Ospamox Paediatric Drops ...............................................95 Osteo~500 .....................................................................39 Osteo~600 .....................................................................39 Ovestin Pessaries, vaginal crm .................................................80 Tab ..............................................................................87 Ox-Pam .........................................................................127 Oxazepam ......................................................................127 Oxis Turbuhaler ..............................................................145 Oxsoralen ........................................................................74 Oxybutynin .......................................................................81 Oxypentifylline..................................................................65 Oxytocin ..........................................................................80

Pacifen ..........................................................................110 Paciﬁc Buspirone ...........................................................126 Paciﬁc Cyproterone ..........................................................84 Pacimol .........................................................................111 Paediatric Seravite..........................................................183 Pallidone ........................................................................112 Pamidronate disodium......................................................83 Pamisol ...........................................................................83 Panadol .........................................................................111 Pancrease ........................................................................34 Pancreatic enzyme ...........................................................34 Pancrex V ........................................................................34 Pancrex V Forte................................................................34 Panteston.........................................................................84 Pantoprazole ....................................................................29 Panzytrat..........................................................................34 Papaverine hydrochloride .................................................80 Paracare ........................................................................111

209

INDEX

Generic Chemicals and Brands

Paracetamol ...................................................................111 Paracetamol with codeine...............................................112 Paradex..........................................................................112 Parafﬁn, white soft ...........................................................72 Parafﬁn liquid with soft white parafﬁn .............................156 Parafﬁn liquid with wool fat liquid....................................156 Paraldehyde ...................................................................116 Paramax ........................................................................119 Parnate ..........................................................................115 Paroxetine hydrochloride ................................................115 Parvolex .........................................................................163 Paxam ...........................................................................117 Peak ﬂow meters ...........................................................150 Pedialyte Fruit ..................................................................47 Pediasure .......................................................................173 Pediasure RTH ...............................................................173 PEG-Intron .....................................................................136 Pegasys .........................................................................136 Pegatron ........................................................................136 Pegulated interferon alpha-2B.........................................136 Pegylated interferon alpha-2A .........................................136 Pegylated interferon alpha-2B with ribavirin ....................136 Penicillamine ..................................................................108 PenMix 10........................................................................30 PenMix 20........................................................................30 PenMix 30........................................................................30 PenMix 40........................................................................30 PenMix 50........................................................................30 Pentasa............................................................................26 Peptisorb .......................................................................175 Pepti Junior ....................................................................185 Pergolide........................................................................122 Perhexiline maleate ..........................................................62 Periactin.........................................................................141 Pericyazine ....................................................................124 Perindopril .......................................................................56 Permax ..........................................................................122 Permethrin .......................................................................73 Persantin .........................................................................43 Pertofran........................................................................114 Pethidine hydrochloride ..................................................113 Pevaryl ............................................................................67 Pevaryl Ovules .................................................................80 Pexsig ..............................................................................62 Phenate ...........................................................................91 Phenergan .....................................................................142 Pheniramine maleate ......................................................142 Phenobarbitone ..............................................................117 Phenobarbitone sodium..................................................163 Phenoxybenzamine hydrochloride.....................................55 Phenoxymethylpenicillin (Penicillin V) ...............................95 Phentolamine mesylate ....................................................55 Phenylephrine hydrochloride ..........................................156 Phenylephrine hydrochloride with zinc sulphate ..............156

Phenytoin sodium Cap, tab, oral liq .........................................................117 Inj ..............................................................................116 Phlexy 10.......................................................................183 Phosphate-Sandoz ...........................................................47 Physostigmine salicylate ................................................106 Phytomenadione ..............................................................43 Pilocarpine Eye drops ..................................................................155 Oral liquid ....................................................................37 Pilopt .............................................................................155 Pimafucort .......................................................................70 Pimozide ........................................................................124 Pindol ..............................................................................61 Pindolol ...........................................................................61 Pinetarsol.........................................................................74 Pioglitazone .....................................................................32 Piportil ...........................................................................125 Pipothiazine palmitate.....................................................125 Piram-D .........................................................................107 Piroxicam ......................................................................107 Pizotifen .........................................................................119 Plaquenil ..........................................................................98 Plasma-Lyte Oral..............................................................47 Plendil ER ........................................................................61 Podophyllotoxin ...............................................................75 Polaramine .....................................................................141 Polaramine Repetab .......................................................141 Poly-Tears ......................................................................156 Poly-Visc .......................................................................156 Polycal...........................................................................165 Polycose ........................................................................165 Polynoxylin ......................................................................66 Polysiloxane .....................................................................25 Polytar Emollient ..............................................................74 Polyvinyl alcohol ............................................................156 Polyvinyl alcohol with povidone ......................................156 Ponoxylan ........................................................................66 Ponstan .........................................................................107 Postinor-2 ........................................................................79 Potassium bicarbonate .....................................................47 Potassium chloride Inj ................................................................................46 Tab ..............................................................................47 Povidone iodine................................................................72 Prantal .............................................................................71 Prazosin hydrochloride .....................................................55 Precision Plus ..................................................................34 Prednisolone acetate ......................................................153 Prednisolone sodium phosphate .......................................84 Prednisone.......................................................................84 Pred Forte ......................................................................153 Pred Mild .......................................................................153 Prefrin ............................................................................156 Pregnancy test - HCG urine ..............................................81

210

Generic Chemicals and Brands

INDEX

Premarin ...................................................................85, 86 Premia 2.5 Continuous .....................................................87 Premia 5 ..........................................................................87 Premia 5 Continuous ........................................................87 Priadel ...........................................................................123 Primidone ......................................................................117 Primolut N........................................................................88 Primoteston .....................................................................84 Prinivil..............................................................................56 Prioderm ..........................................................................72 Pro-Pam ........................................................................126 Probenecid.....................................................................110 Procaine penicillin ............................................................95 Prochlorperazine ............................................................121 Procyclidine hydrochloride .............................................122 Prodopa ...........................................................................62 Progesterone ...................................................................88 Progout ..........................................................................110 Prograf ..........................................................................140 Progynova ................................................................85, 86 Promethazine hydrochloride ...........................................142 Promethazine theoclate ..................................................121 Promod..........................................................................168 Propafenone hydrochloride ...............................................59 Propamidine isethionate .................................................152 Propine ..........................................................................155 Propranolol ......................................................................61 Propylene glycol ............................................................163 Protamine sulphate ..........................................................45 Protaphane ......................................................................30 Protaphane Penﬁll ............................................................30 Protifar 90......................................................................168 Provera ..............................................................86, 87, 88 PSO ...............................................................................188 Pulmicort Nebuliser soln ................................................143 Pulmicort Turbuhaler ......................................................143 Pulmocare .....................................................................169 Pulmozyme ....................................................................149 Purinethol ......................................................................130 Pyrantel embonate ...........................................................92 Pyrazinamide ...................................................................99 Pyridostigmine bromide .................................................106 Pyridoxine hydrochloride ..................................................38 Pytazen SR ......................................................................44

Quellada-P .......................................................................73 Questran-Lite ...................................................................47 Quetiapine......................................................................124 Quinapril ..........................................................................56 Quinapril with hydrochlorothiazide ....................................57 Quinine sulphate ............................................................110 QV ...................................................................................71 Q 200 ............................................................................110 Q 300 ............................................................................110

R3 Superfeucht ................................................................76 RA-Morph ......................................................................113 Ranbaxy-Cefaclor.............................................................92 Ranitidine hydrochloride ...................................................28 Razene...........................................................................141 Recombinant human growth hormone ..............................89 Recormon ........................................................................41 Redipred ..........................................................................84 Regitine ...........................................................................55 Resonium-A .....................................................................47 Resource Diabetic ..........................................................170 Resource Diabetic RTH ..................................................170 Resource Just for Kids ...................................................173 Resource Plus................................................................178 Resource Thicken Up .....................................................179 Respocort 100 Autohaler ...............................................143 Respocort Forte Autohaler..............................................143 Respolin Autohaler .........................................................144 Retrovir ..........................................................................103 ReVia .............................................................................129 Rheumacin ....................................................................107 Rheumacin SR ...............................................................107 Ridaura ..........................................................................108 Rifabutin ..........................................................................99 Rifadin .............................................................................99 Rifampicin .......................................................................99 Riﬁnah .............................................................................99 Risperdal .......................................................................124 Risperidone ...................................................................124 Ritalin SR .......................................................................128 Ritonavir ........................................................................103 Rivotril Injection .....................................................................116 Oral drops ..................................................................117 RMS ..............................................................................113 Rocaltrol ..........................................................................39 Rocaltrol solution .............................................................39 Rocephin .........................................................................92 Rocephin IV .....................................................................92 Roferon A ......................................................................134 Romicin ...........................................................................94 Roxithromycin ..................................................................94 Rubifen ..........................................................................128 Rural Areas for Practitioner’s Supply Orders ...................192 Rynacrom Forte .............................................................150 Rythmodan ......................................................................59 Rytmonorm......................................................................59 R V Paque ........................................................................75

S26LBW ........................................................................184 Sabril .............................................................................119 Safety Cap Medicines.....................................................195 Saizen..............................................................................89 Salamol .........................................................................144

211

INDEX

Generic Chemicals and Brands

Salapin ..........................................................................149 Salazopyrin ......................................................................26 Salazopyrin EN .................................................................26 Salbutamol Inhaler .......................................................................144 Inj, inf ........................................................................149 Nebuliser soln ............................................................147 Oral liq .......................................................................149 Tab ...................................................................148, 149 Salbutamol with ipratropium bromide .............................148 Salicylic acid Oint and soln ................................................................75 Powder ........................................................................74 Saliva Substitute ..............................................................37 Salmeterol ............................................................145, 147 Sandomigran .................................................................119 Sandostatin ....................................................................133 Sandostatin LAR ............................................................133 Saquinavir ......................................................................104 Scopoderm TTS .............................................................120 Selegiline hydrochloride .................................................122 Senna ..............................................................................36 Senokot ...........................................................................36 Serenace .......................................................................123 Serevent ........................................................................147 Serevent Accuhaler ........................................................145 Seroquel ........................................................................124 Sevredol ........................................................................113 Shield Blue .......................................................................76 Silvazine ..........................................................................66 Silver sulphadiazine ..........................................................66 Simethicone .....................................................................25 Similac Special Care ......................................................184 Simvastatin ......................................................................49 Sindopa .........................................................................122 Sinemet .........................................................................122 Sinemet CR....................................................................122 Six Plus Parapaed ..........................................................111 Slow-Lopresor .................................................................60 Sodium acid phosphate ....................................................36 Sodium alginate ...............................................................25 Sodium aurothiomalate ..................................................108 Sodium bicarbonate ................................................46, 163 Sodium calcium edetate .................................................157 Sodium carboxymethylcellulose .......................................37 Sodium chloride ...............................................................46 Sodium citrate with sodium lauryl sulphoacetate...............36 Sodium citrotartrate .........................................................81 Sodium cromoglycate Cap ..............................................................................26 Eye drops ..................................................................153 Nasal spray ................................................................150 Respiratory system ....................................................144 Sodium ﬂuoride ................................................................39 Sodium hypochlorite ........................................................70

Sodium nitroprusside .......................................................33 Sodium polystyrene sulphonate ........................................47 Sodium Tetradecyl Sulphate .............................................43 Sodium valproate ...........................................................117 Sofradex ........................................................................151 Soframycin Eye preparations ........................................................151 Solprin .............................................................................43 Solu-Cortef ......................................................................83 Solu-Medrol .....................................................................84 Somac .............................................................................29 Sotacor ............................................................................61 Sotalol .............................................................................61 Spacer devices and masks .............................................150 Space Chamber .............................................................150 Span-K ............................................................................47 Special Authority Applications ..........................................12 Spiriva ...........................................................................147 Spironolactone .................................................................63 Spirotone .........................................................................63 Sporanox .........................................................................98 Staphlex ...........................................................................95 Stavudine .......................................................................103 Stelazine ........................................................................125 Stelazine Spansules .......................................................125 Stemetil .........................................................................121 Steri-Neb .......................................................................148 Stesolid .........................................................................116 Stocrin ...........................................................................103 Stomahesive ....................................................................37 Stresson Multi-Fibre .......................................................175 Sucralfate ........................................................................29 Sulindac ........................................................................107 Sulphacetamide sodium .................................................152 Sulphasalazine .................................................................26 Sulphur ............................................................................74 Sumatriptan ...................................................................119 Sunscreens, proprietary ...................................................75 Suplena .........................................................................176 Suprefact .........................................................................89 Surgam ..........................................................................107 Surgam SA ....................................................................107 Sustagen Hospital Formula .............................................169 Sustanon 250 Orgaject .....................................................84 Sustanon Ampoules .........................................................84 Symbicort Turbuhaler 100/6 ...........................................145 Symbicort Turbuhaler 200/6 ...........................................145 Symmetrel .....................................................................121 Synacthen........................................................................84 Synacthen Depot ..............................................................84 Synarel ............................................................................89 Synﬂex...........................................................................107 Synphasic 28 ...................................................................78 Syntocinon ......................................................................80 Syntometrine ...................................................................80

212

Generic Chemicals and Brands

INDEX

Tacrolimus .....................................................................140 Tambocor ........................................................................59 Tambocor CR ...................................................................59 Tamoxifen citrate ............................................................133 Tar with cade oil ...............................................................74 Tar with triethanolamine lauryl sulphate and ﬂuorescein ....74 Tasmar ..........................................................................122 Tears Plus ......................................................................156 Tegretol ..........................................................................117 Tegretol CR ....................................................................117 Telfast ............................................................................141 Temazepam ...................................................................127 Temgesic .......................................................................112 Tenoxicam .....................................................................107 Terazosin hydrochloride....................................................55 Terbaﬁn ............................................................................98 Terbinaﬁne .......................................................................98 Terbutaline sulphate Inhaler and Turbuhaler ................................................144 Inj ..............................................................................149 Nebuliser soln ............................................................147 Teril ...............................................................................117 Testosterone cypionate.....................................................84 Testosterone enanthate.....................................................84 Testosterone esters ..........................................................84 Testosterone undecanoate ................................................84 Tetrabenazine .................................................................129 Tetrabromophenol ..........................................................157 Tetracosactrin ..................................................................84 Theophylline ..................................................................149 Thiamine hydrochloride ....................................................38 Thioguanine ...................................................................131 Thioprine .......................................................................134 Thioridazine Hydrochloride .............................................124 Thiotepa.........................................................................130 Thiothixene ....................................................................125 Thixit .............................................................................125 Thymol glycerin mouthwash.............................................37 Thyroxine .........................................................................89 Tiaprofenic acid .............................................................107 Tiberal .............................................................................98 Tilade.............................................................................144 Tilcotil ............................................................................107 Timolol ............................................................................61 Timolol maleate..............................................................153 Timolol maleate with pilocarpine .....................................153 Timoptol XE ...................................................................153 Timpilo 2 .......................................................................153 Timpilo 4 .......................................................................153 Tinaderm .........................................................................67 Tinidazole ........................................................................98 Tiotropium bromide ........................................................147 Titralac ............................................................................25 TMP ................................................................................97

Tobramycin Eye drops & oint ........................................................152 Inj ................................................................................97 Tobrex............................................................................152 Tofranil...........................................................................114 Tolbutamide .....................................................................33 Tolcapone ......................................................................122 Tolciclate .........................................................................67 Tolmicen ..........................................................................67 Tolnaftate .........................................................................67 Tolvon ............................................................................114 Topamax ........................................................................119 Topiramate .....................................................................119 Total Parenteral Nutrition (TPN) .........................................46 Trandate...........................................................................60 Trandolapril ......................................................................56 Tranexamic acid ...............................................................43 Tranylcypromine sulphate ...............................................115 Trasylol ............................................................................43 Travatan .........................................................................154 Travoprost......................................................................154 Trental 400.......................................................................65 Triamcinolone acetonide Crm, oint......................................................................69 Inj ................................................................................84 Paste ...........................................................................37 Triamcinolone acetonide with gramicidin, neomycin & nystatin Crm, oint......................................................................70 Ear drops ...................................................................151 Triamizide ........................................................................63 Triamterene with hydrochlorothiazide ................................63 Triazolam .......................................................................127 Trichozole ........................................................................98 Trifeme ............................................................................78 Triﬂuoperazine hydrochloride ..........................................125 Trimeprazine tartrate ......................................................142 Trimethoprim....................................................................97 Trimipramine maleate .....................................................115 Triphasil 28 ......................................................................78 Tripotassium dicitratobismuthate ......................................29 Tripress..........................................................................115 Triquilar ED ......................................................................78 Trisequens .......................................................................87 Trisul ...............................................................................96 Tropicamide ...................................................................155 Tropisetron.....................................................................121 Trusopt ..........................................................................154 Two Cal HN ....................................................................179 Tyloxapol .......................................................................156

Ultraproct .........................................................................27 Ultratard ...........................................................................30 Ural .................................................................................81 Urea ................................................................................71

213

INDEX

Generic Chemicals and Brands

Ursodeoxycholic acid .......................................................35

Vallergan Forte ...............................................................142 Valoid (AFT) ...................................................................120 Vancomycin hydrochloride ...............................................97 Vaxigrip..........................................................................105 Velosef.............................................................................93 Velosulin ..........................................................................30 Venlafaxine ....................................................................116 Ventolin Inhaler .......................................................................144 Inj, inf, oral liq ............................................................149 Ventolin Nebules ............................................................147 Vepesid ..........................................................................131 Verapamil hydrochloride ...................................................62 Vergo 16 ........................................................................120 Vermox ............................................................................92 Verpamil ..........................................................................62 Verpamil SR .....................................................................62 Viaderm KC ......................................................................70 Vicrom ...........................................................................144 Videx EC ........................................................................103 Vigabatrin ......................................................................119 Vinblastine sulphate .......................................................131 Vincristine sulphate ........................................................131 Viodine ............................................................................72 Viracept .........................................................................103 Viramune .......................................................................103 Vitadol C ..........................................................................38 Vital HN .........................................................................175 Vitamins ..........................................................................39 Vitamin A with vitamins D and C .......................................38 Vitamin B complex ...........................................................38 Vivonex Pediatric ............................................................185 Vivonex TEN ..................................................................175 Volmax .................................................................148, 149 Voltaren .........................................................................106 Voltaren D ......................................................................106 Voltaren Ophtha..............................................................153 Vosol .............................................................................151

Zadine............................................................................141 Zantac .............................................................................28 Zarontin .........................................................................117 Zefﬁx..............................................................................100 Zerit ...............................................................................103 Ziagen............................................................................103 Zidovudine .....................................................................103 Zidovudine with lamivudine.............................................103 Zinacef .............................................................................93 Zincaps ............................................................................40 Zincfrin ..........................................................................156 Zinc and castor oil ointment .............................................71 Zinc cream .......................................................................71 Zinc oxide ........................................................................27 Zinc sulphate ...................................................................40 Zinnat ..............................................................................93 Zithromax.........................................................................94 Zocor ...............................................................................49 Zofran ............................................................................121 Zofran Zydis ...................................................................121 Zoladex ............................................................................89 Zopiclone .......................................................................127 Zoton ...............................................................................29 Zovirax ...........................................................................152 Zuclopenthixol decanoate ...............................................125 Zyprexa ..........................................................................123 Zyprexa Zydis .................................................................126

Warfarin sodium ..............................................................45 Wasp venom allergy treatment .......................................141 Water ...............................................................................46 Wellferon .......................................................................135 Wholesale Supply Order .................................................191 Wool fat with mineral oil ...................................................72

Xalatan...........................................................................154 Xanax ............................................................................126 Xenazine 25 ...................................................................129 XMET Maxamum ............................................................181 Xylocaine 0.5% ..............................................................111 Xylocaine 1.0% ..............................................................111 Xylocard ..........................................................................59

214

NOTES

215

NOTES

216

NOTES

217

NOTES

218

NOTES

AUTHORITY TO SUBSTITUTE

✄

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

Where PHARMAC has entered into sole supply or preferred brand (preferred supplier) arrangements, I give authority to substitute an alternative brand of the same medicinal substance in the same strength and pharmaceutical form in the following situations: Sole Supply Products You may substitute the sole supply brand, except if the patient chooses to pay for the non-sole supply brand. This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised. Preferred Brand (Preferred Supplier) Products You may substitute the preferred brand, except if the patient speciﬁcally requests the brand prescribed. This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised. Exceptions I do not want substitution to occur for the following chemical entities, unless I am contacted verbally in each speciﬁc case.

This authority to substitute replaces all previous authorities relating to these particular chemical entities which I may have provided previously. This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute.

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

219

NOTES

220

NOTES

AUTHORITY TO SUBSTITUTE

✄

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

221

NOTES

222

NOTES

AUTHORITY TO SUBSTITUTE

✄

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

223

NOTES

224

Publishing and subscription details

IT Manager Schedule Analysts Email

Circulation

John Geering Linda Wellington, Kaye Wilson schedule@pharmac.govt.nz

The Pharmaceutical Schedule is published in April, August and December each year. Changes to the contents of the Schedule are published in monthly Updates. An annual subscription includes three Pharmaceutical Schedule books, 12 Updates, and occasional additional information on rule changes and news items. The Schedule is distributed free to over 9000 health professionals, and is also available on an annual subscription. Back issues are available on request, subject to supply.

Prices

All prices include postage, and exclude GST. $22.22 $4.44 $120.00 One Schedule book One Update Annual subscription

ISSN 1172 - 9376

Copyright 1994 Pharmaceutical Management Agency This Schedule is copyright. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the Copyright Act, no part may be reproduced in any form or by any process without written permission, nor be used in any form of advertising, sales, promotion or publicity. While care has been taken in compiling this Schedule, Pharmaceutical Management Agency takes no responsibility for any errors or omissions and shall not be liable to any person for any damages or loss arising out of reliance by that person for any purpose on any of the contents of this Schedule. Errors and omissions brought to the attention of Pharmaceutical Management Agency will be corrected if necessary by an erratum or otherwise in the next edition of the Schedule.

Level 14 Cigna House 40 Mercer Street PO Box 10 254 Wellington New Zealand Telephone 64 4 460 4990 Facsimile 64 4 460 4995 http://www.pharmac.govt.nz Freephone information line (9 am – 4 pm weekdays)

0800 66 00 50

Metadata

Title

Pharmaceutical Schedule - effective 1 April 2005

Abstract

Page 1

Note

This text has been extracted from the source PDF document.

Also available as plain text.

Please contact webmaster to discuss alternative format options.